Investigating the association between pre-implantation cognitive performance and one-year post-implantation speech perception outcomes in adult cochlear implant recipients using the repeatable battery for the assessment of neuropsychological status for hearing impaired individuals (RBANS-H)

Background The comprehensive assessment of cognition should include the immediate recall of information as well as that provided after delay. The phenomenon of patients providing intrusions is well recognised in the realm of cognitive assessment. Certain intrusions have been found to recur across patient performances. Methods Retrospective analysis was undertaken of patients (n=9) screened for dementia using the Repeatable Battery for the Assessment of Neuropsychological Status (Pearson) between 2022 and 2024. Data was sourced from MDT notes cataloguing the results of memory tests undertaken whereby the patient had added information regarding loss of life for persons involved in a fire. Data were elicited regarding List Learning (LL) and Recall; Story Memory and Recall, Figure Copy and Recall. The final sheet was used to elicit scores for each category. Results Median age was 76 (range 61-84 years). Male to female was 4:5. Patients were found to make a comment regarding loss of life e.g. ‘nobody was hurt’ where the information did not exist in the original story script. This occurred equally at Story Memory Stage and Story Recall Stage (77.7%). When compared with list and figure copy elements- only one patient also had errors in both LL and memory figure. Six patients had intrusion errors across other elements. Where the story was accentuated in both immediate and delayed recall stages- pts had intrusions in list learning (n=2, 22%) list recall (n=3, 33.3%) but no intrusions on Figure Copy- immediate or delayed. Conclusion Although this cohort of patients was small- each one of them included the status of life lost when given a short story to recite and then recall. These comments occurred both on immediate episodic recall and after delay and were not always associated with a replicated intrusion phenomena across other elements. This inherent interest in the survival of other humans is worth highlighting.

RBANS analysis of verbal memory in multiple sclerosis

Objective: Due to factors including differences in educational opportunity, African Americans and Caucasians frequently differ on cognitive tests creating diagnostic error risks. Such differences have been found on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and preliminary norms based on a small sample of African Americans have been generated. In a larger sample of community-dwelling older African Americans, we explored sources of variance including age, gender, common medical conditions, years of education, and reading level to generate norms stratified on the most relevant bases. Method: Three hundred and fifty-five African Americans aged 55+ and living independently completed the RBANS and health, education, and psychosocial interviews. Results: Hypertension and type 2 diabetes were unrelated to overall RBANS performance once age and education were accounted for. Age, education, and WRAT-3 Reading score (a proxy for scholastic attainment) were independent predictors of RBANS performance. Females performed better on List Learning, Story Memory, Fluency, Coding, List Recall, and List Recognition; males were superior on Line Orientation and Picture Naming. Conclusions: In addition to generating norms stratified by age, we provide descriptive statistics grouped by age and education, and by age and WRAT-3 Reading grade level, to provide clinicians with the opportunity to tailor their interpretation of scores based upon perceived best fit for their patient. Regression formulas are provided to address gender differences. To complement the standard index norms, we provide norms for alternative indexes representing additional an factor structure of cognitive domains.

