OBJECTIVE: Cognitive assessment is based on performance in different tests. However, this performance might be hindered by lack of effective effort on the one hand, and by too much stress on the other hand. Despite their known impact, there are currently no effective tools for measuring cognitive effort or stress effect during cognitive assessment. We developed real-time electrophysiological markers for cognitive effort and for stress effect, which could be used during cognitive assessment.
METHODS: We assessed these markers during the use of the Montreal Cognitive Assessment (MoCA) before and after cardiac surgery, which is known to involve cognitive decline in up to 30%-50% of elderly patients.
RESULTS: The major findings of the study, for the largest group of patients, with preoperative MoCA in the intermediate range, were that the decline is significantly associated (1) with higher preoperative cognitive effort and (2) with higher postoperative stress effect during the test.
CONCLUSIONS: These findings, as well as preliminary additional ones, suggest a potential importance for monitoring cognitive effort and stress effect during assessment in general, and specifically during perioperative assessment.
CONCLUSIONS: Easy-to-use markers could improve the efficacy of cognitive assessment and direct treatment generally, and specifically for perioperative decline.

When given a choice, people will avoid cognitively effortful courses of action because the experience of effort is evaluated as aversive and costly. At the same time, a body of work spanning psychology, economics, and neuroscience suggests that goods, actions, and experiences are often evaluated in the context in which they are encountered, rather in absolute terms. To probe the extent to which the evaluation of cognitive effort is also context-dependent, we had participants learn associations between unique stimuli and subjective demand levels across low-demand and high-demand contexts. We probed demand preferences and subjective evaluation using a forced-choice paradigm as well by examining effort ratings, taken both on-line (during learning) and off-line (after choice). When choosing between two stimuli objectively identical in terms of demand, participants showed a clear preference for the stimulus learned in the low- versus high-demand context and rated this stimulus as more subjectively effortful than the low-demand context in on-line but not off-line ratings, suggesting an assimilation effect. Finally, we observed that the extent to which individual participants who exhibited stronger assimilation effects in off-line demand ratings were more likely to manifest an assimilation effect in demand preferences. Broadly, our findings suggest that effort evaluations occur in a context-dependent manner and are specifically assimilated to the broader context in which they occur.

People often choose suboptimal attentional control strategies during visual search. This has been at least partially attributed to the avoidance of the cognitive effort associated with the optimal strategy, but aspects of the task triggering such avoidance remain unclear. Here, we attempted to measure effort avoidance of an isolated task component to assess whether this component might drive suboptimal behavior. We adopted a modified version of the Adaptive Choice Visual Search (ACVS), a task designed to measure people\'s visual search strategies. To perform optimally, participants must make a numerosity judgment-estimating and comparing two color sets-before they can advantageously search through the less numerous of the two. If participants skip the numerosity judgment step, they can still perform accurately, albeit substantially more slowly. To study whether effort associated with performing the optional numerosity judgment could be an obstacle to optimal performance, we created a variant of the demand selection task to quantify the avoidance of numerosity judgment effort. Results revealed a robust avoidance of the numerosity judgment, offering a potential explanation for why individuals choose suboptimal strategies in the ACVS task. Nevertheless, we did not find a significant relationship between individual numerosity judgment avoidance and ACVS optimality, and we discussed potential reasons for this lack of an observed relationship. Altogether, our results showed that the effort avoidance for specific subcomponents of a visual search task can be probed and linked to overall strategy choices.

The study aimed to investigate the effects of an embodied mindfulness treatment on chronometric mental rotation. Forty-four women and 47 men participated and were randomly divided into two groups: a mindfulness induction group and a control group. They completed two sets of 150 mental rotation tasks with cube figures each. Subjective cognitive effort (measured after each block), reaction time, and accuracy were analyzed using linear mixed models with the factors of time, mindfulness, angular disparity, and gender. The significant finding was a three-way interaction between pre-post testing, mindfulness, and gender for reaction times. This interaction suggests that women might benefit more from the mindfulness induction, while men may benefit more from the control condition. The analysis of subjective cognitive effort indicates that women and men perceive the same cognitive effort when solving cube-figure tasks.

Current theories propose that mental effort is invested only when the anticipated benefits, such as rewards, outweigh the associated costs, like task difficulty. Yet, it remains unclear whether this motivational and mitigating aspect of reward processing is reflected in the evaluation of reward/difficulty cues as such, and to what extent it depends on task experience. In a pre-registered experiment (N = 84), we used the affect misattribution procedure (AMP) to gauge affective evaluations of nonword cues predicting reward and task difficulty levels. Contrary to previous studies, the AMP was administered at the outset, after cue instructions, and after the cues were used in a random dot motion (RDM) task. Compared to baseline, cues predicting a larger reward were evaluated more positively after RDM task experience, and most importantly, already after cue instructions, with no difference between the two phases. This evaluative effect manifested in increased performance after larger reward cues in the RDM task. Our results suggest that AMP effects may generally capture performance expectations which are independent of task experience. Importantly, these instructed expectations of reward and difficulty play a crucial role in the evaluation and subsequent investment of mental effort.

