Print Knowledge in children starts with recognizing and characterizing printed figures; it is a precursor of other skills like letter knowledge and phonological awareness. The goal was to assess print knowledge components and their predictive value in emerging literacy in a sample of Mexican preschoolers.

60 children (aged 4 to 6 years old; 50% boys and 50% girls) were tested with an analysis of the visual synthesis and the figure copy from the SNBP-MX and the Rey Complex Figure Test (children’s version).

Children with lower performance in the SNBP-MX cannot use visual information to perform correctly at the Rey Complex Figure. They have problems in the reproduction of the figure, and they do not respect the components of the Print Knowledge: 1) figure building characteristics (size, rotation, orientation) and function (relationship with the background and with other figures).

Early visual perception skills impairments are related to the execution of elements from the Print Knowledge. Therefore, it is expected that children with low performance at visoperception and spatial tasks will have difficulties with early literacy. Since visual information is needed for the copy and learning of writing figures, print knowledge could be categorized as a predictor of the early word and letter recognition skills. We thank project PAPIIT IN308219 for sponsoring this research.

Class III obesity is associated with increased risk for cognitive impairment. Though hypothesized to be partially attributable to sedentary time (ST), past research examining the association between ST and cognitive function has produced mixed findings. One possible explanation is that studies do not typically account for the highly correlated and almost inverse relationship between ST and light intensity physical activity (LPA), such that ST displaces time engaging in LPA. Therefore, we aimed to evaluate whether: (1) higher ST-to-LPA time ratio associates with poorer performance across multiple cognitive domains in patients with Class III obesity seeking bariatric surgery; and (2) the associations differ by sex.

Participants (N = 121, 21-65 years of age, BMI > 40 kg/m2) scheduled for either Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) completed the NIH Toolbox, a computerized neuropsychological assessment battery and wore a waist-mounted ActiGraph monitor during waking hours for 7 days to measure minutes/day spent in ST, LPA, and moderate-to-vigorous physical activity (MVPA). A ratio of time spent in ST-to-LPA was calculated by dividing the percentage of daily wear time spent in sedentary behavior (SB) by the percentage of daily wear time spent in LPA.

On average, participants (mean age = 43.22 years old and BMI = 45.83 kg/m2) wore the accelerometer for 909±176 minutes/day and spent 642±174 minutes/day in ST, 254±79 minutes/day in LPA, and 14±13 minutes/day in MVPA. Mean daily ST-to-LPA time ratio was 2.81 ± 1.3 (0.73-7.11). Overall, bivariate Pearson correlations found no significant relationships between LPA and cognitive performance on any of the NIH Toolbox subtests (r values = -.002 to -.158, all p values >.05). Additionally, bivariate Pearson correlations also found no significant relationships between daily ST-to-LPA time ratio and cognitive performance on any of the subtests (r values = .003 to .108, all p values >.05). However, higher ST-to-LPA was associated with lower scores on the Dimensional Change Card Sort Test in women (r = -.26, p = .01).

Results showed that participants’ mean daily time spent in ST was 2.5 times higher than that spent in LPA and a higher ratio of ST-to-LPA was associated with poorer set-shifting in women with Class III obesity. Future studies should look to clarify underlying mechanisms, particularly studies examining possible sex differences in the cognitive benefits of PA. Similarly, intervention studies are also needed to determine if increasing LPA levels for individuals with Class III obesity would lead to improved cognitive performance by means of reducing ST.

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.

Illness perception, or the ways in which individuals understand and cope with injury, has been extensively studied in the broader medical literature and has been found to have important associations with clinical outcomes across a wide range of medical conditions. However, there is a dearth of knowledge regarding how perceptions of traumatic brain injury (TBI) influence outcome and recovery following injury, especially in military populations. The purpose of this study was to examine relationships between illness perception, as measured via symptom attribution, and neurobehavioral and neurocognitive outcomes in Veterans with TBI history.

This cross-sectional study included 44 treatment-seeking Veterans (86.4% male, 65.9% white) with remote history of TBI (75.0% mild TBI). All Veterans were referred to the TBI Cognitive Rehabilitation Clinic at VA San Diego and completed a clinical interview, self-report questionnaires, and a neuropsychological assessment. A modified version of the Neurobehavioral Symptom Inventory (NSI) was administered to assess neurobehavioral symptom endorsement and symptom attribution. Symptom attribution was assessed by having participants rate whether they believe each NSI item was caused by TBI. A total symptom attribution score was computed, as well as the standard NSI total and symptom cluster scores (i.e., vestibular, somatic, cognitive, and affective symptom domains). Three cognitive composite scores (representing mean performance) were also computed, including memory, attention/processing speed, and executive functioning. Participants were excluded if they did not complete the NSI attribution questions or they failed performance validity testing.

Results showed that the symptoms most frequently attributed to TBI included forgetfulness (82%), poor concentration (80%), and slowed thinking (77%). There was a significant positive association between symptom attribution and the NSI total score (r = 0.62, p < .001), meaning that greater attribution of symptoms to TBI was significantly associated with greater symptom endorsement overall.

Symptom attribution was also significantly associated with all four NSI symptom domains (r’s = 0.47-0.66; all p’s < .001), with the strongest relationship emerging between symptom attribution and vestibular symptoms. Finally, linear regressions demonstrated that symptom attribution but not symptom endorsement was significantly associated with objective cognitive functioning. Specifically, greater attribution of symptoms to TBI was associated with worse memory (ß = -0.33, p = .035) and attention/processing speed (ß = -0.40, p = .013) performance.

