Verbal Fluency Research Articles

Association between Multi-Domain Lifestyle and Objective Cognitive Impairment in Elderly People with SCD and MCI in Chinese Communities.

Controlling the lifestyle associated with dementia risk can delay the process of cognitive decline. Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are early states in the development of dementia and are also the window period for early intervention in dementia. The purpose of this study was to explore the association between multi-domain lifestyle and objective cognitive impairment in elderly people with SCD and MCI in Chinese communities and to provide reference for effective implementation of precise health management measures to reduce the risk of dementia. A total of 265 middle-aged and elderly volunteers recruited from the community were divided into SCD group (107 cases), MCI group (80 cases), and healthy control (HC) group (78 cases). All participants received clinical interview, examination, and cognitive assessments. The total Dementia Risk Reduction Lifestyle Scale (DRRLS) scores in the HC, SCD, and MCI groups [110.00 (11.25) vs. 101.00 (10.00) vs. 79.50 (20.75)] exhibited statistically significant differences among them. The total score of the DRRLS showed a significant negative correlation with the Trail-Making Test (TMT), and significant positive correlations with both the Verbal Fluency Test (VFT) and Auditory Verbal Learning Test (AVLT) scores (p < 0.05). After adjusting for confounding factors, such as age and years of education, multiple linear regression analysis revealed several points. In the SCD group, brain-strengthening exercise and interpersonal relationship scores were negatively correlated with TMT scores (β = -11.257, -15.077; all p < 0.05), while health responsibility, smoking control behavior, and interpersonal relationship scores were positively correlated with AVLT scores (β = 0.485, 0.344, and 0.406; all p < 0.05). In the MCI Group, brain-strengthening exercise, brain-healthy diet, and interpersonal relationship were negatively correlated with TMT (β = -22.011, -16.206, -11.696; all p < 0.01), whereas health responsibility, mental activity, smoking control behavior, interpersonal relationship, and stress management were positively correlated with AVLT (β = 0.450, 0.435, 0.308, 0.256, 0.607; all p < 0.05). In Chinese communities, the unhealthy lifestyle of elderly individuals with SCD and MCI is significantly associated with cognitive function impairment. The greater their unhealthy lifestyle habits, the more pronounced the scope and severity of cognitive function impairment becomes. Furthermore, different dimensions of lifestyle have varying impacts on cognitive domains.

Predictors of Verbal Fluency Decline in People with Cognitive Dysfunctions

Background: Verbal fluency impairment is a prospective risk for dementia and conversion from Mild Cognitive Impairment (MCI) to dementia. In elderly may be related to the deficits in other cognitive domains and also with age and duration of cognitive decline. The AIM: The purpose of this study was to analyze the results of Verbal Fluency Tests (VFT) in people with cognitive decline in relation to age, duration of the cognitive decline and the level of cognitive dysfunction. Methods: 279 (177 females and 102 males) people with cognitive decline (MCI and dementia), aged 50-91 years were included in the study. For the evaluation of general cognitive abilities Mini Mental State Examination (MMSE) and for assessment of verbal fluency– Verbal Fluency Test (phonological and categorical) was applied. Statistical analysis was performed using nonparametric tests. Factor analysis of the main components of Verbal Fluency Test and MMSE were used and one-way ANOVA test in the prediction analysis was applied. Results: All dimensions of verbal fluency subscales and MMSE are explained by one factor, which indicate their similar etiological mechanism. The longer duration of the cognitive impairment the worse results in VFT and MMSE. Worse results of MMSE were associated with worse performance on VFT, the most important critical moment of deterioration was associated with scores in the range of 25-23 and 17-18 MMSE points, however there are some differences between verbal fluency categories. The most significant periods of duration of the disease for VFT performance were months 6 and 9, and for the category of categorical fluency months 6,9, as well as 26, 31-32 and 36. No significant associations between the age and VFT and MMSE results were observed. Conclusions: Verbal fluency decline is related to global cognitive functioning. Longer duration time of the disease was associated with the level of verbal fluency and cognitive decline, while the age of patients is not an important factor. The verbal fluency deterioration occurs in leaps and bounds, the critical moments for verbal fluency decline may be established based on the duration of the illness and global functioning measured by MMSE.

The Relationship Between Executive Functioning and Narrative Language Abilities in Aphasia.

