Investigating self-report and neuropsychological assessments of cognitive flexibility in people with and without persistent pain: An online, cross-sectional, observational study.

Introduction: People with persistent pain experience problems modifying their cognition and behaviours when task or environmental demands change - abilities otherwise known as cognitive flexibility. However, limitations and inconsistent results of previous studies raise concerns over the quality of that evidence. We aimed to determine whether people with and without persistent pain differ on two assessments that are commonly used to assess cognitive flexibility. We also examined the relationship between the two assessments and explored whether people with and without persistent pain are distinguishable based on their scores on these assessments. Methods: Participant demographics and symptoms of anxiety and depression were assessed. Participants completed the Cognitive Flexibility Inventory (CFI) and the Wisconsin Card Sorting Test (WCST). Multiple linear regression on the two outcome variables: CFI (total score) and WCST (% perseverative responses) was applied using backward stepwise selection. Both outcomes were calculated as a standardised proportion of the outcome scale and log-odds transformed to meet the model assumptions. Correlation analysis and logistic regression were used to investigate our secondary and exploratory aims. Results: Data were available from 128 participants with persistent pain and 68 pain-free controls. After adjusting for covariates, no differences were found between people with and without persistent pain on either assessment of cognitive flexibility. No significant correlations were detected between the two assessments in either group. The probability of having persistent pain was also not associated with scores on either or both assessments. Conclusion: 'Cognitive flexibility' appears similar in people with and without persistent pain.

Rapid adaptation of predictive models during language comprehension: Aperiodic EEG slope, individual alpha frequency and idea density modulate individual differences in real-time model updating.

Predictive coding provides a compelling, unified theory of neural information processing, including for language. However, there is insufficient understanding of how predictive models adapt to changing contextual and environmental demands and the extent to which such adaptive processes differ between individuals. Here, we used electroencephalography (EEG) to track prediction error responses during a naturalistic language processing paradigm. In Experiment 1, 45 native speakers of English listened to a series of short passages. Via a speaker manipulation, we introduced changing intra-experimental adjective order probabilities for two-adjective noun phrases embedded within the passages and investigated whether prediction error responses adapt to reflect these intra-experimental predictive contingencies. To this end, we calculated a novel measure of speaker-based, intra-experimental surprisal ("speaker-based surprisal") as defined on a trial-by-trial basis and by clustering together adjectives with a similar meaning. N400 amplitude at the position of the critical second adjective was used as an outcome measure of prediction error. Results showed that N400 responses attuned to speaker-based surprisal over the course of the experiment, thus indicating that listeners rapidly adapt their predictive models to reflect local environmental contingencies (here: the probability of one type of adjective following another when uttered by a particular speaker). Strikingly, this occurs in spite of the wealth of prior linguistic experience that participants bring to the laboratory. Model adaptation effects were strongest for participants with a steep aperiodic (1/f) slope in resting EEG and low individual alpha frequency (IAF), with idea density (ID) showing a more complex pattern. These results were replicated in a separate sample of 40 participants in Experiment 2, which employed a highly similar design to Experiment 1. Overall, our results suggest that individuals with a steep aperiodic slope adapt their predictive models most strongly to context-specific probabilistic information. Steep aperiodic slope is thought to reflect low neural noise, which in turn may be associated with higher neural gain control and better cognitive control. Individuals with a steep aperiodic slope may thus be able to more effectively and dynamically reconfigure their prediction-related neural networks to meet current task demands. We conclude that predictive mechanisms in language are highly malleable and dynamic, reflecting both the affordances of the present environment as well as intrinsic information processing capabilities of the individual.

Back to the drawing board-The relationship between self-report and neuropsychological tests of cognitive flexibility in clinical cohorts: A systematic review and meta-analysis.

