3 CE Credits. Four Critical Reviews (JINS 23:3, 2017)

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Educational Objectives
  1. Describe the concept of cognitive reserve in relation to post-stroke cognitive impairments
  2. Describe the effects of carrying an APOE e4 allele in mid-adulthood
  3. Describe the difference between content-specific and content-free cues used within rehabilitation approaches that support prospective memory
  4. Discuss social cognitive deficits associated with multiple sclerosis and the brain structures involved

Course Information
Target Audience:Intermediate
Availability:Date Available: 2017-03-16
You may obtain CE for this JINS package at any time.
Offered for CEYes
CostMembers $30
Non-Members $45
Refund PolicyThis JINS package is not eligible for refunds
CE Credits3.0

Individual Titles, Authors, and Articles:

Effect of Formal Education on Vascular Cognitive Impairment after Stroke: A Meta-analysis and Study in Young-Stroke Patients
  • Roy P.C. Kessels | Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
  • Willem Sake Eikelboom | Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
  • Pauline Schaapsmeerders | Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
  • Noortje A.M. Maaijwee | Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
  • Renate M. Arntz | Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
  • Ewoud J. van Dijk | Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
  • Frank-Erik de Leeuw | Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands

E-mail address | r.kessels@donders.ru.nl

None of the authors have any conflicts of interest to report.


The extent of vascular cognitive impairment (VCI) after stroke varies greatly across individuals, even when the same amount of brain damage is present. Education level is a potentially protective factor explaining these differences, but results on its effects on VCI are inconclusive.


First, we performed a meta-analysis on formal education and VCI, identifying 21 studies (N=7770). Second, we examined the effect of formal education on VCI in young-stroke patients who were cognitively assessed on average 11.0 (SD=8.2) years post-stroke (the FUTURE study cohort). The total sample consisted of 277 young-stroke patients with a mean age at follow-up 50.9 (SD=10.3). Age and education-adjusted expected scores were computed using 146 matched stroke-free controls.


The meta-analysis showed an overall effect size (z') of 0.25 (95% confidence interval [0.18–0.31]), indicating that formal education level had a small to medium effect on VCI. Analyses of the FUTURE data showed that the effect of education on post-stroke executive dysfunction was mediated by age (β age −0.015;p<.05). Below-average performance in the attention domain was more frequent for low-education patients (χ2(2)=9.8;p<.05).


While education level was found to be related to post-stroke VCI in previous research, the effects were small. Further analysis in a large stroke cohort showed that these education effects were fully mediated by age, even in relatively young stroke patients. Education level in and of itself does not appear to be a valid indicator of cognitive reserve. Multi-indicator methods may be more valid, but have not been studied in relation to VCI. (JINS, 2017,23, 223–238)

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The Elusive Nature of APOE ε4 in Mid-adulthood: Understanding the Cognitive Profile
  • Claire Lancaster | School of Psychology, University of Sussex, Brighton, East Sussex
  • Naji Tabet | Brighton and Sussex Medical School, Institute of Postgraduate Medicine, Brighton, East Sussex
  • Jennifer Rusted | School of Psychology, University of Sussex, Brighton, East Sussex

E-mail address | j.rusted@sussex.ac.uk

There are no conflicts of interest to disclose.


The apolipoprotein E (APOE) ε4 allele is an established risk factor for dementia, yet this genetic variant is associated with a mixed cognitive profile across the lifespan. This study undertakes both a systematic and meta-analytic review of research investigatingAPOE-related differences in cognition in mid-adulthood, when detrimental effects of the allele may first be detectable.


Thirty-six papers investigating the behavioral effects ofAPOEε4 in mid-adulthood (defined as a mean sample age between 35 and 60 years) were reviewed. In addition, the effect of carrying an ε4 allele on individual cognitive domains was assessed in separate meta-analyses.


The average effect size ofAPOEε4 status was non-significant across cognitive domains. Further consideration of genotype effects indicates preclinical effects ofAPOEε4 may be observable in memory and executive functioning.


