Story Recall Research Articles

Abstract TP40: Identification of Domain-Specific Cognitive Phenotypes of Post Stroke Vascular Contributions to Cognitive Impairment and Dementia

Introduction: Vascular contributions to cognitive impairment and dementia (VCID) are variably expressed following stroke. The purpose of this investigation is to identify the domain-specific cognitive phenotypes of VCID in the acute and sub-acute post-stroke interval measured using the Mark VCID battery. Methods: Mark VCID neurocognitive test battery was administered to 33 patients with incident ischemic stroke in the left (n=15), right (n=17), and bilateral (n=1) hemispheres including the anterior and middle cerebral artery territory, and 39 age and sex matched healthy controls (HC). Participants ranged in age from 42 to 88 years (Patient M=65.64 yrs, Control M=64.97 yrs). Patient group consisted of 17 males and 22 females, and the control group had 20 males and 13 females. Mean post stroke interval was 8 weeks (Range: 2.5 to 19 weeks). The test battery assessed: language (naming, fluency), perception (facial recognition, spatial orientation), psychomotor speed (digit symbol substitution), memory (word list, story recall), and attention (trails, number span). Normative test scores were converted to z-scores for assessment of between group differences using independent t-tests. Results: Patients with stroke performed significantly worse (p<0.05) than HCs on measures of language (semantic and phonemic fluency), perception (facial recognition and spatial orientation), and psychomotor speed (symbol digit modalities test) (Figure 1). There were no significant group differences in the scores of memory (Hopkins Verbal Learning, Craft Story) and attention tracking (Oral Trails A, Number Span). Conclusion: Cognitive abnormalities in these acute stoke patients represent impairments in diverse dominant (language) and non-dominant (perceptual/spatial) hemisphere cortical and subcortical (psychomotor speed) abilities. At the group level, the findings suggest a phenotype of VCID in patients with acute middle and anterior cerebral artery ischemic stroke.

Cognitive effects of brief and intensive neurofeedback treatment in schizophrenia: a single center pilot study.

Schizophrenia is characterized by significant cognitive impairments and affects up to 98% of patients. Neurofeedback (NF) offers a means to modulate neural network function through cognitive processes such as learning and memorization, with documented structural changes in the brain, most notably an increase in grey matter volume in targeted regions. The present 2-week, open-label, preliminary study aims to evaluate the efficacy on cognition of an adjunctive short and intensive (8 daily sessions lasting 30 minutes) alpha/theta NF training in a sample of subjects affected by schizophrenia on stabilized treatment with atypical antipsychotic drugs. The efficacy was measured at baseline and at the end of the study by the Brief Neuropsychological Examination 2 (ENB 2), the Mini Mental State Examination (MMSE), and the Stroop color-word interference test; the clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). A final sample of nine patients completed the study. Regarding the cognitive performance, at the final assessment (week 2), the NF treatment significantly improved the performance in the "Story Recall Immediate" (p = 0.024), "Story Recall Delayed" (p = 0.007), "Interference Memory 30 s" (p = 0.024), "Clock Test" (p = 0.014) sub-tests, and the ENB2 Total Score (p = 0.007). Concerning the clinical symptoms, no significant changes were observed in the PANSS subscales and the PANSS Total score. NF could represent an adjunctive treatment strategy in the therapeutic toolbox for schizophrenia cognitive symptoms.

Free Recall Outperforms Story Recall in Associations with Plasma Biomarkers in Preclinical Alzheimer Disease

Free Recall Outperforms Story Recall in Associations with Plasma Biomarkers in Preclinical Alzheimer Disease

THE NET ON THE RIVER WHERE VERY LITTLE HAS BEEN CAUGHT: DIFFERENCES IN MEMORY FOR DISCOURSE IN YOUNGER AND OLDER ADULTS

Abstract Experiential learning is key for courses in a gerontology certificate program at a midwestern nursing and health science college. One curricular emphasis is the uniqueness of every older adult that the student will encounter as they move from a novice student role to professional role mastery several years into their careers. To assist in this transition, one course has a unit on memory for discourse, especially memory for printed materials—essential in support of understanding medical conditions and treatment follow-through. Our project had college students compare their memory for short stories with memories of “students” from an OLLI Program who attended this class. The project, in an adult development course, provides students with community service, direct contact with older adults and reflective practices to integrate course content with this activity. Qualitative analyses were used. Content analyses of reflective essays identified four themes (a) older adult focus on key story propositions as well as incidental propositions with tie-in to acquired knowledge on attention/memory from course work (b) frequent use of situational schema based on greater world knowledge held by older adults and implications of this type of discourse in clinical settings (c) differences, that favored older adults, between groups in memory for details in structured versus unstructured stories, and (d) differences in style of recall for stories between age groups. Reflections were encouraged to tie new age-related knowledge about memory processes into better client follow through. Students also reflected on ways to make memory more optimal in clinical settings.

