Cognitive Composite Score Research Articles

A - 70 Contextualizing Racial/Ethnic Differences in Baseline Assessment among Collegiate Athletes

Abstract Objective Compared to other factors that influence neuropsychological test performance, few studies have examined the relationship between racial/ethnic identity and baseline assessment performance in collegiate athletes, and even fewer have contextualized results using structural factors linked to test performance (e.g., premorbid cognitive ability). This study examined racial/ethnic differences in baseline assessment performance before and after controlling for premorbid functioning. We hypothesized that there would be racial/ethnic differences in performance but that controlling for premorbid functioning would reduce these differences. Method Participants included 875 collegiate athletes who were grouped based on racial/ethnic identity (White = 661, Black = 165, Another Race = 49) and underwent a comprehensive neuropsychological battery. Cognitive composite scores and intraindividual variability (IIV) were calculated for two neurocognitive domains: attention/processing speed and memory. Premorbid functioning was assessed with the Wechsler Test of Adult Reading (WTAR). ANCOVAs were used to examine racial/ethnic differences in these four cognitive domains before and after controlling for WTAR scores. Results Before controlling for WTAR scores, there were significant racial/ethnic differences in the attention/processing speed and memory composite scores and in attention/processing speed IIV, p’s < 0.001, ηp2 = 0.02–0.03. However, there were no significant racial/ethnic differences in memory IIV, p = 0.97. After controlling for WTAR scores, there were no significant racial/ethnic differences in the attention/processing (p = 0.530, ηp2 = 0.001) or memory (p = 0.183, ηp2 = 0.004) composite scores, and the relationship between racial/ethnic identity and attention/processing speed IIV became less significant (p = 0.014, ηp2 = 0.01). Conclusions Results suggest that racial/ethnic differences at baseline assessment can be largely accounted for by premorbid functioning, which underscores the importance of considering sociocultural context when assessing racially/ethnically diverse athletes.

A - 16 A Proof-of-Concept for the Construct Validity of Cognitive Dispersion: Longitudinal Relationship between Cognitive Dispersion and Preclinical Alzheimer’s Cognitive Composite Scores

Abstract Objective To examine the construct validity of cognitive dispersion (CD) by examining its relationship with the Preclinical Alzheimer’s Cognitive Composite (PACC) scores across multiple visits among cognitively healthy individuals with hypertension and memory concerns/significant family history of dementia. Methods 435 participants (Mage = 68.90, Meducation = 16.29 years) from the rrAD study with neurocognitive data from five visits over 24 months were included. PACC total scores were derived as per literature from the MMSE, Free and Cued Selective Reminding Test, Digit Symbol Substitution Test, and Logical Memory delayed recall. Raw scores were converted to z-scores using the baseline sample mean and standard deviation (SD) and calculating the mean of these z-scores to form the PACC score. CD was calculated as the intraindividual SD of the z-scores of all tests within the PACC battery. Linear regression, with time representing the five time points as a predictor, examined the relationship between cognitive dispersion and PACC scores. Results The model significantly predicted PACC scores (F[2, 2278] = 65.83, p < 0.001, R^2 = 0.05). Time alone did not significantly predict PACC scores (p = 0.41), but CD was a significant predictor when controlling for time (b = −0.51, SE = 0.04, t = −11.47, p < 0.001), such that greater CD was related to lower PACC composite scores. Conclusion The findings suggest an inverse relationship between CD and PACC scores over time, supporting CD as a potential marker of preclinical cognitive change in this sample. Future research may explore how lifestyle interventions influence this relationship while considering demographic factors such as age, sex, and race/ethnicity.

Assessing Clinical and Cognitive Outcomes in Depressed Youth Following Chronic Cardiovascular Exercise

Cardiovascular exercise is an empirically supported treatment for major depressive disorder (MDD); however, its effect on cognitive functioning is understudied. We examined how cardiovascular exercise influenced cognitive functioning in healthy youth and youth with MDD aged 16-24 (N = 51). We also assessed how twelve weeks of aerobic exercise intervention influenced cognitive functioning and depressive symptoms in youth with MDD. The Beck Depression Inventory (BDI) was used to measure depressive symptoms and the NIH Cognition Toolbox was used to calculate fluid and crystallized cognition composite scores. We expected increased cognitive functioning to correlate with larger decreases in MDD symptoms. We found no significant differences in baseline cognition scores between healthy and depressed youth. There were no significant differences between changes in VO2 max (an index of cardiovascular fitness) and depressive symptoms or cognition scores in depressed youth. We found a trend for an improvement in cognition scores after exercise intervention, suggesting that consistent cardiovascular exercise could enhance cognition. This study advances our understanding of aerobic exercise as a treatment modality for youth with MDD and the importance of alternative therapeutic interventions in depression.