Results showed significant associations between symptom attribution and (1) symptom endorsement and (2) objective cognitive performance in Veterans with a remote history of TBI. Taken together, findings suggest that Veterans who attribute neurobehavioral symptoms to their TBI are at greater risk of experiencing poor long-term outcomes. Although more research is needed to understand how illness perception influences outcomes in this population, results highlight the importance of early psychoeducation regarding the anticipated course of recovery following TBI.

Epilepsy is a chronic neurological disease, and surgery is a common treatment option for persons who do not respond to medication. Neuropsychology plays an important role in the epilepsy presurgical workup, characterizing the cognitive functioning of patients with epilepsy as well as assisting in the determination of which hemisphere seizures originate in the brain through testing of different cognitive functions. NeuroQuant is a relatively newer software that analyzes clinical neuroimaging to quantify brain volume. The objective of this study was to determine if changes in left versus right total hippocampal volume predicted changes in verbal versus nonverbal memory performance.

Cognitive performance and NeuroQuant bilateral hippocampal volume were examined in a cross-sectional sample of 37 patients with epilepsy. All patients had undergone a comprehensive presurgical neuropsychological evaluation as well as magnetic resonance imaging (MRI) and these results were analyzed using a series of linear regression analyses.

Total left hippocampal volume was a significant predictor of delayed verbal free recall (RAVLT F(1, 31) = 4.79, p< .036, RA2 = 0.13, and ß=.37, p<.036). Even when controlling for the effects of biological sex, education, and depression, left hippocampal volume remained a significant predictor (ß=.42, p<.025). Total left hippocampal volume did not predict other verbal memory scores. Total right hippocampal volume was a significant predictor of delayed nonverbal figure recall (RCFT F(1, 31)= 6.46, p<.016), RA2 = .17 and ß=.42) p<.016). When controlling for the effects of biological sex, education, and depression, right hippocampal volume remained a significant predictor (ß=.404, p<.026). Total right hippocampal volume did not predict other nonverbal memory scores.

These findings validate prior research demonstrating the importance of the left hippocampus in verbal memory and right hippocampus in nonverbal memory. Findings also demonstrate the clinical utility of neuropsychological evaluation in determining laterality in the epilepsy presurgical workup process, as well as support NeuroQuants’ inclusion as an additional consideration in that process.

To examine whether suboptimal performance as determined by formal validity testing would predict neurocognitive scores in a sample of 83 pre-surgical, non-litigating epilepsy patients.

Participants were 83 patients who underwent comprehensive outpatient neuropsychological testing as part as their evaluation as epilepsy surgery candidates. The sample consisted of 41 females and 42 males, with 72 patients identifying as White, 5 as Black, 2 as Hispanic, 1 as Asian, and 2 as other. Mean age was 36 (SD=12.4) mean FSIQ was 87 (SD=12.7), mean years of education of 12.9 (SD=2.1). Each patient’s assessment included a stand-alone performance validity test (PVTs)— Word Memory Test (WMT), the Test of Memory Malingering (TOMM), or the Medical Symptom Validity Test (MSVT)—as well as two embedded measures of validity—the California Verbal Learning Test Forced Choice (CVLT FC) and WAIS-IV Reliable Digit Span (RDS). Pass/fail rates were analyzed, with valid performance being defined as pass score on at least two of the completed PVTs (N=73 Pass Effort group 86.9%; N=10 Failed Effort group 11.9%). Point-biserial Pearson correlations were conducted to determine the relationship between validity pass/fail status and WAIS-IV FSIQ, VCI, and PRI scores, CVLT-II Trials 1-5 Total T scores, CVLT-II Long Delay Free Recall z scores, WMS-III Logical Memory II T scores, BVMT Total Recall T scores, BVMT Delayed Recall T scores, and Trail Making Test (TMT) B T scores.

Significant relationships were found between Failed Effort group and all neurocognitive scores except BVMT Total Recall. On average, the Failed Effort group obtained significantly lower FSIQ (M=76.57, SD=10.94), VCI (M=80.89, SD=16.03), PRI (M=81.00, SD=14.91), CVLT-II Trials 1-5 Total (M =34, SD=6.89), CVLT-II Long Delay Free Recall (M =-2.44, SD=1.43), WMS-IV Logical Memory II (M =4.83, SD=2.79), BVMT Delayed Recall (M=26.38, SD=6.41), and TMT B (M=29.70, SD=11.46) standard scores compared to the Pass Effort group (FSIQ M=88.09, SD=12.52; VCI M=92.13, SD=13.61; PRI M=91.14, SD=12.06; CVLT-II Trials 1-5 Total M=47.86, SD=12.02; CVLT- II Long Delay Free Recall M=-.44, SD=1.11; WMS-III Logical Memory II M=8.41, SD=3.17; BVMT Delayed Recall M=39.19, SD=12.66; TMT B M=39.34, SD=13.18). Correlation coefficients were r=-.266* (FSIQ), r=-.255* (VCI), r=-.271* (PRI), r=.361**(CVLT-II Total), r=-.474** (CVLT-II LDFR), r=-.298** (WMS-IV LM II), r=-.308** (BVMT DR), and r=-.240* (TMTB). All coefficients were significant at the .05 (*) or .01 (**) level.

Results suggest that pass/fail status on formal validity testing predicts depressed performance on a variety of neurocognitive measures. Therefore, predicting surgical outcome of resection/ablation (e.g., compensation of contralateral hemisphere) should not be based upon neuropsychological memory performance alone when there are failures on tests of engagement as memory scores have strong correlations to pass/fail status on formal validity testing. Overall, this emphasizes the importance of routinely integrating PVTs as part of pre-epilepsy surgery neuropsychological evaluations.

