Research has shown that external focus (EF) instructions-directing attention to intended movement effects (e.g., ball's or dart's path)-are more effective for enhancing motor performance and learning than internal focus (IF) instructions, which focus on body movements (e.g., arm or foot motion). Nonetheless, the impact of visuospatial working memory capacity (WMC) in this context, especially among children, has been less investigated. This research sought to examine the effects of EF compared to IF on the skill acquisition and motor learning of a dart-throwing task among children with both high and low visuospatial WMC. Forty-eight boys aged 9-11 (Mage: 9.67 ± 0.76 years) were grouped by high or low WMC based on spatial span and memory tests, then assigned to receive either EF or IF instructions. The experiment comprised three stages: practice, retention, and two transfer tests, including throwing from a longer distance and a dual-task scenario with added cognitive load (tone counting). Results showed that EF outperformed IF at all stages. While WMC did not affect performance during practice and retention, children with low WMC performed better than those with high WMC during the longer distance test. In dual-task conditions, an EF continued to surpass an IF, whilst the WMC exerted no significant impact. The present findings suggest that an EF relative to an IF promotes more automatic movement and enhanced multitasking, while the impact of visuospatial WMC was less than expected, highlighting the benefits of EF in teaching motor skills to children, regardless of visuospatial WMC.
- MeSH
- Child MeSH
- Memory, Short-Term * physiology MeSH
- Humans MeSH
- Motor Skills * physiology MeSH
- Attention * physiology MeSH
- Psychomotor Performance * physiology MeSH
- Learning physiology MeSH
- Space Perception physiology MeSH
- Visual Perception physiology MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Despite efforts to improve undergraduate clinical pharmacology & therapeutics (CPT) education, prescribing errors are still made regularly. To improve CPT education and daily prescribing, it is crucial to understand how therapeutic reasoning works. Therefore, the aim of this study was to gain insight into the therapeutic reasoning process. METHODS: A narrative literature review has been performed for literature on cognitive psychology and diagnostic and therapeutic reasoning. RESULTS: Based on these insights, The European Model of Therapeutic Reasoning has been developed, building upon earlier models and insights from cognitive psychology. In this model, it can be assumed that when a diagnosis is made, a primary, automatic response as to what to prescribe arises based on pattern recognition via therapy scripts (type 1 thinking). At some point, this response may be evaluated by the reflective mind (using metacognition). If it is found to be incorrect or incomplete, an alternative response must be formulated through a slower, more analytical and deliberative process, known as type 2 thinking. Metacognition monitors the reasoning process and helps a person to form new therapy scripts after they have chosen an effective therapy. Experienced physicians have more and richer therapy scripts, mostly based on experience and enabling conditions, instead of textbook knowledge, and therefore their type 1 response is more often correct. CONCLUSION: Because of the important role of metacognition in therapeutic reasoning, more attention should be paid to metacognition in CPT education. Both trainees and teachers should be aware of the possibility to monitor and influence these cognitive processes. Further research is required to investigate the applicability of these insights and the adaptability of educational approaches to therapeutic reasoning.
- MeSH
- Pharmacology, Clinical education MeSH
- Clinical Reasoning * MeSH
- Clinical Competence MeSH
- Drug Prescriptions standards MeSH
- Humans MeSH
- Medication Errors prevention & control MeSH
- Metacognition MeSH
- Education, Medical, Undergraduate MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
BACKGROUND: Semantic and short-term episodic memory are impaired in some brain disorders including Alzheimer's disease. OBJECTIVE: Development and validation of an almost self-administered, but cognitively demanding four-minute test identifying very mild cognitive impairment (vMCI). METHODS: The innovative hedgehog PICture Naming and Immediate Recall (PICNIR) consisted of two parts. The first task was to write down the names of 20 black-and-white pictures to evaluate long-term semantic memory and language. The second task involves immediate recall and writing the names of as many previously named pictures as possible in one minute. The PICNIR is assessed using the number of naming errors (NE) and correctly recalled picture names (PICR). The PICNIR and a neuropsychological battery were administered to 190 elderly individuals living independently in the community. They were divided into those with vMCI (n = 43 with Montreal Cognitive Assessment (MoCA) 24 ± 3 points) and sociodemographically matched cognitively normal (CN) individuals (n = 147 with MoCA 26 ± 3). Both subgroups had predicted mean Mini-Mental State Examination scores of 28-29 points. RESULTS: Compared to CN, vMCI participants made more NE (0.3 ± 0.6 versus 0.6 ± 0.9; p = 0.02) and recalled fewer PICR (8.9 ± 2.2 versus 6.8 ± 2.2; p < 0.000001). Discriminative validity was satisfactory using the area under the ROC curve (AUC): 0.76 for PICR, 0.74 for MoCA, 0.67 for MoCA-five-word recall, and 0.59 for NE. The AUCs of PICR and MoCA were comparable and larger than those of MoCA five-point recall or NE. Logical Memory scores, RAVLT scores, Digit symbol, and animal fluency correlated with PICR. CONCLUSIONS: The picture-based PICNIR is an ultra-brief, sensitive cognitive test valid for assessing very mild cognitive impairment. Its effectiveness should be validated for other languages and cultures.