How sleep duration impacts cognitive status among Indian population aged ≥45 years: Evidence from Longitudinal Aging Study India (LASI).

An aging population is associated with an increased risk of cognitive decline. Sleep duration, both excess and deficiency, is a risk factor for cognitive impairment. Therefore, this study was conducted to assess the relationship between sleep duration and cognition in the Indian population. This study was a secondary analysis of the first wave of the Longitudinal Aging Study in India (LASI) conducted across India in all 34 states and union territories. Sleep duration was calculated using sleep and wake times, whereas cognition was measured as a composite cognitive index. Both univariable and multivariable linear regressions were performed on the composite cognitive score. Subgroup analyses were conducted based on sex and age groups (45-59 years and ≥60 years). The median (IQR) cognition score was 25 (20-30). A sleep duration of ≤4 hours was associated with a decrease in cognition status of 1.15 points (1.57-0.72), and a sleep duration of ≥9 hours was associated with a decrease of 0.93 points (1.25-0.60). Subgroup analysis revealed that this relationship remained consistent across both genders and both age groups. Both long and short durations of sleep were seen to be associated with a decrease in cognition scores among Indian adults, in both sexes and both age groups. Thus, proper sleep duration can help in the prevention of declining cognition as one ages and the development of dementia.

Baseline Symptoms and Neurocognitive Performance Across Collision, Contact, and Non-Contact Female High School Athletes.

Our purpose was to represent a rare cohort of female collision sport athletes and investigate the association between sport type (collision, contact, non-contact), symptoms, and performance on baseline neurocognitive assessments. We conducted a cross-sectional study using baseline computerized neurocognitive scores (ImPACT) of 75,128 female high school student-athletes (age: 15.27 ± 1.05 years) playing multiple sports. The dependent variables were verbal memory, visual memory, visual motor speed, reaction time, and total symptom score. The independent variable was sport type, categorized as collision, contact, non-contact, adjusted for the effect of the following co-variables: age, concussion history, and comorbidities (learning disability, ADHD, psychiatric condition, headaches, migraines, speech therapy, special education, and repeating one of more years of school) using multivariable regression models. Female collision sport athletes reported significantly higher symptoms (9.81 ± 12.63) at baseline compared to contact (5.78 ± 9.25) or non-contact (6.39 ± 9.74) sport athletes (p < 0.001). Using non-contact sports as a reference, there was no significant association between collision sport participation and cognitive composite scores (verbal memory: β = -0.57, 95% confidence interval: -1.80, 0.66, p = 0.38; visual memory: β = -0.83, 95% confidence interval: -2.46, 0.79, p = 0.31; visual motor speed: β = -0.21, 95% confidence interval: -1.01, 0.59, p = 0.61; reaction time: β = 0.01, 95% confidence interval: -0.01, 0.02, p = 0.29). Participation in collision sports appears to be associated with baseline symptoms but not neurocognitive functioning among female adolescent athletes.

Hippocampal Availability of the α7 Nicotinic Acetylcholine Receptor in Recent-Onset Psychosis

