The intricacies and difficulties in measuring forgetting rates, both in healthy participants and in clinical patients, have been intensively investigated since the 1970s. In recent years, there has been a revival of interest in ‘long-term’ forgetting rates, particularly in transient epileptic amnesia (TEA) and temporal lobe epilepsy (TLE), and some ‘old’ lessons have had to be re-learned.

Studies of long-term forgetting in patient groups will be reviewed, together with variables that influence different patterns of forgetting. In particular, I will report findings from two recent studies of TLE, as well as other related investigations.

Studies indicate that an impairment in memory ‘acquisition’, rather than differences in ‘long-term’ forgetting, appear critical in amnesic disorders, sometimes associated with differences in ‘early’ forgetting on recall memory measures only. An exception may be the effect of seizures, whether in consequence of epilepsy or ECT, which sometimes, but not always, appears to accelerate forgetting rates. Another important finding has been the pronounced variability in forgetting rates, both between individuals within a patient group and within individuals tested on separate occasions, making inferences from single-case studies problematical.

Findings will be interpreted in the light of these observations.

Health providers frequently probe patients’ recall of current and/or remote news items to determine the extent of memory loss. Impaired memory for transient events (i.e., in the news for a circumscribed time) may provide information regarding the onset of cognitive impairment. We utilized the Transient News Events Test (TNET) to explore how memory changes over time in older adults with cognitive impairment (CI) and non-cognitively impaired (NCI) individuals. We hypothesized that CI individuals would demonstrate reduced memory for transient events. We investigated the role of semantic and episodic memory on TNET performance.

Participants completed the TNET as part a comprehensive neuropsychological evaluation. Analyses included t tests to evaluate group differences for TNET performance, and correlations between TNET and neuropsychological measures, including episodic and semantic memory tests.

NCI adults demonstrated better memory than CI participants for TNET items. The NCI and CI groups did not differ regarding memory for remote items; however, CI participants had worse memory for recent items. There was a significant association between TNET performance and capacity for episodic and semantic memory in people with CI. In the NCI group, the TNET was associated only with episodic memory.

Findings support the use of news events to assess remote memories in older adults. Novel remote memory measures broaden the scope of memory assessment far beyond what is feasible within traditional neuropsychological assessment and provide insight into the onset of memory changes. Results enhance understanding of memory decline in older adults with cognitive impairment.

Accelerated long-term forgetting (ALF) has been reported in healthy older individuals, and is a possible early marker for risk of developing Alzheimer’s disease (AD). The Verbal Associative Learning & Memory Test (VALMT; McGibbon & Jansari, 2013) addresses methodological weaknesses in existing clinical tests and has detected ALF in epilepsy within an hour. We used VALMT to investigate learning and forgetting in healthy older participants.

Older (60-69yrs) and Younger (19-31yrs) participants were compared. Using VALMT, unrelated word-pairs were learned to criterion, then cued-recall was tested at delays of 5, 30 and 55 minutes. Unique pairs were tested at each delay. Subjective memory complaints data were gathered, and the Wechsler Memory Scale Logical Memory test (WMS-LM; a standard clinical measure) was administered.

VALMT identified a significant difference in delayed recall between Younger and Older groups by 55 minutes (d = 1.32). While 'fast-learning’ Older participants scored similarly to Younger participants, 'slow-learning’ Older participants were impaired at all delays. Forgetting rates suggested degradation of memory starts during early synaptic consolidation rather than later system-level consolidation. Increased subjective memory complaints were associated with reduced VALMT scores. By contrast, WMS-LM failed to identify significant differences between any groups, and did not correlate with memory complaints.

We conclude VALMT may be better able than WMS-LM to identify subtle impairments in healthy older adults within a single clinical visit, and VALMT results better reflect subjective experience. Older slow-learners forget faster and report more subjective memory complaints, which may indicate a group at risk of developing AD.

Long-term forgetting rates may be more sensitive for detecting memory decrements compared to short-delay memory assessments (e.g., after 20-30 minutes). To date, much research has been performed on accelerated long-term forgetting (ALF) in epilepsy patients, but research in other patient groups is lacking. ALF may be promising in the field of cerebrovascular disease, as many of these patients experience cognitive complaints, yet do not show impaired performances on neuropsychological assessments.

Here, I will present empirical findings on ALF in individuals after a TIA/minor stroke (n=30) and after stroke (n=91) using short- (20-30 min) and long-delay (1-week) memory testing.

After TIA/minor stroke, short-delay (2030 min) memory testing was unimpaired, but 1-week delayed testing showed an impaired performance compared to stroke-free controls. In the stroke group, ALF was present in 17% of the patients, compared to stroke-free controls, but more prevalent than rapid forgetting after short-delay memory testing.

ALF is present in patients with cerebrovascular disease, despite normal acquisition rates. The relation with neuroimaging findings and the clinical relevance of these results will be discussed.

To present the Mobile Toolbox (MTB), comprised of an expandable library of cognitive and other tests, including adapted versions of NIH Toolbox® measures. The MTB provides a complete research platform for app creation, study management, data collection, and data management. We will describe the MTB project and MTB research platform and demonstrate examples of assessments.

MTB is the product of an NIH-funded, multi-institutional effort involving Northwestern University, Sage Bionetworks, Penn State, University of California San Francisco, University of California San Diego, Emory University, and Washington University. The MTB assessment library is a dynamic repository built upon Sage Bionetworks mobile health platform. All MTB measures are created or adapted for a mobile interface using iOS and Android smartphones. Guided by the principles of open science, many components are open source to allow researchers and developers to integrate externally developed tests, including supplemental scales (e.g., passively collected contextual factors) assessing variables such as mood and fatigue that might influence cognitive test performance.

