Conceptualization of the term "ecological validity" in neuropsychological research on executive function assessment: a systematic review and call to action.

OBJECTIVE: "Ecological validity" (EV) is classically defined as test's ability to predict real-world functioning, either alone or together with test's similarity to real-world tasks. In neuropsychological literature on assessment of executive functions (EF), EV is conceptualized inconsistently, leading to misconceptions about the utility of tests. The goal of this systematic review was to examine how EV is conceptualized in studies of EF tests described as ecologically valid. METHOD: MEDLINE and PsychINFO Databases were searched. PRISMA guidelines were observed. After applying inclusion and exclusion criteria, this search yielded 90 articles. Deductive content analysis was employed to determine how the term EV was used. RESULTS: About 1/3 of the studies conceptualized EV as the test's ability to predict functional outcomes, 1/3 as both the ability to predict functional outcome and similarity to real-world tasks, and 1/3 were either unclear about the meaning of the term or relied on notions unrelated to classical definitions (e.g., similarity to real-world tasks alone, association with other tests, or the ability to discriminate between populations). CONCLUSIONS: Conceptualizations of the term EV in literature on EF assessment vary grossly, subsuming the notions of criterion, construct, and face validity, as well as sensitivity/specificity. Such inconsistency makes it difficult to interpret clinical utility of tests that are described as ecologically valid. We call on the field to require that, at minimum, the term EV be clearly defined in all publications, or replaced with more concrete terminology (e.g., criterion validity).

Longitudinal post-shunt outcomes in idiopathic normal pressure hydrocephalus with and without comorbid Alzheimer's disease.

OBJECTIVE: Alzheimer's disease (AD) is highly comorbid with idiopathic normal pressure hydrocephalus (iNPH) and may diminish the benefits of shunting; however, findings in this area are mixed. We examined postoperative outcomes, with emphases on cognition and utilization of novel scoring procedures to enhance sensitivity. METHODS: Using participant data from an iNPH outcome study at Butler Hospital, a mixed effect model examined main and interaction effects of time since surgery (baseline, 3 months, 12 months, and 24-60 months) and AD comorbidity (20 iNPH and 11 iNPH+AD) on activities of daily living (ADLs) and iNPH symptoms. Regression modeling explored whether baseline variables predicted improvements 3 months postoperatively. RESULTS: There were no group differences in gait, incontinence, and global cognition over time, and neither group showed changes in ADLs. Cognitive differences were observed postoperatively; iNPH patients showed stable improvements in working memory (p = 0.012) and response inhibition (p = 0.010), while iNPH + AD patients failed to maintain initial gains. Regarding predicting postoperative outcomes, baseline AD biomarkers did not predict shunt response at 3 months; however, older age at surgery predicted poorer cognitive outcomes (p = 0.04), and presurgical Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (p = 0.035) and Mini-Mental Status Examination (MMSE) scores (p = 0.009) predicted improvements incontinence. CONCLUSION: iNPH + AD may be linked with greater declines in aspects of executive functioning postoperatively relative to iNPH alone. While baseline AD pathology may not prognosticate shunt response, younger age appears linked with postsurgical cognitive improvement, and utilizing both brief and comprehensive cognitive measures may help predict improved incontinence. These results illustrate the potential benefits of surgery and inform postoperative expectations for those with iNPH + AD.

Branching Condition of the Color-Word Interference Test Enhances Prediction of Meta-Tasking in Community-Dwelling Older Adults.

OBJECTIVES: Meta-tasking (MT) is an aspect of executive functioning (EF) that involves the ability to branch (i.e., to apply "if-then" rules) and to effectively interleave sub-goals of one task with sub-goals of another task. As such, MT is crucial for successful planning, coordination, and execution of multiple complex tasks in daily life. Traditional tests of EF fail to adequately measure MT. This study examined whether Condition 4 of the Color-Word Interference Test (CWIT-4; the inhibition/switching condition that requires branching) predicted MT beyond Condition 3 (CWIT-3; inhibition-only condition) and beyond other subtests from the Delis-Kaplan Executive Function System (D-KEFS) that have a switching condition. METHOD: Ninety-eight non-Hispanic white community-dwelling older adults completed the first four subtests of the D-KEFS and an ecologically valid measure of MT. RESULTS: Time to completion and total errors on CWIT-4 accounted for variance in MT above and beyond CWIT-3 and beyond the switching conditions of other D-KEFS subtests. Results remained virtually unchanged when controlling for demographics and general cognitive status. CONCLUSIONS: Among older adults, CWIT-4 is more strongly associated with MT than other D-KFES tasks. Future research should examine whether CWIT-4 relates to lapses in instrumental activities of daily living among older adults above and beyond other EF tests.

