Clinical Neuropsychological Assessment Research Articles

NCOG-30. FACTORS ASSOCIATED WITH COGNITIVE IMPAIRMENT IN LONG-TERM IDH-MUTANT GLIOMA SURVIVORS

Abstract BACKGROUND Cognitive deficits are less frequent in patients with IDH mutant (IDHm) than wild-type glioma at time of diagnosis, but less is known about factors that influence cognition for long-term survivors. We evaluated long-term neuropsychological outcomes of patients with IDHm glioma. METHODS Patients with IDHm glioma who underwent clinical neuropsychological assessment at Massachusetts General Hospital 3+ years after diagnosis were included and compared to a previously published cohort of IDHm patients tested prior to surgery/diagnosis (Wefel et al., 2016). RESULTS Sixty-three patients were included for analysis (54% male; median age 45 [range 21-75], 16 years of education, and 7 years from diagnosis [range 3-28]). Thirty-eight patients (60%) had astrocytoma and 24 (40%) had oligodendroglioma; 28 (44%) were grade 2, 31 (49%) grade 3, and 4 (6%) grade 4. Fifty-five patients (87%) received radiation and 51 (81%) received chemotherapy. Cognitive impairment (defined as Z score ≤-1.5 on at least two tests) was present in 30 patients (48%) and was associated with lower scores in neurologic aspects of quality of life (QoL; p<0.01), grade 3/4 relative to grade 2 (p=0.01), older age (p=0.03), left-sided lateralization (p=0.02), and less education (p=0.01). Prior radiation (p=0.07) and photon relative to proton radiation (p=0.06) trended toward poorer function. Tumor type, disease duration, and extent of resection were not significant factors (p>0.05). Compared to the pre-diagnosis IDHm cohort, impairment was significantly more common on tests of processing speed and language. Learning/memory, executive, and visuospatial function trended toward more frequent impairment but were not significant. Attention had comparable frequency of impairment. CONCLUSIONS In this cohort of IDHm glioma survivors, neurocognitive deficits were common, related to QoL, and associated with some expected clinical factors, but not length of survival. These findings emphasize the need for future research on interventions aimed at supporting patients’ neurocognitive abilities and QoL.

Methods for assessment of rey auditory verbal learning test performance in memory clinic patients and healthy adults - at the cross-roads of learning theory and clinical utility

Background: Knowledge is still lacking regarding the preferred method for evaluation of learning in the Rey Auditory Verbal Learning Test (RAVLT). Validity of different methods was examined by the effect size in differentiating diagnostic stages in memory clinic patients versus healthy adults and the strength of association between RAVLT performance and brain atrophy. Method: The study included individuals with dementia (n = 247), Mild Cognitive Impairment (MCI, n = 709), Subjective Cognitive Impairment (SCI, n = 175) and cognitively unimpaired adults serving as healthy controls (HC, n = 102). All patients went through a comprehensive clinical examination and neuropsychological assessment of cognition including episodic memory gauged with RAVLT and brain imaging of medial temporal atrophy, cortical atrophy, and white matter hyperintensity. Results: The standard method for evaluation of learning in RAVLT (summed score over five trials) together with the late learning method (mean of trials 4 and 5) were the two most powerful methods according to group differentiation (discriminant validity). Both methods also showed considerable association with medial temporal atrophy (construct validity). The initial RAVLT performance represented by results on trial 1 and the constant in regression analysis with the power function provided information regarding attention that was important for the separation of SCI and HC. Conclusions: The most favorable clinical utility was indicated by discriminant and construct validity by total learning (standard method) including both attention- and learning-related parts and late learning of RAVLT performance, while theoretical understanding of mental processes involved in RAVLT performance was provided by the distinction between initial versus the subsequent learning performance.

Neuropsychological functioning of adults with PTEN hamartoma tumor syndrome.

PTEN hamartoma tumor syndrome (PHTS) might be associated with a distinct cognitive and psychological profile. However, previous studies are limited, predominantly based on small and pediatric cohorts, likely affected by selection bias, and show a broad range of findings. We aimed to characterize the neuropsychological functioning of adults with PHTS. A total of 40 participants, with intellectual disability as exclusion criterium, completed an extensive clinical neuropsychological assessment including cognitive tasks, questionnaires, and a clinical diagnostic interview. The cognitive tasks and questionnaire data were categorized as below and above average based on 1.5 SD. About 80% of participants showed an average level of intelligence. In addition, 30% and 24% of participants scored below average on immediate memory recall and speed of information processing, respectively. Furthermore, about 25% reported above average scores on the majority of the questionnaires, indicating psychological distress, signs of alexithymia, and cognitive complaints. Personality of participants was characterized by inflexibility, social withdrawal, and difficulties in recognizing and describing their own emotions. Adults with PHTS demonstrate a heterogeneous yet distinct neuropsychological profile that is characterized by slower information processing, psychological problems, and specific personality traits. These findings provide directions on how to optimize the care and daily lives of adults with PHTS.

