Everyday Cognition Research Articles

Sleep Phenotypes predict self‐reported measures of cognition and mild cognitive impairment in diverse Hispanics/Latinos

AbstractBackgroundThe Hispanic Community Health Study/Study of Latinos (HCHS/SOL) showed that self‐reported cognitive decline (SCD) is associated with objectively assessed cognition. In HCHS/SOL, sleep phenotypes using empirically derived latent class/cluster analyses are associated with brain vascular outcomes. Since these measures may predict cognitive decline and dementia, we examined the associations between sleep phenotypes, SCD and mild cognitive impairment (MCI) among a diverse sample of Hispanics/Latinos living in the United States.MethodHCHS/SOL is prospective cohort study designed using a multisite (Bronx, NY, Chicago, IL, Miami, FL, San Diego, CA) multistage probability sample. SCD was measured as part of SOL‐INCA, an HCHS/SOL ancillary study. SOL‐INCA obtained repeated cognitive tests, seven‐years apart and the Everyday Cognition Short Form (ECog‐12). The ECog‐12 is a self‐rated questionnaire of current multiple cognitively relevant functional abilities compared to 10‐years ago administered to 5,563 SOL‐INCA participants aged ≥ 50 years. We used latent class analysis using 15 common sleep related symptoms, home sleep apnea test and four comorbidities to derive three sleep phenotypes: (1) Minimally Symptomatic group (49.6%), (2) Disturbed Sleep group (17.1%), and (3) Daytime Sleepiness group (33.3%). We used survey regression to evaluate associations between visit‐1 sleep phenotypes and the ECog‐12 (linear) cognitive domains (memory, language, executive function, and global) and MCI (logistic) using the minimally symptomatic sleep group as the reference. Models were adjusted for age, education, sex, background, field center, insurance, body mass index, cigarette use, alcohol use, cardiovascular disease, language preference, and respiratory event index.ResultAverage age was 64.34±8.25 years and 55% were female. In fully adjusted models, participants with disturbed sleep had worse global cognition β = 0.18 [0.14;0.22], memory β = 0.21 [0.16;0.26], language β = 0.23 [0.17;0.29], and executive function β = 0.16 [0.12;0.21]. Compared to the reference, we observed stronger associations in participants with daytime sleepiness; global cognition β = 0.22 [0.16;0.27], memory β = 0.26 [0.19;0.32], language β = 0.26 [0.19;0.34], and executive function β = 0.20 [0.15;0.26]. Adults with disturbed sleep, OR = 1.44 [1.08;1.93], and daytime sleepiness OR = 1.67 [1.16;2.40] had higher odds of MCI.ConclusionEmpirically derived sleep phenotypes capturing disturbed sleep and sleepiness had associations with self‐reported cognitive function and MCI in this sample of U.S. Hispanic/Latino adults.

Subjective language difficulties are associated with tau and objective verbal memory in older women with increased AD risk

AbstractBackgroundEarly cognitive changes in preclinical Alzheimer’s Disease (AD) include memory problems and language difficulties. Subjective cognitive complaints (SCC) are an AD risk factor and are associated with AD pathologies. Women have higher tau levels over men, despite demonstrating a life‐long “verbal memory advantage.” Therefore, SCC may be a stronger indicator of early tau accumulation than objective cognitive changes. Here, we examined the relationships among tau, subjective cognitive function, and objective cognitive function in older women at higher AD risk.Method16 older women (age: 72.3±3.1years) participated in Women Inflammation and Tau Study (WITS). The inclusion criteria are: 65+ years old, AD polygenic hazard score >50th percentile, and a telephone Montreal Cognitive Assessment score suggestive of mild cognitive impairment (MCI; range 16‐20). Tau was measured with cerebrospinal fluid (CSF) ptau181 and 18F‐MK6240 positron emission tomography (PET) with standardized uptake value ratio (SUVR) calculated in Braak1, correlating with MCI stage. Objective memory and language performance were assessed with the Rey Auditory Verbal Learning Test (RAVLT; immediate and delayed recall) and the Multilingual Naming Test (MINT), respectively. Subjective cognition was measured approximately one year later with the self‐reported Everyday Cognition Scale (ECog) memory and language subscales (higher score indicate more complaints). Spearman partial correlations analyzed the associations among tau, objective cognition, and subjective cognition while controlling for age.ResultGreater CSF ptau181 was significantly associated with higher ECog‐Language (rho = 0.62, p = 0.02), higher ECog‐Memory (rho = 0.53, p = 0.51), and lower RAVLT immediate recall (rho = ‐0.54, p = 0.046; Figure 1). More tau in Braak1 was associated with lower RAVLT immediate recall (rho = ‐0.58, p = 0.03) and higher ECog‐Language (rho = 0.45, p = 0.09), but not ECog‐Memory (p = 0.26; Figure 2). Higher ECog‐Language was significantly associated with lower RAVLT immediate (rho = ‐0.59, p = 0.02) and delayed recall (rho = ‐0.69, p<0.01; Figure 3). MINT correct responses were not related to tau and ECog (p’s>0.28).ConclusionOur preliminary results suggest that, in older women with elevated AD risk, language concerns with memory features (e.g., word finding and forgetting object names) may track with early increases in CSF ptau181 and entorhinal cortex tau‐PET. Self‐reported language decline may be predictive of tau accumulation and worsening objective verbal memory, which could be clinically important for older women.

Detecting Alzheimer’s risk with cognitive dispersion on neuropsychological testing

AbstractBackgroundCognitive dispersion refers to the within‐person variability across tasks. Relative to the normative approach, cognitive dispersion may be more sensitive to subtle changes in preclinical Alzheimer’s disease. Greater dispersion has been associated with increased risk for conversion to mild cognitive impairment and faster rates of medial temporal lobe atrophy. This metric can be derived from a regular neuropsychological assessment and complement traditional outcome approaches, particularly in those underrepresented in normative data. This study evaluated cognitive dispersion as an independent predictor of clinical status across racial and ethnic groups.MethodBaseline data on 1811 cognitively unimpaired older adults with high vascular risk from the U.S. POINTER multisite lifestyle intervention study were examined. Sample characteristics included mean age of 68 (SD = 5.2), 70% female, 30% less‐than‐college education, and 29% underrepresented groups (301 Black, 231 Other). Correlations between cognitive dispersion and other brain health risks (vascular, subjective cognitive decline (SCD), physical activity) were tested. Cognitive dispersion was defined as the standard deviation of individuals’ z‐transformed scores of 8 cognitive tests. Vascular risk burden was the sum of 5 conditions (hypertension, diabetes, hypercholesterolemia, heart disease, obesity). Self‐report SCD was measured by the Cognitive Function Instrument (CFI) and Measurement of Everyday Cognition (ECOG12). Logistic Regression Models were fitted to predict Clinical Dementia Global Ratings (CDR 0.5 vs. 0) to evaluate cognitive dispersion as an independent predictor in the whole sample, White participants and Black participants, controlled for demographics, vascular risk, and physical activity. Logistic Regression Models were also evaluated with CFI or ECOG12 as additional covariate.ResultGreater cognitive dispersion was correlated with older age, greater vascular burden and less physical activity, but not SCD. Cognitive dispersion was significantly higher in men, Black participants, and participants with less education. Cognitive dispersion predicted CDR in Black participants (OR = 4.7, p<0.01), and trended in the whole sample (OR = 1.6, p = 0.05), but was not significant in White participants (OR = 1.2, p = 0.63). Results hold when controlled for SCD (Table 1).ConclusionResults supported cognitive dispersion as a sensitive objective metric, in addition to self‐report SCD, to identify individuals showing the earliest clinical signs of decline, particularly among those underrepresented in traditional norms.

