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Standardization and adult norms for the sequential subtracting tasks of serial 3’s and 7’s

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... Interestingly, a small increase in velocity and stride length has been linked to a decline in executive functioning among participants suffering from vascular dementia (Verghese et al., 2007). Since cognition is an extremely broad area, numerous studies have introduced the idea of separating tasks into higher-level and lower-level cognitive domains to better understand their influence on physiology or functions (Gerton et al., 2004;Scholey et al., 2010;Bristow et al., 2016). However, the relationship between higher-or lower-level cognitive tasks and gait or posture remains largely unexplored. ...
... In this context, vigilance (or sustained attention) has been defined as the ability to perform monitoring tasks that require forebrain activation, which is measured by stimuli detection and the associated reaction time (Sarter et al., 2001). Serial subtraction of 3 and 7 have both been used to measure task vigilance; however, there is a distinct hierarchical increase in cognitive demand when performing the serial subtract 7 compared with the serial subtract 3 (Bristow et al., 2016). It is theorized that the task of serial subtract 3 measures psychomotor performance, while serial subtract 7 task measures working memory and executive function (Scholey et al., 2010;Bristow et al., 2016). ...
... Serial subtraction of 3 and 7 have both been used to measure task vigilance; however, there is a distinct hierarchical increase in cognitive demand when performing the serial subtract 7 compared with the serial subtract 3 (Bristow et al., 2016). It is theorized that the task of serial subtract 3 measures psychomotor performance, while serial subtract 7 task measures working memory and executive function (Scholey et al., 2010;Bristow et al., 2016). Like serial subtraction tasks, continuous performance task (CPT) and rapid visual input processing (RVIP) task both measure vigilance through the identification of discrimination events. ...
Article
Evidence suggests that there is a significant relationship between cognition and gait. However, studies have primarily focused on overall cognition when elucidating the relationship with gait. This study aimed to delineate specific aspects of cognition that are related to gait and postural control parameters. Participants (N = 11, age = 76.55 ± 7.58 years) performed a series of cognitive tasks categorized as either lower-level (serial subtract 3 and continuous performance task) or higher-level (serial subtract 7 and rapid visual input processing task) tasks. Following the completion of the cognitive tasks, participants performed balance and gait activities. This procedure was performed on two separate days with a minimum 48-h rest period between days. A bivariate Pearson correlation analysis was utilized to identify relationships between cognitive task scores and gait speed, step length, gait imbalance as well as the visual, vestibular, and somatosensory aspect of postural control. Lower-level cognitive tasks, specifically the serial subtract 3 was significantly (P < 0.05) associated with gait speed (r = 0.457), step length (r = 0.481), and the ability to maintain postural control with occluded vision and unreliable somatosensory input (r = -0.504). In contrast, higher-level cognitive tasks, specifically serial subtract 7 were associated (P < 0.05) with gait imbalance (r = -0.540), while rapid visual input processing primary reaction time was associated with the ability to maintain postural control in the absence of visual input (r = -0.751). Our findings align with functional magnetic resonance imaging (fMRI) studies that examine gait, postural control, and cognitive task performance and provide a granular insight. These results may help us to better understand the relationship between cognitive deficits, gait, and postural control with aging.
... It stops after 5 answers and each correct response is one point, so the range of total scores goes from 0 to 5 (Phillips et al., 2017). Higher scores indicate better executive function (Lee, Strauss, Adams, & Redline, 1999) and higher levels of basic mathematical ability (Karzmark, 2000;Srygley, Mirelman, Herman, Giladi, & Hausdorff, 2009) and working memory (Bristow, Jih, Slabich, & Gunn, 2016;Srygley et al., 2009). It has also been used as a measure of processing speed (Williams et al., 1996) and attention (Bristow et al., 2016). ...
... Higher scores indicate better executive function (Lee, Strauss, Adams, & Redline, 1999) and higher levels of basic mathematical ability (Karzmark, 2000;Srygley, Mirelman, Herman, Giladi, & Hausdorff, 2009) and working memory (Bristow, Jih, Slabich, & Gunn, 2016;Srygley et al., 2009). It has also been used as a measure of processing speed (Williams et al., 1996) and attention (Bristow et al., 2016). ...
... Regarding serial 7 task, no differences was found between caregivers and non-caregivers. This task has been used as a measure of processing speed (Williams et al., 1996), attention (Bristow et al., 2016) and working memory (Bristow et al., 2016;Srygley et al., 2009). The finding is partially consistent with previous research using different scales to measure these domains (Mackenzie, Smith, Hasher, Leach, & Behl, 2007;Mackenzie et al., 2009;O'Sullivan et al., 2019;Romero-Mart ınez et al., 2018). ...
Article
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Background and objectives: The relationship between caregiving and cognition remains unclear. We investigate this association comparing four cognitive tasks and exploring the role of potential explanatory pathways such as healthy behaviours (healthy caregiver hypothesis) and depression (stress process model). Research design and methods: Respondents were from English Longitudinal Study of Ageing (ELSA) (N = 8910). Cognitive tasks included immediate and delayed word recall, verbal fluency and serial 7 subtraction. Series of hierarchical linear regressions were performed. Adjustments included socio-demographics, health related variables, health behaviours and depression. Results: Being a caregiver was positively associated with immediate and delayed recall, verbal fluency but not with serial 7. For immediate and delayed recall, these associations were partially attenuated when adjusting for health behaviours, and depression. For verbal fluency, associations were partially attenuated when adjusting for depression but fully attenuated when adjusting for health behaviours. No associations were found for serial 7. Discussion and implications: Our findings show that caregivers have higher level of memory and executive function compared to non-caregivers. For memory, we found that although health behaviours and depression can have a role in this association, they do not fully explain it. However, health behaviours seem to have a clear role in the association with executive function. Public health and policy do not need to target specifically cognitive function but other areas as the promotion of healthy behaviours and psychological adjustment such as preventing depression and promoting physical activity in caregivers.
... In addition, a decrease in verbal fluency in SCD has been reported, supporting our finding [7,8,17]. Serial 7 is known to be a test of attention and working memory [18]. There have been reports of decreased attentional function and working memory in SCD [7,18,19], and it is possible that these factors influenced the decrease in the serial 7 test. ...
... Serial 7 is known to be a test of attention and working memory [18]. There have been reports of decreased attentional function and working memory in SCD [7,18,19], and it is possible that these factors influenced the decrease in the serial 7 test. The motor series is known as a test of executive function [20]. ...
Article
Objective To clarify the profile of cognitive dysfunction and the effects of intensive exercise in spinocerebellar degeneration (SCD).Methods We enrolled 60 healthy controls and 16 patients with purely cerebellar type SCD without gait disturbance or organic changes other than cerebellar changes. To assess cognitive function, we evaluated the participants using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Montreal Cognitive Assessment-Japanese (MoCA-J) at admission and after intensive exercise.Results Compared to the controls, SCD patients showed significant cognitive decline. As a result of intensive exercise, significant improvements in motor and cognitive functions were observed: the MMSE score improved from 27.7±1.9 to 29.0±1.3 points (p<0.001); the FAB score improved from 14.8±2.2 to 15.8±2.0 points (p=0.002); and the MoCA-J score improved from 24.6±2.2 to 26.7±1.9 points (p<0.001). For sub-scores, significant improvements were noted in serial 7, lexical fluency, motor series, and delayed recall.Conclusion Our study indicates that intensive exercise can be effective not only for motor dysfunction but also for cognitive dysfunction (Clinical Trial Registration No. UMIN-CTR: UMIN000040079).
... For example, in Cox et al.'s study published in 2020 [27], there were serial seven subtraction, serial three subtraction, and virtual Morris water maze (vMWM) tests in the working memory domain. Serial seven was selected as the representative test because it had the best differentiating power [17,36]. In another example, in Ringman et al.'s study published in 2012 [10], ADAS-Cog and MMSE were used to assess overall cognitive function. ...
... If there was more than one test in a specific domain, the test that best discriminated the outcome change was selected for meta-analysis inclusion by consensus of two authors (I.-C.T. and K.-V.C.). For example, serial 7 and serial 3 subtraction tests were used for the evaluation of working memory [36]. Sensitivity analysis was also performed by substituting the representative test with other similar assessments and re-analyzed to check whether the association between the intervention and outcomes changed significantly [91]. ...
Article
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Curcumin is a polyphenol with strong antioxidant and anti-inflammatory effects that has been shown to be effective in ameliorating cognitive decline in animal studies. However, its clinical effectiveness is inconclusive, and relevant gastrointestinal adverse events (AEs) have been reported. The aim of this meta-analysis was to summarize the existing evidence from randomized controlled trials (RCTs) of effects of curcumin on overall cognitive function, individual cognitive domains, and gastrointestinal AE. The study includes 8 RCTs and 389 participants. A random-effects model was used for the meta-analysis. Compared with the placebo group, the curcumin group was associated with an improvement in working memory (Hedges’ g = 0.396, 95% confidence interval (CI) = 0.078 to 0.714, p = 0.015) and a borderline benefit in processing speed (Hedges’ g = 0.303, 95% CI = ‒0.013 to 0.619, p = 0.06). In the domains of language, episodic memory/visual learning, verbal memory, cognitive flexibility/problem solving, and overall cognitive function, no significant difference existed for the comparison between the curcumin and placebo groups. The curcumin group had a significantly higher risk of gastrointestinal AEs than the placebo group (odds ratio = 3.019, 95% CI = 1.118 to 8.150, p = 0.029). In the future, the effects of curcumin on working memory, processing speed, and gastrointestinal AE should be further investigated.
