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The American Heart Association Life's Simple 7 (LS7), a metric that classifies cardiovascular health using modifiable risk factors, has been reported to be associated with cognitive function. However, the assessment of cognitive function in prior studies has been limited to relatively crude global measures. We hypothesized that greater LS7 scores at baseline are associated with less cognitive decline and lower incidence of dementia and Alzheimer's. Using data from the core Health and Retirement Study survey (2012-2018), 2013 Health Care and Nutrition Questionnaire and enhanced face-to-face interviews we will evaluate cognitive scores in relation to LS7. The participants included in this analysis (n = 2,753) are greater than 50 years of age without dementia. A global cognitive score was calculated using the combination scores on multiple cognitive tests that include measurements of semantic memory, quantitative reasoning, episodic memory, and executive functioning. Changes in cognitive scores are evaluated based on marginal effects after adjustments for confounding variables. Baseline LS7 scores (0-14) were calculated using information on smoking habits, body mass index, habitual diet, blood pressure, non, physical activity, and hemoglobin a1c. Results were analyzed using linear mixed models fit with random intercepts and the use of Huber-White variance estimates to analyze the results. Knots were introduced to explain non-linear change in respondents. Global cognitive scores in all respondents decreased more between baseline to year two and year two to year four than year four to year six (ΔB-2: -2.796, Δ2-4: -3.362 v. Δ4-6: -1.191). A one unit increase in LS7 score presented a protective effect and slowed the rate of decline by 0.11 unit in global cognitive scores between baseline and year two. The protective effect was lower between year two and four (0.07 units) and non-significant between year four and six. Black respondents did not respond similarly in models than white respondents. A one unit increase in LS7 score increased the rate of decline from baseline to year two and year two to year 4 in black respondents (p<0.001, p<0.05). LS7 scores had no significant interaction with global cognitive scores between year 2 and 6. Serial 7 scores did not significantly change over time in any of the racial categories. A unit increase in LS7 scores showed a marginal protective effect on memory scores from year two to four in all respondents (r=0.03, p<0.001). In white respondents, higher LS7 scores had a protective effect on memory scores (r=0.01, p<0.05). The probability of developing dementia or Alzheimer's over the study period was the highest for males (P = 3.6%) than females (P = 3.3%) and lowest for white, females (P=13%) and highest for black, males (P=15%). Having higher LS7 scores at baseline is associated lower cognitive decline over a 6-year period in white, older adults. LS7 scores at baseline delayed word recall/memory scores over time but not serial 7/executive functioning scores. LS7 scores at baseline are not associated with lower incidence of cognitive impairment and dementia. Findings suggest better habits formed earlier in life have a better protective effect than late-life habits / Master of Science / The United States is dealing with a rapidly aging population. By the year 2035, there is expected to be more adults over the age of 65 than children. As the number of older adults increases as will the number of new and existing cases of Alzheimer's and other dementias. The burden of older adults with Alzheimer's and dementia strains the U.S. healthcare system therefore new research is emerging on interventions used to slow the onset of this life-altering disease before critical and expensive care is required. One method that has been effective is modifying lifestyle behaviors. In 2010 the American Heart Association classified the Life's Simple 7 (LS7) metrics which involved both behavioral and biological measures for cardiovascular risk assessment in Americans. The LS7 metrics include smoking behaviors, physical activity, diet, body mass index, blood pressure, cholesterol, and fasting blood glucose. The American Heart Association's LS7 metric adherence during early and mid-life has been shown to decrease risk for Alzheimer's and dementia, however, research of adherence in late-life is limited. Preventing late-life onset of dementia is vital to older adults therefore this study aims to observe late-life adherence LS7 and change in cognitive functioning over a 6-year period (2012-2018). Participants included in this study are from the Health and Retirement Study (HRS) that are 50 years and older without diagnoses of dementia or Alzheimer's at the time of baseline measurement in 2012. Late-life adherence to Life's Simple 7 metrics are associated with slower rates of cognitive decline in white respondents. The Life's Simple 7 metric is not significantly associated lower cases of dementia and is associated slower rates of decline in memory but not executive functioning. This study aimed to expand evidence for racial differences on global cognitive changes and domain-specific cognitive measurements and the effect Life's Simple Seven scores have on that relationship.

SourceURL:file://localhost/Users/ClaesAct/Dropbox/LNU%20psykologi/Uppsats/Examensarbete_ClaesLilja_HT16_2PS600.doc Physical exercise has been associated with various health benefits, including improved cognitive functioning, well-being and life satisfaction. Other variables that have been found to explain these areas include gender, age, dispositional optimism, meditation practice, and videogame habits. The aim of the present study was to explore whether physical exercise on its own has benefits for visuospatial rotation abilities and life satisfaction. It was also the intention to examine how other known factors of age, gender, dispositional optimism, meditation, and videogames may help predict visuospatial rotation abilities and satisfaction with life. The results showed no significant explanation for visuospatial performance while finding some exercise measurements and physical activity level to have significant correlations with life satisfaction. Dispositional optimism was found to be the strongest indicator of life satisfaction, while gender was determined to not hold explanatory power for either of the criterion variables.

