Digit Span Subtest Research Articles

B - 31 Factor Analysis of Neuropsychological Attention Measures with Mild Traumatic Brain Injury Patients

Abstract Objective Mild traumatic brain injury (mTBI) often leads to attentional deficits, yet the neuropsychological tests traditionally used may not adequately reflect the cognitive impairments these patients experience. This study aimed to critically evaluate the construct validity and factor structure of attention-related neuropsychological tests in mTBI patients to better understand and diagnose attentional deficits. Method The research utilized a battery of neuropsychological tests used to assess attention among a sample of 269 adults with mTBI including the NAB Numbers & Letters Test, PASAT, Trail Making Test, and WAIS Digit Span, Coding, and Arithmetic subtests. Exploratory factor analysis was employed to investigate the factor structure of the test battery and to test the hypothesis concerning the dimensionality of attention constructs. Results The analysis revealed that attentional measures did not converge on a single latent factor but instead reflected four distinct factors. These factors were identified as 1) Visual Attention/Psychomotor Speed, 2) Auditory Working Memory, 3) Visuospatial Scanning/Search, and 4) Disruption. Conclusions This exploratory factor analysis unveiled a distinction between auditory and visual attention mechanisms within this population. This separation suggests that attentional processes are not monolithic but rather encompass distinct auditory and visual domains and corroborates the existing literature, including Mirsky’s (1991) model of attention, which posits multiple components of attention, albeit with a focus on differentiating processes rather than sensory modalities. The study highlights the complexity of attentional impairments in mTBI and underscores the need for a nuanced approach to the neuropsychological assessment of attention among mTBI patients.

B - 142 Reason to Forget Use of (Most) Digit Span Validity Measures in Aging Clinical Samples

Abstract Objective The Digit Span (DS) subtest has survived every iteration of the Wechsler Adult Intelligence Scale (WAIS), and the reliable digit span (RDS forward+backward) is an established embedded performance validity test (PVT). The only known DS meta-analysis drew near equivalency between the WAIS-R and WAIS-III RDS and age-corrected scaled score (ACSS) validity cutoffs, recommending use of either. The WAIS-IV included a new DS sequencing subtest. Alternate and enhanced RDS measures, adding sequencing, were derived. However, aging samples often perseverate on sequencing. The aims of this study are to confirm and update the faulty use of the enhanced RDS in the aging, establish that use of the previously recommended DS ACSS cutoff (now including sequencing) is similarly faulty, and update all DS PVT cutoff specificities in a clinical aging sample. Method Memory Clinic data were taken from 350 individuals with neuropsychologist-neurologist consensus diagnoses including 111 individuals with early Alzheimer’s disease (ad), 181 with mild cognitive impairment (MCI; 99 amnestic; 82 non-amnestic) and 58 with subjective cognitive complaints (SCC). Results Most DS embedded PVTs (e.g., ACSS<6, Enhanced RDS < 11) present with poor specificity in aging clinical populations (e.g., Χ2 (3350) = 26.331,p = <0.001), while the traditional RDS (< 6) excludes sequencing and retains the best relative specificity (81–95%), as ad performs worst on sequencing (<0.001). Conclusions While prior research favored the DS ACSS in older individuals, this study provided support for the traditional RDS in a memory clinic population. Future directions include corroborating these findings using standalone PVTs and conducting an updated DS meta-analysis.

B - 131 Validation of the California Verbal Learning Test-II-Short Form Forced Choice Paradigm as an Indicator of Performance Validity

Abstract Objective Although the Forced Choice (FC) paradigm of the standard California Verbal Learning Test-Second Edition (CVLT-II) has been extensively validated as an embedded performance validity test (PVT), no studies have validated the CVLT-II Short Form (SF) against a standard battery of external PVTs. Method Participants included 98 veterans (Mage = 69.7 ± 9.0; 86.7% cisgender-male) who completed the CVLT-II-SF FC and the following independent criterion freestanding/embedded PVTS as part of comprehensive outpatient neuropsychological evaluations: the Advanced Clinical Solutions Word Choice Test, Test of Memory Malingering-Trial 1, and Reliable Digit Span from the Wechsler Adult Intelligence Test-Fourth Edition Digit Span subtest. Invalid performance was identified using two different criteria: (1) failing ≥2 PVTs in addition to other clinical indicators of poor engagement, or (2) failing one PVT. Receiver Operator Characteristic (ROC) curves tested the classification accuracy of identifying participants in the invalid group versus those with valid presentations and with or without cognitive impairment. Results Using both criteria, ROC analyses accurately identified invalidity (AUCs = 0.708–0.807) in the total sample, with cut-scores of ≤7 or ≤ 8 on the CVLT-II-SF FC exhibiting adequate specificities (0.900–0.986) and sensitivities of 0.407–0.500. Classification accuracy was acceptable for differentiating the invalid and cognitively intact groups (AUCs = 0.734–0.829) at a cut score of ≤8 (specificities = 0.923–0.958, sensitivities = 0.500–0.704), but was variably acceptable for differentiating the invalid and cognitively impaired groups (AUCs = 0.684–0.794; cut-score of ≤7 with specificities = 0.962–0.978 and sensitivities = 0.229–0.407). Conclusions Our findings support the CVLT-II-SF FC trial as an embedded PVT, particularly when differentiating cognitively intact examinees from those with noncredible presentations.

