Anxiety severity and cognitive function in primary care patients with anxiety disorder: a cross-sectional study

Background Deficits in cognitive performance are reported in patients with anxiety disorders, but research is limited and inconsistent. We aimed to investigate cross-sectional associations between cognitive function, with focus on executive function, and anxiety severity in primary care patients diagnosed with anxiety disorders. Methods 189 Swedish patients aged 18–65 years (31% men) with anxiety disorders diagnosed according to Mini International Neuropsychiatric Interview were included. Severity of anxiety was assessed using Beck Anxiety Inventory self-assessment scale. Digit span, block design and matrix reasoning tests from the Wechsler Adult Intelligence Scale IV, and the design fluency test from the Delis-Kaplan Executive Function System were used. Multivariable linear regression models were applied to investigate the relationship of anxiety severity and cognitive functioning. Comparisons were also performed to a normed non-clinical population, using the Wilcoxon signed rank test. Results More severe anxiety was associated with lower digit span test scores (R2 = 0.109, B = -0.040, p = 0.018), but not with block design, matrix reasoning or design fluency tests scores, after adjustment for comorbid major depression in a multivariable model. When compared to a normed population, patients with anxiety performed significantly lower on the block design, digit span forward, digit span sequencing and matrix reasoning tests. Conclusions Severity of anxiety among patients with anxiety disorder was associated with executive functions related to working memory, independently of comorbid major depression, but not with lower fluid intelligence. A further understanding of the executive behavioral control in patients with anxiety could allow for more tailored treatment strategies including medication, therapy and interventions targeted to improve specific cognitive domains.

Design and Verbal Fluency in Alzheimer’s Disease and Frontotemporal Dementia: Clinical and Metabolic Correlates

Objective: Cognitive processes underlying verbal and design fluency, and their neural correlates in patients with Alzheimer’s disease (AD) and behavioural variant Frontotemporal Dementia (bvFTD) remain unclear. We hypothesised that verbal and design fluency may be associated with distinct neuropsychological processes in AD and FTD, showing different patterns of impairment and neural basis. Methods: We enrolled 142 participants including patients with AD (n = 80, mean age = 74.71), bvFTD (n = 34, mean age = 68.18), and healthy controls (HCs) (n = 28, mean age = 71.14), that underwent cognitive assessment and 18F-fluorodeoxyglucose positron emission tomography imaging. Results: Semantic and phonemic fluency showed the largest effect sizes between groups, showing lower scores in bvFTD than AD and HCs, and lower scores in AD than HC. Both AD and bvFTD showed a lower number of unique designs in design fluency in comparison to HC. Semantic fluency was correlated with left frontotemporal lobe in AD, and with left frontal, caudate, and thalamus in bvFTD. Percentage of unique designs in design fluency was associated with the metabolism of the bilateral fronto-temporo-parietal cortex in AD, and the bilateral frontal cortex with right predominance in bvFTD. Repetitions in AD were correlated with bilateral frontal, temporal, and parietal lobes, and with left prefrontal cortex in bvFTD. Conclusions: Our findings demonstrate differential underlying cognitive processes in verbal and design fluency in AD and bvFTD. While memory and executive functioning associated with fronto-temporo-parietal regions were key in AD, attention and executive functions correlated with the frontal cortex and played a more significant role in bvFTD during fluency tasks.

