Neuropsychological Test Performance Research Articles

5 Meta-Analysis of Cognitive Functioning Following Non-Severe COVID-19 Infection

Objective:To effectively diagnose and treat cognitive post-COVID-19 symptoms, it is important to understand objective cognitive difficulties across the range of acute COVID-19 severity. The aim of this meta-analysis is to describe objective neuropsychological test performance in individuals with non-severe (mild/moderate) COVID-19 cases in the post-acute stage of infection (>28 days after initial infection).Participants and Methods:This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Inclusion criteria were established before the article search and were as follows: (1) Studies using adult participants with a probable or formal and documented diagnosis of COVID-19 in the post-acute stage of infection; (2) Studies comparing cognitive functioning using objective neuropsychological tests in one or more COVID-19 groups and a comparison group, or one group designs using tests with normative data; (3) Asymptomatic, mild, or moderate cases of COVID-19. Twenty-seven articles (n=18,202) with three types of study designs and three articles with additional longitudinal data met our full criteria.Results:Individuals with non-severe initial COVID-19 infection demonstrated worse cognitive performance compared to healthy comparison participants (d=-0.412 [95% CI, -0.718, -0.176)], p=0.001). We used metaregression to examine the relationship between both average age of the sample and time since initial COVID-19 infection (as covariates in two independent models) and effect size in studies with comparison groups. There was no significant effect for age (b=-0.027 [95% CI (0.091, 0.038)], p=0.42). There was a significant effect for time since diagnosis, with a small improvement in cognitive performance for every day following initial acute COVID-19 infection (b=0.011 [95% CI (0.0039, 0.0174)], p=0.002). However, those with mild (non-hospitalized) initial COVID-19 infections performed better than did those who were hospitalized for initial COVID-19 infections (d=0.253 [95% CI (0.372, 0.134)], p<0.001). For studies that used normative data comparisons, there was a small, non-significant effect compared to normative data (d=-0.165 [95% CI (-0.333, 0.003)], p=0.055).Conclusions:Individuals who have recovered from non-severe cases of COVID-19 may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.

Maximizing utility of neuropsychological measures in sex-specific predictive models of incident Alzheimer's disease in the Framingham Heart Study.

Sex differences in neuropsychological (NP) test performance might have important implications for the diagnosis of Alzheimer's disease (AD). This study investigates sex differences in neuropsychological performance among individuals without dementia at baseline. Neuropsychological assessment data, both standard test scores and process coded responses, from Framingham Heart Study participants were analyzed for sex differences using regression model and Cox proportional hazards model. Optimal NP profiles were identified by machine learning methods for men and women. Sex differences were observed in both summary scores and composite process scores of NP tests in terms of adjusted means and their associations with AD incidence. The optimal NP profiles for men and women have 10 and 8 measures, respectively, and achieve 0.76 mean area under the curve for AD prediction. These results suggest that NP tests can be leveraged for developing more sensitive, sex-specific indices for the diagnosis of AD.

The Efficacy of Cognitive Training on Neuropsychological Outcomes in Mild Cognitive Impairment: A Meta-Analysis.

Mild cognitive impairment (MCI) or mild neurocognitive disorder is an intermediate stage of cognitive impairment between normal cognitive aging and dementia. Given the absence of effective pharmacological treatments for MCI, increasing numbers of studies are attempting to understand how cognitive training (CT) could benefit MCI. This meta-analysis aims to update and assess the efficacy of CT on specific neuropsychological test performance (global cognitive functioning, short-term verbal memory, long-term verbal memory, generativity, working memory, and visuospatial abilities) in individuals diagnosed with MCI, as compared to MCI control groups. After searching electronic databases for randomized controlled trials, 31 studies were found including 2496 participants. Results showed that CT significantly improved global cognitive functioning, short-term and long-term verbal memory, generativity, working memory, and visuospatial abilities. However, no significant effects were observed for shifting, abstraction ability/concept formation, processing speed, and language. The mode of CT had a moderating effect on abstraction ability/concept formation. The findings provide specific insights into the cognitive functions influenced by CT and guide the development of tailored interventions for MCI. While CT holds promise, further research is needed to address certain cognitive deficits and assess long-term effects on dementia progression.

