Fluency Test Research Articles

Cognitive impairment and neuropsychiatric symptoms among individuals with history of symptomatic SARS-CoV-2 infection: a retrospective longitudinal study.

To identify the main cognitive and neuropsychiatric symptoms in adults who had no cognitive complaints prior to the infection. Specifically, to observe the trajectory of cognitive and neuropsychiatric performance after 6 months. This is a retrospective longitudinal study. Forty-nine patients (29 reassessed after 6 months), with a positive PCR test, with no prior cognitive complaints that only presented after the infection and without a history of structural, neurodegenerative or psychiatric neurological diseases. A brief cognitive assessment battery (MoCA), the Trail Making Test (TMT-A, B, ∆), and the Verbal Fluency Test were used, as well as the scales (Hospital Anxiety and Depression Scale-HADS, Fatigue Severity Scale-FSS). Correlation tests and group comparison were used for descriptive and inferential statistics. Level of significance of α=5%. Mean age of 50.4 (11.3), 12.7 (2.8) years of education, higher percentage of women (69.8%). No psycho-emotional improvement (depression and anxiety) was observed between the evaluations, and patients maintained the subjective complaint of cognitive changes. The HAD-Anxiety scale showed a significant correlation with TMT-B errors. The subgroup participating in cognitive stimulation and psychoeducation showed improvement in the global cognition measure and the executive attention test. Our results corroborate other studies that found that cognitive dysfunctions in post-COVID-19 patients can persist for months after disease remission, as well as psycho-emotional symptoms, even in individuals with mild infection. Future studies, with an increase in casuistry and control samples, are necessary for greater evidence of these results.

Language Disorders in People with Cognitive Impairment: A Cross-sectional Study

Introduction: The progressive ageing of the population has generated significant interest in various areas, particularly Cognitive Impairment (CI). It is necessary to know the specific characteristics of people with cognitive development to establish the basis for the intervention. Aim: To understand the relationship between the cognitive deterioration process and language characteristics, aiming to determine whether linguistic alteration could be considered a symptom of cognitive deterioration. Materials and Methods: This study employed a cross-sectional design involving two groups: 17 individuals aged over 70 years, consisting of eight with CI and nine without CI. Participants were assessed using the Mini-Mental State Examination (MMSE). Language abilities were evaluated using the Boston Naming Test and the Verbal Fluency Test in separate individual sessions. Data analysis was conducted using the Statistical Package for Social Sciences (SPSS) program. Results: The results indicated that individuals with CI exhibited poorer performance in language tests, particularly in areas related to productive and comprehensive lexical and semantic development. These differences were statistically significant across all assessed domains (p-value<0.001). Conclusion: CI is accompanied by significant impairment in language skills, which could be considered an indicator of cognitive decline. Therefore, specific interventions targeting language abilities are warranted throughout the progression of CI.

Emotion regulation and executive functions in young and older Brazilian adults

Introduction/objective: The healthy aging process involves changes in neurobiological functions at various levels and is associated with a slight impairment in various cognitive domains, such as executive functions (EF), as well as the enhancement of emotional skills. The objective of this study was to compare the use of emotion regulation (ER) strategies in young adults (YA) and older adults (OA) and explore the association between ER skills and EF between age groups. Method: Participants were 40 YA between 18 and 39 years of age (50% women) and 40 OA > 60 years old (50% women), residents in the Federal District, Brazil. Phonological Verbal Fluency (FAS), semantic and switching (animals and fruits) and action tests were administered, along with the Stroop Test. Results: There was a statistically significant correlation of the Cognitive Reappraisal (CR) strategy and both semantic and switching verbal fluency tests in YA, and between the CR strategy and the FAS test and the Stroop Test in OA. That is, executive performance showed a direct relationship with ER in both groups, with greater use of cognitive reappraisal by older adults. Conclusions: The results of this study highlight the relevance of continuing to investigate the relationship between these abilities and analysing in greater depth their alterations during the aging process.

