Search Results (93)

Virtual reality (VR) can enrich neuropsychological testing, yet the ergonomic trade-offs of its input modes remain under-examined. Seventy-seven healthy volunteers—young (19–29 y) and middle-aged (35–56 y)—completed a VR Trail Making Test with three pointing methods: eye-tracking, head-gaze, and a six-degree-of-freedom hand controller. Completion time, spatial accuracy, and error counts for the simple (Trail A) and alternating (Trail B) sequences were analysed in 3 × 2 × 2 mixed-model ANOVAs; post-trial scales captured usability (SUS), user experience (UEQ-S), and acceptability. Age dominated behaviour: younger adults were reliably faster, more precise, and less error-prone. Against this backdrop, input modality mattered. Eye-tracking yielded the best spatial accuracy and shortened Trail A time relative to manual control; head-gaze matched eye-tracking on Trail A speed and became the quickest, least error-prone option on Trail B. Controllers lagged on every metric. Subjective ratings were high across the board, with only a small usability dip in middle-aged low-gamers. Overall, gaze-based ray-casting clearly outperformed manual pointing, but optimal choice depended on task demands: eye-tracking maximised spatial precision, whereas head-gaze offered calibration-free enhanced speed and error-avoidance under heavier cognitive load. TMT-VR appears to be accurate, engaging, and ergonomically adaptable assessment, yet it requires age-specific–stratified norms. Full article

Background: This study aimed to compare the immediate effects of small-sided games (SSGs) and running-based high-intensity interval training (HIITrb) on serum brain-derived neurotrophic factor (BDNF) levels, cognitive performance, and enjoyment in young, male soccer players. Methods: Twenty-four soccer players [age: 19.2 ± 0.8 years] completed one session each of four-a-side SSG or HIITrb in a randomized, counterbalanced, and crossover design, with a one-week washout period. Blood samples and Trail Making Tests (TMTs) A and B were measured before and after exercise. Heart rate (HR) was monitored throughout the games, and ratings of perceived exertion (RPE) and enjoyment were collected at the end of the measurements. Results: The results show no significant effects of time (p > 0.775), group (p > 0.276) or time × group interaction (p > 0.199) on BDNF levels. For TMT-A, the time effect (p = 0.866) and group effect (p = 0.057) were not significant; however, the time × group interaction was significant (p < 0.019), indicating a superior performance in the SSG compared to HIITrb. In the TMT-B, significant effects were observed for both time (p < 0.001) and group (p < 0.001), while the time × group interaction effect was not statistically significant (p > 0.061). Furthermore, enjoyment levels did not differ significantly between conditions (p = 0.976). Conclusions: These findings suggest that four-a-side SSG may enhance processing speed compared to HIITrb without changes in serum BDNF levels. Coaches may consider using 4v4 SSG formats in early training sessions or warm-ups to stimulate processing speed and mental readiness in young soccer players. Full article

Background: Patients with chronic kidney disease (CKD) have a substantially higher risk of developing cognitive impairment (CI) than the general population. Patients with CKD undergoing haemodialysis (HD) treatment also have an elevated risk of developing cerebrovascular and cardiovascular diseases. This study aims to investigate the relationship between the cognitive performance of haemodialysis patients and cerebral and carotid haemodynamic indices. Methods: This study was a non-interventional observational study; the sample consisted of 32 patients (age 65 ± 12 years) undergoing chronic HD treatment. The patients underwent neuropsychological and haemodynamic instrumental investigations, including Supra-Aortic Trunk Echodoppler (SAT) and Transcranial Doppler (TCD). Results: Patients were 17% deficient at Montreal Cognitive Assessment (MoCA), 45% deficient at Frontal Assessment Battery (FAB), 55% deficient at Trail-Making Test-A (TMT-A) and 65% deficient at TMT-B. The TCD investigation detected a decrease in flow (MFV) and an increase in Breath Hold Index (BHI) predominantly in the right cerebral arterial district. The SAT investigation revealed an altered IMT, plaques and the presence of severe carotid stenosis. A strong association between cerebral and carotid indices and cognitive scores was also observed. Correlation analyses reported statistically significant correlations between TMT-A and TMT-B and cerebral flow indices. Conclusions: Among haemodialysis patients, there is a high percentage of cognitive impairment associated and correlated with alterations in cerebral and carotid haemodynamics. Cerebral haemodynamics are a factor to be taken into consideration as a possible pathological mechanism underlying cognitive impairment in haemodialysis. Full article

