Brief Visuospatial Memory Test-Revised Research Articles

White matter lesion load and location in relation to cognitive impairment in relapsing–remitting multiple sclerosis

Abstract Background In relapsing–remitting multiple sclerosis (RRMS) the connection between cognitive impairment (CI) and white matter lesion load (WM-LL) and location is still unclear. This study aimed to identify the relationship between CI in RRMS patients and WM-LL and locations using a fully automated platform. CI and WM-LL were evaluated in 90 patients with RRMS using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and Automated MRI volumetric measures of WM-LL and lesion distribution. Regression analysis of BICAMS as a dependent variable with different clinical and radiological parameters was performed. Results Data were obtained from 90 patients with RRMS who had a mean age of 32.74 ± 8.43 years and a female-to-male ratio of 3:1. The mean (± SD) cognitive rating scores for the BICAMS subtests were 28.07 ± 11.78 for the Symbol Digit Modalities Test (SDMT), 42.32 ± 12.46 for the California Verbal Learning Test-II (CVLT-II), and 16.13 ± 8.17 for the Brief Visuospatial Memory Test-Revised (BVMT-R). According to the BICAMS criteria, 29 cases (32.2%) had CI. BICAMS scores were significantly correlated with age, education level, relapse frequency, disease duration, and time to start disease-modifying therapies. Whole WM-LL and periventricular lesion load were significantly associated with CI. After controlling for age, sex, and education, logistic regression analysis revealed that total WM-LL was the best predictor for CI together with duration of illness and years of education. The cut-off value of 12.85 cc for total WM-LL predicted CI. Conclusions Whole WM-LL and periventricular lesion load are the best anatomical predictors for CI probably due to the effect on the anterior commissural fibers while years of education and duration of disease are the best demographic predictors for CI.

Learning ratio performance on a brief visual learning and memory test moderates cognitive training gains in Double Decision task in healthy older adults.

Cognitive training using a visual speed-of-processing task, called the Useful Field of View (UFOV) task, reduced dementia risk and reduced decline in activities of daily living at a 10-year follow-up in older adults. However, there was variability in the achievement of cognitive gains after cognitive training across studies, suggesting moderating factors. Learning trials of visual and verbal learning tasks recruit similar cognitive abilities and have overlapping neural correlates with speed-of-processing/working memory tasks and therefore could serve as potential moderators of cognitive training gains. This study explored the association between the Hopkins Verbal Learning Test-Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R) learning with a commercial UFOV task called Double Decision. Through a secondary analysis of a clinical trial, we assessed the moderation of HVLT-R and BVMT-R learning on Double Decision improvement after a 3-month speed-of-processing/attention and working memory cognitive training intervention in a sample of 75 cognitively healthy older adults. Multiple linear regressions showed that better baseline Double Decision performance was significantly associated with better BVMT-R learning (β = - .303). This association was not significant for HVLT-R learning (β = - .142). Moderation analysis showed that those with poorer BVMT-R learning improved the most on the Double Decision task after cognitive training. This suggests that healthy older adults who perform below expectations on cognitive tasks related to the training task may show the greatest training gains. Future cognitive training research studying visual speed-of-processing interventions should account for differing levels of visuospatial learning at baseline, as this could impact the magnitude of training outcomes and efficacy of the intervention.

Duration of Untreated Prodromal Psychosis and Cognitive Impairments

The possible association between the duration of untreated prodromal symptoms (DUPrS) and cognitive functioning in individuals at clinical high risk (CHR) for psychosis remains underexplored. To investigate the intricate interplay between DUPrS, cognitive performance, and conversion outcomes, shedding light on the potential role of DUPrS in shaping cognitive trajectories and psychosis risk in individuals at CHR for psychosis. This cohort study of individuals at CHR for psychosis was conducted at the Shanghai Mental Health Center in China from January 10, 2016, to December 29, 2021. Participants at CHR for psychosis typically exhibit attenuated positive symptoms; they were identified according to the Structured Interview for Prodromal Syndromes, underwent baseline neuropsychological assessments, and were evaluated at a 3-year clinical follow-up. Data were analyzed from August 25, 2021, to May 10, 2023. Duration of untreated prodromal symptoms and cognitive impairments in individuals at CHR for psychosis. The primary study outcome was conversion to psychosis. The DUPrS was categorized into 3 groups based on percentiles (33rd percentile for short [≤3 months], 34th-66th percentile for median [4-9 months], and 67th-100th percentile for long [≥10 months]). The DUPrS, cognitive variables, and the risk of conversion to psychosis were explored through quantile regression and Cox proportional hazards regression analyses. This study included 506 individuals (median age, 19 [IQR, 16-21] years; 53.6% [n = 271] women). The mean (SD) DUPrS was 7.8 (6.857) months, and the median (IQR) was 6 (3-11) months. The short and median DUPrS groups displayed poorer cognitive performance than the long DUPrS group in the Brief Visuospatial Memory Test-Revised (BVMT-R) (Kruskal-Wallis χ2 = 8.801; P = .01) and Category Fluency Test (CFT) (Kruskal-Wallis χ2 = 6.670; P = .04). Quantile regression analysis revealed positive correlations between DUPrS rank and BVMT-R scores (<90th percentile of DUPrS rank) and CFT scores (within the 20th-70th percentile range of DUPrS rank). Among the 506 participants, 20.8% (95% CI, 17.4%-24.5%) converted to psychosis within 3 years. Cox proportional hazards regression analysis identified lower educational attainment (hazard ratio [HR], 0.912; 95% CI, 0.834-0.998), pronounced negative symptoms (HR, 1.044; 95% CI, 1.005-1.084), and impaired performance on the Neuropsychological Assessment Battery: Mazes (HR, 0.961; 95% CI, 0.924-0.999) and BVMT-R (HR, 0.949; 95% CI, 0.916-0.984) tests as factors associated with conversion. The finding of this cohort study suggest the intricate interplay between DUPrS, cognitive performance, and conversion risk in individuals at CHR for psychosis. The findings emphasize the importance of considering both DUPrS and cognitive functioning in assessing the trajectory of these individuals.

