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Collaboration between cognitive science and cognitive rehabilitation: a call for action.

The fields of cognitive science and cognitive rehabilitation share a fundamental interest in the nature of cognition. Both groups address questions that are critical to our understanding of human thought. Researchers in basic cognitive science address these questions from a theoretical perspective. Clinicians in cognitive rehabilitation address them from an applied perspective for individuals with brain injuries. Collaborative efforts and cross-fertilization of theory and practice have been less than what might be expected given the underlying commonality of the two fields. Here, we explore the complex nature of the relationship between cognitive rehabilitation and cognitive science, discuss barriers to collaboration, and suggest ways of overcoming those barriers.

Brain Injuries↗

Cognitive deficits and cognitive training in schizophrenic patients: a review.

OBJECTIVE: The aim of this paper is to review the current status of knowledge of cognitive deficits and remediation in patients with schizophrenia. METHOD: Relevant reports were identified by a literature survey. In addition, some outstanding researchers in these areas were asked to add to the identified list relevant literature that was not included. RESULTS: Our review focuses on the cognitive deficits observed in the areas of attention, memory and executive functions. We attempt to classify dysfunctions as vulnerability- or symptom-linked factors, and we discuss the methodological question of a general performance deficit vs. a differential deficit. Furthermore, we briefly delineate how antipsychotics affect cognitive functions. Finally, controlled studies of cognitive training are discussed in more detail. CONCLUSION: The most outstanding cognitive dysfunctions in patients with schizophrenia can be related to the areas of attention, memory and executive functions. Interest in cognitive remediation has to some extent been rekindled in the 1990s. However, few studies on the effects of cognitive training programs have been conducted.

Antipsychotic Agents↗

[Cognitive enhancement effect of piracetam in patients with mild cognitive impairment and dementia].

Effectiveness and tolerability of two piracetam-containing drugs were compared in the frame of an open, multicentre, Phase-IV, prospective study with group and self control carried out in 9 Hungarian centres in 1998. Patients with cognitive decline from Alzheimer's disease and/or cerebrovascular origin have received the drug, in the first 4 weeks in 4800, later 2400 mg daily doses. One hundred four patients finished the study. No relevant difference with statistically significant degree was registered between the two groups. Based on this fact in this study data of the 104 patients were examined together. Authors examined two problems. The first: on which cognitive function is more effective the drug. Five factors of the modified Mini-Mental State Examination were separated and compared. Nearly all of them significantly increased especially the factors of memory, and concentration-psychomotor speed. The second examined field: are there certain subgroups with prognostic value about the effectiveness of piracetam treatment. Neither the duration of the illness, nor etiologic diagnosis, severity of cognitive decline, or former treatment with piracetam did influence significantly the efficacy. In case of depressive symptoms such connection was established: the more pronounced the severity of these symptoms the higher improvement can be expected in cognitive functions. This was also stressed by the logistic regression analysis. Authors described an original evaluation method of the trail-making test, which could widen the application of this popular test in psychopharmacologic studies. Final conclusions: the cognitive enhancer effect of piracetam appeared in a few weeks. This treatment could be effective even in Alzheimer's disease, in case of more pronounced cognitive decline, longer duration of the illness, and in case of former piracetam treatment as well. The degree of cognitive improvement was most pronounced in patients with comorbid depressive symptoms.

Aged↗

Cognition and life: the autonomy of cognition.

In this paper we propose a philosophical distinction between biological and cognitive domains based on two conditions that are postulated to obtain a useful characterization of cognition: biological grounding and explanatory sufficiency. According to this, we argue that the origin of cognition in natural systems (cognition as we know it) is the result of the appearance of an autonomous system embedded into another more generic one: the whole organism. This basic idea is complemented by another one: the formation and development of this system, in the course of evolution, cannot be understood but as the outcome of a continuous process of interaction between organisms and environment, between different organisms, and, specially, between the very cognitive organisms. Finally, we address the problem of the generalization of a theory of cognition (cognition as it could be) and conclude that this work would imply a grounding work on the problem of the origins developed in the frame of a confluence between both Artificial Life and an embodied Artificial Intelligence.

Animals↗

Cognitive triad: relationship to depressive symptoms, parents' cognitive triad, and perceived parental messages.

