Traumatic Brain Injury (TBI) often leads to cognitive impairments, particularly regarding working memory (WM). This meta-analysis aims to examine the impact of TBI on WM, taking into account moderating factors which has received little attention in previous research, such as severity of injury, the different domains of Baddeley’s multi-component model, and the interaction between these two factors, as well as the interaction with other domains of executive functions.

Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review and meta-analysis searched Google Scholar, PubMed, and PsycNET for studies with objective WM measures. Multiple meta-analyses were performed to compare the effects of TBI severity on different WM components. Twenty-four English, peer-reviewed articles, mostly cross-sectional were included.

TBI significantly impairs general WM and all Baddeley’s model components, most notably the Central Executive (d’ = 0.74). Severity categories, mild-moderate and moderate-severe, were identified. Impairment was found across severities, with “moderate-severe” demonstrating the largest effect size (d’ = 0.81). Individuals with moderate-severe TBI showed greater impairments in the Central Executive and Episodic Buffer compared to those with mild-moderate injury, whereas no such differences were found for the Phonological Loop and Visuospatial Sketchpad.

These findings enhance our understanding of WM deficits in varying severities of TBI, highlighting the importance of assessing and treating WM in clinical practice and intervention planning.

White matter hyperintensity (WMH) volume is a neuroimaging marker of lesion load related to small vessel disease that has been associated with cognitive aging and Alzheimer’s disease (AD) risk.

The present study sought to examine whether regional WMH volume mediates the relationship between APOE ε4 status, a strong genetic risk factor for AD, and cognition and if this association is moderated by age group differences within a sample of 187 healthy older adults (APOE ε4 status [carrier/non-carrier] = 56/131).

After we controlled for sex, education, and vascular risk factors, ANCOVA analyses revealed significant age group by APOE ε4 status interactions for right parietal and left temporal WMH volumes. Within the young-old group (50-69 years), ε4 carriers had greater right parietal and left temporal WMH volumes than non-carriers. However, in the old-old group (70-89 years), right parietal and left temporal WMH volumes were comparable across APOE ε4 groups. Further, within ε4 non-carriers, old-old adults had greater right parietal and left temporal WMH volumes than young-old adults, but there were no significant differences across age groups in ε4 carriers. Follow-up moderated mediation analyses revealed that, in the young-old, but not the old-old group, there were significant indirect effects of ε4 status on memory and executive functions through left temporal WMH volume.

These findings suggest that, among healthy young-old adults, increased left temporal WMH volume, in the context of the ε4 allele, may represent an early marker of cognitive aging with the potential to lead to greater risk for AD.

“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.

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.

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).

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).

Cervical dystonia (CD) is a movement disorder characterized by involuntary muscle contractions causing sustained twisting movements and abnormal postures of the neck and head. Assumed affected neuronal regions are the cortico-striatal-thalamo-cortical circuits, which are also involved in cognitive functioning. Indeed, impairments in different cognitive domains have been found in CD patients. However, to date studies have only investigated a limited range of cognitive functions within the same sample. In particular, social cognition (SC) is often missing from study designs. Hence, we aimed to evaluate a broad range of cognitive functions including SC in CD patients.

In the present study 20 idiopathic CD patients and 40 age-, gender-, and IQ-matched healthy controls (HCs) were assessed with tests for non-SC (verbal memory, psychomotor speed, and executive functions) as well as for SC (emotion recognition, Theory of Mind (ToM), and empathy).

CD patients scored on average significantly lower than HC on tests for non-SC, but did not show impairments on any of the tests for SC.

The current study showed impairments in non-SC in CD, but intact social cognitive functions. These results underline the importance of recognizing non-motor symptoms in idiopathic CD patients, but emphasize a focus on identifying strengths and weaknesses in cognitive functioning as these influence daily life activities.

Accumulating evidence from case-control and population studies suggests attention-deficit/hyperactivity disorder (ADHD) confers a 2- to 5-fold risk of all-cause dementia later in life. Here, we investigate vascular burden as a potential mediator of this relationship, because vascular integrity is well known to be compromised in ADHD (due to chronic obesity, diabetes, and hypertension) and is also a robust risk factor for neurodegeneration (due to reduced cerebral blood flow). We use brain white matter hyperintensities (WMH) as a measure of vascular burden.