Executive functions and functioning in women with fibromyalgia.

Fibromyalgia (FM) is a chronic condition characterized by widespread pain that is associated with sleep, emotional, and cognitive disturbances, including in executive functions (EFs). To investigate the relationship between EFs and functionality in women with FM. The study included 17 women with FM, aged between 30 and 59 years, with no history of neurological disease. The EFs were assessed using the Digit Span Subtest (DS), Five Digit Test, Trail Making Test (TMT), Corsi Block-Tapping Task, Hayling Test (HT), and Verbal Fluency Task. Functionality was evaluated through the Fibromyalgia Impact Questionnaire. The Beck Depression Inventory, Hamilton Anxiety Rating Scale, and Brief Pain Inventory were used to measure depression, anxiety, and pain, which were controlled in the statistical analyses. The FM patients showed longer response latency on the HT and TMT. They made fewer errors on part B of the HT, and they performed worse on the DS backward and on the Corsi Block-Tapping Task forward and backward. There were moderate correlations in the expected direction between performance on the Corsi Block-Tapping Task backward and interference at work, as well as between the time to complete part B of the Trail Making Test - B (TMT-B) and fatigue. An unexpected relationship was found between errors on part B of the HT and interference at work. The results suggest lower efficiency in processes such as inhibitory control and cognitive flexibility, difficulties in working memory and non-executive processes such as processing speed. Even with pain, anxiety, and depression controlled, some relationships between EFs and functionality were observed, indicating that these symptoms do not fully explain this relationship. We suggest that cognition, particularly EFs, and broader measures of functionality be considered in the evaluation of FM.

Evaluation of cognitive deficits and limit of stability in chronic low back pain patients with and without fear-avoidance beliefs

ObjectiveThis study aimed to compare the cognitive performance and limit of stability parameters between chronic low back pain (CLBP) patients with and without fear-avoidance beliefs (FABs) and healthy control subjects. MethodsThirty-four CLBP patients with and without FABs and 17 healthy controls were recruited into the study. Three cognitive components, including working memory, attention, and problem-solving, were assessed using Wechsler's Digit Span subtest, the Tower of London test, and the Integrated Visual and Auditory Continuous Performance Test (IVACPT), respectively.The study assessed the limit of stability using MARS software. One-way ANOVA with Bonferroni-corrected post-hoc comparisons revealed between-group differences. Additionally, Hedge's g effect size was calculated. ResultsThere was no significant difference between CLBP patients with and without FABs in Wechsler's Digit span and the Tower of London test. However, CLBP patients with FABs had lower scores and slower reaction times in the IVACPT(p < 0.05).The statistical analysis of movement velocity during the limit of stability (LOS) tasks revealed no significant difference between chronic low back pain patients with and without fear-avoidance beliefs in all directions. However, CLBP patients with FABs exhibited significantly slower reaction times in the forward (p = 0.001), backward (p = 0.001), and right (p = 0.001) directions. ConclusionThe study indicates that chronic low back pain (CLBP) patients with FABs experience more pronounced cognitive impairments and balance disturbances compared to CLBP patients without FABs. These results underscore the significance of considering psychological factors when assessing the functional abilities of individuals with chronic low back pain.

Enhancing Ecological Validity: Virtual Reality Assessment of Executive Functioning in Children and Adolescents with ADHD.

