Standard Neuropsychological Measures Research Articles

Visual tests, touch responses: Computer-based neuropsychological tools

Objective: Investigate three new computer tests of visual abilities relative to traditional paper-and-pencil (P&P) tests on groups with and without cerebral neurological impairment (CNI, Non-CNI) based on MRI and EEG criteria. The new tests employ an intuitive interface with audio instructions, touch responses, non-response prompts, and videography of test behavior. The Presidents Test was designed as an achievement-related measure of visual knowledge; the Railroad Test – visual perception and delayed recognition; and the Swamp Test – visual attention. Attitudes toward testing were assessed with an original Testing Experience Questionnaire (TEQ). Method: Of the 129 participants, 84 were women, 73 identified as non-White, average age 45.5 and education 14.3 years. Procedures included the new computer tests and a selection of standard neuropsychological measures including performance validity tests (PVT). Participants who failed two or three PVTs or had missing PVT data were excluded from main analyses, resulting in N = 115. Results: The new computer tests demonstrated adequate reliability. Correlations and factor analyses confirmed the computer tests as functioning in accordance with design. The Presidents Test was associated with academic achievement. The Railroad and Swamp Tests were linked to visual perception and visual attention. Correlations between computer total test duration time and traditional speed of processing tasks were modest. Computer and traditional tests demonstrated similar discriminability between CNI and Non-CNI groups. TEQ indicated positive attitudes toward testing in general, and computer testing in particular. Conclusions: The new computer tests evaluated in this study were found to be reliable, functioned to assess the designed cognitive domains, and discriminated between CNI and Non-CNI participants similarly to the traditional neuropsychological measures. Attitudes toward computer testing were favorable.

Detecting accelerated long-term forgetting remotely in a community sample of people with epilepsy: Evidence from the Crimes and Four Doors tests

People with epilepsy often report experiencing memory problems though these are not always detectable using standard neuropsychological measures. One form of difficulty that may be relatively prevalent in epilepsy is termed accelerated long-term forgetting (ALF), typically described as relatively greater loss of memory over days or weeks following initial encoding. The current study used remote assessment to examine memory and forgetting over one week in a broad community sample of people with epilepsy and healthy control participants, using two recently developed tests, one verbal (the Crimes test) and one visual (the Four Doors test). These were administered as part of a short battery of cognitive measures, run remotely with participants over Zoom. Across this community-derived sample, people with epilepsy reported more memory complaints and demonstrated significantly faster forgetting on both the verbal and visual tests. This difference was not attributable to level of initial learning performance and was not detectable through delayed recall on a standard existing test. Our results suggests that ALF may be more common than suspected in people with epilepsy, leading to a potentially important source of memory problems that are currently undetected by standard memory tests.

Iron Deposition and Distribution Across the Hippocampus Is Associated with Pattern Separation and Pattern Completion in Older Adults at Risk for Alzheimer's Disease.

Elevated iron deposition in the brain has been observed in older adult humans and persons with Alzheimer's disease (AD), and has been associated with lower cognitive performance. We investigated the impact of iron deposition, and its topographical distribution across hippocampal subfields and segments (anterior, posterior) measured along its longitudinal axis, on episodic memory in a sample of cognitively unimpaired older adults at elevated familial risk for AD (N = 172, 120 females, 52 males; mean age = 68.8 ± 5.4 years). MRI-based quantitative susceptibility maps were acquired to derive estimates of hippocampal iron deposition. The Mnemonic Similarity Task was used to measure pattern separation and pattern completion, two hippocampally mediated episodic memory processes. Greater hippocampal iron load was associated with lower pattern separation and higher pattern completion scores, both indicators of poorer episodic memory. Examination of iron levels within hippocampal subfields across its long axis revealed topographic specificity. Among the subfields and segments investigated here, iron deposition in the posterior hippocampal CA1 was the most robustly and negatively associated with the fidelity memory representations. This association remained after controlling for hippocampal volume and was observed in the context of normal performance on standard neuropsychological memory measures. These findings reveal that the impact of iron load on episodic memory performance is not uniform across the hippocampus. Both iron deposition levels as well as its spatial distribution, must be taken into account when examining the relationship between hippocampal iron and episodic memory in older adults at elevated risk for AD.

