Delayed Memory Index Research Articles

P.214 Improved Cognition After Endoscopic Third Ventriculostomy In Adult Obstructive Hydrocephalus Using Repeatable Battery For The Assessment Of Neuropsychological Status

Background: In addition to symptoms of raised ICP, adults with obstructive hydrocephalus often present with cognitive dysfunction. We previously reported the improvement of global cognition at 3 and 12 months following primary adult ETV using the Montreal Cognitive Assessment (MoCA). This abstract presents multidomain cognitive testing using the RBANS. Methods: Obstructive hydrocephalus was identified based on tri-ventriculomegaly on MRI findings with a site of obstruction. Cognitive function was measured using the RBANS and MoCA at two timepoints: pre-ETV and post-ETV. Within patient analysis was conducted using the Wilcoxon Signed Rank Test. Results: Nine adults underwent ETV, 7 primary and 2 secondary (ETV after shunt malfunction), and completed follow-up assessment. Mean age was 33 years old and 7 (78%) were female. Etiology: 3 (33%) congenital and 6 (67%) acquired. Mean follow-up time was 4.5 months. The RBANS total scaled score, attention, and delayed memory index scores were significantly improved post-ETV (p < 0.05). Immediate memory, language, and visuospatial index scores were not significantly different. Secondary analysis shows that picture naming and figure recall subtests were significantly improved. MoCA total scores were not significantly different. Conclusions: ETV in adults with obstructive hydrocephalus results in improvements in global cognition, attention, and delayed memory on RBANS testing.

Predicting biomarkers in intact older adults and those with amnestic Mild Cognitive Impairment, and mild Alzheimer’s Disease using the Repeatable Battery for the Assessment of Neuropsychological Status

ABSTRACT Introduction: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been associated, to varying degrees, with commonly used biomarkers of Alzheimer’s disease (AD). Given the ease of RBANS administration as a screening tool for clinical trials and other applications, a better understanding of how RBANS performance is associated with presence of APOE ε4 allele[s], cerebral amyloid burden, and hippocampal volume is warranted. Method: One hundred twenty-one older adults who were classified as intact, amnestic Mild Cognitive Impairment, or mild AD underwent cognitive assessment with the RBANS, genetic analysis, and quantitative brain imaging. APOE ε4 carrier status, 18F-Flutemetamol composite standardized uptake value ratio (SUVR), and hippocampal volume were each regressed on demographic variables and RBANS Total Scale score, Index scores, and subtest scores. Results: Lower RBANS Total Scale score or Delayed Memory Index (DMI) predicted the presence of APOE ε4 allele[s], higher cerebral amyloid burden, and lower hippocampal volumes. DMI was a slightly better predictor than Total Scale score for most AD biomarkers. No demographic variables consistently contributed to these models. Conclusions: The RBANS – DMI in particular – is sensitive to AD pathology. As such, it could be used as a predictive tool, particularly in clinical drug trials to enrich samples prior to less accessible AD biomarker investigation.

Different Modulatory Effects of Cognitive Training and Aerobic Exercise on Resting State Functional Connectivity of Entorhinal Cortex in Community-Dwelling Older Adults.

The entorhinal cortex (EC) plays an essential role in age-related cognitive decline. However, the effect of functional connectivity (FC) changes between EC and other cerebral cortices on cognitive function remains unclear. The aim of this study was to explore the modulation of two interventions (cognitive training and aerobic exercise) on EC-FC in community-dwelling older adults. In total, 94 healthy older adults aged between 65 and 75 years were assigned to either the cognitive training or aerobic exercise group to receive 24 sessions over 12 weeks, or to a control group. Resting-state functional magnetic resonance imaging was performed at both baseline and 12-month follow-up. Compared to the cognitive training group, the aerobic exercise group showed greater EC-FC in the bilateral middle temporal gyrus, right supramarginal gyrus, left angular gyrus, and right postcentral gyrus. Compared to the control group, the cognitive training group had a decreased EC-FC in the right hippocampus, right middle temporal gyrus, left angular gyrus, and right postcentral gyrus and an increased EC-FC in the bilateral pallidum, while the aerobic exercise group showed increased EC-FC between the right medial prefrontal cortex(mPFC), bilateral pallidum, and right precuneus. Baseline EC-FC in the mPFC was positively correlated with the visuospatial/constructional index score of the Repeatable Battery for the Assessment of Neuropsychological Status. In the cognitive training group, EC-FC value changes in the right hippocampus were negatively correlated with changes in the RBANS delayed memory index score, while in the aerobic exercise group, EC-FC value changes in the left angular gyrus were positively correlated with changes in the RBANS attention index score. These findings support the hypothesis that both cognitive training and aerobic exercise can modulate EC-FC in aging populations but through different neural pathways.

