An association between hearing loss and cognitive decline has been found in many epidemiological and clinical studies but few studies have investigated if objectively measured hearing loss is associated with subjective cognitive complaints. Both factors increase with age and are linked to future cognitive decline/dementia. The aim was to investigate if the degree of subjective cognitive complaints was significantly associated with the level of hearing in older adults. Moreover, to what extent this relationship would persist if factors such as age, cognitive dysfunction, and depression were accounted for. Cognitive Function Instrument (CFI) and Cognitive Change Index (CCI) were applied in 60 community-dwelling adults and 83 audiology clinic patients. Participants were 55 years or older and were assessed with Pure Tone Audiometry (PTA), Geriatric Depression Scale, the Logical Memory Test, and Symbol Digit Modalities Test. Persons with moderate-to-severe hearing loss had significantly higher scores than persons with normal hearing on CFI and CCI. Significant group differences were also found for tests of episodic memory and processing speed. PTA results were significantly correlated to both CCI (rho = 0.21) and CFI (rho = 0.25). Regression-based models did not show an independent and significant effect of hearing on subjective cognitive complaints when age, sex, depressive symptoms, and cognitive test scores were also included in the analysis. In conclusion, subjective cognitive complaints increase with decreased hearing (as measured by tone detection) but the association seems to be moderated by other factors such as depressive symptoms and neuropsychological test performances.

Biomarkers related to the diagnosis, prognosis and treatment of dementia will play a key role in future clinical practice. The overarching aim of the ODIN (blood and cerebrospinal fluid) Biobank is to study biomarkers for dementia and contribute to the transition from cerebrospinal fluid to blood-based biomarkers. ODIN recruited 451 patients (median age 74 years, 53% females) referred to the Department of Neurology at Aarhus University Hospital, Denmark, for diagnostic assessment of dementia. Enrolment started in March 2020 and ended in July 2025. Patients referred for a lumbar puncture were eligible for inclusion. Cerebrospinal fluid and blood samples (plasma, serum and buffy coat) were stored at -80°C. Information about sociodemographic, educational level, dementia subtype, cognitive test scores, neuroimaging results, hypertension, diabetes, height, weight, alcohol consumption and smoking was collected. The most frequent diagnoses were Alzheimer's disease (n=268, 59%), frontotemporal dementia (n=26, 5.8%) and mixed Alzheimer's and vascular disease (n=23, 5.1%). N=82 (18%) were cognitively unimpaired or had mild cognitive impairment but not dementia. The median Mini-Mental State Examination score was 23 (IQR: 20-26) and the median Addenbrooke's Cognitive Examination score was 68 (IQR: 58-77). ODIN will contribute to the development, validation and implementation of new biomarkers related to diagnosis, prognosis and treatment of dementia. Furthermore, the cohort will assist the transition from cerebrospinal fluid to blood-based biomarkers.

This study aims to identify retinal biomarkers of NOTCH3 mutation carriers using optical coherence tomography (OCT) data from the UK Biobank. We conducted a cross-sectional, matched case-control study of individuals with or without NOTCH3 mutation from the UK Biobank between 2006 and 2010. All participants had macular OCT scan and cognitive assessment. Cases were identified based on pathogenic/likely pathogenic NOTCH3 mutations and 1:1 matched with controls based on age, sex, hypertension, diabetes mellitus, and cigarette smoking status. Baseline characteristics and cognitive test scores were compared using χ 2 or Mann-Whitney U test appropriately. Macular thickness at central, inner, and outer subfields and at each retinal layer was compared using Wilcoxon signed-rank test. Our analysis included 134 participants (67 cases, 67 controls) with a mean age of 54 ± 9 years. NOCTH3 mutation carriers performed worse in prospective memory ( P =0.043), verbal and numerical reasoning ( P =0.178), visual memory ( P =0.227), and processing speed ( P =0.101) than matched controls. There were no differences in visual acuity between the 2 groups. NOTCH3 mutation carriers had significantly thinner macular inner subfield at the superior ( P =0.006), temporal ( P =0.008), and nasal ( P =0.034) quadrants, and significantly thinner macular RNFL ( P =0.008) compared with age-, sex-, and vascular risk factor-matched controls. The presence of NOTCH3 mutation is associated with reduced thickness in the inner macular subfield and macular RFNL. These retinal changes may reflect early pericyte dysfunction and microvascular ischemia. Longitudinal studies are needed to assess the temporal relationship between these retinal changes, cerebrovascular disease progression, and clinical severity of disease.

