Subjective Cognitive Function Research Articles

MINDFULNESS-BASED STRESS REDUCTION (MBSR): TREATMENT FOR COGNITIVE IMPAIRMENT POST CHEMOTHERAPY (CT)

Abstract The purpose of this R01 trial was to evaluate the efficacy of MBSR(BC) compared to the Breast Cancer Education Support program(BCES) or Usual Care(UC) regimens for improvement in cognitive functioning among breast cancer survivors(BCS) who received (CT), or CT and radiation. Methods: BCS (212) were randomized to MBSR(BC) (n=91) or BCES(90) or UC (n = 31) with MBSR(BC) and BCES participants attending a 6-week program. Measures of neuropsychological and perceived cognitive performance, psychological and physical symptoms were collected at baseline, 6, 12, and 26 weeks. Linear mixed models assessed the MBSR(BC) effects over time. Characteristics at baseline were tested as moderators of MBSR(BC) program effects. Results: 212 BCS had a mean age of 57, 73% were White, non-Hispanic, 78% received CT and radiation; and 22% CT alone. All BCS improved across the study on all measures. For most measures, cognitive and symptom improvement effects followed the hypothesized pattern favoring MBSR(BC), followed by BCES and UC groups. Effect sizes were generally small, particularly for measures of cognition. The largest week 26 effect sizes were observed in the physical symptom fatigue, where the MBSR(BC) group improved with a 0.45 Cohen’s d effect over BCES and 0.65 over UC. Type of CT, radiation treatment, time since treatment, and informal and formal practice techniques of MBSR(BC) moderated the effects of MBSR(BC). Conclusions: Although effects were modest, BCS receiving the MBSR(BC) and BCES groups improved in objective and subjective cognitive functioning and symptoms compared to UC. Longer follow-up studies are needed to determine sustained effects.

PATTERNS OF USE, RISK FACTORS, AND ATTITUDES OF OLDER ADULT CANNABIS USERS

Abstract While cannabis use continues to increase among older adults (OA), research within this population is limited. This study aimed to describe OA patterns of use, risk factors, and subjective effects of cannabis use. OA cannabis users ages 60-79 (N=17, Mage=68.29, SD=5.61) were 94% White and 59% women, with an average education of 15.94 years (SD=2.38). Participants completed online questionnaires and semi-structured interviews regarding medical and mental health, subjective cognitive functioning, and cannabis use patterns and attitudes. Participants reported M=33.41 years of cannabis use (SD=20.15) with an average age of first use of 20.11 years (SD=10.40). Current use was reported as 4.29 days/week (SD=3.14). Current reasons for use were recreational (n=6), medical (n=2), or both (n=8). The most common medical conditions for which participants reported using cannabis were arthritis/joint pain (n=4) and disordered sleep (n=4). The most commonly reported benefits of cannabis use were relaxation (n=8), improved sleep (n=6), improved mood/anxiety (n=6), cognitive enhancement (n=5), and pain management (n=4). Common drawbacks included subjective cognitive decline (n=7), social hindrance (n=6), and health complications (n=5), whereas 5 participants reported no drawbacks. Most participants (76%) reported discussing cannabis use with their physician, although only 38% of those reported that discussion was helpful. Disconnect between OA cannabis users and their physicians could result in cannabis use that is contraindicated by preexisting medical conditions or medications. Emphasis should be placed on individualized psychoeducation regarding the potential risks/benefits of cannabis use as well as continuing education for physicians regarding cannabis use in OA.

RESILIENCE AND AGE MODIFY INFLUENCES OF STRESS AND POSITIVE EXPERIENCES ON SUBJECTIVE COGNITION

Abstract The COVID-19 pandemic is a major, chronic, worldwide stressor related to poorer health and well-being, especially among older adults, but less is known about risk and protective factors related to cognitive functioning during this stressful time. This eight-week study of 229 community-dwelling middle-aged and older adults (Mage=71.1; 74% women) examined associations between the intensities of weekly stress and positive experiences on subjective cognitive functioning. We also examined how age and trait resilience modified these associations. Zero-inflated Poisson models revealed a positive association between the intensity of stress and self-reported cognitive difficulties (γ=0.34, SE=0.07), whereas the intensity of positive experiences was associated with fewer difficulties (γ=-0.09, SE=0.03). Age moderated the effect of stress (γ=-0.01, SE=0.002), with the old-old having more subjective cognitive difficulties under more intense stress than the young-old. Resilience modified effects of stress and positive experiences, respectively, on cognition (γ=0.04, SE=0.01 and γ=-0.01, SE=0.01). Those with lower resilience reported more cognitive difficulties under more intense compared to less intense stress; this association was slightly attenuated for people with more resilience. Similar associations emerged between resilience and positive experience intensity. Older age was a risk factor for subjective cognitive difficulties during the COVID-19 pandemic, especially under conditions of high weekly stress, whereas resilience was a protective factor. Although those high in resilience appeared to be more sensitive to cognitive difficulties during more intense positive experiences, they still reported fewer difficulties than those low in resilience. Older adults’ cognitive resilience during the COVID-19 pandemic was heterogeneous and multifactorial.