Cette thèse vise à étudier expérimentalement les effets de différents types de médiations visuelles (photographies, mots écrits, mots écrits présentés de manière segmentée selon un découpage syllabique) présentées sous format numérique qui pourraient favoriser l'émergence d'une production orale chez des enfants non-verbaux avec autisme. Elle s'inscrit dans une approche respectueuse du fonctionnement cognitif connu des personnes avec autisme, à savoir leur meilleure gestion des informations visuelles qu'auditives mais aussi leur attrait certain pour l'outil informatique et plus particulièrement des stimuli visuels présentés par l'intermédiaire d'un écran, ainsi que leurs difficultés à traiter l'information rapide dynamique. Quatre expérimentations ont été réalisées, mettant les participants dans des situations où ils devaient reconnaître des mots écrits, y associer leur correspondance orale ainsi que leur référent, et les utiliser ensuite comme outil de médiation à la production orale. Les résultats mettent en évidence les capacités des enfants non-verbaux avec autisme à reconnaître des mots écrits et le recours à différents traitements selon qu'ils disposent ou non d'un modèle pour ce faire. Ils montrent également qu'une auto-présentation segmentée de ces mots écrits facilite la perception des syllabes constitutives des mots et leur production orale par ces enfants non-verbaux avec autisme. Au total, ces résultats ouvrent des pistes de travail pour envisager de nouvelles médiations pédagogiques et rééducatives dans le domaine de la production orale, adaptées aux capacités cognitives des enfants avec autisme. / This thesis aims at studying the effects of various types of visual media, (photos, written words, and written words made up by their individual syllables) presented in a digital format, which can facilitate speech in non-verbal children with autism.It combines an approach by recognizing the cognitive abilities, and difficulties of managing heard information for these children. This is best done by using a computer, which can present the heard information in a visual manner, such that the information can be slowed down to a speed which can be best managed and assimilated by the children.Four experiments were done, placing the participants in situations that allowed them to recognize written words and their associated syllables in the formation of speech. The results bring to light not only the capacities of these non-verbal children with autism to recognize written words, but also their ability to identify and produce the presented segmented words as individual syllables.These results present some guidelines for educational institutions working in the field of oral language, and more specifically to those related to the cognitive capacities of children with autism.

Evidências sugerem o envolvimento de um estado de inflamação crônica de baixo grau na fisiopatologia do transtorno bipolar (TB). Os estudos apresentados nesta tese tiveram como objetivo explorar o papel da inflamação crônica nos mecanismos fisiopatológicos do TB através da avaliação dos níveis séricos de proteína C-reativa (PCR). A PCR é um marcador de inflamação sistêmica comumente utilizado na prática clínica, sendo considerado fator de risco para várias patologias, incluindo câncer e doença cardiovascular. O primeiro artigo, através de um estudo de meta-análise, teve como objetivo avaliar o tamanho de efeito da associação entre níveis de PCR em pacientes bipolares nas diferentes fases de humor (n=730) comparado a indivíduos controles (n=888). Pacientes bipolares apresentaram níveis de PCR significativamente elevados em comparação ao grupo controle, com moderado tamanho de efeito (effect size, ES = 0.39; 95% IC, 0.24 – 0.55; P < 0.0001). Níveis de PCR foram significativamente maiores em pacientes maníacos (ES = 0.73; 95% IC, 0.44 – 1.02; P < 0.001) e em eutímicos (ES = 0.26; 95% IC, 0.01 – 0.51; P = 0.04). O segundo artigo se propôs a revisar dados da literatura relacionados a biomarcadores periféricos potencialmente implicados na progressão do TB. Pacientes em diferentes estágios do TB apresentaram níveis alterados de marcadores de estresse oxidativo, neurotrofinas e de inflamação, incluindo a PCR, o que reforça a hipótese da inflamação crônica exercer um papel importante na fisiopatologia do TB. Em seguida, considerando a abordagem multidimensional no TB, o terceiro artigo avaliou a reatividade emocional como uma dimensão relevante para caracterizar pacientes bipolares apresentando sintomas subclínicos de humor durante a fase de remissão (N=613). Apesar de todos pacientes estarem em remissão, a maioria deles (68%) apresentou reatividade emocional anormal (hipo ou hiper-reatividade emocional). Esse estudo avaliou, também, o funcionamento psicossocial nesses pacientes e os níveis de PCR ultra-sensível como um possível marcador objetivo de hiper-reatividade emocional no TB. Os pacientes com hiper-reatividade emocional, em comparação aos pacientes com hipo- ou normal reatividade emocional, apresentaram prejuízo cognitivo e níveis de PCR significativamente mais elevados (P < 0.001). Esses resultados provêm de um estudo transversal e, portanto, conclusões sobre causalidade dessas associações não podem ser inferidas, já que outros fatores, além dos níveis de PCR, podem também contribuir para o estado inflamatório crônico observado nesses pacientes. Em suma, os resultados desta tese sugerem que a inflamação crônica de baixo grau, evidenciada pelas alterações nos níveis de PCR, parece estar implicada na fisiopatologia e na