Neuropsychological Test Performance Research Articles

Can machine learning assist us in the classification of older patients suffering from dementia based on classic neuropsychological tests and a new financial capacity test performance?

Predicting the diagnosis of an older adult solely based on their financial capacity performance or other neuropsychological test performance is still an open question. The aim of this study is to highlight which tests are of importance in diagnostic protocols by using recent advancements in machine learning. For this reason, a neuropsychological battery was administered in 543 older Greek patients already diagnosed with different types of neurocognitive disorders along with a test specifically measuring financial capacity, that is, Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). The battery was analysed using a random forest algorithm. The objective was to predict whether an older person suffers from dementia. The algorithm's performance was tested through cross-validation. Machine learning was applied for the first time in data analysis regarding financial capacity and three factors-tests were revealed as the best predictors: two subscales from the LCPLTAS measuring 'financial decision making' and 'cash transactions', and the widely used MMSE which measures general cognition. The algorithm demonstrated good performance as measured by the F1-score, which is a measure of the harmonic mean of precision and recall. This evaluation metric in binary and multi-class classification integrates precision and recall into a single metric to gain a better understanding of model performance. These findings reveal the importance of focusing on these scales and tests in neuropsychological assessment protocols. Future research may clarify in other cultural settings if the same variables are of importance.

Initial expressed emotion during neuropsychological assessment: investigating motivational dimensions of approach and avoidance

ABSTRACT Objective Prior work indicates that discrete emotions are linked to performance across multiple domains of cognitive function and thus have the potential to impact cognitive profiles in neuropsychological assessment. However, reported presence and magnitude of the relationships between emotion and cognitive test performance are inconsistent. Variable findings in this regard could be due to failure to consider motivations associated with expressed emotion. To better understand the potential impact of expressed emotion on neuropsychological test performance, it may be beneficial to consider approach and avoidance motivation during assessment. Method The current cross-sectional study examined associations between cognitive performance and digitally phenotyped facial expressions of discrete emotions on dimensions of approach (i.e. joy, sadness, anger) and avoidance (i.e. fear, disgust) in the context of virtual neuropsychological assessment in 104 adults (ages 55–90). Results Initial facial expressions categorized as anger and joy predicted later reduced cognitive performance in aspects of memory and executive function within the virtual session, respectively. Test performance was associated neither with sadness nor with avoidance emotions (i.e. disgust or fear). Conclusions Results of the current study did not strongly align with approach/avoidance explanations for links between emotion and cognitive performance; however, results might support an arousal-based explanation, as joy and anger are both high arousal emotions. Additional investigation is needed to understand the intersection of emotion motivation and physiological arousal in the context of neuropsychological assessment.

Cognitive performance, psychiatric comorbidities, and quality of life in pediatric patients with juvenile idiopathic arthritis: a comparative analysis with healthy controls

ABSTRACT This study aimed to assess the extent of cognitive impairment in children and adolescents with Juvenile Idiopathic Arthritis (JIA). While cognitive deficits are recognized in other systemic rheumatic diseases, exploration within the pediatric JIA population remains limited. The investigation utilized a comprehensive approach to examine neuropsychological test performance. A cohort of 160 participants (79 JIA, 81 healthy controls aged 8–17) underwent evaluations using the Pediatric Quality of Life Inventory (PedsQL), Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and the computerized neurocognitive test battery Central Nervous System Vital Signs (CNSVS). Children with JIA exhibited statistically significant cognitive deficits across various parameters (p < .05). This was associated with an increased prevalence of lifelong psychiatric illnesses and diminished overall quality of life compared to healthy counterparts (p < .05). Analysis highlighted that specific JIA subtypes, excluding Oligoarthritis, significantly elevated the risk of neurocognitive impairments, emphasizing the impact on various cognitive outcomes (OR range: 3.1–5.1, 95% CI: 1.163–19.980). Additionally, the active disease stage was identified as a specific risk factor, amplifying the likelihood of low executive functions by 4.3 times (OR: 4.363, 95% CI: 1.095–17.378). This study underscores the critical importance of recognizing and addressing neurocognitive impairments in children with JIA. Specific attention to disease subtypes and activity levels is crucial, with the potential for targeted interventions to enhance overall cognitive well-being and quality of life in this vulnerable population.

Are there predictable neuropsychological impairments in persons with functional movement disorder?

