The Efficacy of Cognitive Intervention in Mild Cognitive Impairment (MCI): a Meta-Analysis of Outcomes on Neuropsychological Measures

Cognitive training in MCI may stimulate pre-existing neural reserves or recruit neural circuitry as “compensatory scaffolding” prompting neuroplastic reorganization to meet task demands (Reuter-Lorenz & Park, 2014). However, existing systematic reviews and meta-analytic studies exploring the benefits of cognitive interventions in MCI have been mixed. An updated examination regarding the efficacy of cognitive intervention in MCI is needed given improvements in adherence to MCI diagnostic criteria in subject selection, better defined interventions and strategies applied, increased use of neuropsychological measures pre- and post-intervention, as well as identification of moderator variables which may influence treatment. As such, this meta-analytic review was conducted to examine the efficacy of cognitive intervention in individuals diagnosed with mild cognitive impairment (MCI) versus MCI controls based on performance of neuropsychological outcome measures in randomized controlled trials (RCT). RCT studies published from January 1995 to June 2017 were obtained through source databases of MEDLINE-R, PubMed, Healthstar, Global Health, PSYCH-INFO, and Health and Psychological Instruments using search parameters for MCI diagnostic category (mild cognitive impairment, MCI, pre-Alzheimer’s disease, early cognitive decline, early onset Alzheimer’s disease, and preclinical Alzheimer’s disease) and the intervention or training conducted (intervention, training, stimulation, rehabilitation, or treatment). Other inclusion and exclusion criteria included subject selection based on established MCI criteria, RCT design in an outpatient setting, MCI controls (active or passive), and outcomes based on objective neuropsychological measures. From the 1199 abstracts identified, 26 articles met inclusion criteria for the meta-analyses completed across eleven (11) countries; 92.31% of which have been published within the past 7 years. A series of meta-analyses were performed to examine the effects of cognitive intervention by cognitive domain, type of training, and intervention content (cognitive domain targeted). We found significant, moderate effects for multicomponent training (Hedges’ g observed?=?0.398; CI [0.164, 0.631]; Z?=?3.337; p?=?0.001; Q?=?55.511; df?=?15; p?=?0.000; I ² ?=?72.978%; τ ² ?=?0.146) as well as multidomain-focused strategies (Hedges’ g?=?0.230; 95% CI [0.108, 0.352]; Z?=?3.692; p??< 0.001; Q?=?12.713; df?=?12; p?=?0.390; I ² ?=?5.612; τ ² ?=?0.003). The effects for other interventions explored by cognitive domain, training type, or intervention content were indeterminate due to concerns for heterogeneity, bias, and small cell sizes. In addition, subgroup and meta-regression analyses were conducted with the moderators of MCI category, mode of intervention, training type, intervention content, program duration (total hours), type of control group (active or passive), post-intervention follow-up assessment period, and control for repeat administration. We found significant overall effects for intervention content with memory focused interventions appearing to be more effective than multidomain approaches. There was no evidence of an influence on outcomes for the other covariates examined. Overall, these findings suggest individuals with MCI who received multicomponent training or interventions targeting multiple domains (including lifestyle changes) were apt to display an improvement on outcome measures of cognition post-intervention. As such, multicomponent and multidomain forms of intervention may prompt recruitment of alternate neural processes as well as support primary networks to meet task demands simultaneously. In addition, interventions with memory and multidomain forms of content appear to be particularly helpful, with memory-based approaches possibly being more effective than multidomain methods. Other factors, such as program duration, appear to have less of an influence on intervention outcomes. Given this, although the creation of new primary network paths appears strained in MCI, interventions with memory-based or multidomain forms of content may facilitate partial activation of compensatory scaffolding and neuroplastic reorganization. The positive benefit of memory-based strategies may also reflect transfer effects indicative of compensatory network activation and the multiple-pathways involved in memory processes. Limitations of this review are similar to other meta-analysis in MCI, including a modest number studies, small sample sizes, multiple forms of interventions and types of training applied (some overlapping), and, while greatly improved in our view, a large diversity of instruments used to measure outcome. This is apt to have contributed to the presence of heterogeneity and publication bias precluding a more definitive determination of the outcomes observed.     

