Executive functioning in TBI from rehabilitation to social reintegration: COMPASS^(goal), a randomized controlled trial(grant: 1I01RX000637-01A3 by the VA ORD RR&D, 2013–2016)

Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function.Methods/design: The COMPASSgoal(Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community reintegration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management(intervention) and supported discharge(control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up.Discussion: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.

Bibliographical Review on Rehabilitation of Executive Functions in Patients With Developmental Coordination Disorder(DCD)

The present study aims to establish a literature review on intervention programs for executive functions(EFs)through the use of fundamental motor skills,from a neuropsychopedagogical perspective in subjects with Developmental Coordination Disorder(DCD).An exploratory study was carried out through an integrative literature review.The research was carried out in the Scientific databases Electronic Library Online(SciELO),Latin American and Caribbean Literature in Health Sciences(LILACS),Virtual Health Library-Psychology Brazil(BVSPSI),Electronic Journals of Psychology(PePSIC),in the periodicals available in the Brazilian Digital Library of Theses and Dissertations(BDTD)and on the website of the Coordination for the Improvement of Higher Education Personnel(CAPES).The covering publications took place from 2018 to 2023,14 articles were selected for analysis.This literature review made it possible to create strategies for stimulating EF and Visuomotor Functions so that educators and other professionals can better deal with students with DCD.It was perceived the need to carry out and develop more empirical research regarding the intervention of EFs and Visuomotor Functions by educators and professionals,with a greater sampling amplitude,to increase the number of studies that enable interventions both in children and in teenagers with DCD.

Assessment of Stress Cognitive Control and Executive Function with Stress Control Rating Scale (ECOSTRESS) and Low Resolution Brain Electromagnetic Tomography (LORETA) (In Portuguese People in Situations of Unemployment and Economic Insufficiency)

This article reviews the constructs of stress, appraisal, coping, according to a transactional perspective, and executive function, and presents a stress control rating scale (ECOSTRESS), which design is founded in these constructs. This psychometric tool is useful in the assessment of cognitive control of stress, correlated with the function of dorsolateral prefrontal cortex. It has been validated for its use in the assessment of Portuguese people in situations of stress related to unemployment and economic insufficiency. Also, within the context of the cognitive control of stress, it is highlighted the usefulness of low resolution brain electromagnetic tomography (LORETA).

Optical neuroimaging of executive function impairments in food addiction

This study investigated the neural mechanisms located in the prefrontal cortex(PFC)involved in maintaining addictive-like eating behavior.Therefore,we aimed toll a gap in the existing literature and help clarify the food addiction(FA)cycle by inspecting the relationship between the executive control and psychopathology involved in the FA cycle.Twenty-three students recruited from the University of Macao participated in this study.We investigated a hemodynamic response captured by NIRS recordings,activated during n-back,set-shifting,and go/nogo paradigms.Moreover,we investigated the FA symptoms through the YFAS clinical inventory to better understand the relationship between hemodynamic response and clinical symptomatology in college students.First,the hemodynamicndings conrm that altered cognitive control in executive function performance appears to be linked to addictive-like eating behaviors,which in turn conrms a circuit similarity between FA and the substance abuse population(SUD)as reported in previous fMRI studies.Secondly,the psychologicalndings conrm the signicant association between the working memory decits and symptoms severity which suggest the role of self-control and regulation in limiting the storage resources as a potential trigger to develop overconsumption episodes in the FA cycle.Ourndings highlight how disrupted self-control and regulation of craving and negative a®ect induced by mental imagery might shape and overload the working memory storage as a potential trigger to develop binge eating episodes to maintain the FA cycle.In conclusion,the use of fNIRS in the context of eating disorders studies represents a valuable application,noninvasive,and patientfriendly tool,providing new insights into understanding the addiction cycle and treatment guidelines.