Frontal Behavior Syndromes in Idiopathic Normal Pressure Hydrocephalus as a Function of Alzheimer's Disease Biomarker Status.

OBJECTIVES: Cognitive impairment and apathy are well-documented features of idiopathic normal pressure hydrocephalus (iNPH). However, research examining other neuropsychiatric manifestations of iNPH is scant, and it is unknown whether the neuropsychiatric presentation differs for iNPH patients with comorbid Alzheimer's disease (AD) versus iNPH without AD. This study aims to advance our understanding of neuropsychiatric syndromes associated with iNPH. METHODS: Fifty patients from Butler Hospital's Normal Pressure Hydrocephalus Clinic met inclusion criteria. Caregiver ratings on the Frontal Systems Behavior Scale (FrSBe) were examined to appraise changes in apathy, executive dysfunction, and disinhibition. Patients also completed cognitive tests of global cognition, psychomotor speed, and executive functioning. AD biomarker status was determined by either amyloid-beta (Aß) positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) total tau to Aß-42 ratio. RESULTS: Results revealed clinically significant elevations on the FrSBe's apathy and executive dysfunction scales and modest correlations among these scales and cognitive measures. Of the 44 patients with available neuroimaging or CSF draw data, 14 presented with comorbid AD. Relative to the iNPH-only group, the iNPH + AD group showed a larger increase from pre-illness to current informant ratings on the executive dysfunction scale, but not the apathy or disinhibition scales. CONCLUSIONS: These results replicate and extend prior research by identifying apathy and executive dysfunction as prominent neuropsychiatric symptoms of iNPH and suggest comorbid AD exacerbates dysexecutive behaviors. Future research is warranted to examine the effects of comorbid AD pathology in response to shunt surgery for iNPH, neuropsychiatric symptom changes, and resultant caregiver burden.

Deleterious Impact of Expressive Suppression on Test Performance Persists at One-Year Follow-Up in Community-Dwelling Older Adults.

OBJECTIVES: Expressive suppression (ES) is an emotion-regulation strategy that is associated with poorer performance on subsequently administered tests of executive functioning (EF). It is not known, however, how far into the future ES interferes with EF. This study examined whether (a) ES negatively affects performance on EF tests repeated 1 year after the initial administration (presumably through interference with learning, leading to a reduced practice effect), and (b) whether such an effect, if seen, is unique to EF or whether it also affects lower-order cognitive processes needed for EF test performance. METHODS: Sixty-six non-demented community-dwelling older adults were randomly assigned to either an ES group or control group. Executive and non-executive tests were administered before and immediately following the exposure to an emotionally evocative video, and then again at 1-year follow-up. Groups were compared at 1-year follow-up on tests of EF and lower-order processes, to examine whether the previously demonstrated impact of ES on EF is evident only immediately following the experimental manipulation (Franchow & Suchy, 2017), or also at 1-year follow-up. RESULTS: The results showed that participants who engaged in ES continued to exhibit poorer performance on EF tests 1 year later. This effect was not present for performance on tests of lower-order processes. CONCLUSIONS: These results suggest that the use of ES before an EF task can interfere with the ability to benefit from exposure to that task, thereby negatively affecting future performance. (JINS, 2019, 25, 29-38).

Naturally Occurring Expressive Suppression is Associated with Lapses in Instrumental Activities of Daily Living Among Community-Dwelling Older Adults.

