ABSTRACT Background Aging alters various aspects of language output. However, health care professionals lack knowledge about language skills in the vastly growing very old (VO) population. Narratives provide a lucrative method for examining language in ageing as they are sensitive to neurological changes. Aims We study the normative lexical diversity and pauses in healthy 80–100-year-old speakers’ narratives and investigate whether they are predicted by physio-anatomical, socio-cognitive or linguistic background variables. Methods This cross-sectional study comprises fifty VO Finnish speakers, who produced a narrative from a wordless cartoon strip. The lexical diversity of the narratives was analysed by number of different words (NDW), type-token-ratio (TTR), words by grammatical class and noun-verb ratio. Pausal variables consisted of pause time ratio, pause frequency, mean pause duration and mean syllables between pauses. Background variables included age, dentition (natural teeth vs. dentures), educational level and linguistic skills by the Western Aphasia Battery Aphasia quotient (WAB-AQ), semantic and phonemic fluency and the Boston Naming Test (BNT). The association between lexical diversity, pausing and the background variables was studied by multiple regression analysis. Results Both lexical diversity and pausing showed notable individual variation. Higher NDW was linked to natural teeth among lexical diversity variables. NDW was also positively predicted by the highest educational level and WAB-AQ but negatively associated with BNT scores. Within the pause variables, pause time ratio was predicted by age as the oldest speakers produced the lowest proportions of pauses. Conclusions This study offers normative data on multiple variables of the VO speakers’ language use. It also provides insight into the interconnections between ageing, language and personal factors. As natural teeth and high education were associated with diverse vocabulary, we recommend that clinicians assess the participants’ dental status and educational history. The contrasting effects of the WAB-AQ and BNT on lexical diversity underscore the need to acknowledge that lexical abilities may appear differently in formal tests and in narration. The finding that the oldest of the speakers used less time pausing challenges the assumption about pausing consistently increasing with age. This study adds to the missing knowledge on ageing and language. It provides health care professionals more expertise in identifying typical age-related variety. Nevertheless, to enable narrative evaluation in routine clinical practice more international research on typical old and adult speakers is required as well as developments in automated analysis of spoken language.

Background/Objectives: Early intervention in the prodromal stages of dementia is a primary focus of contemporary research, as delaying clinical progression may have a substantial public health impact. Citicoline, an endogenous precursor of phosphatidylcholine and acetylcholine, has been proposed as a nutritional compound with potential relevance to multiple cognitive domains. However, real-world evidence regarding its specific contributions in prodromal dementia populations is limited. This study was conducted to examine cognitive, functional, and emotional outcomes associated with the use of an oral citicoline combined preparation in individuals with prodromal dementia and early Alzheimer's type cognitive decline. Methods: This was a two-centre, retrospective, observational, real-world cohort study. A cohort of 100 patients receiving a combined oral citicoline preparation and 50 age-matched healthy controls were evaluated at baseline and followed for 6-9 months. Participants underwent comprehensive neuropsychological assessments that evaluated domains including executive function, attention, processing speed, working memory, visual-spatial and verbal memory, fluency, general cognition, and mood. Standardized instruments included Stroop indices, Trail Making Tests A/B, SDMT, SPART-based measures, SBST, fluency tasks, the Boston Naming Test, and MoCA. Statistical analyses included age-adjusted and education-level-stratified comparisons. Results: Use of the citicoline combined preparation was associated with improvements in several cognitive domains, including executive functions, processing speed, working memory, visual-spatial memory, and both semantic and episodic fluency (all p < 0.05). Functional memory scanning and global cognition also showed improvement over the observation period. Significant differences between groups were observed at baseline and follow-up for multiple cognitive indices (most p < 0.001). Mood outcomes were more favorable in the citicoline combined preparation group, with reductions in depressive and anxiety symptoms. Age-adjusted models identified age as an important covariate, and participants with lower educational levels demonstrated comparatively greater cognitive gains. Conclusions: In this real-world observational study, use of an oral citicoline combined preparation was associated with multidomain improvements in cognitive and mood-related outcomes in individuals with prodromal dementia/early Alzheimer-type decline. Given the observational design, these findings should be considered exploratory and require confirmation in prospective randomised controlled trials.