The effects of cognitive training on the topological properties of brain structural network among community-dwelling older adults

Increased number of neuroimaging studies has revealed association between age-related cognitive decline and alterations in the architecture of brain networks, while trials consistently confirmed benefits following cognitive training in the elderly. As a consequence, the present study aimed to investigate the potential moderating role of topological properties in brain structural network on training benefits. Among 32 community-dwelling older adults, 18 were randomly assigned to the training group to receive 24 sessions of multi-domain cognitive training (MDCT) over 12 weeks, and 14 to the control group. At baseline and 12-month follow-up, diffusion tensor imaging was acquired to construct the brain structural network, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Visual Reasoning Test (VRT) were performed to assess cognitive functions. Compared with controls, participants received MDCT achieved significant larger gain in terms of delayed memory with a trend of better global cognitive function. In addition, Sigma coefficient of small-worldness were reduced in the MDCT group relative to the control group. Correlation between changes in Sigma and in delayed memory index were found among controls, however, not among older adults received MDCT. Our results demonstrated the modulating effects of cognitive training on the small-world architecture of brain structural network. And the present study suggested a trade-off mechanism underlying the benefits of cognitive training among aged people, where brain sacrificed its cost-effectiveness of network wiring for better cognitive functions.

Practice effect of repeated cognitive tests among older adults: Associations with brain amyloid status and other influencing factors

AbstractBackgroundPractice effects (PE), after repeated cognitive measurements, may mask cognitive decline and remain a major issue in clinical and research settings. However, an attenuated practice effect may indicate cognitive decline or the presence of brain pathologies. Exploring factors that influence PE can inform strategies to distinguish true signal from bias in future research. This study aimed to evaluate practice effects on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) scale, and their associations with brain amyloid status in a cohort of older adults enrolled in the Cognitive Health in Ageing Register: Investigational, Observational, and Trial Studies: Prospective Readiness cOhort Study (CHARIOT‐PRO) Sub‐study.Method502 cognitively healthy participants aged 60‐85 years were assessed with RBANS in both screening and baseline clinic visits (median time gap of 3.5 months). We assessed the reliability of the RBANS scale and tested PE based on differences between test and retest scores in total scale and domain‐specific indices. Multiple linear regressions were used to examine factors influencing PE, after adjusting for age, sex, educational attainment, and APOE‐ε4 carriage. PE and the initial RBANS score were also examined as predictors for amyloid positivity status based on defined thresholds, using logistic regression.ResultThe internal consistency (Cronbach's α=0.64) and test‐retest reliability (r=0.79) of RBANS were good. Participants’ Total Scale, Immediate Memory and Delayed Memory indices were significantly higher in the second test than in the initial test (d=3.8, 7.6 and 3.2, P<0.001). On the Immediate Memory index, the PE was significantly lower in the amyloid positive group than the amyloid negative group (d=6.5 vs 8.6, P=0.028). Older participants (≥70 years), women, non‐APOE‐ε4 carriers, and those with worse initial RBANS test performance had larger PE. In addition, worse performance and lower practice effects in immediate or delayed memory index were independent predictors for amyloid positivity (OR=0.97, P<0.05).ConclusionSignificant practice effects on RBANS total scale and memory indices were influenced by age, sex, APOE‐ε4, initial RBANS scores and amyloid status. The association with amyloid suggests that practice effects are not simply a source of measurement error but may be informative with regard to underlying neuropathology.