Passive logging of smartphone interactions as a feasible and reliable measure to monitor everyday cognition in Alzheimer’s Disease

AbstractBackgroundAs cognitive assessments can be burdensome to patients, new approaches are emerging to assess symptomatic changes in Alzheimer’s Disease (AD). Since typing on smartphones requires a variety of cognitive functions, passively and remotely collected typing behaviour has the potential to provide day‐to‐day insights into cognitive decline in AD. We investigated therefore the feasibility and reliability of a keyboard application for smartphones (Neurokeys) that passively collects keystroke dynamics (KD) to monitor cognition in people with preclinical and clinical AD.MethodParticipants with preclinical AD (N = 8) and patients with a clinical AD diagnosis (N = 8, Table 1) were included from the Amsterdam Dementia Cohort. Participants used Neurokeys for 28 consecutive days in the context of the ‘A Personalized Medicine Approach for Alzheimer’s Disease’ (ABOARD)‐project. The retention rate (active users on day 28) and the average number of daily keystrokes were calculated to determine feasibility. KD were aggregated into two commonly investigated features: time between keystrokes (flight‐time) and duration of a keystroke (hold‐time), which were standardized into z‐scores. Intra‐class correlations (ICC) between first and last 14 days of data collection for both features were determined to assess reliability. Finally, KD features were correlated to scores on the Mini‐Mental State Examination (MMSE) to explore the association between KD and global cognition.ResultsThe retention rate was 93.75% for all participants (Figure 1). Participants with preclinical AD used the keyboard for 26.25±2.12 days with 653.67±305.61 keystrokes each day, and clinical AD patients used the keyboard for 22.63±4.10 days with 409.44±288.73 daily keystrokes. For all participants, the ICC for flight‐time and hold‐time are 0.85 and 0.89 respectively. MMSE is negatively correlated with flight‐time (r = ‐0.68, p = 0.003), but not with hold‐time (r = ‐0.20, p = 0.45, Figure 2).ConclusionThe number of daily keystrokes is sufficient to obtain reliable KD features in preclinical and clinical AD. The results show that people with better global cognition type faster, indicating that passive logging of keystrokes can be a feasible measure for cognition in AD. To elaborate on these first findings, a larger validation study can further explore the utility of smartphone interactions and aid the development of digital biomarkers in AD.

Functional Connectivity and White Matter integrity of intercommunity hub nodes in Subjective Cognitive Decline

AbstractBackgroundSubjective Cognitive Decline (SCD) is considered an early preclinical stage of Alzheimer’s Disease and related dementias (ADRD) which may show promise for targeted preventative treatments. Subtle changes in functional connectivity and white matter integrity (WMI) may occur in SCD. Few studies have applied both functional graph theory (GT) and diffusional kurtosis imaging (DKI) techniques in tandem to identify differences in vulnerable network hubs. We addressed these issues by applying GT and DKI to study differences in intercommunity brain hubs. The hypothesis was that in hubs identified in healthy controls, SCD subjects’ hubs would show decreased GT diversity coefficient (DC) and DKI mean kurtosis (MK).MethodImages were acquired on a Siemens PRISMA scanner. Matlab was used to calculate DC and identify 5 hubs in 107 healthy controls (HC) and DC in 30 SCD (93 females, mean age = 67.51). SCD classification was determined by a comprehensive clinician evaluation or Everyday Cognition average item score>1.6, with objectively healthy cognitive performance (Montreal Cognitive Assessment score>22). Hub DC was the target in GLMM analysis, with diagnosis as predictor. Mean Kurtosis (MK) was analyzed in DSI Studio’s cross‐sectional connectometry using the hubs as seeds. Only the covariate of gray matter volume approached significance (p = .059), and was included in analysis. Mean age, education, head motion, and sex balance did not significantly differ between groups.ResultAll hubs had lower DC in SCD compared to HC (p ≤ .006). Connectometry identified positive correlation between MK and diagnosis in Left hemisphere tracts associated with two hubs: Inferior Fronto‐Occipital, Extreme capsule, and Uncinate tracts from Insular cortex, and Superior Longitudinal, Superior Corticalstriatal, Arcuate, Frontal Aslant, and Corticalspinal tracts from Middle Frontal gyrus.Conclusion Conclusion Rs‐fMRI findings show that intercommunity functional hubs are weaker in SCD compared to healthy individuals. Furthermore, the study identified a relationship of higher MK values in SCD for hubs located in insular cortex and middle frontal gyrus, all left hemisphere biased. Higher MK in SCD also runs counter to our hypothesis but is supported by recent paradoxical increase theories of decline. WMI differences between groups may be subtler than functional changes, warranting examination of the 2 modalities’ relationship.