Clinical validity of the Italian adaptation of the Uniform Data Set Neuropsychological Test Battery (I-UDSNB) in Mild Cognitive Impairment and Alzheimer’s Disease

BackgroundThe identification and staging of Alzheimer’s Disease (AD) represent a challenge, especially in the prodromal stage of Mild Cognitive Impairment (MCI), when cognitive changes can be subtle. Worldwide efforts were dedicated to select and harmonize available neuropsychological instruments. In Italy, the Italian Network of Neuroscience and Neuro-Rehabilitation has promoted the adaptation of the Uniform Data Set Neuropsychological Test Battery (I-UDSNB), collecting normative data from 433 healthy controls (HC).Here, we aimed to explore the ability of I-UDSNB to differentiate between a) MCI and HC, b) AD and HC, c) MCI and AD.MethodsOne hundred thirty-seven patients (65 MCI, 72 AD) diagnosed after clinical-neuropsychological assessment, and 137 HC were included. We compared the I-UDSNB scores between a) MCI and HC, b) AD and HC, c) MCI and AD, with t-tests. To identify the test(s) most capable of differentiating between groups, significant scores were entered in binary logistic and in stepwise regressions, and then in Receiver Operating Characteristic curve analyses.ResultsTwo episodic memory tests (Craft Story and Five Words test) differentiated MCI from HC subjects; Five Words test, Semantic Fluency (vegetables), and TMT-part B differentiated AD from, respectively, HC and MCI.ConclusionsOur findings indicate that the I-UDSNB is a suitable tool for the harmonized and concise assessment of patients with cognitive decline, showing high sensitivity and specificity for the diagnosis of MCI and AD.

Association between neuropsychological assessment and amyloid status in a clinical setting.

Large research cohorts show robust associations between neuropsychological tests and Alzheimer's disease (AD) biomarkers, but studies in clinical settings are limited. The increasing availability of AD biomarkers to the practicing clinician makes it important to understand the relationship between comprehensive clinical neuropsychological assessment and biomarker status. This study examined concordance between practicing clinical neuropsychologists' diagnostic impressions and AD biomarker status in patients seen at an outpatient medical center, with a secondary aim of defining the characteristics of discordant cases. Participants (N = 79) seen for clinical neuropsychological assessment who subsequently underwent lumbar puncture or amyloid positron emission tomography imaging were identified via retrospective chart review. Concordance between clinical neuropsychological diagnosis (non-AD, indeterminate, possible/probable AD) and AD biomarker status (negative, indeterminate, positive) was determined. Individual test score data were used to examine between-group differences based on amyloid status. AD biomarker positive and negative patients did not differ on individual neuropsychological tests after correcting for multiple comparisons, though the small number of AD biomarker indeterminate individuals performed better than biomarker positive patients. However, there was 76.7% concordance between neuropsychologists' diagnostic impressions and AD biomarker status (88% sensitivity and 55% specificity of neuropsychological assessment in detecting AD biomarker status). AD biomarker negative patients diagnosed as possible/probable AD (discordant) versus non-AD (concordant) had significantly lower Neuropsychological Assessment Battery Story Delayed Recall, higher Wechsler Adult Intelligence Scale-Fourth Edition Coding, and higher Trail-Making A (i.e., an amnestic memory profile). Comprehensive neuropsychological assessment showed modest concordance with AD biomarker status in patients seen in an outpatient medical center for routine clinical care. Low specificity for the clinical diagnosis of AD could be explained by the multiplicity of etiologies that cause memory impairment (i.e., TAR DNA-binding protein 43, suspected non-AD pathology). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prospective memory performance in veterans with and without histories of mild traumatic brain injury: effect of the apolipoprotein E (APOE) ε4 genotype

