Subjective Cognitive Problems Research Articles

Psychometric properties of the Spanish version of the measure of insight into cognition-self-report in psychosis-risk and non-clinical Mexican young adults.

Cognitive disturbances typically precede the onset of overt psychotic symptoms and represent a neurobiological marker for psychosis risk that is also associated with poor functional outcomes. The Measure of Insight into Cognition-Self Report (MIC-SR) is a widely used 12-item questionnaire that assesses the perceived frequency of cognitive impairment in the domains of executing functioning, attention, and memory. However, the MIC-SR is not available in Spanish, one of the most widely spoken languages worldwide. The present study aimed to provide a Spanish version of the MIC-SR and examine its psychometric properties in psychosis-risk and non-clinical Mexican young adults. The sample comprised 621 participants who completed a battery of self-report measures via an online survey. Of the participants, 478 were non-clinical, and 143 met the screening criteria for a clinical high-risk for psychosis (CHR-positive). Confirmatory Factor Analyses supported a one-factor model, consistent with the findings for the original MIC-SR. The results showed adequate fit indices for the general model and the independent models for both groups, with high Cronbach's alpha coefficients. Furthermore, the CHR-positive group showed more frequent subjective cognitive problems on each of the 12 items, higher total scores, and higher average frequency than the non-clinical group. To our knowledge, this is the first translation of the MIC-SR into Spanish. Using the MIC-SR at the CHR stage may contribute to our understanding of cognitive processes associated with the onset of a psychotic disorder and provide valuable information in the context of detection and early intervention efforts.

The Clock Drawing Task reveals executive dysfunction in the dialysis population – an underrecognized and underestimated problem

Aim of the study The study aimed to assess the prevalence of executive function impairment among patients with chronic kidney disease (CKD) undergoing dialysis, with no subjective cognitive problems and with normal global cognition on the Mini-Mental State Examination (MMSE). We also investigated the relationship between cardiovascular risk factors and cognitive test results. Rationale for the study Patients with CKD, including those undergoing renal replacement therapy, are at a higher risk of developing cognitive impairment (CI) than the general population. Recent research has shown CI to be a growing problem among CKD patients worldwide. Yet, it remains underdiagnosed, even though it may significantly influence the lives of patients. Materials and methods In this cross-sectional, prospective study, 58 dialysis patients with no cognitive decline on the MMSE screening were assessed for executive function impairment using the Executive Clock-Drawing Task (CLOX). Moreover, past medical history, demographic data, and laboratory test results were collected. Results The mean patient age was 59.47 ± 14.98 years, and the mean duration of dialysis was 45.93 ± 48.49 months. The prevalence of executive function impairment amounted to 8.6%. Moreover, remarkably similar pattern of clock drawing was observed, with numbers written outside the clock face in the CLOX1 test. Conclusions Executive dysfunctions in dialysis patients may manifest itself before the onset of global cognitive impairment. There appear to be a deficit in the spatial domain as well. Better education may play a protective role.

Preliminary validation of a dual‐task gait assessment in early Alzheimer’s Disease

AbstractBackgroundEarly stages of Alzheimer’s disease (eAD) are marked by changes in gait characteristics that may be measured using simple smartphone‐based gait tasks. Here we present an assessment of cognitive‐motor‐interference where participants walk for 30 seconds with a smartphone placed in a running belt while counting backwards, called the 30‐Second Walk Test Dual Task (30sWTDT). We report the preliminary reliability and validation of the 30sWTDT in a cohort of healthy individuals (HC), individuals with subjective cognitive decline amyloid‐PET negative and positive (SCDn and SCDp, respectively) and eAD.Method123 participants (32 HC, 31 SCDn, 30 SCDp and 30 eAD) were recruited as a part of a Proof‐of‐Concept study of the Alzheimer’s Disease Digital Assessment Suite (AD‐DAS) (https://www.isrctn.com/ISRCTN17035495). Participants performed 9 sessions of 30sWTDT over 28 days on provisioned smartphones. Feasibility was evaluated as the proportion of completed 30sWTDT relative to the total number of expected sessions. Two gait characteristic metrics were estimated: variability in step frequency (VSF) and the 25th percentile in step power (25SP). Intraclass correlation coefficients (ICC) tested the metrics’ reliability. Convergent validity was established as partial correlation between VSF/25SP and adjusted mean duration in Timed 25 foot Walk Test (T25WT). Clinical validity was evaluated using a proportional odds logistic regression model to differentiate between groups.ResultAmong the 97.5% of participants who completed the study (i.e., n = 120), participants completed 88.9% of all assigned 30sWTDT tasks, with no group difference in adherence. VSF and 25SP metrics showed moderate (ICC = 0.74) and good (ICC = 0.79) reliability, respectively. Both metrics significantly distinguished between HC and all other study groups (odds ratio = [0.012,0.029]), and were associated with T25WT adjusted mean duration (adjusted r2 = [0.09,0.069]).ConclusionPreliminary findings demonstrate that a smartphone‐based 30sWTDT can be successfully self‐administered by cognitively healthy participants and individuals on the eAD continuum. Participants show high adherence in an ecologically valid environment. 30sWTDT differentiated HC from all other groups with subjective or objective cognitive problems, indicating a lack of specificity of gait characteristics to differentiate between increasing levels of cognitive impairment. These findings require replication in larger independent datasets.

