Brian T. Harel

Voice Acoustical Measurement of the Severity of Major Depression.

A number of empirical studies have documented the relationship between quantifiable and objective acoustical measures of voice and speech, and clinical subjective ratings of severity of Major Depression. To further explore this relationship, speech samples were extracted from videotape recordings of structured interviews made during the administration of the 17-item Hamilton Depression Rating Scale (HDRS; ). Pilot data were obtained from seven subjects (five males, two females) from videotapes that have been used to train expert raters on the administration and scoring of the HDRS. Several speech samples were isolated for each subject and processed to obtain the acoustic measurements. Acoustic measures were selected on the basis that they were correlated with HDRS ratings of symptom severity as seen under ideal voice recording conditions in previous studies. Our findings corroborate earlier reports that speaking rate is well correlated (negatively) with HDRS scores, with a strong correlation and nearly significant trend seen for the measure of pitch variability. A moderate pairwise correlation between percent pause time and HDRS score was also revealed, although this relationship was not statistically significant. The results from this cross-sectional study further demonstrate the ability of voice and speech signal analyses to objectively track severity of depression. In the present case, it is suggested that this relationship is robust enough to be found despite the less than ideal recording conditions and equipment used during the original videotape recording. Voice acoustical analyses may provide a powerful compliment to the standard clinical interview for depression. Use of such measures increases the range of techniques that are available to explore the neurobiological substrates of Major Depression, its treatment, and the dynamic interplay of the systems that govern the motor, cognitive, and emotional aspects of speech production.

Subjective Memory Complaints, Cognitive Performance, and Psychological Factors in Healthy Older Adults

Objective: To determine whether subjective memory complaints (SMCs) are associated with performance on objective cognitive measures and psychological factors in healthy, community-dwelling older adults. Method: The cohort was composed of adults, 65 years and older with no clinical evidence of cognitive impairment (n = 125). Participants were administered: CogState computerized neurocognitive battery, Prospective Retrospective Memory Questionnaire, personality and meaning-in-life measures. Results: SMCs were associated with poorer performance on measures of executive function (p = 0.001). SMCs were also associated with impaired delayed recall (p = 0.006) but this did not remain significant after statistical adjustment for multiple comparisons. SMCs were inversely associated with conscientiousness (p = 0.004) and directly associated with neuroticism (p < 0.001). Higher scores on SMCs were associated with higher perceived stress (p = 0.001), and ineffective coping styles (p = 0.001). Factors contributing to meaning-in-life were associated with fewer SMCs (p < 0.05). Conclusions: SMCs may reflect early, subtle cognitive changes and are associated with personality traits and meaning-in-life in healthy, older adults.

Examining the nature of impairment in visual paired associate learning in amnestic mild cognitive impairment.

OBJECTIVE Visual spatial learning is impaired in mild cognitive impairment (MCI) although the nature of this impairment is not clear. This study investigated the nature and magnitude of errors made by adults with amnestic MCI (aMCI) when learning pattern-location paired associations in a continuous manner. METHOD Visual associate learning was measured using the Continuous Paired Associate Learning (CPAL) task in which 30 adults who met clinical criteria for aMCI and 30 matched controls were required to learn a set of associations between patterns and locations across increasing memory loads (two, four, six, and eight). RESULTS As hypothesized, the aMCI group made more total errors than controls for all memory loads above two. However, the rate of increase in errors with memory load in the aMCI group was approximately twice that for controls. CONCLUSIONS In controls, errors on the CPAL task reflected almost exclusively difficulty in memory. In the aMCI group, errors on the CPAL reflected limitations in associative learning but also in short-term memory and response monitoring. These results suggest that impairments in specific aspects of executive function and working memory might contribute to poor performance on visual paired associate learning in aMCI.

Exercise, Sedentary Pastimes, and Cognitive Performance in Healthy Older Adults

Background: Moderately vigorous physical activity (MVPA) provides a protective affect against cognitive decline and cardiovascular risk factors. Less is known about sedentary pastimes or non exercise physical activity (NEPA) and cognitive performance. Method: 125 healthy adults 65 or older with no clinical evidence of cognitive impairment were enrolled. The CogState computerized neurocognitive battery was administered. Leisure activities were measured using the Community Health Activity Program for Seniors (CHAMPS). Results: Sedentary pastimes were associated with executive dysfunction (P = 0.01); MVPA with high memory scores (P = 0.05) and NEPA with improved working memory (P = 0.05). Only sedentary pastimes and executive dysfunction retained significance after correction for multiple comparisons. Smoking and alcohol confounded the association of memory with sedentary pastimes and MVPA. Conclusions: Study highlights: negative impact of sedentary pastimes on executive function, need for additional investigation of sedentary behavior, NEPA, the impact of addictions upon activity in late life.

The nature and rate of cognitive maturation from late childhood to adulthood

To better understand the nature and rate of cognitive change across adolescence, the Cogstate Brief Battery (CBB) was utilized to assess psychomotor function, attention, working memory, and visual learning in individuals aged 10–18 years old. Since all CBB tasks have equivalent perceptual, motor, and linguistic demands as well as being appropriate for both children and adults, this approach allowed direct across-age comparison of multiple cognitive domains. Exponential decreases in reaction time and linear increases in accuracy were observed across adolescent development in a cross-sectional sample of 38,778 individuals and confirmed in a 5788 individual longitudinal sample with 1-year repeat assessments. These results have important implications for the repeated assessment of cognition during development where expected maturational changes in cognition must be accounted for during cognitive testing.

