Journal of clinical and experimental neuropsychology最新文献

Introduction: Understanding the risk factors that associate with early cognitive decline in Alzheimer's disease (AD) is important to identify high-risk individuals and initiate early intervention. Existing studies show that APOEε4, systemic inflammation, and diabetes may play roles in cognitive decline, but the extent to which these factors interact with each other remains unclear. Our objective was to examine the main effects and higher-order interactions between APOEε4, high sensitivity-C-reactive protein (hs-CRP) as a measure of systemic inflammation, and diabetes on domain-specific measures of cognitive function in two ancillary studies of post-menopausal women from the Women's Health Initiative (WHI).

Method: We identified 2979 cognitively unimpaired women from the WHI Epidemiology of Cognitive Health Outcomes and the WHI Memory Study of Younger Women with cognitive follow-up of up to 13 years. Linear mixed-effects models examined the main and interactive effects of APOEε4, hs-CRP, and diabetes on longitudinal changes in the personal communication for Cognitive Status-modified Test (TICS-m), East Boston Memory Test (immediate and delayed; EBMT), Oral Trail Making Test (OTMT), Verbal Fluency Test (VF-A), Digit Span Test Backwards (DST-backward), and the California Verbal Learning Test (CVLT). All models were adjusted for baseline age, education, body mass index, the WHI randomization arm, and the cohort.

Results: APOEε4 carriers had steeper cognitive decline in TICS-m, EBMT (immediate and delayed), VF-A, and CVLT scores relative to non-carriers. Higher levels of hs-CRP were associated with steeper cognitive decline in the DST-backwards scores. There was no association of diabetes or any evidence of interactive effects on cognitive decline in our study.

Conclusions: In this large longitudinal study of post-menopausal women, our findings support the hypothesis that genetic risk and systemic inflammation independently influence cognitive decline, but there was no evidence of synergistic effects in postmenopausal women. Further research is needed to elucidate the mechanistic pathways underlying these associations with cognitive decline.

Introduction: Early detection of cognitive decline is critical, yet commonly used screening tools may yield divergent results. This study examined the alignment of four widely used instruments in a community-dwelling cohort.

Method: Seventy-nine participants (M_age = 71.20, SD = 6.29; 39 male, 40 female) were recruited from the general community and assessed under standardized laboratory conditions. Participants completed the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination-III (ACE-III), from which scores for the MoCA Memory Index Score (MoCA-MIS) and the Mini-Addenbrooke's Cognitive Examination (M-ACE) were also calculated. Test agreement was examined using observed agreement and Cohen's kappa, and score relationships were evaluated using Pearson correlations.

Results: All but one test pair (M-ACE vs MoCA-MIS) showed strong score correlations. However, agreement between MoCA and ACE-III for classifying participants as below threshold was only fair. MoCA identified twice as many participants as impaired compared with ACE-III, raising the possibility of either greater sensitivity or higher false-positive classification. Overall, 41% of participants (n = 32) scored below threshold on at least one measure, but only 6% (n = 5) were below threshold across all four. Of four participants with a prior mild cognitive impairment (MCI) diagnosis, only one, who had more pronounced deficits, scored below threshold in all tests.

Conclusions: Despite strong inter-test correlations, substantial divergence in classification outcome was observed, particularly between MoCA and ACE-III. Reliance on a single screening instrument risks misclassification, with implications for both over- and under-diagnosis. Greater harmonization between screening tools is needed to improve diagnostic consistency. Clinical practice should therefore combine multiple-instrument approaches, potentially including premorbid function, and interpret screening test scores cautiously. Comprehensive neuropsychological assessment may provide a more complete picture, particularly in cases where diagnostic confidence is low, although this is not routine practice in all services.

Objective: Subjective cognitive decline (SCD) is an important yet heterogeneous indicator of mild cognitive impairment (MCI) and dementia. Sex and health-related disparities in risk are well established, but differences in prevalence and conversion rates from SCD to MCI/Dementia by risk factor remain unclear.

Method: This preregistered study followed PRISMA guidelines to conduct a systematic review with a narrative synthesis and meta-analyses. Random-effects meta-analyses calculated the relative risk (RR) of sex, depression, hypertension, and diabetes in conversion from SCD to MCI/dementia. Q and I² statistics investigated heterogeneity. Prevalence rates were also calculated.