... A modified verbal version, based on the original Serial Sevens subtraction task used by Hayman [37], was assessed at four time points in each trial: baseline and following sets 2, 4 and 6 (end). The Serial Sevens task is a complex cognitive task designed to assess attention, concentration and working memory [38], with this modified version similar to that used by Kennedy and Scholey [39]. During this task, participants were presented with a randomly generated number (between 900 and 1000) and asked to count backward (out loud) by 7 as quickly and as accurately as possible for 60 s. ...
... Importantly, the Serial Sevens task is a complex cognitive test that assesses attention, working memory maintenance and manipulation [38]. By maintaining or improving working memory capacity (as seen here), it would be expected that attention would be improved, thus enhancing the ability to block out distractions during sporting events [28]. ...
Article
The purpose of this study was to compare the separate and combined effects of two practical cooling methods (hand and torso) used prior to exercise on subsequent high-intensity cycling performance in heat. Ten trained male cyclists (V̇O2peak: 65.7 ± 10.7 ml.kg⁻¹.min⁻¹) performed four experimental trials (randomised within-subjects design) involving 30-min of pre-cooling (20-min seated; PRE-COOL, 10 min warm-up; PRE-COOL+WUP), while using a: (1) hand-cooling glove (CG); (2) cooling jacket (CJ); (3) both CG and CJ (CG+J); or (4) no-cooling (NC) control, followed by a cycling race simulation protocol (all performed in 35.0 ± 0.6°C and 56.6 ± 4.5% RH). During the 30-min of pre-cooling, no reductions in core (Tc) or mean skin temperature (Tsk) occurred; however, Tsk remained lower in the CJ and CG+J trials compared to NC and CG (p = 0.002–0.040, d= 0.55–1.01). Thermal sensation ratings also indicated that participants felt “hotter” during NC compared to all other trials during both PRE-COOL and PRE-COOL+WUP (p = 0.001–0.015, d= 1.0–2.19), plus the early stages of exercise (sets 1–2; p = 0.005–0.050, d= 0.56–1.22). Following cooling, no differences were found for absolute Tc and Tsk responses between trials over the entire exercise protocol (p > 0.05). Exercise and cognitive (working memory) performance also did not differ between trials (p = 0.843); however, cognitive performance improved over time in all trials (p < 0.001). In summary, pre-cooling (20-min seated and 10-min warm-up) in heat did not improve subsequent high-intensity cycling performance, cognitive responses and associated thermoregulatory strain (Tc and Tsk) compared to control.
... The SSS task was identical to the STS with the exception that it involved serial subtraction of sevens. These two subtraction tasks aimed at evaluating subjects working memory and attention levels along with the challenge [32]. ...
... Indeed, subtraction of 7 s requires more regrouping (borrowing) than subtraction in 3 s and therefore requires more cognitive demand and different brain region. Moreover, although both tasks have attentional components, SSS tests more heavily rely on working memory and executive function [32]. Further to the STS task, a trend towards an increase in RVIP accuracy without modification of reaction time was observed following PEGB supplementation. ...
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Despite an increasing level of evidence supporting the individual beneficial effect of polyphenols on cognitive performance, information related to the potential synergistic action of these phytonutrients on cognitive performance during a prolonged cognitive effort is currently lacking. This study investigated the acute and sustained action of a polyphenols-rich extract from grape and blueberry (PEGB), on working memory and attention in healthy students during a prolonged and intensive cognitive effort. In this randomised, cross-over, double blind study, 30 healthy students consumed 600 mg of PEGB or a placebo. Ninety minutes after product intake, cognitive functions were assessed for one hour using a cognitive demand battery including serial subtraction tasks, a rapid visual information processing (RVIP) task and a visual analogical scale. Flow-mediated dilation (FMD) and plasma flavan-3-ols metabolites quantification were also performed. A 2.5-fold increase in serial three subtraction variation net scores was observed following PEGB consumption versus placebo (p < 0.001). A trend towards significance was also observed with RVIP percentage of correct answers (p = 0.058). No treatment effect was observed on FMD. Our findings suggest that consumption of PEGB coupled with a healthy lifestyle may be a safe alternative to acutely improve working memory and attention during a sustained cognitive effort.
... In this test, an individual is asked to successively subtract '3' from '100' continuously until instructed to stop. 10 The Serial 3 s test evaluates concentration and attention, as it requires sequential registration, recall and mental manipulation of numbers. It is convenient to administer and easy to grade and was thus considered suitable for use in sideline examination. ...
... The Serial 3 s test is a suitable substitute for MBT as it is a common cognitive test that involves a sequential task and is easy to adminster. 10 Although the Serial 3 s test differs from the MBT by requiring foundational subtraction skills, most individuals with an elementary education or above should be capable. We pilot-tested other alternatives, including the seven-item backward reciting of the colours of the rainbow and enumerating the 12-item Chinese zodiac in reverse order but discarded them. ...
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Objective The aim of this study was to translate, adapt and validate the Sport Concussion Assessment Tool 3rd edition (SCAT3), a test for assessing athletes for concussion, into the Chinese context. Methods Translation and adaptation were performed in several stages, which included forward translation by two independent teams, translation merging, backward translation, reviews by both native Cantonese-speaking and Mandarin-speaking multidisciplinary expert panels (n=49) for semantic and conceptual equivalence and reviews by pitch-side physiotherapists (n=18) as end-users of the SCAT3 and rugby players (n=11) for face validity. The Serial 3 s subtraction test was used as a substitute for the Months Backward Test (MBT) for measures of concentration in the Standardized Assessment of Concussion subscale. English-speaking and Chinese-speaking rugby players (n=52) were recruited to perform these tests to assess the level of difficulty, time for completion and accuracy. Inter-rater and test–retest reliability were assessed in 33 and 38 healthy young individuals, respectively. Results Despite the longer mean completion time (p<0.05) for the Serial 3 s test, no significant difference was found in the percentage accuracy between MBT and the Serial 3 s test. No significant difference was found in either the percentage accuracy or completion time between English-speaking and Cantonese-speaking rugby players. All subscales in the Chinese SCAT3 had excellent levels of inter-rater reliability for all items (ICC 2,1 range: 0.96–0.99) but a low to moderate test–retest reliability (ICC 3,2 range: 0.32–0.65). The mean completion time of the Chinese SCAT3 was 10.6±1.1 min. Conclusion Chinese SCAT3 is a valid instrument for pitch-side assessment of concussed Chinese-speaking athletes.
... STCF-Arithmetic . The SST is a simple test used to examine attention and working memory abilities in older adults or those with cognitive impairment (Bristow et al., 2016;Mirsky et al., 1991). Counting backward is thought to be a simple mental tracking task requiring the subject to hold information regarding a tracking number in mind while reversing the order of a set of numbers. ...
... The failure to count backward is likely caused by an intrusion of the inappropriate routine schema (e.g., the process of counting forward), as counting forward is more acquired and automatic than counting backward (Schneider et al., 2009;Smith, 1967). Serial subtraction was shown as an effective screening approach in a mental status test setting with standardization and norms (Bristow et al., 2016). SST by 3's and 7's both need the cognitive process of subtracting, but SST by 7's places a greater demand on the process since it involves regrouping calculations more frequently than SST by 3's (Raghubar et al., 2010). ...
Preprint
This study aims to compare the effects of multitask (MTT; multiple tasks performed simultaneously) and multicomponent training (MCT; various types of exercise performed sequentially) on processing speed, cognitive functions, gait speed, and balance functions in persons with mild cognitive impairment. Forty-two persons with mild cognitive impairment were randomly allocated to MTT (n = 21) or MCT (n = 21). Outcome measures included processing speed, cognitive functions (attention and executive functions), single-task gait speed, dual-task gait speed (DTGS-Arithmetic and DTGS-Verbal), and balance functions. Processing speed (except inhibition), cognitive functions, gait speed, and balance functions improved in the MTT and MCT groups following training, with no significant differences between the groups in processing speed or cognitive functions. The MCT group improved more on single-task gait speed (F = 15.097; p = .000; r = .270) and DTGS (DTGS-Arithmetic ; F = 10.594; p = .002; r = .214), while the MTT group improved more on balance functions (F = 4.366; p = .043; r = .101). MTT and MCT strategies can be used to improve cognitive and physical outcomes in persons with mild cognitive impairment.
... The designed protocol consisted of three tasks: i) spontaneous walking: the participant walked along a straight path with no obstacles; ii) dual-task walking: the participant walked along a straight path with no obstacles, and, at the same time, performed mathematical calculations loud speaking. The calculations consisted in counting backward of 7 starting from 100 [21][22][23][24]; iii) targeted walking: the participant walked along a straight path with target points to be stepped on and areas of discontinuity to avoid being drawn on the floor. Each task lasted two minutes with a resting period in between. ...
... • We considered the beta band (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and the gamma band (30-60 Hz) contributions. The alpha band was not analyzed since patients after complete spinal cord injury show coherence only in this frequency band, suggesting that the origin of alpha band coherence is likely to be only spinal, thus not including the cortical contribution detected by the EEG [4]. ...