Dementia contributes to the disease burden worldwide, and people with hypertension or type 2 diabetes are at an elevated risk of developing dementia. It is essential to prevent or delay cognitive decline in people at high risk within the community. Our trials aim to evaluate the effects of adaptive cognitive training on community-dwelling older adults with hypertension or type 2 diabetes but no dementia. Two multicentre, double-blind, randomised, placebo-controlled trials, named COgNitive Training in community-dwelling older adults at high risk for demENTia and with Hypertension (CONTENT-Hypertension) and COgNitive Training in community-dwelling older adults at high risk for demENTia and with Diabetes (CONTENT-Diabetes), will be conducted to investigate the effects of adaptive cognitive training on participants aged 60 years or above who have been diagnosed with hypertension or type 2 diabetes but no dementia. Each trial will enrol 120 participants. Participants will be recruited from the local community in Shijingshan and Haidian Districts, Beijing, and allocated to either the intervention or control group using a 1:1 ratio. The intervention group will engage in 12 weeks of adaptive cognitive training, while the control group will receive 12 weeks of placebo cognitive training. A 24-week follow-up assessment will be conducted for all participants to evaluate the persistence of the effects. The primary outcome is the 12-week change in Montreal Cognitive Assessment (MoCA) Basic scores from baseline to the end of the intervention (12 weeks). Secondary outcomes include 6-week and 24-week changes in the MoCA from baseline; 6-week, 12-week and 24-week changes in Trail Making Test-A&B (TMT-A, TMT-B), Digit Symbol Substitution Test, the WHO/University of California at Los Angeles Auditory Verbal Learning Test and Boston Naming Test scores of cognitive functions; 6-week and 12-week changes in Geriatric Depression Scale, Generalised Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index and 12-week change in blood pressure (CONTENT-Hypertension) or fasting blood glucose and glycated haemoglobin (CONTENT-Diabetes) from baseline. This study will adhere to the ethical principles outlined in the Declaration of Helsinki and comply with international standards for Good Clinical Practice. All participants will sign the informed consent at baseline. This study has been approved by the Ethics Committee of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (approval numbers: 2023-139 and 2024-162). The findings of the trials will be disseminated through publications in peer-reviewed scientific journals and presented at academic conferences. NCT06512922 and NCT06524388.

To optimize aphasia treatment, it is critical to understand the variables contributing to outcomes. For example, treatment factors such as dosage and treatment type have received considerable attention. In this study, we examine the influence of timing, or when treatment occurs. We investigate the impact of naming training in the morning versus the evening with individuals with chronic poststroke aphasia. Prior work with other populations led to our hypothesis that training conducted in the evening would be more durable compared to training in the morning. Thirteen people with chronic aphasia (at least 1 year poststroke) completed an online confrontational naming training followed by three posttests in two temporal conditions, with training occurring in both the morning and evening. The trained stimuli were unique to each participant and selected based on a screener. This resulted in a within-participant comparison of posttraining retention based on the time of training. Participants were characterized based on their results on the Boston Naming Test, the Quick Aphasia Battery, and the Morningness-Eveningness Questionnaire. There was a significant interaction between training schedule and test timing, such that words trained in the evening showed stable retention, whereas words trained in the morning showed significant decline after a 24-hr delay. We did not detect an overall difference in average naming accuracy between evening and morning conditions when collapsed across all time points. These results indicate that the time of day should be considered when administering aphasia treatment. Although proximity to sleep did not result in overall larger accuracy in this sample, the interaction suggests that sleep may still play a protective role in the retention of learned items, which is consistent with findings from studies of sleep and memory in adults without aphasia. https://doi.org/10.23641/asha.31152322.

ABSTRACT Frontotemporal dementia (FTD) can cause cognitive impairments and disrupt the ability to perceive others’ emotions. We examined whether cognitive impairments in semantic knowledge and executive function are related to two aspects of emotion perception. Individuals with FTD and healthy controls (N = 110; 33 behavioral variant FTD, 23 non-fluent variant FTD, 30 semantic variant FTD, and 24 controls) completed neuropsychological tests of semantic word knowledge (Peabody Picture Vocabulary, Boston Naming Tests) and executive function (Digit Span Backwards, Trail-Making, Stroop, Design Fluency). They also completed two behavioral tests of emotion perception (1) an emotion labeling task that measured the ability to identify specific emotions (e.g. sad, happy) of characters in films and (2) an emotion tracking task that measures the ability to continuously track the emotional valence (i.e. negative, neutral, positive) of a character in a film. Lower semantic word knowledge was associated with less accurate emotion labeling (but was not associated with emotion tracking). In contrast, lower executive function was associated with lower accuracy in both labeling and tracking. Effects were robust even after accounting for diagnosis, age, sex, global cognition, and dementia severity. Findings reveal how distinct cognitive processes are linked with different aspects of emotion perception in FTD.

