Trail Making Test B Research Articles

Cognitive Impact of β-Amyloid Load in the Rapid Eye Movement Sleep Behavior Disorder-Lewy Body Disease Continuum.

Rapid eye movement sleep behavior disorder (RBD) is linked to the diffuse-malignant subtype and higher cognitive burden in Lewy body disease (LBD). This study explores brain β-amyloid deposition and its association with cognitive decline across the RBD-LBD continuum. Patients with isolated RBD (iRBD), Parkinson's disease with probable RBD (PDRBD), and dementia with Lewy bodies with probable RBD (DLBRBD) underwent 18F-florbetaben positron emission tomography, 3T magnetic resonance imaging scans, and comprehensive neuropsychological assessments. Subjects were categorized as cognitively normal (NC), mild cognitive impairment (MCI), or dementia. Global and regional standardized uptake value ratios (SUVR) were estimated in predefined cognitive volumes of interest (VOI) derived from voxel-wise comparison analysis among the cognitive groups, namely the prefrontal, parietal, precentral cortices, lingual gyrus, and supplementary motor area. Generalized linear models assessed the relationship between 18F-florbetaben SUVRs and neuropsychological testing, adjusting for age and sex. Subgroup analysis focused on the polysomnography-confirmed iRBD-continuum subset (n = 41) encompassing phenoconverters and nonconverters in our prospective iRBD cohort. Eighty-six subjects were classified as follows: 14 NC, 54 MCI, and 18 dementia. The proportion of positive β-amyloid scans increased with advanced cognitive stages (P = 0.038). β-Amyloid signals in cognitive VOIs were elevated in subgroups showing impairment in Trail-Making Test B (TMT-B). A linear association between TMT-B z score and global cortical β-amyloid levels was observed in the iRBD-continuum subset (P = 0.013). Cortical β-amyloid accumulates with declines in executive function within the RBD-LBD continuum. TMT-B performance may be a useful marker associating with β-amyloid load, particularly in the iRBD population. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Cognitive processing speed improvement after cochlear implantation.

Untreated hearing loss has an effect on cognition. It is hypothesized that the additional processing required to compensate for the sensory loss affects the cognitive resources available for other tasks and that this could be mitigated by a hearing device. The impact on cognition of cochlear implants (CIs) was tested in 100 subjects, ≥60 years old, with bilateral moderately-severe to profound post linguistic deafness using hearing aids. Data was compared pre and 12 and 18 months after cochlear implantation for the speech spatial qualities questionnaire, Mini Mental State Examination (MMSE), Trail making test B (TMTB) and digit symbol coding (DSC) from the Wechsler Adult Intelligence Scale version IV and finally the timed up and go test (TUG). Subjects were divided into young old (60-64), middle old (65-75) and old old (75+) groups. Cognitive test scores and times were standardized according to available normative data. Hearing significantly improved pre- to post-operatively across all age groups. There was no change post-implant in outcomes for TMTB, TUG or MMSE tests. Age-corrected values were within normal expectations for all age groups for the TUG and MMSE. However, DSC scores and TMTB times were worse than normal. There was a significant increase in DSC scores between baseline and 12-months for 60- to 64-year-olds (t[153] = 2.608, p = 0.027), which remained at 18 months (t[153] = 2.663, p = 0.023). The improved attention and processing speed in the youngest age group may be a consequence of reallocation of cognitive resources away from auditory processing due to greatly improved hearing. The oldest age group of participants had cognition scores closest to normal values, suggesting that only the most able older seniors tend to come forward for a CI. Severe to profoundly deaf individuals with hearing aids or cochlear implants were still poorer than age-equivalent normally hearing individuals with respect to cognitive flexibility, attention, working memory, processing speed and visuoperceptual functions. Due to a lack of data for the TUG, TMTB and DSC in the literature for hearing impaired individuals, the results reported here provide an important set of reference data for use in future research.