Neuropsychological and Clinical Correlations of Optical Coherence Tomography Findings in Patients with Schizophrenia

Objective: There are increasing studies examining retinal fiber layer (RNFL) and ganglion cell layer (GCL) thinning in patients with schizophrenia. However, the results are controversial, and clinical and cognitive reflections of these findings remain unclear. With this study, we aim to examine retinal abnormalities and establish correlations with cognitive and clinical parameters.
 Methods: In this cross-sectional study, we examined 29 patients with schizophrenia and 13 age and gender-matched healthy controls. All participants underwent psychometric assessment, neuropsychological tests, and optical coherence tomography (OCT) measurements. The retinal fiber layer and ganglion cell layer thickness were used as retinal parameters.
 Results: Five patients dropped out during the OCT measurement process, 24 patients with schizophrenia and nine healthy controls were included in the analysis. There was no statistically significant difference between groups in measuring retinal nerve fiber layer or ganglion cell layer thicknesses. The verbal fluency test score negatively correlated with left RNFL superior ( ρ – .422, p

CHARACTERISTICS OF COGNITIVE DYSFUNCTIONS IN PATIENTS WITH RIGHT-SIDE AND LEFT-SIDE ISCHEMIC STROKE

The goal of the study is to assess the characteristics of cognitive dysfunctions in patients with right-side and left-side ischemic stroke (IS).
 Materials and Methods. We examined 55 patients (aged 38–65) with right-side and left-side ischemic stroke during the early rehabilitation period. The patients were treated at the regional vascular center, District Clinical Hospital, Khanty-Mansiysk in 2019–2022. Mini-Mental State Examination (MMSE) was used to check patients for cognitive impairments: Frontal assessment battery, Verbal fluency test, Clock-drawing test, Backward digit span test, Visual assessment battery, Auditory assessment battery, and Verbal assessment battery.
 Results. Cognitive impairments are common post-stroke complications, which can significantly complicate rehabilitation therapy. In the early rehabilitation period, 41.8 % of patients with a hemispheric stroke demonstrate predementia. In patients with right-side stroke, predementia was observed in 22.2 %, whereas 60.7 % of patients with left-side stroke exhibited impaired abilities (p<0.05). There was a significant decrease in short-term memory, time knowledge and orientation abilities in patients with left-side stroke. Assessment of visual, auditory and verbal memory also revealed poorer performance in patients with left-side stroke compared to those with right-side stroke – 20 (17–22) points versus 22 (22–24) points (p<0.05). Moderate frontal dysfunction was detected in all patients (100 %).
 Conclusion. All patients with hemispheric stroke should undergo early cognitive rehabilitation, even if there are no active complaints. Particular attention should be paid to patients with left-side brain damage.

Long COVID neuropsychological follow-up: Is cognitive rehabilitation relevant?

Duration of neuropsychological disorders caused by long COVID, and the variables that impact outcomes, are still largely unknown. To describe the cognitive profile of patients with long COVID post-participation in a neuropsychological rehabilitation program and subsequent reassessment and identify the factors that influence recovery. 208 patients (mean age of 48.8 y.o.), mostly female, were reevaluated 25 months after their first COVID infection and 17 months after their initial evaluation. Patients underwent subjective assessment, Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and Clock Drawing Tests (NEUPSILIN) for executive functions, Hospital Anxiety and Depression Scale (HADS) and WHOQol-Bref. We noted a discrete improvement of neuropsychological symptoms 25 months after the acute stage of COVID-19; nonetheless, performance was not within the normative parameters of standardized neuropsychological testing. These results negatively impact QoL and corroborate patients' subjective assessments of cognitive issues experienced in daily life. Improvement was seen in those who participated in psychoeducational neuropsychological rehabilitation, had higher levels of education, and lower depression scores on the HADS. Our data reveal the persistence of long-term cognitive and neuropsychiatric disorders in patients with long COVID. Neuropsychological rehabilitation is shown to be important, whether in-person or online.

The effects of recalling and imagining prompts on writing engagement, syntactic and lexical complexity, accuracy, and fluency: A partial replication of Cho (2019)

Abstract This replication study examined the effects of writing prompt type on second language (L2) learners’ writing performance. Fifty undergraduate academic and professional writing course pupils wrote narrative essays about a past event (recalling group/high formulation demand condition) or a future event (imagining group/high conceptualization demand condition). Writers completed a freewriting draft and were then given unlimited opportunities to revise. The writing was subjected to syntactic complexity, fluency, accuracy, and lexical complexity analyses. Writer engagement was computed as the time spent revising drafts. The previous study’s results were confirmed in that the recalling group exhibited more complexity and less accuracy in their writing than the imagining group. The recalling group also exhibited a higher level of writing fluency and possessed a higher level of engagement. Furthermore, the results of our study showed that the imagining group produced writing that was slightly more lexically complex than the recalling group. The pedagogical importance of writing prompts and their potential for affecting writing performance and writing engagement was discussed.