The current MTB library includes eight core cognitive tests based on well-established neuropsychological measures: two language tasks (Spelling and Word Meaning), two executive functioning tasks (Arrow Matching and Shape-Color Sorting), an associative memory task (Faces and Names), an episodic memory task (Arranging Pictures), a working memory task (Sequences) and a processing speed task (Numbers and Symbols). Additional cognitive assessments from other popular test libraries including the International Cognitive Ability Resource (ICAR), Cognitive Neuroscience Test Reliability and Clinical Applications for Schizophrenia (CNTRACS) and Test My Brain are currently being implemented, as are non-cognitive measures from the NIH Toolbox Emotion Battery and the Patient-Reported Outcomes Measurement Information System (PROMIS). The MTB library includes measures suitable for use in research studies incorporating point-in-time and burst designs as well as ecological momentary assessment (EMA).

The MTB was created to address many of the scientific, practical, and technical challenges to cognitive assessment by capitalizing on advances in technology measurement and cognitive research. Initial psychometric evaluation of measures has been performed, and additional clinical validation is underway in studies with persons at risk for cognitive impairment or Alzheimer’s disease (AD), diagnosed with mild cognitive impairment (MCI) or AD, Parkinson’s disease, and HIV-associated Neurocognitive Disorders. Calculation of norms and reliable change indicators is in progress. The MTB is currently available to beta testers with public release planned for Summer, 2023. Clinical researchers will be able to use the MTB system to design smartphone-based test batteries, deploy and manage mobile data collection in their research studies, and aggregate and analyze results in the context of large-scale norming data.

To present validation evidence for the first eight cognitive measures available through Mobile Toolbox (MTB). These measures use a remote self-administered platform to assess language, working memory, episodic memory, executive function, and processing speed.

We used two separate samples, recruited as part of a larger study, to validate MTB measures. Sample I, comprised of 92 English-speaking adults ages 18-85, was used to assess internal consistency and construct validity. Participants were first administered “gold standard” cognitive measures (Wechsler Memory Scale-IV Verbal Paired Associates I and II; Wechsler Adult Intelligence Scale-IV Symbol Search, Digit Span, Coding, and Letter-Number Sequencing; Delis-Kaplan Executive Function System Color-Word Interference Test, Peabody Picture Vocabulary Test, Wechsler Individual Achievement Test-4 Spelling, and the Wisconsin Card Sorting Test), after which they completed MTB (pre-loaded on a study-provided smartphone) on their own. Internal consistency was evaluated using measure-appropriate indices (split-half reliability, Cronbach’s alpha or IRT-based indices). Pearson correlation coefficients between MTB tests and measures of similar constructs were used to evaluate concurrent validity. For two tests with timing-dependent scores, Arrow Matching and Shape-Color Sorting, separate analyses were performed for iOS and Android devices. Sample II, with 1,120 English-speaking participants ages 18-90, was used to evaluate age-related change. Participants completed MTB measures remotely on their own smartphones, in a preset order, within a 14-day period. Spearman correlation coefficients, corrected for education, were calculated to evaluate relationships between age and test scores.

Sample I participants were 67% female, 52% white, 99% non-Hispanic; average age=48 (SD= 17). Education was: < high school (1%); high school (55%); some college (21%); college (15%); graduate degree (8%). Internal consistency estimates ranged from 0.81 to 0.99. Pearson correlations between MTB and external measures ranged from 0.41 to 0.86 (all p < .01). Of the timed tests, only Shape-Color sorting showed significant score differences between Android and iOS devices. Sample II was 57% female, 13% Hispanic, 72% white, mean age = 45 (SD = 21). Education distribution was: < high school (2%); high school (34%); some college (34%), college (20%); graduate degree (11%). Measures of executive function (r = -0.50; r=-0.57) and processing speed (r= -0.61) showed the expected negative correlation with age (all p <0.001). Negative correlations, although weaker, were also seen on measures of working memory (r=-0.2) and episodic memory (r=-0.2, r=-0.37; p.<.001). Vocabulary performance improved with age (r=0.4; p<.001), while spelling scores remained stable (r=0.09).

Initial studies support the validity and reliability of the first eight MTB cognitive measures in two diverse samples. MTB tests showed satisfactory construct validity, as demonstrated by the associations between MTB and well-established tests. Furthermore, most MTB measures correlated with age in the expected directions. Executive function, processing speed and memory typically decrease with age and this decrease was reflected in MTB test performance. In contrast, spelling and vocabulary, typically preserved as we age, did not decrease in our sample. Our results support the use of MTB in cognitive aging research.

A critical need in the neuropsychology field is development and validation of efficient, scalable assessments of cognition. The Mobile Toolbox (MTB), a novel suite of mobile device-compatible, app-based cognitive assessments, was developed to address this need. The goals of this study were (1) To collect longitudinal normative data for the MTB assessments in a large, ethnoculturally and educationally diverse cohort; (2) To assess the feasibility and usability of remote assessment using MTB.

