Subjective Cognitive Concerns Research Articles

B - 97 On the Rebound: Resilience and Subjective Cognitive Concerns in Cancer

Abstract Objective There is a connection between resilience and subjective cognitive symptoms in medical populations. However, there is limited understanding of this relationship in cancer survivors, and no studies examine whether subjective cognition may change from pre- to post-resilience training in these patients. This study examined the relationship between subjective cognitive function and resilience in non-CNS cancer survivors who participated in a resiliency training intervention and investigated potential influences of change in subjective cognition. Method Adult cancer survivors at Massachusetts General Hospital (N = 275, Mage = 55.2, 87.3% female) participated in the Stress Management and Resilience Training-Relaxation Response Resilience Program (SMART-3RP) and completed self-report measures assessing subjective cognitive function, resilience, depression, and worry at pre-post the group intervention. Cross-sectional relationships were evaluated using hierarchical regression modeling. Repeated measures ANCOVA assessed differences in subjective cognition from pre-post, controlling for age and time since diagnosis. Mediation modeling assessed whether mental health symptoms change alongside subjective cognition and account for the relationship with resilience. Results Results revealed a significant relationship between subjective cognitive function and resilience at baseline (β = 0.35, p < 0.001) and a significant change post-SMART-3RP (F(1, 77) = 6.09, p = 0.016). Patients experienced a decrease in cognitive concerns while making gains in resilience (β = 0.39, p < 0.001). Changes in depression and anxiety did not mediate the relationship between resilience and subjective cognitive function (p’s > 0.05). Conclusion It may be possible to refer survivors to programs, such as the SMART-3RP, to manage their subjective concerns, in the absence of objective cognitive deficits.

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

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

Subjective cognitive concerns, APOE ε4, PTSD symptoms, and risk for dementia among older veterans

BackgroundPosttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are associated with self-reported problems with cognition as well as risk for Alzheimer’s disease and related dementias (ADRD). Overlapping symptom profiles observed in cognitive disorders, psychiatric disorders, and environmental exposures (e.g., head injury) can complicate the detection of early signs of ADRD. The interplay between PTSD, head injury, subjective (self-reported) cognitive concerns and genetic risk for ADRD is also not well understood, particularly in diverse ancestry groups.MethodsUsing data from the U.S. Department of Veterans Affairs (VA) Million Veteran Program (MVP), we examined the relationship between dementia risk factors (APOE ε4, PTSD, TBI) and subjective cognitive concerns (SCC) measured in individuals of European (n = 140,921), African (n = 15,788), and Hispanic (n = 8,064) ancestry (EA, AA, and HA, respectively). We then used data from the VA electronic medical record to perform a retrospective survival analysis evaluating PTSD, TBI, APOE ε4, and SCC and their associations with risk of conversion to ADRD in Veterans aged 65 and older.ResultsPTSD symptoms (B = 0.50–0.52, p < 1E-250) and probable TBI (B = 0.05–0.19, p = 1.51E-07 – 0.002) were positively associated with SCC across all three ancestry groups. APOE ε4 was associated with greater SCC in EA Veterans aged 65 and older (B = 0.037, p = 1.88E-12). Results of Cox models indicated that PTSD symptoms (hazard ratio [HR] = 1.13–1.21), APOE ε4 (HR = 1.73–2.05) and SCC (HR = 1.18–1.37) were positively associated with risk for ADRD across all three ancestry groups. In the EA group, probable TBI also contributed to increased risk of ADRD (HR = 1.18).ConclusionsThe findings underscore the value of SCC as an indicator of ADRD risk in Veterans 65 and older when considered in conjunction with other influential genetic, clinical, and demographic risk factors.

The Effects of a Single-Session Virtual Rumination Intervention to Enhance Cognitive Functioning in Veterans With Subjective Cognitive Symptoms: Multimethod Pilot Study.