Telecommunication-assisted neuropsychological assessment (teleNP) has become more widespread, particularly in response to the COVID-19 pandemic. However, comparatively few studies have evaluated in-home teleNP testing and none, to our knowledge, have evaluated the National Alzheimer’s Coordinating Center’s (NACC) Uniform Data Set version 3 tele-adapted test battery (UDS v3.0 t-cog). The current study compares in-home teleNP administration of the UDS v3.0, acquired while in-person activities were suspended due to COVID-19, with a prior in-person UDS v3.0 evaluation.

210 participants from the Michigan Alzheimer’s Disease Research Center’s longitudinal study of memory and aging completed both an in-person UDS v3.0 and a subsequent teleNP UDS v3.0 evaluation. The teleNP UDS v3.0 was administered either via video conference (n = 131), telephone (n = 75), or hybrid format (n = 4) with approximately 16 months between evaluations (mean = 484.7 days; SD = 122.4 days; range = 320-986 days). The following clinical phenotypes were represented at the initial assessment period (i.e., the most recent in-person UDS v3.0 evaluation prior to the teleNP UDS v3.0): cognitively healthy (n = 138), mild cognitive impairment (MCI; n = 60), dementia (n = 11), and impaired not MCI (n = 1). Tests included both the in-person and teleNP UDS v3.0 measures, as well as the Hopkins Verbal Learning Test-Revised (HVLT-R) and Letter “C” Fluency.

We calculated intraclass correlation coefficients (ICC) with raw scores from each time point for the entire sample. Sub-analyses were conducted for each phenotype among participants with an unchanged consensus research diagnosis: cognitively healthy (n = 122), MCI (n = 47), or cognitively impaired (i.e., MCI, dementia, and impaired not MCI) (n = 66). Test-retest reliability across modalities and clinical phenotypes was, in general, moderate. The poorest agreement was associated with the Trail Making Test (TMT) - A (ICC = 0.00; r = 0.027), TMT - B (ICC = 0.26; r = 0.44), and Number Span Backward (ICC = 0.49). The HVLT-R demonstrated moderate reliability overall (ICC = 0.51-0.68) but had notably weak reliability for cognitively healthy participants (ICC = 0.12-0.36). The most favorable reliability was observed in Craft Story 21 Recall - Delayed (ICC = 0.77), Letter Fluency (C, F, and L) (ICC = 0.74), Multilingual Naming Test (MINT) (ICC = 0.75), and Benson Complex Figure – Delayed (ICC = 0.79).

Even after accounting for the inherent limitations of this study (e.g., significant lapse of time between testing intervals), our findings suggest that the UDS v3.0 teleNP battery shows only modest relationships with its in-person counterpart. Particular caution should be used when interpreting measures showing questionable reliability, though we encourage further investigation of remote vs. in-person testing under more controlled conditions.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a well validated and reliable clinical assessment tool that can be used for characterizing cognitive function in older adults. The RBANS has been shown to reliably discriminate between Alzheimer’s disease (AD), mild cognitive impairment (MCI), and cognitively healthy (CH) individuals. While the RBANS has traditionally been administered in a face to face setting, administration is also feasible via telehealth. Due to the COVID-19 pandemic, cognitive assessments were unexpectedly moved to telehealth formats. Given this, the current study assessed whether differences emerged between face to face and telehealth RBANS scores in both individuals who were CH and had MCI.

A total of 61 individuals (NCH = 27, NMCI = 34) completed baseline and 1-year follow-up visits in the current study. The sample was predominantly female (N = 43, 70.5%), identified as white (N = 57, 93.4%), and were well educated (MYears = 15.93). Participants completed the RBANS form B at an in-person baseline visit and form C at a one year follow-up visit. Higher RBANS scores indicate overall better cognitive performance. As expected, CH individuals performed better than those with MCI on immediate memory, language, attention, delayed memory, and total score. There were no significant differences found for the visuospatial index. Repeated measures ANOVAs were conducted to assess whether differences in RBANS performance existed based on test administration method.

Group differences between testing formats were observed in CH individuals on immediate memory [F(1,37) =9.10, p < .01)], language [F(1, 37)=9.41=p < .01)], and total score [F(1,37)=6.56, p < .05], with higher performance in those who completed the followup session in-person.There were no differences in baseline performance on any RBANS index between those who received an in person versus telehealth format (p’s > .05). No differences were observed in the MCI group. There were no significant differences observed between the CH and MCI group on demographic factors.

Results from the current study suggest that CH counterparts experienced a greater degree of difference in scores between testing formats, whereas individuals with MCI did not. The lack of difference in MCI individuals may be due to less room for variability over time for this group given already low scores. These results suggest that while telehealth has been shown to be a viable option for RBANS administration in some samples, further work needs to be conducted regarding the equivalence of in-person vs. telehealth formats. This study is not without limitations. The small MCI group was segmented into in-person and telehealth groups, further reducing power to detect statistically significant results. The sample was also homogenous with highly educated, Caucasian women. Future research should aim to assess a larger, more diverse sample to identify whether RBANS is a reliable measure alone for assessing cognitive change over time via telehealth for MCI.

Cognitively healthy individuals who complete a neuropsychological test battery can obtain very low scores. These very low scores are not likely indicative of cognitive impairment but are rather considered spuriously low scores. The expected number of low scores varies based on number and type of neuropsychological tests. Typically, base rates have been determined from normative samples, which could differ from samples seen in clinical settings. The current study reports on base rates of spuriously low cognitive scores in older adults presenting to a memory clinic who were diagnosed with subjective cognitive impairment after interprofessional assessment and information from collateral informants ruled out objective cognitive impairment.