- MeSH
- Memory, Episodic * MeSH
- Cognitive Dysfunction * diagnosis psychology MeSH
- Memory, Short-Term physiology MeSH
- Humans MeSH
- Neuropsychological Tests * statistics & numerical data MeSH
- Reproducibility of Results MeSH
- Mental Recall * physiology MeSH
- Semantics MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Mental Status and Dementia Tests statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Elektrokonvulzívna terapia (ECT) má v psychiatrii svoje stále miesto a nezastupiteľnú úlohu v liečbe závažných psychických porúch. Výskyt vážnejších nežiaducich účinkov je zriedkavý, mortalita ECT je nižšia, v porovnaní s inými lekárskymi zákrokmi realizovanými v celkovej anestéze. V súvislosti s ECT sa popisujú rôzne poruchy kognitívnych funkcií, ktoré predstavujú riziko z hľadiska negatívneho vplyvu na kvalitu života pacienta. Obavy z ich výskytu a údajnej vysokej závažnosti dlhodobo pretrvávajú v laickej verejnosti. Jedná sa o tzv. nesystematický prehľad. Literárne zdroje boli čerpané najmä z databázy PubMed (metaanalýzy, systematické prehľadové práce a klinické štúdie, publikované na danú tématiku v priebehu posledných 10 rokov). Podľa nedávnej a pomerne rozsiahlej metaanalýzy bol výskyt subjektívnych kognitívnych nežiaducich účinkov u pacientov po ECT zaznamenaný v 48 % prípadov. Podľa aktuálne dostupných údajov sú však väčšinou prechodné, krátkodobé a týkajú sa len určitých kognitívnych domén (rýchlosť spracovania informácií, exekutívne funkcie, pozornosť, pracovná a verbálna pamäť, autobiografická pamäť). Napriek tomu porucha autobiografickej pamäti môže pretrvávať v niektorých prípadoch aj viac ako 1 rok s parciálnou ireverzibilitou. Na výskyt kognitívnych nežiaducich účinkov má vplyv viacero modifikovateľných faktorov, ktoré je potrebné poznať a rešpektovať. Podstatným z nich je individualizácia množstva aplikovaného elektrického náboja počas ECT prostredníctvom jeho postupnej titrácie, za účelom nájdenia individuálneho záchvatového prahu. Jednoznačne by mali byť uprednostňované ultrakrátke impulzy (0,3ms) pred dlhšími. Ak to klinický stav umožní, je vhodné použiť unilaterálne umiestnenie elektród (nad nedominantnou hemisférou). Neodporúča sa podávanie viac ako 12 aplikácií v jednej sérii v akútnej fáze liečby (pri bitemporálnom umiestnení elektród). Individuálne faktory pacienta, ku ktorým sa radia vyšší vek, ženské pohlavie, prítomnosť organického poškodenia mozgu a nižší intelekt, predstavujú vyššie riziko rozvoja kognitívnych nežiaducich účinkov po ECT, rovnako aj súbežná liečba lítiom počas ECT. Súčasné národné a medzinárodné odporúčania ponúkajú rôzne psychometrické inštrumenty na monitorovanie kognitívnych nežiaducich účinkov ECT. V niektorých krajinách, napríklad v nemecky hovoriacich regiónoch, ale ani na Slovensku, konkrétne odporúčania neboli vypracované. V dnešnej dobe existujú batérie testov hodnotiace relevantné kognitívne domény, ktoré je možné pri ECT použiť v klinickej praxi, pretože nie sú časovo ani odborne náročné na administráciu. Jedná sa napr. o ECCA test (ElectroConvulsive therapy Cognitive Assessment), prípadne o batériu B4ECT-ReCoDe (Battery for ECT Related Cognitive Deficits). Komplikáciou ich využitia v podmienkach Slovenskej i Českej republiky je, že tam nie sú štandardizované. Alternatívou je použitie jednotlivých testov na spomenuté domény. Významné je najmä hodnotenie dĺžky dezorientácie pacienta po ECT zákrokoch, vyhodnocovanie autobiografickej pamäti, schopnosti verbálneho učenia, exekutívnych funkcií a rýchlosti spracovania informácií a pozornosti, resp. pracovnej pamäti. Hodnotenie výskytu a závažnosti kognitívnych nežiaducich účinkov u pacientov podstupujúcich ECT je v praxi potrebné, zníži riziko rozvoja ich závažnejšieho stupňa, prispeje k optimalizácii liečby, ako aj k zlepšeniu spolupráce pacientov pri tejto terapii.