OBJECTIVE: Cognitive flexibility has been previously described as the ability to adjust cognitive and behavioral strategies in response to changing contextual demands. Cognitive flexibility is typically assessed via self-report questionnaires and performance on neuropsychological tests in research and clinical practice. A common assumption among researchers and clinicians is that self-report and neuropsychological tests of cognitive flexibility assess the same or similar constructs, but the extent of the relationship between these two assessment approaches in clinical cohorts remains unknown. We undertook a systematic review and meta-analysis to determine the relationship between self-report and neuropsychological tests of cognitive flexibility in clinical samples. METHOD: We searched 10 databases and relevant gray literature (e.g., other databases and pearling) from inception to October 2020 and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Eleven articles including 405 participants satisfied our eligibility criteria. RESULTS: A multilevel random-effects meta-analysis revealed no relationship between self-report and neuropsychological tests of cognitive flexibility (0.01, 95% CI [-0.16 to 0.18]). Individual random-effects meta-analyses between 12 different tests pairs also found no relationship. CONCLUSION: Based on our results, it is clear that the two assessment approaches of cognitive flexibility provide independent information-they do not assess the same construct. These findings have important ramifications for future research and clinical practice-there is a need to reconsider what constructs self-report and neuropsychological tests of "cognitive flexibility" actually assess, and avoid the interchangeable use of these assessments in clinical samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

EEG and behavioral correlates of attentional processing while walking and navigating naturalistic environments.

The capacity to regulate one's attention in accordance with fluctuating task demands and environmental contexts is an essential feature of adaptive behavior. Although the electrophysiological correlates of attentional processing have been extensively studied in the laboratory, relatively little is known about the way they unfold under more variable, ecologically-valid conditions. Accordingly, this study employed a 'real-world' EEG design to investigate how attentional processing varies under increasing cognitive, motor, and environmental demands. Forty-four participants were exposed to an auditory oddball task while (1) sitting in a quiet room inside the lab, (2) walking around a sports field, and (3) wayfinding across a university campus. In each condition, participants were instructed to either count or ignore oddball stimuli. While behavioral performance was similar across the lab and field conditions, oddball count accuracy was significantly reduced in the campus condition. Moreover, event-related potential components (mismatch negativity and P3) elicited in both 'real-world' settings differed significantly from those obtained under laboratory conditions. These findings demonstrate the impact of environmental factors on attentional processing during simultaneously-performed motor and cognitive tasks, highlighting the value of incorporating dynamic and unpredictable contexts within naturalistic designs.

Same room - different windows? A systematic review and meta-analysis of the relationship between self-report and neuropsychological tests of cognitive flexibility in healthy adults.

Cognitive flexibility can be thought of as the ability to effectively adapt one's cognitive and behavioural strategies in response to changing task or environmental demands. To substantiate the common inference that self-report and neuropsychological tests of cognitive flexibility provide 'different windows into the same room', we undertook a systematic review and meta-analysis to determine whether self-report and neuropsychological tests of cognitive flexibility are related in healthy adults. Ten databases and relevant grey literature were searched from inception. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to. Twenty-one articles satisfied our inclusion criteria. A multi-level random-effects meta-analysis revealed no relationship (0.05, 95% CI = -0.00 to 0.10). Random-effects meta-analyses raised the possibility that the Cognitive Flexibility Scale and the Trail Making Test - part B (time) may be related (0.19, 95% CI = 0.06 to 0.31). We conclude that the relationship between self-report and neuropsychological tests of cognitive flexibility is not large enough to be considered convincing evidence for the two assessment approaches sharing construct validity. These results have clear implications for assessing and interpreting cognitive flexibility research and clinical practice.

Considerations for using the Wisconsin Card Sorting Test to assess cognitive flexibility.

The Wisconsin Card Sorting Test (WCST) is a popular neurocognitive task used to assess cognitive flexibility, and aspects of executive functioning more broadly, in research and clinical practice. Despite its widespread use and the development of an updated WCST manual in 1993, confusion remains in the literature about how to score the WCST, and importantly, how to interpret the outcome variables as indicators of cognitive flexibility. This critical review provides an overview of the changes in the WCST, how existing scoring methods of the task differ, the key terminology and how these relate to the assessment of cognitive flexibility, and issues with the use of the WCST across the literature. In particular, this review focuses on the confusion between the terms 'perseverative responses' and 'perseverative errors' and the inconsistent scoring of these variables. To our knowledge, this critical review is the first of its kind to focus on the inherent issues surrounding the WCST when used as an assessment of cognitive flexibility. We provide recommendations to overcome these and other issues when using the WCST in future research and clinical practice.