BackgroundThe link between cardiovascular health and cognitive impairment has been documented in the literature. Heart rate variability has the potential to be a biomarker of cognitive impairment as it reflects the sympathetic and parasympathetic cardiac control mechanism of the nervous system. This study investigates the association between ultra‐short term heart rate variability and cognitive measures among older adults using electrocardiogram obtained from the Singapore Longitudinal Ageing Study.MethodA retrospective study where ultra‐short term heart rate variability was calculated through electrocardiogram obtained from the second cohort of the Singapore Longitudinal Ageing Study. 140 participants above the age of 60 years old were selected from the baseline visit. Indices of heart rate variability such as R‐R interval, SDNN, r‐MSSD, SD1, SD2/SD1 ratio and heart rate per minute were calculated. Spearman's rank‐order correlations was conducted to determine the association between time‐domain indices of ultra‐short term heart rate variability and cognitive measures.ResultThere were positive and significant correlations observed between SD2/SD1 ratio and RAVLT immediate memory (rs = .22, n = 140, p < 0.01), SD2/SD1 ratio and RAVLT delayed recall (rs = .22, n = 139, p < 0.05), SD2/SD1 ratio and Block Design test (rs = .19, n = 140, p < 0.05) and R‐R mean and Color Trial Test 1 (rs = .17, n = 138, p < 0.05). Meanwhile, a significant negative correlation was found between r‐MSSD and Boston Naming Test (rs = ‐.21, n = 140, p < 0.05).ConclusionThese results suggest an association between parasympathetic modulation and cognitive performance for measures of memory, visuospatial ability and executive function among community‐dwelling older adults. Following these results, we hope to explore the potential use of ultra‐short term heart rate variability in differentiating between older adults with mild cognitive impairment and healthy cognition.

Neuropsychological assessments are essential for evaluating functional status and guiding surgical planning in patients with brain tumors. However, their complexity may hinder interpretation for patients and junior clinicians. Large language model (LLM)-based chatbots have emerged as tools providing medical information, but their ability to interpret real-world neuropsychological test results remains unevaluated. This study investigates whether LLMs can provide accurate, patient-friendly explanations of neuropsychological tests and support communication in neurosurgical care.We included 20 patients who underwent at least one of five neuropsychological tests (Seoul Neuropsychological Screening Battery, Albert Test, Line Bisection Test, Boston Naming Test, or Western Aphasia Battery) prior to brain tumor surgery. Three LLMs (ChatGPT, Copilot, and Perplexity) were prompted with standardized queries on test explanations. Responses were evaluated for readability using Flesch-Kincaid Grade Level, understandability using a modified Patient Education Materials Assessment Tool, and explanatory accuracy using an expert-rated 4-point scale.Readability scores ranged from 9.6 (Copilot) to 11.0 (Perplexity). Understandability scores were highest for ChatGPT (83.2%), followed by Perplexity (81.3%) and Copilot (66.4%). ChatGPT performed best in test purpose and methodology; Perplexity scored highest in result interpretation and average accuracy score across domains. Patient rated Perplexity highly in understandability (4.0/4.0) and usefulness (3.8/4.0).LLMs generated accurate, understandable explanations of neuropsychological tests. These tools may support multidisciplinary care and patient communication in brain tumor surgery.

Background Social isolation (SI) is an established risk factor for Alzheimer's disease (AD) and cognitive decline. However, its stage-specific effects across the AD continuum, particularly at subjective cognitive decline (SCD) and mild cognitive impairment (MCI) stages, remain unquantified in Chinese populations. The sex-specific effects of SI on cognitive decline remain incompletely characterized. The apolipoprotein E ( APOE ) genotype is a driver of cognitive decline and dementia. Objective To investigate social connection characteristics and gene distribution in individuals with SCD or MCI, examine their cross-sectional associations with cognitive function, and explore gender differences in SCD or MCI risk/prevention. Methods A community-based sample of 164 SCD and 84 MCI patients (July 2021–Dec 2024) was assessed. Demographic, social connectivity, APOE genotype and cognitive data were collected. Social connectivity, APOE genotype and cognitive function were compared between groups. In the overall or male and female genders, Pearson correlation analyzed associations between social connectivity and cognitive scores. Sex-stratified multivariable models tested Lubben Social Network Scale (LSNS-6)-by-sex interactions on MCI risk. Results LSNS-6 scores showed weak-to-moderate correlations with Montreal Cognitive Assessment ( r = 0.140, p = 0.027), Animal Verbal Fluency Test-Huashan (AVLT-H) delayed recall ( r = 0.129, p = 0.043), AVLT-H recognition ( r = 0.190, p = 0.003), Trail Making Test-B ( r = -0.132, p = 0.038), Boston Naming Test ( r = 0.147, p = 0.021), and Animal Verbal Fluency Test ( r = 0.148, p = 0.020). Multivariable binary logistic regression analysis revealed the association between social network and MCI risk differed by sex (OR male = 0.581; OR female = 0.746; p interaction = 0.021). Conclusions SI may exacerbate cognitive dysfunction in adults with SCD or MCI. Women leverage social connectivity into significantly greater neuroprotective gains compared to men. Trial registration ChiCTR2300073429. https://www.chictr.org.cn/bin/project/edit?pid=200381

