Capacity building for providers of cognitive rehabilitation in Queensland: a needs analysis survey.

Background Cognitive rehabilitation of people with traumatic brain injury is a complex and challenging area of practice. Practitioners working in cognitive rehabilitation require ongoing training to stay abreast of new research and best practice interventions. A needs analysis was conducted to inform the development of a capacity building program for cognitive rehabilitation providers. Methods A cross-sectional online survey of providers of cognitive rehabilitation services in Queensland collected data on demographic information, perceptions of knowledge, skills and confidence in cognitive rehabilitation, previously completed training, desired training opportunities and delivery methods, and barriers and facilitators to engaging in training. Results The 103 respondents included 67 occupational therapists, 17 speech pathologists, 12 psychologists and seven social workers with a broad range of practice experience. Participants perceived a need for further training, with executive function and functional cognition the most desired topics. The number of topics previously trained on was significantly correlated with levels of knowledge, skills and confidence (P Conclusion Cognitive rehabilitation providers in Queensland reported a need for further training, delivered flexibly, with a focus on managing complex cognitive impairments.

Specialization of amygdala subregions in emotion processing.

The amygdala is important for human fear processing. However, recent research has failed to reveal specificity, with evidence that the amygdala also responds to other emotions. A more nuanced understanding of the amygdala's role in emotion processing, particularly relating to fear, is needed given the importance of effective emotional functioning for everyday function and mental health. We studied 86 healthy participants (44 females), aged 18-49 (mean 26.12 ± 6.6) years, who underwent multiband functional magnetic resonance imaging. We specifically examined the reactivity of four amygdala subregions (using regions of interest analysis) and related brain connectivity networks (using generalized psycho-physiological interaction) to fear, angry, and happy facial stimuli using an emotional face-matching task. All amygdala subregions responded to all stimuli (p-FDR < .05), with this reactivity strongly driven by the superficial and centromedial amygdala (p-FDR < .001). Yet amygdala subregions selectively showed strong functional connectivity with other occipitotemporal and inferior frontal brain regions with particular sensitivity to fear recognition and strongly driven by the basolateral amygdala (p-FDR < .05). These findings suggest that amygdala specialization to fear may not be reflected in its local activity but in its connectivity with other brain regions within a specific face-processing network.

Breaking the links between ageism and health: An integrated perspective.

Ageism refers to prejudice, stereotypes or discrimination based on a person's actual or perceived chronological age. While ageism can affect people at all stages of the human lifespan, ageism against older adults has emerged as the most pervasive and potentially harmful. Much is now understood about how ageism can impact older people's health and wellbeing via structural, organisational, and provider level biases that threaten the provision of equitable and ethical healthcare. Negative attitudes about age and ageing also contribute to workforce shortages in aged care sectors, such as residential aged care and nursing. However, often underappreciated is how self-directed ageism, which refers to ageism turned against oneself, can also be an important determinant of health and wellbeing. Relative to external sources of ageism, negative internalised ageist beliefs are not only experienced more frequently in older adults' everyday lives, but are also more strongly linked to their health and wellbeing. Here we highlight how this understanding means that eliminating ageism requires a multifaceted approach that targets not only health care systems and aged care professionals, but older people themselves. Because normal age-related cognitive changes in how we think, perceive and reason increase the risk of older people viewing themselves through a negative and ageist lens, we provide a novel discussion of how broader insights from cognitive ageing literature must play a central role in any agenda focused on breaking the links between ageism and health.

The role of external factors in affect-sharing and their neural bases.

Affect-sharing, the ability to vicariously feel another person's emotions, is the primary component of empathy that is typically thought to rely on the observer's capacity to feel the emotions of others. However, external signals, such as the target's physical characteristics, have been demonstrated to influence affect-sharing in the neuroscientific literature that speaks to the underappreciated role of external factors in eliciting affect-sharing. We consider factors that influence affect-sharing, including physical cues, emotional cues, situational factors, and observer-target relationships, as well as the neural circuits involved in these processes. Our review reveals that, while neural network activation is primarily responsible for processing affect-sharing, external factors also co-activate a top-down cognitive processing network to modulate the conscious process of affect-sharing. From this knowledge, an integrative framework of external factor interactions with affect-sharing are explained in detail. Finally, we identify critical areas for future research in social and affective neuroscience, including research gaps and incorporation of ecologically valid paradigms.

