Applied Neuropsychology: Adult

ISSN: 2327-9095 (Print) 2327-9109 (Online) Journal homepage: http://www.tandfonline.com/loi/hapn21

Positive neuropsychology: The science and

practice of promoting cognitive health

John J. Randolph

To cite this article: John J. Randolph (2018) Positive neuropsychology: The science and
practice of promoting cognitive health, Applied Neuropsychology: Adult, 25:4, 287-294, DOI:
10.1080/23279095.2018.1457465

To link to this article: https://doi.org/10.1080/23279095.2018.1457465

Published online: 21 May 2018.

Submit your article to this journal

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=hapn21
APPLIED NEUROPSYCHOLOGY: ADULT
2018, VOL. 25, NO. 4, 287–294
https://doi.org/10.1080/23279095.2018.1457465

SPECIAL SECTION ON POSITIVE NEUROPSYCHOLOGY none defined

Positive neuropsychology: The science and practice of promoting

cognitive health
John J. Randolph
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA

ABSTRACT KEYWORDS
Positive psychology has influenced multiple subfields within psychology and areas outside of Activity engagement;
psychology. While positive psychology’s focus on positive mental health and character strengths cognitive health; lifestyle
did not appear to meaningfully impact neuropsychology in its earlier stages, more recent factors; positive psychology
indications suggest that the neuropsychological literature, and perhaps the field as a whole, has
begun to embrace related research and practice applications. In this context, positive
neuropsychology has emerged as a neuropsychological orientation focused on the study and
practice of promoting cognitive health. The present review discusses the origins of positive
neuropsychology and elaborates on its six key evidence-based domains: compensatory strategy
use, activity engagement, prevention of cognitive impairment, public education, exceptional
cognition, and positive cognitive outcomes in neuropsychiatric populations. This broad perspective
on cognitive wellness can easily be embraced by both clinicians and researchers and offers
multiple directions for future growth. Ultimately, consideration of various methods to promote
cognitive health can inform our understanding of optimal brain function, maximize functioning in
individuals with cognitive limitations, and enhance quality of life among populations served by
neuropsychologists.

Twenty years ago, Dr. Martin Seligman emphasized the p. 847). While his comments in some ways echoed those
need for the broader field of psychology to increase its of Dr. Seligman (1999), has the field of neuropsychology
efforts on promoting positive human qualities, psycho- responded in kind, as was the case with the broader
logical health in the broader population, and character psychology community? In particular, has neuropsy-
strengths. During his American Psychological Associ- chology embraced ideas related to personal growth
ation President’s Address, he stated that one of his and development vis-à-vis cognitive health?
presidential initiatives sought “to utilize quality scien- To consider this possibility empirically, meta-
tific research and scholarship to reorient our science literature reviews of multiple prominent neuropsycho-
and practice toward human strength. In this way, we logical journals (Archives of Clinical Neuropsychology,
can learn to identify and understand the traits and Journal of the International Neuropsychological Society,
underpinnings of preventive psychological health and, Neuropsychology) were conducted at three points in
most importantly, learn how to foster such traits in time over a 10-year period (1999–2009). Key study aims
young people” (Seligman, 1999, p. 561). In the ensuing were derived based on manuscript titles and abstracts,
decades, positive psychology gained international pro- and studies were then categorized based on primary
minence as an emerging scientific and practice-oriented research questions being addressed. Findings from these
focus that impacted clinical psychology, military reviews indicated that across journals and sampled
psychology, and the business world, among others years, 52% of studies focused on documenting cognitive
(Randolph, 2013). deficits in neuropsychiatric populations, 13% con-
In 2003, Dr. Ronald Ruff, then president of the sidered normal cognitive functioning, 10% validated
National Academy of Neuropsychology, stated in his novel measures, and 8% involved neuroimaging. Few
presidential address, “Patients’ needs are not met by studies examined correlates of cognitive health or
merely diagnosing cognitive deficits. There is a growing resilience; 2% of papers evaluated positive cognitive out-
need to advance services that maintain cognitive comes in neuropsychiatric conditions, and 1% of studies
health … the time has come for neuropsychologists to involved cognitive rehabilitation (Randolph, 2013).
identify as caretakers for cognitive health” (Ruff, 2003, While these findings may have differed if other years

CONTACT John J. Randolph [email protected] 20 W. Park Street, Suite 215, Lebanon, NH 03766, USA.
© 2018 Taylor & Francis Group, LLC
288 J. J. RANDOLPH

