Longitudinal changes in executive function in autism spectrum disorder: A systematic review and meta-analyses.

Individuals with an autism spectrum disorder (ASD) diagnosis show impairment in executive function (EF). However, findings are mixed regarding differences in the age effect on EF between autistic individuals and persons with typical development (TD). Questions remain regarding whether the age-related trajectories of EF in ASD are the same as or different from those in TD. To bridge this knowledge gap, we conducted a systematic review and meta-analyses of longitudinal studies that compared age-related changes in EF between ASD and TD groups (preregistration: osf.io/j5764). A literature search was conducted using PubMed, PsycINFO, and Web of Science on January 29, 2024. After screening by two independent reviewers, 14 longitudinal studies were included. Random-effects meta-analyses of studies involving a maximum total of 518 autistic and 3558 TD children and adolescents (mean baseline ages: 5.7-12.0 years) showed that ASD had significantly poorer EF than TD at both baseline and follow-up. However, there was no significant group difference in the age-related change in EF across domains, including working memory, inhibition, shifting, and planning. Robust Bayesian meta-analyses also provided substantial evidence in favor of the null hypothesis that ASD and TD groups showed similar changes over time for most EF processes. Limitations of the literature included the limited number of longitudinal studies and a narrow range of developmental stages and EF constructs analyzed across studies. Altogether, these findings suggest that autistic children and adolescents generally can improve in EF over time similarly to their neurotypical peers. This has important implications for parents and educators, encouraging appropriate EF training and intervention for autistic children and adolescents at an early stage.

Modifiable risk factors for mild cognitive impairment among cognitively normal community-dwelling older adults: A systematic review and meta-analysis.

Although numerous studies have investigated modifiable risk factors for mild cognitive impairment (MCI) among community-dwelling seniors, no meta-analysis has summarized these findings. Five databases were searched from January 1, 2000, to December 30, 2023. The protocol was registered with PROSPERO. Data were extracted and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant meta-analyses of modifiable risk factors were performed. The evidence of each factor was assessed by the GRADE for cohort studies. Of 16,651 citations, 87 studies involving 225,584 community-dwelling seniors were included. Fourteen meta-analyses involving 20 studies with 44,199 participants were performed. The analyses revealed low-to-moderate-quality evidence supporting that diabetes, 2 or more comorbidities, anxiety, apathy, depressive symptoms, and physical frailty were risk factors for incident MCI in older adults. Conversely, hypertension, agitation, and irritability might not be risk factors. Additionally, moderate-quality evidence supports the protective effect of engaging in cognitive-demanding activities on the onset of MCI. Collectively, this study constitutes the first extensive compilation of evidence regarding the various risk factors for the development of MCI in older adults. Our findings hold significant potential to guide the formulation of prevention and management strategies to either prevent or potentially reverse the onset of MCI.

Motivation and emotional distraction interact and affect executive functions.

Previous research on cool-hot executive function (EF) interactions has examined the effects of motivation and emotional distraction on cool EF separately, focusing on one EF component at a time. Although both incentives and emotional distractors have been shown to modulate attention, how they interact and affect cool EF processes is still unclear. Here, we used an experimental paradigm that manipulated updating, inhibition, and shifting demands to determine the interactions of motivation and emotional distraction in the context of cool EF. Forty-five young adults (16 males, 29 females) completed the go/no-go (inhibition), two-back (updating), and task-switching (shifting) tasks. Monetary incentives were implemented to manipulate motivation, and task-irrelevant threatening or neutral faces were presented before the target stimulus to manipulate emotional distraction. We found that incentives significantly improved no-go accuracy, two-back accuracy, and reaction time (RT) switch cost. While emotional distractors had no significant effects on overall task performance, they abolished the incentive effects on no-go accuracy and RT switch cost. Altogether, these findings suggest that motivation and emotional distraction interact in the context of cool EF. Specifically, transient emotional distraction disrupts the upregulation of control activated by incentives. The present investigation has advanced knowledge about the relationship between cool and hot EF and highlights the importance of considering motivation-emotion interactions for a fuller understanding of control.

Effects of age on the interactions of attentional and emotional processes: a prefrontal fNIRS study.