OBJECTIVES: Expressive suppression (i.e., effortful regulation of overt affect) has a deleterious impact on executive functioning (EF). This relationship has potential ramifications for daily functioning, especially among older adults, because a close relationship exists between EF and functional independence. However, past research has not directly examined whether expressive suppression impacts instrumental activities of daily living (IADL). The present study examined this association among older adults. METHODS: One hundred ten community-dwelling older adults completed a self-report measure of acute (past 24 hr) and chronic (past 2 weeks) expressive suppression, a timed test of IADL, and the Behavioral Dyscontrol Scale as a measure of EF. RESULTS: High chronic expressive suppression was related to slow IADL performance beyond covariates (age, IQ, depression), but only for individuals with low EF. High acute expressive suppression was associated with lower accuracy on IADL tasks beyond covariates (IQ, depression), but this association was fully explained by EF. CONCLUSIONS: The current results suggest that expressive suppression is associated with less efficient and more error-prone IADL performance. EF fully accounted for the relationship between acute expressive suppression and IADL performance, showing that suppression is a risk factor for both poorer EF performance and functional lapses in daily life. Furthermore, individuals with weaker EF may be particularly vulnerable to the effect of chronic expressive suppression. (JINS, 2019, 25, 718-728).

Reported Expressive Suppression in Daily Life Is Associated with Slower Action Planning.

Objectives Growing evidence demonstrates that (a) executive functioning (EF) becomes deleteriously affected by engagement in the emotion regulation strategy known as expressive suppression and (b) EF shows considerable functional and neuroanatomical overlap with motor output. The current study aimed to bridge these two literatures by examining the relationships between naturally occurring expressive suppression and several different aspects of motor output, including action planning, action learning, and motor-control speed and accuracy. In addition, we investigated whether any identified relationships could be explained by EF. Methods Fifty-one healthy young adults completed selected subtests from the Delis-Kaplan Executive Function System as indices of EF, a self-report measure of expressive suppression, and a computerized motor sequencing task (Push Turn Taptap task; PTT) designed to assess action planning, action learning, and motor control speed and accuracy. Results Hierarchical regressions using each aspect of PTT performance as the dependent variable revealed that higher than usual self-reported expressive suppression on the day of testing (relative to the 2 weeks preceding testing) was associated with longer action-planning latencies. This relationship was fully explained by EF. No other PTT variables related to expressive suppression on the day of testing. Conclusions These results suggest that increased expressive suppression in daily life is associated with slower action planning, an aspect of motor output that is reliant on EF, highlighting the importance of factors that lead to intra-individual fluctuations in EF and motor performance. (JINS, 2016, 22, 671-681).

Pitfalls in research on ecological validity of novel executive function tests: A systematic review and a call to action.

The term "ecological validity" (EV) has traditionally referred to test scores' ability to predict real-world functioning. However, a test's similarity to real-world tasks is sometimes mistaken for evidence of its ability to predict daily life, sometimes bypassing rigorous validation research. The goal of this systematic review was to examine the type and quality of evidence used to support claims of EV of novel face-valid tests of executive functions (EF). MEDLINE and PsychINFO databases were searched using the following terms: ecologic* AND neuropsychol* AND (executive function* OR executive dysfunction OR executive abilit*). Thirty-two articles that explicitly stated that their results demonstrated EV of a novel face-valid test of EF were identified. Results showed that only 60% of studies based their claims about EV on test scores' ability to predict functional outcomes, with the remaining 40% relying on other evidence (e.g., correlations with other measures, participant feedback, group differences). Among the studies that did base their conclusions on test scores' ability to predict outcomes (n = 19), an overwhelming majority relied on behavioral rating scales, utilized small sample sizes and participant-to-variable ratios, and failed to control for covariates and multiple comparisons. Poor scientific rigor was particularly pronounced in studies of "naturalistic" tests. The present systematic review reveals significant conceptual, methodological, and statistical flaws among an overwhelming majority of studies that claim to have found support for the EV of a novel face-valid test of EF. We call upon authors, reviewers, and editors to safeguard the scientific rigor of research in this area. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceptions of function and recovery among persons with stroke and care partners.