SmartAction-VR uses virtual reality to simulate daily life tasks and assess cognitive performance based on the multi-errand paradigm. This study explored whether this new task could provide insights into the executive functioning of children and adolescents with ADHD in their everyday activities. A cross-sectional study was conducted between November 2021 and December 2022. It consisted of one session and was divided into two parts (cognitive tests; and SmartAction-VR). The sample comprised 76 children and adolescents with a median age (IQR) of 13 (11-14) years and an age range of 9-17 years. Of these participants, 60.50% (n = 46) were males. Out of this sample, 40 participants were in the ADHD group and 36 were in the neurotypical group. The following instruments were used: Waisman Activities of Daily Living Scale, Assessment of Sensory Processing and Executive Functioning, Pediatric Simulator Disease Questionnaire, Digit span subtest, Stroop test, NEPSY-II Subtest of Auditory Attention and Cognitive Flexibility, Trail Making Test, Zoo Map Test, and SmartAction-VR. The ADHD group demonstrated lower accuracy (U = 406, p = 0.010), higher values for total errors (U = 292, p = 0.001), more commissions (U = 417, p = 0.003), new actions (U = 470, p = 0.014), and forgetting actions (U = 406, p = 0.010), as well as fewer perseverations compared to the neurotypical group (U = 540.5, p = 0.029). Additionally, participants who forgot more actions were found to have lower independence in daily life (r = -0.281, p = 0.024). The correlations between the results of SmartAction-VR and activities of daily living, as well as cognitive tests, suggest that this new task could be useful for evaluating executive functioning in daily life.

Association between adolescent alcohol use and cognitive function in young adulthood: A co-twin comparison study.

Studies on adolescent alcohol use and cognition are often unable to separate the potential causal effects of alcohol use on cognition from shared etiological influences, including genetic influences or other substance use comorbidities also known to be associated with cognition, such as nicotine use. The present study aimed to fill this gap and clarify the relationship between adolescent alcohol use and young adult cognition by accounting for both measured and unmeasured confounders. A random effects model accounting for nesting in families was used to control for measured confounders. Next, co-twin comparisons were conducted within the full sample and in monozygotic twin pairs (MZ) to control for unmeasured genetic and environmental confounders shared by co-twins. Participants were 812 individuals (58.6% female, 361 complete pairs, 146 MZ pairs) from the longitudinal FinnTwin12 study in Finland. Adolescent alcohol use was indexed with measures of frequency of use and intoxication averaged across ages 14 and 17. Cognitive outcomes were measured at average age 22 and included Trail Making Test, California Stroop test, Wechsler Adult Intelligence subtests (Vocabulary, Block Design, Digit Symbol), Digit Span subtest of Wechsler Memory Scale, Mental Rotation Test and Object Location Memory test. Covariates included sex, parental education, general cognitive ability, current alcohol use and nicotine use. Greater frequency of alcohol use and frequency of intoxication across adolescence was associated with decreased vocabulary scores in the co-twin control [freq: stnd beta = -0.12, 95% confidence interval (CI) = -0.234, -0.013] and MZ only co-twin control models (freq: stnd beta = -0.305, 95% CI = -0.523, -0.087; intox: stnd beta = -0.301, 95% CI = -0.528, -0.074). In Finland, there appears to be little evidence that adolescent alcohol use causes cognitive deficits in young adulthood, except modest evidence for association of higher adolescent alcohol use with lower young adult vocabulary scores.

Reduced benefit from long-term item frequency contributes to short-term memory deficits in dyslexia.

Dyslexia, a specific difficulty in acquiring proficient reading, is also characterized by reduced short-term memory (STM) capacity. Extensive research indicates that individuals with developmental dyslexia (IDDs) benefit less from exposure, and this hampers their long-term knowledge accumulation. It is well established that long-term knowledge has a great effect on performance in STM tasks, and thus IDDs' reduced benefit of exposure could potentially reduce their relative performance in such tasks, especially when frequent items, such as digit-words, are used. In this study we used a standard, widely used, STM assessment: the Digit Span subtest from the Wechsler Adult Intelligence Scale. The task was conducted twice: in native language and in second language. As exposure to native language is greater than exposure to second language, we predicted that IDDs' performance in the task administered in native language will reveal a larger group difference as compared to second language, due to IDDs' reduced benefit of item frequency. The prediction was confirmed, in line with the hypothesis that reduced STM in dyslexia to a large extent reflects reduced benefits from long-term item frequency and not a reduced STM per se.

Enhanced Learning and Memory in Patients with CRB1 Retinopathy.

Neuropsychological tests of cognitive function were used to test individuals with CRB1 and non-CRB1 retinopathies and compare results with a standardised normative dataset. CRB1 retinopathy subjects significantly outperformed those with non-CRB1 retinopathy in list learning tasks of immediate (p = 0.001) and delayed memory (p = 0.007), tests of semantic verbal fluency (p = 0.017), verbal IQ digit span subtest (p = 0.037), and estimation test of higher execution function (p = 0.020) but not in the remaining tests of cognitive function (p > 0.05). CRB1 retinopathy subjects scored significantly higher than the normal population in all areas of memory testing (p < 0.05) and overall verbal IQ tests (p = 0.0012). Non-CRB1 retinopathy subjects scored significantly higher than the normal population in story recall, verbal fluency, and overall verbal IQ tests (p = 0.0016). Subjects with CRB1 retinopathy may have enhanced cognitive function in areas of memory and learning. Further work is required to understand the role of CRB1 in cognition.