SEVERE ALZHEIMER’S DEMENTIA ALTERS THE RELATIONSHIP BETWEEN EXECUTIVE FUNCTION AND FALLS

Abstract Falls are a public health concern for older adults, particularly those with cognitive impairments, like mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia. Executive function (EF) is linked to falls in older adults, but little is known about the relationship between individual EF assessments and falls in individuals with varying cognitive statuses. Using cross-sectional secondary data analyses with binary logistic regression, we examined the associations between EF assessments (Trail Making Test (ΔTMT), Digit Span (DS), Stroop test, Clock Drawing Test, and phonemic/semantic fluency tests) and falls (fall history and subsequent falls) in 466 participants (aged 66-103) with either intact cognition, MCI, or AD dementia. Surprisingly, a significant interaction effect emerged with AD dementia and EF assessments (ΔTMT, DS, and semantic fluency), revealing that individuals with AD dementia with worse EF had a lower probability of prior fall history. These findings were influenced by a low percentage of reported falls in people with severe AD dementia. Further stratified analysis of the interaction effects showed that DS and semantic fluency were significantly associated with fall history in people without AD dementia. While some EF assessments were individually associated with falls, interpretations should be made cautiously, especially considering the appropriateness of the assessments for specific populations. The counterintuitive result may stem from factors specific to severe AD dementia. In conclusion, this study uncovers complex interactions between cognitive status, EF assessments, and fall history, and the potential for further investigation to enhance our understanding of falls in individuals with severe AD dementia.

Hybrid surgery can improve neurocognitive function in patients with internal carotid artery occlusion

Internal carotid artery occlusion (ICAO) is a relatively uncommon but important cause of transient ischaemic attack and cerebral infarction. Hybrid surgery (HS) improves cerebral perfusion, but its impact on neurocognitive function has been controversial. Patients with symptomatic chronic ICAO treated by hybrid surgery or medical treatment from 2016 to 2019 were included. We recorded and analysed the clinical characteristics, angiographic data, outcomes and cognitive status. Functional assessments, including the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index, and a battery of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale–Cognitive Subtest (ADAS-cog), verbal fluency, and Colour Trail test Parts 1 and 2, were administered. Significant improvements in the ADAS (before, 7.5 ± 6.2 versus after, 5.2 ± 5.7; P = 0.022), MMSE (before, 25.5 ± 2.8 versus after, 28.1 ± 2.3; P = 0.013), and Colour Trail test Part 1 (before, 118.3 ± 26.5 versus after, 96.2 ± 23.1; P = 0.016) were observed six months after HS. Moreover, the abovementioned postprocedure scales were ameliorated in the HS group. This study found that in patients with multiple symptomatic ICAO and objective ipsilateral ischaemia, successful HS leads to improvement in the scores of three cognitive tests.

Effect of Baduanjin exercise on executive function in older adults with cognitive frailty: A randomized controlled trial

Objective To investigate the effectiveness of Baduanjin exercise on executive function in community-dwelling older adults with cognitive frailty. Design Randomized controlled trial. Setting Community residential centers. Subjects 120 eligible older adults. Interventions Baduanjin training group received supervised Baduanjin training, 60 min sessions three times per week for 24 weeks. The control group did not receive any exercise intervention. Main measures Primary outcome was executive function, assessed using Clock Drawing Test. Secondary outcomes included the subcomponents of executive function (working memory, inhibitory control and cognitive flexibility), attention and cognitive frailty (global cognitive function, physical frailty) assessed using Verbal Fluency Test, Trail Making Test-A/B, Stroop Test, Montreal Cognitive Assessment and Edmonton Frailty Scale, respectively, at baseline and 24 weeks after intervention. Results After the 24-week intervention, the scores of Clock Drawing Test and Verbal Fluency Test, the Trail Making Test-B time and the Card correct numbers of Stroop Test in Baduanjin training group showed significant improvement compared with control group (all P < 0.05) with small to moderate effect sizes and the significant interaction effect of group by time in the Clock Drawing Test and Trail Making Test-B test (P = 0.003 and P = 0.043); cognitive frailty variables, including Montreal Cognitive Assessment and Edmonton Frail Scale scores, also showed significant improvement (P = 0.002 and P = 0.004) with a moderate effect sizes and a significant interaction effect (P < 0.001, P = 0.013). No adverse events were reported. Conclusion Regular Baduanjin training may be an effective and safe intervention to improve cognitive frailty and executive function in community-dwelling older adults with cognitive frailty. Trial registration Chinese Clinical Trial Registry, ChiCTR2100050857. Data of registration: 8/5/2020, https://www.chictr.org.cn/showproj.html?proj = 133037.

