Despite growing evidence regarding the association between exercise training (ET) and functional brain connectivity, little is known about the effects of ET on within- and between-network functional connectivity (FC) of core brain networks. We investigated the effects of ET on within- and between-network functional connectivity of the default mode network (DMN), frontoparietal network (FPN), and salience network (SAL) in older adults with intact cognition (CN) and older adults diagnosed with mild cognitive impairment (MCI). We further examined whether the ET-induced changes in FC were associated with changes in cognitive performance.

33 older adults (78.0±7.0 years; 16 MCI and 17 CN) participated in the present study. Before and after a 12-week walking ET intervention, participants underwent cardiorespiratory fitness tests, the Controlled Oral Word Association Test (COWAT), the Rey Auditory Verbal Learning test (RAVLT), a narrative memory test (logical memory; LM), and a resting-state fMRI scan. We examined the within- and between-network connectivity of the DMN, FPN, and SAL before and after ET. We also used linear regression to examine associations between ET-related changes in the within- and between-network connectivity and cognitive function.

There were significant improvements in VO2peak, COWAT, RAVLT, and LM after ET across participants. Significant increases in within-network connectivity of the DMN and SAL were observed in response to ET across participants. FC between the DMN-FPN, DMN-SAL, and FPN-SAL were also increased after ET. Moreover, greater SAL within connectivity and FPN-SAL between connectivity were associated with enhanced LM immediate recall performance after ET. There were no significant interactions between Time (before vs after ET) and Group (CN vs MCI) for network connectivity or cognitive function.

Our findings suggest that increased within- and between-network connectivity following 12-weeks of walking exercise may subserve improvements in memory performance in older individuals with intact cognition and in those diagnosed with MCI.

Aging is associated with disruptions in functional connectivity within the default mode (DMN), frontoparietal control (FPCN), and cingulo-opercular (CON) resting-state networks. Greater within-network connectivity predicts better cognitive performance in older adults. Therefore, strengthening network connectivity, through targeted intervention strategies, may help prevent age-related cognitive decline or progression to dementia. Small studies have demonstrated synergistic effects of combining transcranial direct current stimulation (tDCS) and cognitive training (CT) on strengthening network connectivity; however, this association has yet to be rigorously tested on a large scale. The current study leverages longitudinal data from the first-ever Phase III clinical trial for tDCS to examine the efficacy of an adjunctive tDCS and CT intervention on modulating network connectivity in older adults.

This sample included 209 older adults (mean age = 71.6) from the Augmenting Cognitive Training in Older Adults multisite trial. Participants completed 40 hours of CT over 12 weeks, which included 8 attention, processing speed, and working memory tasks. Participants were randomized into active or sham stimulation groups, and tDCS was administered during CT daily for two weeks then weekly for 10 weeks. For both stimulation groups, two electrodes in saline-soaked 5x7 cm2 sponges were placed at F3 (cathode) and F4 (anode) using the 10-20 measurement system. The active group received 2mA of current for 20 minutes. The sham group received 2mA for 30 seconds, then no current for the remaining 20 minutes.

Participants underwent resting-state fMRI at baseline and post-intervention. CONN toolbox was used to preprocess imaging data and conduct region of interest (ROI-ROI) connectivity analyses. The Artifact Detection Toolbox, using intermediate settings, identified outlier volumes. Two participants were excluded for having greater than 50% of volumes flagged as outliers. ROI-ROI analyses modeled the interaction between tDCS group (active versus sham) and occasion (baseline connectivity versus postintervention connectivity) for the DMN, FPCN, and CON controlling for age, sex, education, site, and adherence.

Compared to sham, the active group demonstrated ROI-ROI increases in functional connectivity within the DMN following intervention (left temporal to right temporal [T(202) = 2.78, pFDR < 0.05] and left temporal to right dorsal medial prefrontal cortex [T(202) = 2.74, pFDR < 0.05]. In contrast, compared to sham, the active group demonstrated ROI-ROI decreases in functional connectivity within the FPCN following intervention (left dorsal prefrontal cortex to left temporal [T(202) = -2.96, pFDR < 0.05] and left dorsal prefrontal cortex to left lateral prefrontal cortex [T(202) = -2.77, pFDR < 0.05]). There were no significant interactions detected for CON regions.

These findings (a) demonstrate the feasibility of modulating network connectivity using tDCS and CT and (b) provide important information regarding the pattern of connectivity changes occurring at these intervention parameters in older adults. Importantly, the active stimulation group showed increases in connectivity within the DMN (a network particularly vulnerable to aging and implicated in Alzheimer’s disease) but decreases in connectivity between left frontal and temporal FPCN regions. Future analyses from this trial will evaluate the association between these changes in connectivity and cognitive performance post-intervention and at a one-year timepoint.

While loss of insight into one’s cognitive impairment (anosognosia) is a feature in Alzheimer’s disease dementia, less is known about memory self-awareness in cognitively unimpaired (CU) older adults or mild cognitive impairment (MCI) or factors that may impact self-awareness. Locus of control, specifically external locus of control, has been linked to worse cognitive/health outcomes, though little work has examined locus of control as it relates to self-awareness of memory functioning or across cognitive impairment status. Therefore, we examined associations between locus of control and memory self-awareness and whether MCI status impacted these associations.

Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (mean age=73.51; 76% women; 26% Black/African American) were classified as CU (n=2177) or MCI (amnestic n=313; non-amnestic n=170) using Neuropsychological Criteria. A memory composite score measured objective memory performance and the Memory Functioning Questionnaire measured subjective memory. Memory self-awareness was defined as objective memory minus subjective memory, with positive values indicating overreporting of memory difficulties relative to actual performance (hypernosognosia) and negative values indicating underreporting (hyponosognosia). Internal (i.e., personal skills/attributes dictate life events) and external (i.e., environment/others dictate life events) locus of control scores came from the Personality in Intellectual Aging Contexts Inventory. General linear models, adjusting for age, education, sex/gender, depressive symptoms, general health, and vocabulary examined the effects of internal and external locus of control on memory self-awareness and whether MCI status moderated these associations.

Amnestic and non-amnestic MCI participants reported lower internal and higher external locus of control than CU participants. There was a main effect of MCI status on memory self-awareness such that amnestic MCI participants showed the greatest degree of hyponosognosia/underreporting, followed by non-amnestic MCI, and CU participants slightly overreported their memory difficulties. While, on average, participants were fairly accurate at reporting their degree of memory difficulty, internal locus of control was negatively associated with self-awareness such that higher internal locus of control was associated with greater underreporting (ß=-.127, 95% CI [-.164, -.089], p<.001). MCI status did not moderate this association. External locus of control was positively associated with self-awareness such that higher external locus of control was associated with greater hypernosonosia/overreporting (ß=.259, 95% CI [.218, .300], p<.001). Relative to CU, amnestic, but not non-amnestic, MCI showed a stronger association between external locus of control and memory self-awareness. Specifically, higher external locus of control was associated with less underreporting of cognitive difficulties in amnestic MCI (ß=.107, 95% CI [.006, .208], p=.038).