ABSTRACT Introduction A range of demographic, reproductive, and health-related factors influence brain health in postmenopausal women, though their relative and combined contributions are not fully understood. Using data from the Canadian Longitudinal Study on Aging (CLSA), this study examined predictors of cognitive performance in postmenopausal women, including hormone therapy (HT) use, age at menopause, and relevant sociodemographic and health-related variables. Method We included baseline and follow-up data from 10,978 CLSA participants. Multiple linear regressions were employed to examine the associations between predictors and cognitive test scores at a 3-year follow-up, adjusting for baseline scores. Cognitive performance was assessed using a neuropsychological battery, which included six tests probing verbal learning, episodic memory, executive function, and verbal and semantic fluency. Results Later age at menopause was predictive of better cognitive performance on specific cognitive tests, including verbal learning and delayed recall, as measured by the CLSA-modified REY I (β = .01, 95% CI [−.04, .02], p = .006) and REY II (β = .02, 95% CI [.01, .03], p < .001), as well as inhibitory control measured by Stroop test interference (β = -.01, 95% CI [−.01, −.02], p = .004). Sociodemographic factors, including education and income, were also consistent predictors of cognitive performance across domains. Conclusions Overall, findings suggest that cognitive performance in postmenopausal women may reflect a combination of reproductive and sociodemographic influences. Future studies incorporating longer follow-up periods and more detailed reproductive and health measures are needed to better characterize the contribution of menopause-related factors to cognitive aging.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder marked by cognitive and motor deficits. With its global prevalence increasing rapidly and no effective treatment available, early identification of high-risk individuals is critical. This study investigated the relationship between motor parameters extracted from virtual reality (VR) tasks, combined with sleep-related measures, and cognitive impairment in patients with mild cognitive impairment (MCI). Our goal was to determine whether integrating VR-derived digital markers with sleep quality metrics could provide an objective and clinically applicable tool for early detection. 66 participants were recruited, including 28 healthy controls (HC) and 38 patients with MCI. Cognitive status was assessed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). All participants performed two scenario-based VR tasks, during which task completion time, accuracy, and overall performance scores were recorded. Group differences were evaluated using independent-samples t-tests, and these behavioral features and sleep quality metrics were further incorporated into ROC analyze to assess predictive performance for distinguishing MCI from HC. Compared with HC, patients with MCI reported significantly poorer sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) and subdomains such as sleep latency and habitual sleep efficiency. In the VR tasks, MCI patients required more time and achieved lower accuracy than HC, consistent with MoCA and MMSE scores. Correlation analysis confirmed strong associations between VR performance metrics and cognitive test scores. Importantly, integrating VR-derived digital markers with sleep parameters yielded superior predictive accuracy for MCI (AUC=0.863; sensitivity = 86.84%; specificity = 71.43%; p < 0.001) compared with single-modality models. VR-based cognitive and sensorimotor tasks, when combined with sleep quality assessments, offer a robust and noninvasive approach for the early identification of prodromal AD. This multimodal strategy holds promise for enhancing clinical decision-making and enabling timely interventions.

Cognitive performance prediction may help identify early cognitive decline. However, the heterogeneity of research findings impedes the identification of key predictors. This study used 21,877 participants (25-74 years) from the German National Cohort (NAKO Gesundheitsstudie, NAKO) to systematically predict cognitive test scores based on brain structure, demographic, health-related, and cognitive data. Importantly, validation analyses were performed across study sites and external samples (1000BRAINS). Higher predictability was observed in the total sample compared to age-specific subgroups (10% difference in explained variance). Demographic (e.g. age) and cognitive data (e.g. memory) outperformed brain structure (e.g. grey matter volume) and health-related data (e.g. hypertension). Cognitive tests were differentially predictable, most evident between episodic memory and motor speed (R2 ≤ 0.32 versus R2 ≤ 0.18). Differences in predictability between age groups finally highlight the importance of comparing prediction outcomes between adult lifespan and age-specific groups to elucidate general and age-sensitive predictors of cognitive test scores.

