Full Neuropsychological Battery Research Articles

358 Quantifying Cognitive and Affective Dysfunction in Chiari Malformation Type I Patients With the Cerebellar Cognitive Affective Syndrome Scale and the Cerebellar Neuropsychiatric Rating Scale

INTRODUCTION: Cognitive and affective dysfunction in Chiari Malformation Type I (CM1) patients are well-documented, but often rely on extensive neuropsychological tests. METHODS: Symptomatic CM1 patients considering surgical decompression were assessed by a board-certified neuropsychologist using the 105-point CNRS (N = 87) and the 10-task CCAS (N = 23), as well as a full neuropsychological battery (N = 24: Wechsler Full Scale IQ, Digit Span, Coding; WRAML Finger Windows; DKEFS Trail Making; verbal list learning; Grooved Pegboard). Descriptive and correlative measures were computed. RESULTS: The study included 66 adults and 21 children. A neuropsychological battery revealed impairment in 29% of patients on 1 test, 12.8% on 2 tests, and 20.8% on 3 or more tests. The CCAS indicated 26% with "possible CCAS" (1 task), 27% with "probable CCAS" (2 tasks), and 18% with "definite CCAS" (3 or more tasks). The median CNRS composite score was 31.0 (IQR: 18.5, 49.0), with positive and negative symptom sub-scores of 18.0 (10.0, 26.5) and 14.0 (7.5, 23.5), respectively. Moderate correlation with the neuropsychological battery was found between impairment detected by CCAS (Spearman rank coefficient ρ = 0.67, p = 0.002) and CNRS (ρ = 0.56, p = 0.003). CONCLUSIONS: A high prevalence of cognitive and affective impairments in pre-operative CM1 patients was observed by all three testing batteries. In this first report of CNRS and CCAS usage in CM1 patients, increased CNRS and CCAS impairment correlated with impairment on standard neuropsychological testing. These tools show promise for future studies CM1, providing a more concise alternative to traditional testing for cognitive and affective dysfunction.

63 Examining TOPF Performance in a Neurodegenerative Population

Objective:Cognitive tests on which performance is unrelated to brain pathology are considered “hold” tests and are often used to estimate cognitive abilities prior to injury or disease. Amongst the most commonly used “hold” tests are measures of irregular word reading, such as the Test of Premorbid Functioning (TOPF). Measures of irregular word reading assess ability to accurately pronounce phonetic irregularities based on prior experience and word knowledge, and tend to be insensitive to most forms of brain pathology (Lezak, 2012). However, research examining whether a relationship exists between neurodegenerative diseases and decline in irregular word reading is limited. The few studies completed have demonstrated a decline in irregular word reading in neurodegenerative disease in general (Berg, Durant, Banks, & Miller, 2016) and Alzheimer’s dementia specifically (McFarlane, Welch, & Rodgers, 2006). However, no known research has been published examining whether irregular word reading and TOPF scores differ depending on cognitive classifications commensurate with DSM-V diagnoses (i.e., mild or major neurocognitive disorder, etc.), or presumed neurological etiology.Participants and Methods:Patients were enrolled from the University of Colorado Hospital Neuropsychology Clinic. This study was a retrospective review of consecutive referrals over the age of 65 to the University of Colorado Hospital Neuropsychology Clinic from 2019 to present. The TOPF was administered along with a full neuropsychological battery and patients were clinically classified by severity of cognitive impairment (e.g., Normal, Mild Neurocognitive Disorder, Major Neurocognitive Disorder) and presumed neurologic etiology (e.g., Alzheimer’s disease (AD), Parkinson’s disease (PD), vascular cognitive impairment (VCI), and mixed dementia (AD and VCI). TOPF Raw scores were used for all analyses. Correlation analysis was conducted to determine significant relationships between various demographic variables and TOPF performance. ANCOVA analyses were conducted to examine differences on TOPF performance by diagnostic classification and differences on TOPF performance by presumed neurologic etiology.Results:Correlation determined a significant relationship between TOPF performance and education (r = .51, p < .001), but not age (p = .092) or gender (p = .680). ANCOVA revealed a significant effect of TOPF performance on diagnostic group classification after controlling for education, F(2, 504)= 26.45, p < .001. Post hoc analysis revealed that those diagnosed with Major Neurocognitive Disorder performed the worst on the TOPF (M=39.801 ± .958), followed by those diagnosed with Mild Neurocognitive Disorder (M= 45.371 ± .767), while those diagnosed as cognitively normal performed the best (M= 49.826 ± .993). Additional ANCOVA analysis revealed a significant effect of TOPF performance on presumed neurologic etiology after controlling for education, F(3,148)=6.07, p = .001. Post hoc analyses revealed that participants with suspected AD (M= 40.728 ± 1.613) and those with suspected VCI (M= 32.804 ± 3.480) performed worse on the TOPF compared to those with suspected PD (M=46.964 ± 1.506), (p=.042 and p = .004, respectively).Conclusions:Results suggest that TOPF performance in older individuals is sensitive to cognitive impairment. Furthermore, these results suggest that this sensitivity may be further influenced by presumed neurologic etiology. These findings are consistent with prior studies which demonstrated a decline in irregular word reading in individuals with neurodegenerative diseases.