ABSTRACT Objective Identifying factors that moderate cognitive outcomes following mild traumatic brain injury (mTBI) is crucial. Prospective memory (PM) is a cognitive domain of interest in mTBI recovery as it may be especially sensitive to TBI-related changes. Since studies show that genetic status – particularly possession of the apolipoprotein E (APOE) ε4 allele – can modify PM performance, we investigated associations between mTBI status and APOE-ε4 genotype on PM performance in a well-characterized sample of Veterans with neurotrauma histories. Methods 59 Veterans (mTBI = 33, Military Controls [MCs] = 26; age range: 24–50; average years post-injury = 10.41) underwent a structured clinical interview, neuropsychological assessment, and genotyping. The Memory for Intentions Test (MIST) measured PM across multiple subscales. ANCOVAs, adjusting for age and posttraumatic stress symptoms, tested the effects of mTBI status (mTBI vs. MC) and ε4 status (ε4+ vs. ε4−) on MIST scores. Results Veterans with mTBI history performed more poorly compared to MCs on the MIST 15-min delay (p=.002, ηp 2 =.160), Time Cue (p = .003, ηp 2 =.157), and PM Total (p = .016, ηp 2 =.102). Those with at least one copy of the ε4 allele performed more poorly compared to ε4- Veterans on the MIST 15-min delay (p = .011, ηp 2 =.113) and PM Total (p = .048, ηp 2 = .071). No significant interactions were observed between mTBI and APOE-ε4 status on MIST outcomes (ps>.25). Within the mTBI group, APOE-ε4+ Veterans performed worse than APOE-ε4− Veterans on the MIST 15-min delay subscale (p = .031, ηp 2 = .150). Conclusions mTBI history and APOE-ε4 genotype status were independently associated with worse PM performance compared to those without head injury histories or possession of the APOE-e4 genotype. Performance on the MIST 15-min delay was worse in Veterans with both risk factors (mTBI history and APOE-ε4 positivity). Findings suggest that genetic status may modify outcomes even in relatively young Veterans with mTBI histories. Future research examining longitudinal associations and links to neuroimaging and biomarker data are needed.

High-resolution diffusion tensor imaging of the fornix predicts memory function in multiple sclerosis.

Cognitive dysfunction is a known symptom of multiple sclerosis (MS), with memory recognized as a frequently impacted domain. Here, we used high-resolution MRI at 7 tesla to build on cross-sectional work by evaluating the longitudinal relationship of diffusion tensor imaging (DTI) measures of the fornix to episodic memory performance. A sample of 80 people with multiple sclerosis (mean age 51.9 ± 8.1 years; 24% male) underwent baseline clinical evaluation, neuropsychological assessment, and MRI. Sixty-four participants had follow-up neuropsychological testing after 1-2 years. Linear regression was used to assess the relationship of baseline imaging measures to follow-up episodic memory performance, measured using the Selective Reminding Test and Brief Visuospatial Memory Test. A reduced prediction model included cognitive function at baseline, age, sex, and disease course. Radial (β = -0.222, p < 0.026; likelihood ratio test (LRT) p < 0.018), axial (β = -0.270, p < 0.005; LRT p < 0.003), and mean (β = -0.242, p < 0.0139; LRT p < 0.009) diffusivity of the fornix significantly added to the model, with follow-up analysis indicating that a longer prediction interval may increase accuracy. These results suggest that fornix DTI has predictive value specific to memory function in MS and warrants additional investigation in the drive to develop predictors of disease progression.

Impaired creative cognition after surgery for an IDH-mutated glioma: A proof-of-concept study

Assessment of high cognitive functions, such as creativity, is often overlooked in medical practice. However, it is crucial to understand the impact of brain tumors, specifically low-grade gliomas, on creative cognition, as these tumors predominantly affect brain regions associated with cognitive creativity. In this study, we investigated creative cognition using the Alternative Uses Task (AUT) and the Combination of Associates Task (CAT) in a cohort of 29 patients who underwent brain surgery for a low-grade glioma, along with 27 control participants. While the group of patients did not exhibit deficits in clinical neuropsychological assessments, our results revealed significant impairment in generating original and creative ideas compared to the control group. Furthermore, when analyzing the specific brain regions affected by the tumors, patients with lesions overlapping the left rostro-lateral prefrontal cortex, a critical region for creativity, displayed more pronounced impairments in the CAT compared to patients with lesions outside this region. These findings provide proof of concept that patients can experience impaired creative cognition following surgery for low-grade glioma, highlighting the importance of assessing higher-order cognitive functions, including creativity, in neurosurgical patients. Moreover, beyond its clinical relevance, our study contributes to advancing our understanding of the neuroscience of creativity.

Isolated anterior cerebral artery occlusion: an atypical form of moyamoya disease

BackgroundThe relationship between anterior cerebral artery (ACA) occlusion and moyamoya disease (MMD) has rarely been studied. In this study, we focused on a special type of MMD: isolated ACA-occlusive MMD....

