Objective Examine academic achievement among pediatric acute lymphoblastic leukemia survivors diagnosed during the years 1993–2008. Method A deterministic linkage of the Iowa Cancer Registry and Iowa Testing Programs databases was performed and yielded 147 survivors. Achievement data, in the form of Iowa Percentile Rank scores, were obtained and analyzed by grade and content domain. Results Children diagnosed before age 5 evidenced more underachievement than those diagnosed later (p = .05). Underachievement was noted in mathematics in grades 8 and 11 (p's < .05), in addition to a longitudinal decrease in scores from grades 4 through 11 (p = .01). No differences were found in academic achievement between males and females. Conclusions Utilization of a population-based approach with a nationally recognized, standardized instrument indicates that academic underachievement is subtle yet exists, most notably in mathematics.
academic achievement; cancer survivorship; cognition; leukemia; population-based
The Ultimatum Game (UG) is a widely used and well-studied laboratory model of economic decision-making. Here, we studied 129 healthy adults and compared demographic (i.e., age, gender, education), cognitive (i.e., intelligence, attention/working memory, speed, language, visuospatial, memory, executive functions), and personality (i.e., “Big Five”, positive affect, negative affect) variables between those with a “rational” versus an “irrational” response pattern on the UG. Our data indicated that participants with “rational” UG performance (accepting any offer, no matter the fairness) endorsed higher levels of trust, or the belief in the sincerity and good intentions of others, while participants with “irrational” UG performance (rejecting unfair offers) endorsed higher levels of negative affect, such as anger and contempt. These personality variables were the only ones that differentiated the two response patterns—demographic and cognitive factors did not differ between rational and irrational players. The results indicate that the examination of personality and affect is crucial to our understanding of the individual differences that underlie decision-making.
trustworthiness; negative affect; decision making; Ultimatum Game
The capacity to make sound financial decisions across the lifespan is critical for interpersonal, occupational, and psychological health and success. In the present study, we explored how healthy younger and older adults make a series of increasingly complex financial decisions. One-hundred sixteen healthy older adults, aged 56–90 years, and 102 college undergraduates, completed the Financial Decision-Making Questionnaire, which requires selecting and justifying financial choices across four hypothetical scenarios and answering questions pertaining to financial knowledge. Results indicated that Older participants significantly outperformed Younger participants on a multiple-choice test of acquired financial knowledge. However, after controlling for such pre-existing knowledge, several age effects were observed. For example, Older participants were more likely to make immediate investment decisions, whereas Younger participants exhibited a preference for delaying decision-making pending additional information. Older participants also rated themselves as more concerned with avoiding monetary loss (i.e., a prevention orientation), whereas Younger participants reported greater interest in financial gain (i.e., a promotion orientation). In terms of sex differences, Older Males were more likely to pay credit card bills and utilize savings accounts than were Older Females. Multiple positive correlations were observed between Older participants’ financial decision-making ability and performance on neuropsychological measures of non-verbal intellect and executive functioning. Lastly, the ability to justify one’s financial decisions declined with age, among the Older participants. Several of the aforementioned results parallel findings from the medical decision-making literature, suggesting that older adults make decisions in a manner that conserves diminishing cognitive resources.
aging; decision-making; financial; cognition
We report a psychophysiological study of “recognition without awareness” in patient 2354, who had severe but circumscribed atrophy in the occipitoparietal region bilaterally (caused by visual-variant Alzheimer’s disease, documented by structural and functional neuroimaging) and an accompanying Balint syndrome that prevented her from recognizing the emotional valence of many highly charged negative visual scenes (e.g., a burned body). Despite this lack of overt recognition, patient 2354 nonetheless generated large amplitude skin conductance responses to highly charged negative pictures, demonstrating the same kind of recognition without awareness that has been reported previously in patients with bilateral occipitotemporal dysfunction and prosopagnosia (e.g., Tranel & Damasio, 1985). Our case complements both previous evidence of covert, nonconscious recognition in patients with prosopagnosia, and previous behavioral studies of patients with Balint syndrome that have shown evidence of “preattentive” visual processing. The findings add to the small but important set of empirical observations regarding nonconscious visual processing in neurological patients, and indicate that recognition without awareness can occur in the setting of dorsal visual stream dysfunction and Balint syndrome. The findings in our patient suggest that she has patent pathways from higher order visual cortices to autonomic effectors in amygdala or hypothalamus, even though the results of such information processing are not made available to conscious awareness.
