Understanding the interrelationships of type-2 diabetes and hypertension with brain and cognitive health: a UK Biobank study

Aims/hypothesis: Diabetes and hypertension are associated with poorer cognitive and brain health. Less is known about comorbid diabetes and hypertension and: cognitive and brain health in mid-life. We hypothesised that individuals with both diabetes and hypertension have worse cognitive and brain health. Methods: Data from the UK Biobank, a population-based study which recruited 500,000 individuals, aged 40-69 years. Type-2 diabetes was assigned using self-report, HbA1c and clinical data, while hypertension was defined based on self-report. Our outcomes included a breadth of brain structural magnetic resonance imaging (MRI) parameters and cognitive function tests in a maximum of 38918 individuals. We tested associations between comorbid diabetes/hypertension (reference category, n=1283) and our outcomes by comparing this group with those with only diabetes (n=760), hypertension (n=9649) and neither disease (n=27226). Our analytical approach comprised linear regression models, with adjustment for a range of demographic and health factors. Results: Those with diabetes had worse overall brain health, as indexed by multiple neuroimaging parameters, with the exception of gFA (white matter integrity) and the amygdala. The largest difference was observed in the pallidum (β=0.179, 95%CI=0.137;0.220). Individuals with diabetes had poorer performance on certain cognitive tests, with the largest difference observed in the symbol digit substitution test (β=0.132, 95%CI=0.079;0.187). Compared to individuals with comorbid diabetes and hypertension, those with only hypertension had better brain health overall, with the largest difference observed in the pallidum (β=0.189, 95%CI=0.241;0.137), while those with only diabetes differed in total grey volume (β=0.150, 95%CI=0.122;0.179). Compared with individuals who had comorbid diabetes and hypertension, those with only diabetes performed distinctly better on the verbal and numeric reasoning task (β=0.129, 95%CI=0.077;0.261), whereas those with only hypertension performed better on the symbol digit substitution task (β=0.117, 95%CI=0.048;0.186) Conclusions/interpretation: Individuals with comorbid diabetes and hypertension have worse brain and cognitive health compared to those with only one of these diseases. These findings potentially suggest that prevention of both diabetes and hypertension may delay changes in brain structure, as well as cognitive decline and dementia diagnosis.

Testing the Foreign Language Effect on Cognitive Reflection in Older Adults

An increasing number of people around the world communicate in more than one language, resulting in them having to make decisions in a foreign language on a daily basis. Interestingly, a burgeoning body of literature suggests that people’s decision-making is affected by whether they are reasoning in their native language (NL) or their foreign language (FL). According to the foreign language effect (FLe), people are less susceptible to bias in many decision-making tasks and more likely to display utilitarian cost-benefit analysis in moral decision-making when reasoning in a FL. While these differences have often been attributed to a reduced emotionality in the FL, an emerging body of literature has started to test the extent to which these could be attributable to increased deliberation in the FL. The present study tests whether increased deliberation leads to a FLe on cognitive reflection in a population of older adults (Mage = 65.1), from the successful aging project in Umeå, Sweden. We explored whether performance on a 6-item version of the cognitive reflection test (CRT) adapted to Swedish would differ between participants for whom Swedish was their NL and those for whom Swedish was their FL. The CRT is a task designed to elicit an incorrect, intuitive answer. In order to override the intuitive answer, one requires engaging in deliberative, analytical thinking to determine the correct answer. Therefore, we hypothesized that if thinking in a FL increases deliberation, then those performing the task in their FL would exhibit higher accuracy rates than those performing in their NL. Our results showed that age and level of education predicted performance on the task but performance on the CRT did not differ between the NL and the FL groups. In addition, in the FL group, proficiency in the FL was not related to performance in the CRT. Our results, therefore, do not provide evidence that thinking in a FL increases deliberation in a group of older adults performing a logical reasoning task that is not typically associated with an emotional connotation.

Qualitative development and content validation of the “SPART” model; a focused ethnography study of observable diagnostic and therapeutic activities in the emergency medical services care process