Computerized assessment of executive functioning: Validation of the CNS Vital Signs executive functioning scores in a sample of community-dwelling older adults

Objective: Computerized assessment of cognitive functioning has gained significant popularity over recent years, yet options for clinical assessment of executive functioning (EF) are lacking. One computerized testing platform, CNS Vital Signs (CNS-VS), offers tests designed to measure EF but requires further validation. The goal of the present study was to validate CNS-VS executive scores against standard clinical measures of EF. We also sought to determine whether a modified CNS-VS composite score that included variables purported to measure inhibition, switching, and working memory would outperform the currently available CNS-VS Executive Function Index. Method: A sample of 73 cognitively healthy older adults completed four tests from the Delis-Kaplan Executive Function System, the Digit Span subtest from the Wechsler Adult Intelligence Scale-fourth edition, and three CNS-VS tasks purported to measure inhibition, switching, and working memory. Results: Performances on the CNS-VS tests were predicted by performances on standard paper-and-pencil measures. Although the currently available CNS-VS Executive Function Index predicted unique variance in a well-validated paper-and-pencil EF composite score, our Modified CNS-VS EF composite accounted for unique variance above and beyond the original CNS-VS Executive Function Index, while the reverse was not true. Conclusions: The present results support the construct validity of CNS-VS EF tests but also suggest that modifications to their current composite scores would improve the prediction of EF performance.

Neuropsychological and biopsychosocial evolution, therapeutic adherence and unmet care needs during paediatric transplantation: study protocol of a mixed-methods design (observational cohort study and focus groups) - the TransplantKIDS mental health project.

The present article describes the protocol of a mixed-methods study (an observational cohort design and focus groups), aimed to examine neuropsychological functioning and other biopsychosocial outcomes, therapeutic adherence and unmet care needs in paediatric population undergoing solid organ or allogeneic hematopoietic transplant during the pre- and post-transplant phases. Following a multi-method/multi-source approach, neuropsychological domains will be comprehensively measured with objective tests (SDMT, K-CPT 2/CPT 3, TAVECI/TAVEC, WISC-V/WAIS-IV Vocabulary and Digit Span subtests, Verbal Fluency tests, Stroop, ROCF, and TONI-4); ecological executive functioning, affective and behavioral domains, pain intensity/interference, sleep quality and therapeutic adherence will be assessed through questionnaires (parent/legal guardians-reported: BRIEF-2 and BASC-3; and self-reported: BASC-3, BPI, PROMIS, AIQ and SMAQ); and blood levels of prescribed drugs will be taken from each patient's medical history. These outcomes will be measured at pre-transplant and at 4-weeks and 6-months post-transplant phases. The estimated sample size was 60 patients (any type of transplant, solid organ, or hematopoietic) from La Paz University Hospital (Madrid, Spain). Finally, three focus group sessions will be organized with patients, parents/guardians, and transplant clinicians (n = 15, with 5 participants per group), in order to qualitatively identify unmet care needs during the pre-, and post-transplant stages of the process. The study protocol was registered at ClinicalTrials.gov (NCT05441436).

Measurement Invariance of the WISC-V across a Clinical Sample of Children and Adolescents with ADHD and a Matched Control Group.

Measurement invariance of the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) 10-primary subtest battery was analyzed across a group of children and adolescents with ADHD (n = 91) and a control group (n = 91) matched by sex, age, migration background, and parental education or type of school. First, confirmatory factor analyses (CFAs) were performed to establish the model fit for the WISC-V second-order five-factor model in each group. A sufficiently good fit of the model was found for the data in both groups. Subsequently, multigroup confirmatory factor analyses (MGCFAs) were conducted to test for measurement invariance across the ADHD and control group. Results of these analyses indicated configural and metric invariance but did not support full scalar invariance. However, after relaxing equality constraints on the Vocabulary (VC), Digit Span (DS), Coding (CD), Symbol Search (SS), and Picture Span (PS) subtest intercepts as well as on the intercepts of the first-order factors Working Memory (WM) and Processing Speed (PS), partial scalar invariance could be obtained. Furthermore, model-based reliability coefficients indicated that the WISC-V provides a more precise measurement of general intelligence (e.g., represented by the Full-Scale IQ, FSIQ) than it does for cognitive subdomains (e.g., represented by the WISC-V indexes). Group comparisons revealed that the ADHD group scored significantly lower than the control group on four primary subtests, thus achieving significantly lower scores on the corresponding primary indexes and the FSIQ. Given that measurement invariance across the ADHD and the control group could not be fully confirmed for the German WISC-V, clinical interpretations based on the WISC-V primary indexes are limited and should only be made with great caution regarding the cognitive profiles of children and adolescents with ADHD.