A-126 One Versus Two or More Head Injuries: A Comparison of Cognitive Performance and Emotional Correlates

Objective The current study compares performance on measures of executive functioning in individuals with a history of 2 or more mTBI versus those with a single documented mTBI. Specific interaction with emotional distress was explored. Method A database from neuropsychological assessment of individuals noting deficits following head injury including 273 individuals provided a sample of 174 males, 98 females (one case missing data); mean age = 21.82 years; mean education = 10.16 years. Executive functioning was measured using the Trails Making Test Form B (TMT-B), Delis-Kaplan Executive Function System (DKEFS) Design Fluency, and Semantic Fluency instruments. Emotional distress was assessed using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Results MANCOVA was employed to determine the effect of multiple head injuries versus one upon cognitive performance after controlling for depression and anxiety. Group differences between those with one versus 2 or more mTBI were present (Wilk’s η = 0.907, F (3, 125) = 4.256, p = 007, Partial η2 = 0.093). Significant differences were not noted with regard to emotional distress (BAI, p = 0.97 l BDI, p = 0.87). Between subject effects identified significant differences between groups in performance on DKEFS Design Fluency (p = 0.05) and Semantic Fluency (P = 0.04), while significant groups differences were not evident Trailmaking Test B performance (P = 0.20). Conclusion Overall, those who had previous concussions performed better on measures of executive functioning. Measures of emotional functioning were not a significant covariate of cognitive performance. Implications and limitations of the current study will be discussed.

Executive Functions of Swedish Counterterror Intervention Unit Applicants and Police Officer Trainees Evaluated With Design Fluency Test

Executive functions (EF) represent higher order top-down mechanisms regulating information processing. While suboptimal EF have been studied in various patient groups, their impact on successful behavior is still not well described. Previously, it has been suggested that design fluency (DF)—a test including several simultaneous EF components mainly related to fluency, cognitive flexibility, and creativity—predicts successful behavior in a quickly changing environment where fast and dynamic adaptions are required, such as ball sports. We hypothesized that similar behaviors are of importance in the selection process of elite police force applicants. To test this hypothesis, we compared elite police force applicants (n = 45) with a control group of police officer trainees (n = 30). Although both groups were better than the norm, the elite police force applicants had a significantly better performance in DF total correct when adjusting for sex and age [F(1,71) = 18.98, p < 0.001]. To understand how this capacity was altered by stress and tiredness, we re-tested the elite police force applicants several days during an extreme field assessment lasting 10 days. The results suggested that there was a lower than expected improvement in DF total correct and a decline in the DF3-subtest that includes a larger component of cognitive flexibility than the other subtests (DF1 and DF2). Although there was a positive correlation between the baseline session and the re-test in DF3 [r(40) = 0.49, p = 0.001], the applicants having the highest scores in the baseline test also displayed the largest percentage decline in the re-test [r(40) = −0.46, p = 0.003]. In conclusion, our result suggests that higher order EF (HEF) that include cognitive flexibility and creativity are of importance in the application for becoming an elite police officer but relatively compromised in a stressful situation. Moreover, as the decline is different between the individuals, the results suggest that applicants should be tested during baseline conditions and during stressful conditions to describe their cognitive capacity fully.

The design fluency test: a reliable and valid instrument for the assessment of game intelligence?

The design fluency test (DFT) has been reported to predict successful sports performance of soccer players and has therefore been in the spotlight of sport psychology research. There is, however, a lack of research regarding the psychometric properties of the DFT in elite sports. Thus, the aim of this research was to provide findings of test–retest reliability, practice effects and the diagnostic power of the DFT. Multiple studies of youth and adult elite athletes, as well as nonathlete students, were conducted in applied settings. Test–retest relationship demonstrated poor to acceptable short-term and long-term correlations. Furthermore, significant changes between test and retest were obtained in some variables that differed among samples. The differential value of the DFT was corroborated by significant differences between adolescent students and adolescent elite soccer players. Regarding the prospective value, significant partial correlation coefficients were found between DFT scores and volleyball performance in adult elite players. Although our research partially confirmed previous findings on the differential and prospective power of the DFT, the findings on test–retest reliability indicate that the DFT cannot be recommended for application in sports. The psychometric properties—in particular the findings on test–retest reliability—of the DFT have to be improved before research can be carried out on the application for the selection of team sport athletes and for the prediction of future success in team sports. Further research is needed to develop a scientific instrument for the assessment of game intelligence.

