Constructional Praxis Research Articles

Possibilities of using innovative non-drug technologies in the rehabilitation of patients with early post-stroke cognitive impairment

BACKGROUND: One of the leading factors complicating social adaptation after ischemic stroke is cognitive and motor impairment. AIM: This study aimed to evaluate the effect of rehabilitation using virtual reality technologies and the influence of the main clinical and functional parameters on virtual reality (VR) therapy in patients with different degrees of cognitive decline in the acute period of ischemic stroke. MATERIALS AND METHODS: This study examined 170 patients diagnosed with ischemic stroke with cognitive decline according to the Montreal Cognitive Assessment. Depending on the volume of therapy, the patients were divided into two groups: group 1 included 120 patients who received additional therapy using VR technologies (62 patients with moderate cognitive impairment, 58 patients with dementia), and group 2 consisted of 50 patients who received only basic therapy and standard methods of early rehabilitation. In group 1, on days 4–5 following basic therapy, rehabilitation using VR was performed. The Barthel Index (BI) scale, Rankin Scale (mRS), and National Institute of Health Stroke Scale (NIHSS) were used to examine cognitive and functional status, and tests were performed to assess cognitive functions, as well as neuroimaging scales ASPECTS, STRIVE, and MTA. The effectiveness of rehabilitation (ΔRE) was measured by the indicator of changes in the parameters of the VR system before and after treatment. RESULTS: A more significant improvement of the patient’s independence and regression of perceptual and executive functions was demonstrated in group 1 than in the control group. In patients with MCI, significant improvement was observed in all cognitive and functional parameters except semantic information processing, attention, and constructive praxis. In patients with dementia, improvement was noted in NIHSS, speech and amnestic disorders. In group 1, ΔRE was found to be associated with the parameters of perception, attention, semantic information processing, IQCODE, and NIHSS and the presence of hypertension and repeated stroke. In patients with MCI, ΔRE was correlated with lesion size, attention level, BI, mRS, and NIHSS and with age, sex, degree of IQCODE and STRIVE, semantic aphasia, and perceptual impairment in patients with dementia. CONCLUSION: The present study revealed a polymorphism of factors influencing the effectiveness of VR therapy in patients with varying degrees of cognitive decline. Modern approaches to VR rehabilitation of patients with post-stroke cognitive impairment require the development of individual methods of rehabilitation using immersion environment focused on the structure, etiology, and severity of cognitive deficit considering the degree of the patient’s functional state.

Impact of pre-stroke cognitive decline on rehabilitation effectiveness and cognitive-functional status of patients in the acute period of ischemic stroke

Summary. The aim was to assess the influence of premorbid cognitive deficit on the effectiveness of rehabilitation using VR technologies and cognitive-functional status of patients in the acute period of ischemic stroke based on statistical methodology. Materials and methods: 120 patients diagnosed with ischemic stroke were examined. The IQCODE questionnaire was used to identify the patient’s cognitive decline before and the Pandas and SciPy libraries. Results: all patients had a multifunctional type of cognitive impairment with a predominant decline in the areas of executive function, memory, speech and perception. Patients of the 2nd group had a more pronounced deficit in the areas of constructive praxis, episodic memory, semantic information processing and perception. Assessment of the dynamics of cognitive impairment during therapy revealed a significant improvement in memory loss (p=0, 0034), executive dysfunction (p<0.0001) and attention impairment (p=0.0001) in patients of 1st group and regression cognitive deficit in almost all cognitive areas in patients of 2nd group. Factors impeding rehabilitation in 1st group of patients were attention (r = -0,325) and perceptual disorders (r = -0,425); in 2nd group: semantic aphasia (r = -0,425), constructive apraxia (r = -0,325), speech impairment (r = — 0,375), object agnosia (r = -0,323) and IQCODE (r = -0,395). Conclusion: pre-stroke cognitive impairments are predictors of the development and progression of post-stroke cognitive deficits and reduce the possibilities of rehabilitation and cognitive recovery. The introduction of IQCODE in the diagnosis of cognitive dysfunction in the acute period of ischemic stroke is a useful tool in predicting the course and development of cognitive deficit and studying the prospects of rehabilitation programmes using VR technologies in patients with pre-stroke cognitive impairment.

Normative data for tests of visuo-spatial, visuo-constructional skills, and visual memory for Spanish-speaking adults in the United States.