Data on changes in biomarkers of brain health, and their associations with cognitive function in adults commencing either dual- or triple-antiretroviral therapy (ART) are sparse. Plasma biomarkers (neurofilament light [NfL], glial fibrillary acidic protein [GFAP], sCD14, CXCL10, neopterin and IL-6) were measured at baseline and after 96 weeks on ART in individuals randomized to darunavir/ritonavir and either tenofovir-DF/emtricitabine (triple-ART, n = 119) or raltegravir (dual-ART, n = 119) in NEAT-001/ANRS143. Regression models examined associations of baseline and week-96 biomarker concentrations with HIV clinical parameters, composite cognitive test scores (Standardized neuropsychological test [NPZ], 7-domains) and treatment arm. In 238 individuals, median age was 38 (interquartile range [IQR] 31, 46) years, 87% male and 83% of white ethnicity. Baseline median log10 HIV RNA 4.73 (IQR 4.23, 5.11) copies/mL and CD4 350 (IQR 285, 412) cells/mm3. At baseline, higher biomarker concentrations were associated with lower CD4 (NfL, GFAP, CXCL10; p < 0.03), higher log10 HIV RNA (sCD14, neopterin, CXCL10; p < 0.02) and longer known duration of HIV (sCD14; p = 0.044). At week-96, 94% had plasma HIV <50 copies/mL, and a decline in biomarker concentrations was observed: GFAP -14.4%, sCD14 -6.8%, neopterin -47.4%, CXCL10 -58.8%, IL-6 -29.5% (all p < 0.001) and NfL -4.4% (p = 0.075). NPZ improved by 0.21 mean points. Change in GFAP, CXCL10, sCD14, neopterin and NfL was negatively associated with change in CD4 (all p ≤ 0.002) but not change in NPZ (p > 0.05). A greater decline in neopterin concentration was observed with dual- (-50.2%) versus triple-ART (-44.3%; p = 0.022). Plasma biomarkers of brain health improved following ART initiation, associated predominantly with improvements in CD4 count and partly with treatment arm.

ABSTRACT Studies often portray the relationship between parental involvement and children's educational outcomes as a one‐directional causal relationship. However, children's academic achievement shapes parental behaviors, and mothers likely respond differently to children's academic performances than fathers do. This study instead considers parent–child communication, a key indicator of parental involvement, and children's academic performance as a reciprocal relationship. Drawing on panel data of middle school students in China, we test two competing theories: the compensation theory, which hypothesizes a negative relationship between children's academic achievement and parental involvement, and the rational choice theory, which argues for a positive relationship. Our findings show that parent–child communication is positively associated with children's test scores, lending support to the rational choice theory. The bidirectional relationship is evident in children's cognitive test scores, as well as in Chinese, math, and English test scores. Additionally, mothers adjust their communication involvement based on children's performance, while fathers do not. By highlighting the reactive dynamics of parent–child communication, this study underscores the interdependent nature of children's schooling outcomes and parental behavior.

The impacts of mean arterial pressure (MAP) and pulse pressure (PP) on cognitive decline have not been fully characterized, and little is known about the gender and racial differences in this relationship. This study aimed to look into the above-mentioned relationship. Information was obtained from the National Health and Nutrition Examination Survey 2011 to 2014. The Consortium to Establish a Registry for Alzheimer's Disease Word Learning Test (CERAD W-L), the Animal Fluency Test, and the Digit Symbol Substitution Test (DSST) were used to assess cognitive functioning in participants aged 60 years and older. Weighted linear regression analyses were employed to detect the relationship between MAP, PP (continuous or quartiles), and 3 cognitive test scores. Additionally, forest maps and smooth curve fitting were utilized to demonstrate subgroup analyses stratified by gender and race. There were 2612 participants in this study. After fully adjusting for covariates, MAP was negatively correlated with cognitive functioning estimated by CERAD W-L (β: -0.026, 95% confidence interval [CI]: -0.045 to -0.008), and PP was negatively associated with cognitive test scores through DSST (β: -0.039, 95% CI: -0.065 to -0.013). This tendency remained statistically significant across different MAP quartile groups and PP quartile groups (P for trend < .01). In the CERAD W-L test, subgroup analyses stratified by race as well as sex revealed that the negative relationship between MAP, PP, and cognitive scores remained significant in females (MAP: β: -0.042, 95% CI: -0.066 to -0.017; PP: β: -0.018, 95% CI: -0.033 to -0.002) and non-Hispanic White (NHW; MAP: β: -0.031, 95% CI: -0.052 to -0.010; PP: β: -0.016, 95% CI: -0.029 to -0.002). Additionally, a negative relationship between PP and cognitive scores was also found in DSST in females (β: -0.044, 95% CI: -0.077 to -0.011) and NHW (β: -0.041, 95% CI: -0.070 to -0.012). Our study suggested that elevated levels of MAP and PP were negatively correlated with cognitive functioning, particularly in females and NHWs. Therefore, the management of MAP and PP might be helpful for the prevention of poor cognitive performance in the elders. However, the cross-sectional nature of this study limits causal inference.

