Association Between Occupational Exposure to Formaldehyde and Cognitive Impairment

Objective:To our knowledge, no study has investigated the effect of exposure to formaldehyde on cognition in the general population. Our objective was to examine the association between occupational exposure to formaldehyde and cognitive impairment in middle-aged and young- old adults (≥45 years).Methods:In the French CONSTANCES cohort, cognitive function was assessed with a standardized battery of seven cognitive tests to evaluate global cognitive function, episodic verbal memory, language abilities and executive functions (e.g., Digit Symbol Substitution Test, DSST). A global cognitive score was created using principal component analysis. Cognitive impairment was assessed in reference to norms of neuropsychological battery according to age, sex and education. Lifetime exposure to formaldehyde was assessed using a French job-exposure matrix created in the framework of the Matgéné project. After performing multiple imputation, separate modified Poisson regression models were used to evaluate the association between cognitive impairment (<25th percentile) and formaldehyde exposure (exposed/never exposed), exposure duration, cumulative exposure index (CEI), and combination of CEI and time of last exposure.Results:Among 75 322 participants (median age: 57.5 years, women: 53%), 8% were exposed to formaldehyde during their professional life. These participants were at higher risk of global cognitive impairment (for global cognitive score: adjusted relative risk, aRR, 1.17, 95% confidence interval, CI: 1.11-1.23), after adjusting for confounders (age, sex, education, income, solvent exposure, Effort–Reward Imbalance, night-shift, repetitive, and noisy work). They were at higher risk of cognitive impairment for all cognitive domains explored. Longer exposure duration and high CEI were associated with cognitive impairment, with a dose-effect relationship for exposure duration. Recent exposure was associated with impairment in all cognitive domains. Time did not fully attenuate formaldehyde-associated cognitive deficits especially in highly exposed individuals (for DSST: high past exposure aRR 1.23, 95%CI: 1.11-1.36; high recent exposure: aRR 1.24, 95%CI: 1.13-1.35).Conclusion:Our findings highlight the long-term detrimental effect of formaldehyde exposure on cognitive health in a relatively young population.

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An Evaluation of DNA Methyltransferase 1 (DNMT1) Single Nucleotide Polymorphisms and Chemotherapy-Associated Cognitive Impairment: A Prospective, Longitudinal Study

Scientific Reports ◽

10.1038/s41598-019-51203-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Alexandre Chan ◽

Angie Yeo ◽

Maung Shwe ◽

Chia Jie Tan ◽

Koon Mian Foo ◽

...

Keyword(s):

Breast Cancer ◽

Cognitive Impairment ◽

Cognitive Function ◽

Cancer Patients ◽

Dna Methyltransferase ◽

Dna Methyltransferases ◽

Breast Cancer Patients ◽

Prospective Longitudinal Study ◽

Cognitive Domains ◽

Prospective Longitudinal

Abstract Strong evidence suggests that genetic variations in DNA methyltransferases (DNMTs) may alter the downstream expression and DNA methylation patterns of neuronal genes and influence cognition. This study investigates the association between a DNMT1 polymorphism, rs2162560, and chemotherapy-associated cognitive impairment (CACI) in a cohort of breast cancer patients. This is a prospective, longitudinal cohort study. From 2011 to 2017, 351 early-stage breast cancer patients receiving chemotherapy were assessed at baseline, the midpoint, and the end of chemotherapy. DNA was extracted from whole blood, and genotyping was performed using Sanger sequencing. Patients’ self-perceived cognitive function and cognitive performance were assessed at three different time points using FACT-Cog (v.3) and a neuropsychological battery, respectively. The association between DNMT1 rs2162560 and cognitive function was evaluated using logistic regression analyses. Overall, 33.3% of the patients reported impairment relative to baseline in one or more cognitive domains. Cognitive impairment was observed in various objective cognitive domains, with incidences ranging from 7.2% to 36.9%. The DNMT1 rs2162560 A allele was observed in 21.8% of patients and this was associated with lower odds of self-reported cognitive decline in the concentration (OR = 0.45, 95% CI: 0.25–0.82, P = 0.01) and functional interference (OR = 0.48, 95% CI: 0.24–0.95, P = 0.03) domains. No significant association was observed between DNMT1 rs2162560 and objective cognitive impairment. This is the first study to show a significant association between the DNMT1 rs2162560 polymorphism and CACI. Our data suggest that epigenetic processes could contribute to CACI, and further studies are needed to validate these findings.

