Hispanic/Latino (H/L) older adults are at greater risk of developing Alzheimer’s disease and related dementias compared to non-Hispanic whites (NHW), and there is an urgent need to identify important factors that may help prevent and/or reduce age-related cognitive health disparities. Positive psychosocial factors, such as social support, may protect against cognitive impairment and decline. However, recent research has highlighted that the effect of social support on cognitive outcomes may differ across racial/ethnic groups. Given the emphasis placed on family relationships and support in H/L culture, the current study sought to clarify whether H/L ethnicity moderated the association between social support and cognitive functioning in a well-characterized sample of community-dwelling older adults residing in Texas.

Participants included 766 NHW and 817 H/L (predominantly Mexican American) older adults (Mage = 66.25 ±8.64) without dementia enrolled in the Health and Aging Brain Study-Health Disparities. Participants completed study questionnaires and a comprehensive neuropsychological battery. Perceived social support was measured using the total sum score from the 12-item abbreviated version of the Interpersonal Support Evaluation List. Episodic memory performance was operationalized as the z-score composite of the immediate and delayed recall totals from the Spanish English Verbal Learning Test and the Weschler Memory Scale (WMS)-III Logical Memory 1 and 2. Executive functioning was operationalized as the z-score composite of scores from the WMS-III Digit Span, Verbal Fluency (FAS), and Trails B. Analyses of covariance were used to explore racial/ethnic group differences in self-reported levels of social support. Multiple linear regression models examined (1) ethnicity x social support interactions on cognition, and (2) ethnicity-stratified social support and cognition associations. Covariates included age, education, sex, yearly income, and depressive symptoms.

H/L older adults reported less perceived social support compared to NHWs (F = 41.16, p < .001). There were no significant ethnicity x social support interactions on episodic memory (ß = 0.04, p = .53) or executive functioning (ß = 0.004, p = .95). However, stratified models revealed that more social support was associated with better memory performance in H/Ls (ß = 0.08, p = .01), but not in NHWs (ß = 0.0004, p = .99). No significant associations between social support and executive functioning were observed amongst H/Ls (ß = -0.01, p = .60) or NHWs (ß = 0.04, p = .29).

Although H/Ls reported lower levels of social support relative to NHWs, we observed that social support was linked to better memory performance within the H/L group only. Results suggest that culturally tailored interventions which encourage strong interpersonal relationships and caring for family could enhance social support in H/Ls and thus help to prevent memory decline. Future work should focus on the development of assessment measures that better characterize unique cultural elements of social support within H/Ls, such as multigenerational households, and explore the direct effects of social support on brain metrics.

Individuals with Parkinson's disease (PD) have varying trajectories of cognitive decline. One reason for this heterogeneity may be "cognitive reserve": where higher education/IQ/current mental engagement compensates for increasing brain burden (Stern et al., 2020). With few exceptions, most studies examining cognitive reserve in PD fail to include brain metrics. This study's goal was to examine whether cognitive reserve moderated the relationship between neuroimaging indices of brain burden (diffusion free water fraction and T2-weighted white matter changes) and two commonly impaired domains in PD: executive function and memory. We hypothesized cognitive reserve would mitigate the relationship between higher brain burden and worse cognitive performance.

Participants included 108 individuals with PD without dementia (age mean=67.9±6.3, education mean=16.6±2.5) who were prospectively recruited for two NIH-funded projects at the University of Florida. All received neuropsychological measures of executive function (Trails B, Stroop, Letter Fluency) and memory (delayed recall: Hopkin's Verbal Learning Test-Revised, WMS-III Logical Memory). Domain specific z-score composites were created using data from age/education matched non-PD peer controls (N=62). For the Cognitive Reserve (CR) proxy, a z-score composite included years of education, WASI-II Vocabulary, and Wechsler Test of Adult Reading. At the time of testing, participants completed multiple MRI scans (T1-weighted, diffusion, Fluid Attenuated Inversion Recovery) from which the following were extracted: 1) whole-brain free water within the white matter (a measure of microstructural integrity and neuroinflammation), 2) white matter hyperintensities/white matter total volume (WMH/WMV), and bilaterally-averaged edge weights of white matter connectivity between 3) dorsolateral prefrontal cortex and caudate and 4) entorhinal cortex and hippocampi. Separate linear regressions for each brain metric used executive function and memory composites as dependent variables; predictors were age, CR proxy, respective brain metric, and a residual centered interaction term (brain metric*CR proxy). Identical models were run in dichotomized short and long disease duration groups (median split=6 years).

In all models, a lower CR proxy significantly predicted worse executive function (WMH/WMV: beta=0.49, free water: beta=0.54, frontal edge weight: beta=0.49, p's<0.001) and memory (WMH/WMV: beta=0.42, free water: beta=0.35, temporal edge weight: beta=0.39, p's <0.01). For neuroimaging metrics, higher free water significantly predicted worse executive function (beta=-0.39, p=0.002) but not memory. No other brain metrics were significant predictors of either domain. Accounting for PD duration, higher free water predicted worse executive function for those with both short (beta=-0.49, p=0.04) and long disease duration (beta=-0.48, p=0.02). Specifically in those with long disease duration, higher free water (beta=-0.57 p=0.02) and lower edge weights between entorhinal cortex and hippocampi (beta=0.30, p=0.03) predicted worse memory. Overall, no models contained significant interactions between the CR proxy and any brain metric.

Results replicate previous work showing that a cognitive reserve proxy relates to cognition. However, cognitive reserve did not moderate brain burden's relationship to cognition. Across the sample, greater neuroinflammation was associated with worse executive function. For those with longer disease duration, higher neuroinflammation and lower medial temporal white matter connectivity related to worse memory. Future work should examine other brain burden metrics to determine whether/how cognitive reserve influences the cognitive trajectory of PD.

Presurgical psychological screening (PPS) is a procedure for mitigating possible unfavorable outcomes after spinal surgery. Although the effectiveness of PPS on degenerative spinal diseases has been investigated in Western studies, a potential cultural influence on PPS is still unknown. This study thus aims to explore the experiences of Taiwanese people before spinal surgery and tries to establish culture-specific components of PPS in Taiwan.