This study attempted to partially test the hypotheses recently proposed by Spagnolo, Garvey, and Hallett that patients with functional movement disorders (FMDs) should demonstrate impaired performance when presented with tasks that sample affect expression/perception, working memory, and cognitive/motor control. A retrospective chart review of the neuropsychological test performance of 17 adult FMD patients was performed to test these hypotheses. Performance on the Barrow Neurological Institute Screen for Higher Cerebral Functions, the Wechsler Adult Intelligence Scale—Fourth Edition, and the modified version of the Halstead Finger Tapping Test were used to measure these behaviors. Patients with FMD had difficulty performing tasks involving affect expression/perception and working memory relative to other cognitive functions. However, only one-third of the sample demonstrated clinically relevant slow finger tapping speeds. Our findings are consistent with the predictions proposed by Spagnolo et al. that disturbance of affect expression/perception and working memory are common in patients with FMD. However, there was less evidence for consistent disturbances in cognitive/motor control. Exploring what FMD patients experience when performing these tasks may facilitate their awareness of how non-neurological factors may contribute to their symptoms.

Efficacy of Cognitive Interventions in Mild Cognitive Impairment due to Alzheimer's Disease- An Open-Labelled Exploratory Analysis.

Efficacy data on nonpharmacotherapy-based interventions such as cognitive retraining and mindfulness meditation on improving neuropsychological functioning in early Alzheimer's disease (AD) are sparse in Indian literature. The objective of the study was to quantify the effect of cognitive retraining (CR) versus mindfulness training (MT) on neuropsychological test performance in patients with early AD. We administered CR and MT strategies in two prospectively enrolled groups of individuals (N = 34) who met the criteria for mild cognitive impairment (MCI) due to AD. Inclusion was based on patient choice and informed consent. One group of 20 patients was imparted supervised CR, and the other group included 14 patients who opted for MT as open-labeled interventions, with group allocation based on participant choice. Paired t test was performed with assessment of baseline and postintervention neuropsychological scores of CR and MT groups. The CR group revealed significant improvement on scores at 3 months (P < 0.05) for Addenbrooke's Cognitive Examination (ACE) subcomponents, particularly total score, memory, visuospatial, and language subscores as well as on Clinical Dementia Rating (CDR) scale. The MT group showed no significant differences on these tests post-intervention with a trend toward improvement on recall scores, and none of the other test scores demonstrated a declining trend. This proof-of-concept study demonstrated significant benefit of CR in improving neuropsychological test performance in patients with MCI due to AD and need to be studied in long-term, multicenter, randomized controlled trials in harmonized groups of patients with MCI and early AD.

Persistent dysfunctions of brain metabolic connectivity in long-covid with cognitive symptoms.

Our study examines brain metabolic connectivity in SARS-CoV-2 survivors during the acute-subacute and chronic phases, aiming to elucidate the mechanisms underlying the persistence of neurological symptoms in long-COVID patients. We perfomed a cross-sectional study including 44 patients (pts) with neurological symptoms who underwent FDG-PET scans, and classified to timing infection as follows: acute (7 pts), subacute (17 pts), long-term (20 pts) phases. Interregional correlation analysis (IRCA) and ROI-based IRCA were applied on FDG-PET data to extract metabolic connectivity in resting state networks (ADMN, PDMN, EXN, ATTN, LIN, ASN) of neuro-COVID pts in acute/subacute and long-term groups compared with healthy controls (HCs). Univariate approach was used to investigate metabolic alterations from the acute to sub-acute and long-term phase. The acute/subacute phase was characterized by hyperconnectivity in EXN and ATTN networks; the same networks showed hypoconnectivity in the chronic phase. EXN and ATTN hypoconnectivity was consistent with clinical findings in long-COVID patients, e.g. altered performances in neuropsychological tests of executive and attention domains. The ASN and LIN presented hyperconnectivity in acute/subacute phase and normalized in long-term phase. The ADMN and PDMN presented a preseverved connectivity. Univariate analysis showed hypometabolism in fronto-insular cortex in acute phase, which reduced in sub-acute phase and disappeared in long-term phase. A compensatory EXN and ATTN hyperconnectivity was found in the acute/subacute phase and hypoconnectivity in long-term. Hypoconnectivity and absence of hypometabolism suggest that connectivity derangement in frontal networks could be related to protraction of neurological symptoms in long-term COVID patients.