PURPOSE/OBJECTIVE: Perceptions of function can differ between persons with stroke and care partners. The current study described the frequency of discrepancy in ratings of poststroke functioning across romantic partners and examined associations between perceptions of function, depressive symptoms, and caregiver strain. RESEARCH METHOD/DESIGN: A secondary analysis was conducted using data from the baseline visit of an intervention pilot study. Twenty-nine dyads completed measures of perceived current functioning of the person with stroke (Stroke Impact Scale 3.0: overall percent recovery, ADL, and cognition), self-reported ratings of depressive symptoms for both partners (PROMIS Depression Short Form v8b), and self-reported caregiver strain for the care partners only (Caregiver Strain Index). RESULTS: A discrepancy of over 10 points on the SIS 3.0 variables was seen in over 50% of dyads for all subscales, with care partners rating worse recovery on average. Actor partner interdependence models showed that more depressive symptoms were associated with perceptions of worse overall recovery and ADL function in persons with stroke, whereas more depressive symptoms were associated with perceptions of worse cognitive and ADL function in care partners. Discrepancy in perception of ADL function was associated with more caregiver strain though this was inextricable from the overall level of impairment in ADL function perceived by the care partner. CONCLUSIONS/IMPLICATIONS: These findings suggest that discrepancy in perceptions of stroke recovery among romantic partners is common. This underscores the importance of perception when considering risk for depression and caregiver strain as well as how to best promote psychological resilience following stroke. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Interoceptive attention regulation in Ehlers-Danlos syndromes: associations between pain and psychiatric symptom severity.

High rates of comorbid chronic pain, anxiety, and mood disorders among individuals with the Ehlers-Danlos syndromes (EDS+) are becoming increasingly recognized, though this complex symptomology remains poorly understood and undertreated. The current project examined whether interoceptive attention regulation is protective against depressive and anxiety symptoms in individuals with suspected EDS+. Data were collected from individuals participating in a transdisciplinary diagnostic visit within an EDS+ specialty consultation clinic. Participants were included in the current analyses (n = 49) if they had complete data on the following measures: the PHQ-8, the GAD-7, the Pain Severity subscale from the West Haven-Yale Multidimensional Pain Inventory, and the Attention Regulation subscale from the Multidimensional Assessment of Interoceptive Awareness. Consistent with expectations, the sample showed high levels of clinically significant anxiety and depressive symptoms. Pain severity ratings were significantly correlated with depressive but not anxiety severity. Moreover, higher levels of perceived interoceptive attention regulation abilities were significantly associated with less severe anxiety and depressive symptoms; however, attention regulation did not moderate the associations of pain with anxiety and depressive symptom severity. CONCLUSIONS: The current project replicated recent findings that pain, anxiety, and depression are common in individuals with EDS+. The ability to focus and control somatic attention appears to be protective and a potential target for interventions in EDS+.

The vulnerability of executive functioning: The additive effects of recent non-restorative sleep, pain interference, and use of expressive suppression on test performance.

Objective: Certain transient contextual factors (i.e. higher expressive suppression, pain, and non-restorative sleep) are all associated with temporary decrements in performance on measures of executive functioning (EF), making clinical interpretation of EF scores challenging. Additionally, pain, non-restorative sleep, and expressive suppression are thought to be mutually interrelated with one another and with depression. This study sought to investigate how these factors impact EF when considered simultaneously.Methods: A total of 95 community-dwelling older adults completed the Push-Turn-Taptap (PTT) task as a measure of EF, and self-report measures of expressive suppression, pain interference, non-restorative sleep, and depressive symptoms.Results: Expressive suppression and pain interference, but not non-restorative sleep, demonstrated unique relationships with EF performance when all factors were considered simultaneously. Expressive suppression fully mediated the relationship between non-restorative sleep and EF performance, but not when controlling for depression. When a single contextual burden composite was generated collapsing across transient contextual factors, a composite that included all three examined factors (i.e. including non-restorative sleep) accounted for more variance in EF scores beyond depression than a composite that only included expressive suppression and pain interference.Conclusion: Expressive suppression, pain interference, and non-restorative sleep share some overlap with one another and with depression, but nonetheless have an additive negative effect on EF performance beyond depression. Quantifying these transient contextual factors may improve the accuracy of EF assessment and, by extension, the utility of EF measures in predicting daily functioning. These transient contextual factors also represent targets that, if better managed, may reduce EF lapses in daily life.

Walking, talking, and suppressing: Executive functioning mediates the relationship between higher expressive suppression and slower dual-task walking among older adults.