A total of five participants aged from 44–69 with degenerative spinal diseases were eligible in this study. All participants visited a neurosurgical outpatient clinic for potential surgical treatment, and each participant underwent an one-hour semi-structured interview before surgery. The demographical information, medical history, psychological status (e.g., personality traits and emotional disturbances) and considerations to make a surgical decision, were recorded and further analyzed following the rule of grounded theory.

Four major components with 21 sub-components were reported when deciding to receive a surgical treatment for their spinal diseases, including disease-related considerations, medical information, self-concept and interpersonal relations. In terms of disease-related aspects, patients concerned about etiology, symptomatology, impacts, coping strategies and rehabilitation methods. As for medical information, patients paid more attention on medical compliance, the relationship with medical system, attitude for treatment, expectation to surgical outcomes, medical decisions and medical information. As for the self-concept, patients considered more on the impacts of disease on self-concept, strategies of emotional regulations and personality traits. In terms of interpersonal relations, patients reported more on the supportive resources, patterns of interpersonal activities and impacts of interpersonal relations on medical decisions. Additionally, other specific factors, such as past negative experiences (e.g., chronic insomnia, experiences of psychological counseling), litigation, physical punishment in childhood and social roles, were also reported.

Like previous findings, our results supported that the interpersonal relations and doctor-patient relationship in PPS were important considerations before surgery, while we further evidenced that influences of family members on medical decision is determinant and unique in this culture.

Major Depressive Disorder (MDD) subtypes have been shown to differentially impact psychiatric symptom presentation, clinical features, and functional abilities. While there is extensive research regarding MDD subtypes and clinical characteristics, there has been limited information regarding the relationship between MDD subtypes and neurocognitive functioning. In particular, the neurocognitive impact of the subtype of treatment resistant depression (TRD), defined as MDD that is unresponsive to treatment, is unknown. The aim of this preliminary study was to address this gap by characterizing the neurocognitive profile of TRD. We characterized the performance of older adults with TRD on measures across multiple neurocognitive domains, and explored whether performance varied based on age and education.

Data utilized were drawn from a broader NIMH-funded, randomized, controlled study conducted at the University of New Mexico that investigated the clinical and cognitive outcomes of varying pulse amplitudes during acute electroconvulsive therapy (ECT) in adults with MDD. Participants in the study were age 50+ with a diagnosis of MDD, and further delineated by subtype as TRD. For this analysis, we utilized demographic and baseline neurocognitive data collected prior to start of treatment for those diagnosed with MDD, recurrent, severe (TRD). Neurocognitive measures included the Delis Kaplan Executive Function System (D-KEFS) Verbal Fluency and Color-Word Interference Subtests, Hopkins Verbal Learning Test-Revised (HVLT-R), and the Wechsler Adult Intelligence Scale 4th Edition (WAIS-IV) Digit Spans. Demographic-adjusted scaled scores were computed, and descriptive statistics were used to characterize the demographic and neurocognitive features of the sample. Multiple Analysis of Variance (MANOVA) was used to investigate difference in performance across neurocognitive measures based on level of education, with age as a covariate.

The sample (n = 42) had a mean age of 65 (SD=8), education level between12 and 14 years, 66.6% were female and 93% were Caucasian. DKEFS Verbal Fluency Category Switching Total Switching Accuracy fell in the Average range (Mean SS=9.5, SD=3.1), and Color Word Inhibition Total Completion Time fell in the Average range (Mean SS=8.5, SD=3.3). HVLT-R Total Recall Correct fell in the Mildly Impaired range (Mean T=35.5, SD=9.9) and Delayed Recall Correct fell in the Mildly to Moderately Impaired range (Mean T=32.9, SD=11.0). WAIS-IV Digit Span fell in the Average range (Mean SS=9.5, SD=2.2). Results indicated that age did not adjust outcomes on the neurocognitive variables, Wilks's λ=0.63, F(6, 23)=2.13, p=0.08. We found no evidence for significant effect of level of education on neurocognitive functioning when controlling for the covariate of age, Wilks's λ=-0.16, F(36, 103.7)=1.47, p=0.07.

To our knowledge, this is one of two studies to examine neurocognitive functioning in patients with TRD. The analysis indicated generally intact performance in the neurocognitive domains of executive function (inclusive of verbal fluency, cognitive flexibility, and inhibition), auditory attention and working memory, and Impaired performance on indices of verbal learning and memory. Age did not impact performance on neurocognitive measures, and there was no significant effect for level of education. Further research is warranted to confirm these findings and further explicate the neurocognitive profile of TRD.

Opioid use disorder (OUD) has been declared a national public health emergency leading to increased enrollment in medication assisted treatment (MAT) programs. Cognitive deficits are seen among those with OUD which can persist even with MAT. Moreover, cognitive deficits predict poor community and treatment outcomes. Neuropsychological evaluations can identify, diagnose, and provide treatment recommendations, and are associated with improved outcomes in non-substance use patient populations. Yet, patients with OUD rarely undergo neuropsychological assessment when participating in opioid use treatment. Teleneuropsychology (TNP) may increase access to care but has not been evaluated with people with substance use disorders (SUDs). This project used a mixed-method design to evaluate the feasibility and impact of a pilot hybrid TNP service with new patients with OUDs entering a MAT program.

Participants were >18 years old and new patients enrolling in MAT for OUD. Participants were excluded if they planned to move out of town within six months or were pending incarceration. Participants were identified by triage questions at MAT intake based on frequency of relevant co-occurring conditions indicating those with greatest need. Positively triaged individuals were referred to the TNP service which was conducted by a hybrid approach (i.e., patient presents to the clinic and is evaluated from a separate room using video-teleconferencing technology). We aimed to schedule participants within two-weeks of 30-days from intake to the MAT program. Consented participants completed questionnaires of feasibility and acceptability (e.g., satisfaction, usefulness) after undergoing a screening TNP evaluation and feedback of the results and recommendations. Participants also were invited to undergo a brief qualitative interview to further assess facilitators and barriers.