THE ROLE OF PSYCHOSOCIAL AND LIFESTYLE FACTORS IN PROMOTING COGNITIVE HEALTH

Abstract This symposium will highlight the role of psychosocial and lifestyle factors in cognitive health. Across four talks, we consider a wide range of psychosocial and lifestyle factors including personality, stress, physical activity, and nutrition, and a wide range of cognitive health outcomes including subjective and objective cognitive performance, clinical diagnoses of cognitive status, and cognitive healthspan. First, Dr. Patrick Hill will share findings on links between Big Five personality traits and the degree of concordance between subjective and objective cognitive functioning. Second, Dr. Tomiko Yoneda uses longitudinal data to investigate personality trait predictors of transitions between cognitive states (no cognitive impairment, mild cognitive impairment, dementia) and death, as well as personality effects on cognitive healthspan (i.e., years without cognitive impairment) and total longevity. Third, Nicole Stuart used ecological momentary assessment and activity trackers to investigate links among daily stress, daily physical activity, and daily cognitive performance. Finally, Dr. Julia Sheffler will discuss how we can apply our knowledge of psychosocial and lifestyle factors in cognitive health to inform the development of interventions. She will share quantitative and qualitative findings from proof-of-concept (N=9) and pilot (N=58) studies of a nutrition intervention in older adults at risk for dementia, and she will discuss implications for lifestyle intervention development more broadly. Together, this symposium showcases how a wide range of methods can be employed to reveal the importance of psychosocial and lifestyle factors for promoting healthy cognitive aging.

Dementia Associated Diseases, Driving Status, and Cognitive Function: Perception Does Not Match Performance – Truth and Consequence for Driving Shared Decision Making

AbstractBackgroundDementia associated diseases (DAD) refer to a group of disorders clinically characterized by progressive cognitive impairment (CI). CI may reflect abnormalities across multiple cognitive domains (CD) to varying degrees and combinations and interfere with the ability to carry out activities of daily living (ADL). Determination of driving ability in routine care relies on patient, family, and clinician shared‐decision making, as availability of routine on‐road driving assessment might be limited. Incorporation of patient reported outcomes (PRO) in routine care has increased, becoming more important for patient care and treatment decisions. Neuro‐QoL Cognitive Function Questionnaire (CF) provides an opportunity to assess self‐reported cognition routinely. The relationship of CF to objective computerized multi‐domain cognitive testing and self‐reported driving has not been explored. Providing easily available objective screening might be of great value for all involved in the decision to continue or stop driving in view of the profound impact loss of driving has on independence.MethodA retrospective review of PwDAD who provided self‐reported driving status and completed both objective and subjective cognitive function (CF) measures. Subjective CF was measured by CF score which pertaining to comprehension, cognition, attention, and learning. The validated computerized cognitive assessment battery (CAB‐NT), includes 7 cognitive domains: memory(Mem), executive function(Exe), attention(Att), information processing speed(Inf), visual‐spatial(Vis), verbal function(Ver), motor skills(Mot) and a global cognitive summary score(GCS). T‐tests and regression analysis was utilized for analysis assuming both equal and unequal variances, with significance (p< 0.05).Results496 PwDAD, average age 73.4±8.9, 61.2% female. T‐test showed significant differences between driving status yes/no for both CF and all CAB‐NT domains. However, regression analysis showed a small effect size between CF and CAB‐NT cognitive domains scores.ConclusionSelf‐reported driving status in PwDAD corresponds to both perceived/subjective CF and objective measures of cognitive function. However, the relationship between subjective and objective cognitive function measures is problematic. With various CDs involved in the safe effective operation of a motor vehicle, it is necessary to objectively assess this risk with objective measures. Evidence of incongruent relationship between objective and subjective cognitive function enhances the importance of incorporating objective measures of cognitive ability to safely maintain an active driving status.

Subjective language difficulties are associated with tau and objective verbal memory in older women with increased AD risk

AbstractBackgroundEarly cognitive changes in preclinical Alzheimer’s Disease (AD) include memory problems and language difficulties. Subjective cognitive complaints (SCC) are an AD risk factor and are associated with AD pathologies. Women have higher tau levels over men, despite demonstrating a life‐long “verbal memory advantage.” Therefore, SCC may be a stronger indicator of early tau accumulation than objective cognitive changes. Here, we examined the relationships among tau, subjective cognitive function, and objective cognitive function in older women at higher AD risk.Method16 older women (age: 72.3±3.1years) participated in Women Inflammation and Tau Study (WITS). The inclusion criteria are: 65+ years old, AD polygenic hazard score >50th percentile, and a telephone Montreal Cognitive Assessment score suggestive of mild cognitive impairment (MCI; range 16‐20). Tau was measured with cerebrospinal fluid (CSF) ptau181 and 18F‐MK6240 positron emission tomography (PET) with standardized uptake value ratio (SUVR) calculated in Braak1, correlating with MCI stage. Objective memory and language performance were assessed with the Rey Auditory Verbal Learning Test (RAVLT; immediate and delayed recall) and the Multilingual Naming Test (MINT), respectively. Subjective cognition was measured approximately one year later with the self‐reported Everyday Cognition Scale (ECog) memory and language subscales (higher score indicate more complaints). Spearman partial correlations analyzed the associations among tau, objective cognition, and subjective cognition while controlling for age.ResultGreater CSF ptau181 was significantly associated with higher ECog‐Language (rho = 0.62, p = 0.02), higher ECog‐Memory (rho = 0.53, p = 0.51), and lower RAVLT immediate recall (rho = ‐0.54, p = 0.046; Figure 1). More tau in Braak1 was associated with lower RAVLT immediate recall (rho = ‐0.58, p = 0.03) and higher ECog‐Language (rho = 0.45, p = 0.09), but not ECog‐Memory (p = 0.26; Figure 2). Higher ECog‐Language was significantly associated with lower RAVLT immediate (rho = ‐0.59, p = 0.02) and delayed recall (rho = ‐0.69, p<0.01; Figure 3). MINT correct responses were not related to tau and ECog (p’s>0.28).ConclusionOur preliminary results suggest that, in older women with elevated AD risk, language concerns with memory features (e.g., word finding and forgetting object names) may track with early increases in CSF ptau181 and entorhinal cortex tau‐PET. Self‐reported language decline may be predictive of tau accumulation and worsening objective verbal memory, which could be clinically important for older women.