Although individuals with aphasia commonly exhibit challenges in executive functioning (EF) and spoken discourse, there is limited research exploring connections between these abilities within this specific population. Therefore, this study investigated the relationship between verbal and nonverbal EF and narrative productions in aphasia using a multilevel linguistic approach. Participants included 22 persons with aphasia (PWA) and 24 age- and education-matched, neurologically healthy controls (NHC). All participants completed assessments for EF and a story retelling task. Narrative samples were analyzed for microlinguistic (productivity, lexical and syntactic features, semantic content, word and sentence errors) and macrolinguistic (coherence, informational content, organization, and language use) characteristics. Correlational analyses were employed to explore the relationships among narrative variables. EF factors, extracted from principal component analysis, were used as predictive variables in hierarchical stepwise regression analyses to evaluate their role in predicting narrative performances of PWA and NHC. Relative to NHC, PWA exhibited impaired narrative performance affecting both microlinguistic and macrolinguistic levels. Breakdowns at the structural level (i.e., reduced productivity, syntax, lexical retrieval, and diversity) correlated with impaired story completeness, organization, and connectedness; this relationship was more prominent for PWA. Three EF factors representing (1) verbal EF, (2) verbal and nonverbal fluency, and (3) nonverbal EF were extracted. Factors 1 and 2 largely predicted narrative performance, whereas Factor 3 (i.e., nonverbal EF) contributed prominently to predicting macrolinguistic discourse performance in both groups although accounting for less variance in the data. Overall, lower EF scores, particularly verbal EF variables, predicted poor narrative performance in both groups. Our results indicate that both linguistic and extralinguistic cognitive abilities play a role in story retelling performances among PWA. Notably, both verbal and nonverbal EF skills were found to be correlated with narrative abilities. However, the extent of their contributions varied depending on the discourse levels assessed. These findings provide a significant contribution to our understanding of the cognitive factors associated with breakdowns in discourse among PWA and highlight the importance of comprehensive assessment of EF and discourse within this population. https://doi.org/10.23641/asha.26485627.

Coping patterns associations with cognitive function in older adults.

Cognitive function may contribute to variability in older adults' ability to cope with chronic stress; however, limited research has evaluated this relationship. This study investigated the relationship between theoretically derived coping domains and cognitive function in 165 middle-to-older adults during the Omicron stage of COVID-19. Participants completed a clinical interview and self-report measures of health. The National Alzheimer's Coordinating Center Uniform Data Set neuropsychological battery was used to evaluate memory, language, executive function/speed, and working memory. Structural equation modeling evaluated the underlying factor structure of the Brief COPE adapted for COVID-19. The data supported the proposed second-order Approach factor comprised of Problem-Solving and Emotion Regulation (ER) strategies and a first-order Avoidance factor. Higher Avoidance was associated with greater depression symptoms, lower income and worse memory, executive function, working memory, and verbal fluency performance. Higher Problem-Solving was associated with better verbal fluency performance. ER strategies were not significantly associated with cognitive function. The use of Problem-Solving was not associated with less Avoidance. Greater use of Problem-Solving, ER, and Avoidance were all associated with higher levels of stress. Post-hoc analyses found that higher Acceptance was the only coping strategy associated with less stress. These findings demonstrate that older adults with worse cognitive function were more likely to use Avoidance during the pandemic, which could result in prolonged stress and adverse health consequences. Future research is warranted to investigate whether acceptance-based interventions reduce the avoidance and impact of stress on health in vulnerable older adults.

Anxiety in late-life depression is associated with poorer performance across multiple cognitive domains.

Anxiety is a common comorbid feature of late-life depression (LLD) and is associated with poorer global cognitive functioning independent of depression severity. However, little is known about whether comorbid anxiety is associated with a domain-specific pattern of cognitive dysfunction. We therefore examined group differences (LLD with and without comorbid anxiety) in cognitive functioning performance across multiple domains. Older adults with major depressive disorder (N = 228, ages 65-91) were evaluated for anxiety and depression severity, and cognitive functioning (learning, memory, language, processing speed, executive functioning, working memory, and visuospatial functioning). Ordinary least squares regression adjusting for age, sex, education, and concurrent depression severity examined anxiety group differences in performance on tests of cognitive functioning. Significant group differences emerged for confrontation naming and visuospatial functioning, as well as for verbal fluency, working memory, and inhibition with lower performance for LLD with comorbid anxiety compared to LLD only, controlling for depression severity. Performance patterns identified among older adults with LLD and comorbid anxiety resemble neuropsychological profiles typically seen in neurodegenerative diseases of aging. These findings have potential implications for etiological considerations in the interpretation of neuropsychological profiles.

