Measures Of Cognitive Function Research Articles

Sensor-Derived Measures of Motor and Cognitive Functions in People With Multiple Sclerosis Using Unsupervised Smartphone-Based Assessments: Proof-of-Concept Study

Background Smartphones and wearables are revolutionizing the assessment of cognitive and motor function in neurological disorders, allowing for objective, frequent, and remote data collection. However, these assessments typically provide a plethora of sensor-derived measures (SDMs), and selecting the most suitable measure for a given context of use is a challenging, often overlooked problem. Objective This analysis aims to develop and apply an SDM selection framework, including automated data quality checks and the evaluation of statistical properties, to identify robust SDMs that describe the cognitive and motor function of people with multiple sclerosis (MS). Methods The proposed framework was applied to data from a cross-sectional study involving 85 people with MS and 68 healthy participants who underwent in-clinic supervised and remote unsupervised smartphone-based assessments. The assessment provided high-quality recordings from cognitive, manual dexterity, and mobility tests, from which 47 SDMs, based on established literature, were extracted using previously developed and publicly available algorithms. These SDMs were first separately and then jointly screened for bias and normality by 2 expert assessors. Selected SDMs were then analyzed to establish their reliability, using an intraclass correlation coefficient and minimal detectable change at 95% CI. The convergence of selected SDMs with in-clinic MS functional measures and patient-reported outcomes was also evaluated. Results A total of 16 (34%) of the 47 SDMs passed the selection framework. All selected SDMs demonstrated moderate-to-good reliability in remote settings (intraclass correlation coefficient 0.5-0.85; minimal detectable change at 95% CI 19%-35%). Selected SDMs extracted from the smartphone-based cognitive test demonstrated good-to-excellent correlation (Spearman correlation coefficient, |ρ|>0.75) with the in-clinic Symbol Digit Modalities Test and fair correlation with Expanded Disability Status Scale (EDSS) scores (0.25≤|ρ|<0.5). SDMs extracted from the manual dexterity tests showed either fair correlation (0.25≤|ρ|<0.5) or were not correlated (|ρ|<0.25) with the in-clinic 9-hole peg test and EDSS scores. Most selected SDMs from mobility tests showed fair correlation with the in-clinic timed 25-foot walk test and fair to moderate-to-good correlation (0.5<|ρ|≤0.75) with EDSS scores. SDM correlations with relevant patient-reported outcomes varied by functional domain, ranging from not correlated (cognitive test SDMs) to good-to-excellent correlation (|ρ|>0.75) for mobility test SDMs. Overall, correlations were similar when smartphone-based tests were performed in a clinic or remotely. Conclusions Reported results highlight that smartphone-based assessments are suitable tools to remotely obtain high-quality SDMs of cognitive and motor function in people with MS. The presented SDM selection framework promises to increase the interpretability and standardization of smartphone-based SDMs in people with MS, paving the way for their future use in interventional trials.

Introduction and preliminary psychometric evaluation of the assessment of functional capacity interview for older adults

Measures of complex functional decision-making capacity can greatly aid in assessing mild cognitive impairment (MCI) and facilitating early intervention in dementia care. We examined the ability of the Assessment of Functional Capacity Interview (AFCI) to detect functional differences among older adults who were cognitively unimpaired (CU), or who presented with subjective cognitive decline (SCD) or MCI. A sample of 97 older adults (CU; n = 30, Mage = 74.64 ± 7.42 years; SCD; n = 34, Mage = 72.56 ± 6.43 years; MCI; n = 33, Mage = 78.28 ± 7.55 years) underwent neuropsychological testing and responded to the Financial Capacity Instrument (FCI-SF). Informants completed the Assessment of Functional Capacity (AFCI), an instrument of functional decision-making capacity, and responded to the Social Vulnerability Scale (SVS15) and Amsterdam Instrumental Activity of Daily Living (A-IADL-Q-SV), a measure of functional status, for comparison. According to informant-reported responses, the CU group had significantly lower AFCI total (and domain) scores, H(2) = 27.59, p<.001, relative to MCI. Additionally, the CU group had significantly lower AFCI scores in the Home and Personal Safety domain relative to the SCD group, H(2) = 14.06, p<.05. In the overall sample, AFCI total scores were associated with FCI-SF, SVS15, and A-IADL-Q-SV scores and cognitive measures. Our results demonstrate that the AFCI is sensitive to impairment in safety, social, financial, and medical functioning in MCI and is associated with measures of cognitive functioning and social vulnerability in older adults. Incorporating this instrument as a supplement to cognitive screening instruments may aid in the prevention of hazardous decision-making in older adults.

