Objective Cognitive Assessment Research Articles

Deranged cytokine levels are linked to cancer-related cognitive impairment in lymphoma patients receiving R-CHOP chemotherapy

Cancer-related cognitive impairment (CRCI) is a significant issue commonly observed following chemotherapy treatment. The study aimed to investigate the changes in cognitive function and their association with IL-6, IL-1β, and IL-10 levels before and after R-CHOP chemotherapy over six cycles. Seventy chemotherapy naïve, newly diagnosed lymphoma patients were enrolled. Cognitive functions and inflammatory cytokines were assessed at baseline (TP1), after 3rd cycle (TP2), and after 6th cycle (TP3). Patients, with mean age of 44.17 ± 13.67 years, showed significantly increased levels of IL-6 and IL-1β and decreased IL-10 levels over time (p < .001). On the Montreal Cognitive Assessment (MoCA), scores of domains such as executive functioning (p = .002), attention (p < .001), language (p < .001), recall (p = .005), and orientation (p < .001) significantly decreased post six cycles of R-CHOP chemotherapy. Correlation analysis at TP2 indicated a positive association between elevated IL-6 levels with a decrease in MoCA scores indicating a decline in cognitive function (ρ = 0.68, p < .001). At TP3, no association of MoCA scores with IL-6 and IL-1β was observed. Decreased IL-10 levels showed a weak association with decreased MoCA scores at TP2 and TP3 ( ρ = 0.2, p = .09; for TP3, ρ = 0.16, p = .17), but this was not significant. In summary, the findings of the present study highlight significant cognitive decline and changes in inflammatory cytokine levels following six cycles of R-CHOP. Objective cognitive assessments may be done to detect CRCI in patients treated with R-CHOP.

Timing of Alzheimer's disease biomarker progressions: A two-decade observational study from the Alzheimer's Disease Neuroimaging Initiative (ADNI).

Alzheimer's Disease Neuroimaging Initiative (ADNI) has been pivotal in identifying and refining Alzheimer's disease (AD) biomarkers for clinical trials. This study leverages longitudinal data from participants who have progressed to amyloid-positivity during their study participation to track evolution of biomarkers and cognitive function. We modeled AD biomarker (positron emission tomography [PET], structural, cerebrospinal fluid [CSF], cognition) trajectories before and after observed amyloid-positivity onset time to detect time at which each biomarker had detectable trajectory changes. Analysis of a sub-cohort of the 20-year ADNI study (N=90) recapitulated Alzheimer's progression beginning with amyloid alterations -4.8 to -5.3 years relative to amyloid-positivity, succeeded by neurodegeneration (t=-4.0 to -4.1 years), and CSF tau (t=-0.4 to -0.5 years). Cognitive decline was observed to significantly correspond with emergence of amyloid-positivity (t=0.2 to 2.4 years). Our results corroborate temporal progression curves of AD biomarkers, providing insights on earliest detectable changes in objective and subjective cognitive function assessments.

Efficacy of Computerized vs. Traditional Cognitive Interventions for the Treatment of Chronic mTBI Symptoms Among Service Members.