The Cognitive Profile of Elderly Patients With Mild Traumatic Brain Injury: A Role for Cognitive Reserve?

To assess cognitive status in elderly patients with mild traumatic brain injury (mTBI) in the subacute phase, examine the role of cognitive reserve, and investigate associations with cognitive complaints, mental distress, and functional outcomes. A level 1 trauma center in the Netherlands. A total of 52 individuals with mTBI and 42 healthy controls. A prospective observational cohort study. Neuropsychological assessment in the subacute phase (2 weeks to 6 months post-injury) to objectively measure the cognitive functioning, the Head Injury Symptom Checklist for subjective cognitive complaints, the Hospital Anxiety and Depression Scale for anxiety and depression, the Cognitive Reserve Index questionnaire for cognitive reserve, the Community Integration Questionnaire for community integration, and the Glasgow Outcome Scale Extended for functional outcome. Cognitive impairments were observed in memory ( P < .001) and attention, processing speed and executive control ( P < .001). Cognitive reserve was not associated with neuropsychological test performance, except for one test measuring working memory. The relationship between injury severity and cognitive outcome was not moderated by cognitive reserve. Elderly patients reported significantly more complains than healthy controls regarding forgetfulness, concentration problems, and slowness. Complaints of concentration were associated with cognitive impairment. All cognitive complaints were significantly correlated with mental distress. Cognitive impairments may be present in elderly patients in the subacute phase after mTBI, and these impairments were not significantly associated with cognitive reserve. This suggests that cognitive reserve might not serve as a protective factor against the effects of mTBI in the elderly. Concentration complaints may serve as a specific indicator for cognitive impairment, while complaints of memory and mental slowness may represent more generic indicators of mental distress. These findings highlight the importance of careful screening in older adults with mTBI, guiding clinicians toward specific treatment targets encompassing cognitive impairment, diminished mental well-being, or both.

Cognitive correlates of reduced driving performance in healthy older adults: A meta-analytic review

Aims / ObjectivesThis meta-analytic review examines the evidence for the relationship between cognitive function and driving performance in older adults. The primary aims of this review were: (a) to identify cognitive correlates of reduced driving performance in older adults and (b) to determine whether such measures reliably predict reductions in driving performance over time. MethodsThis review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Peer reviewed studies that examined the (cross-sectional or longitudinal) relationship between standardised neuropsychological test performance measures and driving performance (e.g., via an on-road test, in-vehicle monitoring system, hazard perception test or driving simulator) in healthy adults aged 60 years and older, were included. Results/DiscussionEighteen studies were eligible for inclusion, of which 12 met requirements for meta-analysis. The results indicated that reaction time and Trail Making Test (TMT) A scores exhibited small-to-moderate correlations with driving performance, with moderate effects identified for block design, TMT B, Useful Field of View (UFOV) 2 and 3 tests. Further, no significant relationships were observed between the Mini-Mental State Examination and UFOV 1 with driving performance. Due to a paucity of data, the longitudinal relationship between such measures and driving could not be identified. The findings highlight (a) the potential of cognitive assessments to identify older adults at risk of driving impairment (as part of a larger diagnostic assessment), and (b) the urgent need for prospective longitudinal studies in investigating the impact of age-related changes in cognition on driving performance over time.

A - 33 Clock Drawing Performance Differences in World Trade Center Responders at Midlife.