A comparative study of cognitive function in young patients with bipolar disorder with and without non-suicidal self-injury

ObjectiveBipolar disorder (BD) is a chronic mental disorder characterized by alternating or mixed episodes of mania or hypomania and depression. Cognitive function impairment is a frequent associated feature of the disease. While many BD patients also engage in non-suicidal self-injury (NSSI), there is a lack of studies on the cognitive function of BD patients with NSSI. This study aimed to evaluate cognitive functioning of BD patients with NSSI and provide a clinical basis for the differential diagnosis and treatment of BD and NSSI. MethodsA total of 60 BD patients with NSSI, 60 BD patients without NSSI, and 60 healthy controls (HC) were selected for the study. All participants met the inclusion criteria and were not taking any medications, excluding the potential effects of medication on cognitive functions. The following neurocognitive tests were used to measure the cognitive functions in areas such as speed of processing, reasoning and problem solving, attention/vigilance, working memory, visual learning, and verbal learning: The Trail Making Test (TMT), Category Fluency, Digit Symbol Coding Test (DSCT), Brief Visuospatial Memory Test-Revised (BVMT-R), The Neuropsychological Assessment Battery Mazes (NABM), Wechsler Memory Scale Third Edition Spatial Span Test (WMS III-SST), Hopkins Verbal Learning Test-Revised (HVLTR) and Continuous Performance Test and Identical Prs (CPT-IP). ResultsThe findings indicated that BD patients with NSSI exhibited cognitive impairment in all measured cognitive domains. On the other hand, BD patients without NSSI showed less pronounced impairment in terms of speed of processing, but exhibited significant cognitive impairment in the remaining five areas compared to the HC group. ConclusionThe study underscores the presence of cognitive impairment in BD, and the cognitive impairment is more severe in BD patients with NSSI compared to those without NSSI. In conclusion, both individuals with NSSI and those without NSSI in BD exhibit cognitive impairment, which provides ideas and strategies for using cognitive-behavioral therapy to treat BD and NSSI.

24 hour rest‐activity rhythms and cognition in community dwelling older adults

AbstractBackgroundCognitive decline associated with aging is a growing public health concern as individuals are living longer with chronic medical conditions. Rest activity rhythm (RAR) describes the pattern of physical activity and sleep period in 24 hours. Compared with younger people, older adults are more likely to maintain a sedentary lifestyle with altered RAR. Although there is no doubt that physical activity plays a vital role in health outcomes, little is known about how RAR is linked to cognitive functioning in late life. This study investigated the association between RAR and cognitive performance among older adults.MethodSixty community dwelling older adults aged 70±7.3 years (mean ± standard deviation) wore Phillips actigraphy spectrum plus 2 for two weeks. RAR parameters were analyzed using cosinor approach, such as amplitude (difference between the peak and lowest activity levels), mesor (mean activity level), pseudo‐F‐statistic (the robustness of RAR), and acrophase (peak activity time). A comprehensive neuropsychological battery was used to assess cognition (i.e., Brief Visuospatial Memory Test – Revised (BVMT‐R), California Verbal Learning Test – II, Boston Naming Test, Wechsler Adult Intelligence Scale‐IV Coding, and Trail Making Test A and B). Multiple linear regression models were built to explore associations between different RAR measures and each cognitive task adjusting for age, gender, and years of education.ResultWe found positive associations between RAR amplitude (p = 0.01), mesor (p = 0.008), acrophase (p = 0.006), pseudo F‐statistic (p = 0.002) and visual memory (BVMT‐R). Similarly, positive associations were found between amplitude (p = 0.006), mesor (p = 0.005), acrophase (p = 0.005), pseudo F‐statistic (p = 0.002) and psychomotor processing speed (Coding). Greater pseudo‐F statistics were associated with stronger performance on naming (BNT); p = 0.03). No association was found between RAR and other cognitive tasks.ConclusionsOur findings provide evidence that some RAR characteristics are associated with cognitive performance among older adults, particularly visual memory, psychomotor processing speed, and naming ability. Further research should be undertaken using a large and diverse sample, prospective design, and inclusion of potentially confounding variables to confirm those associations.