A novel approach to measure dyadic patterns of subjective cognitive changes: its association to Alzheimer’s disease biomarkers and ability to predict clinical progression in cognitively normal older adults

AbstractBackgroundDiscrepancy in the dyadic relationship of subjective cognitive change has revealed both increased/heightened awareness and decreased awareness/unawareness in the predementia stages of Alzheimer’s Disease (AD). The dyadic relationship is often calculated using the mean discrepancy between an individual and their study partner’s scores on a memory complaints questionnaire. However, participants may display heightened awareness on some questions and unawareness on others, canceling out each other’s effect and masking subtle changes in either direction. Here, we present a new item‐level methodological approach allowing us to examine individual subtle changes in these two awareness dimensions separately. Moreover, we compared them to AD pathology and investigated their ability to predict clinical progression.MethodA total of 503 ADNI participants (Table.1) with baseline clinical dementia rating (CDR) = 0 and baseline CSF (Aβ1‐42 and t‐tau) were included. A subset (N = 329) had at least two follow‐up CDR time points to compute clinical progression. A traditional score was calculated as the average discrepancy between the partner and participant’s responses on the Everyday Cognition questionnaire, with positive scores indicating heightened awareness and negative scores indicating unawareness. An unawareness (resp., heightened awareness) sub‐score was computed by applying a ceiling (resp., floor) at zero to item‐level differences before averaging. Each measure was compared by AD pathology, adjusted for age and sex. Survival analyses examined the relationship of the new scores with clinical progression.ResultCSF t‐tau, but not Aβ1‐42, was a significant independent predictor of the traditional and unawareness scores in models adjusting for each other. There was no significant interaction between the two (Table.2). Survival analyses showed a one‐point improvement on the unawareness sub‐score associated with an 84% reduction in progression hazard (HR = 0.16, p<0.001), or equivalently. A one‐point decline and 525% increase in progression hazard, with no significant effect for the heightened awareness score.ConclusionDecomposing the traditional awareness score into two sub‐scores, allowed the investigation of the relationship between AD and awareness with more specific, sensitive measures. Of these, the unawareness sub‐score was associated with t‐tau and a strong predictor of clinical progression, providing further support that discordant self‐ and informant‐reported cognitive decline may provide important clinical information.

Remote, unsupervised measurement of dyadic subjective cognitive change in the Brain Health Registry

AbstractBackgroundEarly, efficient identification of Alzheimer’s disease (AD) risk is a critical need. Dyadic subjective report from a participant and an informant/study partner (SP) who knows the participant well, may be a reliable and accurate method for assessing AD risk.MethodThe Caregiver and Study Partner Portal within the Brain Health Registry (BHR; an online registry and cohort) is a scalable tool for remotely obtaining dyadic data. All BHR participants are asked to identify a potential SP, who is invited to separately enroll and consent. SPs complete a demographic survey and questionnaires pertaining to cognition, behavioral symptoms, activities of daily living, and the health of the participant. Participants and SPs both complete an online adaptation of the Everyday Cognition Scale (ECog) to assess subjective cognitive change. We analyzed demographic characteristics of the dyads enrolled in BHR and measured correlation between SP and self‐report ECog scores. We used ADNI ECog data to estimate cut points likely to indicate cognitive impairment (1.43 for SP‐report scores and 1.65 for self‐report scores) and determined the number of BHR participants who are possibly impaired based on these cut points.ResultOut of 93,134 BHR participants, 10,494 (11.3%) have an enrolled study partner (Figure 1). The mean SP‐report ECog score is 1.35±0.50 and mean self‐report ECog score is 1.46±0.47. SP and self‐report ECog scores are correlated (r = 0.47, p < 0.001) (Figure 1). Out of 8,374 participants with available SP‐report ECog scores, 2,194 (26.2%) are possibly impaired. Out of 10,018 participants with available self‐report ECog scores, 2,384 (23.8%) of participants are possibly impaired (Figure 2).ConclusionThese findings demonstrate the feasibility of collecting online, dyad‐report demographic and subjective cognitive change data from a large cohort of participant‐SP dyads. The study failed to recruit an ethnoculturally and educationally diverse cohort of dyads. The positive correlation between self‐ and SP‐report ECog scores suggests dyad concordance in subjective report of change. Future efforts will focus on improving study partner enrollment and BHR task completion, increasing dyad diversity, and investigating the ability of remote dyadic measures to track cognitive decline and clinical progression along the AD continuum.

Performance of the CANTAB ‐ Paired Associates Learning task in an unsupervised online setting: Results from the Brain Health Registry

AbstractBackgroundThe aim of this study was to evaluate the feasibility and usability of collecting data from an unsupervised online version of the Paired Associates Learning (PAL) task from the Cambridge Neuropsychological Test Automated Battery (CANTAB™) in adults enrolled in the Brain Health Registry (BHR).MethodBHR is an online cognitive aging registry for referral and longitudinal unsupervised assessment. The PAL assesses visual associative learning and memory and was administered in BHR between 03/2021‐07/2022. PAL variables included in this analysis were ‘Memory Score’ (patterns correctly identified at first attempt for each difficulty level) and ‘Total Errors’, adjusted for level reached. We analyzed PAL task completion rate and characteristics of PAL completers and used linear regressions to assess whether cross‐sectional PAL Memory Score and PAL Total Errors were associated with participant data (age, gender, education, self‐ and study partner‐reported cognitive complaints (Everyday Cognition scale (ECog)), self‐reported memory concern, and self‐reported depressive symptom severity (PHQ‐9), self‐report of Mild Cognitive Impairment (MCI)).ResultAs of July 2022, 14,520 participants aged 18+ years have completed PAL at least once. Participants were on average 66.3 years old (SD = 11.3), 72.4% female gender, 92.8% self‐identified as White, and had a mean of 16.6 years of education (SD = 2.27). BHR received 374 requests for study support regarding PAL, of which 36% (135) were related to device compatibility. Mean PAL scores were similar to those of previous, supervised studies (Figure 1). Worse PAL performance was significantly associated with being older, female gender, having less education, more self‐ and study partner‐reported ECog, self‐reported memory concern, more depressive symptoms, and self‐report of MCI (Table 1).ConclusionOur findings provide evidence for the feasibility of collecting PAL data in an unsupervised online setting and construct validity of cross‐sectional BHR PAL. In terms of usability, there was a minimal need for support. Future studies will investigate the predictive value of BHR PAL in identifying adults with self‐reported MCI, longitudinal BHR PAL performance and associations with in‐clinic assessments and Alzheimer’s disease biomarkers. Our sample lacked diversity. Therefore, a future direction is to increase accessibility of PAL to ethnoculturally and socioeconomically diverse communities.

