The Cognitive Awareness Scale for Basic and Instrumental activities of daily living to measure self-awareness after acquired brain injury: preliminary evidence of its validity.

Objective: There is a crucial need for reliable tools to measure impaired self-awareness (ISA) in patients with acquired brain injury (ABI) across cognitive-functional domains. The aim of this study was to assess the psychometric properties of the Cog-Awareness ADL Scale, which is a novel self-proxy discrepancy method for measuring ISA in both basic and instrumental activities of daily living. Methods: This multicenter study included 54 patients (no-low ISA n = 33; severe ISA, n = 21) from four outpatient rehabilitation units in Málaga-Granada, Spain, and 51 healthy controls. The participants and proxy raters completed the Cog-Awareness ADL Scale and the Patient Competency Rating Scale (PCRS). Agreement between both scales was assessed using Spearman's correlations and the Bland-Altman plot. Group comparisons were made on measures of SA, cognitive abilities and demographic variables. Sensitivity and specificity were analysed by ROC curve analysis. Results: Convergent validity was supported by strong correlations with the PCRS and its subscales (rho's ranging from 0.51 to 0.80, p < 0.01 for all). The Bland-Altman plot confirmed measurement agreement (only 3.70% of the scores were outside the 95% limits). External validity was demonstrated by effectively discriminating between healthy controls and ABI patients with no-low and severe ISA on each discrepancy index while controlling for cognitive/demographic variables. The Cog-Awareness ADL Scale showed optimal diagnostic accuracy (AUC = 0.95, sensitivity = 0.90, specificity = 0.90). Conclusions: The Cog-Awareness ADL Scale proved to be a feasible, valid, and clinical tool to assess ISA across different cognitive-functional domains, in Spanish ABI-patients.

Translation, cross-cultural adaptation and validation of the 10-item Weekly Calendar Planning Activity in Spanish-speaking ABI patients: a multicenter study.

We present the process of translation, adaptation, and validation in the Spanish context of the 10-item version of the Weekly Calendar Planning Activity (WCPA-10), a performance-based measure of cognitive instrumental activities of daily living (C-IADL). The study consisted of two phases: I) translation/cultural adaptation of the WCPA, conducted by professional bilingual translators, a panel of experts, and a pilot study, and II) validation in a sample of 42 acquired brain injury patients (ABI) and 42 healthy participants (HC). WCPA primary outcomes showed expected convergent/discriminant validity patterns with socio-demographical and clinical variables and cognitive processes identifying those WCPA outcomes that best predicted executive and memory deficits measured with a battery of traditional neuropsychological tests. In addition, performance on the WCPA was a significant predictor of everyday functioning over variables such as socio-demographics or global cognition when measured with traditional tests. External validity was established by the WCPA's ability to identify everyday cognitive deficits in ABI patients compared to HC, even in those with subtle cognitive impairment based on neuropsychological tests. The Spanish WCPA-10 seems an appropriate and sensitive assessment tool to identify cognitive-functional impairment in ABI-patients, even those with subtle cognitive impairment. The results also highlight the relevance of this kind of test, as they indicate a better prediction of patients' real-world functioning than traditional neuropsychological tests.

The Cognitive Scale of Basic and Instrumental Activities of Daily Living for Multidomain Mild Cognitive Impairment and Dementia Patients: Validation of its Extended Version.