Objective:Concurrent electroencephalography (EEG) during neuropsychological assessment offers a promising method to understand realtime neural and cognitive processes during task performance. For example, previous studies using experimental tasks suggest that midline-frontal theta power (MFT) could serve as a measure of mental exertion and subjective difficulty. The RBANS provides an opportunity to examine this issue in neuropsychological assessment, as a widely-used screening battery that was explicitly developed with subtests that vary according to difficulty within its five domains. This study investigated the effects of task difficulty, cognitive domain, and age on elicitation of MFT during rest and RBANS administration.Participants and Methods:EEG was recorded during eyes-closed and eyes-open resting periods and RBANS administration in a sample of 45 healthy younger adults (n = 21; mean age = 23.29, SD = 3.27, range = 19-33; 48% female) and older adults (n = 24; mean age = 70.58, SD = 5.77, range = 59-83; 83% female). MFT was defined as the highest peak above the overall power spectrum within 4-8Hz from electrode Fz, and operationalized as a binary variable (present/absent). A multilevel generalized logistic regression model was run to assess the main effects of Age (Younger, Older), Difficulty (Easy, Hard), Domain (Rest, Immediate Memory, Visuospatial/Constructional, Language, Attention, Delayed Memory), and their potential interactions, on the presence of MFT.Results:In the full sample, the Coding, Figure Recall, and Picture Naming subtests were numerically most likely to elicit MFT (71.1%, 66.7%, and 62.2%, respectively), whereas Semantic Fluency, Eyes-Closed Rest, and List Recall had the lowest likelihoods (37.7%, 31%, 28.9%). Older adults were also numerically less likely to exhibit MFT (37.50% present) compared to younger adults (62.24% present). An analysis of deviance revealed a significant effect of Age (F(1,43) = 7.22, p = .01) and a significant interaction between Difficulty and Domain (F(5,220) = 4.78, p < .001). Specifically, Hard subtests in the Visuospatial/Constructional (Figure Copy; b = -2.63, p < .05) and Language (Semantic Fluency; b = -2.92, p < .01) Domains were less likely to elicit MFT than the Easy subtests (i.e., Line Orientation and Picture Naming, respectively).Conclusions:Results indicated that MFT can be reliably measured during neuropsychological assessment, and varies in relation to both age and task-related factors. Consistent with previous studies, older adults exhibited less MFT than younger adults in general, possibly suggesting a failure to recruit the relevant networks. Further, present findings suggest that the presence of MFT varies not only by the type of task but also by the level of difficulty. Future research with larger samples can clarify whether and how the amount of MFT elicited during specific subtests relates to objective and subjective difficulty. Overall, MFT can reliably be elicited by cognitive tasks and bears further study as a measure of real-time neural expenditure.

BackgroundLower levels of physical activity (PA) are associated with greater risk of cognitive decline and AD, and some studies suggest that interventions that increase PA engagement lower risk of cognitive decline and AD. However, interventions to date have largely not included substantial representation of African Americans.MethodThe Program for African American Cognition and Exercise (PAACE) randomized 56 sedentary African American adults in the Baton Rouge, Louisiana area (mean age ± s.d.: 69.2 ± 3.4 years) to a physical activity group (PAG) or successful aging group (SAG). The PAG aimed to increase moderate to vigorous PA to national guideline levels over 12 weeks by providing supervised PA 2 days per week (90‐120 minutes/week) at local YMCAs along with 30‐60 minutes/week of home‐based PA. The SAG completed one 60‐minute educational session on successful aging per week for 12 weeks. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was assessed before and after the intervention. ANOVA models assessed pre‐ to post‐intervention RBANS total scale and sub‐scale score changes, as well as differences between PA and control arms in these changes.ResultGroups were well matched by age, sex, BMI, employment, education, and income. The SAG increased scores on the RBANS overall scale and scales of visuospatial function, immediate memory, and delayed memory, along with the story memory, figure copying, coding, and figure recall sub‐scales (all p<.05). The PAG increased scores on only the list learning sub‐scale (p=.047). Scores on the overall scale (p=.034) and story memory sub‐scale (p=.0008) increased significantly more in the SAG than in the PAG. No RBANS scores increased significantly more in the PAG compared to the SAG.ConclusionA 12‐week PA promotion program among community‐dwelling older African American adults provided significant cognitive benefits to an educational control group, and minimal benefits to those engaged in PA. Possible contributors to these results include inadequate PA stimulus in the PAG, and beneficial health behavior changes or cognitive stimulation in the SAG. Future research is needed to fully understand cognitive effects of PA interventions among older African Americans.