THE EFFECTS OF MULTICOMPONENT EXERCISE ON MILD COGNITIVE IMPAIRMENT IN ELDERLY POPULATION: A RANDOMIZED CONTROL TRIAL

Objective: To determine the effectiveness of multicomponent exercise on mild cognitive impairment in older adults. Materials and Methods: This randomized control trial was conducted at the Department of Rehabilitation at Pakistan Railway General Hospital, Rawalpindi. Fifty-eight older persons with mild cognition impairment were allocated randomly into 2 groups. The participants of the experimental group (n=29) performed multicomponent exercises two times a week for 55-60 minutes. In the control group (n=29), participants performed 20 minutes of treadmill walking thrice a week. Both groups performed these exercises for 6 weeks. Pre and post assessment was carried out at baseline and after 6 weeks of intervention for the following test: Mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), Trail-making test A (TMT-A) and Trail making test-B (TMT-B). Data was analyzed using SPSS 21. Results: The overall mean age of study participants was 62.74±74 years. Within-group analysis for MMSE, MoCA, TMT-A, and TMT-B significantly improved (p <0.05) in the experimental group in comparison to the control group. Between-group analysis showed that all parameters were significantly improved (P <0.05) at post-intervention assessment. Conclusion: Multicomponent exercise training was found to be effective in the elderly with mild cognitive impairment. A combination of exercise can enhance cognitive function, help in the prevention of the decline in cognitive function, and reduce the risk for dementia. Keywords: Mild Cognitive Impairment, Cognition, Trail Making Test, Dementia Trial Registration number: NCT03938051

Executive functions and functioning in women with fibromyalgia.

Fibromyalgia (FM) is a chronic condition characterized by widespread pain that is associated with sleep, emotional, and cognitive disturbances, including in executive functions (EFs). To investigate the relationship between EFs and functionality in women with FM. The study included 17 women with FM, aged between 30 and 59 years, with no history of neurological disease. The EFs were assessed using the Digit Span Subtest (DS), Five Digit Test, Trail Making Test (TMT), Corsi Block-Tapping Task, Hayling Test (HT), and Verbal Fluency Task. Functionality was evaluated through the Fibromyalgia Impact Questionnaire. The Beck Depression Inventory, Hamilton Anxiety Rating Scale, and Brief Pain Inventory were used to measure depression, anxiety, and pain, which were controlled in the statistical analyses. The FM patients showed longer response latency on the HT and TMT. They made fewer errors on part B of the HT, and they performed worse on the DS backward and on the Corsi Block-Tapping Task forward and backward. There were moderate correlations in the expected direction between performance on the Corsi Block-Tapping Task backward and interference at work, as well as between the time to complete part B of the Trail Making Test - B (TMT-B) and fatigue. An unexpected relationship was found between errors on part B of the HT and interference at work. The results suggest lower efficiency in processes such as inhibitory control and cognitive flexibility, difficulties in working memory and non-executive processes such as processing speed. Even with pain, anxiety, and depression controlled, some relationships between EFs and functionality were observed, indicating that these symptoms do not fully explain this relationship. We suggest that cognition, particularly EFs, and broader measures of functionality be considered in the evaluation of FM.

Music and the aging brain - Exploring the role of long-term Carnatic music training on cognition and gray matter volumes.

Aging is a natural process and is often associated with an increased incidence of cognitive impairment. Physical exercise, diet, and leisure activities (music, dance, and art) are some of the lifestyle factors that contribute to healthy aging. The present study aims to explore the differences in cognitive functioning between aging individuals involved in musical activity throughout their lifetime and the ones who were not. Fifty-one healthy elderly individuals (50-80 years of age) residing in an urban locality were selected for the study from the Tata Longitudinal Study of Aging cohort. Participants were divided into two groups: Active musicians trained in Carnatic music for more than five years (n = 18) and age-matched non-musicians (n = 33). Addenbrooke cognitive examination-III, Hindi mental status examination, and trail-making test-B (TMT-B) were used to assess cognitive functioning. A Generalized Linear Regression Model was performed including covariates such as gender, age, and years of education. We also looked at the available brain magnetic resonance imaging data of a subset of our study population to inspect the volumetric differences between musicians and non-musicians. Our results showed that musicians had significantly better visuospatial abilities as compared to non-musicians (P = 0.043). Musicians (130.89 ± 45.16 s) also took less time to complete the TMT-B task than non-musicians (148.73 ± 39.65 s), although it was not a statistically significant difference (P =0.150). In addition, brain imaging data suggested that musicians had increased gray matter volumes in the right precuneus, right post-central gyrus, right medial and superior frontal gyrus, right orbital gyrus, left middle temporal gyrus, left cuneus, left fusiform gyrus, and bilateral cingulate gyrus. Our findings are indicative of music being an important attribute in improving cognitive reserve and predicting cognitive resilience. These findings pave the way to explore the utility of non-pharmacological interventions, such as Music Therapy (especially Carnatic music in the Indian context), as a potential factor for improving cognitive reserve in elderly individuals.