Association between central obesity and executive function as assessed by stroop task performance:A functional near-infrared spectroscopy study

Recent studies have suggested a link between executive function(EF)and obesity.Studies oftenadopt body mass index(BM),which reflects the distribution of subcutaneous fat,as the solemarker of obesity;however,BMI is inappropriate to distinguish central obesity,which indicatesthe centralized distribution of visceral fat.Visceral fat compared with subcutaneous fat repre-sents greater relative lipid turnover and may increase the risk of cognitive decline in older adults.However,the relationship between EF and central obesity is largely unknown,particularly inyoung adults.Therefore,we used waist circumference(WC)as a marker of central obesity andinvestigated diferent sensitivities between BMI and WC in the brain function.A total of 26healthy young adults(aged 18-25 years;42%female)underwent functional near-infrared spec-troscopy assessments.EF was assessed using the Stroop task,which is a classical measurementof EF.A significant Stroop effect was observed in the behavioral and hemodynamic data.Inaddition,we observed that behavioral interference on the Stroop task varied much more insubjects with higher BMI and WC than those subjects with lower.Elevated BMI and WC wereassociated with a decreased hemodynamic response during the Stroop task specifically in the pre-frontal cortex(PFC).Compared to BMI,WC was more closely connected with inhibitory controland revealed right lateralized PFC activation.Our findings suggest that WC is a reliable indicatorof brain function in young adults and propose a relationship bet ween EF and central obesity.

Impact of Auditory-Verbal Therapy on executive functions in children with Cochlear Implants

Objective: Auditory-Verbal Therapy(AVT) can be considered one of the best practices for children with Cochlear Implants(CIs) who show impairments in cognitive skills such as executive functions. Hence,this research examined the impact of AVT on the executive functions in children with CIs.Methods: This was a randomized case control study with pre-and post-intervention assessments. The participants were 36 children with CIs and their mothers. They were randomly selected from rehabilitation centers and deaf pre-schools, and randomly allocated to a control(n = 18) and a study(n = 18)group. The mean age of the children in the study and control groups was 3.11 ± 0.31 years and 3.20 ± 0.29years, respectively. Participants in the study group received 20 sessions of AVT over 10 weeks at twice a week, while those in the control group did not. All mothers completed the Behavior Rating Inventory of Executive Function Pre-school Version(BRIEF-P) before and after children in the study group completed their AVT intervention. Data were analyzed by MANCOVA.Results: The results suggest that AVT significantly influenced executive functions and all subscales including shifting, inhibition, emotional control, working memory and organization/planning in children with CIs.Conclusions: These findings suggest that AVT may be effective in resulting in positive outcomes and may play an important role in improving executive functions in children with CIs.

Effectiveness of Mindfulness Training in Enhancing Executive Function and Decreasing Symptoms of Depression and Anxiety in Patients with Multiple Sclerosis (MS)

The purpose of the present study was to evaluate the effectiveness of mindfulness training in enhancing executive function and decreasing symptoms of depression and anxiety in multiple sclerosis patients. The population in this study consisted of people with MS who referred to Karaj city MS society in 1394. These people didn’t experience medicinal changes during the study period and their expanded disability status score (EDSS) was between 0 and 5.5. 40 of them were randomly selected and placed into two experimental and control groups (20 for the experimental and the other for the control group). The treatment of mindfulness training was held in 8 sessions of group training, once a week and for 2 hours. The statistical method of multivariate analysis of covariance was used. The measurement tools were the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory-II (BDI-II) and the Wisconsin Card Sorting Test (WCST). After all, the results in both groups were compared and evaluated by the use of analysis of covariance. The results showed significant differences in symptoms of anxiety and depression between the two groups (p 0.05). Generally, the results of this research showed positive effects of mindfulness training on reducing anxiety and depression among patients with MS and ineffectiveness of mindfulness training on their executive function. Therefore, considering that there is no certain treatment for MS plus results of this study, the application of mindfulness training can be quite useful to reduce levels of anxiety and depression in patients with MS.