Early-onset frontotemporal dementia (EO-FTD) presents before age 65 and is frequently misdiagnosed as psychiatric or behavioural disorders, delaying care. This scoping review synthesizes research on EO-FTD's earliest cognitive symptoms from patients, companions (family and friends), healthcare professionals, and cognitive tests to promote early detection. A systematic search of six databases (Medline, Embase, CINAHL, PsycInfo, Scopus, and Proquest Dissertations and Theses) identified 2197 studies of which 16 met inclusion criteria, encompassing 663 EO-FTD participants. A total of 35 unique cognitive symptoms were identified. Memory, attention, and executive dysfunction were most frequently reported. Symptom terminology varied widely, often mirroring cognitive test phrasing, limiting clinical applicability. Many studies relied on cognitive test scores rather than detailed symptom descriptions, with patient and companion reports underrepresented. The findings underscore the need for standardized nomenclature, improved assessment tools, and greater inclusion of patient and companion perspectives to enhance EO-FTD early diagnosis and intervention strategies.

Cognitive impairment is a core feature of schizophrenia with an unknown neuropathological basis. In older adults with schizophrenia, contributions of Alzheimer's pathology and cerebrovascular disease (CVD) to specific neurocognitive deficits remain largely unexplored. This study investigated the relationship between postmortem neuropathology and neuropsychological performance in 55 older adults with schizophrenia (mean age 78.2 years), providing the most detailed clinicopathologic correlation study in schizophrenia to date. Overall, 70% of the sample met criteria for cognitive impairment, but remarkably nearly half of this cognitively impaired group lacked neuropathological autopsy findings that could explain their symptoms. While the prevalence of postmortem Alzheimer's pathology (35.1%) was similar to rates in the general population, CVD pathology was more frequent (84.2%) and associated with lower Mini-Mental State Examination (MMSE) scores (p < 0.001). No other pathology-cognition relationships were observed. Clustering analysis based upon cognitive testing scores alone identified three subgroups (NCOG_1, NCOG_2, and NCOG_3) with distinct cognitive profiles despite similar postmortem neuropathology findings. NCOG_2 exhibited relatively spared cognition (mean MMSE = 26/30) and a significantly younger age at death. Interestingly, at our level of sample depth, the MMSE-CVD association was specific to only the NCOG_3 cluster, which exhibited more selective impairments, implicating vascular pathology in at least one distinct cognitive phenotype of schizophrenia. Our data suggest a novel clinicopathologic association between CVD pathology and cognitive impairment in schizophrenia and that targeted interventions to reduce cardiovascular risk may offer meaningful cognitive benefits in a specific schizophrenia patient subgroup.

Cognitive domains are central to diagnosing cognitive impairment in people with Parkinson's disease (PwPD), yet are defined by expert consensus and cross-sectional data that assume temporal stability. This study examined whether cognitive domains remain stable or reorganize dynamically over time in PwPD. Using dynamic exploratory graph analysis, we analyzed 19 cognitive test scores from 355 PwPD across four yearly assessments (24,372 data points) from the DEMPARK/LANDSCAPE-study to identify dynamic organization of cognitive dimensions. Panel graphical vector autoregression models assessed dynamic couplings among dimensions. Five dynamic cognitive dimensions emerged, diverging substantially from theoretical domains and cross-sectional dimensions at baseline. Dynamic coupling revealed a temporal separation between card-sorting/cognitive flexibility and visuoconstruction. Cognitive domains in PwPD reorganize over time rather than remaining stable, challenging the static assumption of diagnostic criteria. Using PD as an exemplar, findings demonstrate the need for dynamic frameworks potentially revealing condition-specific temporal architectures when applied to other neurodegenerative disorders.