Individualized Virtual Reality for Increasing Self-Compassion: Evaluation Study.

BACKGROUND: Depression and anxiety are common and debilitating mental disorders with severe negative repercussions at both individual and societal levels. Although virtual reality (VR) has emerged as a safe and effective tool for the treatment of anxiety disorders, studies of the therapeutic application of VR to treat depression are more limited. OBJECTIVE: The purpose of this study was to test whether a novel type of individualized VR (iVR) can be used to improve self-compassion and decrease depressive symptoms and to evaluate the usability and acceptability of this approach, as rated by participants. The iVR system was designed and developed based on the feedback obtained from a previous study, with improved appearance and feel of the avatar and enhanced graphical quality. METHODS: A total of 36 young adult participants were recruited from a university community social media site. Participants were aware that the study was investigating a treatment for depression but were not recruited based on depression diagnosis. Participants were asked to complete 2 iVR sessions, spaced 2 weeks apart. At baseline and upon completion of each iVR session, participants were asked to complete validated measures of self-compassion and depression. Upon completion of both iVR sessions, additional measures were administered to assess participants' perceptions about the perceived usability and system acceptability of the iVR approach. RESULTS: Self-compassion was assessed at the beginning of session 1 (preintervention baseline) and at the end of session 1 (postintervention assessment). Owing to COVID-19 constraints, 36% (13/36) of the participants were unable to complete the follow-up iVR session. Self-compassion was assessed again for the remaining 64% (23/36) of the participants at the end of session 2 (postintervention assessment). Within-group analyses revealed that self-compassion was significantly increased at the end of both session 1 (P=.01) and session 2 (P=.03) relative to baseline. There was also a nonsignificant trend for depressive symptoms to be low at the end of session 2 relative to baseline. Both quantitative and qualitative participant data supported the iVR approach as being acceptable and usable. CONCLUSIONS: Although these data must be treated as preliminary owing to the small sample size and potential selection bias, the data provide encouraging initial evidence that iVR might be a useful tool to enhance self-compassion and reduce depressive symptoms, highlighting the need for randomized controlled trials in the future.

Pilot Randomized, Double-Blind, Placebo-Controlled Crossover Trial Evaluating the Feasibility of an Intranasal Oxytocin in Improving Social Cognition in Individuals Living with Alzheimer's Disease.

Background: Individuals living with Alzheimer's disease (AD) demonstrate extensive deficits in social cognition. To date, no studies have investigated the feasibility of an intranasal oxytocin (INOT) treatment to improve social cognition in individuals living with AD. Objective: We conducted a pilot trial to determine recruitment feasibility, enrolment acceptability, and adherence to an INOT treatment to inform on the subsequent design of a future randomized controlled trial (RCT). We also estimated the effect sizes of potential social cognitive function outcome measures related to participants and their caregivers. Methods: Four individuals with AD were enrolled in a single-center, randomized, double-blind, placebo-controlled crossover trial involving a one-week treatment period with both INOT (72 IU twice daily) and placebo. Results: All participants reported no treatment-causative or serious adverse events following repeated INOT administration. While enrolment acceptability (100%) and INOT adherence (placebo, 95%; INOT, 98%) were excellent, feasibility of recruitment was not acceptable (i.e., n = 4/58 individuals screened met inclusion criteria). However, positive/large effects were associated with secondary outcomes of self-reported health and wellbeing, caregiver 'burden', intimacy and interpersonal-bonding, following repeated INOT administration. No positive effects were associated with participant outcomes of social cognition. Conclusion: This pilot RCT provides first evidence that INOT administration in individuals living with AD is safe and well-tolerated. Despite limitations in sample size, moderate-to-large effect size improvements were identified in participant health outcomes as well as core social cognitive functions and 'burden' as reported by a caregiver. This suggests potential broad-ranging beneficial effects of INOT which should be assessed in future RCTs.