Military service members (SMs) with mild traumatic brain injury (mTBI or concussion) frequently report cognitive and behavioral difficulties. Currently, military clinical guidelines recommend clinician-run, manualized cognitive rehabilitation (CR) to treat these symptoms; however, it is unclear whether this approach adequately addresses the unique needs of warfighters. Computerized cognitive training (CCT) programs represent an innovative, promising approach to treating cognitive difficulties; however, whether these programs can effectively remediate cognitive impairment in individuals with mTBI remains unclear. A total of 65 SMs with a history of at least 1 diagnosed mTBI were recruited from a military hospital. Participants received 1 of 2 interventions: Clinician-run, manualized CR (Study of Cognitive Rehabilitation Effectiveness [SCORE]; n = 37), consisting of 60 total intervention hours over 6 weeks, or CCT (n = 28), in which participants trained with either a commercial CCT (n = 14) or noncommercial CCT (n = 14), for a total of 12 hours over 4 weeks. Participants were assessed pre- and postintervention, using a combination of self-report and objective outcome measures: Key Behaviors Change Inventory (KBCI), a self-report measure of functional difficulties; Paced Auditory Serial Addition Test (PASAT), an objective cognitive assessment that measures both information processing speed and sustained and divided attention; and Symbol Digit Modalities Test (SDMT), an objective cognitive assessment that measures information processing speed. Mixed ANOVA revealed no interaction effect between intervention type and time (pre- and postassessment) on the PASAT (P = .643, ηp2 = 0.003), SDMT (P = .423, ηp2 = 0.010), or KBCI (P = .434, ηp2 = 0.010); however, there was a significant within-group main effect (time) on all 3 outcome measures (PASAT P < .001, ηp2 = 0.54; SDMT P < .001, ηp2 = 0.25; and KBCI P = .001, ηp2 = 0.15). On average, participants showed improvement over baseline on the PASAT (SCORE delta = 6.98, SD = 7.25, P < .001; CCT delta = 7.79, SD = 6.45, P < .001), SDMT (SCORE delta = 4.62, SD = 8.82, P = .003; CCT delta = 6.58, SD = 10.81, P = .003), and KBCI (SCORE delta = -3.22, SD = 7.09, P = .009; CCT delta = -2.00, SD = 4.72, P = .033). Additional analysis comparing the relative effectiveness of the 2 different CCTs revealed that while training with either program resulted in improved performance on the PASAT (P < .001, ηp2 = 0.627), SDMT (P = .003, ηp2 = 0.286), and KBCI (P = .036, ηp2 = 0.158), there was no interaction effect of CCT program type and change over time for any measure (PASAT P = .102, ηp2 = 1.00; SDMT P = .317, ηp2 = 0.038; and KBCI P = .719, ηp2 = 0.005). We showed that CCT programs do not differ in efficacy compared to clinician-run, manualized CR for treating symptoms associated with mTBI; however, exploratory analyses suggest that each approach may have distinct advantages for treating specific symptoms. Additionally, we showed that the improvement in the CCT intervention did not differ between those who trained using the commercial program vs. those who trained with the noncommercial program.

S2VQ-VAE: Semi-Supervised Vector Quantised-Variational AutoEncoder for Automatic Evaluation of Trail Making Test.

Computer-aided detection of cognitive impairment garnered increasing attention, offering older adults in the community access to more objective, ecologically valid, and convenient cognitive assessments using multimodal sensing technology on digital devices. In this study, we aimed to develop an automated method for screening cognitive impairment, building on paper- and electronic TMTs. We proposed a novel deep representation learning approach named Semi-Supervised Vector Quantised-Variational AutoEncoder (S2VQ-VAE). Within S2VQ-VAE, we incorporated intra- and inter-class correlation losses to disentangle class-related factors. These factors were then combined with various real-time obtainable features (including demographic, time-related, pressure-related, and jerk-related features) to create a robust feature engineering block. Finally, we identified the light gradient boosting machine as the optimal classifier. The experiments were conducted on a dataset collected from older adults in the community. The experimental results showed that the proposed multi-type feature fusion method outperformed the conventional method used in paper-based TMTs and the existing VAE-based feature extraction in terms of screening performance. In conclusion, the proposed deep representation learning method significantly enhances the cognitive diagnosis capabilities of behavior-based TMTs and streamlines large-scale community-based cognitive impairment screening while reducing the workload of professional healthcare staff.

Self-reported cognitive function mediates the relationship between employment status and cognitive functioning in persons with multiple sclerosis

