Adults with recurrent depression have been shown to have cognitive deficits also while in remission. Thus, it has been suggested that with a chronic course of depression, poorer executive control can be a vulnerability factor for depressive relapse. This has led to research on how cognitive remediation training can protect against recurrent depressive episodes. Findings indicate that such training has short term effects on cognitive functioning, and small effect on depression symptoms. Less focus has been on how “standard” psychotherapy can have positive effects on executive and attentional control. Mindfulness-based cognitive therapy (MBCT) has been shown to be as effective as antidepressant medication in preventing relapses of depressive episodes. Mindfulness training in healthy samples seems to improve executive and attentional control. However, the few studies of MBCT in recurrent depression show mixed effects on executive and attentional control. As far as we know, no prior study has investigated the effect of MBCT in recurrent depression with the revised version of the attention network test (ANT-R). In a randomized controlled trial, we expected that the MBCT group would show enhanced executive control and lower levels of attentional fluctuations than the wait-list controls (WLC) from pre (T0) to post (T1) treatment. We further investigated if positive effects of MBCT on executive and attentional control were associated with reduction in depression symptoms.

Adults with recurrent depression in partial or full remission (N = 64) were randomized to MBCT or WLC. In the MBCT and WLC groups, 25 and 29, respectively, performed the ANT-R at T0 and T1. The attention network reaction time scores of executive control, alerting, and orienting were calculated in addition to attention fluctuations scores of intra-individual reaction time variability (IIVRT) and exgaussian-mean of longer reaction times (TAU). Self-reported depression symptoms were measured with BDI-II. The two groups were compared at baseline on full-scale IQ (WASI), executive control (D-KEFS Stroop), and processing speed (D-KEFS TMT).

The MBCT and WCL groups did not differ significantly in age or gender distribution, education, full-scale IQ or in baseline executive and attentional control as measured with the ANT-R, Stroop and TMT. The MBCT group showed a higher efficiency in conflict detection as measured with the executive control score from T0 to T1 compared to the WLC. This positive effect of MBCT on executive control was independent from the greater reductions in depression symptoms in the MBCT group compared to in the WLCs. However, reduction in depression symptoms at T1 was associated with enhanced efficiency in responding to alerting cues in conflict detection. No effects of MBCT compared to WLC were found at T1 on the attention fluctuation measures (IIVRT and TAU).

The findings from the current study indicates that MBCT enhances executive control in adults with recurrent depression. As such, MBCT may target an important cognitive vulnerability factor in the chronic course of recurrent depression that may contribute to its efficacy in preventing depressive relapses. It was also observed that reductions in depression symptoms led to higher alertness in conflict detection.

An understanding of factors that contribute to informant ratings of patients’ functional abilities is crucial, not only because these ratings are used to diagnose individuals with mild cognitive impairment (MCI) versus dementia, but also because these ratings are commonly used as outcome measures in clinical trials. While these ratings are assumed to be largely accurate, research shows they are subject to biases. Caregiver distress, higher caregiver educational attainment, and higher patient age are associated with a higher discrepancy between informant and patient reports of functional abilities. Studies on informant ratings of functional abilities that simultaneously control for patient objective cognitive abilities remain sparse. The current study aims to evaluate caregiver characteristics as predictors of informant-rated functional status while controlling for patient objective cognitive abilities in MCI.

Individuals with a clinical diagnosis of MCI (Albert, 2011 criteria) were referred to the Cognitive Empowerment Program (CEP), a comprehensive lifestyle program addressing modifiable risk factors associated with progression. This study included cross-sectional data from 118 newly enrolled individuals and their caregivers who served as informants. Patient cognitive functioning was assessed with the Montreal Cognitive Assessment (MoCA). Predictors of interest included caregiver-rated functional abilities (Functional Activities Questionnaire; FAQ), caregiver burden (Zarit Burden Interview; ZBD), caregiver depressive symptoms (Center for Epidemiological Studies Depression scale; CES-D), caregiver stress (Perceived Stress Scale; PSS), and caregivers’ self-rated communicative effectiveness (Communicative Effectiveness Index; CETI). Hierarchical linear regression models were run to predict FAQ while controlling for patient MoCA scores. Separate models were run for the caregiver variables of interest including caregiver age, ZBD, CES-D, PSS, and CETI.

Caregivers were 75.6% spouses, 17.1% adult children, 3.3% unmarried partners/cohabitating partners, and 4.1% friends. The mean age of individuals with MCI was 74.7 years (SD: 6.96, mean education = 16.2±2.60 years; 47% female) and the mean age of caregivers was 66.4 (SD: 12.88, mean education = 16.3±2.34; 66% female). Worse ratings of functional abilities on the informant-rated FAQ were found for patients with lower MoCA scores (ß = .242, p = .008). Importantly, while controlling for MoCA scores, worse ratings of functional abilities on the FAQ were found for informants with lower age (ß = -0.269, p = .003), higher perceived stress (ß = 0.267, p = .003), higher caregiver burden (ß = 0.289, p < 0.001), and lower self-rated communication effectiveness (ß = -0.324, p < .001). Caregiver depression (ß = 0.089, p = .084) and education (ß = -0.137, p = .147) were not significant predictors of functional ability ratings while controlling for MoCA scores.

Results of the current study highlight the potential for biases in informant ratings regarding functional abilities in MCI. Informant ratings were found to be significantly influenced by caregiver age, stress, burden, and communicative effectiveness. A key finding is that younger caregivers, such as adult children, may report greater functional impairment in individuals with MCI. The current findings have implications for the use of perceived functional ratings, both for diagnostic purposes and as outcome measures in clinical trials.

Goal-Oriented Attentional Self-Regulation (GOALS) is a cognitive rehabilitation training that targets difficulties with executive control functions. Prior research has found that GOALS training improves executive function, functional outcomes, and PTSD symptoms in Veterans with comorbid PTSD and TBI. The objective of this study is to assess the effects of GOALS training versus an active time-matched Behavioral Health Education (BHE) intervention in military Veterans with history of mTBI and executive function difficulties.

