Tinnitus-on the interplay between emotion and cognition.

Subjective tinnitus (hereafter tinnitus) is often considered and studied as a perceptual phenomenon. Accordingly, various abnormalities in the area of cognitive processing have been reported in patients with tinnitus. At the same time, the disorder is characterized by considerable emotional distress, which is associated with a high comorbidity of affective disorders. Here, we aim to outline the close link between cognition and emotion, and how current research from the field of cognitive neuroscience examines the processing and acquisition of emotional stimuli. The emotional valence of stimuli can be acquired after brief exposure to learning, leading from neutral to appetitive or aversive evaluation. In contrast to neutral stimuli, emotional stimuli attract attention very early (about 100 ms) during processing, leading to deeper processing and corresponding memory effects. The involved subcortical and cortical network encompasses limbic and sensory areas. In particular, prefrontal regions are involved in the acquisition and evaluation of emotional stimuli as also shown in studies of patients with affect disorders. The interplay of cognitive and emotional processes seems to be central to the development, maintenance, and treatment of tinnitus.

Deciphering Functional Connectivity Differences Between Motor Imagery and Execution of Target-Oriented Grasping.

This study aimed to delineate overlapping and distinctive functional connectivity in visual motor imagery, kinesthetic motor imagery, and motor execution of target-oriented grasping action of the right hand. Functional magnetic resonance imaging data were obtained from 18 right-handed healthy individuals during each condition. Seed-based connectivity and multi-voxel pattern analyses were employed after selecting seed regions with the left primary motor cortex and supplementary motor area. There was equivalent seed-based connectivity during the three conditions in the bilateral frontoparietal and temporal areas. When the seed region was the left primary motor cortex, increased connectivity was observed in the left cuneus and superior frontal area during visual and kinesthetic motor imageries, respectively, compared with that during motor execution. Multi-voxel pattern analyses revealed that each condition was differentiated by spatially distributed connectivity patterns of the left primary motor cortex within the right cerebellum VI, cerebellum crus II, and left lingual area. When the seed region was the left supplementary motor area, the connectivity patterns within the right putamen, thalamus, cerebellar areas IV-V, and left superior parietal lobule were significantly classified above chance level across the three conditions. The present findings improve our understanding of the spatial representation of functional connectivity and its specific patterns among motor imagery and motor execution. The strength and fine-grained connectivity patterns of the brain areas can discriminate between motor imagery and motor execution.

[Tinnitus-on the interplay between emotion and cognition. German version]. / Tinnitus im Wechselspiel zwischen Emotion und Kognition.

Subjective tinnitus (hereafter tinnitus) is often considered and studied as a perceptual phenomenon. Accordingly, various abnormalities in the area of cognitive processing have been reported in patients with tinnitus. At the same time, the disorder is characterized by considerable emotional distress, which is associated with a high comorbidity of affective disorders. Here, we aim to outline the close link between cognition and emotion, and how current research from the field of cognitive neuroscience examines the processing and acquisition of emotional stimuli. The emotional valence of stimuli can be acquired after brief exposure to learning, leading from neutral to appetitive or aversive evaluation. In contrast to neutral stimuli, emotional stimuli attract attention very early (about 100 ms) during processing, leading to deeper processing and corresponding memory effects. The involved subcortical and cortical network encompasses limbic and sensory areas. In particular, prefrontal regions are involved in the acquisition and evaluation of emotional stimuli as also shown in studies of patients with affect disorders. The interplay of cognitive and emotional processes seems to be central to the development, maintenance, and treatment of tinnitus.

Accelerated Long-Term Forgetting: Prolonged Delayed Recognition as Sensitive Measurement for Different Profiles of Long-Term Memory and Metacognitive Confidence in Stroke Patients.

OBJECTIVE: Deficits in episodic memory are frequently reported after ischemic stroke. In standard clinical care, episodic memory is assessed after a 20-30 min delay, with abnormal memory decay over this period being characterized as rapid forgetting (RF). Previous studies have shown abnormal forgetting over a prolonged interval (days to weeks) despite normal acquisition, referred to as accelerated long-term forgetting (ALF). METHOD: We examined whether ALF is present in stroke patients (N = 91) using immediate testing (T1), testing after a short delay (20-30 min, T2), and testing after a prolonged delay (one week, T3). Based on performance compared to matched controls (N = 85), patients were divided into (1) patients without forgetting, (2) patients with RF between T1 and T2, and (3) patients with ALF at T3. Furthermore, confidence ratings were assessed. RESULTS: ALF was present in a moderate amount of stroke patients (17%), but ALF was even more prevalent in our stroke sample than RF after a 20-30 min delay (which was found in only 13% of our patients). Patients reported a lower confidence for their responses, independent of their actual performance. CONCLUSIONS: Adding a one-week delayed measurement may potentially assist in identifying patients with memory decrements that may otherwise go undetected.