Determining whether false positive rates increase with performance validity test battery expansion

Objective Performance validity test (PVT) misclassification is an important concern for neuropsychologists. The present study determined whether expanding PVT analysis from 4-PVTs to 8-PVTs could lead to elevated rates of false positive performance validity misclassifications. Method Retrospective analysis of 443 patients who underwent a fixed neuropsychological test battery in a mixed clinical and forensic setting. Rates of failing two PVTs were compared to those predicted by Monte Carlo simulations when PVT analysis extended from 4-PVTs to 8-PVTs. Indeterminate performers (IDT; n = 42; those who failed two PVTs only after PVT analysis extended from 4-PVTs to 8-PVTs) were compared to a PVT-Fail group (n = 148; those who failed two PVTs in the 4-PVT battery or failed >2 PVTs). Results Rate of failing two PVTs remained stable when PVT analysis extended from 4- to 8-PVTs (12.9 to 11.9%) and was significantly lower than those predicted by Monte Carlo simulations. Compared to PVT-Fail, the IDT group was significantly younger, had stronger neuropsychological test performance, and demonstrated comparable rates of forensic referral and conditions with known neurocognitive sequelae (e.g. stroke, moderate-to-severe TBI). Conclusions Monte Carlo simulations significantly overestimated rates of individuals failing two PVTs as PVT battery length doubled. IDT did not differ from PVT-Fail across variables with known PVT effects (e.g. age, referral context, neurologic diagnoses), lowering concern that this group is comprised entirely of false-positive PVT classifications. More research is needed to determine the effect of PVT battery length on validity classification accuracy.

Neuropsychological Determinants of Impairment in Activities of Daily Living in Patients With Lewy Body Dementia.

Background Understanding the specific cognitive domains associated with activities of daily living (ADLs) impairment in Lewy body dementia (LBD) may help identify which targeted therapeutic interventions to pursue in future research. This study aimed to investigate the neuropsychological determinants of impairment in ADLs in LBD patients. Methods We conducted a cross-sectional study of LBD patients referred for a clinical neuropsychological evaluation within the Parkinson's Disease and Movement Disorders Center at Virginia Commonwealth University. The presence or absence of impairment in eight ADLs and neuropsychological test performances were collected and analyzed. Cluster analysis and hierarchical analysis were used to define ADL impairment into mild, moderate, and severe ADL impairment groups. We then compared cognitive performance between the ADL groups. Results This study included 193 LBD patients. Compared to LBD patients with mild and moderate ADL impairment, those with severe ADL impairment had worse scores in global cognition as measured by the Dementia Rating Scale-2 (DRS-2) (p=0.002), speeded visuospatial processing as measured by the Trail Making Test A (p=0.001), speeded executive functioning as measured by the Trail Making Test B (p=0.006), and psychomotor processing speed (p<0.001). Impairments in driving and self-care were associated with worse performances on Trail Making Test A, Trail Making Test B, and psychomotor processing speed (all p<0.05). Conclusions In patients with LBD, impaired speeded tasks of visual processing and executive functioning are associated with impaired ADLs, particularly driving and self-care. In order to improve ADLs in LBD, future studies should focus on identifying therapies that improve processing speed performance.

B - 87 The Moderating Effects of Current Substance Use on the Relationship between Neighborhood Deprivation and Cognitive Abilities

Abstract Objective Numerous studies have illustrated the importance of social determinants of health (SDH) on neuropsychological outcomes (Zuelsdorff, 2020); however, what moderates this relationship is poorly understood. One factor that negatively affects neuropsychological outcomes is substance use (Volkow et al., 2016). This study, the first to our knowledge, examines the intersection between a composite measure of SDH, the Area Deprivation Index (ADI; Kind et al., 2018), and current substance use (CSU). We hypothesized that CSU would moderate SDH’s effect on neuropsychological test performance. Method This sample is 236 diverse adults (M age = 55; 64% female; 44% White) who completed a neuropsychological examination in an outpatient neuropsychology clinic between 2017–2023. The composite measure of SDH was the ADI (Kind et al., 2018), which uses 17 socioeconomic indicators. Test scores were converted to z-scores for six cognitive domains (processing speed, attention, executive functioning, language, visuospatial abilities, and memory) and a global cognitive function score. CSU was self-reported use of tobacco, alcohol, and marijuana. Regressions were used to test the hypothesized interaction. Results Results partially supported CSU’s moderation of ADI and cognition. CSU only moderated the relationship between ADI and memory functioning (b = −0.08,p = 0.008); the indirect association between ADI and memory ability was stronger for those who endorsed CSU, even after controlling for covariates. Conclusions Findings demonstrate the interaction between CSU and ADI in predicting memory abilities. Analyses suggest using substances compounds the detrimental effects of neighborhood deprivation on memory, independent of demographic factors. Such results underscore the importance of considering socioecological factors in neuropsychological evaluations and test development.