progressão do TB. Novas intervenções terapêuticas com alvo em mecanismos inflamatórios e na modulação dos níveis de PCR devem ser priorizados em estudos futuros. / Evidence suggests that chronic low-grade inflammation appears to be involved in the pathophysiology of bipolar disorder (BD). The studies presented in this thesis aimed at exploring the role of chronic inflammation in the BD pathophysiological mechanisms by assessing serum levels of C-reactive protein (CRP). CRP is a marker of low-grade inflammation widely used in clinical practice, and a risk factor for cardiovascular and malignant diseases. The first article, a meta-analysis, aimed at evaluating the effect size of the association between CRP levels in bipolar patients (n=730) compared to healthy subjects (n=888). Overall, CRP levels were significantly elevated in patients with BD versus controls (effect size, ES = 0.39; 95% CI, 0.24 to 0.55; P < .0001). CRP levels were significantly higher in manic (ES = 0.73; 95% CI, 0.44 to 1.02; P < 0.001) and euthymic (ES = 0.26; 95% CI, 0.01 to 0.51; P = 0.04). The second paper aimed at reviewing the scientific literature regarding peripheral biomarkers potentially implicated in the progression of BD. Bipolar patients within different disease’s stages presented altered levels of oxidative stress, neurotrophins and inflammatory markers, including PCR. These findings reinforce the hypothesis of the potential role of the chronic inflammation in BD pathophysiology. Regarding the multidimensional approach in BD, the third article assessed emotional reactivity as a major dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms (N=613). Although all patients were in remission, most of them (68%) showed abnormal emotional reactivity (hipo- or hyper-reactivity). In addition, this study assessed the psychosocial functioning in these patients as well as the levels of high-sensitivty PCR (hsCRP) as an objective marker of emotional hyper-reactivity in BD. Patients with emotional hyper-reactivity had higher levels of PCR and cognitive impairment compared to patients with emotional hypo or normal emotional reactivity (P < 0.001). This was a crosssectional study of emotional reactivity, hsCRP levels and functional status in remitted bipolar patients, and no conclusions regarding the causality of these associations can be substantiated. Others factors could also be contributing to the chronic inflammatory state in these patients. In conclusion, the results of this thesis suggest that low-grade chronic inflammation, as evidenced by alteration in CRP levels, may be implicated in the pathophysiology as well as in the BD progression. Novel therapeutic interventions targeting inflammatory mechanisms and the modulation of CRP levels should be prioritized in future studies.

Chemotherapy and adjuvant endocrine treatment for breast cancer has been associated with varying degrees of cognitive dysfunction, with 15-50% of women reported to experience subtle cognitive decline. While these treatments may have direct adverse consequences on neurological functioning, cancer diagnosis and treatment is also associated with many health and psychosocial factors that may decrease performance on neuropsychological tests. However, despite a growing body of literature on affected cognitive domains and observable neurological changes after chemotherapy, there has not been a thorough investigation into potentially important psychosocial and physical health mechanisms that may underlie the observed cognitive dysfunction. Therefore, the primary aim of this thesis was to evaluate the relationship between health/ treatment, psychosocial, and endocrine-related factors and cognitive dysfunction after breast cancer treatment. In addition, a smaller secondary aim was to assess the appropriateness of different methods of individual change. Chapter 1 provides a brief overview of the structure and content of the thesis. Chpaters 2 and 3 are review papers that evaluate whether there is evidence that variations in psychosocial adjustment, health and treatment factors result in cognitive changes after chemotherapy. Based on previous research, the mechanisms evaluated are endocrine-related changes (use of adjuvant endocrine treatment and chemotherapy-induced menopause); chemotherapy-induced anaemia; depression; anxiety; fatigue; quality of life; and other treatment factors (e.g. treatment duration, time since treatment, tumour stage, use of concomitant medications and co-morbid medical conditions). The impact of confounding variables such as age of participants, level of baseline functioning and methodological limitations are also considered. These two chapters have been published (refer to Appendix A for a complete list of presentations and publications arising from this thesis). The fourth and fifth chapters are methodological in nature. Chapter 4 describes methods, while Chapter 5 is a brief paper (under review) which examines methodological considerations regarding analysis of individual change in neuropsychological performance over time and across domains for women undergoing treatment for breast cancer. The sixth and seventh chapters involve empirical analyses of the data collected as part of the Cognition in Breast Cancer (CBC) study, a longitudinal study examining the causes of variation in cognitive functioning, health and well-being in women up to 2 years post-chemotherapy. Chapter 6 was an experimental study designed to investigate the acute effects of psychosocial mechanisms on cognitive functioning after chemotherapy in a sample