The aging of attentional and emotional functions has been extensively studied but relatively independently. Therefore, the relationships between aging and the interactions of attentional and emotional processes remain elusive. This study aimed to determine how age affected the interactions between attentional and emotional processes during adulthood. One-hundred forty adults aged 18-79 performed the emotional variant of the Attention Network Test, which probed alerting, orienting, and executive control in the presence and absence of threatening faces. During this task, contexts with varying levels of task preparatory processes were created to modulate the effect of threatening faces on attention, and functional near-infrared spectroscopy (fNIRS) was used to examine the neural underpinnings of the behavioural effects. The behavioural results showed that aging was associated with a significant decline in alerting efficiency, and there was a statistical trend for age-related deficits in executive control. Despite these age differences, age did not significantly moderate the interactions among attentional networks or between attention and emotion. Additionally, the fNIRS results showed that decreased frontal cortex functioning might underlie the age-related decline in executive control. Therefore, while aging has varying effects on different attentional networks, the interactions of attentional and emotional processes remain relatively unaffected by age.

To flip or not: Case series of coronary angioplasty in patients with right-sided heart.

Coronary angioplasty in patients with a right-sided heart may be difficult due to challenges in engaging the coronary arteries, interpreting angiogram, and further delivering intracoronary therapies. We present our experience of percutaneous coronary intervention in two cases and propose a practical algorithm to approach cardiac catheterization in these patients.

Metamemory and executive function mediate the age-related decline in memory.

OBJECTIVE: Although the effect of aging on episodic memory is relatively well studied, little is known about how aging influences metamemory. In addition, while executive function (EF) is known to mediate the age-related decline in episodic memory, the role of metamemory in aging-related memory differences beyond EF remains unknown. This study aimed to elucidate the effect of aging on metamemory and to clarify the role of metamemory in the age-related decline in memory. METHOD: One hundred and four adults aged 18-79 years (50 M, 54 F) performed several EF tasks, as well as a face-scene paired-associate learning task that required them to make judgments of learning, feeling-of-knowing judgments, and retrospective confidence judgments. RESULTS: Aging was significantly associated with poor metamemory accuracy and increased confidence across metamemory judgment types, even after controlling for EF and memory performance. A parallel mediation analysis indicated that both confidence of learning and EF performance had significant partial mediation effects on the relationship between aging and memory, albeit in different ways. Specifically, poor EF explained the age-related decline in memory, whereas increased confidence of learning served to compensate for this memory decline. CONCLUSIONS: Aging is associated with general changes (i.e., poor inferences from cues) rather than specific changes (i.e., declined activation or utilization of certain cues) in metamemory monitoring. Also, changes in confidence of learning and in EF ability contribute to the preservation and decline of memory during aging, respectively. Therefore, boosting confidence during encoding and enhancing EF skills might be complementary memory intervention strategies for older adults.

Effects of age, gender, and education on task performance and prefrontal cortex processing during emotional and non-emotional verbal fluency tests.

The emotional semantic fluency test (SFT) is an emerging verbal fluency test that requires controlled access to emotional lexical information. Currently, how demographic variables influence neurocognitive processing during this test remains elusive. The present study compared the effects of age, gender, and education on task performance and prefrontal cortex (PFC) processing during the non-emotional and emotional SFTs. One-hundred and thirty-three Cantonese-speaking adults aged 18-79 performed the non-emotional and emotional SFTs while their PFC activation was measured using functional near-infrared spectroscopy. Results showed that more education predicted better non-emotional SFT performance, whereas younger age, being female, and more education predicted better emotional SFT performance. Only age significantly affected PFC activation during the SFTs, and the effect was comparable between the two SFTs. Thus, compared with its non-emotional analog, the emotional SFT is influenced by overlapping yet distinct demographic variables. There is a similar age-related reorganization of PFC function across SFT performances.

The prefrontal cortex is differentially involved in implicit and explicit facial emotion processing: An fNIRS study.