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Is Social Network a Protective Factor for Cognitive Impairment in US Chinese Older Adults? Findings from the PINE Study

Gerontology ◽

10.1159/000485616 ◽

2017 ◽

Vol 64 (3) ◽

pp. 246-256 ◽

Cited By ~ 8

Author(s):

Mengting Li ◽

Xinqi Dong

Keyword(s):

Older Adults ◽

Working Memory ◽

Cognitive Impairment ◽

Social Network ◽

Cognitive Function ◽

Protective Factor ◽

Network Size ◽

Chinese Older Adults ◽

Cognitive Domains ◽

Global Cognition

Background: Social network has been identified as a protective factor for cognitive impairment. However, the relationship between social network and global and subdomains of cognitive function remains unclear. Objective: This study aims to provide an analytic framework to examine quantity, composition, and quality of social network and investigate the association between social network, global cognition, and cognitive domains among US Chinese older adults. Methods: Data were derived from the Population Study of Chinese Elderly (PINE), a community-engaged, population-based epidemiological study of US Chinese older adults aged 60 and above in the greater Chicago area, with a sample size of 3,157. Social network was assessed by network size, volume of contact, proportion kin, proportion female, proportion co-resident, and emotional closeness. Cognitive function was evaluated by global cognition, episodic memory, executive function, working memory, and Chinese Mini-Mental State Examination (C-MMSE). Linear regression and quantile regression were performed. Results: Every 1-point increase in network size (b = 0.048, p < 0.001) and volume of contact (b = 0.049, p < 0.01) and every 1-point decrease in proportion kin (b = -0.240, p < 0.01) and proportion co-resident (b = -0.099, p < 0.05) were associated with higher level of global cognition. Similar trends were observed in specific cognitive domains, including episodic memory, working memory, executive function, and C-MMSE. However, emotional closeness was only significantly associated with C-MMSE (b = 0.076, p < 0.01). Social network has differential effects on female versus male older adults. Conclusion: This study found that social network dimensions have different relationships with global and domains of cognitive function. Quantitative and structural aspects of social network were essential to maintain an optimal level of cognitive function. Qualitative aspects of social network were protective factors for C-MMSE. It is necessary for public health practitioners to consider interventions that enhance different aspects of older adults' social network.

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Aerobic fitness and multidomain cognitive function in advanced age

International Psychogeriatrics ◽

10.1017/s1041610210000797 ◽

2010 ◽

Vol 23 (1) ◽

pp. 114-124 ◽

Cited By ~ 32

Author(s):

Yael Netz ◽

Tzvi Dwolatzky ◽

Yael Zinker ◽

Esther Argov ◽

Ruth Agmon

Keyword(s):

Cognitive Function ◽

Physical Fitness ◽

Controlled Trial ◽

Cardiovascular Fitness ◽

Advanced Age ◽

Neuropsychological Battery ◽

Cognitive Score ◽

Cognitive Domains ◽

And Function ◽

The Relationship

ABSTRACTBackground: Studies generally describe the relationship between physical fitness and cognitive function by measuring only one or two specific cognitive tasks. In addition, in spite of the significant increase in life expectancy, the age of participants in these studies does not extend beyond a mean age of 70 years. This study was thus designed to examine the relationship between physical fitness and function in multiple cognitive domains in subjects older than those previously reported.Methods: Thirty-eight individuals, aged 65.3 to 85.3 years, performed a graded, progressive, maximal exercise test. Based on a median score of peak VO2, participants were divided into low-fitness and moderately-fit groups. Cognitive function was assessed by means of a computerized neuropsychological battery.Results: The moderately-fit group achieved significantly better scores on the global cognitive score (U = 97, p = 0.04), and a significant correlation was found between peak VO2 and attention, executive function, and global cognitive score (rs = .37, .39, .38 respectively). The trend for superior cognitive scores in the moderate-fitness compared to the low-fitness groups was unequivocal, both in terms of accuracy and reaction time.Conclusion: Maintenance of higher levels of cardiovascular fitness may help protect against cognitive deterioration, even at an advanced age. An adequately powered randomized controlled trial should be performed to further evaluate this hypothesis.