Electroconvulsive therapy (ECT) has a solid place in psychiatry and an irreplaceable role in the treatment of serious mental disorders. The occurrence of serious side effects is rare, the mortality rate of ECT is lower, compared to other medical interventions performed under general anesthesia. In connection with ECT, various disorders of cognitive functions are described, which pose a risk in terms of a negative impact on the patient ́s quality of life. Concerns about their occurrence and alleged high severity persist for a long time in the public. This is the so-called unsystematic review. Literary sources were mainly drawn from the PubMed database (meta-analyses, systematic review works and clinical studies published on the given topic during the last 10 years). According to a recent and fairly extensive meta-analysis, the occurrence of subjective cognitive side effects in patients after ECT was recorded in 48% of cases. However, according to the currently available data, they are mostly transitory, short-term and affect only certain cognitive domains (information processing speed, executive functions, attention, working and verbal memory, autobiographical memory). Nevertheless, the autobiographical memory disorder can persist in some cases for more than 1 year with partial irreversibility. The occurrence of cognitive side effects is influenced by several modifiable factors that need to be known and respected. An essential one is the individualization of the amount of applied electric charge during ECT through its gradual titration, in order to find the individual seizure threshold. Ultrabrief pulses (0.3ms) should clearly be preferred over longer ones. If the clinical condition allows it, it is advisable to use unilateral electrode placement (over the non-dominant hemisphere). It is not recommended to administer more than 12 applications in one series in the acute phase of treatment (with bitemporal placement of electrodes). Individual patient factors such as older age, female gender, presence of organic brain damage, and lower intellect pose a higher risk of developing cognitive adverse effects after ECT. So does concurrent lithium treatment during ECT. Current national and international guidelines offer various psychometric instruments to monitor the cognitive side effects of ECT. In some countries, for example in German-speaking regions, but also in Slovakia, specific recommendations have not been developed. Nowadays, there are batteries of tests evaluating relevant cognitive domains that can be used in clinical practice during ECT, because they are neither time nor expertly hard to administer. It is, for example, the ECCA test (ElectroConvulsive therapy Cognitive Assessment), or the B4ECT-ReCoDe battery (Battery for ECT Related Cognitive Deficits). The complication of their use in the conditions of Slovakia and the Czech Republic is that they are not standardized there. An alternative is to use individual tests for the mentioned domains. It is particularly important to assess the length of the patient ́s disorientation after ECT procedures, the evaluation of autobiographical memory, verbal learning ability, executive functions and information processing speed and attention, or working memory. Assessment of the occurrence and severity of cognitive side effects in patients undergoing ECT is necessary in practice, it will reduce the risk of developing their more severe degree, contribute to the optimization of treatment, as well as to the improvement of patient cooperation in this therapy.
Aim: To describe current scientific knowledge on cognitive impairment and emotional disturbances (anxiety and depression) in younger adult patients after ischemic stroke. Design: A scoping review. Methods: For the search, the following scientific databases were utilized: Web of Science, MEDLINE (Ovid), ScienceDirect (Elsevier), PsycInfo (EBSCO), Scopus (Elsevier), and ProQuest. Relevant studies were identified by searching publications from 2000 to July 2023. Results: A total of eight studies were ultimately included in the review. Cognitive impairment occurred in a range between 39.4% and 40%. This encompassed various aspects of cognitive function, such as working memory, processing speed, global cognitive function, immediate and delayed memory, attention, and executive functioning. Depression had an incidence rate ranging from 10.8% to 16.8%. Several risk factors were associated with a higher likelihood of developing generalized anxiety. These included younger age, more depressive symptoms, lower education, unemployment, a history of depression, and alcohol use. In the context of depressive symptoms, a higher risk was linked to lower education and unemployment. Conclusion: The included studies highlighted the need to assess these issues not only at the time of patient discharge but, more importantly, during the stage of further recovery. This can contribute to the creation of tailored interventions for these individuals.
