OBJECTIVES:Several recent clinical trials have shown that docosahexaenoic acid (DHA) supplements have a significant effect on cognition in cognitively impaired older adults. This randomised controlled trial aimed to investigate the cognitive effects of a DHA fish oil supplement in older adults with mild cognitive impairment, and to examine the moderating effect of the apolipoprotein E (APOE) ɛ4 allele on cognition and well-being.METHODS/DESIGN:Seventy-two older adults between the ages of 60 and 90 from New Zealand were given a DHA supplement equivalent to 1491 mg DHA + 351 mg eicosapentaenoic acid per day or a placebo for a period of 12 months. Outcome measures included cognition, wellbeing and self-rated quality of life as well as height, weight, blood pressure and APOE genotyping.RESULTS:The final analysis (n = 60) found no evidence of a treatment effect on cognitive measures, although did find a treatment effect on systolic blood pressure (p = 0.03, ƞ2  = 0.08), and a treatment interaction for APOE ɛ4 carriers on depression (p = 0.04, ƞ2  = 0.07) and anxiety (p = 0.02, ƞ2  = 0.09) scores in favour of the DHA supplement.CONCLUSIONS:Despite no effect on cognition, the positive result in APOE ɛ4 carriers on depression and anxiety scores and on systolic blood pressure justifies further DHA trials. It may be a prudent step going forward for more studies to replicate the design elements (dose, duration and cognitive measures) of previous DHA trials to help understand why not all older adults appear to benefit from taking a fish oil supplement.

Objective: The aims of the survey were to determine: (i) the percentage of fish oil supplement users in a sample population; (ii) why people take fish oil supplements; (iii) where fish oil supplements are stored as well as the average daily dosage; (iv) what dietary and lifestyle behaviours are associated with fish oil supplement use. Design: An online cross-sectional survey. Setting: New Zealand. Respondents: A total of 334 New Zealand residents over the age of 18. Results: Fish oil supplements were taken by 21.9% of respondents. Reasons for taking fish oil supplements were 72.6% for 'general well-being', 54.8% to 'improve brain function', 31.5% for 'pain/inflammation', 12.3% to 'lower cholesterol levels' and 11% for 'a dietary insufficiency'. Approximately 26% of fish oil users reported taking a dose of fish oil supplements that would meet the recommended daily intake of 400-600 mg combined docosahexaenoic acid and eicosapentaenoic acid, and only 6.8% of fish oil users reported storing their fish oil supplements in the refrigerator. After controlling for other characteristics including age, gender, ethnicity and body mass index, fish oil supplementation use was most likely among respondents who already eat oily fish and least likely in respondents who regularly eat nuts and seeds. Conclusions: Fish oil supplements are a commonly used supplement in New Zealand, yet questions remain about the role of these supplements in improving health outcomes. Safety issues related to manufacturing and storage conditions indicate that there is an urgency in answering these questions.

Kiwifruit (KF) effects on the human glycaemic response to co-ingested wheat cereal were determined. Participants (n = 20) consumed four meals in random order, all being made to 40 g of the same available carbohydrate, by adding kiwifruit sugars (KF sug; glucose, fructose, sucrose 2:2:1) to meals not containing KF. The meals were flaked wheat biscuit (WB)+KFsug, WB+KF, WB+guar gum+KFsug, WB+guar gum+KF, that was ingested after fasting overnight. Blood glucose was monitored 3 h and hunger measured at 180 min post-meal using a visual analogue scale. KF and guar reduced postprandial blood glucose response amplitude, and prevented subsequent hypoglycaemia that occurred with WB+KFsug. The area between the blood glucose response curve and baseline from 0 to 180 min was not significantly different between meals, 0–120 min areas were significantly reduced by KF and/or guar. Area from 120 to 180 min was positive for KF, guar, and KF+guar, while the area for the WB meal was negative. Hunger at 180 min was significantly reduced by KF and/or guar when compared with WB. We conclude that KF components other than available carbohydrate may improve the glycaemic response profile to co-ingested cereal food.