Excessive alcohol use is associated with damage to the structure and function of the brain and impairment of cognition and behavior. Traditional test batteries used to assess cognitive performance in alcoholics are extensive and costly, limiting their use across various clinical and research settings. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a relatively new instrument that attempts to overcome some of these limitations. As yet the individual effect of moderate to heavy alcohol consumption on RBANS performance has not been examined. The primary aim of this study was to explore and quantify differences in performance between controls and drinkers on the RBANS and to examine the influence of age, gender, and alcohol use patterns on test performance. Data from a subset of "Using Our Brains" (UoB) donors (n = 28) still actively drinking and meeting criteria for moderate to heavy alcohol use (30 to 80 g of ethanol per day) (Harper, 1988) and 28 matched controls (age, education, and premorbid Intelligence Quotient) were compared. Participants in the alcohol group performed below the healthy control group on the visuospatial and immediate memory index, and also on the RBANS total score p < 0.001 and showed a greater decline in RBANS scores from estimated cross-sectional premorbid levels. There was a positive association between alcohol ingestion in the preceding 12 months and the language index p < 0.03 and the semantic fluency subtest (p < 0.03). Age was negatively associated with story memory (p < 0.02), coding (p < 0.001), list recognition (p < 0.01), story recall (p < 0.03), and figure recall (p < 0.02). Our results suggest that the RBANS is able to detect and characterize differences in verbal fluency, visuospatial skills, components of declarative memory, and psychomotor speed between healthy controls and moderate to heavy active alcohol users. Executive functions, commonly affected by alcoholism and not included in the RBANS, require assessment with additional measures.

ABSTRACTObjective: To determine whether the standard Spanish driving test (ASDE test) was able to identify patients with Parkinson's disease (PD) at risk of unsafe driving and to examine the relationship between the ASDE test and the Useful Field of View (UFOV) as well as with a battery of neuropsychological tests in drivers with PD.Methods: Thirty-seven patients with PD and 33 controls matched by age and education level were included in an observational study. All participants were active drivers and patients with PD underwent study procedures after taking the medication in the “on” period. Subjects with a Mini-Mental State Examination (MMSE) score ≤ 24 were excluded. Neuropsychological tests (Repeatable Battery for Neuropsychological Status [RBANS], Trail Making Test [TMT-A and -B], and Block Design test), driving performance tests (ASDE Driver Test and UFOV), and daytime sleepiness (Epworth Sleepiness Scale) were assessed.Results: The PD group performed significantly worse than healthy controls in the ASDE Motor Coordination tests. No significant differences were observed in anticipation speed, multiple reaction time, concentrated attention, and resistance to monotony. All participants successfully completed the UFOV tests. Statistically significant differences between patients with PD and controls were found in processing speed (UFOV1; P =.03) and more patients with PD were found in the categories of higher driving risk levels (P =.03). In addition, patients with PD showed worse scores than healthy controls in visuospatial capacities (Line Orientation), psychomotor speed (Coding and TMT-A), memory (List Recognition, Story Recall), and executive function (TMT-B). The driving tests (ASDE and UFOV) showed a low sensitivity and a high specificity but a higher percentage of patients in the PD group failed in multiple reaction time, concentrated attention, and resistance to monotony. In addition, 18.9% of patients with PD showed a cutoff of 4 for UFOV risk. In the discriminant analysis, Line Orientation (visuospatial/constructive domain) and Figure Recall (delayed memory) were found to be statistically significant with a rate of correct classification of unsafe drivers with PD of 78.2%. In addition, normal results on the Line Orientation item were associated with a 1.5 times higher probability of non-risky driving in the multivariate analysis.Conclusions: At early stages of the disease, about 19% of patients with PD showed difficulties that may affect their driving capabilities. Line Orientation and Figure Recall are useful to alert clinicians to the risk of unsafe driving. For this reason, patients with PD should be evaluated for driving abilities more regularly to determine the extent of deficits that may influence driving performance.