OBJECTIVE: To develop and validate a novel measure, action entropy, for assessing the cognitive effort associated with electronic health record (EHR)-based work activities.
METHODS: EHR-based audit logs of attending physicians and advanced practice providers (APPs) from four surgical intensive care units in 2019 were included. Neural language models (LMs) were trained and validated separately for attendings\' and APPs\' action sequences. Action entropy was calculated as the cross-entropy associated with the predicted probability of the next action, based on prior actions. To validate the measure, a matched pairs study was conducted to assess the difference in action entropy during known high cognitive effort scenarios, namely, attention switching between patients and to or from the EHR inbox.
RESULTS: Sixty-five clinicians performing 5 904 429 EHR-based audit log actions on 8956 unique patients were included. All attention switching scenarios were associated with a higher action entropy compared to non-switching scenarios (P < .001), except for the from-inbox switching scenario among APPs. The highest difference among attendings was for the from-inbox attention switching: Action entropy was 1.288 (95% CI, 1.256-1.320) standard deviations (SDs) higher for switching compared to non-switching scenarios. For APPs, the highest difference was for the to-inbox switching, where action entropy was 2.354 (95% CI, 2.311-2.397) SDs higher for switching compared to non-switching scenarios.
CONCLUSIONS: We developed a LM-based metric, action entropy, for assessing cognitive burden associated with EHR-based actions. The metric showed discriminant validity and statistical significance when evaluated against known situations of high cognitive effort (ie, attention switching). With additional validation, this metric can potentially be used as a screening tool for assessing behavioral action phenotypes that are associated with higher cognitive burden.
CONCLUSIONS: An LM-based action entropy metric-relying on sequences of EHR actions-offers opportunities for assessing cognitive effort in EHR-based workflows.

Proactive interference (PI) occurs when previously learned information impairs memory for more recently learned information. Most PI studies have employed verbal stimuli, while the role of PI in visual working memory (VWM) has had relatively little attention. In the verbal domain, Johansson and colleagues (2018) found that pupil diameter - a real-time neurophysiological index of cognitive effort - reflects the accumulation and resolution of PI. Here we use a novel, naturalistic paradigm to test the behavioral and pupillary correlates of PI resolution for what-was-where item-location bindings in VWM. Importantly, in our paradigm, trials (PI vs. no-PI condition) are mixed in a block, and participants are naïve to the condition until they are tested. This design sidesteps concerns about differences in encoding strategies or generalized effort differences between conditions. Across three experiments (N = 122 total) we assessed PI\'s effect on VWM and whether PI resolution during memory retrieval is associated with greater cognitive effort (as indexed by the phasic, task-evoked pupil response). We found strong support for PI\'s detrimental effect on VWM (even with our spatially distributed stimuli), but no consistent link between interference resolution and effort during memory retrieval (this, even though the pupil was a reliable indicator that higher-performing individuals tried harder during memory encoding). We speculate that when explicit strategies are minimized, and PI resolution relies primarily on implicit processing, the effect may not be sufficient to trigger a robust pupillometric response.

Individuals exhibit limited awareness of when their attention is captured by salient but irrelevant stimuli, and it has long been argued that involuntary attentional capture by such stimuli is minimally disruptive to information processing. Yet, robust mechanisms of distractor suppression are hypothesized to support the control of attention, which presumably serve in the interest of managing distraction. In the present study, I examine whether participants are aware of the cost of distraction with respect to task performance, and whether they are motivated to manage this cost even when it is effortful to do so. Across three experiments, participants were willing to exert physical effort in order to reduce the frequency with which they encountered physically salient distractors, and in a fourth experiment tended to prefer trials with fewer distractors when given a choice over distractor frequency. Importantly, the amount of physical effort exerted varied as a function of the degree to which task-irrelevant distractors impaired search performance, suggesting that people are sensitive to the cost of distraction.

Despite people\'s general desire to avoid cognitive effort, there is a limit to our parsimony: boredom, a state defined by a lack of successful mental engagement, is found to be similarly aversive. The work presented here investigates how context - the alternative tasks present and the environmental context - impacts people\'s aversion to exerting cognitive effort and avoiding boredom via a demand-selection task. In a population of undergraduate students, we assessed how people\'s willingness to exert mental effort (in a working memory task) is affected by the presence of an easier alternative (less cognitively demanding) or a boring alternative (doing nothing at all). To manipulate environmental context, we conducted the experiment online, where participants completed the task remotely, and in a controlled laboratory setting. We find people willingly seek out effortful tasks to avoid boredom, despite avoiding high demands when both tasks on offer required some effort. We also find large effects of the participants\' environmental context, with preferences for the most demanding task increasing by over 150% in the lab compared to online. These results bear relevance to theories that argue the costs of effort are determined relative to the alternatives available (e.g., opportunity cost theories). Moreover, the results demonstrate that researchers who deliberately (or inadvertently) manipulate effort and boredom must consider the effects context (both choice and environmental) may have on people\'s behaviour.

While the exertion of mental effort improves performance on cognitive tasks, the neural mechanisms by which motivational factors impact cognition remain unknown. Here, we used fMRI to test how changes in cognitive effort, induced by changes in task difficulty, impact neural representations of working memory (WM). Participants (both sexes) were precued whether WM difficulty would be hard or easy. We hypothesized that hard trials demanded more effort as a later decision required finer mnemonic precision. Behaviorally, pupil size was larger and response times were slower on hard compared with easy trials suggesting our manipulation of effort succeeded. Neurally, we observed robust persistent activity during delay periods in the prefrontal cortex (PFC), especially during hard trials. Yet, details of the memoranda could not be decoded from patterns in prefrontal activity. In the patterns of activity in the visual cortex, however, we found strong decoding of memorized targets, where accuracy was higher on hard trials. To potentially link these across-region effects, we hypothesized that effort, carried by persistent activity in the PFC, impacts the quality of WM representations encoded in the visual cortex. Indeed, we found that the amplitude of delay period activity in the frontal cortex predicted decoded accuracy in the visual cortex on a trial-wise basis. These results indicate that effort-related feedback signals sculpt population activity in the visual cortex, improving mnemonic fidelity.