Thirty-four veterans with a history of mild TBI (>6 months post-injury) and cognitive difficulties were randomized to GOALS or BHE group intervention. GOALS is a cognitive rehabilitation intervention that incorporates mindfulness-based attention regulation training, and goal management strategies applied to participant-defined goals. It consists of ten 2-hour sessions administered in small group format, and three individual 1-hour sessions. The BHE group is a matched control condition that mirrors GOALS in terms of duration and level of involvement. Participants completed a comprehensive evaluation consisting of neuropsychological and ecologically valid functional performance measures of complex attention and executive function, before and after GOALS or BHE intervention. Overall neuropsychological attention/executive functioning included measures of working memory (Letter Number Sequencing, Auditory Consonant Trigrams), mental flexibility (Design & Verbal Fluency Switching, Trails B, Stroop Inhibition/Switching), inhibition (Stroop Inhibition), and sustained attention (Digit Vigilance). The Goal Processing Scale (GPS) was used to measure ecologically valid complex functional performance.

Post GOALS training, but not post BHE, participants significantly improved on measures of attention /executive function including overall performance (p=.02), working memory (p=.04), sustained attention (p=.03)., and inhibition (p=.01). On measures of complex functional task performance, post GOALS participants significantly improved in the domain of planning (p=.02).

GOALS training improved performance on neuropsychological and ecologically valid functional measures of complex attention and executive function in Veterans with mild TBI and cognitive difficulties. The current study highlights how mindfulness-based attention regulation and goalmanagement strategies applied to personal goals has positive effects across various outcomes. A percentage of individuals with mTBI continue to report persistent problems with cognition and daily functioning. Cognitive rehabilitation training such as GOALS may be beneficial for those with persistent difficulties following mTBI, even in chronic phase.

Agricultural workers are immersed in environments associated with increased risk for adverse psychiatric and neurological outcomes. Agricultural work-related risks to brain health include exposure to pesticides, heavy metals, and organic dust. Despite this, there is a gap in our understanding of the underlying brain systems impacted by these risks. This study explores clinical and cognitive domains, and functional brain activity in agricultural workers. We hypothesized that a history of agricultural work-related risks would be associated with poorer clinical and cognitive outcomes as well as changes in functional brain activity within cortico-striatal regions.

The sample comprised 17 agricultural workers and a comparison group of 45 non-agricultural workers recruited in the Northern Colorado area. All participants identified as White and non-Hispanic. The mean age of participants was 51.7 years (SD = 21.4, range 18-77), 60% identified as female, and 37% identified as male. Participants completed the National Institute of Health Toolbox (NIH Toolbox) and Montreal Cognitive Assessment (MoCA) on their first visit. During the second visit, they completed NIH Patient-Reported Outcomes Measurement Information System (PROMIS) measures and underwent functional magnetic resonance imaging (fMRI; N = 15 agriculture and N = 35 non-agriculture) while completing a working memory task (Sternberg). Blood oxygen-level dependent (BOLD) response was compared between participants. Given the small sample size, the whole brain voxel-wise group comparison threshold was set at alpha = .05, but not otherwise corrected for multiple comparisons. Cohen’s d effect sizes were estimated for all voxels.

Analyses of cognitive scores showed significant deficits in episodic memory for the agricultural work group. Additionally, the agricultural work group scored higher on measures of self-reported anger, cognitive concerns, and social participation. Analyses of fMRI data showed increased BOLD activity around the orbitofrontal cortex (medium to large effects) and bilaterally in the entorhinal cortex (large effects) for the agricultural work group. The agricultural work group also showed decreased BOLD activity in the cerebellum and basal ganglia (medium to large effects).

To our knowledge, this study provides the first-ever evidence showing differences in brain activity associated with a history of working in agriculture. These findings of poorer memory, concerns about cognitive functioning, and increased anger suggest clinical relevance. Social participation associated with agricultural work should be explored as a potential protective factor for cognition and brain health. Brain imaging data analyses showed increased activation in areas associated with motor functioning, cognitive control, and emotion. These findings are limited by small sample size, lack of diversity in our sample, and coarsely defined risk. Despite these limitations, the results are consistent with an overall concern that risks associated with agricultural work can lead to cognitive and psychiatric harm via changes in brain health. Replications and future studies with larger sample sizes, more diverse participants, and more accurately defined risks (e.g., pesticide exposure) are needed.

Children born very preterm (VPT; <32 weeks gestation) are at increased risk for long-term neurocognitive sequelae such as behavioral problems. These problems may be caused by disrupted brain development, particularly white matter abnormalities that affect network efficiency, as shown via diffusion magnetic resonance imaging (dMRI). There is evidence that short-term interventions for pediatric clinical populations can lead to behavioral improvements as well as associated neuroplasticity. Adapted from a previous parenting intervention for families of young children with traumatic brain injury, the novel Building Better Brains and Behavior (B4) program teaches responsive parenting skills for families of children born preterm. It is hypothesized that parent-reported externalizing symptoms will improve from pre- to postintervention and that these improvements will be mirrored by an increase in neural efficiency.

VPT children between the ages of 3-8 with documented behavioral problems were recruited to participate in a single-arm pilot clinical trial. Families began with a baseline visit in which the Child Behavior Checklist (CBCL) was administered as a measure of behavior problems, and the child underwent dMRI. Parents then participated in the 7-session intervention integrating self-guided, online learning modules with live virtual coaching sessions with a therapist. Twenty three participants enrolled, 15 of which completed the intervention and baseline MRI scan; 4 children were excluded from analysis due to not meeting eligibility criteria, leaving 11 participants for analysis of intervention effects (8 males, Mage=5.42). At program completion, families returned for a follow-up that entailed another CBCL questionnaire and dMRI scan. Eight children completed the post-intervention scan and five were retained for analysis (4 males, Mage=5.83). Imaging data was analyzed using the Brain Connectivity Toolbox, which generated graph theoretical metrics to characterize the topological organization of anatomical networks.

A paired samples t-test showed significant reduction of externalizing behavior problems pre-intervention (M=61.12, SD=10.02) to post-intervention (M=55.00, SD=11.62; f(10)=3.09, p=0.01). At baseline, externalizing behavior problems were positively correlated with normalized clustering coefficient, r(10)=0.59, p=0.04, and small-worldness, r(10)=0.64, p=0.03. Change in externalizing symptoms pre- to post-intervention was positively correlated with baseline global efficiency, r(4)=0.94, p=0.02, and negatively correlated with mean local efficiency, r(4)=-0.89, p=0.03, and normalized characteristic path length, r(4)=-0.89, p=0.03.