Participants were recruited from the UCSF Brain Health Registry (BHR), an online cohort (N>100,000) that collects longitudinal cognitive, functional, behavioral, and health data using online neuropsychological tests and self- and study-partner report surveys. BHR participants who opted to learning about additional research opportunities were sent automated email invitations to enroll in the MTB study. Those who indicated study interest were provided instructions within the BHR online portal for downloading the MTB app. All participants had the opportunity to complete a single baseline administration of MTB (Word Meaning, Sequences, Spelling, Arranging Pictures, Arrow Matching, Faces and Names, Shape-Color Sorting, Number Match). Those who completed the baseline assessment within three days were invited to continue into the longitudinal study, where they complete MTB assessments at a single, short-term timepoint (day 7, 14, or 21; study arms sequentially assigned), and then at 6-month intervals. Enrollment across demographic groups was monitored, and study invitations were sent to specific demographic groups, with the goal of enrolling a sample of 800 participants in the longitudinal study: equal distribution across eight, 10-year age bands (ages 18-80+); 60% with <16 years of education; 10% non-Latinx Black, 15% Latinx, and 5% non-White other ethnocultural identity.

Between January-June 2022, 48,110 BHR participants were invited to the MTB study. Of those, 8294 (17%) expressed interest, 3401 (7%) completed the baseline assessment, 850 (1.8%) were assigned to the longitudinal study, and 782 (1.6%) completed a short-term longitudinal assessment. Study staff received 797 help tickets submitted by participants asking for email support to complete MTB. The baseline cohort had and average age of 64 years and an average of 16.6 years of education, 76.2% female, 2.1% non-Latinx Black, 7.1% Latinx, 86.8% non-Latinx White, and 4% from other ethnocultural groups. The longitudinal cohort had an average age of 62.3 years and an average of 16.1 years of education, 80% female, 2.8% non-Latinx Black, 8.5% Latinx, 83.5% non-Latinx White; and 5% other ethnocultural group. Compared to those invited to the study, those who enrolled in the longitudinal study were older, had higher educational attainment, and were more likely to be female and self-identify as non-Latinx White (p<0.05 for all).

Efficient enrollment and task completion of a large cohort in a novel, app-based mobile cognitive assessment is feasible in a completely remote setting. Most participants were able to complete MTB without individual support, indicating good usability. This approach can be scaled up to efficiently assess cognition in many research and healthcare settings. A remaining challenge is achieving robust ethnocultural and educational diversity.

To describe advantages and disadvantages of using digital assessments remotely and in-person to inform clinical and research practice.

As part of a larger study,1120 adults completed a battery of remotely administered tests (Mobile Toolbox) and a subset of this sample completed examiner administered in-person testing (NIH Toolbox® Cognition Battery). Attention was given to making the sample reflective of the US 2020 Census during participant recruitment. Of the 1120 participants, the majority of the sample were female (57%) and Caucasian (72%) and had a mean age of 45 (SD = 21). In terms of education, equal percentages had high school (34%) or some college (34%).

NIH Toolbox cognitive tests of processing speed, language, executive function, attention, and episodic memory were administered via a trained examiner and correlates of these tests were self-administered remotely via a smartphone. Using examples, we will show which aspects of cognitive assessment had the best correlations between remote self-administration and face-to-face examination and which had lower correlations.

Digital remote assessments can help overcome barriers by enabling repeated testing in naturalistic conditions, reducing participant burden and expense, and increasing research accessibility for populations currently under-represented. Moreover, the ubiquity of internet-connected devices vastly increases opportunities to remotely monitor other dimensions relevant to cognition using smartphone apps and wearable sensors. In addition to improving access to testing, digitally administered assessments dramatically improve some individual’s tolerance to testing with shorter tests that can be administered via computer adaptive testing (CAT). Despite these benefits, some aspects of the cognitive assessment cannot be adequately replicated remotely and thus yield lower correlations to their examiner-administered alternatives. Clinical and research implications are discussed.

Social determinants of health (SDoH) are structural elements of our living and working environments that fundamentally shape health risks and outcomes. The Healthy People 2030 campaign delineated SDoH into five distinct categories that include: economic stability, education access/quality, healthcare access, neighborhood and built environment, and social and community contexts. Recent research has demonstrated that minoritized individuals have greater disadvantage across SDoH domains, which has been linked to poorer cognitive performance in older adulthood. However, the independent effects of SDoH on everyday functioning across and within racial groups remains less clear. The current project explored the association between SDoH factors and 10-year change in everyday functioning in a large sample of community-dwelling Black and White older adults.

Data from 2,505 participants without dementia enrolled in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (age M=73.5; 76% women; 28% Black/African American). Sociodemographic, census, and industry classification data were reduced into five SDoH factors: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community contexts. The Observed Tasks of Daily Living, a performance-based measure of everyday functioning with tasks involving medication management, finances, and telephone use, was administered at baseline, 1-, 2-, 3-, 5, and 10-year follow up visits. Mixed-effects models with age as the timescale tested (1) racial group differences in OTDL trajectories, (2) race x SDOH interactions on OTDL trajectories, and (3) associations between SDoH and OTDL trajectories stratified within Black and White older adults. Covariates included sex/gender, vocabulary score, Mini-Mental Status Examination, depressive symptoms, visual acuity, general health, training group status, booster status, testing site, and recruitment wave.