The Rey-Osterrieth Complex Figure Test (ROCFT) and the Clock Drawing Test (CDT) are commonly used in clinical practice. The ROCFT measures constructional praxis, visual perception, and visuospatial learning and memory, and the CDT assesses for visuospatial, constructional, and executive difficulties. Several neurological disorders are associated with visuospatial and visuo-constructional impairments, yet reliable normative data accounting for sociodemographic and acculturative variables are scarce for Hispanics living in the U.S. To generate normative data for the ROCFT and CDT in a Spanish-speaking adult population living in the U.S. The sample consisted of 245 cognitively healthy adults recruited from several states in the U.S. Each participant was administered the ROCFT and CDT as part of a larger cognitive battery. The ROCFT and CDT were normed using a Bayesian approach. Age, age2, education, sex, acculturation, and language proficiency were included as predictors in the analyses. ROCFT performance was associated with education and age, particularly as they interacted with Spanish language proficiency and time spent in the U.S. Education was significantly associated with recall abilities and a lower memory recall on the ROCFT. Age was found to vary depending on a person's bilingual abilities. Sex did not emerge as a predictor of performance, and it did not interact significantly with other variables. This is the first study to include acculturation and language proficiency variables in the creation of norms for the assessment of visuo-constructional abilities. This study will have a large impact on the practice of neuropsychology in the U.S.

REM sleep without atonia and neurocognitive function in isolated REM sleep behaviour disorder: Cross-sectional and longitudinal study.

This study investigated the relationship between rapid eye movement sleep without atonia and cognitive profiles in individuals diagnosed with isolated rapid eye movement sleep behaviour disorder, assesssing both cross-sectional associations and their link to phenoconversion in a longitudinal follow-up. Participants underwent video-polysomnography, neurological examination, neuropsychological tests and structured interviews to confirm isolated rapid eye movement sleep behaviour disorder. Rapid eye movement sleep without atonia was manually scored using the Montreal method, and participants were categorized into either high or low electromyography activity groups, based on their tonic and phasic electromyography activities. The cross-sectional study included 250 patients with isolated rapid eye movement sleep behaviour disorder, revealing that those with high tonic electromyography activity exhibited significantly lower scores in the constructional praxis recall than those with low tonic electromyography activity (p = 0.002). In the longitudinal study, 79 participants (63 isolated rapid eye movement sleep behaviour disorder and 16 phenoconversion), tracked for at least 5 years, demonstrated that high tonic electromyography activity (odds ratio: 6.14; 95% confidence interval: 1.23-30.60; p = 0.027) and lower performance on the Trail Making Test A (odds ratio: 0.23; 95% confidence interval: 0.11-0.70; p = 0.007) were associated with future phenoconversion. These results confirm the link between tonic electromyography activity and neurodegeneration in isolated rapid eye movement sleep behaviour disorder. Combining rapid eye movement sleep without atonia assessment with cognitive evaluation could serve as an early predictive marker for phenoconversion in clinical settings.

Multicenter, Open-Label, Prospective Study Shows Safety and Therapeutic Benefits of a Defined Ginkgo Biloba Extract for Adults with Major Neurocognitive Disorder.

The safety and therapeutic effects of Gingko biloba extract EGb 761® to treat cognitive decline have been demonstrated in numerous clinical trials. However, trials in Indian populations have been lacking. This open-label, multicenter, single-arm, phase IV trial enrolled 150 patients aged ≥50 years with major neurocognitive disorder due to Alzheimer's disease, major vascular neurocognitive disorder, or mixed forms of both according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria and a Mini-Mental State Examination (MMSE) score of 12-24. Patients took 120 mg EGb 761® twice daily for 18 weeks. Therapeutic effects were assessed by CERAD constructional praxis and recall of constructional praxis (CERAD CP, CERAD recall of CP), Trail-Making Test (TMT), Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD), Clinical Global Impressions (CGI) scale, and 11-point box scales for tinnitus and vertigo. Safety assessment was based on the occurrence of adverse events as well as changes in clinical, laboratory, and functional parameters. After 18 weeks, significant improvements compared to baseline were found in constructional praxis (CERAD CP, p < 0.0001), memory (CERAD recall of CP, p < 0.0001), speed and executive functioning (TMT A, p < 0.0001; TMT B, p < 0.0001), and behavioral symptoms (BEHAVE-AD, p < 0.0001). Forty-five adverse events were reported in 33 (22.0%) patients in total, including ten presumed adverse drug reactions in 9 (6.0%) patients. Headache and diarrhea of mild-to-moderate severity were the most frequent events. Two serious adverse events, both considered unrelated to the study drug, occurred in 2 (1.3%) patients. This study confirmed the favorable safety profile and suggested therapeutic benefits of EGb 761® in Indian patients with major neurocognitive disorder.