- MeSH
- Depression diagnosis etiology MeSH
- Adult MeSH
- Ischemic Stroke * diagnosis complications physiopathology MeSH
- Clinical Studies as Topic MeSH
- Cognitive Dysfunction * etiology classification prevention & control MeSH
- Humans MeSH
- Young Adult MeSH
- Patient Discharge MeSH
- Risk Factors MeSH
- Anxiety Disorders diagnosis etiology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Transcranial direct current stimulation combined with cognitive training (tDCS-cog) represents a promising approach to combat cognitive decline among healthy older adults and patients with mild cognitive impairment (MCI). In this 5-day-long double-blinded randomized trial, we investigated the impact of intensified tDCS-cog protocol involving two trains of stimulation per day on working memory (WM) enhancement in 35 amnestic and multidomain amnestic MCI patients. Specifically, we focused to improve WM tasks relying on top-down attentional control and hypothesized that intensified tDCS would enhance performance of visual object matching task (VOMT) immediately after the stimulation regimen and at a 1-month follow-up. Secondarily, we explored whether the stimulation would augment online visual working memory training. Using fMRI, we aimed to elucidate the neural mechanisms underlying the intervention effects by analyzing BOLD activations during VOMT. Our main finding revealed no superior after-effects of tDCS-cog over the sham on VOMT among individuals with MCI as indicated by insignificant immediate and long-lasting after-effects. Additionally, the tDCS-cog did not enhance online training as predicted. The fMRI analysis revealed brain activity alterations in right insula that may be linked to tDCS-cog intervention. In the study we discuss the insignificant behavioral results in the context of the current evidence in tDCS parameter space and opening the discussion of possible interference between trained cognitive tasks.
- MeSH
- Dorsolateral Prefrontal Cortex MeSH
- Double-Blind Method MeSH
- Cognitive Dysfunction * therapy MeSH
- Memory, Short-Term physiology MeSH
- Humans MeSH
- Brain diagnostic imaging MeSH
- Prefrontal Cortex physiology MeSH
- Transcranial Direct Current Stimulation * methods MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
In this study, we aimed to determine whether childhood trauma moderated the relationship between inflammation and cognitive functioning in persons with first-episode schizophrenia spectrum disorders (SSDs). We included data from 92 individuals who participated in the nationwide Early-Stage Schizophrenia Outcome study. These individuals completed the Childhood Trauma Questionnaire, provided a fasting blood sample for high-sensitivity C-reactive protein analysis, and underwent extensive neuropsychological testing. The intervening effects of age, sex, education, smoking status, and body mass index were controlled. Results indicated that childhood trauma levels significantly moderated the relationship between inflammation and four cognitive domains: speed of processing, working memory, visual memory, and verbal memory. Inflammation also predicted verbal memory scores irrespective of childhood trauma levels or the covariates. Upon further exploration, the significant moderation effects appeared to be primarily driven by males. In conclusion, a history of childhood trauma may be an important determinant in evaluating how inflammation relates to the cognitive performance of people with first-episode SSDs, particularly in speed of processing, working memory, visual memory, and verbal memory. We recommend that future researchers examining the effect of inflammation on cognitive functioning in SSDs include trauma as a moderating variable in their models and further examine additional moderating effects of sex.
INTRO: The purpose of this study was to investigate the effects of quiet eye training (QET) on inhibitory control, visuospatial working memory (WM), and tonic attention in children with attention-deficit hyperactivity disorder (ADHD). METHODS: Forty-eight children with ADHD aged 9-12 years were randomly assigned to QET and control (CON) groups. The QET group practiced targeted hand-eye tasks within a QET protocol developed to optimize controlled attention and gaze through eye fixations. We used the go/no-go (GNG) test, the Corsi test, and the reaction test of alertness (RTA) to verify the effects of QET on inhibition control, WM, and tonic attention. RESULTS: QET group showed significantly shorter reaction times, a higher number of correct responses, and a lower number of omissions in the GNG inhibition test after QET as compared to the pre-measurements, whereas the CON group did not demonstrate significant changes in this test. The measures of WM (Corsi test) and tonic attention (RTA) did not change significantly with the QET-based intervention. CONCLUSION: The study demonstrated that the QET protocol, which includes instructions and a video demonstration to optimize eye fixation on a target during aiming tasks, is acceptable and usable for children with ADHD. Overall, a short-term, 5-week visuomotor training intervention based on the quiet eye paradigm was shown to be effective in improving inhibitory control and focused visual attention, but not visuospatial WM and intrinsic attention in 9-12-year-old children with inattentive or combined ADHD.
