Objective Neuropsychological Tests Research Articles

B - 96 Relationships between Self-Reported Cognitive Dysfunction, Functional Activities, and Intraindividual Cognitive Variability in Persons with Multiple Sclerosis (Pwms)

Abstract Objective To examine the relationships between intraindividual cognitive variability (IIV) and self-reported cognitive and functional difficulties in persons with multiple sclerosis (pwMS). We hypothesized higher perceived cognitive and functional difficulties would be associated with higher IIV. Method Participants (n = 35) were pwMS from a prospective memory intervention study. During the baseline evaluation, participants completed an objective neuropsychological test battery and a self-report measure of cognitive functioning (Perceived Deficits Questionnaire; PDQ Total). Participants were asked if they had problems in eight different functional areas due to their memory, with the number of endorsed problems summed. Two measures of IIV, an intraindividual standard deviation (ISD) score and maximum discrepancy score (MDS), were created from 11 indices. The relationship between the IIV and PDQ were assessed with individual linear regressions, controlling for demographics and disease-related characteristics, while Spearman correlations examined the associations with the number of reported functional memory problems. Results The PDQ was not significantly associated with either the ISD (b = −0.03, 95% CI: −0.15, 0.10, p = 0.672) or MDS (b = −0.01, 95% CI: −0.51, 0.32, p = 0.645). The overall number of functional memory problems was correlated with both the PDQ (ρ = 0.40, p = 0.018) and ISD (ρ = −0.35, p = 0.039), but not MSD (ρ = −0.22, p = 0.201). Conclusion(s) Perceived cognitive dysfunction was not associated with IIV. However, self-reported functional problems with memory were associated with perceived cognition, as well as one metric of IIV. ISD may better reflect moment to moment fluctuations that lead to difficulties with daily functioning, as opposed to MDS which may reflect underlying variation (e.g., base rates of impairment) in cognitive performance.

Correlation between cancer-related cognitive impairment and resting cerebral glucose metabolism in patients with ovarian cancer

BackgroundAn increasing number of research have applied neuroimaging techniques to explore the potential neurobiological mechanism of Cancer-related cognitive impairment (CRCI). PurposeTo explore the correlation between resting brain glucose metabolism and CRCI using 18F-FDG PET/CT in ovarian cancer (OC) patients. MethodsFrom December 2021 to March 2022, 38 patients with OC were selected as the study group, and 38 healthy women of the same age (±1 year) who underwent routine physical examination using PET/CT were selected as the control group. Patients received further assessment with the Montreal Cognitive Assessment Scale (MoCA) and Perceived Deficit Questionnaire (PDQ). Independent sample t-test and Spearman correlation were conducted for data analysis. ResultsThe resting brain glucose metabolism in the OC group was significantly lower than in the healthy controls. 60.52 % patients had neuropsychological impairment and retrospective memory were the most serious perceived cognitive impairments. The resting brain glucose metabolism in OC patients did not significantly correlate with neuropsychological performance but had significant positive correlation with subjective cognitive evaluation. DiscussionResting glucose metabolism was low in OC patients and associated with subjective cognitive impairment but not objective neuropsychological test results. 18F-FDG PET/CT can be used to evaluate brain function in OC patients and provide reliable imaging indicators for early recognition of and intervention for changes in cognitive function.