Design and application of a game‐based WeChat mini‐program for screening cognitive impairments in Chinese older adults

AbstractBackgroundEarly screening for mild cognitive impairment (MCI) is the key method to prevent and delay dementia. Digital screening tools are more efficient than traditional paper‐and‐pencil cognitive assessments, and gamified versions would promote engagement and completion rates. We introduced here the design and development of the Game‐based Cognitive Assessment ‐ 3 Minute Version (G3) WeChat mini‐program for MCI screening in Chinese older adults.MethodG3 is a battery of three one‐minute digital games built within the WeChat platform. Developed based on the cognitive paradigm and classic neuropsychological tests such as Trail Making Test (TMT), the Silhouettes test, the Brief Visuospatial Memory Test‐Revised (BVMT‐R) test, and California Card Sorting Tests (CCST), the G3 mini‐games, “Number Ordering”, “Species Sorting”, and “Gold finding” would measure the computational and executive function, abstractive function and visual perception, memory, and attention, respectively. In each game, the difficulty will be automatically adjusted according to performance. G3 integrates users’ game scores, age, gender, and education levels, to generate a comprehensive assessment of cognitive function with results of the six cognitive domains (Figure 2).ResultAs of August 31, 2022, more than 11 million users have completed G3 tests, 85.38% of them are aged under 40, and 2.05% of them are aged over 60 (Figure 3). Although people in all age groups have desired to know their cognitive function, the number of users decreased as people aged. Among users aged 40‐70, more females than males participated in G3 games, indicating middle‐aged and older women paid more attention to cognitive function. Among users over 45 years old, those of lower education levels (primary school or no education), middle levels (middle or high school), and university degrees accounted for 2.93%, 32.4%, and 59.65% respectively. The completion rate of users aged over 45 is 92.28%, and those over 80 years exceeded 86%.ConclusionThe G3 was a battery of three novel 1‐minute game‐based digital cognitive tests. The process is simple, efficient, and interesting. It is a promising tool for self‐administering, advancing large‐scale community screening, and social education for MCI in Chinese older adults, warranting further clinical trials to validate its feasibility, sensitivity, and diagnostic value.

Design and application of a game‐based WeChat mini‐program for screening cognitive impairments in Chinese older adults

AbstractBackgroundEarly screening for mild cognitive impairment (MCI) is the key method to prevent and delay dementia. Digital screening tools are more efficient than traditional paper‐and‐pencil cognitive assessments, and gamified versions would promote engagement and completion rates. We introduced here the design and development of the Game‐based Cognitive Assessment ‐ 3 Minute Version (G3) WeChat mini‐program for MCI screening in Chinese older adults.MethodG3 is a battery of three one‐minute digital games built within the WeChat platform. Developed based on the cognitive paradigm and classic neuropsychological tests such as Trail Making Test (TMT), the Silhouettes test, the Brief Visuospatial Memory Test‐Revised (BVMT‐R) test, and California Card Sorting Tests (CCST), the G3 mini‐games, “Number Ordering”, “Species Sorting”, and “Gold finding” would measure the computational and executive function, abstractive function and visual perception, memory, and attention, respectively. In each game, the difficulty will be automatically adjusted according to performance. G3 integrates users’ game scores, age, gender, and education levels, to generate a comprehensive assessment of cognitive function with results of the six cognitive domains (Figure 2).ResultAs of August 31, 2022, more than 11 million users have completed G3 tests, 85.38% of them are aged under 40, and 2.05% of them are aged over 60 (Figure 3). Although people in all age groups have desired to know their cognitive function, the number of users decreased as people aged. Among users aged 40‐70, more females than males participated in G3 games, indicating middle‐aged and older women paid more attention to cognitive function. Among users over 45 years old, those of lower education levels (primary school or no education), middle levels (middle or high school), and university degrees accounted for 2.93%, 32.4%, and 59.65% respectively. The completion rate of users aged over 45 is 92.28%, and those over 80 years exceeded 86%.ConclusionThe G3 was a battery of three novel 1‐minute game‐based digital cognitive tests. The process is simple, efficient, and interesting. It is a promising tool for self‐administering, advancing large‐scale community screening, and social education for MCI in Chinese older adults, warranting further clinical trials to validate its feasibility, sensitivity, and diagnostic value.

60 Are all Embedded Measures Created Equal? A look at Embedded PVTs in Major Neurocognitive Disorder

Objective:Although performance validity is critical in determining the quality and accuracy of test data, research suggests not all neuropsychologists incorporate performance validity tests (PVTs) in dementia evaluations (McGuire et al., 2019). Furthermore, well-validated embedded measures, such as Reliable Digit Span (RDS) from the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV), have evidenced an unusually high number of failures in a dementia population when utilizing typical clinical cut-offs (Zenisek et al., 2016). The objective of this study is to explore performance on embedded PVTs among older adults who have a major neurocognitive disorder (MND), specifically among Alzheimer disease (AD) and non-AD patients.Participants and Methods:Archival data from outpatient neuropsychological evaluations were analyzed. All participants were at least 65 years of age, diagnosed with a MND, and completed Digit Span from the WAIS-IV, Brief Visuospatial Memory Test- Revised (BVMT-R), and Hopkins Verbal Learning Test-Revised (HVLT-R). In total, 84 participants, aged 67-96 (M=78.44, SD=6.11) with 6-20 years of education (M=13.47, SD=3.30), were included. The sample predominantly identified as female (n=60) and White (n=61). More individuals were diagnosed with AD (n=50) than non-AD dementia (n=34). Common non-AD diagnoses included Vascular (n=44), Lewy bodies (n=8), and Parkinson’s (n=2) dementias. Fisher’s Exact Test of Independence was used to account for the smaller sample to determine if there was a nonrandom association between diagnosis (AD vs non-AD) and embedded PVT performance: RDS&lt; 7, BVMT-R Hits&lt;4, BVMT-R Recognition Discrimination (RD) &lt; 4, and HVLT-R RD &lt; 5 (Bailey et al., 2018).Results:The Fisher’s Exact Test of Independence revealed a statistically significant association between neurocognitive diagnosis and RDS (p= .008), BVMT-R RD (p&lt;.001), and HVLT-R RD (p&lt;.001). BVMT-R Hits were not significantly associated with diagnosis (p = 0.10). These measures evidenced opposite patterns with RDS demonstrating a higher percentage of fails for the non-AD (63%) versus AD (20%) group. The AD group had a higher percentage of fails for BVMT-R RD (58% for AD and 13% for non-AD groups) and HLVT-R RD (66% for AD and 29% for non-AD group).Conclusions:The current study suggests performance on embedded PVTs vary across MND diagnoses. Individuals with a non-AD diagnosis were more likely to fail RDS than those with AD. This is likely secondary to attention and working memory demands that are mediated by the frontal-subcortical networks, which are less impacted by AD pathology (Bonelli &amp; Cummings, 2022; Loring et al., 2016). In contrast, AD patients were more likely to fail embedded PVTs within memory measures, which are largely mediated by the mesial temporal cortex associated with AD (Pluta, 2022). These results suggest embedded measures operate differently based on diagnosis and neuroanatomical systems affected. The clinical relevance of these findings includes potentially using alternative PVTs or different cut-offs based on diagnosis. Future research should attempt to better delineate more appropriate, as well as time efficient, PVTs among the dementia population.