Subjective cognitive concerns (SCCs) entail perceived difficulties in thinking or memory, often reported without substantial objective evidence of cognitive impairment. These concerns are prevalent among individuals with a history of brain injuries, neurological conditions, or chronic illnesses, contributing to both psychological distress and functional limitations. They are increasingly considered to be a risk factor for future objective decline. A considerable number of individuals reporting SCCs also exhibit mental health symptoms, such as a history of trauma, depression, or anxiety. Interventions that address modifiable emotional and cognitive factors related to SCC could improve functioning and quality of life. Therefore, the use of emotion regulation strategies, especially those directed at minimizing rumination, could serve as a promising focus for interventions aimed at mitigating subjective cognitive concerns in veteran populations. This pilot study explored the feasibility, acceptability, and preliminary efficacy of a brief, 1-session emotion regulation intervention called "Worry Less, Remember More." The Worry Less, Remember More intervention was designed to reduce rumination and improve subjective cognitive functioning in veterans with subjective cognitive changes (N=15). We randomized 15 veterans to either the active telehealth condition or waitlist control and completed the intervention. Participants were aged between 31 and 67 (mean 49.5, SD 10.1) years, and the sample was primarily male (12/15, 83%) and White (10/15, 67%). The most common diagnoses were posttraumatic stress disorder and depression. Following the intervention, veteran input was sought through semistructured interviews with a subset of 12 participants, examining feasibility, acceptability, and perceived efficacy. Preliminary efficacy was also measured using pre- and postintervention self-report measures. Veterans reported that this intervention was acceptable, with 92% (11/12) of the sample reporting that they benefited from the intervention and would recommend the intervention to others with similar difficulties. Semistructured interviews revealed difficulties with feasibility, including problems with the remote consenting process, forgetting appointments, and needing additional strategies to remember to consistently use the interventions. The intervention improved self-reported cognitive symptoms on quantitative measures but did not improve self-reported rumination. This pilot study establishes the preliminary feasibility, acceptability, and efficacy of the Worry Less, Remember More intervention for veterans with subjective cognitive symptoms. Future iterations of the intervention may benefit from simplifying the electronic consent process, providing reminders for appointments, and incorporating compensatory cognitive strategies to assist with using the telehealth system, as well as applying the strategies learned in the intervention. While future research is needed with larger samples, including nonveteran populations, the intervention may also be a useful clinical tool to bridge care between neuropsychology clinics and mental health treatment.

Reduced Subjective Cognitive Concerns With Neurobehavioral Therapy in Functional Seizures and Traumatic Brain Injury.

Functional seizures are common among people with traumatic brain injury (TBI). Subjective cognitive concerns refer to a person's own perception of problems with cognitive functioning in everyday life. The authors investigated the presence and correlates of subjective cognitive concerns and the response to neurobehavioral therapy among adults with TBI and functional seizures (TBI+FS group). In this observational study, participants in the TBI+FS group (N=47) completed a 12-session neurobehavioral therapy protocol for seizures, while participants in the comparison group (TBI without seizures) (N=50) received usual treatment. Subjective cognitive concerns, objective cognition, mental health, and quality of life were assessed before and after treatment. Data collection occurred from 2018 to 2022. Baseline subjective cognitive concerns were reported for 37 (79%) participants in the TBI+FS group and 20 (40%) participants in the comparison group. In a multivariable regression model in the TBI+FS group, baseline global mental health (β=-0.97) and obsessive-compulsive symptoms (β=-1.01) were associated with subjective cognitive concerns at baseline. The TBI+FS group had fewer subjective cognitive concerns after treatment (η2=0.09), whereas the TBI comparison group showed a nonsignificant increase in subjective cognitive concerns. Subjective cognitive concerns are common among people with TBI and functional seizures and may be related to general mental health and obsessive-compulsive symptoms. Evidence-based neurobehavioral therapy for functional seizures is a reasonable treatment option to address such concerns in this population, although additional studies in culturally diverse samples are needed. In addition, people with functional seizures would likely benefit from rehabilitation specifically targeted toward cognitive functioning.

Optimizing Subjective Cognitive Concern Assessment to Predict Cognitive Decline in Motoric Cognitive Risk Syndrome: Results from the Einstein Aging Study

AbstractBackgroundMotoric Cognitive Risk Syndrome (MCR) is a predementia condition that combines slow gait speed and subjective cognitive concerns (SCC), and predicts incident dementia in diverse global populations. MCR status is simple and inexpensive to ascertain, facilitating assessment in low resource settings. Though the slow gait component of MCR diagnosis is well operationalized, there is no standardized approach to SCC assessment. We hypothesized that in older adults with slow gait, the SCC questions that best predicted cognitive decline would most successfully operationalize SCC.MethodEinstein Aging Study participants (n = 324; Mage = 70.4; Meducation= 15; 67%women; 46.3%White) completed the Cognitive Change Index Supplement (CCI‐40) as part of a comprehensive neuropsychological assessment (which included the Clinical Dementia Rating Scale [CDR]) at baseline and over up‐to‐5 annual follow‐ups (Mwave= 1.48). The CCI‐40 queries SCC across cognitive domains, including memory (21 items), language (4), executive functioning (5), attention/concentration (4), visuospatial functioning (2), calculation (1), mental clarity (2), and orientation (1). Slow gait was diagnosed based on established MCR criteria (1 SD below age/sex adjusted means). We used linear mixed effects models (LME) for continuous, and generalized LME for binary longitudinal cognitive outcomes, to examine how various definitions of SCC at baseline predict cognitive changes in older adults with slow gait, adjusting for covariates including age, sex, education, race/ethnicity, and depression. We report the interaction terms between SCC and time. The final sample included 43 participants (13%) who met slow gait criteria at baseline.ResultAmong participants with slow gait, the CCI‐40 total score was associated with decline on neuropsychological measures of attention/processing speed (β = ‐0.09, p = 0.05), verbal fluency (β = 0.03, p = 0.01), and a global dementia rating scale (β = 0.04, p = 0.02). Item‐by‐item analysis revealed a subset of items that were significantly associated with decline in key neuropsychological domains, including executive functioning, language, and memory.ConclusionOur findings suggest that attention to SCC assessment in older adults with slow gait may provide key insight into individuals at greatest risk for cognitive decline. SCC in MCR may be best operationalized through comprehensive assessment across broad cognitive domains. Future work will develop a brief SCC screen optimized to predict cognitive decline in this population.