Base rates of spuriously low scores for a neuropsychological battery of 12 scores were based on 92 cognitively healthy older adults presenting to a specialist memory clinic (M(age) = 61.00, SD = 12.00; M(edu) = 12.00, SD = 2.74). Crawford’s Monte Carlo simulation algorithm was used to estimate multivariate base rates by calculating the percentage of cognitively healthy memory clinic patients who produced age and education normed scores at or below the 5th percentile. The following tests were used to produce the 12 scores: block design, digit span backwards, and coding from the WAIS-IV; logical memory I and II from the WMS-IV; immediate and delayed memory scores from the California Verbal Learning Test Second Edition short form; immediate and delayed memory scores from the Brief Visuospatial Memory Test Revised; category switching, letter number sequencing, and inhibition switching from the Delis Kaplin Executive Functioning System.

An estimated 33.58% of the cognitively healthy memory clinic population would have one or more low scores (5th percentile cutoff),14.7% would have two or more low scores, 6.55% would have three or more, 2.94% would have four or more, and 1.31% percent would have 5 or more very low scores due to chance.

Determining base rates of spuriously low scores on a neuropsychological battery in a clinical sample of referred older adults with subjective memory complaints could assist in the diagnostic process. By understanding base rates of clinical samples, clinicians can use empirical data to adjust for expected low scores rather than using conventional corrections (such as 1/20 test scores expected to be low). In a memory clinic sample, three or more low test scores out of 12 is expected to be relatively rare in those who were later determined to have no objective evidence of cognitive impairment based on interprofessional assessment. Understanding normal frequency of low scores will prevent undue conclusions of cognitive impairment which will minimize false positives in diagnosis.

Research indicates that Veterans with a history of traumatic brain injury (TBI) are at increased risk for dementia. Although the precise mechanisms underlying this relationship are poorly understood, remote TBI may exacerbate normal age-related changes to cerebral white matter (WM) and result in cognitive decline. However, Veterans commonly experience a constellation of mental (e.g., post-traumatic stress disorder [PTSD] and depression) and vascular (e.g., diabetes, hypertension, obesity) health conditions that have also been implicated in pathologic cerebral WM and cognitive aging trajectories. Therefore, the present study sought to (1) clarify the effects of remote TBI within the context of PTSD, depression, and vascular risk on WM micro- and macrostructure, and (2) explore if WM integrity is associated with cognition in a sample of Vietnam-Era Veterans.

The sample consisted of 195 male Veterans ages 60-80 (mean age=69.3) enrolled in the Department of Defense-Alzheimer’s Disease Neuroimaging Initiative (DoD-ADNI) study. 102 Veterans met criteria for TBI by sustaining a head-injury that resulted in a loss of consciousness, alteration of consciousness, or post-traumatic amnesia. Current and/or lifetime PTSD was designated by scores >30 on the Clinician-Administered PTSD Scale. The Geriatric Depression Scale was used as a continuous measure of depression. A vascular risk score (0-3) was calculated based on diabetes, hypertension, and obesity (BMI >30 kg/m2). An executive functioning composite was created by averaging sample-specific z-scores for Trail Making Tests (A and B), with higher scores indicating worse performance. Voxelwise analysis of WM microstructure (fractional anisotropy [FA]) was conducted with Tract-Based Spatial Statistics (TBSS), using non-parametric permutation testing with threshold-free cluster enhancement. SPM’s Lesion Segmentation Tool was used to investigate WM macrostructure (WM hyperintensity [WMH] volume). Lesion probability maps were masked to restrict WMH volume calculations to WM. Robust regression using M-estimation and predictive R2 calculated using 10-fold cross-validation examined WMH volume, predictor, and cognitive associations. Age was a covariate in all WM analyses, and education was a covariate in all cognitive analyses.

TBSS analysis revealed widespread, significant negative relationships between vascular risk and FA across numerous WM tracts (p’s<0.05). These associations remained significant after adjusting for TBI history, PTSD, and depression. TBSS identified significant positive relationships between executive functioning performance and FA across similar brain regions (p’s<0.05). Robust regressions revealed that vascular risk significantly predicted WMH volume (p=0.006; ß=0.161; R2=0.093), whereas TBI history, PTSD, and depression did not (p’s=0.107-0.166; ß's=-0.089-0.101). WMH volume significantly predicted executive functioning (p=0.002; ß=0.216; R2=0.105), whereas TBI history, PTSD, depression, and vascular risk did not (p’s=0.123-0.888; ß's=-0.012-0.125).

Our results suggest that vascular health, relative to remote TBI, PTSD, and depression, may be more robustly associated with cerebral WM micro- and macrostructure in older Veterans. Furthermore, poorer WM integrity is associated with poorer cognitive performance. These findings underscore the importance of vascular health interventions in preventing negative brain and cognitive aging outcomes in Veterans, independent of TBI history. Future studies might leverage other neuroimaging modalities (e.g., functional MRI) to further investigate the effects of vascular health on aging in Veterans with a history of TBI.

The dynamic transitions towards and away from digitizing mental health care services have put immense pressure on neuropsychology to develop a more technologically advanced approach to patient care. Consistent with this, neuropsychologists are faced with an increasing burden to rapidly learn novel techniques of administering digital and/or remote cognitive measures, which may not be sufficiently standardized and/or psychometrically validated.

The Hybrid Neuropsychology model, which aims to provide a framework for the integration of digital tools in neuropsychological assessment, has been incorporated routinely in our clinical practice, and among diverse clinical populations in inpatient and outpatient settings.