75 Neuropsychological performance in vestibular migraine: Preliminary findings from a meta-analysis

Objective:Primary headache disorder is characterized by recurrent headaches which lack underlying causative pathology or trauma. Primary headache disorder is common and encompasses several subtypes including migraine. Vestibular migraine (VM) is a subtype of migraine that causes vestibular symptoms such as vertigo, difficulties with balance, nausea, and vomiting. Literature indicates subjective and performance-based cognitive problems (executive dysfunction) among migraineurs. This study compared the magnitude of the total effect size across neuropsychological domains to determine if there is a reliable difference in effect sizes between individuals with VM and healthy controls (HC). An additional aim was to meta-analyze neuropsychological outcomes in migraine subtypes (other than VM) in reference to healthy controls.Participants and Methods:This study was a part of a larger study examining neuropsychological functioning and impairment in individuals with primary headache disorder and HCs. Standardized search terms were applied in OneSearch and PubMed. The search interval covered articles published from 1986 to May 2021. Analyses were random-effects models. Hedge’s g was used as a bias-corrected estimate of effect size. Between-study heterogeneity was assessed using Cochran’s Q and I2. Publication bias was assessed with Duval and Tweedie’s Trim-and-Fill method to identify evidence of missing studies.Results:The initial omnibus literature search yielded 6692 studies. Three studies (n=151 VM and 150 HC) met our inclusion criteria of having a VM group and reported neuropsychological performance. VM demonstrated significantly worse performance overall when compared to HCs (k=3, g=-0.99, p<0.001; Q=4.41, I2=54.66) with a large effect size. Within-domain effects of VM were: Executive Functioning=-0.99 (Q=0.62, I2=0), Screener=-1.15 (Q=3.29, I2=69.59), and Visuospatial/Construction=-1.47 (Q=0.001, I2=0.00). Compared to chronic migraine (k=3, g=-0.59, p<0.001; Q=0.68, I2=0.00) and migraine without aura (k=23, g=-0.39, p<0.001; Q=109.70, I2=79.95), VM was the only migraine subgroup to display a large effect size. Trim-and-fill procedure estimated zero VM studies to be missing due to publication bias (adjusted g=-0.99, Q=4.41).Conclusions:This initial attempt at a meta-analysis of cognitive deficits in VM was hampered by a lack of studies in this area. Based on our initial findings, individuals with VM demonstrated overall worse performances on neuropsychological tests compared to HCs with the greatest level of impairment seen in visuospatial/construction. Additionally, VM resulted in a large effect size while other migraine subtypes yielded small to moderate effect sizes. Despite the small sample of studies, the overall effect across neuropsychological performance was generally stable (i.e., low between-study heterogeneity). Given than VM accounts for 7% of patients seen in vertigo clinics and 9% of all migraine patients, our results suggest that neuropsychological impairment in VM deserves significantly more study.

Cognitive biases are associated with aberrant salience experience in schizophrenia spectrum disorders

