Objective Cognitive Measures Research Articles

Investigating the links between objective social media use, attentional control, and psychological distress

Social media use (SMU) has been associated with negative mental health outcomes and has been implicated in inhibitory attentional control deficits. However, findings have been inconsistent, in part due to methodological limitations in past studies (e.g., over-reliance on self-report SMU and attentional control measures). Therefore, the aim of the present study was to examine the associations between SMU, psychological distress (including depression, anxiety, and stress), and inhibitory attentional control, using objective measures of SMU and inhibitory attentional control. Participants (N = 425) completed the DASS-21 and an antisaccade task, and SMU data was accessed via mobile phones, as minutes/week spent using TikTok, Instagram, Snapchat, Facebook, and Twitter/X. Bivariate correlations were examined, and a moderation analysis was conducted to determine whether attentional control moderated the association between SMU and psychological distress. Our findings revealed that SMU was positively associated with attentional control and anxiety, while TikTok use was positively associated with attentional control, and Facebook use with psychological distress. However, the observed associations were very small, suggesting that the links between SMU and both psychological distress and attentional control may be over-stated, particularly in studies that have utilised self-report SMU measures. No moderating effect of attentional control on the relationship between SMU and psychological distress was observed. These findings highlight the importance of utilising objective SMU and cognitive measures when examining the links between SMU, mental health, and cognitive processes (like attentional control), and to corroborate findings based on associations with self-report SMU indicators.

Negative global metacognitive biases are associated with depressive and posttraumatic stress disorder symptoms and improve with targeted or game-based cognitive training.

Metacognition is disrupted in several clinical populations. One aspect of metacognition, global metacognitive bias (difference between objective and self-reported abilities), has shown to be particularly relevant to clinical functioning. However, previous studies of global metacognitive biases in populations with elevated depressive/posttraumatic stress disorder (PTSD) symptoms have not measured objective and self-reported abilities relative to normative samples, limiting the quantification of biases. Additionally, few studies have examined whether cognitive interventions can improve metacognitive biases or how this relates to depressive/PTSD symptom severity. A total of 84 participants with mild traumatic brain injury (77% veterans) performed PTSD and depression assessments along with self-reported and objective measures of global cognition. Age-adjusted norm-based z scores were used for self-reported and objective cognition, and bias was calculated by subtracting objective minus self-report scores. Participants then received 13 weeks of targeted cognitive training or entertainment games training (both providing performance feedback). Participants were assessed at baseline, immediately posttraining, and 3 months posttraining. We found large negative metacognitive biases in those with clinically significant severity of depressive symptoms (z score difference = -1.77), PTSD symptoms (-1.47), and depressive + PTSD symptoms (-2.29). Metacognitive biases improved after both targeted and entertainment training and was associated with reductions in depressive/PTSD symptom severity (r = -.41/-.42, respectively), led by the entertainment training group (r = -.54/-.46, respectively). These findings show that clinically significant severity of depressive/PTSD symptoms is associated with substantial negative global metacognitive biases and preliminarily suggests that cognitive training may improve these biases and depressive/PTSD symptom severity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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

It remains unclear whether subjective and objective measures of cognitive function in Post COVID-19 Condition (PCC) are correlated. The extent of correlation has mechanistic and clinical implications. This post-hoc analysis of a randomized, double-blind, placebo-controlled clinical trial contains baseline data of subjective and objective measures of cognition in a rigorously characterized cohort living with PCC. Herein, we evaluated the association between subjective and objective condition function, as measured by the Perceived Deficits Questionnaire, 20-item (PDQ-20) and the Digit Symbol Substitution Test (DSST) and Trails Making Test (TMT)-A/B, respectively. A total of 152 participants comprised the baseline sample. Due to missing data, our statistical analyses included 150 for self-reported PDQ-20, 147 individuals for combined DSST-measured cognitive function (composite z-score of the Pen/Paper plus Online CogState Version, NcombinedDSST), 71 for in-person DSST-measured cognitive function (Pen/Paper Version), 70 for TMT-A-measured cognitive function, and 70 for TMT-B-measured cognitive function. After adjusting for age, sex, and education, PDQ-20 was significantly correlated with pen-and-paper DSST (β = -0.003, p = 0.002) and TMT-B (β = 0.003, p = 0.008) scores, but not with TMT-A scores (β = -0.001, p = 0.751). Overall, a statistically significant correlation was observed between subjective and objective cognitive functions. Clinicians providing care for individuals with PCC who have subjective cognitive function complaints may consider taking a measurement-based approach to cognition at the point of care that focuses exclusively on patient-reported measures.

Brain amyloid load, subjective memory complaints, and cognitive trajectories in older individuals at risk for dementia.

