The International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) provides a systematic framework to identify cognitive phenotypes in patients with various epilepsy syndromes and assess their consistency across diverse cultures and regions. Evidence-based consensus on cognitive profiles will enhance diagnostic processes and foster collaborative epilepsy research. This study evaluated the applicability of the IC-CoDE in adults with temporal lobe epilepsy (TLE) in South Africa. Neuropsychology data from 301 adults with TLE were analysed and the IC-CoDE taxonomy was applied to derive cognitive phenotypes. Cognitive phenotype distributions, along with demographic and clinical characteristics, were evaluated and compared to findings from cohorts in the US and Mumbai, India. Sixty-six percent of our sample was cognitively intact, 19% had single-domain impairment, 9% bidomain and 6% generalized impairment. Adults with mesial temporal lobe sclerosis (MTS) had higher rates of impairment in all cognitive domains, compared to those without MTS. Significantly more adults with TLE were cognitively intact in our sample than in the US and Mumbai cohorts (p < 0.001) and significantly more presented with single-domain impairment in language. Bidomain impairment most commonly involved language and memory, consistent with the US cohort. Differences between our findings and those from other cohorts may be related to varying clinical characteristics, particularly the significantly greater proportion of adults with normal MRIs in our cohort. These results reveal nuanced patterns of cognitive phenotypes in South African adults with TLE but overall provide further support for the cross-cultural application of the IC-CoDE.
The aim was to investigate the effects of transcranial direct current Stimulation on Working memory and some reading skills of adults with Dyslexia. Forty adults with Dyslexia, who met the inclusion criteria were enrolled. All adults were informed of the trial and signed informed consent. Adults were randomly divided into an experimental group and a control group, each consisting of 20 adults. Linear regression models were used to assess within-person differences within conditions for each outcome. Post-test scores were considered as dependent variables explained by condition and pretest scores as the independent variables. Results showed that participants in the Transcranial Direct Current Stimulation(tDCS) experimental condition reported significant changes in scores from pre-intervention to post-intervention. The transcranial direct current stimulation seems to be a promising tool for improving working memory and some reading skills of adults with dyslexia.
This study developed two self-report executive function scales suitable for use with university students and adolescents in Saudi Arabia, respectively, through the collection of empirical data and the testing of the scale's psychometric properties. The pilot phase aimed to identify Saudi Executive Function Index for College Students (SEFI-C) items suitable for use in Saudi Arabia through item analysis and exploratory factor analysis, and to conduct reliability and validity tests. The final administration phase involved confirmatory factor analysis to confirm the factor structure and construct validity. The validation phase involved concurrently administering the scale with other instruments with established reliability and validity to verify its validity. The pilot phase involved a group study of 250 volunteer university students (120 female and 130 male). Comprehensive psychometric validation procedures were conducted. The results showed that both the SEFI-C and Saudi Executive Function Index for High School Students (SEFI-H) exhibited good internal consistency, test-retest reliability, and criterion-related validity. Model reliability and internal consistency were excellent for the general factor (ω = 0.87; a = 0.91) and specific factors (ω = 0.85-0.90; a ≥ 0.84-0.93). Confirmatory factor analysis revealed good model fit and construct validity for the three-factor structure, indicating that the SEFI-C and SEFI-H possess good psychometric properties. With further replication, the EFS has excellent potential for wide adoption across research and clinical contexts.
While the ability to understand others' mental states (Theory of Mind, ToM) is fundamental for social interactions, its relationship with executive functions (EF) in adults with attention-deficit/hyperactivity disorder (ADHD) remains under-explored. This study investigated ToM abilities and three core EFs (working memory, response inhibition, and planning) in adults with ADHD compared to a healthy control group. Thirty adults with ADHD were matched with thirty controls on age, gender, IQ, and education. ToM was assessed using the Strange Stories Test. EFs were evaluated using four subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB): Spatial Span (SSP) for short-term memory, Spatial Working Memory (SWM) for working memory, Stockings of Cambridge (SOC) for planning, and Stop Signal Task (SST) for response inhibition. Mann-Whitney U tests compared groups, and Spearman's rho examined ToM-EF relationships. Individuals with ADHD showed significantly poorer performance on the Strange Stories Test and all CANTAB subtests compared to controls. Within the ADHD group, most EF components showed no significant correlation with ToM scores. These findings confirm deficits in both ToM and EFs in adults with ADHD. The lack of strong correlations suggests that ToM difficulties may represent a distinct cognitive domain, independent of core EF impairments.
