Measures Of Verbal Fluency Research Articles

68 Preliminary Evidence of a Therapeutic Effect of Electrical Neuromodulation on Cognitive Deficits in Patients with Mild Cognitive Impairment

Objective:Episodic memory functioning is distributed across two brain circuits, one of which courses through the dorsal anterior cingulate cortex (dACC). Thus, delivering non-invasive neuromodulation technology to the dACC may improve episodic memory functioning in patients with memory problems such as in amnestic mild cognitive impairment (aMCI). This preliminary study is a randomized, double-blinded, sham-controlled clinical trial to examine if high definition transcranial direct current stimulation (HD-tDCS) can be a viable treatment in aMCI.Participants and Methods:Eleven aMCI participants, of whom 9 had multidomain deficits, were randomized to receive 1 mA HD-tDCS (N=7) or sham (N=4) stimulation. HD-tDCS was applied over ten 20-minute sessions targeting the dACC. Neuropsychological measures of episodic memory, verbal fluency, and executive function were completed at baseline and after the last HD-tDCS session. Changes in composite scores for memory and language/executive function tests were compared between groups (one-tailed t-tests with a = 0.10 for significance). Clinically significant change, defined as > 1 SD improvement on at least one test in the memory and non-memory domains, was compared between active and sham stimulation based on the frequency of participants in each.Results:No statistical or clinically significant change (N-1 X2; p = 0.62) was seen in episodic memory for the active HD-tDCS (MDiff = 4.4; SD = 17.1) or sham groups (MDiff = -0.5; SD = 9.7). However, the language and executive function composite showed statistically significant improvement (p = 0.04; MDiff = -15.3; SD = 18.4) for the active HD-tDCS group only (Sham MDiff = -5.8; SD = 10.7). Multiple participants (N=4) in the active group had clinically significant enhancement in language and executive functioning tests, while nobody in the sham group did (p = 0.04).Conclusions:HD-tDCS targeting the dACC had no direct benefit for episodic memory deficits in aMCI based on preliminary findings for this ongoing clinical trial. However, significant improvement in language and executive function skills occurred in response to HD-tDCS, suggesting HD-tDCS in this configuration has promising potential as an intervention for language and executive function deficits in MCI.

30 Socially Responsible Neuropsychology (SRN) in Action: The Role of Neuropsychology in Migraine Care Among Bilingual Latina/o Patients

Objective:Migraine is one of the leading causes of disability worldwide and a recognized contributor to health disparities with public health implications. Although migraine is a highly prevalent neurological condition, research on the cognitive manifestations of migraines is inconsistent. Studies have confirmed neurocognitive compromise during the presence of a migraine attack, with it’s onset and frequency being associated with greater cognitive decline. Research on the cognitive implications of migraines in underserved communities is scarce. The American Migraine Prevalence and Prevention Study (2015) found that the prevalence of chronic migraines was the highest amongst Hispanic females compared to White females. Latina/os are 50% less likely to receive a migraine diagnosis and adequate headache medication when compared to non-Hispanic White patients. Latina women were more likely to report somatic symptoms than White and African American participants (F=8.96; p>0.001) (Liefland et al., 2014). Somatoform disorders are often diagnosed amongst Latina/os to account for medical unexplained symptoms, and if misdiagnosed can be stigmatizing and detrimental to treatment. We illustrate the critical role that neuropsychologists play by utilizing Socially Responsible Neuropsychology (SRN), a theoretical framework that promotes equitable and precise neuropsychological care to reduce misdiagnosis, elucidate cognitive implications, and address the complex medical needs of Latina/o/ patients. Given the limited literature on migraines and neurocognitive functioning, our objective is to present two case studies to illustrate the neuropsychological implications among bilingual Latina/o with chronic migraines.Participants and Methods:Two highly educated Latina/o women, ages 39 and 41 years old, with chronic migraines, cognitive decline, diagnoses and a history of somatization symptoms. The onset of symptoms was gradual, worsening in intensity and frequency, along with notable motor symptoms (e.g., paralysis, weakness, numbness, bilateral tremors), photophobia, and phonophobia. Their cognitive complaints were conceptualized as part of a somatoform presentation by their providers.Results:The SRN model guided clinical decision-making to establish reliable normative anchors to identify relative impairment compared to premorbid estimates. Testing was completed in English after establishing language dominance via English and Spanish measures of verbal fluency. Cognitive profiles identified declines in attention, processing speed, language, perceptual reasoning, visual memory, executive functioning, motor functioning, and notable decline in their functioning over several years. The neuropsychological profile discounted the presence of a somatoform disorder. One case was diagnosed with an Unspecified Mild Neurocognitive Disorder, while the other case met criteria for a Major Neurocognitive Disorder due to Multiple Etiologies (i.e., vascular contribution, migraines, history of other contributions- choking episode).Conclusions:Given the decline in each profile, it was hypothesized that the patients’ utilization of compensatory strategies and higher education may have masked the onset of symptoms. These complex cases highlight the need for comprehensive neuropsychological evaluations that are culturally and linguistically responsive to boost the sensitivity of accurate diagnosis. The ability to objectively capture neurocognitive decline offers a unique opportunity to enhance treatment, which would have otherwise remained undetected and untreated. The SRN model enhanced diagnostic considerations, treatment planning, and allowed for advocacy strategies to improve the quality of life, and access to culturally/linguistically appropriate resources.

