Despite significant recent advances in test development in research settings, neuropsychological tests and normative data used in clinical settings have fallen behind in innovation in terms of empiricism and modality of administration (Bilder & Reise, 2019). Most widely-used test paradigms were initially developed 50-150 years ago with normative data that is often limited to White American-born monolingual English samples (Pugh et al., 2022; Rabin et al., 2016). Few digital tests have successfully translated into clinical use (Collins & Riley, 2016).

Mayo Test Development through Rapid Iteration, Validation, and Expansion (Mayo Test Drive) is a remote platform for neuropsychological test development and self-administration that is accessible through any web-based device (Stricker et al., 2022). To date, we have demonstrated rapid validation and clinical translation of the SLS in native English speaking older adults and are now beginning cultural/linguistic adaptation for further validation, and clinical translation for Spanish speakers. Mayo Test Drive’s web-based platform captures all item-level data to allow future item level analysis and application of machine learning techniques.

The broader aim of Mayo Test Drive is to provide infrastructure to include more tests, adaptations, and normative datasets to ultimately improve access and utility for diverse patient populations. Mayo Test Drive currently includes two measures: Stricker Learning Span (SLS), a novel learning and recognition memory test, and Symbols Test, an open access processing speed measure (Stricker et al., 2022; Wilks et al., 2022). The SLS was designed with consideration of learning principles from cognitive neuroscience to enhance detection of the early decline in learning observed in preclinical Alzheimer’s disease (AD). The SLS uses computer adaptive testing to adapt task difficulty trial-by-trial (e.g., increasing word span) and uses a sensitive 4-choice format to test recognition memory for each word. The SLS underwent initial piloting in older females to determine psychometric properties, test-retest reliability, convergent validity with traditional measures, and criterion validity (e.g., neuroanatomical associations).

Further validation and normative data development in the Mayo Clinic Study of Aging is ongoing, with additional criterion validation assessed by comparing brain PET (amyloid and tau) biomarker positive vs. negative groups. The SLS is equivalent to an inperson memory measure (AVLT), and the Mayo Test Drive composite including SLS and Symbols is superior to an in-person global screen (Short Test of Mental Status, like the MMSE) in distinguishing biomarker +/- older adults. To adapt the SLS for other languages/cultures, we have added community-based components to development (e.g., cognitive interviewing, additional piloting). We are beginning data-driven linguistic and remote cognitive interviewing approaches to develop an adaptation of the SLS for Spanish speakers. This study involves virtual focus groups with native Spanish speakers from different backgrounds (e.g., countries of origin, multilingualism) to examine the test paradigm, instructions, and items. Following piloting of the adaptations, next steps include normative data collection and clinical implementation. Future work involves in-person adaptation studies for lower/middle income countries including a collaboration with a Master’s level psychology graduate program in Grenada, West Indies to complete cognitive interviewing and pilot work with community members and stakeholders.

The prevalence of significant brain disorders and their economic burden are projected to continually increase as populations age longer. This review aims to analyze the barriers to international collaboration and propose preliminary international competency guidelines for the advancement of the neuropsychology field. Moreover, these guidelines can aid the field in advocating for international development and collaboration. Specifically, these guidelines may lead to clarity of services, culturally informed norms, cross-cultural research opportunities, and improving accessibility globally (Chan et al., 2016; Hessen et al. 2017).

Literature between 2002 and 2022 was obtained by searching the Google Scholar and PubMed databases. Keywords such as guidelines, international, and neuropsychology were used. Articles were selected on the criterion of relevance to the objective, international perspectives, and current national guidelines. The remaining articles were reviewed, and themes were clustered to identify overlapping international competencies within the literature. The findings were utilized to create preliminary competency guidelines and discuss their future implications.

Covid-19 unveiled the feasibility of health service fields collaborating internationally to solve global problems (Bump et al. 2021). The pandemic is a call to action for the neuropsychology field to improve global health equity and collaboration to address international challenges (Obschonka et al., 2021). However, one barrier is the lack of globally accepted definitions of neuropsychology and what a neuropsychologist does (Grote et al., 2016). Yet, a way to address this is for international organizations to propose international competency guidelines. This may allow countries with less developed neuropsychology fields to advocate for legislation and services (Chan et al., 2016; Hessen et al., 2017). In addition, countries reported the need for competencies to advocate for advancing current practices (Chan et al., 2016; Hokkanen et al., 2020; Janzen & Guger, 2016). Notably, by developing guidelines, public understanding and competent practices of neuropsychology can be strengthened (Grote et al., 2016; Hessen et al., 2017). Temple and colleagues (2006) discovered the two largest barriers for physicians referring to neuropsychologists were a lack of familiarity with the field and geographical limitations. Therefore, international competency guidelines present a serendipitous opportunity to benefit clients, physicians, and neuropsychologists.

Therefore, the current study presents 10 international neuropsychology practice competencies and their elements. Foundational competencies include: (1)Scientific knowledge, methods, and evidence-based practice; (2)Individual and community diversity; (3)Ethics, legal standards, and policy; (4)Interdisciplinary systems; (5)Reflective practice; (6)Therapeutic relationships. Functional competencies include: (7)Assessment; (8)Intervention; (9)Consultation; (10)Advocacy.

Although training and regulations may differ internationally, emerging literature supports the establishment of global competencies. Despite data on competencies in many countries being unavailable, the need for services in many locations suggests that using the available data to implement guidelines may allow for the growth of consistently competent neuropsychologists to serve the many underserved populations around the world (Hessen et al., 2017). Fortunately, Covid-19 exposed the need for increased health equity and mental health services globally (Jensen et al., 2021). Ultimately, the international competencies presented should be investigated further to improve international neuropsychology research, practice, advocacy, and legislation to abate global disparities.

