With an increasing focus on biomarkers in dementia research, illustrating the role of neuropsychological assessment in detecting mild cognitive impairment (MCI) and Alzheimer’s dementia (AD) is important. This systematic review and meta-analysis, conducted in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) standards, summarizes the sensitivity and specificity of memory measures in individuals with MCI and AD. Both meta-analytic and qualitative examination of AD versus healthy control (HC) studies (n = 47) revealed generally high sensitivity and specificity (≥ 80% for AD comparisons) for measures of immediate (sensitivity = 87%, specificity = 88%) and delayed memory (sensitivity = 89%, specificity = 89%), especially those involving word-list recall. Examination of MCI versus HC studies (n = 38) revealed generally lower diagnostic accuracy for both immediate (sensitivity = 72%, specificity = 81%) and delayed memory (sensitivity = 75%, specificity = 81%). Measures that differentiated AD from other conditions (n = 10 studies) yielded mixed results, with generally high sensitivity in the context of low or variable specificity. Results confirm that memory measures have high diagnostic accuracy for identification of AD, are promising but require further refinement for identification of MCI, and provide support for ongoing investigation of neuropsychological assessment as a cognitive biomarker of preclinical AD. Emphasizing diagnostic test accuracy statistics over null hypothesis testing in future studies will promote the ongoing use of neuropsychological tests as Alzheimer’s disease research and clinical criteria increasingly rely upon cerebrospinal fluid (CSF) and neuroimaging biomarkers.

Cardiovascular disease is associated with increased risk for cognitive decline and dementia, but it is unclear whether this risk varies across disease states or occurs in the absence of symptomatic stroke. To examine the evidence of increased risk for cognitive decline and dementia following non-stroke cardiovascular disease we conducted two independent meta-analyses in accordance with PRISMA guidelines. The first review examined cardiovascular diagnoses (atrial fibrillation, congestive heart failure, periphery artery disease and myocardial infarction) while the second review assessed the impact of atherosclerotic burden (as indicated by degree of stenosis, calcification score, plaque morphology or number of plaques). Studies eligible for review longitudinally assessed risk for clinically significant cognitive decline and/or dementia and excluded stroke and cognitive impairment at baseline. Summary statistics were computed via the inverse variance weighted method, utilising Cox Proportional Hazards data (Hazard Ratios, HR). Both atrial fibrillation (n = 5, HR = 1.26, 95% CI [1.12, 1.43]) and severe atherosclerosis (n = 4, HR = 1.59, 95% CI [1.12, 2.26]) emerged as significant risk factors for cognitive decline and/or dementia. A small set of studies reviewed, insufficient for meta-analysis, examining congestive heart failure, peripheral artery disease and myocardial infarction suggested that these conditions may also be associated with an increased risk of cognitive decline/dementia. In the absence of stroke, patients with atrial fibrillation or generalised atherosclerosis are at heightened risk for cognitive deterioration. Nonetheless, this paper highlights the need for methodologically rigorous and prospective investigation of the relationship between CVD and dementia.

Background and purpose Aging leads to alterations in cerebrovascular function, and these are thought to contribute to cognitive decline/dementia. Disturbances to cerebral blood flow regulation have been reported, but the findings are inconsistent and to date no study has comprehensively tested the collective and independent contribution of these parameters in the same age range. Such lines of enquiry are vital since aging is a heterogeneous and complex process, with cerebrovascular parameters being differentially affected depending on the individual. A multicomponent comprehensive measure of cerebrovascular function, which accounts for such diversity, is needed to differentiate between healthy young and old adults. Methods We tested the effect of aging on cerebrovascular function by comparing healthy young adults aged 18–30 and older adults aged 60–75, without cognitive impairments. Cerebrovascular blood flow velocity was assessed using transcranial Doppler ultrasound. Parameters included resting middle cerebral artery velocity (MCAv), neurovascular coupling, cerebrovascular reactivity to CO 2 (hypercapnia and hypocapnia), and the pressure-flow response during a sit-to-stand procedure. Results MANOVA revealed that collectively, the parameters discriminated the groups ( p < .001). MCAv and pressure-flow responses were lower in the older group ( p < .001). While there were no differences in hypercapnic responses ( p = .908) and neurovascular coupling ( p = .517), hypocapnic responses were elevated in the old ( p = .002). Conclusions Collectively, cerebrovascular parameters can distinguish between healthy young and older adults, with aging leading to reductions in MCAv, and altering cerebrovascular reactivity and pressure-flow responses under hypotensive conditions.