Black older adults had a steeper decline of OTDL performance compared to Whites (linear: b = -.25, quadratic b=-.009, ps < .001). There was a significant race x social and community context interaction on linear OTDL trajectories (b =.06, p=.01), but no other significant race x SDoH interactions were observed (bs =-.007-.05, ps=.73-.11). Stratified analyses revealed lower levels of social and community context were associated with steeper age-related linear declines in OTDL performance in Black (b = .08, p=.001), but not White older adults (b =.004, p=.64). Additionally, lower levels of economic stability were associated with steeper age-related linear declines in OTDL performance in Black (b =.07, p=.04), but not White older adults (b =.01, p=.35). Finally, no significant associations between other SDoH and OTDL trajectories were observed in Black (bs = -.04-.01, ps =.09-.80) or White (bs = -.02-.003, ps=.07-.96) older adults.

SDoH, which measure aspects of structural racism, play an important role in accelerating age-related declines in everyday functioning. Lower levels of economic and community-level social resources are two distinct SDoH domains associated with declines in daily functioning that negatively impact Black, but not White, older adults. It is imperative that future efforts focus on both identifying and acting upon upstream drivers of SDoH-related inequities. Within the United States, this will require addressing more than a century of antiBlack sentiment, White supremacy, and unjust systems of power and policies designed to intentionally disadvantage minoritized groups.

Prior work with older adults has shown that participating in a range of physical, social, and cognitive activities provides great benefits, such as improved mood and cognitive functioning. These activities can protect against common cognitive problems associated with aging (e.g., poor working memory and processing speed) and lower the risk of developing dementia, thus supporting the cognitive reserve hypothesis. Cognitive reserve refers to the preservation of an individual’s cognitive abilities over time despite changes in the brain that allows them to be resilient in performing daily and complex tasks (Stern, 2012). Historical factors such as education, life experiences, and occupational complexity, as well as current lifestyle behaviors such as cognitive and social activities may serve as proxies for cognitive reserve. It is not clear whether historical proxies of cognitive reserve (e.g., educational attainment) interact with more proximal lifestyle factors (e.g., recent cognitive stimulation) to impact cognitive functioning. In this study, we examined if education, recent cognitive activity, and their interaction predicted enhanced immediate memory and visual and verbal working memory in middle-aged to older adults.

Participants were 62 middle-aged to older adults (age 45-93; mean age = 65.9 years; 80.6% female; 70.9% Black; ∼75.0% with high school education or higher) recruited from a Louisiana housing facility for seniors with low or fixed incomes and a local community center. Data collection included the CHAMPS Physical Activity Questionnaire for Older Adults, Wechsler Adult Intelligence Scale subtests (Digit Span Forward and Digit Span Backward), and the Size Judgment Span Task. Mixed-effects regression analyses were performed with education (less than high school, high school, college), the CHAMPS cognitive activity composite (Weaver & Jaeggi, 2021), and an education * cognitive activity interaction term as independent variables and cognitive test scores as the outcome variables. All models controlled for age and race/ethnicity.

Significant education by cognitive activity effects were observed for Digit Span Backward and Size Judgment Span, but not for Digit Span Forward. The interactions reflected a positive association between cognitive activity and cognitive functioning in people with at least a high school education, but not in people with less than a high school education.

Our results support previous findings that education level and engagement in cognitive activity may serve as protective factors against cognitive decline in later life. The finding that cognitive activity was not associated with better cognitive functioning at lower levels of education suggest that earlier life experiences may moderate the benefit of lifestyle interventions later in life. Future studies should examine whether other lifestyle interventions, such as exercise, are more beneficial for people with less cognitive reserve from earlier life experiences.

People whose parents had dementia or memory impairment are at higher risk for later-life cognitive impairment themselves. One goal of our research is to identify factors that either increase the risk of or protect against family history of dementia over the life course. External locus of control has been associated with lower cognitive function in middle-aged and older adults. Previous findings have shown that adults racialized as Black have relatively high levels of external locus of control due to inequity and racism. We hypothesized that lower parental memory would be associated with lower offspring memory among Non-Latinx Black and Non-Latinx White (hereafter Black and White, respectively) adults; and associations would be stronger among participants with higher levels of external locus of control.

Participants comprised 594 adults racialized as Black or White (60.3% Black; 62% women; aged 56.1 ± 10.4; 15.3 ± 2.7 years of education) from the Offspring Study who are the adult children of participants in the Washington Heights Inwood Columbia Aging Project (WHICAP). Parental memory was residualized for age (74.3 ± 6.0) and education (13.7 ± 3.1). Self-reported external locus of control was assessed using 8 items from the the perceived control questionnaire. Memory was assessed with the Selective Reminding Test, and a composite of total and delayed recall scores were computed. Linear regression quantified the interaction between parental memory and external locus of control on memory in models stratified by race, and adjusted for age, sex/gender, and number of chronic health diseases.

Among Black participants (n=358), there were no main effects of parental memory or locus of control on offspring memory. However, lower parental memory was associated with lower offspring memory among Black participants with high levels of external locus of control (standardized estimate=0.36, p=0.02, 95%CI [0.05, 0.67]). Associations were attenuated and non-significant at lower levels of control. Among White participants (n=236), there was a main effect of parental memory on offspring memory, and this association did not vary by levels of external locus of control.

Poor parental memory, which reflects risk for later-life cognitive impairment and dementia, was associated with lower memory performance among White middle-aged participants. Among Black participants, this association was observed among those with high levels of external locus of control only. Economic and social constraints shape levels of external locus of control and are disproportionately experienced by Black adults. In the face of greater external locus of control, a cascade of psychological and biological stress-related processes may be triggered and make Black adults’ memory function more vulnerable to the detrimental impact of parent-related dementia risk. Longitudinal analyses are needed to clarify temporal associations. Nonetheless, these findings suggest that reducing social and economic inequities disproportionately experienced by Black adults may dampen the effect of intergenerational transmission of dementia risk on cognition.