The Effects of Fluoxetine and Agomelatine on Neurocognitive Functions and Sleep in Patients with Major Depressive Disorder.

We aimed to evaluate the effects of 6 weeks of agomelatine versus fluoxetine treatment on cognition and sleep. Agomelatine 25 mg/day and fluoxetine 20 mg/day were administered to major depressive disorder (MDD) patients. Assessments were conducted before the treatment and at the sixth week of treatment via psychometric measures and comprehensive neurocognitive assessments of various functions, including executive skills, attention, memory, verbal fluency, and speed of processing. They both improved the evaluated neurocognitive test scores (P < .05), except for the scores of the Digit Span Test (P > .05), but only fluoxetine significantly improved the scores of the Controlled Oral Word Association Test (P = .018). Only in relation to the subjective sleep quality part of the Pittsburgh Sleep Quality Index (P = .035) and the Trail Making Test-B (TMT-B) (P = .046) was there an important difference between the study groups, and agomelatine showed better effects than fluoxetine in these measures. Both drugs improved the neurocognitive functioning in the participants. However, the better effect of agomelatine in improving the TMT-B scores suggests that it is a suitable option for MDD patients with noticeable executive disturbances.

Deciphering the interplay between psychopathological symptoms, sensorimotor, cognitive and global functioning: a transdiagnostic network analysis.

Understanding the relationship between psychopathology and major domains of human neurobehavioral functioning may identify new transdiagnostic treatment targets. However, studies examining the interrelationship between psychopathological symptoms, sensorimotor, cognitive, and global functioning in a transdiagnostic sample are lacking. We hypothesized a close relationship between sensorimotor and cognitive functioning in a transdiagnostic patient sample. We applied network analysis and community detection methods to examine the interplay and centrality [expected influence (EI) and strength] between psychopathological symptoms, sensorimotor, cognitive, and global functioning in a transdiagnostic sample consisting of 174 schizophrenia spectrum (SSD) and 38 mood disorder (MOD) patients. All patients (n = 212) were examined with the Positive and Negative Syndrome Scale (PANSS), the Heidelberg Neurological Soft Signs Scale (NSS), the Global Assessment of Functioning (GAF), and the Brief Cognitive Assessment Tool for Schizophrenia consisted of trail making test B (TMT-B), category fluency (CF) and digit symbol substitution test (DSST). NSS showed closer connections with TMT-B, CF, and DSST than with GAF and PANSS. DSST, PANSS general, and NSS motor coordination scores showed the highest EI. Sensory integration, DSST, and CF showed the highest strength. The close connection between sensorimotor and cognitive impairment as well as the high centrality of sensorimotor symptoms suggests that both domains share aspects of SSD and MOD pathophysiology. But, because the majority of the study population was diagnosed with SSD, the question as to whether sensorimotor symptoms are really a transdiagnostic therapeutic target needs to be examined in future studies including more balanced diagnostic groups.

Health related quality of life, physical function, and cognitive performance in mechanically ventilated COVID-19 patients: A long term follow-up study

BackgroundSurvivors of severe COVID-19 related respiratory failure may experience durable functional impairments. We aimed at investigating health-related quality of life (HR-QoL), physical functioning, fatigue, and cognitive outcomes in COVID-19 patients who received invasive mechanical ventilation (IMV). MethodsCase-series, prospective, observational cohort study at 18 months from hospital discharge. Patients referring to the Intensive Care Unit (ICU) of Humanitas Research Hospital (Milan, Italy) were recruited if they needed IMV due to COVID-19 related respiratory failure. After 18 months, these patients underwent the 6-min walking test (6MWT), the Italian version of the 5-level EQ-5D questionnaire (EQ-5D-5L), the Functional Assessment of Chronic Illness Therapy – Fatigue questionnaire (FACIT-F), the Trail Making Test-B (TMT-B) and the Montreal Cognitive Assessment-BLIND test (MoCA-BLIND). Results105 patients were studied. The population's age was 60 ± 10 years on average, with a median Frailty Scale of 2 (Hodgson et al., 2017; Carenzo et al., 2021a [2,3]). EQ-VAS was 80 [70–90] out of 100, walked distance was 406 [331–465] meters, corresponding to about 74 ± 19,1% of the predicted value. FACIT-F score was 43 [36–49] out of 52, and MoCa-BLIND score was 19 (DeSalvo et al., 2006; von Elm et al., 2008; Herdman et al., 2011; Scalone et al., 2015 [16-20]) out of 22. The median TMT-B time was 90 [62–120] seconds. We found a possible age and gender specific effect on HR-QoL and fatigue. ConclusionsAfter 18 months from ICU discharge, survivors of severe COVID-19 respiratory failure experience a moderate reduction in HR-QoL, and a severe reduction in physical functioning. Fatigue prevalence is higher in younger patients and in females. Finally, cognitive impairment was present at a low frequency.