Decline in proper name retrieval during story recall is associated with Alzheimer’s disease CSF biomarkers in cognitively unimpaired individuals

AbstractBackgroundRemembering names of people and places is a common problem in aging that is exacerbated in Alzheimer’s disease (AD). Because retrieval of proper names (PNs) has been associated with brain regions affected by AD (anterior and medial temporal lobe), PN retrieval may be an especially sensitive measure of early AD pathology. Extending results of a previous study from WRAP (Mueller et al., 2020), this study examined associations between cerebrospinal fluid (CSF) AD biomarkers and longitudinal delayed story recall PN retrieval.MethodParticipants were from the BIOCARD study, a cohort of late‐middle aged adults enriched for parental history of AD. Participants were cognitively unimpaired at baseline with longitudinal item‐level data from the Logical Memory (LM; WMS‐R) Story A recall (N = 218; M(SD) baseline age = 58(9); M(SD) follow‐up = 4.1(2.9) years). CSF amyloid beta (Ab42/40) and phosphorylated tau181 (p‐tau181) were measured using automated electrochemiluminescence assays; AD biomarker abnormality (+) was determined using the bottom quartile for Ab42/40 and the top quartile for p‐tau181. We calculated total Story A PNs (range 0‐4) and total score (0‐25). We performed longitudinal linear mixed effects (LME) models examining the interaction between time (LM age, centered) and last available Ab42/40 and/or p‐tau181 status as predictors of PNs and total recall (subject‐specific random intercepts).ResultOf the 218 participants included, forty‐nine (22.4%) were Ab42/40+, 60 (27.5%) were p‐tau181+, and the remainder were A‐/T‐ (Table 1). In LME models, CSF‐Ab42/40+*age was not a significant predictor of either outcome. The p‐tau181+*age interaction showed significantly greater annual decline in PNs in the p‐tau181+ group than the p‐tau181‐ group (interaction beta = ‐.01, p = .02; simple slope estimate p‐tau181‐ = .002, p‐tau181+ = ‐.01) (Table 2, Fig.1). Interaction patterns were weaker yet similar for total recall. In follow‐up analyses, 15 participants who converted to MCI or dementia were removed and results remained unchanged. In an exploratory model combining biomarker statuses, the Ab42/40+/p‐tau181+*age interaction was non‐significant.ConclusionAs in the WRAP study, these results from BIOCARD indicate that PN recall is more sensitive to preclinical change than the traditional story recall total score metric; results also indicate that decline is greatest in those with elevated CSF p‐tau. Future directions should include replication in other longitudinal cohorts.

Automated lexical analysis of story recall in healthy controls

AbstractBackgroundImpaired episodic memory is one of the earliest and most prominent symptoms of Alzheimer’s disease (AD). Examining how patients produce words and phrases in story recall tasks is useful for tracking and understanding progression of their disease. Traditional approaches rely on manual assessments of recalled stories which can be limited, time‐consuming, and not applicable in large‐scale studies. Here, we implement an automated, computational approach to measure verbal episodic memory in a digitally recorded story recall task performed by young healthy speakers using natural language processing models.MethodWe analyzed digitized speech samples of pre‐recorded immediate and delayed Craft Story recall tasks performed by healthy speakers (n = 67, mean age = 20.31 years, SD = 2.17, 45 (67%) females). All transcripts were transcribed by trained annotators and automatically scored for number of verbatim and paraphrase recall, total recall score ( = verbatim+paraphrase), and semantic distance from the original story (degree of semantic similarity between the original craft story and the recalled story based on the Word2vec module in python). We also calculated total word count and number of unique words, and rated all recalled words for word familiarity, concreteness, and semantic ambiguity based on published norms. Number of pauses and total durations of speech and silent pauses were also measured.ResultWe found larger semantic distance between successive words in the delayed recall task compared with immediate recall within speaker (p<.001). Delayed recall also elicited lower total recall scores than immediate recall (p = .03). Comparing the effect sizes of semantic distance vs. total recall scores, our model comparison showed a smaller prediction error for semantic distance (AIC = 95.45) than total recall score (AIC = 736.18). In addition, speakers in the delayed recall task performed more paraphrase recall, had higher total word count, number of unique words, more ambiguous words, and produced more speech (all p‐values<.001).ConclusionOur findings suggest that automated speech analysis can provide informative and cost‐effective measures from a recorded story recall task. The study provides an automated and quantitative way to better measure memory abilities by including semantic distance. Future work will test procedures in patients with AD or other neurodegenerative diseases.