Comparison of micro- and macro- structural narrative features between Turkish-Kurdish bilinguals and Turkish monolinguals

Abstract Bilingualism may lead to differences in narrative micro- and macrostructural features. Creating a normative data set on the narrative characteristics of healthy Turkish-Kurdish bilinguals may allow for a more effective assessment of language disorders that may occur in bilinguals with acquired brain injury. This study aims to determine how narrative micro- and macrostructural features differ in Turkish-Kurdish bilinguals in single picture and story narratives. A total of 23 bilingual (Turkish-Kurdish) and 23 monolingual (Turkish) healthy individuals were included in the study. Narrative samples were obtained using single pictures and a story. Micro- and macrostructural features were compared between bilinguals and monolinguals matched for age, education, and gender. Mean length utterance-morpheme and clausal density variables, considered as indicators of grammatical complexity, were higher in monolinguals in both single picture and story narratives. Morphemic errors were higher for bilinguals. Effort behaviors, which can interrupt verbal efficiency, were higher in bilinguals in single picture narratives. While there was no difference between the groups in verbal fluency (phonemic and categorical), the lexical diversty in storytelling was higher in monolinguals. In terms of macrostructural features, cognitive inferences in the story context and emotional discourse in the single picture context were higher in monolinguals, while enrichment expressions in the single picture narrative were higher in bilinguals. In both groups, macrostructural features such as cognitive inferences and expressions of uncertainty in discourse were negatively correlated with grammatical complexity variables. Turkish-Kurdish bilinguals’ single picture and story narratives in Turkish may show semantic, morphosyntactic and pragmatic differences compared to Turkish-speaking monolinguals.

A new test for evaluation of marginal cognitive function deficits in idiopathic normal pressure hydrocephalus through expressing texture recognition by sound symbolic words.

The number of dementia patients is increasing with population aging. Preclinical detection of dementia in patients is essential for access to adequate treatment. In previous studies, dementia patients showed texture recognition difficulties. Onomatopoeia or sound symbolic words (SSW) are intuitively associated with texture impressions and are less likely to be affected by aphasia and description of material perception can be easily obtained. In this study, we aimed to create a test of texture recognition ability expressed by SSW to detect the presence of mild cognitive disorders. The sound symbolic words texture recognition test (SSWTRT) is constructed from 12 close-up photos of various materials and participants were to choose the best SSW out of 8 choices to describe surface texture in the images in Japanese. All 102 participants seen in Juntendo University Hospital from January to August 2023 had a diagnosis of possible iNPH (age mean 77.9, SD 6.7). The answers were scored on a comprehensive scale of 0 to 1. Neuropsychological assessments included MMSE, FAB, and the Rey Auditory Verbal Learning Test (RAVLT), Pegboard Test, and Stroop Test from the EU-iNPH Grading Scale (GS). In study 1 the correlation between SSWTRT and the neuropsychological tests were analyzed. In study 2, participants were divided into two groups: the Normal Cognition group (Group A, n = 37) with MMSE scores of 28 points or above, and the Mild Cognitive Impairment group (Group B, n = 50) with scores ranging from 22 to 27 points, and its predictability were analyzed. In study 1, the total SSWTRT score had a moderate correlation with the neuropsychological test results. In study 2, there were significant differences in the SSWTRT scores between groups A and B. ROC analysis results showed that the SSWTR test was able to predict the difference between the normal and mildly impaired cognition groups. The developed SSWTRT reflects the assessment results of neuropsychological tests in cognitive deterioration and was able to detect early cognitive deficits. This test not only relates to visual perception but is likely to have an association with verbal fluency and memory ability, which are frontal lobe functions.