Evaluating the relationship between children's depressogenic thinking, children's depressive symptoms, parents' depressogenic thinking, and perceived parental messages about the self, world, and future was the primary objective of this investigation. Children (n = 133) from grades 4 to 7 completed measures of depression and anxiety, including a semistructured clinical interview, a measure of their cognitive triad, and a measure of perceived parental messages about the self, world, and future. Mothers (n = 112) and fathers (n = 95) completed a measure of their own cognitive triad. Results of a series of regression analyses revealed that (1) children's views of self, world, and future (cognitive triad) are related to severity of depression; (2) mothers' but not fathers' cognitive triads are related to their children's cognitive triads; (3) perceived parental messages to the children about the self, world, and future are predictive of the children's cognitive triads and ratings of depression; and (4) the relationship between perceived parental messages and depression is completely mediated by children's cognitive triads. Analyses of covariance indicated that the obtained mediational relationship between children's views of self, world, and future, perceived parental messages, and children's depressive symptoms was specific to depressive versus anxious symptomatology. Implications for existing theory and research are discussed.

Adolescent↗

Subjective reports of cognition in relation to assessed cognitive performance following coronary artery bypass surgery.

Evidence has accumulated to indicate that a proportion of patients who undergo coronary artery bypass surgery (CABS) do develop significant cognitive deficits. This study examines whether those patients who report cognitive deterioration after CABS do show cognitive changes as assessed by neuropsychological testing. The patients who considered that aspects of their cognitive function had deteriorated, were not found to have reduced functions as assessed on appropriate neuropsychological tests. When mood state was examined, it was found that those who report a deterioration in a particular cognitive function, tended to have significantly higher levels of depression as assessed by the Beck Depression Inventory and, to a lesser extent, have higher levels of state anxiety. These findings emphasise that subjective reports of cognitive function following CABS do not reflect actual changes in cognition but rather appear to be sensitive to mood state.

Adult↗

Influence of education on the pattern of cognitive deterioration in AD patients: the cognitive reserve hypothesis.

The cognitive reserve hypothesis proposes that a high educational level could delay the clinical expression of Alzheimer's disease (AD) although neuropathologic changes develop in the brain. Therefore, some studies have reported that when the clinical signs of the disease emerge, high-educated patients may decline more rapidly than low-educated patients because the neuropathology is more advanced. However, these studies have only investigated the decline of global cognition or an isolated cognitive process. To study the differential deterioration pattern of several cognitive processes according to education, the performance of 20 AD patients with a high educational level and a low educational level were compared with the performance of 20 control subjects on a neuropsychological battery. The results showed that cognitive deterioration of AD patients is different according to education, although the global performance was similar in AD patients. The high-educated patients exhibited greater impairment of abstract thinking whereas the low-educated patients showed greater impairment of memory and attentional function. This confirms that some cognitive processes, such as abstract thinking, decline more rapidly in high-educated patients whereas others seem to evolve more slowly if compared to low-educated patients. In this latter case, high-educated patients may still benefit from cognitive reserve after the diagnosis of the dementia.

Aged↗

Approaching a consensus cognitive battery for clinical trials in schizophrenia: the NIMH-MATRICS conference to select cognitive domains and test criteria.

To stimulate the development of new drugs for the cognitive deficits of schizophrenia, the National Institute of Mental Health (NIMH) established the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative. This article presents an overview of decisions from the first MATRICS consensus conference. The goals of the meeting were to 1) identify the cognitive domains that should be represented in a consensus cognitive battery and 2) prioritize key criteria for selection of tests for the battery. Seven cognitive domains were selected based on a review of the literature and input from experts: working memory, attention/vigilance, verbal learning and memory, visual learning and memory, reasoning and problem solving, speed of processing, and social cognition. Based on discussions at this meeting, five criteria were considered essential for test selection: good test-retest reliability, high utility as a repeated measure, relationship to functional outcome, potential response to pharmacologic agents, and practicality/tolerability. The results from this meeting constitute the initial steps for reaching a consensus cognitive battery for clinical trials in schizophrenia.

Clinical Trials as Topic↗

Cognitive change process during group cognitive behaviour therapy for depression.