Vocabulary knowledge as a reliable proxy of cognitive reserve in multiple sclerosis: a validation study

IntroductionThe present study aimed to explore the suitability of the vocabulary knowledge (VOC) test as an accurate and reliable proxy of cognitive reserve (CR) by evaluating its psychometric properties and discrimination accuracy compared with other CR measures in multiple sclerosis (MS).MethodsSixty-eight consecutive people with multiple sclerosis (pwMS), followed at our MS outpatient clinic, completed a clinical evaluation and neuropsychological assessment including: VOC, Brief Repeatable Battery of Neuropsychological Tests (BRB-N), Cognitive Reserve Index Questionnaire (CRIq), Beck Depression Inventory-II, and State-Trait Anxiety Inventory. Reliability, convergent and divergent validity, and discrimination accuracy of the VOC were assessed using educational level as reference standard. The possible effects of sociodemographic and clinical factors on VOC and their role in predicting global cognitive status were also explored.ResultsVOC demonstrated good internal consistency (Cronbach’s α = 0.894) and adequate construct validity. It showed an acceptable level of discrimination between pwMS with high and low CR, comparable to the CRIq score. Education strongly affected VOC scores, which in turn were independent of MS features. VOC emerged as an independent predictor of global cognitive status together with MS-related disability.ConclusionWe demonstrated the validity of VOC as a reliable CR measure in pwMS. Thus, CR may also be estimated using fixed objective measures, independent of brain pathology and clinical features. Early CR estimation may help clinicians identify pwMS at a higher risk of cognitive decline and plan strict neuropsychological monitoring and cognitive interventions.

Correlation and underlying brain mechanisms between rapid eye movement sleep behavior disorder and executive functions in Parkinson's disease: an fNIRS study.

Rapid eye movement sleep behavior disorder (RBD) affects 30%-40% of patients with Parkinson's disease (PD) and has been linked to a higher risk of cognitive impairment, especially executive dysfunction. The aim of this study was to investigate the brain activation patterns in PD patients with RBD (PD-RBD+) compared to those without RBD (PD-RBD-) and healthy controls (HCs), and to analyze the correlation between changes in cerebral cortex activity and the severity of RBD. We recruited 50 PD patients, including 30 PD-RBD+, 20 PD-RBD-, and 20 HCs. We used functional near infrared spectroscopy during a verbal fluency task (VFT-fNIRS) and clinical neuropsychological assessment to explore the correlation between PD-RBD+ and executive function and changes in neural activity. The VFT-fNIRS analysis revealed a significant reduction in activation among PD-RBD+ patients across multiple channels when compared to both the PD-RBD- and HC groups. Specifically, PD-RBD+ patients exhibited diminished activation in the bilateral dorsolateral prefrontal cortex (DLPFC) and the right ventrolateral prefrontal cortex (VLPFC) relative to their PD-RBD- counterparts. Furthermore, compared to the HC group, PD-RBD+ patients displayed reduced activation specifically in the right DLPFC. Significantly, a noteworthy negative correlation was identified between the average change in oxygenated hemoglobin concentration (ΔHbO2) in the right DLPFC of PD-RBD+ patients and the severity of their RBD. Our study offers compelling evidence that RBD exacerbates cognitive impairment in PD, manifested as executive dysfunction, primarily attributed to reduced prefrontal activation. These aberrations in brain activation may potentially correlate with the severity of RBD.

MUSIC CREATIVITY INTERVENTION FOR OLDER ADULTS WITH AND WITHOUT MCI: COGNITIVE BENEFITS AND NEURAL MECHANISMS

Abstract Alzheimer’s and related dementias are debilitating conditions, and at this time, no cure has been identified. Older age is associated with cognitive decline and dementia. Developing and testing innovative non-pharmacological interventions to delay the loss of functional ability and understand the neurobiological mechanisms underlying the intervention’s efficacy is imperative. We conducted a semi-randomized clinical trial evaluating the effects of a novel music creativity curriculum on cognitive and neurological outcomes. Eighty older adults with and without a mild cognitive impairment (MCI) diagnosis were randomized to a 6-week music creativity intervention or a 6-week no-treatment control condition. Before and after the six weeks, both groups participated in a series of self-report and cognitive assessments; they also participated in resting-state fMRI scans to quantify whole-brain network patterns of modularity and flexibility. Those randomized to the music group exhibited improved overall cognitive function and working memory relative to the control group (assessed using standard clinical neuropsychological assessments). The association between being randomized to the music group and increased cognitive function was more robust among those who exhibited greater neural flexibility at baseline. The study shows that music creativity interventions may positively affect cognition, especially among those whose neural network structure is more dynamic or flexible. This study is innovative as it is among the first to identify possible neural mechanisms underlying why music creativity interventions confer a more significant cognitive benefit for some older adults than others.

