The use of driver screening tools to predict self-reported crashes and incidents in older drivers.

There is a clear need to identify older drivers at increased crash risk, without additional burden on the individual or licensing system. Brief off-road screening tools have been used to identify unsafe drivers and drivers at risk of losing their license. The aim of the current study was to evaluate and compare driver screening tools in predicting prospective self-reported crashes and incidents over 24 months in drivers aged 60 years and older. 525 drivers aged 63-96 years participated in the prospective Driving Aging Safety and Health (DASH) study, completing an on-road driving assessment and seven off-road screening tools (Multi-D battery, Useful Field of View, 14-Item Road Law, Drive Safe, Drive Safe Intersection, Maze Test, Hazard Perception Test (HPT)), along with monthly self-report diaries on crashes and incidents over a 24-month period. Over the 24 months, 22% of older drivers reported at least one crash, while 42% reported at least one significant incident (e.g., near miss). As expected, passing the on-road driving assessment was associated with a 55% [IRR 0.45, 95% CI 0.29-0.71] reduction in self-reported crashes adjusting for exposure (crash rate), but was not associated with reduced rate of a significant incident. For the off-road screening tools, poorer performance on the Multi-D test battery was associated with a 22% [IRR 1.22, 95% CI 1.08-1.37] increase in crash rate over 24 months. Meanwhile, all other off-road screening tools were not predictive of rates of crashes or incidents reported prospectively. The finding that only the Multi-D battery was predictive of increased crash rate, highlights the importance of accounting for age-related changes in vision, sensorimotor skills and cognition, as well as driving exposure, in older drivers when using off-road screening tools to assess future crash risk.

Kynurenic acid as a biochemical factor underlying the association between Western-style diet and depression: A cross-sectional study.

Consumption of a Western-style diet (WS-diet), high in saturated fat and added sugar, is associated with increased depression risk. However, the physiological mechanisms underlying the relationship requires elucidation. Diet can alter tryptophan metabolism along the kynurenine pathway (KP), potentially linking inflammation and depression. This study aimed to examine whether urinary inflammatory markers and KP metabolites differed according to WS-diet consumption and depression severity. Depression symptoms and habitual WS-diet consumption were assessed in 169 healthy adults aged 17-35 recruited from two experimental studies. Targeted metabolomics profiling of seven KP metabolites, ELISA-based assays of interleukin-6 (IL-6) and C-reactive protein (CRP) were performed using urine samples collected from the participants. Parametric tests were performed for group comparison and associations analysis. Multilevel mixed-effect modelling was applied to control for biases. Higher intake of WS-diet was associated with lower levels of neuroprotective kynurenic acid (KA; R = -0.17, p = 0.0236). There were no differences in IL-6 or CRP across diet groups (p > 0.05). Physical activity had negative associations with most KP metabolites. Mixed-effects regression analysis showed the glutamatergic inhibitor, KA, was the only biomarker to have a significant association with depression symptoms in a model adjusted for demographic and lifestyle variables: a unit increase in KA was associated with 0.21 unit decrease in Depression Anxiety and Stress Scale-21 depression score (p = 0.009). These findings suggest that urinary KA is associated with both habitual WS-diet intake, and levels of depression symptoms, independent of inflammation. Findings support the role of neuroprotection and glutamatergic modulation in depression. We propose that KA may act as endogenous glutamatergic inhibition in regulating depression severity in the absence of inflammation. Further comparison with blood-based markers will assist in validating the utility of non-invasive urine samples for measuring KP metabolites.

Tracking smell loss to identify healthcare workers with SARS-CoV-2 infection.