1 Neurocognitive Correlates of Oculomotor Performance among U.S. Military Personnel with Mild Traumatic Brain Injury

Objective:To examine neurocognitive correlates of oculomotor performance among U.S. military personnel with history of mild traumatic brain injury (mTBI).Participants and Methods:A series of studies (total n=356) were conducted to examine saccadic eye movements and manual button presses collected in response to attention stimuli, and to compare these findings to the results of standardized neuropsychological tests. Study 1 included n=27 with remote mTBI and n=54 controls who completed the Bethesda Eye and Attention Measure (BEAM), an eye tracking task that was designed to measure visual attention and executive function. In Study 2, n=51 with chronic mTBI and n=33 controls completed the Fusion n-Back task, an eye tracking task that was designed to assess the impact of working memory load on visual attention performance. Study 3 examined psychometric characteristics of BEAM among n=191 military personnel with remote mTBI. In all studies, participants completed eye tracking tasks, a structured TBI diagnostic interview, and a brief battery of standardized neuropsychological tests.Results:In Study 1, BEAM saccadic and manual metrics demonstrated strong reliability and high sensitivity to multiple cognitive cues designed to elicit spatial orienting, temporal alerting, executive interference, perceptual release (gap) and inhibition (n2p=.76, p<.001). However, corresponding saccadic and manual measurements were weakly related to each other, and only manual (not saccadic) measurements were related to estimated verbal intelligence or years of education. Standardized neuropsychological measures did not differ between groups, but mTBI participants were more likely to be impaired on saccadic metrics than controls.In Study 2, Standardized cognitive measures and estimated premorbid intelligence were positively associated with all manual metrics from the Fusion n-Back test, but were not associated with mTBI history or with saccadic metrics. Fusion n-Back saccadic and manual metrics had strong reliability and complementary sensitivity to chronic mTBI, with combined predictive power of PPV=.78, NPV=.72, r2=.44 for classification of remote mild TBI vs. controls on the more cognitively-challenging 1-back task condition.In Study 3, BEAM metrics including manual RT latency and consistency, saccadic RT consistency, and saccadic inhibition errors showed consistent correlations with standardized measures of visual attention, processing speed, task switching, working memory, and executive functions. Hierarchical regressions showed that BEAM saccadic and manual metrics were independently predictive of cognitive test performance, above and beyond effects of demographic factors and clinical characteristics.Conclusions:Results demonstrated some surprising findings related to neurocognitive influences on oculomotor performance. While both saccadic and manual performance were strongly and similarly influenced by attention cues, these two modalities were only weakly correlated to one another. Additionally, manual metrics were more strongly and consistently related to standardized cognitive test performance and premorbid intelligence than saccadic metrics. However, saccadic metrics demonstrated superior sensitivity to remote/chronic mTBI relative to manual metrics and standardized neuropsychological measures. Overall, these results suggest that saccadic eye tracking measures may provide unique value in assessment of mTBI and neurocognitive functions that is complementary with more common forms of assessment relying upon somatomotor response modalities.

Neurocognitive Profiles in Adolescents With Postural Tachycardia Syndrome and Perceived Brain Fog: A Preliminary Report

BackgroundPostural tachycardia syndrome (POTS) is associated with complaints of cognitive and emotional difficulties that may contribute to severe functional disability. For high-achieving adolescents, these symptoms can result in decreased participation in school and extracurricular activities. There are very limited data comparing subjective symptom reports to neurocognitive profiles in adolescents presenting with POTS, “brain fog,” and cognitive difficulties. MethodsA review of medical records and neuropsychological data was conducted for six adolescents diagnosed with POTS at a pediatric neurology clinic. All patients had frequent symptoms of orthostatic intolerance for more than three months. There was heart rate increase of ≥40 beats per minute (bpm) within 10 minutes of active standing or head-up tilt test in five patients and 36 bpm in one patient, who was diagnosed with probable POTS. All were referred for neuropsychological evaluations due to reported debilitating cognitive problems and an inability to function in a regular academic setting. Patients underwent a six-hour neuropsychological evaluation utilizing standardized measures of cognitive and emotional functioning. Clinically reported symptoms included fatigue, poor concentration, and memory impairment as well as “brain fog.” ResultsSubjective complaints differed from patients’ performance on standardized neuropsychological measures. Patients performed in the average to superior range across measures of general intelligence, verbal and working memory, processing speed, and sustained attention. ConclusionsFurther research is needed to elucidate the basis for perceived “brain fog” and cognitive impairment in POTS, such as better understanding of patient and parental perceptions of initial medical symptoms and diagnosis as well as symptom amplification due to biopsychosocial processes.