Higher levels of inflammation are associated with risk factors for Alzheimer’s disease and related dementias (ADRD) in older Black adults including psychosocial stressors (e.g., discrimination and early life adversity) and white matter alterations. Yet, limited work has investigated these risk factors together in a longitudinal neuroimaging study, despite the well-known ADRD disparity in older Black adults. Using data from the Minority Aging Research Study and African American Clinical Core of the Rush Alzheimer’s Disease Center, we examined interactions of psychosocial stressors and change in inflammation on changes in white matter integrity as measured via diffusion tensor imaging (DTI).

Older Black adults (n=102) without known dementia at baseline (age=75.8±6.1 years; 87.3% female; education=15.4±2.7 years) completed blood draws at two time points (follow-up=2.4±0.7 years), neuroimaging at two or more time points (follow-up=3.7±1.8 years), and psychosocial questionnaires at one time point coinciding with the first blood draw/neuroimaging. Blood serum was assayed using highly-sensitive multiplexed sandwich ELISA for interleukin-6, c-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-a) and a change score was calculated for each inflammatory marker (T2 - T1). The Williams Everyday Discrimination Scale quantified experiences of discrimination in all participants and a 16-item questionnaire of emotional and physical trauma from age 0-18 assessed early life adversity in a participant subset (n=63). DTI-derived tract-based spatial statistics (TBSS) slope change measures for trace of the diffusion tensor, fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) were calculated, with the first two scans matched in time to blood assays. Linear regression models investigated interactions of each inflammatory marker change score (separately) and either discrimination or early life adversity (separately) on trace, FA, AD, and RD slopes as individual outcomes adjusting for age, sex, education, white matter hyperintensities (total volume and voxelwise), cardiovascular risk factors, statin and analgesic medications, thyroid conditions, and depression. Statistical significance was determined at p<0.05 using family wise error correction and threshold free cluster enhancement.

Discrimination moderated the relationship between TNF-a and AD whereby those with increasing TNF-a and higher levels of discrimination had increasing levels of AD over time in white matter tracts connecting the left and right cerebellum, the left pallidum and medulla, and the left superior frontal gyrus and left thalamus. Both discrimination and early life adversity moderated associations between CRP and AD, where increases in CRP and higher psychosocial stressors (of either type) resulted in decreasing AD over time in tracts involving cingulate, frontal, and parietal regions. Discrimination and early life adversity also moderated associations between CRP and RD, where increasing CRP combined with greater psychosocial stressors resulted in decreasing RD in right hemisphere association and projection tracts connecting frontal, parietal, central, and subcortical regions.

TNF-a and CRP interacted with measures of psychosocial stress to associate with DTI-derived TBSS slope change measures of AD and RD in differential, and at times, paradoxical ways. Findings suggest that both risk and resilience as related to brain connectivity may be co-occurring in the presence of psychosocial stressors for older Black adults.

Metabolic Syndrome (MetS) is a constellation of deleterious cardiometabolic health conditions (e.g., diabetes, hypertension) that have been linked to cognitive impairment and accelerated cognitive decline in older adults. Research has shown that Latinos are at increased risk for developing MetS relative to non-Latino Whites and the prevention, maintenance, and treatment of cardiometabolic risk factors are largely contingent upon health insurance status. Within the United States there are considerable state-based differences in eligibility and access to health insurance coverage. Although Texas has the second largest population of Latinos, they are one of the most underinsured groups within the state. There is some evidence to suggest that inconsistent healthcare is associated with cognitive impairment among underserved/underprivileged groups. The current study sought to examine whether insurance status moderates the association between MetS and cognitive functioning in an effort to inform public health policy initiatives vital to reducing age-related health disparities amongst Latino older adults residing in Texas.

The study sample included 850 primarily Spanish-speaking (67.6%) Latino older adults (mean age = 63.1±7.81) largely of Mexican origin/descent (95%) enrolled in the Health and Aging Brain Study-Health Disparities. All participants completed neuropsychological testing, a health exam, and questions about health insurance coverage. MetS status (MetS+ vs. MetS-) was determined by abnormal clinical abdominal obesity, triglycerides, high-density lipoprotein, blood pressure, and fasting glucose values. Health insurance status was determined by current enrollment in any private or public insurance plan. Cognition was assessed with Digit Span, Logical Memory I and II, Trail Making Test (A and B), Spanish-English Verbal Learning Test, and Letter Fluency (FAS). Raw scores were converted to z-scores which were subsequently averaged into two distinct memory and executive functioning composite scores. ANCOVAs controlling for age, sex, education, APOE e4 positivity, annual income, and primary language status were used examine health insurance status x MetS interactions on cognitive composites.

Approximately 54.6% of the sample met clinical criteria for MetS+ and 23.6% endorsed having no health insurance. There were no significant group differences in the proportion of MetS+ and MetS- individuals with and without health insurance (X 2 = .002, p =.96). Results revealed there was a significant MetS x health insurance status interaction on the memory composite (F = 5.39, p = .02). Post-hoc comparisons revealed that Latino older adults without health insurance demonstrated poorer memory performance relative to those with health insurance in the MetS+ group (p=.02). In contrast, there were no significant differences in memory performance across insurance status in the MetS- group (p=.35). Finally, there was no significant MetS x health insurance interaction on executive functioning (p=.60).