The present series of three studies aims at investigating the hypothesis that some seemingly normal older persons have deficits in reasoning and decision making due to dysfunction in a neural system which includes the ventromedial prefrontal cortices. This hypothesis is relevant to the comprehensive study of aging, and also addresses the question of why so many older adults fall prey to fraud. To our knowledge, this work represents the first of its kind to begin to identify, from an individual-differences perspective, the behavioral, psychophysiological, and consumer correlates of defective decision making among healthy older adults. Our findings, in a cross-sectional sample of community-dwelling participants, demonstrate that a sizeable subset of older adults (approximately 35–40%) perform disadvantageously on a laboratory measure of decision making that closely mimics everyday life, by the manner in which it factors in reward, punishment, risk, and ambiguity. These same poor decision makers display defective autonomic responses (or somatic markers), reminiscent of that previously established in patients with acquired prefrontal lesions. Finally, we present data demonstrating that poor decision makers are more likely to fall prey to deceptive advertising, suggesting compromise of real-world judgment and decision-making abilities.
aging; frontal lobe; decision making
The problems that some community-dwelling elderly develop in real-world decision-making may have disastrous consequences for their health and financial well-being. Investigations across the adult life span have identified personality as an important individual differences variable that is related to decision-making ability. The aim of this study was to investigate the relationship between personality characteristics, as rated by an informant, and complex decision-making performance among elders. It was hypothesized that deficits in decision-making would be associated with personality characteristics reflecting weak executive functioning (Lack of Planning, Poor Judgment, Lack of Persistence, Perseveration, Lack of Initiative, Impulsivity, and Indecisiveness).
Fifty-eight elderly persons participated. Their health and cognitive status were deemed intact via comprehensive neuropsychological evaluation. The Iowa Scales of Personality, completed by an informant, was used to assess personality characteristics, and the Iowa Gambling Task, completed by the participant, was used to assess complex decision-making abilities.
Longstanding disturbances in executive personality characteristics were found to be associated with poor decision-making, and these disturbances remained predictive of poor decision-making even after taking into consideration demographic, neuropsychological, and mood factors. Acquired personality disturbances did not add significantly to prediction after longstanding disturbances were taken into account. Disturbances in other dimensions of personality were not significantly associated with poor decision-making.
Our study suggests that attentiveness to the personality correlates of difficulties with aspects of executive functioning over the adult years could enhance the ability to identify older individuals at risk for problems with real-world decision-making.
aging; decision making; executive function; personality disturbances; Iowa Scales of Personality Change
To determine whether social support and/or physical activity buffer the association between stressors and increasing risk of depression symptoms at baseline and at 3 year follow-up.
This is a secondary analysis of data from the Women’s Health Initiative Observational Study. 91,912 community-dwelling post-menopausal women participated in this prospective cohort study. Depression symptoms were measured at baseline and 3 years later; social support, physical activity, and stressors were measured at baseline.
Stressors at baseline, including verbal abuse, physical abuse, caregiving, social strain, negative life events, financial stress, low income, acute pain, and a greater number of chronic medical conditions, were all associated with higher levels of depression symptoms at baseline and new onset elevated symptoms at three year follow-up. Social support and physical activity were associated with lower levels of depressive symptoms. Contrary to expectation, more social support at baseline strengthened the association between concurrent depression and physical abuse, social strain, caregiving, and low income. Similarly, more social support at baseline increased the association between financial stress, income, and pain on new-onset depression 3 years later. Physical activity similarly moderated the effect of caregiving, income, and pain on depression symptoms at baseline.
Stressors, social support, and physical activity showed predicted main effect associations with depression. Multiplicative interactions were small in magnitude and in the opposite direction of what was expected.
depression; risk factors; acute stress; chronic stress; protective factors; effect moderation
In a previous study we examined whether frontal patients with impaired decision-making on the Iowa Gambling Task (IGT) would recover over time if retested on the IGT. However, a major limitation of repeated administration of the IGT is practice effects, where control participants show improvement with retesting (Bechara, Damasio, & Damasio, 2000). Therefore, the primary goal of this study was to design two alternative versions of the IGT to eliminate practice effects. We found that control participants did not show improvement in performance across the different versions of the task, thus reflecting success in our attempt to design alternative versions of the IGT. Compared to control participants, patients with damage to the ventromedial prefrontal cortex (vmPFC) performed worse on all three versions of the IGT, even after controlling for age, sex, and education. The development of alternative versions of the IGT provides a valuable tool for clinicians and researchers to utilize the IGT as a way to track how the decision-making abilities of patients change over time. Additionally, these results are consistent with findings from the original studies using the IGT with patients with damage to the vmPFC which showed that decision-making impairments do not recover over time.