A 12-month randomised pilot trial of the Alzheimer’s and music therapy study: a feasibility assessment of music therapy and physical activity in patients with mild-to-moderate Alzheimer’s disease

BackgroundThe Alzheimer’s and Music Therapy (ALMUTH) study is the first randomised controlled trial (RCT) design with 12 months of active non-pharmacological therapy (NPT) implementing music therapy (MT) and physical activity (PA) for participants with Alzheimer’s disease (AD). The aim of the present article is to retrospectively examine the inclusion of mild-to-moderate Alzheimer’s Disease patients into the main ALMUTH study protocol and to determine if continued inclusion of AD patients is warranted.MethodsThe randomised pilot trial was conducted as a parallel three-arm RCT, reflecting the experimental design of the ALMUTH study. The trial was conducted in Bergen, Norway, and randomisation (1:1:1) was performed by an external researcher. The study was open label and the experimental design features two active NPTs: MT and PA, and a passive control (no intervention, CON) in Norwegian speaking patients with AD who still live at home and could provide informed consent. Sessions were offered once per week (up to 90 min) up to 40 sessions over 12 months. Baseline and follow-up tests included a full neuropsychological test battery and three magnetic resonance imaging (MRI) measurements (structural, functional, and diffusion weighted imaging). Feasibility outcomes were assessed and were determined as feasible if they met the target criteria.ResultsEighteen participants with a diagnosis of mild-to-moderate AD were screened, randomised, and tested once at baseline and once after 12-months. Participants were divided into three groups: MT (n = 6), PA (n = 6), and CON (n = 6). Results of the study revealed that the ALMUTH protocol in patients with AD was not feasible. The adherence to the study protocol was poor (50% attended sessions), with attrition and retention rates at 50%. The recruitment was costly and there were difficulties acquiring participants who met the inclusion criteria. Issues with study fidelity and problems raised by staff were taken into consideration for the updated study protocol. No adverse events were reported by the patients or their caregivers.ConclusionsThe pilot trial was not deemed feasible in patients with mild-to-moderate AD. To mitigate this, the ALMUTH study has expanded the recruitment criteria to include participants with milder forms of memory impairment (pre-AD) in addition to expanding the neuropsychological test battery. The ALMUTH study is currently ongoing through 2023.Trial registrationNorsk Forskningsråd (NFR) funded. Regional Committees for Medical and Health Research Ethics (REC-WEST: reference number 2018/206). ClinicalTrials.gov: NCT03444181 (registered retrospectively 23 February 2018, https://clinicaltrials.gov/ct2/show/NCT03444181).

Announcing the Vietnamese Insights into Aging Program (VIP)‐ The First Cohort Study of Cognitive Aging in Vietnamese Americans

AbstractBackgroundAsian Americans are the fastest growing racial population in the U.S; yet very little is known about their cognitive aging and Alzheimer’s disease and related dementias (ADRD) risk. Vietnamese Americans are the largest Southeast Asian group and are at high risk for health disparities. Unlike other large Asian subgroups, due to their sociopolitical history and experiences as refugees, Vietnamese Americans have faced a significant amount of adversity and trauma. As Vietnamese Americans age and their susceptibility to ADRD increases, their context may provide unique understanding in terms of within‐group heterogeneity and reveal key factors in ADRD and cognitive aging. The Vietnamese Insights into Aging Program (VIP) is the first longitudinal study of older Vietnamese Americans and addresses the dearth of ADRD research in this high‐disparity population. The goal is to obtain estimates of cognitive impairment and dementia in the community and identify ADRD risk (e.g., early life trauma) and protective (e.g., social support) factors in this understudied population.MethodWe will enroll 540 Vietnamese (age ≥65 years) across two sites in Northern California. Participants will be seen annually over 3 years to assess cognitive change over time. The following data will be collected: 1) a full neuropsychological battery; 2) an extensive interview about early life history and trauma as well as psychological and sociocultural factors, and 3) cardiovascular risk factors (hypertension, diabetes, smoking, etc.). Assessments will be conducted in Vietnamese and take place at a community partner site. In collaboration with local community partners, extensive community outreach and education were conducted prior to study recruitment.ResultVIP has developed a protocol for the bilingual Vietnamese assessments which has been further refined by scientists, staff, and VIP’s community advisory board, many of whom are bicultural and bilingual Vietnamese American. VIP currently has a waitlist of over 250 participants as of January 2022. We aim to complete Time 1 assessments of all 540 participants by Spring 2023.ConclusionInnovative research with older Vietnamese Americans provides a unique opportunity to refine research methodology and more fully delineate the factors that contribute to ADRD disparities in underserved populations.