Results: Five cross-cultural studies (N = 1136) were eligible for the meta-analyses. Participants, on average, had less than 12 years of education. Pooled analyses showed no significant differences in the RR of conversion for depression, hypertension, or diabetes. The pooled conversion rate of SCD to MCI was 17.2% and 8.7% to dementia. Evidence of heterogeneity suggested that the aggregated data may mask differences between studies; thus, unpublished conversion rates on comorbid SCD and the health conditions are reported to inform future research.

Conclusions: Relative risk estimates align with the greater literature and extend them to an inclusive cross-cultural sample with lower education. The significant heterogeneity found underscores the complexity of the interactions between cognitive decline and modifiable risk factors. This study provides novel conversion rates to MCI and dementia for individuals with comorbid SCD and depression, hypertension, and diabetes. We recommend that sex-stratified conversion rates are reported, as limited data prevented our meta-analysis from examining this important dimension of risk.

Background: This study aimed to investigate the neurobehavioral differences in emotion regulation strategies between individuals with insomnia disorder (ID) and normal controls (NC) using electrophysiological (EEG) assessment, addressing the research gap in understanding how insomnia affects emotion regulation strategies.

Methods: Twenty-five individuals with subclinical insomnia disorder symptoms (ID group) and twenty-two normal controls (NC group) were recruited from local universities. Participants completed emotion regulation tasks using Neutral-View (NV) and Controlled Reappraisal (CR) strategies while undergoing EEG recording. Behavioral responses, EEG measures including frontal alpha asymmetry, Event-Related Potentials (ERPs), and frequency-domain analyses were collected and compared between groups.

Results: Behaviorally, the ID group showed longer response times when using NV versus CR strategy, while NC group showed no such difference. The ID group also reported lower arousal levels to emotional stimuli. Electrophysiologically, the ID group exhibited decreased frontal left-right alpha asymmetry and altered ERP components, including smaller N2, P2, and Late Positive Potential (LPP) amplitudes, but larger P3 amplitudes compared to NC group. Time-Frequency analysis revealed that ID group demonstrated greater theta power overall and enhanced posterior alpha power specifically when using CR strategy for negative images. In contrast, NC group showed distinct anterior-posterior beta power differences during NV strategy that were absent in ID group. Importantly, alpha oscillations correlated significantly with behavioral performance in NC group but not in ID group, suggesting altered brain-behavior coupling in insomnia.

Conclusions: These findings suggest that individuals with insomnia demonstrate distinct behavioral responses to top-down emotion regulation. The observed alterations in neural response patterns may serve as contributors to the persistence of both insomnia and associated emotional dysregulation.

Objective: Stress is a known risk factor for adverse cognitive outcomes; however, it remains unclear whether race/ethnicity is a moderating factor in the stress-cognition connection. In addition, the mechanisms underlying the influence of stress on learning and memory is an area of growing research, particularly among Hispanic/Latino individuals. The objective of this study was to investigate the associations between perceived stress, cardiometabolic risk, and learning and memory among matched Hispanic/Latino and non-Hispanic White individuals.

Methods: Cross-sectional data were obtained from the MindCrowd longitudinal observational online study from Hispanic/Latino (n = 91) and age, sex, and education matched non-Hispanic White adults (n = 95). Participants completed the 10-item Perceived Stress Scale and an online measure of learning and memory, the paired associates learning task. Linear regression models were built to investigate the effects of perceived stress, cardiometabolic risk and race/ethnicity on paired associates learning scores. Mediation between perceived stress and paired associates learning through cardiometabolic risk was tested.

Results: We found an inverse association between perceived stress and PAL scores among both Hispanic/Latino and non-Hispanic White groups (b = -.08, SE = .03, p = .007). The association between perceived stress and PAL scores was partially mediated by cardiometabolic risk (b = -.01, SE = .008, 95% CI [-.03, -.001]). The associations between perceived stress, cardiometabolic risk, and PAL scores did not differ by race/ethnicity (ps > .05). A mediation model moderated by race/ethnicity indicated no difference in the cardiometabolic risk mediation between perceived stress and PAL (b = .007, SE = .01, 95% CI  [-.02, .03]).

Conclusion: Perceived stress is a risk factor for poorer paired associates learning scores among Hispanic/Latino and non-Hispanic White individuals. Cardiometabolic risk accounted for some of the association between perceived stress and paired associates learning performance. Further investigation is needed to better understand the complex mechanisms underlying stress-cognition associations among ethnically diverse samples.

