Cognitive difficulties in Multiple Sclerosis (MS) are important contributors to impairment in instrumental activities of daily living. A non-randomised controlled trial was conducted to explore the effects of a cognitive rehabilitation protocol on MS patients' daily life functionality.

Seventy-five relapsing-and-remitting MS patients were recruited. Intervention Group (IG, n=31) underwent 16 individual rehabilitation sessions (1hx2/week; weeks 2-10), which included paper and pencil cognitive stimulation exercises and training memory strategies and external memory aids; and a booster session (week 37). Control Group (CG, n=44) received care as usual. These primary outcome measures were applied at baseline and at weeks 11, 36, and 62: Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ), Mental Slowness Questionnaire (MSQ), Mental Slowness Observation Test (MSOT), and Sydney Psychosocial Reintegration Scale-2 (SPRS-2). Score differences from baseline were calculated for all measures and follow-up time points except for SPRS-2, which was only applied twice (baseline and week 62). Linear regressions fitted with generalized estimating equations (GEE) were performed to verify the effects of time and group on the outcome measures. Baseline scores were included in the model as covariates for all outcome measure except SPRS-2. Chi-square and Mann-Whitney tests were applied to compare demographic and clinical characteristics of the groups.

Groups had similar demographic (i.e., sex, age, and education) and clinical (i.e., age at disease onset, disease duration, disease modifying treatments, and Expanded Disability Status Scale score) characteristics. IG's MSQ score progressively improved, whereas CG's score did not change from baseline (group x time effect: p<0.001) throughout follow-up. IG's MSNQ score improved from baseline at weeks 11 and 36, but not at week 62. CG's MSNQ score did not change from baseline throughout follow-up (group x time effect: p=0.025). Both IG's and CG's performance on the MSOT improved (time effects). Though, the IG showed greater improvement at follow-up (group effects) on MSOT score and time (both p<0.001). IG's SPRS-2 improved, whereas CG's score declined (group x time effect: p<0.001).

Combining restorative techniques with strategy-based compensatory techniques may produce significant and persistent effects on MS patients' self-reported everyday functioning and on their objective performance of instrumental tasks.

Multiple sclerosis (MS) has historically been considered a syndrome that primarily affects White persons of northern European ancestry. This has been strongly disproven in recent decades with prevalence/incidence studies showing that MS impacts individuals from diverse backgrounds. The few studies available investigating clinical characteristics of MS across diverse groups have shown that Hispanic/Latinx/e (Latinx) and non-Hispanic Black/African American (NHB) persons with MS (pwMS) have more severe disease trajectories compared to non-Hispanic Whites (NHW), including an earlier age of disease onset, greater disability, and more severe symptoms overall. Changes in brain structure have been linked outcomes and MS-itself, but what remains understudied is how brain structure differs across race/ethnicity. As such, the current study aims to investigate volumetric brain differences in a diverse sample of pwMS.

The sample (n=79) was compiled from multiple neuroimaging datasets and divided into three groups- Latinx (n=19), NHB (n=29), and NHW (n=32)- based on self-reported race/ethnicity. Participants completed demographic interviews and structural magnetic resonance imaging (MRI) scans. Neuroimaging data was visually inspected and processed in FreeSurfer (7.3.2). Volumetric measures for total gray matter, cortical gray matter, total white matter, and subcortical gray matter were used as the primary outcome measures.

A multivariate general linear model was used to examine volumetric brain differences across groups. Age and total intracranial volume were included as covariates. Results showed a significant effect of race/ethnicity (Pillai’s Trace=0.175, F(6, 148)=2.36, p=.033), indicating significant differences in volumetric brain metrics across race/ethnicity, namely for subcortical gray matter, total gray matter, and total white matter volumes. Post-hoc testing showed the Latinx group to have less subcortical gray matter, total gray matter, and total white matter than NHWs. There was a trend for the NHB versus NHW, with NHBs having less brain volume. No significant differences were observed between the Latinx and NHB groups. Lesion volume and regional gray matter volumes were also examined.

To the authors’ knowledge, this is among the first studies to investigate structural brain differences across race/ethnicity in pwMS. Results point to disparities in brain volume across racial/ethnic groups with MS. These differences may partially underlie the differing trajectories observed in clinical characteristics across race/ethnicity. Future studies should include larger samples of diverse pwMS and examine the intersection of psychosocial and systemic factors (i.e., social determinants of health) and brain metrics to better understand the divergent disease trajectories observed across groups.

PD patients commonly exhibit executive dysfunction early in the disease course which may or may not predict further cognitive decline over time. Early emergence of visuospatial and memory impairments, in contrast, are more consistent predictors of an evolving dementia syndrome. Most prior studies using fMRI have focused on mechanisms of executive dysfunction and have demonstrated that PD patients exhibit hyperactivation that is dependent on the degree of cognitive impairment, suggestive of compensatory strategies. No study has evaluated whether PD patients with normal cognition (PD-NC) and PD patients with Mild Cognitive Impairment (PD-MCI) exhibit compensatory activation patterns during visuospatial task performance.

10 PD-NC, 12 PD-MCI, and 14 age and sex-matched healthy controls (HC) participated in the study. PD participants were diagnosed with MCI based on the Movement Disorders Society Task Force, Level II assessment (comprehensive assessment). Functional magnetic resonance imaging (fMRI) was performed during a motion discrimination task that required participants to identify the direction of horizontal global coherent motion embedded within dynamic visual noise under Low and High coherence conditions. Behavioral accuracy and functional activation were evaluated using 3 * 2 analyses of covariance (ANCOVAs) (group [HC, PD-NC, PD-MCI] * Coherence [High vs. Low]) accounting for age, sex, and education. Analyses were performed in R (v4.1.2(Team, 2013)).

PD-MCI (0.702± 0.269) patients exhibited significantly lower accuracy on the motion discrimination task than HC (0.853 ± 0.241; p = 0.033) and PD-NC (0.880 ± 0.208; p =0.039). A Group * Coherence interaction was identified in which several regions, including orbitofrontal, posterior parietal and occipital cortex, showed increased activation during High relative to Low coherence trials in the PD patient groups but not in the HC group. HC showed default mode deactivation and frontal-parietal activation during Low relative to High coherence trials that was not evident in the patient groups.