Preprint
A detailed comprehension of the central and peripheral processes underlying walking is essential to develop effective therapeutic interventions to slow down gait decline with age, and rehabilitation strategies to maximize motor recovery for patients with damages at the central nervous system. The combined use of electromyography (EMG) and electroencephalography (EEG), in the framework of coherence analysis, has recently established for neuromotor integrity/impairment assessment. In this study, we propose corticomuscular (EEG-EMG) and inter/intramuscular (EMG-EMG) coherences as measures of the cognitive reserve, i.e., the process whereby a wider repertoire of cognitive strategies, as well as more flexible and efficient strategies, can moderate the manifestation of brain disease/damage. We recorded EEG signals from the main brain source locations and superficial EMG signals from the main leg muscles involved in gait in 16 healthy young adults (age ≤30 years) and 13 healthy elderly (age ≥65 years) during three different overground walking conditions (i.e., spontaneous walking, walking with cognitive dual-task, and walking with targets drawn on the floor). In all conditions, we calculated corticomuscular and inter/intramuscular coherences. We observed higher corticomuscular and inter/intramuscular coherences during targeted walking compared to spontaneous walking in both groups, even if the increase was greater in young people. Considering dual-task walking compared to spontaneous walking, only corticomuscular coherence in the elderly increased. These results suggest age-related differences in cognitive reserve that reflect different abilities to perform complex cognitive or motor tasks during gait. This study demonstrates the feasibility, repeatability, and effectiveness of the proposed method to investigate brain-to-muscle connectivity during different gait conditions, to study the related changes with age, and to quantify the cognitive reserve.
... For the 13's, participants need to subtract the number 13 from the number 100 serially. When subtracting or adding the whole number 13, the ones place digit changes every time, and the tens place a digit change every time as well (for example, 87 − 13 = 74; 74 − 13 = 61; and 61 − 13 = 48), which is more difficult than the 3's and 7's [29][30][31]. ...
Article
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Attention allows us to focus and process information from our environment, and executive function enables us to plan, work, and manage our daily lives. As individuals become older, both of these cognitive abilities decline. It is essential for the elderly to perform more cognitive exercises. Previous studies have shown that arithmetic calculations require attention span and that playing video games requires executive function. Therefore, we developed a serious game involving mental arithmetic calculations specifically for improving attention span and executive functions. Our objective was to analyze the effectiveness of the game and the efficacy of the game’s mechanic factors affecting attention span and executive function in the elderly. Forty elderly volunteers who are over 60 years of age were invited to join an eight-week cognitive training program through an elderly social welfare center. Four assessment tests were used in pre-test and post-test before and after the training period. D-CAT and SAT are used for screening attention span; TMT-A and TMT-B are used for screening executive function. They were instructed to play the game for at least 15 min per day, 5 days per week, for a total of 8 weeks. There were three independent variables (difficulty, pressure, and competition) with two parameters that could be selected. A paired-sample t-test showed the effective results by comparing the pre-test scores and post-test scores of the cognitive training. There were significant improvements in attention span and executive functions. The mixed repeated-measure ANOVA and MANCOVA results showed that two game mechanic factors (difficulty and pressure) had a significant effect and an interaction effect, but the other factor (competition) had a non-significant effect. In conclusion, the game showed a significant enhancement in both attention span and executive functions after training, and the difficulty factor and the pressure factor were shown to have an effect, but the competition factor was shown to have no effect.
... While the inclination for clinicians has been to recognize general categories of impairments according to disease (e.g., bradykinesia and set-switching/attention in PD, dyscoordination and slowed processing speed in MS, hyperkinesia and working memory in HD); the notable heterogeneity of all three diseases and the impairments that are common among them lend support to using systems impairment categories for determining clinical measures and assessment rather than diagnostic criteria. For example, using a serial-7 subtraction task while performing the timed up and go (TUG) task reveals an individual's capability for working memory and attention while walking (Bristow et al., 2016). Alternatively, the Stroop task indicates the ability to selectively inhibit automatic responses in favor of goaldirected ones during functional mobility. ...
Article
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This paper provides a narrative review of cognitive motor interference in neurodegeneration, including brain imaging findings specific to interference effects in neurodegenerative disease, and dual task assessment and intervention in Parkinson’s disease (PD), multiple sclerosis (MS), and Huntington’s disease (HD). In a healthy central nervous system the ability to process information is limited. Limitations in capacity to select and attend to inputs influence the ability to prepare and perform multiple tasks. As a result, the system balances demands, switching attention to the most task-relevant information as it becomes available. Limitations may become more apparent in persons with neurodegenerative diseases (ND) with system-specific impairments in PD, MS, and HD. These ND affect both cognitive and motor function and are thus particularly susceptible to dual task interference. Issues related to performer and task characteristics and implications of these findings for both the standard assessment of dual task abilities as well as development and evaluation of interventions aimed at improving dual task ability are discussed. In addition, we address the need for optimizing individualized assessment, intervention and evaluation of dual task function by choosing cognitive and motor tasks and measures that are sensitive to and appropriate for the individual’s level of function. Finally, we use current evidence to outline a 5-step process of clinical decision making that uses the dual task taxonomy as a framework for assessment and intervention.
... The high correlation coefficient between TUG-CDT and SwayDA suggested that the response to the SwayDA test is not simply the result of the passive receipt of information from peripheral receptors, but is also shaped by central processing (Han et al., 2016). Cognitive dual-task assessments reveal that central processing capabilities utilize working memory and attention capacities of individuals (Bristow et al., 2016) and the TUG-CDT is a common method to assess this interaction (McIsaac et al., 2018). Some studies have provided supportive evidence for the central processing effect on VLSDS. ...
... Gait performance is assessed via ground reaction forces. (3) Serial Threes task: The Serial Threes task is an established measure of updating of working memory [65,66]. Participants stand quietly on the treadmill and look at a fixation cross at the center of the projection screen. ...
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Background Multitasking is an essential part of our everyday life, but performance declines typically in older age. Many studies have investigated the beneficial effects of cognitive, motor and combined cognitive-motor training on multitasking performance in older adults. Previous work, however, has not regarded interindividual differences in cognitive functioning and motor fitness that may affect training benefits. The current study aims to identify whether different training programs may have differential effects on multitasking performance depending on the initial level of cognitive functioning and motor fitness. Methods We conduct a 12-week single-blinded randomized controlled trial. A total of N = 150 healthy older adults are assigned to either a single cognitive, a single motor, or a simultaneous cognitive-motor training. Participants are trained twice per week for 45 min. A comprehensive test battery assesses cognitive functions, motor and cardiovascular fitness, and realistic multitasking during walking and driving in two virtual environments. We evaluate how multitasking performance is related not only to the training program, but also to participants’ initial levels of cognitive functioning and motor fitness. Discussion We expect that multitasking performance in participants with lower initial competence in either one or both domains (cognitive functioning, motor fitness) benefits more from single-task training (cognitive training and/or motor training). In contrast, multitasking performance in participants with higher competence in both domains should benefit more from multitask training (simultaneous cognitive-motor training). The results may help to identify whether tailored training is favorable over standardized one-size-fits all training approaches to improve multitasking in older adults. In addition, our findings will advance the understanding of factors that influence training effects on multitasking. Trial registration DRKS (German Clinical Trials Register), DRKS00022407. Registered 26/08/2020 - Retrospectively registered at https://www.drks.de/drks_web/setLocale_EN.do
... In the current sample, the average number of correct computations was 26.70 (SD ¼ 12.03) and the average number of attempts was 29.17 (SD¼ 11.24). Serial subtraction tasks have been identified as an acceptable proxy for functioning in the cognitive domains of attention and working memory (see a review by Bristow, Jih, Slabich, & Gunn, 2016) and have also been shown to effectively induce stress and cardiovascular reactivity (see review by Krantz & Manuck, 1984). ...
Article
Bullying of medical residents is associated with numerous negative psychological and physiological outcomes. As bullying within this demographic grows, there is increased interest in identifying novel protective factors. Accordingly, the current research investigated whether interpersonal forgiveness buffers the relationship between two forms of workplace bullying and indices of well-being. Medical residents (N = 134, 62% Males) completed measures assessing person and work-related bullying victimization, dispositional forgiveness, and depressive symptoms and underwent a series of cardiovascular assessments during which cardiovascular reactivity was induced by a 3-minute serial subtraction math task. It was hypothesized that the tendency to forgive would be negatively related to bullying victimization and that forgiveness would reduce the association of bullying with psychological distress (i.e. depressive symptoms), cognition errors (i.e. incorrect serial subtraction computations), and exaggerated cardiovascular reactivity and recovery. Findings show that forgiveness reduced the harmful relationship between the two forms of workplace bullying and depressive symptoms, serial subtraction errors, and cardiovascular reactivity and recovery for systolic blood pressure. Study results suggest that forgiveness may serve as an effective means for reducing the outcomes of bullying for medical residents. Implications for forgiveness interventions are discussed. Lay Summary: This research demonstrated that forgiveness reduced the harmful relationship between bullying victimization and negative outcomes (i.e. depressive symptoms, subtraction errors, and exaggerated cardiovascular reactivity and recovery for systolic blood pressure) in medical residents. This study suggests that forgiveness may serve as a protective factor and provide an effective means for reducing the negative association between workplace bullying and negative outcomes.
... Serial-7's was chosen instead of the more common serial-3's subtraction in order to place an even greater demand on the cognitive processes for attention and working memory. 16 19 Three questionnaires were administered (Falls Efficacy Scale International; 20 Freezing of Gait Questionnaire; 21 and Parkinson Disease Questionnaire 39-items Global Index Score, 22 which rates the quality of life from excellent (zero) to very poor (100)). ...