Differential neuropsychological profiles in children and adolescents with motor disability in an inclusive educational setting

ABSTRACT The aim of this study was to determine the potential cognitive impairment associated with motor disability in a group of children attending regular schools and to analyze whether there were different cognitive profiles according to the type of motor disability they presented. The study had 87 participants, 31 healthy and 56 with three types of motor disability: Neuromuscular Diseases (NMD Group), Cerebral Palsy-Hemiparesis (CP- HPx Group) and Cerebral Palsy-Diplegia (CP-DP). Ages ranged from 6 to 18 years and they had medium and medium-high socioeconomic and cultural levels. All participants attended regular state-funded and independent schools in an inclusive modality. The neuropsychological assessment included the following cognitive domains: processing speed, working memory, verbal and visual episodic memory, language, visuo-perception and constructive praxis and executive functioning. A second analysis was performed with the groups with CP: one based on the severity of gross motor impairment (GMFCS-E&R scale) and the other based on the levels of manual dexterity (MACS scale). ANCOVAs were performed controlling for age and processing speed in the three analyses. The group with CP-HPx was shown to be the most cognitively impaired of the three groups, with significant deficits in visuo-perception, verbal working memory, and visuo-spatial memory. Subjects with greater gross motor dysfunction (GMFCS-E&R) did not show the greatest cognitive impairment, while those with worse manual dexterity (MACS) exhibited greater cognitive impairment. Children and adolescents with motor disabilities, a priori cognitively normal, present different levels of cognitive impairment. This should be considered when planning educational adaptations for this infant-juvenile population.

Indicators of cognitive impairment of varying severity in the acute period of ischemic stroke

To assess phenotype and identify biomarkers of cognitive impairment (CI) of varying severity in patients in the acute period of ischemic stroke (IS) based on the analysis of clinical and paraclinical indicators. Two hundred and forty patients with diagnosed IS and presence of CI were examined. Depending on the scores on the Montreal Cognitive Assessment Scale, patients were divided into two groups: group 1 (n=182) with mild CI, group 2 (n=58) with dementia. On admission, stroke severity according to the National Institutes of Health Stroke Scale (NIHSS), activities of daily living assessed by the Barthel Scale and patient independence assessed by the modified Rankin Scale (mRS) were determined. Neuropsychological examination was performed on day 14 and included investigation of episodic memory, executive functions, speech, gnosis, praxis, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) parameters. Immunological diagnostics included a study of the concentration of cytokines of various groups (interleukin (IL)-1b, IL-6, IL-16, granulocyte-macrophage colony-stimulating factor (GM-CSF), chemokines CXCL10, CXCL11, CXCL9, tumor necrosis factor α (TNFα)). Neuroimaging parameters were assessed using brain MRI data with verification of the STRIVE criteria and the medial temporal lobe atrophy scale (MTA). The standard application software package SPSS Statistics, Pandas and SciPy libraries were used for statistical analysis. Patients of group 2 had lower scores in all cognitive domains with the greatest reduction in perception, constructive praxis, semantic information processing and mnestic function. These analyses revealed a higher degree of IQCODE, prevalence of features corresponding to STRIVE/MTA criteria in patients of group 2, while patients of group 1 had higher NIHSS and mRS scores. When serum concentrations of cytokines were assessed, patients of group 1 showed higher concentrations of IL-1b, IL-6, GM-CSF and TNFα, while group 2 patients had higher concentrations of cytokine CXCL10. The presence of pre-stroke CI, baseline indicators of the patient's functional status, neuroimaging parameters of MTA/STRIVE and age are reflected in the structure and severity of cognitive deficit in the acute period of IS. Investigation of the role of interleukins, GM-CSF, TNFα and CXCL10 in the pathogenesis of IS and their association with the progression of post-stroke CI requires further studies with a larger sample size and longer follow-up period.