Bowel movement frequency, the gut microbiome, and cognitive function in women and men

AbstractBackgroundBowel movement frequency and the gut microbiome may be associated with the risk of dementia.MethodWe examined the association between bowel movement frequency and cognitive function in 112,753 women and men from Nurses’ Health Study (NHS), Nurses’ Health Study II (NHSII), and Health Professionals Follow‐Up Study (HPFS) and explored the role of the gut microbiome in explaining these associations in a sub‐cohort of 515 NHSII and HPFS participants. We collected data on bowel movement frequency in 2012/13 and subjective cognitive function from 2014 to 2017 in all participants and objective cognitive function using a neuropsychological battery between 2014 and 2018 in 12,696 NHSII participants. We profiled the gut microbiome using shotgun metagenomics.ResultBowel movement frequency was associated with overall objective cognitive function and learning and working memory in an inverse J‐shape dose‐response manner (both Pnon‐linearity<0.05). Compared to those with once daily bowel movements, participants with bowel movement frequency of every 3+ days had significantly worse cognition, equivalent to 3.0 (95% confidence interval (CI),1.2, 4.7) years of additional aging. We observed similar J‐shape dose‐response relationships of bowel movement frequency with the odds of subjective cognitive decline and the likelihood of having more subjective cognitive complaints over time. Bowel movement frequencies of every 3+ days and ≥twice /day, compared to once daily bowel movement, were associated with odds ratios of subjective cognitive decline of 1.73 (95% CI, 1.60, 1.86) and 1.37 (95% CI, 1.33, 1.44), respectively. These relationships were generally consistent across three cohorts and subgroups. Bowel movement frequency and subjective cognition were significantly associated with the overall variation of the gut microbiome (both P <0.005) and specific microbial species. Butyrate producers were depleted in those with less frequent bowel movements and worse cognitive function, while a higher abundance of dysbiosis‐related, pro‐inflammatory species was associated with bowel movement frequency of ≥twice/day and worse cognitive function.ConclusionLess frequent bowel movements were associated with worse cognitive function. The gut microbiome may be a mechanistic link underlying the association between intestinal motility patterns and cognitive function.

S16: Post-Acute Covid-19 Cognitive Sequelae in an Aging Population

S16: Post-Acute Covid-19 Cognitive Sequelae in an Aging Population

Effects of D-CAG chemotherapy regimen on cognitive function in patients with acute myeloid leukaemia: A resting-state functional magnetic resonance imaging study.

Post-chemotherapy cognitive impairment, also known as 'chemobrain', is a common neurotoxic complication induced by chemotherapy, which has been reported in many cancer survivors who have undergone chemotherapy. In this study, we aimed to explore the effects of D-neneneba dicitabine, C-nenenebb cytarabine, A-aclamycin, G-granulocyte colony-stimulating factor (D-CAG) chemotherapy on cognitive function in patients with acute myeloid leukaemia (AML) and its possible central mechanisms. Twenty patients with AML and 25 matched healthy controls (HC) were enrolled in this study. The cognitive function of patients before and after D-CAG chemotherapy was evaluated by the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). The resting-state functional magnetic resonance imaging data were collected from all patients before and after chemotherapy intervention, as well as HC. Then, resting-state functional magnetic resonance imaging data were preprocessed using DPABI software package and regional homogeneity (ReHo) values of brain regions were calculated. Finally, ReHo values between groups were compared by Resting-State fMRI Data Analysis software package with t-tests and Alphasim method was performed for multiple comparison correction. Moreover, associations between ReHo values of altered brain regions and the scores of FACT-Cog were analysed by Pearson correlation. The total FACT-Cog scores and four factor scores of AML patients increased significantly after treatment. ReHo values showed no significant changes in patients before treatment when compared with HC. Compared with HC, ReHo values of the right middle frontal gyrus, inferior frontal gyrus (opercular part), middle occipital gyrus, and left praecuneus decreased significantly, while ReHo values of the left inferior temporal gyrus, right middle temporal gyrus, and hippocampus increased significantly in patients after treatment. Compared with patients before treatment, ReHo values decreased significantly in the right middle frontal gyrus, inferior frontal gyrus (opercular part), and middle and inferior occipital gyri of patients after treatment. In addition, ReHo values of the right inferior frontal gyrus (opercular part) were negatively correlated with the total scores of FACT-Cog and factor scores of perceived cognitive impairment in patients after treatment. There were also negative correlations between ReHo values of the right middle frontal gyrus and perceived cognitive impairment scores. The present study confirmed that D-CAG chemotherapy might cause impaired subjective self-reported cognitive functioning in AML patients, which might be related to the decreased function of certain regions in the right prefrontal lobe. These findings provided further understanding of the mechanisms involved in post-chemotherapy cognitive impairment and would help develop new therapeutic strategies for 'chemobrain' in AML patients.