Cancer-Related Cognitive Impairments (CRCIs) in Non-Central Nervous System Adult Patients: Outcome Measures and Methodology of Assessment: A Literature Review

Background: Cancer-related cognitive impairment (CRCI) represents one of the most common and debilitating effects in patients surviving after cancer treatments. Neurocognitive deficits are important causes of disability and burden in cancer survivors. The true magnitude of CRCI is difficult to define due to significant heterogeneity of literature data. At present, there is no agreement on the gold standard for detection and grading of CRCI in clinical trials, and there is a lack of clear knowledge of its pathophysiology. Objectives: In this review, we aim to discuss some perspectives for future research to pursue in order to cover the gaps in knowledge in the CRCI field. Methods: We focused our literature research on the following relevant issues: neuroradiological correlates of CRCI; objective neuropsychological evaluation and subjective complaint assessment and their correlation with objective measures; timing of assessment; and possible treatments. Results: The correct methodology for evaluating cognitive deficits induced by anti-tumor treatments still requires a definition based on quality scientific evidence, and literature data are currently scarce. Conclusions: This review highlights the need for further research to understand the causes and consequences of cancer-related cognitive impairment using standardized and sensitive measures of cognitive functions and the long-term effects of chemotherapy on cognitive functions and to develop effective interventions.

Interpreting the direct- and derived-Trail Making Test scores in Argentinian children: regression-based norms, convergent validity, test-retest reliability, and practice effects

Objective: We carried out two research studies (using a cross-sectional and a longitudinal design) to establish regression-based normative data, and to examine the convergent validity, the test-retest reliability, and the changes in performance with practice (1-month and 1-year interval) of the direct- and derived- (B-A, B + A, and B/A ratio) Trail Making Test (TMT) scores in Spanish-speaking children. Method: In S1 (n = 413 6- to 15-year-old children and adolescents), regression-based norming procedure and partial correlations were employed. In S2 (n = 110 6- to 12-year-old children), intraclass correlation coefficient (ICC2,1), Pearson’s r-product-moment correlations, and paired t-tests were used. Results: S1 demonstrated that age was associated with better performance on both TMT-A and TMT-B. This improvement was more strongly related to direct scores than derived measures B-A and B/A. Additionally, TMT-B was found to be more related to other executive functions (EF) compared to the performance of TMT-A. Among the derived scores, only the B-A was related primarily to cognitive flexibility, while the B + A index was associated with most EF, suggesting a general measure of cognitive functioning. In S2, fair to good test-retest reliability coefficients were found at Time 2 for TMT-A and TMT-B, as well as the B + A index, both in 6 to 8-year-olds (ICCs .61 to .74) and 9 to 12-year-olds (ICCs .53 to .65). There was a significant increase in performance on TMT-A and TMT-B from the first assessment (Time 1) to the follow-up testing at Time 2 in older children. However, this significant improvement was not observed for TMT-B in the younger group. Test scores on the TMT direct measures improved significantly across 1-year. The B-A and B/A ratio scores did not change across examinations. Conclusions: These findings have important implications for assessing EF and developing interventions that target cognitive flexibility in pediatric populations.

Exploratory Randomised Trial of Tranexamic Acid to Decrease Postoperative Delirium in Adults Undergoing Lumbar Fusion: A trial stopped early.

Postoperative delirium may be mediated by perioperative systemic- and neuro-inflammation. By inhibiting the pro-inflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA, adding measures of postoperative delirium, cognitive function, systemic cytokines, and astrocyte activation. Adults undergoing elective posterior lumbar fusion randomly received intraoperative intravenous TXA (n=43: 10 mg kg -1 loading dose, 2 mg kg -1 h -1 infusion) or Placebo (n=40). Blood was collected pre- and at 24 h post-operatively (n=32) for biomarkers of systemic inflammation (cytokines) and astrocyte activation (S100B). Participants had twice daily delirium assessments using the 3-minute diagnostic interview for Confusion Assessment Method (n=65). Participants underwent 4 measures of cognitive function preoperatively and during post-discharge follow-up. Delirium incidence in the TXA group (7/32=22%) was not significantly less than in the Placebo group (11/33=33%); P =0.408, absolute difference=11%, relative difference=33%, effect size = -0.258 (95% CI -0.744 to 0.229). In the Placebo group (n=16), delirium severity was associated with the number of instrumented vertebral levels ( P =0.001) and with postoperative interleukin -8 and -10 concentrations ( P =0.00008 and P =0.005, respectively) and these associations were not significantly modified by TXA. In the Placebo group, delirium severity was associated with S100B concentration ( P =0.0009) and the strength of the association was decreased by TXA ( P =0.002). A potential 33% relative decrease in postoperative delirium incidence justifies an adequately powered clinical trial to determine if intraoperative TXA decreases delirium in adults undergoing lumbar fusion.