Adynamic spoken language in corpus callosum dysgenesis

Corpus callosum dysgenesis (CCD) is a congenital brain malformation that occurs when the development of the corpus callosum is disrupted, either partially or completely. The cognitive outcomes in individuals with CCD vary greatly, but generally the neuropsychological profile is characterised by slow processing speed, poor transfer of interhemispheric sensory-motor information, and impaired complex problem solving. Core language skills are often preserved in CCD, but there is some evidence that complex language may be impaired. Thus, the current study sought to examine whether spontaneous speech output was reduced in a cohort of individuals with CCD compared to age-matched controls. We further explored a series of factors that may be contributing to poor spontaneous speech in CCD, such as difficulties generating, selecting, and sequencing ideas for expression, as well as apathy and slowed processing speed. A cohort of 25 individuals with CCD and 39 neurotypical controls were enrolled in this study. Participants completed a picture description task to measure spontaneous speech output, alongside a series of cognitive and language baseline tests. Verbal and nonverbal fluency tasks gauged idea generation and sequencing, and sentence-level selection tasks measured idea selection. We found that, despite having largely intact core language skills, individuals with CCD produced significantly less spontaneous speech on the picture description task than controls. This language profile may be described as “adynamic”. Further, we found that poor spontaneous speech output in CCD was related to problems generating ideas for expression, as individuals with CCD performed below controls on the verbal and nonverbal fluency tasks. Exploratory analyses revealed that apathy and slowed processing speed may be contributing factors. Adynamia in CCD is a novel finding that may be an intervention target for improving communication skills in this population.

New Evidence of Healthier Aging: Positive Cohort Effects on Verbal Fluency.

Cross-sectional studies have shown improvements in cognition in later-born cohorts. However, it remains unclear whether these cohort effects extend beyond cognitive levels and are also detectable in the rate of age-related cognitive decline. Additionally, evidence is scarce on the presence and consistency of cohort effects throughout different segments of the distribution of cognitive trajectories. This study evaluates the existence and variability of cohort effects across the entire distribution of aging-related trajectories of verbal fluency. With this purpose, we develop sex and education-adjusted longitudinal norms of verbal fluency using data from 9 waves of the English Longitudinal Study of Aging (ELSA) by fitting quantile mixed models. The effect of age was modeled using splines to assess birth cohort effects, after grouping individuals in 5-year groups from 1920 to 1950 according to their age at study entry. To test for possible cohort effects across the 10th, 50th, and 90th quantiles, the coefficients associated with the splines were allowed to vary among cohorts. Our results suggest that, consistently across longitudinal quantiles, decline in verbal fluency across age is less pronounced for later-born individuals (p < .001), supporting the hypothesis of cohort effects. Additionally, we also found that quantiles of verbal fluency at any age are shifted upwards in later-born cohorts compared to those in earlier-born cohorts. These results enhance our understanding of cognitive decline in older adults by demonstrating that cohort effects on cognition are observable both cross-sectionally and longitudinally, affecting the entire range of verbal fluency trajectories.

A - 113 Assessing the Feasibility of Machine Learning to Predict Frontotemporal Dementia Severity from Neuropsychological Assessments

Abstract Objective To assess the feasibility of utilizing machine learning (ML) of neuropsychological assessment data in determining the severity of frontotemporal dementia (FTD) as classified by the Clinical Dementia Rating (CDR). Method A Random Forest classification model was employed using a deidentified FTD dataset. Participants’ (N = 3023) were stratified based on CDR scores for severity: Normal (n = 1646, Mage = 46.95, 59.66% female), Mild (n = 855, Mage = 63.06, 57.08% female), Moderate–Severe (n = 522, Mage = 64.57, 62.45% female). Participants were than randomly stratified into a training set (80%) and a testing set (20%) for model evaluation. The model was then trained on the training set using participant data including age, gender, verbal fluency, digit span forward, digit span backward, trails A, trails B, and the MOCA total score. The model was then evaluated on the testing set. Results The model achieved an accuracy of 74.55% on the testing set. Detailed performance metrics revealed a precision of 86%, recall of 91%, and F1-score of 89% for the normal category, 56% precision, 56% recall, and 56% F1-score for mild, and 65% precision, 52% recall, and 58% F1-score for moderate–severe. The most salient features were verbal fluency and age, with assigned importance scores of 0.174 and 0.150, respectively. Conclusions Although the Random Forest model demonstrated potential in predicting FTD severity from neuropsychological data, its moderate performance for mild and severe categories indicates it’s not yet clinically viable. This study offers a foundational framework, suggesting further model refinement and larger datasets are necessary to enhance accuracy and clinical utility. Future research should focus on including diverse variables and populations.