A - 79 Comparison of Neuropsychological Test Performance between Monolingual Older Adults with Varying Cognitive Profiles

Abstract Objective With the rapid aging and cultural differences of the Latinx population, psychologists have expressed concerns regarding neuropsychological evaluations used for Alzheimer’s disease (ad), including the appropriateness of normative data and misinterpretation of test scores. This study explores various facets of neuropsychological performance between Spanish and English-speaking older adults with ad or normal cognition (NC). Method Participants (N = 17,716) from a de-identified database from the National Alzheimer’s’ Coordinating Center were administered Boston Naming Test-30 items (BNT-30), Animal &amp; Vegetable Verbal Fluency, Digit Symbol, Mini-Mental Status Examination (MMSE), Logical Memory I &amp; II (LM-I &amp; II), and Trail Making Test A &amp; B (TMT-A &amp; B). Correlations, multiple linear hierarchical regressions, and two-factor Analyses of Variance (ANOVAs) were used. Results Significant associations between interest areas (e.g., sex, ethnicity, race, age, education level, and/or age of cognitive onset) and test performances were found in each diagnosis group. Primary language, education level, and diagnosis were found to be significant predictors of LM-I (f2 = 0.19), LM-II (f2 = 0.22), and TMT-B (f2 = 0.15) performance. Significant interactions of primary language and diagnosis group were found among test performances for the MMSE, LM-II, Animals Verbal Fluency, TMT-A, and TMT-B (p &amp;lt; 0.05). Conclusions Further research is warranted to understand the complexity of using neuropsychological assessments to detect ad-related deficits among Spanish-speaking Latinx individuals. Evidence-based neuropsychological practice guidelines must acknowledge the importance of education level and primary language on test performance.

A - 70 Contextualizing Racial/Ethnic Differences in Baseline Assessment among Collegiate Athletes

Abstract Objective Compared to other factors that influence neuropsychological test performance, few studies have examined the relationship between racial/ethnic identity and baseline assessment performance in collegiate athletes, and even fewer have contextualized results using structural factors linked to test performance (e.g., premorbid cognitive ability). This study examined racial/ethnic differences in baseline assessment performance before and after controlling for premorbid functioning. We hypothesized that there would be racial/ethnic differences in performance but that controlling for premorbid functioning would reduce these differences. Method Participants included 875 collegiate athletes who were grouped based on racial/ethnic identity (White = 661, Black = 165, Another Race = 49) and underwent a comprehensive neuropsychological battery. Cognitive composite scores and intraindividual variability (IIV) were calculated for two neurocognitive domains: attention/processing speed and memory. Premorbid functioning was assessed with the Wechsler Test of Adult Reading (WTAR). ANCOVAs were used to examine racial/ethnic differences in these four cognitive domains before and after controlling for WTAR scores. Results Before controlling for WTAR scores, there were significant racial/ethnic differences in the attention/processing speed and memory composite scores and in attention/processing speed IIV, p’s &amp;lt; 0.001, ηp2 = 0.02–0.03. However, there were no significant racial/ethnic differences in memory IIV, p = 0.97. After controlling for WTAR scores, there were no significant racial/ethnic differences in the attention/processing (p = 0.530, ηp2 = 0.001) or memory (p = 0.183, ηp2 = 0.004) composite scores, and the relationship between racial/ethnic identity and attention/processing speed IIV became less significant (p = 0.014, ηp2 = 0.01). Conclusions Results suggest that racial/ethnic differences at baseline assessment can be largely accounted for by premorbid functioning, which underscores the importance of considering sociocultural context when assessing racially/ethnically diverse athletes.