Reasoning strategies with rational numbers revealed by eye tracking

Recent research has begun to investigate the impact of different formats for rational numbers on the processes by which people make relational judgments about quantitative relations. DeWolf, Bassok, and Holyoak (Journal of Experimental Psychology: General, 144(1), 127–150, 2015) found that accuracy on a relation identification task was highest when fractions were presented with countable sets, whereas accuracy was relatively low for all conditions where decimals were presented. However, it is unclear what processing strategies underlie these disparities in accuracy. We report an experiment that used eye-tracking methods to externalize the strategies that are evoked by different types of rational numbers for different types of quantities (discrete vs. continuous). Results showed that eye-movement behavior during the task was jointly determined by image and number format. Discrete images elicited a counting strategy for both fractions and decimals, but this strategy led to higher accuracy only for fractions. Continuous images encouraged magnitude estimation and comparison, but to a greater degree for decimals than fractions. This strategy led to decreased accuracy for both number formats. By analyzing participants’ eye movements when they viewed a relational context and made decisions, we were able to obtain an externalized representation of the strategic choices evoked by different ontological types of entities and different types of rational numbers. Our findings using eye-tracking measures enable us to go beyond previous studies based on accuracy data alone, demonstrating that quantitative properties of images and the different formats for rational numbers jointly influence strategies that generate eye-movement behavior.     

Assessing the Role of the Self‐Concept on the Destructive Impact of Obsessive–Compulsive Disorder in Managers

Managers can have personal afflictions that may interfere with their role as managers in an organization. One of these maladies is obsessive‐compulsive disorder (OCD), a condition frequently identified with excessive patterns of seemingly unnecessary behavior. OCD compels individuals to seek “perfection” in the accomplishment of primarily routine tasks. This overt routine of behaviors distracts individuals from accomplishing their goals and those they manage. This paper examines the role of self‐concept as being central in identifying and understanding the characteristics of the behavioral disorder OCD and how to modify the self‐concept to prevent disruption in the workplace. In addition, the paper explores how to measure OCD and the impact of maladies on peers, subordinates, and superiors in the organization. I've learned . . . that we should be glad God doesn't give us everything we pray for. —My father     

Mental abilities and school achievement: A test of a mediation hypothesis

This study analyzes the interplay of four cognitive abilities - reasoning, divergent thinking, mental speed, and short-term memory - and their impact on academic achievement in school in a sample of adolescents in grades seven to 10 (N = 1135). Based on information processing approaches to intelligence, we tested a mediation hypothesis, which states that the complex cognitive abilities of reasoning and divergent thinking mediate the influence of the basic cognitive abilities of mental speed and short-term memory on achievement. We administered a comprehensive test battery and analyzed the data through structural equation modeling while controlling for the cluster structure of the data. Our findings support the notion that mental speed and short-term memory, as ability factors reflecting basic cognitive processes, exert an indirect influence on academic achievement by affecting reasoning and divergent thinking (total indirect effects: β = .22 and .24, respectively). Short-term memory also directly affects achievement (β = .22).     

Attachment, borderline personality, and romantic relationship dysfunction

Previous studies have implicated attachment and disturbances in romantic relationships as important indicators for Borderline Personality Disorder (BPD). The current research extends our current knowledge by examining the specific associations among attachment, romantic relationship dysfunction, and BPD, above and beyond the contribution of emotional distress and nonromantic interpersonal functioning in two distinct samples. Study 1 comprised a community sample of women (N = 58) aged 25-36. Study 2 consisted of a psychiatric sample (N = 138) aged 21-60. Results from both Study 1 and Study 2 demonstrated that (1) attachment was specifically related to BPD symptoms and romantic dysfunction, (2) BPD symptoms were specifically associated with romantic dysfunction, and (3) the association between attachment and romantic dysfunction was statistically mediated by BPD symptoms. The findings support specific associations among attachment, BPD symptoms, and romantic dysfunction.     