COGNITIVE FUNCTIONING AMONG GRANDPARENT CAREGIVERS: AN INTERGENERATIONAL PERSPECTIVE

Abstract Grandparents have a unique bond with their grandchildren, given their position in the grandchild’s life. They may be a historian, mentor, playmate, caregiver, role model, advocate, and friend. These interactions may offer an opportunity for cognitive engagement, but the level of this engagement may in turn be linked to a grandparent’s cognitive status. For example, memory issues may challenge one’s ability to serve as a historian for a grandchild. To better understand the association of caregiving and engagement in activities with a grandchild on cognition, a secondary analysis was conducted to examine how cognitive functions differ by engagement time. Drawing from approximately 1,200 participants in the Health and Retirement Study who indicated activity engagement with grandchildren and who also completed the Harmonized Cognitive Assessment Protocol (HCAP) regression analyses were conducted examining the link between grandparent engagement with grandchildren and cognitive measures including Constructional Praxis Delayed, Backwards Counting, Raven’s Standard Progressive Matrices, Brave Man Delayed, and Digit Symbol Modalities. Results from the analyses revealed that Raven’s Matrices (P = 0.007), Backwards Counting (P = 0.041), and Constructional Praxis (P = 0.030), were most closely linked to activity engagement with grandchildren, providing preliminary evidence that working memory is closely linked to caregiving engagement. However, the results also revealed a bimodal distribution, suggesting that too little and too much caregiving were associated with worse cognition. These findings provide preliminary evidence that illustrates how interacting with and caregiving for grandchildren may be both a protective factor and a risk factor for older adults.

Cognitive profile of idiopathic normal pressure hydrocephalus (INPH)

AbstractBackgroundCognitive deficits in people with idiopathic normal pressure hydrocephalus (INPH) are thought to differ from Alzheimer’s dementia (AD) but this has not been systematically explored.MethodWe undertook a systematic review and meta‐analysis. Peer‐reviewed studies publishing new data, with defined diagnostic criteria for INPH, and using formal cognitive tools were included. Quality was assessed using the Newcastle‐Ottawa Scale. Weighted mean difference (WMD) in score was calculated using random‐effects meta‐analysis for cognitive tests used in at least 2 studies. We assessed heterogeneity using I2. Sensitivity analyses explored results according to global cognition.Result13 studies met inclusion criteria. Participants with INPH had a pooled weighted MMSE score of 22.6 (95% confidence interval (CI) 21.3‐23.9). Studies were divided into those that matched AD participants to INPH participants for global cognition or selected mild AD (n = 6) and those that did not (n = 7). Participants with INPH performed better on the Boston Naming Task across all studies (n = 2; WMD: 1.41; 95% CI: 0.50, 2.31; I2 47%). There were no significant differences in semantic or phonemic fluency, delayed verbal recall, digit span backwards or forwards, or constructional praxis between AD and INPH across all studies. However, sensitivity analyses examining INPH participants compared to mild or matched AD showed significantly worse performance in INPH for semantic (n = 3; WMD: ‐1.37; 95% CI: ‐2.19, ‐0.55; I2 0%) and phonemic fluency (n = 3; WMD: ‐5.18; 95% CI: ‐6.95, ‐3.41; I2 0%), and in the Frontal Assessment Battery (n = 3; WMD: ‐2.33 points; 95% CI: ‐3.30, ‐1.36; I2 0%). Worse performance was also seen on sensitivity analysis in digit span backward (MD: ‐0.70; 95% CI: ‐1.20, ‐0.20) and constructional praxis (MD: ‐0.50; 95% CI: ‐0.90, ‐0.10) but only 1 study was available for each test.ConclusionIn this meta‐analysis, people with INPH tended to score within the mild dementia range on global cognitive testing. There were observable differences in cognitive profile between INPH and AD. People with INPH may have less aphasia but score significantly lower on tests of executive function than people with mild AD. These results could inform identification of INPH in memory services.

Pesticides and cognitive impairment in older adults: evidence from southern Colombia

AbstractBackgroundEnvironmental exposure to specific chemical groups of pesticides (Carbamates, Organophosphates, Pyrethroids, and Organochlorines), as well as the non or inadequate use of personal protective equipment during pest management, have been associated to cognitive decline and increased risk of dementia (Hayden et al., 2010). This study investigated cognitive functioning in older adults exposed to pesticides in southern Colombia.MethodsA sample of 353 older adults was recruited. Of these, 279 had not been exposed to pesticides (n‐Exp) and 74 had (Exp). They were matched according to age [n‐Ex: 63.80 (3.25), Ex: 63.30 (6.96), t = 0.618, p = 0.538] and years of education [n‐Ex: 9.29 (6.28), Ex: 8.95(6.35), t = 0.418, p = 0.676]. They were assessed with a battery of cognitive tests including CERAD (Aguirre‐Acevedo et al., 2016), The Addenbrooke’s Cognitive Examination (ACE‐R), the Free and Cued Selective Reminding Test (FCSRT) and questionnaires.ResultsFDR corrected comparisons revealed overall lower cognitive abilities in the Exp group (ACE‐R, q = 0.027). They also displayed Memory (FCSRT, q = 0.020; World List Learning q = 0.014) and Constructional Praxis (q = 0.007) impairments. Of those exposed, 73% reported no use of personal protective equipment, and neither the participants nor their family members reported concerns about cognitive decline [Self‐reported: n‐Exp: 14.27 (7.44), Exp: 14.92 (7.98), t = ‐0.654, p = 0.513; Family‐reported: n‐Exp: 10.43 (7.12), Exp: 10.26 (7.45), t = ‐0.182, p = 0.856].ConclusionOlder adults from southern Colombia who have been exposed to pesticides show significant cognitive impairments, which have gone unnoticed by both the affected individuals and their family. Cognitive abilities found to be affected have been associated with risk of dementia caused by Alzheimer’s Disease or Parkinson’s Disease (FCSRT and Constructional Praxis). These types of dementia have been previously associated with this environmental risk factor (Chin‐Chan et al., 2015). More awareness about environmental factors and actions to mitigate their risk are urgently needed, and should be considered by future recommendations (e.g., Livingston et al., 2020).Aguirre‐Acevedo et al. (2016). Int. Psychogeriatr, 28(3), 503‐510. https://doi.org/S1041610215001660.Chin‐Chan et al. (2015). Frontiers in Cellular Neuroscience, 9. https://www.frontiersin.org/articles/10.3389/fncel.2015.00124Hayden et al. (2010). Neurology, 74(19), 1524‐1530. https://doi.org/10.1212/WNL.0b013e3181dd4423Livingston et al. (2020). Lancet, 396(10248), 413‐446. https://doi.org/10.1016/S0140‐6736(20)30367‐6