Cognitive impairment is common in older adults and significantly impacts quality of life. This study aimed to assess the psychometric properties of the Persian version of the Brief Assessment of Impaired Cognition (P-BASIC) in an Iranian older adult population. In this cross-sectional study, 120 participants, 80 cognitively healthy (CH) older adults and 40 individuals with cognitive impairment (CI), completed the P-BASIC following translation and cultural adaptation. Validity was evaluated through correlations with established cognitive measures, including the Quick Mild Cognitive Impairment screen-Persian version (QMCI-pr), Mini-Cog, and the Persian Narrative Discourse Test. Construct validity was examined using confirmatory factor analysis (CFA), and reliability was assessed via internal consistency (Cronbach's alpha) and test-retest reliability over a two-week interval. The mean age of the cognitively impaired group was 69.1 ± 6.0 years and 67.2 ± 5.8 years in the CH group. The P-BASIC showed strong correlations with the QMCI-pr (r = 0.86) and Mini-Cog (r = 0.75), supporting concurrent and convergent validity. CFA supported a four-factor structure, indicating adequate reliability and validity. Cronbach's alpha was 0.81, indicating acceptable internal consistency, and test-retest reliability was 0.72. The P-BASIC demonstrated excellent discriminative performance in differentiating CI from CH (area under the curve [AUC]: 95% CI: 0.93-0.99), with a sensitivity of 0.91 and a specificity of 0.90, at an optimal cutoff score of 19/20. The Persian version of the BASIC (P-BASIC) is a brief, valid, and reliable tool for cognitive screening in older adults. Its strong psychometric properties and ease of administration make it a suitable instrument for both clinical and research settings within Persian-speaking populations.
To analyze the role of cognitive reserve (CR) in successful aging among community-dwelling older adults. A random sample of n = 456 adults aged 60 years and older (mean age = 72.6, SD = 7.89; 59% women) was evaluated. CR was measured through indicators such as education, lifelong learning, bilingualism, participation, and the use of information and communication technologies (ICT). Successful aging was operationalized as the absence of major diseases and disabilities, good physical and cognitive functioning, and active engagement. Sociodemographic and health data were collected. Descriptive analyses, correlations, and multivariate analyses of variance were conducted to explore the effect of CR on successful aging and its criteria. Successful aging was observed in 12.1% of participants and was associated with differences in ICT use, social participation, bilingualism, and lifelong occupation. Cognitive reserve explained 20.1% of the variance, showing stronger effects on absence of major disease and life engagement, moderate effects on physical and cognitive functioning, and no significant association with independence in instrumental activities of daily living. Cognitive reserve was significantly associated with successful aging, representing a key target for cognitive interventions not only to prevent cognitive decline but also to promote successful and healthy aging among older adults.
Illiterate older adults are at heightened risk for mild cognitive impairment (MCI) and subsequent dementia, yet few cognitive rehabilitation interventions are tailored for this vulnerable group.We aimed to evaluate the feasibility and effectiveness of the Cognitive Intervention with-Movement-Rhythm-Game-Hobby (CIMORGH) cognitive rehabilitation package illiterate Iranian older adults with MCI. In a nonrandomized clinical trial, 30 illiterate older adults with MCI were assigned to an intervention group (n = 15; CIMORGH package, 24 sessions over 12 weeks) or a control group (n = 15; no intervention). Outcomes were assessed at baseline and one month post-intervention using the Mini-Mental State Examination (MMSE), LEIPAD Quality of Life Questionnaire, and Geriatric Depression Scale (GDS-15). Compared to controls, the intervention group showed significantly greater improvements in global cognition (MMSE change, Cohen's d = 2.43; 95% CI: 1.40 to 3.44), quality of life (LEIPAD change, Cohen's d = 1.09; 95% CI: 0.40 to 1.76), and depressive symptoms (GDS change, Cohen's d = 2.07; 95% CI: 1.13 to 2.98). The intervention was well-tolerated, with high adherence and no reported adverse events.The CIMORGH package is feasible and highly effective in improving cognition, quality of life, and mood among illiterate older adults with MCI, with large between-group effect sizes.