BackgroundCognitive impairment (CI) is common in people with MS (PwMS). Evidence is lacking for the self-reported CI's mediation effect on employment status and objective cognitive performance. Self-reported CI was found to be unreliable and seemed to be more associated with depression rather than formal cognitive performance. We hypothesized that the link between subjective and objective assessments of cognitive functions, mood, and employment status may be more complex in PwMS than previously reported. ObjectiveThe aims of this study are the following: (Romero-Pinel et al., 2022) to determine whether employment status could affect performance in cognitive function testing and (Rao et al., 1991) whether their relationship may be mediated by self-reported CI; and (Deluca et al., 2013) to determine whether self-reported depression interacts with self-reported CI in influencing performance in various cognitive domains in PwMS. MethodologyA retrospective study was performed involving PwMS who completed the self-report Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), Hospital Anxiety and Depression Scale-depression scale (HADS-D), Minimal Assessment of Cognitive Function in MS (MACFIMS) and had data regarding employment status. Included PwMS were classified as employed or unemployed. A structural equation modeling (SEM) approach was taken due to the advantage of examining multiple cognitive outcomes simultaneously while accounting for shared associations. First, a latent factor of memory and executive functioning modeled the error-free associations between both factors and a processing speed task (SDMT). Next, the model tested for the indirect effect of self-reported cognition (MSNQ) on employment status differences in each outcome (memory, speed, and executive functioning). Finally, we tested interactions between MSNQ and HADS-D on each of the outcomes. ResultsWe included 590 PwMS: 72.5% female, mean age 44.2 years (SD = 10.5), mean disease duration 8.6 years (SD 9.0). The majority (n = 455, 77.1%) had relapsing MS; 357 (60.5%) were employed. About half (n = 301, 51%) did not report CI on the MSNQ; of those, 213 (70.8%) were employed. The mean MSNQ for employed PwMS was 24.5 (SD = 10.7) and 29.8 (SD = 11.2) for unemployed PwMS. Employed PwMS had significantly better memory (β = .16, p < .05), executive functioning (β = .25, p < .05), and processing speed (β = .22, p < .05). MSNQ partially indirectly mediated the effect of employment status on memory (Δβ = .03, p < .05) and executive functioning (Δβ = .03, p < .05) and processing speed (Δβ = .04, p < .05), indicating that self-report CI partially explains the influence of employment status on these cognitive domains. The association between MSNQ with both memory and executive functioning was moderated by depression, meaning that in PwMS with high HADS-D scores, MSNQ was more strongly related to worse memory and executive functioning. The final model was an acceptable fit to the data (χ2(87) = 465.07, p < .05; CFI = .90, RMSEA = .08, 90% CI [.06, .09], SRMR = .05) explaining 41.20%, 38.50% and 33.40% of the variability in memory, executive functioning, and processing speed, respectively. ConclusionSelf-reported CI partially explains the associations between employment status and objective cognitive assessment in PwMS. Depression may moderate the relationship between self-reported cognitive assessment and objective cognitive performance. Thus, employment status and mood may guide the interpretation of self-reported CI.

PsyCog: A computerised mini battery for assessing cognition in psychosis

Despite the functional impact of cognitive deficit in people with psychosis, objective cognitive assessment is not typically part of routine clinical care. This is partly due to the length of traditional assessments and the need for a highly trained administrator. Brief, automated computerised assessments could help to address this issue. We present data from an evaluation of PsyCog, a computerised, non-verbal, mini battery of cognitive tests. Healthy Control (HC) (N = 135), Clinical High Risk (CHR) (N = 233), and First Episode Psychosis (FEP) (N = 301) participants from a multi-centre prospective study were assessed at baseline, 6 months, and 12 months. PsyCog was used to assess cognitive performance at baseline and at up to two follow-up timepoints. Mean total testing time was 35.95 min (SD = 2.87). Relative to HCs, effect sizes of performance impairments were medium to large in FEP patients (composite score G = 1.21, subtest range = 0.52–0.88) and small to medium in CHR patients (composite score G = 0.59, subtest range = 0.18–0.49). Site effects were minimal, and test-retest reliability of the PsyCog composite was good (ICC = 0.82–0.89), though some practice effects and differences in data completion between groups were found. The present implementation of PsyCog shows it to be a useful tool for assessing cognitive function in people with psychosis. Computerised cognitive assessments have the potential to facilitate the evaluation of cognition in psychosis in both research and in clinical care, though caution should still be taken in terms of implementation and study design.