IntroductionCognitive models suggest the co-occurrence of cognitive biases and aberrant salience is unique to psychosis, but their interaction is not yet fully understood. Therefore, we aimed to elucidate the relationship between subjective cognitive biases and aberrant salience in individuals with schizophrenia spectrum disorders (SSDs) in this study. MethodsA sample of 92 subjects with SSDs underwent an assessment using Davos Assessment Cognitive Biases (DACOBS) and the Aberrant Salience Inventory (ASI) in a cross-sectional design. We evaluated psychopathological differences based on ASI scores and conducted a linear regression analysis to examine the variables associated with aberrant salience. ResultsSubjects with an ASI score ≥14 demonstrated significantly higher scores across all subscales and total score of ASI and DACOBS (p<0.001). ASI subscales were significantly positive correlated with all DACOBS subscales, ranging from 0.250 for Increased Significance and Safety Behavior to 0.679 for Heightened Emotionality and Social cognition problems. The linear regression analysis revealed a positive association between aberrant salience and the DACOBS subscales jumping to conclusions (JTC) (β=0.220), social cognition problems (β=0.442), subjective cognitive problems (β=0.405), and a negative association with the subscale belief inflexibility (β=−0.350). ConclusionsOur findings suggest that JTC, social cognition problems and subjective cognitive problems may play a central role in the experience of aberrant salience in individuals with SSDs. This work informs about the need of developing prevention and intervention strategies that specifically target cognitive biases and aberrant salience in the treatment of psychosis.

Exploring the relationship between perceived loneliness and subjective cognitive decline in older individuals

Objective Loneliness has been associated to a greater risk of cognitive decline and dementia in older individuals. However, evidence on whether this association also exists for older individuals who complain of cognitive problems is limited. We conducted a survey to examine the association between subjective cognitive decline in the working memory domain, perceived loneliness, depression, anxiety, and stress in older individuals with different profiles. Methods A total of 302 healthy, old individuals completed 3 questionnaires to assess subjective cognitive problems in attention, executive functions, storage, depression, anxiety, stress, and perceived loneliness. Results We conducted a cluster analysis and 3 clusters of individuals with different profiles emerged. Individuals with greater subjective cognitive problems (cluster 1) in the attention and storage domains, reported higher perceived loneliness and stress but not depression. In contrast, individuals with the least subjective cognitive problems (cluster 3) in the storage domain, reported lower perceived loneliness. Conclusions Individuals with higher subjective cognitive decline also report higher levels of perceived loneliness but not more depression than their peers. However, this correlation is present only for individuals with mild subjective cognitive decline (cluster 2). The implications for future research and interventions are discussed.

Subjective and Objective Cognitive Impairments in Non-Hospitalized Persons 9 Months after SARS-CoV-2 Infection.

Studies on cognitive problems of persons with mild COVID-19 courses are still lacking. This study aimed to determine the frequency and associated factors of subjective and objective cognitive problems after COVID-19 in non-hospitalized persons. Study participants were examined at the University Hospital of Augsburg from 04/11/2020 to 26/05/2021. The Wechsler Adult Intelligence Scale (WAIS) IV digit span, Stroop Color and Word Test (SCWT), Regensburger verbal fluency test (RWT) and, subjective ratings of memory and concentration were applied. Of the 372 participants (mean age 46.8 ± 15.2 years, 54.3% women, median time after infection 9.1 months), 24.9% reported concentration and 21.9% memory problems. Overall, 55.6% of the participants had at least a mild negative alteration in any cognitive test. The strongest impairments were found regarding memory functions (41.1% mild alterations, 6.2% distinct impairments) and verbal fluency (12.4% mild alterations, 5.4% distinct impairments). SCWT showed negative alterations in no more than 3.0% of the participants. Level of school education, age, and depressiveness emerged as significantly related to the cognitive tests. The number of complaints and depressiveness were significantly associated with subjective memory and concentration problems. It is important to identify mild cognitive impairment in non-hospitalized COVID-19 patients early to offer them effective interventions.

Improving risk indexes for Alzheimer's disease and related dementias for use in midlife.