50 Pain severity as a predictor of verbal fluency functioning after COVID-19 illness

Objective:Published results focusing on language assessment in acutely recovered COVID-19 patients have shown communication problems in this group, including significant cognitive-linguistic disruptions in verbal fluency (Cummings, 2022). Extant research also indicates that poorer health-related outcomes, such as reduced physical functioning and quality of life, co-occur with cognitive difficulties post-COVID-19 infection (Mendez et al., 2021; Tabacof et al., 2022). Understanding what factors may worsen the impact of COVID-19 on cognition, and aspects of language function specifically, is necessary to determine who is at greatest risk of adverse outcomes following infection. Our goal was to examine the effect of health-related outcomes on language abilities, specifically verbal fluency, post-COVID-19 infection.Participants and Methods:37 adults 19 years and older (M age = 38.78, 67.5% female, 92.5%> high school education) were recruited from British Columbia and Ontario, Canada. Participants provided documentation indicating they had had a COVID-19 infection at least 3 months prior to participation. Participants completed a series of online questionnaires, including the Short Form Health Survey (SF-20), to measure aspects of health-related quality of life. The SF-20 measures dimensions of functioning (physical, social, role) and well-being (mental health, health perception, pain). For each parameter except pain, higher scores indicate better functioning/well-being; for pain higher scores indicate greater pain levels. Participants also completed neuropsychological tests, including measures of verbal fluency, via teleconference. Animals and F-A-S total scores were combined to represent verbal fluency (semantic and phonemic, respectively) performance. To assess the impact of health outcomes on verbal fluency performance, hierarchical regression analyses were conducted. The six SF-20 subscale scores were entered as predictors and verbal fluency score (sum) as the outcome. Age and sex (Male/Female) were controlled for in the model.Results:Age and sex were not significantly related to verbal fluency scores in our sample. After controlling for these demographics, the overall model including SF-20 subscales did not significantly predict fluency performance (F (8, 28) = 1.04, p = .433). However, Pain scores did individually predict verbal fluency performance (B = 5.60, t = 2.53, p = <.05). Unexpectedly, pain ratings were positively associated with fluency scores, such that each increase in pain rating (e.g., “none” to “mild”) was associated with a fluency score increase of 5.60 points (i.e., 5.6 more words stated across administered tasks).Conclusions:These preliminary findings suggest that participants’ self-reported pain severity was positively associated with verbal fluency task performance in our sample (i.e., greater pain severity predicting better fluency). These findings are contrary to substantial evidence showing the deleterious effects of pain on cognitive functions in other populations (Khera & Rangasamy, 2021). It is possible that findings may be explained by a potential unknown intervening variable not included in our model. This is the first study to our knowledge to examine associations between experienced pain and verbal fluency performance post-COVID-19 infection. It will be important for future work to not only utilize more robust measures of pain experiences and explore more areas of cognition and language, but also to employ larger samples and examine a broader set of covariates.

85 Use of Embedded Performance Validity Measures Using Verbal Fluency Tests in a Clinical Sample of Military Veterans

Objective:As neuropsychologists aim to collect valid data, maximize the utility of assessments, make effective use of time, and best serve patient populations, measurement of performance validity is considered a critical issue for the field. As effort may vary across an evaluation, including performance validity tests (PVTs) throughout the assessment is important. Incorporating embedded PVTs in addition to free standing PVTs can be particularly useful in this regard. COWAT and animal naming are commonly administered verbal fluency measures. While there have been past investigations into their potential for detecting invalid performance, they are limited, and more research is needed. Perhaps most promising, Sugarman and Axelrod (2015) described a logistic regression derived formula utilizing the combined raw scores of COWAT and animal naming. The current study aimed to investigate the use of embedded PVTs within COWAT and animal naming to provide further support for the use of embedded PVTs in these measures.Participants and Methods:All subjects were from a mixed clinical sample comprising military veterans from two VA Medical Centers in the northeast U.S., who were referred for neuropsychological evaluation. Subjects deemed credible had zero PVT failures. Subjects were considered non-credible performers if they failed at least two out of a possible eight PVTs administered. Subjects who failed one PVT were excluded from the study (n = 53). The final sample consisted of 116 individuals with credible performance (Mean Age = 35.5, SD = 8.8; Mean Edu = 13.6, SD = 2; Mean Est. IQ = 106, SD = 7.9) and 94 individuals with psychometrically determined non-credible performance (Mean Age = 38.5, SD = 9.4; Mean Edu = 113, SD = 2.1; Mean Est. IQ = 101, SD = 8.7). Performance of COWAT and animals in detecting non-credible performances was evaluated through calculation of classification accuracy statistics and use of the logistic regression formulas reported in Sugarman and Axelrod (2015).Results:For COWAT, the optimal cutoff was a raw score of <27 (specificity = 89%; sensitivity = 31%), and a T-score of <35 (specificity = 92%; sensitivity = 31%). For animal naming, optimal cutoffs were <16 for raw score (specificity = 92%, sensitivity = 38%) and <37 for T-score (specificity = 91%; sensitivity = 33%). The logistic regression formula based on raw scores for both COWAT and animal naming was inadequately sensitive at the recommended cutoff in this sample, but a coefficient of > .28 was revealed to be optimal (91% specificity; 42% sensitivity). When the formula for T-scores was used, a coefficient of > .38 was optimal (91% specificity; 28% sensitivity).Conclusions:Results of the current research suggest that PVTs embedded within the commonly administered COWAT and animal naming verbal fluency tests can effectively detect low effort, in concordance with generally accepted standards. A logistic regression formula using raw scores in particular appears to be most effective, consistent with findings reported by Sugarman and Axelrod (2015).