Differential contribution of language and executive functioning to verbal fluency performance in glioma patients.

Glioma patients often suffer from deficits in language and executive functioning. Performance in verbal fluency (generating words within one minute according to a semantic category-category fluency, or given letter-letter fluency) is typically impaired in this patient group. While both language and executive functioning play a role in verbal fluency, the relative contribution of both domains remains unclear. We aim to retrospectively investigate glioma patients' performance on verbal and nonverbal fluency and to explore the influence of language and executive functioning on verbal fluency. Sixty-nine adults with gliomas in eloquent areas underwent a neuropsychological test battery (verbal fluency, nonverbal fluency, language, and executive functioning tests) before surgery (T1) and a subgroup of 31 patients also at three (T2) and twelve months (T3) after surgery. Preoperatively, patients were impaired in all verbal fluency tasks and dissociations were found based on tumour location. In contrast, nonverbal fluency was intact. Different language and executive functioning tests predicted performance on category fluency animals and letter fluency, while no significant predictors for category fluency professions were found. The longitudinal results indicated that category fluency professions deteriorated after surgery (T1-T2, T1-T3) and that nonverbal fluency improved after surgery (T1-T3, T2-T3). Verbal fluency performance can provide information on different possible underlying deficits in language and executive functioning in glioma patients, depending on verbal fluency task selection. Efficient task (order) selection can be based on complexity. Category fluency professions can be selected to detect more permanent long-term deficits.

Relationship between reaction time variability on go/no go tasks and neuropsychological functioning in younger and older adults

ABSTRACT Introduction Early detection of cognitive impairment in older adults is important for the prevention of dementia. Intra-individual variability in reaction time (IIV-RT) during go/no-go tasks can be used for the early detection of cognitive impairment in older adults living in the community. This study aimed to determine the relationship between IIV-RT and cognitive function during go/no-go tasks and the cutoff values for determining the risk of cognitive impairment in community-dwelling older adults. Methods This study included 31 older adults without cognitive impairment, 15 community-dwelling older adults with cognitive impairment, and 34 healthy young adults. All participants performed a go/no-go task to assess the IIV-RT. Additionally, older adults underwent neuropsychological testing. Based on the results of the Japanese version of the Montreal Test of Cognitive Abilities (MoCA-J), older adults were divided into those with normal cognition and those with cognitive impairment. Results There were significant differences in the IIV-RT among groups, including a higher IIV in the cognitively impaired group than in young adults and cognitively normal older adults. Moreover, the IIV-RT was correlated with the MoCA-J (r = −0.531, p < 0.001), Trail Making Test Part A (r = 0.571, p < 0.001), and Verbal Fluency Test scores (r = −0.442, p = 0.002). Receiver operating curve analysis showed that the area under the curve for IIV-RT was 0.935, and the cutoff value at which the IIV-RT identified cognitive impairment was 25.37%. Conclusions These findings indicate that the IIV-RT during go/no-go tasks is a useful early indicator of cognitive impairment in community-dwelling older adults.