In CU participants, higher external locus of control was associated with greater hypernosognosia/overreporting. In amnestic MCI, the lower external locus of control associations with greater underreporting of objective cognitive difficulties suggests that perhaps reduced insight in some people with MCI may result in not realizing the need for external supports, and therefore not asking for help from others. Alternatively, in amnestic participants with greater external locus of control, perhaps the environmental cues/feedback translate to greater accuracy in their memory self-perceptions. Longitudinal analyses are needed to determine how memory self-awareness is related to future cognitive declines.

In normative aging, there is a decline in associative memory that appears to relate to self-reported everyday use of general memory strategies (Guerrero et al., 2021). Self-reported general strategy use is also strongly associated with self-reported memory abilities (Frankenmolen et al., 2017), which, in turn, are weakly associated with objective memory performance (Crumley et al., 2014). Associative memory abilities and strategy use appear to differ by gender, with women outperforming men and using more memory strategies (Hertzog et al., 2019). In this study, we examine how actual performance and self-reported use of specific strategies on an associative memory task relate to each other and to general, everyday strategy use, and whether these differ by gender.

An international sample of older adults (N = 566, 53% female, aged 60-80) were administered a demographic questionnaire and online tasks, including 1. the Multifactorial Memory Questionnaire (MMQ) which measures self-reported memory ability, satisfaction, and everyday strategy use (Troyer & Rich, 2018); and 2. the Face-Name Task which measures associative memory (Troyer et al., 2011). Participants were also asked about specific strategies that were used to complete the Face-Name Task.

On the Face-Name Task, participants who reported using more strategies performed better (F(3, 562) = 6.51, p < 0.001, n2 = 0.03), with those who reported using three or four strategies performing best (p < .05). There was a significant difference in performance based on the type of strategy used (p(2, 563) = 11.36, p < 0.001, n2 = 0.04), with individuals who relied on a “past experiences/knowledge” strategy performing best (p < .01). Women (M = 0.79, SD = 0.19) outperformed men (M = 0.71, SD = 0.20), f(545) = -4.64, p < 0.001, d = -0.39. No gender differences were found in the number (X2(3, N = 564) = 2.06, p = 0.561) or type (x2(2, N = 564) = 5.49, p = 0.064) of strategies used on the Face-Name Task. Only participants who reported using no strategies on the Face-Name Task had lower scores on the MMQ everyday strategy use subscale (p < .05). A multiple-regression model was used to investigate the relative contributions of the number of strategies used on the Face-Name Task, MMQ everyday strategy subscale score, gender, age, education, and psychological distress to Face-Name Task performance. The only significant predictors in the model were gender (B = 0.08, t(555) = 4.55, p < 0.001) and use of two or more strategies (B = 0.07, f(555) = 2.82, p = 0.005).

Reports of greater self-initiated strategy use, and use of a semantic strategy in particular, related to better performance on an associative memory test in older adults. Self-initiated, task-specific strategy use also related to everyday strategy use. The findings extend past work on gender differences to show that women outperform men on an associative memory task but that this is unlikely to be due to self-reported differences in strategy use. The results suggest that self-reported strategy use predicts actual associative memory performance and should be considered in clinical practice.

Learning curve patterns on list-learning tasks can help clinicians determine the nature of memory difficulties, as an “impaired” score may actually reflect attention and/or executive difficulties rather than a true memory impairment. Though such pattern analysis is often qualitative, there are quantitative methods to assess these concepts that have been generally underutilized. This study aimed to develop a model that decomposes learning over repeated trials into separate cognitive processes and then include other testing data to predict performance at each trial as a function of general cognitive functioning.

Data for CVLT-II learning trials were obtained from an outpatient neuropsychology service within an academic medical center referred for clinical reasons. Participants with a cognitive diagnosis of non-demented (ND) or probable Alzheimer’s disease (AD) were included. The final sample consisted of 323 ND [Mage = 58.6 (14.8); Medu = 15.4 (2.7); 55.7% female] and 915 AD [Mage = 72.6 (9.0); Medu = 14.2 (3.1); 60.1% female cases. A Bayesian non-linear beta-binomial multilevel model was used, which uses three parameters to predict CVLT-II recall-by-trial: verbal attention span (VAS), maximal learning potential (MLP), and learning rate (LR). Briefly, VAS predicts expected first trial performance while MLP, conversely, predicts the expected best performance as trials are repeated, and LR weights the influence of VAS versus MLR over repeated trials. Predictors of these parameters included age, education, sex, race, and clinical diagnosis, in addition to raw scores on Trail Making Test Parts A and B, phonemic (FAS) fluency, animal fluency, Boston Naming Test, Wisconsin Card Sorting Test (WCST) Categories Completed, and then age-adjusted scaled scores from WAIS-IV Digit Span, Block Design, Vocabulary, and Coding. Random intercepts were included for each parameter and extracted for comparison of residual differences by diagnosis.

The model explained 84% of the variance in CVLT-II raw scores. VAS reduced with age and time-to-complete Trails B but improved with both verbal fluencies and confrontation naming. MLP increased as a function of WAIS Digit Span, animal fluency, confrontation naming, and WCST categories completed. Finally, LR was greater for females and WAIS-IV Coding and Vocabulary performances but reduced with age. Participants with AD had lower estimates of all three parameters: Cohen’s d = 2.49 (VAS) - 3.48 (LR), though including demographic and neuropsychological tests attenuated differences, Cohen’s d = 0.34 (LR) - 0.95 (MLP).

The resulting model highlights how non-memory neuropsychological deficits affect list-learning test performance. At the same time, the model demonstrated that memory patterns on the CVLT-II can still be identified beyond other confounding deficits since having AD affected all parameters independent of other cognitive impairments. The modeling approach can generate conditional learning curves for individual patient data, and when multiple diagnoses are included in the model, a person-fit statistic can be computed to return the mostly likely diagnosis for an individual. The model can also be used in research to quantify or adjust for the effect of other patient data (e.g., neuroimaging, biomarkers, medications).

The prevalence of mild to moderate cognitive impairment, including episodic memory deficits, in people living with HIV (PLWH) remains high despite the life-extending success of antiretroviral pharmacotherapy. With PLWH now reaching near-normal life expectancy, questions concerning a potential synergy between age- and HIV disease-related effects, including degradation in fronto-limbic circuits, neural systems also compromised in Parkinson’s disease (PD), have emerged.

This cross-sectional study examined the similarities and differences in component processes of verbal episodic memory and their neural correlates in 42 PLWH, 41 individuals with PD, and 37 controls (CTRL) (all participants aged 45-79 years). Learning over five trials, short-delay (SD) and long-delay, (LD), free-recall (FR) and cued-recall (CR) indices were assessed using the California Verbal Learning Test-2. Retention scores for FR and CR were derived adjusting for Trial 5 performance. All memory scores were age- and education-corrected based on the control group and reported as Z-scores. Regional brain volumes were calculated using 3T MRI data and the SRI24 atlas to delineate frontal (precentral, superior, orbital, middle, inferior, supplemental motor, and medial) and limbic (hippocampus, thalamus) regions. Brain volumes were age- and head-sized corrected based on 238 controls (19-86 years old).