Stereotype threat in telephone‐administered neuropsychological assessment in older Veterans with and without cognitive impairment

AbstractBackgroundNeuropsychological evaluation is ubiquitous in Alzheimer’s disease clinical care and research—from diagnosing cognitive deficits to evaluating treatment and outcomes. However, performance during evaluation can depend on factors other than one’s cognition, including stereotype threat. Stereotype threat occurs when people feel at risk of conforming to stereotypes about their social group, in this case, memory declines associated with aging. While stereotype threat in neuropsychological evaluation in healthy older adults has been established, we tested, for the first time, this construct in older adults with cognitive impairment.MethodTwenty older adults (range 63 – 89; mean age = 77.2, SD = 6.8) recruited from the Veteran’s Affairs Boston Healthcare system were administered a telephone Repeatable Battery of Neuropsychological Assessment (RBANS). Following baseline assessment, one‐week later participants received a stereotype threat condition prior to neuropsychological evaluation. Participants also received a reduced threat condition which de‐emphasized memory diagnosis (during a separate week, counterbalanced with the threat condition). In the fourth week and final session, supplemental measures were administered, including a telephone‐MoCA, demographics, and surveys measuring mood, dementia worry, beliefs about aging, and subjective memory complaints. Planned analyses include a mixed‐effects analysis of variance, with group (healthy; cognitively impaired) and condition (stereotype‐threat; threat‐reduced).ResultsOlder adults with cognitive impairment demonstrated lower performance across all domains of the RBANS, including list learning, story recall, fluency, digit span, delayed recall, and recognition, ηp 2 = .87‐.99. Older adults with impairment scored numerically lower but not statistically lower in list learning under stereotype threat (M = 17.4; SD = 6.6) compared to the reduced threat condition (M = 19.9; SD = 7.2). Confirmation of the analyses, including examination of covariates, will follow final subject recruitment (N = 28).ConclusionWe found that stereotype threat did not significantly impact performance of healthy older adults and older adults with cognitive impairment. We note that small, numerical differences emerged for list learning. Differences of just one point in neuropsychological evaluation can be impactful, especially with respect to norms and cutoff scores. As such, the results carry implications for neuropsychological evaluation in clinic practice and research broadly.

The impact of subjective cognitive decline on aging effects in the brain as measured by diffusion tensor imaging

AbstractBackgroundDiffusion tensor imaging (DTI) can separate subjective cognitive decline (SCD) participants who progress to mild cognitive impairment and those who do not 1. We explored the effect age and memory performance has on DTI measures in SCD and controls in the hippocampal cingulum bundle, which is typically affected early in the course of Alzheimer’s disease2.Method325 participants Cam‐CAN 3 (127 SCD) older than 55 were included in the analysis. Diffusion imaging data was collected on a 3T Siemens TIM Trio scanner with a 32‐channel head coil for 0, 1000 and 2000 s/mm2 b‐values and 30 gradient directions. Preprocessing and calculation of the DTI metrics fractional anisotropy (FA, mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AxD) were completed using MRTrix3, FSL and MATLAB. The hippocampal cingulum bundle regions of interest (ROIs) were extracted from the ICBM‐DTI‐81 atlas. Memory was assessed using the delayed story recall (DSR) task from WMS‐III. Linear regression models were completed in R. Gender was included as a nuisance variable.ResultThere were no differences in gender or age distribution between cohorts, however participants with SCD had a 14% lower DSR score (Table 1). There was a significant interaction effect between age and cohort in MD, AxD, and RD (Figure 1), as well as between memory and age in AxD (Figure 2). In post‐hoc analyses, compared to controls, the SCD group showed a stronger correlation with age in MD, AxD, and RD (Figure 1) while participants with worse memory showed a stronger correlation with age in MD (Figure 2), indicating an accelerated aging effect.ConclusionParticipants with SCD and worse memory present with an accelerated aging effect, showing steeper variations in diffusion microstructure with age. Since SCD is likely to be a preclinical stage of Alzheimer’s disease, future work will analyze this effect with more advanced diffusion microstructure models to further elucidate the underlying pathophysiology. • Selnes P, Aarsland D, Bjornerud A, et al. J Alzheimers Dis. 2013;33(3):723‐36. • Jack Jr CR, Knopman DS, Jagust WJ, et al. The Lancet Neurology. 2013;12(2):207‐16. • Shafto MA, Tyler LK, Dixon M, et al. BMC neurology. 2014;14(1):1‐25.

