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BACKGROUND: High levels of physical conditioning are associated with improvements in cognitive performance. In this sense, electroencephalographic (ECG) correlates are used to investigate the enhancing role of physical exercise on executive functions. Oscillations in the ß frequency range are proposed to be evident during sensorimotor activity. OBJECTIVE: To investigate the ECG changes influenced by aerobic and resistance exercises performed in an attention task by analyzing the differences in absolute ß power in the prefrontal and frontal regions before, during, and after the oddball paradigm in practitioners and nonpractitioners of physical exercise. METHODS: There were 15 physical activity practitioners (aged 27 ± 4.71) and 15 nonpractitioners (age 28 ± 1.50) recruited. A two-way analysis of variance (ANOVA) was implemented to observe the main effect and the interaction between groups and moments (rest 1, pre-stimulus, and rest 2). RESULTS: An interaction between group and moment factors was observed for Fp1 (p < 0.001); Fp2 (p = 0.001); F7 (p < 0.001); F8 (p < 0.001); F3 (p < 0.001); Fz (p < 0.001); and F4 (p < 0.001). Electrophysiological findings clarified exercisers' specificity and neural efficiency in each prefrontal and frontal subarea. CONCLUSION: Our findings lend support to the current understanding of the cognitive processes underlying physical exercise and provide new evidence on the relationship between exercise and cortical activity.

ANTECEDENTES: Níveis elevados de condicionamento físico estão associados a melhorias no desempenho cognitivo. Nesse sentido, correlatos eletroencefalográficos são utilizados na investigação do papel aprimorador do exercício físico sobre as funções executivas. Tem sido proposto que as oscilações na faixa de frequência ß são evidenciadas durante a atividade sensório-motora. OBJETIVO: Investigar as alterações eletroencefalográficas influenciadas por exercícios aeróbio e resistido realizados em uma tarefa atencional analisando as diferenças da potência absoluta de ß nas regiões pré-frontal e frontal antes, na preparação e depois do paradigma oddball em praticantes e não praticantes de exercício físico. MéTODOS: Foram recrutados 15 praticantes de atividade física (idade 27 ± 4.71) e 15 não praticantes (idade 28 ± 1.50). Uma análise de variância (ANOVA) de duas vias foi implementada para observação do efeito principal e a interação entre os grupos e os momentos (repouso 1, pré-estímulo e repouso 2). RESULTADOS: Uma interação entre os fatores grupo e momento para Fp1 (p < 0,001); Fp2 (p = 0,001); F7 (p < 0,001); F8 (p < 0,001); F3 (p < 0,001); Fz (p < 0,001); e F4 (p < 0,001) foi observada. Os achados eletrofisiológicos esclareceram a especificidade e a eficiência neural dos praticantes de exercício físico em cada subárea pré-frontal e frontal. CONCLUSãO: Nossos achados promovem o entendimento atual dos processos cognitivos subjacentes ao exercício físico e acrescentam novas evidências sobre a relação exercício e atividade cortical.

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This study examined the impact of sport-specific cognitive training (CT) on executive functions (EFs) in youth soccer players. Thirty-one athletes (13-15 years) participated, 13 in the intervention group (IG) and 18 in the control group (CG). The IG underwent an 8-week soccer-focused CT program, while the CG maintained regular training. The assessments included working memory, inhibition, and cognitive flexibility tasks. The results revealed no significant improvements in EFs in the IG compared to those in the CG. Both groups showed enhanced cognitive flexibility, possibly due to general cognitive development or learning effects. The study suggested that an 8-week sport-specific CT may not enhance EFs in young soccer players, potentially due to a ceiling effect in highly skilled athletes. These findings should be considered when designing cognitive training programs for athletes, and future research could explore the optimal duration of such programs.