Prevalence and type of subjective cognitive concerns among participants at baseline and their relationship to cognition and other factors

AbstractBackgroundThe U.S. POINTER study is a phase 3, multicenter, 2‐year randomized controlled trial (RCT) of two lifestyle interventions varying in intensity and format, conducted in older adults living in the U.S. who do not have objective cognitive impairment at study entry, but have increased risk of cognitive decline and dementia. Inclusion criteria included specific risk factors (e.g., family history of dementia, vascular risk factors) but not subjective cognitive concerns (SCCs). However, SCCs are likely to be common in this group of at‐risk individuals. U.S. POINTER provides a unique opportunity to evaluate the prevalence of SCCs and their demographic and clinical correlates in an at‐risk group.MethodsRecruitment for the U.S. POINTER study is still ongoing, and the following is based on a partial sample. The sample includes 1811 U.S. POINTER participants with complete baseline data (collected by December 2022), mean age = 68.2y (SD = 5.2), 73.5% are female, 70.2% have18+ years education, and 29.3% are from underrepresented groups. SCCs were measured by the brief 12‐item Everyday Cognition (ECog) questionnaire which includes two items in each of 6 domains: everyday memory, language, visuospatial abilities, planning, organization and divided attention. Responses on the ECog range from 0 = no change/better compared to baseline, 1 = questionably/inconsistently worse, 2 = consistently a little worse, 3 = much worse. Neuropsychological performance was measured using a global composite and episodic memory, executive functioning, and processing speed composites. Other variables included demographics, depression (Geriatric Depression Scale total score; GDS) and sleep (Insomnia severity index (ISI)) and vascular disease burden index.ResultsThirty‐five percent of the cohort endorsed having a subjective complaint on the ECog (score ≥2 on any item). The most frequent complaint was “Remembering where I have placed objects” (23%). SCCs did not differ by age, sex or education. ECog‐12 Total were related to insomnia and depression (p&lt;.0001). After adjusting for age, sex, education, vascular risk burden, GDS and ISI, greater SCC (ECog‐12 Total) was still associated with the global composite and all three domains (ps &lt; 0.003).ConclusionsSCCs, particularly everyday memory complaints, were relatively common in this at‐risk cohort. While SCCs were related to depression and sleep, they were also independently associated with slightly worse cognitive function.

Loneliness and daily subjective cognitive concerns among cognitively normal older adults and individuals with MCI

AbstractBackgroundLoneliness is associated with increased dementia risk and is bidirectionally associated with cognitive decline across several years. Less is known about how loneliness and cognitive function are bidirectionally related on shorter timescales. This study examined daily associations between loneliness and self‐reported cognitive concerns in cognitively normal older adults and those with mild cognitive impairment (MCI).MethodCommunity‐dwelling older adults from the Einstein Aging Study (n = 311, age 70‐90 years, 65.9% female, 41.8% Black/African American, 12.5% Hispanic, 30.9% met Jak/Bondi criteria for MCI) completed a two week ecological momentary assessment (EMA) protocol via smartphone. Participants rated their current feelings of loneliness up to 5 times per day (4 via notifications, and 1 at end of day). These ratings were averaged to obtain a loneliness severity score for each day. Subjective cognitive concerns (prospective and retrospective memory lapses, attention/executive function difficulties) were assessed at the end of each day. Participants also reported how much each concern bothered them and/or disrupted their daily activities. Multilevel models were used to assess same‐day and next‐day associations between loneliness and each of the subjective cognitive concern outcomes bidirectionally.ResultsThere were bidirectional same‐day associations observed between loneliness severity and greater number and more bother of attention/executive concerns, as well as greater disruption of all cognitive concerns. When considering associations of present day loneliness with next day cognitive concerns, greater severity of loneliness predicted more bother of attention/executive concerns on the following day. Additionally, present day number of attention/executive concerns and disruption of all cognitive concerns predicted next day loneliness severity. All effects remained significant after adjusting for age, sex, years of education, and MCI status.ConclusionThese findings demonstrate that loneliness is dynamically associated with attention and executive function, but not memory lapses, on a day‐to‐day basis. Associations between loneliness and experience of bother and disruption due to cognitive concerns, suggest that loneliness may signal greater severity of, or less ability to cope with, cognitive difficulties.

