A fundamental challenge for people with severe mental illness (SMI) is how to deal with cognitive impairments, which are common in this population and limit daily functioning. Cognitive remediation (CR) is a psychological intervention that targets these cognitive impairments to improve everyday functioning. However, reduced neural plasticity in people with SMI might hinder newly learned cognitive skills to sustain. Transcranial Direct Current Stimulation (tDCS) can promote this neural plasticity, which could enhance learning and result in longer-lasting improvements in cognitive and daily functioning. This study aimed to investigate the acceptability of the combination of CR and tDCS for people with severe mental illness who live in residential psychiatric facilities.

We interviewed participants of the ongoing HEADDSET pilot trial. In this pragmatic, randomized, controlled pilot trial, participants (individuals with SMI, 18 years or older, living in psychiatric facilities) received CR in combination with concurrent active tDCS (n = 13) or sham tDCS (n = 13) twice weekly for 16 weeks (32 sessions in total). We invited participants who finished the trial’s training period (n = 16) to participate in the interviews. According to the Theoretical Framework of Acceptability (Sekhon et al., 2017), we assessed seven components of acceptability: Affective attitude, burden, intervention coherence, ethicality, opportunity costs, perceived effectiveness, and self-efficacy.

Twelve of the 16 participants participated in the interviews: seven completers (attended at least 20 of the 32 sessions; M = 22.7, range = 20-25) and five non-completers (M = 11.6, range = 9-15). The reasons for not completing the protocol were mainly unrelated to the training (i.e., prolonged illness, substance abuse, personal circumstances). Only one participant did not complete the training because of its intensity. Independent of whether participants completed the intervention, they were positive about the training. They reported that they liked the CR program CIRCuiTS, that participating in the training was not a burden and that, in their opinion, the training could help others. Moreover, all participants observed improvement in their cognitive functioning, and six individuals (three completers and three non-completers) observed improvements in their everyday life (e.g., fewer problems with doing groceries, being more organized, and being able to concentrate and read a book). Overall, the participants would recommend the training to others. Non-completers of the intervention would recommend the CR with tDCS, while completers neither recommended nor advised against the addition of tDCS. Participants who understood and could explain how the training works reported more improvements in daily life, were better at formulating their treatment goals, and stated that the treatment goals were more relevant to them compared to the participants who were unable to do so.

The combined intervention of CR and tDCS was acceptable to individuals with severe mental illness, the participation in the training was no burden to both completers and non-completers, and participants reported personal benefits for their cognitive functioning and everyday life. Future studies should investigate the effectiveness of the intervention in larger randomized controlled trials.

The goal of our study was to examine the possible effects of a strategies-based training intervention on objective memory performance and subjective memory in healthy older adults. While slight declines in memory naturally occur in the aging process, these changes may impact the quality of life for older adults.

Patients (n = 11, aged 50-80, mean age = 70.73, SD = 4.41) with subjective memory complaints were recruited from memory clinics within an academic medical center. All participants engaged in one-on-one, three one-hour memory training sessions over the course of several weeks to undergo strategies-based training intervention (e.g., mnemonics). All participants completed neuropsychological battery of tests at baseline and at post-intervention (about 8-10 weeks after baseline). Tests included the Montreal Cognitive Assessment (MoCA), the Hopkins Verbal List Test (HVLT-R), the Visual Reproduction subtest of the Weschler Memory Scale (WMS-IV), and the Multiphasic Memory Questionnaire.

Data were analyzed using a mixed between-within subjects ANOVA and t-tests. Groups were created based on the participant’s MoCA score. While a total of 11 participants completed baseline testing and the memory training sessions, two did not return for post-intervention testing; as such their data were excluded from analyses. Older adults with a MoCA score of 26-30 (n = 6), but not older adults with a MoCA score 25 and below (n = 3), had a significant improvement in visual learning and encoding, F (1, 7) = 10.028, r = .50, p < .05. The high MoCA performers demonstrated an improved performance in their immediate visual memory from baseline (M = 10, SD = 3.53) to post-intervention (M = 12, SD = 3.35), t(9) = .895, p = .001 (two-tailed). Ratings of memory satisfaction among high MoCA performers also increased from baseline (M = 48, SD = 11.47) to post-intervention (M = 51, SD = 5.43), t(9) = .707, p < .05 (two-tailed). Among both groups, a significant increase in perceived memory ability was demonstrated from baseline (M = 50, SD =10.1) to post-intervention (M = 54, SD = 12.35), t(8) = .807, p < .05 (two-tailed).

These findings indicate that a brief memory training program may improve visual encoding and subjective memory in healthy older adults with memory concerns. Individuals with subjective memory concerns who undergo a cognitive training program seem to demonstrate improved encoding of nonverbal material. These participants also reported a greater memory satisfaction and improved perceived memory ability after completion of a memory training program. Interestingly, these findings were only seen in adults whose MoCA performance was within normal limits. Although a systematic review suggests the improvement of memory performances on cognitively impaired participants (Simon, Yokomizo, & Bottino, 2012), this may not have been demonstrated in the current study due to a low sample size and/or to the brief duration of the cognitive training. Future directions include increasing sample size and offering booster sessions to explore whether cognitively impaired adults may benefit from repetition.

Inductive reasoning training has been found to be particularly effective at improving inductive reasoning, with some evidence of improved everyday functioning and driving. Telehealth may be useful for increasing access to, reducing time and travel burdens of, and reducing the need for physical spaces for cognitive training. On the other hand, telehealth increases technology burden. The present study investigated the feasibility and effectiveness of implementing an inductive reasoning training program, designed to mimic the inductive reasoning arm used in a large multi-site clinical trial (Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)), via telehealth (using Zoom and Canvas as delivery platforms).

