Social impairment is observed across psychotic-spectrum disorders (PSDs). Prior work demonstrates that neurocognition may account for social impairment in chronic PSDs. Concerning specific neurocognitive facets, there is support for a relationship between language/verbal performance and social outcomes in chronic PSDs. However, few studies have investigated this relationship in at-risk and early intervention samples, despite the clinical importance in these populations. The present study aimed to identify whether language is related to social functioning across the psychosis-spectrum, utilizing a sample comprised of individuals low in schizotypal personality traits, at-risk for psychosis (high in schizotypal traits), and those who recently experienced a first episode of psychosis (FEP). As an exploratory analysis and guided by findings from general studies of neurocognition and functional outcomes in the chronic PSD literature, we also investigated potential mediating mechanisms (i.e, negative traits; social cognition). We hypothesized that language is related to social functioning, and language is indirectly related to social functioning through negative traits and social cognition.

We recruited 42 participants low in schizotypal traits and 44 high in schizotypal traits from undergraduate courses, and 15 FEP individuals were recruited from an early psychosis intervention center. On average, participants were 21.55 (4.39) years old and completed 14 (1.57) years of education. A majority were female (62%) and White (82%). Participants completed the Schizotypal Personality Questionnaire – Brief Revised Updated, which was used to categorize the schizotypy groups and sum negative traits; and measures of language/verbal ability (Similarities, Proverbs Test, semantic fluency, Digit Span), social cognition (Hinting Task, Affect Naming), and examiner-rated (Global functioning [GF]: Social) and performance-based social functioning (Social Skills Performance Assessment; SSPA). We also measured verbal processing speed and COVID-19 distress as covariates. Standardized scores were used for neurocognitive variables, and we used raw scores for most other variables. We utilized hierarchical linear regression models to examine whether specific language/verbal skills accounted for unique variance in examiner-rated and performance-based social functioning. For our exploratory analyses, we created averaged z-scores for language, social cognition, and social functioning and then, employed PROCESS Macro Model 4 to examine whether negative traits or social cognition were significant mediators in two separate mediation models.

Controlling for verbal processing speed and COVID-19 distress, language accounted for a significant portion of variance in SSPA performance, p = .008, ΔR2 = .12. Specifically, better Proverbs Test performance was uniquely associated with better SSPA performance, β = .33, p = .002. Controlling for study covariates, language was unrelated to GF: Social ratings, p = .31, ΔR2 = .038. In exploratory analyses, language was significantly indirectly related to social functioning through social cognition, β = .15, SE = .04, 95% CI [.04, .27], but not through negative traits, β = .08, SE = .06, 95% CI [-.001, .17].

Our findings suggest that executively-mediated language tasks (e.g., Proverbs Test) and social cognition may be beneficial treatment targets for social impairment. Limitations include generalizability of the present findings, small FEP sample, and cross-sectional design. Future work should replicate these findings in longitudinal models.

We developed the Shell Game Task (SGT) as a novel Performance Validity Test (PVT). While most PVTs use a forced-choice paradigm with “memory” as the primary domain being assessed, the SGT is a face-valid measure of attention and working memory. We explored the accuracy of the SGT to detect noncredible performance using a simulatordesign study.

Ninety-four university students were randomly assigned to either best effort (CON) (n=49) or simulating traumatic brain injury (TBI) (SIM) (n=45) conditions. Participants completed a full battery of neuropsychological tests to simulate an actual evaluation, including the Test of Memory Malingering (TOMM) and the SGT. The SGT involves three cups and a red ball shown on the screen. Participants watch as the ball is placed under one of the three cups. Cups are then shuffled. Participants are asked to track the cup that contains the ball and correctly identify its location. We created two difficulty levels (easy vs hard, 20 trials each) by changing the number of times the cups were shuffled. Participants were given feedback (correct vs incorrect) after each trial. At the conclusion of the study, participants were asked about adherence to study directions they were given.