Despite extensive research, the differential roles of the prefrontal cortex (PFC) in implicit and explicit facial emotion processing remain elusive. Functional near-infrared spectroscopy (fNIRS) is a neuroimaging technique that can measure changes in both oxyhemoglobin (HbO) and deoxyhemoglobin (HbR) concentrations. Currently, how HbO and HbR change during facial emotion processing remains unclear. Here, fNIRS was used to examine and compare PFC activation during implicit and explicit facial emotion processing. Forty young adults performed a facial-matching task that required either emotion discrimination (explicit task) or age discrimination (implicit task), and the activation of their PFCs was measured by fNIRS. Participants attempted the task on two occasions to determine whether their activation patterns were maintained over time. The PFC displayed increases in HbO and/or decreases in HbR during the implicit and explicit facial emotion tasks. Importantly, there were significantly greater changes in PFC HbO during the explicit task, whereas no significant difference in HbR changes between conditions was found. Between sessions, HbO changes were reduced across tasks, but the difference in HbO changes between the implicit and explicit tasks remained unchanged. The test-retest reliability of the behavioral measures was excellent, whereas that of fNIRS measures was mostly poor to fair. Thus, the PFC plays a specific role in recognizing facial expressions, and its differential involvement in implicit and explicit facial emotion processing can be consistently captured at the group level by changes in HbO. This study demonstrates the potential of fNIRS for elucidating the neural mechanisms underlying facial emotion recognition.

Context-specific effects of threatening faces on alerting, orienting, and executive control: A fNIRS study.

Real-world threatening faces possess both useful and irrelevant attributes with respect to the current goal. How these attributes interact and affect attention, which comprises at least three processes hypothesized to engage the frontal lobes (alerting, orienting, and executive control), remains poorly understood. Here, the neurocognitive effects of threatening facial expressions on the three processes of attention were examined through the emotional Attention Network Test (ANT) and functional near-infrared spectroscopy (fNIRS). Forty-seven (20M, 27F) young adults performed a blocked version of the arrow flanker task with neutral and angry facial cues applied in three cue conditions (no, center, and spatial). Hemodynamic changes occurring in participants' frontal cortices during task performance were recorded by multichannel fNIRS. Behavioral results indicated that alerting, orienting, and executive control processes existed in both the neutral and angry conditions. However, depending on the context, angry facial cues affected these processes differently compared with neutral facial cues. Specifically, the angry face disrupted the classical decrease in reaction time from the no-cue to center-cue condition specifically during the congruent condition. Additionally, fNIRS results revealed significant frontal cortical activation during the incongruent vs. congruent task; neither cue nor emotion significantly affected frontal activation. Thus, the findings suggest that the angry face affects all three attentional processes while exerting context-specific effects on attention. They also imply that during the ANT, the frontal cortex is most involved in executive control. The present study offers essential insights into how various attributes of threatening faces interact and alter attention.

Changes in task performance and frontal cortex activation within and over sessions during the n-back task.

The n-back task is a popular paradigm for studying neurocognitive processing at varying working memory loads. Although much is known about the effects of load on behavior and neural activation during n-back performance, the temporal dynamics of such effects remain unclear. Here, we investigated the within- and between-session stability and consistency of task performance and frontal cortical activation during the n-back task using functional near-infrared spectroscopy (fNIRS). Forty healthy young adults performed the 1-back and 3-back conditions three times per condition. They then undertook identical retest sessions 3 weeks later (M = 21.2 days, SD = 0.9). Over the course of the task, activation in the participants' frontopolar, dorsomedial, dorsolateral, ventrolateral, and posterolateral frontal cortices was measured with fNIRS. We found significantly improved working memory performance (difference between 1-back and 3-back accuracies) over time both within and between sessions. All accuracy and reaction time measures exhibited good to excellent consistency within and across sessions. Additionally, changes in frontal oxyhemoglobin (HbO) and deoxyhemoglobin (HbR) concentration were maintained over time across timescales, except that load-dependent (3-back > 1-back) HbO changes, particularly in the ventrolateral PFC, diminished over separate sessions. The consistency of fNIRS measures varied greatly, with changes in 3-back dorsolateral and ventrolateral HbO demonstrating fair-to-good consistency both within and between sessions. Overall, this study clarified the temporal dynamics of task performance and frontal activation during the n-back task. The findings revealed the neural mechanisms underlying the change in n-back task performance over time and have practical implications for future n-back research.

