Modifiable lifestyle factors and cognitive reserve: A systematic review of current evidence

This systematic review aims to summarize cognitive reserve (CR) evaluation approaches and to examine the role of seven selected modifiable lifestyle factors (diet, smoking, alcohol consumption, physical activity, cognitive leisure activity, sleep, and meditation) in mitigating the impacts of age- or disease-related brain changes on cognition. Eighteen population-based English empirical studies were included. We summarize the study designs and identify three CR models that were broadly used in these studies, including a residual model assessing lifestyle factors in relation to unexplained variance in cognition after accounting for brain markers, a moderation model testing whether lifestyle factors moderate the relationship between brain status and cognition, and a controlling model examining the associations between lifestyle factors and cognition when controlling for brain measures. We also present the findings for the impact of each lifestyle factor. No studies examined diet, sleep, or meditation, and only two studies focused on smoking and alcohol consumption each. Overall, the studies suggest lifestyle activity factors (physical and cognitive leisure activities) may contribute to CR and attenuate the damaging impact of brain changes on cognition. Standardized measurements of lifestyle factors and CR are needed, and mechanisms underlying CR need to be further addressed as well.     

Longitudinal associations of subjectively-measured physical activity and screen time with cognitive development in young children

PurposeTo examine the longitudinal associations of subjectively-measured physical activity (PA) and screen time with multiple domains of cognitive development in a sample of young children.MethodsParticipants were 96 children (baseline age: 3.69 ± 0.78 years) and their parents from Edmonton, Canada in the Physical Activity and Cognition in Early Childhood (PACE) study. Different types of PA (organized, non-organized) and screen time (television viewing, video games) were measured using a parental questionnaire at baseline and at 6- and 12-month follow-ups. Total proxy-reported PA, total screen time, and meeting/not meeting the screen time recommendations (2–4 years: ≤1 h/d; 5 years: ≤2 h/d) of the Canadian 24-Hour Movement Guidelines were also calculated. Working memory (Nebraska Barnyard task) and inhibitory control (Fish-Shark Go/No-Go task) were assessed at the three time points. Intellectual ability, including language development, inductive reasoning, and perceptual speed, were assessed using the Woodcock-Johnson III test battery at 6- and 12-month follow-ups. Multilevel growth modeling was conducted.ResultsOrganized PA (B = 1.26; 95%CI: 0.19,2.33), non-organized PA (B = 0.89, 95%CI: 0.08, 1.71), and total proxy-reported PA (B = 1.03, 95%CI: 0.41,1.66) were positively associated with intellectual ability. In particular, positive associations in regard to language development and inductive reasoning were observed. As for screen time, most associations were not significant, except for positive associations of meeting the screen recommendation with intellectual ability (B = 3.19; 95%CI: 0.002,6.38) and language development (B = 4.32; 95%CI: 0.34,8.30).ConclusionFor young children, promoting PA participation in organized and non-organized activities, as well as meeting the screen time recommendations, appears important for cognitive development.     

The conflicted practice: Municipal occupational therapists’ experiences with assessment of clients with cognitive impairments

Background: The practice of Norwegian occupational therapists (OTs) in municipal practice is a little explored area and with the Coordination Reform Act from 2012, Norwegian OTs in municipal practice have received responsibilities concerning clients with cognitive impairments. The aim of this study was to explore municipal OTs experiences with assessment of clients with cognitive impairments.

Method: Fourteen individual interviews with OTs who worked with clients with cognitive impairments, were conducted. An inductive thematic analysis, using text condensation and coding, was performed.

Results: The results revealed three themes; power of occupation, advantages and disadvantages of assessments used and the need for competencies within municipal services. The participants emphasized using observation in the assessment process and reflected on pros and cons of the standardized assessment tools they used. They expressed a need for competence development, although it was difficult to prioritize to do so.

Conclusion: This study illustrated a conflicted practice related to choices OTs make in their practices. They valued the importance of working occupation based, however, they chose to use impairment based standardized assessments. They expressed a need to engage in professional development, but due to heavy workloads, the limited power they experienced and lack of knowledge, this was difficult.     

Impaired self-awareness after traumatic brain injury: a systematic review. Part 1: Assessment,clinical aspects and recovery

BackgroundImpaired self-awareness (ISA) has frequently been found to be both frequent and deleterious in patients with moderate to severe traumatic brain injury (TBI).ObjectivesThe present paper is the first of a two-part systematic review of ISA after traumatic brain injury (TBI), focusing on assessment methods, clinical aspects and recovery.MethodsFollowing the PRISMA guidelines, 95 articles meeting the inclusion criteria were included.ResultsISA occurs in 30% to 50% of patients with moderate to severe TBI, although it tends to improve with time. There is no one single gold-standard measure of ISA. Self-proxy discrepancy scores, with scales such as the Patient Competency Rating Scale or the Awareness Questionnaire, or a structured interview such as the Self Awareness of Deficits Interview, are the most frequently used assessment methods, with adequate psychometric properties. Scores on these different scales correlate only moderately with each other, which suggests that they may address different aspects of self-awareness. ISA mainly concerns cognitive and behavioral problems rather than physical or sensory impairments and may concern different areas of functioning, such as anticipatory, emergent or meta-cognitive awareness.ConclusionISA is a complex and multifaceted issue that should be systematically assessed in rehabilitation settings using a range of relatively well-validated tools. The consequences and predictors of ISA after TBI will be addressed in a companion paper.     

Facial expression recognition in Alzheimer’s disease: A systematic review

Introduction: It is well established that behavioral variant frontotemporal dementia can impair social and emotional function. However, there is no consensus regarding how Alzheimer’s disease can affect facial expression recognition. We aim to systematically review all the literature addressing this issue over the last 10 years.