This study evaluated associations of brain amyloid with 2-year objective and subjective cognitive measures in a trial-ready older general population at risk for dementia. Forty-eight participants in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability underwent 11C-Pittsburgh compound B (PiB) positron emission tomography (PET) scans and assessment of cognition (modified Neuropsychological Test Battery [NTB]) and subjective memory complaints (Prospective and Retrospective Memory Questionnaire). Mean age was 71.4 ± 5.06 years, and 20 participants (42%) had positive baseline PiB-PET scans. Amyloid positivity was associated with lower NTB executive function at baseline and less favorable 2-year NTB total score and memory trajectories, but not with other objective or subjective cognitive measures. Overall, there was little cognitive decline during 2 years. Amyloid accumulation may affect objective but not necessarily subjective cognition from a very early at-risk stage, although substantial decline likely requires >2 years to occur.

A network approach to subjective cognitive decline: Exploring multivariate relationships in neuropsychological test performance across Alzheimer's disease risk states

Subjective cognitive decline (SCD) is characterized by subjective concerns of cognitive change despite test performance within normal range. Although those with SCD are at higher risk for developing further cognitive decline, we still lack methods using objective cognitive measures that reliably distinguish SCD from cognitively normal aging at the group level. Network analysis may help to address this by modeling cognitive performance as a web of intertwined cognitive abilities, providing insight into the multivariate associations determining cognitive status. Following previous network studies of mild cognitive impairment (MCI) and Alzheimer's dementia (AD), the current study centered upon the novel visualization and analysis of the SCD cognitive network compared to cognitively normal (CN) older adult, MCI, and AD group networks. Cross-sectional neuropsychological data from CIMA-Q and COMPASS-ND cohorts were used to construct Gaussian graphical models for CN (n = 122), SCD (n = 207), MCI (n = 210), and AD (n = 79) groups. Group networks were explored in terms of global network structure, prominent edge weights, and strength centrality indices. CN and SCD group networks were contrasted using the Network Comparison Test. Results indicate that CN and SCD groups did not differ in univariate cognitive performance or global network structure. However, measures of strength centrality, principally in executive functioning and processing speed, showed a CN-SCD-MCI gradient where subtle differences within the SCD network suggest that SCD is an intermediary between CN and MCI stages. Additional results may indicate a distinctiveness of network structure in AD, a reversal in network influence between age and general cognitive status as clinical impairment increases, and potential evidence for cognitive reserve. Together, these results provide evidence that network-specific metrics are sensitive to cognitive performance changes across the dementia risk spectrum and can help to objectively distinguish SCD group cognitive performance from that of the CN group.

Factors associated with the discrepancy between objective and subjective cognitive impairment in bipolar disorder

ObjectiveThe aim of this study is to evaluate the discrepancy between objective cognitive measures and cognitive subjective complaints in a sample of euthymic patients with bipolar disorder (BD). MethodsOne hundred and sixteen participants (83 euthymic patients with BD and 33 healthy controls) were enrolled for this study. Patients were assessed with a comprehensive neuropsychological battery and they also reported their subjective cognitive complaints with the Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA). The discrepancy between objective and subjective data was calculated using a novel methodology proposed in a previous study (Miskowiak, 2016). Statistical analyses included Pearson correlations and multiple linear regression. ResultsHigher number of previous depressive episodes was identified as one variable associated with the global sensitivity composite score (Beta = 0.25; t = 2.1; p = 0.04) and with the verbal learning and memory sensitivity score (Beta = 0.26; t = 2.16; p = 0.03). That is, patients with more previous depressive episodes tend to over-report cognitive complaints. In contrast, higher number of previous hospitalizations was associated with stoicism in the global total score (Beta = −0.27; t = −2.24: p = 0.029) and in the domain of attention/processing speed (Beta = −0.34; t = −2.52; p = 0.016), indicating patients with more hospitalizations tend to report less cognitive complaints. DiscussionOur study identified some factors that might help to explain the discrepancy between objective and subjective cognitive measures in BD, including number of previous depressive episodes and number of previous hospitalizations. This highlights the need of the combined use of both types of cognitive measures to make an accurate assessment of cognitive dysfunctions and their effective treatment.

Daily life participation in PTSD: pilot study on patterns and correlators.

Participation in daily life activities with both the personal and community meaning is an important component of health and well-being. Even though there are mounting reports on the challenges in various aspects of daily-life functioning among individuals with post-traumatic stress disorder (PTSD), to date little research has been conducted on their comprehensive patterns of participation. The study aimed to describe objective and subjective participation dimensions in PTSD compared to healthy controls and investigate the association between personal and environmental factors and participation. Sixty-one individuals were enrolled in two groups: PTSD (N=31; age: M=34.3; women:77.4%) and healthy controls matched by age and gender. The PTSD group completed standard assessments for symptom severity, general cognition, executive function (EF), sensory processing, self-efficacy, functional capacity, and environmental properties. Both groups completed a participation questionnaire. Individuals with PTSD participated with low intensity and diversity, more occupations were abandoned (-4.73<t<5.73, p<0.05), and less meaning was found in the included occupations. Participation objective dimensions were associated with self-reported EF (-0.47<r<-0.42, p<0.05), sensory modulation profile (2.51<t<2.81, p<0.05), and environmental properties (-0.44<r<0.5, p<0.05), but not with PTSD symptom severity, and objective measures of cognition and functional capacity. No correlators were identified for subjective participation dimensions. The study demonstrates profound restrictions in participation in PTSD raising serious concerns. There are unique patterns of association between objective participation dimensions, subjective cognitive indices, sensory modulation, and environmental factors, suggesting a need for PTSD feature-specific intervention approaches to advance the participation of those with PTSD as a means of promoting health and well-being.