Findings revealed that health insurance coverage differentially impacts memory, but not executive functioning, amongst Latinos with MetS+. Underinsured Latinos with chronic cardiometabolic health conditions may be at risk for poor memory outcomes and increasing access to affordable healthcare could help mitigate the adverse effects of MetS+ on memory. Future studies examining the relationship between health insurance, MetS status, and neuroimaging markers may yield additional insight into mechanisms underlying age-related dementia disparities.

Non-Hispanic Black older adults experience a disproportionate burden of Alzheimer’s Disease and related dementias (ADRD) risk compared to non-Hispanic White older adults. It is necessary to identify mechanisms that may be contributing to inequities in cognitive aging. Psychosocial stressors that disproportionately affect Black adults (e.g., discrimination) have the potential to impact brain health through stress pathways. The brain’s white matter, which appears to be particularly important for ADRD risk among Black older adults, may be uniquely vulnerable to stress-related physiological dysfunction. To further understand whether and how discrimination can affect ADRD risk, this study aimed to examine associations between multiple forms of racial discrimination and white matter integrity, operationalized through diffusion tensor imaging.

Cross-sectional data were obtained from 190 non-Hispanic Black residents aged 65+ without dementia in northern Manhattan. Racial discrimination was self-reported using the Everyday Discrimination and Major Experiences of Lifetime Discrimination scales. Example items from the Everyday Discrimination Scale include: “You are treated with less respect than other people”; “You are called names or insulted.” Example items from the Major Experiences of Lifetime Discrimination Scale include: “At any time in your life, have you ever been unfairly fired from a job?”; “Have you ever been unfairly denied a bank loan?” Racial discrimination was operationalized as experiences attributed to “race” or “skin color.” White matter integrity was assessed using fractional anisotropy (FA) via diffusion tensor imaging. Multivariable regression models evaluated the unique effects of everyday and major experiences of lifetime racial discrimination on mean FA in the whole brain and specific regions. Initial models controlled for age, sex/gender, intracranial volume, and white matter hyperintensities. Subsequent models additionally controlled for socioeconomic and health factors to consider potential confounders or mediators of the relationship between discrimination and white matter integrity.

Major experiences of lifetime discrimination were negatively associated with mean FA within the left cingulum cingulate gyrus and the right inferior fronto-occipital fasciculus. These associations persisted when controlling for additional covariates (i.e., education, depression, and cardiovascular diseases). In contrast, major experiences of lifetime discrimination were positively associated with mean FA within the right superior longitudinal fasciculus (temporal part). This association was attenuated when controlling for additional covariates. Everyday racial discrimination was not associated with mean FA in any regions.

These results extend prior work linking racial discrimination to brain health and provide evidence for both risk and resilience among Black older adults. Major experiences of lifetime racial discrimination, a proxy for institutional racism, may have a stronger effect on white matter integrity than everyday racial discrimination, a proxy for interpersonal racism. Educational opportunities and cardiovascular risk factors may represent mediators between racial discrimination and white matter integrity. White matter integrity within specific brain regions may be a mechanism through which racially patterned social stressors contribute to racial disparities in ADRD. Future research should characterize within-group heterogeneity in order to identify factors that promote resilience among Black older adults.

To describe cognitive impairment in out-of-hospital cardiac arrest (OHCA) survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA.

This was a prospective case control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. We administered an extensive neuropsychological assessment at approximately 7 months post-cardiac event, including a neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes. Z-scores of individual tests were converted to neuropsychological composite scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions). Between-group differences on the neuropsychological composite scores were investigated with linear regression. Associations between anxiety, depression, fatigue, insomnia, hypertension, diabetes, and the neuropsychological composite scores among OHCA survivors were calculated with Spearman’s rho.

Of 184 eligible OHCA survivors, 108 were included (mean age = 62, 88% male), with 92 MI controls enrolled (mean age = 64, 89% male). Amongst OHCA survivors, 29% performed z <-1 indicating at least borderline-mild impairment in >2 cognitive domains, and 14% performed z <-2 exhibiting major impairment in >1 cognitive domain. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = -0.37, 95% confidence intervals [-0.61, -0.12]), verbal (MD = -0.34 [-0.62, -0.07]), and visual/constructive functions (MD = -0.26 [-0.47, -0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, processing speed (MD = -0.41 [-0.74, -0.09]) and executive functions (MD = -0.69 [-1.13, -0.24]) were also worse following OHCA. Depressive symptoms were associated with worse executive functions (rs = -0.37, p <0.001) and worse processing speed (rs = -0.27, p = 0.01) post-OHCA. Anxiety symptoms (rs = -0.21, p = 0.01) and general fatigue (rs = -0.24, p = 0.01) were associated with worse executive functions. Diabetes was associated with worse processing speed (rs = -0.20, p = 0.03), visual/constructive (rs = -0.29, p <0.001) and executive functions (rs = -0.25, p = 0.02), while hypertension and insomnia were not significantly associated with neuropsychological test performance.

Cognitive impairment is generally mild following OHCA, but most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed worse than MI controls. We suggest that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue.

Autistic youth have impaired executive functioning (EF) and these challenges increase throughout adolescence. Deficits in EF have been associated with poor adult outcomes, decreased availability for learning, and linked to academic outcomes. Specifically, flexible problem solving is greatly reduced in autistic youth. We aim to investigate how flexibility contributes to learning in autistic youth and their typically developing peers.