Challenges in identification of HIV‐Associated Neurocognitive Disorders, a focus on low and middle income countries

AbstractBackgroundHIV‐associated neurocognitive disorders (HAND) are highly prevalent amongst people living with HIV (PLWH), especially in Sub‐Saharan Africa (SSA) where the majority of PLWH live. Current HAND identification measures lack accuracy in older PLWH on treatment, with substantial heterogeneity observed in SSA prevalence meta‐analyses There is a need to better understand the current cognitive phenotype of this newly emergent population, to develop appropriate screening tools. We report two linked studies.Study 1 compared diagnostic accuracy of the International HIV dementia scale (IHDS), and Identification and Interventions for Dementia in Elderly Africans (IDEA) screen, for identification of HAND in older PLWH in TanzaniaStudy 2 aimed to identify cognitive domains significantly associated with symptomatic HAND (s‐HAND) in older PLWH in Tanzania, with potential utility in future screening measures.MethodA systematic sample of 253 PLWH aged ≥ 50 attending a Government clinic underwent comprehensive HAND evaluation by consensus American Academy of Neurology (AAN) criteria including locally‐normed low‐literacy clinical neuropsychological assessment. A diagnostic accuracy study of the IHDS and IDEA screen versus AAN criteria was completed with strict blinding. Participants were offered identical annual reassessment at Y1 Y2 and Y3 and the relationship of cognitive domains with s‐HAND in a logistic mixed effects modelResultHAND was highly prevalent (47%) at baseline, increasing to 57.9% at year 3.At baseline, both IHDS and IDEA had limited diagnostic accuracy for HAND (AUROC 0.639–0.667 IHDS, 0.647–0.713 IDEA). On secondary analysis of longitudinal data, tests of verbal learning and memory, categorical verbal fluency, visual memory and visuoconstruction had AUROC &gt; 0.7 for s‐HAND (0.70 ‐ 0.72; p&lt;0.001 for all). Tests of visual memory, verbal learning and memory (delayed recall and recognition memory), psychomotor speed, language comprehension and categorical verbal fluency were independently associated with s‐HAND (p&lt;0.01 for all). Neuropsychological impairment pattern varied by education.ConclusionCurrent HAND screening tests no longer perform well in the new population of older PLWH in Africa. Tests most associated with s‐HAND include broad cortical and subcortical domains, some not included in existing HAND screening tests and vary by educational background. This should be considered in future HAND screening measure development.

Indexing the Predictive Utility of Real‐World Sleep to Discriminate Early Alzheimer’s Disease

AbstractBackgroundSleep dysfunction is one of earliest symptoms of Alzheimer’s disease (AD) and can accelerate cognitive decline, increasing risk of AD. Emerging technologies, like actigraphy, allow for continuous monitoring of real‐world sleep. Our goal is to determine the predictive utility of real‐world sleep dysfunction features for indexing warning signs of incipient dementia like mild cognitive impairment (MCI).MethodSubjects were classed as cognitively neurotypical (N = 31) or impaired: MCI (n = 51) or AD (N = 7) based on NIA‐AA diagnostic criteria, as evaluated by a neurologist from clinical exam, neuropsychological, and demographic assessments. (Table 1) Each subject was tracked for 3 months with wrist‐worn actigraphy. Self‐reported sleep diaries validated real‐world sleep data. Sleep duration and quality were estimated across means and standard deviations (SD) of: Total Sleep Time (TST), Sleep Latency (SL), Sleep Efficiency (SE), Wakefulness After Sleep Onset (WASO), and Awakening Count (AC). An optimal logistic regression model, adjusting for demographics (age, gender, education), was quantified and used to rank the explanatory value of sleep covariates to discriminate impaired vs. typical aging using stepwise selection.ResultAcross 6,530 validated, nightly sleep periods (mean = 73.4 ± 17.0 sleep periods per subject), we found best discrimination of impaired vs. typical aging, ranked from best to least discrimination (Table 2), for average sleep efficiency [SE] (b = 3.58, p = 0.03), nightly wakefulness [WASO] (b = 3.42, p = 0.04), variability of daily sleep quality [SE] (b = 1.65, p = 0.001), and awakening frequency [AC] (b = ‐0.79, p = .03). TST did not discriminate impaired from typical aging.ConclusionResults align with prior literature, demonstrating that sleep quality is an optimal feature to track early warning signs of dementia from real‐world sleep. Critically, SE shows the most promise for discriminating early decline while TST did not show predictive utility in this study. Digital fingerprints of sleep behavior in the real world offer unique added value to neurobiological biomarker evidence of preclinical disease, improving early detection of AD risk to bolster interventions aimed at treating AD—‐even its earliest stages.