Cognition in Pediatric Chiari Malformation Type 1 Before and After Posterior Fossa Decompression.

ABSTRACT Background Prior studies have highlighted the importance of the right hemisphere in recovery from aphasia due to left hemisphere stroke. In particular, the right hemisphere homologous language network appears to support subacute (and sometimes chronic) recovery for many patients. We developed a telemedicine-delivered therapy that engages diverse right hemisphere-dominant skills to target nouns and verbs within utterances, Producing Increasingly Complex Themes Using Right-hemisphere Engagement – Implemented with Telemedicine “PICTURE-IT”. Aims This randomized crossover pilot study was designed to examine the feasibility of the PICTURE-IT therapy and determine whether some participants improve more with PICTURE-IT compared to an established telemedicine approach that targets lexical skills. Methods & Procedures Seventeen adult English-speaking participants with subacute (1–4 months) or chronic (over 6 months) aphasia who continued to experience naming deficits as measured on the Boston Naming Test or Hopkins Assessment of Naming Actions were included. Participants received fifteen 45-minute sessions of each therapy approach, followed by a washout period. Three participants withdrew due to worsening medical circumstances unrelated to therapy. Participants’ naming and discourse were assessed at baseline and one week after each therapy block. As the pilot had a modest number of participants, each participant’s trajectory was examined separately in order to consider how individual differences may play a role in therapy benefit. After the trial, participants were asked to complete a brief survey rating the PICTURE-IT approach and the established approach in their enjoyableness and utility. Outcomes & Results Both treatments were effectively administered remotely throughout the trial. Fisher’s Exact tests contrasting the improvements provided by each therapy approach were not significant for any individual, nor were there significant differences in the proportion of people who experienced more benefit from one approach or the other relative to their time since stroke (subacute versus chronic). Conclusions Although average improvements in communication skills were similar across treatments, order, and subacute vs chronic, individuals often responded better to one therapeutic approach or the other. Future studies will build upon these preliminary observations of effectiveness and identify reasons participants respond better to one treatment or the other.

BackgroundThe detection of early biological and clinical changes in Alzheimer's disease (AD) is mandatory for therapeutic interventions. Blood p‐tau markers, such as p‐tau181 and p‐tau217, have shown promising performance in identifying patients with early amyloid pathology, positioning themselves as potential first‐line diagnostic tests. The development of plasma biomarkers for AD requires understanding their clinical implications and redefining the role of cognitive assessment in screening and diagnosing patients with early symptoms. Our study aimed to determine the optimal combination of biomarkers and cognitive tests to detect AD in its early stages.MethodWe included 124 patients consulting for memory loss with no functional impairment. The mean age was 69.50±6.54 years old, and 73 (58.9%) were women. The mean MMSE was 27.16±3.07. All patients were evaluated with neuropsychological assessment and CSF biomarkers. According to the results of the CSF biomarkers, patients were categorized as AD or non‐AD. Patients with suspicion of other neurodegenerative disorders were not included. Serum p‐tau181 and p‐tau217 were measured afterwards with Lumipulse G600II. The neuropsychological assessment comprised the following cognitive tests: Mini‐Mental State Examination (MMSE), Addenbrooke's Cognitive Examination III (ACE‐III), digit span, Corsi test, Trail Making Test, Symbol Digit Modalities test, Boston Naming Test, Free and Cued Selective Reminding Test (FCSRT), Rey‐Osterrieth Complex Figure (ROCF), verbal fluency, Visual Object and Space Perception Battery, Judgement Line Orientation test, Stroop Color Word and Interference Test, and Tower of London.ResultThe AUC for p‐tau181 and p‐tau217 was 0.935 and 0.886, respectively. The best AUC for neuropsychological tests was 0.865 when age, FCSRT, and ROCF‐memory were combined. A logistic regression model including ptau181 and ACE‐III (memory) showed an AUC of 0.949, and the AUC was 0.964 when combining ptau181 and ROCF (memory).ConclusionOur study suggests that the combination of neuropsychological tests and blood biomarkers could improve diagnostic performance in the early stages of AD. However, the fact that the biomarker's importance in the statistical models was greater partially challenges the utility of cognitive assessments, particularly for screening purposes and in situations where clinical time may be limited.