Objective: Dual-task walking, which is related to fall risk, has also been shown to relate to executive functioning (EF). EF is known to be vulnerable to the effects of an emotion-regulation strategy known as expressive suppression, such that higher engagement in expressive suppression is related to subsequent decrements in EF. However, it is unknown whether expressive suppression is also associated with slower dual-task walking. In addition, if such an association exists, it is unknown whether EF mediates the relationship between expressive suppression and dual-task gait speed.Methods: Ninety-five community-dwelling older adults completed tasks of EF and lower-order component process using the Delis Kaplan Executive Function System (D-KEFS), as well as self-report measures of expressive suppression use in the 24 hours prior to testing and a measure of depressive symptoms.Results: Higher self-reported expressive suppression not only related to poorer EF, but also to slower dual-task walking beyond age and depressive symptoms; however these results did not hold when individuals with possible undiagnosed MCI were excluded. EF mediated the relationship between expressive suppression and dual-task walking speed.Conclusion: Expressive suppression appears to weaken EF, which in turn impacts executive aspects of motor functioning (such as walking under cognitive load) for cognitively vulnerable individuals. Quantifying and accounting for the taxing effect of effortful emotion regulation may improve the accuracy of EF assessment. Expressive suppression represents a potentially modifiable target to help reduce EF lapses and motor failings among older adults.

Interpreting executive and lower-order error scores on the timed subtests of the Delis-Kaplan Executive Function System (D-KEFS) battery: Error analysis across the adult lifespan.

OBJECTIVE: The Delis-Kaplan Executive Function System (D-KEFS) is a battery of tests designed to measure executive functions (EF). Additionally, the D-KEFS contains lower-order tasks, designed to control for speed of visual scanning, sequencing, and verbal and graphomotor output. The construct and criterion validities of D-KEFS scores that are time-based are well established. However, the constructs measured by the D-KEFS error scores are poorly understood, making clinical interpretations of such scores difficult. This study examined the construct validity of D-KEFS errors committed on EF tasks and tasks designed to measure lower-order processes (i.e., non-EF tasks), across the adult lifespan. METHOD: Participants were 427 adults (18-93 years) who completed the timed subtests of the D-KEFS. Four hundred two participants also completed the Push-Turn-Taptap (PTT; a separate measure of EF) to allow cross-validation. RESULTS: General linear regressions showed that D-KEFS errors committed on the EF tests were associated with EF timed performance (assessed using the D-KEFS time-based scores and the PTT), but only among older adults. Importantly, errors committed on the D-KEFS tasks of lower-order processes were also associated with D-KEFS time-based EF performance, and this relationship held across the adult lifespan. CONCLUSIONS: These findings suggest that among older adults EF errors on the D-KEFS can be interpreted as indices of EF, but such interpretations are not automatically warranted for younger adults. Additionally, errors committed on non-EF tasks contained within the D-KEFS battery can be interpreted as reflecting EF weaknesses across the adult lifespan.

Chronic versus recent expressive suppression burdens are differentially associated with cognitive performance among older adults.

Introduction: Expressive suppression (ES; suppression of affective behavior) has been shown to have a deleterious impact on subsequently administered tests of executive functions (EF), threatening validity, and reliability of EF assessment. Past research has shown that recent ES (i.e., across 24 hours prior to testing) and chronic ES (i.e., across 2 weeks prior to testing) have differential impact on test performance. The present study compared the association of chronic vs. recent ES with speed vs. accuracy of performance on tests of EF and tests of lower-order processes. METHOD: Participants were 255 community-dwelling older adults aged 60 and older. Participants completed timed subtests of the Delis-Kaplan Executive Function System and the Burden of State Emotion Regulation Questionnaire. RESULTS: Hierarchical linear regressions examined the contributions of chronic vs. recent ES to test performance. Recent ES was related to scores of both speed and accuracy on EF tests. The association between recent ES and EF errors held beyond covariates (i.e., chronic ES, demographics, depression, and general cognitive status). In contrast, the association between recent ES and EF speed was fully explained by EF error scores. Chronic ES was associated only with speed of performance and only on lower-order tasks, but this relationship did not survive correction for cognitive, psychiatric, and demographic factors. CONCLUSIONS: Recent ES appears to be a risk factor for EF lapses. Chronic ES, while related to performance speed, seems to also relate to several other cognitive, psychiatric, and demographic factors, which themselves explain slower information processing.

Executive functioning interacts with complexity of daily life in predicting daily medication management among older adults.