Progressive Cerebrovascular Reactivity Reduction Occurs in Parkinson's Disease: A Longitudinal Study.

The change of microvascular function over the course of Parkinson's disease (PD) remains unclear. We aimed to ascertain regional cerebrovascular reactivity (CVR) changes in the patients with PD at baseline (V0) and during a 2-year follow-up period (V1). We further investigated whether alterations in CVR were linked to cognitive decline and brain functional connectivity (FC). We recruited 90 PD patients and 51 matched healthy controls (HCs). PD patients underwent clinical evaluations, neuropsychological assessments, and magnetic resonance (MR) scanning at V0 and V1, whereas HCs completed neuropsychological assessments and MR at baseline. The analysis included evaluating CVR and FC maps derived from resting-state functional magnetic resonance imaging and investigating CVR measurement reproducibility. Compared with HCs, CVR reduction in left inferior occipital gyrus and right superior temporal cortex at V0 persisted at V1, with larger clusters. Longitudinal reduction in CVR of the left posterior cingulate cortex correlated with decline in Trail Making Test B performance within PD patients. Reproducibility validation further confirmed these findings. In addition, the results also showed that there was a tendency for FC to be weakened from posterior to anterior with the progression of the disease. Microvascular dysfunction might be involved in disease progression, subsequently weaken brain FC, and partly contribute to executive function deficits in early PD. © 2023 International Parkinson and Movement Disorder Society.

32 Associations between Childhood Attention Deficit Hyperactivity Disorder and Learning Disabilities and Cognition in Late Adulthood.

Objective:There has been relatively little research on the effect of childhood attention difficulties/weaknesses and learning disabilities/differences on cognitive aging. This study examined associations between self-reported symptoms and diagnoses/concerns of childhood attention deficit hyperactivity disorder (ADHD) and reading or math learning disabilities (LD) and cognitive abilities in older adulthood. We hypothesized that cognitive weaknesses in childhood would be associated with cognitive abilities later in life.Participants and Methods:The 25 individuals with healthy cognition or MCI were recruited from the greater Philadelphia area (Mage= 74.4; SD= 5.34; 40% men; 84%white) and completed a self-report questionnaire of childhood ADHD and LD. Specifically, participants rated their experience of ADHD symptoms of inattention and hyperactivity/impulsivity and indicated whether they had a past diagnosis of (or concerns regarding past) ADHD, math LD or language/reading LD Participants also completed tests of language, attention, episodic memory, executive function, and processing speed. Pearson or point-biserial correlation coefficients (r-values) indicating a medium effect size (.30 or greater) were interpreted as meaningful.Results:On average, participants reported 3.48 symptoms of inattention and 2.56 symptoms of hyperactivity/impulsivity (i.e., at least six symptoms from either category are consistent with diagnostic criteria for ADHD). 16% of the sample reported childhood ADHD/attention difficulties, 48% reported childhood math LD/math difficulties, and 32% reported childhood language LD/difficulties. On cognitive tests, the sample performed in the average range, with considerable variability (i.e., norm-based, demographically adjusted T-scores ranged from 20-74). The relation between cognitive scores and report of childhood ADHD symptoms was weak and non-significant correlation (r&lt;.18). By contrast, report of childhood ADHD/attention difficulties was associated with lower scores attention tests (r=.33). Report of childhood language LD/difficulties was associated with a worse overall cognitive composite (r=-.35) and executive function ability (r=-.35). Childhood math LD/difficulties was not meaningfully associated with lower scores on any of the cognitive tests administered. Unexpectedly, report of childhood cognitive difficulties also were associated with higher scores on cognitive tests, such that childhood ADHD/attention difficulties was associated with better performance on tests of episodic memory (r=.39), and childhood math LD/difficulties were associated with better performance on tests of language (r=-.37).Conclusions:Current cognitive abilities in older adults may be influenced by lifelong cognitive weakness and academic difficulties. A history of ADHD and LD/difficulties should be considered in clinical neuropsychological assessment and future research on cognitive aging should consider ADHD/LD from a lifespan, developmental framework.