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Cognitive flexibility, the ability to switch between mental processes to generate appropriate behavioral responses, is reduced with typical aging. Previous studies have found that age-related declines in cognitive flexibility are often accompanied by variations in the activation of multiple regions. However, no meta-analyses have examined the relationship between cognitive flexibility in aging and age-related variations in activation within large-scale networks. Here, we conducted a meta-analysis employing multilevel kernel density analysis to identify regions with different activity patterns between age groups, and determined how these regions fall into functional networks. We also employed lateralization analysis to explore the spatial distribution of regions exhibiting group differences in activation. The permutation tests based on Monte Carlo simulation were used to determine the significance of the activation and lateralization results. The results showed that cognitive flexibility in aging was associated with both decreased and increased activation in several functional networks. Compared to young adults, older adults exhibited increased activation in the default mode, dorsal attention, ventral attention, and somatomotor networks, while displayed decreased activation in the visual network. Moreover, we found a global-level left lateralization for regions with decreased activation, but no lateralization for regions with higher activation in older adults. At the network level, the regions with decreased activation were left-lateralized, while the regions with increased activation showed varying lateralization patterns within different networks. To sum up, we found that networks that support various mental functions contribute to age-related variations in cognitive flexibility. Additionally, the aging brain exhibited network-dependent activation and lateralization patterns in response to tasks involving cognitive flexibility. We highlighted that the comprehensive meta-analysis in this study offered new insights into understanding cognitive flexibility in aging from a network perspective.

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We outline two accounts by which executive function (EF) supports children's moral reasoning: an emergence and an expression account. The emergence account postulates that EF supports the development of moral concepts because it relates to how children navigate their early social environments and how well they can internalize moral messages. The expression account postulates that EF supports children's in-the-moment moral reasoning for complex moral situations. We present data from two studies with preschool children to assess each account. In support of the emergence account, EF longitudinally and positively predicted moral reasoning, but only for children who have experienced moderate forms of peer conflict. In support of the expression account, EF was only correlated with judgments that required the coordination of multiple pieces of information (i.e., retaliation and criterion judgments). We conclude that EF is an important cognitive mechanism of moral development and discuss various implications of these findings for both moral development and EF theory.

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BACKGROUND: Executive functions (EFs) are thought to work in concert to support academic skill. However, EFs are often examined independently, obscuring their symbiotic contribution. We examined the relationship between students' holistic EF profiles and their academic success. METHODS: We sampled over 1200 7-15 year old students from a diverse school district (16 % White; 32 % low income) in the United States. We used 9 EF assessments to construct cognitive profiles via self-organizing maps. We then related profiles to academic achievement scores from both laboratory-based assessments and state-administered standardized tests of reading and math. RESULTS: Six profiles differed in EF performance, but their differences in academic achievement did not suggest a linear relationship between individual EFs and academic skill. CONCLUSIONS: We show cognitive profiles based on individual strengths and weaknesses in EFs can reveal multiple cognitive paths to the same academic outcome.

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INTRODUCTION: This study focuses on 'learning prerequisites', cognitive and non-cognitive skills crucial for school success, often measured in preschoolers. Executive Functions (EF), like inhibition and cognitive flexibility, are vital among these prerequisites. While EF's role in early literacy and numeracy is acknowledged, some components are often overlooked. OBJECTIVE: The study aims to longitudinally explore the link between EF, assessed at the beginning of the preschool year and the learning prerequites, measured at the end of the same preschool year. METHOD AND RESULTS: Evaluating 70 preschoolers (62.30 months, SD 4.55), results showed that certain EF measures predicted performance in literacy and numeracy tasks. Specifically, response inhibition predicted rhyme and syllable recognition, series completion, and cognitive flexibility predicted rhyme recognition. Moreover, EF, particularly response inhibition, correlated with overall metaphonology and pre-math abilities. CONCLUSION: The findings suggest the importance of integrating EF enhancement in early educational interventions, aiding in selecting and optimizing EF skills crucial for later academic success.