Compared with the CTRL group, the HIV and PD groups were impaired on learning across trials and on SD and LD free- and cued-recall, with no group difference between the HIV and PD groups on any score. All three groups benefited similarly from cues compared with free-recall. The HIV and PD groups did not differ from CTRL on retention scores. Regarding brain volumes, the HIV group had smaller middle frontal volumes than the PD or CTRL groups and smaller thalamic volumes than the PD group. Correlational analyses (Bonferroni correction for 8 comparisons, p<.01) indicated that fewer total number of words recalled on Trial 5, learning over Trials 1-5, total words recalled on SD-CR, LD-FR, and LD-CR were associated with smaller orbitofrontal volume in the HIV but not the PD group; the correlations between orbitofrontal volume and memory scores were significantly different between the HIV and PD groups. In PD, but not HIV, lower retention scores on SD-FR and LD-CR correlated to smaller hippocampal volume.

Impairment in learning and cued recall performance indicate that both encoding and retrieval processes are affected in PLWH and PD. Neural correlates of verbal memory differed between groups, with orbitofrontal volume associated with learning and recall in PLWH, whereas hippocampal volume was associated with retention scores in PD. Together, these results suggest that different nodes within the fronto-limbic mnemonic circuitry underlie the mutual verbal episodic memory deficits observed in older PLWH and PD. Support: AA023165, AA005965, AA107347, AA010723, NS07097, MH113406, and the Michael J. Fox Foundation for Parkinson’s Research

Memory is a critical piece of the human experience and impairments in neural memory networks can have devastating consequences for the affected person. A subtype of memory, episodic memory generates context for the present based on past experience and allows us to make predictions about the future. Episodic memories become stable fixtures through long-term memory consolidation. It is believed that consolidation of episodic memory requires a dynamic interplay between connected hippocampal-cortical networks, mainly during sleep. Sleep oscillations, slow oscillations and thalamocortical spindles, coupled with hippocampal sharp wave ripples (SWR) is proposed to be mechanistically involved in establishing the crucial cortical-subcortical dialog. The current study aimed to determine alterations in typical sleep oscillations and oscillation coupling in patients with and without structural hippocampal damage and correlate them with neuropsychological measures believed to be sensitive to hippocampal dysfunction, i.e., Rey Auditory Verbal Learning Task (RAVLT) and Verbal Paired Associates (VPA-II).

We used intracranial electroencephalography (iEEG) in 14 patients with epilepsy to directly record hippocampal and neocortical oscillations and neuropsychological measures obtained prior to implantation. Half of the participants were diagnosed with mesial temporal sclerosis (MTS) in the left hippocampus and healthy tissue in the right hippocampus. The other half did not have MTS and had either mesial temporal epilepsy without MTS or extra-temporal seizures. We analyzed hippocampal SWR output from both hippocampi and characterized neocortical slow oscillations and spindles and their coupling for each participant. We correlated electrophysiological data with behavioral results of neuropsychological testing in order to characterize the clinical relevance.

SWR analysis revealed significant differences in the frequency, t(7639) = 15.52, p>.001, p > .001), amplitude, t(7664) = -23.93, p > .001, and waveforms (p > .001) of SWR in the sclerotic versus healthy hippocampi. Patients with a sclerotic hippocampus but relatively preserved verbal memory scores (RAVLT, VPA-II) showed increased SWR amplitudes in the contralateral hippocampus compared to patients with low verbal memory scores. Additionally, we found differences between hemispheres in phase amplitude coupling of SWRs to spindles and SOs (p > 0.001). Results of our correlational analysis were variable and dependent upon additional factors, such as age of onset and diagnosis duration.

Results from this work will aid in establishing a criterion for characterizing a relationship between subcortical and cortical oscillations as they relate to memory performance. Besides aiding our understanding of the neural mechanisms underpinning memory consolidation this will ideally help with developing neurophysiological biomarkers that may predict possible memory decline in resective or ablative neurosurgery absent of structural lesion. In addition, this work may potentially provide first evidence of a neurophysiological biomarker directly recorded from the human hippocampus to support possible reorganization of memory functioning in the non-sclerotic hippocampus.

Tryptophan is an essential amino acid and precursor to several compounds of neurobiological significance, including serotonin, melatonin, and nicotinamide adenine dinucleotide. However, the tryptophan-kynurenine metabolic pathway exhibits “double-edged sword” effects on neurons with neuroprotective metabolites and neurotoxic intermediates. Given its involvement in neurodegenerative diseases and recent reports of alterations in the pathway in response to obesity, we set out to investigate the potential moderating effect of the kynurenine/tryptophan ratio (KTR) on the relationship between adiposity and verbal memory performance in midlife. Our study is important in providing insight into mechanisms underlying the association between adiposity and cognition through the life course and sheds light on the role of metabolic risk factors before senescence. With the current epidemic of obesity and the expected age-related increase in dementia incidence, even a small association between obesity and cognitive decline may have far-reaching public health implications.

A total of 110 middle-aged adults aged 40-61 years participated in this cross-sectional study. Serum levels of kynurenine and tryptophan, body adiposity measured through bioimpedance, and non-contextual verbal memory performance on the California Verbal Learning Test, Second Edition (CVLT-II) were evaluated. Using factor analysis, the composite score of memory indices from Short Delay Free Recall, Long Delay Free Recall, and Long Delay Recognition tasks were calculated. We used linear regression models with the interaction between KTR and adiposity. Sex, age, years of education, and physical activity were included as covariates, as they predict cognitive performance.

Higher KTR was associated with greater adiposity (p < 0.01). Linear regression analyses for assessing interaction effects indicated that KTR moderated the relation between adiposity and composite memory score (F(7, 100) = 5.22, p < 0.001, R2 = 0.27). These results were robust across individual memory indices and composite memory scores. These findings remained significant even with adjusting for relevant covariates. Interestingly, the marginal effects of adiposity on composite memory score were estimated to be statistically significant and negative (higher adiposity = poorer memory) only when KTR was low (< 0.03).

The present study indicates that KTR may influence the association between adiposity and verbal memory in midlife as KTR moderated the relationship between adiposity and composite memory score even after adjusting for relevant covariates. In contrast to the notion that high KTR is related to increases in neurotoxic metabolites such as quinolinic acid, individuals with high adiposity and low KTR exhibited the weakest memory performance. Unfortunately, our study did not include measurements of quinolinic acid or kynurenic acid, which may have neuroprotective and anti-inflammatory properties. Future studies expanding the number of measured KT metabolites could shed light on the interactions between obesity and KTR on memory function in midlife.