The Moderating Role of Genetics on the Effectiveness of the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR(BC)) Program on Cognitive Impairment.

Genetics may influence symptoms experienced by breast cancer survivors (BCS) by moderating the effects of stress-reducing interventions, including the Mindfulness-Based Stress Reduction (MBSR(BC)) program, to reduce symptom severity. As part of a larger clinical trial, the aim of this study was to evaluate genetic variants as moderators of MBSR(BC) on improvements among BCS in cognitive functioning and symptoms. BCS (n = 128) were randomized to MBSR(BC) or the Breast Cancer Education Support Program. Objective neuropsychological and subjective measures of cognitive performance, and psychological and physical symptoms were collected at baseline, 6, 12, and 26 weeks. Linear mixed models were implemented to identify MBSR(BC)'s effects over time. A total of 22 single nucleotide polymorphisms (SNPs) from 20 genes known to be related to these symptoms were investigated using genomic DNA. These SNPs were tested as moderators of MBSR(BC) program effects. Results showed MBSR(BC) participants experienced significantly greater benefits in cognitive functioning, however, the level of benefit varied based on one's genetic profile. Effects sizes, consistency across similar measures were investigated. Among 22 candidate SNPs, rs4680 in COMT, rs1800497 in ANKK1, and rs6277 in DRD2 demonstrated the strongest, most consistent positive effects in moderating MBSR(BC)'s impact on cognitive outcomes. Although the effects were small, this translational research may potentially identify BCS with genotypes that would be most influenced by the MBSR(BC) program. These results may be used to develop personalized intervention programs tailored to the genetic profile of each breast cancer survivor who received chemotherapy or chemotherapy and radiation. ClinicalTrials.gov, https://www.ClinicalTrials.gov Registration Number: NCT02786797.

Antipsychotic Drugs and Cognitive Function

Cognitive deficits are a substantial part of the symptoms of schizophrenia spectrum disorders (SSDs) and contribute heavily to the burden of disease. Antipsychotic drugs are not cognitive enhancers, but due to their different receptor-binding profiles, they could differ in their effects on cognition. No previous network meta-analysis compared antipsychotics to placebo, which is important to determine whether use of these drugs is associated with cognitive performance in SSDs at all. To determine the association of treatment with various antipsychotics and cognition in patients with SSDs. Cochrane Schizophrenia Trials Register through June 25, 2023. Randomized clinical trials examining the effects on cognition of antipsychotic drugs or placebo in participants with SSD. A systematic review and random-effects frequentist network meta-analysis was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses-Network Meta-analysis reporting guideline. The primary outcome was change in overall cognition score calculated for each study. Secondary outcomes included cognitive domains, quality of life, and functioning. This study included 68 studies involving 9525 participants (mean [SD] age, 35.1 [8.9] years; 5878 male [70%] and 2890 [30%] female; some studies did not provide this information). There were few clear differences between antipsychotics, but first-generation dopamine antagonists haloperidol (standardized mean difference [SMD], 0.04; 95% CI, -0.25 to 0.33) and fluphenazine (SMD, 0.15; 95% CI, -0.39 to 0.69) as well as clozapine (SMD, 0.12; 95% CI, -0.23 to 0.48) ranked low. No individual antipsychotic was associated with a clearly better outcome than placebo, but antipsychotics as a group were, with small effect sizes (mean SMDs: adrenergic/low dopamine, 0.21; serotonergic/dopaminergic, 0.26; muscarinic, 0.28; dopaminergic, 0.40). Although data are relatively sparse, those reviewed in this study suggest that first-generation dopamine antagonists and clozapine should be avoided when cognitive deficits are a concern. Antipsychotics are not procognitive drugs. The overall small superior outcomes compared to placebo may be explained by less disordered thought patterns associated with fewer positive symptoms rather than cognitive deficits in the proper sense. The findings also suggest that harmonizing measurement of cognitive function in randomized clinical trials would be beneficial.

