Higher order cognition

executive functions

Group of top-down processes needed when you have to concentrate and pay attention

Using context, experiences, prior learned information to complete certain activities/functions

3 core executive functions

inhibitory control

working memory

cognitive flexibility

inhibitory control

Ability to control one’s attention, behavior, thoughts, and emotions to override a strong internal predisposition or external lure, and do what is more appropriate or needed

→ Helps us stop doing things we shouldn’t do and do things we should do

Ex. go to class even though very tired and not start screaming in middle of class

working memory

holding info in mind and mentally working with it

cognitive flexibility

Ability to change perspective either spatially or interpersonally

Interpersonal cognitive flexibility → see from another’s perspective

byproducts of core executive functions

Reasoning

Problem solving: taking in information and manipulating it to solve problems

Planning: inhibit certain information to make a plan

how can executive functioning be tested?

Intelligence tests → neuropsychological assessments

• first used as measure of intelligence (comparing people’s IQ) now used more to measure cognitive domains (helpful for diagnosis, screening, evaluating risk of progression)

Used often for adult/older adult intelligence testing

• Weschler’s Adult Intelligence Scale (WAIS)

• Montreal Cognitive Battery (MoCA)

4 indexes of the Weschler’s Adult Intelligence Scale (WAIS) VPWP

verbal comprehension index

perceptual reasoning index

working memory index

processing speed index

perceptual reasoning index

matrix reasoning, visual puzzles, block design

working memory index

digit span, arithmetic

processing speed index

symbol search, coding

attention, visual scanning ability

verbal comprehension index

vocabulary, similarities, information

T/F higher proportion of slow and rapid decline in men compared women

F: women have higher proportion, males tend to do better

T/F less Aβ accumulation in frontal and parietal regions is associated with EF decline (not memory)

F: GREATER Aβ accumulation in frontal and parietal regions is associated with EF decline (not memory)

T/F theres a relationship between tau accumulation across the cortex and cognitive decline (EF) in healthy, older adults

T: More tau accumulation in parahippocampal and entorhinal regions, linked with memory decline 

risk factors of going from primary to secondary aging

APOE4 presence, older, less years or education associated with transition to amnestic MCI (memory prominent deficit)

• significantly associated with transition from normal to dementia diagnosis

Age and less years of education associated with transition to mixed MCI (uniform cognitive deficits) 

• age is significant risk factor of dementia and death

T/F don’t see any risk factors associated with sex (female) or family history of transition to MCI

T: gender or family history aren’t risk factors of transition from normal to MCI

T/F age is big factor in MCI to dementia progression

T: according to Hu et al 2020 

what is neuroprotective from MCI to dementia progression

better attention cognitive domain

T/F more education is assoicated with cognitive decline

F: LESS education is assoicated with cognitive decline

T/F higher prevalence of alzheimer’s in men compared to men, especially those 75+

F: higher in women

what is linked with cognitive decline in women?

menopause/hormonal prevalence

estrogen linked with neuroprotective effects

do men or women have more neuroprotective measures earlier in aging, with sharper decline?

women

what cognitive domains are women better at

verbal memory, verbal fluency task (in healthy women)

treatment

addressing issues that are present in an individual

focus on disease mechanisms: how the disease works, its pathology

ex. neurotransmitters invovled in learning/memory

prevention

proactive measures to stop or slow progression

Focus on modifiable risk factors: high-risk factors for a disease state that can be changed/modified if addressed early enough

pharmacological treatment of cognitive decline

Acetylcholinesterase inhibitors (AChE inhibitors: used to inhibit the role of AChE (enzyme), which breaks down Acetylcholine (ACh) - very important for learning, memory, cognitive functioning

• Ex. increases ACh levels → people with dementia have lower levels of ACh so this drug increases it

• Used to slow cognitive decline in AD, PD dementia

• Donepezil another AChE inhibitor that when combined with other components can target Aβ aggregation 

Anti-Aβ immunotherapy

• Antibody treatment that binds to soluble Aβ 

• Slower decline of dementia vs placebo

• effective clearance of Aβ

• some adverse effects: behavioural effects like agitation

T/F dementia is reversible

F: dementia is currently irreversible

theres 2 main paths to deal with rapid cognitive decline: treatment or prevention

risks for developing dementia in early life, under 45

less education

risks for developing dementia in middle life, 45-65

Hearing loss

Traumatic brain injury

Hypertension

Alcohol (elevated level)

Obesity 

risks for developing dementia in later life, 65+

Smoking

Depression

Social isolation

Physical inactivity

Diabetes

Air pollution

T/F activities with a social component/motorsocial are good at reducing cognitive decline

T: examples include choir, dancing, drum circles

what is one of most reliable neuroprotective lifestyle interventiosn agains neurodegenerative diseases?

exercise

open skill exercise

dynamic, externally paced and more unpredictable environments (ex. Group sports) linked with better cognitive outcomes across all groups compared to solo sports ex. Running, cycling

T/F Mediterranean diet associated with reduced risk of MCI and dementia, also alzheimer’s

T: Mediterranean diet involves

• fruits, veggies, whole grains, at every meal

• fish/seafood, nuts at least 3x/week

• low-fat dairy, eggs, poultry, max 1/day

• red meats, sweets max 1/week