BACKGROUNDDocosahexaenoic acid (DHA) is important for brain function, and its status is dependent on dietary intakes. Therefore, individuals who consume diets low in omega-3 (n-3) polyunsaturated fatty acids may cognitively benefit from DHA supplementation. Sex and apolipoprotein E genotype (APOE) affect cognition and may modulate the response to DHA supplementation.OBJECTIVESWe investigated whether a DHA supplement improves cognitive performance in healthy young adults and whether sex and APOE modulate the response.DESIGNHealthy adults (n = 176; age range: 18-45 y; nonsmoking and with a low intake of DHA) completed a 6-mo randomized, placebo-controlled, double-blind intervention in which they consumed 1.16 g DHA/d or a placebo. Cognitive performance was assessed by using a computerized cognitive test battery. For all tests, z scores were calculated and clustered into cognitive domains as follows: episodic and working memory, attention, reaction time (RT) of episodic and working memory, and attention and processing speed. ANCOVA was conducted with sex and APOE as independent variables.RESULTSRTs of episodic and working memory improved with DHA compared with placebo [mean difference (95% CI): -0.18 SD (-0.33, -0.03 SD) (P = 0.02) and -0.36 SD (-0.58, -0.14 SD) (P = 0.002), respectively]. Sex × treatment interactions occurred for episodic memory (P = 0.006) and the RT of working memory (P = 0.03). Compared with the placebo, DHA improved episodic memory in women [0.28 SD (0.08, 0.48 SD); P = 0.006] and RTs of working memory in men [-0.60 SD (-0.95, -0.25 SD); P = 0.001]. APOE did not affect cognitive function, but there were some indications of APOE × sex × treatment interactions.CONCLUSIONSDHA supplementation improved memory and the RT of memory in healthy, young adults whose habitual diets were low in DHA. The response was modulated by sex. This trial was registered at the New Zealand Clinical Trials Registry (http://www.anzctr.org.au/default.aspx) as ACTRN12610000212055.

The Use of Brief Screening Instruments for Cognitive Impairment in New Zealand It is widely recognised that the ratio of older adults in the general population of Western societies is growing rapidly. This international trend is also seen in New Zealand where the number of people aged 65 years and older has increased by 86.4% between 1971 and 2001 (Statistics New Zealand, 2002), and it is estimated that the rate of older people in the total population will grow to 25.5% over the next 44 years, up from 12% in 1999 (Statistics New Zealand, 2000). As cognitive impairment is highly correlated with age (Gao, Hendrie, Hall, & Hui, 1998), the absolute number of people presenting with cognitive complaints is therefore likely to increase exponentially within the next few years with a corresponding increase in the need for assessment and management of these complaints. Cognitive screening is typically conducted by general practitioners, neurologists, psychiatrists, geriatricians, and psychologists as a precursor to, or as part of, comprehensive clinical assessment of cognitive impairment (Cullen, O'Neill, Evans, Coen, et al., 2007). In addition, screening instruments monitor change over time and assists in ongoing clinical decision-making. Early detection of cognitive impairment maximises the opportunity to put in place compensatory strategies useful as cognitive status deteriorates (Hachinski, 2008). Previous overseas surveys (Reilly, Challis, Burns, & Hughes, 2004; Shulman, Herrmann, Brodaty, Chiu, Lawlor, et al., 2006) found that the screening measure most commonly used internationally was the Mini-Mental State Exam (MMSE; Folstein, Folstein, & McHugh, 1975), followed by the Clock Drawing Test (CDT; Shulman, Shedletsky, & Silver, 1986), the Middlesex Examination of Mental State (MEAMS; Golding, 1989), Cambridge Mental Disorders of the Elderly Examination (CAMDEX; Roth, et al., 1986)), CDT and Delayed Word Recall (Mini-Cog; Borson, Scanlan, Brush, Vitaliano, & Dokmak, 2000), Verbal Fluency Test (FAS; Bechtoldt, Benton, & Fogel, 1962), Similarities (Wechsler, 1997), and the Trail Making Test (Reitan, 1958). While Similarities is not a stand-alone screening instrument, the study by Shulman et al., (2006) had included it as a task commonly used for screening purposes. It is unclear which cognitive screening instruments are most frequently used in New Zealand and clarification of this is one focus of the current study. Anecdotal reports from clinicians had suggested that the MMSE was also used extensively in New Zealand, although there were concerns regarding its validity. These concerns were based on clinical observations of the MMSE's relative insensitivity to the milder forms of dementia and research literature examining the validity and utility of the MMSE in a variety of contexts (Anderson, Sachdev, Brodaty, et al., 2007; Bak & Mioshi, 2007; (Cullen, O'Neill, Evans, Coen, et al., 2007). The MMSE was developed in the 1970's and was based on a unitary, global understanding of dementia (Bak & Mioshi, 2007), a view that has radically changed over time. Whereas dementia was conceived of as a global deterioration of cognitive function, it is currently understood as encompassing a number of neurological conditions with divergent patterns of cognitive impairment (Lezak, Howieson, & Loring, 2004). The MMSE, as a measure of global impairment, is therefore inadequate for detecting various disorders within the dementia spectrum. Moreover, it virtually ignores the frontal-executive, visuospatial, and semantic memory domains which are affected in disorders such as fronto-temporal dementia, Parkinson's disease, progressive supranuclear palsy, cortico-basal deterioration, and right-hemispheric stroke (Bak & Mioshi, 2007). Further, a number of studies have shown the MMSE to be biased according to age, education, gender, socio-economic status, culture, language and ethnicity, test location, and test repetition (Anderson, Sachdev, Brodaty, et al. …

