The aim of the present study was to analyse the effects of the transcranial random noise stimulation (tRNS) technique when placed on the left dorsolateral prefrontal cortex (L-DPFC) and left inferior frontal gyrus (L-IFG), for the improvement of verbal fluency performance and creativity skills in a group of multilingual healthy adults.

Fifty healthy adults, aged 18-47 years, participated in the study. All of them were native Spanish speakers of which three were bilingual (Spanish and English) and 47 were multilingual (Spanish, Basque and English). The study had a randomized, counterbalanced, double-blind, sham-controlled design. The participants were randomly allocated to either a tRNS active group or a placebo-control group. All participants were tested individually in one session divided into three parts: (1) baseline, (2) online, and (3) offline assessment. In the active condition, a 1.5mA current (100-500 Hz) was delivered for 20 minutes (online phase). Participants’ verbal fluency was assessed through semantic and phonemic verbal fluency tasks in three different languages (Spanish, Basque and English), while creativity was assessed in their native language with the Remote Associations Test (RAT, pre and post forms) for convergent thinking, and with the Unusual Uses subtest (UU, pre and post forms) for divergent thinking. In addition, the linguistic profile of the participants was evaluated with the Language Experience and Proficiency Questionnaire (LEAP-Q), and their processing speed and cognitive flexibility were assessed with the Stroop Color and Word Test (SCWT).

The results showed significant differences in phonemic fluency between the groups during the online assessment in Spanish (F= 5.31, p = 0.026), and in the offline assessments in Spanish (F=6.44, p = 0.015) and English (F=10.80, p = 0.002), with participants in the active condition performing better. While no differences were observed in the performance of the groups in verbal fluency in Basque, neither in the online (F=1.06, p = 0.31), nor in the offline assessment (F=2.62, p = 0.11). Furthermore, no significant differences were observed between groups in semantic verbal fluency tasks in any of the languages, neither during stimulation nor offline. However, there were no differences between conditions in the online (Spanish, F=0.86, p = 0.35; English, F=2.95, p = 0.09; and Basque, F=0.01 p = 0.94) and offline (Spanish, F=2.53, p = 0.11; English, F=0.74, p = 0.39; and Basque, F=1.39, p = 0.24) semantic tasks. In creativity, significant differences were observed between groups on the RAT (F=9.58, p = 0.003), while no differences were observed in the performance of any of the three dimensions of the UU (Originality, F=0.44, p = 0.51; Flexibility, F=0.42, p = 0.51; Fluency, F=0.69, p = 0.41). In the SCWT, statistically significant differences were only observed in the colour-word part (F=7.60, p = 0.008) during the online assessment, showing a better performance of the participants under the tRNS condition compare to the sham condition.

The results obtained in this study suggest that the excitatory effects of tRNS over the L-DLPFC L-IFG could contribute to the improvement of phonemic verbal fluency and verbal convergent thinking, in healthy individuals.

Repetitive transcranial magnetic stimulation (TMS) is an evidenced based treatment for adults with treatment resistant depression (TRD). The standard clinical protocol for TMS is to stimulate the left dorsolateral prefrontal cortex (DLPFC). Although the DLPFC is a defining region in the cognitive control network of the brain and implicated in executive functions such as attention and working memory, we lack knowledge about whether TMS improves cognitive function independent of depression symptoms. This exploratory analysis sought to address this gap in knowledge by assessing changes in attention before and after completion of a standard treatment with TMS in Veterans with TRD.

Participants consisted of 7 Veterans (14.3% female; age M = 46.14, SD = 7.15; years education M = 16.86, SD = 3.02) who completed a full 30-session course of TMS treatment and had significant depressive symptoms at baseline (Patient Health Questionnaire-9; PHQ-9 score >5). Participants were given neurocognitive assessments measuring aspects of attention [Wechsler Adult Intelligence Scale 4th Edition (WAIS-IV) subtests: Digits Forward, Digits Backward, and Number Sequencing) at baseline and again after completion of TMS treatment. The relationship between pre and post scores were examined using paired-samples t-test for continuous variables and a linear regression to covary for depression and posttraumatic stress disorder (PTSD), which is often comorbid with depression in Veteran populations.

There was a significant improvement in Digit Span Forward (p=.01, d=-.53), but not Digit Span Backward (p=.06) and Number Sequencing (p=.54) post-TMS treatment. Depression severity was not a significant predictor of performance on Digit Span Forward (f(1,5)=.29, p=.61) after TMS treatment. PTSD severity was also not a significant predictor of performance on Digit Span Forward (f(1,5)=1.31, p=.32).

Findings suggested that a standard course of TMS improves less demanding measures of working memory after a full course of TMS, but possibly not the more demanding aspects of working memory. This improvement in cognitive function was independent of improvements in depression and PTSD symptoms. Further investigation in a larger sample and with direct neuroimaging measures of cognitive function is warranted.

Subthreshold depressive symptoms are both prevalent and associated with negative outcomes in older adults, including conversion to major depressive disorder and other medical conditions. Antidepressants are not recommended as first-line or sole intervention for subthreshold depression; thus, finding other efficacious interventions is important. In depressed adults, transcranial direct current stimulation (tDCS) applied to the frontal lobe has antidepressant properties and pairing tDCS with cognitive training results in additional benefit due to enhancement of frontal cortical activity. However, these studies have primarily targeted depressed adults under age 65 years and less is known about whether this intervention combination is beneficial or affects subthreshold depressive symptoms in older adults.