The aim study was to investigate working memory as a mediator on the relationship between emotional dysregulation and social functioning in Saudi Arabian adults with attention deficit/hyperactivity disorder. The present study has a non-experimental, cross-sectional correlational-causal research design, carried out using convenience sampling. The study included 88 adult ADHD patients who did not have any psychiatric illness as specified in the exclusion criteria. They aged 20 to 50 years. The bootstrap method of the PROCESS model 4 macro program in SPSS, was used to examine the mediating role of WM between emotional dysregulation and social functioning. A mediating effect test was run with 5000 resamples and a 95% confident interval. If the 95% confident interval for the mediating effect did not contain 0, the effect was considered significant. The results indicate that working memory mediated the relationship between emotion dysregulation and social functioning: the development of working memory was related to improved social functioning.
This study aimed to evaluate the predictive power of working memory and processing speed on general fluid intelligence (Gf) in adults with high functioning autism. One-hundred-seven participants were included in the study. They were adults diagnosed with autism spectrum disorder (ASD) according to Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria. Pearson correlation and moderated hierarchical multiple regression analyses were conducted. The scanning electron microscope (SEM) was evaluated. The two independent variables (working memory capacity, processing speed) when put together yielded a coefficient of multiple regression (R) of 0.667 and a multiple correlation square of 0.641. This shows that 64.1% of the total variance in general Gf of those who participated in the study is accounted for by the combination of working memory capacity and processing speed.
This study examined the psychometric properties of the 35-item Keshev-A, one of the first adult ADHD screening questionnaires to include indirect questioning and retrospective school-age indicators. A sample of 1,668 volunteers completed the new scale and the ASRS-v1.1. The internal consistency of the Keshev-A's composite score was excellent (α = 0.94), as was that of each of the eight content-based subscales (α = .70 to .85). An exploratory factor analysis (EFA; n = 904) using principal axis factoring identified three latent factors (1) Executive Functioning/Inattention, (2) Preadolescent Hyperactivity and Attentional Difficulties, and (3) Low Self-Concept. A confirmatory factor analysis (CFA; n = 844) showed acceptable fit (CFI = .94, TLI = .93, SRMR = .044, RMSEA = .069, 90% CI [.066, .071]). The convergent validity of this new scale was supported by its strong positive correlation with the ASRS-v1.1, r(1,668) = .885, p < .001. Additionally, receiver operating characteristic (ROC) analyses showed that the Keshev-A had higher screening accuracy (AUC = .881) than the ASRS-v1.1's total score (AUC = .851) (ΔAUC = .030, z = 2.94, p = .003). This difference was primarily driven by improved negative predictive value (NPV = 63.82% vs. 54.20%) and a lower negative likelihood ratio (LR- = 0.24 vs. 0.35), indicating better identification of individuals without a self-reported ADHD diagnosis. In sum, these results show that the Keshev-A may serve as an effective instrument for screening probable ADHD. Implications for scale use, future integration within multiscale mental health instruments, and the development of symptom exaggeration subscales are discussed.
This study provided a theoretical basis for improving the executive functions of adults with mild intellectual disabilities with theory of mind training. It was a multicenter, double-blind, sham-controlled, randomized trial. The study sample comprised 48 adults (26 men and 22 women) with an average age of 40.43 (40.43 ± 3.32) years with intellectual disability who were attending supported employment or day centers of a disability service organization. The Barkley Deficits in Executive Functioning Scale (BDEFS) was used to collect data. The data was investigated using visual and analytical methods to determine the normal distribution. Quantitative data are described as mean ± standard deviation (X ± SD). The changes after the interventions were analyzed by Wilcoxon sign ranked test, and the differences between the intervention and control group were analyzed by the Mann-Whitney U-test. The results indicate that theory of mind training was effective on self-management, time, self-organization/problem solving, self-restraint, self-motivation, and self-regulation of emotion of the adults with mild intellectual disabilities.
