Is Obstructive Sleep Apnoea Related to Neuropsychological Function in Healthy Older Adults? A Systematic Review and Meta-Analysis

Previous systematic reviews and meta-analyses have identified cognitive deficits in adults with obstructive sleep apnoea (OSA). However, quantitative analysis of the association between OSA and neuropsychological performance has not been conducted specifically in older adults, for whom there is a greater risk of cognitive decline. We searched Medline, Embase and PsycINFO through August 2016 for studies describing associations between OSA and neuropsychological outcomes in people aged>50 years. Meta-analyses were performed on these studies for overall cognition and within cognitive domains. Subgroup analyses were performed taking into account risk of bias and moderating differences in study design. 13 studies met eligibility criteria for analysis. A small negative association was found between OSA and all neuropsychological outcomes combined, g=0.18(95% CI 0.04–0.32), and in memory and processing speed domains. Small case-control studies from sleep clinic populations observed the greatest associations, while larger cohort studies from community samples illustrated no association. Analysis accounting for publication bias resulted in a null overall association, g=0.02 (95%CI -0.12 to 0.16). Associations between OSA and cognition in later life are highly variable and the findings differ based on the type and setting of study. It appears some older adults may be at risk of cognitive impairments attributable to OSA; however, the risk of bias renders the evidence inconclusive. High quality research is warranted in clinically diagnosed OSA patients as well as those already experiencing neuropsychological impairment and who may be regarded at higher risk of further cognitive decline.     

Standing out in Canada and Japan

The need for separation or individuation is held to be a prime motive in Western psychology. Varied accounts of the meaning of selfhood in Japan indicate that separation may be much less important-or as important-for understanding the construction of self-identity in that culture. We focus here on personal distinctiveness, one vehicle for separation from others. We propose that the desire for distinctiveness is not absent or negligible in Japan, but is subject to more constrained expression than in the West. The results of two studies comparing Japanese and Canadian students suggest that Japanese are less desirous of standing out for their own sake and more likely to experience this form of distinctiveness as aversive. The results also suggest that although Japanese and Canadians derive positive distinctiveness from much the same sources, Japanese are less gratified by this type of experience.     

A challenge to current models of past tense inflection: the impact of phonotactics

Is past tense production better modelled by a Single Mechanism or a Words and Rules model? We present data concerning a phenomenon that has not been considered by either model-regular past tense verbs with contrasting phonotactics. One set of verbs contains clusters at the inflected verb end that also occur in monomorphemic words ('monomorphemically legal clusters', MLC) whereas the other has clusters that can only occur in inflected forms ('monomorphemically illegal clusters', MIC). We argue that if children apply a morphological rule, phonotactics will not affect performance. Conversely, if children store past tense forms, they will perform better on verbs with MLCs because these clusters are more frequent. We investigated three populations--typically developing children, Grammatical-SLI (G-SLI) and Williams Syndrome (WS)--using past tense elicitation tasks. In Experiment 1 we reanalyse data from van der Lely and Ullman [van der Lely, H. K. J. & Ullman, M. (2001). Past tense morphology in specifically language impaired and normally developing children. Language and Cognitive Processes, 16: 177-217] and show that G-SLI children perform better on MLC verbs, whereas for typically developing children phonotactics do not affect performance. In Experiment 2 we replicate these findings in new groups of G-SLI and typically developing children. In Experiment 3 we reanalyse data from Thomas et al. [Thomas, M. S. C., Grant, J., Barham, Z., Gsodl, M., Laing, E., Lakusta, L., Tyler, L.K., Grice, S., Paterson, S. & Karmiloff-Smith, A. (2001) Past tense formation in Williams Syndrome. Language and Cognitive Processes, 16: 143-176] and show that phonotactics do not affect performance in individuals with WS. We argue that the results elucidate the underlying nature of morphology in these populations, and are better accommodated within a Words and Rules model of past tense acquisition.     

The relationship between viewing US-produced television programs and intentions to drink alcohol among a group of Norwegian adolescents

The aim of this study was to examine the influence of exposure to US-produced television programs and family rules prohibiting alcohol use on the development of normative beliefs, expectancies, and intentions to drink alcohol in the next 12 months among a group of Norwegian adolescents who reported that they had not previously consumed alcohol. Data were collected via a survey administered to 622 eighth and ninth graders enrolled at ten junior highs in southeastern Norway. To examine these relationships we tested the fit of a structural equation model which was based on the Theory of Planned Behavior (Ajzen, 1988). Data from the non-drinkers (n= 392, 63% of the respondents) were used. To control for the influence of peer drinking on behavioral intentions, our model was tested under two group conditions: (1) those subjects reporting that they have no friends who drink alcohol and (2) those subjects reporting that they have one or more friends who drink. The findings indicate that the influence of TV exposure was a significant predictor (directly) of normative beliefs, expectancies (indirectly) and intentions to drink (both directly and indirectly) only for those subjects who reported having no friends who drink. For the group with non-drinking friends, family rules constrain intentions only indirectly by influencing normative beliefs. For those with friends who drink, however, family rules have a direct (inverse) effect on intentions. It is concluded that exposure to US-produced television programs functions as a limited knowledge source only for those subjects who had little or no personal experience with alcohol while the presence of family rules have limited impact on behavioral intentions.     