Decision Making; Prefrontal Cortex; Iowa Gambling Task; Functional Recovery; Practice Effects
Epidemiologic studies have yielded mixed findings on the association of psychosocial stressors with cardiovascular disease (CVD) risk. In this study, we examined associations of stressful life events (SLE) and social strain with incident coronary heart disease (CHD) and stroke (overall, and for hemorrhagic and ischemic strokes) independent of sociodemographic characteristics, and we evaluated whether these relationships were explained by traditional behavioral and biological risk factors.
Methods and Results
Data from approximately 82 000 Women's Health Initiative Observational Study participants were used for the SLE and social strain analyses, respectively. Participants were followed for events for up to 18.0 years (median, 14.0). Separate Cox proportional hazards models were generated to estimate associations of each stress measure with incident CVD. After adjusting for sociodemographic characteristics and depressive symptoms, higher SLE and social strain were associated with higher incident CHD and stroke (each P trend <0.05). Hazard ratios and 95% confidence intervals were 1.12 (1.01, 1.25) for incident CHD and 1.14 (1.01, 1.28) for incident stroke among participants reporting high versus low SLE. Findings were similar for social strain. Associations were attenuated with further adjustment for mediating behavioral and biological risk factors. Findings were similar for associations of SLE with ischemic stroke and hemorrhagic stroke, but social strain was only associated with ischemic stroke.
Higher SLE and social strain were associated with higher incident CVD independent of sociodemographic factors and depressive symptoms, but not behavioral and biological risk factors.
cardiovascular diseases; epidemiology; stress
The present study examined the long-term cognitive implications of cancer treatment among breast cancer survivors aged 65 years and older. Fifty-seven women survivors were compared to 30 healthy older female adult comparisons, matched in terms of age and education, with no history of cancer. Cancer survivors were also compared based on treatment intervention, involving chemotherapy (n = 27) versus local therapy through surgery and radiation (n = 30). As a group, the breast cancer survivors scored lower on measures of general cognitive function, working memory, psychomotor speed, and executive function, when compared to the normal comparisons. Among the cancer survivors, those who received local therapy scored lower than the other survivors and normal comparisons on measures of verbal learning, visual perception and construction, as well as visual attention and short-term retention. Our findings suggest that cognitive outcomes may involve more age-related deficits among older cancer survivors compared to matched healthy subjects.
breast cancer; chemotherapy; cognition; neuropsychological assessment
The False Tagging Theory (FTT) is a neuroanatomical model of belief and doubt processes that proposes a single, unique function for the prefrontal cortex. Here, we review evidence pertaining to the FTT, the implications of the FTT regarding fractionation of the prefrontal cortex, and the potential benefits of the FTT for new neuroanatomical conceptualizations of executive functions. The FTT provides a parsimonious account that may help overcome theoretical problems with prefrontal cortex mediated executive control such as the homunculus critique. Control in the FTT is examined via the “heuristics and biases” psychological framework for human judgment. The evidence indicates that prefrontal cortex mediated doubting is at the core of executive functioning and may explain some biases of intuitive judgments.
belief; doubt; executive function; heuristics; prefrontal cortex
Markets are mechanisms of social exchange, intended to facilitate trading. However, the question remains as to whether markets would help or hurt individuals with decision-makings deficits, as is frequently encountered in the case of cognitive aging. Essential for predicting future gains and losses in monetary and social domains, the striatal nuclei in the brain undergo structural, neurochemical, and functional decline with age. We correlated the efficacy of market mechanisms with dorsal striatal decline in an aging population, by using market based trading in the context of the 2008 U.S Presidential Elections (primary cycle). Impaired decision-makers displayed higher prediction error (difference between their prediction and actual outcome). Lower in vivo caudate volume was also associated with higher prediction error. Importantly, market-based trading protected older adults with lower caudate volume to a greater extent from their own poorly calibrated predictions. Counterintuitive to the traditional public perception of the market as a fickle, risky proposition where vulnerable traders are most surely to be burned, we suggest that market-based mechanisms protect individuals with brain-based decision-making vulnerabilities.
decision-making; aging; dopaminergic systems; markets; social neuroscience
The Judgment of Line Orientation (JLO) test was developed to be, in Arthur Benton’s words, “as pure a measure of one aspect of spatial thinking, as could be conceived.” The JLO test has been widely used in neuropsychological practice for decades. The test has a high test-retest reliability (Franzen, 2000), as well as good neuropsychological construct validity as shown through neuroanatomical localization studies (Tranel, Vianna, Manzel, Damasio, & Grabowski, 2009). Despite its popularity and strong psychometric properties, the full-length version of the test (30 items) has been criticized as being unnecessarily long (Straus, Sherman, & Spreen, 2006). There have been many attempts at developing short forms; however, these forms have been limited in their ability to estimate scores accurately. Taking advantage of a large sample of JLO performances from 524 neurological patients with focal brain lesions, we used techniques from Item Response Theory (IRT) to estimate each item’s difficulty and power to discriminate among various levels of ability. A random item IRT model was used to estimate the influence of item stimulus properties as predictors of item difficulty. These results were used to optimize the selection of items for a shorter method of administration which maintained comparability with the full form using significantly fewer items. This effectiveness of this method was replicated in a second sample of 82 healthy elderly participants. The findings should help broaden the clinical utility of the JLO and enhance its diagnostic applications.