Preliminary results indicate that VPT children who exhibit higher levels of externalizing symptoms show higher normalized clustering coefficient (which is expected of networks with less integration), and higher small-worldness (which is unexpected). Greater behavioral improvements were associated with higher baseline characteristic path length as expected, but lower baseline global efficiency; this may indicate that children who had lower global efficiency to begin with benefitted from the intervention the most. Due to the small sample size and lack of corrections for multiple comparisons, these results are not definitive and further research is needed to elucidate associations between structural connectivity and behavioral intervention in children born very preterm.

Research on healthcare disparities has found that racial and ethnic minority population were less likely to receive intensive and effective rehabilitation following an acquired brain injury compared to their White counterparts. Immigrant status and language barriers further perpetuate the disparities in access to rehabilitation care. In addition to institutional barriers such as absence of culturally and linguistically appropriate health materials as well as lack of cultural competency training for staff, patient factors such as dissonance in cultural value orientation to health care has been identified as a common culturally-mediated barrier accounting for lower healthcare utilization rate among immigrants. Cultural factors including health beliefs and values impact patient’s self-appraisal of illness and have been studied as significant predictors for treatment adherence. The present case study seeks to demonstrate the role of socio-cultural factors in shaping the course of a Chinese immigrant patient’s neuropsychological evaluation and cognitive rehabilitation following an aneurysm rupture and subarachnoid hemorrhage.

The patient is a 64-year-old, monolingual Mandarin-speaking female who was born and raised in mainland China, referred for neuropsychological evaluation for treatment planning following an anterior communicating artery aneurysm rupture and subarachnoid hemorrhage. Cognitive complaints included selective retrograde amnesia and difficulty with short-term episodic memory. Patient completed neuropsychological assessment, then underwent a course of time-limited cognitive remediation.

Neuropsychological assessment was administered in Mandarin Chinese, and the majority of the tests utilized available norms from Mandarin-speaking Chinese population. While the patient continued to demonstrate at or above average functioning in aspects of executive function, she exhibited a pattern of “rapid forgetting” on modality-nonspecific learning and memory in addition to reductions in attention, working memory, psychomotor speed and visuo-perceptual integration. In the absence of mood symptoms, the patient demonstrated emotional resilience and strong family support system. Given reportedly minimal benefits from prior SLP intervention, barriers to treatment were examined and considered: linguistic factor, difficulty in holding on to information due to anterograde amnesia, and the lack of family involvement in the treatment process. In the context of Chinese family system and immigration history, family-centered care is imperative for the patient’s rehabilitation process. Main treatment goals included improving awareness of cognitive deficits as well as reinforcing consistent use of external strategies to compensate for impaired orientation and memory. Flexibility in the use of evidenced-based interventions were emphasized. The patient’s family were counselled in a culturally competent manner to further understand the aspects that matter the most for the patient and incorporate multi-sensory learning to facilitate intervention.

In this case study, we utilized culturally and linguistically appropriate norms and critically examined barriers to treatment from a contextual lens. This case highlights the role of culturally competent neuropsychological evaluation and incorporating a strength-based and multi-method approach in informing treatment planning for cognitive rehabilitation with immigrant population. Given the dearth in the existing cross-cultural literature, there is a clear need to conduct high-quality research in under-studied and under-represented immigrant populations to reduce the gap in service delivery and enhance treatment effectiveness.

Migraine is one of the leading causes of disability worldwide and a recognized contributor to health disparities with public health implications. Although migraine is a highly prevalent neurological condition, research on the cognitive manifestations of migraines is inconsistent. Studies have confirmed neurocognitive compromise during the presence of a migraine attack, with it’s onset and frequency being associated with greater cognitive decline. Research on the cognitive implications of migraines in underserved communities is scarce. The American Migraine Prevalence and Prevention Study (2015) found that the prevalence of chronic migraines was the highest amongst Hispanic females compared to White females. Latina/os are 50% less likely to receive a migraine diagnosis and adequate headache medication when compared to non-Hispanic White patients. Latina women were more likely to report somatic symptoms than White and African American participants (F=8.96; p>0.001) (Liefland et al., 2014). Somatoform disorders are often diagnosed amongst Latina/os to account for medical unexplained symptoms, and if misdiagnosed can be stigmatizing and detrimental to treatment. We illustrate the critical role that neuropsychologists play by utilizing Socially Responsible Neuropsychology (SRN), a theoretical framework that promotes equitable and precise neuropsychological care to reduce misdiagnosis, elucidate cognitive implications, and address the complex medical needs of Latina/o/ patients. Given the limited literature on migraines and neurocognitive functioning, our objective is to present two case studies to illustrate the neuropsychological implications among bilingual Latina/o with chronic migraines.

Two highly educated Latina/o women, ages 39 and 41 years old, with chronic migraines, cognitive decline, diagnoses and a history of somatization symptoms. The onset of symptoms was gradual, worsening in intensity and frequency, along with notable motor symptoms (e.g., paralysis, weakness, numbness, bilateral tremors), photophobia, and phonophobia. Their cognitive complaints were conceptualized as part of a somatoform presentation by their providers.

The SRN model guided clinical decision-making to establish reliable normative anchors to identify relative impairment compared to premorbid estimates. Testing was completed in English after establishing language dominance via English and Spanish measures of verbal fluency. Cognitive profiles identified declines in attention, processing speed, language, perceptual reasoning, visual memory, executive functioning, motor functioning, and notable decline in their functioning over several years. The neuropsychological profile discounted the presence of a somatoform disorder. One case was diagnosed with an Unspecified Mild Neurocognitive Disorder, while the other case met criteria for a Major Neurocognitive Disorder due to Multiple Etiologies (i.e., vascular contribution, migraines, history of other contributions- choking episode).

Given the decline in each profile, it was hypothesized that the patients’ utilization of compensatory strategies and higher education may have masked the onset of symptoms. These complex cases highlight the need for comprehensive neuropsychological evaluations that are culturally and linguistically responsive to boost the sensitivity of accurate diagnosis. The ability to objectively capture neurocognitive decline offers a unique opportunity to enhance treatment, which would have otherwise remained undetected and untreated. The SRN model enhanced diagnostic considerations, treatment planning, and allowed for advocacy strategies to improve the quality of life, and access to culturally/linguistically appropriate resources.