B - 28 Health Literacy Is a Better Predictor of Neurocognitive Performance on Verbal Fluency Tasks than Race.

Neuropsychologists have historically used demographically-adjusted normative data to account for race-associated differences in neurocognitive performance. Using race-based norms has become increasingly controversial, particularly following the National Football League 2014 concussion settlement, as such practices may perpetuate systemic inequities and biases. Adjusting for the effects of social determinants of brain health may be an alternative approach to race-based norms. A measurable social determinant of brain health that disproportionately affects Black, Indigenous, and People of Color (BIPOC) is health literacy, which has been well-associated with verbal fluency performance. The current study evaluated the incremental value of health literacy and race to predict neurocognitive performance on a verbal fluency measure. The sample comprised 71 BIPOC and 45 White participants (ages 18-87) who underwent an outpatient neuropsychological evaluation. Verbal fluency was measured via the F-A-S and Controlled Animal Word Association Test. Health literacy was measured via the Short Assessment of Health Literacy-English. Demographics included age, sex, race, and years of formal education. Race was categorized as White or BIPOC since binary classification is common in race-based norms. Hierarchical regression analysis revealed that the combination of race and health literacy have a significantly larger effect on verbal fluency performance than race alone (p < 0.001). Including this interaction in the model explained 13.07% more variance in neurocognitive performance than race as an independent predictor (R-squared increased from 4.83% to 17.90%). These findings suggest health literacy may be more helpful for accounting for group differences in neurocognitive performance than race when developing normative data.

A - 103 Persistent Longitudinal Differences in Cognition between Men and Women with Parkinson's Disease.

Cross-sectional studies of Parkinson's disease (PD) patients have identified cognitive differences between men with PD (MPD) and women with PD (WPD) at single time points. WPD generally outperform MPD on global cognition, memory, executive functions, verbal fluency, and processing speed measures, whereas MPD perform better on visuospatial tasks. Little is known about sex-based differences in PD cognition longitudinally. This study examined neurocognitive profiles in WPD, MPD, and health controls (HC) over three years. Participants were 26 PD (16 WPD, 10 MPD) and 51 HC (28 females, 23 males). Age (M = 60.70, SD = 7.89) and education (M = 15.07, SD = 2.77) were consistent across groups. PD mean disease duration was 4.04years (SD = 4.56), with samples matched for disease duration and severity. At baseline and three-year follow-up, neuropsychological measures of attention, memory, language, visuospatial, and executive functions were completed. Repeated measures ANOVAs with Bonferroni correction examined differences between samples over time controlling for age and education. In both PD and control groups, women outperformed men on measures of verbal learning and verbal memory over time. WPD also performed significantly better than MPD in verbal and visual working memory and semantic fluency tasks at baseline and at 3-year follow-up. In contrast, MPD outperformed WPD on visuospatial perception at both time points, with remaining measures being similar. Results build upon earlier cross-sectional studies and confirm that WPD have persisting, comparative strengths in verbal memory, working memory and semantic fluency in contrast to visuospatial perception for MPD in early disease stages.

H - 55 Socially Responsible Neuropsychology (SRN) in Action: the Role of Neuropsychology in Autism Spectrum Disorder (ASD) Care, a Case Study of a Bilingual Latino Patient.

Latinx children with ASD are diagnosed 1-3years later than their White counterparts and typically present with more severe symptoms at the time of assessment. Systemic barriers include language barriers, limited literacy about ASD, mental health stigma, mistrust in healthcare. Latinx children are at greater risk of misdiagnosis, delayed access to special education, limiting early intervention. Within neuropsychology, there are limited bicultural/bilingual neuropsychologists trained in autism evaluations, few Spanish ASD diagnostic tools, no bilingual norms, and little understanding regarding neuropsychologists' role in providing autism evaluations to culturally/linguistically diverse children. This social injustice results in unmet needs and inequities in ASD care for Latinx children. We aim to illustrate how the SRN model increases equitable ASD care amongst Latinx children. SRN model was utilized in 11-year-old bilingual Latinx male by applying culturally responsive interview to identify systemic barriers and language use, and a model of language proficiency testing. Testing was primarily in English after verbal fluency measures established language dominance. Clinical decision making identified the need for autism evaluation using Autism Diagnostic Observation Schedule (ADOS-2). His cognitive profile showed word reading and motor inefficiencies. ADOS-2 identified deficits in communication, reciprocal social interaction, restricted and repetitive behavior. Neuropsychological assessment confirmed ASD and Developmental Coordination Disorder diagnosis. His unremarkable neurocognitive profile suggested compensatory strategies may have masked symptoms. This case highlights need for bicultural/bilingual neuropsychologists with experience providing comprehensive ASD evaluations to practice from equitable framework, using the SRN model to enhance early detection, treatment recommendations, and advocacy for access to culturally/linguistically appropriate resources.