31 older adult participants (mean age = 71.2, range = 65-85; mean education = 15.5, range = 13-18; 64.5% female; 87.1% white) received 10-sessions of telehealth-delivered inductive reasoning training over 5 weeks. Comparison groups (inductive reasoning trained and no-contact controls) were culled from the in-person ACTIVE trial via propensity matching. All participants completed three pretest and posttest inductive reasoning measures (Word Series, Letter Series, Letter Sets), as well as a posttest measure assessing participant perceptions of the telehealth intervention. In addition, at the end of each of the ten training sessions, participants received a final inductive reasoning assessment.

Telehealth participants provided high levels of endorsement suggesting that the telehealth training program was useful, reliable, easy to use and interact on, and employed a useable interface. Participants were generally satisfied with the training program. With regard to performance, telehealth participants demonstrated greater gains than untrained controls on Letter Series [F(1, 116) = 9.81, p = 0.002, partial eta-squared = 0.084] and Letter Sets [F(1, 116) = 8.69, p = 0.004, partial eta-squared = 0.074], but did not differ in improvement on Word Series [F(1, 116) = 1.145, p = 0.287, partial eta-squared = 0.010]. Furthermore, telehealth participants evinced similar inductive reasoning gains as matched inperson inductive reasoning trained participants on Letter Series [F(1, 116) = 1.24, p = 0.226, partial eta-squared = 0.01] and Letter Sets [F(1, 116) = 1.29, p = 0.259, partial eta-squared = 0.01], but demonstrated fewer gains in Word Series performance [F(1, 116) = 25.681, p = < 0.001, partial eta-squared = 0.181]. On the end-of-session reasoning tests, telehealth-trained participants showed a similar general pattern of improvement across the ten training sessions and did not differ significantly from in-person trained comparison participants.

Cognitive training via telehealth evinced similar gains across nearly all measures as its in-person counterpart. However, telehealth also led to substantial challenges regarding the telehealth training platform. Despite these challenges, participants reported perceiving increased competence with computer use, peripherals (mice, trackpad), and videoconferencing. These may be ancillary benefits of such training and may be maximized if more age-friendly learning management systems are investigated. Overall, this study suggests that telehealth delivery may be a viable form of cognitive training in inductive reasoning, and future studies could increase performance gains by optimizing the online training platform for older adults.

Cognitive training using a visual speed-of-processing task, called the Useful Field of View (UFOV) task, reduced dementia risk and reduced decline in activities of daily living at a 10-year follow-up in older adults. However, there is variability in the level of cognitive gains after cognitive training across studies. One potential explanation for this variability could be moderating factors. Prior studies suggest variables moderating cognitive training gains share features of the training task. Learning trials of the Hopkins Verbal Learning Test-Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R) recruit similar cognitive abilities and have overlapping neural correlates with the UFOV task and speed-ofprocessing/working memory tasks and therefore could serve as potential moderators. Exploring moderating factors of cognitive training gains may boost the efficacy of interventions, improve rigor in the cognitive training literature, and eventually help provide tailored treatment recommendations. This study explored the association between the HVLT-R and BVMT-R learning and the UFOV task, and assessed the moderation of HVLT-R and BVMT-R learning on UFOV improvement after a 3-month speed-ofprocessing/attention and working memory cognitive training intervention in cognitively healthy older adults.

75 healthy older adults (M age = 71.11, SD = 4.61) were recruited as part of a larger clinical trial through the Universities of Florida and Arizona. Participants were randomized into a cognitive training (n=36) or education control (n=39) group and underwent a 40-hour, 12-week intervention. Cognitive training intervention consisted of practicing 4 attention/speed-of-processing (including the UFOV task) and 4 working memory tasks. Education control intervention consisted of watching 40-minute educational videos. The HVLT-R and BVMT-R were administered at the pre-intervention timepoint as part of a larger neurocognitive battery. The learning ratio was calculated as: trial 3 total - trial 1 total/12 - trial 1 total. UFOV performance was measured at pre- and post-intervention time points via the POSIT Brain HQ Double Decision Assessment. Multiple linear regressions predicted baseline Double Decision performance from HVLT-R and BVMT-R learning ratios controlling for study site, age, sex, and education. A repeated measures moderation analysis assessed the moderation of HVLT-R and BVMT-R learning ratio on Double Decision change from pre- to post-intervention for cognitive training and education control groups.

Baseline Double Decision performance significantly associated with BVMT-R learning ratio (β=-.303, p=.008), but not HVLT-R learning ratio (β=-.142, p=.238). BVMT-R learning ratio moderated gains in Double Decision performance (p<.01); for each unit increase in BVMT-R learning ratio, there was a .6173 unit decrease in training gains. The HVLT-R learning ratio did not moderate gains in Double Decision performance (p>.05). There were no significant moderations in the education control group.

Better visuospatial learning was associated with faster Double Decision performance at baseline. Those with poorer visuospatial learning improved most on the Double Decision task after training, suggesting that healthy older adults who perform below expectations may show the greatest training gains. Future cognitive training research studying visual speed-of-processing interventions should account for differing levels of visuospatial learning at baseline, as this could impact the magnitude of training outcomes.

Finding effective, innovative, and accessible methods of coping with and mitigating stress has been increasingly relevant in the midst of the COVID-19 pandemic. To do so, it is important to understand the impact of acute stress responses on cognition, behavior, and emotional functioning. The young adult population in particular has been known to show higher levels of stress. Studies have shown that deep breathing interventions are associated with improved affect, decreased stress levels, and improved cognitive functioning. The autonomic nervous system, particularly the functioning of the vagus nerve, has been thought to be a key mechanism in the effect of breathing on stress and mood. Most studies to date investigating the efficacy of breathing practices in stress reduction and mood improvement have lacked appropriate methodology, including adequate control groups, randomization, and cross-sectional designs. This single-blind, randomized, waitlist-controlled study investigated the feasibility of using a mobile application to train in resonance frequency breathing and its efficacy in reducing stress and improving cognitive functioning in a non-clinical sample of young adults with elevated stress.