had been sampled or if other journals had been useful for promoting attention, memory, and executive
considered, a pattern nevertheless emerged that indi- functioning. External strategies are techniques that
cated minimal focus on research investigating cognitive relate to the environment or use of a physical aid. A
health factors. wide variety of external strategies are available to pro-
An updated review of manuscripts published in 2014 mote cognition in daily life, including appointment
in Archives of Clinical Neuropsychology and Journal of books, targeted lists, paper or electronic calendars,
the International Neuropsychological Society indicated auto-payment for bills, and timers. There has also been
that while the majority of published manuscripts showed increased focus on use of technology for maintaining
a continued focus on cognitive dysfunction or validating functional status in older adults, including use of “smart
new or existing measures, approximately 10% of studies environments” that monitor and prompt individuals’
evaluated effects of lifestyle factors on cognition or cog- instrumental activities of daily living and may allow
nitive rehabilitation (Randolph, 2015a, 2015b). Related for longer periods of independent functioning
research examined the role of lifestyle engagement on (Schmitter-Edgecombe, Seelye, & Cook, 2013).
executive function trajectories in older adults (De Frias Internal strategies are self-generated and serve to
& Dixon, 2014), positive effects of exercise on inhibitory improve focus on and learning and organization of
control in ADHD (Chang, Hung, Huang, Hatfield, & new material. One well-researched strategy in this
Hung, 2014), and the moderating role of coping strategy regard is self-instructional training, which involves ver-
on fatigue and cognition in MS (Ukueberuwa & Arnett, balizing one’s task approach and process, often leading
2014). Although this was a much less comprehensive to improved focus on the task at hand. This approach
literature review than the previous one, it was has been applied effectively for many years in popula-
encouraging to see movement toward published studies tions including brain injury patients, individuals with
examining contributors to cognitive health. schizophrenia, and impulsive children (Cicerone &
In sum, despite earlier evidence to the contrary, there Giacino, 1992; Meichenbaum & Goodman, 1971; Perry,
is emerging evidence that perspectives from positive Potterat, & Braff, 2001). Another internal strategy well
psychology have begun to impact the neuropsychologi- known to the neuropsychologist is clustering or
cal literature. Anecdotally, there also appears to be an chunking information into categories to aid later
increased emphasis on factors associated with cognitive retrieval. Some neuropsychological measures explicitly
health in the field based on seminar offerings at recent quantify such strategies to clarify spontaneous organiza-
neuropsychological meetings, not to mention an entire tional abilities and can provide important information
conference recently devoted to this topic (Cleveland to review with patients during evaluation feedback
Clinic’s 2015 “SuperBrains” conference). sessions. As many clinicians can relate anecdotally,
some research has found that individuals with neurop-
sychiatric conditions who spontaneously use such
Positive neuropsychology: Definition and
strategies perform better on memory tasks (Woods
domains
et al., 2010). It is also important to note that some
As an emerging orientation within the field, positive strategies are better to avoid; despite some popularity
neuropsychology is conceptualized as the study and in mainstream culture, “multitasking” is associated with
promotion of cognitive health. There are six key increased errors, reduced task completion speed, and
evidence-based subdomains of positive neuropsychol- poorer overall performance (Ophir, Nass, & Wagner,
ogy that relate to clinical and scientific aspects of 2009).
promoting cognition through various means: compen- Emotional compensation also impacts cognitive
satory strategies, activity engagement, prevention of health, both in neuropsychiatric populations and in
cognitive problems, public education, understanding healthy individuals. Some research indicates that indivi-
positive outcomes in neuropsychiatric populations, duals with multiple sclerosis who use active coping
and studying individuals with robust cognition. strategies (e.g., intently focusing one’s efforts on
managing an issue of concern) are less likely to
experience depression related to cognitive deficits
Compensatory strategies
than those who use avoidant strategies (Rabinowitz &
Compensatory cognitive and emotional strategies are Arnett, 2009). Moreover, mindfulness meditation has
important components of cognitive health promotion. been found to be an effective stress management strat-
Regarding cognitive strategies, two broad categories egy that also increases hippocampal, prefrontal, and
can be considered: external and internal (Sohlberg & cingulate cortex volume (Fox et al., 2014; Holzel et al.,
Mateer, 2001). Both types of strategies are particularly 2011).
 APPLIED NEUROPSYCHOLOGY: ADULT 289