The Influence of Cerebrovascular Pathology on Cluster Analysis of Neuropsychological Scores in Patients With Mild Cognitive Impairment.

The diagnostic entity of mild cognitive impairment (MCI) is heterogeneous, highlighting the need for data-driven classification approaches to identify patient subgroups. However, these approaches can be strongly determined by sample characteristics and selected measures. Here, we applied a cluster analysis to an MCI patient database from a neuropsychology clinic to determine whether the inclusion of patients with MCI with vascular pathology would result in a different classification of subgroups. Participants diagnosed with MCI (n = 166), vascular cognitive impairment-no dementia (n = 26), and a group of older adults with subjective cognitive concerns but no objective impairment (n = 144) were assessed using a full neuropsychological battery and other clinical measures. Cognitive measures were analyzed using a hierarchical cluster analysis and then a k-means approach, with resulting clusters compared on a range of demographic and clinical variables. We found a 4-factor solution: a cognitively intact cluster, a globally impaired cluster, an amnestic/visuospatial impairment cluster, and a mild, mixed-domain cluster. Interestingly, group differences in self-reported multilingualism emerged in the derived clusters that were not observed when comparing diagnostic groups. Our results were generally consistent with previous studies using cluster analysis in MCI. Including patients with primarily cerebrovascular disease resulted in subtle differences in the derived clusters and revealed new insights into shared cognitive profiles of patients beyond diagnostic categories. These profiles should be further explored to develop individualized assessment and treatment approaches.

Neuropsychological Profile of Early Cognitive Impairment in Cerebral Small Vessel Disease

Introduction: The neuropsychological feature of vascular mild cognitive impairment is a deficit of the frontal-subcortical circuit; however, the features in the early stage are not consistent. In the present study, we aimed to investigate the neuropsychological features of the very early stage of cognitive impairment with cerebral small vessel disease (CSVD) and to elucidate the cognitive differences among CSVD subtypes. Methods: A comprehensive neuropsychological test battery was applied to nondemented subjects scoring below the cutoff point 26 of the Japanese version of the Montreal Cognitive Assessment. After factor analysis was conducted to identify covert cognitive factors in the battery, correlation analyses were performed between the factors and CSVD subtypes: white matter hyperintensity (WMH), lacunar infarcts (LIs), cerebral microbleeds (CMBs), perivascular spaces, and cortical atrophy. Results: Among the 465 recruited patients, 139 underwent a full neuropsychological test battery. Through factor analysis, the following three factors were extracted: executive function, memory, and attention. Of the CSVD features, total WMH was correlated with executive function and memory, whereas deep WMH was correlated with memory alone. Of the CSVD subtypes, LIs and CMBs were correlated only with executive function. Frontal and posterior atrophy were correlated with memory and attention, whereas medial temporal atrophy was correlated with memory alone. Conclusions: Executive dysfunction accompanied by subtle impairment of memory and processing speed was the main feature of neuropsychological profiles in the subjects with CSVD, even in the very early stage. Furthermore, each CSVD feature and focal cerebral atrophy are associated with cognitive impairment.

12-item version of Boston Naming Test: usefulness in the diagnosis of primary progressive aphasia, frontotemporal dementia, and Alzheimer's disease.