INTRODUCTION: Healthcare workers (HCW) treating COVID-19 patients are at high risk for infection and may also spread infection through their contact with vulnerable patients. Smell loss has been associated with SARS-CoV-2 infection, but it is unknown whether monitoring for smell loss can be used to identify asymptomatic infection among high risk individuals. In this study we sought to determine if tracking smell sensitivity and loss using an at-home assessment could identify SARS-CoV-2 infection in HCW. METHODS AND FINDINGS: We performed a prospective cohort study tracking 473 HCW across three months to determine if smell loss could predict SARS-CoV-2 infection in this high-risk group. HCW subjects completed a longitudinal, behavioral at-home assessment of olfaction with household items, as well as detailed symptom surveys that included a parosmia screening questionnaire, and real-time quantitative polymerase chain reaction testing to identify SARS-CoV-2 infection. Our main measures were the prevalence of smell loss in SARS-CoV-2-positive HCW versus SARS-CoV-2-negative HCW, and timing of smell loss relative to SARS-CoV-2 test positivity. SARS-CoV-2 was identified in 17 (3.6%) of 473 HCW. HCW with SARS-CoV-2 infection were more likely to report smell loss than SARS-CoV-2-negative HCW on both the at-home assessment and the screening questionnaire (9/17, 53% vs 105/456, 23%, P < .01). 6/9 (67%) of SARS-CoV-2-positive HCW reporting smell loss reported smell loss prior to having a positive SARS-CoV-2 test, and smell loss was reported a median of two days before testing positive. Neurological symptoms were reported more frequently among SARS-CoV-2-positive HCW who reported smell loss compared to those without smell loss (9/9, 100% vs 3/8, 38%, P < .01). CONCLUSIONS: In this prospective study of HCW, self-reported changes in smell using two different measures were predictive of SARS-CoV-2 infection. Smell loss frequently preceded a positive test and was associated with neurological symptoms.

Factors Associated With Anxiety Symptoms in Australian Deaf or Hard of Hearing Children.

Deaf/deaf or hard of hearing (DHH) children are at an increased risk of developing mental health problems, with growing evidence that they may experience greater anxiety symptoms than hearing peers. The present study investigated whether Australian children with varying degrees of hearing loss experienced increased anxiety symptoms compared to hearing children. Furthermore, we examined whether child anxiety symptoms were associated with known risk factors including psychological symptoms of anxiety and depression in parents, age at detection, early intervention and device fitting, type of hearing device, and peer problems. Participants were 65 parents of children with hearing loss aged between 4 and 11 years old (M = 6.05, SD = 1.60) seeking treatment for hearing loss at a specialized hearing clinic in Australia. Based on parent reports, we found that the children with hearing loss had fewer anxiety symptoms than their hearing peers (using normative data). Psychological distress of parents was the only factor that uniquely associated with child anxiety. Parents of children with hearing loss were found to experience greater emotional distress compared to parents of hearing children. This suggests parents may require additional support to cope with the social and economic strains associated with childhood hearing loss.

Tracking Smell Loss to Identify Healthcare Workers with SARS-CoV-2 Infection.

BACKGROUND: Healthcare workers (HCW) treating COVID-19 patients are at high risk for infection and may also spread infection through their contact with vulnerable patients. Smell loss has been associated with SARS-CoV-2 infection, but it is unknown whether monitoring for smell loss can be used to identify asymptomatic infection among high risk individuals, like HCW. METHODS: We performed a prospective cohort study, tracking 473 HCW across three months to determine if smell loss could predict SARS-CoV-2 infection in this high-risk group. HCW subjects completed a longitudinal, novel behavioral at-home assessment of smell function with household items, as well as detailed symptom surveys that included a parosmia screening questionnaire, and RT-qPCR testing to identify SARS-CoV-2 infection. RESULTS: SARS-CoV-2 was identified in 17 (3.6%) of 473 HCW. Among the 17 infected HCW, 53% reported smell loss, and were more likely to report smell loss than COVID-negative HCW on both the at-home assessment and the screening questionnaire (P < .01). 67% reported smell loss prior to having a positive SARS-CoV-2 test, and smell loss was reported a median of two days before testing positive. Neurological symptoms were reported more frequently among COVID-positive HCW who reported smell loss (P < .01). CONCLUSIONS: In this prospective study of HCW, self-reported changes in smell using two different measures were predictive of COVID-19 infection. Smell loss frequently preceded a positive test and was associated with neurological symptoms.