Combined Transcranial Direct Current Stimulation and Pain Neuroscience Education for Chronic Low Back Pain: A Randomized Controlled Trial.

Priming the neural circuity likely targeted by pain neuroscience education (PNE), using transcranial direct current stimulation (tDCS) may enhance the efficacy of PNE. The aim of this study was to compare the effects of active tDCS + PNE to sham tDCS + PNE on measures of pain, pain behaviors, and cognitive function in participants with chronic low back pain (CLBP) and high pain catastrophizing. 20 participants were recruited and randomly allocated into the active tDCS + PNE (n = 10) or sham tDCS + PNE (n = 10) groups. All participants received five sessions of their assigned interventions over a 2-week period. The active tDCS + PNE group received 20 minutes of 2 mA, anodal current applied to the left dorsolateral prefrontal cortex. Within groups, both interventions demonstrated significant improvement in NPRS, PCS, and TSK. The active tDCS + PNE group also demonstrated significant improvement on the SCWT, CTMT2-Inhibitory, and CTMT2-Set Shifting. Between groups, the active tDCS + PNE group showed significantly greater improvement on the PCS, SCWT, and CTMT2-Inhibitory. The results of this pilot study suggest that active tDCS + PNE appeared to provide greater improvement than sham tDCS + PNE on levels of pain catastrophizing and attentional interference in participants with CLBP and high pain catastrophizing, consistent with both interventions targeting brain regions involved in those processes. Considering the differences between groups, tDCS appears to provide a priming effect on PNE.

Investigating DTI-ALPS index and its association with cognitive impairments in patients with alcohol use disorder: A diffusion tensor imaging study

BackgroundThe glymphatic system, a physiological pathway recently identified, has attracted considerable attention for its potential role in the pathophysiology of neurological disorders. Despite significant research efforts, the exact contribution of the glymphatic system to alcohol use disorder (AUD) remains largely elusive. This study was a secondary analysis by analyzing a subset of the original data to examine changes in the ALPS index and determine its association with cognitive abilities in individuals with AUD. MethodsWe recruited 40 individuals with AUD and 40 healthy controls (HC). All subjects underwent MRI scans and clinical cognitive scale assessments. Diffusion tensor imaging along the perivascular space (DTI-ALPS) index was used to estimate the differences in glymphatic activity between both groups, and linear regression analysis was used to examine the association between ALPS index and cognitive performance measures. ResultsA statistically significant difference in the ALPS index was observed between both groups (p < 0.001), with the AUD group showing statistically lower ALPS index compared with the HC group (p < 0.001). Additionally, a positive correlation was identified between the ALPS index and MoCA/MMSE scores, indicating that higher ALPS index is indicative of better cognitive performance in individuals with AUD. ConclusionsThe findings of this study provide evidence of ALPS index in individuals with AUD and establish a link between the ALPS index and the cognitive impairments observed in AUD patients. These findings might suggest the importance of glymphatic activity in the emergence of cognitive deficits among those impacted by AUD, but a stronger link between ALPS index and glymphatic system is needed to better understand the relationship between glymphatic function and healthy outcomes.

A history of traumatic brain injury is associated with poorer cognition and imaging evidence of altered white matter tract integrity in UK Biobank (n = 50 376)

Abstract Traumatic brain injury (TBI) is a risk factor for neurodegenerative disease. We currently have no means to identify patients most at risk of neurodegenerative disease following injury and, resultantly, no means to target risk mitigation interventions. To address this, we explored the association between history of traumatic brain injury with cognitive performance and imaging measures of white matter integrity. From the UK Biobank imaging sub-study (n = 50 376), participants were identified with either self-reported (n = 177) or health record coded broad- (injury codes; n = 1096) or narrow-band (TBI specific codes; n = 274) TBI, or as controls with no such documented history (n = 49 280). Cognitive scores and imaging measures of corpus callosum white matter integrity were compared between injury participants (versus no injury), corrected for age, sex, socioeconomic status and medications. TBI was associated with poorer cognitive and imaging phenotypes. The strongest deleterious associations were for narrow-band injury (β difference 0.2–0.3; P &amp;lt; 0.01). All cognitive and imaging phenotypes were strongly inter-correlated (P &amp;lt; 0.001). This study provides insight into possible early biomarkers predating neurodegenerative disease following brain injury. Measures of cognition and white matter following injury may provide means to identify individuals most at risk of neurodegenerative disease, to which mitigation strategies might be targeted.

