The Efficacy of a Metacognitive Training Program in Amnestic Mild Cognitive Impairment: A 6-Month Follow-Up Clinical Study.

This study was conducted in response to the increasing prevalence of Alzheimer's disease (AD) dementia and the significant risk faced by individuals with amnestic mild cognitive impairment with multiple-domain deficits (aMCI-md). Given the promising effects of MTPs, the primary aim of this study was to further explore their impact by assessing the maintenance of their benefits. Thus, 45 participants were randomly allocated in two groups: the Experimental group (n = 22), which received the metacognitive training program (MTP), and the Control group (n = 23) that received the cognitive exercises program (CEP). The training programs-the MTP and the CEP-included 10 individual sessions of a one-hour duration and took place once per week. To test the efficacy of the MTP, cognitive and metacognitive outcomes were compared between two groups-Experimental (EG) and Control (CG)-at four distinct time points: before-after-3 months-6 months after intervention. Based on this study's findings, the positive effects of the MTP were evident over a six-month period. Specifically, already three months post-training, the CG began to show a decline in training-related gains. In contrast, the EG's performance consistently improved, highlighting the superior efficacy of the MTP. Gains attributed to the MTP were detected in cognitive measures: cognitive flexibility and immediate visual recall, as well as in metacognitive measures: metacognitive control, improved metacognitive beliefs of attention, and an increased use of cognitive strategies. In conclusion, the results demonstrated the sustained effects of the MTP in cognitive and metacognitive measures over a period of six months, providing novel insight into the application and efficacy of the MTP in individuals with MCI.

Metacognitive beliefs of efficacy about daily life situations and use of cognitive strategies in amnestic mild cognitive impairment: a cross-sectional study.

Metacognition, the ability to monitor and regulate cognitive processes, is essential for individuals with Mild Cognitive Impairment (MCI) to accurately identify their deficits and effectively manage them. However, previous studies primarily focused on memory awareness in MCI, neglecting other domains affected in daily life. This study aimed to investigate how individuals with MCI perceive their abilities to handle various cognitively challenging situations representing real-life scenarios and their use of compensatory strategies. Thus 100 participants were recruited, including 50 with amnestic MCI with multiple deficits (aMCI) and 50 cognitively healthy controls (HC) matched in age and education. Participants completed three metacognitive scales assessing self-perceived efficacy in everyday life scenarios and one scale evaluating use of cognitive strategies. Results indicated that aMCI participants reported significantly lower self-efficacy in memory and divided-shifted attention scenarios compared to HC. Surprisingly, no significant group differences were found in the self-reports about the use of cognitive strategies. This suggests a potential gap in understanding or applying effective strategies for compensating cognitive deficits. These findings emphasize the importance of cognitive training programs targeting metacognitive knowledge enhancement and practical use of cognitive strategies that could enhance the quality of life for individuals with MCI.

Metacognitive Differences in Amnestic Mild Cognitive Impairment and Healthy Cognition: A Cross-Sectional Study Employing Online Measures.

This study aimed to examine metacognitive abilities in individuals diagnosed with amnestic mild cognitive impairment (aMCI) by using online metacognitive measures during cognitive tasks. A total of 100 participants were enrolled, all aged 50 or older (mean age = 61.98; SD = 6.27), and with a minimum of six years of education (mean = 14.95; SD = 2.94). The sample included 50 individuals with aMCI (34 females) and 50 healthy controls (HC) (33 females). Both groups underwent metacognitive versions of memory tasks (Doors and People) and executive functions tasks (Wisconsin Card Sorting Test). Metacognition was assessed through confidence ratings given after each answer (referred to as metacognitive monitoring) and the accuracy of the participants' decisions to include or exclude answers from their final scores (known as metacognitive control). The results showed that although individuals with aMCI were aware of their cognitive limitations-evidenced by their lower confidence ratings across all tasks-they still exhibited overconfidence relative to their actual performance. Moreover, they included a greater number of incorrect answers in their final scores compared to the healthy control group. These findings suggest that while individuals with aMCI retain some level of awareness, their self-evaluations appear to lack precision. This observation was consistent across both types of cognitive tasks. The results underscore the need for additional research to better understand metacognition in MCI as well as the interplay between metacognitive monitoring and control.