Hippocampal-dependent appetitive control is impaired by experimental exposure to a Western-style diet.

Animals fed a Western-style diet (WS-diet) demonstrate rapid impairments in hippocampal function and poorer appetitive control. We examined if this also occurs in humans. One-hundred and ten healthy lean adults were randomized to either a one-week WS-diet intervention or a habitual-diet control group. Measures of hippocampal-dependent learning and memory (HDLM) and of appetitive control were obtained pre- and post-intervention. HDLM was retested at three-week follow-up. Relative to controls, HDLM performance declined in the WS-diet group (d = 0.43), but was not different at follow-up. Appetitive control also declined in the WS-diet group (d = 0.47) and this was strongly correlated with HDLM decline (d = 1.01). These findings demonstrate that a WS-diet can rapidly impair appetitive control in humans-an effect that could promote overeating in consumers of a WS-diet. The study also suggests a functional role for the hippocampus in appetitive control and provides new evidence for the adverse neurocognitive effects of a WS-diet.

No evidence of flavour-nutrient learning in a two-week 'home exposure' study in humans.

Flavour-nutrient learning is robust in animals but remains elusive in humans. Recent evidence suggests flavour-nutrient learning may be more likely to occur with beverages that contain relatively few calories (compared to no calories), while others show that learned associations can influence satiation, without an effect on preference. The objective of this research was to determine whether acquired liking for a caloric drink could be observed in a 'home learning' context over 2 weeks, and whether it is impacted by viscosity. In combination, we also explored changes in learning relating to fullness and expected satiety. In a double-blind study, participants (N = 83; BMI = 23.3 kg/m2) were randomly allocated to one of four groups differing in either calories (0 kcal vs. 112.5 kcal) or viscosity (low vs. high) and consumed a novel-flavoured drink over 15 days. Measures of flavour (10 ml sample) and beverage liking, grip force (a measure of beverage reward value), fullness, and expected satiety were taken at the start and the end of the study. While the high-viscous beverages were less liked (M = 40.3 mm, SD = 24.7) than the low viscous beverages (M = 64.4 mm, SD = 15.3; p = .022), there was no evidence that repeated exposure to a calorie-containing beverage impacted subsequent liking for the flavour (p = .115) or for the beverage (p = .448), grip force (ps > .26), fullness, and expected satiety (ps > .12). Accordingly, we conclude that we found no evidence of flavour-nutrient learning and flavour-satiety learning. This null finding accords with previous observations indicating that humans do not acquire flavour-nutrient associations as readily as some non-human animals.

Explicit wanting and liking for palatable snacks are differentially affected by change in physiological state, and differentially related to salivation and hunger.

Incentive salience theory (IST) suggests that 'wanting' and liking are dissociable processes. We argue that explicit measures of wanting in humans can reflect the impact of implicit 'wanting' as envisaged by IST, suggesting that dissociations should also be evident for explicit judgments of wanting and liking. To test this, participants were asked to make ratings of these variables for 8 palatable snack foods - and in a related test salivation rate was also assessed. Participants viewed and sniffed each snack food and rated wanting, and then sampled it and rated liking and whether they wanted more of it. Following a lunch eaten to satiety, and composed in part of half of the palatable snack foods, participants repeated their evaluations of the snack foods (and salivation rate). Liking changed less across lunch than wanting and want more ratings, the last-mentioned changing the most. Change in liking was associated with change in salivation rate, independent of wanting, and change in wanting was associated with change in hunger independent of liking. We argue these dissociations are consistent with 'wanting' influencing explicit wanting, and that want more ratings may represent a 'purer' measure of IST 'wanting'.

A four-day Western-style dietary intervention causes reductions in hippocampal-dependent learning and memory and interoceptive sensitivity.