Proactive inhibitory control as a cognitive contributor to social difficulties in adolescents with ADHD traits

Adolescents with attention deficit hyperactivity disorder (ADHD) represent a significantly heterogenous group in terms of cognitive and social ability. Given the high co-occurrence of ADHD and autism, it is unclear whether the social difficulties seen in ADHD may be attributed to the same underlying factors which contribute to social difficulties in autism, or are a unique feature of ADHD. This study explores differences in cognition in adolescents with clinically elevated ADHD symptoms with and without social difficulties, and adolescents with ADHD symptoms and autism. Thirty-nine adolescents completed objective measures of cognition (attention, working memory, inhibition) and social cognition (affect recognition, theory of mind [ToM]). Adolescents with ADHD symptoms and social difficulties had poorer proactive inhibition than both those without social difficulties, and those with autism. Lower cognitive performance was only significantly related to social functioning for adolescents with ADHD who experienced social difficulties. ToM was weakest in those with autism. Social difficulties in adolescents with clinically elevated ADHD symptoms are associated with poor proactive inhibition, working memory and affect recognition. This highlights the potential benefit of cognitive strategies for remediating social difficulties in ADHD, and the need for ADHD specific interventions. Lay abstract Around half of teenagers with attention deficit hyperactivity disorder (ADHD) experience significant difficulties forming and maintaining friendships. This in turn often has negative effects on schooling and mental health. There is a large body of research that suggests the social difficulties commonly seen in ADHD may be due to weaknesses in skills such as impulse control, working memory, recognising emotions, and perspective taking. Given teenagers with autism often present with similar weaknesses and social difficulties, it is not known whether the social difficulties experienced by teenagers with ADHD have the same underlying causes. If so, this may suggest that social difficulties in ADHD represent undiagnosed autism, or low-level autism traits. This study compared these key skills in teenagers with clinical ADHD symptoms who experience social difficulties, with those who don’t experience social difficulties, and those with co-occurring autism. The results showed that social difficulties in ADHD and autism appear to have different underlying causes, suggesting that the social difficulties seen in teenagers with ADHD are unique to this disorder, and are not due to underlying autism, or autism traits. This highlights the need for social skills interventions, particularly those that target impulse control, emotion recognition and working memory, that are specifically tailored to the needs and weaknesses of teenagers with ADHD, rather than using existing interventions designed for teenagers with autism.

Subjective Cognition as A Predictor of Objective Cognitive Decline Among Older Black/African Americans: A STAR Study

AbstractBackgroundSubjective evaluations of cognition are convenient to administer and can be useful if they accurately identify or predict cognitive impairment. We investigated the relationship between subjective and objective measures of cognition in a cohort of Black older adults.MethodThe Study of Healthy Aging in African Americans (STAR) comprises community‐dwelling Black adults ages 50+ who are long‐term Kaiser Permanente Northern California members. Verbal episodic memory (VEM) and executive function (EF) were assessed at three interview waves by the Spanish and English Neuropsychological Assessment Scales (SENAS). We operationalized subjective cognition two ways. 1) Participants self‐rated changes in their everyday cognition using the Everyday Cognition Scale (ECog). Responses, rated 1 = “Better or no change” to 4 = “Consistently much worse, were averaged across the 16 items. 2) Participants responded (yes/no) to the question: “Are you concerned that you have a memory or other thinking problem?” (Subjective memory concerns). Linear mixed models with random intercept and slope estimated associations of ECog or subjective memory concerns with VEM and EF at baseline and over time. All models adjusted for baseline age, gender, education, parental education, and interview mode (in‐person or phone). Sensitivity models stratified by gender and age (+/‐ 65 years).ResultParticipants’ (n = 671) baseline mean age was 68.4 (SD = 8.7) years, 70.2% were women, mean ECog was 1.26 (SD = 0.3), and 40.1% reported subjective memory concerns (Table 1). Subjective memory concerns were associated with worse baseline VEM and EF, but not associated with rate of change for either domain (Table 2A; Table 3A). In contrast, ECog was associated with rate of change for VEM (b = ‐0.09, 95% CI ‐0.17,0.002; Table 2B) and EF (b = ‐0.07, 95% CI ‐0.13,‐0.003; Table 3B). Among women, higher ECog was associated with faster decline in VEM (b = ‐0.12, 95% CI ‐0.22,‐0.02; Table 2B) and EF (b = ‐0.09, 95% CI ‐0.17,‐0.02; Table 3B). Among participants ages 65 and older, higher ECog was associated with a faster decline in VEM (b = ‐0.11, 95% CI ‐0.22,‐0.001; Table 2B).ConclusionA well‐validated measure of subjective memory concerns, the ECog, was associated with worse objective executive function and verbal episodic memory and faster declines in both domains in this sample of middle‐aged and older Black adults.