Objective: This study expands on the Montefiore Einstein Robust Geriatric (MERGER) norms by providing normative data for two word reading tests (WTAR, AMNART). We also developed regression-based prediction formulas for these tests using demographics and a novel measure of cognitive literacy engagement, establishing base rates for discrepancies between actual and predicted scores. Discrepancy base rates for global cognition, derived from regression-based norms using word reading and demographic factors, were also examined to support detection of cognitive decline.

Method: The MERGER sample included 420 community-dwelling older adults. Backward regression analyses predicted WTAR and AMNART scores. Base rates were calculated for discrepancies on the WTAR, AMNART, and the RBANS Global Cognition Index (GCI). One-way ANOVAs compared discrepancy scores across MERGER, mild cognitive impairment (MCI), and dementia groups. Clinically meaningful cutoffs were set at the 10% base rate, and ROC curves assessed diagnostic accuracy.

Results: Normative data for WTAR and AMNART are presented. Cognitive literacy engagement significantly predicted both WTAR and AMNART scores, explaining small but significant variance. Base rate tables for discrepancies in word reading and GCI are provided. Mean discrepancies in the MERGER sample between actual and predicted word reading scores were near zero. ANOVAs showed MERGER participants had significantly smaller negative discrepancies than the MCI and dementia groups. For MCI detection, WTAR and AMNART discrepancies showed low sensitivity (17-24%) at 90% specificity. In the dementia group, sensitivities were fair (24-29%), improving in a subgroup diagnosed at their initial study visit (30-40%) with acceptable diagnostic accuracy.

Conclusions: This study provides normative data and discrepancy base rates for word reading and global cognition, enhancing the clinical applicability of MERGER norms. These results support more precise interpretation of word reading abilities in older adults, aiding in the differentiation of typical versus atypical cognitive profiles and improving diagnostic confidence when evaluating potential cognitive decline.

Prior research has shown a strong association between insomnia and affective symptoms including depressive and anxiety symptoms. Rumination, defined as repetitive negative thinking, impacts both insomnia and affective symptoms. However, relying solely on self-reported sleep measures, it remains unclear whether rumination and affective symptoms interact with their subjective-objective sleep discrepancy (SOSD) rather than perceived sleep duration per se. SOSD is defined as a mismatch between perceived and objectively measured total sleep time (TST). Negative SOSD (i.e. underestimating TST) is a phenotype of sleep disturbance that increases the risk of insomnia in daily life. Therefore, the cross-sectional study investigated whether trait anxiety and depression influence SOSD performance in the presence of rumination. We measured SOSD using sleep diaries and actigraphy over five days, and assessed subjective sleep quality, rumination, depression, and trait anxiety through self-reported surveys. We further classified 672 participants (20.66 ± 1.89 years old; 68.0% female) into three SOSD groups: underestimating (UE), correctly estimating (CE), and overestimating (OE) TST. The results showed that the CE and UE groups had similar rumination levels, whereas the OE group exhibited significantly lower rumination. We found no differences in depression or trait anxiety across SOSD groups. Linear regression models showed that greater rumination and affective symptoms significantly and separately predicted lower SOSD values, and females showed more underestimation TST compared to males. When rumination was included, neither depression nor anxiety uniquely predicted SOSD, regardless of sex, though each overall model remained significant. These findings suggest that depression and anxiety share overlapping explanatory variance with rumination in relation to SOSD outcomes among young adults and interventions targeting rumination and affective symptoms may hold promise for populations with negative SOSD, especially for females.

The new Chinese version of the SKT (Syndrom-Kurz-Test) Short Cognitive Performance Test aims to detect early cognitive impairment and is a promising addition to neuropsychological test batteries in China and suitable for Chinese speaking patients. This study has three aims: 1. to assess whether the SKT's diagnostic accuracy is comparable to established cognitive impairment tests (e.g. Addenbrooke´s cognitive examination-III (ACE-III) and Montreal Cognitive Assessment-Basic (MoCA-B)); 2. to examine whether the three tests show intra-individual differences according to different types of mild cognitive impairment (single-domain amnestic MCI, semantic MCI and multiple-domain amnestic MCI); 3. to determine whether these tests distinguish between individuals with no cognitive impairment and those with subjective cognitive decline (SCD). The validation sample included 1038 older adults (mean age = 70.04, SD = 6.05) from the Chinese Preclinical Alzheimer's Disease Study (C-PAS). Participants underwent cognitive testing and received consensus diagnoses of normal cognition, MCI, or dementia. Sensitivity and specificity were calculated for each test. ANOVAs examined differences between MCI subtypes, and t-tests assessed group differences between normal cognition and SCD. Results: The SKT showed the highest discrimination between normal cognition and cognitive impairment (MCI or dementia), with a sensitivity of 85.4% and specificity of 69.8%. All three tests demonstrated significant score differences across MCI subtypes. Additionally, all tests significantly distinguished individuals with SCD from those without cognitive impairment (p < 0.01). Conclusions: The new Chinese produced weaker results than the established tests. However, given its strengths, it could be a useful tool for identifying cognitive impairment in certain situations.