A - 80 Moderating Effect of Age on the Relationship between Mood and Executive Functioning among South Asians

Abstract Objective This study investigated whether depression and anxiety are associated with executive functioning (EF) performance among South Asians living in the United States (US). Further, we explored whether age moderated this relationship. Method This retrospective chart analysis study included 28 South Asians referred for a neuropsychological evaluation within multiple northeast US-based outpatient clinics. Participants completed the Beck Depression Inventory-2nd edition (BDI-II), Beck Anxiety Inventory (BAI), Stroop Color Word Test- Color-Word Trial (SCWT-CW), and Verbal Fluency (FAS). Participants were dichotomized by age threshold (age 50 cut-off). Logistic regression analysis was used to determine the moderating effect of age on mood and EF. Results The sample comprised 13 younger adults and 15 older adults (50+), with 60.7% male (Meducation = 16.0, SD = 2.3). Regression analysis indicated a significant overall model between age, BDI-II, and SCWT-CW (F(1,25) = 3.01, p &amp;lt; 0.05, ΔR2 = 0.27). Further interaction analysis showed a stronger positive interaction effect between BDI-II and SCWT-CW (β = 5.39, F(1,24) = 4.91, p &amp;lt; 0.05, ΔR2 = 0.15) in the younger adult group. Conclusions Findings suggest that South Asian older adults with lower levels of depression have worse performance on EF than younger adults. This is one of the first studies to identify links between age, mood, and EF. Interpretation is challenging given that the mean scores of depression and SCWT-CW were in the mild range. Future studies are needed to understand how factors, such as English speaking proficiency and acculturation, may moderate the association and impact clinical relevance.

A - 147 Patient-Centric Considerations for Selecting the Language of Procedure Administration in Candidates for Epilepsy Surgery: Implications for Data Interpretation, Prognostication and Outcomes

Abstract Objective Selecting the language of pre-surgical neuropsychological testing (NPT), intracarotid amobarbital procedure, and intra/extra functional language mapping (ESM) in bi−/multi-lingual patients is a high-stakes neuropsychological decision point. Though a patient’s self-selection of language is an integral consideration, both patient and provider must fully understand the potential implications of language selection on a patient’s data interpretation and overall case conceptualization. Method A 26-year-old, right-handed, bilingual (L1 = Mandarin-, L2 = English-speaking) female received pre-operative NPT, Wada test, and ESM to guide resective surgery targeting medically-refractory epilepsy involving the right superior temporal gyrus (STG) and mesial (MTL) temporal lobe. All procedures were conducted in English at the patient’s request with alternate forms of verbally-mediated NPT administered in Mandarin. Results Confrontation naming and verbal fluencies were impaired in both English and Mandarin. Wada testing administered in English revealed bilateral language and greater left hemisphere memory support. Following considerable psychoeducation regarding possible functional language loss in Mandarin post-operatively, the patient agreed to ESM in L1 with auditory and picture naming disruption after right STG stimulation. Conclusion Despite strong English-language fluency, assessment in Mandarin was of critical importance, as eloquent cortices essential for tonal language production may have been resected if mapping procedures were completed in English-only, as requested. Balancing factors informed by functional and structural neuroanatomy, patient worldview, and cross-cultural neuropsychology requires a tailored, patient-centric approach to case conceptualization.

A - 103 Exploring the Diagnostic Criteria for Alcohol-Related Dementia: a Case Study

Abstract Objective Excessive and chronic alcohol use can cause structural/functional abnormalities in the brain, including cognitive impairment (CI) (Harper, 2009). Despite these established risks, alcohol-related dementia (ARD) has received little recognition, mainly due to lack of a distinct pathophysiological profile. Through a case differential approach (concussion vs. ARD), the authors aim to clarify diagnostic criteria for ARD. Methods A 56-year-old right-handed male presented to the emergency room after fall with head strike (no loss of consciousness) with alcohol withdrawal delirium. Symptoms of cerebellar ataxia and CI of 6-month duration were noted. Past medical history was significant for alcohol use (four standard units per day), hyperlipidemia, tobacco use, and depression/anxiety. Neuroimaging revealed cerebral atrophy and chronic small vessel ischemic disease. A neuropsychological evaluation (NPE) was conducted 18 days post-fall. Results NPE revealed relative weaknesses in working memory, complex attention, and visual abstraction. Impairments were noted in visuospatial organization/planning, processing speed, basic attention, verbal fluency, and verbal memory. Motor examination was evident for intention tremor. Conclusion Brain changes associated with ARD include volume loss, altered glucose metabolism, reduced neuronal density, changes in frontal lobe function, and white matter loss. In contrast, individuals affected by concussions may encounter challenges with attention/concentration, processing speed, and working memory. Distinguishing a clear diagnostic profile for ARD is difficult due to high rates of concomitant concussion in this population. The patient’s deficits exceed those expected due to concussion alone, with an anticipated cognitive recovery timeframe of 7–14 days (Iverson, 2006). Furthermore, neuroimaging and NPE results support the diagnostic hypothesis of ARD.