Studies using human postmortem tissue and imaging with positron emission tomography (PET) support a low hippocampal availability of the α7 nicotinic acetylcholine receptor (α7-nAChR) in psychotic conditions, particularly in schizophrenia or schizoaffective disorder (nonaffective psychosis). If validated further, the finding may have implications for clinical diagnosis and treatment. To test for lower availability of the α7-nAChR in the hippocampus of individuals with recent-onset psychosis compared with healthy control individuals and its association with lower cognitive performance or higher psychotic symptom burden within recent-onset psychosis. In this cross-sectional study, healthy individuals without history of psychosis and patients within 10 years of a first onset of psychotic disorder were recruited from the greater Baltimore, Maryland, and Washington, DC, area. Fluorine 18-labeled ASEM ([18F] ASEM) PET data were acquired from participants enrolled between March 1, 2014, and July 31, 2023, from an academic research institution. Data acquired between March 1, 2014, and January 31, 2018 (n = 26), were published as a pilot study and were combined with new data acquired between January 1, 2019, and July 31, 2023 (n = 33). Regional [18F]ASEM total distribution volume (VT) that measures α7-nAChR availability, global cognition composite score, and total scores on the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms. A total of 59 participants (30 women [51%]; mean [SD] age, 25.5 [5.2] years), including 35 with recent-onset psychosis and 24 healthy controls, completed the study. In age-adjusted analyses, lower hippocampal [18F]ASEM VT was found in individuals with recent-onset psychosis (mean [SE], 17.87 [0.60]) compared with healthy controls (mean [SE], 19.82 [0.73]) (P = .04). In addition, [18F]ASEM VT was lower in individuals with nonaffective psychosis (mean [SE], 16.30 [0.83]) compared with healthy controls (P = .006) or those with affective psychosis (mean [SE], 19.34 [0.80]) (P = .03). Across recent-onset psychosis and after controlling for age, lower hippocampal [18F]ASEM VT was associated with more positive (r = -0.44; P = .009) but not negative symptoms, and higher hippocampal VT was associated with better global cognition composite score (r = 0.38; P = .03). In this cross-sectional study of individuals with recent-onset psychosis compared with healthy controls, a lower hippocampal α7-nAChR availability was found in recent-onset psychosis, and its availability was lower in those with nonaffective vs affective psychosis. Further study of the association between low availability of the α7-nAChR and recent-onset psychosis is warranted toward informing diagnostic or therapeutic strategies related to these findings.

Differential Social Cognitive Performance in Older Adults With Mild Cognitive Impairment and Dementia

To study general and subdomain performance in measures of social cognition in individuals with mild cognitive impairment (MCI), and dementia, and to explore associations between social cognitive and neuropsychological subdomains. Cross-sectional study of participants from the Sydney Memory and Ageing Study (MAS). Current data was collected in 2016-2018. Community-dwelling older adults (n=321) aged 80 years and above, with no history of neurological or psychiatric conditions. Participants had dementia, MCI, or no cognitive impairment (NCI). Social cognition was indexed using the Reading the Mind in the Eyes Test (RMET), the Interpersonal Reactivity Index - Perspective Taking (IRI-PT) and Empathic Concern (IRI-EC) subscales, and the Emotion Recognition Task (ERT). These subdomain scores were used to make a composite social cognition score. Apathy was measured via the Apathy Evaluation Scale (AES). Neurocognitive function was indexed using the Addenbrooke Cognitive Examination v3 (ACE-3). Dementia was associated with poorer overall social cognitive composite performance. MCI and dementia participants performed poorer on RMET and recognition of anger, disgust and happiness on ERT. RMET and ERT disgust remained significant after controlling for relevant covariates. Dementia participants performed poorer than MCI and NCI on the IRI-PT, IRI-EC, and AES. AES remained significant after regression. RMET was correlated with ACE-3 Fluency and/or Language in all study groups. MCI is associated with poorer scores in specific social cognitive assessments. Dementia is somewhat associated with poorer scores in informant-rated social cognition scales, though this is no longer significant after accounting for apathy.

Association of Depression and Cognitive Performance in US Older Adults: A Secondary Analysis of Cross-Sectional Data Using NHANES 2013–2014

Introduction: Depression has been associated with cognitive performance, but whether sociodemographic and clinical characteristics might influence this association is not well elaborated. This study aimed to further explore this relationship in older adults. Methods: This cross-sectional study is based on data from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. A total of 1,433 individuals with complete information on depressive symptoms and cognitive function variables were included in this study. Patient Health Questionnaire 9 (PHQ-9) score ≥10 as the cutoff to identify cases of depression in our study. We defined poor cognitive performance as a composite cognitive score <47. Logistic regression models were used to examine the association of depression with cognitive performance (model 1). We progressively adjusted the covariates as confounders (model 2: model 1 + age, and gender; model 3: model 2 + race, education level, family income, drinking, and smoking; model 4: model 3 + overweight, arthritis, hyperlipidemia, diabetes, hypertension, heart failure, coronary heart disease, heart attack, stroke, and cancer). We then conducted subgroup, interaction, and restricted cubic spline (RCS) analyses to examine this association. Results: The prevalence of poor cognitive performance was 36.6% (53/145) in the depression group and 14.1% (182/1,288) in the non-depression group. In the fully adjusted model, depression was significantly associated with poor cognitive performance (adjusted odds ratio: 2.25; 95% confidence interval: 1.31–3.81). The results were robust to sensitivity analyses. Gender and education level may modify the association between depression and poor cognitive performance. RCS analysis revealed that the PHQ-9 score was related to poor cognitive performance in a nonlinear manner (p for nonlinearity <0.001), and exhibited a J-shaped curve. Conclusion: Depression is associated with poor cognitive performance in US older adults. Early recognition and treatment of depression may be potential intervention strategies to protect cognitive health.