Previous investigations have demonstrated the clinical utility of the Delis-Kaplan Executive Function System (D-KEFS) Color Word Interference Test (CWIT) as an embedded validity indicator in mixed clinical samples and traumatic brain injury. The present study sought to cross-validate previously identified indicators and cutoffs in a sample of adults referred for psychoeducational testing.

Archival data from 267 students and community members self-referred for a psychoeducational evaluation at a university clinic in the South were analyzed. Referrals included assessment for attention-deficit hyperactivity disorder, specific learning disorder, autism spectrum disorder, or other disorders (e.g., anxiety, depression). Individuals were administered subtests of the D-KEFS including the CWIT and several standalone and embedded performance validity indicators as part of the evaluation. Criterion measures included The b Test, Victoria Symptom Validity Test, Medical Symptom Validity Test, Dot Counting Test, and Reliable Digit Span. Individuals who failed 0 criterion measures were included in the credible group (n = 164) and individuals failing 2 or more criterion measures were included in the non-credible group (n = 31). Because a subset of the sample were seeking external incentives (e.g., accommodations), individuals who failed only 1 of the criterion measures were excluded (n = 72). Indicators of interest included all test conditions examined separately, the inverted Stroop index (i.e., better performance on the interference trial than the word reading or color naming trials), inhibition and inhibition/switching composite, and sum of all conditions.

Receiver Operating Characteristics (ROC) curves were significant for all four conditions (p < .001) and the inverted stroop index (p = .032). However, only conditions 2, 3 and 4 met minimal acceptable classification accuracy (AUC = .72 - 81). ROC curves with composite indicators were also significant (p < .001), with all three composite indicators meeting minimal acceptable classification accuracy (AUC = .71- .80). At the previously identified cutoff of age corrected scale score of 6 for all four conditions, specificity was high (.88 -.91), with varying sensitivity (.23 - .45). At the previously identified cutoff of .75 for the inverted stroop index, specificity was high (.87) while sensitivity was low (.19). Composite indicators yielded high specificity (.88 - .99) at previously established cutoffs with sensitivity varying from low to moderate (.19 - .48). Increasing the cutoffs (i.e., requiring higher age corrected scale score to pass) for composite indicators increased sensitivity while still maintaining high specificity. For example, increasing the total score cutoff from 18 to 28 resulted in moderate sensitivity (.26 vs .52) with specificity of .91.

While a cutoff of 6 resulted in high specificity for most conditions, the sum of all four conditions exhibited the strongest classification accuracy and appears to be the most robust indicator which is consistent with previous research (Eglit et al., 2019). However, a cutoff of 28 as opposed to 18 may be most appropriate for psychoeducational samples. Overall, the results suggest that the D-KEFS CWIT can function as a measure of performance validity in addition to a measure of processing speed/executive functioning.

Many individuals who experienced a mild traumatic brain injury (mTBI) have persistent cognitive complaints. Traditional cognitive rehabilitation (TCR) interventions were primarily developed for severe neurological injury which has limited effectiveness in rehabilitation of active duty military personnel who have the goal of returning to full military operational status. To remain on active duty, warfighters must have sufficient mental competency to safely and effectively function in complex environments such as combat. There is need for a cognitive rehabilitation approach that addresses demands of military personnel to expedite return to duty. The Strategic Memory Advanced Reasoning Training (SMART) program is novel alternative to TCR. SMART is an evidence-based advanced reasoning protocol that enhances cognitive domains essential to military readiness (e.g., mental agility, strategic learning, problem solving, and focus) and requires less than half of the treatment time. The objective of this study was to assess the efficacy of SMART compared to TCR in terms of overall recovery as well as change in specific cognitive domains.

Participants were recruited from a military treatment facility. All patients had at least one diagnosed mTBI as well as persistent cognitive complaints. Participants completed the Rey-15 to ensure performance validity. Final sample was SMART n = 28 and SCORE n = 19. Primary dependent measure was the Global Deficit Scale (GDS). GDS was calculated from: Hopkins Verbal Learning Test-Revised (HVLT-R); Delis Kaplan Executive Functioning System Color Word (CW) and Trail Making (TM), Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores were converted to deficit scores as follows: >40 = 0, 35-39 = 1, 30-34 = 2, 25-29 = 3, 20-24 = 4, <20 = 5. Deficit scores were averaged to calculate GDS. For each measure, Hohen’s g was analyzed for effect size comparisons pre-post treatment.

Average number of treatment hours was significantly lower in the SMART condition (SMART: M = 18.47 hours, SD = 2.17; TCR: M = 42.42 hours, SD = 3.79, p <.001). A repeated measures ANOVA showed a significant change on GDS post-treatment (F = 30.25, p < .001) with a large effect size (n2 = .402); however, the interventions did not differ on GDS change. Impact on cognitive domains was relatively equivalent for processing speed (SMART h = 0.67 vs TCR h = -.54) and executive function (SMART h = -0.92 vs TCR h = -.85); however, SMART had a larger impact on memory (SMART h = -0.81 vs TCR h = -.39). SMART resulted in large improvements in retention and recognition memory which were minimally impacted by TCR.

Both TCR and SMART had comparable effectiveness in improving cognitive impairment, though SMART was completed in less than half of the treatment time. Both interventions had large effect sizes on processing speed and executive functioning; however, SMART was more effective in improving long-term memory. Memory is an integral part of military readiness. Further investigation is required to determine the relative effectiveness of these two approaches to improving cognitive readiness of the warfighter.