Efficacy and safety of transcranial direct current stimulation over the left dorsolateral prefrontal cortex in children and adolescents with attention-deficit/hyperactivity disorder: a randomized, triple-blinded, sham-controlled, crossover trial.

Although pharmacological treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) has demonstrated efficacy, several individuals persist in experiencing social and academic impairment. Additionally, the occurrence of significant side effects may render the use of psychotropic medications untenable. However, Transcranial Direct Current Stimulation (tDCS), a non-invasive brain stimulation technique, shows promising results in treating ADHD. To investigate the efficacy and safety of tDCS on the performance of children and adolescents with ADHD in neuropsychological tests involving visual attention, visual and verbal working memory, and inhibitory control. This study was a triple-blind, randomized, sham-controlled, crossover clinical trial. The intervention consisted of a daily session of tDCS (2 mA) or sham targeting the left dorsolateral prefrontal cortex (L-DLPFC), for 30 min, on five consecutive days. The primary outcome was change in the Visual Attention Test, Fourth Edition (TAVIS-4) before and after each intervention. Subjects were also evaluated pre and post-tDCS using the Digit Span subtest of the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V), the Developmental Neuropsychological Assessment, Second Edition (NEPSY-II) Inhibiting Response (IR) subtest, and the Corsi Block-Tapping Task. Fifteen individuals were included, and no statistically significant difference was observed when comparing the results of the TAVIS-4, the IR of NEPSY-II, and the intragroup Digit Span subtest of WISC-V undertaken before and after the procedure. Adverse events were mainly self-limiting and transient. The participants did not perceive any benefit from tDCS when measured on the Patient Global Impression of Improvement (PGI-I) Scale. This study did not meet its primary endpoint and found no performance enhancement in any investigated neuropsychological outcomes relating to the intervention group.

Emotion Comprehension and Socio-cognitive Skills in Children with High Functioning Autism Spectrum Disorders.

This study aimed to compare socio-cognitive skills and emotion comprehension between children with Autism Spectrum Disorder (ASD) and children with neurotypical development. This quantitative, cross-sectional, controlled study involved 19 children in each group, matched by age (6-12 years) and sex. The assessments examined cognitive aspects (Intelligence Quotient was assessed using the Vocabulary and Matrix Reasoning subtests; working memory using the digit span and letter-number sequencing subtests; attention using the Continuous Performance Test - Identical Pairs; and executive functions using the Trail Making Test), social functions (Children's Social Skills, Behavior Problems, and Academic Competence Inventory), and emotion comprehension (language was assessed using the Strange Stories Test; emotional facial expressions using the digital emotion comprehension test; emotional/affective prosody using the Profiling Elements of Prosody in Speech-Communication - Brazilian Portuguese adapted version). The group with ASD exhibited better performance in executive functions (p=0.02). However, they lagged the control group in social skills (p=0.04), behavior problems (p=0.03), and emotion comprehension (language, facial expressions, and prosody) (all p<0.05). The findings indicate that children with ASD have diminished performance in social skills and emotion comprehension compared to children with neurotypical development. Therefore, the development of technologies and/or therapeutic interventions that address these deficits among children with ASD is recommended.

The utility of the Poreh Nonverbal Memory Test (PNMT) for the detection of noncredible performance

Performance validity tests (PVTs) aim to detect noncredible performance during neuropsychological testing. Despite their established utility, their cognitively undemanding nature and format may unintentionally reveal their purpose, leading to ongoing efforts to develop novel PVTs. In this study, we examined the ability of the embedded validity indices of the Poreh Nonverbal Memory Test (PNMT) to detect simulation. An initial sample of 61 participants was randomly assigned to either a simulation or control condition. Participants then completed the PNMT, the Test of Memory Malingering (TOMM), and the Digit Span subtest. A second validation study using 49 participants was conducted in Israel utilizing the same paradigm. In both studies, simulators were less accurate, exhibited shallow and– at times– reversed PNMT learning curves, and obtained lower scores on the delayed and recognition trials. Additionally, PNMT indices showed similar sensitivity and specificity and were highly correlated with more established validity measures. These findings, however, should be considered preliminary and await further validation in clinical settings.