Whole-body hypothermia in mild neonatal encephalopathy: protocol for a multicentre phase III randomised controlled trial

BackgroundMild hypoxic ischemic encephalopathy is associated with sub optimal cognition and learning difficulties at school age. Although whole-body hypothermia reduces death and disability after moderate or severe encephalopathy in high-income countries, the safety and efficacy of hypothermia in mild encephalopathy is not known. The cooling in mild encephalopathy (COMET) trial will examine if whole-body hypothermia improves cognitive development of neonates with mild encephalopathy.MethodsThe COMET trial is a phase III multicentre open label two-arm randomised controlled trial with masked outcome assessments. A total of 426 neonates with mild encephalopathy will be recruited from 50 to 60 NHS hospitals over 2 ½ years following parental consent. The neonates will be randomised to 72 h of whole-body hypothermia (33.5 ± 0.5 C) or normothermia (37.0 ± 0.5 C) within six hours or age. Prior to the recruitment front line clinical staff will be trained and certified on expanded modified Sarnat staging for encephalopathy. The neurological assessment of all screened and recruited cases will be video recorded and centrally assessed for quality assurance. If recruitment occurs at a non-cooling centre, neonates in both arms will be transferred to a cooling centre for continued care, after randomisation. All neonates will have continuous amplitude integrated electroencephalography (aEEG) at least for the first 48 h to monitor for seizures. Predefined safety outcomes will be documented, and data collected to assess resource utilization of health care. A central team masked to trial group allocation will assess neurodevelopmental outcomes at 2 years of age. The primary outcome is mean difference in composite cognitive scores on Bayley scales of Infant and Toddler development 4th Edition.DiscussionThe COMET trial will establish the safety and efficacy of whole-body hypothermia for mild hypoxic ischaemic encephalopathy and inform national and international guidelines in high income countries. It will also provide an economic assessment of whole-body hypothermia therapy for mild encephalopathy in the NHS on cost-effectiveness grounds.Trial registration numberNCT05889507 June 5, 2023.

Types and Predictors of Service use Among Young Children Recommended to Receive Intensive Services After Initial Autism Spectrum Disorder Diagnosis.

Intensive services are recommended for young children with autism spectrum disorder (ASD). Limited research on service receipt in states with mandated ASD-specific service coverage suggests that it remains low, and factors associated with intensity are unclear. Participants were 206 children from the Boston Outcomes of Autism in Toddlers study living in states with autism mandates, diagnosed with ASD through a multidisciplinary consultation at 12-36 months, and recommended to receive at least 20h of services weekly. Outcome measures were caregiver-reported receipt of total and ASD-specific services within 18 months of ASD diagnosis. Separate negative binomial regression models were run for each outcome, with covariates of child adaptive and cognitive functioning, age, gender, household income, primary insurance, and maternal educational level. The sample was 83% male with a mean age of 24.5 months at ASD diagnosis. Mean Vineland adaptive behavior composite and Bayley cognitive standard scores were 73 and 81, respectively. 90% of children received ASD-specific services. The median intensities for total and ASD-specific services were 22 and 17h weekly respectively, with 44% of the participants receiving at least 20h of ASD-specific services weekly. Adjusted regression models found significant associations between lower adaptive scores and increased total and ASD-specific service receipt. Children in insurance-mandated states received a high intensity of intervention after clinical ASD diagnosis. Lower child adaptive functioning was associated with increased service receipt, while socioeconomic factors were not associated. Additional research in other regions and mandate-ineligible populations is needed.

Screen Time and its Relation to Toddlers’ Development

Abstract Background Screen-time or digital-screen exposure is the duration of time spent by the individual in using electronic/digital media like television (TV), smartphone, tablet or computer. Even background television exposure has been shown to impact development by reducing the amount and quality of interactions between parents and children. Studies showed that while babies do not absorb content from TV, it can catch and hold their attention. Aim of the Work The aim of the current study was to determine the effect of screen time on different developmental aspects of toddlers. Patients and Methods This was a cross sectional observational study that was conducted in the outpatients’ and Neurodevelopment Clinics, Children’s Hospital, Faculty of Medicine, Ain Shams University on 83 toddlers aged from 1 year to 3 years old who were exposed to screens for a longer duration than the recommended according to the American Academy of Paediatrics (AAP) guidelines. Of 13 months’ time frame, total duration of screen exposure was calculated in minutes/day and was correlated to the composite scores of Bayley scales of infants’ and toddlers’ development third edition. Results A significant negative correlations were found between duration of screen time exposure and all Bayley scales (cognitive, language and motor) composite scores and language scale is more affected. Conclusion The results of this study supported the directional association between screen time and child development. Parents and all the society should be educated about the hazards of screen time exposure on infants and toddlers’ development.

