Given the results of the clinical trials for the disease-modifying therapy for Alzheimer's disease and its mechanism of action, it is necessary to start at the early stage as soon as possible. To this end, there is a need for a tool that allows easy periodic home assessment of memory change from the early stages of the disease. The purpose of this study is to establish a new method of memory evaluation showing well- correlated with Logical Memory (LM) II subtest score of the WMS-R and that, at the same time, can be done easily in a short time.

The subjects were 85 subjects (including 12 MCI, 8 AD, and 65 age people with normal cognitive function). In the new method, 8-picture recall and 16-word recognition were assessed, respectively, and the index was calculated by adding up the ratio ofcorrect responses to both tests (max point is two). The correlation with the LM II score was examined.

Our statistical analysis showed that 8-picture recall (R=0.872, p<0.001) and the index (R=0.857, p<0.001) showed a significantcorrelation with the LMII score. On the other hand, the 16-word regression and LM II score was R = 0.691(p<0.001), relatively lower than the other two scores, because this task may have been higher than the true ability due to the false recognition of words that were not there.

Our new method can easily predict the LM II score of WMS-R in about one third of the time required by conventional methods. We named this index as Self Assessment Memory Scale (SAMS), and are planning to develop a digital tool to enable easy andself-accessible evaluation of recall.

Despite knowledge concerning the prevalence and adverse consequences of pediatric stroke, there is limited awareness of the immediate and long-term effects on social-emotional functioning and psychological adjustment. Evidence from the broader childhood literature suggests that young individuals living with disabilities or neurological conditions are at considerably greater risk for emotional and behavioral concerns and lower quality of life. Qualitative research methodology can elucidate personal and subjective aspects of experience that cannot be entirely represented through quantitative measures. Although the parent experience of pediatric stroke has been qualitatively investigated, we endeavored to fill a gap in the pediatric stroke literature by focusing on the youth voice. The current project aimed to qualitatively explore emotional, behavioral, and social outcomes in pediatric stroke and identify personal and environmental factors that can influence psychological risk and resilience.

Individual interviews were conducted with 14 children, aged 8 to 18 years, with a history of ischemic stroke. The semi-structured interview protocol aimed to capture the lived experience of survivors and encompassed open-ended questions about daily life, memories, perceptions, and psychosocial experiences. Interviews spanned 40-60 minutes in length, were audio recorded, transcribed verbatim, and qualitatively analyzed using reflexive Thematic Analysis methodology. Coding, theme generation, and data visualization were completed using NVivo12 software.

Participants discussed their views and understanding of their stroke, the perceived impact of stroke on their daily life, and the meaning-making process surrounding this experience. Children shared their perceptions regarding their abilities, challenges, life circumstances, aspirations, and relations to peers. Prominent themes encompassed shyness and social anxiety, cognitive and learning troubles, test anxiety, concealing feelings of sadness, the stigma of physical disability and its impact on social participation, bullying, and loneliness/isolation. Insight into adaptive coping mechanisms was present, as was emphasis on family closeness and the importance of supportive peers. Participants described feeling unique and were proud of their values and personal identity. Gratitude was expressed regarding stroke medical care and rehabilitative services, with an emergent theme surrounding the desire to give back to society.

Taken together, our qualitative study findings illustrate the profound impact that pediatric stroke can have on children’s emotional experiences, personal identity, self-efficacy, learning, behavior, and psychosocial functioning. Despite these challenges, an enormous degree of resiliency was also demonstrated in youth’s insights into coping and adaptation to challenge. Our findings speak to the importance of psychological assessment and treatment planning surrounding internalizing symptoms in children with stroke. Given the potential for pervasive changes in various aspects of daily life, a comprehensive understanding of the personal psychological experiences and perceptions of pediatric stroke patients is essential, as it will facilitate opportunity for timely interventions that can improve coping and adaptive outcome. Implications will be discussed with regard to empowering pediatric stroke survivors, enhancing public education efforts about childhood acquired brain injury, and reducing stigma associated with disability and use of required supports.

The Functional Assessment of Cancer Therapy-Cognitive scale (FACT-Cog) is one of the most frequently used patient-reported outcome (PRO) measures of cancer-related cognitive impairment (CRCI) and of CRCI-related impact on quality of life (QOL). Previous studies using the FACT-Cog found that >75% of women with breast cancer (BCa) experience CRCI. Distress tolerance (DT) is a complex construct that encompasses both the perceived capacity (i.e., cognitive appraisal) and the behavioral act of withstanding uncomfortable/aversive/negative emotional or physical experiences. Low DT is associated with psychopathology and executive dysfunction. We previously found that women with BCa with better DT skills reported less CRCI on the FACT-Cog. However, this relationship has not been tested using a performance-based cognitive measure. Therefore, the aims of this study were to: (1) assess the relationship between the FACT-Cog and the Telephone Interview for Cognitive Status (TICS), a performance-based cognitive measure; and (2) test whether the association between DT and CRCI (using the FACT-Cog) was replicated with the TICS.

Participants completed the Distress Tolerance Scale (DTS), the FACT-Cog, and the TICS after undergoing BCa surgery and prior to starting adjuvant therapy [101 women, age >50 years, M(SD)= 61.15(7.76), 43% White Non-Hispanic, 34.4% White Hispanic, 10.8% Black, with nonmetastatic BCa, 55.4% lumpectomy, 36.6% mastectomy; median 29 days post-surgery].