Exploratory Factor Analysis of Neuropsychological Test Data as Measured by the Original and Extended Version of the Alzheimer’s Disease Assessment Scale in the SIU Longitudinal Cognitive Aging Study

AbstractBackgroundThe original Alzheimer’s disease Assessment Scale (oADAS) has been used to measure cognitive aging in Alzheimer’s disease (AD) since the 1980s and is considered the gold standard for assessing the efficacy of novel treatments for AD. However, the oADAS has been criticized for not being sensitive to predementia syndromes such as mild cognitive impairment (MCI) due to the ceiling effects of many of the ADAS subtests. In the present study, we used Exploratory Factor Analysis (EFA) to determine the underlying factor structure of the oADAS and a novel extended version of this measure (eADAS).MethodWe included data from 978 participants who were enrolled in the SIU LCAS as controls. The majority of the cohort was White/Non‐Hispanic (97.2%) and female (66.4%). Participants had a mean age of 66.1 years and a mean education of 14.6 years. The oADAS was administered using standardized methods. All of the subtest data was converted back from error scores to raw scores and standardized using z‐score transformation. EFA with oblimin rotation was used. The sum of examiner ratings was excluded because it was the only measure not performance‐based.ResultFor the oADAS, we identified two factors: A general factor (including 2 memory measures, naming, commands, and orientation) and a praxis factor (including constructional and ideational praxis). For the eADAS, we also identified two factors: A memory/speed factor (including 5 memory measures, orientation, word generation, and the letter‐digit test) and a general factor (including naming, constructional and ideational praxis, clock to command, and similarities). The commands subtest did not load onto either factor for the eADAS EFA. After controlling for education and sex, linear regression analysis confirmed previous findings that increasing age was associated with decreased factor scores (p < 0.001).ConclusionThe results of the present study provide novel information regarding the underlying factor structure of the oADAS and eADAS. Our results also confirm previous research demonstrating that increasing age is associated with reduced cognition after controlling for education and sex. Future directions include using these factor scores to examine the influence of risk factors for cognitive decline in predementia syndromes.

Plasma biomarkers as prognostic markers in Alzheimer’s disease: Influence of age at onset

