Delayed Recall Task Research Articles

A - 11 Organizational Strategies and Delayed Recall in Older Adults: Insights from the Rey-Osterrieth Complex Figure Test

Abstract Objective The objective of this study was to investigate the factors that influence older adults’ ability to recall complex figure in the Rey-Osterrieth Complex Figure (ROCF) test. Method 172 participants (50% female; M = 74.64) between the ages of 60 and 100 were recruited through the Israel Interior Ministry. Participants were asked to complete the Rey-Osterrieth Complex Figure Test (ROCF), which involved two tasks: A) participants were first instructed to replicate the complex figure exactly as shown (copy task). Subsequently, they were asked to B) recall and redraw the figure after a 30-minute delay (delayed recall task). The evaluations were conducted at the participants’ homes. The participants were evaluated on three criteria: accuracy, continuation, and the symmetry. To analyze the relationship between participants’ scores on the accuracy, continuation, and symmetry, a linear regression analysis was performed. Results A linear regression model predicting delayed recall score was significant F(3,48) = 9.61, p < 0.001. Among the predictors, continuation (b = 0.75, p = 0.01) and copy scores (b = 0.39, p 0.02) displayed a significant positive relationship with delayed recall score. Conclusion(s) The ROCF test serves as a comprehensive measure of cognitive functions, such as visuospatial memory, executive and organizational abilities, and retrieval. The significant influence of organizational score underscores the important link between planning abilities and declarative memory. This supports previous findings that organizing ROCF into meaningful clusters of units during the copy task improves performance in delayed recall task.

Influence of auditory-based cognitive training on auditory resolution, executive function, and working memory skills in individuals with mild cognitive impairment – a pilot randomized controlled study

Background Age-related central auditory processing disorder and mild cognitive impairment (MCI) can be concomitant in older adults, making it difficult to communicate, especially in challenging listening conditions. This preliminary study investigated the efficacy of auditory-based cognitive training on the auditory processing abilities and cognitive functions of older adults with MCI. Methods In this randomized controlled trial twenty-two older adults with mild cognitive impairment (MCI) were randomly assigned to either an experimental (n=11) or a control group (n=11). The experimental group received 15 cognitive training sessions through tasks involving the auditory domain. The outcome measures of this study included auditory resolution (Temporal gap detection, frequency discrimination, and modulation detection) and cognitive measures (Trail making tests and digit recall), which were administered at three-time points (before training, post-training, and follow-up). The linear mixed model computed the effects of training on the outcome measures. Results A significant improvement was observed in the modulation detection threshold between baseline and follow-up and between post-training and follow-up sessions. However, GDT and FD thresholds did not reveal any statistically significant difference. In the trail making test, Part B showed consistent significance across the time points, whereas Part A and the delayed recall task showed no significant difference. Conclusion Auditory-based cognitive training may improve auditory processing and executive function in older adults with mild cognitive impairment (MCI). Trial registration CTRI/2019/01/017073, registered on 14.01.2019

Emotional valence promotes free recall of foreign language words after video exposure

AbstractThe effect of emotional valence in word retrieval is well‐established in native languages, but findings in a foreign language remain inconsistent. This study investigated the impact of emotional valence on free word recall in English as a foreign language after video exposure. Participants were upper‐intermediate English speakers with Spanish as their mother tongue who watched eight emotionally valenced and four neutral videos, followed by an immediate free recall task and a delayed recall task after 2 weeks. Generalized linear mixed models showed that word valence influenced recall, with neutral words being less easily recalled than negative words, and a decline in recall between sessions. These findings support the Motivated Attention Account, which suggests that motivationally significant stimuli capture more attention than neutral stimuli, regardless of their polarity. Furthermore, the results align with previous evidence in native language research and some studies in foreign language contexts. This study highlights the robust effect of emotional valence on word recall at different time intervals, using authentic input with upper‐intermediate English speakers who have Spanish as their mother tongue and who learned English later in life.