Sleep health and subjective cognitive decline in the Vanderbilt Memory and Aging Project

AbstractBackgroundIdentifying modifiable risk factors for Alzheimer’s disease (AD) and related dementias (ADRD) may reveal critical evidence for early prevention. It is commonly believed that poor sleep is an early symptom of neurodegeneration and ADRD. However, distinct neurobiological processes occur during sleep, and dysfunction of these processes may also contribute to AD pathogenesis. Less is known about poor sleep and associations with subjective cognitive decline (SCD), a clinical symptom occurring before overt cognitive impairment due to early pathological AD. This study investigated associations between objective and self‐reported measures of sleep health and SCD in a community‐based cohort of older adults.MethodParticipants from the Vanderbilt Memory and Aging Project (n = 220; 74±7 years; 34% female) completed 7‐days of wrist actigraphy and self‐report measures for SCD [Everyday Cognition Scale (ECog)] and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Actigraphy data was processed to estimate average nightly sleep duration, sleep efficiency, and wake after sleep onset. Linear regressions related objective and self‐report sleep health measures with total ECog score adjusting for age, sex, race/ethnicity, education, body mass index, depressive symptoms, Framingham cardiovascular risk score, and apolipoprotein E‐e4 carrier status.ResultIn main effect models, longer sleep duration was associated with greater SCD (b = 0.05, p<0.01). In models adjusted for age, sex, race/ethnicity, and education, higher PSQI (indicative of poorer sleep quality) was associated with greater SCD (b = 1.06, p = 0.01); however, the association was no longer statistically significant in the fully adjusted model. No associations were observed between sleep efficiency or wake after sleep onset and SCD.ConclusionIn this community cohort of older adults, longer nightly sleep duration and self‐reported poor sleep quality were linked with higher SCD. Findings could suggest that abnormal sleep duration and poor sleep quality increase the earliest clinical symptoms of AD. Further investigations are needed to evaluate the potential pathways connecting sleep health to ADRD development.

Alzheimer disease biomarkers are associated with decline in subjective memory, attention, and spatial navigation ability in clinically normal adults.

Subtle changes in memory, attention, and spatial navigation abilities have been associated with preclinical Alzheimer disease (AD). The current study examined whether baseline AD biomarkers are associated with self- and informant-reported decline in memory, attention, and spatial navigation. Clinically normal (Clinical Dementia Rating Scale (CDR®) = 0) adults aged 56-93 (N = 320) and their informants completed the memory, divided attention, and visuospatial abilities (which assesses spatial navigation) subsections of the Everyday Cognition Scale (ECog) annually for an average of 4 years. Biomarker data was collected within (±) 2 years of baseline (i.e., cerebrospinal fluid (CSF) p-tau181/Aβ42 ratio and hippocampal volume). Clinical progression was defined as CDR > 0 at time of final available ECog. Self- and informant-reported memory, attention, and spatial navigation significantly declined over time (ps < .001). Baseline AD biomarkers were significantly associated with self- and informant-reported decline in cognitive ability (ps < .030), with the exception of p-tau181/Aβ42 ratio and self-reported attention (p = .364). Clinical progression did not significantly moderate the relationship between AD biomarkers and decline in self- or informant-reported cognitive ability (ps > .062). Post-hoc analyses indicated that biomarker burden was also associated with self- and informant-reported decline in total ECog (ps < .002), and again clinical progression did not significantly moderate these relationships (ps > .299). AD biomarkers at baseline may indicate risk of decline in self- and informant-reported change in memory, attention, and spatial navigation ability. As such, subjectively reported decline in these domains may have clinical utility in tracking the subtle cognitive changes associated with the earliest stages of AD.

4 A Novel Brief Measure of Acculturation and its Association with Subjective and Objective Cognition

Objective:There is equivocal evidence that acculturation is associated with cognition. Various factors may contribute to ambiguous findings in the neuropsychology setting, including psychometric limitations of tools available for assessing acculturation as well as the frequent conflation of bilingualism with acculturation. Additionally, neuropsychological research on acculturation and cognition has largely failed to account for bidimensional models of acculturation, which have greater empirical support over unidimensional models. In response to these limitations and the theoretical literature on acculturation, we developed the Perceived Identity &amp; Ethnicity Scales (PIES), a brief rating scale system to quickly (&lt;2 minutes) capture an individual's perceived acculturative identity across several domains. In the current study, we sought to (1) provide initial psychometric support of the PIES and (2) examine how it relates to cognition in a culturally and linguistically diverse sample.Participants and Methods:We recruited 242 individuals from both university and community samples (age=23.7±7.6, range 18-72; &lt;12 Years of Education=4%; 78% Female; 58% Hispanic/Latin American; 69% middle SES; 22% educated outside the USA). In addition to demographic questionnaires, participants completed the PIES; an established measure of acculturation (the Bicultural Involvement Questionnaire, BIQ) and bilingualism (Bilingual Language Profile, BLP); measures of mood (the Depression, Anxiety, Stress Scales, DASS; Apathy Evaluation Scale, AES); and of self-reported cognitive functioning (Everyday Cognition, ECog). A subsample of Spanish speakers (n=86) also completed a cognitive battery validated for use in this population (the Spanish English Neuropsychological Assessment Scales, SENAS). For the first aim, we examined the reliability, validity, and dimensionality of the PIES in the full sample. In the Spanish-speaking subsample, we examined the relationship between the tool and both subjective and objective cognition using linear regression controlling for age, education, sex/gender, and premorbid intellectual functioning.Results:Measures of internal consistency and dimensionality supported a bidimensional model of acculturation; identification with culture of family origin (PIES-O) was not related to identification with US American culture (PIES-U; r=0.036, p&gt;0.05). Cultural preference scores from the BIQ were associated with PIES-O (r=-0.322) and PIES-U (r=0.277; both ps&lt;0.001) in the expected directions. PIES-O (r=0.350) and PIES-U (r=-0.432) were associated with the ability to speak a language other than English on the BLP (both ps&lt;0.001). PIES-U, but not PIES-O, was also strongly associated with other BIQ and BLP scores as well as with receiving education outside of the USA at medium to large effect sizes (rs=0.3 to 0.6; all ps&lt;0.001). In the subsample, PIES-O and PIES-U were not associated with subjective cognition as measured by the ECog (AR2=0.016, p&gt;0.05); global cognition as measured by the Montreal Cognitive Assessment (MoCA; AR2=0.046, p&gt;0.05); or SENAS cognitive composite scores (AR2=0.016, p&gt;0.05) after controlling for covariates.Conclusions:Findings provide strong initial psychometric support for the utility of the PIES in the assessment of acculturation. Moreover, these results further support the bidimensional model of acculturation. Acculturation as measured by the PIES was not associated with cognitive abilities in this highly educated and mainly female cross-sectional sample. Longitudinal research accounting for acculturation is needed to elucidate these relationships.