Acute cognitive complications following COVID-19 infection have been appreciated in a subset of patients since the early months of the global pandemic. Emerging data reveal that some patients go on to experience cognitive improvement, whereas others may experience further cognitive decline. We aimed to assess trajectories and predictors of cognitive change in a sample of post-COVID-19 patients.

This prospective cohort study assessed longitudinal cognitive change in adults receiving care for COVID-19 in the Johns Hopkins Post-Acute COVID-19 Team (JH PACT) clinic. Participants self-administered the Digital Automated Neurobehavioral Assessment (DANA) battery of seven cognitive tests and a performance-based measure of cognitive fatigue on up to six occasions over six weeks. Improvement or decline between the first and last assessment was defined as change of >1 standard deviation of the baseline mean of each outcome. Potential predictors of change included demographic features (age, sex, race/ethnicity, education), COVID-19 illness characteristics (hospitalization or ICU stay, months since symptom onset), and comorbid disease burden. Analyses included measures of central tendency, independent samples t-tests, and chi-square tests of independence.

Of the 36 enrolled participants, 29 (81%) completed at least one DANA assessment (M = 4.7 assessments, SD = 1.8). Those completing at least three assessments (n = 24, 66.7%) were included in the present analyses (71% female; 58% white; M age = 54 years, SD = 10.9; M education = 14.6 years, SD = 2.4; M months since COVID-19 symptom onset at recruitment = 9.8, SD = 4.7; M comorbidities = 2.8, SD = 2.0). Fatigue was the most frequently improved outcome measure, with 41.7% of participants scoring >1 standard deviation above the baseline mean fatigue score at their final assessment. Among cognitive outcomes, the greatest frequency of improvement was observed on tests assessing rapid spatial processing (37.5%), processing speed (33.3%), and memory (33.3%). There were no consistent predictors of improvement, but several subtest-specific findings emerged. Specifically, (a) more comorbidities were positively associated with rate of fatigue reduction (p = .04), (b) longer duration since COVID-19 illness was positively associated with rates of memory improvement (p = .02), (c) older age, male sex, and more comorbidities were positively associated with rate of improvement in reaction time (ps < .05), and (d) more assessments completed was positively associated with rates of improvements in working memory (ps < .05). Response inhibition (12.5%), simple reaction times (16.7%), and working memory (16.7%) showed the lowest rates of improvement over time. Declines in cognition were infrequent, with 4.2 - 8.3% (n = 1 to 2) declining on measures of procedural reaction time, spatial processing, inhibitory control, or working memory.

At an average of >9 months following acute COVID-19 illness, we observed longitudinal improvements in cognitive fatigue as well as processing speed, memory, and spatial reasoning. Consistent predictors of recovery were not identified, although age, sex, comorbid conditions, and time since illness predicted rates of improvement in select domains. Further analyses with a larger sample size and more stringent analyses are needed to confirm and extend these findings.

Context-Dependent Effect (CDE) is a process by which restoring the original learning context enhances recall ability of the material being studied. One type of context is body expressions. Memory is one of the most common areas affected by Traumatic Brain Injury (TBI). However, although the performance of people with TBI is lower than that of healthy people in most memory-related parameters, both groups show evidence for CDE. We examined the CDE via behavioral and eye movement measures.

Twenty-four healthy individuals and 27 patients with moderate-tosevere TBI participated in a memory task. Participants were exposed to pictures of people with neutral facial expression and neutral body expression and were asked to remember them for a subsequent memory test. In the testing session, they were asked to determine whether or not the person presented to them had appeared before, under two conditions: (1) where the context remains constant (facial expression and body expression remained neutral- the Repeat condition) (2) where the context changes (facial expression remained neutral and the body changed to angry or happy expression - the Re-pair condition).

While memory of the individuals with TBI was poorer than that of the control group, both groups exhibited CDE, as this effect was stronger in the Repeat condition compared to the Re-pair angry condition. We found that participants spent most of their time looking at the head. In addition, in both groups, we found a CDE and a group effect with regard to the difference in Dwell Time, so DT toward faces in the Repeat condition was higher than toward faces in the Re-pair condition. Also, DT toward correctly recognized people was higher among the control group than the TBI group. This effect appeared in the study and test phases.

This study supports previous research showing evidence for CDE using body expression in the TBI group, like the control group, and extends our comprehension of the relationship between eye movements, memory, and context of facial and body expression.

Although the relationship between visual attention, impulsivity, and cognitively restrained eating patterns has been established in previous research, less is known about the relationship of cognitive processes and disinhibited eating patterns in older adults. Research postulates that disinhibited eating behaviors may be associated with stress, limited emotional capacity, anxiety, and impulsivity. The current study investigated impulsivity as a potential mediator of the relationship between visual attention and disinhibited eating in older veterans.

This study included 101 Veterans who were screened as part of a larger study assessing the impact of multi-modal activity-based interventions on brain health in older adulthood. The sample included largely White (76%), male (94%) Veterans aged 54 to 88 (M = 70.1, SD 8.9). The Three-Factor Eating Questionnaire was used to assess daily disinhibited eating patterns, and attentional impulsivity was assessed with the Barratt Impulsiveness Scale. Visual attention was evaluated using the Stroop Color Word Test (Color Trial). Mediation analyses were conducted using the SPSS PROCESS Macro. The outcome variable for analysis was disinhibited eating. The predictor variable was visual attention. The mediator variable was impulsivity. Body mass index (BMI) was included as a covariate as it was significantly associated with the predictor and outcome variables.