Results from a randomized controlled trial of zonisamide in the treatment of alcohol use disorder

There is preliminary evidence that the anticonvulsant medication Zonisamide (ZON) may be an effective, well-tolerated treatment for alcohol use disorder (AUD). However, further evaluation of its efficacy for treating patients with AUD is needed, and much remains unknown about ZON's therapeutic mechanisms. The present study aimed to evaluate the efficacy and tolerability of ZON in a double-blind, placebo-controlled, randomized trial. Eighty-one adults (ages 21–65) diagnosed with AUD were randomly assigned to receive either ZON (at a target dose of 400 mg/d) or a pill placebo over 12 weeks, followed by a two-week taper. All participants also received a computerized alcohol reduction program, Take Control (TC). Primary drinking outcomes were average daily drinks, percentage drinking days, and percentage heavy drinking days. Further, we evaluated changes in AUD clinical severity and performance on neuropsychological measures. For both groups, drinking outcomes generally decreased, as did AUD clinical severity, though group differences were not statistically significant. Neuropsychological testing performance was similar for both groups at baseline; however, at post-treatment, participants in the ZON group demonstrated poorer working memory and lower performance on verbal fluency tests compared to the placebo group, and these differences were statistically significant with moderate-large effect sizes. One serious adverse event was reported among individuals receiving ZON. Study findings indicate that ZON combined with TC does not demonstrate superior effectiveness for reducing average daily drinks in this clinical sample with principal AUD compared to placebo and TC, and treatment with ZON may be associated with reduced neurocognitive performance over time.

Effects of repetitive subconcussive head trauma on the neuropsychological functioning and symptom reporting of high school athletes in high and low contact sports: Age and sex.

The present study was designed to assess the neuropsychological test performances of non-concussed female and male high school athletes of different ages in high and low contact sports. Large samples of 2,510 high school athletes in High Contact sports (e.g., football) and 1,437 in Low Contact sports (e.g., basketball) were examined. The participants were administered a baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) prior to their respective seasons. Multivariate linear regression showed that the High Contact athletes had significantly poorer results than the Low Contact athletes in all four ImPACT Composite scores and the Total Symptom scores. No age differences were found, but in all three age groups, the High Contact athletes had lower Visual Motor Speed scores than the Low Contact athletes. No test score differences were noted between the females in the High and Low Contact groups, but the High Contact males had poorer Visual Motor Speed and Reaction Time than the Low Contact males. The present results were consistent with prior studies of subconcussive head trauma, with High Contact athletes obtaining overall poorer neuropsychological test results than Low Contact athletes. More investigations in this age group seems is warranted.

Predicting brain atrophy and cognitive aging trajectories with baseline subjective cognitive concerns in cognitively normal older adults

Subjective cognitive concerns (SCC) are common even in cognitively normal older adults who lack objectively-detectable deficits on standard neuropsychological evaluation. The clinical relevance of these concerns, particularly considering the nature of concerns (e.g., memory versus non-memory), remains unclear. Thus, we examined whether baseline memory and non-memory SCC relate to longitudinal change in brain volume and neuropsychological test performance in 476 functionally-intact, objectively unimpaired older adults (Mage = 72y, 56 % female, follow-up time = 1 – 9 years). Mixed-effects models revealed that both higher baseline memory and non-memory SCC predicted greater atrophy in total gray matter and dorsolateral prefrontal cortex atrophy over time, while only memory SCC predicted steeper medial temporal lobe atrophy. Regarding neuropsychological performance, higher non-memory SCC predicted decline in processing speed performance, while memory SCC did not predict neuropsychological trajectories. SCC are a risk factor for more adverse brain and cognitive aging trajectories, even in functionally-intact, seemingly cognitively normal older adults.

Exploring the Distinct Effect of Age at Onset and Caudate Denervation on Cognitive Deficits in Early Parkinson's Disease.