Topographical Analysis of Frontal Lobe Executive Functions in Patients Following a Stroke

Objective: This study aimed to carry out a topographical analysis of frontal lobe executive function components in post-stroke patients. Methods: A descriptive, cross-sectional study. The assessment using the WCST (Wisconsin Card Sorting Test) included sixteen patients with a clinical diagnosis of CVA and frontal lobe impairment. Results from the two groups were compared (patients with right frontal lobe impairment and patients with left frontal lobe impairment). Statistical analysis was performed using the program “Statistical Package for Social Sciences” (SPSS) Version 20.0. For comparison between groups was used Mann-Whitney test and considered the alpha level of 0.05 on the statistically significant results. Results: There was no statistically significant difference between the groups, thus showing that executive functions are symmetrically distributed across the frontal lobes. Conclusion: Executive functions are symmetrically organized across the two frontal lobes, since the comparison between the groups did not demonstrate a statistically significant difference for any of the variables of WSCT.

Basic Study Impact of stimulant medication on behaviour and executive functions in children with attention-deficit/hyperactivity disorder

BACKGROUND Children with attention-deficit/hyperactivity disorder(ADHD)often exhibit behaviour challenges and deficits in executive functions(EF).Psychostimulant medications[e.g.,methylphenidate(MPH)]are commonly prescribed for children with ADHD and are considered effective in 70%of the cases.Furthermore,only a handful of studies have investigated the long-term impact of MPH medication on EF and behaviour.AIM To evaluate behaviour and EF challenges in children with ADHD who were involved in an MPH treatment trial across three-time points.METHODS Thirty-seven children with ADHD completed a stimulant medication trial to study the short-and long-term impact of medication.Children with ADHD completed three neuropsychological assessments[Continuous Performance Test(CPT)-II,Digit Span Backwards and Spatial Span Backwards].Parents of children with ADHD completed behaviour rating scales[Behaviour Rating Inventory of Executive Functioning(BRIEF)and Behaviour Assessment System for Children-Second Edition(BASC-2)].Participants were evaluated at:(1)Baseline(no medication);and(2)Best-dose(BD;following four-week MPH treatment).Additionally,18 participants returned for a long-term naturalistic follow up(FU;up to two years following BD).RESULTS Repeated measure analyses of variance found significant effects of time on two subscales of BRIEF and four subscales of BASC-2.Neuropsychological assessments showed some improvement,but not on all tasks following the medication trial.These improvements did not sustain at FU,with increases in EF and behaviour challenges,and a decline in performance on the CPT-II task being observed.CONCLUSION Parents of children with ADHD reported improvements in EF and behaviours during the MPH trial but were not sustained at FU.Combining screening tools and neuropsychological assessments may be useful for monitoring medication responses.

Stress, Executive Function, Resilience and Quality of Life in Portuguese Subjects in Situations of Economic Insufficiency and Unemployment

The aim of this study is the investigation of the impact of stress of Portuguese subjects in situations of economic insufficiency and unemployment on executive function and quality of life and the coping strategies and resilience skills used. The sample consists of 41 participants. The psychometric instruments used are validated for Portuguese population, measure (perceived) stress, coping, material deprivation, resilience and quality of life, defined by World Health Organization. Executive function has been evaluated through performances at Stroop and Berg tasks. It has been concluded that, in this population, resilience skills and active coping strategies are positively correlated with quality of life. Quality of life is negatively correlated with material deprivation. Active coping strategies are supported by adequate executive function, which neurobiological substrate is dorso-lateral prefrontal cortex. Not active coping strategies correlate negatively with cognitive flexibility, suggesting the presence of a deficit at infero-lateral prefrontal cortex.