PD-MCI patients exhibited worse visuospatial performance on a motion discrimination task than PD-NC and HC participants and exhibited hyperactivation of the posterior parietal and occipital regions during motion discrimination, suggesting possible compensatory activation.

Neuromelanin imaging is an emerging biomarker for PD as it captures degeneration of the midbrain, a process which is associated with the motor symptoms of the disease. Currently, it is unknown whether this degeneration also contributes to cognitive dysfunction in PD beyond dysfunction associated with fronto-subcortical systems, as quantitative examination of substantia nigra (SN) degeneration could not be studied until recently.

In the current study, we examine whether neuromelanin signal is associated with broader cognitive dysfunction in PD patients with varying degrees of cognitive impairment: PD with normal cognition (PD-NC), PD with mild cognitive impairment (PD-MCI), and healthy controls (HC).

11 PD-NC, 16 PD-MCI and 14 age and sex-matched healthy controls (HC) participated in the study. PD participants were diagnosed with MCI based on the Movement Disorders Society Task force, Level II assessment (comprehensive assessment). In addition, all participants underwent an MRI scan that included a T1-weighted sequence and a neuromelanin-sensitive (NM-MRI) sequence. Contrast-to-noise-ratio of the substantia nigra pars compacta (SNc) was calculated and a distribution-corrected z-score was used to identify the number of extrema voxels for each individual, suggestive of the number of voxels that have exhibited significant degeneration (extrema_count). An analysis of covariance (ANCOVA) was used to evaluate group differences between HC, PD-NC, and PD-MCI in the extrema_count accounting for age, sex, and education. A multiple regression for each cognitive variable with extrema_count as the dependent variable adjusting for age, sex, and education were conducted.

A significant main effect of group (F(2, 33) = 33.548 ; p < 0.001) indicated that PD-NC (21.55 ± 12.57) and PD-MCI (43.64 ± 32.84) patients exhibited significantly greater extrema_counts relative to HC (3.36 ± 3.61; both p < 0.001). Regression results indicated that higher extrema_counts were associated with worse cognitive performance across cognitive domains, including working memory (Digit Span Backward; R2 = .357, F(1,20) = 5.295, p = .032), (Hopkins Verbal Learning Test - Revised, Trials 1 to 3; R2 = .432, F(1,20) = 5.819, p = .026).

PD patients (PD-NC and PD-MCI) exhibited decreased neuromelanin in the SNc relative to healthy controls, confirming the ability of the NM-MRI sequence to differentiate PD from HC. There was no significant difference in SNc neuromelanin levels between PD-NC patients and PD-MCI patients, however, this is likely due to the small sample size. In addition, significant SNc degeneration was associated with worse cognitive performances in tasks associated with working memory and executive functioning. These results warrant further examination of the role of SN in PD patients with differing levels of cognitive impairment.

Parkinsonism and Parkinson's disease (PD) have been described as consequences of repetitive head impacts (RHI) from boxing, since 1928. Autopsy studies have shown that RHI from other contact sports can also increase risk for neurodegenerative diseases, including chronic traumatic encephalopathy (CTE) and Lewy bodies. In vivo research on the relationship between American football play and PD is scarce, with small samples, and equivocal findings. This study leveraged the Fox Insight study to evaluate the association between American football and parkinsonism and/or PD Diagnosis and related clinical outcomes.

Fox Insight is an online study of people with and without PD who are 18+ years (>50,000 enrolled). Participants complete online questionnaires on motor function, cognitive function, and general health behaviors. Participants self-reported whether they "currently have a diagnosis of Parkinson's disease, or parkinsonism, by a physician or other health care professional." In November 2020, the Boston University Head Impact Exposure Assessment was launched in Fox Insight for large-scale data collection on exposure to RHI from contact sports and other sources. Data used in this abstract were obtained from the Fox Insight database https://foxinsight-info.michaeljfox.org/insight/explore/insight.jsp on 01/06/2022. The sample includes 2018 men who endorsed playing an organized sport. Because only 1.6% of football players were women, analyses are limited to men. Responses to questions regarding history of participation in organized football were examined. Other contact and/or non-contact sports served as the referent group. Outcomes included PD status (absence/presence of parkinsonism or PD) and Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15) for assessment of cognitive symptoms. Binary logistic regression tested associations between history and years of football play with PD status, controlling for age, education, current heart disease or diabetes, and family history of PD. Linear regressions, controlling for these variables, were used for the PDAQ-15.

Of the 2018 men (mean age=67.67, SD=9.84; 10, 0.5% Black), 788 (39%) played football (mean years of play=4.29, SD=2.88), including 122 (16.3%) who played youth football, 494 (66.0%) played high school, 128 (17.1%) played college football, and 5 (0.7%) played at the semi-professional or professional level. 1738 (86.1%) reported being diagnosed with parkinsonism/PD, and 707 of these were football players (40.7%). History of playing any level of football was associated with increased odds of having a reported parkinsonism or PD diagnosis (OR=1.52, 95% CI=1.14-2.03, p=0.004). The OR remained similar among those age <69 (sample median age) (OR=1.45, 95% CI=0.97-2.17, p=0.07) and 69+ (OR=1.45, 95% CI=0.95-2.22, p=0.09). Among the football players, there was not a significant association between years of play and PD status (OR=1.09, 95% CI=1.00-1.20, p=0.063). History of football play was not associated with PDAQ-15 scores (n=1980) (beta=-0.78, 95% CI=-1.59-0.03, p=0.059) among the entire sample.

Among 2018 men from a data set enriched for PD, playing organized football was associated with increased odds of having a reported parkinsonism/PD diagnosis. Next steps include examination of the contribution of traumatic brain injury and other sources of RHI (e.g., soccer, military service).