Umibecestat in the API Generation program: Worsening in RBANS and/or CDR on treatment reverses after wash‐out

AbstractBackgroundRecruitment in the API Generation program and treatment with umibecestat were terminated in July 2019 after detection of an early signal of mild worsening in some measures of cognitive function with umibecestat. Participants were followed to assess the reversibility of these and other observed effects. We will summarize the key clinical results for umibecestat vs placebo during treatment and follow up.MethodFollowing randomization to umibecestat or placebo, clinical assessments were scheduled at month 3, month 6 and every 6 month thereafter. After discontinuation of study medication, participants underwent a full evaluation within 3 months of the last dose. Data will be presented for visits on‐ and off‐treatment. For visits off‐treatment, results will be compared for visits occurring before vs after wash‐out of umibecestat (> 31 days after last dose). Analysis of cognitive scales in relation to age, sex, genotype and amyloid status, and a safety summary will also be presented.ResultAt termination about 650 participants had reached week 26. The final evaluation was performed on most of the 1561 ongoing participants (45% after wash‐out). Worsening was detected in a group‐level comparison at month 3 and month 6 in both studies for the two doses of umibecestat (effect size 0.2‐0.3 for RBANS Total, Immediate and Delayed Memory indices). Analysis from the visits conducted after wash‐out indicated that key cognitive findings seen before wash‐out were reversible: we saw no more between‐group differences in RBANS and no more imbalance in the proportion of participants having a >14‐point decrease in total RBANS or > 1‐point increase in CDR‐SB after wash‐out. Similar findings were also seen in homozygotes without elevated amyloid.ConclusionThe negative effect of umibecestat vs placebo on RBANS and CDR‐SOB was detected as early as month 3 and was detectable throughout the treatment period, but was no longer present after wash‐out of umibecestat. This effect seems to be independent of the presence of brain amyloid. Confirmation of the contemporary reversibility of worsening in measures of cognition is an important result to inform development of future prevention therapies for Alzheimer’s disease (AD).

Association Of Cognitive Function With BMI And Physical Function In Older Adults: The CogEx Study

Aging negatively impacts cognitive function and physical function in older adults. Physical activity may protect or improve the brain and physical functions that are crucial for multiple health outcomes in older adults, whereas obesity may negatively impact these outcomes. PURPOSE: To examine the association between cognitive function with BMI and physical function in underactive older adults. METHODS: Baseline data were examined from sedentary older adults (N=31; age=70.3±3.7 years; BMI=28.8±4.6 kg/m2) prior to engaging in a 12-month physical activity intervention. Assessments included height, weight, physical function, and cognitive function. Cognitive function was assessed using the Modified Mini-Mental State (3MS) examination and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Physical function performance was assessed using the time to complete the 400-Meter Walk Test (minutes). RESULTS: Average time to complete the 400-meter walk was 6.3±1.0 minutes, which was modestly associated with BMI (r=0.312, p=0.088). The 3MS Total Score (94.7±3.7) was not significantly correlated with BMI (r=-.158; p=.397) or 400-Meter Walk Test performance (r=-.152; p=.415). Similarly, the RBANS Sum of Index Score (209.0±21.1) was not significantly correlated with BMI (r=-.297; p=.105) or 400-Meter Walk Test performance (r=-.164; p=.378). When examining this relationship by cognitive domain, a higher BMI was associated with a poorer RBANS Immediate Memory Index Score (r=-.412; p=.021). We also observed that worse performance on the 400-Meter Walk Test was associated with poorer RBANS Immediate Memory Index Score (r=-.314; p=.08). Neither BMI nor 400-Meter Walk performance were significantly associated with RBANS Visuospatial/Constructional Index, Language Index, Attention Index, or Delayed Memory Index scores. CONCLUSION: Findings reveal that RBANS Immediate Memory Index score was inversely associated with both BMI and physical function in sedentary older adults. This may suggest that both obesity and poor physical function negatively impact immediate memory performance in older adults. Future studies to investigate whether and how physical therapeutics may enhance short-term memory function in older adults are warranted. Supported by UPMC Enterprises