Trajectories of Cognitive Impairment in Adults Bearing Vascular Risk Factors, with or without Diagnosis of Mild Cognitive Impairment: Findings from a Longitudinal Study Assessing Executive Functions, Memory, and Social Cognition.

With the aging of the population, a key concern of both societies and health services is to keep the population cognitively healthy until the maximum age limit. It is a well-known fact that vascular aging has a negative effect on the cognitive skills of adults, putting them at greater risk of developing dementia. The present longitudinal study aimed to evaluate the main dimensions of cognition in two pathological groups with different health profiles: a group of adults with vascular risk factors (VRF) (n = 35) and a group of adults with vascular risk factors and mild cognitive impairment (VRF + MCI) (n = 35). The two groups were matched in age, education, and gender. They were assessed with extensive neuropsychological testing at three different times with a distance of about 8 months between them; the assessment regarded executive functions, memory capacity, and Theory of Mind abilities. The analyses carried out were (a) mixed-measures ANOVA, (b) repeated measures ANOVA, and (c) ANOVA. The findings showed that global cognitive status and short-term memory are the main cognitive abilities that decline in community dwelling people bearing VRF. Hence, this group of adults should be examined at least every 2 years for this decline. As regards people with both VRF and MCI, it seems that the assessment of Theory of Mind abilities can better capture their further impairment. Global cognitive status, task/rule switching function, and long-term memory (delayed verbal recall) were revealed as the abilities that clearly and steadily differentiate VRF people with and without MCI.

The Role of Working Memory, Short-Term Memory, Speed of Processing, Education, and Locality in Verb-Related Morphosyntactic Production: Evidence From Greek.

This study investigates the relationship between verb-related morphosyntactic production (VRMP) and locality (i.e., critical cue being adjacent to the target or not), verbal Working Memory (vWM), nonverbal/visuospatial WM (nvWM), verbal short-term memory (vSTM), nonverbal/visuospatial STM (nvSTM), speed of processing, and education. Eighty healthy middle-aged and older Greek-speaking participants were administered a sentence completion task tapping into production of subject-verb Agreement, Time Reference/Tense, and grammatical Aspect in local and nonlocal configurations, and cognitive tasks tapping into vSTM, nvSTM, vWM, nvWM, and speed of processing. Aspect elicited worse performance than Time Reference and Agreement, and Time Reference elicited worse performance than Agreement. There were main effects of vSTM, vWM, education, and locality: the greater the participants' vSTM/vWM capacity, and the higher their educational level, the better their VRMP; nonlocal configurations elicited worse performance on VRMP than local configurations. Moreover, vWM affected Aspect and Time Reference/Tense more than Agreement, and education affected VRMP more in local than in nonlocal configurations. Lastly, locality affected Agreement and Aspect (with nonlocal configurations eliciting more agreement and aspect errors than local configurations) but not Time Reference. That vSTM/vWM (but not nvSTM/nvWM) were found to subserve VRMP suggests that VRMP is predominantly supported by domain-specific, not by domain-general, memory resources. The main effects of vWM and vSTM suggest that both the processing and storage components of WM are relevant to VRMP. That vWM (but not vSTM) interacts with production of Aspect, Time Reference, and Agreement suggests that Aspect and Time Reference are computationally more demanding than Agreement. These findings are consistent with earlier findings that, in individuals with aphasia, vWM interacts with production of Aspect, Time Reference, and Agreement. The differential effect of education on VRMP in local vs. nonlocal configurations could be accounted for by assuming that education is a proxy for an assumed procedural memory system that is sensitive to frequency patterns in language and better supports VRMP in more frequent than in less frequent configurations. In the same vein, the interaction between locality and the three morphosyntactic categories might reflect the statistical distribution of local vs. nonlocal Aspect, Agreement, and Time Reference/Tense in Greek.

Episodic Memory in Amnestic Mild Cognitive Impairment (aMCI) and Alzheimer's Disease Dementia (ADD): Using the "Doors and People" Tool to Differentiate between Early aMCI-Late aMCI-Mild ADD Diagnostic Groups.