Epigenetic age acceleration and cognitive performance over time in older adults.

This study investigated whether epigenetic age acceleration (AA) is associated with the change in cognitive function and the risk of incident dementia over 9 years, separately in males and females. Six epigenetic AA measures, including GrimAge, were estimated in baseline blood samples from 560 Australians aged ≥70 years (50.7% female). Cognitive assessments included global function, episodic memory, executive function, and psychomotor speed. Composite cognitive scores were also generated. Dementia (Diagnostic and Statistical Manual for Mental Disorders - IV [DSM-IV] criteria) was adjudicated by international experts. Associations between epigenetic AA and cognitive performance over-time varied by sex. In females only, GrimAA/Grim2AA was associated with worse delayed recall, composite cognition, and composite memory (adjusted-beta ranged from -0.1372 to -0.2034). In males only, GrimAA/Grim2AA was associated with slower processing speed (adjusted-beta, -0.3049) and increased dementia risk (adjusted hazard ratios [HRs], 1.78 and 2.00, respectively). Epigenetic AA is associated with cognitive deterioration in later life but with evidence of sex-specific associations. Epigenetic age acceleration was associated with cognitive deterioration over time.However, these associations differed by sex.In females, accelerated GrimAge appeared to be a better marker of decline in memory.In males, accelerated GrimAge was associated with slower processing speed over time.Association between accelerated GrimAge and dementia risk was found only in males.

Association of germinal matrix hemorrhage volume with neurodevelopment and hydrocephalus.

The objective of this study was to evaluate whether volumetric measurements on early cranial ultrasound (CUS) in high-grade germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) are associated with hydrocephalus and neurodevelopmental metrics. A retrospective case series analysis of infants with high-grade GMH-IVH admitted to the St. Louis Children's Hospital neonatal intensive care unit between 2007 and 2015 who underwent neurodevelopmental testing using the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III) at 2 years of corrected age was performed. GMH volume, periventricular hemorrhagic infarction volume, and frontotemporal horn ratio were obtained from direct review of neonatal CUS studies. Univariate and multivariable regression models were used to evaluate the association between hemorrhage volumes and hydrocephalus requiring permanent CSF diversion with ventricular shunt or endoscopic third ventriculostomy with or without choroid plexus cauterization and composite Bayley-III cognitive, language, and motor scores. Forty-three infants (29 males, mean gestational age 25 weeks) met the inclusion criteria. The mean age at time of the CUS with the largest hemorrhage volume or first diagnosis of highest grade was 6.2 days. Nineteen patients underwent treatment for hydrocephalus with permanent CSF diversion. In multivariable analyses, larger GMH volume was associated with worse estimated Bayley-III cognitive (left-sided GMH volume: p = 0.048, total GMH volume: p = 0.023) and motor (left-sided GMH volume: p = 0.010; total GMH volume: p = 0.014) scores. Larger periventricular hemorrhagic infarction volume was associated with worse estimated Bayley-III motor scores (each side p < 0.04). Larger left-sided (OR 2.55, 95% CI 1.10-5.88; p = 0.028) and total (OR 1.35, 95% CI 1.01-1.79; p = 0.041) GMH volumes correlated with hydrocephalus. There was no relationship between early ventricular volume and hydrocephalus or neurodevelopmental outcomes. Location-specific hemorrhage volume on early CUS may be prognostic for neurodevelopmental and hydrocephalus outcomes in high-grade GMH-IVH.

Predicting Driving Cessation Among Cognitively Normal Older Drivers: The Role of Alzheimer Disease Biomarkers and Clinical Assessments.

