Emilie I. Franchow

Instrumental activities of daily living among community-dwelling older adults: discrepancies between self-report and performance are mediated by cognitive reserve.

The ability to engage in instrumental activities of daily living (IADLs) is known to rely on cognitive abilities, primarily executive functioning and memory. There is also evidence that good self-awareness, which facilitates the use of compensatory strategies, may prolong functionality and delay the diagnosis of dementia. However, little is known about the mechanisms that mediate self-awareness among healthy elderly. The present study examined the correlates of discrepancies between self-report and performance-based measures of IADLs in a sample of 75 community-dwelling elderly. The results indicate that even among independently living individuals, there is still variability in functionality (i.e., 35% of the sample made IADL performance errors) and self-awareness (i.e., 38% of the sample demonstrated a discrepancy between IADL self-report and performances). Better awareness of IADL weaknesses was associated with higher levels of cognitive reserve but, unexpectedly, lower levels of executive abilities. Additionally, consistent with prior research, better IADL performances were associated with better cognition.

Instrumental Activities of Daily Living Among Community-Dwelling Older Adults: Personality Associations With Self-Report, Performance, and Awareness of Functional Difficulties

Self-reports of the ability to engage in instrumental activities of daily living (IADLs) among older adults are known to be related to personality traits. However, self-reports are sometimes discrepant with performance-based IADL assessments, and little is known about personality associations with objective functionality or with poor insight about functional deficits. This study examined the NEO Personality Inventory-Revised profiles associated with (a) self-report of functional problems, (b) functional errors evidenced on performance-based IADL assessment, and (c) discrepancies between self-report and performance. Participants were 65 community-dwelling individuals ranging in age from 60 to 87 years. The results showed that self-report of IADL problems are associated with higher neuroticism and lower conscientiousness, actual IADL difficulties with higher neuroticism and lower agreeableness and openness to experience, underreporting of problems with higher conscientiousness, and overreporting of problems with higher extraversion and neuroticism. These relationships were partly mediated by age, education, and cognitive status. When unique personality associations with self-report and performance were examined, neuroticism and agreeableness, respectively, emerged as the strongest predictors.

Naturally-occurring expressive suppression in daily life depletes executive functioning.

The depleting impact of experimentally manipulated expressive suppression (ES) on cognition (especially executive functioning and related processes) has been well established (Baumeister, 2002a). However, the impact of ES that occurs naturally in the course of daily life has not been examined. Sixty two adults (M = 22.89 years old) completed questions about recent ES burden (over the past 2 weeks and on the test day) and completed cognitive measures assessing executive functioning, working memory, and speed of information processing. Individuals with higher-than-usual burden of ES on the test day exhibited poorer executive performance and those with high ES over the past 2 weeks exhibited poorer processing speed above and beyond depression, suggesting that ES burden as it occurs in the course of daily life is associated with compromised cognitive performance.

Confronting Patients About Insufficient Effort: The Impact on Subsequent Symptom Validity and Memory Performance

Symptom validity tests (SVTs) are commonly used to assess effort in neuropsychological evaluations. However, no empirical research or official guidelines exist about how clinicians should proceed if a patient produces a non-valid SVT result. The purpose of this study was to examine whether confronting patients immediately after scoring in a non-valid range on a SVT would have an impact on subsequent symptom validity and memory tests performance. Archival patient data for 507 adults with clinically definite multiple sclerosis (MS) (ages 18–76) were examined. All patients completed the Victoria Symptom Validity Test (VSVT), the Wechsler Memory Scale, 3rd edition (WMS III), and the Beck Depression Inventory, 2nd edition (BDI II). Although the majority (89%) of patients produced valid VSVT scores (the Valid group), 56 patients produced non-valid VSVT scores. Due to a change in clinical procedure, 28 of the 56 were confronted regarding their non-valid VSVT performances and were asked to complete the test a second time (the CONF group), while the remaining 28 proceeded with testing as usual following a non-valid score (the N-CONF group). Results showed that 68% of the CONF group produced valid VSVT scores on re-administration, as well as memory performances that were comparable to those of the Valid group. In contrast the N-CONF group produced memory scores that were significantly below the Valid group. This is the first study to provide empirical support for the effectiveness of intervention when patients exhibit inadequate effort on SVTs in clinical, non-forensic settings.