The impact of subjective cognitive decline on aging effects in the brain as measured by diffusion tensor imaging

AbstractBackgroundDiffusion tensor imaging (DTI) can separate subjective cognitive decline (SCD) participants who progress to mild cognitive impairment and those who do not 1. We explored the effect age and memory performance has on DTI measures in SCD and controls in the hippocampal cingulum bundle, which is typically affected early in the course of Alzheimer’s disease2.Method325 participants Cam‐CAN 3 (127 SCD) older than 55 were included in the analysis. Diffusion imaging data was collected on a 3T Siemens TIM Trio scanner with a 32‐channel head coil for 0, 1000 and 2000 s/mm2 b‐values and 30 gradient directions. Preprocessing and calculation of the DTI metrics fractional anisotropy (FA, mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AxD) were completed using MRTrix3, FSL and MATLAB. The hippocampal cingulum bundle regions of interest (ROIs) were extracted from the ICBM‐DTI‐81 atlas. Memory was assessed using the delayed story recall (DSR) task from WMS‐III. Linear regression models were completed in R. Gender was included as a nuisance variable.ResultThere were no differences in gender or age distribution between cohorts, however participants with SCD had a 14% lower DSR score (Table 1). There was a significant interaction effect between age and cohort in MD, AxD, and RD (Figure 1), as well as between memory and age in AxD (Figure 2). In post‐hoc analyses, compared to controls, the SCD group showed a stronger correlation with age in MD, AxD, and RD (Figure 1) while participants with worse memory showed a stronger correlation with age in MD (Figure 2), indicating an accelerated aging effect.ConclusionParticipants with SCD and worse memory present with an accelerated aging effect, showing steeper variations in diffusion microstructure with age. Since SCD is likely to be a preclinical stage of Alzheimer’s disease, future work will analyze this effect with more advanced diffusion microstructure models to further elucidate the underlying pathophysiology.1. Selnes P, Aarsland D, Bjornerud A, et al. J Alzheimers Dis. 2013;33(3):723‐36.2. Jack Jr CR, Knopman DS, Jagust WJ, et al. The Lancet Neurology. 2013;12(2):207‐16.3. Shafto MA, Tyler LK, Dixon M, et al. BMC neurology. 2014;14(1):1‐25.

Optimising speech‐testing to predict prodromal Alzheimer’s disease: head‐to‐head comparison study of tasks and analysis methods

AbstractBackgroundChanges in speech occur in early‐stage Alzheimer’s disease. A range of approaches have been used for eliciting and automatically analysing speech, but limited research has directly compared these methods.MethodParticipants from the AMYPRED‐UK (NCT04828122) and AMYPRED‐US (NCT04928976) studies completed four speech‐elicitation tasks: the Automatic Story Recall Task (ASRT), the Logical Memory Test (LMT), Semantic (Animals, Vegetables, Fruit) and Phonemic Verbal Fluency (F, A, S) Tasks. Responses were recorded and automatically transcribed. Analyses were completed with Novoic’s speech analysis software, using four key approaches: (1) feature extraction, (2) representations from large language models (LLM), (3) text‐similarity evaluation, and (4) autoscoring. Together, these evaluated audio, linguistic, and temporal speech domains. Outputs were entered into logistic regression models predicting Mild Cognitive Impairment (MCI)/mild AD and Amyloid positivity in MCI/mild AD. Area under the ROC curves (AUC) were evaluated via 5‐fold cross‐validation.Result165 older adults (including N = 74 MCI and 9 mild AD; of which N = 38 MCI/mild AD and amyloid beta positive) provided data for all tasks. Strength of model predictions varied by task, analytic approach and domain (Fig 1). AUCs predicting MCI/mild AD were generally higher for ASRTs compared to other tasks (Fig 1A). Text‐similarity approaches (G‐match: similarity of word embeddings between the source text and retelling, and V‐match: string‐based matching), produced the highest AUC for ASRTs (G‐match AUC = 0.87‐0.88), and the LMT (V‐match AUC = 0.83‐85). Autoscoring tasks produced the strongest predictor for the semantic fluency (AUC = 0.85), and also one of the strongest for phonemic fluency (AUC = 0.72). Changes in linguistic and temporal characteristics were more sensitive to MCI/mild AD, compared to audio‐only metrics. Amyloid in MCI/mild AD predictions were overall less strong (Fig 1B), with the most consistent pattern being better performance of text‐similarity approaches on story recall tasks (up to AUC = 0.77 for ASRTs, 0.73 for LMT).ConclusionSelection of task and analytic approach is important for developing more sensitive speech‐based testing. The best performing tasks (ASRT, Semantic Fluency) and metrics (text‐similarity metrics and autoscoring) have been incorporated in Novoic’s Storyteller automated remote speech‐based test.