56 TBI Severity Moderates the Association between Subjective and Objective Attention in Older Veterans

Objective:Prior work on associations between self-reported cognition and objective cognitive performance in Veterans has yielded mixed findings, with some evidence indicating that mild traumatic brain injury (TBI) may not impact the associations between subjective and objective cognition. However, few studies have examined these relationships in both mild and moderate-to-severe TBI, in older Veterans, and within specific cognitive domains. Therefore, we assessed the moderating effect of TBI severity on subjective and objective cognition across multiple cognitive domains.Participants and Methods:This study included 246 predominately male Vietnam-Era Veterans (age M=69.61, SD=4.18, Range = 60.87 – 85.16) who completed neuropsychological testing and symptom questionnaires as part of the Department of Defense-Alzheimer’s Disease Neuroimaging Initiative (DoD-ADNI). Participants were classified as having history of no TBI (n=81), mild TBI (n=80), or moderate-tosevere TBI (n=85). Neuropsychological composite scores in the domains of memory, attention/executive functioning, and language were included as the outcome variables. The Everyday Cognition (ECog) measure was used to capture subjective cognition and, specifically, the ECog domain scores of memory, divided attention, and language were chosen as independent variables to mirror the objective cognitive domains. General linear models, adjusting for age, education, apolipoprotein E ε4 carrier status, pulse pressure, depressive symptom severity, and PTSD symptom severity, tested whether TBI severity moderated the associations of domain-specific subjective and objective cognition.Results:Across the sample, subjective memory was associated with objective memory (β=-.205, 95% CI [-.332, -.078], p=.002) and subjective language was associated with objective language (β=-.267, 95% CI [-.399, -.134], p&lt;.001). However, the main effect of subjective divided attention was not associated with objective attention/executive functioning (p=.124). The main effect of TBI severity was not associated with any of the objective cognitive domain scores after adjusting for the other variables in the model. The TBI severity x subjective cognition interaction was significant for attention/executive functioning [F(2,234)=5.18, p=.006]. Specifically, relative to Veterans without a TBI, participants with mild TBI (β=-.311, 95% CI [-.620, -.002], p=.048) and moderate-to-severe TBI (β=-.499, 95% CI [-.806, -.193], p=.002) showed stronger negative associations between subjective divided attention and objective attention/executive functioning. TBI severity did not moderate the associations between subjective and objective cognition for memory or language domains. The pattern of results did not change when the total number of TBIs was included in the models.Conclusions:In this DoD-ADNI sample, stronger associations between subjective and objective attention were evident among individuals with mild and moderate-to-severe TBI compared to Veterans without a TBI history. Attention/executive functioning measures (Trails A and B) may be particularly sensitive to detecting subtle cognitive difficulties related to TBI and/or comorbid psychiatric symptoms, which may contribute to these attention-specific findings. The strongest associations were among those with moderate-to-severe TBI, potentially because the extent to which their attention difficulties are affecting their daily lives are more apparent despite no significant differences in objective attention performance by TBI group. This study highlights the importance of assessing both subjective and objective cognition in older Veterans and the particular relevance of the attention domain within the context of TBI.

3 Smartphone Digital Phenotyping for Unobtrusive and Continuous Assessment of Everyday Cognition and Movement Trajectories in Older Adults

Objective:To evaluate the feasibility, usability, and preliminary validity of a digital phenotyping protocol to capture everyday cognition and activities in vivo among older adults.Participants and Methods:Eight participants (M age=69.1 + 2.6; M education=18.0 + 1.4; 50% female; 88% non-Hispanic White) with normal cognition or mild cognitive impairment used an open-source smartphone application (mindLAMP) to passively and continuously capture sensor data including global positioning system (GPS) trajectories for a 4-week study period. Baseline neuropsychological tests and measures of depression, self-reported cognitive decline and mobility patterns were collected as external validators for digital data. Participants downloaded mindLAMP onto their smartphones and resumed their daily routines for 4 weeks before removing mindLAMP and completing a debriefing questionnaire. A cognitive composite was derived by averaging T-scores across domains of attention, executive functioning, processing speed, memory, and language. GPS raw data were processed to generate monthly average and standard deviation mobility metrics for each participant, including time spent at home, distance travelled, radius of gyration, flight length, and circadian routine. Feasibility and usability findings are presented along with correlation coefficients &gt;.4 between GPS metrics and external validators.Results:100% of enrolled participants completed the 4-week study without requesting to withdraw. Usability ratings ranged from poor to excellent. 75% of participants agreed that mindLAMP was easy to use, whereas only 1 participant enjoyed using mindLAMP. 100% of participants were satisfied with the study team’s explanation of procedures, privacy safeguards, data encryption methods and risks/benefits, reflected in an average score of 98.8% on the comprehension of consent quiz. No participants reported feeling uncomfortable, suspicious, or paranoid due to the study application running on their smartphone. No participants endorsed new problems using their smartphone, though 75% reported charging it more frequently during the study period. On average each day, participants spent 1121 + 227 minutes at home, travelled 38727 + 36210 geodesic units, and had 201 + 149 minutes of missing GPS data. Overall, greater amounts of activity (monthly average) and higher variability (monthly standard deviation) in GPS metrics were associated with better outcomes. Specifically, less time spent at home, greater distance travelled, larger radius of gyration, greater flight length, and greater variability in home time, distance travelled, radius of gyration and flight length were associated with less depression, less self-reported cognitive decline, better cognition, and greater self-reported mobility (.40&lt; |r| &lt;.69). On the other hand, greater circadian routine was associated with more self-reported cognitive decline (r=.66) and less self-reported mobility (r=-.43).Conclusions:Smartphone digital phenotyping is a feasible and acceptable method to capture everyday activities in older adults. Continuous collection of data from personal devices warrants caution; however, participants denied privacy concerns and expressed an overall positive experience. High frequency GPS data collection impacts battery life and should be considered among relative risks and confounds to naturalistic assessment. Patterns of behavior from passive smartphone data show promise as an unobtrusive method to identify cognitive risk and resilience in older adults. Subsequent analyses will evaluate additional sensor metrics across a larger and more heterogeneous cohort.