Article
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Objective To evaluate a group-based music intervention in patients with Parkinson’s disease. Design Parallel group randomized controlled trial with qualitative triangulation. Setting Neurorehabilitation in primary care. Subjects Forty-six patients with Parkinson’s disease were randomized into intervention group ( n = 26), which received training with the music-based intervention, and control group ( n = 20) without training. Interventions The intervention was delivered twice weekly for 12 weeks. Main measures Primary outcome was Timed-Up-and-Go subtracting serial 7’s (dual-task ability). Secondary outcomes were cognition, balance, concerns about falling, freezing of gait, and quality of life. All outcomes were evaluated at baseline, post-intervention, and three months post-intervention. Focus groups and individual interviews were conducted with the intervention group and with the delivering physiotherapists. Results No between-group differences were observed for dual-task ability. Between-group differences were observed for Falls Efficacy Scale (mean difference (MD) = 6.5 points; 95% confidence interval (CI) = 3.0 to 10.0, P = 0.001) and for Parkinson Disease Questionnaire-39 items (MD = 8.3; 95% CI = 2.7 to 13.8, P = 0.005) when compared to the control group post-intervention, but these were not maintained at three months post-intervention. Three themes were derived from the interviews: Expectations versus Results, Perspectives on Treatment Contents, and Key Factors for Success. Conclusion Patient-reported outcomes and interviews suggest that the group-based music intervention adds value to mood, alertness, and quality of life in patients with Parkinson’s disease. The study does not support the efficacy in producing immediate or lasting gains in dual-tasking, cognition, balance, or freezing of gait.
... The intellectual task was assessed based on patients' performance in subtracting 7 from 100 successively for 30 seconds. 16 Please cite this article in press as: Gungor S. Gungor et al. ...
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Background Skin conductance response reflects the activity of the sympathetic nervous system and is used to measure acute pain. This pilot study examines correlations of skin conductance response with emotional stressors postoperatively. Methods The correlation of skin conductance response with pain, anxiety, nausea and intellectual task performance was analyzed in postoperative patients. Results Significant correlations were observed between anxiety and pain during physical activity on both postoperative day 1 and 2. No significant correlations were found between skin conductance response versus mild pain, nausea, anxiety or intellectual task performance. Conclusion This pilot study suggests that when the pain is well-controlled in the early postoperative period, skin conductance response monitoring may not be influenced by other emotional stressors.
... The S7 test assesses attention and working memory (Bristow et al., 2016). Participants were required to count down out loud from any random number given (between 900 to 1000) by sevens in 1 min (similar to Hayman, 1942). ...
Article
This study investigated the effects of precooling via crushed ice ingestion on cognitive performance during repeated-sprint cycling in the heat. Nine males, non-heat acclimatised to heat (mean age: 28.2 ± 2.7 y; height: 175.7 ± 9.7 cm; body-mass: 76.9 ± 10.6 kg) completed a 30 min bout of repeated-sprint (36 × 4 s sprints, interspersed with 56 s rest-breaks) on a cycle ergometer in a climate chamber (35°C, 70% relative humidity). Crushed ice ingestion (7g·kg-1, -0.4°C, ICE) or no cooling (CON) interventions were completed at rest, in the climate chamber, 30 min prior to exercise. Working memory was assessed via the serial seven test (S7) and the automated operation span task (OSPAN) at various time points before, during, and post-exercise. Core body temperature (Tc), forehead temperature (Th), and thermal sensation (TS) were assessed throughout the protocol. Working memory significantly declined during exercise in CON as measured by S7 (p = 0.01) and OSPAN (p = 0.03); however, it was preserved in ICE with no change at the end of exercise in either S7 or OSPAN scores compared to baseline (p = 0.50, p = 0.09, respectively). Following precooling, Th (-0.59°C, p < 0.001) and Tc (-0.67°C, p = 0.005) were significantly decreased in ICE compared to CON. At the end of the exercise, ICE significantly reduced Tc compared to CON (p = 0.03), but no significant differences were recorded for Th. Further, TS was lower following precooling in ICE (p = 0.008) but not during exercise. In conclusion, ice ingestion significantly reduced Th and Tc and facilitated maintenance of cognitive performance during repeated-sprint exercise in the heat, which may lead to better decision making.
... Sequential subtracting tasks of serial 3s and serial 7s are commonly used tests of attention and working memory [56] and are widely used in dual-task paradigms [57,58]. Here, participants were asked to recite aloud serial subtractions of 7 or 3, starting from a random 3-digit number, for a period of 30 s. ...
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The present work aimed to evaluate the effect of 3 mg·kg−1 caffeine consumption on the standing and dynamic balance performance of older adults and sought to establish if caffeine ingestion can modulate the influence of a cognitive dual task on balance performance. Twelve apparently healthy participants (8 females) aged >65 years (72 ± 3.7 years) completed the study. Bipedal postural sway, four square step test, timed up and go, Y-balance (anterior reach only) and force-time characteristics of sit-to-stand performance were used to assess standing and dynamic balance. Attention and working memory were assessed using a serial 3s and 7s subtraction task during seated rest and completion of the bipedal standing assessment and Y-balance test. This battery of assessments was completed on two separate occasions, once following the consumption of a non-ergogenic placebo and again following the consumption of 3 mg·kg−1 caffeine. The administration of treatments was randomised, counterbalanced and double-blind. Caffeine reduced performance in the bipedal standing balance assessments, evidenced by an increase in COPML, COPPath, COPVelocity. Performance during the dynamic balance tests was unaffected, other than rate of force development during the sit-to-stand, which was improved following caffeine ingestion. The introduction of a cognitive dual task had either limited effects, or improved facets of bipedal standing balance, whilst performance during the dynamic balance task was significantly reduced. In both balance assessments, there was evidence for a reduction in the performance of the cognitive task when both the balance and cognitive tests were performed simultaneously, with this effect not modulated by caffeine consumption. These findings refute the idea that caffeine ingestion may have positive effects on balance performance. However, despite a caffeine-induced reduction in bipedal standing balance, it is unlikely that caffeine ingestion would exacerbate fall risk given the limited effects in the dynamic balance tests. Future work should establish if these effects are generalisable to older frail participants and if caffeine can modulate the detrimental effects of an acute exercise bout on balance performance.
... In addition, executive functions comprise three core executive components: "updating" (constant monitoring and tracking of working memory representations), "shifting" (switching between tasks or mental sets), and "inhibition" (to deliberately inhibit dominant, automatic, or prepotent responses) (Miyake et al. 2000). For example, the N-back task, a well-known task reported to promote motor adaptation (Kimura and Nakano 2019), is involved in the "updating" function (Bristow et al. 2016;Ogden et al. 2014). In addition, repeat performing the N-back task improves the executive function (Pappa et al. 2020;Soveri et al. 2017). ...
Article
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Motor adaptation plays an important role in the acquisition of new motor skills. It has been reported that cognitive tasks can promote motor adaptation; however, which cognitive tasks effectively promote motor adaptation remains unknown. This study aimed to examine what factors of cognitive tasks contribute to promoting motor adaptation. Forty-two healthy young adults were randomly assigned to one of three groups: incongruent Stroop task group (iSTG), congruent Stroop task group (cSTG), and control group (CG). All participants underwent 20 blocks of a mouse-tracking task on the 1st and 2nd days. Before the mouse tracking task on the 1st day, the iSTG and cSTG completed the incongruent and congruent Stroop tasks, respectively. Participants in the CG did not perform any cognitive tasks. On the 28th day, all participants underwent 3 blocks of the mouse tracking task to evaluate their retention of motor adaptation. As a result, on the 1st day, the mouse tracking task performance improved equally for both groups. However, on the 2nd and 28th days, the mouse tracking task performance in the iSTG showed greater improvements for all blocks compared to those in the CG. These results suggest that the incongruent Stroop task promotes motor adaptation, but the congruent Stroop task does not. In addition, it is suggested that factors, which are primarily involved in the incongruent Stroop task, might promote motor adaptation.
... We speculated that this difference in the results of our study and the previous studies may have been due to the content of the cognitive task constituted of the dual-task. Previous studies have used the serial-subtraction task as the cognitive task (Zhou et al., 2014(Zhou et al., , 2015Wrightson et al., 2015;Manor et al., 2016), which requires the "updating" function (Ogden et al., 2014;Bristow et al., 2016); one of the brain's executive function. The executive function is considered to be composed of three executive core components: "updating (constant monitoring and tracking of working memory representations)", "shifting (switching between tasks or mental sets)", and "inhibition (to deliberately inhibit dominant, automatic, or prepotent responses)" (Miyake et al., 2000). ...
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Recently, some studies revealed that transcranial direct current stimulation (tDCS) reduces dual-task interference. Since there are countless combinations of dual-tasks, it remains unclear whether stable effects by tDCS can be observed on dual-task interference. An aim of the present study was to investigate whether the effects of tDCS on dual-task interference change depend on the dual-task content. We adopted two combinations of dual-tasks, i.e., a word task while performing a tandem task (word-tandem dual-task) and a classic Stroop task while performing a tandem task (Stroop-tandem dual-task). We expected that the Stroop task would recruit the dorsolateral prefrontal cortex (DLPFC) and require involvement of executive function to greater extent than the word task. Subsequently, we hypothesized that anodal tDCS over the DLPFC would improve executive function and result in more effective reduction of dual-task interference in the Stroop-tandem dual-task than in the word-tandem dual-task. Anodal or cathodal tDCS was applied over the DLPFC or the supplementary motor area using a constant current of 2.0 mA for 20 min. According to our results, dual-task interference and the task performances of each task under the single-task condition were not changed after applying any settings of tDCS. However, anodal tDCS over the left DLPFC significantly improved the word task performance immediately after tDCS under the dual-task condition. Our findings suggested that the effect of anodal tDCS over the left DLPFC varies on the task performance under the dual-task condition was changed depending on the dual-task content.