SAT143 Domains Of Cognitive Dysfunction In Patients With Post-Bariatric Hypoglycemia

Abstract Disclosure: A.M. Puleio: None. A.L. Sheehan: None. G.J. Musen: None. M. Patti: Consulting Fee; Self; AstraZeneca, Fractyl Laboratories. Other; Self; Eiger Pharmaceuticals - Consulting, MBX Biosceinces - Consulting, Hanmi Pharmaceutical - Consulting, Recordati - Consulting. Objective: Bariatric surgery is a highly effective treatment for obesity and associated comorbidities. Studies suggest bariatric surgery may result in improved cognitive function and brain volume in parallel with improved cardiometabolic function. However, some post-bariatric individuals develop post-bariatric hypoglycemia (PBH), which can be frequent and severe. Whether repeated episodes of hypoglycemia can impact cognitive function in PBH is unknown. The objective of this pilot study was to determine whether individuals with PBH display reduced cognitive function compared to surgical non-hypoglycemic counterparts. Inclusion/Exclusion Criteria: Adults aged 18-70 years, with a history of Roux-en-Y gastric bypass (RYGB), without a current diagnosis of diabetes, were recruited and enrolled into two groups: individuals with PBH (PBH+), and asymptomatic individuals with history of prior RYGB without hypoglycemia (RYGB non-hypo). Individuals with a history of traumatic brain injury or cerebrovascular accident, active treatment with any medications for diabetes (other than acarbose), active alcohol/substance abuse, known neuroendocrine tumor, or active depression (score &amp;gt;4 for Patient Health Questionnaire-2 (PHQ-2)) were excluded. Methods: Fourteen adults (PBH+, n=7; RYGB non-hypo, n=7) completed assessments of executive function (Delis Kaplan Executive Function System), working memory and attention (Wechsler Memory Scale Third Edition), as well as psychomotor speed (grooved pegboard). Premorbid intelligence was estimated using the National Adult Reading Test. Results: Individuals with PBH+ displayed significantly decreased performance on tests of category fluency (p &amp;lt;0.01), category switching (p &amp;lt;0.01), and category switching accuracy (p &amp;lt;0.01), compared to those in the RYGB non-hypo group. Performance in other verbal fluency measures, including the first (p =0.03) and third interval (p = 0.045), were significantly lower in PBH+ vs. RYGB non-hypo. All other assessments did not differ, including the estimation of premorbid intelligence (p=0.14). Conclusion: PBH+ individuals may be at greater risk for cognitive impairment compared to RYGB non-hypo individuals, as suggested by the impaired semantic processing and cognitive flexibility, as well as greater difficulty initiating and sustaining word retrieval in PBH+. Groups did not differ in cognitive assessments of psychomotor speed, memory, attention, and executive function. Clinicians should be alert for symptoms of cognitive dysfunction in PBH+ patients and consider neurocognitive testing in parallel with assessment of glycemic control, as well as other potential cognitive risk factors. Larger, longitudinal trials are necessary to further elucidate the impact of hypoglycemia on cognition and risk of dementia in patients with PBH. Presentation: Saturday, June 17, 2023

Normative Data for Single-Letter Controlled Oral Word Association Test in Older White Australians and Americans, African-Americans, and Hispanic/Latinos.

The Controlled Oral Word Association Test (COWAT) is a commonly used measure of verbal fluency. While a normal decline in verbal fluency occurs in late adulthood, significant impairments may indicate brain injury or diseases such as Alzheimer's disease. Normative data is essential to identify when test performance falls below expected levels based on age, gender, and education level. This study aimed to establish normative performance data on single-letter COWAT for older community-dwelling adults. Over 19,000 healthy men and women, without a diagnosis of dementia or a Modified Mini-Mental State Examination score below 77/100, were recruited for the ASPREE trial. Neuropsychological assessments, including the COWAT with letter F, were administered at study entry. Median participant age was 75 years (range 65-98), with 56.5% being women. The majority of participants had 9-11 years of education in Australia and over 12 years in the U.S. The COWAT performance varied across ethno-racial groups and normative data were thus presented separately for 16,335 white Australians, 1,084 white Americans, 896 African-Americans, and 316 Hispanic/Latinos. Women generally outperformed men in the COWAT, except for Hispanic/Latinos. Higher education levels consistently correlated with better COWAT performance across all groups, while the negative association with age was weaker. This study provides comprehensive normative data for the COWAT stratified by ethno-racial groups in Australia and the U.S., considering age, gender, and education level. These norms can serve as reference standards for screening cognitive impairments in older adults in both clinical and research settings.