Diagnostic accuracy of the repeatable battery of the assessment of neuropsychological status update, Spanish version, in predicting Alzheimer’s disease among Hispanic older adults in the United States reporting memory problems

Objectives: There are few standardized, Spanish-language diagnostic tools to help identify Hispanic persons at early stages of Alzheimer’s disease (AD). This study evaluated the accuracy of the Spanish version of the Repeatable Battery for the Assessment of Neuropsychological Status-Update (RBANS) in predicting AD in older Hispanic adults in the United States reporting memory problems.Methods: We analyzed data from age, sex, and education level propensity score-matched Hispanic memory clinic patients with (n = 38) and without (n = 38) a clinical diagnosis of AD. Estimates of diagnostic accuracy included sensitivity, specificity, predictive value, and receiver operating characteristic analysis.Results: After controlling for sex and matched pairs, the Total Scale score [area under curve (AUC) = 0.7417] and the Immediate (AUC = 0.7258) and Delayed (AUC = 0.7735) Memory index scores provided better estimates of diagnostic accuracy than Language, Attention, and Visuospatial/Constructional index scores. A minus 2-standard deviation (SD) cut point enhanced the predictive probability of the Delayed Memory index score. A cut point of −1.5 SD optimized the predictive probability of the Total Scale score.Conclusions: These results suggest that optimal cutoff values for the RBANS Delayed Memory index and Total Scale scores that may help identify Hispanic patients with AD as part of a comprehensive diagnostic AD assessment.

Impact of Expression and Genetic Variation of microRNA-34b/c on Cognitive Dysfunction in Patients with Major Depressive Disorder.

BackgroundPatients suffering from major depressive disorder (MDD) commonly demonstrate lower performance across multiple cognitive domains. Cognitive impairment is an intrinsic characteristic of MDD status and is often influenced by genetic factors. microRNAs (miRNAs or miRs) have been shown to have important implications in the etiology of MDD. Therefore, we aimed to identify and analyze the impact of expression and genetic variation of miR-34b/c on cognitive dysfunction in MDD.MethodsFirst, we analyzed miR-34c-5p expression in 48 cases of MDD and 54 healthy controls in a Chinese population using qRT-PCR. We assessed the relationship between the level of miR-34c-5p expression and cognitive performance by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Trail Making Test (TMT). Second, in order to characterize allelic effects of miR-34b/c on cognitive performance in MDD patients, we performed genetic association analysis of single-nucleotide polymorphism (SNP) loci of the MIR34B/C genes with cognitive function in a second group consisting of 531 MDD patients and 267 healthy controls.ResultsWe found a significant negative correlation between the level of miR-34c-5p expression and both the language and delayed memory index scores in patients with MDD. We also found a significant positive correlation between the level of miR-34c-5p expression and the time required to complete tests A and B of the TMT. The interaction between the rs2187473 genotype and the disease was significant for both immediate memory and delayed memory. In the patient group, the rs2187473 CC genotype was significantly associated with higher performance on immediate memory (F = 6.683, p < 0.05) and delayed memory tasks (F = 4.221, p < 0.05).ConclusionOur findings suggest that changes in miR-34c expression level have important impacts on cognitive function in patients with MDD. In particular, the polymorphism rs2187473 is a potential genetic risk factor for cognitive function in MDD, which may be of clinical use.