11 Sociodemographic, Cultural, and Linguistic Considerations for Clinical Neuropsychological Assessment with Japanese and Japanese American Patients in the United States

Objective:Japanese-Americans are the sixth largest Asian ethnicity in the United States. They represent a highly heterogeneous population due to their history of immigration dating back to the late 19th century. In comparison to the total Japanese-American population, there are very few neuropsychologists of Japanese descent who are familiar with the culture. The Asian Neuropsychological Association lists 16 licensed members of Japanese descent, and only 7 practice outside of Hawaii or California. These numbers suggest that unless non-Japanese neuropsychologists are knowledgeable of the culture, test translations, and appropriate norms, it would be challenging for many Japanese-Americans to receive culturally and linguistically competent neuropsychological services. The aim of the present study is to provide guidance for conducting neuropsychological assessments with Japanese-Americans with the goal of facilitating competent culturally-informed services to this population.Participants and Methods:Pertinent facets of Japanese culture as identified in the ECLECTIC framework and demographics of the U.S. Japanese-American population, and the available literature on neuropsychological tests that are translated into Japanese and normed with Japanese samples, was reviewed by authors with knowledge of Japanese language and culture. Literature published in both English and Japanese were included for review.Results:Psychological testing is a Western technology fraught with the behavioral expectations and values of the culture in which it was developed. Thus, these tests may be biased against persons coming from cultures that differ from the West. Recommendations for providing neuropsychological services to Japanese-Americans are presented with an aim of maximizing test fairness by addressing the following issues: comfort with the testing situation, test biases, accessibility, and validity. Given the emphasis on education, Japanese-Americans should be familiar and comfortable with cognitive testing, although they may experience undue pressure to perform well to avoid shame. Japanese-Americans may experience discomfort disclosing personal information during the interview, particularly if the evaluation is perceived to be psychiatric in nature, as there is a strong stigma associated with mental illness that could bring shame to the family. Japanese communication styles are indirect in nature, where the message is implied and what is “not said” is just as important as what is directly conveyed. Accessibility issues will primarily impact first generation Japanese-Americans who are native Japanese speakers. Another characteristic that may impact responding is hesitancy for guessing when unsure. Recommendations for providing culturally competent neuropsychological assessment given these considerations will be presented and expanded upon in detail. Finally, an online database of translated and normed neuropsychological tests by cognitive domain has been created and will be presented.Conclusions:Providing neuropsychological services to Japanese-Americans can be challenging as Japanese culture is significantly different from western culture. In addition, Japanese-Americans are heterogenous with salient issues of English proficiency and acculturation. Information to individualize a conceptual understanding of Japanese-Americans, translated and normed tests, and recommendations to maximize fairness in testing are presented to assist clinical neuropsychologists provide competent services to Japanese-Americans.

Mask wearing during neuropsychological assessment negatively impacts performance on verbal tests in older patients.

Face masks are recommended to minimize the spread of COVID-19 and are required in many health care settings. Although masks have documented health advantages, they also negatively impact communication, an essential element of clinical neuropsychological assessment. Using a large clinical data set from a major academic medical center, we investigated the effect of mask wearing on neuropsychological test performance. Specifically, we examined performance on eight standard, widely used neuropsychological tests between a prepandemic (unmasked) and postpandemic (masked) group, composed of 754 and 837 adult patients, respectively. We compared performance on verbally mediated versus visually mediated tests, hypothesizing that the postpandemic group, compared to the prepandemic group, would perform significantly lower on the verbally mediated tests but not on the visually mediated tests. In partial support of the hypothesis, we found that the postpandemic group performed significantly worse on the Auditory Verbal Learning Test (AVLT; p = .001). Secondary analyses showed that age moderated the mask-related effect (p = .038), whereby patients 65 and older had significantly worse performance on Digit Span (p = .0027) and the AVLT (p = .0002) with masks on, while patients younger than 65 showed no significant differences. There were no significant differences on any visually mediated tests. These findings suggest that mask wearing during neuropsychological assessment compromises performance on verbally mediated tests in older patients. These findings are particularly relevant for neuropsychologists practicing in geriatric settings. Neuropsychologists performing assessments with masks should be aware that masks may artificially deflate patient scores for reasons unrelated to cognition or clinical condition. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

64 TikTok as a Health Communication Platform in Pediatric Neuropsychology: Opportunities, Pitfalls, and Recommendations Moving Forward