World Trade Center (WTC) responders demonstrate elevated risk for cognitive impairment (CI) consistent with Alzheimer's Disease and Related Dementias (ADRD). Neuropsychological test performance is valuable in early detection efforts and non-invasive longitudinal tracking of populations at risk of ADRD. We hypothesized that WTC-CI would be associated with a greater number of errors on the clock drawing task (CDT). The CDT was administered to responders with/without CI who participated in a case/control study. WTC-CI was diagnosed following NIA-AA guidelines for diagnosing early-onset ADRD (ages <66years). CDT performance was evaluated using subsets of clock errors derived from four existing variations in CDT evaluation measuring the number of errors. An ANOVA was conducted to compare mean differences in clock characteristics. From 99 participants, responders with CI (n = 50, Mage = 55.82) had more errors when compared to responders without CI (n = 49, Mage = 55.94) in the following CDT components: contour (p = 0.006), hands (p < 0.001), hands similarity (p = 0.005), moderate graphical errors (p = 0.042), left-side number crowding (p = 0.038), time incorrectness (p < 0.001), and extra marks on clock face (p = 0.006). In this study, we demonstrated that CDT performance decline is associated with WTC-CI. CDT can be used as a non-invasive investigative tool that can track cognitive performance longitudinally, which can better aid in the early detection, monitoring, and intervention strategies when dealing with the emergence of encephalopathy in high-risk ADRD populations, such as the WTC cohort. Future research should evaluate additional measures that can address other comorbid issues that can arise in such populations, such as post-traumatic stress disorder (PTSD).

A - 50 Examining NfL as a Moderator for APOE Status and Cognitive Dispersion.

Cognitive intra-individual variability (IIV) dispersion, a measure of variability across multiple tasks, has been associated with cognitive decline. Neurofilament light chain protein (NfL) is a known biomarker for several neurodegenerative diseases and reflects disease severity. Apolipoprotein E (APOE ε4) gene is a biomarker known to increase the risk of dementia. This study aimed to examine the relationship between cognitive IIV and biomarkers with established relationships to dementia in a diverse older sample. Data was collected as a part of the Health and Aging Brain Study: Health Disparities (HABS-HD) study, a project examining biomarkers of Alzheimer's disease across diverse populations within a health disparities framework. IIV on neuropsychological test performance was calculated for each participant (n = 1621) as the coefficient of variation (CoV). A moderation test employing Hayes' process model was run, with APOE ε4 status as the predictor, IIV as the dependent variable, and NfL as a moderator. Hayes PROCESS model 1 evaluated the moderating role of APOE ε4 status on the relationships between NfL and IIV. There was a significant interaction found between NfL and APOE ε4 status, (p = 0.0005). The total model was significant but only accounted for approximately 0.74% of the variance in IIV (R^2 = 0.007, SE = 0.001, p < 0.001). A larger moderation effect was found in APOE ε4 carriers. We found a small effect for biomarkers predicting cognitive IIV. The effect of NfL on IIV was partially moderated by APOE ε4 status. This relation between IIV and biomarkers should be examined in samples with greater symptom severity.

A - 72 Neuropsychological Test Performance in Mild to Moderate COVID-19 Patients with and without Subjective Cognitive Complaints.

This cross-sectional study measured cognitive performance in mild-moderate COVID-19 patients with and without self-reported persistent cognitive complaints, while accounting for demographic variables, cardiovascular (CVD) risk factors, and mood symptoms. We hypothesized that individuals with persistent cognitive complaints would demonstrate lower global cognitive composite scores compared to those without. 67 adults aged 24-83 completed in-person neuropsychological testing in a hospital setting in Phoenix, Arizona. PCR-confirmed COVID-19 within 24months before evaluation and no pre-existing neurological conditions. The Long COVID (LC) group included those with persistent cognitive symptoms 4+ weeks after infection; COVID-positive Controls (CC) included those with prior infection but without persistent cognitive symptoms. Demographic information, CVD risk factors, and psychiatric history were collected. Neuropsychological evaluation included performance validity testing and validated measures of attention, language, visuospatial ability, executive function, and memory. T-scores from each domain were averaged to create a global cognitive composite score. Gender, age, race (white/non-white), mood disorder, and CVD were equivalent across groups. Education was significantly higher in the LC group, t(65) = 2.737, p = 0.008, and was included as a covariate in the model to account for differences in cognitive reserve. With this adjustment, there was not a statistically significant difference in global composite scores between groups, F(1, 64) = 0.13, p = 0.911, partial η2 = 0.000. Cognitive performance did not differ between LC and CC groups when demographics, cardiovascular risk, and mood symptoms were held constant, suggesting that other factors influence the development of persistent cognitive complaints in mild-moderate COVID-19 patients.