A - 79 Comparison of Neuropsychological Test Performance between Monolingual Older Adults with Varying Cognitive Profiles

Abstract Objective With the rapid aging and cultural differences of the Latinx population, psychologists have expressed concerns regarding neuropsychological evaluations used for Alzheimer’s disease (ad), including the appropriateness of normative data and misinterpretation of test scores. This study explores various facets of neuropsychological performance between Spanish and English-speaking older adults with ad or normal cognition (NC). Method Participants (N = 17,716) from a de-identified database from the National Alzheimer’s’ Coordinating Center were administered Boston Naming Test-30 items (BNT-30), Animal &amp; Vegetable Verbal Fluency, Digit Symbol, Mini-Mental Status Examination (MMSE), Logical Memory I &amp; II (LM-I &amp; II), and Trail Making Test A &amp; B (TMT-A &amp; B). Correlations, multiple linear hierarchical regressions, and two-factor Analyses of Variance (ANOVAs) were used. Results Significant associations between interest areas (e.g., sex, ethnicity, race, age, education level, and/or age of cognitive onset) and test performances were found in each diagnosis group. Primary language, education level, and diagnosis were found to be significant predictors of LM-I (f2 = 0.19), LM-II (f2 = 0.22), and TMT-B (f2 = 0.15) performance. Significant interactions of primary language and diagnosis group were found among test performances for the MMSE, LM-II, Animals Verbal Fluency, TMT-A, and TMT-B (p &amp;lt; 0.05). Conclusions Further research is warranted to understand the complexity of using neuropsychological assessments to detect ad-related deficits among Spanish-speaking Latinx individuals. Evidence-based neuropsychological practice guidelines must acknowledge the importance of education level and primary language on test performance.

A - 38 Impact of Working Memory and Processing Speed on Executive Function Performances in Youth with Attention-Deficit/Hyperactivity Disorder and Learning Disorder

Abstract Objective Executive function (EF) differences exist among children and adolescents with comorbid attention-deficit/hyperactivity disorder and learning disorders (ADHD+LD), relative to ADHD or LD alone. The impact of cognitive proficiency (i.e., working memory and processing speed) on EF is unclear across these diagnoses. Method This study investigated relations between cognitive proficiency and EF measures for 360 clinic-referred youth (ages 8–18) diagnosed with ADHD, LD, ADHD+LD, or No Diagnosis of ADHD/LD following neuropsychological evaluation. Two-way ANOVAs determined if WISC-V or WAIS-IV working memory (WMI) or processing speed (PSI) indices moderate the associations between group and D-KEFS performance (i.e., Color-Word Interference, Tower, Verbal Fluency, and Trail Making Tests). Results Results revealed significant interactions between group and WMI or PSI affecting D-KEFS Verbal Fluency Category Switching (F’s = 3.00–3.13, p’s = 0.026–0.031). Better performance on WMI or PSI was associated with better performance on Verbal Fluency Category Switching across groups, but this association was significantly less for ADHD+LD compared to other groups. Positive main effects were observed between WMI or PSI and all D-KEFS measures (F’s = 7.62–84.86, p’s &amp;lt; 0.006). Significant main effects were observed between group and D-KEFS Color-Word Interference Inhibition and Trails Number-Letter Sequencing (F’s = 2.95–3.77, p’s = 0.013–0.035), where No diagnosis performed better than other groups. Conclusions Overall, stronger working memory and processing speed may aid EFs for No diagnosis, ADHD, and LD youth, but not ADHD+LD youth. This may suggest an additive impact of a comorbid diagnosis leading to worse deficits in EFs and that stronger working memory and processing speed may be less protective for youth with comorbid diagnoses. Additional research is warranted.