Functional neuroimaging studies suggest that the medial PFC (mPFC) is a key component of a large-scale neural system supporting a variety of self-related processes. However, it remains unknown whether the mPFC is critical for such processes. In this study, we used a human lesion approach to examine this question. We administered a standard trait judgment paradigm [Kelley, W. M., Macrae, C. N., Wyland, C. L., Caglar, S., Inati, S., & Heatherton, T. F. Finding the self? An event-related fMRI study. Journal of Cognitive Neuroscience, 14, 785–794, 2002] to patients with focal brain damage to the mPFC. The self-reference effect (SRE), a memory advantage conferred by self-related processing, served as a measure of intact self-processing ability. We found that damage to the mPFC abolished the SRE. The results demonstrate that the mPFC is necessary for the SRE and suggest that this structure is important for self-referential processing and the neural representation of self.
Although delirium is a common medical comorbidity with altered cognition as its defining feature, few publications have addressed the neuropsychological prodrome, profile, and recovery of patients tested during delirium. We characterize neuropsychological performance in 54 hemapoietic stem cell/bone marrow transplantation (BMT) patients shortly before, during, and after delirium and in BMT patients without delirium and 10 healthy adults. Patients were assessed prospectively before and after transplantation using a brief battery. BMT patients with delirium performed more poorly than comparisons and those without delirium on cross-sectional and trend analyses. Deficits were in expected areas of attention and memory, but also in psychomotor speed and learning. The patients with delirium did not return to normative “average” on any test during observation. Most tests showed a mild decline in the visit before delirium, a sharp decline with delirium onset, and variable performance in the following days. This study adds to the few investigations of neuropsychological performance surrounding delirium and provides targets for monitoring and early detection; Trails A and B, RBANS Coding, and List Recall may be useful for delirium assessment.
Bone marrow transplantation; Cognition; Cancer; Attention; Delirium
We have proposed the False Tagging Theory (FTT) as a neurobiological model of belief and doubt processes. The theory posits that the prefrontal cortex is critical for normative doubt toward properly comprehended ideas or cognitions. Such doubt is important for advantageous decisions, for example in the financial and consumer purchasing realms. Here, using a neuropsychological approach, we put the FTT to an empirical test, hypothesizing that focal damage to the ventromedial prefrontal cortex (vmPFC) would cause a “doubt deficit” that would result in higher credulity and purchase intention for consumer products featured in misleading advertisements. We presented 8 consumer ads to 18 patients with focal brain damage to the vmPFC, 21 patients with focal brain damage outside the prefrontal cortex, and 10 demographically similar healthy comparison participants. Patients with vmPFC damage were (1) more credulous to misleading ads; and (2) showed the highest intention to purchase the products in the misleading advertisements, relative to patients with brain damage outside the prefrontal cortex and healthy comparison participants. The pattern of findings was obtained even for ads in which the misleading bent was “corrected” by a disclaimer. The evidence is consistent with our proposal that damage to the vmPFC disrupts a “false tagging mechanism” which normally produces doubt and skepticism for cognitive representations. We suggest that the disruption increases credulity for misleading information, even when the misleading information is corrected for by a disclaimer. This mechanism could help explain poor financial decision-making when persons with ventromedial prefrontal dysfunction (e.g., caused by neurological injury or aging) are exposed to persuasive information.