80 healthy young adults with elevated stress levels were recruited from the NY/NJ community and the Queens College undergraduate research subject pool. Inclusion criteria: ages 18-29, Perceived Stress Scale score >13. Exclusion criteria: regular (at least 3 times per week) practice of any form of meditation, yoga, or breathing exercise; severe medical or psychiatric disorder; active suicidal ideation; drug or alcohol abuse within the past year; use of medication with a known negative impact on cognition or autonomic nervous system (ANS) arousal. Participants were randomized to a waitlist control group or breathing group. Participants in the breathing group were instructed to complete 10-minute breathing sessions using the free mobile application “The Breathing App” twice a day for five days per week for four weeks. Cognitive assessments were administered over the phone (pre and post-treatment) and self-report measures were completed online due to quarantine restrictions.

There were no significant main effects of group across any of the neuropsychological variables, including verbal memory, letter fluency, category fluency, cognitive flexibility, processing speed, basic attention span, and working memory. This indicated that breathing training did not significantly impact neuropsychological performance. Mediation analysis also demonstrated that breathing training did not indirectly lead to improvement in basic attention, processing speed, working memory, set-shifting, verbal fluency, category fluency, or cognitive flexibility, through its effects on stress reduction.

These results do not support literature suggesting that breathing at resonance frequency is associated with improved cognitive functioning such as greater cognitive flexibility, improved decision-making, stronger response inhibition, faster processing speed, and increased working memory. Future study designs should consider implementing active control groups (e.g., mindfulness meditation) and differential dosages of the breathing treatment.

The objective of the present study is to expand our understanding of visual complaints in people with multiple sclerosis (MS) with the aim of exploring potential rehabilitation approaches for treating visual complaints. Visual complaints are increasingly recognized as a core manifestation of MS. Up to 90% of people with MS report all kinds of visual complaints, such as blurry vision, double vision, being blinded by bright light, a reduced visual field and having trouble with depth perception. Since intact vision is quintessential to many activities of daily life, such as reading or car driving, these complaints affect independent participation to a great extent. The complaints cannot be fully explained by optical neuritis (a common symptom of MS) or other treatable visual or ophthalmological disorders. Moreover, there are no rehabilitation programs available for visual complaints in people with MS. However, the complaints are not yet understood well enough to develop effective rehabilitation strategies to reduce the impact of the visual complaints.

Visual complaints were assessed using the Screening Visual Complaints questionnaire. 68 people with MS with visual complaints, and 37 with hardly any visual complaints received a standard visual function assessment and a neuropsychological assessment. Correlations between the visual complaints, visual functions and cognitive functions were calculated. In addition, correlations were calculated between several visual functions and a composite score of the neuropsychological assessment.

Only some specific visual measures related to visual complaints, with small to moderate effect sizes. While most specific cognitive functions did not show correlations, measures indicative of overall cognitive capacity in people with MS (such as motor speed) consistently correlated with different kinds of visual complaints. Additionally, visual functions that related to visual complaints also correlated with the composite score for cognitive functioning.

Our study serendipitously showed that in developing or composing effective rehabilitation strategies for visual complaints, we should look beyond a person’s visual functioning: first, the overall cognitive capacity should be taken into account. Second, visual functioning and cognitive functioning are closely related. These results indicate that visual complaints may be a result of a general decline of the visual and/or cognitive system as one. When treating these complaints, low vision rehabilitation and neuropsychological rehabilitation strategies may be combined. Strategies should not focus on specific visual or cognitive functions, but at making the visual world more easily accessible, or more easily visible, to reduce the impact on the visual system and cognitive capacity. Strategies could range from applying more contrast in the environment to psycho-education. Future research should focus on developing rehabilitation programs and assessing their effectiveness in people with MS or with other types of non-acquired brain injuries.

The study aimed to develop, validate and field test the cognitive screening tool for use in outpatient departments within health facilities in Uganda.

In the rural eastern region of Uganda, twenty-three (23) purposively selected health facilities and administered a scientifically derived cognitive screening tools to all eligible older persons. We conducted an inter-rater reliability in all the health facilities using three raters. Diagnosis of dementia (DSM IV) was classified as a major cognitive impairment and was quality checked by physiatrist who were blinded to results of the screening assessment.

The area under the receiver operating characterizes (AUROC) curve in health facilities was 0.912. The inter-rater reliability was good (Intra-class correlation coefficient of 0.692 to 0.734). the predictive accuracy of the tool to discriminate between dementia and other cognitive impairment was 0.892. In regression modal, the cognitive screening tool, didn’t appear to be biased by age.

The cognitive screening tool if performed well among the older persons, can be proved useful for screening dementia in other developing countries.

Heart rate variability (HRV) can be an indicator of the flexibility of the central and autonomic nervous systems. Heart rate variability biofeedback (HRV-BF) has been shown to validate the neuro-peripheral relationship and enhance the interaction between top-down and bottom-up processes. Few previous studies have focused on the treatment outcomes of HRV-BF in traumatic brain injury, and such studies have been mostly limited to pilot studies or case reports. The purpose of this study is to investigate the efficacy of HRV-BF for neuropsychological functioning in patients with mild traumatic brain injury (mTBI).

Forty-one patients with mTBI were referred from the neurosurgery outpatient program and randomly assigned to a psychoeducation group or a HRV-BF intervention group. The psychoeducation group received standard medical care and one 60-minute psychoeducation session after brain injury. The HRV-BF group received standard medical care and one 60-minute session of the HRV-BF intervention weekly for 10 weeks. All participants received performance-based and self-reported neuropsychological measures of memory, executive function, mood, and information processing at week 1 of injury (pretest) and week 12 (posttest).

Participants in HRV-BF improved significantly after the intervention compared with the psychoeducation group on the Verbal Learning Test, Frontal Assessment Battery, Verbal Fluency Test, Paced Auditory Serial Addition Test, Trail Making Test, Dysexecutive Questionnaire, Depression Inventory, and Checklist of Post-concussion Symptoms.

HRV-BF was found to be an efficacious and efficient intervention for improving neuropsychological functioning in patients with mTBI and a potential candidate for mTBI rehabilitation.