Differential Impact of an Executive-Function and a Social Cognition Training on Preschoolers with Externalizing Behavior Problems

In preschoolers, externalizing behavior problems are a primary cause of consultation. It is known that externalizing behavior (EB) could result from individual and environmental risk factors. Individual risk factors included notably social cognition (SC) and executive functions (EF). A high level of EB has usually been related to dysfunction in SC and to poor skills in EF. The aim of the present experimental study is to compare the impact of two very targeted child-oriented trainings in the increasing of social competence and decreasing of EB in preschoolers. One training targeted SC abilities while the second one targeted EF capacities. These two trainings were compared on 48 preschoolers presenting clinically relevant levels of EB. The comparison of those results highlighted how each training could help preschoolers with EB in their behavior, emotion regulation and social adjustment. In comparison to a waiting-list control-group, the two trainings were effective in decreasing EB and differentiated impacts of the two trainings were obtained on different dimensions of profiles of social competence and emotion regulation. Results are discussed for their research and clinical implications.

Neuropsychological Rehabilitation of Executive Functions: Challenges and Perspectives

Introduction: Executive Dysfunction (ED) is associated with difficulties in daily life and poor treatment adherence in individuals with neurological and psychiatric disorders. The aim of this paper is to present an update of Executive Function (EF) Rehabilitation Techniques. Methods: We performed a comprehensive literature review using the following keywords: executive function, mental disorders and rehabilitation in the PubMed, specific journals and books. Results: There is evidence of improvement of EF using some rehabilitation techniques, such as goal planning, goal management training, problem solving training, verbalization, drill and practice approach, metacognitive strategy instruction, computer-assisted training and neurofeedback. However, impact of rehabilitation on daily life remains poorly understood. Conclusion: Executive Dysfunction (ED) may be remediated and/or compensated at a certain degree by neuropsychological rehabilitation, but there is still a great challenge in this area based on how to measure effectiveness of EF interventions on daily life. There is a need for the development of new and/or combined techniques (i.e., pharmacological treatment, deep-brain stimulation) for a broader impact on quality of life for patients.

Cognitive and Emotional Factors Related to Obstructive Sleep Apnea Diagnoses: A Brief Review

Sleep apnea is a clinical condition characterized by cessation of breathing in the sleeper due to pharyngeal airway closure. The reduction in air exchange results in decreased cerebral blood circulation with consequential behavioral deficits cognitively and emotionally. Untreated sleep apnea is associated with chronic illnesses of depression, cardiovascular disorder, obesity and diabetes mellitus. Measured cognitive behavior before and following CPAP treatment demonstrates the cognitive deficit as the effectiveness of CPAP treatment. Emotional factors related to sleep apnea diagnosis and adherence to treatment are facilitated in patients with cognitive behavior therapy (CBT) interventions by sleep specialists. This is a brief review paper that presents findings about cognition and emotional factors related to sleep apnea. This is a brief review paper.

Does exercise have a protective effect on cognitive function under hypoxia? A systematic review with meta-analysis

Objective:This study aimed to examine(1)the independent effects of hypoxia on cognitive function and(2)the effects of exercise on cognition while under hypoxia.Methods:Design:Systematic review with meta-analysis.Data sources:PubMed,Scopus,Web of Science,PsychInfo,and SPORTDiscus were searched.Eligibility criteria for selecting studies:randomized controlled trials and nonrandomized controlled studies that investigated the effects of chronic or acute exercise on cognition under hypoxia were considered(Aim 2),as were studies investigating the effects of hypoxia on cognition(Aim 1).Results:In total,18 studies met our inclusionary criteria for the systematic review,and 12 studies were meta-analyzed.Exposure to hypoxia impaired attentional ability(standardized mean difference(SMD)=-0.4),executive function(SMD=-0.18),and memory function(SMD=-0.26),but not information processing(SMD=0.27).Aggregated results indicated that performing exercise under a hypoxia setting had a significant effect on cognitive improvement(SMD=0.3,95%confidence interval:0.14-0.45,I^2=54%,p<0.001).Various characteristics(e.g.,age,cognitive task type,exercise type,exercise intensity,training type,and hypoxia level)moderated the effects of hypoxia and exercise on cognitive function.Conclusion:Exercise during exposure to hypoxia improves cognitive function.This association appears to be moderated by individual and exercise/hypoxia-related characteristics.