PREVENTING THE PRE-SICK CONDITIONS OF THOSE WHO PRACTICE LIFELONG LEARNING.

OBJECTIVE: The aim: Disclosure of the results of the study of the expediency of considering the fluidity of mental processes in the triad "organism - personality Disclosure of the results of the study of the expediency of considering the fluidity of mental processes in the triad "organism - personality - environment" and the alternate stages of the dynamics of performance to prevent the occurrence of pre-painful conditions in students, combining professional activity with formal education. PATIENTS AND METHODS: Materials and methods: The complex of research methods is used in the work: general scientific (analysis, synthesis, comparison, systematization, generalization) and empirical (observations, discussions, questionnaires). The research was carried out within the framework of the international project "AHIA" (innovation in education; access mode: https://sites.google.com/view/project-axia/). The Spielberger-Hanin questionnaire was used to achieve the stated purpose of the study, the purpose of which was to assess reactive and personal anxiety. RESULTS: Results: The results of a study aimed at organizing a lifelong learning process based on mental processes and stages of performance dynamics showed that the likelihood of pre-painful conditions in those who combine full-time education in higher education with professional activity significantly decreases their self-actualization. Educational events taking place here and now, and recognizing the theoretical and practical significance of the educational material at the level of intrinsic motives. It is established that the likelihood of pre-morbid conditions in those who learn during life significantly increases in the case of reduced functional reserves of their body as a result of the intense and prolonged performance of educational activities with the simultaneous experience of "negatively" colored actual emotional states, generated by activities or events ) experiences of relationships in professional activity, family, family, etc. CONCLUSION: Conclusions: The proposed article describes the effectiveness and appropriateness of using mental processes and stages of performance dynamics as a means to prevent the onset of painful conditions in lifelong learners.

An Exploration of the Rapid Automatic Naming Test as Administered to Brazilian Children.

OBJECTIVE: The purpose of this research was to conduct an exploratory study of the performance of Brazilian children on the Rapid Automatic Naming (RAN) test, examining schooling effects of schooling and associations with reading speed, comprehension, and reading level for each of the RAN subtests of colour, numbers, letters, and objects. METHODS: Participants were 97 children, aged 7-11 years, enrolled in the first to fifth grade of elementary public education. RESULTS: The findings indicated a school-year effect on RAN performance, with recurrent differences in grades 1-4 and no effect in RAN Numbers. Correlations ranged from moderate to high for reading level, speed, and comprehension. In addition, multiple linear regression analysis indicated that RAN Letters could significantly predict performance in the three reading abilities studied. CONCLUSION: Thus, the study provided initial evidence of RAN's performance in testing Brazilian children's phonological processing as a form of predictive monitoring of reading development in school-age children as it relates to scholastic progress and reading speed, comprehension, and level.

Cognitive Reserve Capacity: Exploring and Validating a Theoretical Model in Healthy Ageing.

OBJECTIVE: Cognitive reserve (CR) capacity can be viewed as the maximum processing potential of neural systems that support adaptive cognitive performance in age-related cognitive decline. CR is a complex construct that can only be measured indirectly. Proxy measures (e.g., psychosocial/lifestyle variables) are traditionally used to reflect CR. However, strong relationships have been observed between these measures and cognitive functions (e.g., executive function [EF], processing resources [PR], fluid/crystallized abilities); therefore, the organizational structure of indicators implicated in CR remains unclear. The objective of this study was to test a hypothetical, theoretical model of CR capacity that includes both traditional CR proxy indicators and measures of cognitive function [Satz et al. (2011). Journal of Clinical and Experimental Neuropsychology, 33(1), 121-130], which remain, as yet, untested. METHOD: Construct validity of the model was investigated in healthy older adults through exploratory and confirmatory factor analysis (EFA and CFA) using data from the Maastricht Ageing Study (MAAS). A secondary CFA was conducted to validate the model using data from the Irish Longitudinal Study on Ageing (TILDA). RESULTS: EFA and CFA in MAAS established a two-factor model comprising EF/PR and cumulative cognitive enrichment (CCE), which was further validated in a secondary analysis in TILDA. Convergent and discriminant validity was supported in MAAS (range of R2 = .228-.635; factor correlation confidence interval (CI) = .622, .740) and TILDA (range of R2 = .172-.899; factor correlation CI = .559, .624). CONCLUSIONS: A dual model of CR elucidated the relationships between hypothesized indicators of CR capacity and revealed a two-factor structure suggesting that both control (EF/PR) and representational processes (CCE) are involved in CR capacity.