ABSTRACT.The 12-item version of the Boston Naming Test (BNT) was adapted to Argentina for the detection of dementia due to Alzheimer's disease (AD), with scores similar to the original 60-item version (sensitivity and specificity of 85 and 94%, respectively) without demographic influence (age and educational level). To date, no publications on the use of abbreviated BNT in other degenerative pathologies with language impairment have been reported.Objective:The objective of this study was to evaluate the usefulness of 12-item BNT in primary progressive aphasia (PPA), the behavioral variant of frontotemporal dementia (FTDbv), and AD.Methods:Notably, 47 patients with probable AD (NIA-AA 2011) — clinical dementia rating (CDR) 0.5–1, 55 with FTDbv, 17 with PPA, and 46 controls were evaluated and matched for age and education. Exclusion criteria were as follows: alcoholism, other previous neurological or psychiatric illnesses, and education <4 years. All were assessed with a full neuropsychological battery and a 12-item version of BNT.Results:Median scores of 12-item BNT were as follows: PPA: 3.87 (SD=2.99), AD: 6.13 (SD=3.03); FTDbv: 8.41 (SD=2.53); and controls: 10.22 (SD=1.82). Receiver Operating Characteristic (ROC) curves were plotted.Conclusions:The 12-item version of BNT can be useful, simple, and fast to identify and differentiate PPA, FTDbv, and AD from controls while retaining the discriminative ability of the original version.

Differential cognitive correlates of tau and neurofilament light chain in cerebrospinal fluid of frontotemporal lobar degeneration patients with and without Alzheimer’s markers

AbstractBackgroundFrontotemporal lobar degeneration (FTLD) phenotypes can be associated with Alzheimer’s disease (AD). It is unknown whether differences exist in relationship between markers of degeneration such as tau and neurofilament light chain (NFL) and cognition between FTLD with and without AD.Method40 FTLD patients were included in this study: (A) 31 FTLD without AD [5 behavioral variant FTD, 11 corticobasal syndrome (CBS), 1 non‐fluent variant primary progressive aphasia (nfvPPA), 12 progressive supranuclear palsy (PSP), 2 semantic variant PPA (svPPA); age (67.74±10.28); sex (20M:11F)]; and (B) 9 FTLD positive for AD [6 CBS‐AD, 1 nfvPPA‐AD, 1 PSP‐AD, 1 svPPA‐AD; age (66±8.46); sex (5M:4F)]. CSF levels of Aβ42, phosphorylated tau (p‐tau) &amp; total tau (t‐tau) were measured using sandwich ELISA and AD pathology was deemed present if p‐tau &gt; 68 pg/mL and Aβ42 to t‐tau index &lt; 0.8. CSF NFL was measured using SIMOA. Full neuropsychological battery was completed, controlled for age/education.ResultIn the FTLD cohort, significant relationships were observed between CSF t‐tau and CDR sum of boxes (r=0.599, p=.001) and MOCA (r=‐0.530, p=.004). In FTLD group, digit span backwards (DSB) was significantly associated with CSF t‐tau (r=‐0.492, p=.009) &amp; NFL (r=‐0.427, p=.02); while verbal fluency, Trail Making Test part A &amp; digit span forward (DSF) were only related to NFL (r=‐0.410, p=.03; r=0.463, p=.02; r=‐0.374, p=.05, respectively). In the FTLD‐AD cohort, MOCA was significantly associated with CSF p‐tau (r=‐1.00, p&lt;.0001) &amp; t‐tau (r=‐0.887, p=.02); memory and executive function tests including California verbal learning test 30s recall, DSB &amp; DSF were significantly associated with CSF t‐tau (r=‐0.788, p=.04; r=‐0.836, p=.04; r=‐0.760, p=.07, respectively); while verbal fluency &amp; category fluency were significantly associated with CSF markers of NFL (r=‐0.841, p=.04; r=‐1.00, p&lt;.0001), p‐tau (r=‐0.981, p&lt;.001; r=‐1.00, p&lt;.0001), &amp; t‐tau (r=‐0.984, p&lt;.001; r=‐0.977, p=.004).ConclusionIn both FTLD with and without AD, overall severity was related to CSF t‐tau but executive function in FTLD without AD was related to CSF NFL while in FTLD‐AD it was related to p‐tau and t‐tau. The presence of AD in FTLD phenotypes alters relationship to NFL, which may be indicative of differences in extent of degeneration.

Empirically derived composite cognitive test scores to predict preclinical and clinical stages of Alzheimer’s disease