Reported Expressive Suppression in Daily Life Is Associated with Slower Action Planning.

Objectives Growing evidence demonstrates that (a) executive functioning (EF) becomes deleteriously affected by engagement in the emotion regulation strategy known as expressive suppression and (b) EF shows considerable functional and neuroanatomical overlap with motor output. The current study aimed to bridge these two literatures by examining the relationships between naturally occurring expressive suppression and several different aspects of motor output, including action planning, action learning, and motor-control speed and accuracy. In addition, we investigated whether any identified relationships could be explained by EF. Methods Fifty-one healthy young adults completed selected subtests from the Delis-Kaplan Executive Function System as indices of EF, a self-report measure of expressive suppression, and a computerized motor sequencing task (Push Turn Taptap task; PTT) designed to assess action planning, action learning, and motor control speed and accuracy. Results Hierarchical regressions using each aspect of PTT performance as the dependent variable revealed that higher than usual self-reported expressive suppression on the day of testing (relative to the 2 weeks preceding testing) was associated with longer action-planning latencies. This relationship was fully explained by EF. No other PTT variables related to expressive suppression on the day of testing. Conclusions These results suggest that increased expressive suppression in daily life is associated with slower action planning, an aspect of motor output that is reliant on EF, highlighting the importance of factors that lead to intra-individual fluctuations in EF and motor performance. (JINS, 2016, 22, 671-681).

Expressive suppression depletes executive functioning in older adulthood

OBJECTIVES Accurate detection of executive dysfunction in neuropsychological assessments is complicated by the fact that executive functioning (EF) is vulnerable to temporary disruption (i.e., lapses), with more frequent lapses in older adulthood. Effortful regulation of affect (i.e., expressive suppression) is a well-known source of executive lapses in younger adults, but the generalizability of this depleting effect to older adults is unknown. The purpose of this study was to (1) determine whether EF is subject to depletion via expressive suppression and (2) to examine whether this effect is unique to EF, or whether it also applies to lower-order component processes in older adults. METHODS Ninety-seven non-demented, community-dwelling older adults were randomly assigned to either an expressive suppression group or control group. We compared performance of the groups on a battery of tests measuring EF and component processes both before and after exposure to emotionally evocative stimuli. RESULTS Consistent with the hypothesized depletion effect, suppressing participants showed an attenuated practice effect on post-manipulation EF relative to controls, while performance on lower-order component processes was unaffected by suppression. CONCLUSIONS These results suggest that depletion contributes to executive lapses in older adulthood. (JINS, 2017, 23, 341-351).

More than Education: Openness to Experience Contributes to Cognitive Reserve in Older Adulthood

Cognitive reserve (CR) is a well-known indicator of resilience to cognitive decline in older adulthood. Although higher education is the most widely-recognized contributor to CR, research suggests that the personality trait Openness to Experience might also contribute to reserve in later life. The purpose of this study was to examine whether the personality trait Openness contributes uniquely and independently to CR (above and beyond education). 72 adults (M=70.46 years old, SD=6.82) completed the WAIS-III Information subtest (measuring CR), the NEO Personality Inventory-Revised (measuring Openness), and the Dementia Rating Scale-2 (measuring global cognitive status and used in validity analyses confirming Information as a CR proxy). Openness accounted for unique variance in Information above and beyond demographics and education, with some evidence of a greater effect at fewer years of education. These results provide preliminary evidence supporting the association between Openness to Experience and CR, a known indicator of resilience to cognitive decline in older adulthood.

Greater naturally occurring expressive suppression is associated with poorer executive functioning and motor-sequence learning among older adults