Gut microbiota links to serum ferritin and cognition

ABSTRACT Iron is required for the replication and growth of almost all bacterial species and in the production of myelin and neurotransmitters. Increasing clinical studies evidence that the gut microbiota plays a critical role in iron metabolism and cognition. However, the understanding of the complex iron-microbiome-cognition crosstalk remains elusive. In a recent study in the Aging Imageomics cohort (n = 1,030), we identified a positive association of serum ferritin (SF) with executive function (EF) as inferred from the semantic verbal fluency (SVF,) the total digit span (TDS) and the phonemic verbal fluency tests (PVF). Here, we explored the potential mechanisms by analyzing the gut microbiome and plasma metabolome using shotgun metagenomics and HPLC-ESI-MS/MS, respectively. Different bacterial species belonging to the Proteobacteria phylum (Klebsiella pneumoniae, Klebsiella michiganensis, Unclassified Escherichia) were negatively associated both with SF and executive function. At the functional level, an enrichment of microbial pathways involved in phenylalanine, arginine, and proline metabolism was identified. Consistently, phenylacetylglutamine, a metabolite derived from microbial catabolism of phenylalanine, was negatively associated with SF, EF, and semantic memory. Other metabolites such as ureidobutyric acid and 19,20-DiHDPA, a DHA-derived oxylipin, were also consistently and negatively associated with SF, EF, and semantic memory, while plasma eicosapentaenoic acid was positively associated. The associations of SF with cognition could be mediated by the gut microbiome through microbial-derived metabolites.

A 10‐minute Digitally Administered and Scored Neuropsychological Protocol Assessing Executive Control and Episodic Memory

AbstractBackgroundDigital assessment technology provides rapid and reliable assessment of neurocognitive abilities associated with Alzheimer’s Disease and Related Dementia (ADRD) and Mild Cognitive Impairment (MCI). Dysexecutive and amnestic impairment typify many ADRD and MCI disorders. Here, we evaluate a 10‐minute digitally administered protocol assessing these neurocognitive constructs.Method229 community dwelling participants were assessed (age = 68.32+9.85; education = 15.01+2.58, MMSE = 26.84+2.78; 144 females). Executive abilities were assessed with three trials of 5‐digits backward digit span test (BDST) and the ‘animal’ fluency test. Episodic memory was assessed with a 6‐word Philadelphia (repeatable) Verbal Learning Test (PrVLT) consisting of 2 immediate free recall (IFR) trials, delayed free recall (DFR), and delayed recognition. Traditional pencil and paper testing was not used. Data were obtained with an iPad processed using automatic speech recognition.ResultA K‐means cluster analysis (k = 3) classified participants with possible dementia (pDem = 31), MCI (n = 96), and cognitively normal (CN, n = 100; Table 1). Groups differed from each other on all three P(r)VLT parameters (p = 0.001). CN participants outperformed other groups on executive measures (p = 0.001). All between‐group analyses yielded large effect sizes (η2 = 0.277–0.642). Logistic regression analysis using P(r)VLT‐DFR, P(r)VLT‐recognition, BDST, and ‘animal’ fluency parameters classify MCI and pDem participants into their respective groups compared to CN participants (p = 0.003). For the pDem group, within‐group t‐tests found rapid forgetting (PrVLT‐DFT&lt;PrVLT‐IFR trial 2, p = 0.013; PrVLT‐recognition&lt;PrVLT‐DFR (p = 0.013). Additional, within‐group pDem group comparisons found no differences between P(r)VLT‐recognition and either executive tests. Within group comparisons for the MCI group found P(r)VLT delayed recognition improved compared to P(r)VLT delayed free recall (p&lt;0.001), and worse performance on both executive measures compared to P(r)VLT‐ recognition (p = .001). All of these comparisons are consistent with a mild dysexecutive syndrome.ConclusionThe protocol described above is efficient, reliable, removes any inter‐rater reliability issues, and is able to operationally‐define dysexecutive and amnestic cognitive impairment ‐ key neurocognitive constructs related to ADRD and MCI. This 10‐minute digitally administered and automatically scored neuropsychological protocol assessing executive abilities and episodic memory could easily be deployed in clinical trials and in primary‐ and specialty‐care settings to screen for emergent cases of MCI and ADRD by efficient assessment of episodic memory and executive abilities.