Traumatic brain injury screening and neuropsychological functioning in women who experience intimate partner violence

Objective: The potential for traumatic brain injury (TBI) to occur as the result of intimate partner violence (IPV) has received increased interest in recent years. This study sought to investigate the possible occurrence of TBI in a group of women who survived IPV and to measure the specific profile of cognitive deficits using standardized neuropsychological measures. Method: A comprehensive questionnaire about abuse history; neuropsychological measures of attention, memory and executive functioning; and measures of depression, anxiety and post-traumatic stress disorder were given to women who were IPV survivors, women who were sexual assault (SA) survivors, and a comparison group of women who did not experience IPV or SA. Results: Overall, rates of potential TBI, as measured by the HELPS brain injury screening tool, were high and consistent with previous studies. Consistent with potential TBI, lower scores were demonstrated on measures of memory and executive functioning compared to survivors of SA or those not exposed to violence. Importantly, significant differences on measures of memory and executive functioning remained, after controlling for measures of emotion. Of note, cognitive changes were highest among women who experienced non-fatal strangulation (NFS) compared to IPV survivors who did not. Conclusions: Rates of TBI may be high in women who survive IPV, especially those who survive strangulation. Better screening measures and appropriate interventions are needed as well as larger studies that look at social factors associated with IPV.

Children with Rolandic epilepsy have micro- and macrostructural abnormalities in white matter constituting networks necessary for language function

IntroductionSelf-limited epilepsy with centrotemporal spikes is a transient developmental epilepsy with a seizure onset zone localized to the centrotemporal cortex that commonly impacts aspects of language function. To better understand the relationship between these anatomical findings and symptoms, we characterized the language profile and white matter microstructural and macrostructural features in a cohort of children with SeLECTS. MethodsChildren with active SeLECTS (n = 13), resolved SeLECTS (n = 12), and controls (n = 17) underwent high-resolution MRIs including diffusion tensor imaging sequences and multiple standardized neuropsychological measures of language function. We identified the superficial white matter abutting the inferior rolandic cortex and superior temporal gyrus using a cortical parcellation atlas and derived the arcuate fasciculus connecting them using probabilistic tractography. We compared white matter microstructural characteristics (axial, radial and mean diffusivity, and fractional anisotropy) between groups in each region, and tested for linear relationships between diffusivity metrics in these regions and language scores on neuropsychological testing. ResultsWe found significant differences in several language modalities in children with SeLECTS compared to controls. Children with SeLECTS performed worse on assessments of phonological awareness (p = 0.045) and verbal comprehension (p = 0.050). Reduced performance was more pronounced in children with active SeLECTS compared to controls, namely, phonological awareness (p = 0.028), verbal comprehension (p = 0.028), and verbal category fluency (p = 0.031), with trends toward worse performance also observed in verbal letter fluency (p = 0.052), and the expressive one-word picture vocabulary test (p = 0.068). Children with active SeLECTS perform worse than children with SeLECTS in remission on tests of verbal category fluency (p = 0.009), verbal letter fluency (p = 0.006), and the expressive one-word picture vocabulary test (p = 0.045). We also found abnormal superficial white matter microstructure in centrotemporal ROIs in children with SeLECTS, characterized by increased diffusivity and fractional anisotropy compared to controls (AD p = 0.014, RD p = 0.028, MD p = 0.020, and FA p = 0.024). Structural connectivity of the arcuate fasciculus connecting perisylvian cortical regions was lower in children with SeLECTS (p = 0.045), and in the arcuate fasciculus children with SeLECTS had increased diffusivity (AD p = 0.007, RD p = 0.006, MD p = 0.016), with no difference in fractional anisotropy (p = 0.22). However, linear tests comparing white matter microstructure in areas constituting language networks and language performance did not withstand correction for multiple comparisons in this sample, although a trend was seen between FA in the arcuate fasciculus and verbal category fluency (p = 0.047) and the expressive one-word picture vocabulary test (p = 0.036). ConclusionWe found impaired language development in children with SeLECTS, particularly in those with active SeLECTS, as well as abnormalities in the superficial centrotemporal white matter as well as the fibers connecting these regions, the arcuate fasciculus. Although relationships between language performance and white matter abnormalities did not pass correction for multiple comparisons, taken together, these results provide evidence of atypical white matter maturation in fibers involved in language processing, which may contribute to the aspects of language function that are commonly affected by the disorder.