Activity engagement can detrimentally impact executive functioning (Liao

et al., 2014). Effects of social support on cognition have
Another important factor involved in promoting
also been found to differ over time by gender and
cognitive health is activity engagement. There are three
relationship type (Liao & Scholes, 2017).
types of effortful activity that are clearly linked to
Further, consistent intellectual stimulation can main-
cognitive wellness: physical activity, social engagement,
tain and enhance cognition throughout life, particularly
and intellectual activity. Of these three domains, physi-
in older adults. Such activity comes in many forms,
cal fitness and aerobic activity have been most widely
including reading, photography, painting, playing (or
researched to date. Multiple studies have demonstrated
learning/relearning) a musical instrument, learning a
positive effects on cognition in those who exercise
foreign language, doing crossword puzzles, or going to
regularly, with particular improvement in executive
museums. An early study found that older adults who
functioning (Hertzog, Kramer, Wilson, & Lindenberger,
were most intellectually engaged were about 50% less
2009). In a related vein, exercise promotes neurophysio-
likely to develop Alzheimer’s disease than those who
logical functioning on molecular and structural levels.
were less active; common activities included reading
Increases in BDNF have been observed after single exer-
the newspaper, visiting museums, doing puzzles, and
cise sessions and as a function of consistent exercise
playing cards (Wilson et al., 2002). More recent work
(Szuhany, Bugatti, & Otto, 2015). Physical activity is
has found that doing crossword puzzles has a strong
also associated with increased brain volume in controls
buffering effect on memory decline, delaying onset of
and in those with cognitive impairment, including in
decline by 2.5 years (Pillai et al., 2011). Increased job
the anterior hippocampus (Erickson et al., 2011) and
complexity, another aspect of intellectual stimulation,
bilateral frontal regions (Reiter et al., 2015). Across stu-
appears to moderate the relationship between whole
dies, approximately 20 minutes of moderate physical
brain and hippocampal atrophy on cognition (Boots
activity per day appears to be the minimum threshold
et al., 2015).
for positively impacting cognition and brain function.
Exercise also appears to show brain-related benefits
throughout life, including being associated with micro-
Prevention of cognitive dysfunction
structural integrity in adults in their 80s (Tian et al.,
2014) and cognitive improvement in dementia (Cheng Efforts to promote cognitive health can also focus on
et al., 2014). A dose-response effect vis-à-vis exercise prevention of cognitive impairment, which can take
and cognition has been observed across studies, includ- many forms. Regarding diet and nutrition, regular con-
ing in a recent multinational sample with over 100,000 sumption of a Mediterranean-style diet is associated
participants (De Souto Barreto, Delrieu, Andrieu, with a number of cognitive and brain-related benefits,
Vellas, & Rolland, 2016). including slower cognitive decline and a 34–40%
An additional activity that is critical for promoting reduced risk of Alzheimer’s disease as noted in a recent
cognition is social engagement. Some work has found systematic review (Lourida et al., 2013). While this
that higher frequency of social activity has been associa- dietary style may have a number of specific benefits,
ted with less cognitive decline over a five-year period omega-3 polyunsaturated fatty acids (PUFAs) may play
across multiple cognitive abilities including episodic a particularly important role in maintaining cognitive
memory, processing speed, and visuospatial function- health (Dyall, 2015). In a related vein, omega-3 PUFAs
ing. Participants most socially engaged were 70% less have been found to moderate the effect of physical
likely to show cognitive decline (James, Wilson, Barnes, activity on cognition; individuals with higher levels of
& Bennett, 2011). The size of one’s social network also omega-3 fatty acids show fewer negative cognitive
plays an important role in cognitive health. Some effects of sedentary tendencies (Leckie et al., 2014).
research has found that having a larger network of social Additionally, regular consumption (at least once per
contacts (children, family, and friends) can moderate week) of fish has been linked to increased brain volume,
the impact of Alzheimer’s disease pathology on cog- including in the right anterior hippocampus and
nition, particularly regarding semantic memory and posterior cingulate (Raji et al., 2014). More generally,
working memory (Bennett, Schneider, Tang, Arnold, effectively managing cardiovascular risk factors such
& Wilson, 2006). Higher perceived social support is as hypertension, diabetes, and obesity can reduce the
associated with better working memory, processing risk of Mild Cognitive Impairment or dementia
speed, and visuospatial functioning (Krueger, Wilson, (O’Connor & Kraft, 2013).
Barnes, Bienias, & Bennett, 2009). Conversely, poor Other preventative strategies include treating
support and adverse interactions in one’s social network secondary factors such as sleep disturbance, depression,
290 J. J. RANDOLPH

chronic pain, and fatigue, all of which can have detri- public’s understanding of brain injury factors or
mental effects on cognition (Arnett, 2013). In addition sequelae (Guilmette & Paglia, 2004). Common
to sleep apnea, which has well-known negative effects misconceptions include the belief that a second blow
on cognition, sleep duration of less than or greater than to the head improves memory functioning, and that
7–8 hours is associated with multiple cognitive deficits, most people with severe brain injuries will return to
although cognitive gains usually occur when sleep pat- their pre-injury occupations. A recent study found that
terns normalize (Banks, Van Dongen, Maislin, & those with prior concussions or with formal concussion
Dinges, 2010; Waters & Bucks, 2011). There is also evi- information training paradoxically showed more mis-
dence that ongoing activity engagement can moderate conceptions than others in the general population, but
the impact of depression on cognition (Opdebeeck that misconceptions were common across all parti-
et al., 2017). cipants (Merz, Van Patten, & Lace, 2017). Inaccurate
While smoking receives a relatively minimal amount beliefs about dementia are also common, including
of attention in the neuropsychological literature, this among healthcare providers (Annear, 2018; Tan, Hong,
habit increases risk of dementia, is associated with Luo, Lo, & Yap, 2012).
cognitive impairment across the lifespan, and can cause Public education efforts take many forms, including
volumetric decline in multiple cortical regions and in public presentations, writing articles for websites and
the corpus callosum (Randolph & Randolph, 2013). In newspapers, writing letters to the editor of local papers,
contrast, smoking cessation is associated with cognitive media interviews, participation in psychological and
improvement, potentially within a short period of time neuropsychological organizations at state and national
(Sabia et al., 2012). Another avenue of prevention levels, and social media presence. Regarding the latter,
relates to sports concussion. Conservative management it is encouraging to note that multiple neuropsychol-
of concussed athletes, rule changes in contact sports that ogical organizations are regularly involved in posting
penalize overly aggressive play, and legislative content related to brain-behavior relationships on social
efforts leading to increased concussion awareness all media sites. Ultimately, public education can benefit
serve to reduce acute and ongoing concussion sequelae individual patients, providers, and the broader health
(Echemendia, 2013). care system.