A 10‐minute Digitally Administered and Scored Neuropsychological Protocol Assessing Executive Control and Episodic Memory

AbstractBackgroundDigital assessment technology provides rapid and reliable assessment of neurocognitive abilities associated with Alzheimer’s Disease and Related Dementia (ADRD) and Mild Cognitive Impairment (MCI). Dysexecutive and amnestic impairment typify many ADRD and MCI disorders. Here, we evaluate a 10‐minute digitally administered protocol assessing these neurocognitive constructs.Method229 community dwelling participants were assessed (age = 68.32+9.85; education = 15.01+2.58, MMSE = 26.84+2.78; 144 females). Executive abilities were assessed with three trials of 5‐digits backward digit span test (BDST) and the ‘animal’ fluency test. Episodic memory was assessed with a 6‐word Philadelphia (repeatable) Verbal Learning Test (PrVLT) consisting of 2 immediate free recall (IFR) trials, delayed free recall (DFR), and delayed recognition. Traditional pencil and paper testing was not used. Data were obtained with an iPad processed using automatic speech recognition.ResultA K‐means cluster analysis (k = 3) classified participants with possible dementia (pDem = 31), MCI (n = 96), and cognitively normal (CN, n = 100; Table 1). Groups differed from each other on all three P(r)VLT parameters (p = 0.001). CN participants outperformed other groups on executive measures (p = 0.001). All between‐group analyses yielded large effect sizes (η2 = 0.277–0.642). Logistic regression analysis using P(r)VLT‐DFR, P(r)VLT‐recognition, BDST, and ‘animal’ fluency parameters classify MCI and pDem participants into their respective groups compared to CN participants (p = 0.003). For the pDem group, within‐group t‐tests found rapid forgetting (PrVLT‐DFT&lt;PrVLT‐IFR trial 2, p = 0.013; PrVLT‐recognition&lt;PrVLT‐DFR (p = 0.013). Additional, within‐group pDem group comparisons found no differences between P(r)VLT‐recognition and either executive tests. Within group comparisons for the MCI group found P(r)VLT delayed recognition improved compared to P(r)VLT delayed free recall (p&lt;0.001), and worse performance on both executive measures compared to P(r)VLT‐ recognition (p = .001). All of these comparisons are consistent with a mild dysexecutive syndrome.ConclusionThe protocol described above is efficient, reliable, removes any inter‐rater reliability issues, and is able to operationally‐define dysexecutive and amnestic cognitive impairment ‐ key neurocognitive constructs related to ADRD and MCI. This 10‐minute digitally administered and automatically scored neuropsychological protocol assessing executive abilities and episodic memory could easily be deployed in clinical trials and in primary‐ and specialty‐care settings to screen for emergent cases of MCI and ADRD by efficient assessment of episodic memory and executive abilities.

CSF Alzheimer’s Disease Biomarker Changes in Veterans with Mild Traumatic Brain Injury

AbstractBackgroundTraumatic brain injury (TBI) has been reported to increase risk of Alzheimer’s dementia (AD). It remains unknown whether mild TBI (mTBI) caused by blast in Veterans confers a similar increase of risk. This study investigated early AD changes defined by cerebrospinal fluid (CSF) AD biomarkers in Veterans with blast mTBI.MethodFifty‐one Veterans with mTBI, 34 non‐mTBI Veterans, and 51 non‐mTBI civilians were recruited from Seattle, Washington. Age‐matched Veteran and civilian non‐mTBI participants had no lifetime history of TBI. All blast‐mTBI Veterans had experienced at least one war zone blast or combined blast/impact exposure, with acute symptoms meeting VA/Department of Defense criteria for mTBI. All participants underwent standardized clinical and neuropsychological assessments and lumbar puncture for collection of CSF. CSF biomarkers were measured at the Clinical Neurochemistry Lab in Mölndal, Sweden, using Meso Scale Discovery (MSD) assays for Aβ40 and Aβ42, and Innotest ELISAs for phosphorylated Tau181 (pTau181) and total Tau (tTau).ResultDifferences in all 4 CSF AD biomarkers between participants with and without mTBI were highly age‐dependent and most pronounced in older ages (Figure 1). Both CSF Aβ40 and Aβ42 became lower as age increasing in the mTBI group starting around age 40‐45 years, while they increased with age in the non‐mTBI participants. In contrast, CSF tTau and pTau181 mean levels remained relatively constant with age in participants with mTBI, but increased after age 45 in the non‐mTBI participants. Consequently, for participants aged 50+ years, Veterans with mTBI had lower mean AD biomarkers than the non‐mTBI participants. Similarly, the differences in cognitive performance were age‐dependent, i.e., poorer performance in older Veterans with mTBI than in the non‐mTBI participants. Furthermore, the relationships between CSF Aβ42 and cognitive performance were also age‐dependent; specifically, in participants aged 45+ years, lower CSF Aβ42 level was associated with poorer performance on tests of verbal fluency and memory.ConclusionThe earliest AD biomarker, CSF Aβ42, started to decrease in middle‐aged Veterans with mTBI, more than a decade earlier than those without mTBI in our earlier study, suggesting mTBI may accelerate brain deposition of Aβ and increase risk for AD.