BackgroundWith rapid urbanization, the proliferation of densely arranged buildings and increasingly homogeneous architectural designs has made disorientation and navigation difficulties more common, especially for older adults. Meanwhile, advances in virtual reality technology now allow researchers to create highly immersive navigation games, offering opportunities for assessing cognitive abilities and examining how environmental factors shape navigation behavior.ObjectiveThis study aimed to design a virtual reality–based navigation game capable of assessing cognitive abilities through navigation behavior and quantitatively examining how environmental configurations influence navigation patterns in different age groups.MethodsWe designed a virtual goal–directed navigation game and recruited 2 groups, younger adults (n=18) and older adults (n=21), to complete identical wayfinding tasks. Before the formal experiment, participants completed cognitive assessments and received training. To characterize navigational behavior, k-means clustering was applied to classify navigation states and extract behaviorally meaningful navigation measurements, which were then examined for correlations with cognitive test scores. To quantify the effects of environmental structure, space syntax analysis was conducted to calculate line-based and grid-based experienced metrics for each participant, and their associations with navigation performance were examined. Additionally, between-group differences in navigation performance and experienced metrics were evaluated across age groups.ResultsOur results revealed that navigation behavior performance, particularly navigation efficiency, was significantly influenced by cognitive abilities and was strongly associated with several cognitive tests: the Montreal Cognitive Assessment (r=0.495, P=.04), Trail Making Test Part A (r=−0.761, P=.001), and the Mental Rotation Test (r=0.848, P<.001). In terms of environmental influences, experienced axial integration (EAI) and experienced visual integration (EVI) demonstrated significant age-related differences: EAI (z=–2.43, P=.01) and EVI (t=2.48, P=.02). Moreover, navigation efficiency exhibited distinct age-specific correlations with experienced metrics: among older adults, navigation efficiency was negatively associated with EVI (r=–0.48, P=.04), and young adults showed negative correlation between navigation efficiency and EAI (r=–0.64, P=.005).ConclusionsOur findings demonstrate that k-means clustering provides an effective approach for classifying navigation states and extracting quantitative behavioral indicators for assessing cognitive abilities. In addition, the environment-based experienced metrics derived from space syntax analysis revealed distinct age-related navigation patterns, highlighting how spatial configuration shapes wayfinding behavior across age groups. These results establish an important foundation for future applications in clinical cognitive assessment and rehabilitation, as well as the design of age-friendly urban environments.

Network topology measures characterise brain networks' organisation. Graph theoretical approaches have shown fMRI topology metrics' association with cognitive performance. Because arbitrary connectivity threshold selection biases such metrics, alternatives including the minimum spanning tree (MST) and novel measures following principles of persistent homology were proposed. The present study compared alternative and graph theoretical metrics in association with cognition for resting-state and task-fMRI. Functional connectivity matrices were computed from Human Connectome Project (Young Adult) fMRI scans during resting-state, working memory (WM), gambling, language, motor, relational processing, social cognition, and movie-watching conditions. Global efficiency, clustering coefficient (at three thresholds), diameter, leaf fraction (LF), backbone strength (BS), and cycle strength were measured. Each was tested in association with cognitive test scores. ResultsBS significantly predicted general cognitive performance, specifically progressive matrices score, composite fluid and crystallised cognition, vocabulary, spatial orientation, and WM. Diameter significantly predicted WM. WM task BS outperformed the predictive performance of graph theory measures, but not at rest, where MST LF outperformed other measures. Stronger associations were observed between cognitive test scores and topology measures derived from task-based fMRI, especially the N-Back task, as opposed to resting-state fMRI. Among task-based topology measures, BS was the most strongly related to cognition.