Individuals with and without normal tension glaucoma exhibit comparable performance on tests of cognitive function

AIM:To evaluate aspects of cognition impacted by individuals with and without normal tension glaucoma.METHODS:Fifty normal tension glaucoma(NTG)and 50 control patients≥50 y of age were recruited from the UCSF Department of Ophthalmology.Demographic data and glaucoma parameters were extracted from electronic medical records for both groups.Tests of executive function[Executive Abilities:Measures and Instruments for Neurobehavioral Evaluation and Research(EXAMINER)]and learning and memory[California Verbal Learning Test–Second Edition(CVLT-II)]were administered to both NTG and controls.Race,handedness,best-corrected visual acuity,maximum intraocular pressure,optic nerve cup-todisc ratio,visual field and optic nerve optical coherence tomography parameters,and a measure of general health(Charlson Comorbidity Index)were compared between NTG and controls as well as within NTG subgroups.Multivariate linear regression was used to compare group performances on the EXAMINER battery and CVLT-II while controlling for age,sex,and years of education.RESULTS:NTG and controls were comparable with respect to age,sex,race,education,handedness,and the Charlson Comorbidity Index(P>0.05 for all).Performance on the EXAMINER composite score and the CVLT-II did not differ between NTG and controls(P>0.05 for both).CONCLUSION:This is the first prospective study in which the cognitive function of subject with NTG were evaluated using a comprehensive,computerized neurocognitive battery.Subjects with NTG do not perform worse than unaffected controls on tests of executive function,learning,and memor y.Results do not suppor t the hypothesis that individuals with NTG are at higher risk for cognitive dysfunction and/or dementia.

TREFACE: A New Computerized Test of Emotional Stroop with Facial Expressions

Using the conflict principle of the Stroop task, “effect of interference in color naming”, the present study proposes to create a computational version of the emotional Stroop task, called TREFACE, for its acronyms in Portuguese “Teste de Reconhecimento de Expressões Faciais com Conflito Emocional” (Facial Expression Recognition Test with Emotional Conflict). In this protocol, four fixed styles of presentation were generated according to the condition: Congruent Word Reading, Incongruent Word Reading, Congruent Recognition of Face Expression and Incongruent Recognition of Face Expression, counterbalanced in terms of each facial expression, word and gender of the photo character. Forty-two healthy volunteers completed the task. Results revealed that a task associated with word reading allows better performance than a task associated with face recognition. It was also identified that in the congruent condition, there is an advantage in terms of the correct responses. Additionally, the data regarding recognition of face expression showed greater difficulty when the image was not congruent with the word. In general, the results suggest that the emotional attribute can compromise the ability to recognize the faces, reaching the functioning of mechanisms such as cognitive control and regulation of emotions. Thus, the TREFACE paradigm can be considered a good assessment tool for monitoring emotional conflict, in addition to presenting itself as a new instrument in Portuguese language for assessing emotional working memory in healthy individuals and, eventually, in different pathologies that affect the functioning of cortical areas related to executive functions.

The Impact of Fidget Spinners on Fine Motor Skills in Individuals with and without ADHD: An Exploratory Analysis

Fidget spinners have been marketed as repetitive motion devices that improve attention and motor performance, and as such, they have become quite appealing to individuals with Attention Deficit Hyperactive Disorder (ADHD). To date, no studies have explored changes in brain activity that may occur due to fidgeting in ADHD. Our aim was to use functional Near-Infrared Spectroscopy (fNIRS) to examine the prefrontal cortex (PFC) during the performance of a standardized fine motor skills test after using a fidget spinner. Eight right-handed adults with ADHD and eight age and gender matched adults without ADHD (4F/4M, 4 control/4 fidget) performed the Purdue Pegboard Test (PPT) while their brain oxygenation was monitored using fNIRS. Relative neural efficiency (RNE) and involvement (RNI) were calculated and analyzed for all subtasks of PPT including the less cognitively demanding fine motor subtasks and more complex assembly tasks. The fidget spinner improved both task performance and RNE in the ADHD group but not the non-ADHD group for the less cognitively demanding subtasks. Our results indicate Fidget spinners may improve both relative neural efficiency and fine motor performance in adults with ADHD for less cognitively demanding tasks.