The relationship between blast-related mild traumatic brain injury and executive function is moderated by white matter integrity.

Blast-related mild traumatic brain injury (BR mTBI) is a critical research area in recent combat veterans due to increased prevalence of survived blasts. Post-BR mTBI outcomes are highly heterogeneous and defining neurological differences may help in discrimination and prediction of cognitive outcomes. This study investigates whether white matter integrity, measured with diffusion tensor imaging (DTI), could influence how remote BR mTBI history is associated with executive control. The sample included 151 Veterans from the Minneapolis Veterans Affairs Medical Center who were administered a clinical/TBI assessment, neuropsychological battery, and DTI scan as part of a larger battery. From previous research, six white matter tracts were identified as having a putative relationship with blast severity: the cingulum, hippocampal cingulum, corticospinal tract, inferior fronto-occipital fasciculus, superior longitudinal fasciculus and uncinate. Fractional anisotropy (FA) of the a priori selected white matter tracts and report of BR mTBI were used as predictors of Trail-Making Test B (TMT-B) performance in a multiple linear regression model. Statistical analysis revealed that FA of the hippocampal cingulum moderated the association between report of at least one BR mTBI and poorer TMT-B performance (p < 0.008), such that lower FA value was associated with worse TMT-B outcomes in individuals with BR mTBI. No significant moderation existed for other selected tracts, and the effect was not observed with predictors aside from history of BR mTBI. Investigation at the individual-tract level may lead to a deeper understanding of neurological differences between blast-related and non-blast related injuries.

Serum glial cell line-derived neurotrophic factor: a potential biomarker for white matter alteration in Parkinson's disease with mild cognitive impairment.

Mild cognitive impairment (MCI) is a common non-motor manifestation of Parkinson's disease, commonly referred to as PD-MCI. However, there is a lack of comprehensive data regarding the role of glial cell line-derived neurotrophic factor (GDNF) and cerebral white matter damage in the pathogenesis of PD-MCI. The objective of this study is to investigate the association between alterations in GDNF levels and cerebral white matter damage in individuals diagnosed with PD-MCI, as well as to explore their potential involvement in cognitive progression. Neuropsychological assessments were conducted on 105 patients with Parkinson's disease and 45 healthy volunteers to examine various cognitive domains. An enzyme-linked immunosorbent assay (ELISA) was employed to measure serum levels of GDNF. Additionally, all participants underwent 3.0T magnetic resonance imaging (MRI) to acquire diffusion tensor images (DTI), and a voxel-based analysis (VBA) approach was utilized to compare the fractional anisotropy (FA) values of white matter in the brain. There was a significant correlation between the right corpus callosum, right cingulate gyrus, and the Digit Span Backward Test (DSB-T) as well as the Trail Making Test A (TMT-A), both of which assess attention and working memory functions. The left internal capsule exhibited a significant correlation with the Trail Making Test B (TMT-B) and the Clock Drawing Test (CDT), which evaluate executive function. Additionally, the right cingulate gyrus showed a significant association with scores on the Auditory Verbal Learning Test-HuaShan (AVLT-H), assessing memory function. Abnormal fiber structures that demonstrated significant correlations with serum GDNF levels included the left internal capsule, left corticospinal tract, right corpus callosum, and right cingulate gyrus. The decrease in serum GDNF levels among PD-MCI patients exhibiting impairments in attention and working memory function was significantly correlated with alterations in the corpus callosum (knee) and posterior cingulate gyrus. Furthermore, the reduction of serum GDNF levels in PD-MCI patients with impaired executive function is associated with changes in the internal capsule (forelimb) projection fibers. Additionally, the decline of serum GDNF levels in PD-MCI patients experiencing memory function impairment is related to alterations in the right cingulate gyrus.