Knowledge of a person’s risk for Alzheimer’s disease and related dementias (ADRDs) is required to triage candidates for preventive interventions, surveillance, and treatment trials. ADRD risk indexes exist for this purpose, but each includes only a subset of known risk factors. Information missing from published indexes could improve risk prediction. In the Dunedin Study of a population-representative New Zealand-based birth cohort followed to midlife (N = 938, 49.5% female), we compared associations of four leading risk indexes with midlife antecedents of ADRD against a novel benchmark index comprised of nearly all known ADRD risk factors, the Dunedin ADRD Risk Benchmark (DunedinARB). Existing indexes included the Cardiovascular Risk Factors, Aging, and Dementia index (CAIDE), LIfestyle for BRAin health index (LIBRA), Australian National University Alzheimer’s Disease Risk Index (ANU-ADRI), and risks selected by the Lancet Commission on Dementia. The Dunedin benchmark was comprised of 48 separate indicators of risk organized into 10 conceptually distinct risk domains. Midlife antecedents of ADRD treated as outcome measures included age-45 measures of brain structural integrity [magnetic resonance imaging-assessed: (i) machine-learning-algorithm-estimated brain age, (ii) log-transformed volume of white matter hyperintensities, and (iii) mean grey matter volume of the hippocampus] and measures of brain functional integrity [(i) objective cognitive function assessed via the Wechsler Adult Intelligence Scale-IV, (ii) subjective problems in everyday cognitive function, and (iii) objective cognitive decline measured as residualized change in cognitive scores from childhood to midlife on matched Weschler Intelligence scales]. All indexes were quantitatively distributed and proved informative about midlife antecedents of ADRD, including algorithm-estimated brain age (β's from 0.16 to 0.22), white matter hyperintensities volume (β's from 0.16 to 0.19), hippocampal volume (β's from −0.08 to −0.11), tested cognitive deficits (β's from −0.36 to −0.49), everyday cognitive problems (β's from 0.14 to 0.38), and longitudinal cognitive decline (β's from −0.18 to −0.26). Existing indexes compared favourably to the comprehensive benchmark in their association with the brain structural integrity measures but were outperformed in their association with the functional integrity measures, particularly subjective cognitive problems and tested cognitive decline. Results indicated that existing indexes could be improved with targeted additions, particularly of measures assessing socioeconomic status, physical and sensory function, epigenetic aging, and subjective overall health. Existing premorbid ADRD risk indexes perform well in identifying linear gradients of risk among members of the general population at midlife, even when they include only a small subset of potential risk factors. They could be improved, however, with targeted additions to more holistically capture the different facets of risk for this multiply determined, age-related disease.

주관적 인지저하 및 경도인지장애 노인의 단어연상과제 수행특성

Associative ability can be used as the basic assessment data to clarify semantic knowledge preservation and processing speed by checking semantic networks. Especially due to the nature of Korean language, it takes a long time to build a semantic relation since there are a lot of semantically-overlapping words, particularly more in verbs and adjectives than nouns. And this difference depending on word classes could be a distinctive factor to identify cognitive function problems in the elderly. In this regard, this study aims to find out distinctive performance characteristics observed in the subject groups with subjective memory impairment and mild cognitive impairment, by designing multiple-choice word association tasks by word classes. As a result of the study, it was found that the performance of the mild cognitive impairment group had lower accuracy and reaction time than the normal group, and their error frequency by error types also showed significant difference. The subjective memory impairment group showed a significant increase in reaction time, compare to the normal group. To sum up, the quantity and/or quality of semantic knowledge processing could decline even at the stage of suffering from subjective cognitive problems, and particularly this problem could appear more obviously in the speed of semantic knowledge processing. Therefore, associative processing ability is anticipated to be used as a valuable data in future assessments to identify subjective and/or objective memory problems at an early stage.&#x0D;

Impact of self-reported cognitive dysfunction on the alternative model of personality disorders among older adults

Objectives: The Alternative Model of Personality Disorders (AMPD) is a classification system for personality disorders (PDs) proposed in Section III of DSM-5. The AMPD contains two diagnostic constructs: personality functioning and pathological personality traits. Previous research has suggested that the model performed differently among older adults than younger adults (e.g., more generalized patterns). However, explanations for this difference in performance remain unclear. This study examined how self-reported cognitive dysfunction (a common complaint among older adults) impacts the AMPD’s two constructs among a later life sample. Method Older adults (N = 202) completed the Levels of Personality Functioning Scale-Self-Report, Personality Inventory for DSM-5, and Coolidge Axis II Inventory with its six self-report cognitive dysfunction scales. Results Results suggested high correlational overlap between subjective cognitive problems with personality functioning and pathological personality, as measured by the AMPD. Hierarchical regressions revealed that subjective measures of executive functions, perceptual motor, and language difficulties were most strongly related to the AMPD’s constructs. Results are discussed in the context of prior research on objective cognitive impairment among individuals with PDs. Conclusion The degree of overlap found within the current older adult sample suggested an age-related problem or potential age-bias, with older adults being at-risk of (a) having their subjective cognitive problems being incorrectly interpreted as personality pathology under the AMPD or (b) having personality pathology being overlooked under the AMPD, with symptoms instead attributed to subjective cognitive issues. This study suggested that subjective cognitive dysfunction may be one mechanism that contributes to differential performance of the AMPD among older adults.

Diplopia in Parkinson's disease: Indication of a cortical phenotype with cognitive dysfunction?