Objectives:The substantial variability in speech perception outcomes after cochlear implantation complicates efforts to develop valid predictive models of these outcomes. Existing predictive regression models are too unreliable for clinical application, possibly because speech intelligibility (SI) after cochlear implant (CI) rehabilitation is often based on a limited number of assessments. The development of SI after CI has rarely been detailed, although knowing the shape of the learning curve can potentially improve predictive modeling. Knowing the learning curve after CI could also aid in setting expectations about SI immediately after implantation, and the duration of rehabilitation. The current objectives were to construct learning curves to estimate baseline SI at 1 week (B), maximal SI after rehabilitation (M), and rehabilitation time (time to reach 80% of the learning effect; t[M − B]80%), and to subsequently deploy these outcomes for multiple-regression modeling to predict CI outcomes.Design:To assess rehabilitation after cochlear implantation, we retrospectively fitted learning curves using clinically available SI assessments from 533 postlingually deaf, unilaterally implanted adults. SI was assessed with consonant-vowel-consonant words (CVC) in quiet, with phoneme score as the outcome measure. Participants were followed for up to 4 years, with SI measurements collected at fixed intervals. SI was commonly assessed 1, 2, 4, and 8 weeks after device activation. B, M, and t(M − B)80% were determined from the fitted learning curves. Predictive multiple-regression analyses were performed on these three outcome measures based on eight previously identified preoperative demographic and audiometric predictor variables: age at implantation, duration of severe-to-profound hearing loss, best-aided CVC phoneme score (in the free field), unaided ipsilateral and contralateral residual hearing and CVC phoneme scores (measured with headphones), and education type (regular or special education).Results:At 1 week after CI activation, raw phoneme scores had increased from 40% preoperatively (best-aided condition) to 51%, with further improvement to approximately 78% at 4 years. SI increased significantly until 1 year after activation and then plateaued. Fitted learning curves supported better estimates of these parameters, showing that average baseline SI at 1 week after CI activation was 51%, increasing to 85% after rehabilitation. The asymptotic score exceeded the raw average after 4 years because many cases had not yet plateaued. The median t(M − B)80% was 1.5 months. Predictive modeling identified duration of hearing loss, age at implantation, best-aided CVC phoneme score, and education type as the most robust predictors for postoperative SI. Despite the statistically significant correlations, however, the combined predictive value was ~19% for B, 10% for M, and 2% for t(M − B)80%.Conclusions:This study is among the few to generate detailed learning curves after cochlear implantation. By including clinical SI measures in the earliest rehabilitation period, we report a median rehabilitation time with CI of 1.5 months. This implied rapid learning effect emphasizes the value of monitoring SI in the first few weeks after rehabilitation. According to multiple-regression analyses, the most commonly used preoperative variables correlated significantly with postoperative outcomes, but with limited predictive value for the clinic. By fitting learning curves through data reported in the literature, we show that the increase in SI during rehabilitation is an important predictor for t(M − B)80%.

ABSTRACTBackground/Study Context: A number of longitudinal randomized controlled trials (LRCT) have used free verbal recall tests to study the effects of post-menopausal estrogen hormone therapy (HT) on episodic memory, but none have explicitly explored contrasts between list and story recall, in spite of cognitive differences between the tasks. For example, list recall provides little support for the use of gist, while story recall emphasizes it, and there is evidence that estrogen produces gist bias. Moreover, we present a literature tabulation that also suggests a task-specific HT effect.Methods: In an LRCT with up to eight yearly test sessions, post-menopausal women were randomly assigned either to placebo (N = 56) or to an estrogen formulation (N = 44); subgroups received either estrogen alone (hysterectomy; E-alone; N = 16) or with progestin (intact uterus; E + P; N = 28). Participants were tested on the immediate and delayed list and story recall at each session.Results: Linear mixed effects analyses of longitudinal trajectories showed that relative to placebo, the HT group declined significantly faster on immediate list recall and slower on immediate story recall. Separate analyses produced a sharpened version of this pattern for the E-alone subgroup but found no significant effects for the E + P subgroup. No significant effects were found in delayed testing.Conclusion: The dissociation we found for immediate list and story recall is similar to the pattern of results in our literature tabulation. Fuzzy-Trace Theory posits parallel verbatim and gist traces plus a meta-cognitive review which becomes more gist-biased with age. Our results suggest that: (1) estrogen increases gist bias, hastening the normal age-related decline of list recall but slowing the decline of story recall relative to placebo; (2) decay of the verbatim trace over time generally causes a shift to gist, thereby accounting for the absence of a delayed recall difference; and (3) progestin weakens the effects of estrogen, thereby accounting for why the dissociation found in E-alone was absent in the E + P subgroup.