In animals, a Western style diet-high in saturated fat and added sugar-causes impairments in hippocampal-dependent learning and memory (HDLM) and perception of internal bodily state (interoception). In humans, while there is correlational support for a link between Western-style diet, HDLM, and interoception, there is as yet no causal data. Here, healthy individuals were randomly assigned to consume either a breakfast high in saturated fat and added sugar (Experimental condition) or a healthier breakfast (Control condition), over four consecutive days. Tests of HDLM, interoception and biological measures were administered before and after breakfast on the days one and four, and participants completed food diaries before and during the study. At the end of the study, the Experimental condition showed significant reductions in HDLM and reduced interoceptive sensitivity to hunger and fullness, relative to the Control condition. The Experimental condition also showed a markedly different blood glucose and triglyceride responses to their breakfast, relative to Controls, with larger changes in blood glucose across breakfast being associated with greater reductions in HDLM. The Experimental condition compensated for their energy-dense breakfast by reducing carbohydrate intake, while saturated fat intake remained consistently higher than Controls. This is the first experimental study in humans to demonstrate that a Western-style diet impacts HDLM following a relatively short exposure-just as in animals. The link between diet-induced HDLM changes and blood glucose suggests one pathway by which diet impacts HDLM in humans.

A high-fat high-sugar diet predicts poorer hippocampal-related memory and a reduced ability to suppress wanting under satiety.

Animal data indicate that greater intake of fats and sugars prevalent in a Western diet impairs hippocampal memory and tests of behavioral inhibition known to be related to hippocampal function (e.g., feature negative discrimination tasks). It has been argued that such high-fat high-sugar diets (HFS) impair the hippocampus, which then becomes less sensitive to modulation by physiological state. Thus retrieval of motivationally salient memories (e.g., when seeing or smelling food) occurs irrespective of state. Here we examine whether evidence of similar effects can be observed in humans using a correlational design. Healthy human participants (N = 94), who varied in their habitual consumption of a HFS diet, completed the verbal paired-associate (VPA) test, a known hippocampal-dependent process, as well as liking and wanting ratings of palatable snack foods, assessed both when hungry and when sated. Greater intake of a HFS diet was significantly associated with a slower VPA learning rate, as predicted. Importantly, for those who regularly consumed a HFS diet, though reductions in liking and wanting occurred between hungry and sated states, the reduction in wanting was far smaller relative to liking. The latter effect was strongly related to VPA learning rate, suggestive of hippocampal mediation. In agreement with the animal literature, human participants with a greater intake of a HFS diet show deficits in hippocampal-dependent learning and memory, and their desire to consume palatable food is less affected by physiological state-a process we suggest that is also hippocampal related. (PsycINFO Database Record

A systematic review of longer-term dietary interventions on human cognitive function: Emerging patterns and future directions.

Cognitive function may be affected by long-term diet and most of the support for this idea is derived from human correlational studies and animal prescribed diet studies. To date there has been no systematic examination of human experimental studies that examine whether a prescribed long-term (24 h+) diet can cause changes in cognitive function. Here, we review the experimental evidence of long-term changes in cognition following prescribed diet interventions. A total of 30 diet interventions were identified and reviewed. Measures of working memory, long-term memory, and attention appeared most sensitive to dietary manipulation, but there was considerable variability in outcome. Additionally, energy and fat intake manipulations tended to influence performance on these measures to the greatest degree. This review also serves to identify factors that should be considered in designing future diet-cognition studies. We also suggest a series of cognitive tests based on this review and indicate potentially profitable directions to take the diet-cognition literature.

Human olfactory consciousness and cognition: its unusual features may not result from unusual functions but from limited neocortical processing resources.

Human and animal olfactory perception is shaped both by functional demands and by various environmental constraints seemingly peculiar to chemical stimuli. These demands and constraints may have generated a sensory system that is cognitively distinct from the major senses. In this article we identify these various functional demands and constraints, and examine whether they can be used to account for olfaction's unique cognitive features on a case-by-case basis. We then use this as grounds to argue that specific conscious processes do have functional value, a finding that naturally emerges when a comparative approach to consciousness across the senses is adopted. More generally, we conclude that certain peculiar features of olfactory cognition may owe more to limited neocortical processing resources, than they do to the challenges faced by perceiving chemical stimuli.