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Alterations in the reward and cognitive control systems are commonly observed among adolescents with internet dependence (ID), and this impairment is often accompanied by social dysfunctions, such as academic burnout. However, the intercorrelations among ID, reward, cognitive control processing, and learning burnout remain unclear. We recruited 1074 Chinese adolescents to investigate the complex interrelationships among these variables using network analysis. The resulting network revealed patterns that connected ID to the behavioral inhibition/activation system (BIS/BAS), self-control, and learning burnout; these results exhibited reasonable stability and test-retest consistency. Throughout the network, the node of BAS-drive was the critical influencing factor, and the node of self-control was the protection factor. In addition, several symptoms of learning burnout and ID were positively associated with sensitivity to punishment. As revealed by the network comparison test, the network constructed among internet dependent (ID) group differed from the network constructed among internet nondependent (IND) group not only in the edges between BIS and learning burnout but also in terms of the edges associated with learning burnout. In conclusion, this study provides insights into the complex mechanisms underlying ID among adolescents from the perspective of the network relationships between core influencing factors and negative consequences. It validates the dual-system model of risky behavior among adolescents and offers a foundation for early warning and interventions for ID in this context.

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This study explored the interplay of executive functions (EFs), social interactions, and theory of mind (ToM) in middle childhood. The first aim was to examine how specific EFs-shifting, inhibition, and working memory (WM)-predict social-perceptual and social-cognitive ToM. The second aim was to explore the potential mediating role of social interactions in the EF-ToM relationship. A total of 98 children aged 8 to 11 years completed three computerized EF tasks (task switching, flanker, and running span) and two ToM tasks (Strange Stories and Reading the Mind in the Eyes). The quality and quantity of social interactions were self-reported by using questionnaires. First, multiple regression analyses with age-adjusted scores examined how specific EFs predict ToM scores. The regression model was significant for social-cognitive ToM, but not for social-perceptual ToM. WM accuracy was the only significant, positive predictor for performance on the Strange Stories task. Second, mediation analyses assessed whether social interactions mediate this EF-ToM relationship. There were no significant mediation effects of the quality and quantity of social interactions on the relationship between WM and social-cognitive ToM. In conclusion, EFs play a significant role in explaining social-cognitive ToM variability in middle childhood. WM is relevant for understanding others' mental states, in contrast to shifting and inhibition that lacked predictive value. The results also suggest different cognitive processes associated with social-perceptual versus social-cognitive ToM in this developmental stage.

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Watching fantastical content has been shown to negatively affect young children's executive function (EF) skills. No study has investigated how long these negative effects persist and whether they extend to other cognitive skills. The current experimental study aimed to (1) detect how long fantastical content affects children's EF performance and (2) examine whether watching fantastical content negatively affects children's other (non-EF) cognitive task performance, namely mental transformation. A total of 120 5- and 6-year-old children (M = 66 months, SD = 5.52) were randomly assigned to one of the four following conditions: (a) immediate testing after watching an 8-min non-fantastical cartoon, (b) immediate testing after watching an 8-min fantastical cartoon, (c) 10-min delayed testing after watching a fantastical cartoon, and (d) immediate testing after an 8-min free play (control condition). After exposure to each condition, children were tested on EF and mental transformation measures. Results showed that children watching a fantastical cartoon performed worse on working memory and inhibitory control tasks than children watching a non-fantastical cartoon or playing. However, the 10-min delay between the watching and testing sessions eliminated the negative impact observed on inhibitory control. Groups did not differ on cognitive flexibility and mental transformation. As in previous studies, watching fantastical content negatively affected children's EFs, but this negative impact disappeared in a few minutes and seems unique to EFs. These results suggest that fantastical content may temporarily affect attentional and information processing systems related to EFs.