We are reporting secondary data analyses from Nissim et al. (2019), who recruited 30 non-demented healthy older adults and randomized them to receive active or sham tDCS in combination with cognitive training for 2 weeks. Active tDCS was delivered bifrontally over F3 (cathode) and F4 (anode) for 20-min at 2 mA intensity through two 5x7 cm2 saline saturated sponge electrodes using the Soterix Medical 1x1 tDCS clinical trials device. Sham tDCS had identical set-up with 2 mA stimulation for 30-sec with 30-sec ramp up and down. Cognitive training was administered for 40-min daily using attention/processing speed and working memory modules from BrainHQ. The first 20-min of cognitive training was paired with active or sham tDCS. To allow room for symptom improvement, we only included participants with Beck Depression Inventory, 2nd edition (BDI-II) scores of 5 or greater ("minimal" depression severity). We identified 15 participants who met this cut-off (70.93 ± 5.41 years old, 10 females, 16.4 years ± 2.32 years education, MoCA = 27.27 ± 2.34; 7 active, 8 sham).

tDCS conditions did not significantly differ in age, sex, years of education, MoCA scores, number of completed intervention days, or baseline BDI-II (active: 7.71 ± 2.93, sham: 11.38 ± 6.44). There were no differences in sensation ratings between groups or in confidence ratings for condition received (suggesting successful blinding). Results indicated the combination of active (and not sham) tDCS with cognitive training was associated with reduced depressive symptoms (2.7 vs. 1.4 points, active vs. sham). Including covariates (age, sex, education, MoCA scores, and number of completed intervention days) in the model further strengthened this discrepancy (3.7 vs. 0.51 points, active vs. sham).

While preliminary, these results suggest this intervention combination may be a potential method for improving subthreshold depressive symptoms in older adults via targeting prefrontal neural circuitry and promoting neuroplasticity of the underlying neural network. While baseline BDI-II scores did not significantly differ, the active tDCS group had a lower score than sham, but saw greater improvement in BDI-II scores post-intervention despite having less room for change. Adequate treatment of subthreshold depressive symptoms may prevent or reduce negative outcomes associated with depressive symptoms in at-risk older adults. Larger randomized clinical trials are needed to better understand tDCS plus cognitive training antidepressant effects in this age group.

This study builds on the work by Rehman et al (2022) who argued that transcranial magnetic stimulation (TMS) treatment not only helps treat depression but also decreases sleep problems such as difficulty falling asleep,staying asleep, and waking too early. The present study further explores differences in sleep onset latency, meaning the time it takes to fall asleep, and duration of sleep per night in the pre and post treatment phases of rTMS. The information regarding major attributes of sleep is critical because recent research shows that about 90% of patients with major depressive disorder (MDD) also struggle with sleep disorders (Li et al., 2022), and sleeping for less than seven hours may eventually lead to sleep deprivation (Hirshkowitz et al., 2015), with increased risk of physical and mental health problems (Sheehan et al, 2019). Sleep onset latency estimates vary from individual to individual but typical sleep latency is considered between 10 to 20 minutes (Jung et al, 2013). As it has been shown that overall sleep problems improve with rTMS, we hypothesized that self-reported sleep onset latency will decrease, and sleep duration will increase.

All participants met inclusion criteria for MDD diagnosis and completed a full course of TMS treatment (N=470; Mean age=53.45, SD=13.73). The sample was mostly male (81%) and ethnically diverse: 77.7% non-Hispanic White, 13.3% Black Americans, 1.9% Asian, 0.2 % Asian Indian, and 1.9% other ethnicities. Sleep problems were assessed using the following questions at the pre and post treatment stages: the number of minutes it takes to fall asleep and duration of sleep each night.

A Wilcoxon matched-pairs signed-rank test was conducted to determine whether there was a difference in sleep onset latency and hours of sleep per night between pre and post intervention. The results indicated a significant difference in time to fall asleep between pre and post treatment (pre-treatment M = 1.19, SD = 0.99, post-treatment M = 0.93, SD = 0.91; z = -5.01, p < .001. In addition, there was a significant increase in the minutes of sleep per night in pre (M = 6.11, SD = 2.07) compared to the post treatment (M = 6.32, SD = 1.77), z = -2.56, p = .010.

Reduced sleep is known to negatively impact mood, cognitive ability, work performance, and immune function (Besedovsky et al., 2012; Killgore, 2010; Massar et al, 2019; Vandekerckhove & Wang, 2018). Similarly, longer sleep onset latency can cause an individual to enter the first sleep stage later than expected and complete fewer sleep cycles. The results of the present study show the effectiveness of rTMS in decreasing sleep onset latency and increasing the duration of sleep. Given the comorbidity and bidirectionality between sleep disturbances and mood disorders (Fang et al., 2019; Palagini et al., 2019), further researching treatments such as rTMS to improve sleep as a means to also improve mood is crucial. We propose acquiring knowledge about sleep attributes as an essential part of clinicians’ work early on in the rTMS treatment in order to monitor an individual’s global functioning level in light of improved sleep.

Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation therapy most widely used in depression, has shown evidence of secondary benefits for cognition in both neurologic and neuropsychiatric conditions. The recent development of more efficient stimulation protocols, such as accelerated high-dose intermittent theta burst (iTBS)-rTMS, has substantially reduced treatment burden by shortening the treatment course by >50%. This study aimed to establish the safety, feasibility, acceptability, and preliminary efficacy of iTBS-rTMS as a tool for bolstering cognition in individuals with amnestic mild cognitive impairment (aMCI).

Twenty-four patients with aMCI were enrolled in an open-label phase I trial of iTBS-rTMS; 2 withdrew prior to initiating treatment due to personal circumstances. All participants had received a diagnosis of MCI due to possible AD from a healthcare provider (i.e., neurologist or neuropsychologist) and met actuarial neuropsychological criteria for aMCI. This sample of older adults (range: 61.5-85.2 years, M = 74.1, SD = 5.71) was predominantly White/non-Hispanic (n = 23; Black/non-Hispanic: n = 1), roughly half female (n = 13), with a college education (range: 12-20 years, M = 15.9, SD = 2.5). Participants received 24 sessions of iTBS-rTMS to the left dorsolateral prefrontal cortex over 3 days (8 sessions each, lasting roughly 2 hours per day). Participants rated their perceptions and experience of common side effects during and after each treatment session as well as retrospectively at post-treatment and 4-week follow-up. They completed structural and functional brain MRI, neuropsychiatric evaluations, and neuropsychological assessments before and after treatment and were administered a subset of these measures at 4-week follow-up. MoCA scores were used to monitor for adverse neurocognitive effects, and the fluid cognition composite score from the NIH Toolbox Cognition Battery was used to test preliminary efficacy.