Previous research has demonstrated that individuals with Agenesis of the Corpus Callosum (AgCC), the congenital absence of all or part of the corpus callosum, exhibit a pattern of cognitive and psychosocial deficits, even with a FSIQ in the normal range (FSIQ > 80; Brown & Paul, 2019). This includes a core deficit in their complex reasoning and novel problem-solving (Brown & Paul, 2019), with secondary deficits in capacity to imagine complex emotional/cognitive consequences of potential actions involving others (Young et al, 2019), deficits in emotion

perception (Symington et at., 2010, Bridgman et al 2014), and difficulty with cognitively processing emotions within the context of social interactions (Anderson et al., 2017). This constellation of deficits is likely to also impact moral reasoning. While previous research has demonstrated differences in moral reasoning among other neuropsychological populations such as those with ventromedial prefrontal damage (Moretto et al., 2010) and frontotemporal dementia (Gleichgerrcht et al., 2011), there is no research reported regarding moral judgements in AgCC. This study employed the Moral Dilemmas Scale (Greene, 2001) to compare the moral judgements of persons with AgCC to neurotypical controls. It was predicted that individuals with AgCC would be less contextually nuanced than neurotypical controls in responding to moral dilemmas.

Results consist of data derived from 57 neurotypical control participants (ages 23 to 64 years) recruited from MTurk Cloud and 19 AgCC participants (ages 23 to 77 years) with normal-range FSIQ (>80) drawn from the individuals with AgCC involved with the Human Brain and Cognition Lab at the Travis Research Institute. All participants completed an online version of the Moral Dilemmas Scale (Greene, 2001). The scale consists of 25 dilemmas, of which 11 are considered high-conflict, 7 low-conflict and 7 impersonal. Participants were instructed to read each dilemma and rate whether they found the action to be “appropriate” or not. The high-conflict dilemmas share a similar structure in which responses reflect either a utilitarian or deontological judgement.

“Approve” responses to each of the 3 categories of dilemma were separately tallied for each individual and subjected to a 2group ANOVA. Results revealed the control group produced a significantly higher rate of “appropriate” responses to high-conflict dilemmas than did the individuals with AgCC (F=8.17, p = .006, n2 =.113). However, no significant differences were found among the two groups for results on low (n2 = .013) and impersonal (n2 = .003) dilemmas alone. Furthermore, a X2 analysis of responses to each high conflict dilemma revealed a significant difference in 5 out of the 11 such that more persons with AgCC gave a deontological judgement.

Results suggested that adults with AgCC respond similarly to neurotypical controls with respect to the low conflict or

impersonal dilemmas. However, with respect to high conflict dilemmas, compared to controls they tend to respond in a more deontological than utilitarian basis - that is, based on general principles without contextual nuance. These findings are consistent with the conclusion of Renteria-Vasquez et al. (2021) that persons with AgCC have difficulty imagining the wider implications of present information.

Neurocognitive decline is prevalent in patients with metastatic cancers, attributed to various disease, treatment, and individual factors. Whether the presence of brain metastases (BrMets) contributes to neurocognitive decline is unclear. Aims of this study are to examine neurocognitive performance in BrMets patients and compare findings to patients with advanced metastatic cancer without BrMets. Here, we present baseline findings from an ongoing, prospective longitudinal study.

English-speaking adults with advanced metastatic cancers were recruited from the brain metastases and lung clinics at the Princess Margaret Cancer Centre. Participants completed standardized tests (WTAR, HVLT-R, BVMT-R, COWAT, Trailmaking test, WAIS-IV Digit Span) and questionnaires (FACT-Cog v3, EORTC-QLQ C30 and BN20, PROMIS Depression(8a) and Anxiety(6a)) prior to cranial radiotherapy for those who required it. Test scores were converted to z-scores based on published normative data and averaged to create a composite neurocognitive performance score and domain scores for memory, attention/working memory, processing speed and executive function. Neurocognitive impairment was defined according to International Cancer and Cognition Task Force criteria. Univariate and multivariate regressions were used to identify individual, disease and treatment variables that predict cognitive performance.

76 patients (mean (SD) age: 63.2 (11.7) years; 53% male) with BrMets were included. 61% experienced neurocognitive impairment overall; impairment rates varied across domains (38% memory, 39% executive functioning, 13% attention/working memory, 8% processing speed). BrMets quantity, volume, and location were not associated with neurocognitive performance. Better performance status (ECOG; ß[95%CI];-0.38[-0.70,-0.05], p=0.021), higher premorbid IQ (0.34[0.10,0.58], p=0.005) and greater cognitive concerns (0.02[-3.9e-04,0.04], p=0.051) were associated with better neurocognitive performance in univariate analyses. Only premorbid IQ (0.37[0.14,0.60], p=0.003) and cognitive concerns (0.02[0.0004, 0.03], p=0.05) remained significant in multivariate analysis. We also recruited 31 patients with metastatic non-small cell lung cancer (mNSCLC) with no known BrMets (age: 67.5 (8.3); 32% male) and compared them to the subgroup of BrMets patients in our sample with mNSCLC (N=32; age: 67.8 (11.7); 53% male). We found no differences in impairment rates (BrMets/non-BrMets: Cognitive Composite, 59%/55%; Memory, 31%/32%; Executive Functioning, 35%/29%; Attention/working memory, 16%/13%; Processing speed, 7%/6%; Wilcoxon rank-sum test, all p-value’s > 0.5). The presence or absence of BrMets did not predict neurocognitive performance. Among patients with mNSCLC, higher education (0.11[0.03,0.18], p=0.004) and premorbid IQ (0.36[0.12,0.61], p=0.003), fewer days since primary diagnosis (0.00290[-0.0052,-0.0005], p=0.015) fewer pack-years smoking history (0.01[0.02,-0.001], p=0.027) and greater cognitive concerns (0.02[7e-5,0.04], p=0.045) were associated with better neurocognitive performance in univariate analyses; only premorbid IQ (0.26[0.02,0.51], p=0.04) and cognitive concerns (0.02[0.01,0.04], p=0.02) remained significant in multivariate analysis.

Cognitive impairment is prevalent in patients with advanced metastatic cancers, particularly affecting memory and executive functioning. However, 39% of patients in our sample were not impaired in any domain. We found no associations between the presence of BrMets and neurocognitive function in patients with advanced cancers prior to cranial radiation. Premorbid IQ, a proxy for cognitive reserve, was associated with cognitive outcomes in our sample. Our longitudinal study will allow us to identify risk and resilience factors associated with neurocognitive changes in patients with metastatic cancers to better inform therapeutic interventions in this population.

Many people with HIV (PWH) are at risk for age-related neurodegenerative disorders such as Alzheimer’s disease (AD). Studies on the association between cognition, neuroimaging outcomes, and the Apolipoprotein E4 (APOE4) genotype, which is associated with greater risk of AD, have yielded mixed results in PWH; however, many of these studies have examined a wide age range of PWH and have not examined APOE by race interactions that are observed in HIV-negative older adults. Thus, we examined how APOE status relates to cognition and medial temporal lobe (MTL) structures (implicated in AD pathogenesis) in mid- to older-aged PWH. In exploratory analyses, we also examined race (African American (AA)/Black and non-Hispanic (NH) White) by APOE status interactions on cognition and MTL structures.