Relationship between baseline levels of subjective cognitive concern and physical, cognitive and social activity in the U.S. POINTER Study

AbstractBackgroundThere has been little investigation into the relationship between physical, cognitive, and social activity and subjective concern about cognition (SCD) in the absence of objective cognitive decline. This concern about subjective change is an important concept in the field of Alzheimer’s disease as it independently confers risk for developing MCI/AD. However, the exact relationship between SCD and engagement in positive daily activities is poorly understood. This project examines the relationship between SCD and self‐reported engagement in these activities.MethodU.S. POINTER is a phase 3, multicenter, 2‐year randomized controlled trial of two lifestyle interventions varying in intensity and format, conducted in older adults living in the U.S. who do not have objective cognitive impairment at study entry, but have increased risk of cognitive decline and dementia. Participants completed myriad measures at baseline, including the Cognitive Function Inventory (CFI) assessing subjective cognitive decline, and the Community Healthy Activities Model Program for Seniors (CHAMPS) which assesses self‐reported engagement in social, cognitive, and physical activities over the past 4 weeks.ResultsBaseline study characteristics of the current sample (N = 1823) are: Mean age = 68.2y (5.2), 73.5% female, 29.8% with less than 18+ years education, and 29.3% from underrepresented groups (URG). In separate multivariate linear models, CFI was associated with weekly caloric expenditure in exercise (p&lt; .001) and cognitive activity (p &lt;.001), such that CFI scores were higher for participants with lower exercise‐related caloric expenditure and lower cognitive activity levels. Higher CFI scores also tended to predict social activity levels (p = .06). The inverse relationship between CFI and all three variables is significant in women (p = .04; .0001; .05, respectively) but not in men, and the CFI‐cognitive activity relationship is significant for URG (p = .005) but not White participants.ConclusionIn sum, SCD and engagement in physical, cognitive, and social activities are inversely related to varying degrees, such that individuals who report lower levels of engagement in these activities report more subjective cognitive concerns. However, different patterns emerged for some subgroups. Additional modeling is needed to demonstrate the directionality of the relationships between these activities and CFI, and the relationship with demographic variables of interest.

1 Subjective Cognitive Concerns, Neuropsychological Test Performances, and Frontoparietal Thickness and Connectivity in High-Functioning Older Adults

Objective:Neuropsychologists have difficulty detecting cognitive decline in high-functioning older adults, in whom substantially greater neurological change may need to occur before performance on cognitive tests are low enough to indicate cognitive impairment. For high-functioning older adults, subjective cognitive concerns (SCC) may indicate decline that is not detected by the presence of low cognitive test scores but may be related to the absence of high scores and the presence of latent neurological changes. We hypothesized that high-functioning older adults with SCC would have fewer high scores than those without concerns, but a comparable number of low scores. These findings would indicate that objective decline has occurred but would not be detected by a traditional focus on low scores. We also hypothesized that SCC would be associated with lower frontoparietal network volume, thickness, and connectivity, indicating latent neurological change underlying subjective cognitive concerns.Participants and Methods:Participants from an imaging sub-study of an ongoing longitudinal aging study were selected if they had high estimated premorbid functioning, defined as either (a) estimated intelligence &gt;75th percentile on the North American Adult Reading Test (n=48) or (b) having a college degree (n=62). This resulted in 68 participants subdivided based on SCC, defined as one or more self-reported SCC on the Medical Outcomes Study Cognitive Functioning Scale (MOS-Cog). Participants with SCC (n=35; 73.9 years-old, SD=9.6, range: 60-95; 62.9% female; 94.3% White) and without SCC (n=33; 71.0 years-old, SD=7.2, range: 61-85, 75.8% female; 100% White) completed a neuropsychological test battery of memory and executive functions, including the Rey Auditory Verbal Learning Test, Trail Making Test Parts A and B, Controlled Oral Word Association Test, Digit Span, and Letter-Number Sequencing, and underwent structural MRI. MR images were analyzed for frontoparietal network volume, thickness, and connectivity.Results:Participants with and without SCC were compared on the number of low test scores (i.e., at or below the 16th percentile) and high test scores (i.e., at or above the 75th percentile), finding a comparable number of low scores, t=1.66, p=.103, d=.40, but a lower number of high scores among participants with SCC, t=2.95, p=.004, d=.71. Participants with SCC had lower bilateral mean frontoparietal network volumes (left: t=2.98, p=.004, d=.74; right: t=2.63, p=.011, d=.66) and cortical thickness (left: t=2.65, p=.010, d=.66; right: t=2.18, p=.033, d=.54), but did not differ from those without SCC in terms of network connectivity.Conclusions:SCC have been reported as a potential risk factor for dementia in older adults. High-functioning older adults with SCC presented with fewer high scores than those without SCC but had a comparable number of low scores. Among high-functioning older adults, subjective cognitive decline may correspond with objective cognitive change not detected by the traditional emphasis on low scores, but rather the absence of high scores. SCC were also related to underlying changes in the volume and thickness of the frontoparietal network, but not connectivity. In high-functioning older adults, subjective cognitive decline may correspond with a reduction from high average functioning in some domains and underlying neurological changes.