Validation of a Brief Cognitive Assessment for Concussion Delivered on a Mobile Device

Previous research found the Conners Continuous Performance Test (3rd ed; CCPT3) to predict concussion outcomes, but delivery was on a desktop device which can undermine broad use. We examine whether a shortened, mobile CCPT3 predicts concussion symptom endorsement and severity, and evaluate whether the predictive validity changes after controlling for ADHD. From July 2021 to January 2022, 143 participants aged 11 to 23 (approximately 30% female), including 63 consecutively assessed individuals suspected of having a concussion, and 80 randomly selected healthy controls, completed the mobile CCPT3 and the 31-item CDC concussion symptom checklist with severity ratings. Regression analyses indicate the mobile CCPT3 accounts for 19% variance (p < 0.01, d = 0.97) in symptom severity and 17.2% variance (p < 0.01, d = 0.91) in symptom endorsement. Findings persist after controlling for the experience of ADHD. Moreover, CCPT3 scores can differentiate among those suspected of having a concussion, predicting 27.6% variance in total symptom severity (p = 0.02, d = 1.24). Thus, a brief, objective mobile cognitive assessment yields large effect sizes when predicting concussion symptoms, and findings are comparable to previous research. Because the mobile assessment can be administered almost immediately post-injury and in between clinical visits, it can further inform post-injury medical care, rehabilitation, and return-to-play decisions.

Measuring Change over Time on Cognitive Screening Measures: An Evaluation of the Psychometric Properties of ACE-III, CBI-R, and EMQ for the Purpose of Dementia Screening

Introduction: Cognitive screening measures are an established part of a dementia assessment and often include measures of subjective difficulties, e.g., Everyday Memory Questionnaire (EMQ), informant-rated difficulty, Cambridge Behavioural Inventory – Revised (CBI-R), and objective cognitive assessments like Addenbrooke’s Cognitive Examination (ACE-III). While these measures have validity for the purpose of diagnosing dementia, in clinical practice they are often used outside of their evidence base for the purpose of cognitive re-assessment. The current study sought to evaluate the psychometric properties for the repeated use of these assessments. Methods: This study used a longitudinal design, which included 49 healthy controls, 33 people with subjective memory difficulties, and 10 people with Alzheimer’s disease (AD) being assessed twice, with approximately a 1-year interval between assessments. Results: The EMQ has adequate re-test reliability (r = 0.78), but people with an AD diagnosis rated their memory as better than those with SMD, making it unsuitable as a measure. The CBI-R had moderate re-test reliability (r = 0.62). However, deterioration on the CBI-R was not useful for diagnosing AD. The ACE-III has high re-test reliability (r = 0.89). A change of five was associated with reasonable classification accuracy for identifying AD and achieved statistical significance. Conclusion: Using a 1-year interval, of the three measures used in this study, only the ACE-III total score may be a useful measure of change over time, although it should be applied cautiously due to the lack of representativeness of the sample, and change scores should always be triangulated with other forms of evidence of deterioration.

Sex-specific dementia risk in known or suspected obstructive sleep apnea: a 10-year longitudinal population-based study.

To evaluate sex-specific associations between known or suspected obstructive sleep apnea (OSA) and dementia risk over 10 years among older women and men. This study included 18815 women and men age 50+ years (dementia-free at baseline) who participated in the Health and Retirement Study (HRS), a nationally representative cohort of US adults. Presence of OSA was defined by self-reported diagnosis or key HRS items that correspond to elements of a validated OSA screening tool (STOP-Bang). Incident dementia cases were identified using a validated, HRS-based algorithm derived from objective cognitive assessments. Survey-weighted regression models based on pseudo-values were utilized to estimate sex- and age-specific differences in cumulative incidence of dementia by OSA status. Data from 18815 adults were analyzed, of which 9% of women and 8% of men (weighted proportions) met criteria for incident dementia. Known/suspected OSA was more prevalent in men than in women (weighted proportions 68% vs. 31%). Unadjusted sex-stratified analyses showed that known/suspected OSA was associated with higher cumulative incidence of dementia across ages 60-84 years for women and men. By age 80, relative to adults without known/suspected OSA, the cumulative incidence of dementia was 4.7% higher (CI 2.8%, 6.7%) for women with known/suspected OSA, and 2.5% (CI 0.5%, 4.5%) for men with known/suspected OSA, respectively. Adjusted associations between age-specific OSA and cumulative incidence of dementia attenuated for both women and men but remained statistically significant. OSA contributes to dementia risk in older adults, particularly women. This study illuminates the impact of a potentially modifiable yet frequently overlooked risk factor for dementia onset.

