Neuropsychological Test Performance Research Articles

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

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

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

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

Instrumental activities of daily living and mild cognitive impairment

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

Factors perpetuating functional cognitive symptoms after mild traumatic brain injury

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

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

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

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

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

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

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

The influence of physical fatigue on telephone-based neuropsychological test performance in COVID-19 survivors.

Fatigue has been characterized as a post COVID-19 condition known to persist months after SARS-CoV-2 infection. COVID-19 has been reported to be associated with impaired cognitive function, including disorders in attention, memory, information processing, and executive functions. The objective of this study was to determine if post-COVID fatigue, manifested as tiredness while performing low-intensity physical activity, has a detrimental effect on neuropsychological performance, to achieve this, we randomly selected 20 participants with post-COVID fatigue and 20 SARS-CoV-2 negative age-matched controls from a database of 360 residents of Tijuana, Baja California in a cross-sectional study design. All 40 participants responded to a health survey, along with a neuropsychological assessment test via telephone call. Statistical analysis was performed using a multiple linear regression model including the following independent variables: study condition (post-COVID fatigue or negative control), sex, age,years of education, hypertension, asthma, administration of supplemental oxygen during COVID-19 recovery, and the hour at which the evaluation started. Significant regression analysis was obtained for all global parameters of the assessment, including BANFE-2 score (p = 0.021, R2 Adj. = 0.263), NEUROPSI score (p = 0.008, R2 Adj. = 0.319), and total errors (p = 0.021, R2 Adj. = 0.263), with significant regression coefficients for study condition on two global parameters, BANFE-2 score (p = 0.028, β = - 0.371) and NEUROPSI score (p = 0.010, β = -0.428). These findings suggest that the presence of post-COVID fatigue is a factor associated with a decrease in neuropsychological performance.

Protocol for the Development of a Computerized Battery for Cross-Cultural Neuropsychological Assessment: The EMBRACED Project

Globalization is making our world increasingly diverse. However, the field of neuropsychological assessment hasn’t addressed this diversity appropriately and people around the world are being assessed with instruments that are not culturally adapted for them. Practitioners are using tests that were originally created for Western culture(s) to evaluate patients of all demographic backgrounds. The solution is the development of computerized cross-cultural tests, but there is no established standard procedure for creating a battery that is comprehensive, modular, psychometrically robust, easy to use, free, and culturally salient. The EMBRACED battery is intended to be exactly that. The protocol for its development followed strict, evidence-based scientific methods for the determination of all its neuropsychological domains, their relevant constructs, and the best tasks to measure them; the tasks and stimuli are also computerized. The EMBRACED battery is user-friendly, cost-effective, and patient-guided. The preliminary results obtained to date show that culture has a significant effect on neuropsychological test performance, with bias in favor of Western populations. Our field has an ethical responsibility to improve our instruments, increase fairness in testing, and to fight for social justice around the world, which is precisely the aim of the EMBRACED project.

Relationship between Whole-Blood Magnesium and Cognitive Performance among Chinese Adults.

To explore the association between magnesium levels and the odds of mild cognitive impairment (MCI). In this cross-sectional study of 1006 participants (≥55 years) from China, whole-blood magnesium concentration was measured using inductively coupled plasma mass spectrometry. MCI was diagnosed according to Petersen criteria using self-reported cognitive decline and a neuropsychological test battery, including the trail-making test-part B (TMT-B), auditory verbal learning test (AVLT), digit symbol substitution test (DSST), and verbal fluency test (VFT), which measured the assessment of executive, memory, attention, and language functioning, respectively. A logistic regression was used to assess the relationship between magnesium levels and MCI, and linear regression analyses were performed for the association between magnesium and cognitive function score. The MCI group had a significantly lower concentration of magnesium compared to the Non-MCI group (34.7 ± 9.8 vs. 36.7 ± 9.7, p = 0.017). After adjusting for covariates, a negative association was observed between magnesium levels and MCI. Compared with the lowest quartile (median: 25.4 mg/L), the odds ratio for MCI was 0.53 (95%CI 0.32-0.90) for the highest quartile (median: 48.4 mg/L), and there was an inverse dose-response relationship (p for trend = 0.009). In addition, higher levels of magnesium were positively correlated with VFT scores (β = 0.37, 95%CI = 0.11-0.62) and DSST scores (β = 0.50, 95%CI = 0.01~0.98) and negatively correlated with TMT scores (β = -1.73, 95%CI = -3.40--0.07) in the middle-aged and older adults. Whole-blood magnesium was inversely associated with the occurrence of MCI and positively associated with performance in neuropsychological tests assessing attention, executive, and language ability in middle-aged and older adults.