We achieved a high retention rate (95%), with 21 of the 22 participants completing all study procedures. There were no clinically significant adverse neuroradiological, neuropsychiatric, or neurocognitive effects of treatment. Participant reports indicated high tolerability and acceptability, with a modal rating of 0 (on a scale from 0=not at all to 10=extremely) for six common side effects (i.e., headache, pain, scalp irritation, facial twitching, fatigue, fear/anxiety), assessed both during and after each treatment session. They reported very low desire to quit despite some participants rating the treatment as moderately tiring. We observed significant, large effect-size (d = 0.98) improvements in fluid cognition from pre- to post-treatment.

Our findings support the safety, feasibility, and acceptability of iTBS-rTMS treatment in patients with aMCI. Further, although not explicitly dosed for efficacy, we provide preliminary evidence of improved fluid cognition as a function of treatment, highlighting the potential of this treatment for improving trans-domain cognitive impairment. These promising results can directly inform future trials aimed at optimizing treatment parameters, broadening the indication to other MCI subtypes, and testing the augmentation of established cognitive rehabilitation interventions when combined with rTMS.

Poor mood and quality of life is common among patients with medically intractable seizures. Many of these patients are not candidates for seizure focus resection and continue to receive standard medical care. Responsive neurostimulation (RNS) has been an effective approach to reduce seizure frequency for nonsurgical candidates. Previous research using RNS clinical trial participants has demonstrated improved mood and quality of life when patients received RNS-implantation earlier in their medically resistant epilepsy work-up (Loring et al., 2021). We aimed to describe the level of depression and quality of life in adults with medical resistant epilepsy, treated with RNS, presenting to an outpatient clinic.

This pilot study was conducted among 11 adult epilepsy patients treated with RNS at the epilepsy specialty clinic at Baylor College of Medicine. Ages of participants ranged from 18-56 (M=32.01, SD=12.37) with a mean education of 12.43 (SD=0.85). The majority of the participants identified as White (White=72.2%; Hispanic/Latino/a=14.3%, Other=7.1%). We also present pre- and post-RNS preliminary results of a subset of 4 patients for whom pre and post implantation data was available. Depression symptoms were assessed through the Beck Depression Inventory, 2nd Edition (BDI-II) and quality of life was determined using the Quality of Life in Epilepsy (QoLiE-31).

Patients reported minimal symptoms of depression (M=5.45, SD=4.03) and good overall quality of life (M=71.18, SD=14.83) after RNS. Participants’ scores on their overall quality of life ranged from 50 to 95 (100=better quality of life). The QoLiE-31 showed high scores on emotional wellbeing (M=69.45, SD=14.56) and cognitive functioning (M=65.36, SD=16.66) domains. Post-hoc analysis revealed a significant difference in the cognitive functioning domain of QoLiE-31 before (M=44.75, SD=12.58) and after (M=51.0, SD=11.58) RNS implantation(t(3)=-3.78, p=0.016. Additionally, overall QoLiE score approached statistical significance when comparing pre-RNS (M=44.75 SD=9.29) to post-RNS (M=49.75 SD=11.62; t(3)=-2.01, p = 0.069). No significant differences were evident on seizure worry, energy/fatigue, medication effects, and social functioning domains of QoLiE-31 before and after RNS treatment.

These pilot study results suggest low levels of depression with this population post-RNS implantation. Additionally, there is preliminary evidence to suggest improved patient-rated cognitive functioning and overall quality of life. While this is a small study population, the results have important implications for patients with intractable epilepsy, even with those form who surgical resection may not be possible. Future studies with large enough samples to examine moderating and mediating factors to mood and quality of life changes post-RNS will be important.

Neuroimaging is commonly used in medicine to identify neuropathology and is widely considered to be a reliable and valid diagnostic modality. Personality testing is commonly used to identify psychopathology but is generally perceived to have less clinical efficacy than neuroimaging. The purpose of the current study was to compare the clinical efficacy of personality tests to neuroimaging using meta-analysis.

Multiple databases were searched for original research utilizing either personality tests or neuroimaging. The search interval covered articles published within the last 10 years. Studies were selected based on the criteria of having a clinical group and a healthy control sample with a reported diagnostic outcome. For this meta-analysis, neuroimaging studies focusing on diagnostic utility for Alzheimer’s dementia were included. Personality testing studies were included if they broadly reported a clinical outcome, due to fewer studies in this area. Studies were coded using a complex multi-comparison, outcome, and subgroup schema, and were analyzed under random-effects modeling.

Out of the 240 studies identified for the personality domain, 13 were selected for the meta-analysis. Out of 6522 studies identified for the neuroimaging domain, 21 studies were selected for the meta-analysis. Results indicated a significant difference between the neuroimaging and personality testing effect sizes. Specifically, neuroimaging [Hedge’s g = -1.623, 95% CI = -1.973 to -1.273, p<.001] yielded a greater effect size in comparison to the personality tests effect size [Hedge’s g = -0.658, 95% CI = -0.751 to -0.565, p<.001]. The effect size for clinical utility of neuroimaging was close to double that of the effect for personality tests diagnostic utility.

Findings from this meta-analysis showed a significant difference in the effect sizes obtained from neuroimaging studies compared to the studies of personality tests. While both neuroimaging and personality testing demonstrated meaningful clinical utility, neuroimaging studied had a larger effect size.

People living with younger onset neurocognitive disorders (YOND) experience significant delays in receiving an accurate diagnosis. Although neuropsychological assessment can help assist in a timely diagnosis of YOND, several barriers limit the accessibility of these services. Utilising teleneuropsychology may assist with the service access gap. This study aimed to investigate whether similar results were found on neuropsychological tests administered using videoconference and in person in a sample of people living with YOND.

Participants with a diagnosis of YOND were recruited from the Royal Melbourne Hospital (RMH) Neuropsychiatry inpatient ward and outpatient clinic, and through community advertising. A randomised counterbalanced cross-over design was used where participants completed 14 tests, across two administration sessions: one in person and one using videoconference. There was a two-week interim between the administration sessions. The videoconference sessions were set up across two laptops using the Healthdirect Video Call platform and Q-Global. Repeated measures t-tests, intraclass correlation coefficients (ICC) and Bland-Altman plots were calculated to compare results across the test administration sessions.