Cannabis use may attenuate neurocognitive performance deficits resulting from methamphetamine use disorder.

Methamphetamine and cannabis are two widely used, and frequently co-used, substances with possibly opposing effects on the central nervous system. Evidence of neurocognitive deficits related to use is robust for methamphetamine and mixed for cannabis. Findings regarding their combined use are inconclusive. We aimed to compare neurocognitive performance in people with lifetime cannabis or methamphetamine use disorder diagnoses, or both, relative to people without substance use disorders. 423 (71.9% male, aged 44.6 ± 14.2 years) participants, stratified by presence or absence of lifetime methamphetamine (M-/M+) and/or cannabis (C-/C+) DSM-IV abuse/dependence, completed a comprehensive neuropsychological, substance use, and psychiatric assessment. Neurocognitive domain T-scores and impairment rates were examined using multiple linear and binomial regression, respectively, controlling for covariates that may impact cognition. Globally, M+C+ performed worse than M-C- but better than M+C-. M+C+ outperformed M+C- on measures of verbal fluency, information processing speed, learning, memory, and working memory. M-C+ did not display lower performance than M-C- globally or on any domain measures, and M-C+ even performed better than M-C- on measures of learning, memory, and working memory. Our findings are consistent with prior work showing that methamphetamine use confers risk for worse neurocognitive outcomes, and that cannabis use does not appear to exacerbate and may even reduce this risk. People with a history of cannabis use disorders performed similarly to our nonsubstance using comparison group and outperformed them in some domains. These findings warrant further investigation as to whether cannabis use may ameliorate methamphetamine neurotoxicity.

Adversity specificity and life period exposure on cognitive aging

This study set out to examine the role of different adversities experienced at different life course stages on cognitive aging (i.e., level and change). Data from the longitudinal study: Survey of Health, Ageing, and Retirement in Europe (SHARE) with the selection of participants over 60 years were used (N = 2662, Mdnage = 68, SDage = 5.39) in a Structural Equation Modeling. In early life, the experience of hunger predicted lower delayed recall (β = − 0.10, p < 0.001) and verbal fluency (β = − 0.06, p = 0.001) performance in older age, whereas financial hardship predicted lower verbal fluency (β = − 0.06, p = 0.005) performance and steeper decline in delayed recall (β = − 0.11, p < 0.001). In early adulthood, financial hardship and stress predicted better delayed recall (financial hardship: β = 0.08, p = 0.001; stress: β = 0.07, p = 0.003) and verbal fluency performance (financial hardship: β = 0.08, p = 0.001; stress β = 0.10, p < 0.001), but no adversities were associated with a change in cognitive performance. In middle adulthood, no adversities were associated with the level of cognitive performance, but financial hardship predicted lower decline in delayed recall (β = 0.07, p = 0.048). This study highlights the importance of disentangling the period effect from the specific effect of the adversity experienced in the association between adversity and cognition in older age. Moreover, differential results for delayed recall and verbal fluency measures suggest that it is also important to consider the cognitive outcome domains examined.

Evidence of Improved Verbal Fluency Following Unilateral Right Hemisphere Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease (S51.007)

<h3>Objective:</h3> To investigate verbal fluency following unilateral subthalamic nucleus deep brain stimulation (STN-DBS). <h3>Background:</h3> STN-DBS is safe and effective for motor symptoms, but a widely replicated cognitive outcome following bilateral STN-DBS is verbal fluency decline. Since non-motor symptoms, including mild cognitive impairment and dementia are a significant cause of disability in Parkinson’s disease (PD), reducing the risk of DBS-related cognitive decline is important. Compared to bilateral STN-DBS, little is known about unilateral STN-DBS effects on verbal fluency <h3>Design/Methods:</h3> We enrolled 31 PD patients who underwent unilateral STN-DBS in a randomized, cross-over, double-blind study (SUNDIAL). Targets were based on treatment of the most symptomatic side (<i>n</i> = 17 left STN-DBS; 14 right STN-DBS). At 2-, 4-, and 6-months post-surgery, all participants completed a verbal fluency measure (FAS/CFL), and stimulation type (directional versus ring) was randomized. Welch’s two-sample t-test was used to compare verbal fluency baseline scores and the effects of hemisphere and stimulation on cognition were analyzed using linear mixed effects models. Covariates included age, education, and levodopa equivalents at each time point. <h3>Results:</h3> Left STN-DBS patients scored lower on a verbal fluency task than right STN-DBS patients (t(20.66) = −2.49, p = 0.02) at baseline. Following DBS surgery, we observed declines in verbal fluency over the study duration only in the left STN-DBS group (<i>p</i> = 0.02), while the right STN-DBS group improved (<i>p</i>&lt;.001). Stimulation type was not associated with verbal fluency performance. <h3>Conclusions:</h3> After adjusting for age, education, and levodopa equivalent dose, we found group-level verbal fluency declines following unilateral left STN-DBS and improved verbal fluency following unilateral right STN-DBS. In contrast with bilateral STN-DBS where verbal fluency declines are often reported, it is possible that selecting unilateral right STN-DBS to control left-sided symptoms may be a modifiable risk factor to potentially reduce the likelihood of verbal fluency declines in patients with PD. <b>Disclosure:</b> Dr. Del Bene has nothing to disclose. The institution of Roy C Martin, 4854 has received research support from NIH. Ms. Brinkerhoff has received research support from National Institute of Neurological Disorders and Stroke. Dr. Olson has nothing to disclose. The institution of Dr. Nelson has received research support from NIH. Dr. Marotta has nothing to disclose. Mr. Gonzalez has nothing to disclose. Dr. Mills has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Tilosia. The institution of Dr. Mills has received research support from NINDS. The institution of Dr. Mills has received research support from MJFF. The institution of Dr. Mills has received research support from GKC. The institution of Dr. Kamath has received research support from NIH. Dr. Bentley has nothing to disclose. Dr. Walker has nothing to disclose.