Association of subjective and objective cognitive performance to self‐rated driving ability in older adults

AbstractBackgroundOlder drivers often self‐regulate their driving behaviours to avoid more challenging situations that may lead to increased driving risk. However, other research also indicates that many older adults overestimate their driving ability, and therefore may be at risk of road traffic incidents due to not self‐regulating accurately. Understanding how self‐rated driving relates with cognitive performance can uncover markers for at‐risk driving behaviours. The present study therefore aimed to establish how self‐rated driving ability within a healthy older adult cohort relates to subjective and objective cognitive performance.Method925 cognitively healthy individuals were recruited to take part in an online cohort study (age: 71.07, % female = 55.56). Participants completed questionnaires examining driving behaviour and subjective cognitive performance. Subjective cognition was measured by a questionnaire examining spatial ability and memory performance across the lifespan and within the past 3 months. A subjective cognitive change measure was established by subtracting lifetime cognition ratings from recent cognition ratings. Participants then completed a cognitive battery in domains associated with driving performance. Hierarchical regression modelling was conducted to establish how self‐rated driving ability was associated with subjective and objective cognitive performance after controlling for age and gender effects.ResultWithin subjective cognition, individuals who rated their spatial ability and memory performance higher also rated their driving ability higher, and greater subjective cognitive change within both memory and spatial ability was predictive of lower self‐rated driving ability. Within objective cognitive performance, individuals with faster reaction speeds and faster Trail Making Test‐B completion time rated their driving abilities higher. Interestingly, when included in the same regression model, only subjective cognitive measures were predictive of self‐rated driving ability.ConclusionPrevious studies have found that self‐perceived driving ability is a more accurate indicator of self‐regulation behaviour than actual driving ability. Here, we show that subjective cognitive measures were more predictive of self‐rated driving ability than objective cognitive measures within a healthy older adult cohort. These findings add to the understanding in how cognition interacts with self‐regulation behaviour and provides an opportunity for comparison in self‐regulation driving behaviour within prodromal and clinical dementia.

Contributors to sleep disturbances in caregivers and care recipients with dementia

AbstractBackgroundSleep disturbances in Alzheimer’s disease impact people with dementia (PWD) and caregivers (CGS) who have primary responsibility for care provision. However, it is unknown which aspects of dementia including cognitive decline and behavioral disturbance contribute most to sleep disturbances in patients and caregivers. This pilot study aims to discover what contributes most to sleep deficits, and whether these factors are consistent across both PWD and CGS.MethodPatients: Six dyads with PWD and their primary CGS. Cognitive/behavioral variables: the Montreal Cognitive Assessment (MoCA) (PWD) and the Neuropsychiatric Inventory Questionnaire (NPI‐Q) completed by CGS. Polysomnography: recorded and scored for 1 night for each dyad member separately. Actigraphy: Wrist actigraphy recorded for 14 days in both members of the dyad divided into fixed rest (2200‐0600) and activity (0600‐2200) periods. Sleep variables: total sleep time (TST), sleep onset latency (SOL), nighttime activity as measured by actigraphy.ResultPreliminary results indicate that severity of cognitive dysfunction measured by the MoCA correlates with sleep time (CG r = 0.6224, PWD r = 0.5421). However, presence of neuropsychiatric symptoms and caregiver distress as measured by the NPIQ correlate with sleep onset latency (CG r = 0.9432*, PWD r = 0.7819) and nighttime activity in both CGs and PWD (CG r = 0.8467, PWD r = 0.8708). * = p&lt;0.05.ConclusionThis pilot study of six PWD/CGS dyads examines the relationship between cognition, behavioral disturbance, CGS response to the behavioral disturbance, and sleep. This data indicates that sleep disturbances in PWD and their CGs cannot be explained exclusively by worsening cognitive function and likely have stronger dependence on the neuropsychiatric well‐being of the PWD and CGS emotional response. This dyadic model is unique in that it looks at the interdependence of the PWD/CGS dyad using both objective measures of sleep, cognition, and behavioral disturbance as well as subjective CGS stress. Data from additional dyads is currently being collected to increase the sample size along with the inclusion of additional variables in order to increase understanding of the relationship between PWD characteristics, caregiver burden and sleep disturbances.