Cardiorespiratory Fitness and Muscular Strength Do Not Predict Social Cognitive Capacity in Older Age.

OBJECTIVES: Social cognitive function often declines in older age but the mechanisms underlying these declines are not completely clear. Cardiorespiratory fitness (CRF) and muscular strength are positively associated with broader cognitive function in older adults, yet surprisingly, no study has examined whether a similar relationship exists between CRF or muscular strength and social cognition in older age. METHODS: We assessed whether higher CRF and muscular strength were associated with enhanced social cognitive function in a sample of fifty older adults (Mage = 70.08, standard deviation = 3.93). Participants completed a gold-standard cardiopulmonary exercise test to assess CRF, an isometric handgrip strength test to index muscular strength, and validated measures of social cognition to index emotion perception and theory of mind (ToM). RESULTS: The results showed that CRF and muscular strength did not explain any unique variance in older adults' social cognitive performance. Bayesian analyses confirmed that the evidence for the null hypothesis was moderate for all tested relationships, except for the relationship between CRF and cognitive ToM where the evidence for the null was anecdotal. DISCUSSION: This study has provided the first evidence to suggest that CRF and muscular strength-two important modifiable lifestyle factors-are not associated with social cognition in healthy older adults. However, replication studies are now needed to cross-validate these findings and to clarify whether any moderating variables may be important for understanding the relationship between fitness and social cognition in older age.

Enhancing ecological validity of gaze-cueing stimuli is associated with increased gaze following for older but not younger adults.

Gaze following is a core social-cognitive capacity. Previous work has shown that older adults have reduced gaze following relative to younger adults. However, all previous studies have exclusively used stimuli with low ecological validity, leaving room for alternative explanations for the observed age effects. Motivational models suggest that, relative to younger adults, older adults expend cognitive resources more selectively, such that they are less motivated to engage in tasks that are not meaningful or personally relevant. This may explain why their gaze following is reduced when stimuli are low in ecological validity. An expertise-based account suggests that older adults will have enhanced gaze following owing to their greater experience with gaze cues but that this enhancement may only emerge when stimuli are naturalistic and match those that they have more experience with. In the present study, younger (N = 63) and older adults (N = 68) completed a standard gaze-cueing task (static images) and a gaze-cueing task with enhanced ecological validity (videos of shifting gaze). In contrast to past research, both groups showed equivalent gaze following. Notably, in line with motivational model theorizing and experience-based accounts, ecological validity was associated with enhanced gaze following for older but not younger adults. These findings highlight the importance of considering stimulus ecological validity in social-cognitive aging research and provide information regarding the specific types of gaze cues that may be most effective in producing the cognitive and perceptual benefits associated with gaze cues for older adults. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-initiating and applying episodic foresight in middle childhood.

This study provides an important extension to the growing literature on prospection in children by providing the first test of whether one's ability to engage in the functional (as opposed to the purely phenomenological) aspect of episodic foresight improves across middle childhood. Of the various forms of prospection, episodic foresight has been proposed to be one of the most flexible and functionally powerful, defined as the ability to not only imagine future events (simulative aspect) but also use those imaginings to guide behavior in the present (functional aspect). The current study tested 80 typically developing children aged 8 to 12 years using an extensive cognitive battery comprising Virtual Week Foresight, the Autobiographical Interview, and a series of crystallized and fluid intelligence measures. Whereas data indicated age-related improvements in detecting future-oriented problems and taking steps in the present in service of solving these, all children in this age bracket demonstrated a similar capacity for problem resolution (i.e., the ability to subsequently solve successfully identified problems). Results also revealed the importance of broader crystallized and fluid intelligence, but not episodic memory or episodic future thinking, in engaging in this capacity. Research is now required to understand the real-life consequences of episodic foresight during this developmental period as well as the ways in which parents and teachers can help to foster this capacity and consequently help to support children's growing desire for independence during this time.

Cognition and Financial Decision-Making in Older Adult Spouses.