Participants included 44 teens with (n=22) and without (n=22) ASD. All teens were 14-18 years old (ASD M = 15.77, SD = 1.05; TD M = 15.73, SD = .96) with FSIQ 3 70 (ASD M = 105.92, SD= 16.17; TD M = 107.93, SD = 10.14). Teens with ASD met DSM-5 criteria for autism supported by the SCQ and/or ADOS-2. All participants completed the California Verbal Learning Task (Child or Third Edition) over zoom. Parents reported on their child’s flexibility skills on the Flexibility Questionnaire (FQ) which encompasses 5 subscales: routines/rituals, transitions, special interests, social flexibility, and generativity. Independent samples t-tests examined group differences in performance on the CVLT, measured by the long delay recall and learning slope. Bivariate correlations examined the relationship between learning and flexibility in the autistic group. Linear regression was used to determine how flexibility contributes to learning above and beyond age, gender, and diagnosis.

Autistic youth had significantly lower scores on the CVLT long-delay recall (t = 2.311, p = .026) and the learning slope (t = 1.186, p = .038) than their typically developing peers. Special interests on the FQ were related to both performance on the first trial of the CVLT (r = -.482 p = .023) and the short delay cued recall (r = -.469 p = .028) in the autistic group. Fewer transition related problems were predictive of higher scores on the CVLT above and beyond age, gender, and diagnosis (R2 = .366, B = - .088, p = .030).

Learning was significantly lower in autistic teens compared to their typically developing peers. Additionally, autistic youth had a less steep learning slope than their typically developing peers. Autistic youth may focus on the first group of words only and don’t flexibly update their list to add new words as the trials go on. Autistic youth with more restricted interests have difficulty with the first trial due to the shifting required when starting a new unfamiliar task. Additionally, youth with a greater focus on their own interests had more difficulty on cued recall indicating that these youth may have had trouble shifting when prompted to use semantic categories. Fewer challenges with transitions were a significant predictor of learning above and beyond age, gender, and diagnosis. Previous research has shown large discrepancies between parent-report and laboratory-based tasks in autistic youth. This project highlights two unique measures of different modalities that show similarities in their ratings emphasizing their potential as good representations of overall skills. Future research should utilize a larger sample size to continue to examine the role of flexible problem solving in working memory and learning in autistic youth.

Compensatory strategy training has been identified as a useful mechanism to improve everyday cognitive function among older adults with Mild Cognitive Impairment (MCI). Despite this, few studies have looked at cognitive factors that support adherence and engagement in these programs, which are key to maximizing benefit. The present study aimed to evaluate the relationship between cognition, adherence, and engagement during a group-based compensatory strategy training for people with MCI. We hypothesized individuals with better memory and executive function performance would show better adherence and higher engagement scores in cognitive training classes.

Twenty-five participants enrolled in Emory University's Charles and Harriet Schaffer Cognitive Empowerment Program (CEP) completed an 11-week compensatory strategy training group (CEP-CT). CEP-CT is adapted from Ecologically Oriented Neurorehabilitation to be suitable for people with MCI. Participants enrolled were on average 74.3 years old (SD= 5.4), 52% Male, primarily Caucasian (80%; 16% African American), and college educated (M= 16.5 years; SD= 2.7). All participants received clinical diagnoses of MCI prior to enrollment in the program. Participants completed multiple cognitive measures, including Montreal Cognitive Assessment (MoCA), Hopkins Verbal Learning Test (HVLT), Trail Making Test A & B (TMT), Number Span Forward (NSF) and verbal fluency (S-words and Animals). For all group sessions, class attendance (present vs. not present) was recorded for each participant and their care partner, and engagement ratings for participants were recorded by the facilitator on a 1 to 5 scale (higher scores indicate better engagement). Outcomes include adherence to cognitive training (percentage of sessions attended; M= 82% class attendance, SD= 18%) as well as the average engagement ratings across 11 weeks (M= 3.25, SD= .40).

Bivariate Pearson correlations revealed that individuals who attended more classes also demonstrated better engagement in class, r= .44, p= .03. Class attendance was significantly related to performance on measures of memory and executive function (HVLT: r= -.42, p= .04; TMT-B: r= .69, p= .04), such that participants who performed worse on these measures attended more CEP-CT classes. Average engagement ratings were unrelated to cognitive performance.

Results did not support initial hypotheses, and instead indicate individuals with poorer performance on measures of memory and executive function had better adherence to CEP-CT classes, as measured by attendance. These results may indicate individuals experiencing cognitive difficulties are more likely to attend cognitive training classes. Subjective engagement ratings were unrelated to cognition; however, individuals who attended more sessions were more engaged in cognitive training classes. Future areas of research include objective measurement of class engagement as well as the incorporation of nuanced adherence metrics to further elucidate the relationship between these factors and cognition in MCI.

Despite associations between hypoglycemia and cognitive performance using cross-sectional and experimental methods (e.g., Insulin clamp studies), few studies have evaluated this relationship in a naturalistic setting. This pilot study utilizes an EMA study design in adults with T1D to examine the impact of hypoglycemia and hyperglycemia, measured using CGM, on cognitive performance, measured via ambulatory assessment.