Episodic memory is the type of memory that allows the recollection of personal experiences containing information on what has happened and, also, where and when it happened. Because of its sensitivity to neurodegenerative diseases and the aging of the brain, it is considered a hallmark of Alzheimer's disease dementia (ADD). The objective of the present study was to examine episodic memory in amnestic mild cognitive impairment (aMCI) and ADD. Patients with the diagnosis of early aMCI, late aMCI, and mild ADD were evaluated using the Doors and People tool which consists of four subtests examining different aspects of episodic memory. The statistical analysis with receiver operating characteristic curves (ROC) showed the discriminant potential and the cutoffs of every subtest. Overall, the evaluation of episodic memory with the Doors and People tool can discriminate with great sensitivity between the different groups of people with AD and, especially, early aMCI, late aMCI, and mild ADD patients.

Working Memory Deficits in Multiple Sclerosis: An Overview of the Findings.

Although working memory (WM) and information processing speed (IPS) impairments in multiple sclerosis (MS) have been widely investigated, several questions, regarding the nature of these impairments and their relationship, remain unclear. The aim of this short communication article is to present an overview of our recent research findings regarding (a) the characteristics of WM impairment in MS patients and, more precisely, the degree of impairment observed in each WM's component, i.e., phonological loop, visuospatial sketchpad, central executive, and episodic buffer and (b) the relationship between IPS and each of the four WM components, in an attempt to expand the existing rather narrow understanding of the interconnection between reduced IPS and WM impairment. Two studies of our research team are presented here and their findings are briefly discussed, highlighting the importance of further research on a specific component, namely the episodic buffer component among MS patients.

Evaluating the relationship between working memory and information processing speed in multiple sclerosis.

The aim of the present study was to evaluate the effect of information processing speed on the functioning of specific working memory components, i.e. phonological loop, visuospatial sketchpad, central executive and episodic buffer. Cognitive tasks that assess working memory ("word lists recall" for the phonological loop, "block recall" for the spatial component of visuospatial sketchpad, "listening recall" for the central executive and "immediate story recall" for the episodic buffer) and information processing speed (symbol digit modalities test- oral form) were administered to 38 patients with multiple sclerosis. Results showed that the central executive and episodic buffer components were significantly related to information processing speed. However, when age was included in the regression model, information processing speed significantly predicted only the episodic buffer scores. Further research on the relationship between the episodic buffer and information processing speed is recommended.

The Association between the Binding Processes of Working Memory and Vascular Risk Profile in Adults.

Episodic buffer (EB), a key component of working memory, seems to have a rather complicated function as part of binding processes. Recent papers on the field claim that binding processes of working memory (WM) are assisted by attention and executive functions. On the same page, vascular pathology is gaining more ground as the main underlying cause for many brain pathologies. Hypercholesterolemia, hypertension, obesity, diabetes, lack of exercise and smoking are the most common risk factors that people of all ages suffer from and constitute the main vascular risk factors responsible for a possible decline in executive functions and attention. Thus, this research is an attempt to examine the relation between the binding functions of WM and the existence of vascular risk factors via a computerized test focusing on feature binding. The study comprised adults (n = 229) with and without vascular risk factors. The main tools used were a biomarker questionnaire and a feature binding test (FBT). The results showed that participants who report suffering from one or more vascular risk factors had significantly lower performance on specific subtasks of the FBT in comparison to the participants who were healthy. This allows us to assume that there might be a positive association between feature binding and a vascular risk profile in adults, and such a test could be a useful diagnostic tool for early cognitive impairment due to incipient vascular pathology.

Burnout and Cognitive Performance.

The aim of this study was to investigate the relationship between burnout and cognitive functioning. The associations of depression, anxiety and family support with burnout and cognitive functioning were also examined both independently and as potential moderators of the burnout-cognitive functioning relationship. Seven different cognitive tasks were administered to employees of the general working population and five cognitive domains were assessed; i.e., executive functions, working memory, memory (episodic, visuospatial, prospective), attention/speed of processing and visuospatial abilities. Burnout, depression, anxiety and family support were assessed with the Maslach Burnout Inventory-General Survey, the Hospital Anxiety and Depression Scale and the Family Support Scale respectively. In congruence with the first and fourth (partially) Hypotheses, burnout and perceived family support are significantly associated with some aspects of cognitive functioning. Moreover, in line with the third Hypothesis, perceived family support is inversely related to burnout. However, in contrast to the second and fourth Hypotheses, depression, anxiety and perceived family support do not moderate the burnout-cognitive functioning relationship. Additional results reveal positive associations between burnout depression and anxiety. Overall findings suggest that cognitive deficits, depression and anxiety appear to be common in burnout while they underpin the role of perceived family support in both mental health and cognitive functioning. Implications for practice are discussed.