OBJECTIVE: To validate an informant-based tool - the extended version of the Cognitive Scale of Basic and Instrumental Activities of Daily Living (BADL and IADL) or Ext. Cog-ADL Scale - in a larger sample and with a broader range of cognitive-functional items related to activities of daily living (ADL). METHOD: The Ext. Cog-ADL Scale was administered to family informants of 42 patients with dementia, 43 patients with multidomain mild cognitive impairment (mdMCI), and 23 healthy control participants. We analyzed the convergent and concurrent validity and external validity of this scale. RESULTS: The Ext. Cog-ADL Scale demonstrated good psychometric properties. Episodic and working memory tests were the main predictors of most cognitive-functional items of the scale. While patients with dementia obtained lower scores in most error categories of the scale, affecting both BADL and IADL, mdMCI patients showed a more specific pattern of difficulties. Apart from the typical alterations in IADL, mdMCI patients also showed difficulties in several error categories related to BADL (i.e., error detection, problem solving, task self-initiation, distraction inhibition, and restore). CONCLUSIONS: The Ext. Cog-ADL Scale seems to be an adequate tool to capture the specific pattern of cognitive alterations related to IADL and BADL that differentiates dementia from mdMCI and healthy aging; it shows that mdMCI can involve specific cognitive difficulties that affect even BADL.

Awareness of cognitive abilities in the execution of activities of daily living after acquired brain injury: an evaluation protocol.

INTRODUCTION: One of the main limitations that can be observed after acquired brain injury (ABI) is the alteration of the awareness of the deficits that can occur in the cognitive skills necessary for performing activities of daily living (ADL). According to the Dynamic Comprehensive Model of Awareness (DCMA), consciousness is composed of offline component, which contains the information stored about characteristics of the tasks and stable beliefs about one's own capabilities and online awareness, which is activated in the context of the performance of a specific task. The main objective of this project was to generate and validate a detailed cognitive assessment protocol within the context of ADL to evaluate the components of DCMA. METHODS AND ANALYSIS: The proposed protocol consists of two ecological tools: The Cog-Awareness ADL Scale to measure offline component and the Awareness ADL-task: Basic and Instrumental ADL performance-based test to measure online awareness. The aim is to identify the presence of cognitive deficits and anosognosia in patients with ABI within the context of everyday life activities. These two measures will be administered to a group of patients with ABI. In addition, these participants will complete another series of classic tests on anosognosia and cognitive functions in order to find the convergent validity of the two tests proposed in this protocol. The external validity of the Cog-Awareness ADL Scale and the relationships between awareness components within the same ADL domain will be also analysed. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of Biomedical Research of Andalusia, on 13 January /2017 (Proceeding 1/2017). All participants are required to provide written informed consent. The findings from this will be disseminated via scientific publication. TRIAL REGISTRATION NUMBER: NCT03712839.

On the time course of spatial cueing: Dissociating between a set for fast reorienting and a set for cue-target segregation.

The present study tests whether two different manipulations leading to an earlier appearance of Inhibition of Return might operate by setting the system in different ways. Whereas the use of a range of very long SOAs has been proposed to set the system for an early reorienting of attention (Cheal & Chastain, 2002), introducing a distractor at the location opposite the target seems to induce a set to represent the cue and the target as separated events instead of the same event (Lupiáñez et al., 1999, 2001). The effects of these two manipulations were directly compared by using a spatial stroop paradigm. Although both manipulations altered the time course of cueing effects, we report here a pattern of critical dissociations: (i) the distractor manipulation was unique in introducing a shift towards more negative cueing affecting generally all levels of SOA, including the shortest 100 ms SOA; and (ii) the distractor manipulation, but not the range of SOAs, was also able to prevent the expected interaction between spatial stroop effects and cueing effects at the shortest SOA, typically found in previous experiments in the absence of a distractor (Funes et al., 2003). This pattern of dissociations is well accommodated into the hypothesis that these two attentional sets are different in nature.

Brain networks of temporal preparation: A multiple regression analysis of neuropsychological data.