Background/Objective: The Trail Making Test (TMT) is a widely used neuropsychological tool to assess processing speed (Part A) and executive function (Part B). However, the neuroanatomical substrates underlying its Black & White variant (TMT-B&W) and the influence of demographic factors remain poorly understood. This study aimed to identify gray matter (GM) correlates of TMT-B&W performance across unadjusted and covariate-adjusted models in cognitively healthy adults. Methods: In this cross-sectional study, 87 participants (40–80 years) underwent structural magnetic resonance imaging (MRI) and completed TMT-B&W. Whole-brain voxel-based morphometry (VBM) was conducted using FreeSurfer for preprocessing and Computational Anatomy Toolbox (CAT12)/Statistical Parametric Mapping (SPM12) for analysis. Two voxel-wise regression models (unadjusted and adjusted for age, education, gender, and total intracranial volume (TICV)) assessed GM associations with TMT-B&W-A-B performance. Statistical thresholds were voxel-level p < 0.001 (uncorrected) and cluster-level Family-Wise Error (FWE) correction (p < 0.001). Results: In unadjusted models, TMT-B&W-A performance correlated with GM reductions in the right orbitofrontal cortex (T = 42.64, equivk = 515.60, representing peak voxel level T-statistic and cluster size in voxels), while TMT-B&W-B linked to the right insular cortex (T = 50.65, equivk = 515.50). After adjustment, both tasks converged on the left thalamus (TMT-A: T = 8.05, equivk = 594; TMT-B: T = 8.11, equivk = 621), with TMT-B&W-B showing a denser thalamic cluster. Demographic covariates attenuated cortical associations, revealing thalamic integration as a shared mechanism. Conclusions: The thalamus emerges as a critical hub for TMT-B&W performance when accounting for demographic variation, while distinct cortical regions mediate task-specific demands in unadjusted models. These findings support the TMT-B&W as a practical, low-cost neurobehavioral marker of brain integrity in older populations. Full article

Accelerated neurocognitive decline associated with surgeries under general anesthesia (GA), a phenomenon referred to as postoperative neurocognitive disorder (PND), is a significant public health concern. It not only poses inherent risks but may also contribute to the development of other neurodegenerative disorders. We systematically searched five databases for studies examining cognitive function in patients with mild-to-moderate TBI with (participant) or without (control) subsequent extracranial surgeries/GA. A random effects model was applied to calculate mean differences (MDs) and 95% confidence intervals (CIs). Five outcomes were analyzed post hoc: trail-making tests A and B (TMT-A/B), Glasgow Outcome Scale–Extended (GOSE), and length of stay (LOS) in intensive care units (ICUs) and hospitals. Five studies met the criteria for our meta-analysis. Patients with a history of mild-to-moderate TBI who underwent extracranial surgeries/GA exhibited worse outcomes in TMT-A [MD = 2.04; CI 0.38–3.70; p = 0.016] and TMT-B [MD = 16.59; CI 9.58–23.60; p < 0.001]. Differences in the ICU and hospital LOS and GOSE between the study groups were insignificant. Our results suggest that extracranial surgeries/GA may worsen neurocognitive outcomes without affecting functional recovery in mild-to-moderate TBI patients. Given the limited number of studies identified and the high incidence of TBI, more research on PND in TBI patients is warranted. Full article

Dual-task paradigms that combine cognitive and motor tasks offer a valuable lens for detecting subtle impairments in cognitive and physical functioning, especially in older adults. This study used artificial neural network (ANN) modeling to predict clinical, cognitive, and psychosocial outcomes from integrated gait, speech-linguistic, demographic, physiological, and psychological data collected during single- and dual-task conditions. Forty healthy adults (ages 20–84) completed physical, cognitive, and psychosocial assessments and a dual-task walking task involving cell phone use. ANN models were optimized using hyperparameter tuning and k-fold cross-validation to predict outcomes such as the Montreal Cognitive Assessment (MOCA), Trail Making Tests (TMT A and B), Activities-Specific Balance Confidence (ABC) Scale, Geriatric Depression Scale (GDS), and measures of memory, affect, and social support. The models achieved high accuracy for MOCA (100%), ABC (80%), memory function (80%), and social support satisfaction (75%). Feature importance analyses revealed key predictors such as speech-linguistic markers and sensory impairments. First-person plural pronoun used and authenticity of internal thoughts during dual-task emerged as strong predictors of MOCA and memory. Models were less accurate for complex executive tasks like TMT A and B. These findings support the potential of ANN models for the early detection of cognitive and psychosocial changes. Full article