INTRODUCTION: Age-related decline in executive functioning has been found to negatively impact one's capacity to make prudent financial decisions. The broader literature also speaks to the importance of considering interrelatedness in older spouses' functioning, as these individuals typically represent one's longest and closest relationship that involves an extended history of shared experiences. Accordingly, the aim of the present study was to provide the first examination of whether older adults' financial decision-making capacity is impacted not only by their own but also by their partner's, level of cognitive functioning. METHOD: Sixty-three heterosexual spousal dyads comprising older adults aged 60-88 participated. The contribution of executive functioning and perceptions of partner's cognitive decline on financial decision-making behavior and financial competency was assessed through two actor-partner interdependence models. RESULTS: As predicted, for both genders, one's own executive functioning was predictive of one's own financial decision-making capacity. However, of particular interest was the finding that for females (but not males) perceiving greater cognitive decline in their spouse predicted their own (greater) financial competency. CONCLUSION: Examining whether partner interdependence extends to the realm of financial decision-making is not only a theoretically but also practically important question. These data provide initial insights that such a relationship does exist and highlight further important avenues for future research.

The cognitive tenacity of self-directed ageism.

Ageism refers to prejudice or discrimination based on a person's age. When ageism is directed at older people, it is unique in two ways: it is socially condoned in a manner that other types of prejudice are not, and the animus is eventually self-directed. Of central interest here is why ageism becomes self-directed in late adulthood, despite its potentially harmful personal costs. We present a cognitive model in which negative ageist beliefs become increasingly accessible and difficult to eliminate owing to broader developmental shifts in mentation. Given that these effects are contingent on our social environment, systemic changes in societal conceptions of age and aging are needed if we are to reduce vulnerability to self-directed ageism.

Cognitive Reappraisal Impairs Negative Affect Regulation in the Context of Social Rejection for Youth With Early-Stage Borderline Personality Disorder.

Application of emotion regulation strategies might be susceptible to the context of social rejection for individuals with borderline personality disorder (BPD). This study compared the ability of 27 outpatient youths (15-25 years old) with early-stage BPD and 37 healthy controls (HC) to apply expressive suppression and cognitive reappraisal in standard and socially rejecting laboratory contexts. BPD youths were largely as able as HCs to regulate negative affect across instruction and contexts. However, cognitive reappraisal in the context of social rejection heightened BPD negative facial expression relative to HCs. Thus, while BPD emotion regulation ability was largely normative, cognitive reappraisal might be ineffective in the context of social rejection for this group, with social rejection acting as an accelerant that heightens the expression of negative affect. Given the common experience of perceived and actual social rejection for this group, clinicians should carefully consider treatments that include cognitive reappraisal strategies because they might be contraindicated.

Emotion regulation mediates the relationship between social frailty and stress, anxiety, and depression.

Social frailty refers to an inability to meet basic social needs and has been identified as a threat to physical and mental health. Although social frailty has been linked with many adverse health and well-being outcomes, potential mediators of the relationship between social frailty and well-being remain poorly understood. Emotion regulation refers to the capacity to alter the experience of emotions to behave in accordance with a desired goal. The present study was designed to provide the first direct test of whether emotion regulation mediates the relationships between social frailty and important well-being outcomes (stress, anxiety, and depression). A total of 790 participants completed validated measures of social frailty, stress, anxiety, depression, and emotion regulation. In line with our preregistered hypotheses, higher social frailty predicted increased stress, anxiety, and depression, and each of these relationships were partially mediated by emotion regulation capacity. These data provide novel evidence that emotion regulation abilities may serve as a protective factor against the negative consequences of social frailty.

Episodic foresight is impaired following acute alcohol intoxication.