Visuospatial Functioning in the Primary Progressive Aphasias.

OBJECTIVES: The aim of this study was to identify whether the three main primary progressive aphasia (PPA) variants would show differential profiles on measures of visuospatial cognition. We hypothesized that the logopenic variant would have the most difficulty across tasks requiring visuospatial and visual memory abilities. METHODS: PPA patients (n=156), diagnosed using current criteria, and controls were tested on a battery of tests tapping different aspects of visuospatial cognition. We compared the groups on an overall visuospatial factor; construction, immediate recall, delayed recall, and executive functioning composites; and on individual tests. Cross-sectional and longitudinal comparisons were made, adjusted for disease severity, age, and education. RESULTS: The logopenic variant had significantly lower scores on the visuospatial factor and the most impaired scores on all composites. The nonfluent variant had significant difficulty on all visuospatial composites except the delayed recall, which differentiated them from the logopenic variant. In contrast, the semantic variants performed poorly only on delayed recall of visual information. The logopenic and nonfluent variants showed decline in figure copying performance over time, whereas in the semantic variant, this skill was remarkably preserved. CONCLUSIONS: This extensive examination of performance on visuospatial tasks in the PPA variants solidifies some previous findings, for example, delayed recall of visual stimuli adds value in differential diagnosis between logopenic variant PPA and nonfluent variant PPA variants, and illuminates the possibility of common mechanisms that underlie both linguistic and non-linguistic deficits in the variants. Furthermore, this is the first study that has investigated visuospatial functioning over time in the PPA variants. (JINS, 2018, 24, 259-268).

Atypical neuronal activation during a spatial working memory task in 13-year-old very preterm children.

Children born very preterm (VP; <32 weeks' gestational age) are at risk for unfavorable outcomes in several cognitive domains, including spatial working memory (WM). The underlying neural basis of these cognitive impairments is poorly understood. We investigated differences in neuronal activation during spatial WM using a backward span (BS) task relative to a control (C) task in 45 VP children and 19 term-born controls aged 13 years. VP children showed significantly more activation in the bilateral superior frontal gyrus and significantly less activation in the left parahippocampal gyrus compared with controls. We further explored the distinct contributions of maintenance and manipulation processes of WM using forward span (FS)>C and BS > FS, respectively. There were no significant group differences in neuronal activation for FS > C. However, BS > FS revealed that VP children had significantly greater activation in the left middle frontal gyrus, in the left superior parietal gyrus and right cerebellar tonsil, and significantly less activation in the right precentral and postcentral gyrus and left insula compared with controls. Taken together these results suggest that VP children at 13 years of age show an atypical neuronal activation during spatial WM, specifically related to manipulation of spatial information in WM. It is unclear whether these findings reflect delayed maturation and/or recruitment of alternative neuronal networks as a result of neuroplasticity. Hum Brain Mapp 38:6172-6184, 2017. © 2017 Wiley Periodicals, Inc.

[Telomere-telomerase system in aging, norm and pathology (literature review)].

This literature review presents results of research showing association between functional activity of the telomere-telomerase system and mental cognitive and emotional processes in normal and various pathological states: chronic stress, depression, bipolar disorder, schizophrenia, mild cognitive impairment and dementia in aging. It also refers to age-specific, psycho-social, economic, immunological, genetic and epigenetic factors that influence these relationships.

[Risk factors and psychological vulnerabilities to binge-drinking in youth]. / Facteurs psychologiques et de personnalité dans le binge-drinking chez les jeunes.

