Implementation and Validation of an Emergency Department Consult Tracking Tool for Monitoring Consultant Turnaround Times.

In aging, while a few cognitive processes such as semantic knowledge are relatively resistant, most cognitive processes deteriorate, including episodic memory and inhibitory control functions (). This age-related decline in cognitive processing is accompanied by an age-related shift in structural and functional brain properties (; ). To account for these observations, proposed the default–executive coupling hypothesis of aging (DECHA) (; ). DECHA posits that cognitive decline is accompanied by an increased and inflexible coupling between the default-mode network (DMN) and lateral prefrontal regions paralleling decline in cognitive control. How this pattern of default–executive coupling unfolds across the lifespan and relates to episodic memory performance remain unclear, and, importantly, longitudinal data are scarce. Here, we tested the main hypotheses of this DECHA model across the lifespan (ages 6–81 years) using measures of longitudinal changes in cognitive control function over 3.5 years and functional connectivity (FC) during incidental encoding and retrieval of episodic memories. While DECHA does not directly address development, it is broadly known and agreed that cognitive control increases with maturation (; ; ) and decreases with aging (; ; ). Thus, it is of interest to investigate hypotheses of aging in relation to development () and to evaluate the specificity of aging hypotheses with younger age contrasts. Specifically, DECHA consists of two central hypotheses. The first hypothesis states that general cognitive decline in aging is accompanied by increased functional coupling between the default-mode network (DMN) and the left dorsolateral prefrontal cortex (dlPFC). The DMN is a large-scale brain network that includes medial temporal lobe regions, involved in episodic memory, mental simulation, and future imagination (; ; ; ). The dlPFC is involved in prioritizing task-relevant information and likely plays a crucial role in cognitive control (; ; ). In support of this first hypothesis of DECHA, several cross-sectional studies have shown a pattern of greater dlPFC–DMN coupling in older relative to younger adults during tasks of cognitive control (; ; ). A foundational study demonstrated that higher FC between the left dlPFC and key nodes of the DMN was associated with worsened goal-oriented planning behavior in adults between 63 and 78 years of age, while the same pattern of FC was not found in younger adults (18–27 years), indicating different levels of cognitive control relating differentially to this pattern of functional connectivity (). However, in the context of episodic memory, only one study has associated FC between the DMN and a network including the dlPFC, and episodic memory performance in adults over 70 years of age (). This association was derived from resting-state fMRI data within a limited age range and in a clinical sample. Hence, it remains unclear how dlPFC–DMN coupling during episodic memory operations evolves with age in normative aging.