The indirect effect of visual attention on disinhibited eating was found to be statistically significant (effect = 0.06, 95%: 0.02, 0.12)

Attentional impulsivity appears to mediate the relationship between visual attention and disinhibited eating behaviors. This finding extends the current literature about the relationship between visual attention, impulsivity, and other eating patterns (e.g., cognitively restrained eating) in older adults. Exploring this relationship helps us better understand the impact of eating habits through the aging process. Caregivers and older adults should be informed about the impact of increased impulsivity on disinhibited eating behaviors, especially in those with limited visual attention processes. Further understanding of the neurobiological impact of eating behaviors on cognition in older adulthood may assist in developing awareness about the importance of healthy eating patterns when considering brain health in the aging process.

COVID-19 misinformation proliferating online has led to adverse health and societal consequences. Older adults are a particularly vulnerable population due to increased risk for both COVID-19 related complications and susceptibility to, as well as sharing of, misinformation on social networking sites. The present study aimed to: 1) investigate differences in COVID-19 headline accuracy discernment and online sharing of COVID-19 misinformation in older and younger adults; and 2) examine individual differences in global cognition, health literacy and verbal IQ in online sharing of COVID-19 misinformation.

Fifty-two younger (age 18 to 35 years) and fifty older adults (age 50 and older) completed a telephone neurocognitive battery, health literacy and numeracy measures and self-report questionnaires. Participants also completed a social media headline-sharing experiment (Pennycook et al.,2020) in which they were presented true and false COVID-19 headlines and asked to indicate: 1) the likelihood that they would share the story on social media; and 2) the factual accuracy of the story.

A repeated measures multivariate analysis of variance controlling for gender and race/ethnicity showed no effects of age (p=.099), but a significant interaction between actual COVID-19 headline accuracy and likelihood of sharing (p<.001), such that accuracy is more strongly related to sharing false headlines (r=-.64) versus true headlines (r=-.43). Moreover, higher likelihood of sharing false COVID-19 headlines was associated with lower verbal IQ and numeracy skills in older adults (rs=-.51--.40; ps<.01) and with lower verbal IQ, numeracy, and global cognition in younger adults (rs=-.66--.60; ps<.01).

Findings indicate that headline accuracy judgements are an important predictor of sharing COVID-19 misinformation in both older and younger adults. Further, individual differences in cognition, IQ, and numeracy may predict the likelihood of misinformation sharing in younger adults, while IQ and numeracy skills may act as important antecedents of misinformation sharing in older adults. Future work might leverage modern, neuropsychologically-based psychoeducation approaches to improving health and science literacy related to COVID-19.

Neuropsychology is in a nascent stage of understanding the mechanisms that link social forces, psychosocial experiences, and brain health. Discrimination is associated with lower quality of life, higher stress, and worse physical health outcomes in Latinx, but contradictory findings in prior research complicate our understanding of its relationship to cognition. These contradictory results may be explained by heterogeneity within the broad category of Latinx, a cultural identity that requires more nuanced conceptualization. Immigration status is a primary social identifier for Latinx people that carries significant stigma. However, prior research found enculturation promotes better physical and mental health outcomes in immigrants compared to their US-born counterparts, which may protect immigrant Latinx from the cognitive costs of discrimination. The current study hypothesized that the effect of discrimination on cognition will be stronger in US-born Latinx compared to immigrant Latinx.

We partnered with 1,023 neurologically healthy, community dwelling Latinx adults (M age=56.1(±10.7); M education=12.5(±3.7); 69% women) in a prospective cohort study in NYC investigating risks factors for Alzheimer’s disease. Immigration status was determined by self-report of birthplace. Measures of attention, language, and memory were administered by bilingual examiners in the participants’ self-selected preferred language of English (n = 388) or Spanish (n=635). Discrimination, measured with the Everyday Discrimination Scale and Major Experiences of Discrimination Scale, was chronicity coded to weigh experiences of discrimination according to yearly chronicity. Linear regression models were employed for US-born and immigrant participants to assess the relationship between both discrimination measures and each cognitive measure.

Compared to US-born Latinx (n = 224), immigrant Latinx (n = 799; primarily from the Dominican Republic) were older, had fewer years of school, had lower income, and were much more likely to have chosen to be assessed in Spanish. Immigrants reported experiencing significantly fewer everyday and major experiences of discrimination than nonimmigrants. In unadjusted models, discrimination did not predict cognitive performance among US-born Latinx. Among immigrant Latinx, more major experiences of discrimination across the lifetime predicted better phonemic (F(2,362) = 4.167, p<0.05, R2=0.017) and semantic fluency (F(2,362) = 3.304, p<0.05, R2=0.013) but was not associated with measures of attention or memory.

Discrimination is an important life stressor for Latinx people living in the US, particularly when its impact is summed across intersectional identities. The current study is among the first to explore the potential cognitive impact of discrimination within a group of Latinx adults. The described relationship between discrimination and language performance in this cohort may be confounded by the language in which cognitive tests were administered. Future studies should consider how discrimination measures may be limited in their ability to accurately capture the experiences of US-born and immigrant Latinx groups and expand the measurement of cognition to additional domains.

Blast-related traumatic brain injury (bTBI) is one of the most common injuries among Veterans who have served in recent wars in Iraq and Afghanistan. Despite representing a distinct mechanism of injury, long-term clinical and functional outcomes of bTBI are generally comparable with non-blast-related traumatic brain injury (TBI). However, controversy remains over whether bTBI etiology differentially impacts emotional regulation and neurocognition - particularly with respect to post-traumatic stress disorder (PTSD) and verbal and visual memory. Through diffusion tensor imaging (DTI), the present study investigates the microstructural pathophysiology of bTBI, compared to non-blast TBI, in neural pathways involved in emotional regulation and cognitive control.