... The second dimension manipulated the Counting Difficulty of the task by having participants employ either serial 2 s (count by 2 s) or serial 3 s (count by 3 s) tasks. Although difficulty in such tasks is typically accomplished using a serial 3 s versus serial 7 s tasks (see Bristow et al., 2016, for a review), pilot work revealed the serial 7 s task to be especially devastating to performance, with the serials 3 s task in and of itself presenting a significant cognitive challenge compared to serials 2 s. Accordingly, we modified this task to employ serial 2 s versus serial 3 s to vary the level of difficulty. ...
Article
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Multitasking is a critical feature of our daily lives. Using a dual-task paradigm, this experiment explored adults’ abilities to simultaneously engage in everyday motor and cognitive activities, counting while walking, under conditions varying the difficulty of each of these tasks. Motor difficulty was manipulated by having participants walk forward versus backward, and cognitive difficulty was manipulated by having participants count forward versus backward, employing either a serial 2 s or serial 3 s task. All of these manipulations were performed in single-task conditions (walk only, count only) and dual-task conditions (walk and count simultaneously). Both motor performance variables (cycle time, stride length, walking velocity) and cognitive variables (counting fluency, counting accuracy) were assessed in these conditions. Analyses of single-task conditions revealed that both motor and cognitive manipulations predictably influenced performance. Analyses of dual-task performance revealed influences of motor and cognitive factors on both motor and cognitive performance. Most centrally, dual-task costs (normalized difference between single- and dual-task conditions) for motor variables revealed that such costs occurred primarily for temporal or spatiotemporal gait parameters (cycle time, walking velocity) and were driven by cognitive manipulations. Dual-task cost analyses for cognitive measures revealed negative dual-task costs, or dual-task benefits, for cognitive performance. Finally, the effects of dual-task manipulations were correlated for motor and cognitive measures, indicating dual-task performance as a significant individual difference variable. These findings are discussed with reference to theories of attentional allocation, as well as the possible role of auditory–motor entrainment in dual-task conditions.
... Both abilities to do mental arithmetic and draw a clock were significantly associated with specific difficulties in reading analogue clocks. MMSE calculation is characterized by mental arithmetic, requires working memory beyond simple attention [20], and is associated with brain activation in both frontal and parietal regions including the precuneus [21]. Compared to digital clock reading, reading the analogue clock with numbers in the present study, especially the minute hand, may require working memory for transformation from location of both hands and actual number on a clock face to current time. ...
Article
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Background: In ageing population, it is desirable to reduce the impact of cognitive decline on daily life. While various types of dementia-friendly environments have been proposed, the question still remains regarding whether analogue or digital clocks are friendlier for people with dementia. Methods: In clinical practice, we normally use our original clock reading test (10 analogue and 10 digital clocks) to assess patients' ability to read a clock. In the present study, a retrospective medical record survey was conducted. Fifty-five participants who had done the test were identified. The result of the test was compared between analogue and digital clocks. Additionally, to assess specific ability to read analogue clocks, an "analogue-digital gap" was defined as the difference between patients' performance for analogue and digital clocks. Univariate and multivariate analyses were conducted to detect significant factors associated with reading ability specific to analogue clocks. Results: The analogue clock proved less readable than the digital clock, even after adjusting for MMSE total score (p = 0.003). Multivariate analysis revealed reading ability of the analogue clock was significantly associated with MMSE calculation and clock drawing test (p = 0.009 and 0.040, respectively). Conclusions: In the present study, the digital clock was friendlier than the analogue clock for patients with dementia. Compared to the digital clock, reading analogue clocks might require more widespread cognition, such as working memory and visuospatial processing. While our finding was a general tendency, and individual assessment is necessary, it might help the development of personalized environmental adjustments.
... The serial seven test (S7) assesses concentration and working memory function (Bristow et al., 2016) and was administered after min 1 during the first 30-min bout of running (baseline) and again at the 27 th min mark of the first and second 30-min bout of running. Here, participants were required to count down aloud, in sevens, from a random number provided to them (between 900 to 1000) for 1 min. ...
Article
his study assessed the effectiveness of head cooling during exercise in the heat on cognitive performance, either alone or with ice ingestion. Ten healthy males, non-acclimatized to heat, ran (70% V̇O2peak) for 2×30 min in heat (35 ± 0.9°C, 68.2 ± 6.9% RH). Participants completed 3 trials: 10 min of head cooling during exercise (HC); precooling with crushed ice (7gikg-1) and head cooling during exercise (MIX); or no-cooling/control (CON). Working memory was assessed using the automated operation span task (OSPAN) and serial seven test (S7). Following MIX, S7 scores were improved compared to CON (12 ± 9.5, p = 0.004, d = 1.42, 0.34-2.28) and HC (4 ± 5.5, p = 0.048, d = 0.45, -0.47 to 1.3) during exercise. Moderate to large effect sizes were recorded for S7 and OSPAN following MIX and HC compared to CON, suggesting a tendency for improved cognitive performance during exercise in heat. Following precooling (MIX), core body temperature (Tc) and forehead temperature (Th) were lower compared to baseline (-0.75 ± 0.37°C, p < 0.001; -0.31 ± 0.29°C, p = 0.008, respectively) but not in HC or CON (p > 0.05). Thermal sensation (TS) was lower in MIX and HC compared to CON during exercise (p < 0.05). The reduction in Tc, Th and TS with MIX may have attenuated the effect of heat and subsequently improved working memory during exercise in heat.
... Lower limb prosthesis users report the need to concentrate during ambulation [19], [24]. This is incorporated in the safety protocol by including dual-task paradigms such as serial subtraction, in which the participant is asked to count backwards by threes or sevens from a random starting number while performing another task such as standing or walking [25]. Advancing from a less to more challenging environment, for example from the small circuit in the laboratory setting to the larger circuit in the real-world setting, also considers the cognitive workload of the individual as an important safety component. ...
Conference Paper
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In research on lower limb prostheses, safety during testing and training is paramount. Lower limb prosthesis users risk unintentional loss of balance that can result in injury, fear of falling, and overall decreased confidence in their prosthetic leg. Here, we present a protocol for managing the risks during evaluation of active prosthetic legs with modifiable control systems. We propose graded safety levels, each of which must be achieved before advancing to the next one, from laboratory bench testing to independent ambulation in real-world environments.
... Gait performance is assessed via ground reaction forces. (3) Serial Threes task: The Serial Threes task is an established measure of updating of working memory (59,60). Participants stand quietly on the treadmill and look at a xation cross at the center of the projection screen. ...
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Background Multitasking is an essential part of our everyday life, but performance declines typically in older age. Many studies have investigated the beneficial effects of cognitive, motor and combined cognitive-motor training on multitasking performance in older adults. Previous work, however, has not regarded interindividual differences in cognitive functioning and motor fitness that may affect training benefits. The current study aims to identify whether different training programs may have differential effects on multitasking performance depending on the initial level of cognitive functioning and motor fitness. Methods We conduct a 12-week single-blinded randomized controlled trial. A total of N = 150 healthy older adults are assigned to either a single cognitive, a single motor, or a simultaneous cognitive-motor training. Participants are trained twice per week for 45 min. A comprehensive test battery assesses cognitive functions, motor and cardiovascular fitness and realistic multitasking during walking and driving in two virtual environments. We evaluate how multitasking performance is related not only to the training program, but also to participants’ initial levels of cognitive functioning and motor fitness. Discussion We expect that multitasking performance in participants with lower initial competence in either one or both domains (motor fitness, cognitive functioning) benefits more from single-task training (cognitive training and/or motor training). In contrast, multitasking performance in participants with higher competence in both domains should benefit more from multitask training (simultaneous cognitive-motor training). The results may help to identify whether tailored training is favorable over standardized one-size-fits all training approaches to improve multitasking in older adults. In addition, our findings will advance the understanding of factors that influence training effects on multitasking. Trial registration DRKS (German Clinical Trials Register), DRKS00022407. Registered 26/08/2020 - Retrospectively registered at https://www.drks.de/drks_web/setLocale_EN.do
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Background: Skin conductance response reflects the activity of the sympathetic nervous system and is used to measure acute pain. This pilot study examines correlations of skin conductance response with emotional stressors postoperatively. Methods: The correlation of skin conductance response with pain, anxiety, nausea and intellectual task performance was analyzed in postoperative patients. Results: Significant correlations were observed between anxiety and pain during physical activity on both postoperative day 1 and 2. No significant correlations were found between skin conductance response versus mild pain, nausea, anxiety or intellectual task performance. Conclusion: This pilot study suggests that when the pain is well-controlled in the early postoperative period, skin conductance response monitoring may not be influenced by other emotional stressors.