The analysis included 88 PWH between the ages of 45 and 68 (mean age=51±5.9 years; 86% male; 51% AA/Black, 38% NH-White, 9% Hispanic/Latinx, 2% other) from the CNS HIV Antiretroviral Therapy Effects Research multi-site study. Participants underwent APOE genotyping, neuropsychological testing, and structural MRI; APOE groups were defined as APOE4+ (at least one APOE4 allele) and APOE4- (no APOE4 alleles). Eighty-nine percent of participants were on antiretroviral therapy, 74% had undetectable plasma HIV RNA (<50 copies/ml), and 25% were APOE4+ (32% AA/Black/15% NH-White). Neuropsychological testing assessed seven domains, and demographically-corrected T-scores were calculated. FreeSurfer 7.1.1 was used to measure MTL structures (hippocampal volume, entorhinal cortex thickness, and parahippocampal thickness) and the effect of scanner was regressed out prior to analyses. Multivariable linear regressions tested the association between APOE status and cognitive and imaging outcomes. Models examining cognition covaried for comorbid conditions and HIV disease characteristics related to global cognition (i.e., AIDS status, lifetime methamphetamine use disorder). Models examining the MTL covaried for age, sex, and

relevant imaging covariates (i.e., intracranial volume or mean cortical thickness).

APOE4+ carriers had worse learning (ß=-0.27, p=.01) and delayed recall (ß=-0.25, p=.02) compared to the APOE4- group, but APOE status was not significantly associated with any other domain (ps>0.24). APOE4+ status was also associated with thinner entorhinal cortex (ß=-0.24, p=.02). APOE status was not significantly associated with hippocampal volume (ß=-0.08, p=0.32) or parahippocampal thickness (ß=-0.18, p=.08). Lastly, race interacted with APOE status such that the negative association between APOE4+ status and cognition was stronger in NH-White PWH as compared to AA/Black PWH in learning, delayed recall, and verbal fluency (ps<0.05). There were no APOE by race interactions for any MTL structures (ps>0.10).

Findings suggest that APOE4 carrier status is associated with worse episodic memory and thinner entorhinal cortex in mid- to older-aged PWH. While APOE4+ groups were small, we found that APOE4 carrier status had a larger association with cognition in NH-White PWH as compared to AA/Black PWH, consistent with studies demonstrating an attenuated effect of APOE4 in older AA/Black HIV-negative older adults. These findings further highlight the importance of recruiting diverse samples and suggest exploring other genetic markers (e.g., ABCA7) that may be more predictive of AD in some races to better understand AD risk in diverse groups of PWH.

A recent review called for a more robust assessment of cannabis use (CU), including amount and timing of recent use to assess neurocognitive effects of CU among people living with HIV (PWH) (Ellis et al., 2021). The current study addresses some issues raised by investigating between group neurocognitive differences among healthy controls and PWH who differ on their cannabis use histories, using strict inclusion criteria, robust classification of CU, and administration of an established neurocognitive test battery.

Among this community sample of adults (N=309), 58 were classified as CU+/HIV+ group (84.5% Male), 76 as CU-/HIV+ (57.9% M), 86 as CU+/HIV- (58.1% M), and 89 as CU-/HIV- (53.9% M). Exclusion criteria included history of past 12-month dependence and extensive lifetime dependence or significant use of illicit substances other than cannabis, severe or current mood or thought disorder, and other medical conditions that adversely impact neurocognitive functioning. Inclusion criteria for CU+ groups included <30-days since last CU, >10 times of CU in last month, 3 times of CU per month in last 12 months, > 1 year of CU, and > 500 times used in lifetime. CU parameters did not statistically differ between HIV+/CU+ and HIV-/CU+. CU- groups’ inclusion criteria required no CU in last 6 months, 196 lifetime number of times used, and no history of CU dependance. Lifetime CU did not statistically differ between CU-/HIV+ and CU-/HIV- groups. HIV+ groups did not differ significantly on HIV viral load in plasma or nadir CD4+ counts. Significant between group differences included age, sex, years of education, and amount of alcohol and nicotine use within 12 months. The aforementioned sociodemographic and substance use variables that differed between groups were covariates in analyses. A battery of 10 neurocognitive measures, two measures per each domain of learning, memory, motor, executive functioning, and processing speed. Global composite summary scores for overall neurocognitive performance were calculated by averaging M T-scores for each neurocognitive domain. Data transformations were used to address any violations of statistical assumptions.

To facilitate data reduction, neurocognitive task scores were standardized to T-scores using the M and SD of the CU-/HIV-group. An omnibus model of between-group comparisons on global neurocognitive task performance revealed no significant differences, F(3) = .16, p = .923. Subsequent Tukey’s post hoc test revealed no significant differences among the four groups. Results also revealed nonsignificant differences between groups in neurocognitive performance within each domain. However, the CU-/HIV- group performed significantly worse than the CU-/HIV+ group on the Executive Functioning domain, based on Tukey’s post hoc test.

We found no significant global neurocognitive differences among groups; however, there was some evidence for domain-specific neurocognitive differences in executive functioning. This contrasts somewhat with existing literature on HIV and cannabis-associated neurocognitive deficits. Several factors may have contributed to this, including our relatively healthy PWH sample. Future analyses will examine interactive effects of HIV severity and severity of CU on neurocognition. This analysis will better determine who, among PWH, are most at-risk for cannabis-associated neurocognitive effects and what factors may exacerbate them.

Due to decades of structural and institutional racism, minoritized individuals in the US are more likely to live in low socioeconomic neighborhoods, which may underlie the observed greater risk for neurocognitive impairment as they age. However, these relationships have not been examined among people aging with HIV. To investigate neurocognitive disparities among middle- and older-aged Latino and non-Latino White people living with HIV (PWH), and whether neighborhood socioeconomic deprivation may partially mediate these relationships.

Participants were 372 adults ages 40-85 living in southern California, including 186 Latinos (94 PWH, 92 without HIV) and 186 non-Latino (NL) Whites (94 PWH, 92 without HIV) age-matched to the Latino group (for the overall cohort: Age M=57.0, SD=9.1, Education: M=12.7, SD=3.9, 38% female; for the group of PWH: 66% AIDS, 88% on antiretroviral therapy [ART]; 98% undetectable plasma RNA [among those on ART]). Participants completed psychiatric and neuromedical evaluations and neuropsychological tests of verbal fluency, learning and memory in person or remotely. Neuropsychological results were converted to demographically-unadjusted global scaled scores for our primary outcome. A neighborhood socioeconomic deprivation variable (SESDep) was generated for census tracts in San Diego County using American Community Survey 2013-2017 data. Principal components analysis was used to create one measure using nine variables comprising educational (% with high school diploma), occupational (% unemployed), economic (rent to income ratio, % in poverty, (% female-headed households with dependent children, % with no car, % on public assistance), and housing (% rented housing, % crowded rooms) factors. Census tract SESDep values were averaged for a 1km radius buffer around participants’ home addresses.