- MeSH
- Child MeSH
- Double-Blind Method MeSH
- Attention Deficit Disorder with Hyperactivity * therapy MeSH
- Cognition MeSH
- Memory, Short-Term * physiology MeSH
- Humans MeSH
- Fixation, Ocular MeSH
- Reaction Time MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
Methylphenidate is a stimulant used to treat attention deficit and hyperactivity disorder (ADHD). In the last decade, illicit use of methylphenidate has increased among healthy young adults, who consume the drug under the assumption that it will improve cognitive performance. However, the studies that aimed to assess the methylphenidate effects on memory are not consistent. Here, we tested whether the effect of methylphenidate on a spatial memory task can be explained as a motivational and/or a reward effect. We tested the effects of acute and chronic i.p. administration of 0.3, 1 or 3 mg/kg of methylphenidate on motivation, learning and memory by using the 8-arm radial maze task. Adult male Wistar rats learned that 3 of the 8 arms of the maze were consistently baited with 1, 3, or 6 sucrose pellets, and the number of entries and reentries into reinforced and non-reinforced arms of the maze were scored. Neither acute nor chronic (20 days) methylphenidate treatment affected the number of entries in the non-baited arms. However, chronic, but not acute, 1-3 mg/kg methylphenidate increased the number of reentries in the higher reward arms, which suggests a motivational/rewarding effect rather than a working memory deficit. In agreement with this hypothesis, the methylphenidate treatment also decreased the approach latency to the higher reward arms, increased the approach latency to the low reward arm, and increased the time spent in the high, but not low, reward arm. These findings suggest that methylphenidate may act more as a motivational enhancer rather than a cognitive enhancer in healthy people.
- MeSH
- Attention Deficit Disorder with Hyperactivity * drug therapy MeSH
- Rats MeSH
- Methylphenidate * pharmacology therapeutic use MeSH
- Motivation MeSH
- Reward MeSH
- Rats, Wistar MeSH
- Central Nervous System Stimulants * pharmacology therapeutic use MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Intervalové časování je jedním z druhů časové percepce, který operuje s časovými intervaly v rozsahu desetin až desítek sekund a je pod silnou kognitivní kontrolou. Řada studií poukazuje na vzájemnou provázanost mezi pozorností, pracovní pamětí a intervalovým časováním. Časová percepce je v dětském věku méně přesná než u dospělých a skrze postupné zrání specifických mozkových struktur dochází k jejímu postupnému zpřesňování. Děti, kterým bylo diagnostikováno ADHD, vykazují výraznější variabilitu v časových úlohách, než je tomu u dětí z intaktní populace. Toto narušení časové percepce je pro ADHD příznačné a v průběhu dospívání se kompenzuje skrze maturaci specifických mozkových struktur, která vede ke snížení rozdílů mezi zdravou populací a lidmi, kterým bylo diagnostikováno ADHD. I přesto je však u dospělé populace s ADHD narušené časování nadále přítomno. Je tedy otázkou, zda narušení časové percepce představuje jádrový symptom, který by mohl sloužit jako jeden z indikátorů při diagnostice ADHD.
Interval timing is considered to be a specific type of time perception, which operates in durations ranging from tenths of a second to approximately a few tens of seconds and is under strong cognitive control. Recent studies show a mutual connection between interval timing and particular cognitive functions such as attention and working memory. Time perception tends to be less precise in child age than later in adulthood. It becomes more precise throughout the child’s development thanks to the gradual maturation of specific brain structures, which also correspond with attentional and memory functions. Children which were diagnosed with ADHD show significantly more variability during timing tasks when compared to children without ADHD. Alteration in time perception is one of the typical symptoms of ADHD and it is partially compensated through maturation of specific brain structures during the development. This leads to less pronounced differences between these two groups in adolescence but deficits in timing still persist in adults with ADHD. Therefore it is important to ask if deficits in timing represent a possible core symptom, which could be used as one of the indicators of ADHD during diagnostics.
- Keywords
- intervalové časování,
- MeSH
- Child MeSH
- Mental Processes MeSH
- Attention Deficit Disorder with Hyperactivity * diagnosis physiopathology psychology MeSH
- Humans MeSH
- Brain growth & development MeSH
- Memory MeSH
- Attention MeSH
- Time Perception MeSH
- Child Development MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
