John J. Randolph

Metamemory and tested cognitive functioning in multiple sclerosis.

Metamemory, or ones knowledge and self-report of memory ability, has been researched extensively; however, few studies have examined it in multiple sclerosis (MS). Because impairment in cognitive domains besides memory may affect memory functioning, patients may self-report problems with memory that are indicative of impairment in cognitive domains besides memory. One goal of the current study was to test this hypothesis in MS. A group of 55 MS patients were administered a variety of cognitive tasks and a self-report metamemory measure; patients significant others were also given a metamemory measure requiring them to rate patients memory abilities. Results indicated that patients metamemory reports were significantly (p < .05) correlated with verbal recall, attentional, and executive tasks. Significant other ratings of patients metamemory were correlated with verbal recall and attentional measures. Stepwise regression analyses including all relevant cognitive and demographic variables indicated that only education and Symbol Digit accounted for significant independent variance in patients current memory reports. Our results suggest: (1) subjective complaints of memory difficulties by MS patients reflect difficulty in cognitive domains besides memory, (2) MS patient self-reports of memory difficulty are at least as accurate as significant other reports, and (3) patients with more education are more accurate in their metamemory ratings. These findings have implications not only for a better understanding of metamemory in MS, but also for more effective treatment and rehabilitation of MS patients.

Metamemory in multiple sclerosis: exploring affective and executive contributors

Although previous reports have examined metamemory in various neurological groups, no study to date has examined various affective and cognitive contributors to metamemory collectively in a sample of multiple sclerosis (MS) patients. In the present study, 48 MS patients completed the Memory Functioning Questionnaire (MFQ) and were administered measures assessing depression, depressive attitudes, and executive functioning. Correlational analyses indicated that certain aspects of metamemory in MS were associated with both affective and executive variables. Structural equation modeling (SEM) analyses of three a priori models revealed the best fit with one model proposing that greater executive dysfunction and depression were associated with increased self-reported memory complaints, but via the mediating influence of depressive attitudes. Although our results suggest some objective basis for metamemory complaints in MS (i.e., executive dysfunction), they also suggest that these complaints may be exacerbated by the potentially reversible influences of depression and depressive attitudes. Treatment of depression and depressive attitudes in MS may result in MS patients having more accurate perceptions of their actual memory abilities that, in turn, may lead to improvements in their quality of life.

FLAIR lesion volume in multiple sclerosis: Relation to processing speed and verbal memory

Information processing speed and episodic memory are two commonly affected cognitive abilities in MS. Insights into the mechanisms of and relationships between these abilities have recently come from structural neuroimaging techniques, but few studies have used fluid-attenuated inversion recovery (FLAIR), a neuroimaging sequence known to be sensitive to cortical and juxtacortical lesions in MS. We hypothesized that a volumetric index of FLAIR total lesion volume (TLV) would be associated with slowed processing speed and verbal memory dysfunction in MS. Twenty MS patients underwent FLAIR imaging and were administered measures of verbal memory and processing speed. Correlational and regression analyses indicated that TLV was directly and independently related to measures of processing speed and verbal memory, and TLV accounted for 56% of the variance in cognitive performance. These findings, considered in the context of prior work, suggest that FLAIR TLV is a useful predictor of commonly impaired cognitive functions in MS, and shows promise as a functionally relevant biomarker for disease status.

Depression and fatigue in relapsing-remitting MS: the role of symptomatic variability:

Depression and fatigue are common psychosocial sequelae of MS. An infrequently examined issue in the MS literature is the effect of MS-related symptom variability on incidence of depression and fatigue. The current study was designed to examine the relationship of variability in physical, cognitive, and social/environmental functioning with depression and fatigue in MS. Forty-eight relapsing-remitting MS patients from a larger sample completed self-report measures of depression and fatigue. They were also administered a structured interview that assessed current, best, and worst levels of functioning since being diagnosed with MS. Higher levels of symptom variability since disease onset were associated with depression and fatigue, even after accounting for MS-related physical disability. Regression analyses indicated that variability in social and environmental functioning was particularly associated with depression, and variability in physical abilities was associated with fatigue. These findings suggest that a more variable course of MS symptoms is associated with increased depression and fatigue. Focused assessment of variability in symptoms may be useful in detecting and subsequently treating depression and fatigue in MS patients.

What Is Positive Neuropsychology

While the field of positive psychology has gained considerable momentum and empirical support over the past decade, related principles have not been adopted broadly by clinical or academic neuropsychologists. For example, despite significant growth in the neuropsychological literature during the same period, few studies seem to address the study, promotion, and enhancement of cognitive health. In the present chapter, I discuss reviews of three prominent neuropsychological journals over a 10-year period to clarify broad research themes and the relative frequency of studies that address cognitive health. These reviews indicated that the majority of published studies documented cognitive deficits in neuropsychiatric populations, and few studies examined methods to promote cognitive functioning. Further, research on cognitive health has generally not increased over time. Based in part on these findings, the present chapter offers and defines an overarching orientation to neuropsychological research and practice—positive neuropsychology—that incorporates positive psychology principles and aims to promote cognitive health through various means. Areas within positive neuropsychology are briefly summarized here and are explored in more detail throughout this volume.

Promoting the Executive Functions: Core Foundations, Assessment Considerations, and Practical Applications

The executive functions (EFs) comprise an interrelated set of higher-order cognitive abilities associated with goal-oriented behavior and emotional and social functioning. The present chapter considers a spectrum of issues related to EFs, beginning with theoretical foundations and concluding with practical strategies for promoting the EFs in daily life. In particular, we review theoretical, clinical, and empirical frameworks of EFs and examine EF assessment approaches and related dilemmas. We clarify EF assessment use patterns among practitioners in the context of ecological validity. We then discuss research on interventions designed to support or promote the EFs and consider evidence-based external and internal strategies useful in clinical practice. A final section considers future directions that may lead to more effective EF assessment and promotion.