For years, a large number of studies have demonstrated the harmful effects of alcohol consumption on the brain and therefore on behavior and cognition. These studies first aimed at identifying the consequences of alcohol abuse consumption, more specifically in pathologies such as alcohol-dependence or Korsakoff syndrome. Researchers then also started to focus on vulnerabilities to alcohol consumption, especially in hyper fast alcohol consumption called binge-drinking (BD). Indeed BD, which is a particularly dangerous form of alcohol consumption, is usually observed in adolescents and young adults. Typically, young people tend to adopt this way of drinking in order to reach a massive and expeditious intoxication. The aim of this paper is to present the bibliographic data available on the main risk factors to BD and to describe the main measurement tools for investigating these factors in clinical researches. The interaction between psychological dysfunctions and BD is not well understood. For a better understanding of the links between binge-drinking and psychological and personality factors in terms of vulnerability or risk, studies have investigated on affective factors (depression and anxiety), personality characteristics (impulsivity and sensation seeking) and drinking motives (coping, improvement, compliance and wellness). Although different factors are often associated with BD in adolescents and young adults, it is still not clear whether these factors are the consequences of alcohol consumption or a reflection of pre-morbid abnormalities predisposing individuals to excessive alcohol consumption. Furthermore, results are not unequivocal and various distinct personality profiles seem to emerge. Thus, these questions are still not fully resolved and further studies are needed to understand the complex relationships between BD and the various psychological or personality factors. The need for investigating these factors in clinical studies is nevertheless important with regard to therapeutic interventions. Indeed, the identification of specific profiles involved in a binge-drinking type of consumption could allow an adaptation of the contents of therapeutic programs by targeting a specific mechanism. For example, recent findings have revealed that when factors such as impulsivity are considered, therapeutic intervention is more effective.

Attention without intention: explicit processing and implicit goal-setting in family medicine residents' written reflections.

BACKGROUND: Reflection, a process of self-analysis to promote learning through better understanding of one's experiences, is often used to assess learners' metacognitive ability. However, writing reflective exercises, not submitted for assessment, may allow learners to explore their experiences and indicate learning and professional growth without explicitly connecting to intentional sense-making. AIM: To identify core components of learning about medicine or medical education from family medicine residents' written reflections. DESIGN AND SETTING: Family medicine residents' wrote reflections about their experiences throughout an academic year. METHOD: Qualitative thematic analysis to identify core components in 767 reflections written by 33 residents. RESULTS: We identified four themes of learning: 'Elaborated reporting' and 'metacognitive monitoring' represent explicit, purposeful self-analysis that typically would be characterised as reflective learning about medicine. 'Simple reporting' and 'goal setting' signal an analysis of experience that indicates learning and professional growth but that is overlooked as a component of learning. CONCLUSION: Identified themes elucidate the explicit and implicit forms of written reflection as sense-making and learning. An expanded theoretical understanding of reflection as inclusive of conscious sense-making as well as implicit discovery better enables the art of physician self-development.

Relationship between dual task walking, cognition, and depression in oldest old people.

BACKGROUND: The purpose of the study was to investigate the relationship between dual task walking, cognition, and depression in oldest old people living in the community. METHODS: We conducted an observational cross-sectional study at Federal University of São Carlos (Brazil). We assessed 67 community-dwelling older adults aged 80 years and over, who were able to walk alone and did not present with a risk of dementia (assessed by Mini-Mental State Examination, MMSE). The assessment consisted of anamnesis, dual task using the Timed Up and Go test associated with a motor task (TUGT-motor) and a cognitive task (TUGT-cognitive); cognitive measures using MMSE, Montreal Cognitive Assessment (MoCA), Clock Drawing test (CDT) and verbal fluency, and depressive measures by the Geriatric Depression Scale (GDS). RESULTS: There was a correlation with higher magnitude between cognitive tests and TUGT-cognitive, compared to TUGT-motor. For TUGT-motor, the highest correlations with cognitive tests were found between time and MMSE, MoCA (total score), and MoCA visuospatial/executive domain. For TUGT-cognitive, the highest correlations with cognitive tests were between number of steps and MMSE and between time and MMSE. GDS showed a significant weak correlation with number of steps taken in TUGT-motor, wrong words, and correct/time of TUGT-cognitive. CONCLUSIONS: Dual task performances are associated with cognition in oldest old. Furthermore, dual task tests have less influence of educational level, are functional, fast, and easily applicable in clinical practice. Future studies are needed to confirm if dual task test is useful for cognitive screening in oldest old.