Language deficits are frequently described by patients with multiple sclerosis (MS); however, objective characterization remains somewhat limited due to its omission from standard MS cognitive evaluation and the inconsistent findings that arise from current language measures. To establish alternative approaches to characterizing single-word level language in MS, this study (i) validates the Sydney Language Battery (SYDBAT) visual confrontation naming subtest and (ii) examines the insights provided by examining naming errors and latencies. 40 MS patients from Royal Melbourne Hospital's Cognitive Neuroimmunology Clinic and 40 matched controls completed a series of neuropsychological tests, including the SYDBAT and 'gold standard' confrontation naming task, the Boston Naming Test (BNT). Error types and latencies on the SYDBAT were extracted from assessment audio recordings. SYDBAT and BNT scores were highly correlated (r = 0.81, p < .001) and these tasks reported comparable receiver operating characteristic curves (p = .091). Latency analysis captured lexical retrieval difficulties, with patients displaying significantly longer mean latencies than controls on the SYDBAT (p = .012, β=0.54). These findings support the validity of the SYDBAT and value of the latency analysis in characterizing language impairment in MS. Use of the SYDBAT and latency considerations contribute to a broader assessment with a briefer administration time compared to gold-standard evaluation. The study thereby offers clinicians an enhanced toolkit to more effectively and appropriately evaluate language functioning and supplement standard cognitive evaluation in this population.

BackgroundMany people who have been affected by COVID‐19 report impaired cognitive abilities resulting in functional impairments and worsening quality of life. The present study aims to investigate the occurrence of cognitive impairments in a cohort of survivors of moderate or severe forms of COVID‐19.Method361 adults were evaluated 24 months after hospital discharge with a cognitive battery involving the tests: Mini Mental State Examination, CERAD battery, Trail Making Test part A and B, and Digit Span.ResultOf the total sample, 54 adults (15%) showed cognitive changes in the tests, presenting an average of 21 points in the Mini Mental State Examination (SD 2.4). In the CERAD battery, 48.1% (n = 26) showed low performance in the verbal fluency test – animal category remembering less than 13 words; 74% (n = 40) got less than 13 pictures correct in the Boston naming test; and 83.3% (n = 45) recalled less than 6 words in the word list. In the Trail Making Test, part A the average was 115 seconds (SD 61.6) in part B the average was 204.11 seconds (SD 104.5), with 66.7% (n = 36) unable to do it the test. In the digit span test, the greatest difficulty was in the indirect order in which 53.7% (n = 29) scored 2 points, with an average of 2.39 (SD 1.2). Between the tests, there was a correlation between the CERAD word list and verbal fluency (r = 0.630, p <0.001), trails A (r = ‐0.481, p <0.001), age (r = ‐0.535, p <0.001), MMSE (r = 0.405, p = 0.002) and Boston naming test (r = 0.394, p = 0.003).ConclusionThe cognitive battery used was able to identify cognitive deficits related to executive function, memory, attention and language. Identifying patterns of cognitive deficits associated with COVID‐19 is necessary to distinguish cognitive impairments associated with COVID‐19 from other dementias.

BackgroundWord‐finding difficulty is a common complaint among aging individuals. It could be presented in normal aging, Alzheimer's disease (AD), or primary progressive aphasia (PPA), which may initially seem similar but have very different prognoses. This study aimed to explore language characteristics in patients with word‐finding difficulty and compare linguistic differences between their clinical diagnoses.MethodsThis study enrolled 18 patients who complained of word‐finding difficulty. Language profiles were assessed using the Aphasia quotient (AQ), a part of the Korean version of the Western‐Aphasia Battery (K‐WAB). Cognitive functions were evaluated through the Mini‐Mental Status Examination (MMSE), the Clinical Dementia Rating Scale (CDR), and the Seoul Neuropsychological Screening test, also including the Boston Naming test (BNT), comprehension, repetition, and category/phonemic fluency. Participants were divided into AD, non‐fluent variant PPA (nfvPPA), and other PPA groups, and their characteristics were compared.ResultsAD patients (27.8%), confirmed by amyloid positron emission tomography, showed the highest AQ scores but showed significant deficits in controlled oral word association tasks (COWAT), and BNT. nfvPPA patients (27.8%) showed the lowest AQ scores and difficulty with Yes/No questions and command in the comprehension part. The other PPA group (44.4%), which was not obvious nfvPPA and lacked confirmed neuropathology, showed mixed language characteristics. Impairment in COWAT was consistent in all patients with word‐finding difficulty, even in mild cognitive impairment. Unlike AD patients, the nfvPPA and PPA groups showed worse frontal/executive dysfunction and neurologic deficits such as gait difficulty, dysphagia, dysarthria, and rigidity.ConclusionAmong language tests, COWAT, commands, and Yes/No questions differed among patients with word‐finding difficulty. However, given the small sample size, these findings are preliminary. Further research with larger populations is needed to determine whether the identified factors can serve as reliable markers for differential diagnosis.