Visual disturbances are increasingly recognized as common non-motor symptoms in Parkinson's disease (PD). In PD patients, intermittent diplopia has been found to be associated with the presence of visual hallucinations and the Parkinson's psychosis spectrum. Here, we investigated whether diplopia in PD is associated with other non-motor traits and cognitive impairment. We investigated 50 non-demented PD patients with and without intermittent diplopia and 24 healthy controls for visual disturbances, as well as motor and non-motor symptoms. All participants underwent a neuropsychological test battery; visuospatial abilities were further evaluated with subtests of the Visual Object and Space Perception Battery (VOSP). The two PD patient groups did not differ significantly in age, symptom duration, motor symptom severity, frequency of visual hallucinations, or visual sensory efficiency. PD patients with diplopia reported more frequent non-motor symptoms including more subjective cognitive problems and apathy without changes in global cognition measures compared to those without diplopia. PD patients with diplopia had greater impairment in several tests of visuospatial function (pentagon copying p=.002; number location p=.001; cube analysis p<.02) and object perception (p<.001) compared to PD patients without diplopia and healthy controls. By contrast, no consistent group differences were observed in executive function, memory, or language. PD patients with diplopia have a greater non-motor symptom burden and deficits in visuospatial function compared to PD patients without diplopia. PD patients with diplopia might be prone to a cortical phenotype with cognitive decline and apathy associated with worse prognosis.

Association between schizotypal personality traits and emotional instability: mediation and moderation analysis among Chinese college students

BackgroundPrevious studies identified an association between schizophrenia and emotional instability. However, the relationship between schizotypal personality traits and emotional instability has not been explored to date. Furthermore, both mediating and moderating factors need to be identified. MethodsA total of 2936 students completed the Schizotypal Personality Questionnaire (SPQ), the Affective Lability Scale-Short Form (ALS-SF), and the Davos Assessment of Cognitive Biases Scale (DACOBS). Results1) The total scores of DACOBS (and all dimensions) and ALS-SF (and all dimensions) in the high schizotypal personality trait group were higher than in the low schizotypal personality trait group (all P < 0.05). 2) SPQ score and DACOBS social cognition problems, subjective cognitive problems, jumping to conclusions bias, and external attribution bias subscale scores positively predicted the total score of ALS-SF (or the dimensions of ALS-SF) in both male and female populations (all P < 0.05). 3) In the male population, DACOBS social cognition problems, subjective cognitive problems, jumping to conclusions bias, and external attribution bias subscale scores mediated the relationship between SPQ score and ALS-SF total score (or its subscales). In the female population, DACOBS attention for threat bias, external attribution bias, jumping to conclusions bias, social cognition problems, and subjective cognitive problems subscale scores mediated the relationship between SPQ score and ALS-SF total score (or its subscales). 4) Gender exerted a moderating effect on this relationship between SPQ score and ALS-SF total/anxiety-depression score (all P < 0.05). ConclusionsSchizotypal personality traits might influence emotional instability through cognitive biases, and the degree of this influence varies depending on gender.

The role of insecure attachment and cognitive biases in the social functioning of schizophrenia spectrum patients.

The study investigates the relationship between cognitive biases and attachment styles and social functioning. Fifty-three patients (28 females, age M = 41.73, SD = 11.71) with the diagnosis of schizophrenia participated in the study. We measured attachment styles, cognitive biases, and social functioning using self-report questionnaires. Relationships among variables were investigated with correlational and regression analyses. Correlation analysis indicated that social engagement, interpersonal behavior, pro-social activities, and independence-performance significantly correlate with both attachment styles and cognitive biases. However, in regression analysis, after controlling for attachment styles, only subjective cognitive problems turned out to be a significant predictor of social functioning. These preliminary findings might suggest that both attachment styles and cognitive biases are associated with social functioning. Nonetheless, when considered together it might suggest attachment styles have a higher contribution than cognitive biases to social engagement, interpersonal behavior, and pro-social activities decline in schizophrenia spectrum disorders.

