Executive functions and neurocognitive efficiency across the life-span: a novel multidimensional tool for neuropsychological screening

State of the art: Executive functions (EF) are a set of skills that lie at the core of higher cognition. In particular, they support top-down control and regulation of sensations, emotions, behaviour, and thoughts, and allow for learning and flexible adaptation to the environment, self-monitoring, and self-regulation. Consequently, the integrity and efficiency of EF is associated to different achievements and facets of human life, such as academic and professional attainments, relationship quality, and physical/mental health, and are deemed as protective factors, moderators of quality of life, and precursors for effective global functioning across the life-span. Consistently, neurocognitive impairments and, in particular, EF deficits systematically pair with most psychopathological pictures and represent one of the most common transdiagnostic feature across the lifespan. Namely, executive deficits are the main symptom of various typical disorders of pathological aging, including dementia, and, at the same time, the efficiency level of EF has proved to mitigate the effects of time on cognitive functioning by serving as an additional compensatory resource. Therefore, monitoring of EF in adults and elderly people, both for healthcare screening purposes and in routine assessment during long-stay hospitalization, is a fundamental practice for early detection of functional decline and prompt implementation of targeted neurocognitive empowerment interventions. Methods: In the present work, we introduce a new multi-dimension tool for rapid EF screening devised to quickly sketch a broad profile of the examinee’s strengths and weaknesses in executive functioning and higher cognition. The tool consists of standardised neuropsychological tests aimed at evaluating short and long-term verbal memory functions, working memory, focused attention, cognitive flexibility, verbal and non-verbal fluency, and computerized neurocognitive tasks for the assessment of inhibition skills, executive control, and attention regulation. The first exploratory validation sample was constituted by 56 adult/senior participants (age range: 21-60 years, education range: 8-21). The tool was administered by psychologists experienced in neuropsychology or neuroscience in a single session (mean duration: 45 minutes). All participants gave their written informed consent to take part in the study. Main results: Statistical regression analyzes have shown that increasing age generally predicts both lower performance on the total number of words recalled on the verbal memory test (both immediate and deferred recall), and a reduction in focused attention. Participants’ age also predicts slower reaction times (TR) in the responses to the Stroop task and the Go/No-Go task. Regardless of age, a high level of education predicts a greater number of words recalled on the verbal fluency test. The variability of data as captured by the various performance metrics points out the capability of tests/tasks that constitute the tool to discriminate between different proficiency levels even in a validation sample. Conclusion: First validation data highlight the sensitivity of the tool components to cognitive changes associated to physiological aging, its applicability in short times, and its cognitive resolution (i.e. the ability to detect and outline an individual profile of strengths and weaknesses across explored cognitive domains), thus suggesting the potential of the proposed tool as a valid neurocognitive screening tool. In its entirety, the multidimensional tool was built to assess, in a short time, the degree of integrity/impairment of high-order EF. The set of tests and tasks that constitutes the tool was selected based on their relevance, as highlighted by empirical literature, and their diagnostic potential, as highlighted by available psychometric and clinical evidence. In the scenario of cognitive assessment practices, the use of a screening battery created ad hoc for the diagnostic target – possibly followed, if needed, by further in-depth examinations – constitutes, indeed, a good compromise between the accuracy of a complete evaluation and the specificity of an assessment that is completely tailored on the individual patient and that, therefore, may require remarkable clinical experience to be properly set-up.