87 Examining the use of the Embedded Performance Validity Test in the Brief Visuospatial Memory Test-Revised Among Spanish-Speaking Patients

Objective:The Brief Visuospatial Memory Test-Revised (BVMT-R) Recognition Discrimination (RD) index has emerged as an embedded performance validity test (PVT). However, there do not appear to be any studies that have examined its utility in Spanish-speaking samples. This pilot study examined the classification accuracy of the BVMT-R RD for detecting performance invalidity in a Spanish-speaking forensic sample.Participants and Methods:This cross-sectional study utilized a sample of 89 Spanish speakers that were administered the BVMT-R during an outpatient neuropsychological evaluation. Out of the 89 Spanish speakers, 43 were subjects in litigation, 32 were neurological patients evaluated for clinical purposes, and 14 were healthy controls. The sample was 67% male/33% female, 53% South American, 33% Caribbean (Dominican, Puerto Rican, Cuban), 10% Central American, 3% North American (Mexican), and 1% Spanish, with a mean age of 44.2 years (SD = 14.2; range = 20-78) and mean education of 11 years (SD = 3.7; range = 0-20). Test administration for each patient was completed in Spanish by a fluent, Spanish-speaking examiner. In total, 64/89 (72%) were classified as valid and 25/89 (28%) as invalid based on performance across the Test of Memory Malingering (TOMM), at least one additional PVT (Rey-15 item memory test; Rey Dot Counting Test; Reliable Digit Span; WHO-AVLT recognition trial) and objective diagnostic criteria identifying invalid performance. Analyses included three univariate analyses of variance (ANOVA), with the groups (healthy vs neurological vs litigation) as independent variables and performance on BVMT-RD as the dependent variable.Results:Statistically significant differences among the groups were found F(2,86)=8.32, p &lt; .001). Post-hoc analysis (Scheffe test) showed the mean of the litigation group to be significantly lower than the means of the other two groups (healthy and neurological), which showed no difference between them. An ANOVA with validity groups as the fixed factor and BVMT-R RD index as the dependent variable was significant F(1,85)= 21.02, p &lt;.001). Results of a ROC curve analysis yielded statistically significant AUC (.794). The optimal cut-score was BVMT-R RD &lt; 5 (48% sensitivity/88% specificity).Conclusions:Results of the BVMT-R RD index in this Spanish-speaking population differed by subgroup, with worse performance seen in individuals involved in litigation, compared to those who were not (healthy and neurological). Notably, the BVMT-R RD index significantly differentiated validity groups, maintaining adequate sensitivity and good specificity. Overall, results demonstrate promise for BVMT-RD as a PVT for Spanish-speaking populations.