EEG decoders track memory dynamics

Encoding- and retrieval-related neural activity jointly determine mnemonic success. We ask whether electroencephalographic activity can reliably predict encoding and retrieval success on individual trials. Each of 98 participants performed a delayed recall task on 576 lists across 24 experimental sessions. Logistic regression classifiers trained on spectral features measured immediately preceding spoken recall of individual words successfully predict whether or not those words belonged to the target list. Classifiers trained on features measured during word encoding also reliably predict whether those words will be subsequently recalled and further predict the temporal and semantic organization of the recalled items. These findings link neural variability predictive of successful memory with item-to-context binding, a key cognitive process thought to underlie episodic memory function.

The Effect of Hearing Loss and Working Memory Capacity on Context Use and Reliance on Context in Older Adults.

Older adults often complain of difficulty in communicating in noisy environments. Contextual information is considered an important cue for identifying everyday speech. To date, it has not been clear exactly how context use (CU) and reliance on context in older adults are affected by hearing status and cognitive function. The present study examined the effects of semantic context on the performance of speech recognition, recall, perceived listening effort (LE), and noise tolerance, and further explored the impacts of hearing loss and working memory capacity on CU and reliance on context among older adults. Fifty older adults with normal hearing and 56 older adults with mild-to-moderate hearing loss between the ages of 60 and 95 years participated in this study. A median split of the backward digit span further classified the participants into high working memory (HWM) and low working memory (LWM) capacity groups. Each participant performed high- and low-context Repeat and Recall tests, including a sentence repeat and delayed recall task, subjective assessments of LE, and tolerable time under seven signal to noise ratios (SNRs). CU was calculated as the difference between high- and low-context sentences for each outcome measure. The proportion of context use (PCU) in high-context performance was taken as the reliance on context to explain the degree to which participants relied on context when they repeated and recalled high-context sentences. Semantic context helps improve the performance of speech recognition and delayed recall, reduces perceived LE, and prolongs noise tolerance in older adults with and without hearing loss. In addition, the adverse effects of hearing loss on the performance of repeat tasks were more pronounced in low context than in high context, whereas the effects on recall tasks and noise tolerance time were more significant in high context than in low context. Compared with other tasks, the CU and PCU in repeat tasks were more affected by listening status and working memory capacity. In the repeat phase, hearing loss increased older adults' reliance on the context of a relatively challenging listening environment, as shown by the fact that when the SNR was 0 and -5 dB, the PCU (repeat) of the hearing loss group was significantly greater than that of the normal-hearing group, whereas there was no significant difference between the two hearing groups under the remaining SNRs. In addition, older adults with LWM had significantly greater CU and PCU in repeat tasks than those with HWM, especially at SNRs with moderate task demands. Taken together, semantic context not only improved speech perception intelligibility but also released cognitive resources for memory encoding in older adults. Mild-to-moderate hearing loss and LWM capacity in older adults significantly increased the use and reliance on semantic context, which was also modulated by the level of SNR.

Automated lexical analysis of story recall in healthy controls

AbstractBackgroundImpaired episodic memory is one of the earliest and most prominent symptoms of Alzheimer’s disease (AD). Examining how patients produce words and phrases in story recall tasks is useful for tracking and understanding progression of their disease. Traditional approaches rely on manual assessments of recalled stories which can be limited, time‐consuming, and not applicable in large‐scale studies. Here, we implement an automated, computational approach to measure verbal episodic memory in a digitally recorded story recall task performed by young healthy speakers using natural language processing models.MethodWe analyzed digitized speech samples of pre‐recorded immediate and delayed Craft Story recall tasks performed by healthy speakers (n = 67, mean age = 20.31 years, SD = 2.17, 45 (67%) females). All transcripts were transcribed by trained annotators and automatically scored for number of verbatim and paraphrase recall, total recall score ( = verbatim+paraphrase), and semantic distance from the original story (degree of semantic similarity between the original craft story and the recalled story based on the Word2vec module in python). We also calculated total word count and number of unique words, and rated all recalled words for word familiarity, concreteness, and semantic ambiguity based on published norms. Number of pauses and total durations of speech and silent pauses were also measured.ResultWe found larger semantic distance between successive words in the delayed recall task compared with immediate recall within speaker (p<.001). Delayed recall also elicited lower total recall scores than immediate recall (p = .03). Comparing the effect sizes of semantic distance vs. total recall scores, our model comparison showed a smaller prediction error for semantic distance (AIC = 95.45) than total recall score (AIC = 736.18). In addition, speakers in the delayed recall task performed more paraphrase recall, had higher total word count, number of unique words, more ambiguous words, and produced more speech (all p‐values<.001).ConclusionOur findings suggest that automated speech analysis can provide informative and cost‐effective measures from a recorded story recall task. The study provides an automated and quantitative way to better measure memory abilities by including semantic distance. Future work will test procedures in patients with AD or other neurodegenerative diseases.