Participants with missing data (CON=1; SIM=2) or who reported non-adherence to study directions (CON=2; SIM=1) were removed from analyses. Twenty-five percent in SIM and 0% in CON failed TOMM

Trial 2 (<45) suggesting adequate manipulation of groups. Groups were not different in age, gender, ethnicity, or education (all p’s>.05). There were 9 participants in each group with concussion/TBI history. TBI history was not significantly related to performance on the SGT in either group, although participants with TBI history tended to do better. Average performances on TOMM Trial 1 (36.62 vs 47.91, p<.001) and TOMM Trial 2 (37.50 vs 49.71, p<.001) were significantly lower in the SIM group. Performance on SGT was also significantly lower in the SIM group across SGT Total Correct (20.17 vs 24.65 of 40, p=.008), SGT Easy (10.60 vs 13.52 of 20, p=.002), and SGT Hard (9.57 vs 11.13 of 20, p=.068). Mixed ANOVA showed a trend towards significant group by SGT difficulty interaction (F(1,86)=3.41, p=.052, np2=.043). There was steeper decline in performance on SGT Hard compared to SGT Easy for CON. ROC analyses suggested adequate but not ideal sensitivity/specificity: scores <8 on SGT Easy (sensitivity=26%; false positive=11%), <7 on SGT Hard (sensitivity=26%; false positive=7%), and <15 on SGT Total (sensitivity=24%; false positive=9%).

These preliminary data indicate the SGT may be able to detect malingered TBI. However, additional development of this measure is necessary. Further refinement of difficulty level may improve sensitivity/specificity (e.g., CON mean performance for SGT Easy trails was 13.52, suggesting the items may be too difficult). This study was limited to an online administration due to COVID, which could have affected results; future studies should test inperson administration of the SGT. In addition, performance in clinical control groups (larger samples of individuals with mild TBI, ADHD) should be tested to better determine specificity for these preliminary cutoffs.

There are gender-related disparities in age of diagnosis of Mild Cognitive Impairment (MCI) or dementia, with women often receiving delayed diagnoses compared to men. These delays may be related to the general female advantage in episodic verbal memory across aging. Thus, it is important to identify methods of examining memory performance that can help to reduce disparities in diagnosis. The serial position effect, a pattern where individuals tend to remember more words at the beginning (primacy) and end (recency) of a list, is predictive of dementia and may provide an avenue for this endeavor. Whereas healthy adults tend to exhibit a prototypical U-shaped serial position profile, those with MCI or dementia tend to show reduced primacy relative to recency (i.e., a J-shaped profile). To date, few studies have examined gender differences in the serial position effect. There is some evidence to suggest that older, cognitively healthy women perform better than men on middle and recency, but more research is needed to clarify the relationship between gender and the serial position effect, which was the focus of this study.

We utilized data across three archival datasets, which included a total of 338 participants (67.5% female; Mage=66.9, SDage=9.4) divided into three age groups (50-64, 65-75, 76+). Scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) immediate and delayed memory indices (IMI and DMI, respectively) were used to assess verbal episodic memory abilities. Performances across learning trials of the List Learning task were utilized to examine the serial position effect. ANCOVA analyses were conducted and utilized regional scoring of list learning performance, which examined the percentage of correctly recalled words in each portion of the list (primacy, middle, and recency). We also calculated the relative strength of primacy to list learning to examine the relationship between J-curve performance and gender. Years of education was included as a covariate in all analyses.

Consistent with prior literature, men performed worse performance on both IMI F(1, 331)=17.20, p<.001, and DMI, F(1, 331)=6.87, p=.009, across aging. Repeated measured GLM showed that the serial position effect was seen across the full sample, F(1.93, 639.874)=5.66, p=.004, and interacted with gender, F(1.933, 639.874)=5.70, p=.004, and education, F(1.933, 639.874)=6.13, p = .003. Although men and women did not differ in primacy, p = .67, women performed better in middle, p < .001, and recency, p = .03, performance. Higher education was associated with better primacy, but not middle or recency, performance. Additionally, 23.1% of the sample exhibited a J-curve pattern, and there was a main effect of J-curve pattern for both IMI, F(1, 334)=12.33, p<.001, and DMI, F(1, 334)=15.62, p<.001, with those showing a J=curve having worse memory performance.

Our finding of no gender difference in primacy suggests that focusing on primacy performance in verbal list learning may help to address gender-related disparities in MCI or dementia diagnosis. Additionally, given evidence of education being associated with primacy, but not middle or recency, performance, future research should investigate the development of education-based normative data for primacy performance.