Cognition and mental wellbeing after electrical accidents: a survey and a clinical study among Swedish male electricians

PurposeThe purpose was to examine long-term consequences of exposure to electrical current passing through the body. We investigated (1) whether electricians after having experienced an electrical accident report more cognitive problems and lower mental wellbeing and (2) have objectively verifiable reduced cognitive function; and (3) which circumstances at the time of the accident affect long-term subjective cognitive function and mental wellbeing?MethodsA survey of male electricians who had experienced electrical accidents (n = 510) and a clinical study in a subsample (n = 23) who reported residual health problems was carried out. Both groups were examined regarding subjective cognitive function (Euroquest-9) and mental wellbeing (Symptom Checklist-90 subscales). The clinical study included neuropsychological tests of memory, attention, spatial function, and premorbid intellectual capacity. A matched control group was retrieved from reference data.ResultsThe survey participants reported more cognitive problems and lower mental wellbeing than referents. Of the examined circumstances, having experienced mortal fear at the time of the accident and health complaints, especially mental symptoms, for > 1 week after the accident were the most significant risk factors for later subjective cognitive problems and lower mental wellbeing. The only statistically significant difference in neuropsychological tests was better performance in part of the memory tests by the clinical study group compared to the control group.ConclusionsThe participants reported more cognitive problems and lower mental wellbeing than referents, but no long-term objective cognitive dysfunction was detected. Emotional response at the time of the accident and health complaints in the aftermath of the accident may constitute important indications for medical and psychological follow-ups.

Changes in Posttraumatic Cognitions Mediate the Effects of Trauma-Focused Therapy on Paranoia

Abstract Background Evidence suggests that in individuals with psychosis, paranoia is reduced after trauma-focused therapy (TFT) aimed at comorbid posttraumatic stress disorder (PTSD). Objective To identify mediators of the effect of TFT on paranoia. Method In a multicenter single-blind randomized controlled trial 155 outpatients in treatment for psychosis were allocated to 8 sessions Prolonged Exposure (PE; n = 53), 8 sessions Eye Movement Desensitization and Reprocessing (EMDR) therapy (n = 55), or a waiting-list condition (WL; n = 47) for treatment of comorbid PTSD. Measures were performed on (1) paranoia (GPTS); (2) DSM-IV-TR PTSD symptom clusters (CAPS-IV; ie, intrusions, avoidance, and hyperarousal); (3) negative posttraumatic cognitions (PTCI; ie, negative self posttraumatic cognitions, negative world posttraumatic cognitions and self-blame); (4) depression (BDI-II); and (5) cognitive biases (ie, jumping to conclusion, attention to threat, belief inflexibility, and external attribution), cognitive limitations (ie, social cognition problems and subjective cognitive problems), and safety behaviors (DACOBS). Outcome in terms of symptoms of paranoia (1) and potential mediators (2–5) were evaluated at posttreatment, controlling for baseline scores. Results The effects of TFT on paranoia were primarily mediated by negative self and negative world posttraumatic cognitions, representing almost 70% of the total indirect effect. Safety behaviors and social cognition problems were involved in the second step mediational pathway models. Conclusions Targeting the cognitive dimension of PTSD in TFT in psychosis could be an effective way to influence paranoia, whereas addressing safety behaviors and social cognition problems might enhance the impact of TFT on paranoia.

Sleep Duration and Cognition in a Nationally Representative Sample of U.S. Older Adults

ObjectiveExcessive and insufficient sleep have been associated with cognitive dysfunction in older adults in U.S. and non-U.S. studies. However, the U.S. studies were not in nationally representative samples. The authors investigated the association between sleep duration and cognitive performance in a nationally representative sample of U.S. older adults. ParticipantsThe authors studied 1,496 survey participants aged 60 years or older from the National Health and Nutrition Examination Survey 2013–2014 dataset. MeasurementsOur primary predictor was weekday (or workday) nighttime sleep duration, categorized as 2–4, 5, 6, 7 (reference), 8, 9, and 10 hours or more. The authors studied five cognitive outcomes: Consortium to Establish a Registry for Alzheimer's Disease Word Learning (CERAD-WL) immediate recall, CERAD-WL delayed recall, Animal Fluency Test (AFT), Digital Symbol Substitution Test (DSST), and subjective cognitive problems (SCP). ResultsAfter adjusting for age, sex, race, education, depressive symptoms, and sedative-hypnotic use, sleep duration of 10 hours or more was significantly associated with lower scores on CERAD-WL immediate recall, CERAD-WL delayed recall, AFT, and DSST, and greater odds of SCP; sleep duration of 8 hours or more was associated with lower CERAD-WL delayed recall scores: 8, 9, and 10 hours or more. After adjustment, there were no significant associations of shorter sleep duration with cognition. ConclusionIn U.S. adults aged 60 years or older, long nighttime weekday or workday sleep duration is associated with poorer verbal memory, semantic fluency, working memory, and processing speed in addition to greater odds of self-reported cognitive problems. Long sleep duration may be a marker of fragmented sleep or neurodegeneration in U.S. older adults.