9 Predictive Ability of the Performance Assessment of Self-Care Skills (PASS) in a Sample of Predominantly Low-Income, Community Dwelling, African American Older Adults

Objective:Mild decline in independent functioning is a core diagnostic criterion for Mild Cognitive Impairment. Performance-based assessments have been considered the gold standard to identify subtle deficits in functioning. Existing assessments were largely designed using demographically homogenous samples (white, highly educated, middle class) and often assume tasks are performed similarly across populations. The current study aimed to validate the utility of the Performance Assessment of Self-Care Skills (PASS) in determining cognitive status in a sample of predominantly African American, low-income older adults.Participants and Methods:Cognition and functional capacity were measured in n=245 older participants (aged 50+ years) who were recruited from a larger community study located in Pittsburgh, PA. Cognitive status was defined by a mean split on the Modified Mini Mental Status Examination (3MS) score (84/100). Participants above the cutoff were classified as unlikely cognitive impairment (UCI) and those below classified as potential cognitive impairment (PCI). Functional capacity was assessed using the number of cues provided on three PASS subtasks: shopping, medication management, and critical information retrieval (higher score = worse functioning). Self-reported cognitive and functional decline was assessed via the Everyday Cognition (ECog) questionnaire (higher score = greater decline). Generalized linear models compared performance scores between groups adjusting for literacy (WRAT3), age, and education. Receiver operating characteristic curve (ROC) analyses were run for select functional performance scores to assess their predictive ability in discriminating between PCI and UCI.Results:Compared to the UCI group (N = 179), the PCI group (N = 66) was older (68 vs. 65 years, p = 0.05), less educated (11 years vs. 12 years, p &lt; 0.01), had lower WRAT3 z-scores (0.19 vs. -0.55, p &lt; .01), and required more cues on the shopping (4.33 vs. 8.54, p &lt; 0.01) and medication management PASS subtasks (2.74 vs. 6.56, p &lt; .01). Both groups reported elevated levels of subjective cognitive complaints on the ECog (1.46 vs. 1.56, p = .09) and performed similarly on the critical information retrieval PASS subtask (0.25 vs 0.54, p = .06). When discerning between UCI and PCI groups, the PASS Shopping subtask had an optimal cut-off score of 4, sensitivity of 0.86, specificity of 0.47, positive predictive value (PPV) of 0.37, and area under the curve (AUC) of 0.71. PASS Medication Management had an optimal cut-off score of 3, sensitivity of 0.77, specificity of 0.56, PPV of 0.39, and AUC of 0.74.Conclusions:Subjective functional decline and performance on the critical information retrieval subtask were not associated with cognitive groups. PASS shopping and medication management had moderately high AUCs, suggesting they can reliably distinguish between groups. However, both tasks also exhibited low PPVs, low levels of specificity, and high levels of sensitivity, making them strong “rule-out” tests but poor “rule-in” tests in this sample. Because accurate assessment of functioning is useful for MCI and critical to dementia diagnosis, it is imperative we understand how these tasks function across different populations. Future work should 1) validate measures of functional ability across different populations and 2) develop population-appropriate assessments for use in clinical and research settings.

25 Update to: The Predictive Utility of Various Subjective Cognitive Complaints Using Item Level Data from the Everyday Cognition (ECog) Scales

Objective:Early identification of individuals at risk for dementia provides an opportunity for risk reduction strategies. Many older adults (30-60%) report specific subjective cognitive complaints, which has also been shown to increase risk for dementia. The purpose of this study is to identify whether there are particular types of complaints that are associated with future: 1) progression from a clinical diagnosis of normal to impairment (either Mild Cognitive impairment or dementia) and 2) longitudinal cognitive decline.Participants and Methods:415 cognitively normal older adults were monitored annually for an average of 5 years. Subjective cognitive complaints were measured using the Everyday Cognition Scales (ECog) across multiple cognitive domains (memory, language, visuospatial abilities, planning, organization and divided attention). Cox proportional hazards models were used to assess associations between self-reported ECog items at baseline and progression to impairment. A total of 114 individuals progressed to impairment over an average of 4.9 years (SD=3.4 years, range=0.8-13.8). A subset of individuals (n=352) underwent repeat cognitive assessments for an average of 5.3 years. Mixed effects models with random intercepts and slopes were used to assess associations between baseline ECog items and change in episodic memory or executive function on the Spanish and English Neuropsychological Assessment Scales. Time in years since baseline, the ECog items, and the interaction were key terms of interest in the models. Separate models for both the progression analyses and mixed effects models were fit for each ECog item that included age at the baseline visit, gender, and years of education as covariates.Results:More complaints on five of the eight memory items, three of the nine language items, one of the seven visuospatial items, two of the five planning items, and one of the six organization items were associated with progression to impairment (HR=1.25 to 1.59, ps=0.003 to 0.03). No items from the divided attention domain were significantly associated with progression to impairment. In individuals reporting no difficulty on ECog items at the baseline visit there was no significant change over time in episodic memory(p&gt;0.4). More complaints on seven of the eight memory items, two of the nine language items, and three of the seven visuospatial items were associated with more decline in episodic memory (ps=0.003 to 0.04). No items from the planning, organization, or divided attention domains were significantly associated with episodic memory decline. Among those reporting no difficulty on ECog items at the baseline visit there was slight decline in executive function (ps=&lt;0.001 to 0.06). More complaints on three of the eight memory items and three of the nine language items were associated with decline in executive function (ps=0.002 to 0.047). No items from the visuospatial, planning, organization, or divided attention domains were significantly associated with decline in executive function.Conclusions:These findings suggest that, among cognitively normal older adults at baseline, specific complaints across several cognitive domains are associated with progression to impairment. Complaints in the domains of memory and language are associated with decline in both episodic memory and executive function.

34 Association Between Subjective Cognitive Decline and Mental Wellbeing in Normal Cognition and MCI Older Adults

Objective:Subjective cognitive decline (SCD, i.e., perceived cognitive decline without neuropsychological deficits) is associated with Alzheimer’s disease pathology and increased risk for cognitive impairment but is heterogenous in etiology and has been linked to other factors including personality and depression. Mental wellbeing (i.e., the perception and functioning of social, emotional, and health-related aspects of one’s life) has been associated with subjective memory complaints, but its relationship with other subjective cognitive domains is poorly understood. Further characterizing the relationship between mental wellbeing and SCD could refine understanding of SCD and inform development of interventions that prevent progression to objective cognitive decline. This study aimed to describe the relationship between mental wellbeing and subjective decline in multiple cognitive domains and examine whether this relationship differs between older adults with normal cognition and those with mild cognitive impairment (MCI).Participants and Methods:Community-dwelling older adults (normal: n = 58, Mage = 73.7±5.6; MCI: n = 43, Mage = 75.9±6.1) completed the Everyday Cognition scale, a validated self-report measure of SCD, and the RAND-36 Health Survey, a validated self-report measure of health-related quality of life which includes a mental wellbeing subscale. Spearman’s rank correlations were conducted between self-reported mental wellbeing and each self-reported cognitive domain (i.e., memory, language, visuospatial, and executive function) for the Normal Cognition and MCI groups.Results:Worse mental wellbeing was associated with worse subjective language and executive function in the normal group, rs(56) = -.42, p =.001; rs(56) = -.37, p =.005, but not for the MCI group, rs(41) = -.23, p =.15; rs(41) = -.12, p =.46. Worse mental wellbeing was associated with worse subjective visuospatial function in the MCI group, rs(41) = -.39, p =.009, but not in the normal group, rs(56) = -.11, p =.39. For both groups, worse mental wellbeing was associated with worse subjective memory, rs(56) = -.45, p &lt; .001; rs(41) = -.37, p =.02. While this correlation was greater in the normal group, the difference was not significant (z = 0.38, p =.71).Conclusions:These results suggest that perceptions of mental wellbeing are related to perceptions of cognitive decline in multiple domains, and that the specific domains involved differ between normal and MCI groups. The differential associations may mean perception of specific cognitive domains more strongly affect mental wellbeing, or mental wellbeing more acutely influences perception of those domains. The overall observed relationship between SCD and mental wellbeing may have several explanations: the impact of broader health perceptions may extend to cognitive perception, behavioral changes associated with poor wellbeing may reduce subjective cognitive function, or worse subjective cognitive function may lead to negative experiences of wellbeing. Future longitudinal investigation could inform causal inferences. The more limited associations between mental wellbeing and SCD among MCI individuals may point to the role of decreased self-awareness (due to cognitive impairment) precluding detection of subtle changes in cognition or wellbeing. This study highlights the importance of better understanding mental wellbeing in experiences of SCD in both normal and MCI older adults to improve cognitive and mental health outcomes.