Dysnomia may be one of the earlier neuropsychological signs of Alzheimer’ disease (Cullum & Liff, 2014), making it an essential part of dementia evaluations. The Verbal Naming (VNT) is a verbal naming-to-definition task designed to assess possible dysnomia in older adults (Yochim et al., 2015) and has been used as an alternative to tasks that predominately rely on picture-naming paradigms. These researchers investigated the influences of age, educational level, cognitive diagnosis, educational quality, and race to examine if race would be a remaining significant factor in the performance of the VNT.

Black (n=57) and White (n=127) participant data were collected during clinical neuropsychological evaluations, which included the VNT alongside other cognitive measures. A multiple regression was utilized controlling for age, educational level, cognitive diagnosis, educational quality via reading level, and race to investigate if race would remain a significant predictor of test performance.

Results suggested that race was still a significant predictor (p = .003) of VNT scores despite efforts to control other sources of variance. Additionally, other cognitive measures such as WAIS-IV Block Design (p = .004) and D-KEFS Tower Test (p = .004) also showed statistically significant relationships with race in the same model, whereas verbal memory (CVLT) and verbal fluency (D-KEFS) did not. The NAB Naming analysis violated the assumption of homoscedasticity; therefore, results with the NAB Naming test were not further interpreted.

These results suggest that race is a significant predictor of performance on some cognitive measures, including the VNT. However, it did not predict performance on verbal memory or verbal fluency. Future investigations of racial differences on neuropsychological test performance would benefit from consideration of variables that may account for discrepancies between White and Black examinees. Several proxy variables could include educational quality, acculturation, and economic status.

Aggregation of phosphorylated tau (pTau) is a hallmark feature of Alzheimer’s disease (AD). Novel assays now allow pTau to be measured in plasma. Elevated plasma pTau predicts subsequent development of AD, cortical atrophy and AD-related pathologies in the brain. We aimed to determine whether elevated pTau is associated with cognitive functioning in older adults prior to the development of dementia.

Independently living older adults (N = 48, mean age = 70.0 years; SD = 7.7; age range 55-88 years; 35.4% male) free of dementia or clinical stroke were recruited from the community and underwent blood draw and neuropsychological assessment. Plasma was assayed using the Quanterix Simoa® pTau-181 V2 Advantage Kit to quantify pTau-181 levels and APOE genotyping was conducted on the blood cell pellet fraction obtained from plasma separation. Global cognition was assessed using the Dementia Rating Scale-2 (DRS-2) and executive function was assessed using the Stroop, D-KEFS-2 Fluency, and Trails Making Test. Diagnosis of mild cognitive impairment (MCI) was determined based on overall neuropsychological performance. Participants were diagnosed as MCI if they scored >1 SD below norm-referenced values on 2 or more tests within a domain (language, executive, memory) or on 3 tests across domains.

Multiple linear regression analysis revealed a significant negative association between plasma pTau-181 levels and DRS-2 (B = -2.57, 95% CI (-3.68, -1.47), p <.001), Stroop Color-Word score (B = -2.64, 95% CI (-4.56, - 0.71), p = .009) and Fruits and Vegetables Fluency (B = -1.67, 95% CI (-2.84, -0.49), p = .007), adjusting for age, sex, education and APOE4 status. MCI diagnosis was determined for 43 participants, of which 8 (18.6%) met criteria. Logistic regression analysis revealed that pTau-181 levels are associated with increased odds of MCI diagnosis (OR = 2.18, 95% CI (1.01, 4.68), p = .046), after accounting for age, sex, education and APOE4 status.

Elevated plasma pTau-181 is associated with worse cognition, particularly executive function, and predicts MCI diagnosis in older adults. Higher plasma pTau-181 was associated with increased odds of MCI diagnosis. Detection of pTau-181 in plasma allows a novel, non-invasive method to detect burden of one form of AD pathology. These findings lend support to the use of plasma pTau-181 as a valuable marker in detecting even early cognitive changes prior to the development of AD. Additional longitudinal studies are warranted to explore the prognostic value of plasma pTau-181 over time.

Sleep contributes to memory retention and recall. Alzheimer’s disease (AD) patients experience decreased slow wave activity (SWA) during sleep. This decrease in SWA is associated with impaired memory consolidation (Lee et al., 2020). Long-term forgetting (LTF) over days or weeks has been linked to memory consolidation deficits and has been suggested as an early marker of AD that could be useful for identifying at-risk individuals for preclinical AD trials (Weston et al., 2018). Here, we examined associations between LTF and SWA in a sample of Presenilin-1 (PSEN1) E280A mutation carriers with autosomal dominant Alzheimer’s disease and non-carrier family members. Carriers of this mutation usually develop dementia in their forties (Fuller et al., 2019).

Fourteen cognitively unimpaired PSEN1-E280A mutation carriers and sixteen age-matched non-carriers (mean age: 34.2 years) from the Colombia-Boston (COLBOS) biomarker study were included. Participants completed an overnight polysomnogram (PSG) and memory testing (NEUROPSI Word List) at 3-time points: 1) the night before PSG: immediate recall (Day1-ImmRecall) and a 20-minute delayed recall (Day1-DelayedRecall), 2) recall the following day (Day2-recall), and 3) recall one week later (Day7-recall). SWA was measured as the ratio 0. 6-1Hz/0.6-4Hz in frontopolar and frontotemporal regions and was calculated for sleep stages N2+N3 (slow wave sleep) based on an automated staging algorithm. Each participant’s LTF was calculated as the percent retention between Day 1 immediate recall and Day 7 recall (Butler, 2009). Mann-Whitney U tests were used to compare differences in recall, SWA, and LTF between groups. Spearman’s correlation was used to examine the associations between memory recall at different time points and SWA, as well as between LTF and SWA.