Relationship between Life’s essential 8 scores and cognitive decline in the ELSA‐Brasil cohort

AbstractBackgroundLifestyle and cardiovascular risk factors were combined in the Life’s simple 7 (LS7) index to evaluate cardiovascular health, and this index has been previously associated with cognitive decline. The Life’s Essential 8 (LE8) is an update of LS7, which now includes sleep health as an additional factor. We aimed to verify the association between LE8 and cognitive decline during X years of follow‐up in 11,390 participants from a racially diverse sample.MethodIn this cohort study, LE8 score was measured based on diet, physical activity, nicotine exposure, sleep health, BMI, blood lipids, blood glucose, and blood pressure. Cognition was assessed in three waves four years apart from each other using the CERAD word list, semantic and phonemic verbal fluency, Trail Making Test B (TMT‐B), and a global composite score. We used inverse probability weighting to account for mortality and attrition bias and linear mixed models with random intercepts and slopes to verify the association between baseline LE8 score and cognitive decline. We tested the interaction between LE8 and age, sex, and race.ResultThe mean sample age was 51.4±8.9yo at baseline, 56% were women, and 43% Black. Higher baseline LE8 scores were associated with slower memory (β = 0.001; 95%CI = 0.000,0.002; p = 0.013), verbal fluency (β = 0.001; 95%CI = 0.000,0.002; p = 0.003), executive function (β = 0.004; 95%CI = 0.003,0.005; p&lt;0.001), and global cognitive decline (β = 0.001; 95%CI = 0.001,0.002; p&lt;0.001) (Table 1). Age (p &lt; 0.001), sex (p &lt; 0.001), and race (p &lt; 0.001) were modifiers of the association between LE8 score and global cognitive decline (Figure 1), suggesting that in different socioeconomic profiles, this association might have different manifestations.ConclusionHigher baseline LE8 scores were associated with global and domain‐specific decline after eight years of follow‐up. Age, sex, and race were modifiers of this association, suggesting that it might differ based on the participant’s socioeconomic profile.

Optimal cardiovascular health is associated with slower cognitive decline.

Life's Simple 7, a lifestyle and cardiovascular index associated with cognition, has been updated to Life's Essential 8 (LE8) to include sleep. LE8 has been related to cardiovascular outcomes but its association with cognition is unclear. In this longitudinal analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), LE8 score was based on health behaviors (diet, physical activity, nicotine exposure, and sleep health) as well as health-related factors (body mass index, blood lipids, blood glucose, and blood pressure). Cognition was assessed in three waves, 4 years apart, using the Consortium to Establish a Registry for Alzheimer's Disease - Word List, semantic and phonemic verbal fluency, the Trail-Making Test B (TMT-B), and a global composite score. We used linear mixed-model analysis, inverse probability weighting, and interaction analysis. At baseline, the mean age of the study cohort was 51.4 ± 8.9 years, 56% were women, and 53% were White. Higher baseline LE8 scores were associated with slower decline in global cognition (β = 0.001, 95% confidence interval [CI] 0.001, 0.002; p < 0.001), memory (β = 0.001, 95% CI 0.000, 0.002; p = 0.013), verbal fluency (β = 0.001, 95% CI 0.000, 0.002; p = 0.003), and TMT-B (β = 0.004, 95% CI 0.003, 0.005; p < 0.001). This association was mainly driven by LE8 health factors, particularly blood glucose and blood pressure. Age, sex, and race were modifiers of the association between LE8 and global cognitive decline (p < 0.001), suggesting it was more pronounced in older, male, and Black participants. Higher baseline LE8 scores were associated with slower global and domain-specific cognitive decline during 8 years of follow-up, mainly due to health factors such as blood glucose and blood pressure. Sociodemographic factors were modifiers of this association.