Participants included 36 Veterans (25% female; age M = 36.33, SD = 10.11; years of education M = 15.67, SD = 2.34). Axial diffusivity (AD) in networks of emotional and cognitive control was acquired using magnetic resonance imaging (MRI) with a DTI protocol. Analyses of variance (ANOVA) were used to compare Veterans with self-reported bTBI (n = 23) to those with non-blast-related TBI (n = 13).

In the left hemisphere, Veterans with bTBI exhibited significantly smaller AD in axonal projections from the caudate nucleus (CN) to the orbitofrontal cortex (OFC), as well as in projections from the putamen to the OFC (p < 0.05). In the right hemisphere, Veterans with bTBI also exhibited significantly smaller AD in networks connecting the hippocampus to the amygdala (p < 0.05).

Compared to Veterans with non-blast-related TBI, Veterans with bTBI exhibited decreased AD in neural pathways from the CN to the OFC, the putamen to the OFC, and the hippocampus to the amygdala - indicative of increased axonal injury in these areas. Our results suggest that, on a microstructural level, emotional and cognitive networks are susceptible to longitudinal blast-related white matter damage. This is consistent with the literature in post-concussion syndrome (PCS) and provides a potential mechanism underlying results previously reported from this sample, describing subjective cognitive complaints in the absence of objective clinical deficits. As such, therapies that target networks of emotional and cognitive control may be particularly beneficial for Veterans with bTBI.

Higher baseline dispersion (intra-individual variability) across neuropsychological test scores at a single time-point has been associated with more rapid cognitive decline, onset of Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD), faster rates of hippocampal and entorhinal atrophy, and increased AD neuropathology. Comparison between predictions made from test score dispersion within a cognitive domain versus global, cross-domain dispersion is understudied. Global dispersion may be influenced by ability-and test-specific characteristics. This study examined the performance of global versus domain-specific dispersion metrics to identify which is most predictive of cognitive decline over time.

Data for baseline and five follow-up visits of 308 participants with normal cognition (Mage=73.90, SD=8.12) were selected from the National Alzheimer’s Coordinating Center (NACC) Dataset. Participants were required to have no focal neurological deficits, or history of depression, stroke, or heart attack. Diagnoses and progression to MCI and/or dementia were determined at each visit through consensus conferences. Raw neuropsychological scores were standardized using NACC norms. Global baseline dispersion was defined as the intraindividual standard deviation (ISD) across the 10 scores in the NACC battery. Domain-specific dispersions were calculated by constructing composites and ISD was computed across tests sampling their respective domains (executive functioning/attention/processing speed [EFAS], language, and memory; see Table 1 for details on these tests). Higher values on each of these metrics reflect greater dispersion. Multinomial logistic regression model fit statistics and parameter estimates were compared across four different models (global, EFAS, Language, and Memory dispersion) covarying for age, years of education, sex, race, ethnicity, and ApoE4 status. Models were compared using the Likelihood Ratio Test (LRT) and the Akaike Information Criteria (AIC) of Models statistics.

Of the 308 participants, 70 (22.7%) progressed to MCI, and 82 (26.6%) progressed to dementia. Tables 1 and 2 show the results of the logistic regressions for the four models. All models fit the data well, with statistically significant predictions of conversion. Model 1 (global dispersion) showed a better fit than domain-specific models of dispersion per LRT and AIC values. Consistent with the results from mean differences between groups, parameter estimates showed that only global dispersion and EFAS dispersion significantly predicted conversion to dementia (when included with other covariates in models), with higher dispersion reflecting a greater risk of conversion.

In this sample, baseline global and EFAS dispersion measures significantly predicted conversion to dementia. Although global dispersion was a stronger predictor of dementia progression, findings suggest that executive functioning performance may be driving this relationship. A single index of global variability, from the calculation of standard deviation across test scores, may be supplementary for clinicians when distinguishing individuals at risk for dementia progression. None of the models were predictive of conversion to MCI. Further research is required to examine cognitive variability differences among patients who progress to MCI and patient-specific factors that may relate to test score dispersion and its utility in predicting the progression of symptoms.

The Youth Risk Behavior Survey (YRBS), conducted by the United States Centers for Disease Control and Prevention (CDC) in 2019, revealed that a large percentage of boys (30%) and girls (45%) reported serious difficulty concentrating, remembering, or making decisions as a result of a physical, mental, or emotional problem. In 2021, the CDC conducted the Adolescent Behaviors and Experiences Survey (ABES). The ABES included similar methodology and content as the YRBS. This study analyzed ABES data to examine correlates of perceived cognitive impairment among high school students in the United States during the COVID-19 pandemic.

The ABES was a one-time, online survey that was conducted to assess and evaluate the challenges that high-school aged youth experienced during the COVID-19 pandemic. Students’ perceived cognitive impairment was assessed using the same question used in the 2019 YRBS: 'Because of a physical, mental, or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions?' Response options were binary: 'Yes’ or 'No.' The students’ responses were evaluated in relation to nine adversity, mental health, and lifestyle variables.