Article
Objective To compare participants with Parkinson’s disease (PD) motor subtypes, postural instability with gait difficulty (PIGD) (n=46) and tremor dominant (TD) (n=28) in cognitive and motor-cognitive assessments with the purpose of identifying associations between subtype and visuospatial, whole-body spatial, inhibition/switching, and planning/organizational aspects of cognitive and motor-cognitive function. Design Retrospective cohort study. Fisher’s exact test was used for categorical variables, while two-sample independent t tests were used to analyze continuous variables. Setting Assessments took place at [Institution blinded for review]. Participants Participants (n=72) were aged 40 years and older, had a clinical diagnosis of PD, exhibited three of the four cardinal signs of PD, had shown benefit from antiparkinsonian medications, and were in Hoehn and Yahr stages I-IV. Participants could walk three meters or more with or without assistance. Interventions Not applicable. Main Outcome Measures Balance and mobility tests included Fullerton Advanced Balance Scale and the time needed to turn 360 degrees. Cognitive assessments included Montreal Cognitive Assessment (MoCA), Brooks Spatial Memory Task, Color-Word Interference Test, Tower of London, Trail Making Test, Corsi Blocks, Serial Three Subtractions, and Body Position Spatial Task. Motor-cognitive function measures included Four Square Step Test and Timed Up and Go. Results PIGD participants performed lower than TD on mental status (p = .005), spatial memory (p = .027), executive function (p = .0001 - .034), and visuospatial ability (p = .048). Conclusions Findings suggest that PIGD subtype is linked to greater deficits in spatial cognition, attentional flexibility and organizational planning, and whole-body spatial memory domains. These findings support the need for more personalized approaches to clinically managing PD.
Article
The present study expands on current understanding of dual-task cognitive-motor interference, by including cortical activation measures to both traditional and ecologically valid dual-task paradigms. Fifteen individuals with multiple sclerosis and 14 control participants underwent mobility testing while wearing functional near-infrared spectroscopy. In the absence of increased prefrontal cortical activation, subjects with multiple sclerosis performed significantly worse on measures of cognition under both single- and dual-task conditions. These findings suggest that persons with multiple sclerosis may be unable to allocate additional cortical resources to cognition under dual-task conditions, leading to significant cognitive-motor interference and decrements in performance. This study is the first to investigate cortical activation across several commonly used and ecologically valid dual-task assessments.
Article
Objectives Health education may improve health in geriatric patients. To evaluate differences between remote and in-person education, the DREAMS ( Developing a Research Participation Enhancement and Advocacy Training Program for Diverse Seniors) health seminar series compared in-person and remote learning groups to assess feasibility, satisfaction, adherence, health literacy, and cognitive outcomes. Research Design Nonrandomized two-arm interventions occurred remotely or in-person. About 130 diverse, older adults ( M age: 70.8 ± 9.2 years; in-person n = 95; remote, n = 35) enrolled. Data from 115 completers (In-person n = 80; Remote n = 35) were analyzed for performance outcomes. Feasibility, adherence, and satisfaction benchmarks were evaluated at baseline, immediately post intervention, and 8 weeks post intervention. Adjusting for baseline performances, outcomes on health literacy and cognitive measures were compared between groups after intervention (at posttest and at 8-week follow-up) using adjusted mean differences (β coefficients). Results Eighty in-person and all remote participants completed at least six modules. Both programs had high satisfaction, feasibility, and strong adherence. After adjusting for demographic covariates and baseline values, cognitive and motor cognitive measures between groups were domain specific (e.g., global cognition, executive function, spatial memory, mental tracking capacity, and cognitive integration). Discussion and Implications This work explores feasible measures of knowledge acquisition and its link to health literacy and cognitive outcomes. Identifying effective delivery methods may increase involvement in clinical research. Future studies may encourage remote learning for increased accessibility.
Article
Questions What are the degree and pattern of dual-task interference during walking in people after stroke? How do these vary with disease chronicity and different component tasks in people after stroke? How does dual-task interference differ between people after stroke and people without stroke? Design Systematic review with meta-analysis of studies reporting gait-related dual-task interference. Participants People after stroke and people without stroke. Outcome measures Measures of walking and secondary (cognitive or manual) task performance under dual-task conditions relative to those under single-task conditions. Results Seventy-six studies (2,425 people after stroke and 492 people without stroke) were included. Manual and mental tracking tasks imposed the greatest dual-task interference on gait speed, although there was substantial uncertainty in these estimates. Among mental tracking tasks, the apparently least-complex task (serial 1 subtractions) induced the greatest dual-task interference (−0.17 m/s, 95% CI −0.24 to −0.10) on gait speed, although there was substantial uncertainty in these estimates. Mutual interference (decrement in both walking and secondary component task performances during dual-tasking) was the most common dual-task interference pattern. The results of the sensitivity analyses for studies involving people with chronic stroke were similar to the results of the primary analyses. The amount of dual-task interference from a mental tracking or manual task during walking was similar between people with or without stroke. Conclusions The degree and pattern of dual-task interference vary with the choice of component tasks. When evaluating limitations to functional mobility during dual-tasking conditions and in planning interventions accordingly, clinicians should select dual-task assessments that correspond to the daily habits and physical demands of people after stroke. Registration CRD42017059004.
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This study identified cognitive processes that underlie individual differences in working memory (WM) and mathematical problem-solution accuracy in elementary school children at risk and not at risk for serious math difficulties (SMD). A battery of tests was administered that assessed problem solving, achievement, and cognitive processing in children in first (N = 130), second (N = 92) and third grades (N = 131). The results were that (a) younger children and children at risk for SMD performed poorer on WM and problem-solving tasks, as well as measures of math calculation, reading, semantic processing, phonological processing, and inhibition, than older children and children not at risk for SMD and (b) WM predicted solution accuracy of word problems independent of measures of fluid intelligence, reading skill, math skill, knowledge of algorithms, phonological processing, semantic processing,'speed, shortterm memory, and inhibition. The results support the notion that the executive system is an important predictor of children's problem solving. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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A model for conceptualizing the components or elements of attention is presented. The model substitutes for the diffuse and global concept of attention a group of four processes and links them to a putative system of cerebral structures. Data in support of the model are presented; they are derived from neuropsychological test scores obtained from two samples, the first consisting of 203 adult neuropsychiatric patients and normal control subjects, and the second, an epidemiologically-based sample of 435 elementary school children. Principal components analyses of test scores from these two populations yielded similar results: a set of independent elements of attention that are assayed by different tests. This work presents a heuristic for clinical research in which the measurement of attention is essential.
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The Mini-Mental State Examination (MMSE) is a widely used screening test for cognitive impairment in older adults. Because the guidelines for its application are brief, the administration and scoring of the test can vary between different individuals. This can diminish its reliability. Furthermore, some of the items must be changed to accommodate different settings, such as the clinic, home, or hospital. Because there are no time limits, it is not clear how long one should wait for a reply to a question. It is also not clear how one deals with answers that are "near misses." The goal of the Standardized Mini-Mental State Examination (SMMSE) was to impose strict guidelines for administration and scoring to improve the reliability of the instrument. The reliability of the MMSE was compared with the reliability of the SMMSE in 48 older adults who had the tests administered by university students on three different occasions to assess the interrater and intrarater reliability of the tests. The SMMSE had significantly better interrater and intrarater reliability compared with the MMSE: The interrater variance was reduced by 76% and the intrarater variance was reduced by 86%. It took less time to administer the SMMSE compared with the MMSE (average 10.5 minutes and 13.4 minutes, respectively). The intraclass correlation for the MMSE was .69, and .9 for the SMMSE. Administering and scoring the SMMSE on a task-by-task basis are discussed.
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Although frequently mentioned in contemporary neuropsychology, the term executive functioning has been a source of considerable confusion. One way in which the meaning of a variable can be investigated involves examining its pattern of relations with established cognitive abilities. This method was applied to a variety of variables hypothesized to assess executive functioning in 2 data sets, 1 consisting of 328 adults between 18 and 93 years of age and a 2nd composite data set based on nearly 7,000 healthy adults between 18 and 95 years of age. Most of the hypothesized executive functioning variables were strongly related to reasoning and perceptual speed abilities, and very few had any unique relations with age after taking into consideration the relations of age through the cognitive abilities. These results raise questions about the extent to which neuropsychological tests of executive functioning measure a distinct dimension of variation in normal adults.
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Functional magnetic resonance imaging (FMRI) experiments frequently administer substantially adapted cognitive tests. This study was designed to identify FMRI correlates of a well-standardized clinical measure presented with minor adaptations. We administered the WAIS-III Symbol Search (SS) and a visuospatial control task to fifteen adults during FMRI. SS-related brain activity was identified, followed by analyses of activity related to performance level. Compared to the control task, SS was associated with greater activity in bilateral medial occipital, occipitoparietal, occipitotemporal, parietal, and dorsolateral prefrontal cortices (DLPFC). Across both tasks, slower processing speed was also related to greater activity in these areas, except right DLPFC. Greater activity in left DLPFC was specifically related to slower processing speed during SS. Performance was consistent with education levels. Findings suggest that SS performance involves regions associated with executive and visual processing. Furthermore, slower SS performance was related to greater recruitment of left hemisphere regions associated with executive function in other studies.
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Concussion and mild traumatic brain injury (mTBI) are common clinical problems. However, the literature is not consistent in defining how concussion and mTBI are related. Although most patients with concussion recover within days to weeks, approximately 10% develop persistent signs and symptoms of post-concussion syndrome (PCS). There are no scientifically established treatments for concussion or PCS and thus rest and cognitive rehabilitation are traditionally applied, with limited effectiveness. This article presents a clinical model to suggest that concussion evolves to become mTBI after PCS has developed, representing a more severe form of brain injury. The basic pathophysiology of concussion is presented, followed by a recommended approach to the clinical evaluation of concussion in the emergency department and the physician's office. We evaluate the limited evidence-based pharmacologic treatment of acute concussion symptoms and PCS symptoms and also discuss return to activity recommendations, with an emphasis on athletes. Lastly, we suggest a promising new direction for helping patients recover from PCS.