Objective:Various forms of social media have been investigated as platforms for science and health communication, with a recent growing interest in TikTok. TikTok has more than one billion active users. Sixty-two percent of TikTok users are under the age of 29, making it a platform of particular interest when considering the impact of social media content dissemination in pediatric neuropsychology. Personal communication suggests that children, adolescents, and young adults internationally reference specific information from TikToks about attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), tic disorder, and specific learning disorders in the context of clinical neuropsychological assessment. Despite the emerging prevalence of TikTok observed clinically and discussed informally among clinicians, there has yet to be a synthesis of available empirical information of TikTok as a health communication platform for discussing neurodevelopmentally relevant conditions.Participants and Methods:A systematic review of research regarding TikTok and neurodevelopmentally relevant conditions was conducted using PRISMA guidelines. The following databases were searched: Ovid MEDLINE (to 20 July 2022), PsycINFO (to 20 July 2022), and PubMed (to 20 July 2022) using search terms TikTok AND ADHD OR autism OR tic OR learning disorder. Searches using search terms TikTok AND learning disability OR dyslexia OR dysgraphia OR dyscalculia were also conducted but were excluded as they yielded no results. Articles were eligible for inclusion if they presented original data (e.g., case series, descriptive analyses, etc.) related to information about neurodevelopmentally relevant conditions on TikTok. A final sample of 5 original papers met criteria for inclusion.Results:The systematic review sample included a mixture of clinical case series and empirical analyses using primary data from TikTok. Across publications, there was an emphasis on the prevalence of misinformation about disorders on TikTok, the frequency of atypical presentations of neurodevelopmental disorders on TikTok, and the potential for an iatrogenic impact on children and adolescents who view TikTok videos.Conclusions:Despite the increasing frequency with which patients access TikTok for health-related information, there is a relative dearth of published research on TikTok regarding neurodevelopmentally relevant conditions. This is in contrast to other health-related areas (e.g., there are a far greater number of published articles on TikTok and COVID-19 and dermatology compared to neuropsychological disorders). These findings suggest a missed opportunity for researchers and clinicians alike to engage with TikTok. Based on clinical experience and a review of the available literature, the following recommendations are provided and will be presented in-depth: 1.Clinicians should gain familiarity with virally spread information via TikTok, particularly as it relates to symptoms and presentations of neuropsychological and neurodevelopmental conditions.2.Clinicians should explicitly assess for knowledge content and source regarding neuropsychological and neurodevelopmental conditions during intake and/or feedback in order to address misinformation and myths, validate lived experiences, and develop rapport with patients.3.Clinicians and researchers should consider a strengths-based approach to TikTok usage that highlights the value of sharing resources, building community, and decreasing stigma.4.Clinicians and researchers should be aware of information shared via TikTok as a potential concern for test security.

28 Cognitive, Emotional, and Interactional Determinants in Loneliness, in a Heterogeneous Sample of Puerto Ricans with ABI in the Chronic Phase

Objective:An acquired brain injury (ABI) is a neurological pathology that generates a physical injury in the brain. These include cerebrovascular accidents (CVA) and traumatic brain injuries (TBI). Brain injuries can cause cognitive, emotional, and social problems, which have the potential to severely alter a person’s independence and quality of life. Loneliness, thesubjective experience of social isolation, has been shown to be the best predictor of mental health problems and poorquality of life in patients with ABI. This study aimed to explore the relationship between cognitive, emotional, and social determinants and loneliness in Puerto Ricans with ABI in the chronic phase.Participants and Methods:Cross-sectional, exploratory, and correlational methods were implemented. Assessments included the Frontal Systems Behavioral Scale - Spanish version (FrSBe-SP), Perth Emotional Reactivity Scale -Spanish version (PERS), Anticipated Stigma and Concealment (ASC), and the University of California Los Angeles - Loneliness Scale (UCLA-LS).Results:A total of seventeen participated (n=17). Twenty-nine percent of participants were female. Forty-seven percent had history of previous CVA and fifty-two percent had history of TBI. Correlational analyses suggest a positive and significant relationship between executive dysfunction (FrSBe-SP) and feelings of loneliness (UCLA-LS) (p=.601), as well as a positive and significant relationship between neuroticism-negative emotional reactivity (PERS) and feelings of loneliness (UCLA-LS) (p=.736). Correlational analysis suggests there is no significant relationship between anticipated stigma (ASC) and feelings of loneliness (UCLA-LS) (p=.282).Conclusions:Our findings suggest that there is a significant relationship between cognitive determinants (executive functions) and emotional determinants (neuroticism) with feelings of loneliness in people with a history of ABI. These results support the connection between executive dysfunction, the tendency to experience negative emotions, and the subjective experience of loneliness, consistent with previous studies. However, our study did not find any significant relationship between interactional determinants, such as stigma and concealment, and loneliness. Understanding the role of cognition, emotions, and social variables in reported feelings of loneliness is important for clinical neuropsychological assessment and rehabilitation interventions.