The cognitive profile ofAPOEε4 carriers at mid-age remains elusive. Although there is support for comparable performance by ε4 and non-e4 carriers in the 5thdecade, studies administering sensitive cognitive paradigms indicate a more nuanced profile of cognitive differences. Methodological issues in this field preclude strong conclusions, which future research must address, as well as considering the influence of further vulnerability factors on genotype effects. (JINS, 2016,23, 239–253)

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Systematic Review of Neuropsychological Rehabilitation for Prospective Memory Deficits as a Consequence of Acquired Brain Injury
  • Steven Mahan | Child and Adolescent Neuropsychology Group, Psychology, University of Exeter, Exeter, United Kingdom
  • Rebecca Rous | Acute Neurological Rehabilitation Unit, The Wellington Hospital, St John’s Wood, London, United Kingdom
  • Anna Adlam | Child and Adolescent Neuropsychology Group, Psychology, University of Exeter, Exeter, United Kingdom

E-mail address | a.r.adlam@exeter.ac.uk

No conflict of interest to report. This critical review received no funding or financial support.


Prospective memory (PM) impairments are common following acquired brain injury (ABI). PM is the ability to keep a goal in mind for future action and interventions have the potential to increase independence. This review aimed to evaluate studies examining PM rehabilitation approaches in adults and children with ABI.


Relevant literature was identified using PsycARTICLES (1894 to present), PsycINFO (1880 to present), the Cochrane Library (1972 to present), MEDLINE PubMed, reference lists from relevant journal articles, and searches of key journals. Literature searches were conducted using variants of the termsbrain injury,stroke, encephalitis, meningitis, andtumor, combined with variants of the termsrehabilitationandprospective memory.


Of the 435 papers identified, 11 were included in the review. Findings demonstrated a variety of interventions to alleviate PM deficits, including compensatory strategies (e.g., external memory aids) that provide either content-specific or content-free cueing, and remediation strategies (e.g., meta-cognitive training programs) aimed at improving the self-monitoring of personal goals. Risk of bias for individual studies was considered and the strengths and limitations of each of the included studies and the review itself were discussed.


Interventions used with adults can be effective; PM abilities can be improved by using simple reminder systems and performance can be generalized to facilitate everyday PM functioning. There is, however, a lack of research of PM interventions conducted with children with ABI, and pediatric interventions need to consider on-going cognitive maturation. (JINS, 2017,23, 254–265)

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Deficits in Social Cognition: An Unveiled Signature of Multiple Sclerosis
  • Moussa A. Chalah | EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France, Service de Physiologie – Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique – Hôpitaux de Paris, Créteil, France
  • Samar S. Ayache | EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France, Service de Physiologie – Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique – Hôpitaux de Paris, Créteil, France, Neurology Division, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon

E-mail address | samarayache@gmail.com

Both authors declare no conflict of interest.

Background and Objectives:

Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system, representing the primary cause of non-traumatic disability in young adults. Cognitive dysfunction can affect patients at any time during the disease process and might alter the six core functional domains. Social cognition is a multi-component construct that includes the theory of mind, empathy and social perception of emotions from facial, bodily and vocal cues. Deficits in this cognitive faculty might have a drastic impact on interpersonal relationships and quality of life (QoL). Although exhaustive data exist for non-social cognitive functions in MS, only a little attention has been paid for social cognition. The objectives of the present work are to reappraise the definition and anatomy of social cognition and evaluate the integrity of this domain across MS studies. We will put special emphasis on neuropsychological and neuroimaging studies concerning social cognitive performance in MS.


Studies were selected in conformity with PRISMA guidelines. We looked for computerized databases (PubMed, Medline, and Scopus) that index peer-reviewed journals to identify published reports in English and French languages that mention social cognition and multiple sclerosis, regardless of publication year. We combined keywords as follows: (facial emotion or facial expression or emotional facial expressions or theory of mind or social cognition or empathy or affective prosody) AND multiple sclerosis AND (MRI or functional MRI or positron emission tomography or functional imaging or structural imaging). We also scanned references from articles aiming to get additional relevant studies.


In total, 26 studies matched the abovementioned criteria (26 neuropsychological studies including five neuroimaging studies). Available data support the presence of social cognitive deficits even at early stages of MS. The increase in disease burden along with the “multiple disconnection syndrome” resulting from gray and white matters pathology might exceed the “threshold for cerebral tolerance” and can manifest as deficits in social cognition. Admitting the impact of the latter on patients’ social functioning, a thorough screening for such deficits is crucial to improving patients’ QoL. (JINS, 2017,23, 266–286)

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