High School and Beyond: Cohort Data for Studying the Effects of Education on Midlife Cognition

AbstractBackgroundThe objective of our presentation is to describe the utility of data from the High School and Beyond (HSB) cohort for studying the impact of early life circumstances and experiences—especially related to education—on risk of midlife cognitive impairment. HSB is a cohort study of a large (n∼25,500), diverse, nationally‐representative probability sample of American high school students in 1980. Participants were surveyed in 1980, 1982, 1984, 1986, 1992, and 2014/2015 with high rates of response; teachers and school administrators were also surveyed, and transcripts provide information about secondary and postsecondary course taking. HSB data from 1980 through 1992 include detailed information about educational contexts, opportunities, and outcomes as well as about family circumstances, labor force activities, and other early life factors.MethodA 2021/2022 follow‐up survey with surviving cohort members featured lengthy interviews; a home health visit that included blood and saliva collection and anthropometric measures; and linkages to administrative records (e.g., mortality records, prescription records). Interviews included immediate and delayed recall tasks; a phonemic fluency task; a semantic fluency task; working memory tasks; self‐reported memory complaints; and detailed information about health conditions.ResultOf the ∼24,330 surviving HSB panelists, ∼13,900 completed surveys in 2021/2022. Of the ∼13,900 sample members completing surveys, ∼4,880 completed a home health visit; an additional ∼1,560 mailed back saliva kits. HSB ultimately received ∼4,430 blood samples by the time fieldwork concluded in late 2022. Blood collected in 2022 is being used to construct (1) measures that define the main pathological features of ADRD (e.g., Aβ42, Aβ40, p‐tau 181, total tau, NFL, and gFAP); (2) measures that reflect cognition‐relevant pathologies (e.g., hemoglobin A1c, inflammatory markers, markers of endothelial function, markers of blood‐brain barrier disfunction, and blood lead levels); and (3) measures of biological aging (e.g., the GrimAge clock, DunedinPACE pace of aging, the Hannum clock).ConclusionHSB is now an extraordinary resource for studying—using a large, diverse national sample—the effects of educational contexts, opportunities, and outcomes on midlife cognitive functioning and biological markers of ADRD risk.

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.

22 Semantic Processing and its Relation to Brain Pathology in Individuals with Autosomal Dominant Alzheimer's Disease: Preliminary Findings from the Colombia-Boston Biomarker Study