Public education Exceptional cognition

Public education in neuropsychology is critically While neuropsychology has a rich history of case studies
important. Relatively few individuals in the general related to cognitive dysfunction, much less is known
public—not to mention some colleagues in allied about individuals with robust cognition. An early
fields—understand our extensive training and expertise example of the latter was Luria’s case study of “S.” S
in brain-behavior relationships, benefits from the ser- had what appeared to be a nearly limitless memory,
vices we provide, or the myriad roles in which we serve and he ultimately became a successful mnemonist.
across clinical, forensic, military, academic, and other While his ability to remember details was remarkable,
settings. Many people continue to be unsure of differ- this skill became burdensome for him, as he had to force
ences between psychologists and psychiatrists, himself to forget less desired memories (Luria, 1968).
let alone how neuropsychologists differ from clinical, More recently, Hu and Ericsson (2012) studied Chao
counseling, or other psychologists. In this context, we Lu, the world record holder for recall of digits of pi.
all serve as ambassadors for the field, and our ability Lu was able to recall 67,890 digits of pi by using
to communicate who we are and what we do has multi-level strategies, including segmenting 2-digit
considerable implications for the long-term viability of number groups, encoding these groups as words, and
neuropsychology. then creating related stories. Curiously, years after
Borrowing a term from Anthony Jorm (2012) as establishing his world record, he was only able to spon-
related to mental health, the general public tends to taneously recall 39 digits, suggesting that his earlier feat
have fairly poor “cognitive health literacy.” For example, related more to effective encoding and working memory
a recent public survey of cognitive health beliefs found strategies than episodic memory storage per se.
that few participants endorsed aging, stroke, hyperten- Another ongoing line of research relates to
sion, brain injury, depression, or environmental toxins “SuperAgers,” a cohort of older adults (age 80þ) with
as having adverse effects on cognition (Hosking, exceptional cognition and brain morphology for their
Sargent-Cox, & Anstey, 2015). Research across multiple age. The SuperAgers show objective memory perfor-
studies has shown little change over time in the general mance and cortical thickness similar to healthy
 APPLIED NEUROPSYCHOLOGY: ADULT 291

individuals aged 50–65, with thicker anterior cingulate (MCI) to dementia (Dolcos, MacDonald, Braslavsky,
cortex than the same group (Gefen et al., 2015; Camicioli, & Dixon, 2012).
Harrison, Weintraub, Mesulam, & Rogalski, 2012). A related line of inquiry revolves around attitudinal
Demographically, a perhaps unexpected finding (i.e., factors that improve outcomes. Much of this work has
in light of cognitive reserve theory) was that only four examined the role of variables such as determination,
of the 12 individuals in the initial SuperAgers sample dispositional optimism, positive attitudes, and perspec-
were college graduates, suggesting that other factors tive changes in brain injury patients with good recovery
contribute to highly successful cognitive aging beyond (Hawley & Joseph, 2008; Peleg, Barak, Harel, Rochberg,
educational status. Other research on SuperAgers has & Hoofien, 2009; Todis & Glang, 2008). Symptom attri-
indicated that relative to young and elderly controls, butions and knowledge about brain injury may also play
SuperAgers have an atypically high density of von critical roles in recovery (Belanger, Barwick, Kip,
Economo neurons in anterior cingulate cortex (Gefen Kretzmer, & Vanderploeg, 2013). Other research has
et al., 2018). The same group has found that SuperAgers investigated one’s sense of life purpose as a potentially
also report experiencing more positive social relation- protective factor against cognitive decline or neurologic
ships than healthy age peers, which the authors have disease. Indeed, a stronger sense of purpose is associated
speculated could be linked to SuperAgers’ abundant with reduced chance of macroscopic lacunar infarcts or
von Economo neurons (Maher et al., 2017). stroke (Kim, Sun, Park, & Peterson, 2013; Yu et al.,
Ultimately, understanding individuals and groups 2015) and lower risk of developing MCI or dementia
with impressive cognition may have important (Boyle, Buchman, Barnes, & Bennett, 2010). This factor
implications for rehabilitation and “pre-habilitation” has also been found to moderate the impact of
(i.e., training in cognitive strategies prior to onset of Alzheimer’s disease pathology on cognition (Boyle
cognitive dysfunction) of individuals with neuropsy- et al., 2012). In addition, there is evidence that some
chiatric conditions and the general population. Neuro- personality traits, such as conscientiousness and open-
psychologists conducting related research are well ness to experience, confer reduced risk for cognitive
poised to further this science and translate it into decline in older adults (Wilson & Bennett, 2017).
actionable practice-oriented principles and strategies. In summary, positive neuropsychology is a clinical
and research orientation that emphasizes the study and
promotion of cognitive health through various means.
Positive cognitive outcomes in neuropsychiatric
Here, I have discussed related ideas including compensa-
populations
tory cognitive and emotional strategies, activity engage-
Academic and clinical neuropsychologists have clarified ment in daily life, prevention of cognitive limitations,
cognitive dysfunction across multiple neuropsychiatric public education related to neuropsychology, under-
populations over many years. We now have a solid standing robust cognition, and positive cognitive
working knowledge of expected sequelae secondary to outcomes in neuropsychiatric populations. Neuropsy-
multiple sclerosis, stroke, epilepsy, Parkinson’s disease, chology appears to be moving toward a better under-
brain injuries of all severity levels, and various forms standing of cognitive health factors, although the field
of dementia. However, we know much less about indi- remains primarily focused on documenting cognitive
viduals with conditions that impact neuropsychological dysfunction. Considering the six key elements of cogni-
functioning who show positive outcomes. For example, tive promotion, as noted above, can further advance and
roughly 50% of those with multiple sclerosis will exhibit expand this area in the years ahead both in terms of
cognitive changes; much less is known about the other scientific aspects of cognitive health and practical clinical
50% who remain cognitively intact. Some patients may applications. More generally, neuropsychologists who
be particularly cognitively resilient due to lifestyle, gen- embrace a cognitive wellness perspective can help max-
etic, dispositional, or other factors. For example, we imize quality of life and cognitive functioning in those
recently found that individuals with MS who have no with whom they work in community, medical, academic,
objective cognitive impairment, no subjective cognitive military, consulting, and other settings.
complaints, and informant-confirmed lack of daily cog-
nitive dysfunction showed fewer symptoms of fatigue
Declaration of interest
and subclinical mood lability than other MS patients
(Randolph, Randolph, & Wishart, 2018). Other work Dr. Randolph is the editor of Positive Neuropsychology:
has begun to clarify factors (e.g., lifestyle activity Evidence-based Perspectives on Promoting Cognitive
engagement, positive affect) that may reduce the likeli- Health and receives royalties from Springer
hood of converting from Mild Cognitive Impairment ScienceþBusiness Media, LLC.
292 J. J. RANDOLPH