Older age at onset and baseline caudate dopaminergic denervation are recognized risk factors for cognitive impairment in Parkinson's disease (PD), posing challenges in identifying their relative contribution to cognitive outcomes. The objective of this study was to assess the distinct contribution of age at onset and baseline caudate dopaminergic binding to the early cognitive deficits in PD patients. We examined the relationship between baseline dopaminergic striatal dysfunction (measured using [123I]-FP-CIT SPECT), age at disease onset and neuropsychological performance in 128 drug-naive PD patients, utilizing putaminal and caudate binding values of 77 healthy controls (HC) for a comparative exploration of age-dependent loss of DAT availability. Additionally, we investigated whether age at onset and DAT binding value of the caudate could independently predict cognitive changes over a median of 7-year follow-up. [123I]-FP-CIT-SPECT binding values had a significant negative correlation with age in both PD and HC, but in PD, aging was linked with a steeper slope for the caudate than the putamen. Older age at onset and lower caudate uptake were associated with worse global cognitive function and performance in specific neuropsychological tests at baseline and demonstrated to be significant independent predictors of cognitive dysfunction at follow-up. Our findings confirm a differential age effect on [123I]-FP-CIT binding in the striatal subregions of de novo PD patients. Notably, we found less age-related attrition of dopaminergic binding in the putamen than in the caudate, reflecting likely the superimposition of putaminal compensatory mechanisms and an increased predisposition of old onset PD patients to develop cognitive disturbances.

Modified Dead–Alive Test for the assessment of semantic and episodic memory performance of older patients with neurocognitive disorder

The aim of this study is to provide a test that allows for evaluation of both semantic memory (SM) and episodic memory (EM). The study sought to examine psychometric characteristics of the Modified Dead–Alive Test (M-DAT) in patients with neurocognitive disorders and the healthy elderly (HE). The M-DAT consists of 45 names of celebrities who have died in the remote past (15), died in the last five years (15), and are still alive (15), and participants are asked whether they are alive or dead. The M-DAT performances of patients with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) major neurocognitive disorder due to Alzheimer’s Disease (MND-AD) (n = 69) and patients with minor neurocognitive disorder (MiND) (n = 27) who were admitted to a geriatric psychiatry clinic and healthy controls (HC) (n = 29) were compared. Age and level of education were taken as covariates, and an analysis of covariance (ANCOVA) was performed since the MND-AD group was older and less educated. The MND-AD group had lower performance in EM and SM scores of the M-DAT. M-DAT failed to differentiate between MiND and HE. Both subscale scores of the M-DAT were associated with other neuropsychological test performances as well as the level of education. The results suggest that M-DAT is a valid and reliable tool that examines both EM and SM performances. M-DAT is an alternative for the assessment of SM evaluated by verbal fluency or naming tests. Evaluating EM and SM together is an important advantage; however, M-DAT is influenced by education, and the items require updating.

Diagnostic accuracy of the Brief Assessment of Impaired Cognition case-finding instrument in a general practice setting and comparison with other widely used brief cognitive tests-a cross-validation study.

The aim of this study was to examine the discriminative validity of the Brief Assessment of Impaired Cognition (BASIC) case-finding instrument in a general practice (GP) setting and compare it with other widely used brief cognitive instruments. Patients aged ≥70 years were prospectively recruited from 14 Danish GP clinics. Participants were classified as having either normal cognition (n = 154) or cognitive impairment (n = 101) based on neuropsychological test performance, reported instrumental activities of daily living, and concern regarding memory decline. Comparisons involved the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), the Mini-Cog, the 6-item Clock Drawing Test (CDT-6) and the BASIC Questionnaire (BASIC-Q). BASIC demonstrated good overall classification accuracy with an area under the receiver operating characteristic curve (AUC) of 0.88 (95% confidence interval [CI] 0.84-0.92), a sensitivity of 0.72 (95% CI 0.62-0.80) and a specificity of 0.86 (95% CI 0.79-0.91). Pairwise comparisons of the AUCs of BASIC, MMSE, MoCA and RUDAS produced non-significant results, but BASIC had significantly higher classification accuracy than Mini-Cog, BASIC-Q and CDT-6. Depending on the pretest probability of cognitive impairment, the positive predictive validity of BASIC varied from 0.83 to 0.36, and the negative predictive validity from 0.97 to 0.76. BASIC demonstrated good discriminative validity in a GP setting. The classification accuracy of BASIC is equivalent to more complex, time-consuming instruments, such as the MMSE, MoCA and RUDAS, and higher than very brief instruments, such as the CDT-6, Mini-Cog and BASIC-Q.

Patterns of cognitive domain abnormalities enhance discrimination of dementia risk prediction: The ARIC study.