The Utility of the Repeatable Battery of Neuropsychological Status in Patients with Temporal and Non-temporal Lobe Epilepsy.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a brief neuropsychological battery that has been validated in the assessment of dementia and other clinical populations. The current study examines the utility of the RBANS in patients with epilepsy. Ninety-eight patients with epilepsy completed the RBANS as part of a more comprehensive neuropsychological evaluation. Performance on the RBANS was evaluated for patients with a diagnosis of temporal lobe epilepsy (TLE; n=51) and other epilepsy patients (non-TLE, n=47) in comparison to published norms. Multivariate analysis of variance compared group performances on RBANS indices. Rates of impairment were also compared across groups using cutoff scores of ≤1.0 and ≤1.5 standard deviations below the normative mean. Exploratory hierarchical regressions were used to examine the relations between epilepsy severity factors (i.e., age of onset, disease duration, and number of antiepileptic drugs [AEDs]) and RBANS performance. TLE and non-TLE patients performed below the normative sample across all RBANS indices. Those with TLE performed worse than non-TLE patients on the Immediate and Delayed Memory indices and exhibited higher rates of general cognitive impairment. Number of AEDs was the only epilepsy severity factor that significantly predicted RBANS total performance, accounting for 14% of the variance. These findings suggest that the RBANS has utility in evaluating cognition in patients with epilepsy and can differentiate TLE and non-TLE patients. Additionally, number of AEDs appears to be associated with global cognitive performance in adults with epilepsy.

Performance on the repeatable battery for the assessment of neuropsychological status in college students with mild traumatic brain injury

College students recovering from mild traumatic brain injury (MTBI) often experience a constellation of symptoms including cognitive and emotional difficulties. While these symptoms may interfere with academic performance, few students seek supportive services. Assessment of MTBI symptoms may be important to help identify students with symptoms that may interfere with academic performance and assist them in obtaining appropriate treatment and support services. The purpose of this study was to evaluate cognitive performance of college students with a history of MTBI on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as well as symptoms of anxiety and depression. A total of seventy college students participated in this study. Participants were divided into two groups based on self-reported history of MTBI. Participants with a history of MTBI (n = 22) performed significantly higher (p < .05) on the RBANS Delayed Memory Index and endorsed significantly fewer (p < .05) trait anxiety symptoms on the State-Trait Anxiety Inventory (STAI) than students without a history of head injury (n = 48). Students with a history of MTBI displayed few impairments on the RBANS and are more likely to endorse fewer symptoms of trait anxiety (but not state anxiety or depression) than peers without a history of head injury.

Predicting Premorbid Scores on the Repeatable Battery for the Assessment of Neuropsychological Status and their Validation in an Elderly Sample.

Assessing cognitive change during a single visit requires the comparison of estimated premorbid abilities and current neuropsychological functioning. Although premorbid intellect has been widely examined, premorbid expectations for other cognitive abilities have received less attention. The current study sought to develop and validate premorbid estimates for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Using demographic variables and an estimate of premorbid intellect, premorbid performance on the RBANS was predicted in a sample of 143 community-dwelling, cognitively intact older adults. On all six Indexes of the RBANS, premorbid intellect was the best predictor of current cognitive functioning, with gender adding to one of the prediction models (R2 = 0.04-0.16, ps < .02). These prediction formulae were then applied to a sample of 122 individuals with amnestic Mild Cognitive Impairment to look for discrepancies between premorbid and current RBANS scores. Despite minimal differences between premorbid and current RBANS scores in the intact sample, large, and statistically significant differences were observed in the impaired sample, especially on the Immediate Memory Index (discrepancy = -29.00, p < .001), Delayed Memory Index (discrepancy = -32.28, p < .001), and Total Scale score (discrepancy = -25.58, p < .001). Although validation in larger samples is needed, the current estimates of premorbid RBANS abilities may aid clinicians in determining change across time.

The relationship between smell identification and neuropsychological domains: Results from a sample of community-dwelling adults suspected of dementia