References people from 20 countries. Mayo Clinic Proceedings, 91,

1515–1524. doi:10.1016/j.mayocp.2016.06.032
Annear, M. J. (2018). Knowledge of dementia among the Dolcos, S., MacDonald, S. W. S., Braslavsky, A., Camicioli, R.,
Australian health workforce: A national online survey. & Dixon, R. A. (2012). Mild cognitive impairment is
Journal of Applied Gerontology, 1, 073346481775208. associated with selected functional markers: Integrating
doi:10.1177/0733464817752085 concurrent, longitudinal, and stability effects. Neuropsy-
Arnett, P. A. (2013). Secondary influences on neuropsychologi- chology, 26, 209–223. doi:10.1037/a0026760
cal test performance. New York, NY: Oxford University Dyall, S. C. (2015). Long-chain omega-3 fatty acids and the
Press. brain: A review of the Independent and shared effects of
Banks, S., Van Dongen, H. P., Maislin, G., & Dinges, D. F. EPA, DPA and DHA. Frontiers in Aging Neuroscience, 7,
(2010). Neurobehavioral dynamics following chronic sleep 52. doi:10.3389/fnagi.2015.00052
restriction: Dose-response effects of one night for recovery. Echemendia, R. J. (2013). Promotion of cognitive health
Sleep, 33, 1013–1026. through prevention: The case of sports concussion. In
Belanger, H. G., Barwick, F. H., Kip, K. E., Kretzmer, T., & J. J. Randolph (Ed.), Positive neuropsychology: Evidence-
Vanderploeg, R. D. (2013). Postconcussive symptom based perspectives on promoting cognitive health. New York,
complaints and potentially malleable positive predictors. NY: Springer ScienceþBusiness Media.
Clinical Neuropsychologist, 27(3), 343–355. doi:10.1080/ Erickson, K. I., Voss, M. W., Prakash, R. S., Basak, C., Szabo,
13854046.2013.774438 A., Chaddock, L., … Kramer, A. F. (2011). Exercise training
Bennett, D. A., Schneider, J. A., Tang, Y., Arnold, S. E., & increases size of hippocampus and improves memory.
Wilson, R. S. (2006). The effect of social networks on the Proceedings of the National Academy of Science, 108(7),
relation between Alzheimer’s disease pathology and level 3017–3022. doi:10.1073/pnas.1015950108
of cognitive function in old people: A longitudinal cohort Fox, K. C., Nijeboer, S., Dixon, M. L., Floman, J. L., Ellamil,
study. Lancet Neurology, 5, 406–412. doi:10.1016/S1474- M., Rumak, S. P., … Christoff, K. (2014). Is meditation
4422(06)70417-3 associated with altered brain structure? A systematic review
Boots, E. A., Schultz, S. A., Almeida, R. P., Oh, J. M., Koscik, and meta-analysis of morphometric neuroimaging in medi-
R. L., Dowling, M. N., … Okonkwo, O. C. (2015). Occu- tation practitioners. Neuroscience and Biobehavioral
pational complexity and cognitive reserve in a middle-aged Reviews, 43, 48–73. doi:10.1016/j.neubiorev.2014.03.016
cohort at risk for Alzheimer’s disease. Archives of Clinical Gefen, T., Papastefan, S. T., Rezvanian, A., Bigio, E. H.,
Neuropsychology, 30, 634–642. doi:10.1093/arclin/acv041 Weintraub, S., Rogalski, E., … Geula, C. (2018). Von
Boyle, P. A., Buchman, A. S., Barnes, L. L., & Bennett, D. A. Economo neurons of the anterior cingulate across the life-
(2010). Effect of a purpose in life on risk of incident span and in Alzheimer’s disease. Cortex, 99, 69–77.
Alzheimer disease and mild cognitive impairment in doi:10.1016/j.cortex.2017.10.015