Remote, Computerised Cognitive Assessment for Breast Cancer- and Treatment-Related Cognitive Dysfunction: Psychometric Characteristics of the Cogsuite Neurocognitive Battery.

Cancer-related cognitive dysfunction (CRCD) is a significant concern for breast cancer survivors. The Cogsuite battery was developed to improve sensitivity to CRCD with the use of cognitive experimental measures, clarify specific cognitive processes impacted and to be capable of being administered either in-office or remotely. In sum, 357 breast cancer survivors and non-cancer controls completed the Cogsuite Battery in-office (n = 76) or remotely (n = 281). Measure validity, sensitivity to demographic factors, correlations with standard neuropsychological measures and intercorrelations of Cogsuite variables were assessed. Test-retest reliability was evaluated in-office (n = 24) and remotely (n = 80). Test-retest reliability for most variables assessed was adequate to strong. Internal validity, as indicated by the confirmation of expected condition effects within each measure, was established for all measures. Assessment of external validity found age, but not education, was a significant predictor in the majority of measures. Assessment of criterion validity found that Cogsuite variables were correlated with standard measures in psychomotor speed, working memory and executive function, but not associated with self-reported cognition or mood. Cogsuite is reliable and valid, and is sensitive to the effects of increasing age on cognition. The addition of the Cogsuite battery to standard assessment may improve sensitivity to CRCD and identify underlying processes that may be affected. Remote use of the Cogsuite battery in appropriate settings will lessen the burden for providers, researchers and survivors in research and clinical contexts.

Validation of the cross-cultural dementia screening test in Alzheimer's disease and Parkinson's disease.

The Cross-Cultural Dementia (CCD) is a new screening tool to evaluate cognitive impairment based on a cross-cultural perspective to reduce the bias of education, and language and cultural differences. We aimed to evaluate the diagnostic properties of the CCD in Spaniards for the assessment of patients with Alzheimer's disease in mild cognitive impairment (AD-MCI) and mild dementia stages (AD-D) and patients with mild cognitive impairment associated with Parkinson's disease (PD-MCI). Sixty participants with AD (50% MCI) and thirty with PD-MCI were enrolled. Each clinical group was compared against a healthy control group (HC) with the same number of participants and no significant differences in age, education, and sex. A comprehensive neuropsychological test battery and CCD were completed. Intergroup comparisons, ROC curves, and cut-off scores were calculated for the study of diagnostic properties. Intergroup differences were found in accordance with the cognitive profile of each clinical condition. Memory measures (Objects test) were especially relevant for the classification between AD and HC. Memory and executive function scores (Sun-Moon and Dots tests) were useful in the case of PD-MCI and HC. Furthermore, CCD described differences in executive functions and speed scores comparing AD-MCI and PD-MCI. Correlations between standardized neuropsychological tests and CCD measures supported the convergent validity of the test. CCD showed good discrimination properties and cut-off scores for dementia and extended its application to a sample of prodromal stages of AD and PD with mild cognitive impairment.

The predictive role of fatigue and neuropsychological components on functional outcomes in COVID-19 after a multidisciplinary rehabilitation program

To verify the impact of altered cognitive functioning and higher levels of mental fatigue, both reported after coronavirus disease 2019 (COVID-19), on rehabilitation treatment outcomes. In this real-practice retrospective pre-post intervention cohort study, cognitive functioning, measured through standardized neuropsychological measures, and individual levels of fatigue, depression and anxiety symptoms, were evaluated at admission to a rehabilitation program in individuals who had been hospitalized for COVID-19. The rehabilitation program effectiveness was measured through the Functional Independence Measure. Among the patient sample (n = 66), 87.88% reported experiencing high levels of fatigue at admission, while 16.67% reported depressive symptoms, and 22.73% reported anxiety symptoms. After rehabilitation, the sample displayed a significant decrease in the level of disability, in both the motor and cognitive subscales. Neuropsychological and psychological functioning did not play a predictive role. The 45 patients who received mechanical ventilation during intensive care, representing 68.18% of the sample, benefited more from rehabilitation treatment. The results support the importance of an early rehabilitation program after COVID-19 infection, independent of the initial neuropsychological and psychological functioning. Respiratory assistance may represent a crucial factor for short-term neuropsychological disease after-effects. Future studies on the long-term neuropsychological effect of COVID-19 infection on individual levels of disability are necessary.