Psychological and cognitive complaints in individuals with love addiction

BackgroundIndividuals with love addiction (LA) may experience psychological, social, and cognitive difficulties in everyday life. However, no study has explored the psychological symptoms, subjective cognitive complaints, and personological aspects associated with LA. The present study aimed to investigate the psychological, behavioral, and cognitive correlates of LA by comparing individuals with high (H-LAI) and low (L-LAI) levels of LA and to clarify the role of resilience and coping style as protective factors of LA. MethodsThe online questionnaire used to recruit the sample included the Love Addiction Inventory (LAI) to assess the levels of LA and cognitive failures, resilience, coping style, depression, and anxiety assessment. Participants were equally divided into H-LAI and L-LAI groups based on the median LAI value. ResultsThe questionnaire was completed by 600 participants (446 females; mean age = 29.5, SD = 9.44). Compared to L-LAI, H-LAI participants were younger and showed more severe anxiety and depressive symptoms; moreover, they complained more frequently about memory and attention failures. Male sex was found to be a risk factor in the development of LA, resilience emerged as a significant protective factor. LimitationsLongitudinal research is needed to better explore the causal link between love addiction and psychological or cognitive failures. Additionally, objective neuropsychological tests should deeply investigate this connection. ConclusionsOur findings indicated a cognitive and psychological profile associated with love addiction characterized by more severe psychological symptoms and perceived cognitive failures. An early identification of individuals most at risk to develop love addiction and the implementation of timed strategies reinforcing resilience might avoid detrimental consequences.

Effects of Goal Management Training on self-efficacy, self-esteem, and quality of life for persons with schizophrenia spectrum disorders.

Persons with schizophrenia often show executive dysfunction assessed with both subjective (self-report) and objective (neuropsychological tests) measures. In a recent randomized controlled trial (RCT), subjective executive functioning in everyday life was improved following Goal Management Training (GMT). The aim of the current study is to investigate the potential of GMT to improve secondary well-being outcomes from that RCT, including self-esteem, self-efficacy, and quality of life in persons with schizophrenia spectrum disorders. Since well-being is frequently lower in persons with schizophrenia compared to healthy individuals, further knowledge about well-being as an outcome after cognitive remediation may have implications for clinical treatment. Sixty-five participants were randomly assigned to GMT (n = 31) or a waiting list control condition (n = 34). Assessments were conducted at baseline (T1), immediately after the intervention (T2-5 weeks), and at six-month follow-up (T3). Measures included the Rosenberg Self-Esteem Scale, the Perceived Quality of Life Scale, and the General Self-Efficacy Scale. Results were analyzed using a linear mixed model analysis for repeated measures. There were no significant effects of GMT on self-esteem or quality of life. Only the GMT group showed a significant increase in self-efficacy that was most evident at six months follow-up, F(1, 34) = 10.71, p = 0.002, d = 0.71. Improved self-efficacy was found to correlate significantly with a reduction in perceived executive dysfunction in an exploratory post hoc analysis. Our findings demonstrate the potential of GMT in improving self-efficacy in schizophrenia Clinical trial registration:https://clinicaltrials.gov, NCT03048695.

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.

15 Does Subjective Socioeconomic Status Mediate the Relationship Between Objective Socioeconomic Status and Neuropsychological Test Performance Across Race and Ethnicity?