Thirty participants (Mage = 60.23, SD = 7.05) completed both sessions. Huntington's disease was the most common YOND diagnosis (n = 8), followed by Alzheimer's disease (n = 6), mild cognitive impairment (n = 6) and frontotemporal dementia (n = 4). Preliminary results from the current study indicate no statistically significant differences, and small effect sizes, between the in-person or videoconference sessions. ICC estimates range from .69 to .97 across neuropsychological tests.

This study provides preliminary evidence that performances are comparable between in-person and videoconferencemediated assessments for most neuropsychological tasks evaluated in people living with YOND. Should further research confirm these preliminary results, findings will support the provision of teleneuropsychology to address the current service gaps experienced by people with YOND.

Early detection of mild cognitive impairment (MCI) and dementia is crucial for initiation of treatment and access to appropriate care. While comprehensive neuropsychological assessment is often an intrinsic part of the diagnostic process, access to services may be limited and cannot be utilized effectively on a large scale. For these reasons, cognitive screening instruments are used as brief and cost-effective methods to identify individuals who require further evaluation. Novel technologies and automated software systems to screen for cognitive changes in older individuals are evolving as new avenues for early detection. The present study presents preliminary data on a new technology that uses automated linguistic analysis software to screen for MCI and dementia.

Data were collected from 148 Spanish-speaking individuals recruited in Spain (MAge=74.4, MEducation=12.93, 56.7% females) of whom 78 were diagnosed as cognitively normal [CN; Mmmse = 28.51 (1.39)], 49 as MCI [MMMSE = 25.65 (2.94)], and 21 as all-cause dementia [MMMSE = 22.52 (2.06)]. Participants were recorded performing various verbal tasks [Animal fluency, phonemic (F) fluency, Cookie Theft Description, and CERAD list learning task]. Recordings were processed via text-transcription and sound signal processing techniques to capture neuropsychological variables and audio characteristics. Features from each task were used in the development of an algorithm (for that task) to compute a score between 0 or 1 (healthy to more impairment), and a fifth algorithm was constructed using audio characteristics from all tasks. These five classifiers were combined algorithmically to provide the final algorithm. Receiver Operating Characteristic (ROC) analysis was conducted to determine sensitivity and specificity of predicted algorithm performance [CN vs. impaired (MCI or dementia)] against clinical diagnoses, and additional general linear modeling was used to test whether age, sex, education, and multilingualism significantly predicted logistically transformed weighted algorithm scores.

Scores were transformed to logit scores, with significant differences in mean logit scores between all groups (p <.001). Logit-inverse transformation of mean logit scores (possible range 0 -1) resulted in values of 0.06 for CN, 0.90 for MCI, and 0.99 for all-cause dementia groups. ROC curve analyses revealed the algorithm obtained a total area under the curve of 0.92, with an overall accuracy of 86.8%, a sensitivity of 0.92, and specificity of 0.82. Age was identified as a significant predictor (beta = 0.22; p <0.01) of algorithm output, whereas years of education (beta = -0.04; p = 0.64), sex (beta = 0.38; p = 0.02, did not survive correction for type-1 error), and multilingualism (beta = -0.24; p = 0.22) were non-significant.

These findings provide initial support for the utility of an automated speech analysis algorithm to detect cognitive impairment quickly and efficiently in a Spanish-speaking population. Although sociodemographic variables were not included in the algorithm, age significantly predicted algorithm output, and should be further explored to determine if age-adjusted formulas would improve algorithm accuracy for younger versus older individuals. Additional research is needed to validate this novel methodology in other languages, as this may represent a promising cross-cultural screening method for MCI and dementia detection.

Ecological momentary assessment (EMA) allows for tracking participant responses across multiple timepoints within the context of typical daily experiences. This study used EMA delivered via smartwatches to investigate dynamic associations between older adults’ fluctuations in cognitive performance as measured by an n-back test and self-reports of current internal (i.e., mental sharpness, fatigue, stress) and external (i.e., environmental distractions, time of day) contextual states over seven days. We hypothesized that 1) cognitive test fluctuations throughout the week would be meaningful beyond average cognitive test scores and 2) cognitive test scores would fluctuate in response to internal and external contexts.

Participants were 28 community-dwelling older adults recruited for a larger clinical trial assessing the influence of lifestyle factors and compensatory strategy use on cognitive health. During week one of the trial, participants received a smartwatch which sent prompts four times a day for seven consecutive days. The prompts included a 45-second one-back shape test, along with Likert-style questions about their current experience. Questions assessing participants’ internal contexts asked about participants’ experience “right now” of mental sharpness, physical fatigue, and stress. External context was assessed via the EMA prompt, “Right now my environment is distracting,” and time of day of the response.

Data was screened such that all data points outside the 7-day prompt window were removed, one participant who did not respond to any prompts was removed, and participants who responded to less than 60% of the shape test prompts were removed (n = 10). The sample used for this preliminary analysis included 17 participants (Age, M = 71.94 years; Education, M = 14 years; 88% Female; 88% White) with an average compliance of 75% (Range = 17 - 26 shape test responses) and an average shape test accuracy of > 92%. Hypothesis 1 was supported by the large fluctuations of the average cognitive test scores across timepoints (M = 24.35, Min = 16, Max = 27, SD = 2.54) and by repeated-measures ANOVA of average cognitive test scores by day (F(1,7) = 5.24, p < 0.01). Hypothesis 2: Cross-correlation lags 0 to 4 were assessed. For internal contexts, cross-correlation showed a medium correlation between mental sharpness and cognition for lags 0 (r = 0.46) and 1 (r = 0.4); a small to medium correlation between physical fatigue and cognition for lags 0 (r = -0.51) and 1 (r = -0.31); and no correlation between stress and cognition (r < 0.2). For external contexts, cross-correlation revealed no correlation between environmental distraction and cognition (r < 0.3), and repeated measures ANOVA revealed no effect of time of day on cognition scores (p > 0.05).

Older adults’ cognitive performance on an n-back shape test varied over time with internal contextual states. Cognitive performance was positively associated with feelings of mental sharpness and negatively associated with physical fatigue. Current external environmental distractions and time of day were less influential on cognitive performance. As more data is collected, influences of individual fluctuations in cognitive performance will be investigated.