Although there was a significant correlation between the TICS total score and the FACT-CogQOL subscale (r = 0.347, p < 0.001), the TICS total score was not correlated with scores on the FACT-Cog perceived cognitive impairment (CogPCI), perceived cognitive abilities (CogPCA), or comments from others (CogOth) subscales. However, the TICS memory item, a 10-word list immediate recall task, had a weak statistically significant correlation with CogPCI (r = 0.237, p < 0.032), CogOth (r = 0.223, p < 0.044), and CogPCA (r = 0.233, p < 0.036). Next, the sample was divided based on the participant’s score on TICS memory item (i.e., < vs. > sample mean of 5.09). Results of independent samples t-tests demonstrated significant differences in mean scores for CogPCI, f(80) = -2.09, p = 0.04, Mdt = -7.65, Cohen’s d = 0.483, and CogQOL, f(80) = -2.57, p = 0.01, Mditt = -2.38, Cohen’s d = 0.593. A hierarchical linear regression found that DTS subscale and total scores did not significantly predict performance on the TICS. However, DTS continued to be a significant predictor of poorer FACT-Cog PCI scores while controlling for TICS scores.

We found a weak relationship between self-reported cognitive impairment and objective cognitive performance (TICS). However, greater self-reported PCI and its impact on QOL was found in participants who scored below the sample mean on a recall task from the TICS. Although perceived ability to tolerate distress continued to predict self-reported PCI on the FACT-Cog, it did not predict overall performance on the TICS. Therefore, responses on the FACT-Cog may be more representative of an individual’s ability to tolerate distress related to perceived CRCI than actual overall cognitive ability or impairment.

Cognitive training has shown promise for improving cognition in older adults. Aging involves a variety of neuroanatomical changes that may affect response to cognitive training. White matter hyperintensities (WMH) are one common age-related brain change, as evidenced by T2-weighted and Fluid Attenuated Inversion Recovery (FLAIR) MRI. WMH are associated with older age, suggestive of cerebral small vessel disease, and reflect decreased white matter integrity. Higher WMH load associates with reduced threshold for clinical expression of cognitive impairment and dementia. The effects of WMH on response to cognitive training interventions are relatively unknown. The current study assessed (a) proximal cognitive training performance following a 3-month randomized control trial and (b) the contribution of baseline whole-brain WMH load, defined as total lesion volume (TLV), on pre-post proximal training change.

Sixty-two healthy older adults ages 65-84 completed either adaptive cognitive training (CT; n=31) or educational training control (ET; n=31) interventions. Participants assigned to CT completed 20 hours of attention/processing speed training and 20 hours of working memory training delivered through commercially-available Posit Science BrainHQ. ET participants completed 40 hours of educational videos. All participants also underwent sham or active transcranial direct current stimulation (tDCS) as an adjunctive intervention, although not a variable of interest in the current study. Multimodal MRI scans were acquired during the baseline visit. T1- and T2-weighted FLAIR images were processed using the Lesion Segmentation Tool (LST) for SPM12. The Lesion Prediction Algorithm of LST automatically segmented brain tissue and calculated lesion maps. A lesion threshold of 0.30 was applied to calculate TLV. A log transformation was applied to TLV to normalize the distribution of WMH. Repeated-measures analysis of covariance (RM-ANCOVA) assessed pre/post change in proximal composite (Total Training Composite) and sub-composite (Processing Speed Training Composite, Working Memory Training Composite) measures in the CT group compared to their ET counterparts, controlling for age, sex, years of education and tDCS group. Linear regression assessed the effect of TLV on post-intervention proximal composite and sub-composite, controlling for baseline performance, intervention assignment, age, sex, years of education, multisite scanner differences, estimated total intracranial volume, and binarized cardiovascular disease risk.

RM-ANCOVA revealed two-way group*time interactions such that those assigned cognitive training demonstrated greater improvement on proximal composite (Total Training Composite) and sub-composite (Processing Speed Training Composite, Working Memory Training Composite) measures compared to their ET counterparts. Multiple linear regression showed higher baseline TLV associated with lower pre-post change on Processing Speed Training sub-composite (ß = -0.19, p = 0.04) but not other composite measures.

These findings demonstrate the utility of cognitive training for improving postintervention proximal performance in older adults. Additionally, pre-post proximal processing speed training change appear to be particularly sensitive to white matter hyperintensity load versus working memory training change. These data suggest that TLV may serve as an important factor for consideration when planning processing speed-based cognitive training interventions for remediation of cognitive decline in older adults.

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

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

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

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

Memory impairment is a common comorbidity in individuals with temporal lobe epilepsy (TLE). Further, in medication-resistant epilepsy the frontline option, neurosurgical epileptogenic zone destruction, places memory at significant risk. Research has highlighted that TLE causes whole-brain network efficiency disruption, but it is not established how this may explain pre- and post-surgical cognition. Here we examine whether white matter structural network organization predicts pre-operative memory function and/or risk for post-operative memory decline.

Patients with drug-resistant TLE were recruited from two epilepsy centers in a prospective longitudinal study. The pre-operative sample included 51 individuals with left TLE (L-TLE), 52 with right TLE (R-TLE), and 57 healthy controls who underwent T1- and diffusion-weighted MRI (dMRI), and neuropsychological tests of verbal and visual memory. Forty-four patients (n=21 L-TLE) subsequently underwent temporal lobe surgery (36 anterior temporal lobectomy; 7 stereotactic laser amygdalohippocampectomy; 1 amygdalohippocampectomy) and completed post-operative memory testing. Whole-brain connectomes were generated via diffusion tractography and analyzed using graph theory, focusing on network integration (path length) and specialization (transitivity). In the preoperative dataset, first we compared TLE versus controls with analysis of covariance (ANCOVAs) controlling for age. Next, linear regressions examined the association between memory scores and network efficiency between L-TLE, R-TLE and controls. In the post-operative sample, bivariate correlations examined the association between pre- to post-operative memory change and 1) global network efficiency and 2) asymmetry of mesial temporal efficiency (i.e., local efficiency of the hippocampal, parahippocampal, and entorhinal nodes). Finally, efficiency metrics were entered into stepwise regressions along with established predictors of memory decline.