Nationally and internationally, life expectancies continue to increase, and so are age-related cognitive impairment (Stough et al., 2015). As a result, the rise of consumer dietary supplement products has increased significantly in the last 20 years as older adults are inundated with media related to improving cognitive function. However, research on these nootropics and natural supplements reveals mixed efficacy (Brownie, 2009; Stough et al., 2015). Serendipitously, the COVID-19 pandemic has unveiled the necessity for increased healthy equity and screening internationally across health service disciplines (Jensen et al., 2021; Wells & Dumbrell, 2006). This poster encompasses two primary aims: (1) to highlight common international dietary supplements marketed to an older adult population. Next, (2) develop best evidenced-based practices to approach effective use of nutritional information while maintaining a neuropsychologist’s scope of care.

A literature review was conducted of peer review articles from 2006 to 2022 from the following databases PubMed and Google Scholar. Recommendations were constructed based on identifying and analyzing the emerging themes across identified articles. Keywords include neuropsychology, nootropics, natural supplement use, aging, Vitamin E, Vitamin D, Phosphatidylserine, feedback, cognition, older adults, and international.

Although supplement use and regulations may differ by country, current research suggests increased supplement use and inquiries to neuropsychologists (Armstrong & Postal, 2013; Aysin et al., 2021). Literature highlighting the benefit of taking a natural dietary supplement for older adults across the spectrum of cognitive decline has been variable (Brownie, 2009; Haider et al., 2020). Commonly explored vitamins such as Vitamin E, Vitamin D, Vitamin B 12, and Phosphatidylserine have proven to be beneficial in improvements in cognitive domains such as attention and memory for those experiencing mild cognitive impairment (Kang et al., 2022; La Fata et al., 2014; Richter et al., 2013; Van Der Shaft et al., 2013). Therefore, one alternative for defining the utility of supplement usage may be from preventive lens for those with mild or emerging cognitive concerns (Health Quality Ontario., 2013; Joshi & Practice-, 2012). Alternatively, older populations are at risk for malnutrition, which can negatively impact cognition (Well & Dumbrell, 2006).

While recognizing their clinical scope, informed neuropsychologists must be up to date on emerging literature on the efficacy of these supplements. Neuropsychologists should consider following these general guidelines when discussing recommendations for older adult clients with varying degrees of cognitive impairment. For example, neuropsychologists should approach alternative treatments as an exploration of the possible risks, costs, and benefits with evidence-based research while balancing the client’s need for hope (Armstrong & Postal, 2013). Neuropsychologists should also have increased awareness of malnutrition screening amongst this population (Gestuvo & Hung, 2012; Wells & Dumbrell, 2006). Other practices should include ongoing consultation and referral to a nutritionist or following up with their primary care physicians to assist further. With these guidelines, Neuropsychologists can be better equipped to provide ethical recommendations to facilitate clients to become informed consumers.

The prevalence of significant brain disorders and their economic burden are projected to continually increase as populations age longer. This review aims to analyze the barriers to international collaboration and propose preliminary international competency guidelines for the advancement of the neuropsychology field. Moreover, these guidelines can aid the field in advocating for international development and collaboration. Specifically, these guidelines may lead to clarity of services, culturally informed norms, cross-cultural research opportunities, and improving accessibility globally (Chan et al., 2016; Hessen et al. 2017).

Literature between 2002 and 2022 was obtained by searching the Google Scholar and PubMed databases. Keywords such as guidelines, international, and neuropsychology were used. Articles were selected on the criterion of relevance to the objective, international perspectives, and current national guidelines. The remaining articles were reviewed, and themes were clustered to identify overlapping international competencies within the literature. The findings were utilized to create preliminary competency guidelines and discuss their future implications.

Covid-19 unveiled the feasibility of health service fields collaborating internationally to solve global problems (Bump et al. 2021). The pandemic is a call to action for the neuropsychology field to improve global health equity and collaboration to address international challenges (Obschonka et al., 2021). However, one barrier is the lack of globally accepted definitions of neuropsychology and what a neuropsychologist does (Grote et al., 2016). Yet, a way to address this is for international organizations to propose international competency guidelines. This may allow countries with less developed neuropsychology fields to advocate for legislation and services (Chan et al., 2016; Hessen et al., 2017). In addition, countries reported the need for competencies to advocate for advancing current practices (Chan et al., 2016; Hokkanen et al., 2020; Janzen & Guger, 2016). Notably, by developing guidelines, public understanding and competent practices of neuropsychology can be strengthened (Grote et al., 2016; Hessen et al., 2017). Temple and colleagues (2006) discovered the two largest barriers for physicians referring to neuropsychologists were a lack of familiarity with the field and geographical limitations. Therefore, international competency guidelines present a serendipitous opportunity to benefit clients, physicians, and neuropsychologists.

Therefore, the current study presents 10 international neuropsychology practice competencies and their elements. Foundational competencies include: (1)Scientific knowledge, methods, and evidence-based practice; (2)Individual and community diversity; (3)Ethics, legal standards, and policy; (4)Interdisciplinary systems; (5)Reflective practice; (6)Therapeutic relationships. Functional competencies include: (7)Assessment; (8)Intervention; (9)Consultation; (10)Advocacy.

Although training and regulations may differ internationally, emerging literature supports the establishment of global competencies. Despite data on competencies in many countries being unavailable, the need for services in many locations suggests that using the available data to implement guidelines may allow for the growth of consistently competent neuropsychologists to serve the many underserved populations around the world (Hessen et al., 2017). Fortunately, Covid-19 exposed the need for increased health equity and mental health services globally (Jensen et al., 2021). Ultimately, the international competencies presented should be investigated further to improve international neuropsychology research, practice, advocacy, and legislation to abate global disparities.

Several studies have noted associations of higher white matter hyperintensities (WMHs) with cognitive slowing and elevated depressive symptoms in older adults. Depression is also directly associated with cognitive slowing in later life. However, the influence of WMHs on the relationship between depressive symptoms and processing speed is unclear. This interrelationship between depression, processing speed, and WMH may differ between racial groups given the well-documented evidence of racial disparities in vascular disease, WMHs, and cognitive performance, however the literature is sparse. The goal of this current study, therefore, was to investigate whether WMHs mediate the relationship between depressive symptoms and processing speed, and if this relationship differs between Black and White older adults.