The contribution of neuropsychological assessments to risk assessment for incident dementia is underappreciated. We analyzed neuropsychological testing results in dementia-free participants in the Atherosclerosis Risk in Communities (ARIC) study. We examined associations of index domain-specific neuropsychological test performance with incident dementia using cumulative incidence curves and Cox proportional hazards models. Among 5296 initially dementia-free participants (mean [standard deviation] age of 75.8 [5.1] years; 60.1% women, 22.2% Black) over a median follow-up of 7.9 years, the covariate-adjusted hazard ratio varied substantially depending on the pattern of domain-specific performance and age, in an orderly manner from single domain language abnormalities (lowest risk) to single domain executive or memory abnormalities, to multidomain abnormalities including memory (highest risk). By identifying normatively defined cognitive abnormalities by domains based on neuropsychological test performance, there is a conceptually orderly and age-sensitive spectrum of risk for incident dementia that provides valuable information about the likelihood of progression. Domain-specific cognitive profiles carry enhanced prognostic value compared to mild cognitive impairment. Single-domain non-amnestic cognitive abnormalities have the most favorable prognosis. Multidomain amnestic abnormalities have the greatest risk for incident dementia. Patterns of domain-specific risks are similar by sex and race.

Reduced olfactory bulb volume accompanies olfactory dysfunction after mild SARS-CoV-2 infection

Despite its high prevalence, the determinants of smelling impairment in COVID-19 remain not fully understood. In this work, we aimed to examine the association between olfactory bulb volume and the clinical trajectory of COVID-19-related smelling impairment in a large-scale magnetic resonance imaging (MRI) analysis. Data of non-vaccinated COVID-19 convalescents recruited within the framework of the prospective Hamburg City Health Study COVID Program between March and December 2020 were analyzed. At baseline, 233 participants underwent MRI and neuropsychological testing as well as a structured questionnaire for olfactory function. Between March and April 2022, olfactory function was assessed at follow-up including quantitative olfactometric testing with Sniffin’ Sticks. This study included 233 individuals recovered from mainly mild to moderate SARS-CoV-2 infections. Longitudinal assessment demonstrated a declining prevalence of self-reported olfactory dysfunction from 67.1% at acute infection, 21.0% at baseline examination and 17.5% at follow-up. Participants with post-acute self-reported olfactory dysfunction had a significantly lower olfactory bulb volume at baseline than normally smelling individuals. Olfactory bulb volume at baseline predicted olfactometric scores at follow-up. Performance in neuropsychological testing was not significantly associated with the olfactory bulb volume. Our work demonstrates an association of long-term self-reported smelling dysfunction and olfactory bulb integrity in a sample of individuals recovered from mainly mild to moderate COVID-19. Collectively, our results highlight olfactory bulb volume as a surrogate marker that may inform diagnosis and guide rehabilitation strategies in COVID-19.

Neuropsychological Test Performance Differentiates Subgroups of Individuals With Adult Moyamoya Disease: A Cross-Sectional Clinical Study.

Moyamoya disease (MMD) is a rare noninflammatory disorder involving progressive intracranial vasculopathy and impaired cerebral blood flow in the anterior circulation, resulting in stroke and cognitive impairment. We aimed to characterize cognitive impairment and the possible predictive value of sociodemographic and clinical characteristics of adults with MMD. This cross-sectional study examined neurocognitive performance in a group of 42 consecutive adult patients (mean age = 40.52 years; 69% female) referred for a presurgical neuropsychological evaluation. Neuropsychological functioning was assessed with a comprehensive battery, and cognitive dysfunction was defined as 1.5 SDs below the mean. Neurocognitive performance correlated with clinical/demographic characteristics and disease markers. Most patients (91%) had a history of stroke, and 45% had cognitive deficits, most notably on measures of attention/speed (48%), executive functioning (47%), visuoconstruction (41%), and memory (31%-54%). Only higher educational attainment and poor collateral blood flow in the right hemisphere differentiated cognitively impaired (n = 19) and intact groups (n = 23), and MMD-related characteristics (eg, disease duration, stroke history) did not differentiate the 2 groups. Consistent with previous work, frontal-subcortical cognitive deficits (eg, deficits in mental speed, attention, executive functioning) were found in nearly half of patients with MMD and better cognitive performance was associated with factors related to cognitive reserve. Angiographic metrics of disease burden (eg, Suzuki rating, collateral flow) and hemodynamic reserve were not consistently associated with poorer cognitive outcomes, suggesting that cognition is a crucial independent factor to assess in MMD and has relevance for treatment planning and functional status.