Compared to controls, TLE showed longer path length (p < .05; ηp2 = .03) and lower transitivity (p = .01; ηp2 = .04). Pre-operatively, better verbal learning and memory were associated with both shorter path length (β = -0.23 to -0.32; psadjusted < .05) and increased transitivity (β = 0.20 to 0.31; psadjusted < .05). These associations were greater in L-TLE than R-TLE (i.e., a significant interaction; β = -0.29 to 0.25; psadjusted <.05). Post-operatively, global metrics predicted decline on list learning for LTLEs (rs = -.57 to .58; ps < .01), and were marginal on list recall (rs = -.42 to .40; ps < .10). Leftward asymmetry of mesial temporal local efficiency predicted greater decline across most verbal memory measures for L-TLE (rs -.47 to -59; psadjusted <.05), but not R-TLE. Asymmetry of mesial network efficiency uniquely explained at least 20 to 43% of the variance in list learning, recall, and story learning for L-TLE, outperforming hippocampal asymmetry and preoperative score (psadjusted <.05).

Our findings suggest that global white matter network abnormalities contribute to verbal memory impairment pre-operatively and vulnerability to decline post-operatively in L-TLE. Asymmetry of a predefined mesial temporal sub-network may help predict post-operative memory function following left temporal lobe surgery, such that greater efficiency in the to-beresected mesial temporal network may be an important risk factor for decline. Our findings extend the importance of network approaches in TLE to include the relationships between neurobiological networks and memory function.

Accurate early detection of subtle cognitive difficulties is critical for optimizing treatment of neurodegenerative disease. Those who speak English as a second language (ESL) in the US may be at a disadvantage on Englishwritten neuropsychological tests, increasing the potential for error, particularly when cognitive difficulties are mild and/or when informants are not available/unreliable. This study examined the utility of a standardized, performance-based test of everyday function for the assessment of cognition in ESL older adults.

Five ESL participants (Mage=83 years; range 65-84 years old) were recruited along with 43 cognitively healthy, native English speakers (controls) as part of a larger study of functional assessment in community-dwelling older adults. Participants were required to identify a study partner to answer questions about their cognitive abilities and everyday functioning. ESL participants reported diverse native languages: Cantonese, Mandarin, Gujarati/Hindi, Farsi, and Azeri. One of the 5 ESL participants reported a diagnosis of MCI. Participants completed the Mini-Mental Status Exam, Trail Making Tests, Digit Span, Boston Naming Test, Hopkins Verbal Learning Test, and Brief Visual Memory Test, resulting in 15 test scores. Participants also completed the Naturalistic Action Test (NAT), a performance-based tests that requires preparation of a breakfast and lunch using standardized objects presented on a table. Recordings of NAT performance were scored by two coders for time to completion, accomplishment of task steps, and errors (overt, micro-error, motor), resulting in 10 scores for the Breakfast and the Lunch tasks. Any discrepancies amongst the two coders were resolved by our lab. Informant-report questionnaires included the Functional Assessment Questionnaire (FAQ), Everyday Cognition Questionnaire (ECog) and IADL-C. Total scores from the cognitive tests, NAT, and informant reports for each ESL participant were compared against the scores of Controls by computing T-scores using the Control M and SD. Low/impaired test scores were defined as <1.5 SD.

Informants reported intact everyday function (FAQ, IADL-C) for all ESL participants. Informant-reported ECog scores varied as expected; with mild decline reported for the participant with MCI. On traditional cognitive tests, ESL participants showed variable performance, such that low scores were obtained on up to 9 of the 15 scores. The ESL participant with MCI obtained low scores on 11/15 scores. On the NAT, all of the ESL participants without MCI showed scores on the Breakfast (accomplishment, errors) that were comparable to Controls. Completion time for both Breakfast and Lunch and Lunch scores (accomplishment, errors) were variable, with low across observed in ESL participants with healthy cognition.

Older participants with ESL and healthy cognition showed highly variable scores on traditional, neuropsychological tests. However, on one item from a performance-based assessment of everyday function (NAT Breakfast), ESL participants with healthy cognition consistently performed well compared to healthy Controls. Performance was less consistent for completion time across both NAT tasks and on all measures from the Lunch task, for which the steps and objects may have been less familiar to ESL participants. Thus, performance-based testing holds promise for informing neuropsychological assessment of ESL older adults, but care should be taken in selecting test items that are highly familiar and outcome measures that are most meaningful across a range of cultures.

Neuropsychiatric symptoms (NPS) can be observed in mild cognitive impairment (MCI) and dementia. Hallucinations are a core clinical symptom of Dementia with Lewy Bodies (DLB). In this study, we investigated NPS in healthy control and MCI groups who would later be diagnosed with DLB to determine which symptoms would present early.

Participants included those originally diagnosed as healthy controls (n=55), MCI with DLB etiology (n=215), and DLB (n=1059). The control and MCI groups progressed to DLB at later visits in the study. NPS data were collected using the Neuropsychiatric Inventory Questionnaire (NPI-Q) that was obtained from the National Alzheimer's Coordinating Center.

To determine which NPS presented early in the DLB course, we ran ANCOVAs to assess the role of original diagnosis on each NPS, using age as a covariate and applying Bonferroni correction. The control and MCI groups, who were later diagnosed with DLB, had greater severity of delusions, hallucinations, agitation, and apathy than the DLB group. The MCI group that would later be diagnosed with DLB had greater severity of anxiety and motor symptoms than the DLB group. The control group had greater irritability severity than the DLB group, and the controls had greater nighttime behavior severity than the MCI group, who had greater severity than the DLB group.

Overall, we found that NPS present early in those who will be diagnosed with DLB, even when they are diagnosed as healthy controls. These results suggest that examination of NPS is important even in healthy adults, and their presence may be the onset of the DLB process before an official diagnosis of the condition.