Community Pharmacists expand access to cognitive function assessments with Cognivue Clarity™ device

AbstractBackgroundMost initial cognitive assessments are performed by primary care physicians (PCPs). With the growing senior population reaching the age of increased risk for Alzheimer’s (65 yrs), coupled with the projected shortage of up to 48,000 PCPs by 2034 (IHS Market Ltd. AAMC;2021), use of pharmacy‐based cognitive assessments can greatly expand access. Pharmacists are more accessible than PCPs (Tsuyuki et al. 2018) and are among the most trusted healthcare professionals.MethodMember pharmacies of CPESN USA were selected to conduct standardized cognitive function tests using the Cognivue Clarity® device. Study participants were ≥65 yrs and had the ability to complete a survey about their cognitive screening history and PCP contact information. Site education and training were conducted by the Avant Institute and Cognivue. Sites were surveyed following data collection. Study was funded by the Davos Alzheimer’s Collaborative and occurred August 2022 ‐ December 2022.ResultNineteen CPESN pharmacy sites from 13 states, 10 within medically underserved or rural areas, submitted 425 eCare plans that were eligible for analysis. Less than 16% (67/425) patients reported having a previous cognitive assessment, with 81% (343/425) reporting this was their first cognitive assessment, and the remainder reported unknown. Approximately 73% (312/425) of patients had Cognivue clinical overall scores outside the normal range and were referred to their PCP. Site surveys post‐data collection showed that &gt;83% and &gt;72% of pharmacies rated ease of use of the Cognivue Clarity device, and education and training, to be an extremely significant or significant contributor to study success, respectively.ConclusionPharmacists are often overlooked as a vital link to assessing the cognitive health of seniors. With two FDA‐cleared immunotherapies available, it is critical that seniors are aware of their cognitive status so they can seek research studies, further evaluations, and/or medications. This study showed that with training and use of Cognitive Clarity, pharmacists can easily provide seniors with an objective cognitive function assessment. Accordingly, widespread implementation of pharmacy‐based computerized cognitive testing could greatly expand access to meet the brain health needs of the growing senior population.

Modifiable dementia risk factors associated with distinct subjective and objective cognitive outcomes

AbstractBackgroundA range of potentially modifiable environmental, social, and lifestyle factors are estimated to contribute to over a third of dementia cases worldwide. Leading theories propose that these risk factors have different risk‐conferring mechanisms. For example, social isolation, hypertension, and exercise may respectively impact most on cognitive reserve, neurodegeneration, and inflammation. If true, this may support the development of more personalised preventative strategies, depending on risk profiles. Here, we aimed to address this by gathering multiple forms of cognitive assessment in a large sample, across lifespan.MethodN = 2831 users of a free smartphone app, Neureka (aged 18‐82, M(SD) = 46.84(14.7)), completed questionnaires about their background, health, and lifestyle. Additionally, they completed subjective and objective assessments of their cognitive status, via questionnaires (subjective memory problems, attitude to own ageing, and cognitive fluctuations) and cognitive tests (working memory, processing speed, cognitive flexibility, and model‐based planning), respectively. We tested the differential cognitive correlates of previously established risk factors using univariate regressions, controlling for age and gender.ResultLower education and socio‐economic status (SES) were associated with worse cognitive status across all domains (all p&lt;.05). However, the association between SES and subjective cognition (ß = 0.38–0.51) was more than twice that of objective cognition (ß = 0.05–0.09), while this was not the case for education (ß = 0.15–0.32 for subjective and ß = 0.10–0.16 for objective cognition). Subjective measures were also more sensitive to depression, loneliness, hearing handicap, age‐related hearing loss, and tinnitus (all p&lt;.01 for subjective and .001&lt;p&lt;.75 for objective cognition). In contrast, cardiovascular factors like diabetes, hypertension, stroke, and smoking were associated with comparable impacts on objective and subjective cognition. Overall, there was little evidence for risk factor correlates of different aspects of objective cognition (e.g., working memory vs. processing speed).ConclusionObjective and subjective cognition have dissociable associations with certain potentially modifiable risk factors for dementia. This may aid in our understanding of the distinct mechanisms through which they confer risk for dementia. The objective cognitive assessments gathered, model‐based planning, memory, processing speed and flexibility, yielded remarkably similar associations with risk factors, suggesting a common mechanism through which they are linked to risk factors for dementia.