Atlas-Based Structural Disconnectomes Are Associated with Cognitive Performance in Brain Tumors.

Background: Brain tumors are associated with impaired cognitive functioning, which may result from disruptions in brain structural connectivity. Estimating structural disconnections is a more advantageous representation of tumor impact and can be performed indirectly through normative brain atlases. Materials and Methods: Using a publicly available dataset of glioma and meningioma patient MRI scans and tumor masks, latent correlations were estimated between measures of structural disconnection and attention-based cognitive functioning. These measures included gray matter (GM) parcel damage, white matter tract damage, GM parcel-to-parcel disconnections, and reaction time (RTI) as part of the Cambridge Neuropsychological Test Automated Battery to assess attention. Results: Preprocessing pipelines with two different methods of minimizing the pathology impact on MRI normalization were utilized: cost-function masking and lesion filling. The results across both pipelines were nearly consistent, with significant correlations mainly found between RTI measures and the damage to the left inferior fronto-occipital and uncinate fasciculus, as well as the left prefrontal-visual disconnections. Conclusions: This alludes to the importance of left-hemispheric prefrontal-visual coupling in attention-based tasks, particularly those involving object- and feature-based attention.

Associations Between Cognitive Performance and Self-Efficacy for Pain Management in Older Adults With Chronic Pain

BackgroundSelf-efficacy for pain management is the key to successful pain management, yet little is known about the effect of cognitive performance on self-efficacy for pain management. This study aimed to examine to what extent cognitive performance is related to self-efficacy for pain management in older adults with chronic pain. MethodsThe analyses utilized data from the baseline assessment of the MOBILIZE Boston Study. Five neuropsychological tests—the Clock in the Box Test, Letter Fluency Test, Trail-making Test, Hopkins Verbal Learning Test, and WORLD Test—were performed to measure the cognitive performance domains of 458 participants, aged 70 years and reporting chronic pain and self-efficacy for pain management. We measured self-efficacy for pain management using the Chronic Pain Self-Efficacy Scale. Statistical analyses were done using multiple linear regression analysis. ResultsAfter adjusting for sociodemographic factors, general cognitive performance, executive function, as measured by the Clock in the Box Test, and attention, as measured by the Trail-Making Test Part A, were significantly associated with self-efficacy for pain management in older adults with chronic pain. However, after controlling for sociodemographic factors, chronic conditions, pain interference, and physical performance, the associations between cognitive performance measures and self-efficacy for pain management weakened. ConclusionGreater cognitive performance in attention and executive function might be associated with better self-efficacy for pain management. Future longitudinal research is required to investigate the long-term implications of cognitive performance changes on the progress of self-efficacy for pain management in community-dwelling older adults.

The Impact of Using Standardized Autism Screening on Referral to Specialist Evaluation for Young Children on the Autism Spectrum: A Cluster-Randomized Controlled Trial

We tested whether the implementation of standardized, high-fidelity screening for autism during routine well-child check-ups results in the following: increasing the number of children with suspected autism referred to diagnostic evaluation; lowering the age at which they are referred; and facilitating autism diagnosis for children across a more diverse range of demographic backgrounds and clinical presentations, including those with subtle manifestations. As part of a multi-site cluster randomized trial, pediatric practices were randomly assigned to an experimental condition involving training and supervision in the universal, standardized, high-fidelity implementation of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), or a usual care condition. Children in both conditions identified as having a high likelihood of autism during well-child visits were referred to a diagnostic evaluation conducted by clinicians naive to referral source. Children referred to the diagnostic evaluation from the practices in the experimental condition were more numerous (n= 186) and younger (mean age= 20.65 months) than those referred from the practices in the usual care condition (n= 39; mean age= 23.58 months). Children referred by experimental practices who received an autism diagnosis had milder clinical presentations across measures of cognitive, language, adaptive, and social-communication functioning, compared to those referred from usual care practices. Demographic characteristics were similar across groups. Standardized, high-fidelity implementation of autism screening during pediatric well-child visits facilitates the identification of children with high autism likelihood at a younger age, including those presenting with more subtle clinical manifestations. Promoting Positive Outcomes for Individuals With ASD: Linking Early Detection, Treatment, and Long-term Outcomes; https://clinicaltrials.gov/; NCT03333629.