A total of 171 non-Hispanic White and 111 non-Hispanic Black older adults (total sample mean age = 82.71 ± 2.74; 42.91% male) from the Healthy Brain Project (a substudy of the Health, Aging, and Body Composition Study) underwent MRI as well as a neuropsychological evaluation. Total WMH volume was quantified for each participant using an automated procedure and normalized to total brain volume. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Digit Symbol Substitution Test (DSST) served as a measure of processing speed. Causal mediation analyses were performed between CES-D and DSST scores across the total sample as well as within racial groups (Black and White), with total WMH volume as the mediator.

The direct effect of the CES-D on DSST was significant (p = 0.012) for the total sample, reflecting slower processing speed at higher levels of depressive symptoms, but the indirect effect was not (p = 0.207). When analyses were stratified by racial group, the indirect effect was significant for Black (p = 0.054; 37.17% mediated) but not White participants (p = 0.207): For Black participants, the inverse relationship between depressive symptoms and processing speed was mediated by a positive relationship between depressive symptoms and WMHs.

While these data support previous findings relating depressive symptoms to slower processing speed across racial groups, our findings also demonstrate a greater impact of WMHs on this relationship in Black older adults compared to their White counterparts. This suggests that WMHs may serve as an important risk factor for cognitive slowing in older Black adults with higher depressive symptoms. Future studies are needed to further investigate the role of WMHs on depression-related deficits in processing speed and other cognitive domains in racially diverse groups.

There is equivocal evidence that acculturation is associated with cognition. Various factors may contribute to ambiguous findings in the neuropsychology setting, including psychometric limitations of tools available for assessing acculturation as well as the frequent conflation of bilingualism with acculturation. Additionally, neuropsychological research on acculturation and cognition has largely failed to account for bidimensional models of acculturation, which have greater empirical support over unidimensional models. In response to these limitations and the theoretical literature on acculturation, we developed the Perceived Identity & Ethnicity Scales (PIES), a brief rating scale system to quickly (<2 minutes) capture an individual's perceived acculturative identity across several domains. In the current study, we sought to (1) provide initial psychometric support of the PIES and (2) examine how it relates to cognition in a culturally and linguistically diverse sample.

We recruited 242 individuals from both university and community samples (age=23.7±7.6, range 18-72; <12 Years of Education=4%; 78% Female; 58% Hispanic/Latin American; 69% middle SES; 22% educated outside the USA). In addition to demographic questionnaires, participants completed the PIES; an established measure of acculturation (the Bicultural Involvement Questionnaire, BIQ) and bilingualism (Bilingual Language Profile, BLP); measures of mood (the Depression, Anxiety, Stress Scales, DASS; Apathy Evaluation Scale, AES); and of self-reported cognitive functioning (Everyday Cognition, ECog). A subsample of Spanish speakers (n=86) also completed a cognitive battery validated for use in this population (the Spanish English Neuropsychological Assessment Scales, SENAS). For the first aim, we examined the reliability, validity, and dimensionality of the PIES in the full sample. In the Spanish-speaking subsample, we examined the relationship between the tool and both subjective and objective cognition using linear regression controlling for age, education, sex/gender, and premorbid intellectual functioning.

Measures of internal consistency and dimensionality supported a bidimensional model of acculturation; identification with culture of family origin (PIES-O) was not related to identification with US American culture (PIES-U; r=0.036, p>0.05). Cultural preference scores from the BIQ were associated with PIES-O (r=-0.322) and PIES-U (r=0.277; both ps<0.001) in the expected directions. PIES-O (r=0.350) and PIES-U (r=-0.432) were associated with the ability to speak a language other than English on the BLP (both ps<0.001). PIES-U, but not PIES-O, was also strongly associated with other BIQ and BLP scores as well as with receiving education outside of the USA at medium to large effect sizes (rs=0.3 to 0.6; all ps<0.001). In the subsample, PIES-O and PIES-U were not associated with subjective cognition as measured by the ECog (AR2=0.016, p>0.05); global cognition as measured by the Montreal Cognitive Assessment (MoCA; AR2=0.046, p>0.05); or SENAS cognitive composite scores (AR2=0.016, p>0.05) after controlling for covariates.

Findings provide strong initial psychometric support for the utility of the PIES in the assessment of acculturation. Moreover, these results further support the bidimensional model of acculturation. Acculturation as measured by the PIES was not associated with cognitive abilities in this highly educated and mainly female cross-sectional sample. Longitudinal research accounting for acculturation is needed to elucidate these relationships.

Despite the array of neuropsychological tests available, these assessments are largely made and developed for use in WEIRD (western, educated, industrialized, rich, democratic) societies (Fernandez, 2019; Ponsford, 2017). The Multicultural Neuropsychological Scale (MUNS) was developed with underrepresented groups in mind as a universally valid neuropsychological assessment which can be used across cultures and adapted to different languages. To assist with the validation of the MUNS as a cross-cultural instrument, investigators administered the MUNS to a cognitively 'healthy’ college-aged population in the United States as a means of collecting normative data. Results were compared to samples taken from an Argentine university, Universidad Catelica de Cerdoba, and combined with another American university, Marymount Loyola University. The goal of this comparison was to provide evidence supporting the validity of the MUNS as a universal, cross-cultural neuropsychological assessment battery.

Students from James Madison University (JMU) in Harrisonburg, Virginia (N = 24, Age = 20.083 1.93, Female = 87.5%) were recruited via a campus-wide email. Students who met inclusionary criteria were selected for MUNS administration. Students completed a background questionnaire and effort measure (REY-15; Rey, 1964) before completing the MUNS battery, consisting of eight subtests with four delayed trials. Descriptive statistics of the group were assessed, and one-way ANOVAs were conducted on the various subtests to determine whether differences exist between the American and Argentine samples.