Method: We conducted a search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search for literature was undertaken on 19 September 2017, using Pubmed, SciELO, BIREME, and Thomson Reuters Web of Science electronic databases. The key terms for the search were: Alzheimer’s disease, dementia, and facial expression recognition.

Results: We screened 173 articles, and 22 of them were selected. The most common methodology involved showing participants photographs of people expressing the six basic emotions—fear, anger, sadness, disgust, surprise, and happiness. Results were ambiguous. Among people with mild Alzheimer’s disease, happiness was easier to recognize than the other five basic emotions, with sadness and anger the most difficult to recognize. In addition, the intensity level of the emotions presented seems to be important, and facial expression recognition is related to specific cognitive capacities, including executive function and visuoperceptual abilities. Impairment in facial expression recognition does not appear to be a consistent neuropsychological finding in Alzheimer’s disease.

Conclusions: The lack of standardized assessment instruments and the heterogeneity of the methods and samples used across studies hamper comparisons. Future researches should investigate facial expression recognition through more ecological and standardized methods.     

Reliability and validity of the Japanese version of the Biological Rhythms Interview of assessment in neuropsychiatry-self report for delayed sleep-wake phase disorder

ObjectiveThe Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) might be applicable for assessing delayed sleep-wake phase disorder (DSWPD). We aimed to investigate the reliability and validity of the Japanese version of the BRIAN self-report (J-BRIAN-SR) in DSWPD patients and determine a cutoff score to identify the presence of the disorder.MethodsWe enrolled 60 newly diagnosed DSWPD outpatients and 64 age-matched healthy controls. We used Cronbach's alpha for internal reliability to evaluate J-BRIAN-SR. We confirmed the reliability of the A test and re-test using Pearson's correlation coefficient in the controls. We used confirmatory factor analysis to evaluate the factor structure of J-BRIAN-SR and referenced the Morningness-Eveningness Questionnaire (MEQ) to check concurrent validity. We analyzed the receiver operating characteristic curve (ROC) to determine the J-BRIAN-SR cutoff point for the presence of DSWPD.ResultsThe 18-component scores of the J-BRIAN-SR had an overall reliability coefficient (Cronbach's alpha) of 0.82. We confirmed a high test-retest reliability using an intraclass correlation coefficient (r = 0.84). The correlation between J-BRIAN-SR and MEQ was 0.38 (p = 0.003). The J-BRIAN-SR that we extracted by exploratory factor analysis consisted of three factors. A score of 40 points provided a sensitivity of 80.0% and a specificity of 75.6% for the positivity of DSWPD.ConclusionsThe results of the present study revealed that J-BRIAN-SR is a valid and reliable instrument for screening and evaluating the severity of DSWPD. Our findings will be useful to physicians and patients in Japan and those in clinical settings.     

Cognitive and psychosocial effects of an acute sun salutation intervention among adults with stress

Evidence suggests that yoga can improve executive functioning (EF) and psychological well-being, but there is no evidence whether flow-based, moderate-intensity forms of yoga can deliver similar benefits. The purpose of this randomized controlled trial was to test the aforementioned effects of engaging in a 30-min, video-guided sun salutation exercise (n = 25), relative to aerobic exercise (n = 22) and attentional control (n = 24). Low-active participants (Mage = 27.84; 87.3% female), with symptoms of stress, completed psychosocial assessments and tasks assessing EF, before and after the session. Results showed a significant group difference for state anxiety (p = .01, η_p² = 0.13) and stress (p < .05, η_p² = 0.09), in favor of the yoga group. No significant between-groups differences in EF were observed. Results suggest that video-guided, flow-based forms of yoga can induce immediate improvements in well-being, yet extended involvement may be required to realize performance improvements in memory and processing speed.     

Targeting impaired nutrient sensing with repurposed therapeutics to prevent or treat age-related cognitive decline and dementia: A systematic review

BackgroundDementia is a debilitating syndrome that significantly impacts individuals over the age of 65 years. There are currently no disease-modifying treatments for dementia. Impairment of nutrient sensing pathways has been implicated in the pathogenesis of dementia, and may offer a novel treatment approach for dementia.AimsThis systematic review collates all available evidence for Food and Drug Administration (FDA)-approved therapeutics that modify nutrient sensing in the context of preventing cognitive decline or improving cognition in ageing, mild cognitive impairment (MCI), and dementia populations.MethodsPubMed, Embase and Web of Science databases were searched using key search terms focusing on available therapeutics such as ‘metformin’, ‘GLP1’, ‘insulin’ and the dementias including ‘Alzheimer’s disease’ and ‘Parkinson’s disease’. Articles were screened using Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia). The risk of bias was assessed using the Cochrane Risk of Bias tool v 2.0 for human studies and SYRCLE’s risk of bias tool for animal studies.ResultsOut of 2619 articles, 114 were included describing 31 different ‘modulation of nutrient sensing pathway’ therapeutics, 13 of which specifically were utilized in human interventional trials for normal ageing or dementia. Growth hormone secretagogues improved cognitive outcomes in human mild cognitive impairment, and potentially normal ageing populations. In animals, all investigated therapeutic classes exhibited some cognitive benefits in dementia models. While the risk of bias was relatively low in human studies, this risk in animal studies was largely unclear.ConclusionsModulation of nutrient sensing pathway therapeutics, particularly growth hormone secretagogues, have the potential to improve cognitive outcomes. Overall, there is a clear lack of translation from animal models to human populations.