With the aging US population and increasing incidence of Alzheimer disease (AD), understanding factors contributing to driving cessation among older adults is crucial for clinicians. Driving is integral for maintaining independence and functional mobility, but the risk factors for driving cessation, particularly in the context of normal aging and preclinical AD, are not well understood. We studied a well-characterized community cohort to examine factors associated with driving cessation. This prospective, longitudinal observation study enrolled participants from the Knight Alzheimer Disease Research Center and The DRIVES Project. Participants were enrolled if they were aged 65 years or older, drove weekly, and were cognitively normal (Clinical Dementia Rating [CDR] = 0) at baseline. Participants underwent annual clinical, neurologic, and neuropsychological assessments, including β-amyloid PET imaging and CSF (Aβ42, total tau [t-Tau], and phosphorylated tau [p-Tau]) collection every 2-3 years. The primary outcome was time from baseline visit to driving cessation, accounting for death as a competing risk. The cumulative incidence function of driving cessation was estimated for each biomarker. The Fine and Gray subdistribution hazard model was used to examine the association between time to driving cessation and biomarkers adjusting for clinical and demographic covariates. Among the 283 participants included in this study, there was a mean follow-up of 5.62 years. Driving cessation (8%) was associated with older age, female sex, progression to symptomatic AD (CDR ≥0.5), and poorer performance on a preclinical Alzheimer cognitive composite (PACC) score. Aβ PET imaging did not independently predict driving cessation, whereas CSF biomarkers, specifically t-Tau/Aβ42 (hazard ratio [HR] 2.82, 95% CI 1.23-6.44, p = 0.014) and p-Tau/Aβ42 (HR 2.91, 95% CI 1.28-6.59, p = 0.012) ratios, were independent predictors in the simple model adjusting for age, education, and sex. However, in the full model, progression to cognitive impairment based on the CDR and PACC score across each model was associated with a higher risk of driving cessation, whereas AD biomarkers were not statistically significant. Female sex, CDR progression, and neuropsychological measures of cognitive functioning obtained in the clinic were strongly associated with future driving cessation. The results emphasize the need for early planning and conversations about driving retirement in the context of cognitive decline and the immense value of clinical measures in determining functional outcomes.

A multidomain lifestyle intervention to maintain optimal cognitive functioning in Dutch older adults—study design and baseline characteristics of the FINGER-NL randomized controlled trial

BackgroundEvidence on the effectiveness of multidomain lifestyle interventions to prevent cognitive decline in older people without dementia is mixed. Embedded in the World-Wide FINGERS initiative, FINGER-NL aims to investigate the effectiveness of a 2-year multidomain lifestyle intervention on cognitive functioning in older Dutch at risk individuals.MethodsMulti-center, randomized, controlled, multidomain lifestyle intervention trial with a duration of 24 months. 1210 adults between 60–79 years old with presence of ≥ 2 modifiable risk factors and ≥ 1 non-modifiable risk factor for cognitive decline were recruited between January 2022 and May 2023 via the Dutch Brain Research Registry and across five study sites in the Netherlands. Participants were randomized to either a high-intensity or a low-intensity intervention group. The multidomain intervention comprises a combination of 7 lifestyle components (physical activity, cognitive training, cardiovascular risk factor management, nutritional counseling, sleep counseling, stress management, and social activities) and 1 nutritional product (Souvenaid®) that could help maintain cognitive functioning. The high-intensity intervention group receives a personalized, supervised and hybrid intervention consisting of group meetings (on-site and online) and individual sessions guided by a trained lifestyle coach, and access to a digital intervention platform that provides custom-made training materials and selected lifestyle apps. The low-intensity intervention group receives bi-monthly online lifestyle-related health advice via the digital intervention platform. Primary outcome is 2-year change on a cognitive composite score covering processing speed, executive function, and memory.ResultsWithin 17 months, participant recruitment has been successfully completed (N = 1210; mean age: 67.7 years (SD: 4.6); 64% female). Modifiable risk factors commonly present at baseline were physical inactivity (89%), low mental/cognitive activity (50%), low social engagement (39%), hypertension (39%) and high alcohol consumption (39%). The mean body mass index of participants was 28.3 (SD: 4.2) and the total serum cholesterol was 5.4 mmol/L (SD: 1.2).ConclusionsBaseline lifestyle and clinical measurements showed successful recruitment of participants with sufficient potential for prevention. Results of FINGER-NL will provide further insight into the efficacy of a multidomain lifestyle intervention to prevent cognitive decline in older adults.Trial registrationClinicalTrials.gov (ID: NCT05256199)/2022–01-11.

Prevalence of detectable HIV-DNA and HIV-RNA in cerebrospinal fluid of youth with perinatal HIV and impaired cognition on antiretroviral therapy.