Objective: Executive functioning (EF) is critical for performance of instrumental activities of daily living, including medication management. Under complex conditions, daily activities require greater EF resources. This study examined if older adults who exhibit weaknesses in EF are at an increased risk for mismanaging their medications under complex contexts.Method: Participants were 50 non-Hispanic white community-dwelling older adults, ages 60-85. At a baseline visit, EF was assessed using the Push-Turn-Taptap task, and daily life complexity and medication regimen complexity were assessed using a structured interview. Medication management across the subsequent 8 weeks was assessed by weekly pill counts.Results: A general linear regression using at-home medication management as the dependent variable showed that EF and the interaction between EF and life complexity were significant predictors (both p values < .001). Specifically, life complexity had a deleterious impact on medication management, but only for older adults whose EF performance was in the bottom 22% of the sample. There was no association between medication regimen complexity and accuracy of medication management.Conclusions: These findings demonstrate that older adults who have even mild EF weaknesses are at an increased risk for mismanaging their medication when leading complex daily lives. These findings add support for the Contextually Valid Executive Assessment (ConVExA) model, which asserts that EF interacts with contextual factors as a predictor of functional outcomes.

Greater naturally occurring expressive suppression is associated with poorer executive functioning and motor-sequence learning among older adults.

Objectives: Unusually high engagement in expressive suppression (i.e., purposeful regulation of overt affect) has been associated with poorer performance on executive functioning (EF) and motor-sequence learning tasks. As such, expressive suppression represents one possible source of fluctuations in executive test performance. However, the relationship between expressive suppression and EF and motor performance has not yet been examined in older adults, who are more prone to EF and motor fluctuations than are younger adults. The purpose of this study was to test whether greater self-reported, naturally occurring expressive suppression is related to poorer EF performance and motor-sequence learning in older adults. Method: One hundred and ten community-dwelling older adults completed a self-report measure of expressive suppression, a battery of EF tests, and a computer-based measure of motor-sequence learning. Results: As expected, higher self-reported burden of expressive suppression in the 24 hours prior to testing was related to poorer performance on EF tests and on multiple aspects of motor-sequence learning (action planning latencies and sequencing errors) even after accounting for age, depressive symptoms, and component processes (e.g., processing speed). Conclusions: The current results suggest that naturally occurring expressive suppression depletes EF, which builds on previous findings from experimental studies that show that expressive suppression leads to reduced EF performance. Furthermore, this effect can be captured using self-report methods. These findings highlight expressive suppression as one source of intraindividual fluctuations in executive and motor functioning, which likely place older adults at risk for both functional and motor lapses (e.g., medication mistakes, falls).

The Impacts of Sexual Arousal and Its Suppression on Executive Functioning.

Suppression of certain types of reflexive emotional responses is thought to temporarily deplete executive functions (EF), as evidenced by poorer performance on measures of EF, but does not deplete other, lower-order cognitive processes. This study examined whether similar decrements in performance on EF tests would occur following suppression of sexual arousal. A sample of 44 male college students underwent baseline cognitive assessment (EF and lower-order cognitive processes), followed by experimental manipulation consisting of exposure to sexually explicit audiovisual stimuli. Sexual arousal was monitored using penile plethysmography. In this study, 21 participants were assigned to a suppression condition and were instructed to suppress sexual arousal during the video, while 23 were assigned to an arousal condition and were instructed to allow themselves to become aroused. Following experimental manipulation, cognition was reassessed. Unexpectedly, results showed EF decrements in the arousal group but not in the suppression group. As expected, only EF was affected by experimental manipulation, with no group differences in lower-order cognitive processes. Thus, the findings suggest that sexual arousal is associated with temporary decrements in EF performance, at least among young, primarily White, male college students. The results contribute to understanding why sexually charged situations are sometimes associated with poor decisions or unsafe/reckless sexual practices.

Cognitive and gait decrements among non-demented older adults with Type 2 diabetes or hypertension: a systematic review.