Working memory profiles of children with reading difficulties who are learning to read in Greek.

This study investigated working memory skills in a small group of 13 nine-year-old Greek children facing reading difficulties and a group of 14 age matched typical Greek readers. The children were assessed on working memory tasks measuring separately the four components of the working memory model of Baddeley and Hitch (1974) as revised by Baddeley (2000): the phonological loop, visuo-spatial sketchpad, episodic buffer and central executive. Both groups completed tests of accuracy of reading, speed of reading and text understanding. The children with reading difficulties performed significantly more poorly than typical readers on all aspects of working memory apart from visual-spatial short-term memory. These results indicate a similar verbal working memory impairment in Greek children with reading difficulties as in their English peers, despite the fact that they are learning to read a language with a transparent rather than an opaque orthography.

Cognitive Mechanisms of Monolingual and Bilingual Children in Monoliterate Educational Settings: Evidence From Sentence Repetition.

Sentence repetition (SR) tasks have been extensively employed to assess bilingual children's linguistic and cognitive resources. The present study examined whether monoliterate bilingual children differ from their monolingual (and monoliterate) peers in SR accuracy and cognitive tasks, and investigated links between vocabulary, updating, verbal and visuospatial working memory and SR performance in the same children. Participants were two groups of 35 children, 8-12 years of age: one group consisted of Albanian-Greek monoliterate bilingual children and the other of Greek monolingual children attending a monolingual-Greek educational setting. The findings demonstrate that the two groups performed similarly in the grammaticality scores of the SR. However, monolinguals outperformed the monoliterate bilinguals in SR accuracy, as well as in the visuospatial working memory and updating tasks. The findings did not indicate any bilingual advantage in cognitive performance. The results also demonstrate that updating and visuospatial working memory significantly predicted monolingual children's SR accuracy scores, whereas Greek vocabulary predicted the performance of our monoliterate bilingual children in the same task. We attribute this outcome to the fact that monoliterate bilingual children do not rely on their fluid cognitive resources to perform the task, but instead rely on language proficiency (indicated by expressive vocabulary) while performing the SR.

Working memory profiles of patients with multiple sclerosis: Where does the impairment lie?

Introduction: Previous studies have mostly provided general estimations regarding Working Memory impairment in patients with Multiple Sclerosis. The aim of the present study was to investigate the relative degree of impairment in the four Working Memory components in Multiple Sclerosis. Method: Thirty-eight patients diagnosed with MS and 27 matched controls were assessed using 12 different cognitive tasks of the four components, i.e. phonological loop, visuospatial sketchpad, central executive and episodic buffer. More precisely, Greek translated and adapted versions of the following tasks were administered: Digit recall, Word recall, Non-word recall, Block recall, Mazes recall, Visual Patterns recall, Backward Digit recall, Backward Block recall, Listening recall, Logical Memory I-Immediate Story recall and Greek Verbal Learning Test, which is based on the California Verbal Learning Test. Results: The phonological loop, the central executive and the spatial subcomponent of the visuospatial sketchpad were found to be equally disrupted in MS patients. The episodic buffer was found to be more heavily affected. On the other hand, the visual subcomponent of the visuospatial sketchpad proved to be preserved. Conclusions: WM subcomponents are differentially affected in patients with MS. This novel finding is discussed within the framework of existing knowledge regarding WM impairment in MS.

Retrogenetic models of working memory: Preliminary multi-group analysis.