Univariable analyses (independent samples t-tests and Chi-square tests) indicated Latinos were more likely to be female and had fewer years of formal education than NL-Whites (ps<.05). Latino PWH had higher nadir CD4 than White PWH (p=.02). Separate multivariable regression models in the overall sample, controlling for demographics and HIV status, showed Latinos had significantly lower global scaled scores than Whites (b=-0.59; 95%CI-1.13, -0.06; p=.03) and lived in more deprived neighborhoods (b=0.62; 95%CI=0.36, 0.88; p<.001). More SES deprivation was significant associated with worse global neurocognition in an unadjusted linear regression (b=-0.55; 95%CI=-0.82, -0.28; p<.001), but similar analyses controlling for demographics and HIV status, showed SESDep was not significantly related to global scaled scores (b=-0.11; 95%CI= -0.36, 0.14; p=.40). Exploratory analyses examined primary language (i.e., English vs Spanish) as a marker of Hispanic heterogeneity and its association with neurocognition and SESDep. Controlling for demographics and HIV status, both English-speaking (b=0.33; 95%CI=0.01. 0.64; p=.04) and Spanish-speaking Latinos (b=0.88; 95%CI=0.58, 1.18; p<.001) lived in significantly greater SESDep neighborhoods than Whites, with SESDep greater for Spanish-speakers than English-speakers (p<.001). However, only English-speaking Latinos had significantly lower neurocognition than Whites (b=-0.91; 95%CI=0-1.57, -0.26; p<.01; Spanish-speakers: b=-0.27; 95%CI=-0.93, 0.38; p=.41).

Among our sample of diverse older adults living with and without HIV, English-speaking Latinos showed worse neurocognition than Whites. Though SES neighborhood deprivation was worse among Latinos (particularly Spanish-speakers) it was not associated with neurocognitive scores after adjusting for demographics. Further studies investigating other neighborhood characteristics and more nuanced markers of Hispanic heterogeneity (e.g., acculturation) are warranted to understand factors underlying aging and HIV-related neurocognitive disparities among diverse older adults.

Discrimination on the basis of race, gender identity, and age, among others, has been associated with negative cognitive outcomes. However, the mechanisms by which perceived discrimination impacts cognition are not yet well understood. Discrimination can lead to chronic stress, which disrupts glucocorticoid pathways and induces susceptibility to metabolic dysregulation. On the basis of this prior work, and the known associations between metabolic syndrome and cognition, the current study examined the hypothesis that metabolic syndrome mediates the relationship between discrimination and cognition.

1,063 adults (Mean age = 54.92 years, SD = 11.68) who participated in the Midlife in the United States project were included. Confirmatory factor analysis was used to examine the acceptability of a bifactor model of metabolic syndrome using four subfactors (insulin resistance, adiposity, dyslipidemia, and blood pressure). The mediating effect of the metabolic syndrome latent factor on the association between discrimination and cognition was tested using PROCESS (Hayes, 2013). Exploratory analyses were conducted to examine which cognitive domains and which metabolic syndrome subfactors were driving these relationships. Mediation analyses adjusted for age, race, sex, and education.

The three most frequently reported reasons for discrimination were gender (n = 209), age (n = 174), and race (n = 129). The CFA of metabolic symptoms was deemed acceptable based on previously outlined goodness of fit criteria (CFI = 0.986, TLI = 0.976, RMSEA = 0.040, SRMR = 0.034). Results of the mediation analysis indicated a significant indirect effect of major events discrimination on the total cognition composite through the general metabolic syndrome factor (B = -0.0029, 95% CI [-0.0016, -0.0066]). Further examination revealed that this relationship was driven through an indirect path of metabolic syndrome on the relationship between discrimination and executive functioning (B = -0.0024, 95% CI -0.0059, -0.0001]). We examined which subfactors were driving these relationships and found that there were significant indirect effects of major events discrimination on total cognition through the insulin resistance (B = -0.0028, 95% CI -0.0065, -0.0003]) and dyslipidemia factors (B = -0.0026, 95% CI -0.0064, -0.0002]).

Our findings provide evidence that metabolic syndrome can help explain differences in cognitive functioning based on experiences of discrimination, even after adjusting for relevant demographic factors. Results from this study suggest that understanding the impact of perceived discrimination on metabolic syndrome and developing lifestyle interventions that can improve metabolic syndrome may be helpful in reducing stress-related cognitive disparities.

The Personality Assessment Inventory (PAI; Morey, 1991; 2007) is a 344 item self-report measure of personality, psychopathology, and factors affecting treatment. The PAI short form (PAI-SF) contains the first 160 items of the PAI and is often favoured as a screening tool or brief version to mitigate respondent burden and fatigue. The PAI has been psychometrically validated among numerous populations (Slavin-Mulford et al., 2012), while psychometric research on the PAI-SF is gradually emerging. The psychometric properties of the PAI-SF range from adequate to strong in psychiatric (Sinclair et al., 2009), forensic (Sinclair et al., 2010), outpatient and nonclinical (Ward et al., 2018), and stroke (Udala et al., 2020) samples. To advance research validating the PAI-SF among diverse populations, this project investigated the psychometric comparability between the PAI and the PAI-SF in a neuropsychiatric population. Based on previous literature, it was hypothesized that the PAI-SF would produce congruent results to the PAI in this sample.

For this study, participant files (N=214) were collected retrospectively from short- and long-term residential psychiatric and substance use treatment facilities in Minnesota for patients with neurological and cognitive concerns referred for neuropsychological evaluation. The PAI-SF was scored using the first 160 items from a patient’s long-form PAI protocol. To determine the psychometric comparability of long- and short-forms, paired-samples t-tests, intraclass correlations, and percent agreement in clinical classification between forms were analyzed.

Analyses of participant data found that intra-class correlations ranged from .87 to .98 for each subscale on the PAI when compared to the PAI-SF, demonstrating good to excellent reliability between forms. Symptoms are considered clinically elevated when they exceed the clinical significance threshold for a subscale (typically a T-score of 70+). Agreement between the PAI and PAI-SF subscales in the classification of clinically elevated scores ranged from 86% to 100%. When forms did not agree, the PAI-SF was more likely to be clinically significant relative to the PAI. A comparison of subscale means between forms was examined by independent samples T-tests with a Bonferroni correction. Results revealed significant differences between the PAI and PAI-SF on one validity scale (Negative Impression Management), three clinical scales (Anxiety; Depression; Antisocial Features), and one treatment scale (Treatment Rejection).

Results demonstrated that the PAI and PAI-SF have high reliability between forms in a neuropsychiatric population. Although mean scores differed on a small number of subscales between the PAI and PAI-SF, differences did not appear sufficiently large enough to shift clinical classifications, as the two forms performed similarly in their identification of clinically elevated scales. Findings align with previous literature and suggest that the PAI-SF may perform adequately in a neuropsychiatric population if brevity or participant burden is of concern. However, caution is warranted when making clinical decisions with the PAI-SF as more research is needed.