Brain activation and the phonological loop: the impact of rehearsal

Brain activation studies offer valuable techniques for exploring human cognition to complement behavioral measures and several studies report a wide range of neuroanatomical networks activated during verbal immediate memory. Behavioral investigations have shown use of multiple cognitive strategies across and within individuals, although aggregate data appear to reflect a common cognitive function. Variation in cognitive strategies could result in aggregate activation patterns that are relatively widespread and difficult to interpret. Imaging data (fMRI) from six participants instructed to use subvocal rehearsal showed significant left hemisphere activation in the inferior parietal gyrus and inferior and middle frontal gyri, a pattern of activation more clearly focused than in previous brain activation studies of immediate verbal serial ordered recall. Our results should be relatively free of the influence of other mental operations, and emphasise the importance of considering which cognitive strategies might give rise to focused or to diverse patterns of brain activation.     

Perinatal substance abuse and human subjects research: are privacy protections adequate?

Privacy incursions in the clinical care of substance abusing pregnant women have gained lay and professional attention recently as the result of a high-profile Supreme Court finding in Ferguson vs City of Charleston et al. In March, 2001 the Supreme Court determined that nonconsensual drug screening of pregnant women by clinicians in a public hospital violated the women's Fourth Amendment rights to be secure against unreasonable search and seizure. Coercive or punitive policy approaches to perinatal substance abuse are often based on mistaken assumptions about the nature of addiction and the outcomes of punitive interventions. Much attention has been given to efforts to criminalize pregnancy for drug using women, and civil laws are also coming under increasing scrutiny. Although no state has passed a law criminalizing pregnancy and drug use, an estimated 250 women in more than 30 states have been prosecuted around the country on theories of "fetal abuse." A growing number of states (eighteen to date) have amended their civil child welfare laws to address specifically the subject of a woman's drug use during pregnancy. No one has examined how these laws and social policies could affect research that includes pregnant and parenting women; women (and their families) who stand to lose a great deal should their drug use be brought to the attention of child welfare or criminal justice authorities. We examine the adequacy of current protective mechanisms, such as federal certificates of confidentiality, in protecting research subjects (and investigators) who may be subject to punitive civil or criminal sanctions. We determine that current protective mechanisms may be insufficient to protect research subjects and that investigators and IRB members are often ignorant of the risks imposed by punitive policy approaches to perinatal substance abuse or fall prey to the same mistaken assumptions that inform punitive policies. We conclude that investigators and IRB members have a moral responsibility to understand local, state and national policies and laws governing perinatal substance abuse. Investigators and IRB members should balance the harms of punitive interventions against the protections that may, or may not be afforded to prospective research subjects as well as the prospective benefits, individual and social, of the research. In situations where criminal or punitive policies are in effect, investigators and IRB members should consider whether adequate protections can be achieved. In the context of inadequate protections, potential risks to prospective research subjects and their families may outweigh the individual or social benefits that accrue from the research. Clinical researchers are professionally obligated to work toward amending laws and policies that are not in the best interests of prospective research subjects.     

The incremental validity and clinical utility of the MMPI-2 infrequency posttraumatic stress disorder scale

The incremental validity and clinical utility of the recently developed Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Infrequency Posttraumatic Stress Disorder Scale (Fptsd) was examined in relation to the family of MMPI-2 F scales in distinguishing feigned post-traumatic stress disorder (PTSD) from disability claimants with PTSD. Research participants instructed to feign PTSD when completing the MMPI-2 scored significantly higher on the MMPI-2 family of F scales and the Fptsd scale compared with their responses when completing the MMPI-2 under standard instructions and the sample of claimants with PTSD. Although comparable in magnitude, effect sizes derived from mean group differences and hierarchical logistic regressions for the Fptsd scale never exceeded those for F(B), and F(P), F, F(B), and F(P) added incrementally to Fptsd in the prediction of feigned PTSD. These results suggest that the Fptsd scale does not afford any incremental predictive utility for detecting feigned PTSD relative to the complement of the existing family of F scales.     

Culture-fair cognitive ability assessment: information processing and psychophysiological approaches

Valid assessment with diverse populations requires tools that are not influenced by cultural elements. This study investigated the relationships between culture, information processing efficiency, and general cognitive capacities in samples of Caucasian and Mexican American college students. Consistent with the neural efficiency hypothesis, pupillary responses (indexing mental effort) and detection accuracy scores on a visual backward-masking task were both significantly related to the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Full Scale scores. These measures of information processing efficiency were similar in the two groups. However, they were related only to Caucasian American, but not to a comparable sample of Mexican American, students' WAIS-R scores. Therefore, the differential validity in prediction suggests that the WAIS-R test may contain cultural influences that reduce the validity of the WAIS-R as a measure of cognitive ability for Mexican American students. Information processing and psychophysiological approaches may be helpful in developing culture-fair cognitive ability measures.     

Self-regulation and inhibition in comorbid ADHD children: an evaluation of executive functions

The relationship between executive function and comorbid diagnoses in ADHD children is examined. One hundred six children between 7 and 15 years of age are assessed using the Tower of London (TOL), a test of executive function, and the Kiddie Schedule of Affective Disorders and Schizophrenia, Present and Lifetime Version, a diagnostic interview. All children met the diagnostic criteria for ADHD. A majority of the children had comorbid anxiety disorders, mood disorders, or oppositional defiant disorder. Measures on the TOL are total move score, total initiation time, and total rule violations. Age is predictive in all three measures of executive function as assessed by the TOL. Gender is predictive of total initiation time and total rule violations. Comorbid disorders are found to not have significance on executive function as measured by the TOL. This study concludes that comorbid disorders may not affect executive function.