Background/Objectives: Cognitive decline has been increasingly linked to cardiac autonomic regulation; however, its specific associations with cognitive domains, such as information processing speed and executive function, remain unclear. This preliminary study examined the relationship between cardiac autonomic modulation and cognitive performance in older adults. Methods: A cross-sectional study was conducted with 101 older adults (aged ≥60 years) attending a university hospital outpatient clinic. Participants were classified as without cognitive impairment (WCI) or cognitively impaired and not demented (CIND) based on neuropsychological assessments. Heart rate variability (HRV) was measured at rest, focusing on the time-domain parameters (SDNN, rMSSD, and pNN50). Trail making test parts A and B (TMT-A and TMT-B) were used to assess information processing speed and executive function, respectively. Analyses of covariance (ANCOVAs) were performed, adjusting for confounding variables including age, sex, and comorbidities. Results: Participants in the CIND group had significantly lower HRV indices than those in the WCI group (SDNN, p < 0.05, d = 0.44; rMSSD, p < 0.05, d = 0.39; pNN50, p < 0.05, d = 0.40), indicating reduced parasympathetic modulation. Higher HRV values were observed in individuals with preserved processing speed and executive function. Specifically, pNN50 was significantly associated with processing speed (p = 0.04), and SDNN was significantly correlated with executive function (p = 0.02). These associations persisted even after adjusting for confounding factors. Conclusions: Reduced cardiac autonomic modulation, especially lower parasympathetic activity, is significantly associated with cognitive impairment in older adults. Lower pNN50 values were correlated with slower information processing speed, and lower SDNN was associated with poorer executive function. These findings support the potential use of HRV as a physiological biomarker to detect cognitive changes during ageing. Full article

Background/Objectives: this study evaluated the differential effects of two distinct dietary nucleotide supplements, combined with spontaneous physical activity, on neuromuscular, cognitive, and metabolic adaptations in older adults. Methods: Sixty-nine physically independent older adults (aged 60–75 years) were randomly assigned to three groups: (1) a yeast nucleotides formulation (YN) standardized in a high content of free nucleotides (>40%) rich in all macro and micro nutrients naturally occurring in yeast cell (amino acids, minerals and B-group vitamin); (2) a neuro-based formulation (NF) consisting of a blend of monophosphate nucleotides 5′; or (3) a placebo. Participants maintained their spontaneous physical activities without structured exercise during a 10-week intervention. Assessments included physical function, cognitive performance, body composition, quality of life, and serum biomarkers of oxidative stress, inflammation, and neurogenesis. Results: Both nucleotide-supplemented groups demonstrated significant improvements compared to placebo in physical performance (p ≤ 0.045), cognitive function (Trail Making Test B [TMT-B]: p ≤ 0.012), oxidative stress biomarkers (p ≤ 0.048), inflammatory cytokines (p ≤ 0.023), and quality-of-life parameters (p ≤ 0.047). Body composition remained stable in supplemented groups, whereas placebo increased fat mass (5.04%) and decreased muscle mass (−2.18%). Conclusions: Dietary nucleotide supplementation enhances the benefits of spontaneous physical activity across all measured variables in older adults, highlighting nucleotides as promising nutritional support for healthy aging. YN exhibited a trend toward greater inflammatory modulation, whereas NF showed a tendency toward enhanced neurotrophic effects and functional improvements, with a statistically significant improvement in the Timed Up and Go Test (p = 0.014). These findings underscore the potential for tailored nucleotide-based interventions to optimize distinct physiological domains in aging populations. Full article