Psychometric characteristics of the Amsterdam instrumental activities of daily living questionnaire in healthy individuals and NIA‐AA stages of preclinical Alzheimer’s Disease

AbstractBackgroundAs clinical trials increasingly focus on the earliest stages of Alzheimer’s disease (AD), there is a need for reliable and valid functional measures in these stages. The National Institute of Aging and Alzheimer’s Association (NIA‐AA) defined six clinical stages of AD, with stages 1 and 2 covering preclinical AD with normal cognitive and functional performance. Here, we explored the psychometric characteristics of the Amsterdam Instrumental Activities of Daily Living Questionnaire(A‐IADL‐Q), separately in stage1‐2 AD and amyloid negative controls.MethodData from four European memory clinic and community‐based cohorts (SCIENCe, ALFA+, EPAD‐LCS and INSIGHT pre‐AD) were jointly analyzed (Fig.1;selection criteria). Amyloid positivity was determined by cerebrospinal fluid or positron‐emission tomography, using local cut‐offs. We explored three measurement properties:(1) internal consistency, using confirmatory factor analysis and Cronbach’s alpha, (2) construct validity, by correlating A‐IADL‐Q performance with demographics and neuropsychological tests covering global cognition, executive functions, memory and attention, using Pearson’s r or Kendall’s tau, and (3) responsiveness, using linear mixed modelling with time as variable of interest, adjusted for age, sex and education.ResultA total of 396 controls (mean age = 62±7year, 71% female) and 242 stage1‐2 individuals (mean age = 65±9year, 60.7% female) were included (Table1). High internal consistency was supported by a single factor structure (comparative fit index = 0.997, Cronbach’s alpha&gt;0.905). In line with previous validation studies, low correlations were found between A‐IADL‐Q performance and demographic characteristics. Low correlations were found with neuropsychological test performance (Table2). Regarding responsiveness (Ncontrols = 219, mean follow‐up = 1.45±0.75 year, Nstage1‐2 = 127, mean follow‐up = 2.16±1.15 year), A‐IADL‐Q showed a decline in stage1‐2, although this did not reach statistical significance (β = ‐0.1, p = 0.45). Controls showed a small increase in performance, again non‐significant (β = 0.06, p = 0.41)(Fig.2). At baseline, stage1‐2 individuals had lower A‐IADL‐Q scores than controls (Welch two‐sample t‐test: t = ‐3.13, p&lt;0.01).ConclusionOur findings support the psychometric characteristics of the A‐IADL‐Q in stage1‐2 individuals and controls. Construct validity was partially supported, as expected, because cognitive impairments are not evident in this population. In line with this, findings regarding responsiveness may have been affected by the short follow‐up time of one year. Future validation in preclinical AD should include a longer follow‐up duration, to adequately capture potential decline.

Association of inflammatory proteins with cognitive aging, brain MRI markers, and incident dementia

AbstractBackgroundInflammatory cytokines and chemokines related to the innate and adaptive immune system have been linked to neuroinflammation in Alzheimer’s Disease (AD) dementia. We hypothesized that individual blood‐based inflammatory biomarkers would associate with cognitive function, brain magnetic resonance imaging (MRI) volumes, and risk for dementia in Framingham Heart Study (FHS) participants.MethodProtein biomarkers related to immune cells or associated with inflammatory responses including CD14, CD163, CD5L, CD56, CD40L, CXCL16, SDF1, DPP4, SGP130, sRAGE, and MPO were measured at FHS Offspring exam 7. We identified FHS Offspring participants who underwent neuropsychological (NP) testing (n = 2394) or brain MRI (n = 2135) within five years of the examination; and who were followed up 10 years after age 60 for incident all‐cause dementia (n = 1650). We used linear mixed effect models accounting for family relationships to investigate the associations between the protein biomarkers and NP test performance and brain MRI volumes and Cox proportional hazards models to examine the association with incident dementia. A false discovery rate (FDR) within each outcome set was computed to adjust for multiple testing and FDR ≤ 0.1 indicated significance.ResultParticipants from the NP and MRI samples were on average 61 years old and 54% female. Participants from the incident dementia sample (mean age 68 years) included 126 incident dementia cases within 10 years. In addition to CD14 which has an established association, we observed significant associations between higher CD40L and MPO with poorer NP performance from the executive function domain. Higher CD5L levels were significantly associated with smaller total brain volumes (TCBV), whereas higher sRAGE was associated with larger TCBV. Associations persisted after further adjusting for APOE ϵ4 carrier status and cardiovascular risk factors. None of the protein biomarkers included were significantly associated with risk of incident dementia, with trend towards an association for CD5L.ConclusionSince the proinflammatory factors CD5L, CD40L, sRAGE and MPO are associated with immune cells and are involved in vascular pathology, our study suggests the immune‐vascular axis is associated with cognitive and brain aging. If confirmed in other samples, our findings may provide informative biomarkers of abnormal brain aging.