Development of a cognitive composite for measuring change in progressive supranuclear palsy

Executive dysfunction is associated with impaired memory performance, but controversies remain about which aspects of memory are involved and how general intelligence influences these connections. We aimed to clarify these connections in stroke patients by comparing various memory measures in patients with and without executive impairment. Our consecutive cohort included patients with a first-ever ischemic stroke. Neuropsychological assessments were completed 6 months and 2 years after stroke. We classified patients as executively impaired, when at least two of five executive measures were defective at 6 months. At both 6 months and 2 years, we compared list learning of unrelated words, story recall, and recall of geometric figures in patients with and without executive impairment, while controlling for general intelligence. Patients with executive impairment (n=66; 37%) performed worse in list learning (p=.001; partial η2=.058) and immediate recall of a logical passage (p=.010; partial η2=.037) 6 months after stroke compared to executively intact patients (n=113). At the end of the 2-year follow-up period, the patients who were executively impaired at 6 months (n=53; 37%) still performed worse than executively intact patients (n=92) in list learning (p<.001; partial η2=.096), and additionally in delayed recall of the list (p=.006; partial η2=.052) and immediate recall of geometric figures (p=.007; partial η2=.050). In our working-aged stroke patients, executive impairment was common. Executive impairment was associated with memory tasks that provided less inherent structure and required the use of active memory strategies. Clinicians should remember this role of executive dysfunction when interpreting memory performance.

The primary aim was toperform a systematic literature review and extract data necessary for a meta-analytic factor analysis of the RBANS. Secondary aims were to examine the potential validity and utility of the resulting factor structure. Literature was identified through a review of PsycINFO, PubMed, MEDLINE, Academic Search Complete, Psychology & Behavioral Sciences Collection, CINAHL Complete, Health Source: Nursing/Academic Edition, and SocINDEX. A two-stage meta-analytic structural equation modeling method was implemented to pool correlation matrices from primary studies and perform confirmatory factor analyses. Following model selection, factor scores were computed for two datasets and subjected to correlation and diagnostic accuracy analyses. A pooled correlation matrix was computed from 24 sample correlation matrices (N = 5299). Confirmatory factor analysis revealed that the theoretical five-factor model produced the best fit but only when error terms between Story Memory and Story Recall as well as between Figure Copy and Figure Recall were included. Regression-based factor scores showed mixed relationships with the manual-defined indices, and the overall diagnostic accuracy of the factor scores was adequate in both samples examined (AUC = 0.71 and 0.87). The five-factor model was an unexpected result given the failure of multiple previous studies to find support for that model. The five-factor model demonstrates several areas of potential improvement, including better representation of the factors by the indicators. The factor scores implied by this model also require further validation.