A - 139 Neurobehavioral Symptoms Are Not Associated with Objective Neuropsychological Test Performance in a Group of Veterans and First Responders Seeking Care for Post-Concussive Symptoms.

Subjective post-concussive neurobehavioral symptoms do not often relate to objective cognitive assessment. This archival analysis aimed to characterize the relationship of subjective neurobehavioral symptoms to neuropsychological tests among military veterans and retired first responders with previous mild TBI (mTBI) presenting to an outpatient multidisciplinary program. 51 patients (88% male; 82% White; 94% veteran), ages 25-68 (M = 43.9, SD = 10.1) underwent neuropsychological evaluation with a flexible battery (M subtests = 29.6; SD = 5.2), through the Transforming Health and Resilience in Veterans (THRIVE) Program at UNC-Chapel Hill. The proportion of below average neuropsychological scores (i.e., ≤ 8th percentile on published norms) was modeled as a function of three subscales (Affective, Cognitive, Somatosensory) on the Neurobehavioral Symptom Inventory (NSI) and estimated premorbid IQ (PIQ) using fractional logit regression with quasi-maximum likelihood estimation and heteroskedasticity consistent "HC1" standard errors. Model diagnostics and sensitivity analyses for overly influential cases (|DFBETAS| ≥ 2/√n) were conducted. Thirty-eight individuals were included in analyses after removing those with invalid test performance (n = 4) and missing data (n = 9). The mean (median) observed below average scores was 10.9% (5.7%), with the predicted proportion at 8%. No NSI subscale was related to neuropsychological performance. However, upon removal of two overly influential cases, PIQ was inversely associated with rate of low scores - OR: 0.61 (95% CI: 0.36-0.97), SE: 0.14, p = 0.035. Subjective neurobehavioral symptoms were unrelated to objective neuropsychological tests in veterans and first responders seeking care for TBI-related symptoms.

A - 69 Examining Differences in Neuropsychological Test Performance Based on Deployment Era and Years Served in United States Veterans.

To determine the influence of years of military service and deployment era on neurocognitive performance. Archival data included 316 veterans (89.6% male; 94.3% White) seen for neuropsychological evaluation at the Portland VA (M/SD: age = 55.54/14.39; education = 13.32/2.44). Participants were administered a comprehensive neuropsychological battery. Two-way between-subjects analyses of variance (ANOVAs) examined the effects of years of service and deployment era on test performance. Bonferroni post-hoc tests compared differences between groups when a significant main effect was observed. Significant main effects were found for deployment era on TOMM Retention trial (F(4, 20) = 4.39, p = 0.04), WAIS-IV Block Design (F(5, 244) = 2.45, p = 0.04), WMS-IV Logical Memory I (F(5, 230) = 3.79, p < 0.01), Trail Making Test Part A (F(5, 242) = 3.54, p < 0.01), Trail Making Test Part B (F(5, 227) = 3.38, p < 0.01) and Grooved Pegboard for nondominant hand (F(4, 86) = 3.22, p < 0.05). Significant main effects were also observed for years of service for Trail Making Test Part A (F(4, 242) = 2.81, p < 0.05) and DKEFS Color-Word Trial 2 (F(4, 77) = 2.67, p < 0.05). A significant interaction was found between deployment era and years served on the BVMT-R total recall score (F(15, 213) = 1.92, p < 0.05). Post-hoc analyses did not reveal significant variance accounted for on neuropsychological tests. While there were significant differences between multiple measures, deployment era and years of service do not impact veteran's cognitive performance.