Dementia Associated Diseases, Driving Status, and Cognitive Function: Perception Does Not Match Performance – Truth and Consequence for Driving Shared Decision Making

AbstractBackgroundDementia associated diseases (DAD) refer to a group of disorders clinically characterized by progressive cognitive impairment (CI). CI may reflect abnormalities across multiple cognitive domains (CD) to varying degrees and combinations and interfere with the ability to carry out activities of daily living (ADL). Determination of driving ability in routine care relies on patient, family, and clinician shared‐decision making, as availability of routine on‐road driving assessment might be limited. Incorporation of patient reported outcomes (PRO) in routine care has increased, becoming more important for patient care and treatment decisions. Neuro‐QoL Cognitive Function Questionnaire (CF) provides an opportunity to assess self‐reported cognition routinely. The relationship of CF to objective computerized multi‐domain cognitive testing and self‐reported driving has not been explored. Providing easily available objective screening might be of great value for all involved in the decision to continue or stop driving in view of the profound impact loss of driving has on independence.MethodA retrospective review of PwDAD who provided self‐reported driving status and completed both objective and subjective cognitive function (CF) measures. Subjective CF was measured by CF score which pertaining to comprehension, cognition, attention, and learning. The validated computerized cognitive assessment battery (CAB‐NT), includes 7 cognitive domains: memory(Mem), executive function(Exe), attention(Att), information processing speed(Inf), visual‐spatial(Vis), verbal function(Ver), motor skills(Mot) and a global cognitive summary score(GCS). T‐tests and regression analysis was utilized for analysis assuming both equal and unequal variances, with significance (p&lt; 0.05).Results496 PwDAD, average age 73.4±8.9, 61.2% female. T‐test showed significant differences between driving status yes/no for both CF and all CAB‐NT domains. However, regression analysis showed a small effect size between CF and CAB‐NT cognitive domains scores.ConclusionSelf‐reported driving status in PwDAD corresponds to both perceived/subjective CF and objective measures of cognitive function. However, the relationship between subjective and objective cognitive function measures is problematic. With various CDs involved in the safe effective operation of a motor vehicle, it is necessary to objectively assess this risk with objective measures. Evidence of incongruent relationship between objective and subjective cognitive function enhances the importance of incorporating objective measures of cognitive ability to safely maintain an active driving status.

Subjective cognitive complaints and objective cognitive functioning in combat veterans: Effects of PTSD and deployment mild TBI

Objectives (1) Examine the relationship between subjective cognitive complaints and objective cognitive functioning in combat veterans; and (2) evaluate conditional effects of posttraumatic stress disorder (PTSD) and deployment-related mild traumatic brain injury (TBI) within that relationship. Method Combat veterans (N = 225, 86.22% male) completed a lifetime TBI interview, a structured interview assessing PTSD symptoms, a neuropsychological assessment battery, and a self-report measure of cognitive symptoms. Results All correlations between subjective cognitive complaints and objective cognitive measures were not statistically significant. Hierarchical linear regression indicated that cognitive performance was not significantly related to cognitive complaints, but both PTSD diagnosis and history of deployment mild TBI explained a significant amount of unique variance in self-reported cognitive symptoms. Interactions between the studied variables were not significant. Conclusions PTSD and history of deployment mild TBI were uniquely related to cognitive complaints, but cognitive test performance was not. No confounding effects of PTSD or deployment mild TBI were observed in the relationship between cognitive performance and cognitive complaints. This provides support that symptom distress may be a better explanatory factor for perception of lower cognitive functioning than actual cognitive performance.

Feasibility of a remotely-delivered yoga intervention on cognitive function in breast cancer survivors: a mixed-methods study

BackgroundCancer-related cognitive impairment (CRCI) is a common, persistent quality of life complaint among breast cancer survivors (BCS), however there remain no proven treatments. There is emerging evidence that aerobic exercise and yoga may improve CRCI. There remains limited research on the safety and feasibility of virtually-supervised, remotely-delivered yoga interventions among cancer survivors, and no yoga studies to date have assessed cognitive function as a primary outcome in BCS. The purpose of this study was to explore the feasibility of an 8-week, remotely-delivered yoga intervention and examine its impact on cognitive function, fatigue, and exercise levels in BCS using a concurrent mixed-methods design.MethodsParticipants completed objective and self-report cognitive function measures (NIH Toolbox remote cognitive battery, PsyToolkit Task Switch test, Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog3]); fatigue (Revised-Piper Fatigue Scale); and exercise activity level (modified Godin Leisure Time Exercise Questionnaire) before and after the yoga intervention. Semi-structured qualitative interviews were conducted post-intervention to understand participants' experiences with the yoga intervention, CRCI, and fatigue.ResultsThe intervention surpassed a priori feasibility indicators (adherence rate = 83.7%, attrition rate = 5.4%, no adverse events). Participants (n = 18, Mage= 52.2 ± 10.1) had significant improvements in objective memory, fatigue, and weekly minutes of moderate-to-vigorous exercise post-intervention. Qualitative themes indicated that participants found the remote intervention to be enjoyable and beneficial.ConclusionsIn this small proof-of-concept study, remotely-delivered yoga appears safe and effective at improving CRCI. Future randomized controlled trials examining the impact of remotely-delivered yoga interventions on cognitive function in BCS are warranted.