78 Remotely monitored in-home IADLs can discriminate between normal cognition and mild cognitive impairment

Objective:Approximately 6.5 million Americans ages 65 and older have Alzheimer’s disease and related dementias, a prevalence projected to triple by 2060. While subtle impairment in cognition and instrumental activities of daily living (IADLs) arises in the mild cognitive impairment (MCI) phase, early detection of these insidious changes is difficult to capture given limitations. Traditional IADL assessments administered infrequently are less sensitive to early MCI and not conducive to tracking subtle changes that precede significant declines. Continuous passive monitoring of IADLs using sensors and software in home environments is a promising alternative. The purpose of this study was to determine which remotely monitored IADLs best distinguish between MCI and normal cognition.Participants and Methods:Participants were 65 years or older, independently community-dwelling, and had at least one daily medication and home internet access. Clinical assessments were performed at baseline. Electronic pillboxes (MedTracker) and computer software (Worktime) measured daily medication and computer habits using the Oregon Center for Aging and Technology (ORCATECH) platform. The Survey for Memory, Attention, and Reaction Time (SMART; Trail A, Trail B, and Stroop Tests) is a self-administered digital cognitive assessment that was deployed monthly. IADL data was aggregated for each participant at baseline (first 90 days) in each domain and various features developed for each. The receiver operating characteristic area under the curve (ROC-AUC) was calculated for each feature.Results:Traditional IADL Questionnaires.At baseline, 103 participants (normal n = 59, Mage = 73.6±5.5; MCI n = 44, Mage = 76.0±6.1) completed three functional questionnaires (Functional Activities Questionnaire; Measurement of Everyday Cognition (ECog), both self-report and informant). The Informant ECog demonstrated the highest AUC (72% AUC, p = &lt;.001).Remotely monitored in-home IADLs and self-administered brief online cognitive test performance.Eighty-four had medication data (normal n = 48, Mage = 73.2±5.4; MCI n = 36, Mage = 75.6±6.9). Four features related to pillbox-use frequency (73% AUC) and four features related to pillbox-use time (62% AUC) were developed. The discrepancy between self-reported frequency of use versus actual use was the most discriminating (67% AUC, p = .03).Sixty-six had computer data (normal n = 38, Mage = 73.6±6.1; MCI n = 28, Mage = 76.6±6.8). Average usage time showed 64% AUC (p = .048) and usage variability showed 60% AUC (p = .18).One hundred and two completed the SMART (normal n = 59, Mage = 73.6±5.5; MCI n = 43, Mage = 75.9±6.2). Eleven features related to survey completion time demonstrated 80% AUC in discriminating cognition. Eleven features related to the number of clicks during the survey demonstrated 70% AUC. Lastly, seven mouse movement features demonstrated 71% AUC.Conclusions:Pillbox use frequency combined features and self-administered brief online cognitive test combined features (e.g., completion times, mouse cursor movements) have acceptable to excellent ability to discriminate between normal cognition and MCI and are relatively comparable to informant rated IADL questionnaires. General computer usage habits demonstrated lower discriminatory ability. Our approach has applied implications for detecting and tracking older adults’ declining cognition and function in real world contexts.

54 The Relationship between Error-Monitoring and Measures of Real-World Awareness and Everyday Function

Objective:Aging older adults and individuals with mild cognitive impairment (MCI) experience changes in ability to self-monitor errors. Difficulties with accurate self-monitoring of errors can negatively impact everyday functioning. Without proper error recognition, individuals will continue to make mistakes and not implement compensatory strategies to prevent future errors. A modified Sustained Attention to Response Task (SART; Robertson et al., 1997) has previously been used to assess self-monitoring by the number of errors individuals were able to recognize. The current study sought to examine the relationship of this laboratory-based error-awareness task with everyday functional abilities as assessed by informants and with real-world error-monitoring. We hypothesized that self-monitoring would be significantly related to real-world error-monitoring and everyday functional abilities.Participants and Methods:135 community-dwelling participants (110 healthy older adults (HOA) and 25 individuals with MCI) were included from a larger parent study (mean age = 67.73, SD = 8.89). A modified SART was used to measure error-monitoring and create a self-monitoring variable by dividing accurately recognized errors by the total number of errors. Participants also completed simple and complex everyday tasks of daily living (e.g., making lemonade, cooking oatmeal, cleaning, filling medication pillbox) in a university campus apartment. Examiners coded both number of errors committed and self-corrections that were made during task completion. To examine real world error awareness, total self-correct errors were divided by the total number of errors. Knowledgeable informants (KI) completed the Everyday Cognition (ECog) scale, where they rated the participant on domains of memory, language, spatial abilities, planning, organization, and divided attention, to capture changes in everyday function. Pearson correlations were used to examine the relationship between SART self-monitoring and real-world error-monitoring, and changes in everyday functions as rated by their informants.Results:As self-monitoring scores on the SART increased, so too did real-world error awareness scores, r(133) = .18, p = .04. Higher self-monitoring scores on the SART were also significantly positively associated with functional performance abilities on the Ecog total (r(96) = -.24, p = .02). Further, higher self-monitoring on the SART was related to better functional performance within the Ecog domains of everyday memory (r(96) = -.23, p = .02), everyday language (r(96) = -.24, p = .02), everyday spatial abilities (r(96) = -.23, p = .02), and everyday planning (r(96) = -.21, p = .04). SART self-monitoring was not significantly related to everyday organization or divided attention domains.Conclusions:The findings revealed that better error-monitoring performance on a laboratory-based task was related to better error-monitoring when completing real-world activities, and less overall impairment in everyday function as reported by informants. Results support the ecological validity of the SART error-monitoring score and suggest that error-monitoring performance on the modified SART may have important clinical implications in predicting real-world error-monitoring and everyday function. Future research should consider how SART error-monitoring may predict everyday functioning, over and above other clinical measures.