In the aftermath and continuance of the COVID-19 pandemic, the field of neuropsychology has experienced a burgeoning literature base on remote telehealth practices. These practices include both videoconference and telephone modalities. Several studies to date have proposed evidence suggesting that inperson and remote telehealth assessments demonstrate comparable results. One of the major limitations to telehealth practices is the scarcity of measures of processing speed. A widely used measure is the Oral Trail Making Test, which has two trials (A & B). Oral Trails B is often conceptualized as a measure of set-shifting and cognitive flexibility. And validity studies support Oral Trails B having strong test-retest reliability and correlation to its written counterpart. In contrast, there is contention as to whether Oral Trails A can be conceptualized as a measure of basic attention and speed versus simple numerical automaticity. Importantly, to our knowledge, the test-retest reliability of Oral Trails A administered specifically via telephone has never been reported in a healthy sample. The following study presents test-retest reliability for the Oral Trails A and B (in a healthy control group) administered as part of a larger study investigating the effects of deep diaphragmatic breathing on cognitive functioning.

Eighty healthy young adults with elevated stress levels were recruited from a major metropolitan city at a major university. The subjects had to be between the ages of 18 to 29 and self-reported Perceived Stress Scale score >13. The subjects could not practice any form of meditation, yoga, or breathing exercise regularly. Additionally, they could not have any severe medical or psychiatric disorder, be actively suicidal; have a substance use disorder within the past year, or 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 an intervention group. Cognitive assessments were administered over the phone to both groups (pre and post-treatment) and self-report measures were completed online due to quarantine restrictions.

Among participants in the waitlist control group, the mean difference (MD) between time points on OTMT-A (MD= -0.17, SD= 1.69) was small and not significant (p>0.05). The mean difference for OTMT-B (MD= -13.06, SD=26.99) was large and significant (p=0.01). Bivariate Pearson correlations were computed revealing a significant moderate strength relationship between OTMT-A performance across time points (r=0.6, p<0.001). In contrast, performance on OTMT-B across time points revealed a nonsignificant, weak relationship (r=0.2, p=1.94).

These results do not support literature demonstrating strong test-retest reliability for OTMT-B. Furthermore, this is the first study establishing test-retest reliability for the OTMT-A as administered via a novel telephonic modality. Given the novel and non-standardized method of administration, the data should be interpreted with caution. Nonetheless, given the weak relationship in OTMT-B performance and the only moderate relationship of OTMT-A performance across time points, the results suggest that the OTMT may not be highly reliable as administered via a telephonic modality.

Gaining access to specialty care services, including neuropsychology, can be challenging, especially for older adults and individuals who live in rural areas. In addition to these barriers, the ongoing COVID-19 pandemic further disrupted patient access to essential healthcare services. Telehealth, which underwent rapid expansion in response to service disruptions due to COVID-19, offers opportunities to prevent or reduce disruptions in patient care, including neuropsychological assessment. Here we describe the development and implementation of a teleneuropsychology (telenp) clinic within a major VA medical center and discuss salient clinical observations and patient feedback gathered during telenp evaluations.

A hybrid telenp clinic was developed at the Tennessee Valley VA Healthcare system to serve patients referred for neuropsychological evaluations whose access to services was impacted by the COVID-19 pandemic. Patients presented to the VA and were connected to neuropsychology providers seated in separate rooms of the hospital through synchronous video. Test batteries were created to closely approximate in-person evaluations while allowing for minor procedural modifications so tests could be administered virtually. All tests were administered by on-site trained staff. After the evaluation, anecdotal information about patient experiences and satisfaction and salient clinical observations were gathered to elucidate potential benefits and shortcomings of hybrid telenp model.

65 telenp neuropsychological evaluations were conducted between December 2020 and April 2021. Overall, patients consistently and strikingly reported a high degree of openness and acceptance towards telenp services, even despite initial technological apprehension. Importantly, patients ubiquitously reported believed they were able to adequately engage in telenp assessments, and no perceptible barriers were identified. Clinically, examiners consistently expressed surprise at the relative ease with which the evaluations could be adapted to a telenp program. Additionally, clinicians generally felt confident in the validity of the results and that the data gathered were sufficient to answer the referral question and make salient treatment recommendations and referrals. Importantly, there were some notable limitations to telenp assessment and not all patients were testable via telehealth.

Qualitatively, hybrid telenp evaluations are feasible and acceptable, and appear to be a valid alternative to face to face neuropsychological assessments. Future research should focus on establishing the reliability and validity of telenp testing compared to face-to-face testing, collective quantitative data regarding patient and clinician experiences of telenp and identify methods for implementing telenp in clinics in rural catchment areas to increase access to neuropsychological services.

During the COVID-19 pandemic, many neuropsychological services shifted from an in-person assessment to a tele-neuropsychological assessment format. Prior research studies support the use of telemedicine assessments but have also noted some limitations (i.e., tasks involving direct manipulation of physical stimuli and visuospatial tasks). We sought to examine the relationship between the same neuropsychological tasks administered via a telemedicine versus inperson format in a treatment seeking clinical sample of Veterans with history of TBI.

Veterans with history of mild to severe TBI (predominantly mild TBI) referred to the TBI Cognitive Rehabilitation Clinic within the San Diego Veterans Affairs Medical Center completed a comprehensive neuropsychological assessment to help inform diagnosis and treatment recommendations. 515 Veterans completed traditional in-person assessment (pre-pandemic) and 45 Veterans completed neuropsychological assessment via a telemedicine platform during the pandemic (Veteran was in their home and examiner was in their home or facility office). The total sample consisted of 93% male and 7% female, average age of 33, 13 years of education, 63% White, 13% Other/Non-reported, 12% Black, 6% Asian, 6% Pacific Islander, 2% Alaskan Native, and 1% Multi-Racial, 73% Non-Hispanic, and 27% Hispanic. For the purposes of this study, we used age-corrected subtest scores from the Delis-Kaplan Executive Function System (D-KEFS): Color Word Interference (CWI) and Verbal Fluency (VF), WASI-II Matrix Reasoning, California Verbal Learning Test (CVLT-II), Wechsler Memory Scale (WMS-IV): Logical Memory, and WRAT-IV Reading. We also examined symptoms of anxiety (BAI), sleep quality (PSQI), neurological symptoms (NSI), and symptoms of PTSD (PCL-5). ANOVAs were used to analyze the relationship between tele-neuropsychological versus in-person administration. Additionally, we controlled for performance validity failure.