Objective:To determine if the degree of split between phonemic verbal fluency and semantic verbal fluency at initial visit is predictive of decline in memory performance between initial evaluation and follow-up.Participants and Methods:Data from a retrospective multidisciplinary memory clinic database at Spectrum Health was utilized. We examined data from 90 participants who had both an initial and follow-up evaluation completed (initial age = 77.1±4.7 years, follow-up age = 78.4±4.7 years, education = 13.9±3.1 years, race = 91% White, 7% Black, &amp; 2% Hispanic, sex = 61% female, time between evaluations = 15.2±9.9 months). Patients who returned for follow-up did not meet criteria for dementia at time one. Split between phonemic and semantic fluency, termed the semantic-phonological delta (SPD) was measured at the initial evaluation by subtracting the Controlled Oral Word Association Test (COWAT; FAS) T-score from the Animal Naming Test (ANT) T-score. Change in memory score was defined in two ways: 1) subtracting the follow-up evaluation Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) List Recognition Score (RBANS percentiles were converted to a scaled score) from the initial evaluation List Recognition Score (List Recognition Delta), and 2) computing the difference in the RBANS Delayed Memory Index Standard Score between the initial evaluation and the follow-up evaluation (RBANS Memory Delta).Results:Average semantic fluency T scores were (M = 40.3, SD = 12.3) and phonemic fluency T scores were (M = 42.7, SD = 10.3) at initial evaluation. Bivariate correlations were used to determine the relationship between the clinical variables. SPD was significantly correlated with List Recognition Delta, r(88) = .23, p = .026, with greater discrepancies in verbal fluency scores associated with higher level of decline in List Recognition at follow-up. By comparison, Semantic Fluency performance itself at initial evaluation was not significantly correlated with List Recognition Delta, r(88) = .17, p = .097. The correlation between SPD and the RBANS Memory Delta was also not significant, r(88) = .14, p = .166. At follow-up evaluation, 39% of the sample received a diagnosis of Alzheimer’s disease. Of those diagnosed with Alzheimer’s disease, 66% had a negative SPD split at time one, performing worse on semantic fluency compared to phonemic fluency.Conclusions:SPD is a better predictor of decline in RBANS List Recognition performance between evaluations than semantic fluency alone, with a larger negative SPD score (worse semantic fluency performance compared to phonemic fluency) at initial evaluation predicting decline in List Recognition performance at follow-up evaluation. SPD at initial evaluation was not significantly correlated with change in RBANS Delayed Memory Index score between evaluations. This may be because there are some patients who are similarly impaired in both semantic and phonemic verbal fluency at initial evaluation who later demonstrate progressive decline in memory retrieval due to hippocampal-sparing etiologies (e.g., vascular dementia). Overall, these findings are consistent with previous work suggesting that declines in the semantic memory system precede declines in episodic memory retention in conditions such as Alzheimer’s disease.

To examine the link between RBANS scores and functional impairment. Functional status was evaluated through informant report using the clinical dementia rating (CDR) scale. Archival data were reviewed from records of 99 patients in a memory disorder clinic (MDC) research database. Consensus-based diagnoses were Alzheimer's disease (AD; n = 48), mild cognitive impairment (MCI; n = 48), AD with vascular components; (n = 2) and dementia due to psychiatric conditions (n = 1). The RBANS language index score was significantly related to CDR domain scores of community affairs (p < .01), home and hobbies (p < .01), personal care (p < .05), memory (p < 0.01), and judgment (p < 0.01). RBANS immediate memory index scores were significantly related to (p < 0.05) the CDR Memory and judgment and problem solving domains. Based on these findings, follow-up regressions were conducted. Semantic fluency was significantly related to CDR memory (p < 0.01), judgment (p < 0.05), community affairs (p < 0.05), home/hobbies (p < 0.05), and personal care (p < 0.05) functional domains. Picture naming was significantly related to the CDR personal care domain (p < 0.05). List learning was significantly related to CDR memory functional domain (p < 0.01) and judgment (p < 0.05). Lastly, story memory was significantly related to the CDR judgment domain (p < 0.05). The RBANS may be an indicator of functional impairment as well as a neuropsychological testing tool. The use of the RBANS could reduce the amount of testing that is administered to the patient, or can provide a way to compare other measurements of functional impairment to assess accuracy of findings.

B - 118 Exploration of Supplemental Recognition Measures for the RBANS