Of 57 individuals screened positive, 51 were referred, and 14 were reached to offer TNP. Ten (71.4%) agreed to the TNP evaluation and scheduled an appointment, though 50% had the first appointment scheduled within two weeks of 30-days after intake to MAT. Seven (70%) did not keep the first appointment (no show or cancellation) or were rescheduled due to clinic scheduling. Three were reached to reschedule. All three were unable to keep the appointment, but one did reschedule and keep the third appointment. Of the 4 who attended TNP, only 1 (25%) was within two weeks of 30-days after intake. Of those who attended the TNP appointment, 100% completed the protocol, 75% were satisfied with the evaluation overall, 75% found the evaluation useful, and 67% would recommend TNP to others (one participant did not respond to this question).

Neuropsychological assessment may provide valuable information to improve treatment for those with OUDs. This pilot project revealed that individuals with OUDs can tolerate and are satisfied with a screening TNP evaluation and find the evaluation useful. The primary barrier was reaching referred patients. Treatment engagement among those with SUDs is a common challenge. Those with counselors who coordinated with the clinic schedulers were more likely to be reached and scheduled, suggesting support for regular case management. Other lessons learned and potential future steps are discussed.

Prion disease is a rare, invariably fatal neurodegenerative disease characterized by rapid neuronal degeneration; Mutations to PRNP gene cause genetic prion disease (GPD). In animal models, microglial activation, astrocytosis, and release of neurofilament precede the onset of frank symptoms (Sorce & Nuvolone 2020, Minikel 2020). In humans at risk for GPD, prodromal pathology appears to occur in only a brief window prior to symptom onset (Vallabh et al. 2020, Thompson et al. 2021), but some data suggest that known PRNP mutation carriers may exhibit cognitive abnormalities prior to meeting clinical diagnostic criteria (Mole et al., 2021). We aim to examine pre-symptomatic differences in cognitive processing speed (CPS) and executive function (EF) in PRNP mutation carriers and controls.

Our sample includes two groups from an ongoing observational study on GPD (Vallabh et al., 2020): known PRNP mutation carriers (N = 32, Age M = 45.77, SD = 14.75) and control group of non-carriers with a family history of GPD and healthy controls with no known history (N = 11, Age M = 42.01, SD = 12.43). All participants completed a full cognitive battery at baseline and on an annual basis. We compared first visit cognitive testing measuring CPS and EF using: National Institute of Health (NIH) Toolbox [Pattern Comparison (NIH-PC), Flanker, Dimensional Card Sorting Task (NIH-DCCS)], Trail Making Test (TMT) A and B, and Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Test (CWIT).

Independent t-tests and Mann-Whitney U tests compared cognitive test performance between groups. Across all cognitive test measures assessed, none exhibited significant differences between groups after Bonferroni correction for N=10 tests (corrected P > 0.05). Mean scores for mutation carriers were non-significantly lower than controls on TMT-B (Z-score Mdn = .29, SD = 1.33 vs. Z-score Mdn = .96, SD = .97), NIH-PC (Age-corrected Standard Score [ACSS] M = 100.13, SD = 20.76 vs. ACSS score M = 114.82, SD = 14.61) and NIH-Flanker (ACSS score M = 83.58, SD = 9.72 vs. ACSS score M = 90.64, SD = 10.94), and NIH-DCCS (ACSS M = 101.29, SD = 16.37 vs. ACSS score M = 112.00, SD = 16.28) but not for TMT-A or all four conditions of CWIT.

We did not detect any significant cognitive deficits in known PRNP mutation carriers. This is consistent with the lack of prodromal pathological biomarker changes or cognitive changes as reported in Vallabh et al 2020, and with the finding of Mole et al. 2021 that most tests reveal impairment only at a stage where carriers report subjective symptoms. Our results suggest an opportunity for primary prevention to preserve full cognitive health in at-risk individuals. However, small sample size and limited test sensitivity may leave us underpowered to detect subtle deficits. Future research is warranted to further investigate the neuropsychological profile of pre-symptomatic GPD.

The objectives of this study were to investigate family members’ perception of the impact of the neuropsychological evaluation and subsequent feedback session on (1) caregiver understanding of the patient’s diagnosis and symptoms and (2) treatment planning, patient well-being, caregiver stress, and support utilization.

Participants included family members of patients undergoing a neuropsychological dementia evaluation and subsequent oral feedback session at a midwestern university medical center by one of five neuropsychology providers. The average age of patients undergoing dementia evaluation was 73.4 (range = 52 - 92). Patients in the sample were categorized as having dementia (67%), mild cognitive impairment (24%), or no cognitive disorder (9%), with 46% of the sample suspected to have Alzheimer’s disease or mixed Alzheimer’s and vascular disease. Immediately following the feedback session, family members were provided a brief survey, $10 prepaid gift card to keep regardless of survey completion, and a stamped, pre-addressed envelope to return the survey anonymously by mail. A total of 200 surveys were disseminated and 127 (64%) were completed and returned. Family members completing the survey were most often the spouse (60.6%) or the child (29.1%) of the patient. Eighty-two percent of respondents identified as being the patient’s primary caregiver.

Family members were asked to rate their agreement to perceptions held both prior to and following the neuropsychological evaluation. Ninety-seven percent strongly agreed (81%) or agreed (16%) that the neuropsychological evaluation was helpful, and 95% strongly agreed (62%) or agreed (33%) that the neuropsychological evaluation would help the patient get better or more targeted care. Comparison using Wilcoxon signed-rank tests indicated that family members were significantly more likely to agree (p < .001) with the following beliefs after, as opposed to preceding, the neuropsychological evaluation: (1) the patient’s symptoms had been well addressed (z = -7.95), (2) I was explained the diagnosis (z = -8.12), (3) I am confident in my family member’s diagnosis (z = -7.88), and (4) I am more likely to use dementia-related community resources (z = -5.78). Additionally, family members nearly unanimously agreed or strongly agreed that, following the neuropsychological evaluation, their family member’s symptoms had been well addressed (98%), they were explained the patient’s diagnosis (98%), and they were confident in the diagnosis (97%). In instances where dementia was diagnosed, 91% of family members agreed/strongly agreed that they planned to use dementia-related community resources. Furthermore, a majority of family members reported that the neuropsychological evaluation positively impacted the patient’s psychological wellbeing (82%), caregiver stress (74%), caregiver interactions with the patient (76%), treatment plan (82%), and overall patient care (79%).