Improve the management of cancer-related cognitive impairment in clinical settings: a European Delphi study

PurposeCancer-related cognitive impairment (CRCI) is under-addressed by healthcare professionals owing to a lack of clinical management guidelines. This European Delphi study proposes recommendations to healthcare professionals for the management of CRCI in patients with non-central nervous system (non-CNS) cancers.MethodsTwenty-two recommendations were developed based on a literature review and authors’ clinical experience, split into three categories: screening, cognitive assessment, intervention. The survey included European professionals, experts in CRCI. The Delphi method was used: experts rated the clinical relevancy of recommendations on a 9-point Likert scale in three rounds. A recommendation was accepted if all votes were between 7 and 9. Recommendations not accepted in round 1 and round 2 were deleted, or modified and rated in round 3.ResultsEighteen professionals (psychologists, physicians, researchers) voted and accepted 15 recommendations. Experts recommended the systematic screening of CRCI, followed by a short objective cognitive assessment, if complaints screened. A comprehensive evaluation is recommended if CRCI persists 6 months post-treatment. Cognitive rehabilitation, physical activity, meditative-movement therapy, and multimodal intervention should be offered. Recommendations about frequency and duration of interventions, the professional to administer cognitive rehabilitation and the use of meditation and cognitive training without psychoeducation were not accepted.ConclusionsThis survey provides 15 recommendations to assist healthcare professionals in detecting, assessing and offering interventions for CRCI.Implications for cancer survivorsThese recommendations should be included in supportive care to help healthcare professionals to detect CRCI and propose the best available intervention for patients with cognitive complaints. Developing CRCI management in clinical settings would improve patients’ quality of life.

HCTMFS: A multi-modal feature selection framework with higher-order correlated topological manifold for ESRDaMCI

Background and ObjectiveThe diagnosis of end-stage renal disease associated with mild cognitive impairment (ESRDaMCI) mainly relies on objective cognitive assessment, clinical observation, and neuro-psychological evaluation, while only adopting clinical tools often limits the diagnosis accuracy. MethodsWe proposed a multi-modal feature selection framework with higher-order correlated topological manifold (HCTMFS) to classify ESRDaMCI patients and identify the discriminative brain regions. It constructed brain structural and functional networks with diffuse kurtosis imaging (DKI) and functional magnetic resonance imaging (fMRI) data, and extracted node efficiency and clustering coefficient from the brain networks to construct multi-modal feature matrices. The topological relationship matrices were constructed to measure the lower-order topological correlation between features. Then the consensus matrices were learned to approximate the topological relationship matrices at different confidence levels and eliminate the noise influence of individual matrices. ResultsThe higher-order topological correlation between features was explored by the Laplacian matrix of the hypergraph, which was calculated through the consensus matrix. The new framework achieved an accuracy rate of 93.56 % for classifying ESRDaMCI patients, and outperformed the existing state-of-the-art methods in terms of sensitivity, specificity, and area under the curve. ConclusionsThis study contributes to effectively reflect the functional neural degradation of ESRDaMCI and provide a reference for the diagnosis of ESRDaMCI by selecting discriminative brain regions.

Exposure to Sedation and Analgesia Medications: Short-term Cognitive Outcomes in Pediatric Critical Care Survivors With Acquired Brain Injury.