This research aimed to investigate the relationship between executive functions and life satisfaction in people with intellectual disabilities. The population for this research was selected through non-probability convenience sampling and consisted of 110 participants with intellectual disabilities; 43 women and 67 men, ranging in age from 20 to 64 years. This research employed a quantitative approach, allowing for the collection and analysis of numerical data to obtain objective results. Descriptive statistics were used to present the prevalence of EF deficits in the sample. Pearson correlation analyses were used to examine the relationships between variables. The Structural Model was used to examine the direct effect of executive functions on life satisfaction among adults with intellectual disabilities. There were significant negative relationship between executive dysfunction and life satisfaction. In sum, the present study broadens the understanding of adults with intellectual disabilities within a Saudi context by demonstrating that difficulties in EFs contribute to their reduced life satisfaction. In sum, the present study broadens the understanding of adults with intellectual disabilities within a Saudi context by demonstrating that difficulties in EFs contribute to their reduced life satisfaction.
The aim of this study was to investigate the mediating role of quality of life on the relationships between executive functions and cognitive emotion regulation of adults with deaf and hard-of-hearing. A total of 110 participants took part in the study. All participants across groups were between the ages of 20.4 and 45.3 years. Structural equation modeling was used to test the hypothesis that quality of Life would mediate the relationship between executive functions and cognitive emotion regulation. The findings revealed that cognitive emotion regulation had a significant positive role in executive functions (β = 0.354; p < .01), cognitive emotion regulation had a significant positive role in quality of life (β = 0.344; p < .01), quality of life had a significant positive role in quality of life (β = 0.321; p < .01), and quality of life had a mediating role in the relationship between executive functions and cognitive emotion regulation (β = -0.378; p < .01).
This study aimed to explore the impairment patterns of verbal and spatial working memory in Arabic aphasia adults after stroke. A total of 50 patients with Saudi aphasia admitted to the University Hospital between September 2023 and November 2025 were included in this study. The patient group consisted of 13 females (26.0%) and 37 males (74.0%), with a mean age of 50.3 years, mean years of education of 13.43 years, mean disease duration of 20.30 months, and mean lesion volume of 41.30 mL. The control group consisted of 10 females (20%) and 40 males (80%), with a mean age of 50.88 years and a mean years of education of 12.60 years. The Moroccan Arabic Bedside Western Aphasia Battery-Revised was used to test the subjects' spontaneous speech, listening comprehension, repetition and naming. functions. It was found that both verbal and spatial working memory were significantly impaired in patients with Arabic aphasia after stroke, with verbal working memory impairment being more pronounced than spatial working memory impairment. After excluding demographic, lesion, and cognitive factors, a positive correlation was found between verbal or spatial working memory and the degree of language impairment in patients with Arabic aphasia after stroke. This study suggests that working memory training will be of great significance in improving language function in aphasia patients.
Aging is associated with cognitive decline and memory impairment, but the underlying neural mechanisms remain unclear. Phase-amplitude coupling (PAC) between mid-frontal theta and occipital gamma is a proposed marker for the parallel storage of multiple items in working memory. However, prior research has mainly focused on young adults, with only a few studies in aging populations. Moreover, these studies typically used univariate PAC methods, which are susceptible to spurious estimates due to EEG nonstationarities and often assess PAC at individual electrodes, potentially overlooking the broader functional significance of PAC in coordinating neural activity across distant brain regions. To address these limitations, we applied multivariate PAC (mPAC) using generalized eigendecomposition (GED), which avoids confounds from non-sinusoidal waveforms and captures coupling across distributed brain regions. EEG was recorded from 113 younger and 117 older healthy adults during a sequence learning paradigm (6423 repetitions, 55,944 stimuli), where participants learned a fixed visual sequence over repeated observations, allowing us to track mPAC throughout incremental learning. Younger adults learned significantly faster than older adults. In both groups, mPAC increased with learning and distinguished fast from slow learners. However, older participants showed overall reduced mPAC, suggesting compromised parallel storage in working memory. Crucially, stratification analysis revealed that mPAC effects persisted across performance groups matched for mid-frontal theta power, indicating that theta amplitude alone does not explain the observed effects. These findings shed light on the age-related differences in memory formation processes and may guide interventions to enhance memory performance in older adults and slow learners.