Results indicate that family members of patients undergoing neuropsychological evaluation for suspected dementia perceive the neuropsychological evaluation as improving diagnostic understanding and confidence. Additionally, family members nearly unanimously agreed that the neuropsychological evaluation had a positive impact on treatment planning, patient well-being, caregiver stress, and utilization of supports.

Deep Brain Stimulation (DBS) is an FDA-approved treatment for Parkinson's Disease (PD), for which the medical workup includes routine pre- and post- operative neuropsychological assessment to determine potential surgical cognitive risk. Existing research suggests that cognitively normal individuals experience good cognitive outcome, whereas those with pre-existing cognitive deficits are prone to accelerated cognitive decline post-DBS. The goal of this study is to identify characteristics that determine which individuals with PD are at risk for accelerated post-DBS cognitive loss, and to characterize the nature of the decline in this population.

We conducted a retrospective chart review of PD- DBS patients who completed their DBS workup and surgery at Mount Sinai Hospital NYC between 2015 and 2022. Non-English speakers were excluded from this study due to small sample size and use of a neurocognitive battery different from that of English speakers. Using repeated measures t-tests, chi square, and regression analyses, we explored variables related to disease (e.g., duration, L-Dopa burden, DBS target), socio-demographic background (e.g., age onset, current age, education), assessment modality (telehealth vs in-office), neurocognitive performances (e.g., WMS-IV Logical Memory (LM), HVLT-R, WASI-II Matrix & Similarities, WAIS-IV Digit Span), and cognitive diagnosis (amnestic vs non-amnestic MCI) for all individuals in the sample. At the individual level, we utilized Reliable Change Indices (RCI) to identify clinically significant cognitive differences from pre- to post-DBS exam. We considered LM- Delayed Recall (LMDR) as a proxy for memory loss, as this cognitive function is expected to remain generally unchanged post PD-DBS. Therefore, decline on this measure in the first year after DBS could indicate a change in global memory function and possible evidence of accelerated postoperative decline.

Of 65 charts reviewed, 44 patients were native English-speaking and included in our analyses. At the group level, there were no significant differences in disease characteristics, socio-demographic variables, or cognitive classification between those who declined versus those who did not decline on LMDR. Regression statistics for predictors of cognitive decline also were non-significant. Of the eight individuals who declined on LMDR, one patient declined on a total of one neuropsychological measure, four declined on a total of two measures, two declined on a total of three measures, and one declined on a total of four measures. Two of these eight individuals had a diagnosis that changed to amnestic MCI based on concomitant interval history of ADL compromise. Of these two individuals, one declined in two tests and the other declined in four tests. Six of the eight individuals who declined also showed abnormalities in their imaging with either edema or hemorrhage.

Our analysis is unique in that we explored cognitive decline at both the group and individual levels. Despite this, we did not find predictors of post-DBS cognitive decline. Further detailed analysis of additional post-operative factors that might play a greater role in our understanding of this phenomenon is warranted. This said, our data do support that the majority of individuals with non-amnestic MCI did not decline cognitively.

Research on healthcare disparities has found that racial and ethnic minority population were less likely to receive intensive and effective rehabilitation following an acquired brain injury compared to their White counterparts. Immigrant status and language barriers further perpetuate the disparities in access to rehabilitation care. In addition to institutional barriers such as absence of culturally and linguistically appropriate health materials as well as lack of cultural competency training for staff, patient factors such as dissonance in cultural value orientation to health care has been identified as a common culturally-mediated barrier accounting for lower healthcare utilization rate among immigrants. Cultural factors including health beliefs and values impact patient’s self-appraisal of illness and have been studied as significant predictors for treatment adherence. The present case study seeks to demonstrate the role of socio-cultural factors in shaping the course of a Chinese immigrant patient’s neuropsychological evaluation and cognitive rehabilitation following an aneurysm rupture and subarachnoid hemorrhage.

The patient is a 64-year-old, monolingual Mandarin-speaking female who was born and raised in mainland China, referred for neuropsychological evaluation for treatment planning following an anterior communicating artery aneurysm rupture and subarachnoid hemorrhage. Cognitive complaints included selective retrograde amnesia and difficulty with short-term episodic memory. Patient completed neuropsychological assessment, then underwent a course of time-limited cognitive remediation.

Neuropsychological assessment was administered in Mandarin Chinese, and the majority of the tests utilized available norms from Mandarin-speaking Chinese population. While the patient continued to demonstrate at or above average functioning in aspects of executive function, she exhibited a pattern of “rapid forgetting” on modality-nonspecific learning and memory in addition to reductions in attention, working memory, psychomotor speed and visuo-perceptual integration. In the absence of mood symptoms, the patient demonstrated emotional resilience and strong family support system. Given reportedly minimal benefits from prior SLP intervention, barriers to treatment were examined and considered: linguistic factor, difficulty in holding on to information due to anterograde amnesia, and the lack of family involvement in the treatment process. In the context of Chinese family system and immigration history, family-centered care is imperative for the patient’s rehabilitation process. Main treatment goals included improving awareness of cognitive deficits as well as reinforcing consistent use of external strategies to compensate for impaired orientation and memory. Flexibility in the use of evidenced-based interventions were emphasized. The patient’s family were counselled in a culturally competent manner to further understand the aspects that matter the most for the patient and incorporate multi-sensory learning to facilitate intervention.

In this case study, we utilized culturally and linguistically appropriate norms and critically examined barriers to treatment from a contextual lens. This case highlights the role of culturally competent neuropsychological evaluation and incorporating a strength-based and multi-method approach in informing treatment planning for cognitive rehabilitation with immigrant population. Given the dearth in the existing cross-cultural literature, there is a clear need to conduct high-quality research in under-studied and under-represented immigrant populations to reduce the gap in service delivery and enhance treatment effectiveness.

Postoperative neurocognitive disorder is common after all forms of surgery in older adults. The mechanisms are multifactorial, and probably require pre-existing neuropathology, whether the patient is symptomatic or not. In Alzheimer's disease (AD) and other tauopathies, the microtubule-associated protein tau can undergo aberrant hyperphosphorylation potentially leading to the development of neurofibrillary pathology, one of the neuropathological hallmarks of the disease. Preclinical and human CSF studies suggest that anesthesia and surgery elicits an increment in CNS tauopathy, which may accelerate any preexisting neuropathology and produce a risk of delirium and the commonly reported changes in cognition.