Participants were 6,992 students, age 14 to 18, with 3,294 boys (47%) and 3,698 girls (53%). A large proportion endorsed experiencing serious difficulties concentrating, remembering, and making decisions (45%). Girls (56%) were significantly more likely to endorse perceived cognitive impairment compared to boys (33%) [X2(1)=392.55, p<.001; OR=2.66, 95% CI=2.41-2.93]. Youth who reported that their mental health was poor most of the time or always were very likely to report perceived cognitive impairment (boys: 67%; girls: 81%). Binary logistic regressions were used to examine the associations between perceived cognitive impairment, adversity, and lifestyle variables while controlling for mental health. These analyses were conducted separately for boys [X2(9)=596.70, p<.001; Nagelkerke R2=.24] and girls [x2(9)=883.35, p<.001; Nagelkerke R2=.30]. After controlling for current mental health, significant independent predicters of cognitive problems in boys and girls included: a lifetime history of discrimination based on race or ethnicity, lifetime history of being sexually assaulted or abused, lifetime history of using illicit drugs, being bullied in the past year, current marijuana use, and getting insufficient sleep (5 of fewer hours per night). Participation in sports and exercising regularly were both independently associated with lower rates of cognitive impairment.

Perceived cognitive impairment was endorsed by a strikingly high percentage of high school students in 2021 during the COVID-19 pandemic. More than half of high school aged girls and one third of boys reported having serious difficulty concentrating, remembering, and making decisions. These rates are considerably higher than in 2019. Current mental health, unfair treatment because of race or ethnicity, being sexually assaulted, being bullied, drug use, and insufficient sleep were associated with perceived cognitive impairment. Indicators of a physically active lifestyle (participation in sports and exercising regularly) were associated with lower rates of cognitive problems.

The increasing incidence rates of concussive injuries, specifically among the youth age demographic, has led to the Center for Disease Control and Prevention to classify these injuries as a “silent epidemic.” While symptoms from concussion typically remit within four weeks, many experience symptoms that persist beyond what is typically expected. For children, the persistence of symptoms can have damaging side-effects that impact daily functioning and the progression through developmental and educational milestones. Recent research highlights factors that modify the nature of outcomes after a concussive injury. For youth-aged individuals, one such factor is the presence of premorbid conditions. A growing body of research suggests children with learning disorders (LDs) may be more susceptible to negative symptom outcomes across neuropsychological domains. Therefore, the purpose of this study is to further examine the influence of developmental learning disorders on concussion outcomes among youths.

Youths between 7 and 19 years of age that sought care at a concussion specialty clinic were screened for inclusion in the current study. The final sample of included 54 patients who reported having a neurodevelopmental LD between the ages of 8 and 17 and 54 patients without LDs matched on age, race/ethnicity, and gender to serve as paired case-controls. Measures of post-concussive physical symptoms (Modified Balance Error Scoring System; Quality of Life in Neurological Disorders: Neuro-QoL-SD, Neuro-QoL-F), emotional state (BAI, BDI), parent report measure of behavioral manifestations of cognitive functioning (Behavioral Rating Inventory of Executive Function), and select measures from the CogState automated test battery (i.e., One-Back, Two-Back, Groton Maze Learning, and Groton Maze Recall) were administered during the patient’s first examination at the clinic. Patients were instructed by the provider to follow-up at the clinic between two-three weeks for a repeat examination. The current study examined concussion outcome variables via two (group: LD, control) by two (time: initial examination, follow-up examination) repeated measures ANCOVAs where time between injury and the first examination was included as a covariate to control for the duration of elapsed days since injury.

Regarding cognitive symptoms, parent reported behaviors associated with executive functioning symptoms increased over time to reach clinically significant levels for the LD group, while symptoms decreased and remained within normal limits for the control group. Performance-based measures of cognition revealed no significant interactions or group/time differences. Additionally, the LD group showed more intense balance problems compared to the control group and symptom trends suggest LD participants may be more susceptible to prolonged, clinically significant, balance problems. With respect to sleep disturbances and fatigue, symptoms remained within normal limits across groups and time. Depression and anxiety symptoms remained within normal limits across groups and time as well.

Results highlight more intense balance problems and parent-reported executive dysfunction following concussion for youths with LDs compared to those without LDs. Additionally, though not significantly different

than the control group, results reveal several symptom domains in which the level of dysfunction meets clinical significance for the LD group participants only. As such, this study highlights the continued need for the scientific study of risk factors for vulnerable populations to aid in assessment and prevention efforts, especially for youths with LD.

Functional magnetic resonance imaging (fMRI) research has generally focused on drawing conclusions from average brain activation patterns. Importantly, the brain is inherently variable; growing literature has found that within-individual blood oxygen level-dependent (BOLD) signal variability may be meaningful, and not just “noise.” For example, recent research has identified increased BOLD signal variability in healthy younger and older adults during more effortful/complex task loads of n-back paradigms, commonly used tasks that involve important elements of executive function (e.g., attention, working memory, planning, inhibition, etc.). Verbal fluency is a complex cognitive domain that also involves similar processes to generate words given certain rules. As a result, the current study builds on existing literature to investigate within-individual BOLD signal variability patterns in peak coordinates of a verbal fluency network during different loads of a letter n-back task. Due to greater executive demands, greater variability was expected during more effortful/complex n-back task loads in regions of a verbal fluency network.

Forty-eight healthy young adults (Mage(SD) = 22.41(4.47), 25 females) from the Atlanta area completed a letter n-back task in an MRI scanner. After standard processing in AFNI, images were corrected for motion and physiological artifacts, which may be confounding sources of variability. Volumes associated with each load of the letter n-back task (0-back, 1-back, 2-back, 3-back, crosshair) were identified. Task runs were normalized and respective run means were subtracted prior to concatenating all runs for each load type. Standard deviations were calculated across this mean-run corrected time series. Ten peak regions of interest (ROIs) were identified from a verbal fluency network generated from 84 peer-reviewed publications for this domain gathered on NeuroSynth. Paired samples t-tests with Benjamini-Hochberg correction for multiple comparisons were conducted to explore differences in variability during n-back task loads.

