Self- and informant-ratings of functional abilities are used to diagnose mild cognitive impairment (MCI) and are commonly measured in clinical trials. Ratings are assumed to be accurate, yet they are subject to biases. Biases in self-ratings have been found in individuals with dementia who are older and more depressed and in caregivers with higher distress, burden, and education. This study aimed to extend prior findings using an objective approach to identify determinants of bias in ratings.

Participants were 118 individuals with MCI and their informants. Three discrepancy variables were generated including the discrepancies between (1) self- and informant-rated functional status, (2) informant-rated functional status and objective cognition (in those with MCI), and (3) self-rated functional status and objective cognition. These variables served as dependent variables in forward linear regression models, with demographics, stress, burden, depression, and self-efficacy as predictors.

Informants with higher stress rated individuals with MCI as having worse functional abilities relative to objective cognition. Individuals with MCI with worse self-efficacy rated their functional abilities as being worse compared to objective cognition. Informant-ratings were worse than self-ratings for informants with higher stress and individuals with MCI with higher self-efficacy.

This study highlights biases in subjective ratings of functional abilities in MCI. The risk for relative underreporting of functional abilities by individuals with higher stress levels aligns with previous research. Bias in individuals with MCI with higher self-efficacy may be due to anosognosia. Findings have implications for the use of subjective ratings for diagnostic purposes and as outcome measures.

Research suggests greater perceived social support is associated with better general cognitive function in community-dwelling older adults. While these findings expand our understanding of the role of social support in healthy aging, further work is needed to investigate the role of social support in mild cognitive impairment (MCI). Of particular interest is the relationship between executive function (EF), communicative effectiveness, and social support, as these are common areas of decline and are likely to impact one’s ability to meaningfully interact with others. The present study aimed to evaluate the association between perceived social support, EF, and communicative effectiveness. We hypothesize better EF performance and communicative effectiveness would be associated with higher levels of perceived social support in older adults with MCI.

One hundred and twenty-one older adults with MCI were included in the current study. All participants were enrolled in Charles and Harriett Schaffer Cognitive Empowerment Program (CEP) at Emory University, a comprehensive lifestyle program for individuals diagnosed with MCI and their care partners. Upon CEP enrollment, participants completed self-report questionnaires, including the Multidimensional Scale of Perceived Social Support (MSPSS), the Communicative Effectiveness Index (CETI), and EF assessments including Letter Fluency (phonemic fluency), Digit Span Backward (working memory), and the Test of Practical Judgment (decision making). Additionally, a subset of participants completed the written Trail Making Test - Part B (set-shifting; n = 63). Pearson bivariate correlations were utilized to explore the relationship between MSPSS, CETI, and EF performance.

Higher levels of perceived social support were significantly associated with communicative effectiveness (r = .210, p = .021), such that participants who endorsed having more social support also reported greater confidence in their communicative effectiveness. Perceived social support was associated with better working memory performance (r = .342, p < .001), phonemic fluency output (r = .261, p = .041), and shorter time to complete TMT-B (r = -.244, p = .052), indicating individuals with higher perceived social support demonstrated better EF abilities. Finally, greater confidence in communicative effectiveness was associated with better performances in working memory (r = .274; p = .008), phonemic fluency output (r = .213; p = .020) and decision making (r =.192; p = .044), suggesting stronger working memory, phonemic fluency, and practical decision-making abilities support better communicative effectiveness. There was no association between social support and practical decision-making abilities (r = .146, p = .129).

The current findings demonstrate a link between higher levels of social support, communicative effectiveness, and EF abilities, particularly in the subdomains of working memory, phonemic fluency, and set-shifting. This link suggests individuals with stronger EF abilities may have greater communicative effectiveness and, in turn, may be better able to maintain social relationships and garner social support. Future research is needed to evaluate the causality in this relationship, as it remains possible those with stronger social support networks maintain communicative effectiveness and EF for longer. Thus, further evaluation of the mechanism(s) underlying the relationships between social support, EF, and communicative effectiveness is needed.

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

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

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

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

During the COVID-19 pandemic the Oral Trail Making Test (O-TMT) was frequently used as a telehealth-compatible substitute for the written version of the Trail Making Test (W-TMT). There is significant debate among neuropsychologists about the degree to which the O-TMT measures the same cognitive abilities as the W-TMT (i.e., processing speed for part A and set-shifting for part B). Given the continued use of the O-TMT - especially for patients with fine-motor or visual impairments -we examined how O-TMT and W-TMT scores were correlated in patients with movement disorders.

Between April 2021 and July 2022 thirty individuals with movement disorders (n=27 idiopathic Parkinson’s disease [PD]; n=1 drug-induced PD; n=1 progressive supranuclear palsy [PSP]; n=1 possible PSP) completed in-person neuropsychological evaluations at the Emory Brain Health Center in Atlanta, GA. The patients were on average 71.3 years old (SD=7.5 years), had 16 years of education (SD=2.8 years), and the majority were non-Hispanic White (n=27 White; n=3 African American) and male (n=17). In addition to other neuropsychological measures, these patients completed both the O-TMT and the W-TMT. O-TMT and W-TMT administration was counterbalanced across patients and took place thirty-minutes apart. Raw scores (i.e., time in seconds) to complete O-TMT and W-TMT part A and part B, as well as discrepancy scores (part B - part A), were used for statistical analysis; a raw score of 300 seconds was assigned when a participant could not complete that section of the O-TMT or W-TMT. Given the non-normal distribution of the data, Spearman correlations were performed between O-TMT and W-TMT scores.

Ten patients were unable to perform W-TMT part B. Of these, seven patients could also not perform O-TMT part B. Part A scores on O-TMT and W-TMT were not significantly correlated (rs = 0.27, p = .15). In contrast, part B scores were strongly correlated, such that slower performances on O-TMT part B corresponded with slower performances on W-TMT part B (rs = 0.82, p < .001). Discrepancy scores for the O-TMT and W-TMT were also significantly correlated, such that larger part A and part B discrepancy scores on O-TMT corresponded with larger discrepancy scores on W-TMT (rs = 0.78, p <.001). The pattern of results was replicated when examining these correlations only in patients who could complete all parts of O-TMT and W-TMT (n=19); part A scores of the O-TMT and W-TMT were again not correlated (rs = -0.20, p = .41), whereas the part B scores (rs = 0.54, p = .02) and discrepancy scores (rs = 0.59, p = .008) were significantly correlated.

Results suggest that an oral version of the Trail Making Test shows promise as an alternative to the written version for assessing set shifting abilities. These findings are limited to patients with movement disorders, and future research with diverse patient populations could help determine whether O-TMT can be generalized to other patient groups. Additionally, future research should examine whether O-TMT scores obtained via virtual testing correspond with W-TMT scores obtained in-person.