Tele-neuropsychological task results were comparable to in-person assessment across all tasks, except for D-KEFS CWI color naming subtest where individuals completing the task via telemedicine performed approximately 2 scaled scores below the in-person assessment group, F (1, 278)=6.44, p=.012. Individuals who completed the tele-neuropsychological assessment during the COVID-pandemic did not differ on scores of self-reported symptoms of PTSD or neuropsychological symptoms when compared to in-person assessment of pre-pandemic individuals within our clinic. However, the telemedicine group reported better sleep quality (F (1, 377)=11.94, p=.001) but a trend towards more symptoms of anxiety (F (1, 552)=2.90, p=.089.

These results suggest that many of the verbal memory, language, premorbid functioning, and verbal/visual tasks of executive function can be adequately administered via telemedicine. Substantial variability may exist on measures of processing speed administered via telemedicine, however. Additionally, changes in lifestyle and daily demands during the COVID-19 pandemic may have created unique circumstances that benefited sleep quality for some individuals but also increased symptoms of anxiety/uncertainty.

Unsupervised remote digital cognitive assessment makes frequent testing feasible and allows for measurement of learning across days on participants’ own devices. More rapid detection of diminished learning may provide a potentially valuable metric that is sensitive to cognitive change over short intervals. In this study we examine feasibility and predictive validity of a novel digital assessment that measures learning of the same material over 7 days in older adults.

The Boston Remote Assessment for Neurocognitive Health (BRANCH) (Papp et al., 2021) is a web-based assessment administered over 7 consecutive days repeating the same stimuli each day to capture multi-day-learning slopes. The assessment includes Face-Name (verbal-visual associative memory), Groceries-Prices (numeric-visual associative memory), and Digits-Signs (speeded processing of numeric-visual associations). Our sample consisted of200 cognitively unimpaired older adults enrolled in ongoing observational studies (mean age=74.5, 63% female, 87% Caucasian, mean education=16.6) who completed the tasks daily, at home, on their own digital devices. Participants had previously completed in-clinic paper-and-pencil tests to compute a Preclinical Alzheimer’s Cognitive Composite (PACC-5). Mixed-effects models controlling for age, sex, and education were used to observe the associations between PACC-5 scores and both initial performance and multi-day learning on the three BRANCH measures.

Adherence was high with 96% of participants completing all seven days of consecutive assessment; demographic factors were not associated with differences in adherence. Younger participants had higher Day 1 scores all three measures, and learning slopes on Digit-Sign. Female participants performed better on Face-Name (T=3.35, p<.001) and Groceries-Prices (T=2.00, p=0.04) on Day 1 but no sex differences were seen in learning slopes; there were no sex differences on Digit-Sign. Black participants had lower Day 1 scores on Face-Name (T=-3.34, p=0.003) and Digit Sign (T=3.44, p=0.002), but no racial differences were seen on learning slopes for any measure. Education was not associated with any measure. First day performance on Face-Name (B=0.39, p<.001), but not learning slope B=0.008, p=0.302) was associated with the PACC5. For Groceries-Prices, both Day 1 (B=0.27, p<.001) and learning slope (B=0.02, p=0.03) were associated with PACC-5. The Digit-Sign scores at Day 1 (B=0.31, p<.001) and learning slope (B=0.06, p<.001) were also both associated with PACC-5.

Seven days of remote, brief cognitive assessment was feasible in a sample of cognitively unimpaired older adults. Although various demographic factors were associated with initial performance on the tests, multi-day-learning slopes were largely unrelated to demographics, signaling the possibility of its utility in diverse samples. Both initial performance and learning scores on an associative memory and processing speed test were independently related to baseline cognition indicating that these tests’ initial performance and learning metrics are convergent but unique in their contributions. The findings signal the value of measuring differences in learning across days as a means towards sensitively identifying differences in cognitive function before signs of frank impairment are observed. Next steps will involve identifying the optimal way to model multi-day learning on these subtests to evaluate their potential associations with Alzheimer’s disease biomarkers.

Korsakoff’s syndrome (KS) is a neuropsychiatric disorder, caused by malnutrition. Central to KS are severe amnesia and executive dysfunctions. KS patients often fail to remember future intentions (prospective memory),and rely heavily on external support by caregivers. Recently, specialized smartwatches have been developed to support prospective memory verbally and by displaying pictures of future events. We investigated the benefit of a smartwatch and smartphone compared to no aid in supporting time accuracy and the ability to carry out future intentions in one case study. In three subsequent case studies, we investigated the possible benefits of a smartwatch aid for prospective memory (PM) compared to verbal in-person reminders.

In the first case study, one high-functioning KS patient with a WAIS IQ of 127 points, performed a total of 36 novel prospective memory tasks in three conditions (smartwatch, smartphone and no-aid).

In the second case series, three KS patients with average IQ performed 30 everyday PM tasks in two conditions (smartwatch, in-person).

Two dependent variables were indexed in both studies: PM time accuracy (in minutes), this was calculated as minutes difference from the assigned time, and precision of the PM task (correct or incorrect).

In the first study, time accuracy was improved with a smartwatch compared to a smartphone and no-aid condition. Furthermore, the smartwatch and smartphone conditions were more effective than no aid in assisting memory for task content. In the second study, both the smartwatch and in-person instructions were equally effective in supporting prospective memory tasks.

Since prospective memory is compromised in KS, patients require assistance throughout the day in performing everyday and non-everyday tasks. The results of our case studies suggest that a smartwatch that gives specific verbal and visual reminders can be particularly helpful in supporting prospective memory for KS patients. Giving in-person instructions was equally effective as the use of this smartwatch, highlighting the possibility to support KS patients with less intensive everyday coaching. Together, these results are promising in applying smartwatches clinically to support prospective memory.