The Effects of Systemic Lupus-Related Cognitive Impairments on Activities of Daily Living and Life Role Participation: A Qualitative Framework Study.

Cognitive impairment (CI) in systemic lupus erythematosus (SLE) negatively impacts health-related quality of life leading to activity limitations. This qualitative study aimed to (1) explore the effect of SLE-related CI on activities of daily living and life role participation and (2) describe factors influencing activity restriction and life role participation. Semistructured, in-depth interviews of lived experience of CI in SLE were conducted with 24 participants with SLE. Sociodemographic and clinical data, and objective and subjective cognitive function, were collected to characterize participants. A qualitative thematic content analysis was undertaken guided by a framework analytical approach. Participants reported problems in multiple cognitive domains, with multiple perceived causes. CI was felt to impact work, social, domestic, and family life, health, and independence. Five overarching themes were represented in the data: (1) characterization of SLE-reported CI, (2) perceived cause of CI, (3) perceived impact of CI on activities of daily living and life role participation, (4) adaptations for managing CI, and (5) influence of CI adaptations on activities of daily living and life role participation. This study provides a better understanding of the patient experience of CI in SLE, how it impacts their lives, and what coping strategies they employ. It highlights the long-term challenges those with CI in SLE undergo and provides evidence for the urgent need to implement multidisciplinary treatment options. When managing CI, it may be beneficial to evaluate and understand available psychosocial support resources to help identify and reinforce relevant adaptations to improve health-related quality of life.

47 The Impact of COVID-19 Infection on Objective and Subjective Cognitive Functioning: Resilience as a Protective Factor

Objective:Growing evidence indicates that COVID-19 infection adversely impacts cognitive functioning, with COVID-19 patients demonstrating high rates of objective and subjective cognitive impairments (Daroische et al., 2020; Miskowiak et al., 2021). Given the prevalence and potentially debilitating nature of post-COVID-19 cognitive symptoms, understanding factors that mitigate the impact of COVID-19 infection on cognitive functioning is paramount to developing interventions that facilitate recovery. Resilience, the ability to cope with and grow from challenges, has been associated with improved cognitive performance in healthy adults and linked to decreased perceived cognitive difficulties in post-COVID-19 patients (Connor & Davidson, 2003; Deng et al., 2018; Jung et al., 2021). However, resilience has not yet been examined as a potential attenuator of the relationship between COVID-19 and either perceived or objective cognitive function. This study aims to investigate the role of resilience as a protective factor against experience of cognitive function difficulties in COVID-19 patients by probing the role of resilience as a moderator of the relationship between COVID-19 diagnosis and cognitive functioning (both perceived and objective).Participants and Methods:Participants (mean age=36.93, 30.10% male) were recruited from British Columbia and Ontario. The sample included 53 adults who had never been diagnosed with COVID-19 and 50 adults diagnosed with symptomatic COVID-19 at least three months prior and not ventilated. Participants completed online questionnaires (n=103) to assess depression (the Center for Epidemiological Studies Depression Scale), anxiety (7-item Generalized Anxiety Disorder Scale), subjective cognitive functioning (The Subjective Cognitive Decline Questionnaire), and resilience (2-item Connor-Davidson Resilience Scale). Participants then completed neuropsychological tests (n=82) measuring attention, processing speed, memory, language, visuospatial skills, and executive function via teleconference, with scores averaged to create a global objective cognition score. Moderated multiple regression was employed to assess the impact of resilience on the relationship between COVID-19 diagnosis and both objective and perceived cognition, controlling for gender, ethnicity, income, age, anxiety, and depression.Results:Average scores in the COVID-19 group exceeded diagnostic cut-offs for clinical depression (M=16.67, SD=10.77) and mild anxiety (M=5.27, SD=4.99), while the control group scored below diagnostic thresholds for depression (M=11.96, SD=9.76) and mild anxiety (M=4.48, SD=5.07). Controlling for sociodemographic and mental health characteristics, COVID-19 diagnosis was not associated with objective global cognitive functioning (b=-.07, se=1.71, p=.624) or subjective cognitive functioning (b=.16, se=1.32, p=.12), nor was resilience associated with objective global cognitive functioning (b=.19, se=1.50, p=.44) or subjective cognitive functioning (b=-.02, se=1.09, p=.89).Conclusions:Findings indicate that COVID-19 patients may be at risk for depression and anxiety. Results of this study fail to support a relationship between COVID-19 and cognitive functioning beyond the impact of sociodemographic and mental health variables. Thus, the role of resilience as a protective factor against COVID-19 related cognitive difficulties could not be fully explored. However, findings should be considered in the context of study limitations, including a small sample size. Future research should employ larger samples to further examine the relationship between COVID-19 infection and cognition, focusing on mental health characteristics and resilience as potential risk and protective factors.