BACKGROUND: Alcohol intoxication disrupts many aspects of cognition, including the generation of phenomenological characteristics of future events (a component of episodic foresight), and the execution of directed preparatory behaviours (a component of prospective memory). However, no study has tested whether alcohol intoxication is also associated with deficits engaging episodic foresight to guide future-directed behaviour. AIMS: This study was designed to provide the first test of how alcohol intoxication influences the functional application of episodic foresight. The secondary aim was to establish the degree to which any observed episodic foresight difficulties associated with alcohol use might reflect broader problems in retrospective memory and executive control. Sex differences were also examined. METHODS: Healthy adult social drinkers randomly received either a moderate dose of 0.6 g/kg alcohol (n = 61) or a matched placebo drink (n = 63) and then completed a validated measure that met strict criteria for assessing the functional application of episodic foresight as well as a broader cognitive test battery. RESULTS: Relative to the placebo condition, episodic foresight was impaired by acute alcohol consumption, with this impairment related to poorer retrospective memory, but not executive control. The negative effects of alcohol intoxication on episodic foresight did not differ as a function of sex. CONCLUSIONS: Even a moderate level of intoxication impairs the ability to use episodic foresight in a functionally adaptive way. These findings have implications for understanding many of the maladaptive behaviours that are often associated with acute alcohol use.

Prospective Memory Function Predicts Future Cognitive Decline and Incident Dementia.

OBJECTIVES: This study aimed to test whether prospective memory (PM) was an early cognitive marker of future cognitive decline and incident dementia using longitudinal data spanning 8 years from the Sydney Memory and Ageing Study. METHODS: At baseline, 121 participants aged 72-91 years were tested in PM using a validated PM task, Virtual Week, which included time- and event-based tasks presented with varying regularity. Responses were scored "Correct" if completed accurately and "Missed" if the target was not remembered at any time. Measures of cognition were taken at baseline and 2-year intervals over 8 years. Dementia diagnoses were made by expert consensus panels using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Linear mixed models and Cox proportional hazards regression models were used to analyze the data, controlling for potential confounds. RESULTS: Both decreased PM accuracy and missed PM responses were associated with rate of cognitive decline measured by Mini-Mental State Examination over 8 years and global cognitive decline over 4 years. Risk of incident dementia increased with poorer baseline PM ability and missed responses. These effects remained significant after controlling for baseline cognition and were strongest for event-based and regular PM tasks. DISCUSSION: PM is a sensitive early marker of future cognitive decline and risk of incident dementia. PM tasks supported by spontaneous retrieval (event-based) and those with lower retrospective memory demands (regular tasks) function as particularly sensitive predictors. In other words, deficits in performing less effortful PM tasks best predicted cognitive decline. These findings may encourage clinicians to incorporate PM tasks in clinical assessments.

Empathy moderates the relationship between cognitive load and prosocial behaviour.

Cognitive load reduces both empathy and prosocial behaviour. However, studies demonstrating these effects have induced cognitive load in a temporally limited, artificial manner that fails to capture real-world cognitive load. Drawing from cognitive load theory, we investigated whether naturally occurring cognitive load from the ongoing COVID-19 pandemic moderated the relationship between empathy and prosocial behaviour (operationalised as support for public health measures). This large study in an Australian sample (N = 600) identified negative relationships between pandemic fatigue, empathy for people vulnerable to COVID-19, and prosocial behaviour, and a positive relationship between empathy and prosocial behaviour. Additionally, we found that the negative effect of the pandemic on prosocial behaviour depended on empathy for vulnerable others, with pandemic fatigue's effects lowest for those with the highest empathy. These findings highlight the interrelationships of cognitive load and empathy, and the potential value of eliciting empathy to ease the impact of real-world cognitive load on prosocial behaviour.

[Ethical issues in the long-term follow-up of pediatric cancers: (1) Living a "normal life" after pediatric cancer]. / Les enjeux éthiques du suivi à long terme des cancers pédiatriques - (1) Vivre une « vie normale ¼ après un cancer pédiatrique.