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Simplified explanation of exam procedures such as assessment of level of consciousness, language acuity, memory, and attention Pocket card summarizes the main points to remember in assessing mental status in limited patient-contact time DSM-IV diagnostic criteria are covered to ease filling out insurance forms Findings about cognition and testing a patient's mental function Covers the refinement of testing procedures and the psychological test battery to speed up the exam Presents age-related norms, important when assessing the elderly for early dementia Reviews ways to use the exam as a screening procedure, particularly when diagnosing dementia and differentiating between organic and functional disorders
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Objective: To evaluate the ability of uninjured high school athletes to pass three mental status tests that are commonly used on the sidelines for the evaluation of concussions: the serial sevens test, the serial threes test, and recitation of months of year in reverse order (MOYR). Participants: High school student athletes in grades 9, 10, 11, and 12 having sports preparticipation physical examinations. The initial study tested 522 consecutive athletes. The follow-up study tested 109 consecutive athletes. Intervention: The athletes of the initial group were asked to perform a serial sevens test, followed by a serial threes test, and finally to recite the MOYR. The second group was asked to perform the same tests in a random order. Main Outcome Measures: Participants were given 1-min time limits for each test, with passing defined as either 7 consecutive correct iterations or 11 correct with one mistake. Results: For the initial group, 51.3% successfully performed serial sevens, 78.7% successfully performed serial threes, and 89.5% successfully recited the MOYR. For the second group, 52.7% successfully performed serial sevens, 78.1% success-fully performed serial threes, and 88.9% successfully recited the MOYR. The pass rates were significantly different for both groups. The pass rates were similar for both sexes, all grade levels, and all sports in both test groups. Participants, both overall and in all subgroups, failed serial sevens more often than serial threes and MOYR (p < 0.001 for the initial group; p < 0.0001 for the second group). They failed serial threes more often than MOYR (p < 0.001 for the initial group; p < 0.01 for the second group). Conclusions: The percentage of uninjured high school athletes successfully completing serial sevens is too low to make the test useful for evaluation of concussion; the test lacks specificity. The percentage of athletes passing the MOYR was greatest, perhaps making this a better sideline test than the traditional serial sevens test. However, testing needs to be done in injured athletes before clinical application can be recommended.
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One of the prime necessities for the clinical psychiatrist in the completion of a mental examination is a quickly applicable and reasonably accurate test for the measurement of intellectual efficiency and the estimation of the degree of mental impairment. Most of the available psychologic tests are time consuming and require special technics, and not infrequently special training, for their application. The serial subtraction of 7 from 100 has been found to fulfil the essential requirements, and the purpose of this paper is to establish the standardization and thus to provide a basis of comparison for the results, which heretofore have been impressionistically interpreted. The successful performance of the test depends on the subject's ability to comprehend and utilize simple mathematical concepts involving symbolism and abstractions. As such, in addition to factors of memory and learning, it requires particularly abstract thinking ability. In a previous paper1 the evolution and development
Chapter
Working memory is currently a 'hot' topic in cognitive psychology and neuroscience. Because of their radically different scopes and emphases, however, comparing different models and theories and understanding how they relate to one another has been a difficult task. This volume offers a much-needed forum for systematically comparing and contrasting existing models of working memory. It does so by asking each contributor to address the same comprehensive set of important theoretical questions on working memory. The answers to these questions provided in the volume elucidate the emerging general consensus on the nature of working memory among different theorists and crystallize incompatible theoretical claims that must be resolved in future research. As such, this volume serves not only as a milestone that documents the state-of-the-art in the field but also as a theoretical guidebook that will likely promote new lines of research and more precise and comprehensive models of working memory.
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The hypothesis of decay of the memory trace as a cause of forgetting has been unpopular. The reasons for this unpopularity are criticized and a theory of the memory span, based on this hypothesis, is put forward. Three experiments which test the hypothesis are described. In each, two kinds of stimuli are presented to the subject, viz., “required” stimuli, which he attempts to remember, and “additional” stimuli, to which he merely makes responses. The first experiment will show that even when the number of required stimuli is well below the memory span, forgetting occurs if the presentation of additional stimuli delays recall for several seconds. The second shows that the effect of the additional stimuli depends only slightly on their similarity to the required stimuli: it also shows that their effect is negligible when they precede, instead of follow, the required stimuli. The third shows that the effect of additional stimuli interpolated before recall remains considerable even when there is an interval of several seconds between presentation of required and additional stimuli.
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Data from the National Education Longitudinal Study of 1988 (NELS:88) national samples were used to investigate gender differences in mathematics achievement. Gender differences were not found when total-group means were compared. When the high end of math score distributions was examined, however, noteworthy gender differences favoring male students emerged. These differences became larger from the 8th grade to the 12th grade and were more prominent at more extreme score ranges. The trends were consistent for Whites, Asians, and Hispanics, but not for African Americans. The observed gender differences for students at the high end of the math score distributions are important because these students are likely to consider pursuing careers in science, mathematics, and engineering. Gender differences at the high end of the math score distributions are likely to be one reason for the gender imbalance in the flow of new students into science and engineering careers.
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Working memory refers to a mental workspace, involved in controlling, regulating, and actively maintaining relevant information to accomplish complex cognitive tasks (e.g. mathematical processing). Despite the potential relevance of a relation between working memory and math for understanding developmental and individual differences in mathematical skills, the nature of this relationship is not well-understood. This paper reviews four approaches that address the relation of working memory and math: 1) dual task studies establishing the role of working memory during on-line math performance; 2) individual difference studies examining working memory in children with math difficulties; 3) studies of working memory as a predictor of mathematical outcomes; and 4) longitudinal studies of working memory and math. The goal of this review is to evaluate current information on the nature of the relationship between working memory and math provided by these four approaches, and to present some of the outstanding questions for future research.
Article
Individual differences in reading comprehension may reflect differences in working memory capacity, specifically in the trade-off between its processing and storage functions. A poor reader's processes may be inefficient, so that they lessen the amount of additional information that can be maintained in working memory. A test with heavy processing and storage demands was devised to measure this trade-off. Subjects read aloud a series of sentences and then recalled the final word of each sentence. The reading span, the number of final words recalled, varied from two to five for 20 college students. This span correlated with three reading comprehension measures, including verbal SAT and tests involving fact retrieval and pronominal reference. Similar correlations were obtained with a listening span task, showing that the correlation is not specific to reading. These results were contrasted with traditional digit span and word span measures which do not correlate with comprehension.
Article
to examine racial differences in (a) the prevalence of financial exploitation and psychological mistreatment since turning 60 and in the past 6 months and (b) the experience-perpetrator, frequency, and degree of upset-of psychological mistreatment in the past 6 months. random digit dial telephone recruitment and population-based survey (telephone and in-person) of 903 adults aged 60 years and older in Allegheny County (Pittsburgh), Pennsylvania (693 non-African American and 210 African American). Covariates included sex, age, education, marital status, household composition, cognitive function, instrumental activities of daily living/activities of daily living difficulties, and depression symptoms. prevalence rates were significantly higher for African Americans than for non-African Americans for financial exploitation since turning 60 (23.0% vs. 8.4%) and in the past 6 months (12.9% vs. 2.4%) and for psychological mistreatment since turning 60 (24.4% vs. 13.2%) and in the past 6 months (16.1% vs. 7.2%). These differences remained once all covariates were controlled in logistic regression models. There were also racial differences in the experience of psychological mistreatment in the past 6 months. Risk for clinical depression was also a consistent predictor of financial exploitation and psychological mistreatment. although the results will need to be replicated in national surveys, the study suggests that racial differences in elder mistreatment are a potentially serious issue deserving of continued attention from researchers, health providers, and social service professionals.
Article
We used functional magnetic resonance imaging (fMRI) to explore the patterns of brain activation associated with different levels of performance in exact and approximate calculation tasks in well-defined cohorts of children with mathematical calculation difficulties (MD) and typically developing controls. Both groups of children activated the same network of brain regions; however, children in the MD group had significantly increased activation in parietal, frontal, and cingulate cortices during both calculation tasks. A majority of the differences occurred in anatomical brain regions associated with cognitive resources such as executive functioning and working memory that are known to support higher level arithmetic skill but are not specific to mathematical processing. We propose that these findings are evidence that children with MD use the same types of problem solving strategies as TD children, but their weak mathematical processing system causes them to employ a more developmentally immature and less efficient form of the strategies.
Article
The need for a measure of severity of concussion apart from duration of post-traumatic amnesia is examined. The paced auditory serial-addition test, a measure of rate of information processing, is presented as a convenient test for estimating individual performance during recovery. Procedures for administration and control data are given, and the programme used for managing the rehabilitation of concussion patients described.