A Professional Musician with Sight‐Reading Difficulties: A Case Study

AbstractBackgroundThere have been few reports of musical alexia in neurodegeneration. In this case report, we describe a professional orchestral musician who presented with a chief complaint of decline in performance accuracy. While he had previously been exceptional in sight‐reading, he was now making frequent mistakes and falling behind. He stated that performing a familiar piece was, “like reading it for the first time.” He later developed difficulties with visuospatial abilities and language.MethodsWe aimed to characterize his musical and cognitive symptoms using a battery that consisted of the Montreal Battery of Evaluation of Amusia, novel tasks to assess accuracy of music reading and music production, standard neuropsychological testing, and review of clinical imaging and CSF.ResultsThe patient completed the Montreal Battery of Evaluation of Amusia (MBAE) with no errors. His pitch, interval, auditory memory, rhythm perception, as well as basic note names and values were unaffected. (Fig.1). We had designed two novel measures to assess his ability to play unfamiliar music using a key signature task and a performance piece. (Fig 2,3,4). Results indicated that he was able to sight read familiar excerpts but not unfamiliar excerpts. On unfamiliar pieces, his sight reading, comprehension, and production showed marked impairment. He was unable to accurately reproduce note sequences in musical passages. On standard neuropsychological measures, he demonstrated impairment on tasks requiring mental rotation and figure discrimination as well as language measures including reading comprehension (BDAE), and confrontation naming (MINT). MRI (Fig 5) showed atrophy in the patient’s parietal lobes and CSF fluid analysis was positive for abnormal Aβ‐42 and normal tau (Aβ‐42:521.55, ptau:25.55).ConclusionOur novel tasks revealed specific deficits in music sight reading, echoed in impairment in visuospatial abilities and language on neuropsychological measures. The patient’s imaging, positive CSF amyloid testing and cognitive testing suggest that amusia was an early stage of a probable parietal variant of Alzheimer’s disease (i.e., PCA). His case highlights the importance of considering a neurodegenerative process in patients presenting with isolated deficits in music reading. Future studies will be needed for normative and validation studies of our novel tasks.

Subtle cognitive deficits assessed by means of CANTAB in a cohort of subjects with CSF AD profile

AbstractBackgroundIn order to make successful disease‐modifying treatments, it is needed to shift Alzheimer’s disease (AD) diagnosis toward individuals with subtle cognitive deficits not yet fulfilling MCI criteria (pre‐MCI), entity associated with AD biomarkers positivity and increased risk of progression (Parnetti et al.,2019). This might allow to identify the individuals candidate to biomarker assessment. The detection of subtle cognitive impairment is limited by the sensitivity of standard neuropsychological measures (Wolfsgruber et al.,2020; Chipi et al.,2019). Cambridge Neuropsychological Test Automated Battery (CANTAB) represents an advanced computerized tool for the assessment of non‐verbal frontal‐subcortical functioning (Robbins et al.,1994). We aimed to explore the frequency of cerebrospinal fluid (CSF) AD‐like profile in pre‐MCI subjects defined as those obtaining low scores (≥‐1 SD) in at least one CANTAB test.MethodWe retrospectively analyzed 64 consecutive subjects (31 males, 33 females, mean age = 67±7.9) referring to our Memory Clinic for subjective cognitive complaints. All participants performed a comprehensive standard neuropsychological battery, reporting normal scores, and tests from CANTAB (Paired Associated Learning‐PAL; Pattern Recognition Memory‐PRM; Spatial Working Memory‐SWM). Pathological performance at CANTAB (CANTAB+) was defined as scores ≥‐1 SD in at least one task. All of them underwent lumbar puncture for the analysis of CSF core AD biomarkers (Aβ42/Aβ40 ratio, total tau, phospho‐tau). By applying the A/T/(N) classification scheme (Jack et al.,2018), AD CSF profile was defined as A+/T+. As A biomarker, we considered the Aβ42/40 ratio.ResultOut of 64 subjects, 43 performed ≥‐1SD in at least one test from CANTAB. In those 43 CANTAB+ subjects, 10 (23%) were A+/T+, 4 (9%) A+, and 22 (51%) A‐/T‐. Among CANTAB‐ (N = 21), 3 (14%) were A+/T+; 3 (14%) A+; 13 (61%) A‐/T‐. Among CANTAB+ subjects with A+/T+ (N = 10), 8 (80%) showed deficit in PAL, 4 at SWM and none of them showed altered scores at PRM.ConclusionConsistent proportion (23%) of pre‐MCI subjects with at least one altered score at CANTAB showed a CSF pattern compatible with AD. Since PAL test was altered in 80% of these subjects, if confirmed in independent cohorts, it might represent a sensitive neuropsychological measure to identify subjects with subtle cognitive deficits who may deserve CSF analysis for detecting preclinical AD.