Twenty adults with T1D (mean age 38.9 years, range 26-67; 55% female; 55% bachelor’s degree or higher; mean HbA1c = 8.3%, range 5.4% - 12.5%), were recruited from the Joslin Diabetes Center at SUNY Upstate Medical University. A blinded Dexcom G6 CGM was worn during everyday activities while completing 3-6 daily EMAs using personal smartphones. EMAs were delivered between 9 am and 9 pm, for 15 days. EMAs included 3 brief cognitive tests developed by testmybrain.org and validated for brief mobile administration (Gradual Onset CPT d-prime, Digit Symbol Matching median reaction time, Multiple Object Tracking percent accuracy) and self-reported momentary negative affect. Day-level average scores were calculated for the cognitive and negative affect measures. Hypoglycemia and hyperglycemia were defined as the percentage of time spent with a sensor glucose value <70 mg/dL or > 180 mg/dL, respectively. Daytime (8 am to 9 pm) and nighttime (9 pm to 8 am) glycemic excursions were calculated separately. Multilevel models estimated the between- and within-person association between the night prior to, or the same day, time spent in hypoglycemia or hyperglycemia and cognitive performance (each cognitive test was modeled separately). To evaluate the effect of between-person differences, person-level variables were calculated as the mean across the study and grand-mean centered. To evaluate the effect of within-person fluctuations, day-level variables were calculated as deviations from these person-level means.

Within-person fluctuations in nighttime hypoglycemia were associated with daytime processing speed. Specifically, participants who spent a higher percentage of time in hypoglycemia than their average percentage the night prior to assessment performed slower than their average performance on the processing speed test (Digit Symbol Matching median reaction time, b = 94.16, p = 0.042), while same day variation in hypoglycemia was not associated with variation in Digit Symbol Matching performance. This association remained significant (b = 97.46, p = 0.037) after controlling for within-person and between-person effects of negative affect. There were no significant within-person associations between time spent in hyperglycemia and Digit Symbol Matching, nor day/night hypoglycemia or hyperglycemia and Gradual Onset CPT or Multiple Object Tracking.

Our findings from this EMA study suggest that when individuals with T1D experience more time in hypoglycemia at night (compared to their average), they have slower processing speed the following day, while same day hypoglycemia and hyperglycemia does not similarly impact processing speed performance. These results showcase the power of intensive longitudinal designs using ambulatory cognitive assessment to uncover novel determinants of cognitive variation in real world settings that have direct clinical applications for optimizing cognitive performance. Future research with larger samples is needed to replicate these findings.

Older adults represent the fastest-growing population of individuals with epilepsy with an incidence that peaks after age 65. Patients with late-onset epilepsy (LOE) have a multitude of risk factors for accelerated cognitive and brain aging, including vascular and metabolic risk factors. Despite this, there are few studies investigating the cognitive profiles of older adults with LOE, a neglected area in aging research. We examine the cognitive profiles of older adults with LOE and determine the contribution of demographic and vascular risk factors to impairment.

Participants were part of the Atherosclerosis Risk in Communities Study (ARIC) and the incidence of epilepsy was identified using ARIC hospitalization records and Centers for Medicare and Medicaid Services claims data from 1991 to 2015. Approximately 1.8% of the participants with sufficient Medicare coverage data were classified as having LOE (LOE n=281; Non-LOE n=9808). Vascular, lifestyle, and cognitive data were obtained from the ARIC Neurocognitive Study (ARIC-NCS) which consisted of three visits since 2011. Participants with ARIC-NCS visits completed after the onset of seizures were included in the final sample. Non-LOE participants with normal cognition (Black: n=603 and White: n=2543 participants independently) were used to generate z-scores across tests of language, memory, executive function, and processing speed/attention. Impairment was defined as <1.5 standard deviations below the mean of the normative sample. Stepwise regressions were conducted to examine the contribution of demographic (age, race, sex, education) and vascular risk factors (hypertension, diabetes, hyperlipidemia, obesity, smoking) to cognitive performance.

Average age of first seizure of all LOE participants (n=281) was 76.23 (SD=6.24), 55.9% female, 30.7% Black/African American, and the majority had either a college (28.1%) or high school degree (26%). Fifty-six LOE participants had ARIC-NCS visits after the onset of seizures (average age=79.84, SD=5.17, 57.1% female, 32.1% Black). Approximately 67.9% of the sample had at least one vascular risk factor with 81.5% having hypertension, 37% diabetes, 26.4% hyperlipidemia, 20.4% obesity (BMI>30), and 4.5% current smoker. The most frequently impaired domains were language (naming=29.7%; animal fluency=20%; letter fluency=30%) and memory (prose immediate recall=18.4%; prose delayed recall=44.7%; word delayed recall=19.4%). Higher education was associated with better naming (b=0.801, p=0.040). Female sex (b=-0.799, p=0.017) and lower education levels (b=0.418, p=0.050) were associated with poorer immediate prose recall. Older age was associated with poorer delayed prose recall (b=-0.191, p=0.036). Hypertension was associated with worse digit span backward (b=-0.942, p=0.002).

In older adults with LOE, language and memory were the most commonly impaired cognitive domains, similar to studies in early onset epilepsy. Vascular risk factors were prevalent among LOE and hypertension was associated with worse working memory. Further, important demographic factors (sex, education, and age) were associated with the extent of cognitive impairment. Characterizing cognitive profiles in LOE and determining the contribution of demographic and vascular factors to impairment could help to identify patients at risk for future cognitive decline and/or the development of LOE itself, as well as interventions aimed at reducing the risk of further decline.