Cognitive-motor dual-task interference in adults with sickle cell disease

BackgroundSickle cell disease (SCD) is a genetic disorder that causes physical and cognitive impairment due to hemolysis, painful vaso-occlusion episodes, joint avascular necrosis, and strokes. As individuals with SCD age and develop conditions impacting their physical and cognitive function, their ability to multitask successfully and safely may decline. Cognitive-motor dual-task interference occurs when there is deterioration in one or both tasks while dual-tasking relative to single-tasking. Dual-task assessment (DTA) is a valuable measure of physical and cognitive function; however, there is limited data on DTA in adults with SCD. Research questionIs DTA a feasible and safe method of measuring physical and cognitive function in adults with SCD? What patterns of cognitive-motor interference occur in adults with SCD? MethodsWe enrolled 40 adults with SCD (mean age 44 years, range 20–71) in a single-center prospective cohort study. We used usual gait speed as the measure of motor performance and verbal fluency (F, A, and S) as the measure of cognitive performance. We measured feasibility as the proportion of consented participants able to complete the DTA. We calculated the relative dual-task effect (DTE %) for each task and identified patterns of dual-task interference. ResultsMost consented participants completed the DTA (91%, 40/44) and there were no adverse events. There were 3 main dual-task interference patterns for the first trial using letter ‘A′: Motor Interference (53%, n = 21), Mutual Interference (23%, n = 9), and Cognitive-Priority Tradeoff (15%, n = 6). For the second trial using letter ‘S′, there were two main dual-task interference patterns: Cognitive-Priority Tradeoff (53%, n = 21) and Motor Interference (25%, n = 10). Statement of significanceDTA was feasible and safe in adults with SCD. We identified specific patterns of cognitive-motor interference. This study supports further evaluation of DTA as a potentially useful tool to measure physical and cognitive function in ambulatory adults with SCD.

Grip Strength and Sarcopenia Predict 2-Year Cognitive Impairment in Community-Dwelling Older Adults.

Using the Asian Working Group for Sarcopenia (AWGS2019) and the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, this study examined associations of sarcopenia and its components with specific domains of cognitive impairment over time. A prospective cohort study with a 2-year follow-up. This study is part of the Taiwan Initiatives for Geriatric Epidemiological Research (TIGER), which recruited participants aged 65years old who attended the senior health checkup program at National Taiwan University Hospital (NTUH). Grip strength was measured using a handgrip dynamometer. Walking speed (m/s) was measured as the time required to walk 8 feet. Muscle mass was measured by performing a bioelectrical impedance analysis. Global cognition (assessed using the Taiwanese version of the Montreal Cognitive Assessment) and 4 cognitive domains (memory, executive function, verbal fluency, and attention) were assessed over time. Associations of sarcopenia and its components with cognitive impairment were evaluated after stratification by sex using generalized linear mixed models adjusted for essential covariates for cognitive impairment. Compared with robust women, those with severe sarcopenia were more likely to have a global cognitive impairment over time (β=-0.87, P= .03 based on AWGS2019 criteria and β=-1.07, P= .02 based on the EWGSOP2 criteria). Among men, low grip strength was associated with poor scores on measures of global cognition (β=-0.80, P= .03), executive function (β=-0.35, P= .001), verbal fluency (β=-0.31, P= .02), and attention (β=-0.34, P= .008) over time. Severe sarcopenia predicted global and specific domains of cognitive impairment in older adults. Poor grip strength predicted cognitive impairment in men but not in women. A screen for sarcopenia severity and low muscle strength may be used to identify the risk of cognitive impairment.

Verbal Fluency in Prelingually Deaf, Early Implanted Children and Adolescents With Cochlear Implants.