22 The Effect of Ibogaine on Cognitive Functioning

Objective:To determine the effects of the non-classic psychedelic, ibogaine, on cognitive functioning. Ibogaine is an indole alkaloid derived from the Tabernanthe Iboga plant family, indigenous to Africa, and traditionally used in spiritual and healing ceremonies. Ibogaine has primarily been studied with respect to its clinical efficacy in reducing substance addiction. There are, however, indications that it also may enhance recovery from traumatic experiences. Ibogaine is a Schedule 1 substance in the USA.ParticipSabants and Methods:Participants were U.S. Special Operations Veterans who had independently and voluntarily referred themselves for an ibogaine retreat at a specialized clinic outside the USA prior to learning about this observational study. After meeting rigorous screening requirements, 30 participants were enrolled, all endorsing histories of combat and repeated blast exposure, as well as traumatic brain injury. Participants were seen in person pre-treatment, post-treatment, and one-month post-treatment for neuropsychological testing, neuroimaging, and collection of clinical outcome measures. All 30 participants were seen pre- and post-treatment, of whom 27 were also able to return one-month post-treatment.The neuropsychological battery included the the Hopkins Verbal Learning Test (HVLT), the Brief Visuospatial Memory Test - Revised (BVMT-R), the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Working Memory Index (Digit Span and Arithmetic) and Processing Speed Index (Symbol Search and Coding), and the Delis-Kaplan Executive Function System (D-KEFS) tests of Verbal Fluency (VF), Trail Making (TMT), Color Word (CW), and Tower Test (TT). For repeated measures, alternate forms were used whenever possible.Results:Repeated-measures ANOVA revealed significant effects of time, with post-treatment improvements across multiple measures including processing speed (WAIS-IV PSI; F(2,25) = 26.957, p &lt; .001), executive functions (CW Conditions 3 and 4: F(1.445,25) = 11.383, p &lt; .001 and F(1.381,25) = 7.687, p = .004, respectively), verbal fluency (VF Condition 3 correct and accuracy: F(2,25) = 6.419, p = .003 and F(2,25) = 153.076, p &lt; .001, respectively), and verbal learning (HVLT Total Recall (alternate forms used at each time point): F(1.563,23) = 6.958, p = .004). Score progression graphs are presented. Performance on all other cognitive measures did not significantly change following treatment.Conclusions:To our knowledge, this is the first prospective study examining neuropsychological test performance following ibogaine use at post-treatment and one-month post-treatment time points. Our results indicated that several cognitive domains improved either post-treatment or one-month post-ibogaine treatment, suggesting ibogaine’s therapeutic potential for cognition in the context of traumatic brain injury and mood disorders. Potential explanations include neuroplastic changes, reduction of PTSD and mood-related effects on cognitive functioning, and practice effects. While we found no evidence of negative cognitive consequences for up to one-month post-single-ibogaine treatment, further study of this substance is necessary to clarify its clinical utility and safety parameters.

4 Assessing Visuospatial Skills in Parkinson’s Disease Using the Identi-Fi

Objective:Patients with Parkinson’s disease (PD) commonly show deficits on tests of visuospatial functioning. The Identi-Fi is a new measure of visual organization and recognition composed of two components. The Visual Recognition (VR) subtest asks persons to identify an object that has been broken its pieces and rearranged, akin to the Hooper Visual Organization Test, but using updated and colorful pictures. The Visual Matching (VM) subtest involves showing the same stimuli, but the examinee must select the correct response from among five choices (1 correct and 4 foils), placing greater demand on visuospatial discrimination. Together, the two subtests comprise the Visual Organization Index (VOI), reflecting overall visual processing and organization ability. The present study examined performance on the Identi-Fi in patients with PD and its association with other aspects of cognition.Participants and Methods:Participants were 23 patients with PD (95% male; mean age = 69.7 years [SD = 7.8], range = 47-79) and 12 patients with cognitive concerns (CC) who were intact on neuropsychological testing (excluding consideration of Identi-Fi scores; 50% male, mean age = 71.08 [SD = 6.27], range = 60-78) seen for a neuropsychological evaluation at a large Northeastern medical center. As part of a larger battery, patients completed the Identi-Fi, Trail Making Test (TMT), Category Fluency, Test of Premorbid Functioning (TOPF), and Brief Visuospatial Memory Test, Revised (BVMT-R).Results:The PD group performed significantly worse than the CC group on VR and VM, as well as VOI, of the Identi-Fi (p &lt; .001). Within the PD group, poorer VR, VM, and VOI performance was associated with lower scores on the TOPF (p &lt; .05), BVMT-R learning (p &lt; .05) and delayed recall (p &lt; .05), as well as TMT Parts A and B (p &lt; .05). VR was significantly correlated with Category Fluency (p &lt; .05), while a trend was seen for the association between VOI and Category Fluency (p = .094).Conclusions:Identi-Fi performance was worse in the PD group than the CC group, which is consistent with prior research indicating that visuospatial processing is often abnormal in patients with PD. Furthermore, findings indicate that poorer performance on the Identi-Fi in the PD group is associated with poorer cognitive functioning in other domains (i.e., visuospatial learning and memory, processing speed, cognitive flexibility, and semantic fluency), as well as lower premorbid intellectual functioning. While these findings suggest that the Identi-Fi is useful in identifying visuospatial dysfunction in PD, findings should be interpreted with caution given the small sample sizes and uneven gender distribution

Low serum 25‑hydroxy-vitamin D levels are associated with cognitive impairment in multiple sclerosis.

Cognitive impairment frequently affects people with multiple sclerosis (MS). Low vitamin D has been associated with cognitive dysfunction in different neurodegenerative diseases, and, in MS, with motor disability and disease activity. We aim to investigate associations between vitamin D and cognitive status in MS. In this cross-sectional study, we included 181 MS patients, recruited consecutively at the MS Unit of the Policlinico Federico II University Hospital of Naples, Italy, between January and April 2022, with serum 25‑hydroxy (25-OH) vitamin D measurements using Chemiluminescence-ImmunoAssay, and cognitive assessment using the Brief International Cognitive Assessment for MS (BICAMS), which includes Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-II (CVLT-II) and Brief Visuospatial Memory Test-Revised (BVMT-R). We collected demographics (age, sex, education), and clinical variables (disease duration, disease subtype, expanded disability status scale (EDSS), disease modifying treatment, relapses in previous 12 months, vitamin D supplementation, comorbidities). For a subset of patients (n=41, 23.2% of the total sample), we collected Beck Depression Inventory-II, Beck Anxiety Inventory, and Modified Fatigue Impact Scale. At univariable linear regression models, serum 25-OH-vitamin D levels were 0.9ng/mL higher for each unit increase of SDMT adjusted scores (Coeff=0.93; 95%CI=0.81, 1.04; p<0.01), 0.7ng/mL higher for each unit increase of CVLT-II adjusted scores (Coeff=0.68; 95%CI=0.53, 0.83; p<0. 01), 0.6ng/mL higher for each unit increase of BVMT-R adjusted scores (Coeff=0.58; 95%CI=0.43, 0.73; p<0.01), -9.63ng/mL lower for each impaired BICAMS test (Coeff=-9.63; 95%CI=-11.48, -7.79; p<0.01), and -2.2ng/mL lower for each unit increase of EDSS (Coeff=-2.16; 95%CI=-3.57, -0.75; p<0.01). At multivariable linear regression models, we confirmed associations between 25-OH-vitamin D and EDSS (Coeff=-2.09; 95%CI=-4.45, -0.43; p<0.01), SDMT (Coeff=0.75; 95%CI=0.60, 0.90; p<0.01), and CVLT-II (Coeff=0.14; 95%CI=0.01, 0.28; p=0. 04). Results remained unchanged when including depression, anxiety and fatigue scores. Lower serum 25-OH-vitamin D was associated with worse cognitive function in MS. Future studies should consider longitudinal variations in cognitive function in relation to vitamin D supplementation.