Influence of Subclinical Neck Pain on the Ability to Perform a Mental Rotation Task: A 4-Week Longitudinal Study With a Healthy Control Group Comparison.

OBJECTIVE: Mental rotation of objects and the frame of reference of those objects are critical for executing correct and skillful movements and are important for object recognition, spatial navigation, and movement planning. The purpose of this longitudinal study was to compare the mental rotation ability of those with subclinical neck pain (SCNP) to healthy controls at baseline and after 4 weeks. METHODS: Twenty-six volunteers (13 SCNP and 12 healthy controls) were recruited from a university student population. Subclinical neck pain participants had scores of mild to moderate on the Chronic Pain Grade Scale, and controls had minimal or no pain. For the mental rotation task, participants were presented with an object (letter "R") on a computer screen presented randomly in either normal or backwards parity at various orientations (0°, 45°, 90°, 135°, 180°, 225°, 270°, and 315°). Participants indicated the object's parity by pressing "N" for normal or "B" for backwards. Each orientation for normal and backward parities was presented 5 times, and the average response time for all letter presentations was calculated for each participant, at baseline and 4 weeks later. RESULTS: Both groups had overall improved response times from baseline to 4 weeks. Healthy participants had significantly improved response times compared to SCNP, both at baseline (P < .05) and 4 weeks (P < .05). CONCLUSIONS: Healthy participants performed better than the SCNP group at both time points. Subclinical neck pain may impair the ability to perform a complex mental rotation task involving cerebellar connections, possibly due to altered body schema.

[The practical measurement of health literacy in Hungary and in international comparison]. / Az egészségértés gyakorlati mérése Magyarországon és nemzetközi összehasonlításban.

INTRODUCTION: The study presents results of an innovative measurement of practical health literacy in international context. AIM: To show the level of practical health literacy in the Hungarian society and in international comparison. METHOD: We measured practical health literacy with Newest Vital Sign test on a Hungarian national representative sample, asked from 1008 persons, between May and June, 2015 from population 16 years or older, using methodological standards of Eurobarometer. The sample is representative to the above mentioned population by gender, age, region and settlement-size. RESULTS: Based on Newest Vital Sign test, members of the Hungarian society have good practical health literacy. The accomplishment is inconsistent with self-reported health literacy, since it shows weak results. CONCLUSIONS: As low level of self-reported health literacy implies that respondents don't have daily routine in practicing their skills, we could draw people's attention to food-information, that are important and show, how to utilize them. Orv. Hetil., 2016, 157(50), 2002-2006.

Therapies for Cognitive Deficits Associated With Chemotherapy for Breast Cancer: A Systematic Review of Objective Outcomes.

OBJECTIVE: To systematically review evidence of treatments for cognitive impairments experienced by at least 20% of all women who undergo chemotherapy for breast cancer. DATA SOURCES: Searches of 5 databases (PubMed, Embase, Cochrane CENTRAL, PsycINFO, CINAHL), with no date or language restrictions, identified 1701 unique results. Search terms included breast cancer, chemotherapy, chemobrain, chemofog, and terms on cognition and language deficits. STUDY SELECTION: Included only peer-reviewed journal articles that described therapies for cognitive dysfunction in women undergoing (or who had undergone) chemotherapy for breast cancer and provided objective measurements of cognition or language. DATA EXTRACTION: Data were extracted according to Cochrane recommendations, including characteristics of participants, interventions, outcomes, and studies. Quality assessment of all 12 eligible studies was performed using the Physiotherapy Evidence Database scale and treatment fidelity criteria. Screening, data extraction, and quality assessment reliability were performed. DATA SYNTHESIS: Six articles described interventions for cognition that took place during cancer treatment; 6, afterward. Five interventions were medical (including a strength-training program), 2 were restorative, and 5 were cognitive. Medicinal treatments were ineffective; restorative and exercise treatments had mixed results; cognitive therapy had success in varying cognitive domains. The domains most tested and most successfully treated were verbal memory, attention, and processing speed. CONCLUSIONS: Cognitive therapy protocols delivered after chemotherapy and aimed at improving verbal memory, attention, and processing speed hold the most promise. Future research is needed to clarify whether computerized cognitive training can be effective in treating this population, and to identify objective assessment tools that are sensitive to this disorder.