Optimising speech‐testing to predict prodromal Alzheimer’s disease: head‐to‐head comparison study of tasks and analysis methods

AbstractBackgroundChanges in speech occur in early‐stage Alzheimer’s disease. A range of approaches have been used for eliciting and automatically analysing speech, but limited research has directly compared these methods.MethodParticipants from the AMYPRED‐UK (NCT04828122) and AMYPRED‐US (NCT04928976) studies completed four speech‐elicitation tasks: the Automatic Story Recall Task (ASRT), the Logical Memory Test (LMT), Semantic (Animals, Vegetables, Fruit) and Phonemic Verbal Fluency (F, A, S) Tasks. Responses were recorded and automatically transcribed. Analyses were completed with Novoic’s speech analysis software, using four key approaches: (1) feature extraction, (2) representations from large language models (LLM), (3) text‐similarity evaluation, and (4) autoscoring. Together, these evaluated audio, linguistic, and temporal speech domains. Outputs were entered into logistic regression models predicting Mild Cognitive Impairment (MCI)/mild AD and Amyloid positivity in MCI/mild AD. Area under the ROC curves (AUC) were evaluated via 5‐fold cross‐validation.Result165 older adults (including N = 74 MCI and 9 mild AD; of which N = 38 MCI/mild AD and amyloid beta positive) provided data for all tasks. Strength of model predictions varied by task, analytic approach and domain (Fig 1). AUCs predicting MCI/mild AD were generally higher for ASRTs compared to other tasks (Fig 1A). Text‐similarity approaches (G‐match: similarity of word embeddings between the source text and retelling, and V‐match: string‐based matching), produced the highest AUC for ASRTs (G‐match AUC = 0.87‐0.88), and the LMT (V‐match AUC = 0.83‐85). Autoscoring tasks produced the strongest predictor for the semantic fluency (AUC = 0.85), and also one of the strongest for phonemic fluency (AUC = 0.72). Changes in linguistic and temporal characteristics were more sensitive to MCI/mild AD, compared to audio‐only metrics. Amyloid in MCI/mild AD predictions were overall less strong (Fig 1B), with the most consistent pattern being better performance of text‐similarity approaches on story recall tasks (up to AUC = 0.77 for ASRTs, 0.73 for LMT).ConclusionSelection of task and analytic approach is important for developing more sensitive speech‐based testing. The best performing tasks (ASRT, Semantic Fluency) and metrics (text‐similarity metrics and autoscoring) have been incorporated in Novoic’s Storyteller automated remote speech‐based test.

A comparison of word‐list and story recall tests for prediction of biomarker‐determined Alzheimer’s disease

AbstractBackgroundWord‐list and story recall tests are routinely employed in clinical practice for dementia screening. Previous research has shown that both types of tests are predictive of subsequent clinical diagnoses of dementia, including when examining process scores such as forgetting rate. In this study, our aim was to establish how well standard clinical metrics compared to process scores derived from word‐list and story recall tests in predicting biomarker‐determined Alzheimer’s disease (bdAD), as defined by CSF p‐tau/Abeta42 ratio.MethodData from 381 participants (mean age = 65, ± 9) were drawn from the University of Wisconsin – Madison Alzheimer’s Disease Research Center (ADRC) and Wisconsin Registry for Alzheimer’s Prevention (WRAP). Rey’s Auditory Verbal Learning Test (AVLT; word‐list) and Logical Memory Test (LMT; story) data were available. The conventional clinical scores examined were: AVLT total recall, AVLT delayed recall, LMT immediate recall, and LMT delayed recall. The process scores examined were: AVLT recency ratio (i.e., recency forgetting), AVLT total forgetting, LMT recency ratio, LMT total forgetting, and LMT primacy ratio (i.e., primacy forgetting). Bayesian linear regression analyses were carried out with either the nearest or farthest CSF p‐tau/Abeta42 ratio as outcome; the standard and process baseline memory scores as predictors; and baseline age, time elapsed from baseline to lumbar puncture, APOE risk score, sex, and years of education as control variables. Sensitivity analyses were carried out with logistic regressions using a cut‐off of 0.038 CSF p‐tau/Abeta42 ratio as outcome, to assess diagnosticity. CSF biomarkers were measured using the NeuroToolKit (Roche Diagnostics International Ltd, Rotkreuz, Switzerland).ResultLMT recency ratio and LMT primacy ratio were the best performing predictors (BF10 > 1 billion) both when evaluating the nearest (Figure 1a) and the farthest (Figure 1b) outcomes. However, sensitivity analyses with a binary cut‐off favored the primacy ratio. Areas under the curve (AUCs) ranged from 0.86 to 0.87 (including covariates). Specificity was consistently high for primacy ratio with 94% probability of correctly identifying individuals without bdAD.ConclusionOur study shows that story recall tests may be better than word‐list tests for dementia screening, especially when employing process scores alongside conventional clinical scores.

Long-term effects of vagus nerve stimulation therapy on cognitive functioning in patients with drug-resistant epilepsy.