Thirty-nine adults aged 48-81 years with clinical ADHD, and 37 matched controls, completed neuropsychological testing and 1.5 T structural neuroimaging. None had stroke. Cognitive tests were demographically-adjusted to Z scores using regression-based norms generated from the control group, and averaged across tests within domains of short- and long-term verbal memory (forward digit span, California Verbal Learning Test, Logical Memory), visual memory (Visual Recognition, Rey Complex Figure), processing speed (coding, trails A, Stroop word-reading and color-naming), language (Boston Naming Test, semantic fluency), visuoconstruction (clock drawing, Rey Complex Figure copy), and executive function (backward digit span, trails B, phonemic fluency, Stroop inhibition, Wisconsin Card Sorting Test). Total WMH volumes (i.e., combined periventricular and deep) within subcortical, temporal, frontal, parietal, and occipital regions were individually divided by regional volumes to produce a proportion of each region representing WMH, then log-transformed to correct for skew. Age-corrected linear regression quantified total effects of ADHD on cognition; when these were significant, mediation models quantified the direct effects of ADHD on WMH volumes and the direct effect of WMH volumes on cognition. Sobel’s test estimated indirect effects of ADHD on cognition via WMH.

Group had a significant total effect on Processing Speed (ß=-1.154, p<.001) and on Executive Functioning (ß=-0.587, p=.004), where ADHD participants had lower composite scores (M=-1.10, SD=1.76 and M=-0.54, SD=1.14 respectively) than controls (M=0.02, SD=0.74; M=0.00, SD=0.49). Only frontal-lobe WMH had direct effects on Processing Speed (ß=-0.315, p=.012) and Executive Functioning (ß=-0.273, p<.001). The direct effect of ADHD on frontal WMH was significant (ß=-0.734, p=.016), and Sobel’s tests supported an indirect effect of ADHD on Executive Functioning (z=2.079, p=.038) but not Processing Speed (z=1.785, p=.074) via WMH. Because the effect of ADHD on WMH was negative (i.e., fewer WMH in ADHD) despite worse cognition than controls, we tested the a posteriori hypothesis that WMH burden may be relatively more deleterious for ADHD than controls. We found considerably stronger negative correlations between total WMH volumes and Processing Speed (r=-.423, p=.009) and Executive Functioning (r=-.528, p<.001) in the ADHD group than in controls (r=-.231, p=.175 and r=-.162, p=.346, respectively), even though total whole-brain proportion of WMH (M=0.15%, SD=0.27; Mann-Whitney l/=430.0, p=.002) and frontal-lobe proportion of WMH volumes (M=0.33%, SD=0.51; Mann-Whitney U=464.0, p=.007) were lower in ADHD than in controls (M=0.29%, SD=0.42 and M=0.66%, SD=0.88, respectively).

WMH burden contributes significantly to the relationship between ADHD and cognition, but ADHD remains an independent contributor to worse processing speed and executive functioning in older adults. Vascular burden may have relatively more deleterious effects on cognition in ADHD, potentially due to decades of accumulated allostatic load, whereas healthy controls can accumulate greater amounts of WMH before cognition is impacted.

Executive function is known to decline in later life, largely attributed to structural and functional changes in the prefrontal cortex. However, other regions of the brain are integral to executive functioning, including the hippocampus. The hippocampus plays a large role in memory but its intricate connections to limbic regions including the prefrontal cortex likely underlies associations between the hippocampus and executive functions. Due to the hippocampus’ complex structure, hippocampal subregions may be differentially associated with executive function, but this possibility remains largely unexplored. Therefore, we examined the association between volume of the hippocampus and its subregions with executive function to understand these relationships across the adult lifespan.

The study included 32 healthy, community-dwelling participants (age range = 18-81, mean age = 51.06 ± 20.98, 91% white, 72% female) who received a 3-Tesla magnetic resonance imaging (MRI) scan and completed a cognitive battery. We calculated an executive composite based on Trail Making Test Part B and the interference score from the Stroop Color and Word Test. Freesurfer (version 5.3) as used to quantify total hippocampal volume and subfield volumes for CA1, CA2-3, CA4-dentate gyrus, subiculum, and presubiculum. We conducted mixed-effects regression analyses with total hippocampal and subfield volume, age group (young, middle-aged, and older), and their interaction predicting the executive function composite, controlling for total intracranial volume.

Larger hippocampal subregion volumes in CA1 (p = 0.03), the subiculum (p = 0.01), and the CA4-dentate gyrus (p = 0.04) predicted better executive function. Total hippocampal volume and the presubiculum were not significantly associated with the executive function composite. The age group interaction was not significant for any of the models. Follow-up analyses by hemisphere showed that the effects were right lateralized in CA1and CA4-dentate gyrus, and bilateral in the subiculum.