76 Differential Performance in Visual Learning and Retrieval in a Validity Controlled Chronic Pain Sample

Objective:Individuals with chronic pain frequently report diminished cognitive functioning. Prior cross-sectional studies have demonstrated strong associations between chronic pain and neurocognitive impairment, most notably in memory, attention, processing speed, and executive functioning. However, there is a paucity of research evaluating visual learning and memory abilities in this population. Further, while current practice standards advocate for the use of performance validity tests (PVTs) to assess the credibility of neuropsychological test performance, they have infrequently been incorporated into studies examining chronic pain samples, despite a higher observed rate of noncredible performance in the literature. This study aimed to compare visual learning and memory performance between a mixed neuropsychiatric (MNP) group and a chronic pain group in a validity-controlled sample.Participants and Methods:The study consisted of 371 adults referred for outpatient neuropsychological evaluation. Between groups, various PVTs were administered, which included, at minimum, one freestanding and four embedded PVTs. All patients were administered the Brief Visuospatial Memory Test-Revised (BVMT-R) as part of a comprehensive neuropsychological evaluation. Only patients classified as valid performers (&lt;1 PVT fails; n=295) were included in the analyses (Pain: n=109; MNP: n=186). The overall sample was 69% female and racially diverse (22% non-Hispanic Black, 43% non-Hispanic White, 30% Hispanic, 3% Asian/Pacific Islander, and 2% other race/ethnicities), with a mean age of 46.8 (SD=14.8) and mean education of 13.7 years (SD=2.7). Independent samples t-tests were performed to investigate the differences in visual learning and memory abilities between the chronic pain and MNP groups.Results:Chi-square analyses revealed significant differences between the pain and MNP groups on race, with more non-Hispanic White and Hispanic patients represented in the MNP group. There were also modest group differences in age and education. For the chronic pain group, patients scored lower on both BVMT-R Total T-Score (mean difference = 9.65T, p&lt;.001) and BVMT Delayed Recall T-Score (mean difference = 8.97T, p&lt;.001). The effect size was robust for both for Total T-Score (d = 0.682) and Delayed Recall T-Score (d = 0.632). In contrast, the difference in BVMT Recognition Discriminability was not statistically significant.Conclusions:This study demonstrated significant differences in performance between mixed neuropsychiatric and chronic pain patients. Preliminary evidence indicated that chronic pain patients displayed lower visual mediated encoding and retrieval performance, although their recognition is comparable. Although the nature of this study was targeted toward visual learning and retrieval, it is likely that the known impact of chronic pain on attention, working memory, and processing speed accounts for this relationship. Future studies will benefit from further elucidating these potential mechanisms and better inform clinical decision-making and neuropsychological testing performance in patients with chronic pain.

A - 183 Novel Performance Validity Indicators for Frequently Used Memory Tests Using Infrequent Patterns of Memory Performance.

Determining performance validity is an imperative part of neuropsychological assessment in concussion management. Several existing embedded performance validity tests (PVTs) have been developed for popular measures of memory, Hopkins Verbal Learning Test Revised (HVLT-R) and Brief Visuospatial Memory Test Revised (BVMT-R). However, many PVTs utilize cognitive performance measures to classify performance invalidity, which increases the likelihood of false positives, especially in clinical populations. To reduce this possibility, a novel embedded PVT was developed utilizing infrequent patterns of performance in a primarily amnestic, dementia population. Neuropsychological data for 50 adult outpatients (Mean Age = 73, Range = 50-97) who met criteria for Major Neurocognitive Disorder (MND) were reviewed. Infrequent patterns of performance (IPOP) were identified on the HVLT-R and BVMT-R, including inconsistency between recall and recognition, unusually high intrusions, exceedingly poor learning, and lack of primary effect. Scaled scores were developed from the IPOP scores (0 = 0-74%, 1 = 75-94%, 2 = 95-99%). Total IPOP scaled scores were compared to existing embedded PVTs, which utilized recognition discrimination and percent retention scores, to examine classification rates. Failure rates on the embedded PVTs for the HVLT-R were 16-42% and BVMT-R 38-58% whereas elevated IPOP scaled scores were identified in less than 15% of the sample. High frequencies of embedded PVT failures were found in a clinical sample of patients with MND, which is concerning for false positive misclassification. Infrequent patterns of memory performances identified in a dementia population were less frequent and could potentially be utilized to examine performance validity in persons suspected of producing invalid memory performances.