community-dwelling older persons. Archives of General Gefen, T., Peterson, M., Papastefan, S. T., Martersteck, A.,
Psychiatry, 67(3), 304–310. doi:10.1001/archgenpsychiatry. Whitney, K., Rademaker, A., … Geula, C. (2015).
2009.208 Morphometric and histologic substrates of cingulate
Boyle, P. A., Buchman, A. S., Wilson, R. S., Yu, L., Schneider, integrity in elders with exceptional memory capacity.
J. A., & Bennett, D. A. (2012). Effect of purpose in life on Journal of Neuroscience, 35, 1781–1791. doi:10.1523/
the relation between Alzheimer disease pathologic changes JNEUROSCI.2998-14.2015
on cognitive function in advanced age. Archives of General Guilmette, T. J., & Paglia, M. F. (2004). The public’s miscon-
Psychiatry, 69(5), 499–506. doi:10.1001/archgenpsychiatry. ceptions about traumatic brain injury: A follow up survey.
2011.1487 Archives of Clinical Neuropsychology, 19, 183–189.
Chang, Y.-K., Hung, C.-L., Huang, C.-J., Hatfield, B. D., & Harrison, T. M., Weintraub, S., Mesulam, M. M., & Rogalski,
Hung, T.-M. (2014). Effects of an aquatic exercise program E. (2012). Superior memory and higher cortical volumes
on inhibitory control in children with ADHD: A prelimi- in unusually successful cognitive aging. Journal of the
nary study. Archives of Clinical Neuropsychology, 29, International Neuropsychological Society, 18, 1081–1085.
217–223. doi:10.1093/arclin/acu003 doi:10.1017/S1355617712000847
Cheng, S.-T., Chow, P. K., Song, Y. Q., Yu, E. C. S., Chan, Hawley, C. A., & Joseph, S. (2008). Predictors of
A. C. M., Lee, T. M. C., & Lam, J. H. M. (2014). Mental positive growth after traumatic brain injury: A longitudinal
and physical activities delay cognitive decline in older study. Brain Injury, 22, 427–435. doi:10.1080/
persons with dementia. American Journal of Geriatric 02699050802064607
Psychiatry, 22, 63–74. doi:10.1016/j.jagp.2013.01.060 Hertzog, C., Kramer, A. F., Wilson, R. S., & Lindenberger, U.
Cicerone, K. D., & Giacino, J. T. (1992). Remediation of (2009). Enrichment effects on adult cognitive development.
executive function deficits after traumatic brain injury. Psychological Science in the Public Interest, 9(1), 1–65.
Neurorehabilitation, 2, 73–83. doi:10.3233/NRE-1992- doi:10.1111/j.1539-6053.2009.01034.x
2304 Holzel, B. K., Carmody, J., Vangel, M., Cogleton, C.,
De Frias, C. M., & Dixon, R. A. (2014). Lifestyle engagement Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011).
affects cognitive status differences and trajectories on Mindfulness practice leads to increases in regional brain
executive functions in older adults. Archives of Clinical gray matter density. Psychiatry Research: Neuroimaging,
Neuropsychology, 29, 16–25. doi:10.1093/arclin/act089 191, 36–43. doi:10.1016/j.psychresns.2010.08.006
De Souto Barreto, P., Delrieu, J., Andrieu, S., Vellas, B., & Hosking, D. E., Sargent-Cox, K. A., & Anstey, K. J. (2015). An
Rolland, Y. (2016). Physical activity and cognitive function Australian survey of cognitive health beliefs, intentions,
in middle-aged and older adults: An analysis of 104,909 and behaviours through the adult life course. Preventive
 APPLIED NEUROPSYCHOLOGY: ADULT 293

Medicine Reports, 2, 498–504. doi:10.1016/j.pmedr.2015. NY: Springer ScienceþBusiness Media. doi:10.1007/978-1-