On Day 1, carriers had lower performance in immediate recall (p=0.02), compared to non-carriers, but there were no group differences in the 20-minute delayed recall. Carriers also recalled fewer words on Day 2 (p=0.03) and Day 7 (p=0.009) and had greater LTF (p=0.03). There were no group differences in SWA. In our overall sample, worse performance on word list delayed recall on Day 1, Day 2, and Day 7 was associated with less SWA across both frontotemporal (Day1: p=0.04, Day2: p=0.02, Day7: p=0.02) and frontopolar (all Ps<0.01) regions. In carriers, only worse performance on Day 1 delayed recall was associated with lower SWA in the frontopolar region (r= 0.535; p=0.049). Memory recall on other days was not associated with SWA in any brain regions. Additionally, greater LTF was associated with less SWA across both frontopolar (r= 0.507; p=0.005) and frontotemporal regions (r= 0.463 p= 0.01).

Preliminary findings suggest that long-term forgetting is associated with less slow- wave activity in preclinical autosomal dominant Alzheimer’s disease. These results also suggest that SWA may be related to pre-sleep learning and subsequent overnight memory consolidation processes. LTF testing may be useful in selecting individuals for preclinical AD trials. Future research on the impact of slow wave activity on LTF may be useful in identifying ways to enhance short- and long-term memory consolidation in individuals at greater risk for dementia.

Identification of pre-clinical Alzheimer’s disease (AD) is necessary for the development of future disease-modifying treatments, which would ideally target pre-clinical stages to mitigate functional loss. Despite advanced in biomarker development, clinical trials are still without a non-invasive and cost-effective means of identifying pre-symptomatic subjects who are at high risk for eventual conversion to AD. In previous work, we developed a machine learning algorithm using neuropsychological test scores and health history to identify subjects at high risk for eventual conversion. Here, we examine the performance of a similar algorithm in predicting the timing of that conversion in years.

Data were obtained from the National Alzheimer’s Coordination Center (NACC) Uniform Data Set (UDS) version 3.0. Subjects with normal cognition at baseline were used to train a multi-class Random Forest classifier to predict conversion to AD. Each subject could be classified as a short-, mid-, or long-term converter (0-3 years, 4 to 6 years, and 7 to 9 years, respectively) or as a non-converter, if no dementia diagnosis was given within ten years of baseline. Predictors included baseline demographics, basic medical history, and neuropsychological test results. Algorithms were evaluated using standard, cross-validated performance metrics.

Multi-class Matthews correlation coefficient between predicted time to diagnosis and the ground truth averaged 0.26 +/- 0.06 across 100 cross validation splits. Prediction accuracy exceeded 0.67 in all cases, when computed for each class individually, and was greatest for the short-term (0.75) and nonconverter (0.78) classes.

Machine-learning algorithms applied to neuropsychological, demographic, and medical history information were able to predict the eventual timing of conversion to dementia in cognitively healthy adults significantly better than chance. Results were most accurate when predicting shorter time to conversion. Results illustrate the potential of this data analytic approach for targeted recruitment in clinical trials.

Population studies have shown that Black individuals are at higher risk for MCI and dementia than White individuals but are more likely to be underdiagnosed or misdiagnosed. Although multiple contributory factors have been identified in relation to neurocognitive diagnostic disparities among persons of color, few studies have investigated race-associated differences in MCI and dementia classification across diagnostic methods. The current study examined the agreement of cognitive classification made via semi-structured interview and neuropsychological assessment.

Only participants assigned normal cognitive status or cognitive impairment with presumed Alzheimer’s etiology were included in the study. Baseline visit data in the National Alzheimer’s Coordinating Center (NACC) dataset was collected to compare correspondence of cognitive classification (normal cognition, MCI, dementia) via semi-structured interview (Clinical Dementia Rating; CDR) with formal NACC diagnostic determination. NACC diagnostic determination was further separated by single clinician and consensus diagnostic methods. Inter-rater agreement was evaluated using chi-squared tests, and respective analyses were stratified for race (Black vs White), ethnicity (Hispanic vs Non-Hispanic), and education (<12 years vs. >12 years).

The sample size included 4,739 Black and 26,393 White participants across 43 Alzheimer’s Disease Research Centers (ADRCs). Inter-rater analyses between CDR (semi-structured interview) versus single-clinician and formal consensus NACC diagnostic methods showed strong (all (pc>.70) consistency in cognitive diagnoses overall, irrespective of race, ethnicity, and education. The percentage of agreement between diagnostic methods was nearly 100% for those categorized as cognitively normal or with dementia. However, the agreement for MCI was considerably lower (ranging from 28-74%) and revealed a disparity in diagnostic method between Black and White individuals. White individuals diagnosed with MCI via CDR (CDR total =0.5) were more likely to be labeled as having dementia regardless of NACC diagnostic method. However, Black individuals diagnosed with MCI via CDR were equally likely to be diagnosed as cognitively normal or with dementia via the formal consensus method.

Irrespective of race and other demographic variables, diagnostic methods had high agreement for groups labeled with normal cognition and dementia. Agreement was consistently lower for the group labeled with MCI, with Black individuals having greater variability in diagnostic differentials when diagnosed via formal consensus method. The results of the study suggest that neuropsychological assessment continues to be an integral component of diagnosing individuals with MCI, reducing possible sources of bias.

Responsive neurostimulation (RNS) is a surgical intervention to reduce the frequency of seizures as an adjunctive therapy for patients with drug-resistant epilepsy (DRE). Presurgical neuropsychological evaluations capture symptoms of anxiety and depression, which occur in higher rates within the epilepsy population than in the general population; however, the effects of mood are commonly overlooked or underappreciated in the conceptualization of cognitive functioning and overall quality of life. Previous studies have shown the effects of attentional control and executive functioning on engagement in meditative states. The present study examines pre and post-meditation self-reported anxiety symptoms and the electrophysiological changes captured intracranially during meditation sessions in patients implanted with an RNS device. This study seeks to utilize presurgical neuropsychological evaluations to explore relationships between cognitive profiles and meditative state changes, and reductions in anxiety.

This study presents a series of 10 patients who underwent RNS device implantation for the treatment of DRE at Mount Sinai Hospital. All patients had at least one contact in the basolateral amygdala. Prior to surgical implantation of the RNS device, all patients completed a comprehensive neuropsychological evaluation based on the NIH Common Data Elements Battery for Epilepsy Patients. Patients in this study completed a 17-and 22-minute meditation protocol based on loving-kindness and Focal Awareness (FA) meditation. Control points and mind-wandering phases were utilized to distinguish the meditative portion of the study during intracranial recordings. All patients completed a pre- and post-meditation questionnaire adapted from the PROMIS Anxiety Short Form as well as self-ratings on meditation depth and satisfaction.