68 Subjective Cognitive Functioning Following Non-Severe COVID-19 Acute Infections: A Meta-Analysis

Objective:Emerging evidence suggests that individuals recovering from COVID-19 perceive changes to their cognitive function and psychological health that persist for weeks to months following acute infection. Although there is a strong relationship between initial COVID-19 infection severity and development of prolonged symptoms, there is only a modest relationship between initial COVID-19 severity and self-reported severity of prolonged symptoms. While much of the research has focused on more severe COVID-19 cases, over 90% of COVID-19 infections are classified as mild or moderate. Previous work has found evidence that non-severe COVID-19 infection is associated with cognitive deficits with small-to-medium effect sizes, though patients who were not hospitalized generally performed better on cognitive measures than did those who were hospitalized for COVID-19 infection. As such, it is important to also quantify subjective cognitive functioning in non-severe (mild or moderate) COVID-19 cases. Our meta-analysis examines self-reported cognition in samples that also measured objective neuropsychological performance in individuals with non-severe COVID-19 infections in the post-acute (>28 days) period.Participants and Methods:This study’s design was preregistered with PROSPERO (CRD42021293124) and used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist for reporting guidelines. Inclusion criteria were established prior to article searching and required peer-reviewed studies to have (1) used adult participants with a probable or documented diagnosis of non-severe (asymptomatic, mild, or moderate) COVID-19 who were in the post-acute stage (>28 days after initial infection); (2) used objective neuropsychological testing to document cognitive functioning; and (3) include a self-report measure of subjective cognition. At least two independent reviewers conducted all aspects of the screening, reviews, and extraction process. Twelve studies with three types of study design met full criteria and were included (total n=2,744).Results:Healthy comparison group comparison: Compared with healthy comparison participants, the post-COVID-19 group reported moderately worse subjective cognition (d=0.546 [95% CI (0.054, 1.038)], p=0.030). Severity comparison: When comparing hospitalized and not hospitalized groups, patients who were hospitalized reported modestly worse subjective cognition (d=-0.241, [95% CI (-0.703, 0.221)], p=0.30), though the difference was not statistically significant. Normative data comparison: When all non-severe groups (mild and moderate; k=12) were compared to the normative comparison groups, there was a large, statistically significant effect (d=-1.06, [95% CI (-1.58, -0.53)], p=0.001) for self-report of worse subjective cognitive functioning.Conclusions:There was evidence of subjective report of worse cognitive functioning following non-severe COVID-19 infection. Future work should explore relationships between objective neuropsychological functioning and subjective cognitive difficulties following COVID-19.

34 Association Between Subjective Cognitive Decline and Mental Wellbeing in Normal Cognition and MCI Older Adults

Objective:Subjective cognitive decline (SCD, i.e., perceived cognitive decline without neuropsychological deficits) is associated with Alzheimer’s disease pathology and increased risk for cognitive impairment but is heterogenous in etiology and has been linked to other factors including personality and depression. Mental wellbeing (i.e., the perception and functioning of social, emotional, and health-related aspects of one’s life) has been associated with subjective memory complaints, but its relationship with other subjective cognitive domains is poorly understood. Further characterizing the relationship between mental wellbeing and SCD could refine understanding of SCD and inform development of interventions that prevent progression to objective cognitive decline. This study aimed to describe the relationship between mental wellbeing and subjective decline in multiple cognitive domains and examine whether this relationship differs between older adults with normal cognition and those with mild cognitive impairment (MCI).Participants and Methods:Community-dwelling older adults (normal: n = 58, Mage = 73.7±5.6; MCI: n = 43, Mage = 75.9±6.1) completed the Everyday Cognition scale, a validated self-report measure of SCD, and the RAND-36 Health Survey, a validated self-report measure of health-related quality of life which includes a mental wellbeing subscale. Spearman’s rank correlations were conducted between self-reported mental wellbeing and each self-reported cognitive domain (i.e., memory, language, visuospatial, and executive function) for the Normal Cognition and MCI groups.Results:Worse mental wellbeing was associated with worse subjective language and executive function in the normal group, rs(56) = -.42, p =.001; rs(56) = -.37, p =.005, but not for the MCI group, rs(41) = -.23, p =.15; rs(41) = -.12, p =.46. Worse mental wellbeing was associated with worse subjective visuospatial function in the MCI group, rs(41) = -.39, p =.009, but not in the normal group, rs(56) = -.11, p =.39. For both groups, worse mental wellbeing was associated with worse subjective memory, rs(56) = -.45, p < .001; rs(41) = -.37, p =.02. While this correlation was greater in the normal group, the difference was not significant (z = 0.38, p =.71).Conclusions:These results suggest that perceptions of mental wellbeing are related to perceptions of cognitive decline in multiple domains, and that the specific domains involved differ between normal and MCI groups. The differential associations may mean perception of specific cognitive domains more strongly affect mental wellbeing, or mental wellbeing more acutely influences perception of those domains. The overall observed relationship between SCD and mental wellbeing may have several explanations: the impact of broader health perceptions may extend to cognitive perception, behavioral changes associated with poor wellbeing may reduce subjective cognitive function, or worse subjective cognitive function may lead to negative experiences of wellbeing. Future longitudinal investigation could inform causal inferences. The more limited associations between mental wellbeing and SCD among MCI individuals may point to the role of decreased self-awareness (due to cognitive impairment) precluding detection of subtle changes in cognition or wellbeing. This study highlights the importance of better understanding mental wellbeing in experiences of SCD in both normal and MCI older adults to improve cognitive and mental health outcomes.