Common and dissociated mechanisms for estimating large and small dot arrays: value-specific fMRI adaptation.

An fMRI pair-adaptation paradigm was used to identify the brain regions linked to the apprehension of small and large numbers of items. Participants classified stimuli on the basis of their numerosities (fewer or more than five dots). We manipulated the type of repetition within pairs of dot arrays. Overall processing of pairs with small as opposed to large quantities was associated with a decreased BOLD response in the midline structures and inferior parietal cortex. The opposite pattern was observed in middle cingulate cortex. Pairs in which the same numerosity category was repeated, were associated with a decreased signal in the left prefrontal and the left inferior parietal cortices, compared with when numerosities changed. Repetitions of exact numerosities irrespective of sample size were associated with decreased responses in bi-lateral prefrontal, sensory-motor regions, posterior occipital and left intraparietal sulcus (IPS). More importantly, we found value-specific adaptation specific to repeated small quantity in the left lateral occipito-temporal cortex, irrespective of whether the exact same stimulus pattern repeated. Our results indicate that a large network of regions (including the IPS) support visual quantity processing independent of the number of items present; however assimilation of small quantities is associated with additional support from regions within the left occipito-temporal cortex. We propose that processing of small quantities is aided by a subitizing-specific network. This network may account for the increased processing efficiency often reported for numerosities in the subitizing range.

Physical Exercise and Executive Function in the Pediatric Overweight and Obesity Population: A Systematic Review Protocol.

BACKGROUND: Executive function is often altered in overweight/obese children and adolescents, which has a negative impact on their learning and daily life. Furthermore, research has shown the benefits of physical exercise in improving cognitive performance. This protocol aims to define in a detailed and structured manner the procedures that will be conducted for the development of a systematic review of the literature aimed at evaluating the effects of physical exercise on the executive functions of children and adolescents (≤18 years) with overweight/obesity in comparison with peers in control groups. METHODS: The Web of Science, PubMed, Scopus, and EBSCO databases will be searched for longitudinal studies that have at least one experimental and one control group using pre- and post-intervention measures of executive function, including working memory, inhibition, and cognitive flexibility in the pediatric population who are overweight or obese. The risk of bias and certainty of evidence will be assessed using Cochrane RoB2 and GRADE, respectively. Furthermore, Der Simonian-Laird's random effects model will be employed for meta-analyses. The effect sizes will be calculated with 95% confidence intervals, and p values < 0.05 indicate statistical significance for each dimension of executive function in the different groups before and after the intervention. DISCUSSION: The results of this review may be useful for education and health professionals to design treatment plans for overweight/obese children and adolescents, offering potential benefits related to the learning and cognitive abilities of this population. PROSPERO registration number: CRD42023391420.

Attention, response inhibition, and hoarding: A neuropsychological examination.

Background and aims: The prominent cognitive-behavioral model of hoarding posits that information processing deficits contribute to hoarding disorder. Although individuals with hoarding symptoms consistently self-report attentional and impulsivity difficulties, neuropsychological tests have inconsistently identified impairments. These mixed findings may be the result of using different neuropsychological tests, tests with poor psychometric properties, and/or testing individuals in a context that drastically differs from their own homes. Methods: One hundred twenty-three participants (hoarding = 63; control = 60) completed neuropsychological tests of sustained attention, focused attention, and response inhibition in cluttered and tidy environments in a counterbalanced order. Results: Hoarding participants demonstrated poorer sustained attention and response inhibition than the control group (CPT-3 Omission and VST scores) and poorer response inhibition in the cluttered environment than when in the tidy environment (VST scores). CPT-3 Detectability and Commission scores also indicated that hoarding participants had greater difficulty sustaining attention and inhibiting responses than the control group; however, these effect sizes were just below the lowest practically meaningful magnitude. Posthoc exploratory analyses demonstrated that fewer than one-third of hoarding participants demonstrated sustained attention and response inhibition difficulties and that these participants reported greater hoarding severity and greater distress in the cluttered room. Discussion and conclusions: Given these findings and other studies showing that attentional difficulties may be a transdiagnostic factor for psychopathology, future studies will want to explore whether greater sustained attention and response inhibition difficulties in real life contexts contribute to comorbidity and functional impairment in hoarding disorder.