Objective:Socioeconomic disadvantage is a chronic stressor associated with several biological markers of health (e.g., inflammation) as well as early-onset cognitive aging. Studies examining socioeconomic status (SES) and its link with health outcomes exhibit no uniformity in the way in which SES is measured and defined. Also, studies have found that subjective socioeconomic status (SSES), defined by a subjective SES scale, was more consistently and strongly related to psychological functioning and health-related outcomes than objective socioeconomic status (OSES), defined by a composite score of education, household income, and occupation. The goal of the current study was to assess whether SSES mediates the relationship between OSES and neuropsychological test performance similarly across racial and ethnic groups.Participants and Methods:Participants were 1,912 middle-aged older adults (13% non-Hispanic white, 17% non-Hispanic Black, 69% Hispanic/Latinx) from the Offspring study. Participants are the adult children of participants in the Washington Heights Inwood Columbia Aging Project, a community-based cohort study of aging and dementia representing the ethnic/racial diversity of upper Manhattan. Participants on average were 56.5 years of age and 67% were women. Measures of verbal learning and memory (SRT immediate and delayed recall), verbal fluency (animal and letter fluency), and attention/working memory (digit span forward and backward) were administered. OSES was characterized by years of formal education completed. SSES was measured by the MacArthur Scale of Subjective Social Status. The scale measures perceptions of one’s social standing relative to others. We conducted separate stratified mediation analyses for each neuropsychological outcome across each racial and ethnic group. All models were adjusted for age.Results:Participants with higher OSES demonstrated higher neuropsychological test scores (effect size associations ranged from .29 to .45) and reported higher SSES (b=.109 95% CI: .08, .14). Lower SSES was associated with lower neuropsychological test scores (effect-size range .06 to .13). In stratified analyses, the relationship between OSES and SSES was strongest for White participants (b=.13 [.01, .24]) compared with Latinx (b=.06 [.02, .11]) and Black (b=.06 [-.03, .16]) participants. Associations between SSES and neuropsychological outcomes were only reliable for White participants on SRT Immediate and Delayed Recall and Animal Fluency and for Black participants on Digit Span Forward. In mediation analyses, SSES mediated the relationship between OSES and Immediate Recall (indirect effect b=.18 [.001, .45]; 39% mediated), Delayed Recall (indirect effect b=.05 [.004, .09]; 44% mediated), and Animal Fluency (indirect effect b=.09 [.01, .20]; 22% mediated) for White participants. There was no evidence of mediation in Black or Latinx participants.Conclusions:The relationship between OSES and SSES was strongest for White participants compared to Black and Latinx participants. Even though perception of social status predicted lower cognitive test scores among Black and Latinx adults, it is only a part of the indirect pathway linking OSES to cognitive function among White adults. It is likely that mechanisms related to tangible resources that benefit health (as opposed to perceived inequity) are in the pathway linking education to cognition among Black and Latinx, and thus intervening on systems of inequality throughout the life course has the most promise for improving brain health in those communities.

68 Subjective Cognitive Functioning Following Non-Severe COVID-19 Acute Infections: A Meta-Analysis

Objective:Emerging evidence suggests that individuals recovering from COVID-19 perceive changes to their cognitive function and psychological health that persist for weeks to months following acute infection. Although there is a strong relationship between initial COVID-19 infection severity and development of prolonged symptoms, there is only a modest relationship between initial COVID-19 severity and self-reported severity of prolonged symptoms. While much of the research has focused on more severe COVID-19 cases, over 90% of COVID-19 infections are classified as mild or moderate. Previous work has found evidence that non-severe COVID-19 infection is associated with cognitive deficits with small-to-medium effect sizes, though patients who were not hospitalized generally performed better on cognitive measures than did those who were hospitalized for COVID-19 infection. As such, it is important to also quantify subjective cognitive functioning in non-severe (mild or moderate) COVID-19 cases. Our meta-analysis examines self-reported cognition in samples that also measured objective neuropsychological performance in individuals with non-severe COVID-19 infections in the post-acute (>28 days) period.Participants and Methods:This study’s design was preregistered with PROSPERO (CRD42021293124) and used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist for reporting guidelines. Inclusion criteria were established prior to article searching and required peer-reviewed studies to have (1) used adult participants with a probable or documented diagnosis of non-severe (asymptomatic, mild, or moderate) COVID-19 who were in the post-acute stage (>28 days after initial infection); (2) used objective neuropsychological testing to document cognitive functioning; and (3) include a self-report measure of subjective cognition. At least two independent reviewers conducted all aspects of the screening, reviews, and extraction process. Twelve studies with three types of study design met full criteria and were included (total n=2,744).Results:Healthy comparison group comparison: Compared with healthy comparison participants, the post-COVID-19 group reported moderately worse subjective cognition (d=0.546 [95% CI (0.054, 1.038)], p=0.030). Severity comparison: When comparing hospitalized and not hospitalized groups, patients who were hospitalized reported modestly worse subjective cognition (d=-0.241, [95% CI (-0.703, 0.221)], p=0.30), though the difference was not statistically significant. Normative data comparison: When all non-severe groups (mild and moderate; k=12) were compared to the normative comparison groups, there was a large, statistically significant effect (d=-1.06, [95% CI (-1.58, -0.53)], p=0.001) for self-report of worse subjective cognitive functioning.Conclusions:There was evidence of subjective report of worse cognitive functioning following non-severe COVID-19 infection. Future work should explore relationships between objective neuropsychological functioning and subjective cognitive difficulties following COVID-19.