41 Analyzing Perceived Workloads in Bilinguals and Monolinguals’ Digit Span Performance

Objective:A common neuropsychological task used is the Digit Span, known as a test of attention and working memory. The Digit Span Forward (DS-F) task evaluates attention; meanwhile, the Digit Span Backward (DS-B) and Sequencing (DS-S) evaluate working memory. Research shows that persons that speak multiple languages demonstrate better attention and working memory abilities compared to monolingual speakers. The NASA Task Load Index (NASA-TLX) was conditionally validated by Hardy and Wright (2018) to measure perceived mental workload. Research also shows that bilinguals report higher perceived workloads on cognitive tasks compared to monolinguals. With that said, it was hypothesized that bilinguals would demonstrate better performances on Digit Span tasks compared to monolinguals. Additionally, it was hypothesized that bilinguals would report higher perceived workloads on all digit span tasks compared to monolinguals.Participants and Methods:The sample consisted of 29 psychologically and neurologically healthy participants with a mean age of 29.66 (SD = 7.14). Participants were divided into two groups: English monolingual speakers (n = 10) and English and other language bilingual speakers (n = 19).Participants completed all the subtests of the Digit Span (i.e., DS-F, DS-B, DS-S) in English. The NASA-TLX was used to measured DS-F, DS-B, and DS-S perceived workloads. The NASA-TLX was completed after each Digit Span subtest in English. We used ANOVAs to evaluate DS-F, DS-B, and DS-S performance and their perceived workload between our language groups.Results:We found no significant differences between language groups on the DS-F. However, the bilingual group reported the DS-F to be more temporally demanding and frustrating compared to the monolingual group, p’s &lt; .05, nps2 =.14-.15. Next, we found that the monolingual group outperformed the bilingual group on the DS-B task, p = .027, np2 = .17. On the other hand, the bilingual group reported the DS-B task to be more temporally demanding and frustrating compared to the monolingual group, p’s &lt; .05, nps2=.18-.20. Finally, on the DS-S task the monolingual group outperformed the bilingual group, p = .043, np2 = .14. Meanwhile, the bilingual group reported the DS-S task to be more mentally and temporally demanding compared to the monolingual group, p’s &lt; .05, nps2=.18-.34.Conclusions:Contrary to our hypothesis, results show that monolinguals outperformed bilinguals on DS-B and DS-S, but not DS-F. However, as expected, bilinguals did report higher perceived workloads (e.g., frustration) on Digit Span tasks compared to monolinguals. A possible explanation could be that bilinguals’ efforts to remember the numbers were more taxing compared to monolinguals’ because they had to inhibit from verbally responding in their other language. Rushing bilinguals to provide responses, ultimately developing higher perceived workloads on Digit Span tasks. Future work should investigate if time perspective may be influencing bilingual speakers Digit Span performances and perceived workloads.

42 Associations Between Mild Traumatic Brain Injury, Executive Function, and Criminal Justice Involvement among Veterans and Service Members: a LIMBIC-CENC study

Objective:To examine relationships between history of mild traumatic brain injury (mTBI), neuropsychological measures of executive function, and lifetime history of criminal justice (CJ) involvement among combat-exposed Veterans and Service Members (V/SM).Participants and Methods:Participants were combat-exposed V/SM who completed a baseline assessment for the multicenter Long-term Impact of Military-Relevant Brain Injury Consortium - Chronic Effects of Neurotrauma Consortium study (N=1,341) and had adequate engagement/symptom reporting on measures of performance and symptom validity (i.e., Medical Symptom Validity Test and Mild Brain Injury Atypical Symptoms Scale). Neuropsychological battery included the Trail Making Test (A and B), Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span subtest, and the National Institute of Health (NIH) Toolbox Flanker subtest. Lifetime history of brain injury, criminal justice involvement, and demographics were collected. Participants were 87% male, 72% white, with a mean age of 40 years (SD=9.67). Eighty-one percent had at least some college education. Nineteen percent were active duty. Eighty percent of Veterans and 86% of Service Members reported a history of &gt;1 mTBI, and of these 31% and 47% respectively experienced 3+ mTBIs.Results:Three groups were composed based on level of involvement with the CJ system: 1.) No history of arrests or incarcerations (3+ mTBIs: 64%), 2.) A lifetime history of arrest but no felony incarceration (3+ mTBIs: 34%), and 3.) A lifetime history of felony incarceration (3+ mTBIs: 2%). Ordinal regression analyses revealed that performance on a working memory task (Digit Span; b= 0.024, p= .041; OR= 1.024) was significantly associated with increased CJ involvement after adjusting for age, education, service status, and mTBIs. Performance on measures of processing speed (Trails A), set-shifting (Trails B), and inhibition (Flanker) were not significantly associated with CJ involvement. Number of mTBIs was significantly and positively associated with level of CJ involvement in all four models; Digit Span (p= .016), Trails A (p= .016), Trails B (p= .020), and Flanker (p= .008).Conclusions:Performance on most measures of executive functioning was not significantly associated with CJ involvement in this large, representative sample of V/SM who served in combat. Although performance on a working memory task was significantly associated with CJ involvement, the size of the effect was small and the association was in the opposite direction as expected. Number of mTBIs was significantly associated with level of CJ involvement, indicating that sustaining multiple mTBI may be linked to greater risk of CJ involvement. These findings suggest that social and psychological factors beyond executive dysfunction may better explain the relationship between history mTBIs and CJ involvement. Some aspects of military service and veteran status, such as interdisciplinary treatment for brain injury and physical, mental, and psychosocial health needs, may be protective against previously identified risk factors for arrest (e.g., deficits in executive functioning). Contextualizing mTBI within the larger behavioral health profile of V/SM, with emphasis placed on intervention for related co-morbidities, may reduce the impact of previous arrest on wellbeing and/or reduce the risk of future CJ involvement.