84 Utilizing the DSM-5 Cross Cutting Measure to Characterize the Neuropsychiatric Correlates of Subjective and Objective Cognition

Objective:Historically, psychiatric conditions and neurodegenerative diseases have been considered differential diagnoses in older adults with cognitive impairment. However, recent evidence has shown that neuropsychiatric symptoms may be prodromal for neurodegenerative disease. Subjective Cognitive Decline (SCD) is a potential marker for pre-clinical Alzheimer’s Disease (AD) that is frequently related to mood disturbances. Delineating the relationship between neuropsychiatric symptoms, SCD, and cognitive impairment will help to define both the independent and combined utility of SCD and neuropsychiatric symptoms as markers of preclinical AD. This abstract uses the DSM-5 Cross-Cutting Measure (DSM-5 CC), a novel comprehensive screening tool for psychiatric symptoms, to examine the relationship between objective and subjective measures of cognition as they relate to neuropsychiatric symptoms.Participants and Methods:27 community dwelling, cognitively diverse older adults (78% female, mean age 71.9 ± 7) were enrolled in the Concerns about Memory Problems (CAMP) study. Inclusion criteria included the expressed concern about memory functioning by participants on a 5-item screener, while exclusion criteria were defined as previous diagnosis of neurodegenerative diseases and/or major stroke. All participants completed neuropsychological testing and study surveys including the DSM-5 CC. Participants completed Level 1 and all Level 2 (L2) forms of the DSM-5 CC. Spearman two-tailed non-parametric correlations and independent samples t-tests were conducted to examine the relationship between the DSM-5 CC and the 5-item subjective cognition screener, as well as the DSM-5 CC and objective cognition results.Results:Subjective measures of cognition, as measured by answers to the 5-item screening measure, were significantly associated with DSM-5 CC measures. Question 1 on the SCD screener which asks, “Compared to others your age, do you have difficulty with memory or thinking abilities?” was associated with anger (p=.033) and depression (p=.018) L2 forms. Question 3, “Do any difficulties with memory or thinking abilities make it difficult for you to do things in daily life?)” was associated with the L2 forms for somatic symptoms (p=.016) and repetitive thoughts and behaviors (p&lt;.001). Objective measures of cognition from neuropsychological testing also correlated with DSM-5 CC sub-scores. Digits Backwards Length (DBL) correlated with DSM-5 CC Level 1 Sum (r= -.57, p=.002). DBL (r=-.59 p=.001) and Digits Backwards Total Correct (DBTC) (r=-.47, p=.013) associated with somatic symptoms L2 and sleep L2 (DBL: r=,-.45 p=.019; DBTC: r=-.39, p=.044). Category Naming (animals) was also associated with anxiety L2 (r=-.42, p=.030).Conclusions:Subjective and objective measures of cognition were each related to sub-scores of the DSM-5 CC. Interestingly, the associations were largely non-overlapping. These results highlight the importance of considering a wide range of neuropsychiatric symptoms in the assessment of SCD and cognitive impairment. Findings contribute to the growing body of literature suggesting that neuropsychiatric symptoms should be studied in conjunction with cognitive symptoms among older adults as co-occurring phenomena. Future directions will need to include longitudinal studies that can examine the prodromal nature of SCD and neuropsychiatric symptoms for Alzheimer’s and other neurodegenerative disorders.

19 Accuracy of Self- and Informant-Reported Domain-Specific Cognitive Ratings

Objective:Diagnostic criteria for mild cognitive impairment (MCI) include a report of cognitive decline from the patient or a close informant. It is therefore important to understand the relationship between self- and informant-rated cognition and actual patient performance. Furthermore, it is unknown whether the nature of the relationship between the patient and their informant impacts accuracy of subjective reports. This study aimed to determine the association between informant report, self-report and objective cognitive performance based on relationship factors. We predicted that informant report would be more closely associated with objective performance than self-report after controlling for demographics and mood (Geriatric Depression Scale [mean= 1.4, SD=2]), especially among those who live with the participant and those who are spouses/partners.Participants and Methods:Participants (n = 338; age= 73.5 ±6.7) of varying diagnoses and their respective informants were drawn from the longitudinal cohort of the Michigan Alzheimer’s Disease Research Center (MADRC). The majority of informants were spouses/significant others (55.6%), followed by 23.7% being other family members and 20.7% were non- family members; 58.9% of informants live with the participant. Both respondents completed the Cognitive Change Index (CCI) to rate the patient’s cognitive status (higher scores indicating worsening cognition) across three domains: memory (12 questions), language (1 question), and attention/executive functioning (7 questions). These domains were matched to objective cognitive performance measured using the MADRC neuropsychological battery. Executive functioning and attention were assessed using Number Span Test Forward and Backward (NSF, NSB) and Trail Making Test Part B and Trail- Making Test Part A and B ratio (TMTB, TMTB: A); memory was measured using Craft Story 21 (Immediate and Delayed), Hopkins Verbal Learning Test-Revised (HVLT-R) Total Recall, Delayed Recall, and Benson Complex Figure (BCF) Delayed Recall; and Language was measured by the Controlled Oral Word Association Test (COWAT) and Animal fluency.Results:Linear regression adjusted for sex, race, and mood indicated that both patient and informant CCI ratings were significantly (p&lt;.05) associated with objective cognitive performance. For every one unit increase on executive CCI items, there was a significant decline in executive functioning (NSF patient and informant ß= -0.09, NSB: [ßP= -.14; ßp-0.13]) and TMTB [ßP= 3.85; ß= 3.10 [% change]). Memory performance also declined per unit increase on CCI memory items: (Craft Story 21 Immediate [ßP=-0.32; ß= -0.37] and Delayed [ßP=-.40; ßp -.47], HVLT-R Total Recall [ßP= -.31; ßI=-.37] and Delayed Recall [ßP= -.16; ß=-.20], and BCF Delayed Recall [ßP= -.18; ß= -.23]. Similarly, one unit increase on the single CCI language item was associated with a decline in COWAT (ßP= -2.27; ß= -4.61) and Animal fluency (ßP= -1.88; ß= -3.03). Effect modification by participant-informant relationship type or participant-informant cohabitation was not significant.Conclusions:Patient and informant ratings are associated with objective measures of cognition regardless of the relationship between informant and patient or if they live together. This study was limited by a well-educated sample (mean= 16.1 years of education, SD= 2.4 years) with relatively limited diversity among participant-informant relationships. Future studies should replicate analyses across a larger and more diverse sample.