Bilingual neurocognitive resiliency, vulnerability, and Alzheimer's disease biomarker correlates in Latino older adults enrolled in the Health and Aging Brain Study - Health Disparities (HABS-HD).

The effects of bilingualism on neuropsychological test performance in bilinguals with and without cognitive impairment are not well-understood and are relatively limited by small sample sizes of Latinos. Using analysis of covariance (ANCOVA), we explored patterns of cognitive performance and impairment across a large sample of community-dwelling bilingual and monolingual Latino older adults with (n=180) and without (n=643) mild cognitive impairment (MCI) enrolled in HABS-HD. Bilinguals demonstrated cognitive resiliency in the form of significantly better performance on the Trail Making Test and Digit Symbol Substitution Test, observed across the cognitively unimpaired and MCI groups. In contrast, bilinguals demonstrated cognitive vulnerability in the form of significantly poorer performance and higher impairment rates on phonemic fluency in the MCI phase, only. Follow-up analyses revealed less balanced bilinguals demonstrated poorer performance and higher impairment rates on this measure, supported by lower levels of plasma Aβ 42/40. Patterns of cognitive performance and impairment differ as a function of bilingualism. Bilingualism must be considered when evaluating cognitive and biomarker outcomes in Latino older adults. Latino bilinguals perform better on measures of processing speed and coding.Latino bilinguals with MCI demonstrate cognitive vulnerability in verbal fluency.Less balanced bilinguals demonstrate greatest vulnerability anchored by Aβ42/40.

Neuropsychological Evaluation and Functional Magnetic Resonance Imaging Tasks in the Preoperative Assessment of Patients with Brain Tumors: A Systematic Review.

Current surgical treatment of gliomas relies on a function-preserving, maximally safe resection approach. Functional Magnetic Resonance Imaging (fMRI) is a widely employed technology for this purpose. A preoperative neuropsychological evaluation should accompany this exam. However, only a few studies have reported both neuropsychological tests and fMRI tasks for preoperative planning-the current study aimed to systematically review the scientific literature on the topic. PRISMA guidelines were followed. We included studies that reported both neuropsychological tests and fMRI. Exclusion criteria were: no brain tumors, underage patients, no preoperative assessment, resting-state fMRI only, or healthy sample population/preclinical studies. We identified 123 papers, but only 15 articles were included. Eight articles focused on language; three evaluated cognitive performance; single papers studied sensorimotor cortex, prefrontal functions, insular cortex, and cerebellar activation. Two qualitative studies focused on visuomotor function and language. According to some authors, there was a strong correlation between performance in presurgical neuropsychological tests and fMRI. Several papers suggested that selecting well-adjusted and individualized neuropsychological tasks may enable the development of personalized and more efficient protocols. The fMRI findings may also help identify plasticity phenomena to avoid unintentional damage during neurosurgery. Most studies have focused on language, the most commonly evaluated cognitive function. The correlation between neuropsychological and fMRI results suggests that altered functions during the neuropsychological assessment may help identify patients who could benefit from an fMRI and, possibly, functions that should be tested. Neuropsychological evaluation and fMRI have complementary roles in the preoperative assessment.