In this session, the author will present a bench to beside review of how tau protein is altered by perioperative factors and its potential relationship to the impairment of cognition after surgery and anesthesia. Published and ongoing studies will be reviewed to result in a discussion as to why changes in tau protein are concerning in perioperative disorders of cognition.

The presenter will initially review pre-clinical studies focusing on the impact of anesthetics and surgery-induced inflammation on tau pathology and how the impairment of resolution of surgery-induced inflammation, notably decreased lipoxin A4 signaling, is altered by aging, gender, or an increase in the tau pathology burden. These preclinical studies have partially informed a multi-center federally funded observational clinical study, currently in progress, involving neuroimaging to determine whether pre-operative CNS tauopathy, as reflected by PET imaging, predicts delirium and other cognitive and functional outcomes. This translational study will also examine whether anesthesia and spine surgery produces a longitudinal change in the brain tau burden in older adults, as compared to control, nonoperative patients.

Bench to bedside research is needed in order to promote evidence-based care for patients at risk for ADRD.

Neuropsychiatric/behavioral-psychological symptoms of dementia (BPSD) frequently contribute to worse prognosis of patients with neurodegenerative conditions. BPSD are commonly measured via a brief, informant-rated version of the Neuropsychiatric Inventory (NPI), the NPI-Q. Previously (see our other submission to this conference), we established optimal latent structures by comparing different factor models in the literature using confirmatory factor analyses (CFAs). However, questions remain as to why so many different models were found in the literature. One possibility is sampling differences, including different proportions of individuals across cognitive stages (e.g., mild cognitive impairment, moderate dementia) or syndromes (e.g., Alzheimer’s amnestic syndrome, Dementia with Lewy Bodies). We tested this hypothesis by subjecting candidate models to measurement invariance (MI) analyses stratified by cognitive stage and syndrome.

Individuals were included if they had completed an NPI-Q during their first visit at an Alzheimer Disease Research Center reporting to the National Alzheimer Coordinating Center (NACC). This resulted in 20,500 individuals (57% female; 80% White, 13% Black, 8% Hispanic), with a mean age of 71 (SD = 10.41) and 15 average years of education (SD = 3.43). Regarding staging, 75.9% of individuals did not meet criteria for all-cause dementia, whereas 24.1% individuals had all-cause dementia. Regarding syndromes, 35.6% had an Alzheimer’s presentation (“AD-type”) and 5.6% had either a behavioral variant frontotemporal dementia or Lewy-Body dementia presentation (“behavioral-type”). A 3-factor and 4-factor model were subject to MI across these groupings. We conducted MI analyses for equal forms, equal loadings, and equal intercepts using the lavaan R package with a diagonally weighted least squares (DWLS) estimator.

The 3-factor model demonstrated good fit among individuals experiencing (CFI = 0.965, TLI = 0.955) and not experiencing (CFI = 0.984, TLI = 0.979) dementia, as well as among AD-type (CFI = 0.983, TLI = 0.978) presentations, but had borderline poor fit for behavioral-type (CFI = 0.932, TLI = 0.912) presentations. The 4-factor model had better fit among those experiencing (CFI = 0.985, TLI = 0.977) and not experiencing (CFI = 0.995, TLI = 0.992) dementia. Additionally, the 4-factor model demonstrated good of fit for AD-type (CFI = 0.993, TLI = 0.989) and poorer fit for behavioral-type (CFI = 0.949, TLI = 0.922) syndromes. Chi-square differences suggested that equal loading and equal intercept hypotheses should be rejected for both 3- and 4-factor models, for both staging and syndromal groupings. However, relative fit indices suggested that the equal form, equal loading, and equal intercept hypotheses could be adequate for only the 4-factor model.

The variability of factor structures in the BPSD literature appears, at least partially, explained by sampling variability among cognitive stages and dementia syndromes. The best models in the literature appear to have good fit in non-demented individuals and, among those who have dementia, in those with an AD syndrome. Only Sayegh & Knight’s 4-factor model had adequate (albeit, not optimal) fit among those with all-cause dementia and, more specifically, among those with a behavioral-type dementia syndrome. These findings inform BPSD theory and practical implementation of NPI-Q subscales.

Prior research has found that a greater history of concussion is associated with subtle increases in symptom endorsement. Recent work indicates that a family history of psychiatric disorder is a potential risk factor for prolonged recovery following a single injury. While greater symptom endorsement is observed among those with a personal psychiatric history, the potential role of family psychiatric history in elevated symptom endorsement in the context of repeated concussion has not been investigated. Therefore, the objective of this work was to determine whether family psychiatric history moderates the association of concussion history and elevated symptom endorsement in active collegiate athletes.

A total of 176 (mean age = 21.19 ± 1.63; 116 male) collegiate athletes completed this study at the Medical College of Wisconsin. Participant’s family psychiatric history was collected through a modified Family History Screen (FHS) regarding the participant’s biological parents, siblings, and children, focusing on questions relating to major depressive disorder (MDD; 3 total questions) and general psychiatric history (5 total questions). Concussion history was assessed through a semi-structured interview using American College of Rehabilitation Medicine criteria for mild traumatic brain injury. Concussion symptoms were measured via the Sport Concussion Assessment Tool (SCAT-5) and psychological distress was assessed using the Brief Symptom Inventory-18 (BSI-18). General linear models tested the association of the number of prior concussions with log-transformed SCAT-5 and BSI-18 scores. Additional general linear models were fit to assess the effects of number of prior concussions, family psychiatric history (MDD family history and general family history, each coded as Yes/No), and the interaction of prior concussion and family psychiatric history on log-transformed SCAT-5 and BSI-18 scores. Sex was included as a covariate in all models.