Presurgical neuropsychological evaluation of patients showed elevated levels of anxiety on the BAI (M = 18.14, SD = 12.03) and depression on the BDI-II (M = 15.57, SD = 6.92). Neuropsychological findings localized to frontal or frontotemporal deficits in 80% of the patients were captured in this study. Regarding lateralization, 50% of patients presented with bilateral weakness on neuropsychological evaluation, with the rest showing unilateral profiles. A negative correlation was observed between patient responses on pre-meditation anxiety measures and self-reported depth of engagement in meditation, r = -0.65, p = .043. When all meditation sessions were evaluated, patients displayed a reduction in anxiety levels pre- and post- meditation, t = 2.3, p = .03.

Present findings suggest a reduction in anxiety symptoms following completion of a meditation paradigm. Additionally, a relationship between anxiety and depth of engagement in meditation was identified. During each meditation session, electrocorticography data was collected and analyzed. Given the high comorbidities of anxiety and depression as well as cognitive symptoms common for individuals with epilepsy, a systems-based approach may enhance conceptualization of neuropsychological and neuropsychiatric evaluations, which may have a significant clinical impact. Evaluation of neuropsychological profiles, meditation effects, and anxiety in this population may support cross-discipline understanding of cognitive and psychiatric profiles to better inform treatment recommendations.

Epilepsy is one of the most common neurological disorders affecting young people globally. While up to 60% of seizures experienced during childhood will resolve, childhood epilepsy can give rise to long-lasting neuropsychological effects which extend far beyond those attributed to seizure activity. While these effects have been explored extensively using quantitative methodologies, little research has examined the lived experience of epilepsy in childhood. The aim of the present study was to capture adults' retrospective insights into the impact of epilepsy throughout their schooling years.

Participants consisted of Irish adults between 18 and 35 years, who had their first seizure on or before the age of 16 years. Participants were recruited from epilepsy support agencies and social media, and self-referred to the study. A bespoke semi-structured interview protocol was developed in collaboration with a patient expert which explored learning experiences, relations with peers, and participants' understanding and support of epilepsy during childhood. The methodology adopted a fully qualitative approach to reflexive thematic analysis. Therefore, patterns across the data were examined whilst taking into consideration the wider social context in which the data were generated. Latent assumptions that may have underpinned participants' experiences were prioritised and data was interpreted using pre existing theories and/or concepts. Interviews were completed following the original abstract deadline, and data analysed thereafter.

Thirteen adults who experienced epilepsy during childhood in Ireland were interviewed. Three primary themes and 14 subthemes were generated from the data. The primary themes were that of (1) disenfranchised grief, (2) the need to belong and (3) meeting the child where they're at. Adults reflected that, as children, the diagnosis of epilepsy evoked feelings typically associated with bereavement or loss. Although adults described childhood epilepsy as isolating, these feelings were countered by the support of friends, family and others with epilepsy, as participants recalled finding their tribe. Participants also called for developmentally appropriate practice when dealing with children and their families, across clinical and educational settings, in order to facilitate more comprehensive understandings of epilepsy and its consequences.

Retrospective qualitative research offers a unique opportunity to explore changes in perception those with childhood epilepsy over time. The present study highlights the need for developmentally appropriate practice, which takes the child's neuropsychological and developmental standing into consideration, when supporting for young people with epilepsy. Given the dearth of research in this field, further retrospective research is needed to fully comprehend the impact of epilepsy in childhood globally.

The purpose of this investigation was to examine neuropsychological functioning after frontal (FL) or temporal lobectomy (ATL) in patients with localization related epilepsy. Few studies have compared cognitive changes following FL and ATL. Past research found improvement on measures of verbal and visual memory along with confrontation naming after FL (Busch et al., 2017). In contrast, a number of studies have reported verbal memory and naming decline in those undergoing left ATL. The current study examined post-operative cognitive changes in epilepsy patients who underwent either a left or right FL or ATL.

Subjects include 430 patients (204 men, 225 women, 1 gender not specified), who underwent surgical resection; Right FL = 25, Left FL = 26, Right ATL = 211, Left ATL = 168. Patients had a mean FSIQ = 90, ages ranging from 18 to 71 (mean age = 37 years), right (n=359), left (n=50), or mixed (n=18) handedness, and education ranging from 3 to 22 years (mean = 12.9 years of education). Change from pre- to post FL and ATL was examined in the following domains: learning and memory [Long Term Storage for Selective Reminding Tests (SRT), Wechsler’s Memory Scale (WMS): Logical Memory Delayed Recall (LM) and Visual Reproduction Delayed Recall (VR)], and language [Boston Naming Test (BNT)].

A one-way ANOVA was used to examine changes in language and memory. Our findings revealed statistically significant differences between resection groups for LM, SRT, and BNT. There were significant declines (p<.001) for left ATL when compared to right ATL for LM, SRT, and BNT. There were significant declines for left ATL, when compared to the gains in both left (p<.001; p=.002) and right (p=.018; p=.008) FL for LM and BNT. Left ATL also had significant declines when compared to gains in SRT (p<.001) for right FL. There were significant declines for left FL when compared to right ATL for SRT (p=.007). Lastly, there were significant gains for right FL when compared to left FL for SRT (p=.020).

The pre- to post-surgical neuropsychological change in learning, memory, and language is understudied in frontal lobe epilepsy (FLE); although several investigators reported some learning and memory impairments in FLE at either pre- or post-surgical time points (Johnson-Markve et al., 2011; Incisa Della Rocchetta et al., 1993). The current study suggests that resections of the frontal lobes are associated with better outcomes for naming and verbal memory (LM) when compared to left ATLs. Interestingly, verbal list learning declined more in left than right FL and right ATL patients suggesting a possible language based executive functioning component to this memory measure. As expected, our study further supports that left ATLs are associated with material specific memory declines. This pattern was not seen for those undergoing a right ATL (i.e., nonverbal memory did not decline in patients with right ATL).