A - 173 Symbol Match Validity at the Montefiore Memory Disorder Centers.

To demonstrate the validity of the Symbol Match in a diverse clinical setting. To improve detection of cognitive impairment in older primary care patients, our team developed the 5-Cog, a 5-minute cognitive assessment and decision tree paradigm that can be administered by non-clinicians. The Symbol Match is a new 90-second oral symbol and digit substitution task that is one of the three tests in the 5-Cog that assesses processing speed and executive function. 50 participants (66% female; 44% Hispanic, 38% Non-Hispanic Black; 36% evaluated in Spanish) with a mean age of 77.84 ± 7.3, and 12 ± 4.7 mean years of education. Participants were recruited following clinical evaluations at the Montefiore Memory Disorder Centers and had confirmed clinical diagnoses of dementia, mild cognitive impairment (MCI), or subjective cognitive concerns (SCC). Symbol Match scores were significantly different (p < 0.001) between participants with SCC (N = 5, M = 48 ± 9.7), MCI (N = 14, M = 31.7 ± 14.3), and dementia (N = 28, M = 9.6 ± 11.5). Age (p = 0.004) and education (p < 0.001) were correlated with Symbol Match score in the overall sample. Symbol Match scores were significantly different between the 3 disease states (p < 0.001) even when controlling for age and education. The Symbol Match was highly correlated (r = 0.843, p < 0.001) with the Symbol Digit Modalities Test (SDMT), an established neuropsychological measure of processing speed and executive function. This study provides initial validation of the Symbol Match and its utility in a clinical population. Further research on psychometric properties and construct validity of this new tool is needed.

Psychological Correlates of Self-Rated Resilience in the Context of Subjective Cognitive Concerns in Older Adults.

The purpose of this study was to evaluate psychological correlates of self-rated resilience, as assessed with the 10-item version of the Connor-Davidson Resilience Scale (CD-RISC-10), in older adults. In particular, we were interested in the degree to which self-rated resilience might be a protective factor against cognitive decline. In total, 100 adults aged 60-90years who had been referred because of subjective cognitive concerns completed self-report measures of resilience, symptoms of anxiety and depression, and satisfaction with life. They also completed a test of learning and memory. Ratings about daily functioning at home and in the community were obtained from both participants and proxy informants. Resilience ratings correlated strongly negatively with concurrent self-rated symptoms of anxiety and depression, and strongly positively with self-rated life satisfaction. However, only informant ratings of daily functioning correlated with actual participant performance on a test of learning and memory, with lower ratings being associated with worse test performance. Self-rated resilience, as measured by the CD-RISC-10, is primarily related to subjective well-being and does not inform sufficiently about relative risk for cognitive dysfunction in older adults.

Prevalence and correlates of subjective cognitive concerns in Australian university students during the COVID-19 pandemic.

Coronavirus (COVID-19) instigated unprecedented global effects on healthcare systems, economies, employment, education, travel, and social lives. In addition to increased mental health challenges, pandemic restrictions have triggered emerging cognitive concerns. University students are at particularly high risk of adverse lockdown-related effects, yet despite the substantial adaptions to learning necessitated by COVID-19, limited research has so far focused on the cognitive consequences of the pandemic among university students. This study aimed to comprehensively examine the nature, prevalence, and correlates of subjective cognitive concerns among 972 students (Median age = 22 years, 70% female) enrolled at Monash University, Australia, in December 2020. Students completed the online THRIVE@Monash survey, 5 weeks following prolonged lockdown in Melbourne. Using group comparisons and hierarchical binary logistic regression analyses, we examined associations between demographic and enrolment characteristics, COVID-19-related experiences and impacts (author-developed questions), self-reported anxiety and depression symptoms (PROMIS Anxiety and Depression scales), and students' perceived changes in everyday cognitive functions (author-developed questions). Over 60% of students reported subjective cognitive concerns (SCCs). After controlling for anxiety and depression symptoms, students reporting more SCCs were more likely to be younger, from White/European ethnic backgrounds, and in their first year of undergraduate study. No differences in SCCs were found between male and female students. Greater worry, anxiety, or stress related to COVID-19 (e.g., infection, leaving the house, hygiene and exposure prevention, impact on physical and mental health), and time spent reading or talking about COVID-19, were generally not associated with SCCs after controlling for anxiety and depression symptoms. These findings highlight vulnerable subgroups of students who might benefit from regular monitoring, education, and interventions to support their cognitive health during the pandemic and beyond. In addition, cognitive concerns may provide additional insight into mental health problems among students, and emphasize the importance of understanding factors that impact students' long-term academic and career success.