Despite the increasing use of vagus nerve stimulation (VNS) for drug-resistant epilepsy, its impact on cognitive functioning remains insufficiently investigated. We aimed to comprehensively assess changes in cognition after long-term VNS therapy in a prospective sample of adults with epilepsy. Between December 2019 and March 2023, patients scheduled for VNS implantation were invited for neuropsychological assessment, including tests of executive functions, working and short-term memory (recall of a verbal logical story and the Rey-Osterrieth complex figure (ROCF)), and social cognition. Participants were re-evaluated after a year of VNS therapy and the pre- and postoperative scores were compared by means of the Student's t or Wilcoxon's signed rank tests for paired samples. Patients available only after a longer follow-up (more than 24 months) were also re-examined and included in a secondary analysis. The study included 28 PWE (16, 57.1% female, average age 33.7 ± 10.0 years). Twenty-two PWE followed-up at 14.5 ± 4.8 months had worse categorical verbal fluency than preoperatively (t = 2.613, p = 0.016). After including patients with long follow-up (n = 28, 21.6 ± 11.4 months), the group scored better on the delayed recall of the ROCF (17.09 ± 8.84 to 20.65 ± 8.32 points, t(22) = - 2.618, p = 0.016) and the Happé strange stories test (5.0 ± 2.6 to 6.1 ± 2.1 points, t(14) = - 3.281, p = 0.005). No significant changes were observed in other cognitive domains (p > 0.05). We suggest improvements in a task of social cognition and short-term visual memory after longer use of VNS therapy. Such findings should be confirmed in larger trials after controlling for changes in ictal or interictal activity.

Norms for the Triana Test: A Story Recall Test Based on Emotional Material.

The "Triana Test" is a novel story recall test based on emotional material with demonstrated accuracy in diagnosing mild cognitive impairment patients. This study aims to obtain normative data for the "Triana Test". A normative study was conducted at a university hospital in Spain. Partners of patients were systematically recruited if eligible (age ≥50, no memory complaints, and a total TMA-93 score at or above the 10th percentile). The "Triana Test" was administered and scored. For developing the normative data, a regression-based method was followed. The final sample included 362 participants (median age = 66, range = 50-88; 64.9% females). A model including age and educational level better predicted the total scores. Combinations of these variables resulted in different 10th percentile scores. Norms for using the "Triana Test" are now available. The provided cutoffs for the 10th percentile will aid in the diagnosis of prodromal Alzheimer's disease.

57 Clinical Utility of Neuropsychological Evaluation in the Differential Diagnosis Between Late-Onset Primary Progressive Aphasia Semantic Variant (PPA-SV) Versus Limbic Predominant Age-Related TDP-43 Encephalopathy (LATE): A Case Report

Objective:Primary progressive aphasia semantic variant (PPA-SV) is an atypical dementia subtype on the frontotemporal dementia (FTD) spectrum. PPA-SV is clinically defined by naming and semantic deficits, with progressive language decline that generalizes to other domains over time. Typically, it presents as an early-onset dementia with TDP-43 pathology, but 33-46% of PPA-SV cases display initial onset after age 65 with potentially different clinical features. Limbic Predominant Age-Related TDP-43 Encephalopathy (LATE), a more recently discovered neurodegenerative entity, is defined by an older age of onset, hippocampal sclerosis/atrophy, and TDP-43 pathology with a gradually progressive amnestic profile that expands to other cognitive deficits over time. The authors present a case report with overlapping features and suspected TDP-43 neuropathology ante-mortem for two reasons: first, to highlight the need for clinical criteria to formally diagnose LATE, and second, to address a gap in the literature on the possible clinical differences of late-onset PPA-SV.Participants and Methods:The authors present a case of a 78-year-old Indian bilingual man (English dominant) with 18 years of education, noncontributory medical history, and gradually progressive cognitive complaints reported over the past few years who was seen for outpatient neuropsychological evaluation. Prior workup was notable for negative amyloid PET scan, negative p-tau 217 blood test, and abnormal brain MRI revealing marked bilateral hippocampal atrophy with ex vacuo ventriculomegaly and minimal cerebrovascular disease. He scored 23/30 on prior MMSE, was diagnosed with amnestic MCI, prescribed Namenda and Exelon, and complained of minor memory and word-finding difficulties with reportedly intact IADLs and no signs of NPH.Results:Neuropsychological testing revealed a profound dysnomia (RBANS Naming raw score = 1/10), and he provided 0 words on two semantic fluency tasks but 15 words on letter fluency. Receptive vocabulary score was also impaired (PPVT-4, <1st %). Memory performance also demonstrated rapid forgetting of information (RBANS List Recall raw = 0/10, Story Recall raw = 0/12) with no benefit to recognition cues (RBANS List Recognition raw = 12/20), but slightly better visual memory recall, albeit still impaired (RBANS Figure Recall raw = 4/20). Grooved pegboard scores were significantly worse with right-hand than left-hand. Irregular word reading (NAART = 16th %ile) was significantly below expectations and thought to reflect more of a surface dyslexia rather than a cultural confounder given that he has lived in the US for over 50 years and his occupational and educational history was completed in English.Conclusions:Results support the clinical utility of neuropsychological evaluation in the differential diagnosis to support a predominant clinical syndrome of PPA-SV despite overlapping features with LATE and suspected TDP-43 pathology. This case report highlights the diagnostic issue with the lack of literature describing the typical clinical progression or suggested diagnostic criteria of LATE. These findings also indicate that late-onset PPA-SV may include greater memory deficits earlier in the course, but this may also be a clinical masquerade that is more reflective of the extent of language deficits. Further research on late-onset manifestations of PPA-SV and LATE consensus clinical guidelines is advised.