BACKGROUND: This study extended that of Kwon and Oei [Kwon, S.M., Oei, T.P.S., 2003. Cognitive change processes in a group cognitive behavior therapy of depression. J. Behav. Ther. Exp. Psychiatry, 3, 73-85], which outlined a number of testable models based on Beck's cognitive theory of depression. Specifically, the current study tested the following four competing models: the causal, consequential, fully and partially interactive cognitive models in patients with major depressive disorder. METHODS: A total of 168 clinically depressed outpatients were recruited into a 12-week group cognitive behaviour therapy program. Data was collected at three time points: baseline, mid- and at termination of therapy using the ATQ, DAS and BDI. The data were analysed with Amos 4.01(Arbuckle, J.L., 1999. Amos 4.1. Smallwaters, Chicago.) structural equation modelling. RESULTS: Results indicated that dysfunctional attitudes, negative automatic thoughts and symptoms of depression reduced significantly during treatment. Both the causal and consequential models equally provided an adequate fit to the data. The fully interactive model provided the best fit. However, after removing non-significant pathways, it was found that reduced depressive symptom contributed to reduced depressogenic automatic thoughts and dysfunctional attitudes, not the reverse. CONCLUSION: These findings did not fully support Beck's cognitive theory of depression that cognitions are primary in the reduction of depressed mood.

Adolescent↗

Conversion from cognitive health to mild cognitive impairment and Alzheimer's disease: prediction by plasma amyloid beta 42, medial temporal lobe atrophy and homocysteine.

The changes of plasma amyloid beta (Abeta42) protein, homocysteine and medial temporal lobe atrophy (MTA) were studied by the transition from cognitive health to mild cognitive impairment (MCI) and to Alzheimer's disease (AD) in a prospective cohort of individuals aged 75 years. MTA but not plasma Abeta42 measured at baseline predicted which persons remained cognitively healthy (CH) and who developed AD 2.5 years later. The increase of plasma Abeta42 over time significantly distinguished between persons who remained CH on the one hand and MCI converters and AD converters out of cognitive health on the other (CH-to-MCI and CH-to-AD converters). Although both groups showed similar increase of Abeta42 levels, CH-to-AD converters had a higher increase of homocysteine compared to CH-to-MCI converters or to persons remaining CH. In comparison to all cognitive subgroups, the AD converters from MCI at baseline showed the smallest increase of Abeta42 levels and rather no increase of homocysteine. In logistic regression analysis, the increase of plasma Abeta42 but not change of MTA significantly predicted the conversion from CH to MCI, and changes of MTA and homocysteine but not of plasma Abeta42 predicted the conversion from CH to AD. The increase of plasma Abeta42 correctly allocated CH-to-MCI and CH-to-AD converters with low (63%) specificity (for both) and low (60%) sensitivity (54% for AD group). These results indicate that (1) plasma Abeta42 alone is not suitable as a biomarker for AD, (2) in the course of cognitive deterioration of the AD-type the increase of plasma Abeta42 seems to be an initial event, (3) similar to cerebrospinal fluid, changes of plasma Abeta42 may reflect the transition from cognitive health to AD, and (4) whether persons with MCI develop AD may depend on an accumulation of further toxic metabolites such as homocysteine.

Aged↗

COMT val108/158met genotype, cognitive function, and cognitive improvement with clozapine in schizophrenia.

Preliminary evidence suggests that a single nucleotide polymorphism (SNP), the val108/158met SNP, within the gene that codes for catechol-O-methyltransferase (COMT), a key enzyme involved in regulating dopamine (DA) transmission within the prefrontal cortex (PFC), is related to cognitive function in schizophrenia and cognitive improvement with atypical antipsychotic drugs (APDs). Specifically, several studies have identified an association between working memory and executive functions, and COMT val108/158met genotype in schizophrenia; although there have been several negative findings that are likely related to small sample sizes and, possibly, medication status of patients at the time of testing. The association between COMT val108/158met genotype, cognitive function, and cognitive improvement with clozapine was investigated in a relatively large prospective sample of patients with schizophrenia, most of whom were unmedicated at baseline. Patients were genotyped for the COMT val108/158met SNP after completing a cognitive battery consisting of tests of attention, working memory, verbal learning and memory, executive function, and verbal fluency at baseline and after 6 weeks and 6 months of treatment with clozapine. Consistent with several previous studies, an association between COMT genotype and tests of executive function and working memory was identified at baseline. In addition, a novel interaction between genotype and improvement on tests of attention and verbal fluency was identified. Specifically, met homozygous and val/met heterozygous patients demonstrated significantly greater improvement than val homozygous patients following 6 months of treatment with clozapine. The results are discussed in relation to previous cross-sectional studies and prospective investigations of the associations between COMT genotype, cognition, and cognitive improvement with atypical APDs in schizophrenia.