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.

Subjective cognitive concerns differ by race/ethnicity among einstein aging study (EAS) participants: Implications for assessment and interpretation of self‐perceived cognitive functioning

AbstractBackgroundSubjective cognitive concerns (SCC) play an important role in the identification of preclinical dementia, especially among individuals who have experienced health disparities. It is critical to discern differential patterns of SCC endorsement among racially/ethnically diverse groups to enhance the ability to accurately capture current and future cognitive status. Moreover, it is important to determine whether the association of SCCs and objective neuropsychological test scores vary by racial/ethnic background.MethodUsing data from the EAS, a longitudinal community residing cohort aged 70+, SCCs were captured using an expanded version of the Cognitive Change Index (CCI‐40), which taps multiple cognitive domains. Objective cognition was measured using the FCSRT and tests from the Uniform Data Set, Neuropsychological Battery (UDSNB3.0). Linear regression models evaluated racial/ethnic differences in SCC at baseline. Additional models for objective cognition examined its association with SCC adjusting for racial/ethnic groups, and furthermore the interaction effects between race/ethnicity and SCC. Covariates included demographics, depressive symptoms, income, and co‐morbidities.ResultWe included 313 participants of non‐Hispanic (NH) White (47%), NH Black (40%) and Hispanic/Latino (13%) racial/ethnic groups who were not demented at baseline. NH Blacks and Hispanic/Latino participants reported significantly more SCC than NH Whites after adjusting for covariates. Higher CCI‐40 scores were associated with worse FCSRT free recall and Trail Making Test Part B performing, adjusting for race and other covariates. When interactions between race/ethnicity and CCI‐40 were included, higher levels of SCC were associated with lower MoCA and FCSRT free recall scores for NH Whites but not for NH Blacks.ConclusionStronger perceptions of self‐reported cognitive decline do not necessarily correspond to worse performance on memory and global cognitive tasks for all racial groups. Although racial/ethnic differences were found in levels of SCC, it is important to investigate factors that may influence self‐perceived cognitive functioning for specific groups (e.g., health status, social support), and the consequential impact on access to healthcare settings (where assessment and diagnosis typically occur). In addition, researchers should consider diversity variables when setting cut points on self‐report questionnaires to enhance diagnostic sensitivity and inform optimal assessment and monitoring needs.

Cognition Test Battery Survey: Development of a Single Alertness and Mood Score for Short- and Long-Duration Spaceflight

Astronaut behavioral and mental health are key factors for space mission success. NASA’s Cognition test battery is often preceded by a brief 18-item Alertness and Mood Survey (AMS) adding subjective assessments to Cognition’s 10 objective neuropsychological tests. Therefore, the main objective of this study was to generate a single AMS summary score for short (<6 months) and long (>6 months) space missions based on the relevance of individual items. With the paired comparison (PC) method, 19 subject matter experts (SMEs) were asked to rate the relevance of 14 AMS items for astronaut behavioral health. Boredom (22.1% of comparisons), monotony (23.1%), and sleepiness (35.6%) were considered the least relevant, and health (74.3%), depression (76.5%), and crew conflicts (77.9%) were considered the most relevant by SMEs. Six of the fourteen items differed statistically significantly between PCs for short- and long-duration missions: sleepiness, tiredness, energy level, and mental status were considered more relevant for short-duration missions, while monotony and loneliness were considered more relevant for long-duration missions (all adjusted p < 0.05). We also demonstrated systematic changes in AMS summary scores during a 60-day 6° head-down tilt bed rest (HDBR) study, with increased alertness and mood disturbance during and after the HDBR period relative to pre-HDBR levels. This analysis identified the AMS domains considered most relevant for space mission success by SMEs, and highlighted differences between long- and short-duration missions. The resulting AMS summary scores were based on item relevance and will be useful for monitoring astronaut behavioral health on short- and long-duration space missions.