Association between pain intensity and cognitive function in primary headache

Background: Patients suffering from primary headaches such as migraine, tension-type headache, and cluster headache frequently report cognitive problems, particularly with attention and memory. The aim of this study was to see if there was a link between pain intensity and cognitive function in people who had primary headaches. Methods: This cross-sectional study included 69 primary headache patients (37 migraines, 27 tension-type headaches and 5 cluster headaches; age range 18–80 year). Migraine, tension-type headache and cluster headache diagnosis were determined according to the International Classification of Headache Disorders 3rd edition beta version (ICHD-3 beta) diagnostic criteria. All eligible subjects underwent cognitive function examination using Montreal Cognitive Assessment Indonesian version (MoCA-INA), Trail Making test A (TMT-A), Trail Making test B (TMT-B), Trail Making test C (TMT-C), Forward Digit Span and Backward Digit Span. The intensity of pain was assessed using Numeric Rating Scale (NRS). Results: There were 69 primary headache patients included in this study, 52 (75.4%) patients had abnormal MoCA-INA, 52(75.4%) patients had abnormal Forward Digit Span and 48(69.6%) patients had abnormal Backward Digit Span. There was significant correlation between pain intensity and cognitive function in migraine, TTH and cluster headaches patients. The MoCA-INA, Forward Digit Span and Backward Digit Span had negative correlations with pain intensity, whereas TMT A-time, TMT A-error, TMT B-time and TMT B-error had positive correlation. Conclusion: There were significant associations between pain intensity of and cognitive function in primary headaches with p&amp;lt;0.05. It is suggested that the more severe pain intensity, the more impair of cognitive function.

Impact of insulin resistance on mild cognitive impairment in type 2 diabetes mellitus patients with non-alcoholic fatty liver disease

AimsInsulin resistance (IR) is a pivotal factor in the pathogenesis of type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Nevertheless, the impact of IR on cognitive dysfunction in T2DM patients with NAFLD remains inadequately understood. We aim to investigate the effect of IR on mild cognitive impairment (MCI) in T2DM individuals with NAFLD.Materials and methods143 T2DM individuals were categorized into Non-MCI and MCI groups, as well as Non-NAFLD and NAFLD groups. Clinical parameters and cognitive preference test outcomes were compared. Correlation and regression analyses were executed to explore the interconnections between IR and cognitive details across all T2DM patients, as well as within the subgroup of individuals with NAFLD.ResultsIn comparison to the Non-MCI group, the MCI group displayed elevated HOMA-IR levels. Similarly, the NAFLD group exhibited higher HOMA-IR levels compared to the Non-NAFLD group. Additionally, a higher prevalence of MCI was observed in the NAFLD group as opposed to the Non-NAFLD group. Notably, HOMA-IR levels were correlated with Verbal Fluency Test (VFT) and Trail Making Test-B (TMTB) scores, both related to executive functions. Elevated HOMA-IR emerged as a risk factor for MCI in the all patients. Intriguingly, increased HOMA-IR not only correlated with TMTB scores but also demonstrated an influence on TMTA scores, reflecting information processing speed function in patients with NAFLD.ConclusionIR emerges as a contributory factor to cognitive dysfunction in T2DM patients. Furthermore, it appears to underlie impaired executive function and information processing speed function in T2DM individuals with NAFLD.

Trail making test B in postoperative delirium: a replication study

BackgroundThe Trail Making Test B (TMT-B) is indicative of cognitive flexibility and several other cognitive domains. Previous studies suggest that it might be associated with the risk of developing postoperative delirium, but evidence is limited and conflicting. We therefore aimed to replicate the association of preoperative TMT-B results with postoperative delirium. MethodsWe included older adults (≥65 yr) scheduled for major surgery and without signs of dementia to participate in this binational two-centre longitudinal observational cohort study. Presurgical TMT-B scores were obtained. Delirium was assessed twice daily using validated instruments. Logistic regression was applied and the area under the receiver operating characteristic curve calculated to determine the predictive performance of TMT-B. We subsequently included covariates used in previous studies for consecutive sensitivity analyses. We further analysed the impact of outliers, missing or impaired data. ResultsData from 841 patients were included and of those, 151 (18%) developed postoperative delirium. TMT-B scores were statistically significantly associated with the incidence of postoperative delirium {odds ratio per 10-s increment 1.06 (95% confidence interval [CI] 1.02–1.09), P=0.001}. The area under the receiver operating characteristic curve was 0.60 ([95% CI 0.55–0.64], P<0.001). The association persisted after removing 21 outliers (1.07 [95% CI 1.03–1.07], P<0.001). Impaired or missing TMT-B data (n=88) were also associated with postoperative delirium (odds ratio 2.74 [95% CI 1.71–4.35], P<0.001). ConclusionsThe TMT-B was associated with postoperative delirium, but its predictive performance as a stand-alone test was low. The TMT-B alone is not suitable to predict delirium in a clinical setting. Clinical trial registrationNCT02265263. (https://clinicaltrials.gov/ct2/show/results/NCT02265263).