A study protocol on teaching english to people with mild cognitive impairment with the use of songs

AbstractBackgroundPeople with Mild Cognitive Impairment (MCI) need to improve their cognitive functions in order to avoid the deterioration of their condition. Cognitive abilities can be improved by learning a foreign language. Due to the cognitive deficits of MCI people, conventional methods that teaching English cannot have significant results. The use of songs in teaching English is proved to be a promising method for more effective acquisition of the language while also improving cognitive functions and symptoms of depression and anxiety.MethodThis learning method had been designed by combining elements from four methodologies in language learning “Communicative Language Teaching”, “Natural Approach”, “(De) suggestopedia” and “Neurolinguistic Programming (NLP)”. The intervention of this study involves a randomized controlled trial design with two arms (an intervention arm and a control group) over a nine‐month period and will be provided twice a week. Participants will be people with MCI aged 60‐85 years, of both genders. A sample size of 90 participants is targeted based on expected neuropsychological test performance, and drop‐out rates. Interventions will be provided by trained staff with a control group not receiving any intervention but continuing life as usual. Assessments will be done at baseline, and nine months, and include neuropsychological tests to measure for changes in cognition. Secondary outcome measures will include mood changes in anxiety, depression and quality of life. All efficacy statistical analysis will be carried out on an intention to treat basis. Primary and secondary outcomes will be modeled using the linear mixed model for repeated measurements and further analysis will be undertaken.ResultThis study protocol is implementing by Greek Association of ALzheimer Disease and Related Disorders and the final results will be announced soon.ConclusionThis will be the first study to implement and assess this intervention in a randomized controlled trial. We expect that this study protocol could prevent cognitive decline, decrease symptoms of depression and anxiety and significantly impact quality of life and the wellbeing of people with MCI.

Combined use of gray matter volume and neuropsychological test performance for classification of individuals with bipolar I disorder via artificial neural network method.

Diagnosis of patients with bipolar disorder may be challenging and delayed in clinical practice. Neuropsychological impairments and brain abnormalities are commonly reported in bipolar disorder (BD); therefore, they can serve as potential biomarkers of the disorder. Rather than relying on these predictors separately, using both structural and neuropsychiatric indicators together could be more informative and increase the accuracy of the automatic disorder classification. Yet, to our information, no Artificial Intelligence (AI) study has used multimodal data using both neuropsychiatric tests and structural brain changes to classify BD. In this study, we first investigated differences in gray matter volumes between patients with bipolar I disorder (n = 37) and healthy controls (n = 27). The results of the verbal and non-verbal memory tests were then compared between the two groups. Finally, we used the artificial neural network (ANN) method to model all the aforementioned values for group classification. Our voxel-based morphometry results demonstrated differences in the left anterior parietal lobule and bilateral insula gray matter volumes, suggesting a reduction of these brain structures in BD. We also observed a decrease in both verbal and non-verbal memory scores of individuals with BD (p < 0.001). The ANN model of neuropsychiatric test scores combined with gray matter volumes has classified the bipolar group with 89.5% accuracy. Our results demonstrate that when bilateral insula volumes are used together with neuropsychological test results the patients with bipolar I disorder and controls could be differentiated with very high accuracy. The findings imply that multimodal data should be used in AI studies as it better represents the multi-componential nature of the condition, thus increasing its diagnosability.

Acquired Stuttering in Parkinson's Disease.

