Junghee Lee

Background and Purpose: Cognitive intra-individual variability (IIV) refers to the fluctuations observed in cognitive performance. The aim of this article was to characterize and describe for illustrative purposes an approach to administer executive functioning training to people living with HIV (PLWH) to reduce their cognitive IIV. This brief report highlights four cases in an on-going study investigating cognitive IIV in HIV. In HIV, cognitive IIV has been associated with cognitive decline, cortical atrophy, and mortality risk. The Executive Dysfunction Hypothesis suggests improving executive functioning could reduce cognitive IIV. Study Design: In the parent on-going pilot RCT (called the Executive Functioning Training (EFT) Study), 120 PLWH are randomized to either a no-contact control group or an executive functioning training group which receives 20 hours of computerized exercises. To characterize this study, this article describes an interim descriptive case analysis (N = 4) that was conducted with the first two participants who completed training (n = 2) and compared to demographically matched control (n = 2) participants. Results: Using the Connor’s Continuous Performance Test 3^rd Edition, results showed improvements in reaction time (Hit RT, by − 24.5 points) and cognitive IIV (HRT SD, Variability, by − 16 points) in the training group compared to the no-contact control group. In other words, the training appeared to reduce cognitive IIV. Conclusion: This finding suggests that by improving executive functioning through executive functioning training, this may stabilize cognitive functioning in general, as indicated by reduced cognitive IIV. Although preliminary, these encouraging results support the Executive Dysfunction Hypothesis and suggests further exploration of cognitive IIV may provide insights on how to improve cognition in aging PLWH. Implications for neuroscience nursing are provided. Plain Language Summary: People living with HIV (PLWH) may experience more cognitive fluctuation which interferes with performing instrumental activities of daily living (IADLs). When our cognitive abilities fluctuate a lot, a phenomenon called cognitive intra-individual variability, this can affect how well we perform everyday activities such as driving a car or paying attention to a TV program. In fact, cognitive fluctuation can impact whether an activity is performed correctly or completed at all. If we can reduce cognitive fluctuation, we might be able to improve everyday functioning. We tested whether PLWH receiving 20 hours of cognitive training, called executive functioning training, can reduce such cognitive fluctuation. We compared two participants who received the cognitive training to two participants who did not. Those who received the cognitive training had less cognitive fluctuation. Although more participants are needed to determine whether this cognitive training is helpful, these findings are encouraging. Perhaps this cognitive training can reduce cognitive fluctuation and improve everyday functioning such as remembering to take one’s medications or performing an activity.

Background and Purpose: Cognitive training programs have been attempted to improve cognition in cognitively vulnerable people living with HIV (PLWH). Some have attempted to improve episodic memory or speed of processing, while others have used an individualized cognitive domain approach targeting each person’s cognitive deficits. Although effective, none of these approaches considered the influence of cognitive intra-individual variability (IIV). Cognitive IIV refers to the fluctuations in one’s individual cognitive ability across cognitive domains (dispersion) or within the same test (inconsistency). Greater cognitive IIV predicts cognitive decline as well as decreased cognitive integrity and increased neuropathology. Some neuroscientists posited that poor executive functioning, known as the Executive Dyscontrol Hypothesis, increases cognitive IIV. Thus, if we can improve executive functioning, we may be able to decrease cognitive IIV and improve overall cognitive functioning. This article provides the rationale and protocol for a feasibility clinical trial examining an executive functioning training intervention in middle-aged and older PLWH. Study Design: This study utilizes a two-arm baseline/posttest experimental design to examine the primary aim 1 (feasibility and acceptability) and the exploratory aim 1 (cognition) in 120 community-dwelling PLWH aged 40 and older. Participants will be randomized into one of the two arms: 1) 20 hours of computerized executive functioning training group, or 2) a no-contact control group. The proposed training time is 10 to 12 weeks (1 to 2 one-hour training sessions/week while working around participants’ schedules). At baseline and posttest, participants will receive a 1.5 to 2-hour assessment that includes many measures including the Connor’s Continuous Performance Test (Version 3), and a 50-minute self-administered computerized cognitive performance battery (BRACE+ = BrainBaseline Assessment of Cognition and Everyday Functioning). Conclusion: This study tests an innovative intervention designed to reduce cognitive IIV; to our knowledge, no other study has targeted cognitive IIV as an intervention outcome. Plain Language Summary: Cognitive intra-individual variability (IIV) refers to the fluctuations in one’s individual cognitive ability across cognitive domains or within the same test. Greater cognitive IIV predicts cognitive decline as well as decreased cognitive integrity, increased neuropathology, and even greater mortality. We are using this concept to design cognitive interventions to help people with HIV to age successfully cognitively.

Social disconnection, including objective social isolation and subjective loneliness, is linked to substantial health risks. Yet, little is known about the predictors of social disconnection in individuals with mental illness. Here, we used machine learning to identify predictors of social isolation and loneliness in schizophrenia (N = 72), a psychiatric condition associated with social disconnection. For comparison, we also included two other groups: a psychiatric comparison sample of bipolar disorder (N = 48) and a community sample enriched for social isolation (N = 151). We fitted statistical models of social isolation and loneliness within and across groups. Each model included five candidate predictors: social avoidance motivation, depression, nonsocial cognition, social anhedonia, and social cognition. The results showed that social anhedonia explained unique variance in social isolation and loneliness in all samples, suggesting that it contributes to social isolation and loneliness broadly. However, nonsocial cognition explained unique variance in social isolation only within schizophrenia. Thus, social anhedonia could be a potential intervention target across populations, whereas nonsocial cognition may play a unique role in determining social disconnection in schizophrenia.