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Visual working memory depends on both material-specific brain areas in the ventral visual stream (VVS) that support the maintenance of stimulus representations and on regions in the prefrontal cortex (PFC) that control these representations. How executive control prioritizes working memory contents and whether this affects their representational formats remains an open question, however. Here, we analyzed intracranial EEG (iEEG) recordings in epilepsy patients with electrodes in VVS and PFC who performed a multi-item working memory task involving a retro-cue. We employed Representational Similarity Analysis (RSA) with various Deep Neural Network (DNN) architectures to investigate the representational format of prioritized VWM content. While recurrent DNN representations matched PFC representations in the beta band (15-29 Hz) following the retro-cue, they corresponded to VVS representations in a lower frequency range (3-14 Hz) towards the end of the maintenance period. Our findings highlight the distinct coding schemes and representational formats of prioritized content in VVS and PFC.

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Network neuroscience explores the brain's connectome, demonstrating that dynamic neural networks support cognitive functions. This study investigates how distinct cognitive abilities-working memory and cognitive inhibitory control-are supported by unique brain network configurations constructed by estimating whole-brain networks using mutual information. The study involved 195 participants who completed the Sternberg Item Recognition task and Flanker tasks while undergoing electroencephalography recording. A mixed-effects linear model analyzed the influence of network metrics on cognitive performance, considering individual differences and task-specific dynamics. The findings indicate that working memory and cognitive inhibitory control are associated with different network attributes, with working memory relying on distributed networks and cognitive inhibitory control on more segregated ones. Our analysis suggests that both strong and weak connections contribute to cognitive processes, with weak connections potentially leading to a more stable and support networks of memory and cognitive inhibitory control. The findings indirectly support the network neuroscience theory of intelligence, suggesting different functional topology of networks inherent to various cognitive functions. Nevertheless, we propose that understanding individual variations in cognitive abilities requires recognizing both shared and unique processes within the brain's network dynamics.

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Virtual reality (VR) applications in paediatric rehabilitation are recent but promising. This brief report describes a VR rehabilitation program for a small sample of children with Developmental Coordination Disorder (DCD). The program focused explicitly on executive functions, a key area of concern for this population. It was conducted over 11 weeks in the CARE Lab. This lab was designed with appropriate structural characteristics and sophisticated technology to provide a rehabilitative setting with recreational and semi-immersive features. Before and after the VR training, the children were evaluated in terms of visual attention, inhibition, planning abilities, and visual-motor coordination. The rehabilitation programs were customised according to the clinical needs and the functional profile of each patient, proposing different games with variable complexity levels. These preliminary results showed a global and clinically significant change in executive functions, especially visual attention and inhibition skills. These findings suggest interesting implications for clinical practice, providing new information for professionals regarding the application of VR in the field of paediatric rehabilitation.

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BACKGROUND: Awake craniotomy (AC) allows intraoperative brain mapping (ioBM) for maximum lesion resection while monitoring and preserving neurological function. Conventionally, language, visuospatial assessment, and motor functions are mapped, while assessment of executive functions (EFs) is uncommon. Impaired EF may lead to occupational, personal, and social limitations, thus, a compromised quality of life. METHODS: A comprehensive literature search was conducted through Scopus, Medline, and Cochrane Library using a pre-defined search strategy. Articles were selected after duplicates removal, initial screening, and full-text assessment. The demographic details, ioBM techniques, intraoperative tasks, and their assessments, the extent of resection (EOR), post-op EF and neurocognitive status, and feasibility and potential adverse effects of the procedure were reviewed. The correlations of tumor locations with intraoperative EF deficits were also assessed. RESULTS: A total of 13 studies with intraoperative EF assessment of 351 patients were reviewed. Awake-asleep-awake protocol was most commonly used. Most studies performed ioBM using bipolar stimulation, with a frequency of 60 Hz, pulse durations ranging 1-2 ms, and intensity ranging 2-6 mA. Cognitive function was monitored with the Stroop task, spatial-2 back test, line-bisection test, trail-making-task, and digit-span tests. All studies reported similar or better EOR in patients with ioBM for EF. When comparing the neuropsychological outcomes of patients with ioBM of EF to those without it, all studies reported significantly better EF preservation in ioBM groups. Most authors reported EF mapping as a feasible tool to obtain satisfactory outcomes. Adverse effects included intraoperative seizures which were easily controlled. CONCLUSIONS: AC with ioBM of EF is a safe, effective, and feasible technique that allows satisfactory EOR and improved neurocognitive outcomes with minimal adverse effects.