These data support the literature demonstrating the involvement of the hippocampus in executive function and demonstrates variation across hippocampal subfields. The lack of significant age interactions suggests these relationships may not differ across the lifespan, although this finding would need to be replicated in larger samples. These findings support previous literature showing CA4-dentate gyrus’ association with neurogenesis may facilitate better executive function by increasing connection strength among CA1, CA2-3, and the frontal cortex. This study contributes to our understanding of how specific hippocampal subregions relate to executive function, which has both clinical and research implications.

Neurobiological and cognitive theories implicate deficits in executive function (EF) as a core facet of both depressive disorders and attention-deficit/hyperactivity disorder (ADHD), but empirical investigations inconsistently support this conclusion. Despite recognition of the likely bi-directional relationship of EF deficits to depression and ADHD, respectively, the extent to which comorbid depression might impact EF in adults remains unclear, considering more of the literature has examined children and adolescents. This study examined performance differences on EF measures in clinically-referred adults diagnosed with ADHD or a non-ADHD primary psychopathological condition in the presence/absence of comorbid depression.

This cross-sectional study included data from 404 adults referred for neuropsychological evaluation at a Midwestern academic medical center. In total, 343 met DSM-5 diagnostic criteria for ADHD (ADHD-all group:164 Predominantly Inattentive presentation [ADHD-I] and 179 Combined presentation [ADHD-C]) and 61 met criteria for a non-ADHD primary psychopathological condition (psychopathology group: 31 mood disorder, 17 anxiety disorder, and 13 posttraumatic stress disorder) when assessed via semi-structured clinical interview. All patients completed the Beck Depression Inventory-Second Edition (BDI-II) and five EF tests: Letter Fluency, Trail Making Test-Part B (Trails-B), Stroop Color and Word Test Color-Word trial (SCWT CW); and WAIS-IV Working Memory Index (WMI). Oneway MANOVAs assessed for significant EF differences between groups with high (BDI-II greater than or equal to 20) or low (BDI-II less than or equal to 19) depressive symptoms.

When group diagnosis (ADHD-all vs. psychopathology) was examined in the context of high or low depression, a significant difference in EF performance emerged between groups, F(12, 1042.72)=2.44, p<.01, Wilk's A=.93, partial n2=.02, with univariate analyses indicating a significant difference in FAS-T between at least two of the groups (F(3, 397)=3.92 , p< .01, partial n2=.03). Tukey's HSD Test for multiple comparisons found that the mean value of FAS-T was significantly different between the ADHD-high depression and ADHD-low depression groups (p=.046 , 95% CI = [5.81, -.04]) as well as between the ADHD-low depression and psychopathology-high depression groups (p=.05, 95% CI = [-8.89, .00]). A one-way MANOVA examining differences between groups when distinguishing ADHD by subtype revealed a statistically significant difference in EF performance between groups, F(20, 1301)=1.85, p<.05, Wilk's A=.91, partial n2=.02, with univariate analyses indicating a statistically significant difference in FAS-T between at least two of the groups (F(5, 395) = 2.39 , p<.05, partial n2 = .03). However, Tukey's HSD Test for multiple comparisons found that the mean value of FAS-T was not significantly different between any of the groups.

Overall, results indicate that clinically-referred patients with ADHD perform comparably on tests of EF regardless of the presence or absence of comorbid depression. These findings have implications for conceptualizing EF weaknesses in neuropsychological profiles for individuals with ADHD and suggest examining factors beyond comorbid depression.

COVID-19 caused a worldwide restructuring of daily life, necessitating a sharp increase in social distancing, telecommunication, and adherence to rapidly changing public health recommendations. Coping, a response to stressors, is a protective mechanism to increase resiliency against uncertainty and decreased social connectedness. This disruption of daily life has prompted unanticipated and unique research opportunities and allowed researchers to consider whether individuals' primary coping style with the pandemic is associated with cognition. Previous research has found that problem coping, or action-oriented approaches to a stressor, is the most adaptive coping strategy. Emotion-based coping, like venting or humor, varies and depends on the stressor. Avoidant coping, like denial or ignoring the stressor, is generally considered maladaptive (Carver, 1977), which may lead to increased psychosocial disturbance. Executive functioning, responsible for planning, organizing, inhibition, and self-management are theorized to be most impacted by the social and psychological effects of COVID-19 (Pollizi et al., 2021). While some research has examined this question in working parent and older adult populations, we seek to understand this relationship in emerging adults, whose frontal lobes, responsible for executive functioning, are still developing. The present study seeks to examine the association between coping with the COVID-19 pandemic and executive functioning.