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Does Acute Exercise Stress Affect Postural Stability and Cognitive Function in Subjects with Chronic Ankle Instability?

Brain Sciences ◽

10.3390/brainsci11060788 ◽

2021 ◽

Vol 11 (6) ◽

pp. 788

Author(s):

Miriam Peri ◽

Uri Gottlieb ◽

Aharon S. Finestone ◽

Shmuel Springer

Keyword(s):

Information Processing ◽

Cognitive Function ◽

Postural Control ◽

Postural Stability ◽

Acute Exercise ◽

Spatial Perception ◽

Ankle Instability ◽

Cognitive Score ◽

Cognitive Domains ◽

Visual Spatial

Altered postural control in people with chronic ankle instability (CAI) may be attributed to deficits that are associated with neurocognitive function. Acute training is another factor that may negatively affect postural control and increase the risk of ankle sprain. The purpose of this investigation was to determine the effect of acute exercise on postural stability and cognitive function among patients with CAI. Fifteen patients with CAI (aged 21.5 ± 2.0 years) and 15 healthy controls (aged 20.3 ± 1.7 years) completed a single-limb stance postural control test and a battery of computer-based cognitive tests before and after acute exercise. The overall stability index (OSI) was used as a measure of postural stability. The cognitive domains tested were global cognitive score, executive function, attention, visual-spatial perception, information processing, and fine motor control. Subjects in both groups had similar OSI scores, with a trend for reduced stability in the CAI after the exercise protocol (p = 0.053). There were no differences between the groups in all cognitive domains before or after exercise. Following exercise, the domains of overall cognitive score, visual-spatial perception, and information processing speed improved in both groups (p = 0.003, p = 0.033, p = 0.001; respectively). These findings should be considered with caution due to the heterogeneity of the CAI population.

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The association of Lewy bodies with limbic-predominant age-related TDP-43 encephalopathy neuropathologic changes and their role in cognition and Alzheimer’s dementia in older persons

Acta Neuropathologica Communications ◽

10.1186/s40478-021-01260-0 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Sonal Agrawal ◽

Lei Yu ◽

Sukriti Nag ◽

Konstantinos Arfanakis ◽

Lisa L. Barnes ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Older Persons ◽

Lewy Bodies ◽

Alzheimer’S Dementia ◽

Community Dwelling ◽

Alzheimer's Dementia ◽

Cognitive Domains ◽

Age Related ◽

Global Cognition

AbstractLewy bodies (LBs) and limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) are common in older persons and associated with cognitive impairment. However, little is known about the relationship between LBs and LATE-NC and their combined roles in cognitive impairment and Alzheimer’s dementia in community-dwelling participants. The study included 1670 community-based participants (mean age-at-death, 89.5 years (SD = 6.65); 69% females) who underwent annual assessments of cognition to create summary measures of global cognition and cognitive domains and evaluation for Alzheimer’s dementia. Systematic neuropathologic evaluations were performed to assess LBs, LATE-NC, and Alzheimer’s disease (AD) pathology. We excluded cases with pathologically confirmed frontotemporal lobar degeneration in this study. Logistic and linear regression analyses were used, adjusted for demographics and AD pathology. LBs were present in 428 (25.6%) decedents (29 nigra-predominant, 165 limbic-type, and 234 neocortical-type) while 865 (51.7%) decedents exhibited LATE-NC (307 stage 1, 167 stage 2, and 391 stage 3). LBs combined with LATE-NC were common (15% of all participants) and in those with Alzheimer’s dementia (25%). Neocortical-type, but not nigral-predominant or limbic-type LBs increased the odds of stage 2/3 LATE-NC (odds ratio = 1.70; 95% confidence interval = 1.26–2.30). The association between neocortical-type LBs and stage 2/3 LATE-NC was stronger in those under 90 years of age and in women. In analyses of cognition and Alzheimer’s dementia, LATE-NC and neocortical-type LBs, separately, were related to lower global cognition, five specific cognitive domains, and an increased odds of Alzheimer’s dementia, above and beyond the AD pathology. Limbic-type LBs were related to lower global cognition, and the domains of episodic, working, and semantic memory, and increased odds of Alzheimer’s dementia. Furthermore, there was no interaction between limbic/neocortical-type LBs and LATE-NC on cognitive function, cognitive domains, or Alzheimer’s dementia. These findings suggest that neocortical-type LBs are associated with LATE-NC, specifically in the younger old and in women. Limbic/neocortical-type LBs and LATE-NC have separate and additive effects on cognitive function and odds of Alzheimer’s dementia.