More prior concussions were significantly associated with greater symptom severity scores on the SCAT-5 (x2=26.87, p<0.001, unstandardized beta[B](standard error[SE])=0.25(0.05)) and BSI-18 (x2=20.94, p<0.00, B(SE)=0.19(0.04)). For the models investigating the effects of family psychiatric history, neither the main effect of MDD family history nor the MDD family history by prior concussion interaction were significant for either the SCAT-5 (ps>0.05) or BSI-18 (ps>0.05). Similarly, for the general history model, neither the main effect of general family psychiatric history nor the interaction of general family psychiatric history and number of prior concussions were significant for either the SCAT-5 (ps>0.05) or BSI-18 (ps>0.05). For both the MDD family history and general psychiatric family history models, the number of prior concussions remained positively associated with subjective symptoms on both the SCAT-5 (X2=20.10, p<0.001, and x2=23.50, p<0.001) and BSI-18 (x2=16.46, p<0.001, and x2=20.68, p<0.001).

The results of the current study provide further evidence for a relationship between elevated sub-clinical symptom endorsement and the number of prior concussions in active, collegiate athletes. The results do not, however, support the hypothesis that the association between prior concussion and an athletes’ level of symptom endorsement are moderated by the family psychiatric history. Additional research is needed to determine what factors predispose some individuals to the adverse chronic effects of repeated concussion.

Cerebral amyloid angiopathy (CAA) is one of the most frequent causes of non-traumatic intracerebral hemorrhage (ICH). ICH recurrence risk is significantly higher in patients with CAA than for those without the condition, and CAA is a risk factor for the development of dementia, particularly Alzheimer’s disease. There is a growing body of research describing neuropsychological impairment observed in patients with CAA. Among patients with a history of CAA-related ICH, the most commonly identified cognitive impairments include attention, processing speed, executive functioning, and episodic memory. However, little is known about potential additive or synergistic effects of each CAA-related lesion (such as recurrent ICHs) on cognitive functioning.

We present a case of a 74-year-old female with sporadic CAA, who had recurrent ICHs involving the left occipitoparietal lobe, left frontoparietal lobe, right occipital lobe, and left frontal lobe. She experienced residual visual impairment and probable Charles Bonnet Syndrome. Her clinical presentation and cognitive functioning were tracked with an inpatient neuropsychological evaluation completed after each ICH occurrence within the past year, as well as an outpatient neuropsychological evaluation completed approximately 3-months post-discharge from her most recent hospital admission. Record review, including clinical notes, lab tests, and imaging results supplement her performance on serial inpatient and outpatient neuropsychological evaluations.

Data from three inpatient neuropsychological screenings and one lengthier outpatient evaluation are presented. With each inpatient evaluation, her profile demonstrated further cognitive decline involving visuospatial skills, semantic fluency, and episodic memory. In fact, results from her last inpatient screening raised concern for an underlying cortical degenerative process. In contrast, her follow-up outpatient evaluation, after three separate ICH events within one year, demonstrated an isolated set-shifting impairment, with intact performance across all other domains, which ruled out the prior suspicion of a cortical process.

While specific domains of cognition are more vulnerable in CAA, it is difficult to identify a specific and expected cognitive pattern given the extensive number of varied neurological insults patients typically develop throughout the disease course. This case demonstrates the wide range effects of repeated ICH, as well as the contrast between the acute effects of new lesions and the lasting effects of these lesions on cognitive ability after a period of recovery and stabilization. Given that our service was able to perform neuropsychological assessment in the acute phase of each ICH and in the subacute phase after a period of stabilization, this case adds to the literature by providing an example of the additive or synergistic effects of each CAA-related lesion over time.

The objective of this study was to examine whether novel pandemic-related stressors have any effect on cognitive functioning. This study aimed to examine whether the overall number of pandemic-related stressors, and whether stressor type, are associated with cognitive problems. The coronavirus pandemic, and societal changes to prevent and respond to it, have created novel stressors, including unemployment, social isolation, and health risks. While prior research has focused on the physical and psychological consequences of these stressors, these stressors may also be associated with cognitive impairments. Individuals who have been infected with SARS-CoV-2 and individuals who experience chronic stress are at risk for cognitive impairments, however, research has not yet examined whether pandemic-related stressors not specifically related to infection but to the experience of the pandemic overall, are associated with cognitive deficits. This study evaluated whether pandemic-related psychosocial stressors (financial, health, role/responsibility, and social) were related to cognitive functioning. We hypothesized that individuals with a higher number of pandemic-related stressors will perform worse on cognitive domains of attention, memory, and executive functions, than those with fewer stressors.

An online survey recruited participants (A/=19), of whom 89.5% were female, and the average age was 34 years (SD=15.7), to complete an online neuropsychological battery. Participants first completed questionnaires on the coronavirus pandemic, demographic characteristics, and completed the BDI-II and the BAI. An online neuropsychological battery was administered to participants over Zoom consisting of various neuropsychological tests, including the RAVLT, story memory, digit span, FAS, animal fluency, a go-no/go task, the Stroop, and the NAART-R.

A majority of participants (89.5%) experienced one or more coronavirus pandemic stressors, with only two participants reporting no coronavirus stressors. A majority of participants experienced at least one social stressor (57.9%), role/responsibility stressor (63.2%), and health stressor (52.6%), with financial stressors (47.4%) experienced by just fewer than half of participants. Pearson’s correlations showed significant negative correlations between stressors and performance on several neuropsychological tests. Specifically, social, health, and total stressors were associated with significantly poorer performance on digit span backwards and trials of the RAVLT (i.e., Trials 15, delayed recall, recognition) (ps<.05). Social stressors, health stressors, and total pandemic stressors were significantly associated with poorer performance on measures of working memory, processing speed, verbal learning, and verbal memory.

While small sample size limits the power and generalizability of these findings, this study highlights the need to investigate the cognitive effects of pandemic-related stressors. An expanded coronavirus questionnaire would be beneficial as the current questionnaire may have not captured all stressors of the pandemic, or level of severity, that could potentially contribute to changes in neuropsychological function. Pandemic-related stressors have spread into many areas of everyday life and the consequences that have stemmed from these stressors seem to play a negative role on the general wellbeing of individuals and also show an effect on psychological and neuropsychological functioning. This study illustrates the need for an expanded response to health crises, as the negative results of this pandemic have not been solely affecting physical health.