The intricate role of sleep in sustaining critical physiological functions and preserving cognitive integrity is well-established. Inadequate sleep, whether in duration or quality, profoundly impairs fundamental cognitive functions, including memory consolidation, sustained attention, executive decision-making, and temporal perception. This study endeavors to explore the effects of short-term sleep restriction on subjective time perception employing both retrospective and prospective paradigms to unveil how acute sleep restriction reshapes temporal cognition in healthy adults. Following ethical approval, 31 healthy volunteers aged between 18 and 35 years participated. The experimental protocol which included assessments conducted under two conditions: after four consecutive nights of regular sleep and following three nights of sleep restriction, during which participants' sleep duration was reduced by two hours per night. Subjective time perception was evaluated using both retrospective and prospective time generation tasks (RTP and PTP). To assess cognitive performance, participants completed the Stroop test, which measures selective attention and cognitive flexibility, and the Wechsler Memory Scale-III (WMS-III), a validated instrument for evaluating short-term and working memory functions. The RTP after sleep restriction showed a significant prolongation compared to regular sleep duration (20.2 ± 8.8 vs 26.6 ± 12.3 sec, respectively; ANOVA p < 0.001). Short-term and working memory performances decreased after sleep restriction (10.8 ± 1.9 vs 10.0 ± 2.1 sec and 12.3 ± 2.1 vs 11.4 ± 2.3 sec respectively; ANOVA p ≤ 0.001 for both). Even moderate sleep restriction (e.g. a two-hour reduction) disrupts temporal cognition and memory, underscoring the critical need for sufficient sleep to sustain optimal cognitive performance in high-demand scenarios.

Background: Women face disproportionately high Alzheimer's disease (AD) rates, with Latina women experiencing particularly elevated cognitive impairment rates. Understanding reproductive factors' impact on brain aging is critical for this underrepresented population. Given sex disparities in AD and reproductive factor influence on brain aging, we examined relations among reproductive history, white matter integrity, and cognitive function in post-menopausal Latina women.

Methods: Participants were 95 post-menopausal Latina women from the Boston Latino Aging Study, mean age 65.7 (SD = 6.5) years and 11.7 (SD = 4.8) years of education. Reproductive history was obtained via self-report questionnaire. Cognitive assessment included Mini-Mental State Examination, Free and Cued Selective Reminding Test, Category Fluency, Story Memory Delayed Recall, and Symbol Digit Modalities Test administered in Spanish or Portuguese. White matter microstructure was assessed with diffusion weighted imaging using fixel-based methods. Regression models tested associations among reproductive factors, cognitive and imaging outcomes, adjusting for age, education, and cardiovascular risk. Mediation analyses evaluated whether white matter abnormalities explained reproductive-cognitive relations.

Results: Pregnancy history was associated with worse delayed recall, with women having 1-2 (β = -0.79, p = .016) and 3-4 term pregnancies (β = -0.93, p = .005) performing worse than nulliparous women. Overall, hormone replacement therapy use was associated with better delayed recall (β = 0.58, p = .037). White matter analyses revealed trends suggesting pregnancy-related reductions in fiber density and cross-section across multiple tracts, with 3-4 term pregnancies showing most consistent patterns. Hysterectomy showed trends toward higher fiber density in several tracts. Mediation analyses indicated white matter integrity did not account for reproductive-cognitive associations.

Conclusions: Reproductive history, particularly pregnancy number, is associated with cognitive performance and white matter microstructure in post-menopausal Latina women. These findings underscore the importance of considering reproductive factors in AD risk assessment and highlight the need for longitudinal studies to clarify mechanisms driving these associations.