There are only a few studies on the brain networks involved in the ability to prepare in time, and most of them followed a correlational rather than a neuropsychological approach. The present neuropsychological study performed multiple regression analysis to address the relationship between both grey and white matter (measured by magnetic resonance imaging in patients with brain lesion) and different effects in temporal preparation (Temporal orienting, Foreperiod and Sequential effects). Two versions of a temporal preparation task were administered to a group of 23 patients with acquired brain injury. In one task, the cue presented (a red versus green square) to inform participants about the time of appearance (early versus late) of a target stimulus was blocked, while in the other task the cue was manipulated on a trial-by-trial basis. The duration of the cue-target time intervals (400 versus 1400ms) was always manipulated within blocks in both tasks. Regression analysis were conducted between either the grey matter lesion size or the white matter tracts disconnection and the three temporal preparation effects separately. The main finding was that each temporal preparation effect was predicted by a different network of structures, depending on cue expectancy. Specifically, the Temporal orienting effect was related to both prefrontal and temporal brain areas. The Foreperiod effect was related to right and left prefrontal structures. Sequential effects were predicted by both parietal cortex and left subcortical structures. These findings show a clear dissociation of brain circuits involved in the different ways to prepare in time, showing for the first time the involvement of temporal areas in the Temporal orienting effect, as well as the parietal cortex in the Sequential effects.

Proportion congruent effects in the absence of sequential congruent effects / Efectos de proporción de congruencia en ausencia de efectos secuenciales de conflicto

A debated question in the cognitive control field is whether cognitive control is best conceptualized as a collection of distinct control mechanisms or a single general purpose mechanism. In an attempt to answer this question, previous studies have dissociated two well-known effects related to cognitive control: sequential congruence and proportion congruent effects. In the present experiment, we pursued a similar goal by using a different strategy: to test whether proportion congruent effects can be present in conditions where sequential congruence effects are absent. We used a paradigm in which two conflict types are randomly intermixed (Simon and Spatial Stroop) and the proportion of congruency is manipulated for one conflict type and kept neutral for the other conflict type. Our results showed that in conflict type alternation trials, where sequential congruence effects were absent, proportion congruent effects were still present. It can be concluded that, at least under certain circumstances, sequential congruence and proportion congruent effects can be independent of each other and specific to the conflict type (AU)

En el campo del control cognitivo, una pregunta de gran interés es si el control cognitivo está formado por uno o varios mecanismos. Una forma de responder a esta pregunta ha sido la disociación de dos efectos relacionados con control cognitivo: los efectos secuenciales y los efectos de proporción de congruencia. De forma similar, este experimento tiene como objetivo disociar ambos efectos pero en este caso investigando si los efectos de proporción de congruencia se producen en ausencia de los efectos secuenciales. Para ello se presentaron dos tipos de conflicto mezclados aleatoriamente (Simon y Stroop Espacial) y con la proporción de congruencia manipulada en uno de ellos, manteniendo neutral el número de ensayos congruentes e incongruentes en el otro conflicto. Nuestros resultados mostraron que en los ensayos en los que se producía una alternancia de tipo de conflicto, y dónde los efectos secuenciales estaban ausentes, se observaron efectos de proporción de congruencia. Esto indica que, al menos en circunstancias concretas, los efectos de proporción de congruencia y secuenciales son independientes y específicos al tipo de conflicto (AU)

Reduction of the spatial stroop effect by peripheral cueing as a function of the presence/absence of placeholders.

In a paradigm combining spatial Stroop with spatial cueing, the current study investigated the role of the presence vs. absence of placeholders on the reduction of the spatial Stroop effect by peripheral cueing. At a short cue-target interval, the modulation of peripheral cueing over the spatial Stroop effect was observed independently of the presence/absence of placeholders. At the long cue-target interval, however, this modulation over the spatial Stroop effect only occurred in the placeholders-present condition. These findings show that placeholders are modulators but not mediators of the reduction of the spatial Stroop effect by peripheral cueing, which further favor the cue-target integration account.

Dissociating proportion congruent and conflict adaptation effects in a Simon-Stroop procedure.