This talk aims to 1) provide a brief background on Hybrid Neuropsychology; 2) discuss preliminary findings from our ongoing studies implementing this approach in clinical populations; and 3) offer key insights gleaned from methodological, analytical, and practical perspectives.

Future work towards building a more integrative method of data collection and storage based on extant preliminary data will also be discussed.

Word finding difficulty is a prevalent cognitive symptom in multiple sclerosis (MS). Word finding relies on retrieving concepts and word forms from the long-term store. Neuropsychological assessment of word finding difficulty in persons with MS (pwMS) is typically characterized by semantic errors and decreased speed in naming tests, along with decreased semantic verbal fluency scores. Despite this, there is significant heterogeneity in the detection of verbal fluency deficits across studies in the MS literature. This may be partially due to disease-related heterogeneity and/or low sensitivity of commonly used scoring approaches. We investigate the latter in the present study. Semantic network analysis, derived from graph theory, provides a fine-grained approach to understanding semantic retrieval by utilizing information about the co-occurrence of words produced on semantic verbal fluency tasks. Analysis results in a graphical quantification of the conceptual-lexical store. A preliminary study found that semantic networks from Spanish-speaking pwMS had fewer associative connections and more central connective pathways, which if affected, may lead parts of the network to become inaccessible for retrieval. However, their investigation was limited in the generalizability of their findings, as they excluded pwMS who have cognitive impairment (CI), which represents a significant proportion of pwMS. We sought to investigate network differences in an English-speaking MS sample, without exclusion based on CI, using widely-used metrics of micro-, meso-, and macroscopic structure. We hypothesize the MS network will be less efficiently organized, thus characterized by higher average shortest path length (ASPL), lower clustering coefficient (CC) and lower modularity (Q).

53 persons with MS and 44 neurologically healthy controls (HC) were recruited as a part of an ongoing study (NMSS RG-1907-34364 & RG-1901-33304). As a part of a larger battery, participants were administered the semantic verbal fluency subtest of the Controlled Oral Word Association Test. Responses were analyzed using a network-analysis R suite.

The MS and HC networks were characterized by having similar average shortest path lengths (ASPL MS =2.466, ASPL HC=2.463, F(1,1997)=0.281, p=0.596), indicating they require similar numbers of edges to be traversed to reach other nodes in the network. This suggests similar efficiency of information transfer. Clustering coefficient was not significantly different between the MS and HC networks (CC MS = 0.742, CC HC =0.742, F(1,1997)=0.10, p=0.919), suggesting similar local interconnectivity. The MS network had significantly lower modularity compared to the HC network (Q MS =0.497, Q HC = 0.502, F(1,1997)=16.678, p<0.001). This means that sub-communities of the network were less segregated into densely connected sub-graphs.

Contrary to expectation, ASPL and CC were not significantly different between groups. The absence of finding lower CC was consistent with prior findings. Consistent with our hypothesis, the MS network had lower modularity. This may suggest that pwMS were unable to use categorical clustering to aid in retrieval from the lexicon. Specifically, low modularity coupled with similar CC may suggest the structure of the MS lexicon is characterized by intact clustering on a microscopic scale but less strong organization into distinct clusters on a larger scale.

Neuropsychiatric symptoms concerning mood are common in Alzheimer's disease (AD), but it is unclear if they are etiologically related to AD pathophysiology or due to factors considered to be non-pathogenic, such as small vessel cerebrovascular disease. New generation clinical trials for AD often enroll participants with evidence of AD pathophysiology, indexed by amyloid PET scanning, but who are cognitively asymptomatic. We used screening data from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's (A4) study to examine the extent to which depressive symptoms are associated with amyloid pathophysiology and small vessel cerebrovascular disease, in the form of white matter hyperintensities (WMH).

The A4 study randomizes cognitively healthy older adults with evidence of amyloid pathophysiology on PET scanning. We used screening data, which included amyloid status (positive, negative) by visual read, amyloid PET standard uptake value ratio (SUVR) in cortical regions, and MRI data acquired in a subset (n=1,197, mean age 71.6 +/- 4.8 years, 57% women) to quantitate total WMH volume. Depressive symptoms were evaluated with the 15-item Geriatric Depression Scale, which we used both as a continuous variable and to define 'depressed' and 'non-depressed' groups, based on a cut score of > 5. We examined whether 1) depressive symptoms and proportion of depressed individuals differed between amyloid positive and negative groups, 2) there is a relationship between amyloid SUVR and depressive symptoms that differs as a function of amyloid positivity status, and 3) there is a relationship between WMH volume and depressive symptoms that differs as a function of amyloid positivity status.

Although depressive symptom severity did not differ between groups (t=0.14, p=0.88), a greater proportion of individuals were classified as depressed in the amyloid negative group than the amyloid positive group (3.5% vs. 1.9%, X2=4.60, p=0.032). Increased amyloid SUVR was associated with increased GDS scores among amyloid positive individuals (r=0.117, p=0.002) but not among amyloid negative individuals (r=0.006, p=0.68, Positivity Status x SUVR interaction on GDS: ß=0.817, p=0.029). Increased WMH was associated with higher GDS scores (ß=0.105, p=0.017) but not differentially in amyloid positive and negative participants (Positivity Status x WMH interaction on GDS: ß=-0.010, p=0.243).

These analyses have several implications. First, individuals who are screened to participate in a clinical trial but do not have evidence of amyloidosis may be misattributing concerns about underlying AD pathophysiology to depressive symptoms. Second, the severity of AD pathophysiology, indexed by amyloid PET SUVR, may drive a small increase in depressive symptomatology among individuals over visual diagnostic thresholds. Third, small vessel cerebrovascular changes are additionally associated with depressive symptoms but in a manner that is independent of AD pathophysiology. Overall, depressive symptoms and depression are likely multiply determined among prospective clinical trial participants for preclinical AD.