Central nervous system (CNS) HIV infection can impact cognition and may be an obstacle to cure in adolescents and young adults with perinatal HIV (AYAPHIV). IMPAACT2015 enrolled AYAPHIV on suppressive antiretroviral therapy (ART) with cognitive impairment to detect and quantify HIV in blood and cerebrospinal fluid (CSF). IMPAACT2015 was a U.S.-based multi-site, exploratory, observational study. Cognitive impairment was defined as NIH Toolbox Fluid Cognition Composite score (FCCS) more than 1 standard deviation below age-adjusted normative group mean. Cell-free HIV-RNA and cell-associated HIV pol/gag -DNA and 10 biomarkers of inflammation/neuronal injury were measured in paired CSF and blood. ART exposure concentrations were quantified in hair. Among 24 participants, 20 had successful CSF collection and 18 also met viral suppression criteria. Nine of 18 (50%) were female sex-at-birth, and 14 of 18 (78%) were black. Median (range) age was 20 years (13-27), time on ART was 18.3 years (8.0-25.5), and FCCS was 68 (53-80). HIV-DNA was detected in PBMCs from all participants. In CSF, two of 18 (11%, 95% CI: 1.4-34.7%) participants had detectable cell-free HIV-RNA, while HIV gag or pol -DNA was detectable in 13 of 18 (72%, 95% confidence interval: 47-90). Detectable HIV-DNA in CSF was associated with male sex-at-birth ( P = 0.051), lower CD4 + cell count at enrollment ( P = 0.016), and higher PBMC HIV pol -DNA copies ( P = 0.058). Hair antiretroviral concentrations and biomarkers were not associated with CSF HIV-DNA detection. We found that a high proportion of AYAPHIV with neurocognitive impairment had CSF cells harboring HIV-DNA during long-term virologic suppression. This evidence of persistent HIV-DNA in CSF suggests that the CNS should be considered in treatment and cure studies.

False-Positive Rates, Risk Factors, and Interpretations of the Vestibular/Ocular Motor Screening in Collegiate Athletes.

Biological sex and history of motion sickness are known modifiers associated with a false-positive baseline Vestibular/Ocular Motor Screening (VOMS). However, other factors may be associated with a false-positive VOMS in collegiate athletes. To identify contributing factors to false-positive VOMS assessments using population-specific criteria. We also critically appraised previously reported interpretation criteria. Descriptive laboratory study. Single-site collegiate athletic training clinic. National Collegiate Athletic Association Division I athletes (n = 462 [41% female]) aged 18.8 ± 1.4 years. Participants completed the Athlete Sleep Behavior Questionnaire, the 7-Item Generalized Anxiety Index, the Immediate Postconcussion Assessment and Cognitive Testing battery, the Patient Health Questionnaire-9, the Revised Head Injury Scale, the Sensory Organization Test, and the VOMS as part of a multidimensional baseline concussion assessment. Participants were classified into 2 groups based on whether they had a total symptom score of greater than or equal to 8 after VOMS administration, excluding the baseline checklist. We used χ2 and independent t tests to compare group demographics. A binary logistic regression with adjusted odds ratios (ORs) was used to evaluate the influence of sex, corrected vision, attention-deficit/hyperactivity disorder, Immediate Postconcussion Assessment and Cognitive Testing composite scores, concussion history, history of treatment for headache and/or migraine, Generalized Anxiety Index scores, Patient Health Questionnaire-9 scores, Athlete Sleep Behavior Questionnaire scores, and Sensory Organization Test equilibrium scores and somatosensory, visual, and vestibular sensory ratios on false-positive rates. Approximately 9.1% (42 of 462 [30 females]) met criteria for a false-positive VOMS. A significantly greater proportion of females had false positives (χ21 = 18.37, P < .001). Female sex (OR = 2.79; 95% CI = 1.17, 6.65; P = .02) and history of treatment for headache (OR = 4.99; 95% CI = 1.21, 20.59; P = .026) were the only significant predictors of false-positive VOMS. Depending on cutoff interpretation, false-positive rates using our data ranged from 9.1% to 22.5%. Our results support the most recent interpretation guidelines for the VOMS in collegiate athletes due to a low false-positive rate and ease of interpretation. Biological sex and history of headaches should be considered when administering the VOMS in the absence of a baseline.

Continuous Electroencephalogram (cEEG) Findings and Neurodevelopmental Outcomes in Neonates with Congenital Heart Disease (CHD) at 12-24 Months of Age.