Objective:Semantic processing dysfunction has been shown to be an early indicator of cognitive decline in Alzheimer's disease (AD) and has been linked to early accumulation of AD-pathology. We examined semantic processing and its relation to AD pathology in non-demented individuals from a Colombian kindred with autosomal dominant AD due to the Presenilin1 E280A mutation (PSEN1).Participants and Methods:A total of 13 cognitively unimpaired PSEN1 mutation carriers (mean age: 36.92± 4.94), 7 carriers with mild cognitive impairment (MCI; mean age: 45±2.65), and 17 family non-carriers (mean age: 36±6.38) from the Colombia-Boston (COLBOS) longitudinal biomarker study were included. We used the Bateria IV Woodcock-Munoz verbal analogies and text comprehension subtests to examine semantic processing, the Mini-Mental State Examination (MMSE) to assess global cognition and the CERAD word list delayed recall task to measure verbal memory. Participants also underwent PiB and flortaucipir-PET to measure mean cortical amyloid and regional tau burden (entorhinal cortex and precuneus), respectively. Mann-Whitney U tests and Spearman's Rho correlations compared group differences in semantic processing, and its associations with age and pathological markers. Post-hoc analyses excluded carriers with MCI and controlled for education.Results:Carriers (including cognitively unimpaired and symptomatic individuals) performed significantly worse on the MMSE (carriers: 14.55, non-carriers: 24.24; U=81.00, p=.006), CERAD word list delayed recall (carriers: 13.63, non-carriers: 25.32; U=48.00, p=.001), and text comprehension (carriers: 16.36, non-carriers: 23.81; l/=107.00, p=.042,) than non-carriers, and showed a trend towards worse performance on verbal analogies (carriers: 17.16, non-carriers: 23.68; U=124.50, p=.077). There were no differences in text comprehension or verbal analogies performance between cognitively-unimpaired carriers and non-carriers.Across the whole sample, age was negatively associated with performance on verbal analogies (r=-.341, p=.039), but not text comprehension (r=-.136, p=.428). Among carriers only, better MMSE and CERAD delayed recall performance was associated with higher verbal analogies (r=.561, p=<.001; r=.662, p=<.001, respectively) and text comprehension scores (r=.468, p=.004; r=.480, p=.003, respectively). Greater amyloid burden was associated with worse verbal analogies performance (r=-.432, p=.007) and text comprehension (r=-.430, p=.008). Greater entorhinal cortex (r=-.384, p=.016) and precuneus tau burden (r=-.318, p=.049) was associated with worse performance on verbal analogies, but not text comprehension. These associations did not survive when excluding carriers with MCI or controlling for education.Conclusions:Preliminary results show that non-demented mutation carriers had worse performance in semantic processing than non-carriers and performance was associated with markers of AD pathology. These findings suggest that changes in semantic processing may be early indicators of disease progression in individuals at increased risk for Alzheimer's disease dementia. Future studies with larger samples need to examine the role of education and the longitudinal trajectory of semantic processing dysfunction in AD.

Physical activity and cognitive function in middle-aged adults: a cross-sectional analysis of the PATH through life study.

Investigate the independent associations of objectively measured or self-reported physical activity at different intensities with cognitive performance in middle-aged adults. Cross-sectional. 156 middle-aged adults (age: 40.6 ± 1.5, 58.3% female) participated in the physical activity sub-study of the Personality and Total Health through life (PATH) project. Physical activity was measured objectively with the SenseWear™ armband (SWA), worn for seven consecutive days, and measured via self-report with a Physical Activity Recall survey (PAR). Cognitive performance was assessed with the Symbol Digit Modalities Test, the Digit Span Backwards, and an Immediate and Delayed Recall task. Associations between physical activity intensity and cognitive function were investigated in general linear models, controlling for age, sex, and education. Neither objectively measured nor self-reported physical activity were associated with cognitive function at light-, moderate-, vigorous-, or combined moderate-to-vigorous intensity in this cohort of well educated, healthy middle-aged adults. Sensitivity analyses with additional moderators (e.g., body mass index, hypertension, alcohol intake) and the use of composite cognitive measures did not alter the results. In this cohort of middle-aged adults, objectively measured and self-reported physical activity do not appear to be associated with cognitive function. Longitudinal follow-ups utilising objective physical activity measures may be important in determining the impact of mid-life behaviours on the trajectory of cognitive changes into older age.