Head‐to‐head comparisons of cognitive screening tests administered in primary care centers

AbstractBackgroundCognitive screening tests are often used in primary care to aid in the decision whether further investigation is needed. The most widely used tests, MMSE and the Clock Drawing Test (CDT), were developed more than 40 years ago and there is a need to update the primary care neuropsychological toolbox. The objective for this pilot study was to examine the diagnostic accuracy of AD for different cognitive tests administered at primary care centers.MethodThe BioFINDER Primary Care Study consecutively recruits patients with cognitive complaints (SCD, MCI, or mild dementia) at different primary care centers in Sweden. Cognitive tests are examined as well as plasma AD‐biomarkers. A test battery including MMSE, MoCA, CDT, Verbal fluency tests, TMT A and B, Symbol Digit Test, ADAS 10‐wordlist and Recall of Picture Test (RPT) are administered to all patients at their respective primary care center. Patients are then referred to a memory clinic where they undergo a full clinical work‐up (including neuropsychological assessment, lumbar puncture or Aβ‐PET, MRI and an examination by a physician specialized in dementia diseases) after which a diagnosis is made (blinded to the tests done in primary care). A clinical diagnosis of AD is supported by CSF or PET findings. The diagnosis of AD, either at the MCI or mild dementia stage, was here used as the dependent variable in logistic regression models with the different cognitive tests as predictors (adjusted for age, sex, education). Comparisons of AUC were performed using DeLong statistics.ResultIn this pilot study the first 276 recruited patients were analyzed (Table 1). Four tests, MMSE (AUC = 0.73, P &lt;0.01), MoCA (AUC = 0.71, P &lt;0.05), ADAS 10‐wordlist (AUC = 0.80, P &lt;0.001) and RPT (AUC = 0.79, P &lt;0.001), performed significantly better than the basic model (age, sex, education) in predicting a diagnosis of AD. Both the ADAS 10‐wordlist and RPT performed significantly better than MMSE (P &lt;0.05). Adding the CDT to MMSE did not improve the AUC (0.73).ConclusionIn a diverse population, as seen at primary care centers, brief tests of memory may provide better accuracy in detecting AD than standard of care tests as MMSE and MoCA.

Effects of Cognitive‐motor Rhythmic Training on Executive Functions and Motor Performance in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial

AbstractIntroductionIn recent years, prevalence of mild cognitive impairment (MCI) has increased in older adults, exacerbating the potential impact on global health. Cognitive‐motor training is an emerging treatment modality with proven benefits in enhancing both physical and cognitive functions. In recent research findings, training of musical rhythmic skills with auditory‐motor synchronization is beneficial to reactivate the brain’s sensorimotor and perceptual regions as well as to improve cognition. However, there is limited research on combining these modalities.ObjectivesThis pilot study aims to develop a pioneer program on cognitive‐motor rhythmic training (CMRT), and to investigate whether the program would improve the executive functions (EF) and hand functions of patients with MCI.MethodologyThirty patients recruited from the Hong Kong Buddhist Hospital were randomized into two groups: (i) an intervention group receiving a 6‐week training program and (ii) a waitlist control group. The program was designed with reference to the rhythm game “Taiko no Tatsujin”, in which precise timed motor responses were required to hit the circular cues against the target zone. The game was designed with progression of difficulty levels and instant feedback. Classical Cantopop songs that were familiar to Hong Kong older adults were selected. Mental flexibility, inhibitory control, working memory, visuospatial memory, verbal fluency, processing speed and problem‐solving were assessed using domain‐specific cognitive tests, while hand dexterity was measured by the Purdue Pegboard Test. Paired t‐test and ANOVA were used to examine the within group difference and the comparison between groups. The level of significance was set at P&lt;0.05.ResultsThe analysis showed significant Time x Group interaction effects in Color Trail Test (p = 0.001), Color Word Stroop Test (P = 0.002), Digit Span Test (P&lt;0.001), Corsi Block‐Tapping Test (P&lt;0.001), Verbal Fluency Test (P&lt;0.001), Symbol Digit Modalities Test (P = 0.015), Maze Test (P&lt;0.001) and the Purdue Pegboard scores (P&lt;0.001) compared to the control group after training.ConclusionsThe 6‐week CMRT program is effective in improving the executive functions and motor performance in patients with MCI. This innovation can serve as an affordable and quality intervention in early stages of cognitive decline.