A - 184 Validity of the Infrequent Patterns of Performance Embedded Performance Validity Indicators in a Mixed Clinical Sample.

Novel performance validity tests (PVTs) for the Hopkins Verbal Learning Test-Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R), derived from infrequent patterns of performance (IPOP), were developed to examine invalid memory performance while reducing false positive misclassification. To examine their classification accuracy, these indicators were compared to several existing embedded PVTs in a mixed clinical sample. A chart review was completed for 75 adult outpatients (Mean Age = 52, Range = 19-85) referred to an academic medical center outpatient clinic for neuropsychological evaluation. Twenty-eight percent of the sample failed the Medical Symptom Validity Test (MSVT), which was used as the criterion to indicate invalid performance. Several established embedded validity indicators were calculated from HVLT-R and BVMT-R scores, including the recognition discrimination index (RDI) and percent retention (PR), as well as the Reliable Digit Span (RDS) validity indicator. Classification statistics, including sensitivity, specific, likelihood ratios, predictive values, and overall accuracy, were calculated and compared. The HVLT-R IPOP had a higher overall classification accuracy (72%) compared to the RDI indicator (68%) while maintaining excellent specificity (97%). The BVMT-R IPOP had identical classification accuracy (75%) compared to the RDI and PR indicators with very high specificity (96%). Both indicators were more accurate than RDS (72%). The HVLT-R and BVMT-R IPOP performance validity indicators produced adequate classification statistics when compared to existing embedded PVTs. Both indicators maintained excellent specificity, which is crucial in reducing false positive classification. Future research will focus on further examining the validity of these indicators in other clinical groups and known groups, including medico-legal populations.

The effect of atomoxetine on cognitive function in patients with multiple sclerosis.

Background: Recent research shows that most of the patients with multiple sclerosis (MS) have cognitive-like disorders. Due to the beneficial effects of atomoxetine on improving cognition in limited animal and human surveys, the aim of the present study was to investigate the effect of the atomoxetine on improving cognitive disorders of MS. Methods: This study was a parallel, randomized clinical trial, designed to investigate the effect of atomoxetine drug on the improvement of cognitive impairment (CI) in MS, from April 2021 to March 2022. According to the inclusion and exclusion criteria, a total of 52 participants were involved in the study and then randomly divided in two groups of 26. Experimental group was treated with atomoxetine and the control group was treated with placebo. The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) test was performed for assessment at the beginning and after 3 months. The California Verbal Learning Test (CVLT), the CVLT-delay, the Brief Visuospatial Memory Test-Revised (BVMT-R), and the Symbol Digit Modalities Test (SDMT) were used to evaluate the CI and changes following medication. Finally, data were analyzed by SPSS software at significance level of 0.05. Results: The mean age of patients in the experimental group was 37.7 ± 8.5 and in the placebo group was 37.8 ± 7.6 (P = 0.32). The results showed significant changes in cognitive levels before and after the use of atomoxetine and also in comparison to the placebo group (P < 0.05). Conclusion: This study showed that atomoxetine improved the cognitive domains after administration compared to placebo.

H - 37 Impact of Barriers to Healthcare Access on Cognition and Accelerated Brain Aging in Diverse Persons with Multiple Sclerosis: Preliminary Pilot Data.

Racially/ethnically diverse persons with multiple sclerosis (pwMS) have worse outcomes than their white counterparts. Barriers to healthcare access may contribute to these disparities, though much remains unknown. The current pilot study investigates the impact of barriers to healthcare on cognition and accelerated brain aging in diverse pwMS. We hypothesize that greater barriers to healthcare will be associated with poorer cognitive performance and increased brain aging. Eighteen middle-aged pwMS (40-60years) were included. Barriers to healthcare access was evaluated using total and subscale (skills, marginalization, expectations, knowledge, and pragmatics) scores of the modified Barriers to Care Questionnaire. Cognition was measured using raw scores from the Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), and California Verbal Learning Test-II (CVLT-II). Accelerated brain aging was calculated by subtracting chronological age from predicted brain age based on the brainageR paradigm. Given established directional hypotheses, one tailed correlations were conducted. Greater marginalization-related barriers to healthcare were associated with poorer performance on the SDMT (r = -0.409, p = 0.046). Greater knowledge-based barriers to healthcare were associated with increased brain aging (r = -0.615, p = 0.004). Lastly, brain age was significantly related to immediate (r = -0.653, p = 0.003) and delayed (r = -0.549, p = 0.014) visual memory, such that increased brain age was associated with poorer visual memory. To the authors' knowledge, this is among the first studies to examine the impact of barriers to healthcare on cognition and brain health in diverse pwMS. It demonstrates the importance of sociocultural determinants when examining outcomes in MS. This work has implications for culturally informed research and clinical care.