Learning process variables such as the serial position effect and learning ratio (LR) are predictive of cognitive decline and dementia. Gender differences on memory measures are well documented, but there is inconsistent evidence for gender effects on learning process variables. In the present study, we examined the relationship of serial position and LR to memory performance and to cortisol levels, considering gender as a potential moderator.

Data were taken from a deidentified dataset of a study on stress and aging in which 123 healthy community-dwelling adults over age 50 completed various assessments. Our analyses included 100 participants (56% female, 93% white, Mage 60.65, Meducation 15.22 years) who completed all measures of interest. LR, primacy effect, and recency effect were calculated from the learning trials of the Auditory Verbal Learning Test (AVLT). Additional memory measures included recall measures from the AVLT and from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). AUC cortisol was calculated from salivary cortisol samples taken across 6 time points in the study.

Women performed better than men on LR, primacy, and traditional memory measures (ps=<.001 to .018) but not on recency (p=.40). LR was moderately correlated with primacy (r=.481, p<.001) and weakly correlated with recency (r=.271, p=.008), after controlling for age, gender, and education. After controlling for age, gender, and education, better LR was related to better memory performance across all measures (rs=.276-.693, ps= <.001-.007) and better recency was related to better performance on all memory measures (rs=.212-.396, ps=<.001-.038). Better primacy was related to better AVLT immediate and delayed recall and RBANS Immediate Memory Index (rs=.326-.532, p<.001) but not RBANS delayed (r=.115, p=.263).

Hierarchical linear regressions were conducted to examine gender as a moderator of relationships between learning process variables and memory performance, after accounting for age, gender, and education. There were no gender by LR (ps=.349-.830) or gender by primacy interactions (ps=.124-.671). There was an interaction between gender and recency on AVLT memory measures (ps=.006-.022), but not on RBANS measures (ps=.076-.745). For men, higher recency was related to higher AVLT immediate and delayed recall (rs=.501-.541, ps<.001), but not for women (rs=.-.029-.020, ps=.839-.888), after controlling for age and education. The relationship of AUC salivary cortisol to learning process measures was also moderated by gender (LR/gender interaction p=.055; primacy/gender interaction p=.047; but not recency/gender p=.79). Interestingly, for women, higher cortisol was related to higher LR (r=.16) and higher primacy (r=.36), while for men, it was related to lower LR (r=-.22) and not to primacy (r=-.05). Cortisol was not related to recency (rs=-.04 to -.07).

Women performed better on LR and primacy, as well as on other traditional memory variables, but gender did not appear to differentially impact the relationship of LR or primacy to memory outcomes. Findings suggest some differential relationships of recency to memory outcomes by gender. Results also suggested potential gender differences in the relationship of cortisol to learning process variables, but further study is necessary, especially with samples of individuals with memory impairment.

There has been a surge in individuals seeking neuropsychological assessment for attention-deficit/hyperactivity disorder (ADHD) after watching social media created by people claiming to have ADHD. While online content may promote destigmatization of ADHD, self-diagnoses derived from social media use may contribute to the development of inaccurate illness beliefs. Individuals who feel strongly connected to social media that mentions personal anecdotes of ADHD might be more likely to believe they also have ADHD. We examined associations between social media search for ADHD and beliefs about everyday experiences being diagnostic of ADHD among adults concerned about having ADHD, as compared to a control group.

A cross-sectional online study included 320 university students (Mage=19.56±2.92; 72% female; 81% White) without history of ADHD. Participants who reported concern about having ADHD, with (n=43) or without other psychological history (n=73) rated whether 100 experiences taken from social media were diagnostic of ADHD, and then rated the amount of time they spent on social media searching for ADHD content. They then rated how often they personally experienced the symptoms. Participants who reported no concern about having ADHD (n=184) only rated how often they personally experienced the symptoms.