Due to decades of structural and institutional racism, minoritized individuals in the US are more likely to live in low socioeconomic neighborhoods, which may underlie the observed greater risk for neurocognitive impairment as they age. However, these relationships have not been examined among people aging with HIV. To investigate neurocognitive disparities among middle- and older-aged Latino and non-Latino White people living with HIV (PWH), and whether neighborhood socioeconomic deprivation may partially mediate these relationships.

Participants were 372 adults ages 40-85 living in southern California, including 186 Latinos (94 PWH, 92 without HIV) and 186 non-Latino (NL) Whites (94 PWH, 92 without HIV) age-matched to the Latino group (for the overall cohort: Age M=57.0, SD=9.1, Education: M=12.7, SD=3.9, 38% female; for the group of PWH: 66% AIDS, 88% on antiretroviral therapy [ART]; 98% undetectable plasma RNA [among those on ART]). Participants completed psychiatric and neuromedical evaluations and neuropsychological tests of verbal fluency, learning and memory in person or remotely. Neuropsychological results were converted to demographically-unadjusted global scaled scores for our primary outcome. A neighborhood socioeconomic deprivation variable (SESDep) was generated for census tracts in San Diego County using American Community Survey 2013-2017 data. Principal components analysis was used to create one measure using nine variables comprising educational (% with high school diploma), occupational (% unemployed), economic (rent to income ratio, % in poverty, (% female-headed households with dependent children, % with no car, % on public assistance), and housing (% rented housing, % crowded rooms) factors. Census tract SESDep values were averaged for a 1km radius buffer around participants’ home addresses.

Univariable analyses (independent samples t-tests and Chi-square tests) indicated Latinos were more likely to be female and had fewer years of formal education than NL-Whites (ps<.05). Latino PWH had higher nadir CD4 than White PWH (p=.02). Separate multivariable regression models in the overall sample, controlling for demographics and HIV status, showed Latinos had significantly lower global scaled scores than Whites (b=-0.59; 95%CI-1.13, -0.06; p=.03) and lived in more deprived neighborhoods (b=0.62; 95%CI=0.36, 0.88; p<.001). More SES deprivation was significant associated with worse global neurocognition in an unadjusted linear regression (b=-0.55; 95%CI=-0.82, -0.28; p<.001), but similar analyses controlling for demographics and HIV status, showed SESDep was not significantly related to global scaled scores (b=-0.11; 95%CI= -0.36, 0.14; p=.40). Exploratory analyses examined primary language (i.e., English vs Spanish) as a marker of Hispanic heterogeneity and its association with neurocognition and SESDep. Controlling for demographics and HIV status, both English-speaking (b=0.33; 95%CI=0.01. 0.64; p=.04) and Spanish-speaking Latinos (b=0.88; 95%CI=0.58, 1.18; p<.001) lived in significantly greater SESDep neighborhoods than Whites, with SESDep greater for Spanish-speakers than English-speakers (p<.001). However, only English-speaking Latinos had significantly lower neurocognition than Whites (b=-0.91; 95%CI=0-1.57, -0.26; p<.01; Spanish-speakers: b=-0.27; 95%CI=-0.93, 0.38; p=.41).

Among our sample of diverse older adults living with and without HIV, English-speaking Latinos showed worse neurocognition than Whites. Though SES neighborhood deprivation was worse among Latinos (particularly Spanish-speakers) it was not associated with neurocognitive scores after adjusting for demographics. Further studies investigating other neighborhood characteristics and more nuanced markers of Hispanic heterogeneity (e.g., acculturation) are warranted to understand factors underlying aging and HIV-related neurocognitive disparities among diverse older adults.

The MMPI-2-RF contains scales that assess different types of invalid response styles, especially potential symptom over-reporting (e.g., F-r, Fs, Fp-r, FBS-r, RBS). However, these scales are not designed to specifically capture noncredible symptoms reports associated with Attention-Deficit/Hyperactivity Disorder (ADHD). Robinson & Rogers (2018) proposed the experimental Dissimulation ADHD validity scale (Ds-ADHD) on the MMPI-2-RF that was effective in distinguishing credible and non-credible ADHD diagnoses via a simulator-based study. Within the current study, the Ds-ADHD scale was compared to the established MMPI-2-RF validity scales within a mixed sample of U.S. Military Veterans.

173 Veterans (Mage = 36.18, SDage = 11.10, Medu = 14.01, SDedu = 2.11, 88% male, 81% White, 17% Black) completed a neuropsychological evaluation which included an internally consistent MMPI-2-RF profile and up to 10 performance validity tests (PVTs) as well as a question about a possible ADHD diagnosis. The credible group was determined if participants passed all PVTs (n=146) and completed at least 2 PVTs. The non-credible group was determined by failing two or more PVTs (n=27). Group assignment was clinically confirmed. The Ds-ADHD scale was calculated according to Robinson & Rogers’ (2018); responses of “true” (i.e., erroneous stereotypes) were coded as 1 and “false” answers were coded 2, creating a 10- to 20-point scale. Thus, lower scores would be associated with a higher likelihood of a feigned ADHD presentation. Other MMPI-2-RF validity scales of interest included F-r, Fs, Fp-r, FBS-r, and RBS.