Joint associations of physical activity and sleep duration with cognitive ageing: longitudinal analysis of an English cohort study

Physical activity and sleep duration are key factors associated with cognitive function and dementia risk. How physical activity and sleep interact to influence cognitive ageing is not well explored. We aimed to examine the associations of combinations of physical activity and sleep duration with 10-year cognitive trajectories. In this longitudinal study, we analysed data from the English Longitudinal Study of Ageing collected between Jan 1, 2008, and July 31, 2019, with follow-up interviews every 2 years. Participants were cognitively healthy adults aged at least 50 years at baseline. Participants were asked about physical activity and nightly sleep duration at baseline. At each interview, episodic memory was assessed using immediate and delayed recall tasks and verbal fluency using an animal naming task; scores were standardised and averaged to produce a composite cognitive score. We used linear mixed models to examine independent and joint associations of physical activity (lower physical activity or higher physical activity, based on a score taking into account frequency and intensity of physical activity) and sleep duration (short [<6 h], optimal [6-8 h], or long [>8 h]) with cognitive performance at baseline, after 10 years of follow-up, and the rate of cognitive decline. We included 8958 respondents aged 50-95 years at baseline (median follow-up 10 years [IQR 2-10]). Lower physical activity and suboptimal sleep were independently associated with worse cognitive performance; short sleep was also associated with faster cognitive decline. At baseline, participants with higher physical activity and optimal sleep had higher cognitive scores than all combinations of lower physical activity and sleep categories (eg, difference between those with higher physical activity and optimal sleep vs those with lower physical activity and short sleep at baseline age 50 years was 0·14 SDs [95% CI 0·05-0·24]). We found no difference in baseline cognitive performance between sleep categories within the higher physical activity category. Those with higher physical activity and short sleep had faster rates of cognitive decline than those with higher physical activity and optimal sleep, such that their scores at 10 years were commensurate with those who reported low physical activity, regardless of sleep duration (eg, difference in cognitive performance after 10 years of follow-up between those with higher physical and optimal sleep and those with lower physical activity and short sleep was 0·20 SDs [0·08-0·33]; difference between those with higher physical activity and optimal sleep and those with lower physical activity and short sleep was 0·22 SDs [0·11-0·34]). The baseline cognitive benefit associated with more frequent, higher intensity physical activity was insufficient to ameliorate the more rapid cognitive decline associated with short sleep. Physical activity interventions should also consider sleep habits to maximise benefis of physical activity for long-term cognitive health. UK Economic and Social Research Council.

Music Engagement and Episodic Memory Among Middle-Aged and Older Adults: A National Longitudinal Analysis.

The objective of this study was to examine associations between music engagement and episodic memory for more than 12 years in a nationally representative sample of middle- and older-aged adults in the United States. This study is based on a secondary analysis of data from a sample (N = 5,021) of cognitively normal adults from the Health and Retirement Study (2006-2018). Episodic memory was measured by immediate and delayed recall tasks. Music engagement was classified as none, passive (i.e., listening to music), active (i.e., singing and/or playing an instrument), or both (i.e., listening to music and singing or playing an instrument). Compared with those with no music engagement, respondents who reported both passive and active engagement performed 0.258 points better at baseline on episodic memory tasks. This group also performed better across time with scores that declined by 0.043 points fewer per study visit. Additionally, compared to those with no music engagement, participants with passive music engagement had scores that declined by 0.023 points fewer per visit. There were no significant differences in performance at baseline for those with passive or active music engagement, or across time for those with active engagement. The results of this study suggest that engaging in both passive and active music engagement may be superior to engaging with music only passively or actively and that engaging in music both ways may be able to protect against age-related declines in episodic memory. Future research should examine whether community-based music engagement interventions can affect this trajectory of decline.

Lifespan differences in visual short-term memory load-modulated functional connectivity