Face masks are required in many healthcare settings. Face masks have well documented health advantages, but they can negatively impact interpersonal communication, an essential element of neuropsychological assessment. The purpose of this study was to quantify the impact of face masks on neuropsychological assessment in a large clinical setting.

Participants included 755 pre-pandemic onset (51.3 % men, M = 59.54 years, SD = 17.23) and 838 (51.7% men, M = 60.63 years, SD = 16.71) post-pandemic onset outpatients from a large academic medical center in the Midwest. Performance was compared on selected assessments characterized by visual function (WAIS-IV Block Design, WAIS-IV Matrix Reasoning, and the Rey-Osterrieth Complex Figure Test - Copy trial) and assessments characterized by verbal function (WAIS-IV Digit Span (DS), Rey Auditory Verbal Learning Test (AVLT) total score, and Complex Ideational Material). Secondary analyses compared performance between the groups by age: in an older group (greater than 65 years old) and a younger group (less than 65 years old).

The pre-and-post pandemic onset groups did not differ with respect to age, gender, education, or clinical diagnosis. Independent Samples T-tests showed that the post-pandemic onset group performed significantly worse on two verbal tests, DS (p =.005, Cohen’s d = 0.131) and the AVLT (p <.001, Cohen’s d = 0.245). Within the older group, the frequency of patients with dementia (54.1 vs 54.8 percent), and all other diagnoses, was comparable pre-and-post pandemic onset. The younger group also had comparable rates of clinical diagnoses at each time point. Secondary analyses showed that the older group was the only group to perform significantly worse on the two verbal tests post-pandemic onset: DS (p =.004, Cohen’s d = 0.20) and AVLT (p <.001, Cohen’s d = 0.39). The younger group had no differences in their performance on any of the verbal tests. For both the primary and secondary analyses, none of the groups had a significant change in performance on the tests that were characterized by visual function.

These results suggest that mask use during neuropsychological assessment may hinder performance on tests that require close attention to verbal output in older patients. This finding is not otherwise explained by demographic or clinical differences. In fact, these patients had nearly identical rates of dementia before and after the onset of the pandemic. In contrast, performance on tests that rely mainly on visual function was not affected. Attending to masked speech may be more cognitively demanding for older individuals, thus influencing their performance during testing. This may be particularly relevant for neuropsychologists working in geriatric settings.

Neuropsychologists performing assessments inperson, with masks, should be aware that patient scores on certain tests may be artificially deflated for reasons unrelated to cognition or clinical condition.

With the emergence of the coronavirus 2019 pandemic, investigating the validity of tele-screenings for neuropsychological status has become increasingly necessary. While the telephone version of the Montreal Cognitive Assessment (MoCA-T) has been validated for use in patients with Parkinson’s and stroke/cerebrovascular disease, the clinical utility of this instrument in geriatric patients with other suspected cognitive disorders has yet to be determined. Thus, the present study aimed to examine the classification accuracy of the MoCA-T in a mixed clinical sample of patients with mild cognitive impairment (MCI) or dementia.

Ninety-one older adults were administered the MoCA-T via videoconferencing technology as part of a comprehensive neurocognitive evaluation performed by a multidisciplinary treatment team within a dementia specialty clinic. Based on this evaluation, 51 (56.0%) patients were diagnosed with dementia, 27 (29.7%) with MCI, and 13 (14.3%) with no neurocognitive diagnosis (i.e., subjective cognitive complaints). In addition to MoCA-T total and item scores, we also computed subscale scores for between-group comparisons as the sum of items assessing orientation, language, attention/executive function, and memory. ANOVA/ANCOVA and ROC curve analyses were used to examine between-group differences on the MoCA-T and its psychometric properties in discriminating patients with MCI or dementia, respectively.

Participants had a mean age of 74.3 ± 8.7 and education of 16 ± 2.9 years. Patients with dementia were significantly older than those with MCI and no diagnosis, but there were no other significant between-group differences in clinical characteristics. MoCA-T total [F(2,86)=28.5, p<0.001] and all subscale scores (p<0.01) differed significantly between groups and in the expected direction (dementia<MCI<no diagnosis) even after controlling for age. The only exception was language for which there was initially a statistical trend (p=0.06) that reached significance (p<0.05) after controlling for age. In terms of individual items, abstraction, fluency, orientation to place/city, and category cued recall were the only items that did not differ significantly between groups. ROC curve analyses revealed -5 points to be the optimum cut-off for distinguishing between cognitively normal individuals from patients with MCI (Sensitivity=0.67; Specificity=0.77; AUC=0.78), and a cut-off of -8 points optimally distinguished between patients with MCI and dementia (Sensitivity=0.77; Specificity=0.74; AUC=0.81).

The current study provides further evidence for the clinical utility of the MoCA-T as a screening instrument for neurocognitive disorders in older adults and extends prior work to include administration via videoconferencing technology. While previous studies have focused on the use of MoCA-T in specific patient populations, here, we demonstrate the validity of this screening tool in a mixed-clinical sample, which suggests its broader use in clinical settings for distinguishing between neurocognitive disorders, regardless of the underlying etiology.

Patients with Parkinson’s disease (PD) commonly show deficits on tests of visuospatial functioning. The Identi-Fi is a new measure of visual organization and recognition composed of two components. The Visual Recognition (VR) subtest asks persons to identify an object that has been broken its pieces and rearranged, akin to the Hooper Visual Organization Test, but using updated and colorful pictures. The Visual Matching (VM) subtest involves showing the same stimuli, but the examinee must select the correct response from among five choices (1 correct and 4 foils), placing greater demand on visuospatial discrimination. Together, the two subtests comprise the Visual Organization Index (VOI), reflecting overall visual processing and organization ability. The present study examined performance on the Identi-Fi in patients with PD and its association with other aspects of cognition.

Participants were 23 patients with PD (95% male; mean age = 69.7 years [SD = 7.8], range = 47-79) and 12 patients with cognitive concerns (CC) who were intact on neuropsychological testing (excluding consideration of Identi-Fi scores; 50% male, mean age = 71.08 [SD = 6.27], range = 60-78) seen for a neuropsychological evaluation at a large Northeastern medical center. As part of a larger battery, patients completed the Identi-Fi, Trail Making Test (TMT), Category Fluency, Test of Premorbid Functioning (TOPF), and Brief Visuospatial Memory Test, Revised (BVMT-R).

The PD group performed significantly worse than the CC group on VR and VM, as well as VOI, of the Identi-Fi (p < .001). Within the PD group, poorer VR, VM, and VOI performance was associated with lower scores on the TOPF (p < .05), BVMT-R learning (p < .05) and delayed recall (p < .05), as well as TMT Parts A and B (p < .05). VR was significantly correlated with Category Fluency (p < .05), while a trend was seen for the association between VOI and Category Fluency (p = .094).