Children who suffer from brain insults (i.e., traumatic brain injury (TBI), chemotherapy and radiation treatment for brain tumors) are susceptible to late-emerging cognitive sequelae. Even with similar neurological risk variables, variability in long-term cognitive outcomes remains an area of investigation for researchers of acquired brain injury. Given the potential for genetic factors to influence response to chemoradiation, researchers have examined associations between germline, inherited, single nucleotide polymorphisms (SNPs), and neurocognitive outcomes for cancer survivors. Children who sustain an uncomplicated mild TBI generally recover without long-term neuropsychological consequences. However, TBI survivors have overlapping mechanism categories with cancer survivors through secondary injury variables that can be influenced by genomic variation (e.g., oxidative stress and neuroinflammation). Furthermore, the study of genomic vulnerability is limited in heterogenous groups of pediatric TBI survivors. This study aims to identify associations between genotype and long-term neurocognitive outcomes for acquired brain injury survivors by utilizing machine learning to uncover pathophysiological similarities and differences between groups.

Fourteen brain tumor survivors, 139 traumatic brain injury survivors, and 63 healthy, age-matched controls completed the Letter N-back task to obtain performances on core neurocognitive skills (attention, working memory, and processing speed). Ten targeted genotypes were examined across five pathophysiological pathways (neurotransmission, oxidative stress, neuroinflammation, plasticity, growth and repair, and folate metabolism). Data were trained and tested utilizing three regression machine learning models. Mean estimated error and R2 were generated for each neurocognitive outcome. A feature importance score for models with positive variance was generated to determine how predictive a given SNP is for neurocognitive outcomes.

Genotype only accounted for a small amount of variance in cognitive outcomes when all clinical groups were combined. The mean absolute error for the best-fitting models from analyses where all groups were combined decreased when groups were examined separately; however, the differences in model R2 values were not significant. The relationship between brain tumor survivors and processing speed performance depended on genotype. Two SNPs had positive feature importance at the interaction level (rs58225473 and rs1801394). These SNPs are located on the CACNB2 and MTR genes and have functional consequences for neurotransmission and folate metabolism. Models of traumatic brain injury survivors did not explain positive variance and could not be examined for feature importance. Additionally, even when removing the only mechanism of action that should not be relevant for TBI survivors (folate metabolism polymorphisms), the TBI models still did not explain positive variance.

Findings of the importance of two key SNPs on MTR and CACNB2 genes align with recent systematic reviews, which found associations between these polymorphisms and neuropsychological outcomes in more than one group or cohort of pediatric cancer survivors. Models for TBI survivors were limited by the heterogeneity of the group and ceiling effects on performance. An understanding of genetic vulnerabilities influenced by treatment and injury-related factors in acquired brain injury will inform our understanding of the developing and recovering childhood brain. The current study is an initial contribution to this goal and highlights the utility of machine learning methodology for future studies that examine the influence of genetic heterogeneity in pediatric acquired brain injury.

Finding effective, innovative, and accessible methods of coping with and mitigating stress has been increasingly relevant in the midst of the COVID-19 pandemic. To do so, it is important to understand the impact of acute stress responses on cognition, behavior, and emotional functioning. The young adult population in particular has been known to show higher levels of stress. Studies have shown that deep breathing interventions are associated with improved affect, decreased stress levels, and improved cognitive functioning. The autonomic nervous system, particularly the functioning of the vagus nerve, has been thought to be a key mechanism in the effect of breathing on stress and mood. Most studies to date investigating the efficacy of breathing practices in stress reduction and mood improvement have lacked appropriate methodology, including adequate control groups, randomization, and cross-sectional designs. This single-blind, randomized, waitlist-controlled study investigated the feasibility of using a mobile application to train in resonance frequency breathing and its efficacy in reducing stress and improving cognitive functioning in a non-clinical sample of young adults with elevated stress.

80 healthy young adults with elevated stress levels were recruited from the NY/NJ community and the Queens College undergraduate research subject pool. Inclusion criteria: ages 18-29, Perceived Stress Scale score >13. Exclusion criteria: regular (at least 3 times per week) practice of any form of meditation, yoga, or breathing exercise; severe medical or psychiatric disorder; active suicidal ideation; drug or alcohol abuse within the past year; use of medication with a known negative impact on cognition or autonomic nervous system (ANS) arousal. Participants were randomized to a waitlist control group or breathing group. Participants in the breathing group were instructed to complete 10-minute breathing sessions using the free mobile application “The Breathing App” twice a day for five days per week for four weeks. Cognitive assessments were administered over the phone (pre and post-treatment) and self-report measures were completed online due to quarantine restrictions.

There were no significant main effects of group across any of the neuropsychological variables, including verbal memory, letter fluency, category fluency, cognitive flexibility, processing speed, basic attention span, and working memory. This indicated that breathing training did not significantly impact neuropsychological performance. Mediation analysis also demonstrated that breathing training did not indirectly lead to improvement in basic attention, processing speed, working memory, set-shifting, verbal fluency, category fluency, or cognitive flexibility, through its effects on stress reduction.

These results do not support literature suggesting that breathing at resonance frequency is associated with improved cognitive functioning such as greater cognitive flexibility, improved decision-making, stronger response inhibition, faster processing speed, and increased working memory. Future study designs should consider implementing active control groups (e.g., mindfulness meditation) and differential dosages of the breathing treatment.

Children with Down syndrome (DS) show marked differences in their early development when compared to typically developing (TD) peers. Major domains of challenge include intellectual abilities, executive functioning, and structural language. Children with DS have a unique profile of strengths and weaknesses that must be considered when comparing them to TD children, especially in terms of Theory of Mind (ToM). ToM encompasses the developmental milestones reached early in childhood when children develop the ability to conceptualize and understand others' thoughts, emotions, perspectives, and intentions. In TD children, these abilities typically begin to mature around 4-6 years of age, while in children with DS, delays are observed relative to chronological age expectations. Evidence shows that children with DS have impaired ToM abilities; however, these deficits might be more related to underlying delays in structural language, rather than a fundamental misunderstanding of social cues. The present study seeks to fill gaps in the literature by using a nonverbal assessment (The Penny Hiding Game; PHG) to evaluate a) ToM abilities in children with DS relative to younger TD peers of a similar mental ability level and b) relationships between ToM performance and structural language skills.