AbstractBackgroundAlzheimer’s disease (AD) clinical trials require cognitive test scores that assess change in cognitive function accurately. Here, we propose new composite cognitive test scores to detect earlier stages of AD accurately by using the full neuropsychological testing battery (in ADNI) and a manifold learning dimension reduction technique namely UMAP.MethodData for this study included N=1585 ADNI participants ([492 cognitively normal (CN), 804 mild cognitively impaired (MCI), 289 AD; aged 73.8±7.1; 708 females]; Table 1). Subjects with 3 or more follow‐up sessions were included. Cognitive test scores with more than 60% missing data were excluded. Missing data within included test scores were imputed using the MissForest algorithm. A linear mixed model using all follow‐up data was applied to calculate the random slope (rate of change) and random intercept for each cognitive score and for each subject. The scores and demographic measurements: age, gender, years of education and APOE‐ɛ4 status were used to inform the UMAP. Levels for the output variable were defined as: 1) stable CN, 2) CN who progressed to MCI or probable dementia due to AD, 3) stable MCI, 4) MCI who progressed to dementia AD and 5) dementia due to AD. The model calculated two composite scores. These cognitive stages were predicted using Support Vector Machine (SVM) analysis of both the new composite scores and the traditional clinical rating measures of Clinical Dementia Rating (CDR) and Mini‐Mental State Examination (MMSE).ResultPredicting cognitive stages using the proposed composite scores show a highly significant improvement with a 0.981 accuracy and 0.976 reliability (evaluated by Cohen's kappa coefficient), compared to using the combination of CDR and MMSE scores covaried for demographics, which had 0.660 accuracy and 0.567 reliability. Individuals’ clinical and preclinical stages with regards to UMAP two‐dimensional embedding and the clinical rating measures, CDR and MMSE, are presented in Figure 1. Table 2 reports the importance of the test measures on the UMAP components used in AD staging predictions.ConclusionThe results here suggest that the proposed empirically derived composite cognitive test scores provides a practical solution to differentiate cognitive stages with a high accuracy and reliability.

Virtual Reality-Based Early Neurocognitive Stimulation in Critically Ill Patients: A Pilot Randomized Clinical Trial.

This study focuses on the application of a non-immersive virtual reality (VR)-based neurocognitive intervention in critically ill patients. Our aim was to assess the feasibility of direct outcome measures to detect the impact of this digital therapy on patients’ cognitive and emotional outcomes. Seventy-two mechanically ventilated adult patients were randomly assigned to the “treatment as usual” (TAU, n = 38) or the “early neurocognitive stimulation” (ENRIC, n = 34) groups. All patients received standard intensive care unit (ICU) care. Patients in the ENRIC group also received adjuvant neurocognitive stimulation during the ICU stay. Outcome measures were a full neuropsychological battery and two mental health questionnaires. A total of 42 patients (21 ENRIC) completed assessment one month after ICU discharge, and 24 (10 ENRIC) one year later. At one-month follow-up, ENRIC patients had better working memory scores (p = 0.009, d = 0.363) and showed up to 50% less non-specific anxiety (11.8% vs. 21.1%) and depression (5.9% vs. 10.5%) than TAU patients. A general linear model of repeated measures reported a main effect of group, but not of time or group–time interaction, on working memory, with ENRIC patients outperforming TAU patients (p = 0.008, ηp2 = 0.282). Our results suggest that non-immersive VR-based neurocognitive stimulation may help improve short-term working memory outcomes in survivors of critical illness. Moreover, this advantage could be maintained in the long term. An efficacy trial in a larger sample of participants is feasible and must be conducted.

A-21 Neuropsychological Differentiation of Dementia with Lewy Bodies and Parkinson’s Disease Dementia

Abstract Objective To determine whether or not distinct neuropsychological profiles could be created to aid in earlier detection in Dementia with Lewy Bodies (DLB) and Parkinson’s Disease Dementia (PDD). Data Selection A literature review was conducted informally to search for articles pertaining to neuropsychological testing with individuals with DLB or PDD that were dated within the past fifteen years. Data Synthesis Results indicated DLB typically has greater impairment in executive functioning, visuospatial, and attention in comparison to PDD. More specifically, individuals with DLB had significantly worse results on the Rey Complex Figure Test Copy Trial and Digit Span Forward than individuals with PDD. PDD was shown to typically have greater impairment in motor symptoms in comparison to DLB. These impairments, however, depend on the severity of disease progression. Conclusions In conclusion, DLB and PDD have very similar neuropsychological deficits, with greater deficits observed in executive functioning, visuospatial, and attention for individuals with DLB. Overall, majority of the literature is unsure of concrete diagnostic criteria for both individuals with DLB and PDD. This inconsistency has led the comparison of overall research to also been quite difficult as well. Future studies should try to control for medication and comorbidities, as well as include larger and more diverse samples with a full neuropsychological battery to include all domains of functioning. By doing this, the focus will shift more to on early detection and prevention of DLB and PDD and therefore reduce the financial burden of a neurocognitive disorder and the strain of caregiving that is usually placed within on the family.