AbstractBackgroundLittle is known about the influence of age at onset (AAO) on plasma biomarkers and their use as prognostic biomarkers in Alzheimer’s disease (AD).MethodWe selected patients with AD diagnosis with available neuropsychological testing (NPS) at time of diagnosis and two years later, and plasma biomarkers at baseline.NPS battery included Free and Cued Selective Reminding Test (FCSRT), Landscape test (visual memory), Boston Naming Test, Semantic Fluency, BDAE auditory comprehension, Constructional and Ideomotor Praxis, Visual Object and Space Perception (VOSP) Incomplete Letters and Number Location subtests, Trail Making Test (TMT) A and B, Phonemic Fluency, and Digit Span Forward and Backward. NPS scores were compared by AAO: early‐onset AD (EOAD; <65 years) vs. late onset AD (LOAD; >65y).We analyzed plasma biomarkers phosphorilated‐tau181 (p‐tau181), total tau (t‐tau), neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP) and ubiquitin C‐terminal hydrolase L1 (UCHL‐1) using the Quanterix Simoa p‐tau181 Advantage V2 and Neurology 4‐Plex A assays. Group comparisons and linear regressions adjusted by years of education (YOE) were performed in Stata/IC 16.1.ResultForty‐two participants were included, 23 LOAD and 19 EOAD. Plasma p‐tau181 and GFAP levels were higher in LOAD (Table 1). We did not find differences between LOAD and EOAD in NPS tests at baseline or +2 years (Table 2).Plasma ptau‐181 was associated with progression in MMSE globally, VOSP‐Incomplete letters globally and in EOAD. Plasma NfL were associated to Boston Naming test globally and in EOAD, Semantic fluency test globally, VOSP‐incomplete letters in EOAD, and Free and Total Learning of FCSRT in LOAD. Plasma GFAP was associated to MMSE globally and in EOAD, Free learning of FCSRT in LOAD and VOSP‐Incomplete letters and number location globally. Plasma UCHL‐1 was associated to Semantic fluency test in LOAD (Table 3). Praxis and attention and executive function tests loss were not associated to plasma biomarkers.ConclusionPlasma p‐tau18, NfL, GFAP and UCHL‐1 were associated to pogression in memory, language and visual tests. They were predominantly associated to memory loss in LOAD and language and visual function loss in EOAD. Results need to be interpreted cautiously due to small sample size.

The effect of age and years of schooling on CERAD‐MX performance of Mexican preclinical carriers and non‐carriers’ relatives of the V717I APP mutation

AbstractBackgroundIn a previous study in a sample of young neurotypical adults (18 to 59 years), we found that years of schooling (YoS) have a greater effect than age on the tasks included in the neuropsychological protocol of the Mexican adaptation of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD‐MX).MethodThirty‐eight participants (Mage = 31.08 years; MYoS = 8.27 years), from Jalisco State in Mexico, identified as first‐degree relatives of symptomatic autosomal dominant Alzheimer’s disease (ADAD) carriers of the V71 7I APP mutation were divided into two groups, MC (n = 15) and NC (n = 23). Eight CERAD‐MX tasks were used: the Mini‐mental State Examination (MMSE), Semantic Verbal Fluency (SVF), Verbal Boston Naming (VBN), Word List Memory (WLM) with delayed recall (WLD) and recognition (WLR), as well as Constructional Praxis copy (CPC) and recall (CPR). We used z‐scores, then defined random vectors with Sklar’s theorem and a Gaussian dome from simulations of new samples obtained by inverse transform sampling.ResultIn both groups, YoS had a greater positive effect on the MMSE, WLM, WLD z‐scores. In the MC group only, this same effect was evident in the SVF and CPR scores, while in the NC group this effect was seen in the VBN, and CPC z‐scores. Age effect was more pronounced that YoS in MC performance on the CPC, while in NC, on SVF performance.ConclusionFor both groups, YoS has a greater effect than age on several tasks, showing that YoS is a confounding variable when analyzing performance on CERAD‐MX tasks. Moreover, in the MC group, age has a positive effect on CPC task performance suggesting that graphic abilities are not vulnerable to the presence of V717I APP mutation at the preclinical stage.

Delayed recovery from ataxic dementia following liposuction

ABSTRACT A 19-year-old student developed hypoventilation and cyanosis at the end of a cosmetic liposuction procedure. She was awake, but severely abulic, disoriented, and unable to stand and walk due to severe locomotor ataxia. Neuropsychological evaluation showed psychomotor slowness, and deficits in memory encoding and retrieval, and on executive, and visuospatial and visuoperceptual tests; oral comprehension and constructional praxis were spared. ¹H-MRS showed a reduction of NAA. A year later, her cognitive and neurological exam, and NAA returned to normal, and she resumed her normal life. The severity of the acute manifestations of hypoxic encephalopathy not always entail a poor prognosis.