Technology use and subjective cognitive concerns in older adults

ObjectivesHow technology impacts the day to day cognitive functioning of older adults is a matter of some debate. On the one hand, the use of technologies such as smartphones and social media, may lead to more subjective cognitive concerns (SCC) by promoting distractibility and reliance on devices to perform memory tasks. However, continued digital engagement in older adults may also be related to better cognitive functioning. Given these competing viewpoints, our study evaluated if frequency of digital device use was associated with greater or less subjective cognitive concerns. MethodParticipants were 219 adults over the age of 65 (mean age =75 years) who had internet access. Measures assessing frequency of digital device use along with SCC were administered. Hierarchical multiple regression was used to gage association between frequency of device use and SCC, controlling for relevant demographic and lifestyle factors. ResultsIncreased frequency of digital device use was associated with less SCC, over and above the influence of demographic factors, across cognitive (but especially in executive) domains. This effect was observed for general device usage, with no statistically significant associations were observed between texting/video call, social media use and SCC. DiscussionResults were broadly consistent with the technological reserve hypothesis in that digital engagement was associated with better experienced cognitive functioning in older adults. While device use may contribute to distractibility in certain cases, the current results add to a burgeoning literature that digital engagement may be a protective factor for cognitive changes with age.

Using the Everyday Cognition Scales (ECog), depression, and vascular risk to predict conversion to cognitive impairment in different ethnoracial groups

AbstractBackgroundOur previous work found that greater subjective cognitive concerns (SCC) at baseline was associated with increased risk of developing mild cognitive impairment (MCI) or dementia in Caucasians and African Americans, but not Hispanics. The present study examined whether medical co‐morbidities or depression may account for some of these differences.MethodsParticipants included 205 Caucasians, 101 African Americans, and 95 Hispanics, all cognitively normal at baseline, who are part of the University of California, Davis Alzheimer’s Disease Center longitudinal cohort. SCC was measured using the self‐reported Everyday Cognition Scales (ECog) Memory domain. Over an average of 4.7 years, 116 developed MCI or dementia. Associations with incident cognitive impairment were assessed using Cox proportional hazards models, adjusting for age and education. Models considered the interaction between race/ethnicity and the ECog score, as well as either depression (Geriatric Depression Scale) or vascular risk (proportion present out of hypercholesterolemia, diabetes, hypertension). Models were then run separately in each racial/ethnic group.ResultsIn models that included depression and vascular risk separately, there was a significant interaction (p&lt;0.05) between racial/ethnic group and SCC, consistent with our earlier findings. GDS was not associated with progression for any racial/ethnic group (p&gt;0.1), SCC was associated with progression in African Americans (HR=2.05, 95% CI=1.20, 3.50; p=0.009), but not Caucasians (p=0.08) or Hispanics (p=0.34). In contrast, vascular risk was marginally associated with progression in Hispanics (HR=3.4, 95% CI=0.98, 11.72; p=0.054), but not Caucasians (p=0.8) or African Americans (p=0.4). When accounting for vascular risk, SCC was associated with progression in Caucasians (HR=1.7, 95% CI=1.1, 2.6; p=0.01) and African Americans (HR=2.04, 95% CI=1.27, 3.26; p=0.003), but not Hispanics (p=0.4).ConclusionsResults suggest there are differences in the degree to which SCCs and vascular risk are associated with developing cognitive impairment across different ethnoracial groups. SCC was generally associated with incident impairment in Caucasians and African Americans, but not Hispanics. Medical co‐morbidities were more associated with incident impairment in Hispanics compared to Caucasians.