prefrontal cortex; deception; advertising; lesion; credulity; false tagging theory; belief; doubt
Previous studies have reported conflicting evidence concerning the contribution of declarative memory to advantageous decision-making on the Iowa Gambling Task (IGT). One study, in which the measurement of psychophysiology during the task necessitated a 10-sec delay between card selections, found that six participants with amnesia due to hippocampal damage failed to develop a preference for advantageous decks over disadvantageous decks (Gutbrod et al., Neuropsychologia, Vol. 44, pp. 1315–1324, 2006). However, a single case study (where psychophysiology was not measured and no delay between card selections occurred) showed that an amnesic patient developed normal preference for advantageous decks (Turnbull & Evans, Neuropsychologia, Vol. 44, pp. 300–306, 2006). We sought to resolve these discrepant findings by examining IGT performances in five patients with profound amnesia (WMS-III General Memory Index M =63) and bilateral hippocampal damage caused by anoxia (n = 4) or herpes simplex encephalitis (n = 1). In one administration of the IGT, psychophysiology measurements were utilized and a 6-sec delay was interposed between card selections. In a second administration, no delay between card selections was interposed. While age-, sex-, and education-matched healthy comparison participants showed significant learning with a gradual preference for advantageous decks in both conditions, amnesic patients, irrespective of IGT administration condition and extent of medial temporal lobe damage, failed to develop this preference. These findings strongly discount the possibility that the delay between card selections explains why amnesic participants fail to learn in the IGT, and suggest instead a significant role for medial temporal lobe declarative memory systems in the type of complex decision-making tapped by the IGT.
amnesia; Iowa Gambling Task; declarative memory; hippocampus; decision-making
Informant reporting is important in the assessment of depression and anxiety among individuals with cognitive impairment. We examined the influence of the visibility effect on the ease of rating depression and anxiety symptoms. 53 family members of dementia patients and 65 staff members working with cognitively impaired adults judged the ratability of the Inventory of Depression and Anxiety Symptoms item pool. Results indicated that Appetite Loss, Lassitude and Insomnia scales were easiest to rate; Suicidality and Traumatic Intrusions were most difficult to rate. Findings support the visibility effect and emphasize the importance of selecting easy to rate items for informants.
informant reporting; dementia; depression; anxiety; visibility effect
Damage to the ventromedial prefrontal cortex (VMPFC) impairs concern for other people, as reflected in the dysfunctional real-life social behavior of patients with such damage, as well as their abnormal performances on tasks ranging from moral judgment to economic games. Despite these convergent data, we lack a formal model of how, and to what degree, VMPFC lesions affect an individual’s social decision-making. Here we provide a quantification of these effects using a formal economic model of choice that incorporates terms for the disutility of unequal payoffs, with parameters that index behaviors normally evoked by guilt and envy. Six patients with focal VMPFC lesions participated in a battery of economic games that measured concern about payoffs to themselves and to others: dictator, ultimatum, and trust games. We analyzed each task individually, but also derived estimates of the guilt and envy parameters from aggregate behavior across all of the tasks. Compared to control subjects, the patients donated significantly less and were less trustworthy, and overall our model found a significant insensitivity to guilt. Despite these abnormalities, the patients had normal expectations about what other people would do, and they also did not simply generate behavior that was more noisy. Instead, the findings argue for a specific insensitivity to guilt, an abnormality that we suggest characterizes a key contribution made by the VMPFC to social behavior.
prefrontal; lesion; social preference; guilt; neuroeconomics; ventromedial
This study examined the relationship between age and inhibitory functioning within a sample of older adults ranging in age from 60 to 85 years old. On the basis of earlier research, and confirmed by factor analysis, measures typically referred to as frontal lobe tasks were used as measures of inhibitory functioning. Findings demonstrated that inhibitory processes continued to decline with advancing age within the older sample. In addition, the role of inhibition in age-related performance deficits on a verbal list learning measure and an attention measure was examined. Hierarchical regression analyses showed that inhibition accounted for a significant proportion of the age-related variance on the two cognitive measures, whereas measures of reading speed accounted for a smaller proportion of the variance. In addition, when inhibition was first covaried out, reading speed no longer accounted for a significant proportion of the age-related variance. It is argued that inhibition is an important contributor to age-related performance decrements in cognition.
To test the hypothesis that higher levels of red blood cell (RBC) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have a protective association with domain-specific cognitive function in women aged 65 years and older.
A total of 2,157 women with normal cognition enrolled in a clinical trial of postmenopausal hormone therapy were followed with annual cognitive testing for a median of 5.9 years. In this retrospective cohort study, we assessed the relationship between prerandomization RBC DHA + EPA levels and a) cognitive measures at baseline, and b) cognitive change over time. Endpoints were composite cognitive function and performance in 7 cognitive domains: fine motor speed, verbal memory, visual memory, spatial ability, verbal knowledge, verbal fluency, and working memory.
After adjustment for demographic, clinical, and behavioral characteristics, no significant (p < 0.01) cross-sectional cognitive differences were found between women in the high and low DHA + EPA tertiles at the time of the first annual cognitive battery. In addition, no significant (p < 0.01) differences were found between the high and low DHA + EPA tertiles in the rate of cognitive change over time.
We did not find an association between RBC DHA + EPA levels and age-associated cognitive decline in a cohort of older, dementia-free women.