No significant difference between groups was found for seven subtests. A difference existed on the Attention subtest between the American (f (1, 106) = 45.409, p < .001).

The results show support for the cross-cultural validity of the MUNS. The only significant difference was found in the Arrows (Old) subtest. This is in alignment with previous administrations of the MUNS (Fernandez et al., 2018). Further studies are needed to assess potential bias within this subtest, as well as to pursue comparison studies for the New Arrows subtest administered within this USA sample. The present findings provide further evidence that the MUNS can be applied as a neuropsychological assessment across a variety of populations.

There are approximately 1.5 million Japanese and Japanese Americans in the United States, with the Japanese population increasing steadily over the past two decades. Given the growing number of the Japanese population, it is likely that a clinical neuropsychologist may encounter a Japanese patient, particularly for neurocognitive disorder evaluations given the aging population. Literature has reported that cross-cultural bias in neuropsychological testing and cultural factors affect individuals’ test performance. In order to conduct and interpret neuropsychological assessments for this population, it is important to use normative data and consider the impact of various factors such as acculturation, language, and generation in the U.S. Availability of normative cognitive test data for Japanese-Americans is limited. Tests with most extensive use, adaptation, validation, and norming were identified. Many clinically used measures of executive functioning (EF) have been translated into Japanese and studied in multiple clinical populations. We present information on tests in this domain given their appropriateness for use in cross-linguistic and cross-cultural evaluations.

Available studies of neuropsychological tests measuring EF that have been translated and normed in the Japanese and/or Japanese-American patient population are reported. Review of the literature was conducted by authors of Japanese descent familiar with neuropsychological assessment and Japanese and Japanese-American culture. We prioritized studies published in both English and Japanese and those that included commonly utilized tests in the U.S, allowing for maximum accessibility and utility for Western-based neuropsychologists. Additionally, inclusion priority was given to studies published in English which report the clinical diagnoses, age range, and gender characteristics of the sample population. The Wisconsin card sorting test (WCST) and Trail Making Test (TMT) were reviewed.

The WCST and the TMT, with its variant, was the most normed EF cognitive test currently available. The Keio version Japanese-Trail Making Test (J-TMT) and a simplified version of the Trail Making Test (S-TMT) has been utilized in Japan, however norms are still lacking. Of the available studies, the S-TMT and J-TMT were found to be moderately correlated with the TMT. The Keio version WCST (KWCST) (Kao et al., 2012) was correlated to education level (Abe et al., 2004), appropriately differentiating severity of social anxiety disorder (Fujii et al., 2013), patients with schizophrenia (Banno et al., 2012), and cognitive impairment in Parkinson’s disease (Yoshii et al., 2019).

Information regarding translated and normed tests are presented to assist clinical neuropsychologists provide competent services to Japanese-Americans. The J-TMT and the S-TMT may be clinically useful as an evaluation of attention for the Japanese population. The KWCST has also been found to be an appropriate tool for this population. However, publicly available norms for these assessments are still sparse, and there is very limited information about administration of these tests by English-speaking neuropsychologists with the use of interpreters. Further work is needed to increase access to and awareness of linguistically and culturally appropriate versions of clinical measures to better serve the Japanese and Japanese-American population.

To establish how participant and informant reports of cognitive decline may differ between groups or remain consistent based on race and level of education in a large, national sample.

Participants were selected using the National Alzheimer’s Coordinating Center (NACC) database. Participants who were cognitively healthy at baseline and at least 65 years of age were selected. All informants either lived with the participant or visited the participant weekly (N = 9300). Participant racial groups included White American (n = 7534), Black American (n = 1453), Native American/Alaskan (n = 68), or Asian American (n = 239). Native Hawaiians were not included in this study, given the small sample size (n = 6). Participant education-levels included less than high school degree (n = 395), high school degree or GED (n = 1326), some post-secondary education (n = 1727), bachelor’s degree (n = 2184), and graduate studies (n = 3668). Pairwise comparisons examined each racial and educational attainment group by subjective reports of cognitive decline using Bayesian contingency tables to find reliable evidence to support the null or alternative hypothesis. Participant and informant reports of decline were coded to create a single variable to express no reported decline, participant reported decline, informant reported decline, or agreed decline.

Pairwise race comparisons found moderate evidence that Native Americans reliably reported cognitive decline differently than Black (BF10 = 6.973) and White Americans (BF10 = 3.634). In both cases, the Native American group reported more cases of decline than expected in all groups and reported no decline less than expected. Further analysis found very strong evidence for the null hypothesis when comparing White Americans with Black (BF01 = 60.506) and Asian Americans (BF01 = 65.72). A comparison of Black and Asian Americans found extremely strong evidence for the null hypothesis (BF01 = 199.464). No conclusive evidence was found when comparing reports of Native and Asian Americans (BF01 = 2.401). Pairwise comparisons of educational attainment with subjective reporting of cognitive decline found no evidence of reliable differences between groups. No conclusive evidence was found when comparing the reporting pattern of individuals with some post-secondary education and individuals who did not complete high school (BF01 = 1.257). Moderate evidence for the null hypothesis was found when comparing individuals with a bachelor’s degree with those who did not complete high school (BF01 = 8.57). Strong evidence for the null hypothesis was found when comparing individuals who did not complete high school with those who have studied at the graduate level (BF01 = 17.141) and those who completed high school (BF01 = 16.306). When making all other pairwise comparisons (BF01 > 100), there was extremely strong evidence for the null hypothesis.

These findings suggest that how participants and their informants report cognitive decline does not differ based upon educational attainment in almost all cases, and no evidence was found supporting differences based upon educational attainment. There is evidence that Native Americans/Native Alaskans and their informants report more cognitive decline compared to White and Black Americans. However, the findings suggest that White, Black, and Asian Americans do not differ in how participants and their informants report cognitive decline.