Clinical factors contributing to functional change over time in individuals with subjective cognitive concerns and mild cognitive impairment

AbstractBackgroundAccumulating research suggests individuals with subjective cognitive concerns (SCC) and Mild Cognitive Impairment (MCI) experience subtle but noticeable functional changes, despite diagnostic criteria emphasising predominantly intact daily functioning to differentiate them from more severe stages of decline, i.e. dementia. This study investigates how factors associated with cognition, general health, and psychosocial wellbeing relate to functional change longitudinally in older adults with early‐stage cognitive change.MethodOne hundred and thirty‐seven participants with SCC or MCI (mean age=70.4 years, SD=8.0) completed standardised neuropsychological, medical and psychosocial assessments, and the self‐report Healthy Brain Ageing ‐ Functional Assessment Questionnaire (HBA‐FAQ) at baseline and again at follow‐up at least one year later (mean time to follow‐up= 25.5 months, SD=8.0). Correlational and linear regression analyses were used to explore relationships between subjective functional change over time and cognition, general health, and psychosocial wellbeing, where p was set at .05.ResultOlder people with SCC and MCI reported a similar amount of functional change (p = .13) and were therefore analysed as one ‘at risk’ group. Overall, greater subjective functional change over time was significantly and most markedly correlated with poorer baseline cognitive performance on tests of new learning (r = ‐.23), memory (r = ‐.25), processing speed (r = ‐.25), and cognitive flexibility (r = ‐.21), as well as poorer baseline psychosocial wellbeing including subjective disability (r = .56), quality of life (r = ‐.54), sleep quality (r = .29), mood disturbance (r = .51) and subjective memory complaints (r = .51). Of these factors, greater subjective memory complaints and greater mood disturbance at baseline significantly predicted increased functional change at follow‐up, accounting for 9.7% and 3.3% respectively of the unique variance in the model.ConclusionThese results suggest that functional change over time is evident in older adults with early‐stage cognitive change and is associated with poorer cognition and psychosocial wellbeing. This has important implications for early intervention, as this research highlights key clinical factors predictive of functional decline that clinicians can look out for when assessing older adults in primary practice. Targeted early intervention and management strategies may then help to maximise and maintain day‐to‐day functioning.

Compensation training and lifestyle modifications to promote healthy aging in persons at risk for Alzheimer's disease: A digital application supported intervention

AbstractBackgroundThe protocol for ‘Brain Boosters’, a novel combined compensatory training and lifestyle modification intervention aimed at Alzheimer’s disease (AD) risk reduction is presented. Training in compensation will focus on a calendar and tracking system, organizational strategies, and goal setting, all aimed at supporting independent function. These same compensatory tools will be employed to facilitate adoption of lifestyle changes that support brain health (e.g., physical exercise, cognitive exercise, wellbeing exercise) through behavioral monitoring and feedback. A comprehensive suite of digital tools encapsulated in the Electronic Memory and Management Aid (EMMA), an easy to use, interactive application, will be used to facilitate behavioral change and enhance participant motivation. EMMA also allows collection of real‐time data to track intervention adherence and factors that influence adherence.MethodsTo capitalize on a critical window of opportunity to intervene, we will target cognitively normal older adults with subjective cognitive concerns (SCC), an established risk for AD and cognitive impairment. The trial will enroll 200 older adults with SCC who will be randomized to our digital application‐supported compensation training and lifestyle modification intervention or to an education only control group that will not use the EMMA app or be taught how to implement the educational material into their daily lives. Both intervention arms will be delivered in a group setting over 6 months, followed by 12 months of unsupervised follow‐up.ResultsSpecific aims of the project include to: 1) evaluate intervention efficacy on primary outcomes (global cognition and everyday function); secondary outcomes focus on indicators of well‐being, cognitive domains (memory and executive function), physical function, compensation, and health behaviors; 2) evaluate characteristics of treatment responders; 3) evaluate adherence and identify the effective components of the target intervention using a mixed‐method approach; and 4) design machine learning algorithms that use patterns of change in real‐time data metrics to identify incipient declines in treatment adherence and changes in health status.ConclusionsThe project is expected to expand understanding of factors that may impact adherence to and outcomes of a preventative intervention leading to optimization of a scalable intervention to reduce dementia risk applicable to diverse populations.

Aging research in the time of COVID‐19: A telephone screen for subjective cognitive concerns in community‐dwelling ethnically diverse older adults