How does apathy impact exploration-exploitation decision-making in older patients with neurocognitive disorders?

Apathy is a pervasive clinical syndrome in neurocognitive disorders, characterized by a quantitative reduction in goal-directed behaviors. The brain structures involved in the physiopathology of apathy have also been connected to the brain structures involved in probabilistic reward learning in the exploration-exploitation dilemma. This dilemma in question involves the challenge of selecting between a familiar option with a more predictable outcome, and another option whose outcome is uncertain and may yield potentially greater rewards compared to the known option. The aim of this study was to combine experimental procedures and computational modeling to examine whether, in older adults with mild neurocognitive disorders, apathy affects performance in the exploration-exploitation dilemma. Through using a four-armed bandit reinforcement-learning task, we showed that apathetic older adults explored more and performed worse than non-apathetic subjects. Moreover, the mental flexibility assessed by the Trail-making test-B was negatively associated with the percentage of exploration. These results suggest that apathy is characterized by an increased explorative behavior and inefficient decision-making, possibly due to weak mental flexibility to switch toward the exploitation of the more rewarding options. Apathetic participants also took longer to make a choice and failed more often to respond in the allotted time, which could reflect the difficulties in action initiation and selection. In conclusion, the present results suggest that apathy in participants with neurocognitive disorders is associated with specific disturbances in the exploration-exploitation trade-off and sheds light on the disturbances in reward processing in patients with apathy.

A - 135 The Relationship between Executive Functioning and Psychological Outcomes Post Mild Traumatic Brain Injury.

Cognitive outcomes post mTBI are well-researched, but the relationship between executive functioning and psychiatric outcomes have received much less attention. This study explored emotional outcomes of individuals who sustained a mTBI and the potential relationship to executive functioning. A research study by Zainal & Newman (2021) found that older adults with severe depression and anxiety experienced increased inflammation, which potentially resulted in reduced executive functioning. mTBI is also associated with inflammation - potentially providing a compound effect or interaction. Additional research is needed to clarify the potential compound impact of mTBI and depression and anxiety might have upon cognition. 185 individuals were extracted from an archival clinical database of neuropsychological evaluations of individuals noting deficits following mTBI. Executive functioning was measured using Trail Making Test B (TMT-B). Emotional distress was assessed using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). A Multiple Linear Regression was used to assess the impact of emotional distress (BAI and BDI) upon executive functioning performance (TMT-B) in this population. Regression analysis identified a relationship between emotional distress upon executive functioning that approached significance (p = 0.057; r^2 = 0.031). These findings are consistent with previous literature suggesting a modest relationship between emotional distress and executive functioning - this time in a sample with mTBI population. Specific injury, resilience, and other confounding factors to clarify the actual risk and relationship is warranted.

B - 64 Association of Perceived Stress during the COVID-19 Pandemic on Cognitive Performance in HIV+ Adults.

Stress may impact cognitive ability, and perceived stress may be a modifiable risk factor for cognitive impairment. This study investigates the potential impact of perceived stress levels on cognitive test performance in a NYC cohort of people living with HIV (PLWH), assessed during the COVID-19 pandemic. 124 racially-diverse PLWH participating in a longitudinal cohort completed comprehensive face-to-face neurocognitive test batteries between August 2020 and February 2023 (Mage = 61.22). Self-reported stress was assessed using the Perceived Stress Scale-14, and a median split (value of 18) was used to divide the sample into high and low stress groups. One-way ANOVAs were used to evaluate differences in cognitive performance based on stress grouping. Significant differences between high and low stress groups were found in: Trail Making Test-A (TMT-A), F(1,104) = 3.962,p = 0.049; Trail Making Test-B (TMT-B), F(1,80) = 7.106,p = 0.009; Paced Auditory Serial Addition Test (PASAT), F(1,80) = 7.096,p = 0.009; and Symbol Search (SS), F(1,102) = 5.280,p = 0.024. Participants in the high stress group had lower performance on TMT-A (M = 48.78, SD = 13.47), TMT-B(M = 49.56, SD = 13.92), PASAT (M = 43.07, SD = 12.57), and SS (M = 44.85, SD = 11.76) compared to the low stress group (M = 53.71, SD = 11.87; M = 57, SD = 10.72; M = 50.20, SD = 11.62; M = 49.78, SD = 9.85; respectively). Individuals reporting higher levels of stress during the COVID pandemic had reduced performance on tasks assessing information processing speed, executive functioning, and attention. This suggests that higher perceived stress levels and ambient stressors (such as the pandemic) may influence cognitive functioning.