ABSTRACTObjective: This study aimed to test the theoretical relationships between smell identification and cognitive tasks based on existing neuroimaging and anatomical findings.Method: Utilizing data collected from a memory assessment clinic, theory-derived mediation and moderation models were tested. The sample used in this study consisted of 103 (39 male, 64 female) individuals referred for memory assessments. The sample’s mean education was 12.4 years (SD = 3.2), and the mean age of the sample was 77.2 years (SD = 6.3).Results: The University of Pennsylvania Smell Identification Test (UPSIT) was a significant, partial mediator of the relationship between the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Immediate and Delayed Memory indexes. Olfactory identification did not mediate list learning and retrieval; however, olfactory identification was a significant partial mediator of the relationship between story encoding and later memory retrieval of the story. Olfactory identification also fully mediated the relationship between a visuospatial construction task and its reconstruction from memory after a short delay. The relationship between processing speed and the olfactory identification was significantly mediated by semantic memory. Finally, the UPSIT moderated the relationship between a measure of premorbid ability, the Wechsler Test of Adult Reading, and current global cognitive functioning.Conclusions: Our results support theoretical relationships between olfaction and neuropsychological domains. Additionally, our results suggest that the UPSIT may serve as a proxy for cerebral integrity and is likely related to the duration of neurodegeneration.

Relationship between smell identification testing and the neuropsychological assessment of dementia in community-dwelling adults

ABSTRACTThe objective of this research was to investigate the relationship of the University of Pennsylvania Smell Identification Test (UPSIT) with neuropsychological tests and identify the utility of the UPSIT in detecting cognitive impairment. This research was an archival study of neuropsychological test results obtained from 70 clients (30 male/40 female) of a community-based memory clinic. The sample had an average age of 69.7 (SD = 9.7) and education of 14.6 (SD = 2.8) years. Hypotheses were tested using correlations, receiver operating characteristic (ROC) curves, and logistic regression. The UPSIT showed significant, weak to moderate correlations with neuropsychological tests. The UPSIT raw score correlated significantly with all but one cognitive ability domain. The UPSIT T-score was significantly correlated with all cognitive domains. Obtained areas under the ROC curve (AUC) for the UPSIT ranged from .60 to .87. The AUCs of the UPSIT did not differ significantly from verbal semantic fluency tests, but the Repeatable Battery for the Assessment of Neuropsychological Status Total Scale and Delayed Memory index tended to produce larger AUCs than the UPSIT. Results from step-wise logistic regressions suggest that the UPSIT raw score provides unique information beyond its relationship to age. Olfaction relates broadly to cognitive ability and may be sensitive to early symptoms of cognitive decline. Further research is needed to explore the relationships between smell identification tests and neuropsychological assessment.

PRE-SCREENING FOR EPISODIC MEMORY DEFICITS CAN ENRICH FOR ELIGIBLE SUBJECTS IN EARLY ALZHEIMER’S DISEASE CLINICAL TRIALS

Positive biomarkers and a mild cognitive deficit define Prodromal Alzheimer's disease (AD). A key challenge of clinical trials is identifying subjects to meet screening criteria for both biomarker and cognitive deficits. Scores on the CANTAB Paired Associates Learning (PAL) task of episodic memory correlate with AD biomarkers. Pre-screening with PAL is easy to implement and is time as well as cost effective. Here we assess the use of PAL to enhance samples for biomarker positive subjects and deficits in other cognitive screening tasks; RBANS total score, delayed memory index, Clinical Dementia Rating Scale (CDR), and Mini-mental state examination (MMSE). During screening for an early Alzheimer's disease trial, data was collected on cognitive function and CSF biomarkers (AB1–42,Tau) in adults aged over 50 (n= 56). Estimates for improving sample selection were based on the age-specific probability of biomarker positivity in the general population together with the sensitivity and specificity of episodic memory tasks (PAL and RBANS). Ability of PAL to detect a deficit in RBANS, CDR and MMSE was based on demographically adjusted logistic regression, and subject scores relative to quantile bands of normative (PAL) data. The correlation between PAL and the RBANS delayed memory index was -0.81, and PAL predicted a deficit in RBANS (>-1sd) with an accuracy of 89%; the AUC was 0.96. Participants with a predicted deficit on RBANS also showed a lower average MMSE score (24.8 vs 28.6) and a higher CDR-SOB score (1.85 vs 0.48). Performance on PAL (-1sd) worse than age adjusted norms (∼1700) displayed high specificity for identifying deficits in the RBANS and CDR. The number of subjects screened to identify those who are AB biomarker positive is reduced with increasing impairment on PAL, in accordance with the sensitivity and specificity. PAL can validily identify subjects’ with episodic memory deficits, early in the recruitment process, to enrich samples for biomarker positive subjects, and identify those likely to show deficits in other cognitive tasks. As such, PAL has potential for reducing trial costs, screen failure rates, site and patient burden, by targeting subjects with a high probability of meeting screening criteria.