16 The Multicultural Neuropsychological Scale (MUNS): The New Attention Subtest, Preliminary Cross-Cultural Data

Objective:The MUNS is a screening scale developed in Cordoba, Argentina (2018). It is devised with multicultural stimuli that are easily translated into different languages. The scale consists of seven subtests evaluating five cognitive domains: attention, memory, executive functioning, constructional praxis, and language. Previous cross-cultural studies with this scale found significant differences in performance on the attention subtest. The authors have developed a new attention subtest called “Arrows Cancellation”, a short cancellation test designed to overcome its predecessor’s shortcomings. The minimum score of this subtest is 0, and the maximum score is 160. It takes between 3 to 5 minutes to administer. A pilot study of this subtest was performed in Argentina in 2021 (n=62, M=105.61 ± 15.06). The aim of this study is to present the first cross-cultural comparison for the Arrows Cancellation subtest of the MUNS.Participants and Methods:Argentinian (n=25, 84% female) and U.S.A. (n=39, 87% female) samples were administered the Arrows Cancellation subtest. In both cases, individuals gave their consent to participate voluntarily in this study. Participants’ health backgrounds, explored through a set of questions, determined their inclusion in the study. Participants with any of the following diagnoses were excluded from this sample: stroke, loss of consciousness (at least 20 minutes), traumatic head injury, central nervous system disease, chronic renal insufficiency, hepatic encephalopathy, non-treated thyroid disease, epilepsy, non-treated high blood pressure, severe cardiac failure, severe sleep disorders, coma, diagnosed psychiatric disease, or illegal drug consumption. Argentinians were given the instructions in Spanish whilst Americans were instructed in English. The mean age for the Argentinian sample was 21.24 ± 2.44, and for the American sample it was 20.18 ± 1.89. The mean years of education was 13.44 ± 0.96 for the Argentinian group and 13.6 ± 1.55 for the American group. A t-test showed that there were no significant differences in age (p=.06), years of schooling (p=.67) between both samples.Results:The mean score of the Arrows Cancellation subtest for the Argentinian sample was 107.30 ± 14.51 and 108.95 ± 14.12 for the American sample. A t-test did not show significant differences in the Arrows Cancellation subtest score between samples (p=.65). In addition, there were no significant differences between males and females (p=.43).Conclusions:The results of this study show that the new attention subtest of the MUNS did not show significant differences between two different cultural samples. Further studies are needed to confirm its utility in other cultural settings. Among the limitations of this study are the sample sizes and the restricted ranges of age and years of schooling.

33 Title: Examining memory performances in a sample of cognitively healthy illiterate older adult population in India

Objective:Despite the rise in literacy, 773 million of the global population is estimated to be illiterate. The rate of illiteracy is even higher among women and older adults (OA). Literacy has been well documented to impact cognitive skills, and most neuropsychological tests developed are for individuals with higher education. Moreover, there is sparse research on cognitive process and performance of illiterate individuals across cognitive domains.Per a 2011 census, the illiteracy rate in the Indian older adult population was as high as 56%, and within this group, women and older adults in rural regions were especially vulnerable. Thus, it is important to understand cognitive performance of illiterate Indian older adult population, especially when they are being assessed for neurodegenerative disorders.Participants and Methods:This study used subset of data from Harmonized Longitudinal Aging Study of India, Diagnostic Assessment of Dementia (LASI DAD), which was developed by the Gateway to Global Aging Data. A sample of cognitive healthy OA (n = 715) was selected based on Hindi Mental Status Exam score of >19 and a Clinical Dementia Rating Scale of 0 (literate = 419, illiterate = 296). Given the heterogeneity of the population, adapted cognitive instruments were used. This study compared memory performances, using word list and constructional praxis with delayed recall tasks, of OA based on their literacy status (illiterate vs. literate).Results:Literate cognitive healthy OA (M = 15.27, SD = 3.9) learned more words over three trials than illiterate OA (M = 12.17, SD = 3.7) on a world list task, a statistically significant difference (M = 3.1, 95% CI [2.5, 3.6], t (713) = 10.62, p<0.05. Literate OA (M = 8.7, SD = 2.2) had higher scores on task of copy of simple geometrical figures than illiterate OA (M = 5.3, SD = 2.8), a statistically significant difference (M = 3.3, 95% CI [2.9, 3.7], t (713) = 7.1, p<0.05. Literate OA (M = 4.5, SD = 1.8) also recalled more words than illiterate OA (M = 3.6, SD = 2.1) after a delay. Recall of geometric figures after a delay was higher for literate OA (M = 5, SD = 2.9) as well compared to illiterate OA (M = 2.4, SD = 2.5).Conclusions:Conclusion: In a sample of cognitively healthy Indian older adults, literate OA consistently performed better than illiterate OA on both verbal and nonverbal memory measures. This is consistent with past literature which shows that illiterate individuals take longer to learn verbal information and have lower recall. Additionally, use of geometric figure may be complicated for these individuals. These are important considerations when assessing an OA for memory problems with low or no education. Next steps would be to look at differences across other cognitive domains and also examining if cognitive differences exist in illiterate OA based on gender.

The Use of Verbal and Nonverbal Memory Tests for Alzheimer's Disease Screening in Taiwan Chinese.