BackgroundAn increase in life expectancy implies an increase in people with cognitive impairment and dementia who request a driver's license. While it is accepted that subjects with moderate or severe dementia are disqualified from driving, this does not happen in mild stages. People with cognitive impairment have an increased risk suffering traffic accidents. In Uruguay, as in many South American countries, the cognitive evaluation for the driving license is not protocolized. An investigation is being carried out to identify which neuropsychological tests predict better driving performance.ObjectiveTo find South American publications regarding cognitive evaluation in people with cognitive impairment and older adults.MethodA comprehensive search was carried out in PubMed, LILACS and SciELO for articles from countries in South America with the terms “vehicular driving”, “cognitive impairment”, “dementia”, “older adults” and synonyms. The search was extended to Google Scholar, adding as a filter that the terms were in the title.Results19 articles were obtained. Five were eliminated because they weren’t related to the objective of the analysis. Of the remaining 14, we highlight a clinical practice guideline and three neuropsychological batteries, all from Argentina. The guideline is based on a systematic review of literature. We also found 4 other revisions with international information.We found 7 cross‐sectional studies that performed cognitive assessments, very dissimilar to each other. All used the Mini Mental State Examination (MMSE). In five MMSE was found useful, while in another it was reported as inconsistent, which was also described in a review.Other tests described as correlated with driving were: Digit Symbols Test, Boston Naming Test (BNT), Trail Making Tests, Semantic Verbal Fluency, AD8 Interview, Logical Memory, Verbal and Visual Learning Test, Frontal Assessment Battery, Neuropsychiatric Inventory, and Functional Assessment Questionnaire.The conclusions of the studies are summarized in Table 1.ConclusionThere is little evidence in South America regarding the best form of cognitive assessment for driving in older adults or those with cognitive impairment. The available information highlights the relevance of the assessment of executive functions and BNT, as well as the importance of obtaining information from multiple sources.

BackgroundGRN (progranulin) mutation is a common cause of autosomal dominant frontotemporal lobar degeneration (FTLD) but can also occur in non‐familial cases. These mutations usually occur in the behavioral variant FTD (bvFTD) and more rarely in the primary progressive aphasia (PPA), particularly in the non‐fluent / agrammatic (nfvPPA). Recently, it was also described in the semantic (sPPA), logopenic (lvPPA), and mixed (mPPA) variants, suggesting that GRN may cause an overlapping PPA syndrome with a heterogeneous phenotype.MethodWe report the clinical, genetic, and imaging features of a rare case of a patient with Sporadic primary progressive aphasia with mixed phenotype and GRN mutation.ResultA right‐handed 68‐year‐old woman with 9 years of progressive course of language impairment, showing difficulties in naming objects, comprehending words, and talking over the telephone. The spontaneous speech output was slow and labored, with poor syntax, limited to few words or simple phrases, and repetition possible only for simple sounds. This communication problem led her to avoid conversations, impacting her daily activities. She was a primary education teacher, her medical family history was unremarkable, and the neurological exam was normal. On neuropsychological evaluation, she presented a mixed phenotype (nfvPPA and sPPA), showing anomia, single‐word comprehension/object knowledge, apraxia of speech, and agrammatism. She scored 15/30 on MMSE, 3 on semantic verbal fluency, and 10/20 on the Boston Naming Test. Brain MRI showed a marked asymmetric atrophy in the left hemisphere, predominant in anterior superior / inferior temporal, and fronto‐insular areas in coronal, axial and sagittal T1 sequences. The genetic testing confirmed the GRN gene mutation.ConclusionThe mixed PPA‐GRN can show multiple levels of language impairment simultaneously altered, such as grammatical, verbal fluency, and semantic, affecting different language pathways, as in this case. The high prevalence of patients with PPA without a family history of FTLD indicates that genetic studies should not be limited to familial cases. Also, GRN mutations are usually present on atypical/mixed PPA phenotypes, suggesting that GRN should be considered primarily in patients with this clinical pattern.