15 Associations Among Subjective Cognitive Function and Cannabis Use in Older Adults

Objective:Cannabis use in older adults is becoming increasingly common as cannabis becomes both more socially acceptable and legally permissible, whether for medical or recreational purposes. While previous research has found harmful effects of cannabis use on cognition in adolescents and younger adults, few studies have explored cognition and cannabis use in older adults. This study aimed to examine the relationship between lifetime cannabis use patterns and subjective cognitive performance in older adults.Participants and Methods:The sample (N=51) consisted of adults ages 60 and older residing in the United States who endorsed cannabis use within the previous year. Participants completed online questionnaires on demographics, mental health [Geriatric Anxiety Scale (GAS) short form and Geriatric Depression Scale (GDS) short form], and measures of subjective cognitive function [Cognitive Failures Questionnaire (CFQ), the Cognitive Problems and Strategies Assessment (CPSA), and part IV of the Cognitive Self Efficacy Questionnaire (CSEQ)]. The Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQCU) and the Cannabis Use Disorder Identification Test (CUDIT) were used to assess cannabis use, and the Alcohol Use Disorders Identification Test Consumption items (AUD-C) were used to assess alcohol use. Partial Pearson’s correlations were used to examine relationships between scores of subjective cognitive functioning and cannabis use patterns while controlling for alcohol consumption.Results:Participants aged 60+ (M=68.06, SD=5.80, 49% women) had 15.39 (SD=2.21, range 12-18) years of education on average. Participants’ race/ethnicity was reported as 90.2% White (n=47), 5.9% Latinx or Hispanic (n=3), 2% Black or African American (n=1), and 1% Other (n=1). Most participants (59%) reported first using cannabis as a child or adolescent (range of ages 7-17 years), while 31% reported first using cannabis as an adult (ages 18-58 years), and only 8% endorsed initial use in older adulthood (62-84 years). On average, this sample reported using cannabis for 19.75 days (SD=11.14) in the last month with n=35 (69%) and having used cannabis for 20 or more years (range 1-60 years). The total CUDIT score was positively correlated with CFQ (rp=.47, p<.001), CPSA problems (rp=.46, p<.001), GAS (rp=.43, p=.002), and GDS (rp=.35, p=.014), and negatively correlated with the CSEQ (rp=-.33, p=.02), all while controlling for alcohol consumption. Days of use in the past month and total years of use were not significantly associated with subjective cognitive function.Conclusions:Among older adult cannabis users, symptoms of Cannabis Use Disorder (CUD) were significantly associated with greater self-reported cognitive failures/problems and worse self-efficacy for cognitive ability, as well as symptoms of anxiety and depression, when controlling for alcohol use. Notably, there was no relationship between subjective cognition and frequency of recent use or lifetime use. For patients who use cannabis, neuropsychologists may find it helpful to focus their clinical interview on CUD symptoms when discussing cognitive complaints rather than other measures of cannabis use. Additional research is needed to examine objective measures of cognitive functioning in older adult cannabis users.

71 Sleep Quality and Measures of Attention and Learning in Middle-Aged Adults

Objective:Sleep has been shown to directly impact cognitive function throughout the lifespan; good quality sleep benefits and improves cognitive function, including processing speed and attention, while poor quality sleep can contribute to negative cognitive outcomes1. In particular, attention, learning, and memory have been demonstrated to be sensitive to sleeping changes, including fragmentation and restriction2. Subjective sleeping scales are utilized in both research and clinical practice, allowing sleep to be measured via self-report on various domains, including duration and factors that can contribute to sleep disruption and disturbances3. This study aims to examine the possible relation between subjective sleep quality and cognitive function among middle-aged adults to inform future research for early interventions of modifiable behaviors that can contribute to abnormal cognitive decline.Participants and Methods:Data for this analysis is part of the preliminary results of an ongoing pilot study. 29 middle-aged (40-65 years, inclusive), cognitively unimpaired individuals were recruited from the community. Subjective sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Attention and memory were measured using the California Verbal Learning Test, Third Edition (CVLT-III).Results:Multiple hierarchical regression analyses were conducted to evaluate if aspects of sleep quality were significantly correlated to complex attention and learning performance in this sample. First, correlation amylases showed significant relationships between PSQI Component 6 (Use of Sleeping Medication) and Trials 1 to 2 Learning Slope (R2 = -0.56, p =0.002) and CVLT-III Trials 1 through 5 Recall Discriminability (R2 = -0.42, p = 0.02), each with significant regression analyses outcomes (b =0.42, p = 0.04 and b = -0.46, p = 0.04, respectively). There were other variables that were found to be significantly correlated; however, after adjusting for relevant demographic variables (age, education, sex), the hierarchical regression analyses revealed no association between the aforementioned variables.Conclusions:While multiple aspects of sleep quality were expected to influence measures of attention and learning, only PSQI Component 6 was found to be statistically significantly associated with only two learning variables. Limitations of this study included a small sample size which was limited to cognitive and relatively physically healthy middle-aged adults. Further, sleep quality was measured with one subjective measure and no objective data was collected to support the hypotheses. Future analysis is needed to continue to explore the relation between subjective sleep quality and cognitive outcomes. As this is an ongoing study, we look forward to exploring this research question in more detail as the study progresses.