Individuals tend to overestimate their abilities in areas where they are less competent. This cognitive bias is known as the Dunning-Krueger effect. Research shows that Dunning-Krueger effect occurs in persons with traumatic brain injury and healthy comparison participants. It was suggested by Walker and colleagues (2017) that the deficits in cognitive awareness may be due to brain injury. Confrontational naming tasks (e.g., Boston Naming Test) are used to evaluate language abilities. The Cordoba Naming Test (CNT) is a 30-item confrontational naming task developed to be administered in multiple languages. Hardy and Wright (2018) conditionally validated a measure of perceived mental workload called the NASA Task Load Index (NASA-TLX). They found that workload ratings on the NASA-TLX increased with increased task demands on a cognitive task. The purpose of the present study was to determine whether the Dunning-Kruger effect occurs in a Latinx population and possible factors driving individuals to overestimate their abilities on the CNT. We predicted the low-performance group would report better CNT performance, but underperform on the CNT compared to the high-performance group.

The sample consisted of 129 Latinx participants with a mean age of 21.07 (SD = 4.57). Participants were neurologically and psychologically healthy. Our sample was divided into two groups: the low-performance group and the high-performance group. Participants completed the CNT and the NASA-TLX in English. The NASA-TLX examines perceived workload (e.g., performance) and it was used in the present study to evaluate possible factors driving individuals to overestimate their abilities on the CNT. Participants completed the NASA-TLX after completing the CNT. Moreover, the CNT raw scores were averaged to create the following two groups: low-performance (CNT raw score <17) and high-performance (CNT raw score 18+). A series of ANCOVA's, controlling for gender and years of education completed were used to evaluate CNT performance and CNT perceived workloads.

We found the low-performance group reported better performance on the CNT compared to the high-performance, p = .021, np2 = .04. However, the high-performance group outperformed the low-performance group on the CNT, p = .000, np2 = .53. Additionally, results revealed the low-performance group reported higher temporal demand and effort levels on the CNT compared to the high-performance group, p's < .05, nps2 = .05.

As we predicted, the low-performance group overestimated their CNT performance compared to the high-performance group. The current data suggest that the Dunning-Kruger effect occurs in healthy Latinx participants. We also found that temporal demand and effort may be influencing awareness in the low-performance group CNT performance compared to the high-performance group. The present study suggests subjective features on what may be influencing confrontational naming task performance in low-performance individuals more than highperformance individuals on the CNT. Current literature shows that bilingual speakers underperformed on confrontational naming tasks compared to monolingual speakers. Future studies should investigate if the Dunning-Kruger effects Latinx English monolingual speakers compared to Spanish-English bilingual speakers on the CNT.

There is a well-established relationship in the literature between cognitive impairment and functional disability, such that, increased cognitive impairment is associated with diminished capacity to perform daily activities independently. However, there has been limited research on the relationship between cognitive impairment and daily functioning in older adults from an Indian population, or differences between Indian and U.S samples. The relationship may differ across these two populations due to their unique cultures. For example, India and the United States have significantly different social systems and family structures, with different emphases placed on the community as compared to the individual. Therefore, the role that older adults play or the support they receive within the family and society differs between the two countries and could significantly impact the relationship between cognitive ability and functional disability. The primary objective of this study is to further explore the similarities and differences in this relationship across cross-cultural populations. We hypothesized that individuals across both samples with lower cognitive functioning will have increased disability. Furthermore, we propose that the relationship between cognitive functioning and functional disability will be stronger in the U.S sample as compared to the Indian sample.

Community-dwelling older adults were sampled through local senior centers and by convenience sampling in the United State and India, respectively (N = 40 and 36, respectively). All participants were administered the Montreal Cognitive Assessment (MoCA) to evaluate cognitive ability. Functional status was assessed using the Activities of Daily Living section of the OARS multidimensional functional questionnaire and the World Health Organization Disability Assessment Schedule (WHODAS).

A significant association between cognitive functioning and functional disability was demonstrated in the combined sample, i.e., the MoCA was correlated with OARS (r[70] = .42, p < .001) and the WHODAS (r[59] = -.32, p = .009). However, when comparing samples, significant differences in associations between the MoCA and functional measures were noted in the Indian and U.S. samples: In the Indian sample, the MoCA was not significantly correlated with either the WHODAS (r[38] = -.28, p = .09) or the OARS (r[39] = .17, p = .31). Comparatively, in the United States, the MoCA was correlated with the OARS (r[32] = .51, p = .002) and the WHODAS (r[26] = -.40, p = .04).

These results, in keeping with most previous studies done in the U.S. point to a robust relationship between cognition and functional disability in the U.S sample. However, this association is substantially diminished in the Indian sample. One possible reason maybe, greater support available to older Indians may mitigate the negative effect of cognitive impairment on adaptive function. A major limitation of this study is the small sample size. Additionally, due to vast cultural differences that exist across India, the sample collected from an urban well-education population will likely not generalize to the larger country. Future research from larger and more diverse samples across the country will likely provide more valuable insight.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly associated with relative impairments on processing speed, working memory, and/or executive functioning. Anxiety commonly co-occurs with ADHD and may also adversely affect these cognitive functions. Additionally, language status (i.e., monolingualism vs bilingualism) has been shown to affect select cognitive domains across an individual’s lifespan. Yet, few studies have examined the potential effects of the interaction between anxiety and language status on various cognitive domains among people with ADHD. Thus, the current study investigated the effects of the interaction of anxiety and language status on processing speed, working memory, and executive functioning among monolingual and bilingual individuals with ADHD.

The sample comprised of 407 consecutive adult patients diagnosed with ADHD. When asked about their language status, 67% reported to be monolingual (English). The Mean age of individuals was 27.93 (SD = 6.83), mean education of 15.8 years (SD = 2.10), 60% female, racially diverse with 49% Non-Hispanic White, 22% Non-Hispanic Black, 13% Hispanic/Latinx, 9% Asian/Pacific Islander, and 6% other race/ethnicity. Processing speed, working memory, and executive function were measured via the Wechsler Adult Intelligence Scale-Fourth Edition Processing Speed Index, Working Memory Index, and Trail Making Test B, respectively. Anxiety was measured via the Beck Anxiety Inventory (BAI). Three separate linear regression models examined the interaction between anxiety (moderator) and cognition (processing speed, working memory, and executive function) on language. Models included sex/gender and education as covariates with Processing Speed Index and Working Memory Index as the outcomes. Age, sex/gender, and education were used as covariates when Trail Making Test B was the outcome.