Given that the evidence of a longitudinal association between cumulative blood pressure (BP) levels and cognitive function is inadequate and inconclusive, we conducted this study to determine whether higher cumulative BP was independently associated with subsequent cognitive decline and to evaluate the potential dose-response relationship between them. This cohort study used data from the 2011 to 2018 China Health and Retirement Longitudinal Study (CHARLS). All cognitive test scores were transformed into standardized z-scores, with negative values indicating worse performance. We used linear mixed models and restricted cubic splines to assess the association of cumulative BP levels with cognitive function. A total of 7877 participants were included (mean [SD] age, 58.4 [9.0] years; 46.8% men; median follow-up duration, 6.9 [IQR, 3.8-7.0] years). After controlling for multiple factors, compared with the lowest quartile, the highest quartiles of cumulative systolic BP (SBP, β = -0.096 SD/year, 95% CI: -0.149 to -0.044) and pulse pressure (PP, β = -0.099 SD/year, 95% CI: -0.154 to -0.043) were independently associated with faster cognitive decline, whereas no significant association was observed for diastolic BP (DBP, β = -0.023 SD/year, 95% CI: -0.075 to 0.029). Each SD increment in cumulative SBP and PP, but not DBP, was also associated with accelerated cognitive decline. Additionally, nonlinear dose-response relationships were observed between cumulative SBP and DBP levels and the rate of cognitive decline (all p < 0.05). In conclusion, elevated cumulative SBP and PP, but not DBP, were independently associated with accelerated cognitive decline among middle-aged and older Chinese adults.

Despite the rising prevalence of sarcopenia, frailty, and dementia, their interrelationships remain unclear. This study investigated the associations of sarcopenia and frailty with cognitive function, brain structure, incident dementia, and their longitudinal changes. This study included 390,903 participants aged 40-70 years from the UK Biobank. Sarcopenia was assessed using hand grip strength, muscle mass index, and gait speed; frailty was measured based on weight loss, exhaustion, physical activity, gait speed, and grip strength. Outcomes included cognitive test scores, magnetic resonance imaging-derived brain volumes, and incident dementia. Linear regression, Cox proportional hazards models, and linear mixed effects models were used. Frailty was associated with poorer performance across cognitive domains (all p<0.05), while sarcopenia was associated with slower reaction time (p<0.001). Frailty, but not sarcopenia, was associated with reduced cortical volume. Both conditions increased all-cause dementia risk: frailty with a dose-response gradient (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.87 to 2.38) and particularly strong associations with vascular dementia (VaD, HR, 2.39; 95% CI, 1.85 to 3.07); sarcopenia with a moderate increase (HR, 1.53; 95% CI, 1.09 to 2.12). Longitudinally, sarcopenia-but not frailty-was associated with accelerated cognitive decline. Sarcopenia and frailty show overlapping but non-identical patterns of association with neurocognitive outcomes: sarcopenia was linked to longitudinal cognitive decline, whereas frailty was associated with cortical volume reduction and VaD. Early identification of these conditions is crucial for mitigating neurodegenerative decline and reducing dementia risk.

Developmental disabilities are prevalent among U.S. children, child disability rates have been increasing, and the increases have been driven by cognitive and behavioral disorders. This study estimates the effects of low cognitive test scores and high behavior problem scores in childhood on educational attainment, employment, wages, and access to transportation and credit in adulthood. We assess cognitive and behavior scores at multiple time points during childhood and estimate cross-household and household fixed-effects models. We find that individuals with low cognitive scores in childhood are 10% less likely to graduate from high school, 23% less likely to be employed, 31% less likely to own a motor vehicle, and 18% less likely to have a credit card, and they have 51% lower earnings compared with individuals with higher cognitive scores. We also find that individuals with high behavior problem scores in childhood are 7% less likely to graduate from high school, 11% less likely to be employed, and 13% less likely to own a motor vehicle, and they have 14% lower earnings compared with those with lower behavior problem scores. The findings have important implications for well-being over the life course for a nontrivial share of the U.S. population as well as their families and communities.