10 The Impact of Performance and Symptom Invalidity on Relationships Between Subjective and Objective Cognitive Functioning

Objective:Inconsistent relationships between subjective and objective performance have been found across various clinical groups. Discrepancies in these relationships across studies have been attributed to various factors such as patient characteristics (e.g., level of insight associated with cognitive impairment) and test characteristics (e.g., using too few measures to assess different cognitive domains). Although performance and symptom invalidity are common in clinical and research settings and have the potential to impact responding on testing, previous studies have not explored the role of performance and symptom invalidity on relationships between objective and subjective performance. Therefore, the current study examined the impact of invalidity on performance and symptom validity tests (PVTs and SVTs, respectively) on the relationship between subjective and objective cognitive functioning.Participants and Methods:Data were obtained from 299 Veterans (77.6% male, mean age of 48.8 years (SD = 13.5)) assessed in a VA medical center epilepsy monitoring unit from 2008-2018. Participants completed a measure of subjective functioning (i.e., the Patient Competency Rating Scale), PVTs (i.e., Word Memory Test, Test of Memory Malingering, Reliable Digit Span), SVTs (i.e., Minnesota Multiphasic Personality Inventory-2-Restructured Form Response Bias Scale, Structured Inventory of Malingered Symptomatology), and neuropsychological measures assessing objective cognitive performance (e.g., Trail Making Test parts A and B). Pearson correlations were conducted between subjective functioning and objective cognitive performance in the following groups: 1.) PVT and SVT valid, 2.) PVT and SVT invalid, 3.) PVT-only invalid, 4.) SVT-only invalid. Using Fisher’s r-to-z transformation, tests for the differences between correlation coefficients were then conducted between the PVT and SVT valid vs. PVT and SVT invalid groups, and the PVT-only invalid vs. SVT-only invalid groups.Results:Participants with fully valid PVT and SVT performances demonstrated generally stronger relationships between subjective and objective scores (r’s = .058 - .310) compared to participants with both invalid PVT and SVT scores (r’s = -.033 - .132). However, the only significant difference in the strengths of correlations between the groups was found on Trail Making Test Part B (p = .034). In separate exploratory analyses due to low group size, those with invalid PVT scores only (fully valid SVT) demonstrated generally stronger relationships between subjective and objective scores (r’s = -.101 - .741) compared to participants with invalid SVT scores only (fully valid PVT; r’s = -.088 - .024). However, the only significant difference in the strengths of correlations between the groups was found on Trail Making Test Part A (p = .028).Conclusions:The present study suggests that at least some of the discrepancies in previous studies between subjective and objective cognitive performance may be related to performance and symptom validity. Specifically, very weak relationships between objective and subjective performance were found in participants who only failed SVTs, whereas relationships were stronger in those who only failed PVTs. Therefore, findings suggest that including measures of PVTs and SVTs in future studies investigating relationships between subjective and objective cognitive performance is critical to ensuring accuracy of conclusions that are drawn.

The effect of elevated inflammation and depression on subjective and objective cognitive function among breast cancer survivors

The effect of elevated inflammation and depression on subjective and objective cognitive function among breast cancer survivors

Psychometric Properties of the Acceptance and Action Questionnaire-II (AAQ-II) in Older Adult Primary Care Patients

ABSTRACT Objectives Considering that the examination of psychological flexibility measures among older adults is scant, this study explores the psychometric properties of the Acceptance and Action Questionnaire-II (AAQ-II) among outpatient geriatrics primary care clinic patients in a university-affiliated medical center in the Deep South. Methods On average, patients who consented to participate in research (N = 119) were 75.42 (SD = 9.14) years old. Approximately 74% were women, 91% were non-Hispanic white, and 86% lived in urban areas. Measures included psychological inflexibility, subjective health literacy, depression, anxiety, and global cognitive functioning. Results The AAQ-II demonstrated adequate internal reliability, Cronbach’s α = 0.79, and good test-retest reliability, r(28) = .84, p < .001. With the removal of item 4, confirmatory factor analysis demonstrated adequate construct validity for the use of AAQ-II with older adults. As predicted, the AAQ-II exhibited concurrent, predictive, discriminant, and incremental validity within this older adult sample. Conclusions These results demonstrate meaningful scientific and clinical implications. This is the first study to examine the psychometric properties of the Acceptance and Action Questionnaire-II (AAQ-II) in an older adult sample. Clinical Implications The AAQ-II is a psychometrically sound measurement that can be clinically used on older adults.