Relación entre las funciones ejecutivas y el nivel de actividad física en estudiantes de la ESO y Bachillerato

Centrándonos en estudiantes con edades comprendidas entre 12 y 17 años de edad, el objetivo de este trabajo fue conocer la relación entre el nivel de actividad física y las funciones ejecutivas (flexibilidad cognitiva e inhibición); así como las diferencias en función del género, edad y tipo de deporte practicado. La muestra de la investigación estuvo compuesta por 71 estudiantes (28 chicos y 43 chicas). El nivel de actividad física fue evaluado mediante el Physician-based Assessment and Counseling for Exercise, la flexibilidad cognitiva a través del Design Fluency Test, y para los mecanismos inhibitorios se utilizó el Test Stroop. Los resultados de este trabajo mostraron que existe una relación positiva y significativa entre las horas de actividad física y la flexibilidad cognitiva en adolescentes. En función del género, los chicos obtuvieron valores significativamente más altos de horas de actividad física. Además, los estudiantes de mayor edad presentaron unas puntuaciones significativamente mayores en las funciones ejecutivas. Finalmente, los estudiantes de deportes colectivos muestran valores significativamente mayores de horas de práctica de actividad física y de flexibilidad cognitiva.

Correlation between executive function and quantitative EEG in patients with anxiety by the Research Domain Criteria (RDoC) framework

The Research Domain Criteria (RDoC) project was proposed by the National Institute of Mental Health in 2010 to create a new diagnostic system including symptoms and data from genetics, neuroscience, physiology, and self-reports. The purpose of this study was to determine the link between anxiety and executive functions through quantitative electroencephalography (qEEG) based on the RDoC system. Nineteen-channel EEGs were recorded at the psychiatric clinic from 41 patients with symptoms of anxiety. The EEG power spectra were analysed. The Executive Intelligence Test (EXIT) including the K-WAIS-IV, Stroop, controlled oral word association, and the design fluency tests were performed. A partial, inversed, and significant association was observed between executive intelligence quotient (EIQ) and the absolute delta power in the central region. Similarly, a partial, inversed, and significant association was observed between design fluency and the absolute delta power in the left parietal area. Our findings suggest that the increase in delta power in the central region and left P3 was negatively correlated with the decrease in executive function. It is expected that the absolute delta power plays a specific role in the task-negative default mode network in the relationship between anxiety and executive function.

Children with deficit in executive abilities have risk for emerging weakness in grammar understanding

Background Children with specific language impairment have difficulties producing and understanding language (Bishop, 1997). Specifically, these children have deficit in grammar understanding. The goal of this research was to examine the hypothesis that children at the age of 5-6 with deficit in executive abilities have a risk for emerging weakness in grammar understanding at the age of 8-9. Methods 136 children at the age of 5-6 were assessed using 5 subtests from NEPSY (Tower, Auditory Attention and Response Set, Visual Attention, Statue, Design Fluency), which are designed to assess executive abilities in children. We have revealed 27 children with deficit in executive abilities. These children were included in the experimental group. The control group included 27 children with no deficit in executive abilities. In the framework of longitudinal research children at the age of 8-9 from both groups were assessed by Grammar Understanding Test from Luria's neuropsychological assessment technique. Results One-way ANOVA has revealed significant differences (p<.05) between groups for scores in Grammar Understanding Test. Children from experimental group had low level of grammar understanding. Conclusions This research has shown that deficit in executive abilities can predict the delay in development of grammar understanding in children. These results provided insight into cognitive mechanisms in typically developing and the underlying nature of specific language impairments, helping to elucidate the nature of impaired mechanism in this disorder. It can be assumed that deficit in executive abilities is one of the risk factors for emerging weakness in grammar understanding in children. Key messages Deficit in executive abilities is one of the risk factors for emerging weakness in grammar understanding in children. There is relationship between grammar understanding and executive abilities in children.