Working memory is critical to higher-order executive processes and declines throughout the adult lifespan. However, our understanding of the neural mechanisms underlying this decline is limited. Recent work suggests that functional connectivity between frontal control and posterior visual regions may be critical, but examinations of age differences therein have been limited to a small set of brain regions and extreme group designs (i.e., comparing young and older adults). In this study, we build on previous research by using a lifespan cohort and a whole-brain approach to investigate working memory load-modulated functional connectivity in relation to age and performance. The article reports on analysis of the Cambridge center for Ageing and Neuroscience (Cam-CAN) data. Participants from a population-based lifespan cohort (N = 101, age 23–86) performed a visual short-term memory task during functional magnetic resonance imaging. Visual short-term memory was measured with a delayed recall task for visual motion with three different loads. Whole-brain load-modulated functional connectivity was estimated using psychophysiological interactions in a hundred regions of interest, sorted into seven networks (Schaefer et al., 2018, Yeo et al., 2011). Results showed that load-modulated functional connectivity was strongest within the dorsal attention and visual networks during encoding and maintenance. With increasing age, load-modulated functional connectivity strength decreased throughout the cortex. Whole-brain analyses for the relation between connectivity and behavior were non-significant. Our results give additional support to the sensory recruitment model of working memory. We also demonstrate the widespread negative impact of age on the modulation of functional connectivity by working memory load. Older adults might already be close to ceiling in terms of their neural resources at the lowest load and therefore less able to further increase connectivity with increasing task demands.

DIFFERENCES IN THE MEASUREMENT OF COGNITION FOR THE ASSESSMENT OF DEMENTIA ACROSS GEOGRAPHIC CONTEXTS

Abstract Most cognitive assessments have been developed in high-income countries but are subsequently used in diverse contexts. Differences in culture and context may affect performance of cognitive items. We used the Harmonized Cognitive Assessment Protocol surveys in the US, Mexico, India, England, and South Africa (combined N=11,364) to quantify associations across countries between cognitive items and cognitive impairment status using age- and gender-adjusted logistic regression. Associations were stronger in the US (Median Odds Ratio [OR] across items=0.17) and England (Median OR=0.19), compared to South Africa (Median OR=0.23), India (Median OR=0.29), and Mexico (Median OR=0.28). Items assessing memory (e.g. delayed recall tasks) had the most consistent associations of the largest magnitudes across contexts. Transporting cognitive items among countries and cultures warrants caution. We identified items that performed well either in individual contexts or across the range of contexts considered; this information can be used to guide the design of future instruments.

Differences in the measurement of cognition for the assessment of dementia across geographic contexts: Recommendations for cross‐national research

AbstractBackgroundAlthough 71% of individuals with dementia are projected to live and low‐ and middle‐income countries by 2050, most dementia research to‐date has been conducted in high‐income countries. Cross‐national studies are needed to understand how the causes and consequences of dementia may differ by country. However, factors such as urbanicity, language of administration or race/ethnicity, which vary across countries, affect the measurement of cognition. A better understanding of which cognitive items perform well across countries or within specific countries will allow researchers to optimize dementia measurement in future cross‐national and international studies.MethodWe used data from the Harmonized Cognitive Assessment Protocol surveys in the US, Mexico, India, England, and South Africa (combined N = 11,364). To define cognitive impairment consistently across countries, we compared participants’ cognitive performance with robust neuropsychological norms within each country. For each HCAP country, we assessed item performance by estimating associations between each cognitive item and cognitive impairment using logistic regression models, controlling for age and gender. We avoided circularity in the analysis by using an iterative quasi‐leave‐one‐out approach. We compared patterns of associations across countries using median odds ratios, and visually, using heatmaps.ResultThe associations between cognitive items and cognitive impairment were stronger in the US (Median Odds Ratio [OR] = 0.17) and England (Median OR = 0.19), in comparison to South Africa (Median OR = 0.23), India (Median OR = 0.29), and Mexico (Median OR = 0.28). Memory items, notably delayed recall tasks, had the most consistent associations of the largest magnitudes across countries. In comparison, there was variability in performance between settings for many language items (e.g. naming a hammer). Items requiring numeracy, including the Trail‐making test, did not perform well in countries with low educational attainment.ConclusionThe performance of cognitive items for the classification of cognitive impairment was not consistent across countries. Although items performing well in a single country could be used to improve measurement precision in specific settings, transporting items between countries without prior validation warrants caution. However, we did identify items that performed well across a range of countries (i.e. delayed recall, animal naming); these items may be of particular utility in future cross‐national research.