OBJECTIVE: Older adults with Type 2 diabetes (DM2) and hypertension (HTN) often experience cognitive weaknesses. Growing evidence suggests that such weaknesses place patients at risk for gait disturbance and falls. The current systematic review evaluated (a) the impact of DM2 and HTN on cognition and gait and (b) the association between cognition and gait in the context of DM2 and HTN. METHODS: PubMed was searched to identify studies published in English before 15 April 2017 that evaluated both cognition and gait among non-demented older adults either as a function of DM2 or HTN status or as a function of continuous variables that indicate disease severity and/or management (e.g. blood pressure, HbA1C). Risk of bias was assessed by examining the method of verifying HTN/DM2 and excluding dementia as well as included covariates. RESULTS: In the majority of studies reviewed (n = 17), both DM2 and HTN status were associated with poorer cognitive and/or gait functioning (8 out of 10 studies). In addition, in 10 out of 11 studies cognition was reliably associated with gait. For continuous variables, higher systolic blood pressure (measured with ambulatory methods) was consistently related to poorer cognition and slower gait, but other continuous variables (e.g. HbA1C) were studied inconsistently with inconclusive results. CONCLUSIONS: Cognitive and gait decrements are not only common in the context of HTN and DM2, but also are related to each other. This suggests that clinical neuropsychologists should address cognitive contributions to gait disturbance and falls in their clinical work and research with these patient populations.

Exaggerated reaction to novelty as a predictor of incipient cognitive decline among community-dwelling older adults.

OBJECTIVE: The ability to detect covert markers of incipient cognitive decline among older adults before cognitive decline becomes overtly evident on traditional cognitive tests represents an important topic of research. Exaggerated reactions to novelty, reflected in novelty-induced increases in action planning latencies ("novelty effect"; NE) and low openness to experience (openness), have been previously associated with incipient cognitive decline among older adults who appeared cognitively normal at baseline. The purposes of the present study were to extend prior research on the utility of these markers by examining whether (a) NE and openness each predict cognitive change uniquely, and (b) whether these indices predict cognitive change above and beyond measures of memory, executive functions, processing speed/efficiency, premorbid IQ, and depressive symptoms. METHOD: Sixty-one cognitively normal community-dwelling older adults were administered a battery of tests assessing the relevant constructs at baseline and one-year follow up. Changes in cognitive status were assessed using the Demetia Rating Scale, 2nd Edition, NE was assessed using the Push-Turn-Taptap task (an electronic motor sequence learning task), and openness using the NEO Personality Inventory-Revised. The Test of Premorbid Functioning, and subtests from Repeatable Battery for the Assessment of Neuropsychological Status, Delis-Kaplan Executive Function System, and Wechsler Adult Intelligence Scale, 4th Edition, were used for additional assessment of baseline cognition. Depressive symptoms were assessed using the Geriatric Depression Scale. RESULTS: Results confirmed our hypothesis that both NE and openness contribute to prediction of cognitive change beyond baseline cognition and depressive symptoms, but none of the covariates (i.e., depression, executive functions, processing efficiency, or memory) themselves contributed to the model. NE and openness each contributed unique variance and were independent of each other. CONCLUSIONS: Openness and NE have the potential to provide evidence-based methods for estimating risk of future cognitive change in persons with currently normal standardized test scores.

Motor sequencing in older adulthood: relationships with executive functioning and effects of complexity.

OBJECTIVE: Older adults' motor sequencing performance is more reliant on executive functioning (EF) and more susceptible to complexity than that of younger adults. This study examined for which aspects of motor sequencing performance these relationships hold. METHODS: Fifty-seven younger and 90 non-demented, community-dwelling, older adults completed selected subtests from the Delis-Kaplan Executive Function System as indices of EF and component processes (CP; graphomotor speed; visual scanning; etc.), as well as a computerized motor sequencing task (Push Turn Taptap task; PTT). The PTT requires participants to perform motor sequences that become progressively more complex across the task's four blocks, and is designed to assess action planning, action learning, and motor control speed and accuracy. RESULTS: Hierarchical regressions using each discrete aspect of performance as the dependent variable revealed that action planning is the only aspect of motor sequencing that is uniquely related to EF (beyond the CP composite) for both age groups. Action learning and motor control accuracy are uniquely associated with EF for older adults only, and only if the sequences are complex. Component processes do not fully account for the unique relationships between motor sequencing and EF in older adults. CONCLUSIONS: These results clarify prior findings by showing (a) more aspects of motor sequencing relate to EF for older compared to younger adults and (b) for these unique relationships, EF is only related to action during the generation of sequences that are complex. These findings further our understanding of how aging shapes the links between EF and motor actions, and can be used in evidence-based and theoretically driven intervention programs that promote healthy aging.