Monolingual and bilingual patients differed in mean age (p < .05) but did not differ in level of anxiety, education, or sex/gender. Overall, anxiety was not associated with processing speed, working memory, and executive function. However, the interaction between anxiety and language status was significantly associated with processing speed (ß = -0.37, p < .05), and executive functioning (ß = 0.82, p < .05). No associations were found when anxiety was added as a moderator for the associations between language and working memory.

This study found that anxiety moderated the relationship between language status and select cognitive domains (i.e., processing speed and executive functioning) among individuals with ADHD. Specifically, anxiety had a greater association on processing speed and executive functioning performance for bilinguals rather than monolinguals. Future detailed studies are needed to better understand how anxiety modifies the relationship between language and cognitive performance outcomes over time amongst a linguistically diverse sample.

Japanese-Americans are the sixth largest Asian ethnicity in the United States. They represent a highly heterogeneous population due to their history of immigration dating back to the late 19th century. In comparison to the total Japanese-American population, there are very few neuropsychologists of Japanese descent who are familiar with the culture. The Asian Neuropsychological Association lists 16 licensed members of Japanese descent, and only 7 practice outside of Hawaii or California. These numbers suggest that unless non-Japanese neuropsychologists are knowledgeable of the culture, test translations, and appropriate norms, it would be challenging for many Japanese-Americans to receive culturally and linguistically competent neuropsychological services. The aim of the present study is to provide guidance for conducting neuropsychological assessments with Japanese-Americans with the goal of facilitating competent culturally-informed services to this population.

Pertinent facets of Japanese culture as identified in the ECLECTIC framework and demographics of the U.S. Japanese-American population, and the available literature on neuropsychological tests that are translated into Japanese and normed with Japanese samples, was reviewed by authors with knowledge of Japanese language and culture. Literature published in both English and Japanese were included for review.

Psychological testing is a Western technology fraught with the behavioral expectations and values of the culture in which it was developed. Thus, these tests may be biased against persons coming from cultures that differ from the West. Recommendations for providing neuropsychological services to Japanese-Americans are presented with an aim of maximizing test fairness by addressing the following issues: comfort with the testing situation, test biases, accessibility, and validity. Given the emphasis on education, Japanese-Americans should be familiar and comfortable with cognitive testing, although they may experience undue pressure to perform well to avoid shame. Japanese-Americans may experience discomfort disclosing personal information during the interview, particularly if the evaluation is perceived to be psychiatric in nature, as there is a strong stigma associated with mental illness that could bring shame to the family. Japanese communication styles are indirect in nature, where the message is implied and what is “not said” is just as important as what is directly conveyed. Accessibility issues will primarily impact first generation Japanese-Americans who are native Japanese speakers. Another characteristic that may impact responding is hesitancy for guessing when unsure. Recommendations for providing culturally competent neuropsychological assessment given these considerations will be presented and expanded upon in detail. Finally, an online database of translated and normed neuropsychological tests by cognitive domain has been created and will be presented.

Providing neuropsychological services to Japanese-Americans can be challenging as Japanese culture is significantly different from western culture. In addition, Japanese-Americans are heterogenous with salient issues of English proficiency and acculturation. Information to individualize a conceptual understanding of Japanese-Americans, translated and normed tests, and recommendations to maximize fairness in testing are presented to assist clinical neuropsychologists provide competent services to Japanese-Americans.

The Immigrant Health Paradox (IHP) suggests that immigrants have better health upon arrival in comparison to their U.S.-born Latinx counterparts, indicating that immigrants’ unique experiences may buffer against negative health outcomes, including cognition. Some studies indicate that IHP-related cognitive health benefits diminish with increased time spent in the U.S., while others suggest that this relationship may be age-dependent such that compared to migration during earlier or later life, migration during young/middle adulthood may be related to better cognition-potentially due to higher simultaneous cognitive demands associated with this age epoch (e.g., language acquisition, acculturation). However, this literature is equivocal and has methodological limitations (e.g., cognition typically assessed with cognitive screeners, lack of clinical populations) Thus, this study aimed to examine the role of age related to IHP and cognition within a well-characterized sample of HIV+ Latinx adults. It was hypothesized that compared to U.S.-born Latinx adults and those who immigrated earlier or later in life, the Latinx immigrant subgroup who migrated during young/middle adulthood would demonstrate better cognitive functioning.

This cross-sectional study included a HIV+ sample (A/=105) of 34 Latinx immigrants (Mage=45.56, SD=6.99) and 71 U.S.-born Latinx individuals (Mage=46.03, SD=7.63), who completed a comprehensive sociocultural questionnaire and cognitive battery. Demographically-adjusted average T-scores were computed for each cognitive test and domain (e.g., learning, memory). A series of Welch’s-corrected ANOVAS with post hoc Games-Howell tests for multiple comparisons were conducted to compare cognitive function across three groups: Latinx immigrants who migrated during earlier (<19 yrs) or later adulthood (>50 yrs), young/middle adulthood (20-49 yrs), and U.S.-born Latinx adults.

Compared to the other Latinx subgroups, Latinx immigrants who migrated during middle adulthood performed worse in Verbal Fluency (F(2,98)=8.04, p<.001), Attention/Working Memory (f(2,96)=6.10, p<.01), Executive Function (f(2,99)=5.11, p<.01), and Processing Speed (F(2,101)=3.36, p<.05). Posthoc Games-Howell tests showed that the mean Verbal Fluency (p<.01, 95% C.I.=[-21.37, -2.66]), Attention/Working Memory (p<.05, 95% C.I.=[-16.82, -1.59]), Executive Function (p<.01, 95% C.I.=[-14.66, -2.49]) and Processing Speed (p<.05, 95% C.I.=[-13.60, -1.31]) T-scores were significantly lower in Latinx immigrants who migrated in young/middle adulthood compared to the U.S.-born Latinx sample. Further, there were no differences between the U.S.-born Latinx group compared to the Latinx immigrant group who migrated earlier or later in life (ps>.05).