Social media search for ADHD was related to total number of experiences believed to be diagnostic of ADHD among participants concerned about having ADHD without psychological history (r=.28, p=.03), but not for those with psychological history (r=.09, p=.57). For participants concerned about having ADHD (regardless of psychological history), social media search for ADHD was related to total number of symptoms personally experienced (rs=.48-.56, ps<.001) and to the number of symptoms endorsed at a clinical level (rs=.48, ps<.001). Total number of experiences believed to be diagnostic of ADHD was related to the number of symptoms personally experienced among participants concerned about having ADHD with psychological history (r=.53, p<.001; clinical level .47, p=.002), but not for those without psychological history (r=.14, p=.31; clinical level .19, p=.15). Of the 100 symptoms, 56 were believed to be diagnostic of ADHD by at least 50% of participants concerned about having ADHD. Of the 56, 43 were personally experienced at a clinical level by controls. For the 13 remaining symptoms not endorsed at a clinical level by controls, symptoms believed to be diagnostic of ADHD was related to symptoms personally experienced among participants concerned about having ADHD with psychological history (r=.53, p<.001; clinical level .52, p<.001), but not for those without psychological history (r=.14, p=.30; clinical level .19, p=.15).

Greater social media search for ADHD is related to higher symptom report among individuals concerned about having ADHD regardless of psychological history. However, individuals concerned about having ADHD without psychological history who engage in greater social media use appear to be more likely to believe that general symptoms are specifically due to ADHD. These individuals may be more prone to misattribute symptoms to ADHD. Nearly 77% of symptoms rated as diagnostic of ADHD were frequently experienced by individuals without concern about having ADHD, which demonstrates the high base rate of ADHD-like symptoms in the general population.

Process-based measures of verbal learning, such as the recently described learning ratio (LR; Hammers et al., 2022) may add valuable data to neuropsychological assessment. Women tend to have higher episodic verbal memory ability compared to men at all ages, including older adulthood (Golchert et al., 2019; Maitland et al., 2004). However, it is unclear whether gender is related to the process of learning, as quantified through measures of learning slope and ratio. To date only one study has examined this, with Hammers et al. (2021) finding no gender differences on LR in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); therefore, further study is necessary. We examined whether men and women differed in LR, learning over time (LOT), and raw learning slope (RLS) in a healthy older adult sample, as well as whether these learning process variables predicted delayed memory equally for men and women.

203 cognitively healthy community-dwelling adults aged 50 and above (mean age 67.7; 133 women) were taken from a larger archival database; all were administered the RBANS in the context of other studies. LR, LOT, and RLS were calculated from the List Learning task. We examined whether men and women differed in these learning process measures. We then examined whether process measures differentially predicted performance on list recall and delayed memory index (DMI) of the RBANS for men and women.

Men and women did not differ in age or years of education. After accounting for age and education, there were no gender differences on LR (p=.455) or RLS (p=.502) but LOT was lower in women (p=.013).

LR was equally predictive of list recall across genders (p<.001 for LR; p=.21 for gender). Correlations between LR and list recall were r=.65 (p<.001) for men and r=.56 (p<.001) for women. Both LR (p<.001) and gender (p=.008) predicted DMI but the interaction was nonsignificant. Correlations between LR and DMI were r=.52 for men (p<.001) and r=.46 for women (p<.001).

RLS predicted list recall equally across genders (p<.001 for RLS; p=.07 for gender; p=.18 for interaction). Correlations between RLS and list recall were r=.43 for men (p<.001) and r=.23 for women (p=.008). RLS (p<.001) and gender (p=.002; p=.19 for interaction) predicted DMI scores. Correlations between RLS and DMI were r=.31 for men (p=.008) and r=.21 for women (p=.015).

LOT predicted list recall equally across genders (p<.001; p=.97 for gender; p=.80 for interaction). Correlations between LOT and list recall were r=-.50 for men (p<.001) and r=-.60 for women (p<.001). LOT also predicted DMI equally across genders (p<.001; p=.084 for gender; p=.159 for interaction). Correlations between LOT and DMI were r=-.46 for men (p<.001) and r=-.49 for women (p<.001).

Of the three process variables, LR was the only one that did not show gender differences and was related to delayed memory outcomes with medium to large effect across both genders. Results suggest that LR can be used consistently across genders. As this sample consisted of healthy, independently-living older adults, future study should examine LR by gender in MCI and dementia samples.