Executive functions (EFs) are considered to be both unitary and diverse functions with common conceptualizations consisting of inhibitory control, working memory, and cognitive flexibility. Current research indicates that these abilities develop along different timelines and that working memory and inhibitory control may be foundational for cognitive flexibility, or the ability to shift attention between tasks or operations. Very few interventions target cognitive flexibility despite its importance for academic or occupational tasks, social skills, problem-solving, and goal-directed behavior in general, and the ability is commonly impaired in individuals with neurodevelopmental disorders (NDDs) such as autism spectrum disorder, attention deficit hyperactivity disorder, and learning disorders. The current study investigated a tablet-based cognitive flexibility intervention, Dino Island (DI), that combines a game-based, process-specific intervention with compensatory metacognitive strategies as delivered by classroom aides within a school setting.

20 children between ages 6-12 years (x̄ = 10.83 years) with NDDs and identified executive function deficits and their assigned classroom aides (i.e., “interventionists”) were randomly assigned to either DI or an educational game control condition. Interventionists completed a 2-4 hour online training course and a brief, remote Q&A session with the research team, which provided key information for delivering the intervention such as game-play and metacognitive/behavioral strategy instruction. Fidelity checks were conducted weekly. Interventionists were instructed to deliver 14-16 hours of intervention during the school day over 6-8 weeks, divided into 3-4 weekly sessions of 30-60 minutes each. Baseline and post-intervention assessments consisted of cognitive measures of cognitive flexibility (Minnesota Executive Function Scale), working memory (Weschler Intelligence Scales for Children, 4th Edn. Integrated Spatial Span) and parent-completed EF rating scales (Behavior Rating Inventory of Executive Function).

Samples sizes were smaller than expected due to COVID-19 related disruptions within schools, so nonparametric analyses were conducted to explore trends in the data. Results of the Mann-Whitney U test indicated that participants within the DI condition made greater gains in cognitive flexibility with a trend towards significance (p = 0.115. After dummy coding for positive change, results also indicated that gains in spatial working memory differed by condition (p = 0.127). Similarly, gains in task monitoring trended towards significant difference by condition.

DI, a novel EF intervention, may be beneficial to cognitive flexibility, working memory, and monitoring skills within youth with EF deficits. Though there were many absences and upheavals within the participating schools related to COVID-19, it is promising to see differences in outcomes with such a small sample. This poster will expand upon the current results as well as future directions for the DI intervention.

Older adults experiencing mild cognitive difficulties (MCD) may benefit from compensatory cognitive training (CCT) to address cognitive changes. CCT can be delivered over various lengths of time and can focus on a specific cognitive domain (e.g., memory) or multiple domains. Identifying the most relevant and impactful portions of a CCT intervention could allow for more effective and streamlined delivery of compensatory strategies, perhaps allowing this type of training to be included in feedback sessions or brief interventions. This study sought to investigate which factors older adults with MCD found to be most beneficial and applicable to their daily lives after completion of a brief telehealth CCT program.

Adults age 55+ with documented MCD (n=28) and an optional care partner (CP; n=18) were recruited for video-chat delivery of a 6-week, motivationally-enhanced CCT program adapted from CogSMART. The six weeks included content addressing: Education and Lifestyle Strategies (Session 1); Organization, Prioritization, and Prospective Memory (Session 2); Attention, Concentration, and Working Memory (Session 3); Learning and Memory (Session 4); Executive Functions: Decision-Making, Problem-Solving, and Planning (Session 5); and Skills Integration and Next Steps (Session 6). After completing the course, participants (n=25) provided open-ended feedback on course content, including the areas they found most helpful. They were also asked which strategies from the course they had successfully applied in their daily lives, and which they expected to continue using following the course. Qualitative data were coded and analyzed by two researchers.

Participants most often endorsed strategies from Session 2 (44% of participants) and Session 3 (44%) as being helpful and applicable in daily life. Session 1 content was also frequently endorsed (36%). Content from Session 5 was noted to have been helpful/applicable least often (12%). Participants also reported having found common factors of the program to be helpful (35%), such as interaction with the clinician, education on relevant resources, or greater self-reflection and self-awareness through the program. A minority of participants reported “all” (22%) or “none” (24%) of the content to be helpful.

Among older adults with MCD, strategies related to prospective memory (e.g., calendar training) and attention (e.g., mindfulness) were most frequently reported as being helpful and applicable in daily life. Participants reported confidence in their ability to continue using these strategies after the program, along with continued implementation of lifestyle factors to promote healthy brain aging (e.g., exercise). Clinicians interested in providing CCT to older adults with MCD may find the most benefit from emphasizing and prioritizing strategies within these domains. Future research could use ecological momentary assessment techniques to gather real-time measures of how these learned strategies are employed in daily life. Continued exploration of the most salient and effective compensatory strategies for older adults with MCD will support effective intervention and promote independence among aging patients.

The goal-control model of the functional impairment in dementia posits two different underlying mechanisms: decay of task goals (reduced task accomplishment) and poor control over goal execution (high error rates). Here we present a case series in which we explore the effects of a performance-based, functional intervention on two participants. Outcomes were evaluated using the goal-control framework.

Two participants with dementia (CS: age 70, 14 years of education; EM: age 93, 18 years of education) completed neuropsychological tests (scored using age, education, and IQ-adjusted norms) and baseline testing with the Naturalistic Action Task (NAT; a validated performance-based task of everyday function including a Breakfast and Lunch task). The Virtual Kitchen (VK) was used to train, through repeated performance, either the Breakfast (CS) or Lunch (EM) tasks for 30 minutes (or 10 total repetitions) per day over 5 days. After VK training, participants performed the NAT Breakfast and Lunch tasks again to evaluate improvement on the trained and untrained tasks. Baseline and post-training NATs were scored for task accomplishment and errors by two coders observing video recordings. Z scores were derived by calculating accomplishment and error change scores for each participant relative to the mean and standard deviations of change scores from a cohort of 36 healthy controls (mean age: 73.3, SD: 6.44; mean education: 17.42, SD: 2.17).