This preliminary study is the first to examine whether the potential protective cognitive effects of the IHP vary across the lifespan among Latinx immigrants with HIV, using a comprehensive neuropsychological battery. Age-related IHP benefits were not observed in this study. Moreover, Latinx immigrants who migrated during young/middle adulthood had worse cognitive functioning compared to their U.S.-born Latinx counterparts and those that migrated earlier or later in life. A possible explanation for this study’s unexpected findings is that the IHP is outdated due to the current sociopolitical climate immigrants experience compared to the 1980s when the theory was developed. Future studies, with larger samples, longitudinal designs, and greater sociocultural characterization (e.g., immigration reason/s, country of origin, discrimination), are needed to better understand the role of IHP in cognition.

Although the majority of Japanese speakers live in Japan, there are also large populations of Japanese speakers in the United States of America and Brazil, with more than a million Japanese speakers across the two countries. Only 53% of foreign-born Japanese individuals in the United States report proficiency in English. Although there has been increasing attention to the neuropsychological assessment of linguistically diverse patients broadly in recent years, there are specific considerations unique to Japanese that clinicians and researchers should be aware of when working with Japanese speakers outside of Japan. The aim of the present study is to present considerations and appropriately normed assessments of verbal abilities for Japanese patients.

A systematic review of cognitive screeners and assessments of verbal fluency, verbal memory, and verbal academic skills that have been translated and normed for use with Japanese speaking populations was conducted. Studies published in both English and Japanese were reviewed. Test content modifications, administration modifications, and relevant cultural and linguistic considerations were synthesized and summarized.

One consideration in translation is the use of words that are linguistically and culturally comparable across the two languages. Multiple cognitive screeners and verbal learning/memory tasks have been translated with cultural equivalency considerations (e.g., for the Montreal Cognitive Assessment, velvet, church, and daisy were changed to silk, shrine, and lily). In Japanese, there is a one-to-one correspondence between sound (syllable) and graphemes (kana script), compared to one-to-many associations in alphabet-based languages like English. This impacts normative expectations on letter fluency tasks. The hiragana letters, A, Ka, and Shi (fc, fr, L) are recommended because there are relatively large number of words that start with these letters and the number of words generated with these letters showed close to normal distributions in previous research. Unlike letter fluency, semantic fluency is believed to be relatively culture-free and independent of language systems. The Japanese writing system utilizes both phonographic systems where written symbols map onto sounds, and logographic systems, where written symbols map onto concepts. This is in contrast to English, which has a solely phonographic written system. These two separate writing systems complicate the assessment of reading among Japanese-speaking individuals, as there may be a dissociation between abilities in reading in the phonographic versus logographic systems. Acculturation has been shown to impact performance on certain verbal task performances, along with demographic variables such as immigration generation status and bilingualism.

Neuropsychologists should be familiar with linguistic differences between English and Japanese such as the one-to-one correspondence between sound and grapheme in Japanese and the use of both phonographic and logographic systems in written Japanese. Neuropsychologists should also be careful to use tests that are translated for cultural equivalence rather than direct translations, and that have been normed for use with Japanese speakers. Finally, general cross-cultural considerations in assessment such as the evaluation of bilingualism, familiarity with the testing environment, and other factors remain essential.

When assessing individuals from diverse backgrounds, APA ethical principles emphasize the consideration of language and culture when selecting appropriate measures. Research among hearing, English-speaking individuals has shown the effects in identifying cognitive deficits when language, culture, and educational background are not considered in the selection and administration of measures (Ardilla, 2007). Among the Deaf community in the US, a minority group with a unique culture and language (American Sign Language: ASL), there have been few attempts to adapt existing English cognitive measures. Factors complicating this include research resources given the limited number of neuropsychologists and researchers who understand both the complexities of the measures as well as the linguistic and cultural factors within the Deaf population. The goal of the current project is to develop a culturally informed interpretation of a cognitive screening tool for appropriate use with older Deaf adults.

Item selection was informed by MMSE data from Dean et al. (2009) and methods utilized by Atkinson et al. (2015). Items selection occurred through consultation with three neuropsychologists and graduate peers with either native signing abilities or demonstrated ASL fluency, as well as Deaf identities, cultural affiliation and or community engagement. Selection considered the potential for translation errors, particularly related to equivalence of translation from a spoken modality to a signed. Items were categorized into the following domains: Orientation, Attention, Memory, Language, Executive Functioning, Visuospatial, and Performance Validity. Two native signers (Deaf interpreters) provided formal translation of the items. The measure was piloted with 20 deaf and hard of hearing (DHH) adult signers (ages M=41.10, SD=5.50, Range=31-48). Items were prerecorded to standardize the administration, which was shown to participants through the screenshare function of Zoom software.

The average performance was 100.80 (SD=3.91)/ 105 possible points. Within the memory domain, some errors, especially for word selection on delayed recall, were noted which may be related to sign choice and dialect. Additionally, with culture-specific episodic memory items, participants 35% of participants were unable to provide a correct answer with qualitative responses indicating this information may be more familiar to a subset of the Deaf community that had attended Gallaudet University in Washington, D.C. There was a significant positive relationship between ASL fluency, determined by the ASL-Comprehension Test, and performance on the cognitive screener (r(18)=.54, p=.01) while age of onset of deafness (r(18)=-.16, p=.51) and age of ASL acquisition (r(18)= .21, p=.37), were not significant.

Results of this preliminary project yielded a measure that benefited from inclusion of content experts in the field during the process of interpretation and translation. It appears appropriate for Deaf signers who are proficient in ASL. The pattern of correlations suggests the measure may be appropriate for use with fluent signers with experience in ASL acquisition. Further development of the measure should focus on appropriate items that address the diversity of the Deaf experience as well as continue to explore inclusive translation approaches.