Adult↗

Cognitive neuropsychology and functional brain imaging: implications for functional and anatomical models of cognition.

We discuss the relations between functional imaging and cognitive neuropsychological research. We begin by elaborating on some of the problems of traditional neuropsychological research, which attempted to provide accounts of cognitive performance at a neural as well as at a functional level of description. The difficulties in making neural-level arguments from neuropsychological data include: problems of associated deficits, problems due to interactive effects between brain regions, problems with analyses based on behavioural syndromes, problems due to the influence of compensatory strategies, and problems in separating damaged from disconnected representations. We discuss how cognitive neuropsychology by-passed many of these problems by emphasising functional rather than neural-level theories, though problems with inferences at the neural-level remain. We then consider the contribution that functional imaging can make to cognitive neuropsychology. Using evidence drawn from studies of language, object recognition and visual attention, we argue that functional imaging complements cognitive neuropsychology by: (i) not being reliant on accidents of nature and by enabling effects of lesions on 'distant' neural areas to be measured, (ii) revealing the brain systems necessary and sufficient for a given task, (iii) providing tests of neural-level models of cognition, and by (iv) providing novel evidence on the mechanisms of functional recovery in patients. In addition to this, imaging studies can contribute directly to functional-level theories, by providing converging evidence on the neural locus of cognition--knowing 'where' can allow new inferences about 'how' a given task is performed.

Brain↗

Heuristic and analytic processing: age trends and associations with cognitive ability and cognitive styles.

Developmental and individual differences in the tendency to favor analytic responses over heuristic responses were examined in children of two different ages (10- and 11-year-olds versus 13-year-olds), and of widely varying cognitive ability. Three tasks were examined that all required analytic processing to override heuristic processing: inductive reasoning, deductive reasoning under conditions of belief bias, and probabilistic reasoning. Significant increases in analytic responding with development were observed on the first two tasks. Cognitive ability was associated with analytic responding on all three tasks. Cognitive style measures such as actively open-minded thinking and need for cognition explained variance in analytic responding on the tasks after variance shared with cognitive ability had been controlled. The implications for dual-process theories of cognition and cognitive development are discussed.

Adolescent↗

Cognitive reserve and mortality in dementia: the role of cognition, functional ability and depression.

OBJECTIVE: This study examined whether dementia patients with greater cognitive reserve had increased mortality rates, and whether this association was different across strata of cognition, functional ability and depression. METHODS: In the community-based Amsterdam Study of the Elderly, 261 non-institutionalized dementia patients, identified using the Geriatric Mental State Schedule (GMS), were followed for an average of 55.5 months after which mortality data were obtained. Cognitive reserve was indicated by years of education and pre-morbid intelligence (measured using the Dutch Adult Reading Test). Cognition, functional ability and depression were indicated by Mini-Mental State scores, ADL and IADL measurements and GMS depressive syndrome, respectively. RESULTS: During the follow-up 146 persons (55.9%) died. Cox regression analyses showed that more highly educated dementia patients had higher mortality rates, only if they had low MMSE scores or if they had a concurrent depression. Pre-morbid intelligence was associated with a higher mortality rate, independent of cognition, but this association was much stronger among patients with depression. The positive association between education or intelligence and mortality was not modified by functional disabilities. CONCLUSIONS: The results suggest that dementia patients with greater cognitive reserve have increased mortality rates, only if the disease has progressed to such an extent that clinical symptoms are more severe. In this respect, the reserve hypothesis needs a modification. Depression in dementia patients with greater cognitive reserve may reflect a subgroup of patients with poor prognosis.

Aged↗

Is vision continuous with cognition? The case for cognitive impenetrability of visual perception.