Calibrating the Dice Loss to Handle Neural Network Overconfidence for Biomedical Image Segmentation.

The Dice similarity coefficient (DSC) is both a widely used metric and loss function for biomedical image segmentation due to its robustness to class imbalance. However, it is well known that the DSC loss is poorly calibrated, resulting in overconfident predictions that cannot be usefully interpreted in biomedical and clinical practice. Performance is often the only metric used to evaluate segmentations produced by deep neural networks, and calibration is often neglected. However, calibration is important for translation into biomedical and clinical practice, providing crucial contextual information to model predictions for interpretation by scientists and clinicians. In this study, we provide a simple yet effective extension of the DSC loss, named the DSC++ loss, that selectively modulates the penalty associated with overconfident, incorrect predictions. As a standalone loss function, the DSC++ loss achieves significantly improved calibration over the conventional DSC loss across six well-validated open-source biomedical imaging datasets, including both 2D binary and 3D multi-class segmentation tasks. Similarly, we observe significantly improved calibration when integrating the DSC++ loss into four DSC-based loss functions. Finally, we use softmax thresholding to illustrate that well calibrated outputs enable tailoring of recall-precision bias, which is an important post-processing technique to adapt the model predictions to suit the biomedical or clinical task. The DSC++ loss overcomes the major limitation of the DSC loss, providing a suitable loss function for training deep learning segmentation models for use in biomedical and clinical practice. Source code is available at https://github.com/mlyg/DicePlusPlus .

Aberrant prefrontal functional connectivity during verbal fluency test is associated with reading comprehension deficits in autism spectrum disorder: An fNIRS study.

Children with autism spectrum disorder (ASD) show marked difficulties in reading comprehension, a complex cognitive skill fundamental to successful daily functioning that is associated with core executive functions. However, the neurophysiological mechanisms underlying reading comprehension deficits in these children remain elusive. Twenty-one right-handed males with high-functioning ASD (mean age = 10.24 years) and 23 age-, IQ-, educational level-, sex- and handedness-matched typically developing (TD; mean age = 10.14 years) individuals underwent a reading comprehension test and the semantic verbal fluency test that tapped core executive functions underlying reading comprehension during concurrent prefrontal functional near-infrared spectroscopy (fNIRS) measurement. Participants' information processing efficiency was also assessed. High-functioning ASD children exhibited general reading comprehension [main effect of group: F (1,40) = 7.58, p = 0.009], selective verbal fluency deficits [Group × category interaction: F (1,42) = 4.90, p = 0.032] and slower processing speed (t 42 = 2.36, p = 0.023). Regarding the hemodynamics of the prefrontal cortex (PFC), although ASD individuals showed comparable patterns of PFC brain activation to their healthy counterparts, lower PFC intrahemispheric [main effect of group: F (1,42) = 11.36, p = 0.002] and interhemispheric [main effect of group: F (1,42) = 7.79, p = 0.008] functional connectivity were evident during the semantic verbal fluency test. At the whole-group level, poorer reading comprehension performance was associated with poorer performance in the semantic verbal fluency test (r 42 = 0.508, p < 0.001). Moreover, poorer semantic verbal fluency test performance was associated with slower information processing speed (r 42 = -0.312, p = 0.044), which is associated with reduced left medial PFC functional connectivity (r 42 = -0.319, p = 0.040). Abnormal intrahemispheric and interhemispheric prefrontal hypoconnectivity is associated with deficits in executive processes essential for reading comprehension in ASD. Our study has provided important implications for the neuropsychological and neurophysiological mechanisms underlying reading comprehension deficits in ASD.

Stability and consistency of metamemory judgments within a session.