Identi-Fi performance was worse in the PD group than the CC group, which is consistent with prior research indicating that visuospatial processing is often abnormal in patients with PD. Furthermore, findings indicate that poorer performance on the Identi-Fi in the PD group is associated with poorer cognitive functioning in other domains (i.e., visuospatial learning and memory, processing speed, cognitive flexibility, and semantic fluency), as well as lower premorbid intellectual functioning. While these findings suggest that the Identi-Fi is useful in identifying visuospatial dysfunction in PD, findings should be interpreted with caution given the small sample sizes and uneven gender distribution

Cognitive, motor and sensory deficits associated with aging, and with some neurological conditions such as acquired brain injury, may lead to severe driving performance impairment. While rehabilitation and driver assistance technologies may improve driving performance, the assessment of the actual fitness-to-drive of these people is challenging. Office-based neuropsychological/physical tests are considered insufficient to understand one’s ability to drive. The gold standard is the on-road assessment with dual control cars, superior in ecological validity, but expensive, stressful, and potentially unsafe. Valid, more cost-effective solutions for a safer, more accurate, standardized assessment of fitness-to-drive are currently needed. Modern and sensorized driving simulators offer key advantages, such as the possibility of exposing drivers to several relevant driving scenarios, including hazard situations, and of assessing their driving performance without being physically at risk. However, the extraction and direct interpretation of existing simulator-produced data may require specialized data processing skills or simulation expertise. To overcome this, we have developed an easy-to-use, pencil-and-paper observational instrument. The Sim-DOS is an adaptation of the widely used instrument to assess “natural driving”, the Driving Observation Schedule (DOS; Vlahodimitrakou et al., 2013).

Via expert consensus, DOS targeted behaviors were adapted to a simulated-based environment (signaling, observation of environment, speed regulation, slow or unsafe reaction, distance interpretation, vehicle/lane positioning), and the Sim-DOS scores calculation (based on errors while doing such behaviors) was adapted from DOS to include hazard situations (HS, 0-100) and free driving (FD, 0-°°) scores. The instrument was then piloted with a sample of 35 older adults, along with the collection of simulator-produced data on number of harsh events and driving speed. Participants drove two consecutive 20-minutes long scenarios, with low and high traffic density (LTD, HTD). In each scenario, there were periods with and without potentially hazard situations.

Assessments were performed by two independent trained observers, producing substantial inter-rater reliability (intra-class correlation coefficients above 0.94). Participants (70.7±4.1 years old, 60% male, 46.1±6.7 years of driving experience) were mostly regular drivers (74%). However, psychomotor skills of the majority were compromised, with only one participant being above the 80th percentile in the reaction times test of the national mandatory driving assessment. When exposed to hazard situations, most of the participants (94.1%) did not perform well, independently of traffic density, with average Sim-DOS-HS scores of 87.1±9.7 (out of 100, t-values>7.3, p-values<.05).

Compared to LTD scenarios, in HTD scenarios participants drove less smoothly (HTD:0.97±1.24 vs. LTD:0.33±0.58 of harsh events, Z=3.1, p<.05). However, they also drove slower (HTD:82.41±27.43 vs. LTD:103.55±14.61 km/h, t=5.2, p<.05), improving their ability to manage hazard situations, and therefore producing higher than expected Sim-DOS scores (HTD:87.05±10.28). During free driving, participants performed worse under LTD conditions (Sim-DOS-FD scores: HTD:11.68±6.20 vs. LTD:14.40±9.58, t=2.15, p<.05) as they drove at higher speed (HTD:85.01±24.28 vs. LTD:104.70±11.94 km/h, t=5.8, p<.05), although they did it more smoothly (HTD:1.94±3.74 vs. LTD:0.45±0.74 harsh events, Z=2.65, p<.05).

Our study provides a validated driving assessment tool for use in driving simulators that will allow a safer, more ecologic, holistic and informative evaluation of the fitness-to-drive of older adults and neurological patients.

The Montreal Cognitive Assessment (MOCA) is a brief cognitive screener, widely used by providers to detect mild cognitive impairment (MCI). It encompasses 30 questions, assessing executive functioning, visuospatial skills, language, memory, attention, and orientation. Although the MOCA has been shown to have high sensitivity (90%) and specificity (87%) for detecting MCI, existing studies have primarily included participants who were already diagnosed with amnestic MCI via neuropsychological testing. Since several factors beyond the presence of MCI can contribute to low performance on the MOCA (e.g., premorbid IQ, fatigue, mood symptoms), over-reliance on the MOCA runs the risk of falsely identifying individuals as having cognitive impairment. The MOCA’s memory subtest raises particular concern as there are several language-based tasks between the learning and delay trials, introducing the potential for interference effects. Thus, the MOCA’s ability to accurately identify those at risk for MCI in the community remains unclear. The objective of the present study was to evaluate: (1) the MOCA’s association with neuropsychological memory measures; and (2) its ability to distinguish between neurocognitive groups (intact vs. MCI vs. dementia).

This study involved a retrospective analysis of fifty-one patients (M age=72.58 [7.90]; M education= 16.37 [16.37]) who underwent neuropsychological evaluation. Standardized scores for total list-learning (HVLT; CVLT-bf) were used to capture memory encoding; retention % scores were used to capture memory storage. MOCA scores included Total MOCA, MOCA-Orientation, and the MOCA Memory Index (MOCA-MEM). MOCA-MEM was calculated based on Julayanont et al., 2014— (Free-Delayed Recall*3) + (Category-Cued Recall*2) + Multiple Choice-Cued Recall. Bivariate correlations were conducted for the MOCA and neuropsychological test scores. Participants were divided into three diagnostic groups, classified by the neuropsychologist: (1) Cognitive Intact (CI; n=13); (2) MCI (n=26); and (3) Major Neurocognitive Disorder/Dementia (MNCD; n=11). Analysis of covariance was used to analyze differences between the cognitive groups on Total MOCA, MOCA-Orientation, and MOCA-MEM.

Total MOCA correlated with word-list learning (r=.434, p=.004) and retention% (r=.306, p=.049). MOCA-MEM was correlated with word-list learning (r=.367, p=.042); it did not significantly correlate with retention%. MOCA-Orientation had the strongest correlation with retention0/) (r=.406, p=.009). Means of Total MOCA significantly differed between CI (25.31[2.56]), MCI (22.04[4.14]), and MNCD (15.44[4.13]). MOCA-MEM only differentiated CI (10[3.66]) and MNCD (5.71[2.14]); it did not differentiate MCI (6.94[3.13]) from either CI or MNCD.

Our findings suggest that the MOCA has limitations in accurately classifying memory deficits in older adults. First, our study suggests that the MOCA-MEM reflects encoding rather than memory storage. Given that deficiency in encoding may be secondary to other cognitive deficits, such as attention and executive dysfunction, performance on MOCA-MEM cannot readily delineate the presence of an amnestic process. Second, the findings show that MOCA-MEM does not differentiate between patient groups with intact cognition versus MCI, nor those with MCI versus MNCD. These findings argue the importance of neuropsychological evaluation in deciphering patterns of memory performance and the presence of an amnestic process.