Technological advances allow for increased international collaboration within the medical community (e.g., internet, e-mail, instant messaging, video-teleconferencing [VTC]). Partnering with clinicians and researchers across the globe allows for shared resources, particularly beneficial for underserved populations and communities with poor access to specialty resources, including neuropsychology. Along with the potential benefits of such collaborations comes challenges including language, cultural, and physical barriers. The presented findings detail important lessons learned from an ongoing research collaboration between the Einstein team (Bronx, NY) and a research group in Kerala, India, called the Kerala Einstein Study (KES), a study evaluating pre-dementia syndromes in Indian older adults. Here we highlight the training process of research assistants administering neuropsychological measures to older adults in India, by neuropsychologists in the USA.

One study manager and several research assistants (collectively referred to as RAs) based in India were trained by the first author, a neuropsychology postdoctoral fellow (MS) based in the US via VTC (i.e., Zoom), under supervision of a clinical neuropsychologist. RAs were trained in test administration and scoring for a variety of neuropsychological measures. RAs speak Malayalam and English; training occurred in English. Following training, VTC meetings were held to process testing experience and channels were created for ongoing administration/scoring questions and concerns (i.e., email, WhatsApp). RAs scanned and uploaded scored protocols to a protected web-based platform. MS double-scored several protocols and additional VTC meetings were held to discuss/update scoring procedures.

Physical challenges included time difference between sites, internet connectivity, language barriers (i.e., varying English dialects) cultural considerations (e.g., some test/task directions were changed based on RAs knowledge of more appropriate wording). Test administration challenges included cultural factors (i.e., allowing for continuation of some tasks beyond time limits for rapport) and RA comfort level with administration of some tasks (e.g., trail making test). Scoring challenges included RAs tendency to score too strictly or leniently and confusion regarding specific scoring criteria. At an initial VTC meeting, MS modeled test administration. Then RAs practiced the tests together. To reduce challenges including time difference, connectivity problems, language barriers, and comfort with testing/scoring, VTC training sessions were scheduled individually between MS and each RA. During these sessions, the RA 'tested’ MS and received immediate feedback. Most sessions lasted approximately 90 minutes with one RA requiring a second session (i.e., sessions were tailored for individuals to obtain level of testing comfortability and competency). After each RA was 'cleared’ by MS to start testing, RAs began testing and scoring. Following MS’s review of several scored protocols, meetings took place in groups in order to improve scoring skills and increase consistency between RAs. Given the continued high degree in scoring variability, a third RA was hired with one of his main responsibilities being to double score all protocols.

Findings highlight important challenges and considerations for remotely training study personnel to administer neuropsychological measures (i.e., RAs in India and neuropsychologists in the USA). Important steps to reduce identified barriers included individualized training sessions, specific training in scoring, and open/ongoing communication channels.

Children born very preterm (VPT; <32 weeks gestation) are at increased risk for long-term neurocognitive sequelae such as behavioral problems. These problems may be caused by disrupted brain development, particularly white matter abnormalities that affect network efficiency, as shown via diffusion magnetic resonance imaging (dMRI). There is evidence that short-term interventions for pediatric clinical populations can lead to behavioral improvements as well as associated neuroplasticity. Adapted from a previous parenting intervention for families of young children with traumatic brain injury, the novel Building Better Brains and Behavior (B4) program teaches responsive parenting skills for families of children born preterm. It is hypothesized that parent-reported externalizing symptoms will improve from pre- to postintervention and that these improvements will be mirrored by an increase in neural efficiency.

VPT children between the ages of 3-8 with documented behavioral problems were recruited to participate in a single-arm pilot clinical trial. Families began with a baseline visit in which the Child Behavior Checklist (CBCL) was administered as a measure of behavior problems, and the child underwent dMRI. Parents then participated in the 7-session intervention integrating self-guided, online learning modules with live virtual coaching sessions with a therapist. Twenty three participants enrolled, 15 of which completed the intervention and baseline MRI scan; 4 children were excluded from analysis due to not meeting eligibility criteria, leaving 11 participants for analysis of intervention effects (8 males, Mage=5.42). At program completion, families returned for a follow-up that entailed another CBCL questionnaire and dMRI scan. Eight children completed the post-intervention scan and five were retained for analysis (4 males, Mage=5.83). Imaging data was analyzed using the Brain Connectivity Toolbox, which generated graph theoretical metrics to characterize the topological organization of anatomical networks.

A paired samples t-test showed significant reduction of externalizing behavior problems pre-intervention (M=61.12, SD=10.02) to post-intervention (M=55.00, SD=11.62; f(10)=3.09, p=0.01). At baseline, externalizing behavior problems were positively correlated with normalized clustering coefficient, r(10)=0.59, p=0.04, and small-worldness, r(10)=0.64, p=0.03. Change in externalizing symptoms pre- to post-intervention was positively correlated with baseline global efficiency, r(4)=0.94, p=0.02, and negatively correlated with mean local efficiency, r(4)=-0.89, p=0.03, and normalized characteristic path length, r(4)=-0.89, p=0.03.

Preliminary results indicate that VPT children who exhibit higher levels of externalizing symptoms show higher normalized clustering coefficient (which is expected of networks with less integration), and higher small-worldness (which is unexpected). Greater behavioral improvements were associated with higher baseline characteristic path length as expected, but lower baseline global efficiency; this may indicate that children who had lower global efficiency to begin with benefitted from the intervention the most. Due to the small sample size and lack of corrections for multiple comparisons, these results are not definitive and further research is needed to elucidate associations between structural connectivity and behavioral intervention in children born very preterm.