The current study sought to examine the discriminant validity of 3 commonly used measures of mindfulness. The discriminative ability of the Mindful Attention Awareness Scale (MAAS), the Five Factor Mindfulness Questionnaire (FFMQ), and a breath counting task (BCT) was assessed in a randomized control trial involving an 8-week mindfulness training (MT) condition (n ϭ 53) and an active control computerized attention training (CT) program (n ϭ 33). No evidence to support the discriminant validity of MAAS or FFMQ scores was found, as these self-report measures responded to both the MT and CT conditions. Breath counting scores however demonstrated unique responsiveness to the MT program, suggesting this behavioral task may be useful in measuring changes in mindfulness as it closely resembles core cognitive processes trained during this practice. Implications of these findings for the construct validity of both self-report and behavioral measures of mindfulness are discussed, along with the suitability of current mindfulness-based interventions in studies aiming to assess mindfulness outcomes. Public Significance StatementThe current study finds that behavioral breath counting tasks are more accurate measures of mindfulness than self-report questionnaires. Self-report measures are responsive to nonmindfulness factors, and thus are not suitable as accurate measures of mindfulness.

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Acute exercise generally benefits memory but little research has examined how exercise affects metacognition (knowledge of memory performance). We show that a single bout of exercise can influence metacognition in paired-associate learning. Participants completed 30-min of moderate-intensity exercise before or after studying a series of word pairs ( cloud - ivory ), and completed cued-recall ( cloud -?; Experiments 1 & 2) and recognition memory tests ( cloud -? spoon; ivory ; drill ; choir ; Experiment 2). Participants made judgments of learning prior to cued-recall tests (JOLs; predicted likelihood of recalling the second word of each pair when shown the first) and feeling-of-knowing judgments prior to recognition tests (FOK; predicted likelihood of recognizing the second word from four alternatives). Compared to no-exercise control conditions, exercise before encoding enhanced cued-recall in Experiment 1 but not Experiment 2 and did not affect recognition. Exercise after encoding did not influence memory. In conditions where exercise did not benefit memory, it increased JOLs and FOK judgments relative to accuracy (Experiments 1 & 2) and impaired the relative accuracy of JOLs (ability to distinguish remembered from non-remembered items; Experiment 2). Acute exercise seems to signal likely remembering; this has implications for understanding the effects of exercise on metacognition, and for incorporating exercise into study routines.

Purpose Our aim was to compare cerebrovascular and systemic vascular function between older adults with and without mild cognitive impairment (MCI), and to determine which measures of vascular function best predict the presence of MCI. Methods In 41 adults with MCI and 33 adults without MCI (control) we compared middle cerebral artery velocity (MCAv) and cerebrovascular pulsatility index (PI) at rest, cerebrovascular reactivity to CO2, and responsiveness to changes in blood pressure (%∆MCAv/%∆MAP). Systemic vascular function was assessed by flow-mediated dilation (FMD) and stiffness by pulse wave velocity (PWV). Results Cerebrovascular PI was higher in MCI compared with control (mean ± SD: 1.17 ± 0.27 vs. 1.04 ± 0.21), and MCI exhibited a lower %∆MCAv/%∆MAP (1.26 ± 0.44 vs. 1.50 ± 0.55%). Absolute (p = 0.76) and relative cerebrovascular reactivity to CO2 (p = 0.34) was similar between MCI and control. When age was included as a covariate the significant difference in cerebral PI between groups was lost. PWV was higher (13.2 ± 2.2 vs. 11.3 ± 2.5 m s−1) and FMD% (4.41 ± 1.70 vs. 5.43 ± 2.15%) was lower in MCI compared with control. FMD% was positively associated with PI across the cohort. Logistic regression analysis indicated that FMD and PWV significantly discriminated between MCI and controls, independent of age, whereas the inclusion of cerebrovascular measures did not improve the predictive accuracy of the model. Conclusion These findings raise the possibility that early changes in systemic vascular stiffness and endothelial function may contribute to altered cerebrovascular haemodynamics and impaired cognitive function, and present potential targets for prevention and treatment strategies in people with MCI.