88 Social Cognition and Information Processing Speed in Individuals with Multiple Sclerosis and Co-Morbid Diabetes: An Interim Analysis

Objective:Multiple sclerosis (MS) is associated with cognitive and social cognitive deficits. Social cognition impairments may include difficulty with facial expression and emotion recognition. People with MS (PwMS) may also not be aware of their cognitive challenges as demonstrated through discrepant objective and subjective assessments. Research recently conducted in demyelinated mouse models demonstrated that metformin, a drug typically used to treat type II diabetes mellitus (DMII), promotes remyelination and reverses existent social cognition impairment by repressing the monoacylglycerol lipase (MgII) enzyme in the brain. We aim to translate this basic science research and are conducting a pilot study to determine if metformin improves social cognition in PwMS. This project will compare social cognition in those with MS and comorbid DMII who are treated with metformin and those who are not. For the purposes of this interim data analysis, we collapse across both MS groups who are, and who are not, treated with metformin. The current objective is to evaluate the relationship between subjective (i.e., perceived empathy), objective social cognition and information processing speed (IPS) in PwMS and co-morbid diabetes.Participants and Methods:Preliminary data on 15 PwMS are included. Participants completed a demographic questionnaire, a cognitive assessment battery, an objective social cognition assessment and self-report questionnaires. These questionnaires assessed subjective social cognition, fatigue, mood, and disability level.Results:Preliminary results showed that IPS was positively correlated with the affective empathy domain of social cognition, r = .53, p = .04. Additionally, IPS was positively correlated with objective social cognition, r = .71, p = 003. Follow-up regression analyses demonstrated that IPS predicted objective social cognition, R2 = .71, SE = 3.04, F(1,13) = 13.36, p = .003 and subjective social cognition, R2 = .53, SE = 5.39, F(1,13) = 4.97, p = .04. However, subjective and objective measures of social cognition were not correlated, p &gt; .05 and remained uncorrelated when IPS was controlled for, p &gt; .05.Conclusions:A majority of the variance in social perception is explained by IPS, suggesting that how quickly one can think may be a fundamental cognitive process to allow optimal functioning in social situations. While the reason for the relationship between IPS and subjective social cognition is perhaps less apparent, it may reflect a more global cognitive compromise that impacts both cognitive and social processes. This lends support to the Relative Consequence Model that suggests IPS deficits are a fundamental cognitive deficit underlying other more complex cognitive processes. The lack of correlation between subjective perception of empathy and objective social cognition requires further exploration and could potentially be related to some individuals with MS having a diminished ability to judge their own social proficiency. Further analyses with a larger sample will be conducted to assess group differences in social cognitive outcomes and MgII levels between metformin and non-metformin groups. If PwMS who take metformin have better social cognition compared to PwMS who do not take metformin, Mgll levels can be used as a biomarker to guide metformin treatment with the goal of improving social cognition.

Recent contributions to the field of subjective cognitive decline in aging: A literature review.

Subjective cognitive decline (SCD) is defined as self-experienced, persistent concerns of decline in cognitive capacity in the context of normal performance on objective cognitive measures. Although SCD was initially thought to represent the "worried well," these concerns can be linked to subtle brain changes prior to changes in objective cognitive performance and, therefore, in some individuals, SCD may represent the early stages of an underlying neurodegenerative disease process (e.g., Alzheimer's disease). The field of SCD research has expanded rapidly over the years, and this review aims to provide an update on new advances in, and contributions to, the field of SCD in key areas and themes identified by researchers in this field as particularly important and impactful. First, we highlight recent studies examining sociodemographic and genetic risk factors for SCD, including explorations of SCD across racial and ethnic minoritized groups, and examinations of sex and gender considerations. Next, we review new findings on relationships between SCD and in vivo markers of pathophysiology, utilizing neuroimaging and biofluid data, as well as associations between SCD and objective cognitive tests and neuropsychiatric measures. Finally, we summarize recent work on interventions for SCD and areas of future growth in the field of SCD.