Validity of the NIH toolbox cognitive battery in a healthy oldest-old 85+ sample.

To evaluate the construct validity of the NIH Toolbox Cognitive Battery (NIH TB-CB) in the healthy oldest-old (85+ years old). Our sample from the McKnight Brain Aging Registry consists of 179 individuals, 85 to 99 years of age, screened for memory, neurological, and psychiatric disorders. Using previous research methods on a sample of 85 + y/o adults, we conducted confirmatory factor analyses on models of NIH TB-CB and same domain standard neuropsychological measures. We hypothesized the five-factor model (Reading, Vocabulary, Memory, Working Memory, and Executive/Speed) would have the best fit, consistent with younger populations. We assessed confirmatory and discriminant validity. We also evaluated demographic and computer use predictors of NIH TB-CB composite scores. Findings suggest the six-factor model (Vocabulary, Reading, Memory, Working Memory, Executive, and Speed) had a better fit than alternative models. NIH TB-CB tests had good convergent and discriminant validity, though tests in the executive functioning domain had high inter-correlations with other cognitive domains. Computer use was strongly associated with higher NIH TB-CB overall and fluid cognition composite scores. The NIH TB-CB is a valid assessment for the oldest-old samples, with relatively weak validity in the domain of executive functioning. Computer use's impact on composite scores could be due to the executive demands of learning to use a tablet. Strong relationships of executive function with other cognitive domains could be due to cognitive dedifferentiation. Overall, the NIH TB-CB could be useful for testing cognition in the oldest-old and the impact of aging on cognition in older populations.

Validation of At-Home Application of a Digital Cognitive Screener for Older Adults.

Standardized neuropsychological assessments of older adults are important for both clinical diagnosis and biobehavioral research. Over decades, in-person testing has been the basis for population normative values that rank cognitive performance by demographic status. Most recently, digital tools have enabled remote data collection for cognitive measures, which offers the significant promise to extend the basis for normative values to be more inclusive of a larger cross section of the older population. We developed a Remote Characterization Module (RCM), using a speech-to-text interface, as a novel digital tool to administer an at-home, 25-min cognitive screener that mimics eight standardized neuropsychological measures. Forty cognitively healthy participants were recruited from a longitudinal aging research cohort, and they performed the same measures of memory, attention, verbal fluency and set-shifting in both in-clinic paper-and-pencil (PAP) and at-home RCM versions. The results showed small differences, if any, for how participants performed on in-person and remote versions in five of eight tasks. Critically, robust correlations between their PAP and RCM scores across participants support the finding that remote, digital testing can provide a reliable assessment tool for rapid and remote screening of healthy older adults’ cognitive performance in several key domains. The implications for digital cognitive screeners are discussed.

A promising cognitive screener in multiple sclerosis: The NIH toolbox cognition battery concords with gold standard neuropsychological measures

Background: Routine cognitive screening is a priority in MS clinical care. The National Institutes of Health Toolbox (NIHTB) Cognition Battery is a 30-min instrument validated in neurological populations excluding MS. Objectives: To assess construct validity of NIHTB tests and compare classification of cognitive impairment with gold-standard tests. To evaluate relationships between fluid cognition and clinical measures. Methods: Eighty-seven individuals, aged 30–59 years, completed the NIHTB, Minimal Assessment of Cognitive Function in MS (MACFIMS), Wechsler Adult Intelligence Scale-IV subtests, and measures of disease severity, depression, and fatigue. Results: The NIHTB showed adequate convergent validity for processing speed, working memory, and episodic memory. Although fluid cognition scores from the NIHTB and MACFIMS classified a similar proportion of participants as cognitively impaired, the two batteries differed in which individuals were classified as impaired versus preserved. NIHTB fluid cognition was inversely correlated with disease severity but not related to depression or fatigue. Conclusions: The NIHTB concords with gold-standard measures, and classifies cognitive impairment at similar rates to the MACFIMS. Adjusted NIHTB fluid cognition was negatively associated with disease severity suggesting clinical utility. Psychometric validation of the NIHTB in clinical practice will elucidate its promise as a cognitive screener in MS.