Both participants exhibited similar cognitive profiles: high estimated IQ; low MMSE (total = 19 for both CS and EM; 1st percentile); anterograde amnesia, slowed processing speed and impaired executive function; average scores on tests of attention, language, and self-reported depression. Informant report of daily functioning (FAQ) suggested that EM (FAQ=28) exhibited greater functional impairment than CS (FAQ=9). Both participants completed all VK training sessions. Z scores of the change from pre- to post-training showed significant increases in task accomplishment on the trained task (trained condition change z scores: EM = +27.69; CS =+ 6.06), but significantly less improvement or worse task accomplishment on the untrained task (untrained condition change z scores: EM = +4.06; CS = -13.69). The training did not reduce errors, as error rates increased for both participants on the trained task.

The participants presented in this case study exhibited comparable cognitive profiles, including marked anterograde amnesia. Our results suggest that repeated training in a virtual context can improve specific aspects of functioning on real, life everyday tasks. Further, according to the goal-control framework, repeated practice reduces the decay of the task goal, as represented by greater task accomplishment, but does not improve executive control over the task execution. Important future directions are to determine if people with different cognitive profiles will demonstrate different benefits from VK training and to examine if virtual training of personally relevant, everyday tasks can promote independent living and improve quality of life.

Perceived poor sleep quality is the most commonly reported issue among veterans with a history of mild traumatic brain injury (mTBI). Poor sleep can impact aspects of objective and subjective executive functioning abilities (e.g., planning, organization, decision-making) and lead to decreased societal participation. However, less is known about how perceived executive dysfunction impacts the relationship between perceived poor sleep and societal participation in veterans with a prior history of mTBI. We hypothesized that executive dysfunction mediates the relationship between subjective sleep quality and societal participation.

Participants included sixty-two U.S. veterans [Age: M=41.73 (SD=13.19); Education: M=15.16 (SD=2.20); 14.5% female]. The participants completed the Mayo-Portland Adaptability Inventory - 4 (MPAI-4; total scores), the Behavior Rating Inventory of Executive Function - Adult (BRIEF-A; subscale planning/organizing), and the Pittsburg Sleep Quality Index (PSQI; total scores). 21 participants met diagnostic criteria for Post-traumatic stress disorder (PTSD) [as determined by a cutoff score of 45 on the PTSD Checklist for DSM-5 (PCL-5)]. A mediation analysis was utilized to examine the impact of executive functions on the relationship between perceived sleep quality and societal participation. Mediation analyses were conducted via linear regression modeling using SPSS Version 27. Post hoc analyses were conducted to control for PTSD, which is common in veteran populations.

The total PSQI scores significantly predicted MPAI-4 total scores F(1, 53) = 16.740, p < .001 (R2= .55) when controlling for PTSD diagnoses. A mediation analysis showed that BRIEF-A Planning/Organizing T-scores partially mediate the relationship between PSQI scores and MPAI-4 scores when controlling for PTSD diagnoses F(2, 54) = 12.055, p < .001 (R2 = .61).

Results suggest that per000eived sleep quality impacts societal participation. However, how patients perceive their executive functioning abilities partially mediates the relationship between perceived sleep quality and societal participation, such that perceived poor sleep quality leads to reduced societal participation when there is subjective executive dysfunction. Therefore, clinical interventions should focus on the cognitive rehabilitation of executive functioning among veterans with a history of mTBI to improve their subjective experience. Ultimately, these efforts may improve veterans’ participation and utilization of healthcare services.

I-InTERACT-North is a stepped-care telepsychological parenting intervention designed to promote positive parenting skills and improve child behaviour. Initially developed for children with traumatic brain injury, our pilot study has shown efficacy in increasing positive parenting skills and reducing problem behaviours for children with early brain injury (e.g., stroke, encephalopathy). Recently, the program has expanded to include children with neurodevelopmental disorders, including Autism Spectrum Disorder. Although positive parenting programs (e.g., Parent-Child Interaction Therapy) can be effective for autistic children, it is unknown whether the goals most important to these families can be addressed with IInTERACT-North program. An examination of suitability and preliminary efficacy was conducted.

Parent participants of autistic children between 3 and 9 years (n= 20) were recruited from the neonatal, neurology, psychiatry, or cardiology clinics at The Hospital for Sick Children and the Province of Ontario Neurodevelopmental Disorders (POND) Network. Top problems, as reported by parents at baseline, were analyzed qualitatively through a cross-case analysis procedure in order to identify common themes and facilitate generalizations surrounding concerning behaviours. Parent-reported intensity of their children’s top problem behaviours on a scale from 1 (“not a problem”) to 8 (“huge problem”) were quantified. To explore preliminary program efficacy, t-tests were used to compare pre- and post-intervention problems and intensity on the Eyberg Child Behavior Inventory (ECBI) (n=16).

A total of 56 top problem data units were examined, with convergent thematic coding on 53 of 56 (94.6% inter-coder reliability). Four prevalent, high-agreement themes were retained: emotion dysregulation (19; 33.9%), non-compliance (12; 21.4%), sibling conflict (7; 12.5%), and inattention and hyperactivity (7; 12.5%). Average problem intensity for these themes ranged from 5.85 to 6.53 (where 8 is greatest impairment) with emotion dysregulation having the highest intensity (6.53) compared to the others. Scores on the ECBI were lower post-intervention (Intensity scale: M= 59.06, SD= 8.1; Problem scale: M= 60.69, SD= 11.5) compared to pre-intervention (Intensity scale: M= 61.19, SD= 10.4; Problem scale: M= 64.31, SD= 11.7), but small sample size precluded detecting statistical significance (p’s = .16 and .07, respectively).