The objective of this study was to examine whether novel pandemic-related stressors have any effect on cognitive functioning. This study aimed to examine whether the overall number of pandemic-related stressors, and whether stressor type, are associated with cognitive problems. The coronavirus pandemic, and societal changes to prevent and respond to it, have created novel stressors, including unemployment, social isolation, and health risks. While prior research has focused on the physical and psychological consequences of these stressors, these stressors may also be associated with cognitive impairments. Individuals who have been infected with SARS-CoV-2 and individuals who experience chronic stress are at risk for cognitive impairments, however, research has not yet examined whether pandemic-related stressors not specifically related to infection but to the experience of the pandemic overall, are associated with cognitive deficits. This study evaluated whether pandemic-related psychosocial stressors (financial, health, role/responsibility, and social) were related to cognitive functioning. We hypothesized that individuals with a higher number of pandemic-related stressors will perform worse on cognitive domains of attention, memory, and executive functions, than those with fewer stressors.

An online survey recruited participants (A/=19), of whom 89.5% were female, and the average age was 34 years (SD=15.7), to complete an online neuropsychological battery. Participants first completed questionnaires on the coronavirus pandemic, demographic characteristics, and completed the BDI-II and the BAI. An online neuropsychological battery was administered to participants over Zoom consisting of various neuropsychological tests, including the RAVLT, story memory, digit span, FAS, animal fluency, a go-no/go task, the Stroop, and the NAART-R.

A majority of participants (89.5%) experienced one or more coronavirus pandemic stressors, with only two participants reporting no coronavirus stressors. A majority of participants experienced at least one social stressor (57.9%), role/responsibility stressor (63.2%), and health stressor (52.6%), with financial stressors (47.4%) experienced by just fewer than half of participants. Pearson’s correlations showed significant negative correlations between stressors and performance on several neuropsychological tests. Specifically, social, health, and total stressors were associated with significantly poorer performance on digit span backwards and trials of the RAVLT (i.e., Trials 15, delayed recall, recognition) (ps<.05). Social stressors, health stressors, and total pandemic stressors were significantly associated with poorer performance on measures of working memory, processing speed, verbal learning, and verbal memory.

While small sample size limits the power and generalizability of these findings, this study highlights the need to investigate the cognitive effects of pandemic-related stressors. An expanded coronavirus questionnaire would be beneficial as the current questionnaire may have not captured all stressors of the pandemic, or level of severity, that could potentially contribute to changes in neuropsychological function. Pandemic-related stressors have spread into many areas of everyday life and the consequences that have stemmed from these stressors seem to play a negative role on the general wellbeing of individuals and also show an effect on psychological and neuropsychological functioning. This study illustrates the need for an expanded response to health crises, as the negative results of this pandemic have not been solely affecting physical health.

Driving is a cognitively demanding activity commonly affected by brain injury and illness. Accurate driving assessment is essential for reducing risk, optimizing independence, and informing driving-related interventions. Virtual reality driving simulation (VRDS) enables safe, sensitive, objective, and standardized measurement of driving abilities. VRDS has been validated in relation to self-reports and driver records. However, self-reports are subjective, and driver records include only major events (collisions, violations). Video telematics platforms can measure naturalistic driving in a more objective and sensitive manner. The present study used video telematics to examine relationships between VRDS performance and directly observed naturalistic driving.

20 healthy adult drivers (ages 23-61, mean age=36; 75% women) completed a VRDS assessment that included 1) driving on a straight road, 2) following a truck on a highway, and 3) reacting to a child running into a street to retrieve a ball. Primary VRDS measures were 1) speed and lane management on the straight road; 2) speed and following distance management in the truck-following task; and 3) reaction time, stopping, and distance from the child in the child-ball task. Participants also completed 28 days of naturalistic driving with a video telematics platform in their vehicle. Driving events were detected automatically using accelerometer, GPS, and video data, and driving behaviors were coded by driving risk analysts. The primary naturalistic measure was the number of unsafe driving behaviors per hour driven; specific driving behaviors served as exploratory variables. We examined correlations between VRDS and naturalistic driving variables. Given limited statistical power, we reported correlations that were small-to-medium or greater (r>.2) in primary analyses and medium-to-large or greater (r>.4) in exploratory analyses.

On average, drivers exhibited approximately one unsafe driving behavior per hour (M=0.9, SD=0.9, range=0.1-2.7). Common behaviors were failing to stop, unsafe following distance, speeding, and cell phone use. No collisions occurred. Average lane position in VRDS (specifically, leftward deviation from the center of the lane) was correlated with more real-world unsafe driving behaviors per hour (r=.35, p=.13), as were higher average straight road speed (r=.26, p=.27), greater straight road speed variability (r=.28, p=.24), and failing to stop for the child in the child-ball task (r=.22, p=.36). In exploratory analyses, failing to stop for the child was associated with real-world distracted driving (r=.45, p=.047), greater lane position variability in VRDS was associated with real-world unsafe following distance (r=.57, p=.009), and greater speed variability in VRDS was associated with real-world seat belt non-use/misuse (r=.49, p=.03).

The present findings provide preliminary evidence that VRDS variables are related to directly observed naturalistic driving, supporting the potential utility of VRDS as a sensitive, ecologically valid driving evaluation tool. As the present study used a small sample of healthy drivers, further research will explore this topic in larger samples and in clinical populations, such as acquired brain injury. Future work will also investigate whether incorporating VRDS with conventional driving evaluation tools (e.g., neuropsychological tests, behind-the-wheel assessments) can enhance the ability of clinical driving evaluations to predict real-world risky driving.

Stroke results in various cognitive and motor impairments. The most frequent cognitive problem is spatial and non-spatial attention, typically caused by unilateral brain lesion. Attention is typically assessed with several different paper-and-pencil tests, which have long been criticized for their lack of theoretical basis, their limited ecological validity to deficits experienced in daily life, and their lack of measurement sensitivity (Appelros et al., 2004; Azouvi, 2017). Here, our global aim was to develop an innovative integrative serious game in an immersive environment. The REASmash, combines the evaluation of spatial attention, non-spatial attention, and motor performance. We present the spatial and non-spatial cognitive attention evaluation results.

Eighteen first stroke individuals and 40 age-match healthy controls were assessed on the REASmash. They were instructed to find a target mole presented amongst distractor moles. The stimulus array consisted of a grid of 6 columns and 4 rows of molehills, from which the target and 11, 17 and 23 distractors moles could randomly appear, in two search conditions (single feature condition and saliency condition). Responses were made with the ipsilesional hand for individuals with stroke and with the dominant hand for the healthy controls. Participants were evaluated also with two standardized clinical tests of attention; the hearts cancellation task of the Oxford Cognitive Screen, and the visual scanning subtest of the Test for Attentional Performance.