Linking social determinants of health to mental health, movement behaviors, and cognitive function among U.S. youth

BackgroundFew studies have focused on a comprehensive view of social determinants of health (SDOH) domains as influences on the health of young people. This study aimed to investigate the associations between the Healthy people 2030 SDOH-related domains (i.e., economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context) with mental health, movement behaviors, and cognitive function among U.S. youth. MethodsThis cross-sectional study used nationally representative data from the 2020–2021 National Survey of Children's Health, covering 54,595 youth aged 6–17 years. The associations of indicators of SDOH-related domains with mental health (depression and anxiety), movement behaviors (physical activity and screen-based sedentary behavior), and cognitive function were estimated using multivariable logistic regression models, adjusting for age, sex, and race. ResultsEconomic stability, education access and quality, health care access and quality, and social and community context were associated with at least one outcome measure of mental health, movement behaviors, and cognitive function, while neighborhood and built environment was associated with mental health and movement behaviors. The social and community context domain stood out, with friendship difficulty and household-based adverse childhood experiences being associated with poorer outcomes on most health indicators. ConclusionAll five SDOH-related domains are related to aspects of youth health, with the social and community context domain showing the most associations, highlighting the need for interventions to improve social connection and address adverse childhood experiences, which may be more impactful in ameliorating many health-related challenges.

The effect of fruits and vegetables on children's mental and cognitive health: A systematic review of intervention studies and perspective for future research.

ObjectiveTo synthesize evidence from fruit and vegetable intervention studies investigating mental and/or cognitive health outcomes in children ≤10 years. Our aim was to understand the efficacy of such interventions in improving measures of cognitive performance or mental health, and to identify successful intervention elements to inform future research. Research MethodsWe conducted a systematic search of Cochrane, Embase, PubMed, and CINAHL databases for articles published before August 2022 (PROSPERO registration: CRD42022356571). A narrative synthesis was conducted according to SWiM (Synthesis without Meta-Analysis) guidelines. ResultsFrom 4686 articles identified, only 7 of the 17 full texts screened were included in the final review. No studies investigated the efficacy of interventions using ‘whole’ fruits or vegetables. Six studies examined the effects of blueberries using drinks made from fresh (1 cup) or freeze-dried (30g) blueberries, and one study evaluated a mulberry powder-based drink. Sample sizes ranged from 14-54, and most studies were acute interventions with outcomes measured in a 2–3-hour window (n=6). Through a narrative synthesis of direction of responses, measures of executive function appeared sensitive to intervention effects in both acute and longer-term settings. Some concerns with risk of bias were evident according to the ROB2 tool, related to incomplete reporting of methodological aspects. ConclusionsThe studies identified through this systematic review could not directly address the planned research question, resulting in a poor certainty of evidence. Future research with whole fruit and vegetable interventions could better inform population health strategies for improved mental and cognitive health outcomes in children.

1.4 Development of Webcam-Collected and Artificial-Intelligence–Derived Social and Cognitive Performance Measures for Neurodevelopmental and Neurogenetic Conditions

1.4 Development of Webcam-Collected and Artificial-Intelligence–Derived Social and Cognitive Performance Measures for Neurodevelopmental and Neurogenetic Conditions

Concurrent Validity of Performance-Based Measures of Daily Functioning with Cognitive Measures and Informant Reported Everyday Functioning.

Despite the substantial need for reliable and valid assessment of functional ability in older adults, there is currently limited research on the emergence of early functional declines during prodromal dementia stages, such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This study uses novel performance-based assessments to characterize subtle, yet clinically meaningful, changes in functional ability. A sample of 93 older adults classified as cognitively unimpaired (CU; n = 30, Mage = 73.57 ± 6.66), SCD (n = 34, Mage = 72.56 ± 6.43), or MCI (n = 29, Mage = 78.28 ± 7.55) underwent neuropsychological testing along with an informant-rated daily functional skills measure (Assessment of Functional Capacity Interview). Participants also completed the Night Out Task (NOT), an open-ended performance-based measure of functional assessment, and the Financial Capacity Instrument-Short Form (FCI-SF) that assesses financial skills. The MCI group performed worse on the NOT and FCI-SF relative to SCD and CU. NOT and FCI scores were associated with measures of global cognitive function, executive function, processing speed, language and memory, and FCI-SF overall score was correlated with informant-rated functional ability. The NOT and FCI-SF were also predictive of informant-reported daily functioning over and above traditional cognitive data and demographics. Performance-based measures of IADL may allow for earlier detection of subtle functional changes that might not be adequately captured by traditional measures. The measurement of early functional changes is an important global outcome to evaluate the efficacy of interventions in dementia research.