In several of the verbal fluency network ROIs, within-individual BOLD signal variability was significantly greater for 2-back versus 0-back loads with medium to large effect sizes (p’s < .001 - < .01, Cohen’s d range: .53-.93). Variability was also significantly greater for 3-back versus 0-back loads with small to medium effect sizes (p’s < .001 - < .01, Cohen’s d range: .48-.74). Specific regions that evidenced this pattern included ROIs in the left inferior frontal gyrus, left cingulate, right inferior frontal gyrus, left middle frontal gyrus, and left superior parietal lobule. Only two regions demonstrated increased variability in the 1-back load versus crosshair (left middle frontal gyrus, p < .001, d = .63; left lentiform nucleus, p < .05, d = .42). No regions demonstrated a significant difference in variability in the 0-back load versus crosshair.

This study contributes to growing literature examining within-individual BOLD signal variability in healthy individuals by exploring variability patterns in a verbal fluency network. The observed pattern of results supports the hypothesis and is in line with previous research, demonstrating that greater variability occurs with greater executive task demands. Future research can use an inscanner task of verbal fluency and can extend variability findings during this in-scanner task to out-of-scanner measures of verbal fluency.

Relative to their typically developing peers, autistic individuals experience greater difficulties in domains of functioning that are relevant to learning and adult outcomes, such as sensory sensitivities, anxiety, and social. However, little is known about how difficulties in these domains relate to the receipt of special education services as well as adult outcomes, such as vocational achievement. The current study sought to fill this gap by examining if difficulties in various learning-related domains as ascertained via the Learning Needs Screening Tool (LNST) were associated with historical special education receipt and vocational status.

400 autistic adults, recruited via the Simons Powering Autism Research (SPARK) participant registry Research Match service, participated in this study (40.5% male, mean age=28.9 years). All participants completed the LNST, which collects responses to 13 core questions about learning (such as challenges with memorization, note taking, spelling and identifying arithmetic signs), as well as 7 additional questions with checkbox and free response options, and yields a total score from 0-30. LNST item 14 and its response options (1-9) capture suspected causes of learning difficulties (e.g., 'too much noise or activity bothers me,' 'I get nervous taking tests'). These individual questions as well as the total of endorsed learning related challenges were then evaluated in relation to historical special education receipt (“yes” vs. “no”) and vocational outcomes (“yes” vs. “no” engaging in 10+ hours of postsecondary education or employment without supports), as assessed via the Taylor Vocational Index.

Logistic regression was utilized to predict the dependent variables of interest. Models included sex assigned at birth and age in the first step as covariates. Then either the total of learning related challenges endorsed or the 9 individual learning-related challenges from the LNST were included as independent variables of interest. For historical special education receipt, two items - “It’s hard for me to work by myself” (B = .78, p<.05) and “I get nervous taking tests” (B = .49, p<.05) were positively associated with a history of special education services. For vocational outcomes, the total learning related challenges (B = -.25, p<.001) as well as endorsement of one item -“It’s hard for me to work by myself” (B = -.88, p=<.05) were associated with poorer vocational outcomes.

These findings shed light on the possible learning-related challenges that are experienced by autistic adults. Further examination of the role these learning related challenges play in the receipt of special education and on vocational outcomes is warranted. In particular, difficulties with independence in work was related to both special education receipt and poorer vocational outcomes, indicating that it may be a fruitful area of focus for vocational training programs.

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.

In recent decades, a large body of evidence has linked prenatal exposure to environmental neurotoxins to adverse intellectual, neurodevelopmental, and psychiatric outcomes in offspring. This evidence has clearly highlighted the widespread impact of neurotoxin exposure on the developing brain; however, it is unclear how and why these exposures alter brain development in a way that appears to increase risk for multiple, seemingly disparate outcomes.

Shifting our focus from describing links between neurotoxin exposure and symptoms of offspring mental/cognitive problems considered categorically, to investigating how neurotoxins adversely affect domains of functioning known to cut across risk for multiple problems in offspring may be critical to answering these questions. This presentation will discuss how combining research in developmental neurotoxicology with novel systems that take dimensional approaches to understanding emotions, cognition, and behaviour (i.e., the NIHM Research Domain Criteria (RDoC)) may provide a fruitful future research direction for the field. The RDoC framework aims to understand neuropsychological outcomes (i.e., mental health, mental illness, IQ) across major domains of human emotion, cognition, behaviour, and social functioning, rather than within distinct diagnostic categories.

Using lead exposure as an example, this presentation will outline a framework for how researchers can use this dimensional approach to develop more specific hypotheses that can reveal how and why neurotoxin exposure increases risk for multiple adverse outcomes and elucidate the mechanisms that may underly these links.

Additionally, given that adverse development within domains of functioning can be detected prior to the onset of full-blown diagnoses, this research could enable us to develop more precise, targeted prevention and risk reduction campaigns. Adopting a dimensional framework will provide a more complete picture of the overall impact of prenatal exposure to neurotoxins - critical for informing public health policy.