Adverse childhood experiences (ACEs) is a broad construct that refers to negative events one may experience during childhood, including, but not limited to, childhood maltreatment, household dysfunction, and trauma. ACEs have consistently shown to be associated with negative physical and mental health outcomes. Although researchers have investigated the effects of trauma and abuse on personality measures, few studies have examined differences between those with high ACEs, low ACEs, and no ACEs on measures of personality in the context of neuropsychological evaluations.

The current study included 128 consecutive adult patients referred for outpatient neuropsychological evaluation of attention-deficit/hyperactivity disorder. The sample was 39.8% non-Hispanic White, 21.9% non-Hispanic Black, 16.4% Hispanic, 10.9% Asian/Pacific Islander, and 10.9% other race/ethnicity, with a mean age of 27.9 years (SD=6.3) and mean education of 16.1 years (SD=2.2). Multivariate analyses of variance were performed to evaluate differences on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) between individuals who experienced high levels of ACEs (>4/10 on the Adverse Childhood Experiences Questionnaire), low levels of ACEs (1-3/10), and no ACEs (0/10).

When analyzing Higher-Order (H-O) scales, there was a significant group difference in mean elevation on the Behavioral/Externalizing Dysfunction (BXD) scale, F(2,113)=3.124, p < .05, such that individuals in the high ACEs group evidenced higher scores than those in the low ACEs group (p < .05). Additionally, there were significant differences on several Restructured Clinical (RC) scales. Specifically, there were group differences on the Low Positive Emotions (RC2) scale, F(2,113)=3.427, p < .05, such that those in the low ACEs group evidenced higher scores than those in the no ACEs group (p < .05). The Antisocial Behavior (RC4) scale also had significant differences, F(2,113)=13.703, p < .001, such that those in the high ACEs group had higher scores than those in the low and no ACEs groups (p < .001). Finally, the Ideas of Persecution (RC6) scale yielded significant group differences, F(2,113)=4.793, p < .05, such that those in the high ACEs group evidenced higher scores than those in the low and no ACEs groups (p < .05).

In sum, this study demonstrated that ACEs, particularly high levels of ACEs, are related to higher difficulties with problems with under-controlled and rule-breaking behaviors, low positive emotional responses, and beliefs that others pose a threat. As such, assessment of ACEs may serve an important role in characterizing patients’ psychological status as part of a comprehensive neuropsychological evaluation.

Over the past decade, resting state functional connectivity has shown great promise as a diagnostic and prognostic tool when applied to neurological and psychiatric populations. For example, the integrity of the default mode network - among other large-scale brain networks - has emerged as a common target of neurological disease and psychopathology. Despite this explosion in research, relatively little is understood about the cognitive characteristics of the mind at rest, and most inquiries have relied on retrospective self-report questionnaires that pose challenges for clinical populations with memory or metacognitive deficits. Understanding how different people mentally structure their idle thoughts may shed light on existing clinical neuroscience findings. Furthermore, the resting state is common context in daily life, and the lack of external stimulation during rest periods may foster the emergence of dysfunctional and/or impoverished thoughts for individuals with mental health or neurological conditions. Considering these important gaps, we conducted a line of research quantifying clinical and demographic sources of variability in resting state cognition.

Across three studies, resting state cognition was captured by training adults to voice aloud their thoughts in real time across 7-10 minute rest periods in the lab, the MRI scanner, and participants’ own home. Participants were audio recorded using this think aloud technique, while efforts to minimize thought censorship were also employed. Audio-recorded speech was then transcribed and analyzed for content and dynamic characteristics by external coders and automated text analysis. Relevant characteristics were isolated and examined in relation to variability across participants in trait rumination, divergent thinking (a measure of creativity assessed with a separate Alternate Uses Task), as well as age.

Across studies, the think aloud paradigm in resting state contexts showed promising ecological validity. Participants reported a low degree of thought censorship and a moderate-to-high degree of similarity of thoughts to everyday life. Additionally, total word counts across the transcripts were similar to typical rates of natural speech. Notable variability across participants also emerged in the content and dynamic characteristics of resting state thought.

Increased trait rumination was associated with the emergence of brooding in real time, including a) more negative, self-focused, and past-oriented thoughts, as well as b) dynamic signatures marked by an attraction towards negative conceptual states, and c) a narrowing of conceptual scope following negative content. In contrast, more creative individuals exhibited a pattern of exploration and curiosity in their idle thoughts, with thought transitions characterized as more loosely associative. Finally, older adults generated more linguistic diversity in their use of positive emotional words (a novel marker of emotional granularity), accompanied by increases in psychological well-being.

Taken together, these studies highlight substantial demographic and clinical sources of variability in resting state cognition, with important implications for resting state functional connectivity findings. They also offer a promising methodological tool and theoretical framework to promote further research in neuropsychology and related fields.

Pain is a mechanism for attention disruption due, in part, to a shared reliance on the prefrontal cortex (PFC). Amongst older adults, the experience of pain is both prevalent and functionally impactful. Dual-task walking (DTW) paradigms are a useful means of assessing the impact of pain on attentional control and known to be sensitive to changes in the cortical hemodynamic response within the PFC. To date, however, few studies have utilized such paradigms to examine the impact of self-reported pain on attentional control via assessment of cognitive, gait and neuroimaging outcomes. Examining these associations would facilitate a better understanding of the ways in which pain may negatively impact neural efficiency, thereby increasing risk of adverse functional outcomes, in healthy aging.