The Cognitive Connectome in SCD

AbstractBackgroundSubjective cognitive decline (SCD) in cognitively normal individuals is a relevant predictor of future cognitive decline, dementia, and neurodegeneration. Previous studies showed that the cognitive decline cannot be captured by objective neuropsychological testing in SCD. However, whether sophisticated multivariate approaches such as graph theory can potentially capture subtle cognitive abnormalities in SCD individuals is unknown. This study aimed to assess the cognitive connectome in a relatively large cohort of SCD individuals, in comparison with healthy controls (HC), and assess whether such a connectome differs in SCD across age groups.MethodWe included a total of 390 individuals, of which 211 fulfilled the core SCD criteria proposed by the international SCD Initiative (SCD‐I), and 179 individuals were classified as healthy controls. Participants were stratified into early middle‐age (37–50 years, n = 125), late‐middle‐age (51–64 years, n = 119), and elderly (65–78 years, n = 146) groups. We built cognitive networks from 47 cognitive variables separately for each age and study group using graph theory and compared the groups using global measures of average strength, average global efficiency, average local efficiency, and transitivity.ResultSCD individuals had more segregated networks in all age groups, but more prominently in the late‐middle‐age group. We observed lower within‐module connectivity in SCD individuals, in verbal memory and executive—premotor functions compared with HC. The late middle‐age SCD group showed a pattern of connectivity similar to the elderly HC group. The late‐middle‐age SCD group also showed reduced transitivity compared with the HC. We did not observe significant differences in the rest of the graph measures and in the other groups.ConclusionUsing a sophisticated multivariate approach, we demonstrate that a segregated pattern of cognitive connectivity seems to underlie SCD, particularly in individuals in the age range 51 to 64 years. After the age of 65 years, this pattern tends to be less segregated, contrary to an efficient dedifferentiation process in aging. This, together with subtle signs of brain pathology and other risk factors identified in SCD may increase the likelihood of future cognitive impairment and dementia.

Pre- and postoperative self-reported and objectively assessed neurocognitive functioning in lower grade glioma patients

Due to the tumor itself or its therapy glioma patients may complain on cognitive impairment, while validated neuropsychological testing (NPT) capturing specific neuropsychological domains does not indicate “objective” dysfunction. Little is known on the relevance of this disturbance for patients’ everyday life. We aimed to address whether glioma patients treated with state-of-the-art neurosurgical techniques complain on neuropsychological impairment and whether these subjective complaints are disclosed in formal NPT. We assessed both, “objective” and “subjective” neurocognitive functioning in 13 patients with newly diagnosed WHO grade 2 and 3 gliomas, operated between 06/2018 and 12/2020. All underwent both, preoperative and follow-up NPT as well as a semi-structured interview on subjective complaints and specific questionnaires (post-therapeutic) on attention, memory and executive functioning. On group level, no significant changes between preoperative and post-therapeutic NPT occurred. On the individual level, in 3/13 patients new post-therapeutic deficits in objective NPT were detected in specific domains (verbal memory, non-verbal memory, verbal fluency). By contrast, 8/13 patients reported on “subjective” memory impairments post-therapeutically. Furthermore, on specific questionnaires cognitive and emotional executive dysfunction and increased fatigue occurred in patients relative to normative data. Although the findings have to be replicated in larger populations, a discrepancy between “subjective” and “objective” measures was evident. While subjective neurocognitive impairment may simply not represent a true dysfunction, an alternative explanation might be that established standardized NPT is not suitable to detect subtle dysfunction in this population. “Subjective” and “objective” neurocognitive functioning might represent distinct constructs, which should complement each other in patient-centered Neuro-Oncology.