of 157 breast cancer patients. Many of the methodological limitations identified in the review studies were addressed and the neuropsychological performance of two groups was compared, namely recently diagnosed breast cancer patients scheduled for chemotherapy (n = 136) or other forms of treatment (n = 21). Participants were assessed prior to commencing treatment and approximately one month post completion of chemotherapy (or 6 months after the first assessment). Individual cognitive impairment was examined using the Reliable Change Index, while Pearson correlations were utilised in order to investigate the effect of psychosocial and health factors on cognitive change. The results indicated that decline in haemoglobin levels and increased anxiety over the course of chemotherapy significantly predicted impairment in multiple cognitive measures, while change in specific cognitive measures was significantly associated with baseline measures of fatigue, depression and functional well-being. The impact of these findings on rehabilitation strategies for women after chemotherapy was discussed. Chapter 7 investigated whether endocrine-related changes, namely chemotherapy-induced menopause and adjuvant endocrine treatment, resulted in increased cognitive dysfunction. One hundred and thirty-six breast cancer patients were assessed using a comprehensive neuropsychological assessment over three time-points, namely pre-chemotherapy, one month and six months post chemotherapy (or at similar time-points). Linear mixed models evaluated the effects of these two factors, with little evidence found to suggest that endocrine-related factors contribute to cognitive dysfunction in breast cancer patients. Chapter 8 comprises a brief summary and overview of the entire thesis and offers overarching conclusions, strengths and weaknesses, and directions for future research. The findings of the present investigations attempt to elucidate the contributions of potentially important psychosocial and health/ treatment-related mechanisms for cognitive dysfunction after breast cancer treatment. While there was little evidence to suggest endocrine-related changes impacted on cognition, the findings linking chemotherapy-induced anaemia and baseline psychosocial measures may play an important role in identifying and treating at-risk individuals. These findings have potential research implications for the ways data is collected, analysed and presented in empirical research as well as clinical ramifications for how women are affected cognitively as well as psychologically by treatment for breast cancer.

The general aim of the thesis was to investigate potential differences in memory performance between participants across the adult life span with and without self-reported musculoskeletal pain. Chronic musculoskeletal pain is a major health related problem in our society. A common complaint related to chronic pain is about cognitive difficulties in attention, memory, and decision making. A number of studies have demonstrated that people with pain also perform wors on tasks measuring, for example episodic memory, semantic memory, and working memory. The present thesis aimed at replying these findings, by using a non-clinical population based sample. the potential differences in memory performance between people with and without pain were examined across the adult life span, in order to disentangle potential pain by age interactions. This was made by using both cross-sectional and longitudinal data. Study I aimed at studying differences in episodic memory performance, semantic memory performance, and implicit memory performance, between people with and without musculoskeletal pain. Differences were found for all three memory systems, but disappeared after controlling for years of formal education. In Study II an extension of the first study was made, in which performance on a range of cognitive tests were analysed. General differences were demonstrated , but yet again, years of education together with depression ruled out the effects. The most robust effects were found for word comprehension and construction ability. Finally, Study III used 5- and 10 year follow up studies to examine change over time in cognitive performance as a function of pain. The main finding from this study was that semantic memory for the oldest is impaired over time as a function of pain. An additional analysis showed similar patterns, regardless of age, for construction ability.

Background: Research suggests that musculoskeletal injury (MSI) influences cognitive functioning. Cognitive functioning following MSI in athletes is not evaluated currently. Purpose and Method: To examine cognitive deficit in athletes following musculoskeletal injuries, the Automated Neuropsychological Assessment Metric (ANAM) was administered to 22 varsity athletes prior to competition and following MSI. A healthy comparison group of 22 athletes was also tested at time intervals matched with the injured group. Results: A 2 (Group) X 2 (Time) repeated measures ANOVA revealed significant main effects for time on ANAM subtests of Delayed Code Substitution and Simple Reaction Time. Post-hoc Paired t-Tests revealed significant improvements in both groups for Simple Reaction Time, and a significant improvement for the comparison group on Match-to-Sample. Implications: Athletes with musculoskeletal injuries did not show cognitive deficit post-injury; however, the apparent absence of practice effects on a test of spatial processing and working memory requires further examination.