The tasks used to assess working memory are a highly contentious issue in cognitive psychology. Previous research has found a weak relationship between two key types of working memory tasks: N-Back and Complex Span. This is commonly interpreted as evidence that one or both tasks possess poor construct validity. However, this finding may be a result of assessing different modalities of working memory. The current pilot study aimed to clarify the differences between the two tasks by assessing performance on each within the same modality. A spatial and verbal version of each task was used. Although, theoretically, these tasks assess the same construct, the pilot data revealed low correlations between them. This suggests that the current models of working memory may be inadequate, or that unidentified differences between the tasks may be influencing the results. Due to their widespread use and applications, it is important to better understand models of working memory and develop improved tasks.

Eighty-five New Zealand based practitioners experienced in treating adults with a history of child sexual abuse participated in an online judgment study of child sexual abuse outcomes using signal detection theory methodology. Participants' level of sensitivity was assessed independent of their degree of response bias when discriminating (a) known child sexual abuse outcomes from behaviors thought to be unrelated to child sexual abuse and (b) direct child sexual abuse effects from subsequent coping strategies. Results demonstrated good sensitivity (accuracy) when identifying child sexual abuse effects from noneffects. When asked to discriminate direct child sexual abuse effects from ways of coping with distress, practitioners' accuracy was reduced, revealing a tendency to identify all effects as coping. Although treatment approaches highlight the pivotal role of identifying coping strategies, practitioners did not perceive maladaptive coping as a distinct clinical feature. Complex abuse cases may benefit from replacing maladaptive coping strategies (e.g., self-harm) with constructive coping (e.g., social support) in order to deliver efficacious practice.

This article examines theory and identifies gaps in research related to the role of driving skills in driving anxiety. Increasingly, investigators have examined the clinical features of driving anxiety and the more severe situation of driving fear and phobia, but the possible involvement of driving skills has been neglected. This is surprising given the potential implications for skills training and remediation in the assessment and treatment of some of those who experience driving anxiety, fear, and phobia. The largest body of relevant research comes from the driving and human factors literature on the relationship between anxiety and driving performance. The main theories addressing the relationship between anxiety and performance are examined, with specific attention to studies that have applied theoretical models to the driving situation. The paper identifies the need for further research regarding the relationship between driving skills and performance for individuals reporting driving anxiety. The implications for assessment and treatment are outlined, such as the role of driving task characteristics in planning exposure therapy. ********** Anxiety, fear, and phobia related to driving have received increasing research attention over the last decade, especially regarding fears of driving reported in clinical and non-clinical samples (for a review, see Taylor, Deane, & Podd, 2002). A recent pilot study of a non-probability convenience sample in New Zealand found that 8% of a sample of 99 community dwellers reported a moderate to extreme level of driving anxiety and 7% reported moderate to extreme driving fear, using a scale from 0 (no anxiety/fear) to 10 (extreme anxiety/fear; Taylor & Paki, 2008). These rates are relatively high although further epidemiological research is needed to more accurately determine the general population rate of driving fear and phobia. Anxiety and fear are both alerting signals but fear tends to signal a known, external, definite threat and to be experienced as a stronger emotion, while anxiety signals dangers that are less clear and specific (Craske, 2003). The term phobia is more frequently associated with the concept of fear and signals a level of fear that indicates psychological disorder. In terms of driving, such concerns range from mild anxiety with no avoidance behaviour or other impact on daily functioning, through to severe anxiety and fear, that reaches phobic level and impacts significantly on social, occupational, and personal functioning. Some people describe feeling anxious or nervous about driving in certain situations, such as reversing from a driveway (perhaps because of a minor accident in that situation), while others develop such an extreme anxiety of driving that driving is avoided altogether. This variability along the continuum of driving anxiety is reflected in the wide range of driving situations in which people describe experiencing anxiety or fear. Such situations include motor vehicle accidents (MVAs) or crashes (1), unexpected panic attacks, getting lost, vehicle malfunction, driving in certain unpleasant road situations or weather conditions, errors by other drivers, or making mistakes and annoying other drivers (Ehlers, Hofmann, Herda, & Roth, 1994; Taylor et al., 2002). For some, concern may focus on one of these issues, such as avoiding an accident at a certain intersection, while the concern for others is part of a broader pattern of anxiety, such as panic disorder with agoraphobia or generalised anxiety disorder. There is growing understanding of the nature of anxiety and fear related to driving and of its often complex pattern of concerns (Ehlers et al., 1994; Taylor et al., 2002). However, an aspect that has not been thoroughly examined relates to the extent that driving skill might play a part in driving anxiety. Driving can be considered a skill which involves many different aspects of behaviour, such as sensorimotor coordination, psychophysical judgement, attention, emotion, and reaction time. …