BackgroundThere is an urgent need for validation of remotely‐administered cognitive screens to identify older adults at risk for dementia, to monitor disease progression, and to facilitate follow‐up when in‐person visits are not feasible. Restrictions on in‐person cognitive assessments due to COVID‐19 have spurred a growing literature on telephone‐based cognitive screening. However, few studies have evaluated the value of telephone‐administered screens of subjective cognitive concerns (SCC), an important early marker of dementia‐risk.MethodEinstein Aging Study participants (subsample, n=455; Mage=77.0; Myears education=15.0; 64.1% women; 46.4% White) completed the Telephone Screen for Subjective Cognitive Concerns (T‐SSCC), a 16‐item measure of self‐reported memory, language, executive functioning, visuospatial/navigation, concentration, calculation, and mental clarity concerns, as well as the Telephone Montreal Cognitive Assessment (T‐MoCA). In‐person assessments included the paper‐and‐pencil Cognitive Change Index (CCI) and comprehensive neuropsychological evaluation. Classification as cognitively normal (CN; n=288) or mild cognitive impairment (MCI; n=153) was based on Jak/Bondi criteria. Primary analyses included correlations between the objective and subjective screening instruments, and logistic regression to evaluate the association between the T‐SSCC and MCI status.ResultTotal endorsement of concerns on the T‐SSCC (OR 1.095, CI 1.018‐1.178, p=0.015) was significantly associated with MCI status. In particular, endorsement of “Do any of these problems interfere with your daily life?” was strongly related to MCI (OR 2.296, CI 1.284‐4.108, p=0.005). The T‐SSCC was moderately correlated with the in‐person CCI (r[114]=0.577, p<0.001). A small but significant relationship was observed between the T‐SSCC and T‐MoCA (r[258]=‐0.206, p<0.001).ConclusionTo our knowledge, this is the first study to validate a telephone SCC screen in response to the crucial need for such remotely administered measures. The T‐SSCC was significantly associated MCI status; furthermore, specific items related to the impact of cognitive problems in daily life were particularly sensitive to MCI. Such SCC measures are brief, accessible, and well‐tolerated and may provide additionally valuable information that enhances remotely‐administered cognitive screens.

Are Adverse Childhood Experiences Associated with Worse Cognitive Function in Older Adults?

Adverse childhood experiences (ACE) are associated with an increased risk for dementia, but this relationship and modifying factors are poorly understood. This study is the first to our knowledge to comprehensively examine the effect of ACE on specific cognitive functions and measures associated with greater risk and resiliency to cognitive decline in independent community-dwelling older adults. Verbal/nonverbal intelligence, verbal memory, visual memory, and executive attention were assessed. Self-report measures examined depression, self-efficacy, and subjective cognitive concerns (SCC). The ACE questionnaire measured childhood experiences of abuse, neglect, and household dysfunction. Over 56% of older adults reported an adverse childhood event. ACE scores were negatively associated with income and years of education and positively associated with depressive symptoms and SCC. ACE scores were a significant predictor of intellectual function and executive attention; however, these relationships were no longer significant after adjusting for education. Follow-up analyses using the PROCESS macro revealed that relationships among higher ACE scores with intellectual function and executive attention were mediated by education. Greater childhood adversity may increase vulnerability for cognitive impairment by impacting early education, socioeconomic status, and mental health. These findings have clinical implications for enhancing levels of cognitive reserve and addressing modifiable risk factors to prevent or attenuate cognitive decline in older adults.

A-88 College Students with Depression or Anxiety: Greater Subjective Cognitive Concerns, Lower Academic Self-Efficacy, but Comparable Compensatory Cognitive Strategy Use

Abstract Objective This study examined whether college students with and without depression or anxiety differed in subjective cognitive concerns, college self-efficacy, and compensatory cognitive strategy use, hypothesizing that students with depression or anxiety would report greater cognitive concerns and lower self-efficacy in coursework, but comparable frequencies of compensatory cognitive strategy use. If confirmed, this finding would imply that, despite greater cognitive and academic problems, students with depression or anxiety do not implement behaviors in their everyday lives to address these problems. Method Participants (N = 582; age: 19.0 ± 1.0 years-old; 79.4% women; 81.9% White) completed online self-report questionnaires on subjective cognitive functioning, academic self-efficacy, compensatory cognitive strategy use, and depression and anxiety symptoms, which were used to categorize participants as having anxiety or depression based on established clinical cutoffs. Results Participants with anxiety or depression reported higher rates of elevated cognitive concerns, χ2 = 108.70, p &amp;lt; 0.001, OR = 7.75, and lower academic self-efficacy, t = 8.46, p &amp;lt; 0.001, d = 0.71, compared to participants without anxiety or depression, but these groups differed only modestly in compensatory cognitive strategy use, t = 2.42, p = 0.016, d = 0.20. Conclusion(s) Most students with depression or anxiety had elevated subjective cognitive concerns (52.0%), compared to a minority of participants without these conditions (12.3%). Despite substantially elevated cognitive concerns, participants with anxiety or depression reported only modestly greater compensatory cognitive strategy use. There appears to be a need to address cognitive concerns in college students with psychiatric conditions, and compensatory cognitive training may be a valuable supplemental service for clinicians working with college students in mental healthcare settings.