B - 11 Alien Limb and Corticobasal Degeneration: a Neuropsychological Case Study

Abstract Objective The patient presented with alien limb, frequently associated with corticobasal degeneration, an atypical parkinsonian syndrome with rigidity, akinesia, dystonia, cortical sensory deficit, and apraxia. Subjective memory complaints are also common. Neuropsychological performance typically includes poor performance on verbal fluency and measures tapping into executive functioning, but confrontation naming and verbal comprehension are initially well-preserved. Method The patient is a right-handed 69-year-old male who developed the sensation of alien limb in his left arm 2 years prior, in which his left hand did not feel “real.” Additionally, the patient presented with memory difficulties, mild word-finding problems, and physical/motor complaints (i.e., limb apraxia, tremor, bradykinesia, occasional limb dystonia, and postural instability) for approximately 2 years. The patient sought neuropsychological assessment to clarify his cognitive functioning in light of his neurologic symptoms. Results Premorbid functioning was in the exceptionally high range, with 18 years of education. Neuropsychologically, immediate memory was generally average, and generally low average delayed memory and recognition abilities. Mild inefficiencies were observed in executive functioning and semantic fluency. Otherwise, the patient performed generally average across other tasks of language, including confrontation naming, and attention. Conclusions In light of the literature, it is expected that corticobasal degeneration will be associated with subjective memory difficulties, executive dysfunction and poor verbal fluency. The patient presented with generally intact memory, mild executive dysfunction, and poor semantic fluency abilities. Given the patient’s high intelligence, he may be more sensitive to cognitive lapses. Neuropsychological results, along with his reported parkinsonian features, are fairly consistent with possible incipient corticobasal degeneration.

B - 21 11-Year Longitudinal Study of a Competitive Swimmer Following a Severe TBI

Abstract Objective Symptoms of severe traumatic brain injuries (TBIs) are oftentimes significant, long lasting, and treated by a variety of medications and therapies. Although exercise is known to be beneficial for brain health, the effects of substantial exercise on recovery following severe TBI (sTBI) in female athletes are undiscovered. Method This case study examines a 51-year-old woman who sustained a sTBI, involving multiple hemorrhagic contusions to the right cerebellum, inferior bilateral frontal lobes, anterior left temporal lobe, and diffuse axonal injury on 8/5/13 from a bicycle accident, resulting in a 13-day coma and cognitive impairment. She underwent 6 brain surgeries, an artificial skull implant and intensive therapies. Before the accident, she was a competitive swimmer and triathlon racer. Despite being told that she would never swim again, she resumed swimming on 09/1/14. She swims 6 days a week for 90-minutes a day, winning open water races. Results Examination from four neuropsychological assessments over 11 years provide substantial longitudinal data. Results revealed improvement over the 4 testing periods particularly on processing speed, verbal fluency, and Boston Naming Test with t-score differences ranging between 8 and 24. Additionally, she performed in the average range on General Abilities Index, NAB Mazes, and Trail Making Test across all four assessments. Conclusion This longitudinal case study provides evidence that extensive swimming is associated with cognitive recovery from sTBI in a female athlete and documents her return to high level exercise and competition. Evidence suggests that carefully tailored and monitored exercise programs can benefit long term cognitive following from sTBI.

B - 66 Cognitive Dispersion Is Uniquely Associated with Executive Functions in HIV Disease

Abstract Objective Among persons living with HIV (PLWH), higher levels of intraindividual variability (IIV) across a battery of neuropsychological measures (i.e., dispersion) increase the risk of dependence in everyday functioning. Higher levels of dispersion are theorized to reflect lapses in executive aspects of attention, but few studies have directly evaluated the construct validity of dispersion. Method 72 PLWH completed the Cogstate battery (www.cogstate.com). Exclusion criteria were inability to provide informed consent, psychosis, active substance use disorders, and major neurological conditions. Dispersion was operationalized as a coefficient of variance (CoV) across age-adjusted scores on six tests from the Cogstate battery (i.e., intra-individual standard deviation divided by the intra-individual mean). The predictor variables were mean-level, demographically-adjusted performance scores from well-validated clinical measures of executive functions (Trailmaking Test B, WCST-64 Perseverative Responses, PASAT-50, and Verbal Fluency), psychomotor speed (WAIS-III Digit Symbol, Trailmaking Test A, Grooved Pegboard), and episodic memory (HVLT-R and BVMT-R Learning and Delayed Recall). Results A multiple regression analysis indicated that the three domain-level cognitive predictors explained 12.1% of the variance in Cogstate CoV (p = 0.03). Within this model, lower levels of executive functions were significantly associated with higher CoV on the Cogstate (p = 0.01), but the psychomotor and memory domains were not (ps &amp;gt; 0.05). Conclusion The findings from this cross-sectional study align with cognitive theory in demonstrating dispersion is uniquely associated with external measures of executive functions (e.g., cognitive flexibility) among PLWH. Future experimental studies are needed to determine the precise executive mechanism of dispersion.