Study participants (N= 408; mean age = 76 ± 6.5ys; % female =55.4) were grouped into pain (n= 266) and no pain (n= 142) groups based upon their responses on the MOS-PSS and MOS-PES. These questionnaires were also used to assess self-reported levels of pain severity and interference amongst individuals with reported pain. Functional near-infrared spectroscopy was used to measure intraindividual variability (IIV) of the cortical hemodynamic response within the PFC during a DTW paradigm which consisted of Single-Task-Walk (STW), Cognitive Interference (Alpha), and Dual-Task-Walk (DTW) conditions. Participants walked along an electronic walkway and quantitative gait data were extracted in order to assess IIV in stride length during STW and DTW conditions. The rate of correct letter generation was used as a measure of cognitive accuracy during Alpha and DTW conditions. Linear mixed effects models (LMEMs) were used to examine the effects of perceived pain on neural and behavioral responses as well as on the change in these outcomes form single- to dual-task conditions. Stratified LMEMs were used to examine whether these associations differed by gender.

LMEMs revealed that perceived pain presence was associated with reduced IIV in PFC oxygenation (estimate = -0.032, p = 0.037) and reduced IIV in stride length in the DTW condition (estimate = -1.180, p = 0.006). High pain severity was associated with a greater increase in stride length IIV from STW to DTW (estimate = -1.301, p = 0.039). Stratified LMEMs revealed that the association between pain and neural IIV was significant in only males (estimate = -0.049, p = 0.037), while the association between pain and gait IIV was significant in only females (estimate = -1.712, p = .008).

Study results suggest that self-reported pain over one month is associated with differential patterns of neural and behavioral responding amongst healthy, community-dwelling older adults. Furthermore, it appears that males are more susceptible to the neural effects of pain, while females are more susceptible to the behavioral effects under attention-demanding conditions. In this population, these patterns may reflect a tendency towards inefficient neural and behavioral modifications in response to perceived pain. These findings highlight the need for clinical use of routine pain assessments and, when appropriate, the implementation of timely and effective pain treatments in aging.

Adults with recurrent depression have been shown to have cognitive deficits also while in remission. Thus, it has been suggested that with a chronic course of depression, poorer executive control can be a vulnerability factor for depressive relapse. This has led to research on how cognitive remediation training can protect against recurrent depressive episodes. Findings indicate that such training has short term effects on cognitive functioning, and small effect on depression symptoms. Less focus has been on how “standard” psychotherapy can have positive effects on executive and attentional control. Mindfulness-based cognitive therapy (MBCT) has been shown to be as effective as antidepressant medication in preventing relapses of depressive episodes. Mindfulness training in healthy samples seems to improve executive and attentional control. However, the few studies of MBCT in recurrent depression show mixed effects on executive and attentional control. As far as we know, no prior study has investigated the effect of MBCT in recurrent depression with the revised version of the attention network test (ANT-R). In a randomized controlled trial, we expected that the MBCT group would show enhanced executive control and lower levels of attentional fluctuations than the wait-list controls (WLC) from pre (T0) to post (T1) treatment. We further investigated if positive effects of MBCT on executive and attentional control were associated with reduction in depression symptoms.

Adults with recurrent depression in partial or full remission (N = 64) were randomized to MBCT or WLC. In the MBCT and WLC groups, 25 and 29, respectively, performed the ANT-R at T0 and T1. The attention network reaction time scores of executive control, alerting, and orienting were calculated in addition to attention fluctuations scores of intra-individual reaction time variability (IIVRT) and exgaussian-mean of longer reaction times (TAU). Self-reported depression symptoms were measured with BDI-II. The two groups were compared at baseline on full-scale IQ (WASI), executive control (D-KEFS Stroop), and processing speed (D-KEFS TMT).

The MBCT and WCL groups did not differ significantly in age or gender distribution, education, full-scale IQ or in baseline executive and attentional control as measured with the ANT-R, Stroop and TMT. The MBCT group showed a higher efficiency in conflict detection as measured with the executive control score from T0 to T1 compared to the WLC. This positive effect of MBCT on executive control was independent from the greater reductions in depression symptoms in the MBCT group compared to in the WLCs. However, reduction in depression symptoms at T1 was associated with enhanced efficiency in responding to alerting cues in conflict detection. No effects of MBCT compared to WLC were found at T1 on the attention fluctuation measures (IIVRT and TAU).

The findings from the current study indicates that MBCT enhances executive control in adults with recurrent depression. As such, MBCT may target an important cognitive vulnerability factor in the chronic course of recurrent depression that may contribute to its efficacy in preventing depressive relapses. It was also observed that reductions in depression symptoms led to higher alertness in conflict detection.

Cognitive reappraisal is a frequently researched emotion regulation strategy. It broadly describes one's ability to alter or reinterpret the meaning of personally relevant events. Cognitive reappraisal is robustly associated with lower self-reported negative affect, lower physiological arousal, and higher positive affect, which is the reason why it is a key component of many psychotherapeutic interventions. However, little research to date has investigated different types of cognitive reappraisal tactics and their association with cognitive reappraisal success. Given that there are an arguably indefinite number of ways to reappraise personally relevant events, it would be clinically informative to identify those tactics that are associated with the greatest decline in negative emotionality. The current study investigated whether one's predominant use of a specific reappraisal strategy is associated with divergent cognitive reappraisal success.

A total of 42 participants (67% women; M = 23.33 years, SD = 6.05 years) took part in this cross-sectional study. Cognitive reappraisal was administered via a computerized task modeled after McRae et al. (2012). A total of 45 previously normed pictures were shown in the cognitive reappraisal task (Lang et al., 2001). Participants were asked to either decrease how they felt or look at negatively evocative images. The dependent measure was success of downregulating negative emotion after the “decrease” versus “look” instruction (i.e., cognitive reappraisal success). A mood manipulation check, a questionnaire asking about participants' reappraisal strategies, and frequency of each reappraisal tactic was conducted after the task was completed to ensure that participants implemented the task as intended. Reappraisal tactics were rated by 3 independent raters individually according to a previously established rating tactic coding system (McRae et al., 2012). An analysis of variance was conducted comparing reappraisal success across groups of the reappraisal tactic most frequently used for each participant. Additionally, total number of reappraisal strategies used was included as a covariate.