There has been much interest in assessing individual and group differences in metamemory skills. These endeavors require or would benefit from enhanced knowledge about the stability and consistency of metamemory judgments over successive trials. However, few studies have examined these aspects. Thus, the present study investigated and compared the within-session stability and consistency of three major types of metamemory judgment: judgment of learning (JOL), feeling-of-knowing judgment (FOK), and retrospective confidence judgment (RCJ), using a single-task paradigm. A total of 38 healthy young adults (17 males, 21 females) completed three trials of a face-scene associative learning task designed to assess metamemory. In each trial, participants rated their JOLs while studying a new set of face-scene pairs, and then rated their FOKs and RCJs while their memory was being tested. The stability and consistency of the mean confidence ratings and the relationships between confidence rating and memory performance, indexed by two gamma estimates, were analyzed and compared across types of metamemory judgments. Over trials, there was a significant decrease in the mean rating for JOL but not for FOK or RCJ. Also, the gamma scores of JOL, but not that of FOK or RCJ, significantly improved with practice. Furthermore, for each type of metamemory judgment, the mean confidence rating showed excellent consistency across trials. Depending on the judgment type and gamma estimation method, the consistency of gamma scores ranged from poor to excellent. Thus, the present study clarified the temporal dynamics of various types of metamemory judgments and the consistency of metamemory measures.

Multimodality delineation of a fistulous ruptured sinus of Valsalva aneurysm: a teaching case report.

Background: Ruptured sinus of Valsalva (SOV) is a rare cardiac anomaly with poor prognosis if untreated. Early diagnosis with accurate delineation of its anatomy is critical for timely treatment and choice of surgical vs. percutaneous intervention. Here we report a case of fistulous rupture of SOV; the preoperative multimodality studies including echocardiography, cardiac magnetic resonance and cardiac catheterization provided teaching and learning points. Case summary: A 48-year-old man with history of heart murmur and hypertension presented with a 5-day history of shortness of breath and peripheral oedema. He was diagnosed with rapid atrial flutter. The transthoracic and transesophageal echocardiography showed severe biventricular systolic dysfunction with a left-to-right shunt from ruptured SOV. The colour Doppler by transthoracic and transesophageal echocardiography and cardiac magnetic resonance revealed a swaying shunt flow exiting in direction to the right atrium (RA) and basal right ventricle (RV) during systole and diastole with no myocardial scaring. The left and right heart catheterization showed elevated right-sided pressures, pulmonary capillary wedge pressure, and left ventricular end-diastolic pressure. There was no difference in O2 saturation between venae cavae and RA but a misleading step-up in O2 saturation between RA and RV. Owing to rupture anatomy with uncertainty, the patient underwent surgical intervention. The ruptured SOV tunnelled through the base of tricuspid annulus to the RA very close to the basal RV. Discussion: Even with multimodality studies it can still be challenging to delineate the anatomy of a ruptured SOV without uncertainty preoperatively.

Understanding the Neural Basis of Prospective Memory Using Functional Near-Infrared Spectroscopy.

Prospective memory (PM) is the ability to perform a planned action at an intended future time. This study examined the neural correlates of PM using functional near-infrared spectroscopy (fNIRS). This study employed a within-participants design. A laboratory PM task was adapted for use with fNIRS to investigate regions of interest and levels of brain activation during task performance in 32 participants (63% female, Mage = 21.31 years, SDage = 4.62 years). Participants first completed a working memory (WM) task (N-back ongoing task) followed by a WM plus PM task while neural activity was measured using fNIRS. Behavioral results revealed an interference effect for reaction time on the WM task, whereby participants were significantly slower to respond in the WM plus PM task compared to the WM task. Ongoing task accuracies did not differ between the two conditions. fNIRS results revealed a higher level of neural activity in the fronto-polar prefrontal cortex and dorsolateral prefrontal cortex in the WM plus PM task compared to the WM Condition. These findings highlight that fNIRS is a suitable tool for studying and understanding the neural basis of PM.

Differential and subtype-specific neuroimaging abnormalities in amnestic and nonamnestic mild cognitive impairment: A systematic review and meta-analysis.