Cognitive profile and mild cognitive impairment in people with chronic lower back pain

A growing body of evidence suggests Chronic Lower Back Pain (CLBP) is associated with cognitive dysfunction. Little is known, however, about the extent of cognitive impairment in CLBP. The present study explored the cognitive profile of people with CLBP and sought to determine the extent of Mild Cognitive Impairment (MCI) according to the DSM-V and the Movement Disorders Society criteria for MCI. Thirty-one participants with CLBP and 27 age and gender matched healthy controls completed a full neuropsychological battery, consisting of two tasks for each of the five cognitive domains (Executive Function, Attention/Working Memory, Memory, Language, and Visuospatial). Participants with CLBP performed worse, compared to controls, on measures of Attention/Working Memory, Memory, Language, and Visuospatial performance. Cognitive performance in CLBP was also compared to equivalent normative data to determine cognitive impairment. Sixteen CLBP participants were impaired on at least one cognitive measure, with 5 participants meeting criteria for MCI. MCI was not associated with pain-related experience, or psychological health. The present study supports and extends previous findings that CLBP is associated with cognitive dysfunction and some people with CLBP meet criteria for MCI. These findings support that rehabilitation in people with CLBP requires a multidisciplinary approach.

Cognitive, community functioning and clinical correlates of the Clinical Assessment Interview for Negative Symptoms (CAINS) in psychotic disorders

Negative symptoms are a core dimension of schizophrenia and other psychoses that account for a large degree of the poor functional outcomes related to these disorders. Newer assessment scales for negative symptoms, such as the Clinical Assessment Interview for Negative Symptoms (CAINS), provide evidence for separate dimensions of motivational and pleasure (MAP) and expression (EXP) dimensions. This study was aimed at extending the analysis of the clinical, functional and cognitive correlates of CAINS dimensions in a sample of patients with psychotic disorders (n = 98) and 50 healthy controls.A psychopathological evaluation was conducted by using the Comprehensive Assessment of Symptoms and History (CASH). To assess the extrapyramidal signs, the UKU scale was used. Community functioning was evaluated by means of real-world and functional attainment measures. Additionally, a full neuropsychological test battery was administered. Pearson correlation and hierarchical multiple linear regression analyses were performed to identify the influencing and predictive factors associated with the CAINS dimensions.The MAP and EXP dimensions showed strong associations with the Scale for the Assessment of Negative Symptoms (SANS) items and were not significantly associated with extra-pyramidal or cognitive deficits. The MAP and EXP CAINS dimensions revealed good predictive validity for real-world functioning and functional attainment measures.These findings suggest that the CAINS scale endorses good convergent validity for the assessment of negative symptoms and is very useful in the prediction of psychosocial functioning. In addition, the CAINS dimensions might provide advantages over old assessment scales on disentangling the complex associations between negative symptoms and cognitive impairment.

A-053 Importance of Neuropsychological Assessment in a Patient with DiGeorge Syndrome

Abstract Objective 22q11.2 Deletion Syndrome, (DiGeorge Syndrome), is a genetic disorder which commonly causes heart defects, a submucosal cleft palate, and other health conditions, in addition to developmental delays. Individuals with DiGeorge Syndrome are more likely to have Attention-Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), with research also supporting a high risk for developing schizophrenia in adulthood. Method In this case study, a 22-year-old woman presented with DiGeorge Syndrome and trunkus arteriosus at the Department of Human Services (DHS) for employment services. Additionally, the patient’s parents reported concerns about behavioral outbursts and emotional regulation difficulties for the last three years. The patient completed a full neuropsychological, cognitive, and emotional assessment battery to help understand any neurocognitive and psychological limitations in obtaining and maintaining employment. Results On neurocognitive testing, she performed in the Severely Impaired range on measures of attention, processing speed, working memory, verbal memory, visual memory, visuospatial ability, motor functioning, and nonverbal problem solving. While performing in the Moderately Impaired range for tactile memory, verbal fluency, and cognitive flexibility. However, the patient exhibited a personal strength on the Verbal Comprehension Index of the Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV). On emotional functioning testing, she did not display early signs of schizophrenia nor psychosis. However, the patient did express emotional and behavioral signs of ADHD and ASD. Conclusion This case study emphasizes the need for neuropsychological testing and ongoing psychological monitoring for individuals with DiGeorge Syndrome, as it relates to treatment recommendations and planning.