P180: Prefrontal activation during a verbal fluency test in patients with major depressive disorder: an fNIRS study

Objective:Although various clinical indicators of suicide have been recorded, the previous suicide attempt is meaningful as one of the most robust risk factors predicting subsequent suicide attempts but there are lacking in biomarkers for evaluating suicide attempts. This study aimed to analyze the correlation of changes in oxygenated hemoglobin concentration with lifetime suicide attempt during verbal fluency test.Method:A total of 60 patients with major depressive disorder (MDD) were enrolled. Demographic, clinical, physical, and psychological evaluations were conducted. We evaluated the suicidal behaviors through MINI suicidality item. We indicated verbal fluency test to examine prefrontal activation during the cognitive execution while fNIRS was observed.Results:54 of enrolled patient with MDD (23 those with a lifetime history of suicide attempt; 31 those without a lifetime history of suicide attempt) are eligible for the subject. The patients were 35.19% of those with a lifetime history of suicide attempt. The values of the changes in oxygenated hemoglobin involving the entire regions of prefrontal cortex were smaller in those with a lifetime history of suicide attempt. The biggest difference is in right VMPFC, the mean score of those with a lifetime history of suicide attempt and those without a lifetime history of suicide attempt were 0.095(SD, 1.032) and 0.610(SD, 1.038) although the statistically non-significance. We discovered that a small value of changes in oxygenated hemoglobin was related to lifetime suicide attempt through multivariable logistic regression analysis. After adjusting for age, sex, years of education, and HAMD, there was a significant difference in the right VMPFC [OR = 0.491(95% CI=0.235~0.916), p = 0.036].Conclusions:Study result indicated that the values of the changes in oxygenated hemoglobin were smaller in who attempted suicide before during cognitive execution. The adjusted regression analysis was presented significant result in right VMPFC. Therefore, the changes in oxygenated hemoglobin measured by fNIRS can be applied as a biomarker for suicidal behavior such as lifetime suicide attempt.

Impacts of depression, apathy, and anxiety on cognitive function in older adults with subjective cognitive decline

AbstractBackgroundAlthough previous studies showed that neuropsychiatric symptoms are associated with cognitive decline, the results are controversial. We investigated the impacts of depression, apathy, and anxiety on cognitive function in older adults with subjective cognitive decline (SCD).MethodAltogether, 464 subjects aged 65‐85 years who had SCD were enrolled in this study. All participants were evaluated with the short version of Geriatric Depression Scale (GDS15), Starkstein’s Apathy Scale (AS), the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS), and 9 cognitive tasks assessed using the Mini‐Mental State Examination, Logical Memory and Visual Reproduction subtests of the Wechsler Memory Scale‐Revised, Verbal Fluency Test, Digit Span, Visual Memory Span and Digit‐Symbol subtests of the Wechsler Adult Intelligence Scale‐III, Stroop Test, and Trail Making Test. We performed a Pearson correlation analysis to examine the associations between depression, apathy, and anxiety, and a multiple linear regression analysis, adjusted for age, sex, educational level, and global cognitive state to determine the impacts of depression, apathy, and anxiety on cognitive function.ResultPearson correlation analysis revealed a low‐ to moderate‐grade relationship among depression, apathy, and anxiety, as shown by the correlation between GDS15 and AS (r = 0.49, p &lt; 0.01), GDS15 and HADS (r = 0.36, p &lt; 0.01), and AS and HADS (r = 0.18, p &lt; 0.01). The multiple linear regression analysis, with each cognitive task score as dependent variable, indicated a significant association of the HADS with lower scores on Logical Memory I (beta = −0.18, p &lt; 0.001) and II (beta = −0.14, p = 0.002), after adjusting for the subjects’ age, sex, educational level, and global cognitive state.ConclusionOur results suggest that anxiety may be associated with immediate and delayed memory functions in older adults with SCD.