2 Water-Based Exercise Improves Cognition and Reduces Neurological-Related Plasma Proteins in Older Adults.

Objective:In the United States, Alzheimer’s disease (AD) is the most common cause of dementia and the seventh leading cause of death. Exercise has demonstrated health benefits in older adults and reduces the risk of developing AD. Exploring underlying biological mechanisms of exercise could aid in identifying therapeutic targets to prevent AD progression, especially for high-risk individuals such as those with Mild Cognitive Impairment (MCI). Many studies of dementia focus on memory; however, executive function and processing speed are also vulnerable to the neuropathology that causes AD. This exploratory study aimed to identify potential mechanisms by which physical activity can facilitate change in cognitive functioning in older adults. This was accomplished by investigating correlations between changes in neurology-related plasma proteins and changes in measures of executive function and processing speed after participation in a water-based exercise intervention.Participants and Methods:The sample included 20 older adults with amnestic MCI, ages 55-82 years (mean 68.15 ±7.75). Participants were predominately male (90%), White (70%), and non-Hispanic (85%), with more than high school education (95%). Participants engaged in supervised high-intensity water-based exercise three times per week for six months. Neuropsychological assessments and blood samples were assessed at baseline and after completion of the exercise intervention. Cognitive measures included: the Digit Span subtests from the Wechsler Adult Intelligence Scale, 4th Edition, Trail-Making Test (TMT), Stroop Color Word Test (SCWT), and the Symbol Digit Modalities Test (SDMT). Plasma protein levels were analyzed using the Olink Target 96 Neurology assay (Uppsala, Sweden), selected a priori for the established markers linked to neurobiological processes and diseases. Changes in cognitive measures and protein levels were assessed using paired-sample t-tests, and Pearson’s correlations were calculated for significant findings.Results:Participants’ cognitive performance significantly improved on the SCWT color trial (t = -2.19, p = 0.042) and SDMT (t = -2.17, p = .043). Significant decreases in plasma proteins levels were found for GDNF family receptor alpha-1 ([GFRA1]: t =2.05, p = 0.055), neuroblastoma suppressor tumorigenicity-1 ([NBL1]: t = 2.13, p= .046), and neuropilin-2 ([NRP2]: t = 2.61 p= 0.017). Correlational analyses showed reductions in NBL1 were significantly associated with changes in both SDMT (r = -.61, p = 0.006) and the color trial of SCWT (r = .48, p = .038), and NRP2 was significantly associated with improvement on the SDMT (r = -.46, p = 0.045). GFRA1 was not significantly associated with change on any cognitive measure.Conclusions:In a sample of older adults with MCI, participation in high-intensity water-based exercise led to significant improvements in cognitive function as well as changes in neurological plasma proteome. Improved outcomes in processing speed, attention, visuospatial scanning, and working memory were associated with changes in specific plasma protein concentrations. This highlights potential activity-dependent neurobiological mechanisms that may underlie the cognitive benefits derived from physical activity. Future studies should explore these findings in Randomized Control Trials with a comparative condition and larger sample size.