The immersive virtual memory task: Assessing object-location memory in neurological patients using immersive virtual reality

ABSTRACT Memory for object locations in proximity is an essential aspect of everyday activities and has high clinical relevance. Immersive Virtual Reality (VR) has the potential to bridge the gap between the experimental control of laboratory conditions and reliable predictions of functional abilities. We developed the immersive Virtual Memory Task (imVMT), a neuropsychological assessment tool for spatial memory that combines gesture-based natural hand interaction and a head-mounted display. Our aim was to investigate the imVMT task characteristics, to validate the imVMT regarding the underlying cognitive processes, and to evaluate its applicability and feasibility in the clinical context in a sample of thirty-five patients with various neurological disorders and functional deficits. We further aimed to assess object-location memory in a small-scale virtual environment. Our results show that task difficulty can be efficiently manipulated by increasing the number of objects to memorize and rotation angle against the encoding perspective. We demonstrate construct validity as our primary outcome measure was significantly related to spatial memory performance in conventional neuropsychological tests. The imVMT was highly feasible and received high ratings for usability. The imVMT represents an ecologically relevant and valid VR task for assessing object-location memory in a wide range of neurological patients. Trial registration German Clinical Trials Register identifier: DRKS00024005.

Usefulness of the Montreal Cognitive Assessment in Older Adults With Type 1 Diabetes.

Older adults with type 1 diabetes are at high risk for cognitive impairment, yet the usefulness of common cognitive screening instruments has not been evaluated in this population. A total of 201 adults ≥60 years of age with type 1 diabetes completed a battery of neuropsychological measures and the Montreal Cognitive Assessment (MoCA). Receiver operating characteristic (ROC) curves and Youden indices were used to evaluate overall screening test performance and to select an optimal MoCA cutoff score for detecting low cognitive performance, as defined as two or more neuropsychological test performances ≥1.5 SD below demographically corrected normative data. The ROC area under the curve (AUC) was 0.745 (P < 0.001). The publisher-recommended cutoff score of <26 resulted in sensitivity of 60.4% and specificity of 71.4%, whereas a cutoff score of <27 resulted in sensitivity of 75.0% and specificity of 61.0%. The Youden indices for these cutoff scores were 0.318 and 0.360, respectively. Minimally acceptable sensitivity (i.e., >0.80) was obtained when using a cutoff score of <28, whereas >0.80 specificity was obtained with a cutoff score of <25. The MoCA has modest overall performance (AUC 0.745) as a cognitive screening instrument in older adults with type 1 diabetes. The standard cutoff score of <26/30 may not adequately detect individuals with neuropsychological testing-defined abnormal cognition. The optimal MoCA cutoff score (based on the Youden index) was <27/30. A score of <28 resulted in acceptable sensitivity but was accompanied by low specificity (42%). Future studies with a more diverse population are needed to confirm these findings.

Pain in the Context of Virtual Neuropsychological Assessment of Older Adults.

Pain and cognitive impairment are prevalent and often co-occur in older adults. Because pain may negatively affect cognitive test performance, identification of pain in the context of neuropsychological evaluation is important. However, pain detection based on self-report presents challenges, and pain is often under-detected in this population. Alternative methods (e.g., video-based automatic coding of facial biomarkers of pain) may facilitate pain identification and thus enhance interpretation of neuropsychological evaluation results. The current study examined pain in the context of virtual neuropsychological assessment in 111 community-dwelling older adults, first seeking to validate the use of software developed to automatically code biomarkers of pain. Measures of pain, including self-report of acute and chronic pain and automatic coding of pain, were compared while participants completed neuropsychological testing. Self-reported pain was negatively associated with poorer performance on a measure of executive function (both acute and chronic pain) and a global cognitive screening measure (acute pain only). However, self-reported acute and chronic pain did not correlate significantly with most neuropsychological tests. Automatic coding of pain did not predict self-report of pain or performance on neuropsychological tests beyond the influence of demographic factors and psychological symptoms. Though results were largely not significant, correlations warrant further exploration of the influence of pain on neuropsychological test performance in this context to ensure that pain does not influence test performance in individuals with higher levels of pain and in other samples.