One-year regional brain volume changes as potential predictors of cognitive function in multiple sclerosis: a pilot study

BackgroundThe most reliable magnetic resonance imaging (MRI) marker of cognitive dysfunction in multiple sclerosis (MS) is brain atrophy. However, 1-year volumetric changes prior to cognitive assessment were never studied as potential predictors of cognition, which we aim to assess with this pilot work.MethodsTwenty-two MS patients were submitted to a baseline measure of 83 regional brain volumes with MRI and re-evaluated 1 year later; they were also tested with the Brief International Cognitive Assessment for MS (BICAMS): sustained attention and processing speed were examined with the Symbol Digit Modalities Test (SDMT), verbal and visuo-spatial learning and memory with the learning trials from the California Verbal Learning Test-II (CVLT) and the Brief Visuo-spatial Memory Test-revised (BVMT), respectively. Controlling for age, sex, and years of education, a multivariate linear regression model was created for each cognitive score at 1-year follow-up in a backward elimination manner, considering cross-sectional regional volumes and 1-year volume changes as potential predictors.ResultsDecreases in the volumes of the left amygdala and the right lateral orbitofrontal cortex in the year prior to assessment were identified as possible predictors of worse performance in verbal memory (P = 0.009) and visuo-spatial memory (P = 0.001), respectively, independently of cross-sectional brain regional volumes at time of testing.ConclusionOur work reveals novel 1-year regional brain volume changes as potential predictors of cognitive deficits in MS. This suggests a possible role of these regions in such deficits and might contribute to uncover cognitively deteriorating patients, whose detection is still unsatisfying in clinical practice.

Cognitive impairment among an Egyptian sample of patients with schizophrenia and bipolar disorders: a comparative study

BackgroundThe cognitive profile among patients with schizophrenia (SZ) and bipolar disorder (BD) has varied widely across different studies. The aim of the current study was to compare different cognitive domains using psychometric and neurophysiological tests in patients with SZ to those with BD. A case–control study was conducted on 30 BD, 30 SZ and 30 age and sex matched control group. Each subject was submitted to the following: Wechsler Adult Intelligence Scale-3rd edition (WAIS-III), Montreal cognitive assessment scale (MoCA), Brief Visuospatial Memory Test-Revised (BVMT-R), Memory Assessment Scales (MAS), and the P300 event related potential (ERP).ResultsSZ and BD patients had significantly lower total and subscales of WAIS-III scores than the control group. SZ patients had significantly higher deterioration index (DI) than controls, while absence of such significant between BD and controls. SZ patients reported significantly lower MoCA scores and subitems, especially in visuospatial, naming, attention, delayed recall, and orientation subtests than controls. Only visuospatial and delayed recall scores were significantly decreased in BD than controls. SZ patients performed poorer on BVMT-R subscales than the control group. Both SZ and BD groups had lower mean values of all subscales except verbal assessment in the four memory tests. P300 latencies and amplitude had no significant difference among the three groups, although the BD group had a shorter P300 latency.ConclusionPatients with SZ and BD had significantly lower scores on various cognitive function domains in comparison to controls with more affection in SZ. The frequency of mood episodes, disease duration, and education level must be considered.

Longitudinal assessment of neurocognitive function in people with relapsing multiple sclerosis initiating alemtuzumab in routine clinical practice: LEM-COG study results.

Alemtuzumab is effective in reducing relapse rate and disability, but limited data exist on its effect on cognitive function in relapsing multiple sclerosis (RMS). The present study assessed neurocognitive function and safety associated with alemtuzumab treatment in RMS. This longitudinal, single-arm, prospective study included people with RMS (aged 25-55 years) who were treated with alemtuzumab in clinical practice in the United States of America and Canada. The first participant was enrolled in December 2016. The primary endpoint was the change from baseline to post-baseline (month [M] 12/24) in MS-COGnitive (MS-COG) composite score. Secondary endpoints included Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Selective Reminding Test (SRT), Controlled Oral Word Association Test (COWAT), and Automated Neuropsychological Assessment Metrics (ANAM) scores. Depression and fatigue were assessed using Hamilton Rating Scale-Depression (HAM-D) and Fatigue Severity Scale (FSS)/Modified Fatigue Impact Scale (MFIS), respectively. Magnetic resonance imaging (MRI) parameters were assessed when available. Safety was assessed throughout the study. Descriptive statistics were used for the pre-specified statistical analyses. Since the study was terminated early (November 2019) because of operational and resource difficulties, post hoc analyses for statistical inference were performed among participants who had a baseline value and at least one complete post-baseline assessment for cognitive parameters, fatigue, or depression. Of the 112 participants enrolled, 39 were considered as the primary analysis population at M12. At M12, a mean change of 0.25 (95% confidence interval [CI]: 0.04, 0.45; p=0.0049; effect size [ES]: 0.39) was observed in the MS-COG composite score. Improvements were observed in processing speed (based on PASAT and SDMT; p < 0.0001; ES: 0.62), as well as in individual PASAT, SDMT and COWAT scores. An improvement was also noted in HAM-D (p=0.0054; ES: -0.44), but not in fatigue scores. Among MRI parameters, decreases in burden of disease volume (BDV; ES: -0.12), new gadolinium-enhancing lesions (ES: -0.41) and newly active lesions (ES: -0.07) were observed at M12. About 92% of participants showed stable or improved cognitive status at M12. There were no new safety signals reported in the study. The most common adverse events (≥10% of participants) were headache, fatigue, nausea, insomnia, urinary tract infection, pain in extremity, chest discomfort, anxiety, dizziness, arthralgia, flushing, and rash. Hypothyroidism (3.7%) was the most frequent adverse event of special interest. The findings from this study suggest that alemtuzumab has a positive impact on cognitive function with significant improvements in processing speed and depression in people with RMS over a period of 12 months. The safety profile of alemtuzumab was consistent with previous studies.