17 The Chinese Version of Craft Story Recall: A Preliminary Study on the Diagnostic Values of Mild Cognitive Impairment and Dementia.

Objective:Craft story recall test in the National Alzheimer’s Coordinating Center Uniformed Data Set 3 (NACC UDS3) neuropsychological battery has been employed to assess verbal memory and assist clinical diagnosis of mild cognitive impairment (MCI) and dementia. While a Chinese version of the test was adapted, no existing literature has examined the diagnostic validity of the test in Chinese Americans. This study aimed to evaluate the predictive validity of both immediate and delayed recall.Participants and Methods:The Chinese version of Craft Story was administered in to 78 Chinese participants per their language preference of Mandarin or Cantonese. Outcome measures were verbatim and paraphrase recall of the story immediately and after a 20-minute delay. A multiple linear regression was performed to investigate the association of each outcome measure with age, education, gender, age when moved to the U.S., years in the U.S., and testing language. To assess its diagnostic value, cutoff standard deviation scores of -1.5 and -2.0 from the mean of the clinically cognitive normal participants were generated for MCI and dementia diagnoses, respectively. Due to the small sample size, a normative group fitting the mean age (73 years), years of education (12 years), and the majority gender (female) of the current sample were used to identify standard cut points. A receiver-operating characteristic analysis was used to compare predicted diagnosis with actual clinical diagnosis obtained through patients’ overall performance and a consensus meeting by licensed clinicians.Results:Younger age (p < 0.05) and being tested in Mandarin (p < .01) were positively associated with immediate and delayed recall. Strong positive correlations between each measure were observed (all p < .001), indicating a significant relationship between information encoded and retained. Among all the participants, 15 (19.2%) were diagnosed with MCI and 22 (28.2%) with dementia. For MCI diagnosis, the standard cutoff scores demonstrated adequate sensitivity (verbatim=82%, paraphrase=91%) but low specificity (verbatim=44%, paraphrase=67%) in all outcome measures. For dementia diagnosis, delayed recall showed strong sensitivity (100%) and adequate specificity (75%) in both verbatim and paraphrasing scores. Immediate recall paraphrase (sensitivity = 95%, specificity = 50%) showed a better sensitivity but lower specificity than verbatim scoring (sensitivity = 86%, specificity = 58%). The accuracy was higher in delayed recall for both MCI and dementia diagnosis. A preliminary analysis on the optimal cut points indicated higher cutoff scores to distinguish MCI and dementia from clinically cognitive normal population, and from each other (e.g., the optimal cut point for delayed verbatim in distinguishing MCI from normal is 8.0 (sensitivity=89%, specificity=73%, AUC=84.3%)).Conclusions:Consistent with previous literature, Craft Story delayed recall served as a more accurate diagnostic tool for both MCI and dementia compared to immediate recall in older Chinese Americans. However, poor specificity might increase the chance of following false positive subjects in clinical trials. In addition, testing language appeared to impact performance on verbal memory recall of constructed information. Thus, future studies should focus on developing normative scores that address both the overall cultural differences of Chinese Americans and the heterogeneity within this population.

The utility of word list and story recall for identifying older U.S. Chinese immigrants with cognitive impairment.