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While previous research has identified executive functions as predictors of academic performance in school children, similar studies conducted among adults show mixed results. One of the reasons given for executive functions having a limited effect on academic achievements in adulthood is that they are usually fully developed by that time. Since these executive functions are at their peak at that age, the individual differences in these as well as their influence on academic performance in adults are harder to trace. The paper describes a study conducted among 107 university students the goal of which was to find out whether there is any relationship between the adult students' inhibitory control values measured with the Stroop Test and their academic achievements. Although the results indicate a weak correlation between the Stroop Effect and the students' academic performance of low statistical significance, which seems to confirm the outcomes of the previous studies focusing on adults, the study reveals an unexpected statistically significant correlation between the students' grade averages and the number of their incorrect color identifications. This phenomenon appears to be worth pursuing in future research since it suggests the existence of another, relatively quickly measurable, variable possibly reflecting other predictors of academic performance in adults such as a degree of their manifested conscientiousness, their ability to concentrate on an assigned, relatively short, one-off task and their attitude to fulfilling this task. The Stroop Test, despite not being originally designed for this purpose, might thus be used as a simple tool suitable for providing information about these variables via the subject's number of color identification errors. Such information can subsequently inform the activities that educators may include in their curricula to foster conscientiousness and concentration in the students lacking these.

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BACKGROUND AND OBJECTIVES: Neuroimaging studies have so far identified structural changes in individuals with juvenile myoclonic epilepsy (JME) when compared with controls. However, the underlying mechanisms of drug-resistant JME remain unknown. In this study, we aimed at characterizing the structural underpinnings of drug-resistant JME using MRI-derived cortical morphologic markers. METHODS: In this prospective cross-sectional 2-center study, T1-weighted MRI and neuropsychological measures of verbal memory and executive function were obtained in individuals with drug-resistant and drug-responsive JME recruited from epilepsy outpatient clinics and healthy controls. We performed vertexwise measurements of cortical thickness, surface area, and local gyrification index (LGI). Vertexwise group comparisons were corrected for multiple comparisons at a familywise error (FWE) of 0.05. The neuropsychological profile of disease subgroups was analyzed through principal component analysis. RESULTS: We studied 42 individuals with drug-resistant JME (mean age 29 ± 11 years, 50% female), 37 with drug-responsive JME (mean age 34 ± 10, years, 59% female), and 71 healthy controls (mean age 21 ± 9 years, 61% female). Surface area was increased in participants with drug-resistant JME in the left temporal lobe (Cohen d = 0.82 [-0.52 to -1.12], pFWE < 0.05) when compared with the drug-responsive group. Although no cortical thickness changes were observed between disease subgroups, drug-resistant and drug-sensitive participants showed discrete cortical thinning against controls (Cohen d = -0.42 [-0.83 to -0.01], pFWE < 0.05; Cohen d = -0.57 [-1.03 to -0.11], pFWE < 0.05, respectively). LGI was increased in the left temporal and occipital lobes in drug-resistant participants (Cohen d = 0.60 [0.34-0.86], pFWE < 0.05) when contrasting against drug-sensitive participants, but not controls. The composite executive function score was reduced in drug-resistant individuals compared with controls and drug-sensitive individuals (-1.74 [-2.58 to -0.90], p < 0.001 and -1.29 [-2.25 to -0.33], p < 0.01, respectively). Significant correlations were observed between executive function impairment and increased surface area in the precuneus and medial prefrontal regions (r = -0.79, pFWE < 0.05) in participants with drug-resistant JME. DISCUSSION: We identified a developmental phenotype in individuals with drug-resistant JME characterized by changes in cortical surface area and folding complexity, the extent of which correlates with executive dysfunction. No association was observed between cortical thickness and disease severity. Our findings support a neurodevelopmental basis for drug resistance and cognitive impairment in JME.