AIM: The aim of the present study was the qualitative comparison of working memory capacity of young children and older adults through the investigation of the latent structure stability or change in Working Memory capacity (WM) in childhood and aging, using Multiple Group Confirmatory Factor Analysis (MGCFA). METHOD: The sample consisted of 62 kindergarten and 56 elementary school students (age range: 4-8 years) and 52 young-old adults and 54 old-old adults (age range: 60-94 years). Adults were asked to complete the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale-15 (GDS-15) as screening tests. The children were examined via the Raven Colored Progressive Matrix (CMP) test for the same reason. WM was examined via four measures of Working Memory Test Battery for Children (WMTB-C). RESULTS: MGCFA applied to the data of the kindergarten students' subsample, elementary school students' subsample, young-old and old-old adults' subsamples as well as of older adults with low (0-9 years of education) educational level. Initially, through MGCFA, four "models" were confirmed, one for each age-related subsample, and they were different from each other. However, when the same method was applied exclusively to young-old and old-old adults with low educational level, the models that emerged were similar to the kindergarten students' model. CONCLUSION: When we "keep" the educational level equal (low) for all, the hypothesis of retrogenesis is confirmed. Cognitive reserve appears to be protective, keeping differentiated WM's components in every age group other than that of kindergarten students. The results support the "retrogenetic" hypothesis, mainly due to the finding of a delay in WM components' development in the group of kindergarten students, and their dedifferentiation in the low-educated young-old and old-old adults.

Inefficient understanding of non-factive mental verbs with social aspect in adults: comparison to cognitive factive verb processing.

INTRODUCTION: Mental verbs denote inner mental states and are an important link between language and Theory of Mind ability conceptualized as mental state understanding. Non-factive mental verbs denote an obligation or intention and constitute a discrete class of mental verbs which are characterized by their social aspect. This study aimed to examine adults' ability to understand non-factive mental verbs with the social aspect as compared to cognitive factive mental verbs which denote a true event. METHODS: A total of 94 participants, aged 18-95 years, were examined using two tasks measuring non-factive and factive verb processing, respectively, and a working memory test. RESULTS: The results indicated that non-factive verbs process is at a significantly lower level than those of cognitive factives. CONCLUSION: The inspection of the way adapted to process the non-factive verbs denoting obligation or intention, as well as the confirmation of a unifactorial structure of the task developed to measure non-factives' processing, showed that adults have a common pattern of non-factive mental verb understanding, which is based on heuristic ways of thinking and is not affected by working memory capacity and age.

Verbal working memory and reading abilities among students with visual impairment.

AIM: This study investigated the relationship between working memory (WM) and reading abilities among students with visual impairment (VI). Seventy-five students with VI (visually impairment and blindness), aged 10-15 years old participated in the study, of whom 44 were visually impaired and 31 were blind. METHODS: The participants' reading ability was assessed with the standardized reading ability battery Test-A (Padeliadu & Antoniou, 2008) and their verbal working memory ability was assessed with the listening recall task from the Working Memory Test Battery for Children (Pickering et al., 2001). RESULTS-IMPLICATIONS: Data analysis indicated a strong correlation between verbal WM and decoding, reading comprehension and overall reading ability among the participants with VI, while no correlation was found between reading fluency and verbal WM. The present study points out the important role of verbal WM in reading among students who are VI and carries implications for the education of those individuals.

Cognitive event-related potentials in multiple sclerosis: Correlation with MRI and neuropsychological findings.