Verbal fluency tasks assess the ability to quickly and efficiently retrieve words from the mental lexicon by requiring subjects to rapidly generate words within a phonological or semantic category. This study investigated differences between cochlear implant users and normal-hearing peers in the clustering and time course of word retrieval during phonological and semantic verbal fluency tasks. Twenty-eight children and adolescents (aged 9-17 years) with cochlear implants and 33 normal-hearing peers completed measures of verbal fluency, nonverbal intelligence, speech perception, and verbal short-term/working memory. Phonological and semantic verbal fluency tests were scored for total words generated, words generated in each 10-s interval of the 1-min task, latency to first word generated, number of word clusters, average cluster size, and number of word/cluster switches. Children and adolescents with cochlear implants generated fewer words than normal-hearing peers throughout the entire 60-s time interval of the phonological and semantic fluency tasks. Cochlear implant users also had slower start latency times and produced fewer clusters and switches than normal-hearing peers during the phonological fluency task. Speech perception and verbal working memory scores were more strongly associated with verbal fluency scores in children and adolescents with cochlear implants than in normal-hearing peers. Cochlear implant users show poorer phonological and semantic verbal fluency than normal-hearing peers, and their verbal fluency is significantly associated with speech perception and verbal working memory. These findings suggest deficits in fluent retrieval of phonological and semantic information from long-term lexical memory in cochlear implant users.

Extremes of baseline cognitive function determine the severity of delirium: a population study.

Although delirium is a significant clinical and public health problem, little is understood about how specific vulnerabilities underlie the severity of its presentation. Our objective was to quantify the relationship between baseline cognition and subsequent delirium severity. We prospectively investigated a population-representative sample of 1510 individuals aged ≥70 years, of whom 209 (13.6%) were hospitalized across 371 episodes (1999 person-days assessment). Baseline cognitive function was assessed using the modified Telephone Interview for Cognitive Status, supplemented by verbal fluency measures. We estimated the relationship between baseline cognition and delirium severity [Memorial Delirium Assessment Scale (MDAS)] and abnormal arousal (Observational Scale of Level of Arousal), adjusted by age, sex, frailty and illness severity. We conducted further analyses examining presentations to specific hospital settings and common precipitating aetiologies. The median time from baseline cognitive assessment to admission was 289 days (interquartile range 130 to 47 days). In admitted patients, delirium was present on at least 1 day in 45% of admission episodes. The average number of days with delirium (consecutively positive assessments) was 3.9 days. Elective admissions accounted for 88 bed days (4.4%). In emergency (but not elective) admissions, we found a non-linear U-shaped relationship between baseline global cognition and delirium severity using restricted cubic splines. Participants with baseline cognition 2 standard deviations below average (z-score = -2) had a mean MDAS score of 14 points (95% CI 10 to 19). Similarly, those with baseline cognition z-score = + 2 had a mean MDAS score of 7.9 points (95% CI 4.9 to 11). Individuals with average baseline cognition had the lowest MDAS scores. The association between baseline cognition and abnormal arousal followed a comparable pattern. C-reactive protein ≥20 mg/l and serum sodium <125 mM/l were associated with more severe delirium. Baseline cognition is a critical determinant of the severity of delirium and associated changes in arousal. Emergency admissions with lowest and highest baseline cognition who develop delirium should receive enhanced clinical attention.

Automated clustering and switching algorithms applied to semantic verbal fluency data in schizophrenia spectrum disorders

ABSTRACT In the cognitive assessment of Schizophrenia Spectrum Disorders (SSD), the standard scoring method for Verbal Fluency (VF) tasks is the number of correct words produced. Finer-grained measures, such as the size of semantic clusters and the number of transitions between them, have been proposed to characterise the cognitive functions involved, but results based on human ratings are heterogeneous. The objective of this study was to develop a computational procedure based on Vector Space Models (VSMs) to assess the predictive ability of these fine-grained measures for class membership in SSD. A semantic VF task was administered to thirty-five people with SSD and a matched group of healthy participants, and their VF productions were characterised manually and using a set of ad-hoc algorithms. Computational estimates consistently showed higher predictive accuracy than models built on VF measures computed by a human rater and models built on the sole total number of words.

A longitudinal study of episodic memory recall in multilinguals

Aim: This study investigates the effects of degree of multilingualism on cognitive functions in adulthood, with focus on episodic memory recall and including measures of verbal fluency as well as global cognition. Design: We studied a large population-based cohort cross-sectionally, and we also assessed changes over time through longitudinal measurements on four time-points over a 15 year period. Participants were drawn from the Betula prospective cohort study in Umeå, Sweden. The participants included in this study at baseline ( n = 894, mean age = 51.44, 59.4% females) were divided according to number of languages into bilinguals ( n = 395), trilinguals ( n = 284), quadrilinguals ( n = 169), and pentalinguals ( n = 46). Data and analysis: We analysed performance on tasks of episodic memory recall, verbal fluency (letter and category) and global cognition (Minimental State Examination, MMSE) both cross-sectionally and longitudinally. The control background variables were baseline age, gender, years of education, general fluid ability Gf (Wechsler Block Design Test), and socioeconomic status. We employed a linear mixed modelling approach with entropy balancing weights to assess effects of degree of multilingualism on cognitive functions. Findings and conclusions: Using bilinguals as the reference group, our results indicated that all the other multilingual groups exhibited superior performance on episodic memory recall than bilinguals at baseline. The rate of change over time did not differ for trilinguals and pentalinguals compared to bilinguals. While quadrilinguals declined more over time than bilinguals, they still scored significantly higher than bilinguals at the last test wave. For letter fluency, similarly, all language groups scored higher than bilinguals at baseline, and none of the groups differed from bilinguals in rate of change over time. With regard to category fluency, quadrilinguals scored higher than bilinguals at baseline, but trilinguals and pentalinguals did not differ from bilinguals and none of the groups differed in change over time compared to bilinguals. Finally, for global cognition (MMSE), trilinguals and quadrilinguals scored significantly higher than bilinguals at baseline with no differences in change over time for any of the groups relative to bilinguals. Our study contributes to the understanding of multilingual cognition and sheds light into an under-researched cognitive domain known to decline in normal ageing, namely episodic memory recall. Significance: Our study emphasizes the importance of researching less explored aspects of multilingualism on cognition, in particular on episodic memory recall, to aid our understanding of factors that could potentially aid cognitive decline in later adulthood.