Parkinson's disease frequently causes communication impairments, but knowledge about the occurrence of new-onset stuttering is limited. To determine the presence of acquired neurogenic stuttering and its relationship with cognitive and motor functioning in individuals with Parkinson's disease. Conversation, picture description, and reading samples were collected from 100 people with Parkinson's disease and 25 controls to identify the presence of stuttered disfluencies (SD) and their association with neuropsychological test performance and motor function. Participants with Parkinson's disease presented with twice as many stuttered disfluencies during conversation (2.2% ± 1.8%SD) compared to control participants (1.2% ± 1.2%SD; P < 0.01). 21% of people with Parkinson's disease (n = 20/94) met the diagnostic criterion for stuttering, compared with 1/25 controls. Stuttered disfluencies also differed significantly across speech tasks, with more disfluencies during conversation compared to reading (P < 0.01). Stuttered disfluencies in those with Parkinson's disease were associated with longer time since disease onset (P < 0.01), higher levodopa equivalent dosage (P < 0.01), and lower cognitive (P < 0.01) and motor scores (P < 0.01). One in five participants with Parkinson's disease presented with acquired neurogenic stuttering, suggesting that speech disfluency assessment, monitoring and intervention should be part of standard care. Conversation was the most informative task for identifying stuttered disfluencies. The frequency of stuttered disfluencies was higher in participants with worse motor functioning, and lower cognitive functioning. This challenges previous suggestions that the development of stuttered disfluencies in Parkinson's disease has purely a motoric basis.

Associations with youth psychotic-like experiences over time: Evidence for trans-symptom and specific cognitive and neural risk factors.

The current study examined whether impairments in cognitive and neural factors at baseline (ages 9-10) predict initial levels or changes in psychotic-like experiences (PLEs) and whether such impairments generalize to other psychopathology symptoms (i.e., internalizing and externalizing symptoms). Using unique longitudinal Adolescent Brain Cognitive Development Study data, the study examined three time points from ages 9 to 13. Univariate latent growth models examined associations between baseline cognitive and neural metrics with symptom measures using discovery (n = 5,926) and replication (n = 5,952) data sets. For symptom measures (i.e., PLEs, internalizing, externalizing), we examined mean initial levels (i.e., intercepts) and changes over time (i.e., slopes). Predictors included neuropsychological test performance, global structural MRI, and several a priori within-network resting-state functional connectivity metrics. Results showed a pattern whereby baseline cognitive and brain metric impairments showed the strongest associations with PLEs over time. Lower cognitive, volume, surface area, and cingulo-opercular within-network connectivity metrics showed associations with increased PLEs and higher initial levels of externalizing and internalizing symptoms. Several metrics were uniquely associated with PLEs, including lower cortical thickness with higher initial PLEs and lower default mode network connectivity with increased PLEs slopes. Neural and cognitive impairments in middle childhood were broadly associated with increased PLEs over time, and showed stronger associations with PLEs compared with other psychopathology symptoms. The current study also identified markers potentially uniquely associated with PLEs (e.g., cortical thickness). Impairments in broad cognitive metrics, brain volume and surface area, and a network associated with information integration may represent risk factors for general psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social Determinants of Health: Associations Between Dichotomous Versus Dimensional Scores, Neuropsychological Test Performance, and Psychiatric Symptoms.

This study examined the utility of dichotomous versus dimensional scores across two measures of social determinants of health (SDOH) regarding their associations with cognitive performance and psychiatric symptoms in a mixed clinical sample of 215 adults referred for neuropsychological evaluation (Mage = 43.91, 53.5% male, 44.2% non-Hispanic White). Both dimensional and dichotomous health literacy scores accounted for substantial variance in all cognitive outcomes assessed, whereas dimensional and dichotomous adverse childhood experience scores were significantly associated with psychiatric symptoms. Tests of differences between correlated correlations indicated that correlations with cognitive and psychiatric outcomes were not significantly different across dimensional versus dichotomous scores, suggesting that these operationalizations of SDOH roughly equivalently characterize risk of poorer cognitive performance and increased psychiatric symptoms. Results highlight the necessity of measuring multiple SDOH, as different SDOH appear to be differentially associated with cognitive performance versus psychiatric symptoms. Furthermore, results suggest that clinicians can use cut-scores when characterizing patients' risk of poor cognitive or psychiatric outcomes based on SDOH.

Sex-specific differences in neuropsychological profiles of mild cognitive impairment in a hospital-based clinical sample.