Modifiable Lifestyle Factors and Cognition Through Midlife

Research on lifestyle factors and human cognition has largely focused on identifying determinants of cognitive decline or possible cognitive enhancement in older adults. Much less attention has been devoted to the more immediate effects of various lifestyle factors on cognition from childhood through middle age and whether these factors can be exploited to optimize cognitive functioning. This present chapter serves to review the literature related to various lifestyle factors in this age range, including sleep, exercise, tobacco use, and iron intake. We discuss the relevance of examining the impact of these lifestyle factors on cognition, review potential mechanisms through which they influence cognitive functioning, and consider related findings from laboratory and epidemiological studies. Applications of lifestyle factor research to neuropsychological practice are then considered, as are challenges and future directions for lifestyle factor research in children and adults.

Promoting Psychosocial and Cognitive Wellness in the Workplace: The Emerging Neuroscience of Leadership Development

While traditional management science has been criticized for being slow to adopt findings from psychological research, an emerging movement seeks to incorporate cognitive and neuroscience research and perspectives into workplace applications and leadership development. In the present chapter, social, cognitive, and affective neuroscience findings are discussed in the context of topics related to leadership development. These topics include workplace stress and stress management, emotional regulation, social interaction, and emotional intelligence. I then review efforts to understand and promote cognitive health in the workplace with a particular focus on organizational skills, decision making, and reasoning. These topics are subsequently considered in the context of executive coaching interventions and future directions that may bolster research and applications in this area.

Positive Neuropsychology: Synthesis and Future Directions

The present volume has defined and clarified an overarching orientation to neuropsychological practice and research focused on promoting cognitive health: positive neuropsychology. This chapter serves as a brief review of contributions here and considers additional areas and future directions related to positive neuropsychology topics. Other domains discussed include positive outcomes in neuropsychiatric disorders, promoting cognitive health through public education, studying individuals with superior cognitive functioning, and further clinical applications of positive neuropsychology. Possible strategies to prioritize the study and promotion of cognitive health are also considered.

Introduction to the special section on positive neuropsychology

While neuropsychology has a rich history of assessing, studying, and clarifying cognitive dysfunction, considerably less work has been devoted to understanding and promoting cognitive health. The field’s historical focus on cognitive impairment is particularly notable in light of our patients’ oft-stated interest in better understanding how they can maintain or enhance their cognition in daily life. Fortunately, there is recent evidence that neuropsychology has begun to embrace a more balanced perspective, regarding cognitive impairment and wellness. The present special issue is in concert with this trend to offer multiple perspectives on positive neuropsychology—the study and promotion of cognitive health (Randolph, 2013)—and to consider the value of such a paradigm shift to neuropsychology and society as a whole (Pimental, 2017). The issue’s authors contribute to this emerging orientation within the field by considering cognitive health from unique and forward-thinking vantage points. Randolph (2018) describes the origins and current status of positive neuropsychology, its foundation in positive psychology, and key empirically based domains as related to both clinical practice and empirical study. Since this orientation was codified five years ago, there has been much attention focused on cognitionpromoting domains including compensatory cognitive and emotional strategy use, physical activity, social and intellectual engagement, nutritional habits, and preventative lifestyle choices. Exceptional cognition and positive outcomes in neuropsychiatric populations are additional areas related to cognitive promotion that are considered here. Rabinowitz and Arnett (2018) provide a critical synthesis of positive psychology constructs as related to brain injury recovery. These authors consider characteristics such as positive affect, hope, resilience, and active coping tendencies and their role in psychosocial outcome post-TBI. Given that these phenomena are potentially modifiable, interventions that serve to develop or enhance positive characteristics may ultimately improve rehabilitation efforts. In an empirical study, Strober, Becker, and Randolph (2018) examine correlates of cognitive health factors— nutritional choices, physical activity, social engagement, and intellectual activity—with self-efficacy, well-being, and disease-oriented variables in a multiple sclerosis (MS) sample. Few studies in the neuropsychological literature have examined variables known to play a role in cognitive health in neuropsychiatric populations, and Strober and colleagues’ study serves to add to our understanding of effects of positive lifestyle choices in MS. Neuropsychology has experienced considerable growth related to assessment of performance validity and response effort, although Hill and Aita (2018) clarify an equally important issue: the positive side of the effort continuum. In their piece, the authors discuss constructs that may relate to positive effort in the neuropsychological assessment process, including conation, grit, need for cognition, and “Big Five” personality factors. Their perspectives on effort from a positive standpoint will hopefully inform future clinical and scientific pursuits in this regard. In the issue’s final piece, Pimental, O’Hara, and Jandak (2018) describe a broad-based service delivery model of cognitive health. They delineate various areas that can be incorporated into treatment including: brain stimulating activities, restorative techniques, automatic negative thoughts/maladaptive thinking reduction, inflammation and pain management techniques, nutrition and culinary focused cognitive wellness, spirituality based practices and mindfulness, movement and exercise, alternative/complimentary therapies, relationship restoration/social engagement, and trauma healing/meaning. Relatively few neuropsychologists utilize cognitive health interventions, and this piece suggests multiple avenues for adding such services. We are pleased to provide varied state-of-the-art perspectives on positive neuropsychology in the present none defined