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Protective Lifestyle Factors and Cognitive Function in a Middle- to Older-Aged Population: A Cross-Sectional Analysis

Proceedings of The Nutrition Society ◽

10.1017/s0029665120000221 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Laxmi Gautam ◽

Sean Millar ◽

Ivan J. Perry ◽

Janas Harrington

Keyword(s):

Logistic Regression ◽

Cognitive Impairment ◽

Cognitive Function ◽

Cognitive Decline ◽

Inverse Association ◽

Cross Sectional ◽

Cognitive Score ◽

Lifestyle Behaviours ◽

Cross Sectional Analysis ◽

Sectional Analysis

AbstractBackground and ObjectivesCognitive impairment among the elderly is an important concern worldwide. Evidence suggests that certain lifestyle behaviours may have a protective effect against cognitive decline. In this study we examined the relationship between a 5-component protective lifestyle behaviour score and cognitive function to determine whether the number of protective lifestyle behaviours is related to cognitive decline.Materials and MethodsThis was a cross-sectional analysis of the Mitchelstown Cohort Rescreen study, a random sample of men and women aged 51–77 years recruited from a single primary care centre. Cognitive function was assessed using the Mini Mental State Exam (MMSE) and cognitive data were available for 1,022 participants. Cognitive impairment was classified as an upper 75th percentile reversed MMSE score value for the study sample. We defined 5 low-risk protective lifestyle behaviours as never smoking, moderate alcohol intake, moderate to vigorous physical activity, a high-quality diet score (upper 40%) and a body mass index between 18.5 to 24.9 kg/m2. Linear and logistic regression analyses were used to test associations between a protective factor score and the MMSE.ResultsThere was a linear relationship between the number of protective lifestyle behaviours and mean cognitive score values and a significant inverse association was observed between a protective lifestyle score and the MMSE cognitive score (β = -0.20, 95% CI: -0.30, -0.10). Logistic regression suggested a dose-response relationship, with odds ratios of having poorer cognitive functioning being noticeably increased in subjects with 0 or 1 PLBs (OR = 2.18, 95% CI: 1.06, 4.52) when compared to participants with 4 or 5 PLBs in multivariable analysis.ConclusionsThese data imply that a combination of healthy lifestyle behaviours protects against cognitive impairment. As all of the examined factors are modifiable, small behavioural changes may help in preventing cognitive decline in an elderly population.

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A study on the characteristics of cognitive function in patients with multiple system atrophy in China

Scientific Reports ◽

10.1038/s41598-021-84393-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Nannan Li ◽

Tianwen Yang ◽

Weizheng Ran ◽

Xinning Zhang ◽

Yao Wang ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Executive Functions ◽