A-047 Examining the relationship between Learning Diagnoses and Social Skills Deficit subscales within the Personality Inventory for Children, Second Edition

Abstract Objective The present study examined the relationship between the Social Skills Deficit (SSD) subscales obtained on the Personality Inventory for Children, second edition (PIC-2), and diagnoses of three major Learning Disorders (LD) of Math, Reading, and Writing. Method Participants in the present study consisted of 523 children from a mixed clinical sample who were between the ages of 3 to 17 years (M = 9.897, SD = 3.130). Participants were referred to a south Florida neuropsychology community assessment center and completed a full neuropsychological battery. Males composed 64% of the sample. Measures included SSD subscales, limited peer status and conflict with peers, within the PIC-2. Results To evaluate the relationship between scores on SSD subscales from the PIC-2 on three LD diagnoses, a Pearson Correlation with 2-tailed significance was used. Limited peer status was significantly correlated with a LD of Reading (r = −.160, p = .001) and Writing (r = −.160, p = .001). Additionally, conflict with peers was significant correlated with a LD of Reading (r = −.139, p = .001) and Writing (r = −.125, p = .004). There were no SSD subscales that were significantly correlated with a diagnosis of LD of Math. Conclusion From these results, the SSD subscale had the strongest correlation with diagnosis of a LD of Reading followed by LD of Writing. This study explicates the issue of reduced language-based skills and its impact on social skills. Due to the association between reading and writing and social skills, academic intervention should also include social skills training to increased peer interactions and reduce peer conflict.

APOE ϵ4 modifies the relationship between infectious burden and poor cognition.

ObjectiveWe investigated whether APOE ϵ4 is an effect modifier of the association between infectious burden (IB) and poor cognition in a multiethnic cohort, the Northern Manhattan Study.MethodsIB was assessed by a quantitative weighted index of exposure to common pathogens associated with vascular risk, infectious burden index (IBI), and by serology for individual infections. Cognition was assessed by completion of the Mini-Mental State Examination at baseline and a full neuropsychological test battery after a median follow-up of approximately 6 years. Adjusted linear and logistic regressions estimated the association between IBI and cognition, with a term included for the interaction between APOE ϵ4 and IBI.ResultsAmong those with full neuropsychological test results (n = 569), there were interactions between IBI and APOE ϵ4 (p = 0.07) and herpes simplex virus 1 (HSV-1) and APOE ϵ4 (p = 0.02) for processing speed. IBI was associated with slower processing speed among non–ϵ4 carriers (β = −0.08 per SD change in IBI, 95% confidence interval [CI] −0.16 to −0.01), but not among APOE ϵ4 carriers (β = 0.06 per SD change in IBI, 95% CI –0.08 to 0.19). HSV-1 positivity was associated with slower processing speed among non–ϵ4 carriers (β = −0.24, 95% CI −0.45 to −0.03), but not among APOE ϵ4 carriers (β = 0.27, 95% CI −0.09 to 0.64).ConclusionsPotential effect modification by the APOE ϵ4 allele on the relationship of infection, and particularly viral infection, to cognitive processing speed warrants further investigation.

Developing a Brief Neuropsychological Battery for Early Diagnosis of Cognitive Impairment

ObjectivesEarly diagnosis of cognitive impairment is increasingly emphasized in the literature to facilitate timely preventive interventions. Although bedside cognitive tests such as the Montreal Cognitive Assessment (MoCA) are widely used for such early diagnostic purposes, they may not have comparable performance to a full neuropsychological battery (FNB) in diagnosing early cognitive impairment. This study investigated whether a small subset of neuropsychological tests can be added on to MoCA to match its performance to that of the FNB in discriminating mild cognitive impairment and dementia (MCI/dementia) from normal cognition. DesignCross-sectional diagnostic study. SettingAlzheimer's Disease Centers across the United States. ParticipantsOlder participants (≥50 years) who completed MoCA and the FNB (N = 9187). MeasuresThe study sample was split into two: the derivation sample (n = 1837) was used to develop a brief neuropsychological battery that best discriminated MCI/dementia (using the best-subset approach with 10-fold cross-validation); while the validation sample (n = 7350) verified its actual performance in discriminating MCI/dementia. ResultsA 3-item neuropsychological battery was identified, comprising MoCA, Benson Complex Figure Recall, and Craft Story 21 Delayed Recall. It had excellent performance in discriminating MCI/dementia from normal cognition (area under the receiver operating characteristic curve [AUROC] 90.0%, 95% confidence interval [CI] 89.2%-90.7%), which was comparable to that of the FNB (AUROC 88.4%, 95% CI 87.6%-89.2%). By contrast, MoCA alone had significantly worse AUROC (86.9%, 95% CI 86.0%-87.7%) than that of the FNB. Conclusions/ImplicationsUsing rigorous methods, this study developed a brief neuropsychological battery that maintained the brevity of a bedside cognitive test, while rivaling the diagnostic performance of an FNB in early cognitive impairment. This brief battery offers a viable alternative when the FNB is needed but cannot be feasibly administered in nonspecialty clinics. It can have a wider health systems effect of improving patients’ access to accurate diagnosis in early cognitive impairment and facilitating timely interventions to delay the progression of cognitive impairment.