The established MMPI-2-RF validity scales were significantly correlated with PVT group membership, but correlations were weak to moderately strong (rS ranged from -.43 to -.18; ps < .05). A series of stepwise regression models were completed with the Ds-ADHD scale and one of the MMPI-2-RF validity scales as independent variables, with group membership as the dependent variable. Ds-ADHD) contributed uniquely to each model (CÜ ranged from .03 to .04, ps < .05). The established MMPI-2-RF validity scales effectively classified group membership (AUC values ranged from .57 to .68), and the Ds-ADHD scale had a marginally higher AUC (.69); however, it was not statistically significantly stronger than any of the established scales (ps > .05).

Clinicians interested in identifying potentially simulated ADHD presentations with the MMPI-2-RF may desire to calculate the Ds-ADHD scale, which previously only had support from a simulator-based study. The Ds-ADHD scale significantly contributed to each model, suggesting that it helped explain groups over and above each of the traditional MMPI-2-RF validity scales. However, it only had a marginally stronger ability to classify participants, indicating that there may be diminishing returns for clinicians. Among the traditional validity scales, RBS and F-r best classified groups, and FBS-r was the least effective. This study employed a cross-sectional design in a mixed sample of Veterans undergoing a neuropsychological evaluation. Future research should focus on replicating the findings using a credible sample that was limited to an independently verified diagnosis of ADHD.

Obstructive sleep apnea (OSA) has been associated with cognitive deficits as evidenced by neuropsychological testing in the domains of attention/working memory, verbal memory, processing speed, and executive function. OSA is often comorbid with hypertension and has been considered a risk factor for hypertension (Kareem et al., 2018; Tietjens et al., 2019). Both hypertension and OSA have been shown to be independent predictors of memory (Kinoshita et al., 2012). OSA and posttraumatic stress disorder (PTSD) are also frequently co-occurring, especially among veterans. In a group of veterans with a history of PTSD, we seek to explore the effects of sleep apnea and hypertension on cognitive functioning, particularly auditory learning/memory.

One hundred and three male and female participants with comorbid OSA and PTSD symptomology were screened as part of a larger VA Palo Alto Health Care System study. Participants (age: x=56.3, a=13.8, 24-81 years; education: x=14.6, a=2.3, 8-20 years; 9.6% female, 89.6% male) completed a neuropsychological battery, including the CVLT-II and WMS-IV Logical Memory. Presence or absence of hypertension was dichotomously coded and AHI severity was categorically coded. An auditory learning/memory composite variable was created using the z-score transformation method (Dodge et al., 2020). Variables and covariates were entered into a hierarchical regression.

The initial regression model revealed hypertension and OSA severity to be independent predictors of performance on auditory learning/memory (hypertension: ß= -0.71, p<0.01; OSA: ß= -0.42, p<0.01), where presence of hypertension or increased severity of OSA resulted in worse performance on the auditory learning/memory composite.

Results suggest that hypertension and OSA may independently and negatively affect performance on measures of auditory learning/memory in veterans with PTSD symptomology and OSA. Such findings underscore the importance of assessing and treating both hypertension and OSA among veterans with PTSD to improve not only physical health, but also cognitive health. Further research demonstrating similar findings is recommended along with studies investigating whether or not the treatment of hypertension and OSA can improve auditory learning/memory.

Traumatic brain injury and cardiovascular disease (CVD) are modifiable risk factors for cognitive decline and dementia. Greater concussion history can potentially increase risk for cerebrovascular changes associated with cognitive decline and may compound effects of CVD. We investigated the independent and dynamic effects of CVD/risk factor burden and concussion history on cognitive function and odds of mild cognitive impairment (MCI) diagnoses in older former National Football League (NFL) players.

Former NFL players, ages 50-70 (N=289; mean age=61.02±5.33 years), reported medical history and completed the Brief Test of Adult Cognition by Telephone (BTACT). CVD/risk factor burden was characterized as ordinal (0-3+) based on the sum of the following conditions: coronary artery disease/myocardial infarction, chronic obstructive pulmonary disease, hypertension, hyperlipidemia, sleep apnea, type-I and II diabetes. Cognitive outcomes included BTACT Executive Function and Episodic Memory Composite Z-scores (standardized on age- and education-based normative data), and the presence of physician diagnosed (self-reported) MCI. Concussion history was discretized into five groups: 0, 1-2, 3-5, 6-9, 10+. Linear and logistic regression models were fit to test independent and joint effects of concussion history and CVD burden on cognitive outcomes and odds of MCI. Race (dichotomized as White and Non-white due to sample distribution) was included in models as a covariate.

Greater CVD burden (unstandardized beta [standard error]; B=-0.10[0.42], p=.013, and race (B=0.622[0.09], p<.001), were associated with lower executive functioning. Compared to those with 0 prior concussions, no significant differences were observed for those with 1-2, 3-5, 6-9, or 10+ prior concussions (ps >.05). Race (B=0.61[.13], p<.001), but not concussion history or CVD burden, was associated with episodic memory. There was a trend for lower episodic memory scores among those with 10+ prior concussion compared to those with no prior concussions (B=-0.49[.25], p=.052). There were no significant differences in episodic memory among those with 1-2, 3-5, or 6-9 prior concussions compared to those with 0 prior concussions (ps>.05). CVD burden (B=0.35[.13], p=.008), race (greater odds in Non-white group; B=0.82[.29], p=.005), and greater concussion history (higher odds of diagnosis in 10+ group compared to those with 0 prior concussions; B=2.19[0.78], p<.005) were associated with higher odds of MCI diagnosis. Significant interaction effects between concussion history and CVD burden were not observed for any outcome (ps >.05).