College students (N=440; M=19.30 years old, SD=1.42, 76% female) across seven US universities completed self-report questionnaires on SONA, which included Barkley's Deficits in Executive Functioning, Short Form (BDEFS-SF; Barkley, 2011) and the Brief Coping Orientation to Problems Experienced Inventory adapted for coping with the COVID-19 pandemic (Brief COPE; Carver 1989). Items on the BDEFS-SF were summed to create a global executive functioning score. Items on the Brief COPE were combined to create three factors: emotional,, avoidant,, and problem-focused (Dias et al., 2011).

Stepwise linear regression was used to assess whether coping style predicted executive functioning. Results indicate that the use of emotional coping (ß =0.19, p< .001) and avoidant coping (ß =0.33, p< .001) predicted higher scores on the BDEFS (greater deficits in executive functioning). Additionally, the use of problem coping (ß =-0.27, p< .001) predicted lower BDEFS scores (better executive functioning), with this overall model explaining 16.37% of the variance.

Results from this study confirm that COVID-19 coping styles are associated with decreased executive functioning. Specifically, emotional coping and avoidant coping predicted decreased executive functioning, which has been supported in non-pandemic samples. The use of problem-focused coping predicted increased executive functioning, indicating that this may be a protective form of coping with the pandemic. Because tasks necessary for daily life, such as planning, organizing, and judgment, rely on executive functioning, maladaptive coping with COVID-19 may impede college students' daily functioning necessary for successful engagement in schoolwork, emotion regulation, and activities of daily living. This research begins to address the gap in knowledge regarding the relationship between coping with the COVID-19 pandemic and executive functioning. This knowledge can be used in future crises in order to promote the use of problem-focused coping and mitigate the self-observed deficits in executive functioning demonstrated in this population.

Pediatric cancer and cancer-related treatments may disrupt brain development and place survivors at risk for long term problems with cognitive functions. Processing efficiency has been operationalized as a nuanced cognitive skill that reflects both processing speed (PS) and working memory (WM) abilities and is sensitive to neurobiological disruption. Pediatric cancer survivors are at risk for processing efficiency deficits; however, a thorough characterization of processing efficiency skills across pediatric primary central nervous system (CNS) tumor and non-CNS cancer survivors has not yet been reported.

Participants were selected from a mixed retrospective clinical database of pediatric cancer survivors (Total n=160; primary CNS tumor n=33; Non-CNS n=127). Univariate analyses were conducted to examine differences in processing efficiency mean scores (t-tests) and percent impairment (scores >1 SD below mean; chi-squared tests) between the total sample and normative sample, and across groups (CNS vs. Non-CNS). Multiple linear regressions were utilized to evaluate the relationships between additional risk factors, including biological sex, age at diagnosis, time since treatment, and socioeconomic status, and processing efficiency outcomes.

The total sample obtained lower scores on WM (M=90.83, SD=13.35) and PS (M=88.86, SD=14.38) measures than normative samples (M=100, SD=15), p < 0.001. Greater percentage of pediatric cancer survivors demonstrated impairment across all processing efficiency measures (24.8-38.1%) than normative samples (15.9%), p < 0.001. Regarding group differences, the CNS group obtained lower mean WM (M=84.85, SD =11.77) and PS (M=80, SD=14.18) scores than the Non-CNS group (WM M=92.39, SD=13.32; PS M=91.16, SD=13.56), p < 0.001. Rates of impairment between groups only differed for PS scores, with 63.6% of the CNS group and 31.5% of the non-CNS group demonstrating impairment, p < 0.001. Primary CNS tumor cancer type and male biological sex emerged as the only significant risk factors that predicted processing efficiency skills, with male sex predicting lower scores on PS (ß=8.91 p<.001) and semantic fluency (ß=7.59, p=.007).

These findings indicate that both pediatric primary CNS tumor and non-CNS cancer survivors exhibit substantial weaknesses in processing efficiency skills after treatment. While both groups demonstrated deficits compared to normative samples, the CNS group was more susceptible to PS impairments than non-CNS group. A basic initial study of the relationships between risk factors and processing efficiency skills revealed that primary CNS cancer was a predictor of lower performance on working memory and processing speed measures, while male biological sex was a significant risk factor for worse performance on processing speed and semantic fluency measures. Continued focus on the construct of processing efficiency in pediatric cancer survivors is warranted. Applying a standardized approach to assessing and communicating this nuanced cognitive skill could contribute to advancing both clinical practice and outcomes research of pediatric cancer survivors.