Previous Syphilis Not Associated With Neurocognitive Outcomes in People Living With Human Immunodeficiency Virus in Ontario, Canada.

Background About 40% to 60% of people living with human immunodeficiency virus (HIV) experience neurocognitive impairments, irrespective of antiretroviral status. We hypothesized that a history of syphilis or neurosyphilis would be associated with worse neurocognitive outcomes in this population. Methods Among health care–engaged people living with HIV in Ontario older than 16 years enrolled in the OHTN Cohort Study, neurocognitive outcomes were as follows: (1) self-reported Medical Outcome Study–HIV Health Survey 4-item cognitive scale; (2) average T score summary scores based on objective neuropsychological testing of complex attention, speed of processing, and learning/memory; and (3) global deficit score dichotomized into impaired/unimpaired neurocognitive status. Syphilis history was determined by laboratory data or chart review. Univariable and multivariable generalized linear mixed models assessed the association between each of: syphilis, number of episodes of syphilis, and years since syphilis diagnosis with these neurocognitive outcomes controlling for age, sex, race, education, income, years of HIV, nadir and most recent CD4 count, most recent HIV viral load, substance use, depression, and number of prior neurocognitive tests. Results Of 1288 eligible participants, 218 (16.9%) had a history of syphilis at baseline and an additional 53 were diagnosed during follow up for a total of 271 (21.0%) at the most recent visit. Of those with past infection at baseline, 179 (82.1%) had 1 and 39 (17.9%) had 2 or more episodes of syphilis. In longitudinal multivariable models, we observed no relationship between syphilis diagnosis or years since syphilis diagnosis and any of the neurocognitive outcomes. Conclusions In this sample, prior syphilis was not associated with worse neurocognitive outcomes over time according to self-reported scales or objective neuropsychological testing.

EEG markers and subjective memory complaints in young and older people

Subjective memory complaints (SMCs) have been related to subtle cognitive deficits and neural changes. In this study, we investigated whether EEG rhythms, usually altered in mild cognitive impairment and Alzheimer's disease, are also affected in SMCs compared to people without SMCs. Seventy-one older adults (55–74 years old) and 75 young people (18–34 years old) underwent 3 min of EEG recording in a resting-state condition with their eyes open (EO) and eyes closed (EC) and a comprehensive neuropsychological evaluation. The EEG measures included were power spectral delta (0.5–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (13–30 Hz), and EEG reactivity to EO. Compared to controls, older people with SMCs showed increased theta power and a loss of alpha reactivity to EO. Additionally, in older participants with SMCs, the theta power spectral was related to deficits in verbal memory. In contrast, we failed to find differences in the young people with SMCs, compared to the control group, in the power spectral or the EEG reactivity to EO. Our findings suggest that neurophysiological markers of brain dysfunction may identify cognitive changes even before they are observed on objective neuropsychological tests, at least in older people.

Clinical Progression of Baseline Risk States for Mild Cognitive Impairment.

This memory-clinic study joins efforts to study earliest clinical signs and symptoms of Alzheimer's disease and related dementias: subjective reports and objective neuropsychological test performance. The memory-clinic denoted two clinical "grey zones": 1) subjective cognitive decline (SCD; n = 107) with normal objective test scores, and 2) isolated low test scores (ILTS; n = 74) without subjective complaints to observe risk for future decline. Initial and annual follow-up clinical research evaluations and consensus diagnosis were used to evaluate baseline characteristics and clinical progression over 2.7 years, compared to normal controls (NC; n = 117). The ILTS group was on average older than the NC and SCD groups. They had a higher proportion of people identifying as belonging to a minoritized racial group. The SCD group had significantly more years of education than the ILTS group. Both ILTS and SCD groups had increased risk of progression to mild cognitive impairment. Older age, minoritized racial identity, and baseline cognitive classification were risk factors for progression. The two baseline risk groups look different from each other, especially with respect to demographic correlates, but both groups predict faster progression than controls, over and above demographic differences. Varied presentations of early risk are important to recognize and may advance cognitive health equity in aging.