Depression, Inflammation, and Intestinal Permeability: Associations with Subjective and Objective Cognitive Functioning throughout Breast Cancer Survivorship.

About one-in-three breast cancer survivors have lingering cognitive complaints and objective cognitive impairment. Chronic inflammation and intestinal permeability (i.e., leaky gut), two risk factors for cognitive decline, can also fuel depression-another vulnerability for cognitive decline. The current study tested whether depression accompanied by high levels of inflammation or intestinal permeability predicted lower subjective and objective cognitive function in breast cancer survivors. We combined data from four breast cancer survivor studies (n = 613); some had repeated measurements for a total of 1015 study visits. All participants had a blood draw to obtain baseline measures of lipopolysaccharide binding protein-a measure of intestinal permeability, as well as three inflammatory markers that were incorporated into an inflammatory index: C-reactive protein, interleukin-6, and tumor necrosis factor-α. They reported depressive symptoms on the Center for Epidemiological Studies depression scale (CES-D), and a binary variable indicated clinically significant depressive symptoms (CES-D ≥ 16). The Kohli (749 observations) and the Breast Cancer Prevention Trial (591 observations) scales assessed subjective cognitive function. Objective cognitive function tests included the trail-making test, Hopkins verbal learning test, Conners continuous performance test, n-back test, FAS test, and animal-naming test (239-246 observations). Adjusting for education, age, BMI, cancer treatment type, time since treatment, study visit, and fatigue, women who had clinically elevated depressive symptoms accompanied by heightened inflammation or intestinal permeability reported poorer focus and marginally poorer memory. However, poorer performance across objective cognitive measures was not specific to inflammation-associated depression. Rather, there was some evidence of lower verbal fluency; poorer attention, verbal learning and memory, and working memory; and difficulties with visuospatial search among depressed survivors, regardless of inflammation. By themselves, inflammation and intestinal permeability less consistently predicted subjective or objective cognitive function. Breast cancer survivors with clinically significant depressive symptoms accompanied by either elevated inflammation or intestinal permeability may perceive greater cognitive difficulty, even though depression-related objective cognitive deficits may not be specific to inflammation- or leaky-gut-associated depression.

SARS-CoV-2-Specific Immune Responses in Patients With Postviral Syndrome After Suspected COVID-19.

Millions of Americans were exposed to SARS-CoV-2 early in the pandemic but could not get diagnosed with COVID-19 due to testing limitations. Many have developed a postviral syndrome (PVS) including neurologic manifestations similar to those with postacute sequelae of SARS-CoV-2 infection (Neuro-PASC). Owing to those circumstances, proof of SARS-CoV-2 infection was not required for evaluation at Northwestern Medicine's Neuro COVID-19 clinic. We sought to investigate clinical and immunologic findings suggestive of SARS-CoV-2 exposure in patients with PVS. We measured SARS-CoV-2-specific humoral and cell-mediated immune responses against Nucleocapsid and Spike proteins in 29 patients with PVS after suspected COVID-19, 32 confirmed age-matched/sex-matched Neuro-PASC (NP) patients, and 18 unexposed healthy controls. Neurologic symptoms and signs, comorbidities, quality of life, and cognitive testing data collected during clinic visits were studied retrospectively. Of 29 patients with PVS, 12 (41%) had detectable humoral or cellular immune responses consistent with prior exposure to SARS-CoV-2. Of 12 PVS responders (PVS+), 75% harbored anti-Nucleocapsid and 50% harbored anti-Spike responses. Patients with PVS+ had similar neurologic symptoms as patients with NP, but clinic evaluation occurred 5.3 months later from the time of symptom onset (10.7 vs 5.4 months; p = 0.0006). Patients with PVS+ and NP had similar subjective impairments in quality of life measures including cognitive function and fatigue. Patients with PVS+ had similar results in objective cognitive measures of processing speed, attention, and executive function and better results in working memory than patients with NP. Antibody and T-cell assays showed evidence of prior SARS-CoV-2 exposure in approximately 40% of the PVS group. Three-quarters of patients with PVS+ had detectable anti-Nucleocapsid and one-half anti-Spike responses, highlighting the importance of multitargeted COVID-19 immunologic evaluation and the limitations of commercially available diagnostic tests. Despite their persistent symptoms, lack of COVID-19 diagnosis likely delayed clinical care in patients with PVS. Our data suggest that millions of Americans presenting with PVS resembling Neuro-PASC were indeed exposed to SARS-CoV-2 at the beginning of the pandemic, and they deserve the same access to care and inclusion in research studies as patients with NP with confirmed COVID-19 diagnosis.