Background Clinical reasoning is a crucial task within the Emergency Medical Services (EMS) care process. Both contextual and cognitive factors make the task susceptible to errors. Understanding the EMS care process’ structure could help identify and address issues that interfere with clinical reasoning. The EMS care process is complex and only basically described. In this research, we aimed to define the different phases of the process and develop an overarching model that can help detect and correct potential error sources, improve clinical reasoning and optimize patient care. Methods We conducted a focused ethnography study utilizing non-participant video observations of real-life EMS deployments combined with thematic analysis of peer interviews. After an initial qualitative analysis of 7 video observations, we formulated a tentative conceptual model of the EMS care process. To test and refine this model, we carried out a qualitative, thematic analysis of 28 video-recorded cases. We validated the resulting model by evaluating its recognizability with a peer content analysis utilizing semi-structured interviews. Results Based on real-life observations, we were able to define and validate a model covering the distinct phases of an EMS deployment. We have introduced the acronym “SPART” to describe ten different phases: Start, Situation, Prologue, Presentation, Anamnesis, Assessment, Reasoning, Resolution, Treatment, and Transfer. Conclusions The “SPART” model describes the EMS care process and helps to understand it. We expect it to facilitate identifying and addressing factors that influence both the care process and the clinical reasoning task embedded in this process.

Enhancing students’ critical thinking skills: is comparing correct and erroneous examples beneficial?

There is a need for effective methods to teach critical thinking (CT). One instructional method that seems promising is comparing correct and erroneous worked examples (i.e., contrasting examples). The aim of the present study, therefore, was to investigate the effect of contrasting examples on learning and transfer of CT-skills, focusing on avoiding biased reasoning. Students (N = 170) received instructions on CT and avoiding biases in reasoning tasks, followed by: (1) contrasting examples, (2) correct examples, (3) erroneous examples, or (4) practice problems. Performance was measured on a pretest, immediate posttest, 3-week delayed posttest, and 9-month delayed posttest. Our results revealed that participants’ reasoning task performance improved from pretest to immediate posttest, and even further after a delay (i.e., they learned to avoid biased reasoning). Surprisingly, there were no differences in learning gains or transfer performance between the four conditions. Our findings raise questions about the preconditions of contrasting examples effects. Moreover, how transfer of CT-skills can be fostered remains an important issue for future research.

"Qualitative Development And Content Validation of The "SPART" Model; A Focused Ethnography Study of Observable Diagnostic And Therapeutic Activities In The Emergency Medical Services Care Process"

Background:Clinical reasoning is a crucial task within the Emergency Medical Services (EMS) care process. Both contextual and cognitive factors make the task susceptible to errors. Understanding the EMS care process’ structure could help identify and address issues that interfere with clinical reasoning. The EMS care process is complex and only basically described. In this research, we aimed to define the different phases of the process and develop an overarching model that can help detect and correct potential error sources, improve clinical reasoning and optimize patient care. Methods:We conducted a focused ethnography study utilizing non-participant video observations of real-life EMS deployments combined with thematic analysis of peer interviews.After an initial qualitative analysis of 7 video observations, we formulated a tentative conceptual model of the EMS care process. To test and refine this model, we carried out a qualitative, thematic analysis of 28 video-recorded cases. We validated the resulting model by evaluating its recognizability with a peer content analysis utilizing semi-structured interviews. Results:Based on real-life observations, we were able to define and validate a model covering the distinct phases of an EMS deployment. We have introduced the acronym “SPART” to describe ten different phases: Start, Situation, Prologue, Presentation, Anamnesis, Assessment, Reasoning, Resolution, Treatment, and Transfer. Conclusions: The “SPART” model describes the EMS care process and helps to understand it. We expect it to facilitate identifying and addressing factors that influence both the care process and the clinical reasoning task embedded in this process.

Metacognitive monitoring and metacognitive strategies of gifted and average children on dealing with deductive reasoning task

In this paper, we inquire into possible differences between children with exceptionally high intellectual abilities and their average peers as regards metacognitive monitoring and related metacognitive strategies. The question whether gifted children surpass their typically developing peers not only in the intellectual abilities, but also in their level of metacognitive skills, has not been convincingly answered so far. We sought to examine the indicators of metacognitive behavior by means of eye-tracking technology and to compare these findings with the participants’ subjective confidence ratings. Eye-movement data of gifted and average students attending final grades of primary school (4th and 5th grades) were recorded while they dealt with a deductive reasoning task, and four metrics supposed to bear on metacognitive skills, namely the overall trial duration, mean fixation duration, number of regressions and normalized gaze transition entropy, were analyzed. No significant differences between gifted and average children were found in the normalized gaze transition entropy, in mean fixation duration, nor - after controlling for the trial duration – in number of regressions. Both groups of children differed in the time devoted to solving the task. Both groups significantly differed in the association between time devoted to the task and the participants’ subjective confidence rating, where only the gifted children tended to devote more time when they felt less confident. Several implications of these findings are discussed.