Thematic analysis of top problems identified by parents of autistic children suggested that concerns were transdiagnostic in nature, and represent common treatment targets of the I-InTERACTNorth program. Though challenging behaviours related to restricted interests or repetitive behaviours may exist in our sample, parental behavioural goals appeared to align with the types of concerns traditionally raised by participants of the program, supporting a transdiagnostic approach. Preliminary data point to positive treatment outcomes in these families.

Lateralization and localization of neuropathology helps determine the extent to which eloquent cortex and diseased brain tissue share loci, important information for neurosurgical decision-making, and predicting neurocognitive outcomes. Emerging data suggest that lateralization and localization can inform specific neurorehabilitation approaches following acquired brain injury (ABI). In recent years, computerized cognitive remediation (CCR) of attention and working memory (WM) has been included among treatment guidelines to enhance cognition in post-acute recovery following ABI. Although CCR has shown promise for improving attention and executive functioning in ABI, it is unknown how treatment response may be predicted by locus of ABI. Even less is known about the effects of CCR following neurosurgery. The current study explores neurosurgical lateralization and localization as potential variables for predicting treatment response to CCR.

Adult patients with a variety of neurological diagnoses (N = 17; ∼47% women) completed a full course of Cogmed Working Memory Training (CWMT) s/p neurosurgical intervention. All participants engaged in 30 sessions of CWMT over eight weeks, as well as neuropsychological (NP) assessment at pre-training baseline, immediate post-training, and at 3-month follow-up. Objective and subjective indices of attention, working memory, executive functioning, and emotional well-being were evaluated at three time-points. Neurosurgical loci included left-hemisphere frontal, temporal, and temporoparietal lobes, as well as right-hemisphere frontal, frontotemporal, and temporal lobes.

NP data were reviewed and yielded a clinical impression of cognitive and affective functioning for a cohort of patients with heterogeneous diagnoses (e.g., brain tumor, epilepsy, NPH). Preliminary NP findings suggested that treatment response to CCR for WM was consistent with extant literature on brain-behavior relationships according to lateralization and localization of neurosurgical intervention.

Neurosurgical patients experience neurocognitive and affective dysfunction that may respond well to cognitive rehabilitation (CR) that includes CCR. Additionally, it is possible that lateralization and localization of surgical intervention may contribute to individual differences in treatment response. Further neurorehabilitation research is warranted to identify patients most likely to benefit from CCR and better tailor CR modalities to optimize recovery s/p neurological surgery.

Preterm birth (gestational age < 37 weeks) is associated with delays in the development of executive functions and their precursors, including controlling attention and retaining task-relevant information. In the current study, we aim to examine the potential therapeutic effects of a novel cognitive tablet game, Dino Island (DI), and its implementation through a parent-delivered intervention program on cognitive development in preterm children.

In total, 34 participants (M = 4.99 years old) were recruited from a perinatal follow-up clinic or through the community in Calgary, AB. Participants were randomly assigned to either the DI intervention (n = 20) or tablet-based educational control games (C; n = 14). Parents completed a 2-hour training program that included information about how to support their child through the intervention using behavioural supports and metacognitive strategies. Neuropsychological assessment was done prior to beginning the intervention and after 12 weeks of intervention. Various tests were used to assess near transfer measures of sustained attention, shifting attention, executive function, verbal working memory and inhibition, and to assess far transfer measures of language skills and early numeracy. Families tracked weekly progress using journals, with the goal of 3-4 30-minute sessions per week. Multiple ANCOVA analyses were run to analyze quantitative data using the pre-test score as a covariate.

A total of 21 participants completed the 12 weeks of intervention (DI: n = 11 and C: n = 10). Those who did not complete the intervention withdrew from the study or were unable to make a follow-up assessment due to COVID-19 restrictions. Groups did not significantly differ in age (DI: M = 4.92, C: M = 4.61), sex (DI: Female = 6, C: Female = 6), or in weeks preterm (DI: M = 29.49 weeks, C: M = 32.7 weeks).

Multiple ANCOVAs were run to determine the effect of either the DI or Control intervention on the cognitive measures after controlling for the pre-intervention score of participants. As compared to the Control group, the DI intervention group showed near transfer gains in sustained attention (F(1,7) = 5.1, p = 0.043), and executive functions (F(2,18) = 5.41, p = 0.014), as well as far transfer gains in phonetic awareness (F(2,16) = 11.63, p = 0.001), vocabulary and oral language skills (F(2,7) = 5.54, p = 0.014), and number identification fluency (F(2,17) = 11.37, p = 0.001). Detailed analyses will be discussed in the poster.

This study provides preliminary support for the potential efficacy of the DI intervention when delivered by parents to children born preterm. Pre-post testing after 12 weeks of intervention indicated both near and far transfer gains. These results highlight the benefits of utilizing a tablet game format to facilitate collaborative parent-child interactions in cognitive intervention. This intervention provides a potential affordable and engaging alternative to existing cognitive interventions. Further investigation with a larger and more diverse sample is required.

Children with neurodevelopmental disorders (NDDs) commonly experience attentional and executive function (EF) difficulties that are negatively associated with academic success, psychosocial functioning, and quality of life. Access to early and consistent interventions is a critical protective factor and there are recommendations to deliver cognitive interventions in schools; however, current cognitive interventions are expensive and/or inaccessible, particularly for those with limited resources and/or in remote communities. The current study evaluated the school-based implementation of two game-based interventions in children with NDDs: 1) a novel neurocognitive attention/EF intervention (Dino Island; DI), and 2) a commercial educational intervention (Adventure Academy; AA). DI is a game-based attention/EF intervention specifically developed for children for delivery in community-based settings.

Thirty five children with NDDs (ages 5-13 years) and 17 EAs participated. EAs completed on-line training to deliver the interventions to assigned students at their respective schools (3x/week, 40-60 minutes/session, 8 weeks, 14 hours in total). We gathered baseline child and EA demographic data, completed pre-intervention EA interviews, and conducted regular fidelity checks throughout the interventions. Implementation data included paper-pencil tracking forms, computerized game analytic data, and online communications.