Article
MANY CURRENT neurological texts continue to recommend the inclusion of the serial sevens test (counting backward from 100 in sevens) in neurologic examinations of the mental function of patients with suspected or confirmed brain lesions. Hayman1 (1942) administered this test to 580 adult psychiatric patients and concluded that it was a quick and reasonably accurate test for assessing intellectual efficiency or deterioration in patients with psychiatric and neurologic disorders. Hayman also compared patterns of errors of the adult psychiatric patients with errors of 433 normal male and female school children between the ages of 8 and 15 years, and he described four identical patterns of errors in the two populations. However, the origins, rationale, and validity of this now conventional neurological test have rarely been reviewed.In 1966, Luria2,3 described serial sevens as an important neurologic diagnostic aid in many cases becauseThis test makes particularly high
Article
The serial subtraction of seven beginning with the number 100 is a conventional part of mental status evaluation of patients. My observations of its administration by medical students and residents clearly indicates they do not administer it as originally described, eg, not done as a timed test, nor do they know how to interpret the results obtained. Hayman1 proposed the test in 1942 as a "two minute clinical test for measurement of intellectual impairment in psychiatric disorders," stating the following: The test is administered orally, the subject being asked to take 7 away from 100, to take 7 away from the answer obtained, and so on. The subjects are placed as much at ease as possible and encouragement is freely given, but no assistance. Each subtraction is considered as a unit and calculations are made on the basis of the 14 possible correct subtractions, that is 93-86-79-72-65-58-51-44-37-30-23-16-9-2. Answers more
Article
It is widely accepted nowadays that some kind of neurological abnormality msu be responsible for the symptoms of autism (impairments of language and social interaction, limitations of the behavioral repertoire). This paper focus on selected recent studies to show how a neuropsychological approach to autistic symtoms can provide new ways of analysing cognitive deficits in this syndrome, which may guide the search for neurological correlates of the disorder using more direct techniques.
Article
To evaluate the ability of uninjured high school athletes to pass three mental status tests that are commonly used on the sidelines for the evaluation of concussions: the serial sevens test, the serial threes test, and recitation of months of year in reverse order (MOYR). High school student athletes in grades 9, 10, 11, and 12 having sports preparticipation physical examinations. The initial study tested 522 consecutive athletes. The follow-up study tested 109 consecutive athletes. The athletes of the initial group were asked to perform a serial sevens test, followed by a serial threes test, and finally to recite the MOYR. The second group was asked to perform the same tests in a random order. Participants were given 1-min time limits for each test, with passing defined as either 7 consecutive correct iterations or 11 correct with one mistake. For the initial group, 51.3% successfully performed serial sevens, 78.7% successfully performed serial threes, and 89.5% successfully recited the MOYR. For the second group, 52.7% successfully performed serial sevens, 78.1% successfully performed serial threes, and 88.9% successfully recited the MOYR. The pass rates were significantly different for both groups. The pass rates were similar for both sexes, all grade levels, and all sports in both test groups. Participants, both overall and in all subgroups, failed serial sevens more often than serial threes and MOYR (p < 0.001 for the initial group; p < 0.0001 for the second group). They failed serial threes more often than MOYR (p < 0.001 for the initial group; p < 0.01 for the second group). The percentage of uninjured high school athletes successfully completing serial sevens is too low to make the test useful for evaluation of concussion; the test lacks specificity. The percentage of athletes passing the MOYR was greatest, perhaps making this a better sideline test than the traditional serial sevens test. However, testing needs to be done in injured athletes before clinical application can be recommended.
Article
Serial subtraction by seven (Serial Seven Test, SST) is frequently used in mental status evaluation for dementia as a measure of concentration. Validation research on the SST has been limited. The literature to date raises significant concern about the nature of the procedure. The purpose of the present study was to evaluate the nature and validity of the SST. The participants were 80 consecutive outpatient referrals to the neuropsychology consultation service of two large general medical hospitals. All subjects were administered a comprehensive neuropsychological assessment battery, including the Mini Mental State Examination version of the SST. Multiple regression analysis indicated that calculation skill is at least as important as concentration, in predicting SST performance. Measures of overall level of cognitive dysfunction, education, and psychopathology were unrelated to SST performance. The results suggest that SST performance is heavily influenced by basic arithmetic skill and that the procedure should be used with caution as a measure of concentration or other nonacademic mental abilities.
Article
Though many neuroscientific methods have been brought to bear in the search for functional specializations within prefrontal cortex, little consensus has emerged. To assess the contribution of functional neuroimaging, this article reviews patterns of frontal-lobe activation associated with a broad range of different cognitive demands, including aspects of perception, response selection, executive control, working memory, episodic memory and problem solving. The results show a striking regularity: for many demands, there is a similar recruitment of mid-dorsolateral, mid-ventrolateral and dorsal anterior cingulate cortex. Much of the remainder of frontal cortex, including most of the medial and orbital surfaces, is largely insensitive to these demands. Undoubtedly, these results provide strong evidence for regional specialization of function within prefrontal cortex. This specialization, however, takes an unexpected form: a specific frontal-lobe network that is consistently recruited for solution of diverse cognitive problems.
Article
The trailblazing research on sleep mechanisms and petit mal epilepsy, conducted during the period from 1940 through 1970, illuminated the brain substrate for normal consciousness and attention, as well as their disorders. This research helped inform and structure our neuropsychologically based model of the "elements" of attention. The model has been used to assess attention in the research laboratory and clinic, and has led to a "nosology of disorders of attention," which is presented here in preliminary form. The nosology reviews the possible causes of the symptom(s) of impaired attention, as well as suggesting a blueprint for future research in this area.
Article
Event-related fMRI was used to investigate the hypothesis that neural activity involved in response inhibition depends upon the nature of the response being inhibited. Two different Go/No-go tasks were compared-one with a high working memory load and one with low. The 'simple' Go/No-go task with low working memory load required subjects to push a button in response to green spaceships but not red spaceships. A 'counting' Go/No-go task (high working memory load) required subjects to respond to green spaceships as well as to those red spaceships preceded by an even number of green spaceships. In both tasks, stimuli were presented every 1.5 s with a 5:1 ratio of green-to-red spaceships. fMRI group data for each task were analyzed using random effects models to determine signal change patterns associated with Go events and No-go events (corrected P< or =0.05). For both tasks, Go responses were associated with signal change in the left primary sensorimotor cortex, supplementary motor area (SMA) proper, and anterior cerebellum (right>left). For the simple task, No-go events were associated with activation in the pre-SMA; the working memory-loaded 'counting' task elicited additional No-go activation in the right dorsolateral prefrontal cortex. The findings suggest that neural contributions to response inhibition may be task dependent; the pre-SMA appears necessary for inhibition of unwanted movements, while the dorsolateral prefrontal cortex is recruited for tasks involving increased working memory load.
Article
The investigation is concerned with individual items instead of lists. "Forgetting over intervals measured in seconds was found. The course of retention after a single presentation was related to a statistical model. Forgetting was found to progress at differential rates dependent on the amount of controlled rehearsal of the stimulus. A portion of the improvement in recall with repetitions was assigned to serial learning within the item, but a second kind of learning was also found." (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Article
The digits forward (DF) and backward (DB) tasks are widely used neuropsychological measures believed to tap overlapping systems of phonological processing and working memory. Studies of focal brain lesions have partially elucidated the brain regions essential for these tasks; however relatively little information exists on the underlying functional neuroanatomy in the intact brain. We therefore examined the shared and separate neural systems of these tasks in two positron emission tomography (PET) experiments. In Experiment 1, eight healthy participants performed verbal DF, DB, and a sensorimotor control task during measurement of regional cerebral blood flow (rCBF). DF and DB each activated frontal, parietal, and cerebellar regions as well as prominently activating medial occipital cortex. To eliminate possible visuospatial confounds, Experiment 2 replicated the first experiment in six additional healthy participants who were blindfolded during the study. No differences in activation were found between the two experimental groups. Combined data from both experiments demonstrate that DF and DB rely upon a largely overlapping functional neural system associated with working memory, most notably right dorsolateral prefrontal cortex (DLPFC) and bilateral inferior parietal lobule (IPL) as well as the anterior cingulate, a region associated with attentional effort. The degree of activation increased linearly with increasing task difficulty in DF. DB additionally recruited bilateral DLPFC, left IPL, and Broca's area. Medial occipital cortex (including higher and lower visual processing areas) was robustly activated in both DF and DB and could not be attributed to visual processing per se, suggesting a possible visual imagery strategy for these aural-verbal tasks.
Article
MRI scans measured white matter lesion prevalence (WMLP) in 65 people ages 65-84 years who also took 17 cognitive tests: 3 tests of general fluid intelligence, 3 of vocabulary, 2 of episodic and 3 of working memory, 2 of processing speed, and 4 of frontal and executive function. Entry of age with WMLP into regression equations as predictors of test scores showed that inferences about the functional relationships between markers of brain aging and cognitive impairments are seriously misleading if they are based on simple correlations alone. A new finding that WMLP accounts for all of the age-related variance between individuals in tests of speed and executive ability but for none of the age-related variance in intelligence revises current hypotheses that gross brain changes affect general fluid intelligence and other mental abilities solely through their effects on information-processing speed.
NAEP trends in academic progress: Three decades of student performance
  • J R Campbell
  • C M Hombo
  • J Mazzeo
Concussion recognition and response. Lutz, FL: Psychological Assessment Resources
  • G Gioia
  • J Mihalik
Models of working memory: Mechanisms of active maintenance and executive control
  • A Baddeley
  • R Loggie
Screening test for the Luria-Nebraska neuropsychological battery: Adult form, administration & scoring booklet
  • C Golden
Concussion assessment and response (sports version). Lutz, FL: Psychological Assessment Resources
  • J Mihalik
  • G Gioia