06.008 4614-6605-5_7
Hu, Y., & Ericsson, K. A. (2012). Memorization and recall of Opdebeeck, C., Matthews, F. E., Wu, Y. T., Woods, R. T.,
very long lists accounted for within the long-term working Brayne, C., & Clare, L. (2017). Cognitive reserve as a
memory framework. Cognitive Psychology, 64, 235–266. moderator of the negative association between mood and
doi:10.1016/j.cogpsych.2012.01.001 cognition: Evidence from a population-representative
James, B. D., Wilson, R. S., Barnes, L. L., & Bennett, D. A. cohort. Psychological Medicine, 19, 1–11. doi:10.1017/
(2011). Late-life social activity and cognitive decline in S003329171700126X
old age. Journal of the International Neuropsychological Ophir, E., Nass, C., & Wagner, A. D. (2009). Cognitive control
Society, 17, 998–1005. doi:10.1017/S1355617711000531 in media multitaskers. Proceedings of the National Academy
Jorm, A. F. (2012). Mental health literacy: Empowering of Science, 106, 15583–15587. doi:10.1073/pnas.0903620106
the community to take action for better mental health. Peleg, G., Barak, O., Harel, Y., Rochberg, J., & Hoofien, D.
American Psychologist, 67, 231–243. doi:10.1037/a0025957 (2009). Hope, dispositional optimism and severity of
Kim, E. S., Sun, J. K., Park, N., & Peterson, C. (2013). Purpose depression following traumatic brain injury. Brain Injury,
in life and reduced incidence of stroke in older adults: The 23, 80–808. doi:10.1080/02699050903196696
health and retirement study. Journal of Psychosomatic Perry, W., Potterat, E. G., & Braff, D. L. (2001). Self-
Research, 74, 427–432. doi:10.1016/j.jpsychores.2013.01.01 monitoring enhances Wisconsin card sorting test perfor-
Krueger, K. R., Wilson, R. S., Barnes, L. L., Bienias, J. L., & mance in patients with schizophrenia: Performance is
Bennett, D. A. (2009). Social engagement and cognitive improved by simply asking patients to verbalize their sort-
function in old age. Experimental Aging Research, 35, ing strategy. Journal of the International Neuropsychological
45–60. doi:10.1080/03610730802545028 Society, 7, 344–352.
Leckie, R. L., Manuck, S. B., Bhattacharjee, N., Muldoon, Pillai, J. A., Hall, C. B., Dickson, D. W., Buschke, H., Lipton,
M. F., Flory, J. M., & Erickson, K. I. (2014). Omega-3 fatty R. B., & Verghese, J. (2011). Association of crossword
acids moderate effects of physical activity on cognitive puzzle participation with memory decline in persons who
function. Neuropsychologia, 59, 103–111. doi:10.1016/j. develop dementia. Journal of the International Neuro-
neuropsychologia.2014.04.018 psychological Society, 17, 1006–1013. doi:10.1017/
Liao, J., Head, J., Kumari, M., Stansfield, S., Kivimaki, M., S1355617711001111
Singh-Manoux, A., & Brunner, E. J. (2014). Negative Rabinowitz, A. R., & Arnett, P. A. (2009). A longitudinal
aspects of close relationships as risk factors for cognitive analysis of cognitive dysfunction, coping, and depression
aging. American Journal of Epidemiology, 180, 1118–1125. in multiple sclerosis. Neuropsychology, 23(5), 581–591.
doi:10.1093/aje/kwu236 doi:10.1037/a0016064
Liao, J., & Scholes, S. (2017). Association of social support and Randolph, J. J. (2013). What is positive neuropsychology?
cognitive aging modified by sex and relationship type: A In J. J. Randolph (Ed.), Positive neuropsychology:
prospective investigation in the English Longitudinal Study Evidence-based perspectives on promoting cognitive health
of Ageing. American Journal of Epidemiology, 186, 787–795. (pp. 1–11). New York, NY: Springer ScienceþBusiness
doi:10.1093/aje/kwx142 Media, LLC. doi:10.1007/978-1-4614-6605-5_1
Lourida, I., Soni, M., Thompson-Coon, J., Purandare, N., Randolph, J. J. (2015a). Searching for cognitive health:
Lang, I. A., Ukoumunne, O. C., & Llewellyn, D. J. (2013). Another look through the Archives. Archives of Clinical
Mediterranean diet, cognitive function, and dementia: A Neuropsychology, 30, 583–584. doi:10.1093/arclin/
systematic review. Epidemiology, 24, 479–489. doi:10.1097/ acv047.259
EDE.0b013e3182944410 Randolph, J. J. (2015b). State of the field of positive neuropsy-
Luria, A. R. (1968). The mind of a mnemonist. Cambridge, chology. Invited Keynote presentation delivered at SuperB-
MA: Harvard University Press. rains 2015 Conference, Las Vegas, NV, May 2015.
Maher, A. C., Kielb, S., Loyer, E., Connelley, M., Rademaker, Randolph, J. J., Randolph, J. S., & Wishart, H. A. (2018). Sub-
A., Mesulam, M.-M., … Rogalski, E. (2017). Psychological group analysis of individuals with MS showing increased
well-being in elderly adults with extraordinary episodic resilience and cognitive reserve. Presented at the 46th annual
memory. PLoS ONE, 12(10), e0186413. doi:10.1371/ meeting of the International Neuropsychological Society,
journal.pone.0186413 Washington, DC.
Meichenbaum, D. H., & Goodman, J. (1971). Training Randolph, J. S., & Randolph, J. J. (2013). Modifiable lifestyle
impulsive children to talk to themselves: A means of factors and cognition through midlife. In J. J. Randolph
developing self-control. Journal of Abnormal Psychology, (Ed.), Positive neuropsychology: Evidence-based perspectives
77, 115–126. on promoting cognitive health. New York, NY: Springer
Merz, Z. C., Van Patten, R., & Lace, J. (2017). Current public ScienceþBusiness Media, LLC. doi:10.1007/978-1-4614-
knowledge pertaining to traumatic brain injury: Influence 6605-5_3
of demographic factors, social trends, and sport concussion Raji, C. A., Erickson, K. I., Lopez, O. L., Kuller, L. H., Gach, H.
experience on the understanding of traumatic brain injury M., Thompson, P. M., … Becker, J. T. (2014). Regular fish
sequelae. Archives of Clinical Neuropsychology, 32, 155–167. consumption and age-related brain gray matter loss.
doi:10.1093/arclin/acw092 American Journal of Preventative Medicine, 47, 444–451.
O’Connor, M. K., & Kraft, M. L. (2013). Lifestyle factors and doi:10.1016/j.amepre.2014.05.037
successful cognitive aging in older adults. In J. J. Randolph Reiter, K., Nielson, K. A., Smith, T. J., Weiss, L. R., Alfini,
(Ed.), Positive neuropsychology: Evidence-based perspectives A. J., & Smith, C. (2015). Improved cardiorespiratory
on promoting cognitive health (pp. 121–141). New York, fitness is associated with increased cortical thickness in
294 J. J. RANDOLPH