This study examined the utility of the Chinese-language translations of the word list memory test (Philadelphia Verbal Learning Test) and story memory test (Logical Memory subtest of the Wechsler Memory Scale) for differentiating cognitive diagnosis in older U.S. Chinese immigrants. Participants were ≥ 60 years old, with Chinese language proficiency to complete a diagnostic workup at the Mount Sinai's Alzheimer's Disease Research Center. The workup included an evaluation by a geriatric psychiatrist and cognitive testing with a psychometrician. Diagnosis of normal, mild cognitive impairment (MCI), and dementia was made independent of the cognitive tests at consensus led by a dementia expert physician. Multivariable logistic regression models were used to assess the sensitivity of story and word list memory tests for distinguishing between groups. Receiver operating characteristic (ROC area/area under the curve [AUC]) was used to compare the predictive accuracy of the two tests. The sample included 71 participants with normal cognition, 42 with MCI, and 24 with dementia. The MCI group was older and less educated than normal controls but younger and more educated than the dementia group. Delayed recall of both memory tests, but not immediate recall of either test, predicted diagnosis. While composite memory score of word list (AUC = 0.90) predicted diagnosis slightly better than that of stories (AUC = 0.85), the difference was not significant in this small sample (p = .14). Chinese-language translations of verbal memory tests, in particular delayed recall scores, were equally sensitive for classifying cognitive diagnosis in older U.S. Chinese immigrants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Andrew Mayes’ expert analysis of a case of memory distortion

In this single-case study of memory distortion where Andrew Mayes was involved as an expert witness, a surgeon falsely recalled aspects of a patient safety adverse event in which he was involved, and where he was put through an investigatory process by a regulatory body. Andrew Mayes’ expert analysis of the role of memory distortion in this case resulted in the surgeon being exonerated.

A - 129 An Examination of the Relationship between Posttraumatic Stress Disorder Symptom Severity and Cognitive Test Performance in a Veteran Sample.

This study examined the relationship between Posttraumatic Stress Disorder (PTSD) symptom severity and cognitive test performance in veterans, hypothesizing that PTSD Checklist for DSM-5 (PCL-5) scores would be correlated with test performance on commonly used neuropsychological measures. Clinically-referred veterans without a neurocognitive disorder who passed the Test of Memory Malingering (TOMM), completed the PCL-5, and completed Weschler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Digit Span or Coding, Weschler Memory Scale-Fourth Edition (WMS-IV) Logical Memory (LMI/LMII), letter fluency (FAS), or Trail Making Test (Parts A and B) were included. The sample included 38 veterans (81.6% male); mean age = 58.79 (SD = 14.71; range 22-80) and mean education level = 13.97years (SD = 2.42, range 6-20). Primary diagnoses included PTSD (47.4%), depression (21.1%), and no diagnosis (23.7%). Pearson, Spearman, and partial correlations were calculated. Moderate negative correlations were found between PCL-5 and FAS raw scores (r = -0.41, p = 0.014; 95%CI [-0.654,-0.089]) and LMI raw scores (r = -0.453, p = 0.02; 95%CI [-0.715,-0.080]). After controlling for age and education, moderate negative correlations remained for FAS (r = -0.46, p = 0.004) and LMI (r = -0.43, p = 0.018) and a weak, non-significant correlation with LMII (r = -0.297, p = 0.079). In veterans with valid cognitive test performance and no neurocognitive disorder, PTSD symptom severity negatively correlated with FAS and WMS-IV LM performance. This suggests PTSD symptoms may influence performance on phonemic fluency and story recall task. Assessing and addressing PTSD symptoms may result in more accurate diagnoses and improved cognitive functioning. Understanding the PTSD-cognition relationship can inform interventions and support strategies to enhance veterans' quality of life.

A - 167 Neuropsychological Correlates of Challenging Behavior in Moderate to Severe ABI.

Cognitive and behavioral changes, common after severe acquired brain injury (ABI), are important predictors of functional recovery, independence, and quality of life. The Overt Behavior Scale (OBS) is a standardized measure of challenging behaviors following ABI, and has been associated with pre-injury risk factors and psychosocial stressors. Information about the neuropsychological underpinnings of OBS scores is unknown, however. The current study is a preliminary analysis of relationships among OBS scores and neuropsychological data associated with behavioral dysregulation in adults with chronic moderate to severe ABI in a residential neurorehabilitation setting. Participants were 81 adults, ages 27-71 (SD = 10.46), 55 males, with average education of 12.6years, and average time since injury of 26.34 (SD = 13.35). Participants were administered neuropsychological tests (including NAB Screening Module Memory, Executive Functioning, and Attention Index and subtests, NAB Judgment, and Trails B). The OBS was administered by the psychology provider with input from the treatment team. Exploratory correlations examined the relationship between neuropsychological tests and OBS scores. Results found a significant relationship between the number of challenging behaviors on the OBS and NAB delayed story recall (p < 0.040, r = -0.266). Other correlations between OBS and the NAB and Trails B were not significant. The results raise the possibility that the OBS captures unique aspects of behavioral change that are not measured by traditional neuropsychological tests. Other possible explanations of the data include that the severity of cognitive impairment and physical limitations may be moderating factors, which will be examined in future studies.