Lower executive functioning and higher odds of MCI diagnosis were associated with higher CVD burden and race. Very high concussion history (10+) was selectively associated with higher odds of MCI diagnosis. Reduction of these modifiable factors may mitigate adverse outcomes in older contact sport athletes. In former athletes, consideration of CVD burden is particularly pertinent when assessing executive dysfunction, considered to be a common cognitive feature of traumatic encephalopathy syndrome, as designated by the recent diagnostic criteria. Further research should investigate the social and structural determinants contributing to racial disparities in long-term health outcomes within former NFL players.

Given that at least 75% of traumatic brain injuries in the U.S. are mild, concussions are a serious public health concern that cause significant neurological damage and negatively impact individuals’ quality of life. Due to the rotational forces that occur during a concussion, immediate damage to the corpus callosum is common, resulting in neurological and behavioral deficits. However, the longitudinal damage to the integrity of the corpus callosum is unclear and may differ across sections of the corpus callosum. Our primary aim was to compare the white matter integrity across eight corpus callosum tracts in concussed individuals to healthy controls 3-4 weeks after injury and at a 10-month follow-up.

Seventeen concussed participants completed a diffusion tensor imaging (DTI) scan 3-4 weeks after receiving a concussion and again 10 months after injury. Nineteen control participants completed a single DTI scan. DTI data were analyzed using the automated fiber quantification (AFQ) pipeline, which extracts fractional anisotropy (FA) values from 100 nodes in eight tracts of the corpus callosum (listed anterior to posterior): orbital frontal, anterior frontal, superior frontal, motor, superior parietal, posterior parietal, occipital, and temporal. Given the non-linearity, high multicollinearity, and large number of data points, a cubic smoothing spline was used to fit a penalized regression to the FA values in each tract, allowing us to compare the FA values of each node in each tract between groups and across time. To assess acute damage, a spline model for the concussed participants at 3-4 weeks was compared to a spline model for the control participants in each tract. To assess longitudinal damage, a spline model of the FA difference value (10-month minus acute visit) in concussed participants was compared to a spline model of the FA difference value for controls (zero, representative of a theoretical no change in FA values). Significant nodes were defined as p-values less than 0.006 (alpha of .05/8, given 8 tracts).

Acutely following injury, concussed participants showed lower FA values than controls in the anterior frontal, posterior parietal, occipital, and temporal tracts. In the orbital frontal tract, concussed participants had higher FA values on the left, but decreased FA values compared to controls in the middle. Longitudinally, concussed participants showed continued decreased white matter integrity in the orbital frontal, superior parietal, and occipital tracts, but improved white matter integrity in the anterior frontal and superior frontal tracts. The motor, posterior parietal, and temporal tracts showed mixed longitudinal results of decreased or improved white matter integrity within each tract.

Concussed individuals show decreased white matter integrity across the corpus callosum acutely after injury. Longitudinally, the most anterior and posterior portions of the corpus callosum (i.e., genu and splenium) show continued damaged while the more medial sections of the corpus callosum may show some recovery. Results suggest the corpus callosum displays differential patterns of damage acutely and longitudinally following concussion, with some tracts improving while others continue to deteriorate.

The stria terminalis (ST) is a white matter tract with connections to limbic and autonomic brain structures that is implicated in affective functioning. Recent works suggests that ST functional integrity and connectivity is associated with faster responses to emotional cues (Dzafic et al., 2019) and may be influenced by environmental factors including socioeconomic status (SES) and childhood adversity (Banihashemi et al., 2020). The role of the ST in the experience of more daily affective experiences, such as depressive symptoms, remains unexplored. Therefore, the present study examined the role of the ST and SES, as assessed by household income, in the relationship between age and depressive symptoms in typically developing children and adolescents.

Participants include 64 typically developing children and adolescents age 8-21 (Mage=13.27, SD=3.15) who participated in an ongoing study of development of neurocognitive and social-cognitive skills. Participants completed imaging on a 3Tesla MR Siemens PRISMA scanner. Tractography was executed via ENIGMA tract-based spatial statistics to quantify WM integrity and provided values for mean fractional anisotropy (mFA) of the ST. Depressive symptoms were measured with the Behavior Assessment Scale for Children-Third Edition (BASC-3) parent report scale, and annual family income was obtained per parent report. Mediation and moderation analyses were conducted using Process version 4.1 (Hayes, 2022) in SPSS version 28. As depression symptoms are often higher in early adolescence than later, we examined the indirect effect of age on depressive symptoms through ST mFA and evaluated this relationship at different levels of family income.

Age was associated with lower levels of depressive symptoms (b=-.98, t=-2.18, p<.05), whereas greater right ST mFA was associated with higher levels of depressive symptoms (b=42.05, t=2.50, p<.05). Right ST mFA explained significant variance in the relationship between age and parent-reported depression (ab=.13, 95% CI [.02, .29]). The conditional indirect effect of family income was significant for children with annual family incomes between 25-50k (effect=.16, 95% CI [.01, .38]) and 75-100k (effect=.13, 95% CI [.001, .31]), but not for 100k+ (effect=.11, 95% CI [-.05, .33]).

The present study revealed a significant, positive relationship between white matter integrity in the right ST and parent-reported depressive symptoms in healthy children and young adults. Finding extend on prior work implicating the ST in threat responsivity (Dzafic et al., 2019). Moreover,results suggest the role of the ST in the relationship between age and depression depends on level of family income, such that ST mFA explains more variance at lower income levels, and is no longer significant for children from families with income greater than 100k. These findings support the notion that environmental stressors (such as lower family income) may strengthen ST pathways via activity-dependent plasticity and repeated, coordinated activation (Rinaman et al., 2011). Future studies should examine these brain-behavior associations, as they may replicate in a larger sample, with more nuanced indicators of environmental stress.