The serial position effect is the tendency to recall items at the beginning (primacy) and end (recency) of a word list best and middle items the worst, demonstrated by a 'U-shaped’ profile. Individuals with memory impairment often demonstrate a 'J-shaped’ profile, with a diminished primacy effect. An attenuated primacy effect could be one of the earliest indicators of cognitive decline in older adults. Chronic elevations in cortisol are related to hippocampal atrophy and decreased learning and recall. Given the rehearsal and encoding required to recall words at the beginning of a list, we hypothesized that reduced primacy would be related to higher cortisol levels, measured via hair cortisol concentration, in older adults, particularly caregivers of people with dementia (PWD), who are under increased stress.

Data were taken from a deidentified dataset of 60 community-dwelling older adults (> 50) with no evidence of dementia who participated in a larger study on memory and caregiving stress; 26 identified themselves as caregivers of PWD. The sample was 83% women and 98% White, with a mean age of 67.58 (SD=8.85) and 80% holding at least a college degree. Stress was measured with the Perceived Stress Scale. The List Learning and List Recall subtests from the Repeatable Battery for the Assessment of Neuropsychological Status were used to assess the serial position effect. Primacy and recency were determined by the first three and last three words on the list, respectively, and were measured for trials 1-4. Relative strength of primacy versus recency at delayed recall was also calculated such that positive scores indicate better primacy than recency and negative scores indicate worse primacy than recency (J-shaped profile). Hair samples were collected, and the first one cm of hair was used to assay hair cortisol concentration, reflecting the past month of cortisol.

Caregivers were younger than non-caregivers (p<.001), but groups did not differ in gender (p=.412). Age was controlled for in all subsequent analyses. Caregivers reported more stress (p<.001), but groups were not different in hair cortisol (p=.093). On memory tasks, caregivers showed lower list learning raw scores (p=.002) and lower list recall raw score (p=.046); groups were not different in primacy learning (p=.114), but caregivers showed worse recency over learning trials (p<.001). Caregivers were not more likely to show the J-shaped serial position profile at recall (p=.285). Collapsed across groups, perceived stress was not related to cortisol (p=.124) but was related to recency (p=.001) and list learning raw (p=.004), but not list recall raw (p=.485) or primacy (p=.109). Cortisol was not related to primacy (p=.277) or recency (p=.538).

Contrary to predictions, caregivers were not worse on primacy but were worse on recency. Caregivers also reported more stress; collapsed across groups, stress was associated with recency performance. This may suggest that stress is related more to poor attention and short-term memory (recency) than encoding and recall related memory problems (primacy).

Dementia worry (DW) is anxious rumination about personal risk for dementia. Personal experience with dementia may affect DW, such that individuals with personal experience with dementia may have higher worry about developing dementia themselves. Further, dementia knowledge (DK), including what may increase one’s dementia risk as well as treatment options for dementias, may be influenced by one’s dementia experience. Prior studies have suggested that personal experience alters the relationship of age to DW; no prior studies have examined this for DK. In the present study, we examined whether DW and/or DK were differentially related to age in older adults.

Adults (≥ 50 years old; N=252) in Ohio and Louisiana completed an online survey. 94 participants reported no personal dementia experiences, and 158 participants endorsed having a biological relative with dementia. The sample ranged in age from 23 to 92 (M=65, SD=9.3), with 96% identifying as White and 76% holding advanced degrees. DW was measured with the Dementia Worry Scale. Dementia knowledge was measured with true or false questions about causes and treatments for dementia.

Groups did not differ in age (p=.73), education (p=.50), or perceived SES (p=.28), but did differ in gender (p=.06). The experience group had higher dementia knowledge (p=.02). In those with biological dementia experience, lower age was related to higher dementia worry (r=-.24, p=.003) and greater dementia knowledge (r=-.18, p=.03). However, in those with no experience, age was not related to either dementia worry (r=.04) or to dementia knowledge (r=.16). Dementia worry did not relate to dementia knowledge in either group (no experience r=.03, experience r=.13).

Findings suggest that younger individuals who have personal experience with dementia are highly worried about personal risk for dementia, despite having higher knowledge of dementia. Further, these results demonstrate that dementia knowledge is not related to dementia worry in older individuals with or without biological dementia experience. Findings may be important for informing dementia prevention education efforts.