Dual trajectories of insomnia symptoms and BMI and their associations with cognitive functioning

Abstract Introduction Insomnia symptoms and high body mass index (BMI) are separately associated with poorer cognitive functioning. However, little is known about dual associations of sleep and obesity, and the changes in subjective cognitive functioning. We used a person-oriented approach to identify these dual trajectories and their associations with changes in subjective cognitive functioning. Methods Repeated surveys of the Helsinki Health Study (n = 2360, 79% women,40-60 years at baseline) were used to identify developmental patterns of insomnia symptoms and BMI (2000-2017) and changes in subjective cognitive functioning (2017-2022). Subjective cognitive functioning was inspected in three dimensions: memory, concentration, and learning ability problems. Latent group-based dual trajectory modeling and logistic regression analysis were used. Results Regarding dual trajectories of insomnia and BMI, three latent groups were selected for each. Insomnia symptoms defined as: stable low, decreasing and increasing symptoms; and BMI as: stable healthy weight (BMI &amp;lt; 25), stable overweight (BMI 25-29.9) and stable obesity (BMI ≥ 30). While BMI and insomnia symptoms can develop together, this study suggests that the higher likelihood of reporting poorer memory, concentration, and learning ability problems, is explained by insomnia symptoms at all levels of BMI. Thus, BMI was not associated with cognitive functioning, while increasing insomnia symptoms were associated with poorer perceived cognitive functioning for all measures examined (odds ratios ranged from 1.8 to 2.9, all statistically significant) Conclusions Dual development of insomnia and overweight is possible, but only insomnia seems to be associated with changes in subjective cognitive functioning at all BMI levels. A potential intervention point to prevent or postpone cognitive decline in later life starts likely years or even decades before retirement, when the risk factors emerge or start to increase. Key messages • The association between dual trajectories of insomnia symptoms and BMI and subjective cognitive decline is dominated by insomnia symptoms. • Our results showed that developmental patterns of insomnia symptoms are associated with decline in subjective cognitive functioning.

Postsurgery Subjective Cognitive and Short-Term Memory Impairment Among Middle-Aged Chinese Patients

Perioperative neurocognitive disorder, particularly postoperative cognitive impairment, is common and associated with multiple medical and social adversities, although data from China are lacking. To examine the incidence, trajectory, and risk factors for subjective cognitive and short-term memory impairment after surgery in the Chinese population. This cohort study used data from the China Surgery and Anesthesia Cohort to assess surgical patients aged 40 to 65 years from 2 medical centers between July 15, 2020, and March 31, 2023, with active follow-up within 1 year after the surgery. Of 11 158 patients who were successfully recruited (response rate, 94.4%), 10 149 participants were eligible and available for analysis. From this population, separate cohorts were constructed for analyzing subjective cognitive impairment (8105 noncardiac and 678 cardiac surgery patients) and short-term memory impairment (5246 noncardiac and 454 cardiac surgery patients). Twenty-four potential risk factors regarding comorbidities, preoperative psychological conditions, anesthesia- or surgery-related factors, and postsurgical events were included. Outcomes included subjective cognitive function measured by the 8-Item Informant Interview to Differentiate Aging and Dementia (AD8; scores range from 0 to 8, with higher scores indicating more severe cognitive impairment) and short-term memory measured by the 3-Word Recall Test (TRT; scores range from 0 to 3, with lower scores indicating more severe short-term memory impairment) at 1, 3, 6, and 12 months after noncardiac and cardiac surgery. Generalized linear mixed models were used to identify risk factors associated with the presence of AD8 (score ≥2) or TRT (score <3) abnormality as well as the aggressively deteriorative trajectories of those cognitive measurements. For noncardiac surgery patients, the AD8 analysis included 8105 patients (mean [SD] age, 52.3 [7.1] years; 3378 [41.7%] male), and the TRT analysis included 5246 patients (mean [SD] age, 51.4 [7.0] years; 1969 [37.5%] male). The AD8 abnormality incidence rates after noncardiac surgery increased from 2.2% (175 of 8105) at 7 days to 17.1% (1059 of 6191) at 6 months after surgery, before appearing to decrease. In contrast, the TRT abnormality incidence rates followed a U-shaped pattern, with the most pronounced incidence rates seen at 7 days (38.9% [2040 of 5246]) and 12 months (49.0% [1394 of 2845]). Similar patterns were seen among cardiac surgery patients for the AD8 analysis (678 patients; mean [SD] age, 53.2 [6.3] years; 393 [58.0%] male) and TRT analysis (454 patients; mean [SD] age, 52.4 [6.4] years; 248 [54.6%] male). Among noncardiac surgery patients, the top risk factors for aggressively deteriorative AD8 trajectory and for AD8 abnormality, respectively, after surgery were preoperative sleep disturbances (Pittsburgh Sleep Quality Index ≥16 vs 0-5: odds ratios [ORs], 4.04 [95% CI, 2.20-7.40] and 4.54 [95% CI, 2.40-8.59]), intensive care unit stay of 2 days or longer (ORs, 2.43 [95% CI, 1.26-4.67] and 3.07 [95% CI, 1.67-5.65]), and preoperative depressive symptoms (ORs, 1.76 [95% CI, 1.38-2.24] and 2.23 [95% CI, 1.79-2.77]). Analyses for TRT abnormality and trajectory, as well as the analyses conducted among cardiac surgery patients, found fewer associated factors. This cohort study of middle-aged Chinese surgery patients found subjective cognitive and short-term memory impairment within 12 months after both cardiac and noncardiac surgery, with multiple identified risk factors, underscoring the potential of preoperative psychological interventions and optimized perioperative management for postoperative cognitive impairment prevention.