Unsupervised mobile app-based cognitive testing in a population-based study of older adults born 1944.

Mobile app-based tools have the potential to yield rapid, cost-effective, and sensitive measures for detecting dementia-related cognitive impairment in clinical and research settings. At the same time, there is a substantial need to validate these tools in real-life settings. The primary aim of this study was thus to evaluate the feasibility, validity, and reliability of mobile app-based tasks for assessing cognitive function in a population-based sample of older adults. A total of 172 non-demented (Clinical Dementia Rating 0 and 0.5) older participants (aged 76-77) completed two mobile app-based memory tasks-the Mnemonic Discrimination Task for Objects and Scenes (MDT-OS) and the long-term (24 h) delayed Object-In-Room Recall Task (ORR-LDR). To determine the validity of the tasks for measuring relevant cognitive functions in this population, we assessed relationships with conventional cognitive tests. In addition, psychometric properties, including test-retest reliability, and the participants' self-rated experience with mobile app-based cognitive tasks were assessed. MDT-OS and ORR-LDR were weakly-to-moderately correlated with the Preclinical Alzheimer's Cognitive Composite (PACC5) (r = 0.3-0.44, p < .001) and with several other measures of episodic memory, processing speed, and executive function. Test-retest reliability was poor-to-moderate for one single session but improved to moderate-to-good when using the average of two sessions. We observed no significant floor or ceiling effects nor effects of education or gender on task performance. Contextual factors such as distractions and screen size did not significantly affect task performance. Most participants deemed the tasks interesting, but many rated them as highly challenging. While several participants reported distractions during tasks, most could concentrate well. However, there were difficulties in completing delayed recall tasks on time in this unsupervised and remote setting. Our study proves the feasibility of mobile app-based cognitive assessments in a community sample of older adults, demonstrating its validity in relation to conventional cognitive measures and its reliability for repeated measurements over time. To further strengthen study adherence, future studies should implement additional measures to improve task completion on time.

P01.09.A Prevalence and predictors of cognitive impairment in adult glioma survivors after multimodal therapy

Abstract Background Long-term survival can be achieved in an increasing number of glioma patients after treatment. Therefore, safeguarding these survivors’ quality of life (QoL) is essential. Neurocognitive decline arises in many young patients, placing a heavy burden on the social and economic aspects of the patients’ lives. A lot of debate is currently ongoing regarding the prevalence of neurocognitive impairment and individual predictors of whom is susceptible for such side effect. Material and Methods In this cross-sectional study, 37 WHO grade 2-3 adult glioma survivors, at least one year after multimodal therapy, were tested using a comprehensive neurocognitive test battery covering multiple cognitive domains. Neurocognitive test scores were converted into z-scores using country-specific normative data. Cognitive impairment was defined as a z-score lower or equal to -1.50 for each subtest. Age, time since multimodal therapy, radiotherapy treatment and tumour location were included as predictors in a linear regression model per outcome (n=12). Results In this cohort, 29 patients (78%) showed a test score below the predefined cutoff on at least one cognitive test. The percentage of patients who showed test-specific cognitive impairment ranged from 8.1% to 56.76% per test. Fine motor skills, verbal memory, processing speed and executive functioning were the most commonly affected cognitive domains. In this study, the variability in processing speed performance was associated with age (TMT A, p=0.03), time since therapy (WAIS-IV coding, p=0.02) and tumour location. In these measures, poorer outcomes were observed with increasing age, longer time since therapy and in patients with gliomas located in the left frontal lobe. Moreover, age showed to be a significant predictor of verbal memory, with poorer outcomes on the HVLT-R delayed recall task with increasing age (p=0.04). Tumour location predicted working memory performance, as patients with right parietal tumours (p=0.03) showed significantly worse on the WAIS-IV digit span task. Conclusion These preliminary data underline the various alterations of neurocognitive functioning in glioma survivors after multimodal therapy. Therefore, future research needs to shift towards a patient-tailored approach. The next step in this study will be to link these neurocognitive data to advanced neuroimaging data to explore the potential predictive value of imaging markers for neural damage and cognitive outcomes, paving the path to innovative treatment planning techniques.