Proportion congruent and conflict adaptation are two well known effects associated with cognitive control. A critical open question is whether they reflect the same or separate cognitive control mechanisms. In this experiment, in a training phase we introduced a proportion congruency manipulation for one conflict type (i.e. Simon), whereas in pre-training and post-training phases two conflict types (e.g. Simon and Spatial Stroop) were displayed with the same incongruent-to-congruent ratio. The results supported the sustained nature of the proportion congruent effect, as it transferred from the training to the post-training phase. Furthermore, this transfer generalized to both conflict types. By contrast, the conflict adaptation effect was specific to conflict type, as it was only observed when the same conflict type (either Simon or Stroop) was presented on two consecutive trials (no effect was observed on conflict type alternation trials). Results are interpreted as supporting the reactive and proactive control mechanisms distinction.

The modulation of spatial congruency by object-based attention: analysing the "locus" of the modulation.

Earlier studies have demonstrated that spatial cueing differentially reduces stimulus-stimulus congruency (e.g., spatial Stroop) interference but not stimulus-response congruency (e.g., Simon; e.g., Lupiáñez & Funes, 2005). This spatial cueing modulation over spatial Stroop seems to be entirely attributable to object-based attention (e.g., Luo, Lupiáñez, Funes, & Fu, 2010). In the present study, two experiments were conducted to further explore whether the cueing modulation of spatial Stroop is object based and/or space based and to analyse the "locus" of this modulation. In Experiment 1, we found that the cueing modulation over spatial Stroop is entirely object based, independent of stimulus-response congruency. In Experiment 2, we observed that the modulation of object-based attention over the spatial Stroop only occurred at a short cue-target interval (i.e., stimulus onset asynchrony; SOA), whereas the stimulus-response congruency effect was not modulated either by object-based or by location-based attentional cueing. The overall pattern of results suggests that the spatial cueing modulation over spatial Stroop arises from object-based attention and occurs at the perceptual stage of processing.

Thinking about the future moves attention to the right.

Previous studies have shown that past and future temporal concepts are spatially represented (past being located to the left and future to the right in a mental time line). This study aims at further investigating the nature of this space-time conceptual metaphor, by testing whether the temporal reference of words orient spatial attention or rather prime a congruent left/right response. A modified version of the spatial cuing paradigm was used in which a word's temporal reference must be kept in working memory whilst participants carry out a spatial localization (Experiment 1) or a direction discrimination, spatial Stroop task (Experiment 2). The results showed that the mere activation of the past or future concepts both oriented attention and primed motor responses to left or right space, respectively, and these effects were independent. Moreover, in spite of the fact that such time-reference cues were nonpredictive, the use of a short and a long stimulus onset asynchrony in Experiment 3 showed that these cues modulated spatial attention as typical central cues like arrows do, suggesting a common mechanism for these two types of cuing.

Analyzing the generality of conflict adaptation effects.

Conflict adaptation effects refer to the reduction of interference when the incongruent stimulus occurs immediately after an incongruent trial, compared with when it occurs after a congruent trial. The present study analyzes the key conditions that lead to adaptation effects that are specific to the type of conflict involved versus those that are conflict general. In the first 2 experiments, we combined 2 types of conflict for which compatibility arises from clearly different sources in terms of dimensional overlap while keeping the task context constant across conflict types. We found a clear pattern of specificity on conflict adaptation across conflict types. In subsequent experiments, we tested whether this pattern could be accounted in terms of feature integration processes contributing differently to repetition versus alternation of conflict types. The results clearly indicated that feature integration was not key to generating conflict type specificity on conflict adaptation. The data are consistent with there being separate modes of control for different types of cognitive conflict.

Sustained vs. transient cognitive control: evidence of a behavioral dissociation.

This study assessed whether two well known effects associated with cognitive control, conflict adaptation (the Gratton effect) and conflict context (proportion congruent effects), reflect a single common or separate control systems. To test this we examined if these two effects generalized from one kind of conflict to another by using a combined-conflict paradigm (involving the Simon and Spatial Stroop tasks) and manipulating the proportion of congruent to incongruent trials for one conflict (Simon) but not the other (Spatial Stroop). We found that conflict adaptation effects did not generalize, but the effect of conflict context did. This contrasting pattern of results strongly suggests the existence of two separate attentional control systems, one transient and responsible of online regulation of performance (conflict adaptation), the other sustained and responsible for conflict context effects.