Patients with Alzheimer's disease typically have initial deficits in memory. Memory testing can be categorized as verbal or nonverbal by the modality of the stimuli used. We compared the discriminative validity of selected verbal and nonverbal memory tests between non-dementia and Alzheimer's disease in Taiwan. Ninety-eight patients with mild Alzheimer's disease and 269 non-dementia individuals underwent story recall test (immediate and delayed recall), and constructional praxis test (copy and delayed recall). The receiver-operating characteristic curve and area under the curve were evaluated to compare between tests. Patients with Alzheimer's disease performed poorly across all memory tests, and the receiver-operating characteristic curve analysis indicated that story recall immediate and relayed recall, and constructional praxis delayed recall had good classification accuracy with area under the curve of .90, .87 and .87 respectively. These results provide support that both verbal and nonverbal memory tests are reliable measure for screening patients with Alzheimer's disease.

Visuospatial and Verbal Memory Differences in Amish Individuals With Alzheimer Disease and Related Dementias.

Verbal and visuospatial memory impairments are common to Alzheimer disease and Related Dementias (ADRD), but the patterns of decline in these domains may reflect genetic and lifestyle influences. The latter may be pertinent to populations such as the Amish who have unique lifestyle experiences. Our data set included 420 Amish and 401 CERAD individuals. Sex-adjusted, age-adjusted, and education-adjusted Z-scores were calculated for the recall portions of the Constructional Praxis Delay (CPD) and Word List Delay (WLD). ANOVAs were then used to examine the main and interaction effects of cohort (Amish, CERAD), cognitive status (case, control), and sex on CPD and WLD Z-scores. The Amish performed better on the CPD than the CERAD cohort. In addition, the difference between cases and controls on the CPD and WLD were smaller in the Amish and Amish female cases performed better on the WLD than the CERAD female cases. The Amish performed better on the CPD task, and ADRD-related declines in CPD and WLD were less severe in the Amish. In addition, Amish females with ADRD may have preferential preservation of WLD. This study provides evidence that the Amish exhibit distinct patterns of verbal and visuospatial memory loss associated with aging and ADRD.

Efecto de los pesticidas sobre el rendimiento cognitivo y motor en habitantes de zonas rurales del Tolima

Organophosphate pesticides can cause cognitive impairment. However, the farmer uses different pesticides in all phases of the same crop. The aim of this study was to analyze the effect of serial pesticides on cognitive and motor performance in samples of exposed, indirectly exposed, and unexposed people. In the exploratory study with a cross-sectional design, a total of 135 small farmers from the informal sector participated. Mini-Mental, Trail Making, Rey-Osterrieth Complex Figure, Digit Retention, Hopkins Verbal Learning and the Grooved Pegboard tests were administered. The results show that the highest serial exposure occurs with Glyphosate, Lorsban, Furadan and Paraquat. The group with direct exposure to pesticides presented a lower performance in working memory, explicit verbal memory, constructive praxis and fine motor control of the right hand, than the indirectly exposed group and the unexposed group. In conclusion, direct and serial exposure to pesticides generates neuropsychological and motor impairment in informal sector farmers, it is recommended the development of public politics that promote healthy and safe practices, to minimize the risks due to the use of these substances

Neuropsychological Performance in Alzheimer's Disease versus Late-Life Depression: A Systematic Review and Meta-Analysis.

Despite decades of research, neuropsychological tests (NPTs) that clearly differentiate between Alzheimer's disease (AD) and late-life depression (LLD) have yet to be agreed upon. Given this gap in knowledge and the rapid deployment of disease-modifying drugs for the two disorders, accurate clinical diagnosis using evidence-based assessment is essential. This study aims to systematically examine the literature to identify NPTs that would be able to differentiate AD and LLD. Databases and bibliographies were searched to identify articles for analysis. Two major inclusion criteria were that the studies compared neuropsychological functioning of AD versus LLD using normed NPTs and provided data for effect size calculation. Risk of bias was minimized by having independent coders for all steps in the review. Forty-one studies met inclusion criteria (N = 2,797) and provided effect sizes for tests that were classified as belonging to 15 domains of functioning. The two groups were well differentiated by tasks of delayed contextual verbal memory as compared to immediate or non-contextual memory, recognition cueing, confrontation naming, visuospatial construction, and conceptualization. Specific NPTs that appear to be useful for differential diagnosis include the Rey Auditory Verbal Learning Test-Delayed Recognition; Boston Naming Test; the Dementia Rating Scale's memory, conceptualization, and construction subscales; and the CERAD Constructional Praxis. The NPTs highlighted in this systematic review could be used as a relatively simple and cost-effective method to differentiate between patients with cognitive dysfunction due to AD versus LLD.