Premorbid IQ Predicts Postconcussive Symptoms in OEF/OIF/OND Veterans with mTBI.

Extant literature has demonstrated that symptoms of postconcussive syndrome (PCS) persist well beyond the expected 3-month post-injury recovery period in a minority of individuals with mild traumatic brain injury (mTBI). Suboptimal performance on validity measures and pre- and post-injury psychosocial stressors - rather than actual mTBI or current cognitive functioning - have been identified as predictors of chronic PCS. Whether premorbid IQ has any influence on chronic PCS has been understudied, in the context of established psychogenic etiologies. The sample included 31 veterans, who underwent mTBI neuropsychological evaluations six or more months post-injury in a VA outpatient neuropsychology clinic. A two-step multiple linear regression was conducted to examine the effects on the outcome variable, PCS (Neurobehavioral Symptom Inventory), of the following predictors: cognitive functioning (Repeatable Battery for the Assessment of Neuropsychological Status; Attention, Immediate Memory, and Delayed Memory Indices), performance validity, depression (Beck Depression Inventory-Second Edition), posttraumatic stress disorder (PTSD Checklist, Civilian Version), quality of sleep (Pittsburgh Sleep Quality Index), pain (Brief Pain Inventory), education, and Premorbid IQ (Wechsler Test of Adult Reading). The overall regression model containing all nine predictor variables was statistically significant. Depression (p < .05) and premorbid IQ (p < .05) were the most salient predictors of chronic PCS; in that lower premorbid IQ and greater endorsed symptoms of depression were associated with higher PCS scores. In Step 2 of the multiple linear regression, the WTAR explained an additional 6.7% of the variance in PCS after controlling for psychosocial stressors and current cognitive ability. The findings support premorbid IQ as a unique and relevant predictor of chronic PCS, with significance variance accounted for beyond education, cognitive functioning, and psychosocial variables. Given the predictive relationship between premorbid IQ and PCS, adapting postconcussive interventions to meet the specific needs of individuals with varying levels of intellect may be important in minimizing ongoing symptomatology.

Relationship between 18F-Flutemetamol uptake and RBANS performance in non-demented community-dwelling older adults

Objective: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been used extensively for clinical care and in research for patients with mild cognitive impairment and Alzheimer’s disease (AD); however, relatively few studies have evaluated the relationship between RBANS performance and AD imaging biomarkers. The purpose of the current study was to evaluate the association between a relatively new amyloid positron emission tomography imaging biomarker and performance on the RBANS. Methods: Twenty-seven nondemented community-dwelling adults over the age of 65 underwent 18F-Flutemetamol amyloid– positron emission tomography imaging, along with cognitive testing using the RBANS and select behavioral measures. Partial correlation coefficients were used to identify relationships between the imaging and behavioral markers. Results: After controlling for age and education, amyloid deposition and RBANS Indexes of Immediate Memory, Delayed Memory, and Total Scale score were significantly correlated (p’s < .001, r’s = −.73 to −.77, d’s = 2.13–2.39), with greater amyloid burden being associated with lower RBANS scores. The Delayed Memory Index was particularly highly associated with 18F-Flutemetamol binding (r2 = .59, p < .001, d = 2.39). Neither 18F-Flutemetamol binding nor RBANS performance was significantly correlated with levels of depression, subjective cognitive difficulties, or premorbid intellect. Conclusions: Because of the limited use of amyloid imaging in clinical settings due to high cost and lack of reimbursement, these findings suggest that in particular RBANS Delayed Memory Index may be a cost-efficient tool to identify early signs of AD pathology, and its use may enlighten clinical decision-making regarding potential progression to dementia due to AD.