Modulation of spatial Stroop by object-based attention but not by space-based attention.

Earlier studies have shown that the spatial Stroop effect systematically decreases when a peripheral precue is presented at the same location as the target, compared to an uncued location condition. In this study, two experiments were conducted to explore whether the cueing modulation of spatial Stroop is object based and/or space based. In Experiment 1, we found evidence favouring the view that the cueing modulation of the spatial Stroop effect is entirely object based, as no differences were found in conflict reduction for the same-location and same-object conditions. In Experiment 2, the cue was predictive, and a similar object-based modulation of spatial Stroop was still observed. However, the direction of such modulation was affected by the rectangles' orientation. Overall, the pattern of results obtained favours the object-integration (Lupiáñez & Milliken, 1999; Lupiáñez, Milliken, Solano, Weaver, & Tipper, 2001) and referential-coding accounts (Danziger, Kingstone, & Ward, 2001) and seems to provide evidence against the attention-shift account (Rubichi, Nicoletti, Iani, & Umilta, 1997; Stoffer, 1991).

Left visual neglect: is the disengage deficit space- or object-based?

Attention can be directed to spatial locations or to objects in space. Patients with left unilateral spatial neglect are slow to respond to a left-sided target when it is preceded by a right-sided "invalid" cue, particularly at short cue-target intervals, suggesting an impairment in disengaging attention from the right side in order to orient it leftward. We wondered whether this deficit is purely spatial, or it is influenced by the presence of a right-sided visual object. To answer this question, we tested 10 right brain-damaged patients with chronic left-neglect and 41 control participants on a cued response time (RT) detection task in which targets could appear in either of two lateral boxes. In different conditions, non-informative peripheral cues either consisted in the brightening of the contour of one lateral box (onset cue condition), or in the complete disappearance of one lateral box (offset cue condition). The target followed the cue at different stimulus-onset asynchronies (SOAs). If the disengagement deficit (DD) is purely space-based, then it should not vary across the two cueing conditions. With onset cues, patients showed a typical DD at short SOAs. With offset cues, however, the DD disappeared. Thus, patients did not show any DD when there was no object from which attention must be disengaged. These findings indicate that the attentional bias in left-neglect does not concern spatial locations per se, but visual objects in space.

The modulation of exogenous Spatial Cueing on Spatial Stroop interference: Evidence of a set for “cue-target event segregation”

Modulación de la interferencia Stroop especial por la señalización espacial exógena. Evidencia a favor de un set de “segregación señalobjetivo”. Se presentan dos experimentos para estudiar si la modulación delos efectos de señalización exógena debida a la presencia de un distractor en el lugar opuesto al estímulo objetivo (alteración del curso temporal dedichos efectos de señalización, Lupiáñez et al., 1999, 2001) son producidos por la reorientación rápida de la atención o por un set de tarea para prevenirla integración perceptual de la señal y el objetivo en una misma representación. Se usó una tarea de Stroop espacial para explorar si el efecto de facilitación tan prolongado que se suele usar con esta tarea, así como eltípico efecto de reducción de la interferencia en los ensayos señalados (Funes et al., 2003, 2005, en prensa), desaparecería con la presencia de un distractor. En el experimento 1, la presencia del distractor produjo uncambio hacia efectos de señalización mucho más negativos, incluso al nivel de SOA más corto, 100ms, además de eliminar la interacción de Stroopespacial por Señalización. En el experimento 2, introdujimos un rango de SOAs mayor y demostramos que el cambio hacia efectos de señalización