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In recent years, aging has become a focal point of scientific research and health policies due to the growing demographic trend of an aging worldwide population. Understanding the protective and risk factors that influence aging trajectories is crucial for designing targeted interventions that support healthy aging and improve people's quality of life. The aim of this study was to explore the relationships between variables of aging. A total of 103 Italian participants (55-75 years old) underwent multidimensional assessments that covered cognitive, functional, emotional, and quality of life dimensions. Structural equation modeling was used to analyze the data and elucidate the relationships between depression, quality of life, cognitive reserve, executive functions, and daily autonomy. The findings revealed that a higher quality of life was associated with reduced depressive symptoms. In addition, cognitive reserve emerged as a protective factor positively correlated with both quality of life and daily autonomy. In this study, quality of life was determined using physical health, psychological, social relationships, and environmental domains. Identifying the significant relationships between these variables in a sample of late adults and young-aged people has given us useful elements for designing psycho-educational interventions that can be aimed at preventing frailty in later old age or supporting healthy longevity.

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OBJECTIVES: To evaluate the developmental trajectory of key cognitive, social, and emotional features in girls with fragile X syndrome (FXS). METHODS: This longitudinal, parallel cohort study collected data between January 2018 and December 2022. Participants were evaluated 3 times with ∼12-18 months between visits. Participants included 65 girls with FXS, 6 to 16 years, and 52 age- and developmentally-matched girls without FXS. Participants' scores from direct assessment and caregiver report evaluated 3 cognitive domains (verbal abilities, nonverbal abilities, executive function) and 4 social-emotional domains (depression, general anxiety, social behavior, and social anxiety). RESULTS: Participants included 117 girls (mean [M] [SD] age at study entry: FXS M = 10.59 [3.00]; comparison M = 10.45 [2.40])). Omnibus tests showed 4 domains with significant group differences: Verbal (P < .0001, eg, Differential Abilities Scale-II(DAS-II), Picture Vocabulary (-6.25 [1.87])), nonverbal (P < .0001, eg, Kaufman Test of Educational Achievement, Third Edition, Brief Form, Math (-8.56 [2.90])), executive function (P < .0001, eg, NIH Toolbox List Sorting (-6.26 [1.48])), and social anxiety (P < .03, eg, Anxiety, Depression, and Mood Scale (ADAMS) Social Avoidance (1.50 [0.65])). Three domains had significant group by age interaction: Verbal (P < .04, eg, DAS-II, Word Definitions (-1.33 [0.55])), social behavior (P < .01, eg, Social Responsiveness Scale-2 Social Communication (1.57 [0.51])), and social anxiety (P < .01, eg, ADAMS Social Avoidance (0.46 [0.19])). CONCLUSIONS: These findings support the development of early, disorder specific interventions for girls with FXS targeting verbal and nonverbal skills, executive function, social behavior, and social anxiety.