Disentangling subjective symptom complaints and objective cognitive performance in veterans: Impact of posttraumatic stress disorder and lifetime traumatic brain injury burden

Self-reported histories of mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) symptoms are prevalent among post-9/11 veterans. Both are associated with subjective and often overlapping symptom complaints, but variably with objective neuropsychological test performances. These outcomes are seldom explored in relation to lifetime mTBI burden. This cross-sectional study examined associations of PTSD and lifetime mTBI with subjective (persistent symptoms after concussion and cognitive complaints) and objective (performances across five cognitive domains) measures among 46 veterans. Within this sample, 20 veterans had Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) confirmed PTSD (PTSD+), whereas 26 demographically-similar participants did not meet criteria (PTSD−). The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) yielded total mTBI scores ranging from 0 to 8. Regressions showed PTSD was associated with increased subjective symptoms/cognitive complaints, along with reduced verbal fluency, visuospatial memory, and processing speed performances. Lifetime mTBI burden was associated with subjective symptoms, but not with objective cognitive test performance, after controlling for PTSD. No significant interactions were observed. Exploratory correlations suggested that all PTSD symptom clusters were generally associated with the subjective and objective measures. However, fewer significant associations emerged within the PTSD+/− groups separately, with each group yielding somewhat different patterns of relationships. PTSD and increasing mTBI burden are consistently associated with negative subjective symptoms, including cognitive complaints. Each condition likely explains some degree of unique variance in symptom reporting. PTSD is associated with poorer objective cognition on some tasks, including processing speed, executive functioning, and learning/memory. Implications are explored.

Mother knows best… or does she? Perceptions of the memory abilities of pediatric patients with epilepsy as reported by patients and their parents across time

PurposeThis study compared the self-reported and parent-reported memory of children with epilepsy across time and explored the relationships between these measures of subjective memory and the children’s actual performance on objective neuropsychological tests. MethodOne-hundred and nineteen children with epilepsy who were surgical candidates underwent comprehensive neuropsychological testing that included the Everyday Verbal Memory Questionnaire (EVMQ). Each child’s parent and 82 of the children themselves completed the appropriate version of this subjective memory measure. After 9 months, the children returned for a second neuropsychological evaluation with 71 parents and 39 children completing the same questionnaire. Approximately one-third of the children in the study underwent surgery between the two evaluations. Standardized regression-based norms were used to quantify change in cognitive abilities across assessments. ResultsResults revealed significant relationships between parent reports and child reports of the children’s memory abilities. Parent reports, but not child reports, correlated with the children’s objective test scores at baseline. In contrast, children were more attuned to changes in their memory across time. ConclusionsThese findings demonstrate the importance of considering both parent and child perceptions of everyday cognitive functioning when evaluating cognition and cognitive changes over time in pediatric patients with epilepsy.

Pretreatment patient-reported cognitive function in patients with diffuse glioma

PurposeCognitive function is frequently assessed with objective neuropsychological tests, but patient-reported cognitive function is less explored. We aimed to investigate the preoperative prevalence of patient-reported cognitive impairment in patients with diffuse glioma compared to a matched reference group and explore associated factors.MethodsWe included 237 patients with diffuse glioma and 474 age- and gender-matched controls from the general population. Patient-reported cognitive function was measured using the cognitive function subscale in the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire. The transformed scale score (0–100) was dichotomized, with a score of ≤ 75 indicating clinically important patient-reported cognitive impairment. Factors associated with preoperative patient-reported cognitive impairment were explored in a multivariable regression analysis.ResultsCognitive impairment was reported by 49.8% of the diffuse glioma patients and by 23.4% in the age- and gender-matched reference group (p < 0.001). Patients with diffuse glioma had 3.2 times higher odds (95% CI 2.29, 4.58, p < 0.001) for patient-reported cognitive impairment compared to the matched reference group. In the multivariable analysis, large tumor volume, left tumor lateralization, and low Karnofsky Performance Status score were found to be independent predictors for preoperative patient-reported cognitive impairment.ConclusionsOur findings demonstrate that patient-reported cognitive impairment is a common symptom in patients with diffuse glioma pretreatment, especially in patients with large tumor volumes, left tumor lateralization, and low functional levels. Patient-reported cognitive function may provide important information about patients’ subjective cognitive health and disease status and may serve as a complement to or as a screening variable for subsequent objective testing.