The prism adaptation (PA) with rightward shifting lenses is a promising rehabilitation technique for left hemispatial neglect. The PA has also been applied in healthy individuals to investigate cognitive mechanism(s) underlining such adaptation. Importantly, studies have suggested that PA may primarily impact the functions of the dorsal or the ventral attentional stream, and we have previously reported that PA to the upward and downward shifting lenses leads to a significant aftereffect in vertical line bisection task. However, this post-adaptation effect, similarly to that seen in the horizontal plane, might have been modified by the presence of the vertical pseudoneglect healthy participants often experience prior to PA. Thus, the aim of this study was to test this hypothesis.

30 right-handed healthy adults (age M=22,4) performed a computerized line bisection (LB) in vertical and horizontal condition. The bisections were performed twice: before and after PA procedure. Participants took experimental procedure three times, each in at least 24 h of break, each time in one of three conditions of shifting lenses; down, up, control. Both LB tasks (vertical and horizontal) consisted of 24 lines, each centered on 23" touch screen. The participants were asked to find the middle of the line. Throughout the experiment, participants were comfortably seated with their head positioned on a chinrest. Participants were fitted with prismatic goggles that deviated their visual field by 10 degrees. For the adaptation we used the Peg-the-mole procedure consisting of 120 pointing movements.

To assess the effect of the vertical PA on landmark judgments we performed a repeated measures ANOVA with direction of PA (upward/downward), the condition of LB (vertical/ horizontal) and pre- vs post adaptation as a between-subjects factor. This analysis revealed a main effect of the direction of PA (p< 0.001) and a main effect of condition (p< 0.001). Overall, however, only adaptation in up-shifting lenses led to significant aftereffects (p<0.05). Further, when we excluded participants who did not exhibited horizontal pseudoneglect in preadaptation LB, the effect of PA in downshifting PA emerged in vertical LB (p<0.05). Further, this group also exhibited the aftereffect of PA in up-shifting lenses for the horizontal (p<0.01) and the vertical LB (p<0.05). Additionally, these participants exhibited a congruent tendency after upward and downward PA, and tended to allocate their attention more upward and rightward.

The results of this study confirm that the vertical PA evokes a visuo-spatial bias. Moreover, the PA aftereffect seems to be modified by the presence of the pre-adaptation pseudoneglect. Whereas the mechanism inducing this bias is not fully known, it might be explained in light of the interhemispheric activation-inhibition balance. Both the upward and downward PA may primarily lead to activation of the posterior regions of the right hemisphere, and this activation may result with the upward and rightward bias in the LB task. However, future research with neuroimaging techniques is needed to test this hypothesis.

In December 2019, the first reports came from China about cases of pneumonia caused by a previously unknown coronavirus, SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), responsible for a disease called COVID-19. Since then, the pandemic has spread worldwide, affecting people’s physical and mental health and as well as quality of life. Currently, many people are experiencing the health consequences of contracting COVID-19, also due to the impact this disease has on the central nervous system. As a result, in addition to well-known ailments, such as headaches, chronic fatigue or smell and taste disorders, COVID-19 survivors may develop neuropsychological problems such as executive-attentional deficits. However, the specificity of these executive-attentional problems has not been determined. Thus, the purpose of this study was to learn if survivors of COVID-19 may present with more generalized or rather specific dysfunction(s) of the anterior attentional-executive system.

The study group consisted of 37 individuals who underwent COVID-19 (age M=44, education M=17). The comparison group consisted of 25 matched controls tested before the COVID-19 pandemia. The experimental procedures included (1) a clinical interview, (2) an assessment of selected cognitive functions (3) and attentionalexecutive functioning, which was assessed using the ROtman-Baycrest Battery to Investigate Attention (ROBBIA); a battery was designed to measure three attentional processes (i.e., energizing, task setting, and monitoring). Overall, four reaction time (RT) subtests from ROBBIA were administered: (1) Simple RT, (2) Choice RT, (3), Prepare RT, and (4) Concentrate. For each subtest, the instruction was to press an appropriate button on a response pad as quickly as possible when a target stimulus (one of the following capital letters: A, B, C, or D) is detected, but also (in Choice RT, Prepare RT and Concentrate) to make as few errors as possible.

Overall, the analyses revealed that individuals who survived COVID-19 exhibited a different effect of the warning stimulus compared to controls. Specifically, COVID19 survivors presented an increase in reaction time from 1s warning condition to 3s warning condition being significantly greater than the control group’s increase (p < .05). Also, only in the COVID-19 group, reaction time in the Concentrate task tended to be longer (p = 0.01). No group differences in monitoring (e.g., number of errors) or task setting emerged.

The patients’ problems appear analogous to those observed in other chronic somatic diseases, likely due to the impact of COVID-19 on the frontal lobe’s medial regions. However, due to a small sample size, future neuroimaging research, including computerized studies of attentional-execution networks, is needed to confirm that COVID-19 may predominantly affect the energization system that contributes to these patient’s cognitive slowing and defective ability to sustain attention.

Factors such as physical activity and sports participation may have a positive effect on executive functioning. However, people involved in sports are at a higher risk of experiencing a concussion, which may have a detrimental effect. Previous research has yet to investigate those combined negative and positive effects while also utilizing a comprehensive assessment of executive function. This study aims precisely to examine the effects of physical activity, athletic status and concussion history on subjective (e.g., questionnaire) and objective measures (e.g., latent variables) of three well-established components of executive function (i.e., inhibiting, shifting, and updating) in young adults.

247 Canadian university students (ages 18 - 25; 83% female) completed a remote assessment of executive function involving nine computerized tasks and a behavioural self-report, in addition to demographic questionnaires and items assessing weekly physical activity, athletic status, and concussion history. A linear regression analysis was used to assess the effects of the predictor variables (age, sex, concussion history, physical activity and athletic status) on subjective reporting of executive functioning using the Executive Function Index. Furthermore, structural equation modelling (SEM) was used to predict objective executive function using a three-factor model (shifting, updating, inhibition).