This study aims to assess the role of continuous EEG (cEEG) background patterns and duration of cross-clamp time and cardiopulmonary bypass (CPB) in children with congenital heart disease (CHD) undergoing cardiac surgery and its correlation with abnormal neurodevelopmental outcomes at 12-24 months on Bayley Scales of Infant and Toddler Development (BSID-III). This retrospective cohort study included infants with CHD and cEEG monitoring, who underwent surgery by 44 weeks gestational age. 34 patients were included, who were operated at median age - 7 days. Longer duration of cross- camp time was associated with poor language composite scores (LCS) (p value = 0.036). A significant association existed between severity of encephalopathy in 24-hour post-operative period and poor LCS (p value = 0.026). Majority of neonates with CHD have below average cognitive, language and motor composite scores on BSID-III. Longer duration of cross-clamp time and severity of encephalopathy during 24-hour post-operative EEG monitoring are associated with poor LCS.

Association of Age with Dual-Task Objective Cognitive Indicators and Gait Parameters in Older Adults.

Early recognition of dementia like Alzheimer's disease is crucial for disease diagnosis and treatment, and existing objective tools for early screening of cognitive impairment are limited. To investigate age-related behavioral indicators of dual-task cognitive performance and gait parameters and to explore potential objective markers of early cognitive decline. The community-based cognitive screening data was analyzed. Hierarchical cluster analysis and Pearson correlation analysis were performed on the 9-item subjective cognitive decline (SCD-9) scores, walking-cognitive dual-task performance, walking speed, and gait parameters of 152 participants. The significant differences of indicators that may related to cognitive decline were statistically analyzed across six age groups. A mathematical model with age as the independent variable and motor cognition composite score as the dependent variable was established to observe the trend of motor cognition dual-task performance with age. Strong correlation was found between motor cognitive scores and SCD and age. Gait parameters like the mean value of ankle angle, the left-right difference rate of ankle angle and knee angle and the coefficient of variation of gait cycle showed an excellent correlation with age. Motor cognition scores showed a decreasing trend with age. The slope of motor cognition scores with age after 50 years (k = -1.06) was six times higher than that before 50 years (k = -0.18). Cognitive performance and gait parameters in the walking-cognitive dual-task state are promising objective markers that could characterize age-related cognitive decline.

Mid-to-Late Life Healthy Lifestyle Modifies Genetic Risk for Longitudinal Cognitive Aging among Asymptomatic Individuals.

Genetic and lifestyle factors contribute to an individual's risk of developing Alzheimer's disease. However, it is unknown whether and how adherence to healthy lifestyles can mitigate the genetic risk of Alzheimer's. The aim of this study is to investigate whether adherence to healthy lifestyles can modify the impact of genetic predisposition to Alzheimer's disease on later-life cognitive decline. This prospective cohort study included 891 adults of European ancestry, aged 40 to 65, who were without dementia and had complete healthy-lifestyle and cognition data during the follow-up. Participants joined the Wisconsin Registry for Alzheimer's Prevention (WRAP) beginning in 2001. We conducted replication analyses using a subsample with similar baseline age range from the Health and Retirement Study (HRS). We assessed participants' exposures using a continuous non-APOE polygenic risk score for Alzheimer's, a binary indicator for APOE-ε4 carrier status, and a weighted healthy-lifestyle score, including factors such as no current smoking, regular physical activity, healthy diet, light to moderate alcohol consumption, and frequent cognitive activities. We z-standardized cognitive scores for global (Preclinical Alzheimer's Cognitive Composite score 3 - PACC3) and domain-specific assessments (delayed recall and immediate learning). We followed 891 individuals for up to 10 years (mean [SD] baseline age, 58 [6] years, 31% male, 38% APOE-ε4 carriers). After false discovery rate (FDR) correction, we found statistically significant PRS × lifestyle × age interactions on preclinical cognitive decline but the evidence is stronger among APOE-ε4 carriers. Among APOE-ε4 carriers, PRS-related differences in overall and memory-related domains between people scoring 0-1 and 4-5 regarding healthy lifestyles became evident around age 67 after FDR correction. These findings were robust across several sensitivity analyses and were replicated in the population-based HRS. A favorable lifestyle can mitigate the genetic risk associated with current known non-APOE genetic variants for longitudinal cognitive decline, and these protective effects are particularly pronounced among APOE-ε4 carriers.