Evidence for a Behaviourally Measurable Perseverance Trait in Humans

The aim was to create and study a possible behavioural measure for trait(s) in humans that reflect the ability and motivation to continue an unpleasant behaviour, i.e., behavioural perseverance or persistence (BP). We utilised six different tasks with 54 subjects to measure the possible BP trait(s): cold pressor task, hand grip endurance task, impossible anagram task, impossible verbal reasoning task, thread and needle task, and boring video task. The task performances formed two BP factors. Together, the two-factor solution is responsible for the common variance constituting 37.3% of the total variance in the performances i.e., performance times. Excluding the impossible anagram task, the performance in any given task was better explained by performances in the other tasks (i.e., “trait”, η2 range = 0.131–0.253) than by the rank order variable (“depletion”, i.e., getting tired from the previous tasks, η2 range = 0–0.096).

How Negative Is Negative Information

Daily, we face a plenty of negative information that can profoundly affect our perception and behavior. During devastating events such as the current COVID-19 pandemic, negative messages may hinder reasoning at individual level and social decisions in the society at large. These effects vary across genders in neurotypical populations (being more evident in women) and may be even more pronounced in individuals with neuropsychiatric disorders such as depression. Here, we examine how negative information impacts reasoning on a social perception task in females with breast cancer, a life-threatening disease. Two groups of patients and two groups of matched controls (NTOTAL = 80; median age, 50 years) accomplished a psychometrically standardized social cognition and reasoning task receiving either the standard instruction solely or additional negative information. Performance substantially dropped in patients and matched controls who received negative information compared to those who did not. Moreover, patients with negative information scored much lower not only compared with controls but also with patients without negative information. We suggest the effects of negative information are mediated by the distributed brain networks involved in affective processing and emotional memory. The findings offer novel insights on the impact of negative information on social perception and decision making during life-threatening events, fostering better understanding of its neurobiological underpinnings.

Morphology of the Prefrontal Cortex Predicts Body Composition in Early Adolescence: Cognitive Mediators and Environmental Moderators in the ABCD Study

Morphological features of the lateral prefrontal cortex (PFC) in late childhood and early adolescence may provide important clues as to the developmental etiology of clinical conditions such as obesity. Body composition measurements and structural brain imaging were performed on 11,226 youth at baseline (age 9 or 10) and follow-up (age 11 or 12). Baseline morphological features of the lateral PFC were examined as predictors of body composition. Findings revealed reliable associations between mid-frontal gyrus volume, thickness and surface area and multiple indices of body composition. These findings were consistent across both time points, and remained significant after covariate adjustment. Cortical thickness of the inferior frontal gyrus and lateral orbitofrontal cortex were also reliable predictors. Morphology effects on body composition were mediated by performance on a non-verbal reasoning task. Modest but reliable moderation effects were observed with respect to environmental self-regulatory demand after controlling for sex, race/ethnicity, income and methodological variables. Overall findings suggest that prefrontal cortex morphology is a reliable predictor of body composition in early adolescence, as mediated through select cognitive functions and partially moderated by environmental characteristics.

Holistic processing only? The role of the right fusiform face area in radiological expertise

Radiologists can visually detect abnormalities on radiographs within 2s, a process that resembles holistic visual processing of faces. Interestingly, there is empirical evidence using functional magnetic resonance imaging (fMRI) for the involvement of the right fusiform face area (FFA) in visual-expertise tasks such as radiological image interpretation. The speed by which stimuli (e.g., faces, abnormalities) are recognized is an important characteristic of holistic processing. However, evidence for the involvement of the right FFA in holistic processing in radiology comes mostly from short or artificial tasks in which the quick, ‘holistic’ mode of diagnostic processing is not contrasted with the slower ‘search-to-find’ mode. In our fMRI study, we hypothesized that the right FFA responds selectively to the ‘holistic’ mode of diagnostic processing and less so to the ‘search-to-find’ mode. Eleven laypeople and 17 radiologists in training diagnosed 66 radiographs in 2s each (holistic mode) and subsequently checked their diagnosis in an extended (10-s) period (search-to-find mode). During data analysis, we first identified individual regions of interest (ROIs) for the right FFA using a localizer task. Then we employed ROI-based ANOVAs and obtained tentative support for the hypothesis that the right FFA shows more activation for radiologists in training versus laypeople, in particular in the holistic mode (i.e., during 2s trials), and less so in the search-to-find mode (i.e., during 10-s trials). No significant correlation was found between diagnostic performance (diagnostic accuracy) and brain-activation level within the right FFA for both, short-presentation and long-presentation diagnostic trials. Our results provide tentative evidence from a diagnostic-reasoning task that the FFA supports the holistic processing of visual stimuli in participants’ expertise domain.