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OBJECTIVE: Attention Deficit Hyperactivity Disorder (ADHD) is defined as a persistent pattern of inattention and hyperactivity-impulsivity that interferes with functioning anofd development. Increased emotional reactivity and impaired emotion regulation are established findings in children with ADHD. Impairments in executive functions such as impulse control and working memory, in turn, have also been suggested to have a negative effect on emotion recognition. However, studies exploring suspected deficits in the ability to recognise facial emotions in ADHD have to date yielded controversial results. We sought to clarify the mechanism of possible emotion recognition dysfunction in children with ADHD. METHODS: Sixty-one children diagnosed with ADHD (aged 10.36 ± 1.89 years) and a control group (N = 78; aged 9.6 ± 1.8 years) were evaluated with questionnaires and computerized tests for cognitive and facial emotion recognition capacity. RESULTS: The ADHD group displayed more behavioural issues and performed worse in cognitive tests compared to the control group. Group status (i.e. ADHD vs. control group) did not predict facial emotion recognition when controlled for age, IQ and sex in linear regression models. Performance in Divided Attention predicted facial emotion recognition in linear regression in the ADHD group. CONCLUSIONS: Individuals with ADHD showed facial emotion recognition capacity similar to a typically developing control group. Good performance in a cognitive test assessing divided attention predicted capacity for facial emotion recognition, but only in the ADHD group.

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Increased metalinguistic awareness (MLA) has been associated with improved performance in tasks of theory of mind; researchers have proposed that individuals with increased MLA, such as bilinguals, rely on metalinguistic skills when completing tasks that require taking other people's perspective into account compared to other individuals who mostly rely on general executive control to complete the same tasks. MLA would, therefore, act as a less effortful path to understanding other perspectives, especially when they differ from one's own. However, the evidence underlying this claim is scant and largely limited to children's theoretical frameworks. In this study, we investigated whether individual differences in MLA predict perspective-taking Theory of Mind above and beyond inhibitory control in a sample of diverse adults across a wide range of linguistic, socioeconomic, and cognitive factors. Bootstrapped mediation analyses revealed that inhibitory control partially, but not fully, mediated the relationship between MLA and perspective-taking. In addition, when differences in language, education and culture were controlled for, the effects of both MLA and inhibitory control were reduced. Overall, the findings emphasize the need to consider multivariate approaches towards understanding the mechanisms underlying theory of mind.

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INTRODUCTION: The apnea-hypopnea index (AHI) is the current diagnostic parameter for diagnosing and estimating the severity of obstructive sleep apnea (OSA). It is, however, poorly associated with the main clinical symptom of OSA, excessive daytime sleepiness, and with the often-seen cognitive decline among OSA patients. To better evaluate OSA severity, novel hypoxic load parameters have been introduced that consider the duration and depth of oxygen saturation drops associated with apneas or hypopneas. The aim of this paper was to compare novel hypoxic load parameters and traditional OSA parameters to verbal memory and executive function in OSA patients. METHOD: A total of 207 adults completed a one-night polysomnography at sleep laboratory and two neuropsychological assessments, the Rey Auditory Verbal Learning Test and Stroop test. RESULTS: Simple linear regression analyses were used to evaluate independent associations between each OSA parameter and cognitive performance. Associations were found between immediate recall and arousal index, hypoxia <90 %, average SpO2 during sleep, and DesSev100+RevSev100. Total recall was associated with all OSA parameters, and no associations were found with the Stroop test. Subsequently, sex, age, and education were included as covariates in multiple linear regression analyses for each OSA parameter and cognitive performance. The main findings of the study were that average SpO2 during sleep was a significant predictor of total recall (p < .007, ß = -.188) with the regression model explaining 21.2 % of performance variation. Average SpO2 during sleep was also a significant predictor of immediate recall (p < .022, ß = -.171) with the regression model explaining 11.4 % of performance variation. Neither traditional OSA parameters nor novel hypoxic load parameters predicted cognitive performance after adjustment for sex, age, and education. CONCLUSION: The findings validate that the AHI is not an effective indicator of cognitive performance in OSA and suggest that average oxygen saturation during sleep may be the strongest PSG predictor of cognitive decline seen in OSA. The results also underline the importance of considering age when choosing neurocognitive tests, the importance of including more than one test for each cognitive domain as most tests are not pure measures of a single cognitive factor, and the importance of including tests that cover all cognitive domains as OSA is likely to have diffuse cognitive effects.

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