Executive function assessment is central in clinical practice and research, and the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is widely used in adults. However, its nine-factor structure has rarely been evaluated with contemporary factor-analytic standards, prompting this study to examine its factorial validity and propose a psychometrically robust alternative. Adult participants completed the French version of the BRIEF-A, including a university student sample (N = 775) and a community adult sample (N = 1599). Factorial validity was examined using confirmatory and exploratory factor analyses, conducted on manifest items. A split-sample cross-validation procedure was applied to item-level analyses to identify a reduced item configuration reflecting the latent structure. None of the traditional BRIEF-A factor structures reported in the literature demonstrated acceptable model fit, whether analyses were based on individual items or parceled scores. In contrast, a six-factor, 24-item solution emerged, showing strong model fit, accounting for approximately 50% of the variance, and replicating across samples. The 24-item configuration provides a parsimonious representation of response patterns associated with adult executive functioning compared with the original 70-item organization. These findings concern the latent structure of BRIEF-A responses and do not constitute an alternative instrument. Future studies should examine the factorial structure of the BRIEF-A in clinical populations to further assess the robustness and generalizability of these findings.
Ischemic stroke disrupts structural connectivity between grey matter regions, influencing functional outcomes. Diffusion MRI-based tractography allows assessment of white matter damage and may guide rehabilitation. It remains unclear how structural connectivity disruption (SCD) estimated from individual tractography compares with model-based estimates using normative tractograms. Diffusion MRI data were analyzed from 23 individuals with subacute ischemic stroke and 60 healthy adults from two age-specific cohorts (Human Connectome Project/HCP, Alzheimer's Disease Neuroimaging Initiative/ADNI3). In Experiment 1, SCD estimates from individual tractography were compared to scores from the model-based Network Modification (NeMo) tool in the stroke cohort. In Experiment 2, synthetic middle cerebral artery lesions were applied to healthy adults' diffusion data to compare SCD estimates from tractography on synthetically lesioned versus complete data, to SCD estimates from the model-based NeMo tool. Rank-based linear mixed-effects models compared differences across approaches, cohorts, and 13 regions of interest (ROIs). In stroke, SCD scores from individual tractography and NeMo were strongly correlated (R2 ≥ 0.81), with largest differences in the inferior parietal gyrus (median [IQR]: -4.2% [-9.2-1.4]). In healthy controls, NeMo underestimated SCD relative to individual tractography, with larger median SCD differences across ROIs in older (11.8% [7.7-13.3]) than younger adults (-6.7% [-9.3--1.9]). Cohort and ROI explained 47-69% of variance in SCD difference across approaches. Both individual tractography and the model-based framework capture regional SCD patterns, with larger differences in older adults. The model-based framework is efficient for large-scale studies, while individual tractography may better capture patient- and age-specific SCD.
Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in young adults is complicated by reliance on self-report, psychiatric comorbidity, and vulnerability to exaggerated or noncredible responding in assessment-seeking populations. The Test of Attentional Distraction (TOAD) is a computerized attention task developed to function as a domain-specific performance validity indicator. Archival data from 95 postsecondary students referred for comprehensive ADHD evaluation were examined using a multimethod battery that included clinical interview, collateral information, self-report ADHD measures, embedded ADHD-specific symptom validity indices, traditional performance validity tests (PVTs), continuous performance test (CPT) indices, and the TOAD. Thirty-one participants (32.6%) were classified as significant or high risk for suspect effort on the TOAD. TOAD failure was associated with substantially elevated ADHD symptom endorsement across nearly all Conners' Adult ADHD Rating Scales (CAARS) subscales and with ADHD-specific symptom validity indices, including Dissimulation and Infrequency scales. Associations with most traditional memory-based PVTs were limited. In contrast, TOAD indices demonstrated strong convergence with CPT-derived exaggeration indices and effectively discriminated individuals with extreme CPT profiles previously linked to noncredible ADHD presentation. Findings support the TOAD as a clinically useful, domain-specific performance validity indicator that provides incremental information beyond traditional PVTs in adult ADHD assessment.
Research on psychosocial interventions for dementia demonstrates increased rigour and robustness. However, if we are to influence practice, beyond results from randomised controlled trials, a variety of types and sources of evidence is needed. The Medical Research Council (MRC) framework offers a valuable guide for developing, evaluating and implementing complex interventions, to facilitate integration of research into practice. There is limited knowledge of how researchers design, evaluate and implement psychosocial intervention studies in dementia, using the MRC framework. This scoping review aims to: (1) identify the methodological and methods trends, use and gaps in the development, evaluation and implementation of psychosocial interventions for dementia, and (2) determine if and how the MRC six core elements were considered and applied in studies. Six databases (Ovid MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library) will be searched for studies published from 2015 (when MRC process guidance was published) to 2025. Identified deduplicated citations will be imported into Covidence software, where up to 40% of title/abstracts will be double screened by independent reviewers. ASReview will be used to rank articles by relevance, with a stopping criterion of 250 consecutive irrelevant articles. Full texts will be reviewed by a single reviewer and those excluded will be checked by a second reviewer. Data extraction will include study aim/objective (ie, to develop/adapt; test feasibility/pilot; evaluate; implement); methodology and methods applied; information on which MRC six core elements were considered (yes/no), and if so, how they were addressed (ie, qualitative details). A narrative synthesis, alongside graphical representations (eg, table/bar charts/histograms), will be used to synthesise findings on methodologies and methods mapped onto the MRC framework. This secondary analysis scoping review does not require ethics approval. Results will be disseminated through peer-reviewed publication(s), seminars, webinars, conferences, postgraduate dementia programmes, blogs, commissioner briefings and social media. The findings will provide a state-of-the-art overview of current practices; advance methods/methodology such as informing a Delphi consensus study on appropriate research approaches; and guide researchers in application of the MRC framework to widen the scope of dementia care evidence for practice improvements. Submitted to Open Science Framework https://doi.org/10.17605/OSF.IO/S56NQ.
Transcutaneous auricular vagus nerve stimulation (taVNS) is a promising non-invasive neuromodulation technique with the potential to enhance memory. However, the optimal timing of stimulation across memory stages-encoding, consolidation, and retrieval-remains unclear. This study aimed to systematically investigate the effects of taVNS applied at three different stages of episodic memory processing. A total of 90 healthy young adults (mean age = 23.71 ± 2.90) participated in a randomized, single-blind, within-subject, crossover experiment involving both active taVNS and sham stimulation conditions. Participants were assigned to receive stimulation during one of three memory stages. They learned emotional (positive and negative) and neutral pictures. Memory performance was assessed 24 h later through a free recall task. Mixed-effects logistic regressions were used to analyze the effects of stimuli valence, stimulation conditions and timing on memory performance. taVNS significantly enhanced memory recall compared to sham stimulation (χ2 (1) = 22.1, p < 0.001), regardless of whether it was administered during encoding, consolidation, or retrieval (χ2 (2) = 0.98, p = 0.6). Emotional stimuli (positive and negative) were better recalled than neutral ones (χ2 (2) = 46.54, p < 0.001), but no interaction between valence and stimulation timing was observed. taVNS enhances episodic memory across all stages of memory processing, likely through arousal-related mechanisms. These findings support taVNS as a flexible cognitive enhancement tool that might be promising for different clinical populations.