The three-factor measurement model of executive function fit the data adequately: x2 = 26.10, df = 17, p = 0.07, CFI = 0.97, TLI = 0.95, RMSEA = 0.05 [90% CI: 0.00-0.09], SRMR = 0.04. Then, the three-factor SEM of executive function also fit the data adequately: X2 = 66.38, df = 51, p = 0.07, CFI = 0.95, TLI = 0.93, RMSEA = 0.04 [90% CI: 0.00-0.06], SRMR = 0.05. Using SEM, no direct relationship was found between the factors of executive function and the predictor variables (i.e., age, physical activity, concussion history, and athletic status). Sex was significantly related to inhibition (b = 0.52, p = 0.02), such that males had greater inhibition. For the regression, physical activity (b = 0.09, p < .01), concussion history (b = 3.29, p < .05) and athletic status (b = -4.01, p < .05) were found to be significant predictors for the Executive Function Index.

Concussion history, physical activity, and athletic status were all predictive of subjective but not objective measures of executive function. Interestingly, these findings align with previous research that demonstrated performance-based executive function measures often do not align with self-report measures, which may suggest they are complementary but measure slightly different aspects of the underlying executive function construct. Mixed findings in the extant literature regarding sex differences and executive function require continued research to understand better the relationship and mechanisms behind the sex differences in inhibition. In summary, these findings offer support for the differentiation between subjective and objective measures of executive function when investigating their relationship with physical activity, sport participation, concussion history, age and sex.

The aim of the current longitudinal study was to use improved brain white matter integrity outcomes (better at resolving white matter complexity, hence with improved biological significance compared to traditional diffusion tensor imaging - DTI outcomes) while considering baseline age, cardiovascular diseases (CVD), and HIV disease markers impacts on the health of major white matter tracts in virally suppressed people Living with HIV infection (PLHIV) versus demographically, geographically, and life-style comparable HIVnegative controls. Furthermore, white-matter hyperintensity (WMH) and normal-appearing white matter (NAWM) volumes and microstructure were considered.

At baseline 48 HIV-controls and 84 virally suppressed PLHIV (mean age 55), and at 24-month follow-up, 40 HIV-controls and 75 virally suppressed PLHIV underwent an MRI scan (3T Phillips) collecting a high-resolution anatomical MRI, FLAIR, and a 32-direction diffusion imaging. The diffusion data were processed using mrtrix and intra-cranial volume-corrected outcomes included fibre density (FD), fibre cross-section (log was used; logFC) and a composite fibre density and cross-section (FDC). The volumetric data was first processed in Freesurfer 6.0, and WMH were segmented using the “pgs” U-Net neural network. Using mixed models, we examine the longitudinal mrtrix outcomes across major white matter tracts by HIV status, and associations with CVD (sum of the scaled scores of total cholesterol, HDL, Systolic BP, current smoking, and diabetes) and HIV disease (HIV duration, historical AIDS, nadir CD4, baseline CD4) markers. Additionally, we assessed the volume, and FDC in the periventricular and deep WMH, as well as NAWM, and the associations with CVD and HIV disease markers. We used FDR control procedure (alpha = 0.05), and all p-values reported are FDR adjusted.

Relative to controls, PLHIV showed significant reductions (p<.05 - p<.01) of FC, and FDC to a lesser extent, in multiple long cortical association tracts, and within striatal- and thalamic-frontoparietal connections. A small HIV by age interaction was only detected for FC of inferior longitudinal fasciculus (Beta = -0.004, SE = 0.002 p<.04). However, HIV duration (corrected for baseline age) was associated with worse FDC across multiple tracts (p<03 -p<.001). Baseline CD4 counts associated with lower FD in frontal association tracts (p<.05 -p<.005). Furthermore, WMH increased in size with time, age, and higher CVD risk factors, but not HIV status. In PLHIV, deep WMH and NAWM microstructure were both associated with worse CVD but not HIV disease markers.

The fine integrity of major white matter tracts is impacted by HIV status, HIV duration and baseline CD4, whereas WMH and NAWM volumes and microstructure are affected by CVD. Our study provides further evidence of the immuno-vascular underpinning of HIV neuropathogenesis in virally suppressed PLHIV. The convergence of these effects in aging PLHIV may lead to early neurodegeneration. Hence, improving CVD health and maintaining high CD4 is critical.

Despite the prevalence of aphasia in Morocco, standardized quick assessment tools are not available for use with patients in acute stroke care. The present study set out to (1) describe the processes of linguistic adaptation of a Moroccan Arabic (MA) version of the Bedside Western Aphasia Battery-Revised (WAB-R), (2) examine the test’s sensitivity to the detection of aphasia in an acute clinical setting, and (3) measure the instrument’s ability to detect improvement in language ability in the acute period.

To achieve the first objective, the English Bedside WAB-R was adapted to Moroccan Arabic by a group of linguists. The instrument’s psychometric properties were established by (1) ascertaining the test’s sensitivity to the presence of aphasia, and (2) verifying the tool’s validity and reliability. Participants included a group of age- and education-matched non-brain-damaged individuals (N = 106), a group of right hemisphere brain-lesioned patients (N = 20), and a group of left hemisphere aphasic patients (N = 52). To accomplish the second and third objectives, the Bedside MA-WAB-R was administered to a group of aphasic participants in the acute period (less than three months post-stroke), and a group of age- and education-matched participants (N = 20). Aphasic patients in the acute stage were tested twice on a seven-day interval (3 days and 10 days post-onset). All data were collected from the Neurology department at the University Medical Hospital Hassan II, and the study received approval from the ethics committee of the Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah.

Regarding the first objective, the results indicated that the MA-WAB-R is sensitive to the presence of aphasia, as revealed by the significantly worse performance of the aphasic group on all subtests relative to matched normal and right-hemisphere participants (p = .000). Analyses revealed excellent content and construct validity (correlations between subtests and AQ ranging from .5 to .8) as well as high inter-rater reliability, intra-rater reliability and test-retest reliability (ICC (2,1) > .9). For the second and third objectives, the results supported the test’s sensitivity to the detection of aphasia in the acute phase, as confirmed by the significantly worse performance of aphasic patients relative to matched normal controls (p = .000). The instrument also proved as a reliable measure of language improvement in the acute period, as supported by better scores on the second testing point relative to the first across all subtests.

The MA-WAB-R is the first standardized assessment tool that can be used for a quick but reliable screening of aphasia in both chronic and acute clinical settings. The test can inform the initial diagnosis of aphasia, and guide a more comprehensive assessment of patients’ spared and impaired linguistic abilities within a context receiving little attention in the aphasia literature.