Participants endorsed significantly higher negative mood after looking at negative versus neutral pictures, t(41) = 22.70, p < .05). Ratings further indicated that participants were able to significantly decrease how negative they felt when reappraising versus looking at negative pictures, t(41) = 11.95, p < .05. On average, participants' most frequently used reappraisal tactic was used 50.54% (SD = 16.32) of the time. Descriptive statistics on frequency of reappraisal tactics across participants is shown. Regarding the analysis of variance of divergent reappraisal success based on tactic, no significant relationship was found (p > .05). The inclusion of number of reappraisal strategies per participant did not impact the results (p > .05).

The present study did not show a significant difference between reappraisal tactics regarding their cognitive reappraisal success. This replicates past findings and indicates that type of reappraisal tactic used may be not as impactful as using cognitive reappraisal in some fashion. However, reappraisal tactics were not distributed equally across participants. Future studies should include larger samples to attain adequate sample sizes for each reappraisal tactic. Furthermore, participants should be instructed to use a specific reappraisal tactic alongside their self-selected reappraisal preferences to gain insight into the relative success of different reappraisal tactics. Clinical relevance of present findings is discussed.

Evaluate measures used to operationalize apathy in relation to cognitive impairment among Hispanic/Latin Americans and synthesize associations of apathy with cognitive impairment.

A systematic review of the available literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. This review covered studies on the relationship between apathy and cognitive impairment among Hispanic/Latin Americans across normal aging and neurocognitive disorders. The first stage of the review consisted of collecting all publications that contained (1) English or Spanish-speaking participants, (2) with measures for reported apathy, (3) assessment of cognitive functioning or diagnosis of neurocognitive disorder, (4) with Hispanic/Latin Americans represented in the sample. There was no limit regarding publication date. The required minimum of H/L participants in selected studies was determined based on a standard of representation in the United States general population, which is around 18.5%. In the second stage of the review, studies were screened excluding all studies that did not meet the criteria.

Thirteen, 37, and 17 studies were identified by APA PsychInfo, EMBASE, and PubMed, respectively. After removing 19 duplicate records, 48 reports were then assessed for eligibility. Thirty-five of those reports were missing apathy and cognition associations, were under-reported in information such as conference abstracts, or were missing adequate representation of H/L participants. This resulted in a total of 13 papers included in this review. Of the eleven cross-sectional studies, nine demonstrated significant differences or associations between apathy and cognitive status, one demonstrated a descriptive difference between apathy and cognitive status (i.e., no hypothesis test conducted), while one demonstrated null effects. All effects suggested that as apathy increased, cognitive impairment increased. These cross-sectional studies spanned across Säo Paulo, Brazil, Los Angeles, California, West Texas, Cuba, the Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico, and Southwestern United States. This included community and clinic samples of participants. Of the two longitudinal studies, they both demonstrated non-significant associations of apathy and cognitive status. One study in Mexico suggested a risk ratio over 1 where apathy was non-significantly associated with dementia risk, while the other study in Texas, United States had hazard ratios below 1 where apathy was non-significantly associated with mild cognitive impairment risk.

The Neuropsychiatric Inventory (NPI) apathy subscale was the most used measure for apathy in this review (81.8% of included studies). However, a recent systematic review on apathy measurement in older adults and people with dementia specifically stated that the apathy dimension commonly used in the NPI should not be employed outside of screening for apathy. This suggests potential bias and poor evidence in the current literature consisting of apathy research with H/Ls. Longitudinal studies evaluating the utility of examining apathy in relation to cognitive impairment with diverse ethnoracial groups, in addition to Hispanic/Latin Americans, are warranted. Assessing construct equivalence of apathy across demographic characteristics such as language, education, and informant characteristics should be conducted to elucidate potential biases in measurement.

Aging is associated with changes in cortical excitability which may affect motor learning and cognitive function via selective modulation of gamma aminobutyric acid (GABA). Previous studies using magnetic resonance spectroscopy (MRS) to measure GABA in older adults found that increased baseline GABA levels in the sensorimotor cortex (M1S1) were associated with better motor performance. GABA levels in M1S1 have tended to decrease during the execution of a repeated motor sequence. The dynamic change in GABA density in M1S1 in older adults is currently unknown and represents a critical gap in our understanding of how it could impact motor learning and cognitive performance. As such, the purpose of the current study is to quantify changes in cortical GABA during motor learning in the aging brain and examine those changes in relation to motor and cognitive performance. We hypothesize that older adults with greater dynamic range in M1S1 GABA levels will display more efficient motor learning and increased cognitive scores.

We report on a total of 18 healthy older adults aged 64 to 80 years (M = 70.44, SD = 4.99, 12 females). Using MRS at 3T, we measured changes in GABA concentration in M1S1 at rest, during an eight or 12 finger-movement motor entrainment task, and during a recall task. Gannett was used for GABA quantification relative to water. Change in GABA was calculated by subtracting Rest1 GABA from Recall1 GABA. In a separate session, participants completed a battery of cognitive assessments. We computed linear regressions to examine the relationship between dynamic GABA change, recall accuracy of the motor task and cognitive performance.

In relation to motor performance, we found that both greater baseline (Rest1) GABA levels and greater dynamic change in GABA significantly predicted better recall accuracy on the motor task. For cognitive performance, we found that greater dynamic change in GABA significantly predicted better performance on Word Reading in the Stroop Color and Word Test and Delayed Recall in the Hopkins Verbal Learning Test (HVLT). No additional significant relationships were found for the remaining cognitive assessments.