Background/Objectives: A mango (Mangifera indica) leaf extract (Zynamite^®), rich in the polyphenol mangiferin, has been demonstrated to modulate brain activity, boost cognitive function, and reduce mental fatigue. Research evidence supports that improving the solubility of this extract could significantly enhance its efficacy as an active ingredient. This study examined the effects of a soluble version of Zynamite^®, Zynamite^® S (Zyn-S), on cognitive function and mood in young adults at low doses. Methods: A total of 119 university students were enrolled in the study. Participants were randomly assigned to receive either 100 mg, 150 mg, or placebo in a double-blind crossover design. Short- and long-term memory were evaluated using the Rey Auditory Verbal Learning Test (RAVLT), executive functions with the Trail Making Test (TMT), processing speed with the Digit Symbol Substitution Test (DSST), and selective attention with the Stroop Color and Word Test. Additionally, mood was assessed using the Spanish short version of the Profile of Mood States (POMS). All these assessments were conducted before taking the product and at 30 min, 3 h, and 5 h post-intake. Results: The results demonstrated that participants who received Zynamite^® S experienced significant improvements in reduced tension, depression, and confusion, suggesting an enhancement in mental clarity and overall emotional well-being. Both interventions also improved processing speed and cognitive flexibility. However, no significant differences were observed in short- and long-term verbal memory. Conclusions: In summary, these findings support Zynamite^® S as a natural nootropic capable of acutely improving key cognitive functions and emotional balance at low doses in young adults, with sustained efficacy for at least five hours. Full article

Background: Virtual Reality (VR) is transforming neuropsychological assessment by providing immersive environments that closely replicate real-world conditions. This study presents the Trail Making Test in VR (TMT-VR), a novel adaptation of the traditional TMT, aimed at evaluating cognitive functions in adults with Attention Deficit Hyperactivity Disorder (ADHD). We examined the ecological validity, convergent validity, usability, and user experience of the TMT-VR compared to the traditional version. Methods: Fifty-three adults (18–40 years old), including 25 with ADHD and 28 neurotypical controls, completed both the traditional and VR versions of the TMT. The participants also provided feedback on the VR experience via standardized questionnaires. Results: The statistical analyses demonstrated a significant positive correlation between TMT-VR scores and both the traditional TMT and ADHD symptomatology as measured by the Adult Self-Report Scale, confirming the TMT-VR’s ecological and convergent validity. High usability and positive user experience ratings indicated strong acceptability of the VR platform. Notably, the ADHD group exhibited greater performance differences in the VR environment, suggesting that VR may more effectively capture real-world cognitive challenges. Conclusions: These findings suggest that TMT-VR is a valid, engaging, and ecologically valid tool for cognitive assessment in ADHD and other clinical populations, offering enhanced insights over traditional methods. Full article

Background/Objectives: Obesity is linked to a higher risk of cognitive impairment. The objective of this single blind randomized trial was to evaluate the impact of dark sweet cherry (DSC) intake on cognitive function in obese adults. Methods: Participants (body mass index (BMI): 30–40 kg/m², >18 years, without chronic diseases and/or antibiotic use) consumed 200 mL of DSC drink with 3 g of cherry powder (n = 19) or an isocaloric placebo drink (n = 21) twice daily for 30 days. Cognitive function was assessed at Day 1 (D1) and Day 30 (D30) using standardized cognitive tests and the NeuroTracker (NT) 3D training program. Blood biomarkers related to cognitive health (neurotensin, substance p, and oxytocin) and circadian rhythm (melatonin and cortisol) were assessed at D1 and D30 using a Luminex multiplex bead-based immunoassay. Results: DSC supplementation significantly improved working memory and concentration, as indicated by higher scores in the digit span forward (DSF, p = 0.006) and backward (DSB, p = 0.01) tests. However, processing speed, sustained attention, and visual spatial skills, assessed through the trail making (TMT) and digit symbol substitution (DSST) tests, as well as visual cognitive performance (VCP) evaluated by the NT program, showed no significant differences between groups. Neurotensin, associated with cognitive deficits, increased in both cherry and placebo groups but was significant only in the placebo group (p = 0.007). Similarly, melatonin increased in both groups, reaching significance only in the placebo group (p = 0.02), and it correlated positively with IFNγ, suggesting a compensatory response to inflammation. Conclusions: These findings suggest DSC supplementation may enhance specific cognitive functions in obese adults. Further clinical trials are needed to confirm these results. Full article