Damage to the human dentate gyrus impairs the perceptual discrimination of complex, novel objects

The hippocampus (HPC), and the dentate gyrus (DG) subregion in particular, is purported to be a pattern separator, orthogonally representing similar information so that distinct memories may be formed. The HPC may also be involved in complex perceptual discrimination. It is unclear if this role is limited to spatial/scene stimuli or extends to the discrimination of objects. Also unclear is whether the DG itself contributes to pattern separation beyond memory. BL, an individual with bilateral DG lesions, was previously shown to have poor discrimination of similar, everyday objects in memory. Here, we demonstrate that BL's deficit extends to complex perceptual discrimination of novel objects. Specifically, BL was presented with closely matched possible and impossible objects, which give rise to fundamentally different 3D perceptual representations despite being visually similar. BL performed significantly worse than controls when asked to select an odd object (e.g., impossible) amongst three identical counterpart objects (e.g., possible) presented at different rotations. His deficit was also evident in an atypical eye fixation pattern during this task. In contrast, BL's performance was indistinguishable from that of controls on other tasks involving the same objects, indicating that he could visually differentiate the object pairs, that he perceived the objects holistically in 3D, and that he has only a mild weakness in categorizing object possibility. Furthermore, his performance on standardized neuropsychological measures indicated intact mental rotation, visual-spatial attention, and working memory (visual and auditory). Collectively, these results provide evidence that the DG is necessary for complex perceptual discrimination of novel objects, indicating that the DG might function as a generic pattern separator of a wide range of stimuli within high-level perception, and that its role is not limited to memory.

Abstract WP173: Children’s Post-Stroke Expressive Language Outcomes Are Affected By Bilingual Exposure

Introduction: Approximately 2/3 of children face neurological deficits following arterial ischemic stroke (AIS). In neurotypical development, bilingualism is thought to confer certain linguistic and cognitive advantages. However, research on whether this may affect development in bilingual pediatric stroke patients is scarce. Objectives: To evaluate the effects of bilingual vs. monolingual exposure on language and cognitive outcomes in children following arterial ischemic stroke across two studies: (1) large-scale group analysis using the Pediatric Stroke Outcome Measure (PSOM); (2) exploratory case studies using neuropsychological measures. Methods: An institutional stroke registry and chart review were used to gather patient and stroke data, including the Pediatric Stroke Outcome Measure (PSOM) and standardized neuropsychological measures performed at several timepoints post-stroke in children with AIS. In Study 1, growth curve modeling based on PSOM subscales, predicted by age at stroke groups, language groups and their interactions was used. In Study 2, comparative case studies were conducted with a monolingual-bilingual pair, aged 7 and 8 at stroke onset. Results: In Study 1, 237 patients were identified (44%, bilingual patients). Patients were stratified based on age at stroke onset i.e. neonatal (<28 days of life), first-year (28 days-12 months) and childhood (13 months - 18 years). On the PSOM’s language expression subscale, an interaction revealed better post-stroke outcomes among bilingual children aged 1-12 months at stroke (beta = -0.32, t =-2.33, p = 0.02). In Study 2, the bilingual’s performance on neuropsychological assessments corroborated findings of Study 1, favoring a recovery of expressive language. Conclusion: Overall, we found no negative consequences of a bilingual environment on post-stroke outcomes. Additionally, it is possible that bilingualism has a faciliatory effect on expressive language development post-stroke. Further research should evaluate linguistic advantage effects prospectively in bilingual children with stroke and a control group.