Title: Les enjeux éthiques du suivi à long terme des cancers pédiatriques - (1) Vivre une « vie normale ¼ après un cancer pédiatrique. Abstract: Les avancées en termes de traitement des cancers pédiatriques permettent aujourd'hui de guérir plus de 80 % des enfants atteints, leur ouvrant la perspective d'un retour à une « vie normale ¼ après une période plus ou moins longue marquée par les traitements curatifs et des hospitalisations à répétition. L'idée de « vie normale ¼, cependant, prend un sens particulier chez les personnes qui ont vécu le cancer dans l'enfance et qui sont à risque de développer des séquelles en lien avec les traitements qu'elles ont reçus. Bien loin de toujours consister dans la fermeture d'une parenthèse, celle de l'épisode du cancer, et le retour à une forme de stabilité, la reprise d'une « vie normale ¼ doit composer avec de nombreuses incertitudes et repose sur un équilibre que l'incitation à reprendre un suivi médical « de surveillance ¼ à long terme vient parfois perturber.

[Ethical issues in the long-term follow-up of pediatric cancers: (2) Professional practices in redefinition]. / Les enjeux éthiques du suivi à long terme des cancers pédiatriques - (2) Des pratiques professionnelles en redéfinition.

Title: Les enjeux éthiques du suivi à long terme des cancers pédiatriques - (2) Des pratiques professionnelles en redéfinition. Abstract: Dans l'article précédent, nous avons abordé les contours fragiles et fluctuants de ce qui est appréhendé comme une « vie normale ¼ par les personnes guéries d'un cancer dans l'enfance ainsi que la manière dont celle-ci devient un objet d'interlocution complexe et singulier pour les professionnels de santé impliqués dans le suivi à long terme des cancers pédiatriques. Le présent article décrit la seconde étape de l'enquête qualitative que nous avons menée, reposant sur la mise en place d'un groupe de réflexion éthique. Elle a permis de révéler la manière dont le suivi à long terme vient questionner et transformer les pratiques de soin et de suivi dans le champ de la cancérologie pédiatrique. Il précise également l'apport spécifique de la philosophie de terrain dans ce contexte.

Subjective and objective sleep quality does not predict behavioural episodic foresight in younger or older adults.

Episodic foresight refers to one's capacity to use imagined scenarios to guide future-directed behaviors. It is important in facilitating complex activities of daily living, such as managing finances. Broader literature shows that older adults perform more poorly on tests of episodic foresight relative to their younger counterparts. At the same time, age-related changes in sleep often contribute to age-related decline in other cognitive abilities known to support episodic foresight, such as memory. No study to date has tested whether sleep quality is associated with episodic foresight when it is measured behaviorally; or whether this relationship is moderated by age. To address this, in the present study healthy younger (n = 39) and older (n = 41) adults were asked to wear an actigraphy watch and self-report their sleep quality for seven nights. Participants then completed the virtual-week foresight task-a behavioral assessment of episodic foresight. Neither objective or subjective sleep quality predicted episodic foresight outcomes, and this was not moderated by age group. Bayesian analyses provided evidence in favour of the null hypotheses. These results suggest that sleep quality (at least in healthy adult populations) may not be linked to episodic foresight.

Oral health-related quality of life is more strongly correlated with mental health than with oral health in relapsing-remitting multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a leading cause of neurological disability in young and middle-aged populations, associated with substantial burden of illness. Because a growing literature now shows that this burden extends to poorer oral health, oral health-related quality of life (OHRQoL) may be reduced as well. OBJECTIVES: To test whether people with relapsing-remitting MS (RRMS) have poorer OHRQoL than demographically matched controls, and to establish which variables are associated with worse OHRQoL. MATERIALS AND METHODS: In total, 64 people with RRMS and 69 demographically matched controls participated. Both groups completed the Oral Health Impact Profile (OHIP-14), a validated measure of OHRQoL, as well as an objective oral health examination performed by a qualified dentist, a measure of dental-related functionality and a measure of mental health. RESULTS: OHRQoL was significantly poorer in the RRMS relative to the control group. However, although poorer OHRQoL in the RRMS group was moderately associated with objectively assessed oral health (r = .30), it was more strongly associated with mental health (r = .61). For the control group, the reverse pattern of association was evident, with OHRQoL more strongly associated with oral health (r = .48) relative to mental health (r = .20). CONCLUSION: People with RRMS report poorer OHRQoL than demographically matched controls, but these appraisals are more strongly linked to mental health than to objective oral health indicators.