Validation results showed significant and strong correlations between the REASmash and the two reference tests, with the REASmash showing high sensitivity and specificity (i.e., the correct identification of the post-stroke vs. control individuals). The REASmash also showed significant and strong test/re-test reliability. We additionally evaluated user experience using the UEQ, and the results showed excellent attractiveness and novelty, and good stimulation and efficiency.

In conclusion, the REASmash is a novel immersive virtual environment serious game that is valid, sensitive, and usable. It provides a new diagnosis measure spatial and non-spatial attention impairment.

Mobile, valid, and engaging cognitive assessments are essential for detecting and tracking change in research participants and patients at risk for Alzheimer’s Disease and Related Dementias (ADRDs). The mobile cognitive app performance platform (mCAPP) includes memory and executive functioning tasks to remotely detect cognitive changes associated with aging and preclinical Alzheimer’s disease. This study assesses participants’ comfort and subjective experiences with mCAPP as the potential utility and advantage of mobile app-based assessments for remote monitoring among older adults will depend upon usability and adoptability of such technology.

The mCAPP includes three gamified tasks: (1) a memory task involving learning and matching hidden card pairs (“Concentration”) (2) a stroop-like task (“Brick Drop”), and (3) a digit-symbol coding-like task (“Space Imposters”). Participants included 37 older adults (60% female; age=72±4.4; years of education=17±2.5; 67% White) with normal cognition enrolled in the Penn ADRC cohort. Participants completed one baseline session of mCAPP in-person, followed by two weeks of at-home use with eight scheduled sessions. Information on prior experience with mobile technology and games was collected, and usability of mCAPP was measured at baseline and after 2-weeks of use with the IBM Computer Usability Satisfaction Questionnaire and the mHeath App Usability Questionnaire (MAUQ) respectively. Feedback on perceived difficulty, enjoyment, and likelihood to play mCAPP games again on their own was collected.

Participants completed on average 11±4.9 sessions over 2 weeks, with each session lasting 11.5±2.5 minutes. 59% of participants reported using their mobile device to play games (“mobile game players”). Performance on mCAPP tasks was slower at baseline for non-players, with trend-level differences on higher-load blocks of Space Imposters (p=.057 and .059). No differences in game performance were seen between groups after playing 8 sessions at-home. There were no differences in usability of mCAPP between groups, with average usability 8.2±1.5 (IBM, 0-9 scale) at T1 and 6.2±0.8 (MAUQ, 1-7 scale) after completion of two weeks of at-home use (TLast). Reported enjoyment was moderate to high for both groups at baseline and increased over time. Likelihood to play Concentration and Brick Drop again trended lower among nonplayers at T1 (p=.061 and .054), but not at TLast. Further, change in likelihood to play mCAPP from T1 to TLast was positive among non-players, with change for Concentration significantly higher for non-players than for players (p=.037).

Participants were willing and able to complete at-home cognitive testing and most completed more than the assigned sessions. While participants who do not play games on their own mobile device were slower on some tasks at baseline, these differences dissipated with further play at-home. Usability and enjoyment of mCAPP games were high regardless of mobile game-playing status, and non-players demonstrated increased willingness to play mCAPP games again at the end of participation compared to baseline. This pilot study shows preliminary feasibility and adoptability of mobile app-based assessment regardless of prior experience with mobile games.

Frequent and remote cognitive assessment may improve sensitivity to subtle cognitive decline associated with preclinical Alzheimer’s disease (AD). The objective of this study was to evaluate the feasibility and acceptability of repeated remote memory assessment in late middle-aged and older adults.

We recruited participants from a longitudinal aging cohort to complete three medial temporal lobe-based memory paradigms (Object-In-Room Recall [ORR], Mnemonic Discrimination for Objects and Scenes [MDT-OS], Complex Scene Recognition [CSR]) using the neotiv application at repeated intervals over one year. We conducted initial telephone calls to perform screening, consent, and download instructions. Participants were assigned 24 remote sessions on a smartphone or tablet and were alerted via push notification when an assignment was ready to complete. Participants were randomly assigned to: (1) complete memory tests every other week or (2) complete memory tests for multiple days within one week every other month. Each remote session lasts approximately 10 minutes and includes one memory paradigm and brief usability/acceptability questionnaires followed by a delayed retrieval session 90 minutes later. Feasibility metrics examined included participation, retention, compliance, and usability/acceptability.

Of 150 participants recruited, 113 consented and were enrolled into the study (participation rate = 75%). Current retention rate is 75%, with 85/113 currently active (n=73) or completed (n=12). Of the 85 active or completed participants, the mean age is 68.7 (range = 4882), 64% are women, 70% used a smartphone (30% tablet), 84 are cognitively unimpaired and 1 has mild cognitive impairment. The primary threat to retention was participants consenting into the study but never registering in the app or completing their first scheduled assignment. After enrollment, 130 telephone calls were made by study staff to facilitate registration into the app or to remind participants to complete tasks. 74-80% of participants completed delayed retrieval tasks within 30 minutes of push notification, but average retrieval time was 125137 minutes post-learning trials. Regarding acceptability/usability, 94% agreed the application was easy to use, 56% enjoyed completing the mobile memory tests (36% felt neutral), 40% prefer remote mobile memory tests to standard in-person paper and pencil tests, and 50% understood the test instructions. 87% felt the frequency of tests assigned was “just right” (13% “too often”) and 90% felt the test length was “just right” (7% too short, 3% too long). Participants who completed all 24 sessions to date (n=12) all endorsed being “satisfied” or “very satisfied” with the platform and visit schedule, as well as recommended continued use of this type of cognitive testing.

Remote memory assessment using smartphones and tablets is feasible and acceptable for cognitively unimpaired late middle-aged and older adults. Follow-up by study staff was needed to ensure adequate retention. Comprehension of instructions and compliance with completing delayed retrieval tasks within the expected timeframe was lower than expected. These feedback will be incorporated into an updated version of the app to improve compliance and retention. Longitudinal data collection is ongoing and results will be updated with a larger sample. Results will be compared across frequency schedule groups.