Hal, do I have memory problems? A pilot study investigating a voice recognition cognitive screening tool for detection of neuropsychological changes

AbstractBackgroundThe prevalence of mild, age‐advanced changes in cognition, defined as mild cognitive impairment, is spiking as the baby boomer population ages. Early and accurate detection of age‐advanced changes in thinking abilities leads to proper care, efficient use of resources, and promotion of research. Indeed, government based health care systems and insurance programs incentivize routine neurocognitive assessment. Brief, paper and pencil cognitive screeners such as the MMSE and MOCA are widely utilized in clinical settings. Such screeners lack sensitivity to subtle cognitive change and specificity related to the cause of decline. Moreover, administration and interpretation of these screeners is time consuming in a busy, clinical setting. Prior research has determined that electronic‐based testing is effective in detecting cognitive change (Zygouris & Tsolaki, 2014). This pilot study aimed to investigate a convenient, platform agnostic, voice‐recognition screening tool for detection of mild, age‐advanced neurocognitive problems.MethodParticipants (n=16) were recruited from a large community‐based neurology practice, who underwent a comprehensive neuropsychological (NP) evaluation as part of their standard of care. Participants were administered an auditory list learning/recall test and a verbal fluency test (F/A/S and animals) via a voice recognition cognitive screening tool. Pearson correlations were conducted to examine the concurrent validity between the standard NP measures and those obtained using the current screening tool.ResultPreliminary data suggests a positive correlation between standard NP measures and those obtained using voice recording and speech recognition technologies; language: F/A/S (r = .716, p < .005), animals (r .810, p < .005); memory: delayed recall (r = .515, p < .05).ConclusionThis pilot study demonstrated concurrent validity between standard NP measures of memory and verbal fluency and those obtained using a novel, voice recording and speech recognition screening tool. These initial data provide support for the efficacy of a computerized based screening tool for older adults. Such a screening too has the potential to maximize utilization across multiple settings (e.g., medical office, hospital, in‐home) and improve early detection of cognitive decline.

Association of Dietary Inflammatory Index (DII) and Depressive Disorders.

A lot of evidence shows that inflammation is related to the development of depression. However, the heterogeneity of depression hinders efforts to understand, prevent and treat this disease. The purpose of this comprehensive review is to summarize the links between inflammation and the established core features of depression, which show more homogeneity than the syndrome itself: overreaction to negative information, changes in reward processing, and cognitive control decline, and somatic syndrome. For each core feature, we first briefly outline its relevance to depression and neurobiological basis, and then review the evidence to investigate the potential role of inflammation. We mainly focus on the discovery of the experimental paradigm of exogenous inflammation. We concluded that inflammation may play a role in overreaction to negative information, altered reward responses, and physical symptoms. There is less evidence to support the effect of inflammation on cognitive control by standard neuropsychological measures. Finally, we discussed the implications for future research and recommendations on how to test the role of inflammation in the pathogenesis of heterogeneous mental illness.

Brain structure in subjective cognitive decline: A replication study

AbstractBackgroundAlzheimer’s disease (AD) is an incurable neurodegenerative disorder, which disproportionately affects women (Erol et al., 2015). Given that the current treatments for AD aim to prevent symptom progression, the primary objective of emerging research is to identify pre‐clinical biological markers. Investigating such biomarkers would be appropriate in those experiencing subjective cognitive decline (SCD). Individuals with SCD are thought to be the earliest along the cognitive continuum between healthy aging and AD, as their reported change in cognition is not yet measurable using standard neuropsychological assessment measures. Previous research has found differences to exist in brain function, but not structure between healthy controls and those with SCD (Parker et al., 2020). The current study represents a preliminary analysis of structural brain images in healthy women compared to women with SCD; no structural differences between groups were hypothesized.MethodThe 3T T1 anatomical magnetic resonance images (MRI) used in this analysis was a subset of participants obtained from the Women’s Healthy Ageing Project collected in 2012 (N = 170). This subset included 30 healthy women (mean age = 71.4; SD = 3.12) and 30 women with SCD (mean age = 70.5; SD = 2.23). Voxel‐based morphometry (VBM) analyses were conducted using FMRIB’s Software Library to examine cross sectional differences between healthy women and women with SCD.ResultWhole brain VBM analyses did not reveal any significant differences in grey matter tissue density between healthy women and women with SCD at p < 0.05 level with threshold free cluster enhancement (corrected for multiple comparisons).ConclusionAlthough the current findings did not reveal differences in grey matter between healthy women and women with SCD, this result replicates our previous findings and other reports in the literature that structural differences may not be detectable between healthy individuals and those with SCD. Follow‐up work will include investigation of differences in functional connectivity between these two groups using resting‐state functional MRI with the total sample collected in 2012 (N = 170). Identifying changes in brain function prior to structural atrophy and measurable decline on neuropsychological measures would represent a major advance in AD biomarker research.