Justice sensitivity and the processing of justice‐related information

We investigated how Justice Sensitivity (JS) shapes the processing of justice‐related information. We proposed that due to frequently perceiving and ruminating about injustices, persons high in JS develop highly accessible and differentiated injustice concepts that shape attention, interpretation and memory for justice‐related information. Three studies provided evidence for these assumptions. After witnessing injustice, persons high in JS attended more strongly to unjust stimuli than to negative control stimuli (Study1) and interpreted an ambiguous situation as less just than persons low in JS (Study2). Finally, they displayed a memory advantage for unjust information (Study3). Results suggest that JS involves the availability and accessibility of injustice concepts as parameters of cognitive functioning and offer explanations for effects of JS on justice‐related behaviour. Copyright © 2010 John Wiley & Sons, Ltd.     

Direct and indirect transmission of relationship functioning across generations

Relationship functioning is assumed to propagate across subsequent generations, but most studies have lacked appropriate methodologies to test this assumption prospectively. In a randomly selected sample of youth (N = 821) followed prospectively for over 25 years across multiple generations, we examined the association of romantic engagement (i.e., emotional involvement and closeness) between parents with offspring romantic relationship quality. We tested two developmental pathways linking parents' romantic engagement with offspring adult romantic relationship quality, the first operating via parenting practices, and the second operating via adolescent depression. Parents' romantic engagement predicted offspring romantic relationship quality a mean of 17 years later, net age and socioeconomic status. Results supported a developmental pathway from parents' romantic engagement at offspring mean age 14, to parenting at offspring mean age 16, to offspring socioemotional functioning at mean age 22, and offspring romantic relationship quality at mean age 33. However, the influence of parents' romantic engagement on offsprings' adult romantic relationship quality does not appear to operate via a pathway of adolescent depression. Implications for prevention are discussed.     

The role of inhibition in task switching: A review

The concept of inhibition plays a major role in cognitive psychology. In the present article, we review the evidence for the inhibition of task sets. In the first part, we critically discuss empirical findings of task inhibition from studies that applied variants of the task-switching methodology and argue that most of these findings— such as switch cost asymmetries—are ambiguous. In the second part, we focus on n-22 task-repetition costs, which currently constitute the most convincing evidence for inhibition of task sets. n-22 repetition costs refer to the performance impairment in sequences of the ABA type relative to CBA, which can be interpreted in terms of persisting inhibition of previously abandoned tasks. The available evidence suggests that inhibition is primarily triggered by conflict at selection of stimulus attributes and at the response level. Author Note     

Virtual social interactions in social anxiety--the impact of sex, gaze, and interpersonal distance

In social interactions, interpersonal distance between interaction partners plays an important role in determining the status of the relationship. Interpersonal distance is an important nonverbal behavior, and is used to regulate personal space in a complex interplay with other nonverbal behaviors such as eye gaze. In social anxiety, studies regarding the impact of interpersonal distance on within-situation avoidance behavior are so far rare. Thus the present study aimed to scrutinize the relationship between gaze direction, sex, interpersonal distance, and social anxiety in social interactions. Social interactions were modeled in a virtual-reality (VR) environment, where 20 low and 19 high socially anxious women were confronted with approaching male and female characters, who stopped in front of the participant, either some distance away or close to them, and displayed either a direct or an averted gaze. Gaze and head movements, as well as heart rate, were measured as indices of avoidance behavior and fear reactions. High socially anxious participants showed a complex pattern of avoidance behavior: when the avatar was standing farther away, high socially anxious women avoided gaze contact with male avatars showing a direct gaze. Furthermore, they showed avoidance behavior (backward head movements) in response to male avatars showing a direct gaze, regardless of the interpersonal distance. Overall, the current study proved that VR social interactions might be a very useful tool for investigating avoidance behavior of socially anxious individuals in highly controlled situations. This might also be the first step in using VR social interactions in clinical protocols for the therapy of social anxiety disorder.