Neural and Cognitive Markers and Regulation of Emotion in Depression: A Mini-Review and a Short Case Report

In the presented short clinical case of depression, the constructs of Research Domain Criteria (RDoC) of loss (negative valence systems) and cognitive control (cognitive systems) have been operationalized. It has been concluded that a normal cognitive control of emotion, requiring the functional and structural integrity of prefrontal cortex (PFC) and orbitofrontal cortex (OFC), is lacking in depression, but its amelioration can be achieved through the implementation of cognitive remediation/rehabilitation programs. A mini-review on neural and cognitive markers and regulation of emotion in depression is previously presented.

Neonatal opioid exposure:public health crisis and novel neuroinflammatory disease

Substance use,specifically the use of prescription and non-prescription opioids among pregnant women,is a major public health issue and chief contributor to the opioid crisis.The prevalence of Neonatal Opioid Withdrawal Syndrome has risen 5-fold in the past decade,and is a well-recognized consequence of perinatal opioid exposure.By contrast,the long-term damage to the developing brain from opioid medications is just beginning to be recognized as a serious concern.Published data suggest that opioid exposure commencing in utero negatively affects the maturation of the neural-immune system,and trajectory of central nervous system development.Methadone induces peripheral immune hyper-reactivity,lasting structural and microstructural brain injury,and significant deficits in executive function and cognitive control in adult animals following in utero exposure.Thus,to address the cascading public health crisis stemming from the multitude of infants with in utero opioid exposure who will grow up with altered neurodevelopmental trajectories,rigorous preclinical,mechanistic studies are required.Such studies will define the long-term sequelae of prenatal opioid exposure in an effort to develop appropriate and targeted interventions.Specifically,the development of novel fluid,neuroimaging and biobehavioral biomarkers will be the most useful to aid in early identification and treatment of opioid exposed infants with the greatest risk of poor clinical outcomes.These studies will be essential to understand how in utero insults determine brain structure and function in adulthood,and what targeted interventions will be required to improve longterm outcomes in the countless children being born exposed to opioids each year.

EEG Mapping of Cortical Activation Related to Emotional Stroop with Facial Expressions: A TREFACE Study

TREFACE (Test for Recognition of Facial Expressions with Emotional Conflict) is a computerized model for investigating the emotional factor in executive functions based on the Stroop paradigm, for the recognition of emotional expressions in human faces. To investigate the influence of the emotional component at the cortical level, the electroencephalographic (EEG) recording technique was used to measure the involvement of cortical areas during the execution of certain tasks. Thirty Brazilian native Portuguese-speaking graduate students were evaluated on their anxiety and depression levels and on their well-being at the time of the session. The EEG recording was performed in 19 channels during the execution of the TREFACE test in the 3 stages established by the model-guided training, reading, and recognition—both with congruent conditions, when the image corresponds to the word shown, and incongruent condition, when there is no correspondence. The results showed better performance in the reading stage and in congruent conditions, while greater intensity of cortical activation in the recognition stage and in incongruent conditions. In a complementary way, specific frontal activations were observed: intense theta frequency activation in the left extension representing the frontal recruitment of posterior regions in information processing;also, activation in alpha frequency in the right frontotemporal line, illustrating the executive processing in the control of attention, in addition to the dorsal manifestation of the prefrontal side, for emotional performance. Activations in beta and gamma frequencies were displayed in a more intensely distributed way in the recognition stage. The results of this mapping of cortical activity in our study can help to understand how words and images of faces can be regulated in everyday life and in clinical contexts, suggesting an integrated model that includes the neural bases of the regulation strategy.