Abstract P4-12-06: Quality of life, fatigue, and subjective cognitive functioning immediately and 6 months after adjuvant chemotherapy in breast cancer patients

Abstract Background The aim of this study was to examine quality of life (QoL), fatigue, and subjective cognitive functioning (SCF) after chemotherapy in breast cancer (BC) patients. Methods BC patients were recruited before chemotherapy (3 FEC+3 Tax, BC-Chemo) and compared with disease-specific controls (i.e., BC patients not receiving chemotherapy, BC-Controls) and healthy controls (HC) matched for age and education. All participants completed questionnaires assessing QoL (using the Functional Assessment of Cancer Therapy – General Population), fatigue (using the Functional Assessment of Chronic Illness Therapy-Fatigue), and SCF (with the Cognitive Failure Questionnaire) at recruitment and 6 months later (i.e., one month after the end of chemotherapy). Follow-up data (1 year after recruitment) were available for BC-Chemo and HC only. Difference scores were computed for each participant (i.e., score after 6 months/ 1 year minus score at baseline) and transformed when necessary so that negative scores would reflect decline over time (i.e., decreased QOL, increased fatigue, and increased cognitive complaints). These difference scores were analysed using independent t-tests (BC-Chemo vs BC-Controls on one hand, and BC-Chemo vs HC on the other hand). Results Eighteen BC- Chemo, 19 BC-Controls, and 20 HC completed the study (mean age = 49, 58, and 44 years, resp., p = 0.001, BC-Controls being significantly older). Statistical analyses showed that, after chemotherapy, BC- Chemo patients showed significantly lower QoL, more fatigue, and declined SCF than both groups of controls (see Table 1). However, 6 months later, no statistically significant differences were found between BC- Chemo and HC with respect to QoL and fatigue. Only SCF remained significantly lower in BC- Chemo. Table 1.Mean Scores (standard deviations) for Quality of Life (QoL), Fatigue, and Subjective Cognitive Functioning (SCF) in Breast Cancer Patients treated with Chemotherapy (BC-Chemo) or not (BC-Controls) and Healthy Controls 6 months and 1 Year After Baseline BC-ChemoBC-ControlsHealthy ControlsQoL (FACT-GP) 6 months after baseline-5.8 (8)1.1 (8.7)*-0.3 (4.7)*1 year after baseline-5.3 (11.8) 0.2 (9.4)Fatigue (FACIT-F) 6 months after baseline-6.1 (11.1)0 (7.3)*-0.1 (3.8)*1 year after baseline-3.6 (10.3) -2.1 (6.5)SCF (CFQ) 6 months after baseline-7.4 (9.4)0.3 (10.9)*1 (5)*1 year after baseline-10.4 (13) 1.2 (6)**p &amp;lt; 0.05 (two-tailed independent t-tests vs BC-Chemo). Note. FACT-GP: Functional Assessment of Cancer Therapy – General Population (higher scores = greater QoL). FACIT-F: Functional Assessment of Chronic Illness Therapy-Fatigue Scale (higher scores = low fatigue). CFQ: Cognitive Failure Questionnaire (higher scores = greater subjective cognitive problems). All difference scores reflect decline over time. Conclusions Shortly after chemotherapy (i.e., 6 months after baseline), breast cancer patients experienced diminished QoL and increased fatigue compared to both disease-specific and healthy controls, but these differences were no longer significant 6 months later. In contrast, group differences in SCF were significant at both timepoints, suggesting long-lasting cognitive decline for patients receiving chemotherapy. Citation Format: Mebis J, Censabella S, Engels S, Van Marsenille C, Orye G, Marquette S, Vansteelant L, Luyten D, Maes A, Noé L, Bulens P. Quality of life, fatigue, and subjective cognitive functioning immediately and 6 months after adjuvant chemotherapy in breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-12-06.