Older adults who were able to accurately perform the task had a greater dynamic change in GABA and increased baseline GABA levels. These adults with greater dynamic change also had better cognitive performance on HVLT Delay and Stroop Word Reading. This modulation of GABA associated with better performance could be related to changes in neuroplasticity. Although these results are in the preliminary stages, they point to a greater understanding of aging related changes in motor and cognitive performance. We’ll continue to explore the relationship between sensory motor performance and changes in GABA concentration as a potential predictor for cognitive performance and future rehabilitation.

There are approximately 1.5 million Japanese and Japanese Americans in the United States, with the Japanese population increasing steadily over the past two decades. Given the growing number of the Japanese population, it is likely that a clinical neuropsychologist may encounter a Japanese patient, particularly for neurocognitive disorder evaluations given the aging population. Literature has reported that cross-cultural bias in neuropsychological testing and cultural factors affect individuals’ test performance. In order to conduct and interpret neuropsychological assessments for this population, it is important to use normative data and consider the impact of various factors such as acculturation, language, and generation in the U.S. Availability of normative cognitive test data for Japanese-Americans is limited. Tests with most extensive use, adaptation, validation, and norming were identified. Many clinically used measures of executive functioning (EF) have been translated into Japanese and studied in multiple clinical populations. We present information on tests in this domain given their appropriateness for use in cross-linguistic and cross-cultural evaluations.

Available studies of neuropsychological tests measuring EF that have been translated and normed in the Japanese and/or Japanese-American patient population are reported. Review of the literature was conducted by authors of Japanese descent familiar with neuropsychological assessment and Japanese and Japanese-American culture. We prioritized studies published in both English and Japanese and those that included commonly utilized tests in the U.S, allowing for maximum accessibility and utility for Western-based neuropsychologists. Additionally, inclusion priority was given to studies published in English which report the clinical diagnoses, age range, and gender characteristics of the sample population. The Wisconsin card sorting test (WCST) and Trail Making Test (TMT) were reviewed.

The WCST and the TMT, with its variant, was the most normed EF cognitive test currently available. The Keio version Japanese-Trail Making Test (J-TMT) and a simplified version of the Trail Making Test (S-TMT) has been utilized in Japan, however norms are still lacking. Of the available studies, the S-TMT and J-TMT were found to be moderately correlated with the TMT. The Keio version WCST (KWCST) (Kao et al., 2012) was correlated to education level (Abe et al., 2004), appropriately differentiating severity of social anxiety disorder (Fujii et al., 2013), patients with schizophrenia (Banno et al., 2012), and cognitive impairment in Parkinson’s disease (Yoshii et al., 2019).

Information regarding translated and normed tests are presented to assist clinical neuropsychologists provide competent services to Japanese-Americans. The J-TMT and the S-TMT may be clinically useful as an evaluation of attention for the Japanese population. The KWCST has also been found to be an appropriate tool for this population. However, publicly available norms for these assessments are still sparse, and there is very limited information about administration of these tests by English-speaking neuropsychologists with the use of interpreters. Further work is needed to increase access to and awareness of linguistically and culturally appropriate versions of clinical measures to better serve the Japanese and Japanese-American population.

Chronic insomnia is a highly prevalent disorder affecting approximately one-in-three Americans. Insomnia is associated with increased cognitive and brain arousal. Compared to healthy individuals, those with insomnia tend to show greater activation/connectivity within the default mode network (DMN) of the brain, consistent with the hyperarousal theory. We investigated whether it would be possible to suppress activation of the DMN to improve sleep using a type of repetitive transcranial magnetic stimulation (rTMS) known as continuous theta burst stimulation (cTBS).

Participants (n=9, 6 female; age=25.4, SD=5.9 years) meeting criteria for insomnia/sleep disorder on standardized scales completed a counterbalanced sham-controlled crossover design in which they served as their own controls on two separate nights of laboratory monitored sleep on separate weeks. Each session included two resting state functional magnetic resonance imaging (fMRI) sessions separated by a brief rTMS session. Stimulation involved a 40 second cTBS stimulation train applied over an easily accessible cortical surface node of the DMN located at the left inferior parietal lobe. After scanning/stimulation, the participant was escorted to an isolated sleep laboratory bedroom, fitted with polysomnography (PSG) electrodes, and allowed an 8-hour sleep opportunity from 2300 to 0700. PSG was monitored continuously and scored for standard outcomes, including total sleep time (TST), percentage of time various sleep stages, and number of arousals.

Consistent with our hypothesis, a single session of active cTBS produced a significant reduction of functional connectivity (p < .05, FDR corrected) within the DMN. In contrast, the sham condition produced no changes in functional connectivity from pre- to post-treatment. Furthermore, after controlling for age, we also found that the active treatment was associated with meaningful trends toward greater overnight improvements in sleep compared to the sham condition. First, the active cTBS condition was associated with significantly greater TST compared to sham (F(1,7)=14.19, p=.007, partial eta-squared=.67). Overall, individuals obtained 26.5 minutes more sleep on the nights that they received the active cTBS compared to the sham condition. Moreover, the active cTBS condition was associated with a significant increase in the percentage of time in rapid eye movement (REM%) sleep compared to the sham condition (F(1,7)=7.05, p=.033, partial eta-squared=.50), which was significant after controlling for age. Overall, active treatment was associated with an increase of 6.76% more of total sleep time in REM compared to sham treatment. Finally, active cTBS was associated with fewer arousals from sleep (t(8) = -1.84, p = .051, d = .61), with an average of 15.1 fewer arousals throughout the night than sham.

Overall, these findings suggest that this simple and brief cTBS approach can alter DMN brain functioning in the expected direction and was associated with trends toward improved objectively measured sleep, including increased TST and REM% and fewer arousals during the night following stimulation. These findings emerged after only a single 40-second treatment, and it remains to be seen whether multiple treatments over several days or weeks can sustain or even improve upon these outcomes.