Although the study of visual perception has made more progress in the past 40 years than any other area of cognitive science, there remain major disagreements as to how closely vision is tied to cognition. This target article sets out some of the arguments for both sides (arguments from computer vision, neuroscience, psychophysics, perceptual learning, and other areas of vision science) and defends the position that an important part of visual perception, corresponding to what some people have called early vision, is prohibited from accessing relevant expectations, knowledge, and utilities in determining the function it computes--in other words, it is cognitively impenetrable. That part of vision is complex and involves top-down interactions that are internal to the early vision system. Its function is to provide a structured representation of the 3-D surfaces of objects sufficient to serve as an index into memory, with somewhat different outputs being made available to other systems such as those dealing with motor control. The paper also addresses certain conceptual and methodological issues raised by this claim, such as whether signal detection theory and event-related potentials can be used to assess cognitive penetration of vision. A distinction is made among several stages in visual processing, including, in addition to the inflexible early-vision stage, a pre-perceptual attention-allocation stage and a post-perceptual evaluation, selection, and inference stage, which accesses long-term memory. These two stages provide the primary ways in which cognition can affect the outcome of visual perception. The paper discusses arguments from computer vision and psychology showing that vision is "intelligent" and involves elements of "problem solving." The cases of apparently intelligent interpretation sometimes cited in support of this claim do not show cognitive penetration; rather, they show that certain natural constraints on interpretation, concerned primarily with optical and geometrical properties of the world, have been compiled into the visual system. The paper also examines a number of examples where instructions and "hints" are alleged to affect what is seen. In each case it is concluded that the evidence is more readily assimilated to the view that when cognitive effects are found, they have a locus outside early vision, in such processes as the allocation of focal attention and the identification of the stimulus.

Agnosia↗

1H magnetic resonance spectroscopy, cognitive function, and apolipoprotein E genotype in normal aging, mild cognitive impairment and Alzheimer's disease.

The aim of this study was to examine the associations of apolipoprotein E (APOE) genotype, metabolic changes in the posterior cingulate detected by 1H magnetic resonance spectroscopy (MRS), and neuropsychologic measures of memory and cognition both in normally aging elderly, and in patients with mild cognitive impairment (MCI) and AD. We studied 67 controls, 18 MCI and 33 AD patients. We used the Dementia Rating Scale total score (DRSTOT) as a measure of general cognitive function and the total learning from the Auditory Verbal Learning Test (AVTOT) as a measure of memory performance. No differences were noted on 1H-MRS metabolite ratios or cognitive measures across APOE genotype within control and patient groups. In controls, age was a significant predictor of both cognitive test scores, and NAA/Cr was a univariate associate of DRSTOT. All 3 1H-MRS metabolite ratios, N-acetylaspartate (NAA)/creatine (Cr), myoinositol (MI)/Cr, and NAA/MI, were univariate associates of AVTOT and DRSTOT scores in the combined MCI and AD group. In stepwise regression analyses in the combined patient group only NAA/MI entered the models. These data suggest NAA/Cr could be a modest predictor of general cognitive function in both healthy elderly and impaired patients, while MI/Cr is a more specific marker for neuropsychologic dysfunction associated with neurodegenerative disease. Among 1H-MRS measurements, the NAA/MI ratio maybe the most efficient predictor of memory and cognitive function in patients with MCI and AD.

Aged↗

What is mild cognitive impairment? Variations in definitions and evolution of nondemented persons with cognitive impairment.

Numerous studies have endeavoured to explore the nature of cognitive impairment in nondemented elderly persons. Comparison of this literature is hampered by huge variations in criteria and methodology. Despite these limitations, there are repeated reports that nondemented persons with cognitive impairment have a higher chance of progressing to dementia. Evidence also indicates higher mortality in cognitively impaired persons but there is also a chance of improvement in cognition over time. The current paper provides an overview of the various concepts and criteria proposed for cognitive impairment in nondemented persons, discusses some of the problems with current research in this field, and presents some of the findings concerning the evolution of cognitive impairment in relation to dementia, mortality and cognitive improvement.

Cognition Disorders↗

The developmental origins of cognitive vulnerability to depression: temperament, parenting, and negative life events in childhood as contributors to negative cognitive style.

Cognitive models of depression have been well supported with adults, but the developmental origins of cognitive vulnerability are not well understood. The authors hypothesized that temperament, parenting, and negative life events in childhood would contribute to the development of cognitive style, with withdrawal negativity and negative parental feedback moderating the effects of negative life events to predict more depressogenic cognitive styles. These constructs were assessed in 289 children and their parents followed longitudinally from infancy to 5th grade; a subsample (n = 120) also participated in a behavioral task in which maternal feedback to child failure was observed. Results indicated that greater withdrawal negativity in interaction with negative life events was associated with more negative cognitive styles. Self-reported maternal anger expression and observed negative maternal feedback to child's failure significantly interacted with child's negative events to predict greater cognitive vulnerability. There was little evidence of paternal parenting predicting child negative cognitive style.

Child↗