Comparison of Cognitive Performance on the Cogstate Brief Battery When Taken In-Clinic, In-Group, and Unsupervised

Objective: Repeat cognitive assessment comparing post-injury performance to a pre-injury baseline is common in concussion management. Although post-injury tests are typically administered in clinical settings, baseline tests may be conducted individually with one-on-one supervision, in a group with supervision, or without supervision. The extent to which these different test settings affect cognitive performance is not well understood. To assess if performance on the Cogstate Brief Battery (CBB) differs across these settings, tests completed individually with one-on-one supervision were compared to those taken either in a group with supervision or individually but without supervision. Method: A crossover study design was utilized to account for any effect of individual variability or test order to provide an unbiased examination of the effect of test setting on cognitive performance. Young adult participants completed an individually supervised test either before or after also completing a group or unsupervised test. Results: CBB scores from the same individuals were not significantly different across test settings. Effect sizes ranged in magnitude from .09 to .12 for supervised versus unsupervised tests and from .01 to .37 for individual versus group tests across CBB tasks. Conclusion: These results suggest that cognitive testing with the CBB in alternate settings can provide valid cognitive data comparable to data obtained during individually supervised testing.

Simultaneous treatment of neurocognitive and psychiatric symptoms in veterans with post-traumatic stress disorder and history of mild traumatic brain injury: a pilot study of mindfulness-based stress reduction

Treating patient populations with significant psychiatric and neurocognitive symptomatology can present a unique clinical dilemma: progress in psychotherapy can be significantly fettered by cognitive deficits, whereas neurocognitive rehabilitation efforts can be ineffective because of psychiatric overlay. Application of mindfulness-based interventions to address either cognitive or psychiatric symptoms in isolation appears efficacious in many contexts; however, it remains unclear whether this type of intervention might help address simultaneous neurocognitive and psychiatric symptomatology. In a pre-post mixed methods design pilot study, nine Veterans with post-traumatic stress disorder (PTSD) and a history of mild traumatic brain injury with chronic cognitive complaints participated in Mindfulness-Based Stress Reduction (MBSR). Clinical interview, questionnaires, and attention and PTSD measures were administered immediately before, immediately after, and 3 months after MBSR completion. Qualitative and quantitative findings suggest high levels of safety, feasibility, and acceptability. Measurement of attention revealed significant improvement immediately following MBSR (p < 0.05, d = 0.57) and largely sustained improvement 3 months after completion of MBSR (p < 0.10, d = 0.48). Significant reduction in PTSD symptoms was found immediately after MBSR (p < 0.05, d = -1.56), and was sustained 3 months following MBSR completion (p < 0.05, d = -0.93). These results warrant a randomized controlled trial follow-up. Potential mechanisms for the broad effects observed will be explored.

A process-based approach to characterizing the effect of acute alprazolam challenge on visual paired associate learning and memory in healthy older adults

Alprazolam is a benzodiazepine that, when administered acutely, results in impairments in several aspects of cognition, including attention, learning, and memory. However, the profile (i.e., component processes) that underlie alprazolam‐related decrements in visual paired associate learning has not been fully explored.

Preliminary evidence concerning the pattern and magnitude of cognitive dysfunction in major depressive disorder using cogstate measures

BACKGROUND Cognitive deficits are common in individuals with major depressive disorder (MDD), and are associated with treatment non-responsiveness and poorer functional outcomes. Characterization of the nature and magnitude of deficits in this population has been limited in part by lack of brief, practical, and well-validated assessment measures. The goal of this study was to use a brief, practical, and repeatable computerized cognitive test battery from Cogstate to examine differences in cognitive functioning between individuals with MDD and healthy controls. METHODS Forty participants (22 healthy controls (HCs), 18 with MDD) completed a battery of six cognitive measures, as well as measures of intellectual functioning (intellect) and depressive symptom severity. A multivariate analysis of covariance (MANCOVA) was conducted to compare cognitive test performance across groups while controlling for intellect. RESULTS Individuals with MDD had lower full-scale IQ scores on average, and performed worse on measures of visual attention (d=1.04), verbal learning (d=1.22) and memory (d=1.22), and visuospatial problem solving (d=0.80) than HCs after adjustment for differences in intellect. Psychomotor speed, visual memory, and working memory did not differ between groups. CONCLUSIONS Cogstate measures appear to be sensitive in assessing deficits in attention, verbal learning and memory, and executive function in individuals with MDD. Further research will be useful in establishing the utility of Cogstate measures for standard use in research and clinical practice.

The Development of Associate Learning in School Age Children

Associate learning is fundamental to the acquisition of knowledge and plays a critical role in the everyday functioning of the developing child, though the developmental course is still unclear. This study investigated the development of visual associate learning in 125 school age children using the Continuous Paired Associate Learning task. As hypothesized, younger children made more errors than older children across all memory loads and evidenced decreased learning efficiency as memory load increased. Results suggest that age-related differences in performance largely reflect continued development of executive function in the context of relatively developed memory processes.