Background/Objectives: The purpose of this study has been to evaluate the effects of a dance-based aerobic training program on frailty, cognitive impairment, executive functions, and verbal fluency in older adults with mild cognitive impairment. Methods: Randomized clinical trial, whose sample was made up of 92 older adults, of which 47 performed rhythmic physical activity for 12 weeks. Data on frailty were collected through FRAIL, cognitive function through the Mini-Mental State Examination (MMSE), cognitive impairment through The Montreal Cognitive Assessment (MoCA), verbal fluency using the Isaac test, and executive functions with the Trail Making Test (TMT). All variables were measured before and after the intervention by an independent researcher blinded to the treatment. Results: Participants in the experimental group showed statistically significant improvements in frailty (Cohen’s d = 0.60), cognitive function (Cohen’s d = 0.98), cognitive impairment (Cohen’s d = 1.22), verbal fluency (Cohen’s d = 0.61) and executive functions (Cohen’s d = 0.64). Conclusions: This study demonstrated that a 12-week dance-based aerobic training program can significantly reduce frailty and improve cognitive abilities in older adults with mild cognitive impairment. These improvements suggest that the intervention is not only effective in terms of physical health, but also in promoting mental health and general well-being. Full article

Virtual Reality (VR) is increasingly used in neuropsychological assessments due to its ability to simulate real-world environments. This study aimed to develop and evaluate the Trail Making Test in VR (TMT-VR) and investigate the effects of different interaction modes and gaming skills on cognitive performance. A total of 71 young female and male adults (aged 18–35) with high and low gaming skills participated in this study. Participants completed the TMT-VR using three interaction modes as follows: eye-tracking, head movement, and controller. Performance metrics included task completion time and accuracy. User experience, usability, and acceptability of TMT-VR were also examined. Results showed that both eye tracking and head movement modes significantly outperformed the controller in terms of task completion time and accuracy. No significant differences were found between eye tracking and head movement modes. Gaming skills did not significantly influence task performance using any interaction mode. The TMT-VR demonstrates high usability, acceptability, and user experience among participants. The findings suggest that VR-based assessments can effectively measure cognitive performance without being influenced by prior gaming skills, indicating potential applicability for diverse populations. Full article

Background: This study was designed to adapt the Delis–Kaplan Executive System (D-KEFS) version of the Color-Word Interference (CWIT) and Trail Making Tests (TMTs) for the Greek adult population from 20 to 49 years old, since it is of research as well as clinical importance to detect executive functions’ impairment in young adults with neurological or/and psychiatric conditions. Aims: Norms for the Greek adult population have been calculated to be available for neuropsychologists and health professionals who work in relevant settings. Methods: The study sample consisted of 101 healthy adults (41% male and 60% female) aged 20 to 49 years (M = 32.16, SD = 11.57) with education from 12 to 19 years of schooling (M = 14.51, SD = 0.89). A Pearson correlation test as well as a chi square test were conducted to examine potential associations between gender, age, education, and participants’ performance. Afterwards, we calculated normative data using raw scores and transformed them into percentile scores. Finally, Greek norms were compared to the original raw scores, which were transformed into scaled scores by Delis et al. (2001). Results: The findings showed that age was the only variable which affected CWIT, whereas level of education as well as age were predictive factors for most TMT conditions, except for the visual scanning test (Condition 1). Gender did not affect both tests. Finally, D-KEFS norms for CWIT and TMT are available for the Greek adult population to help clinicians detect executive functions’ deficits and therefore adjust tailored therapeutic strategies. Additionally, it is of great importance to use these tests for research purposes. Conclusion: Given that executive functions are assumed as high-level skills, which are highly related to everyday functionality, adapted tests contribute not only to assess the progression of any existing neurological as well as psychiatric disorders, but they can also be used to evaluate patients’ ability to live independently, as well as their access to work. Full article

Background: The Frontal Assessment Battery (FAB), which is used to assess executive function, has been translated into several languages and shown to be valid and reliable. However, the validity and reliability of the Japanese version in patients with stroke are unknown. This study aimed to investigate the validity and reliability of the Japanese version of the FAB in patients with stroke. Methods: The Japanese version of the FAB for dementia was modified and evaluated in 52 patients with stroke. FAB measurements were obtained twice over a 10-day period. Convergent validity was assessed using the Stroop Color Word Test (SCWT) and the Trail Making Test (TMT) part B. Internal consistency was measured using Cronbach’s alpha (Cα). Test-retest evaluations were performed using intraclass correlation coefficient [ICC (2.1)] measurements, and limits of agreement (LOA) were calculated using the total FAB score. Results: The mean total FAB score was 13.4 ± 2.8 points, the ICC (2.1) was 0.856, and Cα was 0.92. The total FAB score was correlated with SCWT scores for parts I through IV (r = 0.70 to 0.77) and the TMT score for part B (ρ = −0.53). The LOA were −1.7 to 2.9 points. Conclusions: The Japanese version of the FAB had higher validity and reliability in patients with stroke. Full article