Psychomotor slowing in schizophrenia is associated with cortical thinning of primary motor cortex: A three cohort structural magnetic resonance imaging study

Psychomotor slowing (PS) is characterized by slowed movements and lower activity levels. PS is frequently observed in schizophrenia (SZ) and distressing because it impairs performance of everyday tasks and social activities. Studying brain topography contributing to PS in SZ can help to understand the underlying neurobiological mechanisms as well as help to develop more effective treatments that specifically target affected brain areas. Here, we conducted structural magnetic resonance imaging (sMRI) of three independent cohorts of right-handed SZ patients (SZ#1: n = 72, SZ#2: n = 37, SZ#3: n = 25) and age, gender and education matched healthy controls (HC) (HC#1: n = 40, HC#2: n = 37, HC#3: n = 38). PS severity in the three SZ cohorts was determined using the Positive and Negative Syndrome Scale (PANSS) item #G7 (motor retardation) and Trail-Making-Test B (TMT-B). FreeSurfer v7.2 was used for automated parcellation and segmentation of cortical and subcortical regions. SZ#1 patients showed reduced cortical thickness in right precentral gyrus (M1; p = 0.04; Benjamini-Hochberg [BH] corr.). In SZ#1, cortical thinning in right M1 was associated with PANSS item #G7 (p = 0.04; BH corr.) and TMT-B performance (p = 0.002; BH corr.). In SZ#1, we found a significant correlation between PANSS item #G7 and TMT-B (p = 0.005, ρ=0.326). In conclusion, PANSS G#7 and TMT-B might have a surrogate value for predicting PS in SZ. Cortical thinning of M1 rather than alterations of subcortical structures may point towards cortical pathomechanism underlying PS in SZ.

Indoxyl Sulphate Levels and Its Relation with Executive Function in Routine Hemodialysis Patients

Executive function is a crucial cognitive domain that can be adversely affected by various toxic substances, including the uremic toxin indoxyl sulfate. Although it's known that indoxyl sulfate has harmful effects on intra or extra-kidney organs, its impact on executive function remains unclear. This study aimed to evaluate indoxyl sulfate levels in patients with chronic kidney disease (CKD) undergoing hemodialysis and to understand its correlation with executive function impairments. This observational cross-sectional study was conducted at the Dr. M. Djamil General Hospital Padang Hemodialysis Unit from March to July 2022; 60 patients undergoing hemodialysis and 20 healthy controls participated. Executive function was assessed using the Trail Making Test B (TMT-B). Indoxyl sulfate levels were quantified using an ELISA assay with the Assay Genie kit. The Mann-Whitney test set statistical significance at a p&lt;0.05. The average age of the subjects was 51.4±11.4 years, with 53.3% being male. The mean indoxyl sulfate levels were considerably higher in the CKD group (118.79 ng/mL, range: 11–1,709 ng/mL) compared to the control group (6.028±1.829 ng/mL), with a significant difference (p&lt;0.001). Impaired executive function was observed in 75% of the CKD patients. The average indoxyl sulfate level was 165.12 ng/mL (range: 29–1709 ng/mL) in the impaired executive function group and 71.22 ng/mL (range: 11–333 ng/mL) in the group with normal executive function, indicating a significant difference (p=0.013). Patients with CKD undergoing hemodialysis exhibit elevated serum indoxyl sulfate levels compared to healthy individuals. Moreover, CKD patients with impaired executive function have notably higher indoxyl sulfate levels than those with normal executive function. Further research is needed to elucidate the mechanistic links between indoxyl sulfate and cognitive impairments.