Accounting for ethnic-cultural and linguistic diversity in neuropsychological assessment of patients with drug-resistant epilepsy: A retrospective study.

Neuropsychological assessment is critical in both diagnosis and prognosis of patients with epilepsy. Beyond electrophysiological and anatomical alterations, other factors including different ethnic-cultural and linguistic backgrounds might affect neuropsychological performance. Only a few studies considered migration and acculturation effects and they typically concerned nonclinical samples. The current study aimed at investigating the influence of ethnic background and time spent in Italy on a full neuropsychological battery administered to both Italian and foreign-born patients and at providing a brief interview for obtaining relevant information on each patient's transcultural and language-related history. Clinical reports from 43 foreign-born patients with drug-resistant epilepsy were collected from the archives of Milan Niguarda Hospital. Epileptogenic zone, age, education, profession, illness duration, seizure frequency, handedness, and gender were considered in selecting 43 Italian controls. Ethnicity (Italian/foreign-born) and years spent in Italy were analyzed as main predictors on 21 neuropsychological scales by means of General(ized) Linear Models. An additional analysis studied two composite scores of overall verbal and nonverbal abilities. Ethnicity significantly affected the following: the verbal overall score, Verbal Fluency, Naming, Token-test, Digit Span, Attentional Matrices, Trail-Making-Test, Line-Orientation-Test, and Raven matrices; no effects were found on the nonverbal overall score, Word Pairs Learning, Episodic Memory, reading accuracy, visual span, Bells test, Rey Figure, and face memory and recognition. No significant effects of years spent in Italy emerged. While years spent in Italy does not predict neuropsychological performance, linguistic background had a strong impact on it. With respect to Italian-speaking patients, those who were foreign-born showed large task-related variability, with an especially low performance on language-related tests. Hence, language tests should not be considered as valid measures of neuropsychological impairment in this population, not even in foreign-born patients with good Italian fluency. Clinicians should consider such asymmetries in order to improve the accuracy of neuropsychological assessment of foreign-born patients.

2.64 AN ANALYSIS OF THE RELATIONSHIP BETWEEN EXECUTIVE FUNCTIONING AND RISK-TAKING BEHAVIOR IN HOMELESS YOUTH

Very few studies have investigated executive function (EF) in homeless youth, and those that have studied EF typically used a limited number of subjects and assessment options. By use of a sample group larger than any in the current literature and a full neuropsychological battery, this study examined the relationship between components of EF and engagement in risk-taking behaviors among shelter-living urban homeless youth.

Preliminary study of a novel cognitive assessment device for the evaluation of HIV-associated neurocognitive impairment.

Given the high prevalence of HIV-associated neurocognitive disorders (HAND), we examined the performance of a novel computerized cognitive assessment device (NCAD) for the evaluation of neurocognitive impairment in the setting of HIV. In addition to a standard 8-test neuropsychological battery, each participant underwent testing with the NCAD, which requires approximately 20min and has been shown to accurately measure neurocognition in elderly individuals. The NCAD yields seven subtest scores in addition to an overall predictive score that is calculated based on subtest results. Thirty-nine HIV-infected participants were included in this study; the majority of which (71.8%) had undetectable plasma HIV RNA levels and a history of significant immunocompromise (median nadir CD4+ count 34 cells/μl). The mean composite neuropsychological score (NPT-8) was 46.07, and mean global deficit score (GDS) was 0.59. NCAD total subtest accuracy correlated significantly with NPT-8 (Pearson correlation r = 0.59, p < 0.0001) as well as GDS (Spearman's rho = -0.36, p = 0.02). NCAD predictive score also correlated significantly with NPT-8 (Spearman's rho = -0.5601, p = 0.0016) and GDS (Spearman's rho = 0.45, p = 0.0144). When using the most recent nosology of HAND criteria for neurocognitive impairment, the area under the curve (AUC) for NCAD total subtest accuracy was 0.7562 (p = 0.012), while the AUC for the HIV dementia scale was 0.508 (p = 0.930). While not as comprehensive as a full neuropsychological battery, the NCAD shows promise as a rapid screening tool for HIV-infected individuals, and additional research of this device is indicated.