The relationship between mental fatigue, cognitive functioning, and employment status in patients with low-grade glioma: a cross-sectional single-center study

Purpose To evaluate fatigue and cognitive functioning in patients with low-grade glioma and to assess whether cognitive functioning and employment status differ between patients with severe and non-severe mental fatigue. Methods Cross-sectional study. Fatigue was measured with the multidimensional fatigue inventory, objective cognitive functioning with a neuropsychological test battery, and mood with the Center for Epidemiological Studies Depression Scale. Results Thirty-one patients, mean age 44 ± 11, mean time post-diagnosis 2.5 ± 1.4 years, participated. Severe mental fatigue was present in 55% and depression in 36% of the patients. Attention deficits were observed in 75% (Stroop’s test), memory deficits in 36% (Rey Auditory Verbal Learning Test), and executive functioning deficits in 42% (Stroop’s test). Severe mental fatigue patients demonstrated significantly worse scores on Stroop’s test-Card-II (p = 0.043), Trail Making Test-B (p = 0.014), Trail Making Test-B/A (p = 0.014), and Digit-Span (p = 0.046), compared to non-severe mental fatigue patients. Severe mental fatigue patients worked significantly less hours per week (p = 0.013) and had more changes in their employment status (p = 0.009) after diagnosis. Conclusions Patients with low grade glioma show high rates of fatigue, especially in the mental domain, which might be associated with deficits in cognitive functioning and changes in employment status. Implications for rehabilitation The majority of patients with low grade glioma suffers from severe mental fatigue and has deficits in cognitive functioning, which may affect employment status. Patients with low grade glioma should be screened for fatigue with the multidimensional fatigue inventory, to differentiate between mental and physical fatigue. Patients with low grade glioma with severe mental fatigue should be screened for problems in cognitive functioning with an objective neuropsychological test battery. Cognitive and vocational rehabilitation programs should aim at coping with severe mental fatigue and attention deficits in patients with low grade glioma.

Study Design and Baseline Results in a Cohort Study to Identify Predictors for the Clinical Progression to Mild Cognitive Impairment or Dementia From Subjective Cognitive Decline (CoSCo) Study.

Subjective cognitive decline (SCD) refers to the self-perception of cognitive decline with normal performance on objective neuropsychological tests. SCD, which is the first help-seeking stage and the last stage before the clinical disease stage, can be considered to be the most appropriate time for prevention and treatment. This study aimed to compare characteristics between the amyloid positive and amyloid negative groups of SCD patients. A cohort study to identify predictors for the clinical progression to mild cognitive impairment (MCI) or dementia from subjective cognitive decline (CoSCo) study is a multicenter, prospective observational study conducted in the Republic of Korea. In total, 120 people aged 60 years or above who presented with a complaint of persistent cognitive decline were selected, and various risk factors were measured among these participants. Continuous variables were analyzed using the Wilcoxon rank-sum test, and categorical variables were analyzed using the χ2 test or Fisher's exact test. Logistic regression models were used to assess the predictors of amyloid positivity. The multivariate logistic regression model indicated that amyloid positivity on PET was related to a lack of hypertension, atrophy of the left temporal lateral and entorhinal cortex, low body mass index, low waist circumference, less body and visceral fat, fast gait speed, and the presence of the apolipoprotein E ε4 allele in amnestic SCD patients. The CoSCo study is still in progress, and the authors aim to identify the risk factors that are related to the progression of MCI or dementia in amnestic SCD patients through a two-year follow-up longitudinal study.