T208. LONGITUDINAL FEASIBILITY AND ACCEPTABILITY OF THE EXPRESS SMARTPHONE APP: RECRUITMENT, RETENTION AND PRELIMINARY FINDINGS

BackgroundRelapse of schizophrenia is common, has profound, adverse consequences for patients and is costly to health services. Early signs interventions aim to use warning signs of deterioration to prevent full relapse. These interventions show promise but could be further developed. There is preliminary evidence that adding ‘basic symptoms’ to conventional early signs of relapse may improve relapse prediction. Basic symptoms are subtle, sub-clinical disturbances in one’s experience of oneself and the world that can include, for example, perceptual changes, mild subjective cognitive problems and decreased tolerance of stressors. This study aimed to evaluate the feasibility and acceptability of using the ExPRESS smartphone app to monitor both conventional early signs and basic symptoms as possible predictors of relapse.MethodsPatients who had experienced a relapse of schizophrenia within the past year took part in a screening interview. Those with at least one basic symptom emerging prior to a previous relapse were eligible for the longitudinal feasibility study. Consenting participants were asked to use the ExPRESS smartphone app once a week for 6 months, answering questions on their experience of conventional early signs, basic symptoms and psychotic symptoms. When app responses indicated an increase in psychotic symptoms above a pre-defined threshold, the researcher conducted the PANSS positive symptoms interview over the phone to assess whether the symptom increase was indicative of relapse. At the end of the follow-up period, face-to-face qualitative interviews were conducted to explore participants’ experiences of using the phone app and reasons for study dropout.Results82% (18/22) of those screened were eligible for the longitudinal feasibility study and consented to participate. Of these, 72% (13/18) completed at least half of the weekly phone app assessments, with two participants dropping out of the study without completing any assessments on the phone app. Two participants met pre-defined relapse criteria during the 6 month follow up period. Initial findings from sixteen qualitative interviews are discussed, including interviews with the two participants who met relapse criteria and two study drop-outs.DiscussionThe rate of recruitment to the longitudinal study was much higher than expected, since a higher than expected proportion of screened participants had experienced basic symptoms prior to a previous relapse. Retention rates were as expected, suggesting that the ExPRESS app is acceptable to patients with psychosis. Qualitative feedback from participants supports this conclusion. The results from this longitudinal feasibility study will inform the design of a well-powered definitive study prospectively examining the sensitivity and specificity of basic symptoms in predicting relapses of schizophrenia.

Untangling chronic pain and post-concussion symptoms: the significance of depression

ABSTRACTObjectives: Post-concussion-like symptoms (PCS) are common in patients without a history of brain injury, such as those with chronic pain (CP). This exploratory study examined neuro-cognitive and psychological functioning in patients with PCS following mild traumatic brain injury (mTBI) or CP, to assess unique and overlapping phenomenology.Methods: In this case-control study, participants (n = 102) with chronic symptoms after mTBI (n = 45) were matched with mTBI recovered (n = 31) and CP groups (n = 26), on age, gender, ethnicity and education. Psychological status, cognitive functioning, health symptoms, beliefs and behaviours were examined.Results: Participants who had not recovered from an mTBI and participants with CP did not differ in terms of PCS symptoms, quality of life, distress or illness behaviours, however, the CP group endorsed fewer subjective cognitive problems, more negative expectations about recovery and more distress (p < 0.05). On cognitive testing participants who had not recovered from an mTBI demonstrated greater difficulties with attention (p < 0.01) although differences disappeared when depression was controlled in the analyses.Conclusions: Unique patterns associated with each condition were evident though caution is required in attributing PCS and cognitive symptoms to a brain injury in people with mTBI presenting with chronic pain and/or depression. Psychological constructs such as illness and recovery beliefs appear to be important to consider in the development of treatment interventions.

Objective cognitive impairment and subjective cognitive problems in veterans initiating psychotherapy for posttraumatic stress disorder: An exploratory study

ABSTRACTThe prevalence of cognitive impairment in Veterans initiating an evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD) is not yet established and has implications for service delivery. Our objectives were to (1) describe the type, severity, and prevalence of objective cognitive impairment and subjective cognitive problems experienced by Veterans at the time they began an EBP for PTSD and (2) determine whether assessments of objective cognitive impairment and subjective cognitive problems agree. We conducted objective and subjective (self-report) cognitive assessments in a sample of 38 Veterans initiating EBP for PTSD at one Veterans Affairs Medical Center. Thirty Veterans produced valid assessments. Almost half (14/30) of the participants demonstrated objective impairment in one or more cognitive domains, primarily in the areas of learning, memory, and processing speed. Almost all (29/30) participants endorsed moderate or greater cognitive problems on at least one self-report measure. After adjustment for multiple comparisons, there were no significant correlations between objective and subjective assessments. Objective cognitive impairment and subjective cognitive problems are common in Veterans beginning an EBP for PTSD. Longitudinal research on a larger sample is warranted to better understand relationships among subjective cognitive problems, objective cognitive impairment, and PTSD treatment participation and outcomes.