Using a mixed methods approach we evaluated the following implementation outcomes: fidelity, feasibility, acceptability, and barriers. Overall, no meaningful between-group differences were found in EA or child demographics, except for total number of years worked as an EA (M = 17.18 for AA and 9.15 for DI; t (22) = - 4.34, p < .01) and EA gender (χ2 (1) = 6.11, p < .05). For both groups, EA age was significantly associated with the number of sessions played [DI (r = .847, p < .01), AA (r = .986, p < .05)]. EAs who knew their student better completed longer sessions [DI (r = .646), AA (r = .973)], all ps < .05]. The number of years worked as an EA was negatively associated with the total intervention hours for both groups. Qualitative interview data indicated that most EAs found DI valuable and feasible to deliver in their classrooms, whereas more implementation challenges were identified with AA. Barriers common to both groups included technical difficulties (e.g., game access, internet firewalls), environmental barriers (e.g., distractions in surroundings, time of the year), child factors (e.g., lack of motivation, attentional difficulties, frustration), and game-specific factors (e.g., difficulty level progression). Barriers specific to DI included greater challenges in motivating children as a function of difficulty level progression. Furthermore, given the comprehensive nature of training required for delivery, EAs needed a longer time to complete the training for DI. Nevertheless, many EAs in the DI group found the training helpful, with a potential to generalize to other children in the classroom.

The availability of affordable, accessible, and effective cognitive intervention is important for children with NDDs. We found that delivery of a novel cognitive intervention by EAs was feasible and acceptable, with similarities and differences in implementation facilitators/barriers between the cognitive and commercialized academic intervention. Recommendations regarding strategies for successful school-based implementation of neurocognitive intervention will be elaborated on in the poster.

Studies have reported that athletic conditioning or training may have neuropsychological benefits for adult athletes, including enhanced processing speed, executive function, and working memory and attention. However, others have reported that these benefits may be attenuated by an athlete’s level of exposure to repetitive, subconcussive head impacts, such as heading the ball in soccer. Neurocognitive dispersion, or intraindividual variability (IIV), has become an increasingly popular tool to assess neuropsychological performance in various clinical populations. Less dispersion is typically associated with more consistent and better overall performance (i.e., fewer lapses of reaction time and accuracy). However, few studies have utilized these measures in healthy young adults. The objective of this study was to determine if athletes and non-athletes exhibited different levels of neurocognitive dispersion on a battery of neuropsychological tasks. It was hypothesized that athletes would exhibit less neurocognitive dispersion compared to non-athletes, despite their exposure to repetitive subconcussive head impacts.

Division 1 varsity and club team university athletes (n = 74, Mage = 19.93, female = 55%), and non-athlete undergraduate students (N = 154, Mage = 20.12, female = 69%) completed a neuropsychological battery consisting of 13 cognitive tests. Outcomes for each test were converted to standard scores and combined for overall neuropsychological performance. Two measures of IIV, intraindividual standard deviation (ISD) and maximum discrepancy (MD), were calculated across all 13 cognitive tests for each participant. Intraindividual standard deviation was calculated by taking the standard deviation of the mean performance across each task for each participant. Maximum discrepancy was calculated by subtracted the lowest standard score from the highest standard score per participant across all 13 cognitive tests.

Controlling for the impact of premorbid functioning, depressive symptoms, and gender, an analysis of covariance (ANCOVA) found significantly less ISD in athletes (M = 11.28, SD = 2.76) compared to non-athletes (M = 12.56, SD = 3.61) across all 13 neuropsychological tasks (η2 = 0.04, p = .004). Similarly, significantly lower MD scores were found in athletes (M = 40.25, SD = 11.14) compared to non-athletes (M = 44.69, SD = 14.07) across all 13 neuropsychological tasks (η2 = 0.03, p = .008). Post-hoc analyses revealed no significant differences when athletes were divided into contact and non-contact athletes.

Similar to prior findings that aerobic exercise may enhance cognitive performance, both contact and non-contact college athletes exhibited less neurocognitive dispersion (as measured by ISD and MD) compared to non-athlete college students. However, no significant differences were found between non-contact athletes and contact athletes (soccer players) who were exposed to repetitive subconcussive heading events. These findings suggest that athletic performance in college-aged athletes may lead to more consistent and therefore overall better neuropsychological performance despite exposure to repetitive subconcussive head impacts.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary form of cerebral small vessel disease leading to early cerebrovascular changes. These changes result from mutations in the NOTCH3 gene that cause progressive accumulations of granular osmiophilic material (GOM) deposits, thickening arterial walls and reducing or restricting blood flow in the brain. The clinical presentation of CADASIL is characterized by migraines with aura, early and recurrent strokes, progressive cognitive impairment, and psychiatric disturbances. CADASIL is rare but frequently underrecognized or misdiagnosed. A genetic condition with a 50% risk of inheritance from an affected parent, the gold standard for diagnosis is genetic testing to determine the presence of mutations in the NOTCH3 gene. This presentation aims to familiarize neuropsychologists with the condition of CADASIL through a unique case study highlighting important psychological, social, and ethical considerations raised by genetic testing.

This case study presents a 67-year-old, right-handed, married female diagnosed with CADASIL who was referred for neuropsychological evaluation of cognitive function and low mood concerns following multiple ischemic events.

Results revealed severe cognitive deficits in domains of attention, learning, and memory. Her superior verbal abilities and executive function remained largely intact. Assessment of mood revealed elevations in symptoms of depression and anxiety. The patient was aware of CADASIL in her father, paternal aunt, and younger brother, but elected to forego any genetic testing to confirm whether she had the condition until she experienced a stroke at age 61. She has two adult children who have also elected to forego testing and currently remain asymptomatic. Cognitive profile, mood disturbances, and patient perspectives on refraining from pre-symptomatic genetic testing for CADASIL diagnosis will be discussed.