BackgroundPoor sleep health has emerged as a potentially modifiable risk factor for Alzheimer's disease (AD) and related dementias (ADRD). Previous studies have mainly focused on self‐reported sleep duration or a single measure of sleep health with cognitive performance. In a cohort of older adults with comprehensive neuropsychological assessment, we investigated actigraphy‐measured sleep health with cognitive trajectories over a 9‐year period.MethodParticipants from the Vanderbilt Memory and Aging Project (n = 553, Mean age: 68.5± 9.3 year; 50.3% women) wore ActiGraph GT9X accelerometers on their wrist daily for 10 days. Data were processed for estimates of sleep duration, timing, regularity, efficiency and several measures of fragmentation. We used linear mixed effects models to assess the associations between baseline sleep measures and longitudinal changes in three cognitive domains: memory, executive function and language (measured by Boston Naming Test). Models were adjusted for age, sex, race, education, APOE‐ε4 status, cognitive status, sleep medication use, body mass index, physical activity, depressive symptoms, and cardiovascular risk.ResultIn the fully adjusted models, we found longer night time awakenings were associated with annual declines in memory (β = ‐0.010, 95% CI = ‐0.019 to ‐0.002) and language function (β = ‐0.042, 95% CI = ‐0.072 to ‐0.011). We also found evidence connecting longer sleep duration and greater sleep irregularity with worse memory (β = ‐0.021, 95% CI = ‐0.036 to ‐0.006) and poorer executive function (β = ‐0.019, 95% CI = ‐0.036 to ‐0.003). Both sleep timing (β = ‐0.067, 95% CI = 0.113 to ‐0.022) and sleep irregularity (β = ‐0.138, 95% CI = ‐0.267 to ‐0.009) were associated with annual declines in language function. There was no evidence of effect modification by age, sex, APOE or cognitive status.ConclusionOur results suggest that several measures of poor sleep health are associated with 9‐year declines in memory and cognitive performance. Night time awakening length may be a novel indicator of sleep fragmentation worthy of further exploration. Future molecular and mechanistic studies are needed to expand on why sleep fragmentation may contribute to cognitive declines.

BackgroundThe use of digital cognitive assessment tools has been rapidly increasing. However, digital literacy—a potential influential factor on performance with such tools—is often overlooked, and existing digital literacy scales are overly complex and time‐consuming. To address this gap, we developed a Brief Digital Literacy Scale (BDLS) specifically tailored for older adults to provide a simple pre‐assessment tool for digital cognitive evaluations.MethodThe BDLS consists of 10 items measuring fundamental digital skills and frequency, scored on a 5‐point Likert scale. A total of 202 older adults participated in this study, including individuals with cognitive normal (CN), mild cognitive impairment (MCI), and Alzheimer's disease (AD) from the Gwangju Alzheimer's Disease and Related Dementia Cohort in Korea. Internal consistency and exploratory factor analysis (EFA), regression and partial correlation analysis were performed.ResultThe BDLS demonstrated excellent internal consistency (α=0.874). EFA revealed a three‐factor structure, explaining 70.73% of the total variance: Factor 1: Technical Proficiency, Factor 2: Smart Device Usage, and Factor 3: Digital Usage Frequency and Information Evaluation. Higher BDLS scores were significantly associated with younger age, and longer years of education. Gender differences were not significant, though women showed a trend toward higher scores. BDLS scores showed significant partial correlations (controlling for age, gender, education) with: Boston Naming Test (r = 0.36, p <0.001), Visual Memory Test scores (r = 0.26∼0.37, p <0.01), Psychomotor Speed (r = −0.24, p <0.05). Significant associations were also observed with digital cognitive scores measuring visual memory (r = 0.19∼0.28, p <0.05∼ p <0.001), and processing speed (r = ‐0.23∼‐0.15, p <0.05 ∼ p <0.01). BDLS scores significantly differed across cognitive status groups (F=9.71, p <0.001), with scores decreasing progressively from CN to MCI to AD.ConclusionOur preliminary results suggest that the BDLS is a reliable and valid tool for assessing digital literacy in older adults. It demonstrates relationships with cognitive performance (both paper‐and‐pencil and digital format). Notably, BDLS scores were significantly associated with visual memory and naming, highlighting the role of visual information processing and memory in digital literacy. This scale may provide a practical solution for pre‐assessment in digital cognitive testing and highlights the importance of considering digital literacy in clinical and research contexts.