Predicting conversion to dementia in mild cognitive impairment with Lewy bodies (MCI-LB) remains challenging. Furthermore, there is limited research combining predictive markers in MCI-LB. We explored the utility of Lewy body and Alzheimer's disease biomarkers for the prediction of future decline in MCI-LB. Eighty-seven participants were included (35 MCI-AD, 15 possible MCI-LB, 37 probable MCI-LB). Baseline assessment involved MRI, EEG, bloods and cognitive testing. Follow up was completed yearly with review of diagnosis and repeat cognitive testing. We evaluated the relationship between baseline biomarkers and dementia-free survival time. We also investigated biomarker effects on future cognitive decline using annualised change in ACE-R. The value of combining biomarkers with baseline cognitive test score was assessed using forward selection. In probable MCI-LB, shorter dementia-free survival time was strongly associated with smaller hippocampal volume (hazard ratio=2.36, 95% CI 1.41 - 3.94) and smaller posterior cortical volume (hazard ratio=2.62, 95% CI 1.35 - 5.10). Reduced EEG dominant frequency, increased relative delta and theta power, reduced insula volume, increased plasma tau, and increased plasma GFAP were also associated with an increased hazard ratio. Posterior atrophy, hippocampal atrophy, and GFAP were significant predictors of ACE-R decline. Combining blood and MRI biomarkers improved model quality for dementia-free survival (GFAP and hippocampal atrophy) and cognitive test decline (AB ratio and posterior atrophy). Blood, EEG and MRI biomarkers of dementia with Lewy bodies, neurodegeneration and Alzheimer's co-pathology demonstrate utility for prognosis in MCI-LB. Combining biomarkers across modalities improves prognostic accuracy.

Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder affecting older adults for which symptoms may improve following shunting; however, the criteria for surgical referral remain unclear. While most studies rely on fixed cut-off scores for cognitive and gait tests, the present study examined decision-making based on clinical judgment to identify which factors influence referral. A secondary objective was to compare pre- and post-CSF tap test (CSF-TT) changes between the shunt and no shunt groups. This retrospective study included 175 patients assessed at CHU de Québec - Hôpital de l'Enfant-Jésus. Based on a combination of objective test results and clinical judgment, patients were categorized as referred (n = 119) or not referred (n = 56) for shunt surgery. Logistic regression identified the variables influencing referral decisions. Mixed-effects ANOVA models for repeated measures were conducted to compare pre- and post-CSF-TT changes in gait and cognitive performance between shunt and no shunt groups. Three change indices significantly predicted referral: the 10-Meter Walk Test (normal pace), the Trail Making Test Condition 5 and the Berg Balance Scale. Higher education positively influenced referral. While most gait and balance measures showed significant improvement following CSF-TT, cognitive tests appeared less responsive to the procedure. Although this study employed a clinically grounded approach based on clinical judgment rather than fixed thresholds, the findings align with prior literature identifying gait and balance as robust indicators. This study reinforces the need to shift from rigid threshold-based criteria toward individualized, clinically grounded decision-making models that can better capture the heterogeneity of iNPH presentations.

Dual-task (DT) performance is a key component of game speed in ice hockey, where athletes must maintain high skating velocities while processing perceptual and cognitive information. Although DT training (DTT) and virtual reality training (VRT) are increasingly used in high-performance settings, little is known about their acute effects on DT speed performance and individual variability in responsiveness. Therefore, this study examined (1) the acute effects of DTT and VRT warm-up on DT tapping speed with two different cognitive conditions and (2) related performance outcome measurements derived from cognitive testing and on-ice speed diagnostics. Seventy-four elite youth ice hockey players (17.3 ± 1.7 years) from U18 female, U18 male, and U20 male squads completed a simple tapping task (ST) and two DT paradigms - tapping paired with either a speed-reading task (SR) or a Stroop task (STR). Using a randomized crossover pre-post design, all athletes performed both a 20-minute DTT intervention and a 20-minute VRT intervention. Individual responsiveness was determined using the smallest worthwhile change (SWC). Moderating variables included cognitive test scores and on-ice speed performance. Both DTT and VRT yielded significant improvements in ST performance (p < .001). DTT produced a significant improvement of DT tapping frequency with SR (p < .001), whereas VRT caused a small decline (i.e., lower frequencies). Neither intervention improved STR, and VRT was associated with more decrements than benefits across DT conditions. SWC analyses revealed notable interindividual variability: most athletes showed no certain change, but a subset demonstrated clear improvements or decrements. Correlation analyses indicated that DTT-induced improvements in STR were moderately associated with several on-ice measures (ρ = .27-.39, p < .05). No consistently related performance outcome measurements emerged for VRT. VRT did not lead to improved performance in DT paradigms requiring linguistic processing or inhibitory control and even produced motor performance decrements in some athletes. Our study suggests that DTT appears more effective than VRT in acutely supporting DT speed performance, particularly in SR. The heterogeneity in responsiveness underscores the need for individualized cognitive-motor warm-up strategies and highlights the limitations of group-level outcomes.