A - 39 The Physical and Neurological Examination of Subtle Signs (PANESS) as a Predictor of ADHD

Abstract Objective The Physical and Neurological Examination of Subtle Signs (PANESS) is a pediatric neuromotor exam. Prior research shows children with attention deficit hyperactivity disorder (ADHD) may exhibit neurological soft signs. This study investigates the predictability of PANESS performance on other ADHD measures. Methods Subjects included 52 children aged 8–16 seen clinically for evaluation at Austin Neuropsychology. Dependent variables included Digit Span (DS), Test of Everyday Attention (TeaCh), Conners Continuous Performance Test (CCPT-3), and Delis-Kaplan Executive Function System (DKEFS). The raw scores of PANESS tasks were the independent variables. Results DS was significantly predicted by the foot tap (FT) (p = 0.017), foot heel-toe tap (FH) (p = 0.028), hand pat (HP) (p = 0.018), finger tap (FinT) (p &amp;lt; 0.001), and appose finger succession (AFS) (p = 0.012) tasks on the PANESS. The Category Fluency (CF) subtest on DKEFS Verbal Fluency was also significantly predicted by the FT (p = 0.043), FH (p &amp;lt; 0.001), hand pronate/supinate (HPS) (p = 0.003), FinT (p = 0.003), FA (p &amp;lt; 0.001) tasks. All PANESS tasks significantly predicted performance on Trial 2 of DKEFS Color-Word (FT: p = 0.012; FH: p = 0.015; HP: p = 0.002; HPS: p = 0.009; FinT: p = 0.003; FA: p = 0.002). The FA task was a significant predictor of all trials of CWI (T1: p &amp;lt; 0.001; T2: p = 0.002; T3: p &amp;lt; 0.001; T4: p &amp;lt; 0.001). Conclusion The PANESS predicts performance on some ADHD tasks, though not others. This finding prompts further investigation into how PANESS can be integrated into clinical settings to enhance ADHD diagnosis and understanding.

A - 99 Examining the Relationship between Adverse Childhood Experiences, Neuropsychological Functioning, and Neurocognitive Status among Older Adults

Abstract Objective Adverse childhood experiences (ACEs) are associated with poorer cognitive and mental health outcomes in adulthood. However, there is limited research elucidating the relationship between ACE severity and specific neuropsychological outcomes among examinees with cognitive impairment. This study assessed the relationship between ACE exposure and cognitive and psychiatric outcomes among older adults with and without cognitive impairment. Method This cross-sectional study included 75 patients (64% female; MAge = 67, SD = 8.6; MEducation = 12.8, SD = 3.2) undergoing neuropsychological evaluation at an academic medical center. Analyses of variance (ANOVAs) compared high versus low ACE groups on specific tests of verbal fluency, processing speed, working memory, executive functions, and on depression and anxiety measures. Groups were formed based on neurocognitive status (i.e., no diagnosis, mild cognitive impairment, dementia) and ANOVAs were re-run for each diagnosis. Results No significant differences were detected on neurocognitive measures among the overall group or when groups were subdivided by diagnosis. Among the overall sample, significant group differences were detected for depression and anxiety symptoms, F(1,73) = 16.696, p &amp;lt; 0.001 and F(1,73) = 12.268, p = 0.001 respectively, such that higher ACE groups endorsed significantly more psychiatric symptoms. Among the no-diagnosis group, depressive symptoms were bordering insignificance, p = 0.048, and no differences were detected for anxiety. By contrast, higher ACEs were associated with greater anxiety among the mild cognitive impairment group and greater depression among the dementia group. Conclusions Findings reinforce the impact of ACEs on psychiatric symptoms among older adults. Although there were no significant cognitive differences, further research is necessary to better understand the relationship between ACEs, neurocognitive impairment, and psychiatric functioning.