ABSTRACT Objectives: Unusually high engagement in expressive suppression (i.e., purposeful regulation of overt affect) has been associated with poorer performance on executive functioning (EF) and motor-sequence learning tasks. As such, expressive suppression represents one possible source of fluctuations in executive test performance. However, the relationship between expressive suppression and EF and motor performance has not yet been examined in older adults, who are more prone to EF and motor fluctuations than are younger adults. The purpose of this study was to test whether greater self-reported, naturally occurring expressive suppression is related to poorer EF performance and motor-sequence learning in older adults. Method: One hundred and ten community-dwelling older adults completed a self-report measure of expressive suppression, a battery of EF tests, and a computer-based measure of motor-sequence learning. Results: As expected, higher self-reported burden of expressive suppression in the 24 hours prior to testing was related to poorer performance on EF tests and on multiple aspects of motor-sequence learning (action planning latencies and sequencing errors) even after accounting for age, depressive symptoms, and component processes (e.g., processing speed). Conclusions: The current results suggest that naturally occurring expressive suppression depletes EF, which builds on previous findings from experimental studies that show that expressive suppression leads to reduced EF performance. Furthermore, this effect can be captured using self-report methods. These findings highlight expressive suppression as one source of intraindividual fluctuations in executive and motor functioning, which likely place older adults at risk for both functional and motor lapses (e.g., medication mistakes, falls).

Exaggerated reaction to novelty as a predictor of incipient cognitive decline among community-dwelling older adults

ABSTRACT Objective: The ability to detect covert markers of incipient cognitive decline among older adults before cognitive decline becomes overtly evident on traditional cognitive tests represents an important topic of research. Exaggerated reactions to novelty, reflected in novelty-induced increases in action planning latencies (“novelty effect”; NE) and low openness to experience (openness), have been previously associated with incipient cognitive decline among older adults who appeared cognitively normal at baseline. The purposes of the present study were to extend prior research on the utility of these markers by examining whether (a) NE and openness each predict cognitive change uniquely, and (b) whether these indices predict cognitive change above and beyond measures of memory, executive functions, processing speed/efficiency, premorbid IQ, and depressive symptoms. Method: Sixty-one cognitively normal community-dwelling older adults were administered a battery of tests assessing the relevant constructs at baseline and one-year follow up. Changes in cognitive status were assessed using the Demetia Rating Scale, 2nd Edition, NE was assessed using the Push–Turn–Taptap task (an electronic motor sequence learning task), and openness using the NEO Personality Inventory–Revised. The Test of Premorbid Functioning, and subtests from Repeatable Battery for the Assessment of Neuropsychological Status, Delis–Kaplan Executive Function System, and Wechsler Adult Intelligence Scale, 4th Edition, were used for additional assessment of baseline cognition. Depressive symptoms were assessed using the Geriatric Depression Scale. Results: Results confirmed our hypothesis that both NE and openness contribute to prediction of cognitive change beyond baseline cognition and depressive symptoms, but none of the covariates (i.e., depression, executive functions, processing efficiency, or memory) themselves contributed to the model. NE and openness each contributed unique variance and were independent of each other. Conclusions: Openness and NE have the potential to provide evidence-based methods for estimating risk of future cognitive change in persons with currently normal standardized test scores.

P2-101: Judgment of line orientation and FDG-PET parietal metabolism

patients with delusion and their age-sex-severity matched probable AD patients without delusion were underwent fluorodeoxy-glucose positron emission tomography (FDG-PET) scanning. Paranoid delusion was defined using Korean version of Behavior Rating Scale for Dementia (Youn et al., 2008). The mean differences in the regional cerebral glucose metabolism between paranoid and non-paranoid groups were estimated based on the results of voxel-by-voxel comparison using statistical parametric mapping (SPM2) and partial least square (PLS, McIntosh and Lobaugh, 2004). To identify the functional connectivity, seed-voxel PLS analysis was performed. Results: Neuropsychiatric symptoms other than paranoid delusion were not significantly different between AD patients with and without delusion. Paranoid delusion ( ) group had significantly decreased cerebral glucose metabolism in temporal area including left hippocampus (BA36, ,y,z -32,-24,-6), right parahippocampal gyrus (BA36, ,y,z 20,-40,12) and right inferior frontal gyrus (BA 47, ,y,z 58,38,-8) than paranoid delusion (-) group (p 0.05, uncorrected for SPM, p 0.01 for PLS). Seed-voxel PLS analysis using peak metabolic rates in the hippocampus and inferior frontal gyrus as seeds identified four different connectivity patterns (LV1-4). Paranoid delusion ( ) group was significantly correlated with LV 1 and LV 4, whereas paranoid delusion (-) group was significantly correlated with LV 2 and LV 3 (p 0.001). Conclusions: This study showed that altered functional connectivity of frontal and temporal lobe was important for the development of paranoid delusion in AD.