Multiple System Atrophy ◽

Cognitive Assessment ◽

Case Control Study ◽

Nonmotor Symptoms ◽

Clinical Trial Registry ◽

Cognitive Domains ◽

Control Study

AbstractNonmotor symptoms in patients with multiple system atrophy (MSA) have received an increasing amount of attention in recent years, but no research on MSA patients' cognitive characteristics has been conducted in China. To evaluate the cognitive function of MSA patients in China. Using a case–control study design, 256 MSA patients and 64 controls were evaluated by the Montreal cognitive assessment (MoCA) scale to characterize their cognitive function. Like the controls, 60.5% of the patients with MSA had cognitive impairment, but the characteristics of cognitive impairment between the two groups were different. The cognitive impairment in MSA patients was prominent in the cognitive domains of visuospatial/executive functions, naming, attention, and orientation; particularly, the visuospatial/executive functions were the most significantly impaired, while impairment in language function was mainly seen in the controls. Besides, impairments in visuospatial/executive functions, attention, language, and orientation were more prominent in MSA-P (MSA with predominant Parkinsonism) patients than in MSA-C (MSA with predominant cerebellar ataxia). The cognitive impairments were more severe in patients with probable MSA than in patients with possible MSA. In addition, the results showed that the level of cognitive function was negatively correlated with the severity of MSA. This study, which characterized the cognitive function of MSA patients with the largest sample size known so far in China, found that patients with MSA do have cognitive impairment and display specific characteristics. Therefore, the cognitive impairment of MSA should be paid more attention.The study has been registered in the Chinese Clinical Trial Registry (ChiCTR) (Registration No: ChiCTR1900022462).

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Sarcopenia is Associated Cognitive Impairment Mainly Due to Slow Gait Speed: Results from the Korean Frailty and Aging Cohort Study (KFACS)

10.20944/preprints201904.0240.v1 ◽

2019 ◽

Author(s):

Miji Kim ◽

Chang Won Won

Keyword(s):

Cohort Study ◽

Cognitive Impairment ◽

Cognitive Function ◽

Gait Speed ◽

Final Analysis ◽

Community Dwelling ◽

Disease Assessment ◽

Cross Sectional ◽

Cognitive Domains ◽

Sectional Analysis

Cognitive impairment and sarcopenia may share common risk factors and pathophysiological pathways. This study was performed to examine the association between impairments in specific cognitive domains and sarcopenia (and its defining components) in a large group of community-dwelling older adults. Cross-sectional analysis was performed on the baseline data of 3,014 adults aged 70–84 years enrolled in the Korean Frailty and Aging Cohort Study (KFACS). The final analysis included 1,887 adults underwent dual-energy X-ray absorptiometry and cognitive function assessments. Those with disability in activities of daily living, dementia, severe cognitive impairment, Parkinson’s disease, musculoskeletal complaints, neurological disorders, or who were illiterate were excluded. Cognitive function was assessed using the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet, the Frontal Assessment Battery. For sarcopenia, we used the diagnostic criteria of the Asian Working Group for Sarcopenia. The prevalence of sarcopenia was 9.6% for men and 7.6% for women. Sarcopenia (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.04–2.99) and slow gait speed (OR 2.58, 95% CI 1.34–4.99) were associated with cognitive impairment in men. Only slow gait speed (OR 1.88, 95% CI 1.05–3.36) was associated with cognitive impairment in women. Sarcopenia is associated with cognitive impairment mainly due to slow gait speed. Our results suggested that cognitive impairment domains, such as processing speed and executive function, are associated with sarcopenia-related slow gait speed.

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Cerebral Microbleeds and Cognitive Function in Ischemic Stroke or Transient Ischemic Attack Patients

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000379744 ◽

2015 ◽

Vol 40 (3-4) ◽

pp. 130-136 ◽

Cited By ~ 12

Author(s):

Zhaolu Wang ◽

Adrian Wong ◽

Wenyan Liu ◽

Jie Yang ◽

Winnie C.W. Chu ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Cognitive Function ◽

Transient Ischemic Attack ◽

Cerebral Microbleeds ◽

Cognitive Domains ◽

Deep Region ◽

Ischemic Attack ◽

The Impact

Background: We explored the association between cerebral microbleeds (CMBs) and cognitive impairment in patients with ischemic stroke/transient ischemic attack (TIA). Methods: A total of 488 ischemic stroke/TIA patients received magnetic resonance imaging. Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive function and cognitive domains. The association of CMB quantity with cognitive function and the impact of CMB locations (strictly lobar, strictly deep, and mixed regions) on cognitive impairment were examined in regression models with adjustments for confounders. Results: A total of 113 subjects (23.2%) had ≥1 CMB. Strictly lobar, strictly deep, and mixed CMBs were identified in 36, 40, and 37 patients, respectively. The presence of ≥5 CMBs or strictly deep CMBs was associated with the MoCA total score (p = 0.007 and 0.020, respectively). Of all MoCA domains tested, a lower score in the attention domain was related to the presence of ≥5 CMBs (p = 0.014) and strictly deep CMBs (p = 0.028). Conclusion: CMBs were associated with cognitive dysfunction in stroke/TIA patients, especially in the attention domain. This association was mainly driven by CMBs in the deep region, underlining the role of hypertensive microangiopathy in stroke-related cognitive impairment.