Two experiments are reported that test whether the modulation of exogenous cuing effects by the presence of a distractor at the location opposite thetarget (altering the time course of cueing effects, Lupiáñez et al., 1999, 2001) is due to the fast reorienting of attention or to a set for preventing theintegration of the cue and the target within a single event representation. A Spatial Stroop task was used to explore whether the long lasting facilitationeffect usually found in this task, as well as the typical reduction of Spatial Stroop interference on cued trials (Funes et al., 2003, 2005) is prevented bythe presence of distractors. In Experiment 1, the distractor produced a shift towards more negative cuing effects even at the shortest 100 ms SOA, andeliminated the Spatial Stroop by Cueing interaction. In Experiment 2, a larger range of SOAs was introduced, demonstrating further that the negative shift of cueing effects found in Experiment 1 affected all levels ofSOA equally. This pattern of results is explained in terms of the event segregation hypothesis (AU)

Time (also) flies from left to right.

Everyday linguistic expressions in many languages suggest that back and front space is projected onto temporal concepts of past and future (as in the sentence we are years ahead of them). The present experiment tested the psychological reality of a different space-time conceptual metaphor--projecting the past to left space and the future to right space--for which there are no linguistic traces in any language. Participants categorized words as referring to the past or to the future. Irrelevant to this task, words appeared either to the left or right of the screen, and responses were given by keypresses of the left or right hand. Judgments were facilitated when word position and response mapping were congruent with the left-past right-future conceptual metaphor. These results are discussed in the context of current claims about the embodiment of meaning and the possible mechanisms by which conceptual metaphors can be acquired.

Separate mechanisms recruited by exogenous and endogenous spatial cues: evidence from a spatial Stroop paradigm.

The present experiments tested whether endogenous and exogenous cues produce separate effects on target processing. In Experiment 1, participants discriminated whether an arrow presented left or right of fixation pointed to the left or right. For 1 group, the arrow was preceded by a peripheral noninformative cue. For the other group, the arrow was preceded by a central, symbolic, informative cue. The 2 types of cues modulated the spatial Stroop effect in opposite ways, with endogenous cues producing larger spatial Stroop effects for valid trials and exogenous cues producing smaller spatial Stroop effects for valid trials. In Experiments 2A and 2B, the influence of peripheral noninformative and peripheral informative cues on the spatial Stroop effect was directly compared. The spatial Stroop effect was smaller for valid than for invalid trials for both types of cues. These results point to a distinction between the influence of central and peripheral attentional cues on performance and are not consistent with a unitary view of endogenous and exogenous attention.

The manifestation of attentional capture: facilitation or IOR depending on task demands.

Orienting attention exogenously to a location can have two different consequences on processing subsequent stimuli appearing at that location: positive (facilitation) at short intervals and negative (inhibition of return) at long ones. In the present experiments, we manipulated the frequency of targets and responses associated with them. Results showed that, even at long SOAs, where IOR is usually observed, facilitation was observed for infrequent targets at the same time that IOR was measured for frequent targets. These results are difficult to explain on the basis of either task set modulation of attentional capture or task set modulation of subsequent orienting processes. In contrast, we offer an explanation by which the different cuing effects can be considered as different manifestations of attentional capture on target processing, depending on the task set.

Modulations among the alerting, orienting and executive control networks.

This paper reports a series of experiments that were carried out in order to study the attentional system. Three networks make up this system, and each of them specializes in particular processes. The executive control network specializes in control processes, such as conflict resolution or detection of errors; the orienting network directs the processing system to the source of input and enhances its processing; the alerting network prepares the system for a fast response by maintaining an adequate level of activation in the cognitive system. Recently, Fan and collaborators [J Cogn Neurosci 14(3):340-347, 2002] designed a task to measure the efficiency of each network. We modified Fan's task to test the influences among the networks. We found that the executive control network is inhibited by the alerting network, whereas the orienting network raises the efficiency of the executive control network (Experiment 1). We also found that the alerting network influences the orienting network by speeding up its time course function (Experiment 2). Results were replicated in a third experiment, proving the effects to be stable over time, participants and experimental context, and to be potentially important as a tool for neuropsychological assessment.