86 Memory Performance in Children with Duchenne and Becker Muscular Dystrophy

Objective:There is limited and mixed research describing the memory performance of boys with Duchenne muscular dystrophy (DMD), a progressive disorder that affects the muscle and the brain, presumably due to the absence of dystrophin; however, the literature indicates either the existence of a selective deficit in verbal working memory, or more generalized impairment in both verbal and visual memory. Far less is documented about the neurocognitive profile of boys with Becker muscular dystrophy (BMD), a closely related neuromuscular disorder which allows for at least some functional dystrophin protein to circulate. The Child and Adolescent Memory Profile (ChAMP) is a valid and widely used memory battery that has not been studied in either DMD or BMD. This study aimed to assess the verbal and visual memory performance in boys having either a DMD or a BMD diagnosis using the ChAMP. A working memory measure, the Digit Span subtest from the Wechsler Intelligence Scale for Children-Fifth Edition, was also included for comparison.Participants and Methods:Twenty-one patients (Age M = 12.19 ± 3.60; 100% male; 76% DMD, 24% Becker) were selected from retrospective data collection of neuropsychological performance in children with neuromuscular disorders. Patients were recruited and assessed as part of a larger scale IRB-approved research study designed to better understand the neurocognitive and behavioral trajectories of boys with DMD or BMD with a complete neuropsychological battery.Results:Independent samples f-tests revealed no significant differences between groups across verbal (DMD M = 88.71; BMD M = 100.80; p = .08), visual (DMD M =90.36; BMD M 93.60; p = .33), and working memory (DMD M = 84.69; BMD: M 82.60; p = .40) domains. In additional analyses, a one sample f-test comparing verbal and visual memory within DMD children revealed significantly worse verbal than visual memory scores (verbal memory M = 88.71; visual memory M = 90.36; p = &lt;.001).Conclusions:There were no significant differences between groups in verbal, visual, and working memory performance, though sample size was a significant limitation. However, based on a comparison of means, children with BMD appear to have stronger verbal memory skills than children with DMD. Furthermore, significant differences between verbal and visual memory within DMD children were observed, such that verbal memory skills were weaker. These findings add to the absence of literature on verbal and visual memory outcomes in children with DMD and BMD.

47 Attention and Working Memory (WM) in Pediatric Patients Prior to Hemopoietic Stem Cell Transplant (HSCT) for Hematologic Malignancies

Objective:HSCT is increasingly used for curative therapy for patients with high risk hematologic diseases. Existing research regarding the neurocognitive impact of HSCT on pediatric patients is notably variable. One area of identified risk is attention/working memory (WM) [Perkins et al., 2007]. The current study examines the degree to which difficulties in attention/WM are present prior to HSCT, as assessed using parent-report of working memory and cognitive tests of attention span and working memory.Participants and Methods:Participants were 19 children and adolescents ages 6-17 years (M= 9.63, SD= 3.22) who were enrolled in a prospective longitudinal study monitoring neurocognitive outcomes in children undergoing HSCT. Participants were eligible for this study if they were 2-18 years old at the time of transplant and had a diagnosis that qualified for an allogenic HSCT. Participants were ineligible if they had a pre-HSCT developmental delay, were non-English speaking, and had a prior HSCT or prior CAR T-cell therapy. Participants were 53% female and 95% Caucasian. Diagnoses in the current study sample included acute lymphoblastic leukemia (n=10), acute myeloid leukemia (n=8), and myelodysplastic syndrome (n=1).Measures included were the Working Memory Index score from the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000) and the Digit Span subtest from the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV; Wechsler, 2003) and the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV; Wechsler, 2008).Results:Mean scores on parent-reported WM scores and cognitive measures of attention/WM fell within normal limits, including the Digit Span Total score (M = 48.42, SD= 6.33), Digit Span Forward score (M = 47.28, SD = 9.9.83), and Digit Span Backward score (M = 48.94, SD = 6.31). However, further analyses suggested that between 11-32% of patients had scores falling at least one standard deviation below the mean on these measures, with more than half of the sample (52.6%) identified with at least one measured weakness in attention and WM. The most commonly identified weakness (33.3% of patients) was Digit Span Forward. Correlations between parent-reported WM issues and cognitive measures of attention and WM were generally strong, with parent report of WM significantly correlated with the Digit Span Total score (r(18)= -0.52, p=.02) and the Digit Span Forward score (r(18) = -0.51, p=.03). No correlations were found between Digit Span Backward and other measures of attention and WM.There were no significant differences in WM scores between patients with ALL and AML. Additional analyses will examine potential contribution of medical factors (e.g., pre-HSCT treatment) to pre-HSCT performance on measures of attention and WM.Conclusions:These results suggest that, prior to undergoing HSCT, pediatric patients present with attention and WM issues. This finding has implications for research related to neurocognitive outcomes in HSCT, indicating the need to obtain pre-HSCT cognitive data in this area in order to fully understand potential change after HSCT. In addition, providers may need to consider adapting communication methods with patients during their transplant stay, given potential attention and WM issues within this population.