Are people who are better able to understand or feel the emotions of others also better at understanding or feeling emotions conveyed through music? Although evolutionary theories have proposed that both empathy and music help to foster social connection, few studies to date have examined the relation between behavioral assessments of empathic processes for people and music. We examined this question using 2 independent samples: a laboratory sample of undergraduates (n = 236) and a larger online direct replication with participants across the United States (n = 596). Across both samples, linear mixed effects models showed positive associations between empathic accuracy and affect sharing for people telling personal stories and for musical expression, and results were maintained when including relevant individual differences as covariates. These findings provide initial evidence of a relation between behaviorally assessed empathic processes across social and musical domains. Future research is needed to build upon this evidence by investigating whether active, socially engaged music listening may have a beneficial effect on social cognition. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Previous research has shown a weak association between self-reported empathy and performance on behavioral assessments of social cognition. However, previous studies have often overlooked important distinctions within these multifaceted constructs (e.g., differences among the subcomponents of self-reported empathy, distinctions in tasks assessing lower- vs. high-level social cognition, and potential covariates that represent competing predictors). Using data from three separate studies (total N = 2,376), we tested whether the tendency to take the perspective of others (i.e., perspective-taking), and the tendency to catch the emotions of others (i.e., emotional contagion for positive and negative emotions), were associated with performance on tasks assessing lower- to higher-level social-cognitive ability (i.e., emotion recognition, theory of mind, and empathic accuracy) and affect sharing. Results showed little evidence of an association between any of the self-reported empathy measures and either social-cognitive ability or affect sharing. Using several large samples, our findings add additional evidence to previous work showing that self-report measures of empathy are not valid proxies of behaviorally assessed social cognition. Moreover, we find that the ease with which individuals recognize and understand their own emotions (i.e., alexithymia) is more related to social-cognitive abilities and affect sharing, than their tendency to take the perspective of others, or to vicariously experience the emotions of others. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cognitive impairment is a core feature of schizophrenia. This selective review examines whether schizophrenia patients show preserved sexual dimorphism in cognition. Existing studies using performance tasks largely show comparable sex effects between schizophrenia patients and healthy populations. This pattern appears to be similar across multiple cognitive domains and across phase of illness. Our selective review also identifies several unresolved questions about sex differences in cognition in schizophrenia. A better understanding of sex differences in cognition in schizophrenia may provide important clues to probing the relationship between cognitive impairment and pathophysiological processes of the disorder. Keywords Nonsocial cognition Schizophrenia Sex differences Social cognition

Social cognitive impairment is a core feature of schizophrenia and plays a critical role in poor community functioning in the disorder. However, our understanding of the relationship between key biological variables and social cognitive impairment in schizophrenia is limited. This study examined the effect of sex on the levels of social cognitive impairment and the relationship between social cognitive impairment and social functioning in schizophrenia. Two hundred forty-eight patients with schizophrenia (61 female) and 87 healthy controls (31 female) completed five objective measures and one subjective measure of social cognition. The objective measures included the Facial Affect Identification, Emotion in Biological Motion, Self-Referential Memory, MSCEIT Branch 4, and Empathic Accuracy tasks. The subjective measure was the Interpersonal Reactivity Index (IRI), which includes four subscales. Patients completed measures of social and non-social functional capacity and community functioning. For objective social cognitive tasks, we found a significant sex difference only on one measure, the MSCEIT Branch 4, which in both patient and control groups, females performed better than males. Regarding the IRI, females endorsed higher empathy-related items on one subscale. The moderating role of sex was found only for the association between objective social cognition and non-social functional capacity. The relationship was stronger in male patients than female patients. In this study, we found minimal evidence of a sex effect on social cognition in schizophrenia across subjective and objective measures. Sex does not appear to moderate the association between social cognition and functioning in schizophrenia.

Event-related potential (ERP) studies of motivated attention in schizophrenia typically show intact sensitivity to affective vs. non-affective images depicting diverse types of content. However, it is not known whether this ERP pattern: 1) extends to images that solely depict social content, (2) applies across a broad sample with diverse psychotic disorders, and (3) relates to self-reported trait social anhedonia. We examined late positive potential (LPP) amplitudes to images involving people that were normatively pleasant (affiliative), unpleasant (threatening), or neutral in 97 stable outpatients with various psychotic disorders and 38 healthy controls. Both groups showed enhanced LPP to pleasant and unpleasant vs. neutral images to a similar degree, despite lower overall LPP in patients. Within the patients, there were no significant LPP differences among subgroups (schizophrenia vs. other psychotic disorders; affective vs. non-affective psychosis) for the valence effect (pleasant/unpleasant vs. neutral). Higher social anhedonia showed a small, significant relation to lower LPP to pleasant images across all groups. These findings suggest intact motivated attention to social images extends across psychotic disorder subgroups. Dimensional transdiagnostic analyses revealed a modest association between self-reported trait social anhedonia and an LPP index of neural sensitivity to pleasant affiliative images.