Background/Objective: Pediatric intensive care unit (PICU) survivors risk significant cognitive morbidity, particularly those with acquired brain injury (ABI) diagnoses. Studies show sedative and analgesic medication may potentiate neurologic injury, but few studies evaluate impact on survivor outcomes. This study aimed to evaluate whether exposures to analgesic and sedative medications are associated with worse neurocognitive outcome. Methods: A retrospective cohort study was conducted of 91 patients aged 8 to 18 years, undergoing clinical neurocognitive evaluation approximately 1 to 3 months after PICU discharge. Electronic health data was queried for sedative and analgesic medication exposures, including opioids, benzodiazepines, propofol, ketamine, and dexmedetomidine. Doses were converted to class equivalents, evaluated by any exposure and cumulative dose exposure per patient weight. Cognitive outcome was derived from 8 objective cognitive assessments with an emphasis on executive function skills using Principal Components Analysis. Then, linear regression was used to control for baseline cognitive function estimates to calculate a standardized residualized neurocognitive index (rNCI) z-score. Multivariable linear regression evaluated the association between rNCI and medication exposure controlling for covariates. Significance was defined as P < .05. Results: Most (n = 80; 88%) patients received 1 or more study medications. Any exposure and higher cumulative doses of benzodiazepine and ketamine were significantly associated with worse rNCI in bivariate analyses. When controlling for Medicaid, preadmission comorbid conditions, length of stay, delirium, and receipt of other medication classes, receipt of benzodiazepine was associated with significantly worse rNCI (β-coefficient = -0.48, 95% confidence interval = -0.88, -0.08). Conclusions: Exposure to benzodiazepines was independently associated with worse acute phase cognitive outcome using objective assessments focused on executive function skills when controlling for demographic and illness characteristics. Clinician decisions regarding medication regimens in the PICU may serve as a modifiable factor to improve outcomes. Additional inquiry into associations with long-term cognitive outcome and optimal medication regimens is needed.

A - 71 Cognitive Complaints and Neuropsychological Performance in Cancer: the Role of Affect.

To examine the impact of cancer treatments in affect and in cognition. The study evaluated 115 breast cancer patients before- and 6months after-treatment, and a group of 90 cognitively healthy subjects paired for age and education at matched intervals. All participants performed a comprehensive assessment with measures of affect (HADS and PANAS), subjective complaints (FACT-Cog), and a battery of neuropsychological tests comprising memory, attention, and executive functioning domains. Comparisons were done between-groups pre-treatment, and within-groups between timepoints. Correlations between psychological and cognitive measures were made at 6months. Before treatment, patients exhibited significant lower levels of positive affect (PANAS, p = 0.003), but no complaints or cognitive impairment, when compared to controls. Longitudinal analyses revealed an effect of time, towards improvement, in HADS anxiety (p = 0.0006) and PANAS negative (p < 0.0001), in the clinical group, and a small but significant increase in subjective complaints for both groups (p < 0.001). No objective cognitive decline was found in any group across time. A pattern of significant negative correlations between HADS measures and subjective cognitive assessment was found in the two groups, suggesting that higher affective symptoms are related to more cognitive complaints. No correlations were found between affect and neuropsychological performance, or between subjective and objective cognitive assessments, in any group. Our data showed that there is a discrepancy between cognitive complaints and objective scores due to the presence of affective symptoms in breast cancer patients. Importantly, the similar pattern in matched controls assessed in the same timepoints shows that it is not attributable to cancer treatments.

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.

UNITE Project: understanding neurocognitive impairment after trauma exposure–study protocol of an observational study in Christchurch, New Zealand

IntroductionOur previous research has demonstrated significant cognitive effects of earthquake exposure 2–3 years following the Canterbury earthquake sequence of 2011. Such impairment has major implications for a population trying to...

Association of Alcohol Consumption with Cognition in Older Population: The A4 Study.