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Cognitive Impairment in Tramadol & Synthetic Cannabinoids Use Disorder Patients

QJM ◽

10.1093/qjmed/hcab102.006 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Yasser Abdelrazik Mohamed ◽

Hanan Hany Elrassas ◽

Zeinab Mohamed Ahmed ◽

Aya Taha Mohamed

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Personality Disorder ◽

Personality Disorders ◽

Visual Memory ◽

Borderline Personality ◽

Synthetic Cannabinoid ◽

Trail Making Test ◽

Cognitive Domains ◽

Trail Making

Abstract Background Studies have suggested that Patients with polysubstance abuse (n = 76) and tramadol alone abuse (n = 24) were more likely to have cognitive impairment (CI) (81% and 66.7%, respectively) than the control subjects (28%) as reflected by the total Montreal cognitive assessment (MoCA) scores. All cognitive domains were significantly impaired among tramadol-abuse patients, whereas tramadol-alone patients had significant impairment in all cognitive domains except attention, visuoconstructional (cube), and trail-making test. The most affected cognitive domains were memory, visuospatial skills, and verbal fluency. Reliable estimates of tramadol and synthetic cannabinoids addiction prevalence are important to prevent, treat, and identify causes of addiction, especially in light of recent work revealing a high prevalence of cognitive impairment among drug abusers. Aim of the Work to assess the cognitive function among tramadol & synthetic cannabinoid use disorder patients in addiction clinic of Ain shams university hospitals, as well as comparing the cognitive function between them and healthy adults. Patients and Methods This is a Cross sectional case-control observational study conducted in Ain Shams University hospitals. This present study aimed at analyzing the data of 30 tramadol dependent, 30 synthetic cannabinoid dependent patients & 30 healthy controls, diagnosed by DSM-4 and then they will undergo SCIDI (to exclude any psychiatric comorbidity), SCIDII (for personality disorders), addiction severity index, Wechsler memory scale (for different memory functions), trail making test (for visual attention and task switching) and Benton visual retention test (for visual perception and visual memory), over a period from October 2018 to August 2019. Results A total of 30 tramadol dependent patients, 14 (46.67) were diagnosed as major depressive disorder, 14 (46.67%) as antisocial personality disorder, 23 (76.67) as borderline personality disorder. 26 (86.67 %) patients showed impairment in Benton visual test, 10 (33.33%) patients showed impairment in trail making test. 29 (96.69%) out of 30 patients showed impairment in verbal paired association I & II and visual memory span scales, 30 (100%) out of 30 patients showed impairment in visual paired association I&II and digit span scales. A total 30 synthetic cannabinoid patients, 9 (30%) were diagnosed as psychotic disorder, 7 (23.33%) as bipolar disorder, 1 (3.33%) as major depressive disorder, 19 (63.33%) as antisocial personality disorder, 27 (90%) as borderline personality disorder. 29 (96.67%) patients showed impairment in Benton visual test, 22 (73.33%) patients showed impairment in trail making test. 30 (100%) out of 30 patients showed impairment in visual paired association I&II, verbal paired association I&II, visual memory span and digit span. Conclusion This study provides observation of impaired cognitive function in chronic tramadol and SC users. Tramadol and SC users have shown impairments in visual, auditory, working, immediate, delayed memory and task shifting, as well as an elevation of comorbid psychiatric and personality disorders as psychotic, bipolar and depressive disorders. Also, there was comorbid antisocial and borderline personality disorders. Further research is required to examine the effects of acute and chronic SC consumption on cognitive function with comprehensive explorations of demographic background and objective measurements of substance use.

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