Aspects of this case are consistent with a small body of literature evidencing distinct psychological, emotional, and social challenges among families carrying genetic risk of CADASIL. While providing an example of an often underrecognized neurological disorder with which neuropsychologists should be familiar, this case uniquely raises ethical questions relevant to care providers and current treatment guidelines regarding genetic testing among families carrying highly heritable neurological conditions. In particular, personal ethical challenges around deciding to pursue or forego pre-symptomatic testing, and implications for family planning, highlight the importance of genetic counseling for affected families.

Poor cardiovascular health occurs with age and is associated with increased dementia risk, yet its impact on frontotemporal lobar degeneration (FTLD) and autosomal dominant neurodegenerative disease has not been well established. Examining cardiovascular risk in a population with high genetic vulnerability provides an opportunity to assess the impact of lifestyle factors on brain health outcomes. In the current study, we examined whether systemic vascular burden associates with accelerated cognitive and brain aging outcomes in genetic FTLD.

166 adults with autosomal dominant FTLD (C9orf72 n= 97; GRN n= 34; MAPT n= 35; 54% female; Mage = 47.9; Meducation = 15.6 years) enrolled in the Advancing Research and Treatment for Frontotemporal Lobar Degeneration (ARTFL) and Longitudinal Evaluation of Familial Frontotemporal Dementia Longitudinal FTD study (ALLFTD) were included. Participants completed neuroimaging and were screened for cardiovascular risk and functional impairment during a comprehensive neurobehavioral and medical interview. A vascular burden score (VBS) was created by summing vascular risk factors (VRS) [diabetes, hypertension, hyperlipidemia, and sleep apnea] and vascular diseases (VDS) [cerebrovascular disease (e.g., TIA, CVA), cardiac arrhythmia (e.g., atrial fibrillation, pacemaker, defibrillator), coronary artery disease (e.g., myocardial infarction, cardiac bypass, stent), and congestive heart failure] following a previously developed composite (range 0 to 8). We examined the interaction between each vascular health metric (VBS, VDS, VRS) and age (vascular health*age) on clinical severity (CDR plus NACC FTLD-SB), and white matter hyperintensity (WMH) volume outcomes, adjusting for age and sex. Vascular risk, disease, and overall burden scores were examined in separate models.

There was a statistically significant interaction between total VBS and age on both clinical severity (ß=0.20, p=0.044) and WMH burden (ß=0.20, p=0.032). Mutation carriers with higher vascular burden evidenced worse clinical and WMH outcomes for their age. When breaking down the vascular burden score into (separate) vascular risk (VRS) and vascular disease (VDS) scores, the interaction between age and VRS remained significant only for WMH (ß=0.26, p=0.009), but not clinical severity (ß=0.04, p=0.685). On the other hand, the interaction between VDS and age remained significant only for clinical severity (ß=0.20, p=0.041) but not WMH (ß=0.17, p=0.066).

Our results demonstrate that systemic vascular burden is associated with an “accelerated aging” pattern on clinical and white matter outcomes in autosomal dominant FTLD. Specifically, mutation carriers with greater vascular burden show poorer neurobehavioral outcomes for their chronological age. When separating vascular risk from disease, risk was associated with higher age-related WMH burden, whereas disease was associated with poorer age-related clinical severity of mutation carriers. This pattern suggests preferential brain-related effects of vascular risk factors, while the functional impact of such factors may be more closely aligned with fulminant vascular disease. Our results suggest cardiovascular health may be an important, potentially modifiable risk factor to help mitigate the cognitive and behavioral disturbances associated with having a pathogenic variant of autosomal dominant FTLD. Future studies should continue to examine the neuropathological processes underlying the impact of cardiovascular risk in FTLD to inform more precise recommendations, particularly as it relates to lifestyle interventions.

Cerebral amyloid angiopathy (CAA) is one of the most frequent causes of non-traumatic intracerebral hemorrhage (ICH). ICH recurrence risk is significantly higher in patients with CAA than for those without the condition, and CAA is a risk factor for the development of dementia, particularly Alzheimer’s disease. There is a growing body of research describing neuropsychological impairment observed in patients with CAA. Among patients with a history of CAA-related ICH, the most commonly identified cognitive impairments include attention, processing speed, executive functioning, and episodic memory. However, little is known about potential additive or synergistic effects of each CAA-related lesion (such as recurrent ICHs) on cognitive functioning.

We present a case of a 74-year-old female with sporadic CAA, who had recurrent ICHs involving the left occipitoparietal lobe, left frontoparietal lobe, right occipital lobe, and left frontal lobe. She experienced residual visual impairment and probable Charles Bonnet Syndrome. Her clinical presentation and cognitive functioning were tracked with an inpatient neuropsychological evaluation completed after each ICH occurrence within the past year, as well as an outpatient neuropsychological evaluation completed approximately 3-months post-discharge from her most recent hospital admission. Record review, including clinical notes, lab tests, and imaging results supplement her performance on serial inpatient and outpatient neuropsychological evaluations.

Data from three inpatient neuropsychological screenings and one lengthier outpatient evaluation are presented. With each inpatient evaluation, her profile demonstrated further cognitive decline involving visuospatial skills, semantic fluency, and episodic memory. In fact, results from her last inpatient screening raised concern for an underlying cortical degenerative process. In contrast, her follow-up outpatient evaluation, after three separate ICH events within one year, demonstrated an isolated set-shifting impairment, with intact performance across all other domains, which ruled out the prior suspicion of a cortical process.

While specific domains of cognition are more vulnerable in CAA, it is difficult to identify a specific and expected cognitive pattern given the extensive number of varied neurological insults patients typically develop throughout the disease course. This case demonstrates the wide range effects of repeated ICH, as well as the contrast between the acute effects of new lesions and the lasting effects of these lesions on cognitive ability after a period of recovery and stabilization. Given that our service was able to perform neuropsychological assessment in the acute phase of each ICH and in the subacute phase after a period of stabilization, this case adds to the literature by providing an example of the additive or synergistic effects of each CAA-related lesion over time.