12 Purpose in Life, Loneliness, and Subjective Cognitive Decline in an Ethnically Diverse US Sample

Objective:Subjective cognitive decline (SCD), the self-reported experience of worsening cognitive abilities (Jessen et al., 2014), is associated with increased risk of developing Alzheimer’s disease and Mild Cognitive Impairment. Modifiable factors such as purpose in life (PiL), the experience of living a meaningful life where one’s life goals are attainable or being achieved (Boyle et al., 2009), and loneliness, an individual’s perceived social isolation (Luhmann &amp; Hawkley, 2016), are known to be associated with SCD. These relationships are understudied among ethnically diverse groups. Using an online survey, we examined associations between PiL, loneliness and SCD in older ethnically diverse individuals living in the US.Participants and Methods:870 older adults (126 Latino, 74 Black, 33 Asian, and 637 White; average age=67.0 [7.6]) completed an online survey including the Life Purpose Questionnaire, the Gierveld Loneliness Scale, and the Everyday Cognition scale (ECog), which measures subjective cognitive concerns in memory, language, executive function, and divided attention. Chi-square tests and analyses of variance were conducted to assess group differences in SCD and demographic/lifestyle predictors. Multiple regressions and correlations were conducted to assess the relationships between ethnicity and PiL with SCD, and the moderating effect of race/ethnicity. Multiple regressions and correlations were conducted to identify sociodemographic and lifestyle predictors of SCD in each study group.Results:White participants were older (p&lt;.001), and White and Asian groups had higher levels of education (p=.009) compared to Latinos. The White group had a higher proportion of female (p=.016) and middle-income (p=.019) respondents. Black participants had higher PiL (p=.035) and lower loneliness (p=.047) compared to White participants; there were no group differences in ECog ratings (p=.143). Regression results indicated that higher PiL associated with lower SCD in the whole sample (β=-.435, p&lt;.001). The interaction between PiL and ethnic group was significant (β=.078, p=.025), suggesting the relationship between PiL and SCD was strongest in White participants, followed by Asian, then Latino, and finally Black participants. In Latinos, female sex (β=-.281, p=.004) and higher PiL (β=-.240, p=.034) predicted lower SCD ratings. In White participants, higher PiL (β = -.394, p &lt; .001), and lower loneliness (β = .128, p = .003) predicted lower SCD ratings. Correlation analyses revealed no significant associations with SCD in the Black group, although the correlation between loneliness and SCD was trending (r=.222, p=.063). In the Asian group, greater PiL was associated with lower SCD ratings (r=-.439, p=.011).Conclusions:Our findings suggest that PiL may be protective against SCD, particularly in Latino, Asian, and White adults. Differential predictive factors of SCD were also identified for our study groups, suggesting certain groups may benefit from specific targeted interventions. Overall, findings suggest that interventions geared toward increasing PiL and/or mitigating loneliness may help reduce SCD and the risk of cognitive decline in older adults in the US. As the current study was cross-sectional and faced sample size limitations in Asian and Black groups, future studies should include longitudinal assessment of these associations with larger and more representative samples to confirm our findings.

50 Examining the Utility of a Performance-Based Test of Everyday Function for Assessing Cognition in Older Adults Who Speak English as a Second Language

Objective:Accurate early detection of subtle cognitive difficulties is critical for optimizing treatment of neurodegenerative disease. Those who speak English as a second language (ESL) in the US may be at a disadvantage on Englishwritten neuropsychological tests, increasing the potential for error, particularly when cognitive difficulties are mild and/or when informants are not available/unreliable. This study examined the utility of a standardized, performance-based test of everyday function for the assessment of cognition in ESL older adults.Participants and Methods:Five ESL participants (Mage=83 years; range 65-84 years old) were recruited along with 43 cognitively healthy, native English speakers (controls) as part of a larger study of functional assessment in community-dwelling older adults. Participants were required to identify a study partner to answer questions about their cognitive abilities and everyday functioning. ESL participants reported diverse native languages: Cantonese, Mandarin, Gujarati/Hindi, Farsi, and Azeri. One of the 5 ESL participants reported a diagnosis of MCI. Participants completed the Mini-Mental Status Exam, Trail Making Tests, Digit Span, Boston Naming Test, Hopkins Verbal Learning Test, and Brief Visual Memory Test, resulting in 15 test scores. Participants also completed the Naturalistic Action Test (NAT), a performance-based tests that requires preparation of a breakfast and lunch using standardized objects presented on a table. Recordings of NAT performance were scored by two coders for time to completion, accomplishment of task steps, and errors (overt, micro-error, motor), resulting in 10 scores for the Breakfast and the Lunch tasks. Any discrepancies amongst the two coders were resolved by our lab. Informant-report questionnaires included the Functional Assessment Questionnaire (FAQ), Everyday Cognition Questionnaire (ECog) and IADL-C. Total scores from the cognitive tests, NAT, and informant reports for each ESL participant were compared against the scores of Controls by computing T-scores using the Control M and SD. Low/impaired test scores were defined as &lt;1.5 SD.Results:Informants reported intact everyday function (FAQ, IADL-C) for all ESL participants. Informant-reported ECog scores varied as expected; with mild decline reported for the participant with MCI. On traditional cognitive tests, ESL participants showed variable performance, such that low scores were obtained on up to 9 of the 15 scores. The ESL participant with MCI obtained low scores on 11/15 scores. On the NAT, all of the ESL participants without MCI showed scores on the Breakfast (accomplishment, errors) that were comparable to Controls. Completion time for both Breakfast and Lunch and Lunch scores (accomplishment, errors) were variable, with low across observed in ESL participants with healthy cognition.Conclusions:Older participants with ESL and healthy cognition showed highly variable scores on traditional, neuropsychological tests. However, on one item from a performance-based assessment of everyday function (NAT Breakfast), ESL participants with healthy cognition consistently performed well compared to healthy Controls. Performance was less consistent for completion time across both NAT tasks and on all measures from the Lunch task, for which the steps and objects may have been less familiar to ESL participants. Thus, performance-based testing holds promise for informing neuropsychological assessment of ESL older adults, but care should be taken in selecting test items that are highly familiar and outcome measures that are most meaningful across a range of cultures.