BackgroundLogopenic primary progressive aphasia (lvPPA) is an atypical language variant of Alzheimer's disease (AD). Non‐fluent / agrammatic (nfvPPA) is related to frontotemporal lobar degeneration (FTLD) but is rarely found in AD pathology. The annexin A11 (ANXA11) gene mutation is usually associated with amyotrophic lateral sclerosis / FTLD, but recently, it has been reported in the semantic variant (svPPA). Diffusion tensor tractography (DTI) can be used in PPA to localize white matter (WM) tract changes in the inferior longitudinal fasciculus (ILF), superior longitudinal fasciculus (SLF), and uncinate fasciculus (UF). The nfaPPA WM pattern is seen in the left SLF; sv‐PPA reveals focal severe left/bilateral changes in UF and anterior ILF; the lvPPA pattern is more widespread in the left FLS, FLI, and UF, marked in the middle/posterior ILF.MethodWe report the clinical, genetic, and imaging features of a rare case of atypical AD with mixed PPA (lvPPA / nfvPPA) phenotype and ANXA11 gene mutation.ResultA right‐handed 65‐year‐old woman with 8 years of a language progressive impairment with difficulty in finding words for expression, repeating sentences, and naming objects, which affected her daily activities, scoring 14/30 on MMSE, 3 on semantic verbal fluency, and 10/20 on the Boston Naming Test. She also had memory problems, such as forgetting recent events/appointments and losing objects, and over the years, manifested effortful speech and agrammatism. She was illiterate, her medical family history was negative, and the neurological exam was unremarkable. The CSF indicated increased t‐tau/p‐tau levels and a decreased Aβ 42/40 ratio, suggesting an AD pathology. The genetic testing confirmed the ANXA11 gene mutation. MRI revealed a left‐predominant atrophy in the frontoinsular and perisylvian/temporoparietal areas. The DTI showed widespread WM atrophy in the left SLF, ILF, and UF tracts, predominant in ILF and SLF, consistent with this mixed PPA phenotype.ConclusionThis report can provide valuable insight into considering AD when confronted with atypical clinical presentations with mixed‐PPA, as in this case. It also reinforces the clinical variability of ANXA11 gene mutations and highlights the importance of using DTI for detecting WM matter‐specific pattern changes in different PPA phenotypes.

BackgroundDiagnosing primary progressive aphasia (PPA) is challenging. It requires establishing language impairment as predominant and classifying the PPA variant based on speech and language features. Neuroimaging and biomarker assessments are recommended for greater diagnostic accuracy. However, difficulties in diagnosis are common, particularly in low‐ and middle‐income countries (LMICs), where socio‐economic variables exacerbate these challenges. This work presents the PPA diagnostic roadmap developed at Fleni (Argentina) to address these barriers.MethodThe PPA diagnostic roadmap combines extensive clinical experience with insights from existing literature, integrating clinical, neuropsychological, neuroimaging, and biomarker data to identify and classify PPA variants. Based on the diagnostic criteria by Gorno‐Tempini et al. (2011), the framework has been adapted to the local population to streamline diagnostic processes and reduce delays in resource‐limited settings.ResultPatients undergo an initial assessment by a neurologist, including a neurological‐physical examination and extended anamnesis (Stage 1, see Figure 1). During the same visit, Stage 2 tests are ordered. These include laboratory tests (e.g., blood count, thyroid profile, vitamin B12), a cognitive 3T MRI protocol with resting‐state, and a standard neuropsychological assessment (MoCA, UDS‐3, and socioemotional and functional scales). Stage 2 results enable the neurologist to establish a baseline PPA diagnosis, identifying primary progressive language impairment and obtaining imaging‐based confirmation. Determining the specific PPA variant, however, requires a language‐specific assessment (Stage 3). The PPA protocol at Fleni evaluates key aspects of language and speech to determine the patient's linguistic profile. It includes the MLSE, Token Test, Boston Naming Test, Pyramids and Pharaohs Test, FTLD‐module of UDS‐3, and a speech protocol. Additionally, FDG‐PET, amyloid‐PET biomarkers, and/or genetic counseling and testing are requested (Stage 4).ConclusionStages 1 and 2 of the diagnostic roadmap constitute possible scenarios considering the region's capabilities. Laboratory tests and MRI are viable, and the standard neuropsychological assessment includes readily available tests in Spanish. However, Stages 3 and, especially, Stage 4 are currently achievable only in specific socio‐economic contexts due to limiting factors (e.g., limited access to language specialists, high costs of specialized studies, lack of healthcare coverage). This roadmap serves as a framework to guide professionals in the region and optimize the diagnostic process.