Alcohol use disorders have been categorized as a 'strongly modifiable' risk factor for dementia. To investigate the cross-sectional association between alcohol consumption and cognition in older adults and if it is different across sexes or depends on amyloid-β (Aβ) accumulation in the brain. Cognitively unimpaired older adults (N = 4387) with objective and subjective cognitive assessments and amyloid positron emission tomography (PET) imaging were classified into four categories based on their average daily alcohol use. Multivariable linear regression was then used to test the main effects and interactions with sex and Aβ levels. Individuals who reported no alcohol consumption had lower scores on the Preclinical Alzheimer Cognitive Composite (PACC) compared to those consuming one or two drinks/day. In sex-stratified analysis, the association between alcohol consumption and cognition was more prominent in females. Female participants who consumed two drinks/day had better performance on PACC and Cognitive Function Index (CFI) than those who reported no alcohol consumption. In an Aβ-stratified sample, the association between alcohol consumption and cognition was present only in the Aβ- subgroup. The interaction between Aβ status and alcohol consumption on cognition was not significant. Low or moderate consumption of alcohol was associated with better objective cognitive performance and better subjective report of daily functioning in cognitively unimpaired individuals. The association was present only in Aβ- individuals, suggesting that the pathophysiologic mechanism underlying the effect of alcohol on cognition is independent of Aβ pathology. Further investigation is required with larger samples consuming three or more drinks/day.

Examining the factors that moderate progression from subjective cognitive decline to objective cognitive decline: A 4‐year longitudinal study

AbstractBackgroundSubjective cognitive decline (SCD) in older adults has been identified as a risk factor for dementia, although the literature is inconsistent, and the factors that contribute to this inconsistency are not fully understood. We focused on the protective factors for dementia risk and aimed to determine whether SCD has more protective factors for dementia risk and whether they reduce the association with future objective cognitive decline (OCD) from a 4‐year longitudinal study.MethodWe included 4,363 older adults (age: 71.7±5.3 [mean ± standard deviation] years; 2,239 women) from the National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes. SCD, OCD, and protective factors such as lifestyle and activity for dementia risk were assessed using a face‐to‐face interviews and objective cognitive assessment tools. Participants were categorized into cognitive status: normal cognition (neither SCD nor OCD), SCD only, OCD only, and SCD and OCD (both SCD and OCD) groups. Four years later, participants were classified as having or not having mild cognitive impairment or global cognitive impairment. Binomial logistic regression analysis was performed with follow‐up on the cognitive status and at the baseline cognitive status groups as the dependent and independent variables, respectively.ResultPotential confounding factors‐adjusted odds ratios for SCD only, OCD only, and SCD and OCD groups for developing OCD at follow‐up were 1.08 (95% CI, 0.80‐1.45; p = 0.608), 4.00 (95% CI, 2.64‐6.07; p&lt;0.001), and 3.12 (95% CI, 2.22‐4.37; p&lt;0.001), respectively. The SCD only group had more protective factors for dementia risk than the OCD only group.ConclusionCommunity‐dwelling elderlies with SCD had more protective factors for dementia risk at the baseline and a lower association with OCD in the 4‐year follow‐up. Our results suggest that the presence of protective factors for dementia risk may be a contributing factor to the inconsistent literature on the SCD outcomes.

Assessment of cognitive status in pediatric anti-NMDA receptor encephalitis during inpatient rehabilitation: A retrospective cohort

ObjectivesAnti-NMDA receptor autoimmune encephalitis (NMDARE) is a common pediatric encephalitis, resulting in neuropsychiatric symptoms. Predicting severity and course is challenging, with objective cognitive assessments lacking in NMDARE, especially in children. The CASE (Clinical Assessment Scale in Autoimmune Encephalitis) measures severity in autoimmune encephalitis. The CALS (Cognitive and Linguistic Scale) assesses cognitive-linguistic recovery in children with acquired brain injury. This study examines severity and cognitive status in pediatric NMDARE by comparing objectives measures: modified Rankin score (mRS), CASE, and CALS. MethodsTwenty-one patients were identified via retrospective chart review with a confirmed NMDARE diagnosis (ages of 3–18 years) who required inpatient rehabilitation. The mRS, CASE, and CALS were assessed at admission and discharge. ResultsScores demonstrated improvement from admission to discharge, with variability in individual recovery trajectories. CALS identified three clusters of patients with differential rates of early recovery. CALS <30 was associated with minimal improvement and poor outcomes. CALS ≥30 had a likelihood ratio score of 12.0 to predict improvement. CASE and CALS were moderately correlated, but neither correlated with mRS. DiscussionCALS and CASE appear to be complementary measures for assessing severity and cognitive status in pediatric NMDARE, including those with low responsiveness, with implications for treatment and outcomes.