The present study explores driving skills in a group of 50 media-recruited driving-fearful and 50 control drivers, all of whom were women. Participants completed an on-road practical driving assessment with a professional driving instructor. Diagnostic as well as pre-post self-report and instructor driving assessments were conducted. Fearful drivers made more errors on the driving assessment than controls. However, the pattern of errors was identical for both groups, indicating that fear and anxiety may be associated with the number rather than the type of driving errors made. These differences remained when factors such as driving history, current driving frequency, and diagnosis were controlled using case selection. More research is needed to replicate the findings in more diverse samples. Additional work should also aim to clarify the specific role of driving skills in driving fear, which will facilitate treatment planning for exposure-based treatments and help identify cases where driving skills assessment may be appropriate.

Recent research has suggested that fear of driving is common in the general population. People may have various concerns when driving, and instruments for the assessment of these concerns are lacking. The present paper describes the development and preliminary evaluation of the Driving Cognitions Questionnaire (DCQ). The DCQ is a 20-item scale that measures three areas of driving-related concerns--panic-related, accident-related, and social concerns. In three separate samples from different countries (n=69, 100, and 78), the scale showed good internal consistency and substantial correlations with measures of the severity of driving fear. It discriminated well between people with and without driving phobia. It also showed convergent validity with other measures. The questionnaire shows promise for use in research and clinical practice.

This paper examines the clinical features, symptom severity, diagnostic profile, and help-seeking behaviour of a media-recruited sample of driving-fearful women. Results support previous findings of the primary foci of fear as motor vehicle accidents as well as specific driving situations and conditions. Consistent with prior research, there was difficulty relating the foci of fear to current diagnostic concepts. Social concerns were identified as having a role in driving fear for some individuals. Fearful participants exhibited high levels of fear and symptom severity according to various diagnostic and self-report measures, although most reported that they would be unlikely to seek professional psychological help or driving instruction. Assessment of cognitions indicated a range of errors likely to maintain anxiety and fear reactions that would be a target of treatment. There were no group differences in number of major recent accidents, although fearful drivers learnt to drive later than controls, suggesting early fearfulness.

The purpose of this study was to investigate deficits in recognition, recall, and prospective memory among Parkinsons disease (PD) patients, and to ascertain whether task difficulty and disease severity moderate these deficits. Comparisons were made between 41 nondemented PD participants, divided into early-stage and advanced-stage groups, and 41 matched controls. PD participants exhibited deficits in recognition, recall, and prospective memory. The advanced-stage PD group produced greater deficits than the early-stage PD group in all tasks, suggesting that these deficits increase in step with overall disease severity. The results of the task difficulty manipulation provide a partial explanation for the inconsistencies in the literature concerning the existence of recognition memory deficits in PD.

In the present study, we investigated age-related decline in face recognition memory and whether this decline is moderated by the age of the target faces and by the number of faces that the participant must learn (memory load). Thirty-two participants in each of three age groups (18-39 years, 60-75 years, and 76-96 years) completed a face recognition task. Signal detection analyses confirmed that face recognition accuracy declined with age. However, this finding was qualified by an interaction between participant age and target age, which revealed that the age-related decline in face recognition accuracy occurred only for young target faces. Increased memory load was associated with comparable performance decrements across all age groups. However, memory load appears not to be the cause of these decrements. Instead, they appear to be a product of recognition load (the number of stimuli presented in the recognition phase).