Cross-Validation of the Financial Exploitation Vulnerability Scale

ABSTRACT Objectives The present study is a cross-validation of the Financial Exploitation Vulnerability Scale (FEVS), a measure of contextual risk for financial exploitation. Methods The sample was drawn from both the community and the SAFE program, a service for older adults who have been financially scammed. FEVS was administered within a larger assessment battery. The total score ability to differentiate exploitation groups and its correlates were examined. ROC analysis and logistic regression evaluated the clinical utility of the FEVS to detect exploitation. Results were compared to the initial validation study. Results FEVS score was significantly higher for those who were exploited and correlated with age. ROC analysis revealed adequate detection of financial exploitation. FEVS total score remained a strong predictor of exploitation when compared to demographic factors and several measures of cognitive functioning. Conclusions Cross-validation demonstrates strong evidence that the FEVS detects financial exploitation in older adults, beyond the ability of many known risk factors. Clinical Implications FEVS is an evidence-based tool for identifying exploitation and is accessible to many professionals working with older adults. Items query contextual factors that allow professionals to support clients with the appropriate standard of care.

Deprescribing of Antihypertensive Medications and Cognitive Function in Nursing Home Residents

Antihypertensive medication deprescribing is common among nursing home residents, yet its association with cognitive decline remains uncertain. To investigate the association of deprescribing antihypertensive medication with changes in cognitive function in nursing home residents. This cohort study using a target trial emulation approach included VA long-term care residents aged 65 years or older with stays of at least 12 weeks from 2006 to 2019. Residents who were not prescribed antihypertensive medication, with blood pressure greater than 160/90 mm Hg, or with heart failure were excluded. Eligible residents with stable medication use for 4 weeks were classified into deprescribing or stable user groups and followed for 2 years or until death or discharge for intention-to-treat (ITT) analysis. Participants switching treatment groups were censored in the per-protocol analysis. Cognitive function measurements during follow-up were analyzed using an ordinal generalized linear mixed model, adjusting for confounders with inverse probability of treatment weighting. Per-protocol analysis included inverse probability of censoring weighting. Data analyses were performed from May 1, 2023, and July 1, 2024. Deprescribing was defined as a reduction in the total number of antihypertensive medications or a decrease in medication dosage by 30%, sustained for a minimum of 2 weeks. Cognitive Function Scale (CFS) was classified as cognitively intact (CFS = 1), mildly impaired (CFS = 2), moderately impaired (CFS = 3), and severely impaired (CFS = 4). Of 45 183 long-term care residents, 12 644 residents (mean [SD] age 77.7 [8.3] years; 329 [2.6%] females and 12 315 [97.4%] males) and 12 053 residents (mean [SD] age 77.7 [8.3] years; 314 [2.6%] females and 11 739 [97.4%] males) met eligibility for ITT and per-protocol analyses, respectively. At the end of the follow-up, 12.0% of residents had a worsened CFS (higher score) and 7.7% had an improved CFS (lower score) with 10.8% of the deprescribing group and 12.1% of the stable user group showing a worsened CFS score. In the per-protocol analysis, the deprescribing group had a 12% reduction in the odds of progressing to a worse CFS category per 12-week period (odds ratio, 0.88; 95% CI, 0.78-0.99) compared to the stable user group. Among residents with dementia, deprescribing was associated with 16% reduced odds of cognitive decline (odds ratio, 0.84; 95% CI, 0.72-0.98). These patterns remained consistent in the ITT analysis. This cohort study indicates that deprescribing is associated with less cognitive decline in nursing home residents, particularly those with dementia. More data are needed to understand the benefits and harms of antihypertensive deprescribing to inform patient-centered medication management in nursing homes.

Correction: Subjective and objective measures of cognitive function are correlated in persons with Post-COVID-19 Condition: a secondary analysis of a Randomized Controlled Trial

Correction: Subjective and objective measures of cognitive function are correlated in persons with Post-COVID-19 Condition: a secondary analysis of a Randomized Controlled Trial