Instrumental activities of daily living and mild cognitive impairment

ABSTRACT Background Functional impairments are a necessary requirement for the diagnosis of a dementia along with observed cognitive impairment. Comparatively, functional abilities are often relatively intact in those with mild cognitive impairment (MCI). Objective The current research examined the associations between memory clinic participants classified as cognitively intact, amnestic MCI, and mixed/dysexecutive MCI, using Jak-Bondi criteria, and Instrumental Activities of Daily Living - Compensation Scale (IADL-C) abilities, an informant-based questionnaire that quantifies functional abilities. The associations between functional abilities as assessed with the IADL-C and performance on neuropsychological tests were also investigated. Methods IADLC scores were obtained along with a comprehensive neuropsychological protocol on memory clinic participants (n = 100) classified as cognitively normal (CN), amnestic MCI (aMCI), or a combined mixed/dysexecutive (mixed/dys) MCI. Regression analyses were employed to determine how the IADLC related to neuropsychological test performance. Results On the IADLC, greater functional impairment was commonly observed in the mixed/dys MCI group compared to CN participants. Furthermore, the mixed/dys MCI group had lower scores on activities such as Money and Self-Management, Travel and Event Memory subscales compared to the CN group. Linear regression analyses found greater functional impairment in relation to lower scores on executive and episodic memory tests. Conclusions Greater functional impairment as assessed with the IADL-C appears to be disproportionately associated with dysexecutive difficulty, and to a lesser degree, episodic memory.

Factors perpetuating functional cognitive symptoms after mild traumatic brain injury

ABSTRACT Introduction Self-reported memory difficulties (forgetting familiar names, misplacing objects) often persist long after a mild traumatic brain injury (mTBI), despite normal neuropsychological test performance. This clinical presentation may be a manifestation of a functional cognitive disorder (FCD). Several mechanisms underlying FCD have been proposed, including metacognitive impairment, memory perfectionism, and misdirected attention, as well as depression or anxiety-related explanations. This study aims to explore these candidate perpetuating factors in mTBI, to advance our understanding of why memory symptoms frequently persist following mTBI. Methods A cross-sectional study of 67 adults (n = 39 with mTBI mean = 25 months ago and n = 28 healthy controls). Participants completed standardized questionnaires (including the Functional Memory Disorder Inventory), a metacognitive task (to quantify discrepancies between their trial-by-trial accuracy and confidence), and a brief neuropsychological test battery. We assessed candidate mechanisms in two ways: (1) between-groups, comparing participants with mTBI to healthy controls, and (2) within-group, examining their associations with functional memory symptom severity (FMDI) in the mTBI group. Results Participants with mTBI performed similarly to controls on objective measures of memory ability but reported experiencing much more frequent memory lapses in daily life. Contrary to expectations, metacognitive efficiency did not differentiate the mTBI and control groups and was not associated with functional memory symptoms. Memory perfectionism was strongly associated with greater functional memory symptoms among participants with mTBI but did not differ between groups when accounting for age. Depression and checking behaviors produced consistent results across between-groups and within-group analyses: these factors were greater in the mTBI group compared to the control group and were associated with greater functional memory symptoms within the mTBI group. Conclusions This study highlights promising (e.g., depression, checking behaviors) and unlikely (e.g., metacognitive impairment) mechanisms underlying functional memory symptoms after mTBI, to guide future research and treatment.

Höffding step and beyond: The impact of visual sensory impairment on cognitive performance in neuropsychological testing of survivors of acute methanol poisoning.

Sensory deficits can result in limitations regarding how well neuropsychological test findings can be interpreted. Only a few studies have investigated the influence of vision alteration on neuropsychological tests. In 2012 the Czech Republic experienced mass methanol poisoning. Methanol metabolites cause histotoxic hypoxia to the optic nerve. In the current study, the effect of the toxic damage on the parts of the visual pathway on visual and non-visual neuropsychological measures was investigated using electrophysiological methods (visual evoked potential (VEP) and optical coherence tomography (OCT) with retinal nerve fibre layer (RNFL) thickness measurement. 53 individuals who experienced methanol poisoning participated in this research (76% men; ages 24 to 74 years, mean = 43.8±14.6 years; education 11.9±1.4 years). Each participant underwent comprehensive neurological, ophthalmological, and neuropsychological examinations. The results of mixed-effect models revealed significant small to a medium association between the Stroop test weak interference and Grooved Pegboard with the left eye global, nasal and temporal RNFL thickness. Also, medium associations between the Finger Tapping test and the Stroop test weak interference and left eye temporal RNFL, right eye temporal RNFL, and the latency P1 of VEP in the left eye were significant. The results of this study found a small to medium association (r = .15- .33; p = .010- .046) between RNFL thickness and cognitive visual test performance. Careful interpretation is suggested regarding results obtained from visual tests of the executive or motor functioning with participants with RNFL decrease or other types of early visual processing damage.