Previous studies had shown that very low birth weight(VLBW) preterm children with normal early development had poorer cognitive executive functions(CEFs) and emotional executive functions(EEFs) at preschool-aged. There were still about 73% of children with deficits of CEFs and 74% of them with deficits of EEFs at school-aged. (Ni et al., 2011; Chiang et al., 2019; Lee et al., 2022). Besides, former studies less discuss the core neuropsychological ability related to the EFs development. In this study, meta-attention was chosen as the core ability. This study applied longitudinal design aimed to discuss the predictive power of meta-attention at preschool-aged on the CEFs and EEFs at school-aged for VLBW preterm and typically developing children.

The VLBW group was referred by Premature Baby Foundation of Taiwan. These children have been followed up with Bayley Scales of Infant Development(BSID) II or III administered at the age of 12 months and 24 months and Wechsler Preschool and Primary Scale of Intelligence-Revised(WPPSI-R) at the age of 5-year-old. Children with visual impairment, auditory impairment, cerebral palsy developmental indices of BSID-II or III less than 70, or full-scale IQ of WPPSI-R less than 70 were excluded.

The typical group was recruited from the community and included 30 children whose development was typical. Both preterm and typically developing children completed the CEFs and EEFs test at 6 and 8. Four types of CEFs including 33 indicators were assessed: Meta-attention including 18 indicators through Comprehensive Nonverbal Attention Test Battery(CNAT), working memory including 2 indicators through Digit Span Subtest of Wechsler Intelligence Scale for Children-IV(WISC-IV) and Knox’s Cube Test(KCT), planning ability including 6 indicators through Tower of London(ToL), and cognitive flexibility including 7 indicators through Wisconsin Card Sorting Test(WCST).

Two types of EEFs including 5 indicators were assessed. We designed Emotional EF Ecological Assessment Battery for Children in Taiwan to assess EEFs, including 3 indicators of theory of mind and 2 indicators of emotion regulation. Data were analyzed with correlation analysis and independent sample t-test.

Meta-attention at 6 among the VLBW group significantly correlated with 73.3% of CEFs and 80% of EEFs indicators at 8 and had significant predictive power on working memory, planning ability, cognitive flexibility, emotion regulation, and theory of mind. (p<.05) When the significance level was 0.01, meta-attention still correlated with 33% of CEFs and 80% of EEFs indicators and can predict those CEFs and EEFs among the VLBW group. Meta-attention at 6 among the typical group significantly correlated with 26.7% of CEFs and 80% of EEFs indicators at 8 and had significant predictive power on working memory, planning ability, emotion regulation, and theory of mind. (p<.05)

When the significance level was 0.01, meta-attention only correlated with 80% of EEFs indicators and can’t predict any CEFs and EEFs among the typical group.

Meta-attention at 6 can predict CEFs and EEFs among VLBW preterm children at 8, while the effect didn’t be found among typically developing children. Thus, meta-attention can be served as a clinical cut-point for VLBW preterm children to find the deficits and intervene early.

Anxiety is very common in Parkinson’s disease (PD) where according to a systematic review, the average prevalence is 31%, surprisingly higher than the average 17% of depressive disorders found in PD. Only a few studies have investigated the impact of anxiety on cognitive performance and brain morphology in PD. They demonstrated anxiety to be a significant predictor of cognitive impairment, where PD patients with anxiety have shown to be twice more likely to have deficits in the memory domain compared to those without anxiety. Furthermore, poorer cognitive performance in all cognitive domains was reported to be a significant risk factor for increased anxiety the following year. Anxiety in PD has also shown reduced volume/thinning in the fronto-cingulate, anterior cingulate cortex, left parietal cortices and the precuneus, despite the scant number of studies on this topic. Hence, the objective of this study aims to determine the evolution of cognitive performance and brain morphology in PD patients with and without anxiety over a three-year span.

We analyzed the baseline and three-year follow-up Parkinson’s Progression Markers Initiative (PPMI) data of 58 PD patients. MRI 3T was processed with FreeSurfer 7.1.1 on the Compute Canada cluster “Cedar” and we extracted cortical (Desikan-atlas-based volumes, thickness, area, folding index, curvature) and volumes of subcortical structures. Additionally, anxiety subscores from the State-trait anxiety inventory as well as neuropsychological tests were analyzed. PD patients were classified in two groups: PD-no-anxiety (n=46) and PD-anxiety (n=12) (subscore of > 40 on the State anxiety scale). Two-way mixed ANOVA models were established with presence/absence of anxiety as a between-subjects factor, time (baseline and three year) as a within-subjects factor and neuropsychological and MRI data were regarded as dependent variables.

Mixed ANOVA revealed that PD-anxiety saw a significantly greater decline in performance on the Montreal Cognitive Assessment test compared to PD-no-anxiety. In addition, PD-anxiety saw their performance decline over time in the Hopkins Verbal Learning test (HVLT) immediate recall, HVLT retention and HVLT delayed recall while PD-no-anxiety saw an increase in performance. In terms of brain morphology, over the three years, PD-anxiety had a greater decrease in the frontal precentral thickness, cingulate isthmus area and thickness, and temporal regions (transverse area and inferior folding) all in the left hemisphere compared to PD-no-anxiety. In subcortical regions, PD-anxiety had a greater decrease in volume of the hippocampal cornu ammonis-1 and pallidum compared to PD-no-anxiety. By contrast, PD-anxiety showed a greater increase in curvature of the frontal middle rostral, frontal pole, parietal supramarginal, and insula cortex as well as in the folding of the parietal superior and occipital pericalcarine of the right hemisphere in comparison to PD-no-anxiety.

This study highlights the importance of taking into consideration anxiety symptoms in PD, as they contribute to poorer cognitive performance and frontal, parietal and temporal differences over time. More studies with a larger sample size are needed in order to confirm these results.