Spontaneous recovery of memory functions in an untreated case of anti NMDAR encephalitis – a reason to maintain hope

Objective: Anti N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder that was only fully discovered recently and neuropsychological outcome data remains sparse. We present the case of BA, a 19-year-old male, which illustrates the cognitive outcome in an untreated case over a time period of over 2½ years.Method: We conducted three cognitive assessments, including tests of memory and executive functioning, over this time period and considered the evidence for reliable change in memory function using the Wechsler Advanced Clinical Solutions (ACS) serial assessment package.Results: Our findings revealed mild memory problems 6 months post-discharge with, at best, static and potentially declining memory functioning at follow-up assessment 12 months post-discharge. However, the results of testing at 30 months post-discharge revealed significant improvements in immediate and delayed memory index performances.Conclusions: Our report of a case of anti-NMDAR encephalitis provides evidence for spontaneous improvements in memory functioning occurring more than 2 years after initial assessment and also demonstrates both the utility and potential limitations of the ACS serial assessment software when used in a relatively typical clinical assessment situation.

Cognitional Impairment: Is There a Role for Cognitive Assessment in the Treatment of Individuals Civilly Committed Pursuant to the Sexually Violent Predator Act?

Sexually Violent Predator statutes allow the involuntary treatment of individuals who are found to pose a threat to public safety. Most sex offender treatment programs rely on cognitive interventions to reduce the risk of recidivism. The purpose of this study was to examine (a) whether individuals with paraphilia diagnoses have cognitive deficits compared with the general population; (b) whether individuals diagnosed with pedophilia differed on cognitive performance when compared with individuals diagnosed with paraphilia not otherwise specified (NOS), nonconsent; and (c) whether individuals with paraphilia plus antisocial personality disorder (ASPD) differed in cognitive performance when compared with individuals with a paraphilia diagnosis only. The sample consisted of 170 males (M age = 50.21; SD = 10.22) diagnosed with pedophilia or paraphilia NOS, nonconsent, who were detained or civilly committed to a forensic psychiatric hospital. Assessments included Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Wechsler Abbreviated Scale of Intelligence (WASI), and Wide Range Achievement Test 4 (WRAT4). Individuals diagnosed with pedophilia and paraphilia NOS, nonconsent, obtained lower scores than matched controls based on the RBANS Immediate Memory, Visuospatial/Constructional, Delayed Memory indices and Total Score. In comparison with individuals with paraphilia NOS, nonconsent, those with pedophilia diagnosis had lower scores on the RBANS Delayed Memory. Individuals diagnosed with a paraphilia disorder combined with ASPD demonstrated trends toward lower IQ scores than those with a paraphilia diagnosis only. Treatment programs can improve their chance of success by assessment of cognitive processes, and offer therapy in a style that is consistent with the cognitive abilities of their clients.

RBANS memory percentage retention: No evidence of incremental validity beyond RBANS scores for diagnostic classification of mild cognitive impairment and dementia and for prediction of daily function

ABSTRACTRBANS percentage retention scores may be useful for diagnosis, but their incremental validity is unclear. Percentage retention versus RBANS immediate and delayed memory subtests and delayed index scores were compared for diagnostic classification and for prediction of function. Data from 173 memory clinic patients with an interdisciplinary diagnosis (no cognitive impairment, amnestic mild cognitive impairment [aMCI], and dementia due to Alzheimer’s disease [AD]) and complete RBANS data were analyzed. Across diagnostic contrasts, list percentage retention classification accuracy was similar to List Learning delayed recall, but below the Delayed Memory Index (DMI). Similarly, for classifying no cognitive impairment versus aMCI or dementia due to AD, story percentage retention was similar to Story Memory subtests and below the DMI. For classifying aMCI versus AD; however, Story Memory exceeded the DMI, but was similar to Story Memory subtest scores. Similarly, for prediction of function percentage retention measures did not predict variance beyond that predicted by the RBANS subtest or index scores. In sum, there is no evidence that calculation of percentage retention for RBANS adds clinical utility beyond those provided by the standard RBANS scores.