While mild cognitive impairment (MCI) has been classified into amnestic MCI (aMCI) and nonamnestic MCI (naMCI), the neuropathological bases of these two subtypes remain elusive. Here, we performed a systematic review and meta-analysis to determine the subtype specificity of neuroimaging abnormalities in MCI and to identify neural features that may differ between aMCI and naMCI. We synthesized 50 studies that used common neuroimaging modalities, including magnetic resonance imaging and positron emission tomography, to compare brain atrophy, white matter abnormalities, cortical thinning, cerebral hypometabolism, amyloid/tau deposition, or other features among aMCI, naMCI, and normal cognition. Compared with normal cognition, aMCI shows diverse neuroimaging abnormalities of large effect sizes. In contrast, naMCI exhibits restricted abnormalities of small effect sizes. Some features, including medial temporal lobe atrophy and white matter abnormalities, are shared by the two MCI subtypes. Overall, brain abnormalities are worse, if not similar, in aMCI than in naMCI. The only neuroimaging abnormality specific to aMCI is increased amyloid burden; no feature specific to naMCI was found. Taken together, our findings have elucidated the neuropathological changes that occur in aMCI and naMCI. Clarifying the neuroimaging profiles of aMCI and naMCI can improve the early identification, differentiation, and intervention of prodromal dementia.

Prefrontal Activation During Effortful Processing Differentiates Memory Abilities in Adults with Memory Complaints.

BACKGROUND: Identifying individuals at increased risks for developing Alzheimer's disease (AD) is crucial for early intervention. Memory complaints are associated with brain abnormalities characteristic of AD in cognitively normal older people. However, the utility of memory complaints for predicting mild cognitive impairment (MCI) or AD onset remains controversial, likely due to the heterogeneous nature of this construct. OBJECTIVE: We investigated whether prefrontal oxygenation changes measured by functional near-infrared spectroscopy (fNIRS) during an arduous cognitive task, previously shown to be associated with the AD syndrome, could differentiate memory abilities among individuals with memory complaints. Episodic memory performance was adopted as a proxy for MCI/AD risks since it has been shown to predict AD progression across stages. METHODS: Thirty-six adults self-reporting memory complaints in the absence of memory impairment completed a verbal list learning test and underwent a digit n-back paradigm with an easy (0-back) and a difficult (2-back) condition. K-means clustering was applied to empirically derive memory complaint subgroups based on fNIRS-based prefrontal oxygenation changes during the effortful 2-back task. RESULTS: Cluster analysis revealed two subgroups characterized by high (n = 12) and low (n = 24) bilateral prefrontal activation during the 2-back but not a 0-back task. The low activation group was significantly less accurate across the n-back task and recalled significantly fewer words on the verbal memory test compared to the high activation group. CONCLUSION: fNIRS may have the potential to differentiate verbal memory abilities in individuals with self-reported memory complaints.

Contemporary Trends and Comparison of Racial Differences in Hospitalizations of Adults With Congenital Heart Disease.

As advancements in care improve longevity in patients with congenital heart disease (CHD), it is crucial to further characterize this rapidly growing adult population. It is also essential that equitable care is offered across demographic groups. Hospitalizations for adults with CHD in the National Inpatient Sample were identified to describe trends in overall and cause-specific rates of admission per 1,000 adults with CHD from 2000 to 2018. Primary admission causes were then analyzed and stratified by race. An aggregate rate of left-ventricular assist device placements and heart transplants was calculated for each group and trended over the years. A total of 1,562,001 weighted hospitalizations were identified. Overall, annual rates of hospital admissions increased from 39 per 1,000 adults with CHD in 2000 to 74 per 1,000 in 2018, as did rates of cardiovascular admissions (16 of 1,000 to 34 of 1,000, p <0.001 for both). Transient ischemic attack/stroke (2.5 of 1,000 to 10.7 of 1,000), coronary artery disease (4.1 of 1,000 to 5.6 of 1,000), arrhythmias (2.8 of 1,000 to 4.6 of 1,000), and heart failure (2.8 of 1,000 to 5.0 of 1,000) were the most common cardiovascular primary causes of admission (other than CHD itself), and each significantly increased over time (p <0.001 for each). Mean age at all-cause and primary heart failure hospitalization increased for all races but remained 7 to 9 years younger for Black and Hispanic adults than White adults. In conclusion, hospitalization rates of adults with CHD in the United States increased from 2000 to 2018, largely driven by an increase in adults ≥55 years. Although the age at hospitalization increased overall, Black and Hispanic patients were substantially younger at presentation for advanced heart failure. Anticoagulation guidelines in this population may need revisiting as transient ischemic attack/stroke hospitalizations were frequent.