Mild cognitive impairment (MCI) is an etiologically nonspecific diagnosis including a broad spectrum of cognitive decline between normal aging and dementia. Several large-scale cohort studies have found sex effects on neuropsychological test performance in MCI. The primary aim of the current project was to examine sex differences in neuropsychological profiles in a clinically diagnosed MCI sample using clinical and research diagnostic criteria. The current study includes archival data from 349 patients (age M = 74.7; SD = 7.7) who underwent an outpatient neuropsychological evaluation and were diagnosed with MCI. Raw scores were converted to z-scores using normative datasets. Sex differences in neurocognitive profiles including severity, domain-specific composites (memory, executive functioning/information processing speed, and language), and modality-specific learning curves (verbal, visual) were examined using Analysis of Variance, Chi-square analyses, and linear mixed models. Post hoc analyses examined whether sex effects were uniform across age and education brackets. Females exhibit worse non-memory domain and test-specific cognitive performances compared to males with otherwise comparable categorical MCI criteria and global cognition measured via screening and composite scores. Analysis of learning curves showed additional sex-specific advantages (visual Males>Females; verbal Females >Males) not captured by MCI subtypes. Our results highlight sex differences in a clinical sample with MCI. The emphasis of verbal memory in the diagnosis of MCI may result in diagnosis at more advanced stages for females. Additional investigation is needed to determine whether these profiles confer greater risk for progressing to dementia or are confounded by other factors (e.g., delayed referral, medical comorbidities).

Development of a home-based cognitive test for cognitive monitoring in subjective cognitive decline with high risk of Alzheimer's disease.

Subjective cognitive decline (SCD) indicates a self-perceived persistent cognitive worsening despite of normal performance in standard neuropsychological tests. Owing to its heterogeneity and potential risk of Alzheimer's disease, baseline biomarkers to predict cognitive decline are important. In the present study, we developed a home-based cognitive test (HCT) to monitor cognitive changes regularly without visiting hospitals. This study aims to compare cognitive and biomarker trajectories during a 48-month period between amyloid positive SCD and amyloid negative SCD subjects. Data will be collected from a prospective observational cohort study conducted in South Korea. Eighty participants with SCD aged ≥ 60 years are eligible for the study. All participants undergo annual neuropsychological tests and neurological examinations, bi-annual brain MRI scans and plasma amyloid markers, and baseline florbetaben Positron Emission Tomography scans. The amyloid burden and regional volumes will be measured. Cognitive and biomarker changes will be compared between the amyloid-positive SCD and amyloid negative SCD groups. Validation would be performed to assess reliability and feasibility of HCT. This study would suggest a perspective on SCD in terms of cognitive and biomarker trajectories. Baseline characteristics and biomarker status might affect faster cognitive decline and future biomarker trajectories. In addition, HCT could be an alternative option of in-person neuropsychological tests to track cognitive changes without visiting hospitals.

Challenges and opportunities for harmonization of cross-cultural neuropsychological data.

In this position article, we highlight the importance of considering cultural and linguistic variables that influence neuropsychological test performance and the possible moderating impact on our understanding of brain/behavior relationships. Increasingly, neuropsychologists are realizing that cultural and language differences between countries, regions, and ethnic groups influence neuropsychological outcomes, as test scores may not have the same interpretative meaning across cultures. Furthermore, attempts to apply the same norms across diverse populations without accounting for culture and language variations will result in detrimental ethical dilemmas, such as misdiagnosis of clinical conditions and inaccurate interpretations of research outcomes. Given the lack of normative data for ethnically and linguistically diverse communities, it is often challenging to merge data across diverse populations to investigate research questions of global significance. Methodological Considerations: We highlight some of the inherent challenges, limitations, and opportunities for efforts to harmonize cross-cultural neuropsychological data. We also explore some of the cultural factors that should be considered when attempting to harmonize cross-cultural neuropsychological data, sources of variance that should be accounted for in data analyses, and the need to identify evaluative criteria for interpreting data outcomes of cross-cultural harmonization approaches. In the future, it will be important to further solidify principles for aggregating data across diverse cultural and linguistic cohorts, validate whether assumptions are being satisfied regarding the relationship between neuropsychological measures and the brain and/or behavior of individuals from diverse cultural and linguistic backgrounds, as well as methods for evaluating relative successful validation for data harmonization efforts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).