The effect of aging on context use and reliance on context in speech: A behavioral experiment with Repeat-Recall Test.

PurposeTo elucidate how aging would affect the extent of semantic context use and the reliance on semantic context measured with the Repeat–Recall Test (RRT).MethodsA younger adult group (YA) aged between 18 and 25 and an older adult group (OA) aged between 50 and 65 were recruited. Participants from both the groups performed RRT: sentence repeat and delayed recall tasks, and subjective listening effort and noise tolerable time, under two noise types and seven signal-to-noise ratios (SNR). Performance–Intensity curves were fitted. The performance in SRT50 and SRT75 was predicted.ResultsFor the repeat task, the OA group used more semantic context and relied more on semantic context than the YA group. For the recall task, OA used less semantic context but relied more on context than the YA group. Age did not affect the subjective listening effort but significantly affected noise tolerable time. Participants in both age groups could use more context in SRT75 than SRT50 on four tasks of RRT. Under the same SRT, however, the YA group could use more context in repeat and recall tasks than the OA group.ConclusionAge affected the use and reliance of semantic context. Even though the OA group used more context in speech recognition, they failed in speech information maintenance (recall) even with the help of semantic context. The OA group relied more on context while performing repeat and recall tasks. The amount of context used was also influenced by SRT.

Differences in the measurement of cognition for the assessment of dementia across geographic contexts: Recommendations for cross-national research.

Most cognitive assessments have been developed in high-income countries but are used in diverse contexts. Differences in culture and context may affect the performance of cognitive items. We used the Harmonized Cognitive Assessment Protocol (HCAP) surveys in the United States, Mexico, India, England, and South Africa (combined N=11,364) to quantify associations across countries between cognitive items and cognitive impairment status using age- and sex-adjusted logistic regression. Associations were stronger in the United States (median odds ratio [OR] across items=0.17) and England (median OR=0.19), compared to South Africa (median OR=0.23), India (median OR=0.29), and Mexico (median OR=0.28). Items assessing memory (e.g., delayed recall tasks) had the most consistent associations of the largest magnitudes across contexts. Transporting cognitive items among countries and cultures warrants caution. Our results can guide the design of future instruments by identifying items that performed well either in individual contexts or across the range of contexts considered. Little quantitative evidence exists to guide the design of cognitive assessments in cross-national studies. The performance of cognitive items for the measurement of dementia varied across countries. Items with lower variation across countries (e.g., delayed word recall) should be used in future cross-national assessments. Across countries, there was variability in the performance of language assessments, with the exception of the animal naming task. Results can be used to design future cross-national or location-specific cognitive assessments.

The unique contribution of depression to cognitive impairment in Post-Acute Sequelae of SARS-CoV-2 infection

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with significant cognitive impairment and increased risk for mental health comorbidities. This study aimed to identify specific associations between cognitive impairment, self-reported disruptions in memory, and psychiatric symptoms including depression, anxiety, posttraumatic stress disorder (PTSD), and perceived sleep concerns. MethodsData collected from all consecutive patients with Post-Acute Sequelae of SARS-CoV-2 infection (PASC) who presented to a dedicated Post-COVID Clinic were used to evaluate whether certain psychiatric symptoms were more strongly associated with cognitive impairment and self-reported memory disturbances. ResultsUnivariate and multivariable analyses revealed that depression symptom severity was significantly associated with the severity of cognitive impairment among patients with PASC. This association was driven primarily by lower performance on verbal fluency, attention, and delayed recall tasks among patients with higher depression symptoms severity. Perceived sleep concerns were an important predictor of self-reported memory disturbances. Conversely, neither PTSD symptom severity nor anxiety symptom severity were significant predictors of cognitive impairment or self-reported memory disturbances. ConclusionsThese findings have important clinical implications for justifying the need for screening patients with PASC for both depression and cognitive impairment.