BACKGROUND: Cognitive event-related potentials (ERPs) have been previously correlated with T2 lesion load (Τ2LL) in patients with multiple sclerosis (MS). It is currently unknown, however, whether ERPs also correlate with brain atrophy or the presence of T1 hypointense lesions ("black holes") which reflect tissue destruction and axonal loss. The primary aim of the current study is to explore the effect of neuroradiological parameters such as brain atrophy, T1 and T2 lesion load on auditory ERPs in MS patients. In addition, we correlated cognitive impairment with neurophysiological (ERP) and neuroradiological (MRI) variables and investigated whether a combination of ERP and MRI parameters is capable of distinguishing patients suffering from secondary progressive (SP), primary progressive (PP) and relapsing-remitting (RR) MS. MATERIALS AND METHODS: The study sample consisted of fifty nine MS patients (mean age±SD: 37.82±1.38 years; average disease duration: 6.76±5.3 years) and twenty six age-matched controls (mean age±SD: 41.42±15.39 years). The patients' EDSS and NRS scores were 3.77±2.14 (range: 1-7.5) and 75.88±11.99 (range: 42-94) respectively. ERPs were recorded using the auditory "odd-ball" paradigm. T1 and T2 lesions were automatically segmented using an edge-finding tool and total lesion volumes were calculated. MRI measures of brain atrophy included third ventricle width (THIRDVW) and the ratio of mid-sagittal corpus callosum area to the mid-sagittal intracranial skull surface area (CC/MISS). Statistical analysis was performed using multiple regression, principal component (PCA) and discriminant analysis. RESULTS: T1 lesion load emerged as the most significant predictor of P300 and N200 latency. The rest of the endogenous ERPs parameters (P300 amplitude, N200 amplitude) were not significantly correlated with the MRI variables. PCA of pooled neuroradiological and neurophysiological markers suggested that four components accounted for 64.6% of the total variability. Discriminant analysis based on ERP & MRI markers classified correctly 79.63% of patients in RR, PP and SP subgroups. CONCLUSION: T1 lesion load is the most significant MRI correlate of auditory ERPs in MS patients. Importantly, ERPs in combination with MRI variables can be usefully employed for distinguishing patients with different subtypes of MS.

Comparing the latent structure of Raven's educational coloured progressive matrices among young children and older adults: A preliminary study.

OBJECTIVE: The aim of the present study was the comparison of the general cognitive ability (g) between young children and older adults through the investigation of the latent structure qualitative changes in [R] Educational Coloured Progressive Matrices (CPM) from age to age, using Confirmatory Factor Analyses (CFA) and testing a conventional unidimensional model. METHOD: The sample consisted of 42 kindergarten and 56 elementary school students (age range: 5-8 years) and 118 new-old adults and 27 old-old adults (age range: 61-88 years). The participants' cognitive abilities were examined in: (a) the Raven's Educational CPM test, and (b) the Mini-Mental State Examination (MMSE). RESULTS: CFA applied to data of the total sample, elementary school students subsample and new-old adults subsample, indicating that individual variability across [R] CPM measured variables (total scores for each of the three sets) can be modeled by one latent variable (a single underlying factor). The same pattern of [R] CPM latent structure was not verified for the subsamples of kindergarten students and old-old adults, since the variance of a single underlying factor was not found to be statistically significant. CONCLUSION: The results support the existence of a different factor structure in [R] Educational CPM between first- to second- grade elementary school students and new-old adults, on the one hand, and kindergarten students and old-old adults, on the other. This difference could possibly reflect the underdevelopment of inductive reasoning and executive functioning in the group of kindergarten students and the disorganization of them in the group of old-old adults.

Re-examining the contribution of visuospatial working memory to inhibition of return.

Castel and colleagues (Percept Psychophys 65(6):970-981, 2003) proposed that visuospatial working memory is needed to retain and update the irrelevant but attended location in an inhibition of return (IOR) procedure. In a series of three experiments, we re-examined this hypothesis by loading visuospatial working memory and manipulating the timing of encoding. When the visuospatial memory items were presented right after the cue, as in Castel et al. (Percept Psychophys 65(6):970-981, 2003), we replicated the lack of IOR in the dual-task condition (Experiment 1). However, when we presented the visuospatial memory items before the spatial cue, to control for retroactive interference in encoding, we found robust IOR effects (Experiment 2); the effect remained strong even when participants were prevented from using verbal labels to rehearse the memory material (Experiment 3). We conclude that IOR does not seem to depend on retaining the position of the irrelevant cue in visuospatial working memory.

Contrasting contributions of phonological short-term memory and long-term knowledge to vocabulary learning in a foreign language.

The contributions of phonological short-term memory and existing foreign vocabulary knowledge to the learning of new words in a second language were compared in a sample of 40 Greek children studying English at school. The children's speed of learning new English words in a paired-associate learning task was strongly influenced by their current English vocabulary, but was independent of phonological memory skill, indexed by nonword repetition ability. However, phonological memory performance was closely linked to English vocabulary scores. The findings suggest that in learners with considerable familiarity with a second language, foreign vocabulary acquisition is mediated largely by use of existing knowledge representations.