mild cognitive impairment. Journal of the International memory-related networks in very old adults. Journals of
Neuropsychological Society, 21, 757–767. doi:10.1017/ Gerontology: Medical Sciences, 69, 1284–1290. doi:10.1093/
S135561771500079X gerona/glt287
Ruff, R. M. (2003). A friendly critique of neuropsychology: Todis, B., & Glang, A. (2008). Redefining success: Results of a
Facing the challenges of our future. Archives of Clinical qualitative study of postsecondary transition outcomes
Neuropsychology, 18, 847–864. doi:10.1016/j.acn.2003. for youth with traumatic brain injury. Journal of Head
07.002 Trauma Rehabilitation, 23, 252–263. doi:10.1097/01.
Sabia, S., Elbaz, A., Dugravot, A., Head, J., Shipley, M., HTR.0000327257.84622.bc
Hagger-Johnson, G., … Singh-Manoux, A. (2012). Impact Ukueberuwa, D. M., & Arnett, P. A. (2014). Evaluating the
of smoking on cognitive decline in early old age: The role of coping style as a moderator of fatigue and risk for
Whitehall II cohort study. Archives of General Psychiatry, future cognitive impairment in multiple sclerosis. Journal
69, 627–635. doi:10.1001/archgenpsychiatry.2011.2016 of the International Neuropsychological Society, 20,
Schmitter-Edgecombe, M. S., Seelye, A., & Cook, D. J. (2013). 751–755. doi:10.1017/S1355617714000587
Technologies for health assessment, promotion, and assist- Waters, F., & Bucks, R. S. (2011). Neuropsychological effects
ance: Focus on gerontechnology. In J. J. Randolph (Ed.), of sleep loss: Implication for neuropsychologists. Journal
Positive neuropsychology: Evidence-based perspectives on of the International Neuropsychological Society, 17,
promoting cognitive health (pp. 143–160). New York, NY: 571–586. doi:10.1017/S1355617711000610
Springer ScienceþBusiness Media. doi:10.1007/978-1- Wilson, R. S., & Bennett, D. A. (2017). How does psychosocial
4614-6605-5_8 behavior contribute to cognitive health in old age? Brain
Seligman, M. E. P. (1999). 1998 Annual report. The Sciences, 7, 56. doi:10.3390/brainsci7060056
president’s address. American Psychologist, 54, 559–562. Wilson, R. S., De Leon, C. F. M., Barnes, L. L., Schneider, J. A.,
doi:10.1037/0003-066X.54.8.537 Bienias, J. L., Evans, D. A., & Bennett, D. A. (2002).
Sohlberg, M. M., & Mateer, C. A. (2001). Cognitive Participation in cognitively stimulating activities and risk
rehabilitation: An integrative neuropsychological approach. of Alzheimer disease. Journal of the American Medical
New York, NY: Guilford. Association, 287(6), 742–748.
Szuhany, K. L., Bugatti, M., & Otto, M. W. (2015). A meta- Woods, S. P., Weber, E., Cameron, M. V., Dawson, M. S.,
analytic review of the effects of exercise on brain-derived Delano-Wood, L., Bondi, M. W., … The HIV Neuro-
neurotrophic factor. Journal of Psychiatric Research, 60, behavioral Research Center (HNRC) Group. (2010).
56–64. doi:10.1016/j.jpsychires.2014.10.003 Spontaneous strategy use protects against visual working
Tan, W. J., Hong, S.-L., Luo, N., Lo, T. J., & Yap, P. (2012). memory deficits in older adults infected with HIV. Archives
The lay public’s understanding and perception of dementia of Clinical Neuropsychology, 25, 724–733. doi:10.1093/
in a developed Asian nation. Dementia and Geriatric arclin/acq069
Cognitive Disorders, 2, 433–444. doi:10.1159/000343079 Yu, L., Boyle, P. A., Wilson, R. S., Levine, S. R., Schneider,
Tian, Q., Erickson, K. I., Simonsick, E. M., Aizenstein, H. J., J. A., & Bennett, D. A. (2015). Purpose in life and cerebral
Glynn, N. W., Boudreau, R. M., … Rosano, C. (2014). infarcts in community-dwelling older people. Stroke, 46,
Physical activity predicts microstructural integrity in 1071–1076. doi:10.1161/STROKEAHA.114.008010