25 children with DS (60% F, M=11.39 years) and 25 TD children (40% F, M = 5.37, range = 3 to 7) participated. Participants' structural language abilities were briefly assessed using the Wechsler Individual Achievement Test- III Listening Comprehension Test (Oral Discourse Comprehension subcomponent). ToM was assessed using the PHG.

Univariate analysis of covariance was used to explore differences in ToM performance between groups while controlling for mental ability level. Children with DS (M= 2.79, SD= 2.23) performed significantly worse than TD peers (M= 4.28, SD= 1.87) on the ToM task (F(1, 60)= 4.5, p= .038). Linear regression was used to assess associations between ToM and structural language abilities. When both groups were lumped together, there was a modest association between ToM and Listening Comprehension scores (R2 = .12, F (1, 55) = 7.29, p= .009). However, when groups were considered separately, significant associations were not observed (p>.1).

The DS group showed markedly diminished ToM performance compared to TD controls, as expected based on the literature. However, data did not suggest a clear association between ToM and structural language skills. While an association was observed when groups were lumped, this relationship was likely driven by group differences in both ToM and structural language skills. Future research should examine the relationship between ToM performance, different aspects of language functioning, and the cooccurrence of autistic traits among children with DS in order to augment our understanding of linguistic and social correlates of ToM performance in young children with DS.

Subjective Cognitive Decline (SCD) is the self-reported experience of one’s own declining cognition prior to objective impairment on clinical neuropsychological testing. While SCD is a promising marker of preclinical Alzheimer’s disease (AD), information is needed to determine which cognitive complaints reflect typical aging versus prodromal degenerative disease. The objective of the current study was to examine the extent to which specific cognitive complaints were associated with two clinical outcomes including: 1) lower performance on cognitive tasks sensitive to preclinical AD; and 2) seeking help (i.e., medical attention) for cognitive difficulties.

The current sample consisted of 175 healthy older adults (56 Male, 119 Female), aged 51 to 90 (M=72.67, SD=7.12) with a mean education of 16 years (SD=2.3 years) who performed > -1.5 SD on clinical neuropsychological testing. 26.8% of the sample self-reported as race/ethnic minorities (e.g., Hispanic or Non-Hispanic, Black, Asian, Other.) Participants completed a 20-item SCD questionnaire assessing perceived cognitive difficulties in comparison to same aged peers, and tests shown to be sensitive to preclinical AD including the Face Name Associative Learning Test and the Loewenstein-Acevedo Scales for Semantic Interference and Learning. Participants were coded as having sought help for SCD (39%) if they entered the current study from a clinical referral source, OR if they entered through a non-clinical referral stream but indicated that they had previously seen a doctor specifically for memory concerns or spoken to their doctor about memory concerns. Chi square tests were used to examine relationships between SCD item endorsement and help-seeking; ANOVAs were used to the extent to which item endorsement was associated with performance on cognitive tests. Results were considered significant at p < .05.

Three SCD items were associated with both lower cognitive test scores and having sought help for SCD (p values ranged from < .001 to .02). Items included difficulty remembering the date or day of the week and remembering a few shopping items without a list. One non-memory item was also associated with both outcomes including difficulty thinking ahead. In contrast, six items were not related to either outcome of interest. Such items included difficulty remembering appointments, remembering where you put things like keys, following a map to a new location, doing two things at once, understanding what you read, or understanding what people say to you. The remaining eleven items explore the extent to which selective associations exist with either help-seeking or cognitive performance.

Patients and clinicians alike are often unsure about which cognitive difficulties are typical for aging and which may be the cause for further workup. Current results suggest that certain complaints among cognitively healthy older adults may be cause for more thorough evaluation or monitoring. These complaints include specific memory and nonmemory concerns. Future work is needed to determine if these complaints predict future cognitive decline or conversion to Mild Cognitive Impairment.

Children born preterm are at increased risk of deviation from the typical developmental trajectory. The probability of adverse developmental sequelae is increased in those with history of major perinatal complications. Retinopathy of prematurity (ROP) is a pathological disordered growth of retinal blood vessels occurring in very preterm neonates who require supplemental oxygen. ROP has been linked to intermittent hypoxemic events and blood gas derangements occurring in the Neonatal Intensive Care Unit (NICU), particularly in ventilated infants. Though presence and severity of ROP have been linked to neurodevelopmental impairment, little is known about the relationship between ROP severity and motor development in the preschool age. Because the same hypoxemic events and blood gas changes that lead to severe ROP may also lead to greater developmental deficits in motor control, we hypothesized that ROP severity will be inversely linked to the quality of motor functioning even in NICU graduates without neurological impairments.

We included 95 preterm (23.6 - 33.6 weeks gestation) preschoolers (49 females, 44 members of twin pairs or triplets). The participants' age ranged from 3.3 - 4.1 years (adjusted for prematurity). ROP screening was conducted during NICU stay and rated from immature retina (0) to grade 4. Motor abilities were assessed with the Peabody Developmental Motor Scales (PDMS-2). Cases with diagnosed perinatal brain pathology (moderate to severe) or cerebral palsy were excluded from analyses.

We used linear mixed regression analyses with multiple gestation as a random factor. Severity of ROP was our predictor of interest, whereas socioeconomic status, sex, gestational age, and birth-weight SD served as covariates. Separate analyses were conducted using the PDMS-2 Total Motor, Fine Motor, and Gross Motor Quotients as dependent variables. ROP severity explained a unique portion of the variance in the Total Motor Quotient (F[1, 89] = 5.59, p = .02). Examination of the relationship between ROP severity and motor skill domains yielded a significant association for the Fine Motor Quotient (F[1, 89] = 6.19, p = .015) and a trend for the Gross Motor Quotient (F[1, 89] = 3.64, p = .06).

The results of this study reveal that increase in ROP severity is linked to poorer motor skills in preterm-born preschoolers without major disabilities or perinatal diagnosis of moderate to severe brain pathology. This association was evident for both fine and gross motor skills, though only the relationship between ROP severity and the former motor index reached conventional statistical significance. Importantly, ROP severity accounted for a unique portion of the variance in motor performance, over and above the variance explained by other perinatal risk factors. This result is consistent with previous research findings indicating that ROP is linked to the occurrence of multiple, subtle hypoxemic events and 'exposure' to blood gas derangements during NICU stay in very preterm neonates who require respiratory support.