Heterogeneity in subjective cognitive decline in the Sino Longitudinal Study on Cognitive Decline(SILCODE): Empirically derived subtypes, structural and functional verification.

We evaluated whether Subjective Cognitive Decline (SCD) subtypes could be empirically derived within the Sino Longitudinal Study on Cognitive Decline (SILCODE) SCD cohort and examined associated neuroimaging markers, biomarkers, and clinical outcomes. A cluster analysis was performed on eight neuropsychological test scores from 124 SCD SILCODE participants and 57 normal control (NC) subjects. Structural and functional neuroimaging indices were used to evaluate the SCD subgroups. Four subtypes emerged: (1) dysexecutive/mixed SCD (n = 23), (2) neuropsychiatric SCD (n = 24), (3) amnestic SCD (n = 22), and (4) cluster-derived normal (n = 55) who exhibited normal performance in neuropsychological tests. Compared with the NC group, each subgroup showed distinct patterns in gray matter (GM) volume and the amplitude of low-frequency fluctuations (ALFF). Lower fractional anisotropy (FA) values were only found in the neuropsychiatric SCD group relative to NC. The identification of empirically derived SCD subtypes demonstrates the presence of heterogeneity in SCD neuropsychological profiles. The cluster-derived normal group may represent the majority of SCD individuals who do not show progressive cognitive decline; the dysexecutive/mixed SCD and amnestic SCD might represent high-risk groups with progressing cognitive decline; and finally, the neuropsychiatric SCD may represent a new topic in SCD research.

Midlife Neuropsychological Profiles and Associated Vascular Risk: The Bogalusa Heart Study.

Individuals with Alzheimer's disease (AD) often present with coexisting vascular pathology that is expressed to different degrees and can lead to clinical heterogeneity. To examine the utility of unsupervised statistical clustering approaches in identifying neuropsychological (NP) test performance subtypes that closely correlate with carotid intima-media thickness (cIMT) in midlife. A hierarchical agglomerative and k-means clustering analysis based on NP scores (standardized for age, sex, and race) was conducted among 1,203 participants (age 48±5.3 years) from the Bogalusa Heart Study. Regression models assessed the association between cIMT ≥50th percentile and NP profiles, and global cognitive score (GCS) tertiles for sensitivity analysis. Three NP profiles were identified: Mixed-low performance [16%, n = 192], scores ≥1 SD below the mean on immediate, delayed free recall, recognition verbal memory, and information processing; Average [59%, n = 704]; and Optimal [26%, n = 307] NP performance. Participants with greater cIMT were more likely to have a Mixed-low profile [OR = 3.10, 95% CI (2.13, 4.53), p < 0.001] compared to Optimal. After adjusting for education and cardiovascular (CV) risks, results remained. The association with GCS tertiles was more attenuated [lowest (34%, n = 407) versus highest (33%, n = 403) tertile: adjusted OR = 1.66, 95% CI (1.07, 2.60), p = 0.024]. As early as midlife, individuals with higher subclinical atherosclerosis were more likely to be in the Mixed-low profile, underscoring the potential malignancy of CV risk as related to NP test performance, suggesting that classification approaches may aid in identifying those at risk for AD/vascular dementia spectrum illness.