Analyses of correct responses and errors on measures of verbal fluency among Parkinson’s disease and essential tremor patients

Objective: Parkinson’s disease (PD) and essential tremor (ET) involve neuroanatomical circuitry that impact frontal lobe functioning, via the striatum and cerebellum, respectively. The aim of this exploratory study was to investigate quantitative and qualitative performance between and within these groups on measures of verbal fluency. Method: Sixty-three PD and 53 ET patients completed neuropsychological testing. Linear regression models with robust variance estimation compared verbal fluency performance between groups related to correct responses and errors. Paired t-tests investigated within group error rates. Results: PD patients gave more correct responses for phonological ( β ̂ =5.3, p=.01) and category fluency ( β ̂ =4.1, p=.01) than ET patients; however, when processing speed was added as a covariate, this attenuated performance on both measures and only phonological fluency remained significant ( β ̂ =4.0, p=.04). There were no statistical differences in error scores between groups. Error rates within groups suggested that PD patients had higher error rates in total errors and perseveration errors on phonological fluency (M = 2.6, p=.00; M = 1.6, p=.00) and higher total errors and set-loss error rates on category switching (M = 5.1, p<.001; M = 4.1, p<.001). ET patients had higher error rate with relation to total errors and set-loss errors on phonological fluency (M = 2.5, p=.00; M = 1.5, p=.02) and category switching (M = 3.9, p=,00; M = 3.9, p<.001). Conclusions: PD patients performed better than ET patients on phonological fluency. PD patients appear to make more perseveration errors on phonological fluency, while ET patients made more set-loss errors. Implications for frontal lobe dysfunction and clinical impact are discussed.

Bilingualism Appears to be Protective Against Cognitive Decline Related to Amyloid Burden in Mexican Americans: An HABS‐HD Study

AbstractBackgroundBilingualism has been considered to exert protective effects from neurodegeneration and age‐related diseases such as Alzheimer’s Disease (AD). The protective effect is considered to be due to differences in grey and white matter between monolingual and bilinguals; however, no work to date has looked at differences in additional AD brain pathology. The aim of this study was to fill this gap and examine among Mexican Americans the impact of amyloid burden on cognitive functioning stratified by language status.MethodData were analyzed on n = 111 Mexican Americans (n = 45 Monolingual; n = 66 Bilingual) participants from a study of health disparities. All participants underwent cognitive testing and PET amyloid imaging, which was conducted using a Siemens Biograph Vision 450 PET/CT scanner with florbetaben. SUVR regions of interest (ROIs) included Frontal, Anterior/Posterior Cingulate, Lateral Parietal, and Lateral Temporal cortex and were derived using the cerebellum as a reference region in FreeSurfer. Linear regressions were conducted with each ROI included as a predictor variable and cognitive functioning as the outcome variable. Covariates included age, sex, and education. Analyses were split by language status (monolingual, bilingual).ResultAmong monolingual Mexican Americans, higher Global and Lateral Temporal SUVR were significantly related to poorer performance across measures of executive functioning (p = 0.039 and p = 0.038) and processing speed (p = 0.013 and p = 0.027); Global SUVR showed a trend towards significance on a measure of verbal fluency (p = 0.052). In the same group, Frontal SUVR was significant related to poorer performance across measures of global cognition (p = 0.046), executive functioning (p = 0.015), processing speed (p = 0.007) and verbal fluency (p = 0.037), the latter two were also significantly related to Anterior/Posterior Cingulate SUVR (p = 0.008 and p = 0.029). In addition, higher Lateral Parietal SUVR was significantly related to poorer performance on a measure of processing speed (p = 0.030). Among bilingual Mexican Americans, Frontal and Anterior/Posterior Cingulate SUVR were positively associated with semantic fluency (p = 0.049 and p = 0.043).ConclusionAmyloid burden was found to be related to poorer cognitive functioning across multiple domains specifically among monolinguals. Those who identified as bilingual did not present with the same relationship between amyloid uptake and cognitive functioning further supporting the potential protective effect of bilingualism.