bluuebunny/crossref_metadata_2025 huggingface dataset:
A - 44 Social Cognition and its Neuroanatomic Correlates in Frontotemporal Dementia
Authors: Dotterer Hailey L , Morrow Christopher , Corona-Long Caitlin , Bakker Arnold , Oniyke Chiadi U , Kamath Vidyulata
Published: October 2023

Objective

Frontotemporal dementia (FTD) often presents with impaired social cognition in both the behavioral and language variants. Establishing reliable measures and neural correlates of social cognition may aid in staging and monitoring FTD subtypes. Here, we examined group differences in social cognitive measures between FTD subtypes and cortical thickness correlates of social cognition across groups.

Method

Participants with behavioral variant FTD (n = 53; bvFTD), semantic variant primary progressive aphasia (n = 32; svPPA) and non-fluent variant PPA (n = 32; nfPPA) were enrolled in the Frontotemporal Lobar Degeneration Neuroimaging Initiative (NIFD). In first-visit data, we examined group differences in social cognition measures [Interpersonal Reactivity Index (IRI), Revised Social-Monitoring Scale (RSMS), and Behavioral Inhibition/Activation (BIS/BAS) Scales]. We used multivariate regression adjusted for age, total intracranial volume, and CDR global score to explore associations between social cognition and cortical thickness in pre-specified regions.

Results

Reduced perspective-taking and sensitivity to socio-emotional expressiveness was observed in early-stage bvFTD and svPPA groups compared to the nfPPA group. Across FTD cohorts, increased perspective-taking was associated with reduced cortical thickness of regions within the salience and default mode networks. Increased empathic concern was associated with increased left inferior parietal cortical thickness. Increased behavioral inhibition was associated with reduced right posterior cingulate cortical thickness. Increased behavioral activation was associated with reduced right pars triangularis cortical thickness.

Conclusions

Social cognition is affected in early-stage bvFTD and svPPA to a greater extent than nfPPA. Neural correlates of social cognition are varied and warrant additional study as our findings contrast with previous literature that has typically linked lower perspective-taking with atrophy.
A - 45 Diverse Perspectives in Cognitive Reserve: Changing Theories for a Changing World
Authors: Edwards Katie , Burks Alexis , Mullins Teagan , Shendo Macaiah , Dixon Naila DeCruz , Gillezeau Christina , Hernandez-Vallant Alexandra , Schodt Kaitlin , Abrams-Silva Lynette
Published: October 2023

Objective

The Cognitive Reserve (CR) Theory proposes protective factors that aid in acting against cognitive decline due to factors such as dementia and head injury. Here we conduct a narrative review of diverse perspectives in CR. We provide an overview of CR models not previously highlighted, as well as how traditional models of CR may not be applicable for all populations.

Data Selection

A review of the literature on diverse perspectives of CR was carried out through PubMED, Sage Research Methods (SRM) Core, and Web of Science: All Databases. Two specific types of articles were selected. We first looked at traditional models of CR (premorbid intelligence estimates and educational or occupational attainment) tested with diverse populations not historically represented in the original models. The second category of articles included an open-ended search of CR expressions outside of these traditional understandings (i.e., resiliency).

Data Synthesis

Reviewed evidence suggests that historical models of CR are not homogeneously valid across racial and ethnic groups. Other conceptualizations expand the understanding of CR and show evidence supporting CR expressions in bilingualism, personal social networks, and protective health behaviors, among others.

Conclusion

To the best of our knowledge, this is the first attempt to provide a comprehensive review of diverse perspectives in CR. The growing body of research suggests good support for alternative understandings of CR, and indicates reconsideration of historical understandings of CR within minoritized groups. Overall, the theory of CR should continue to evolve and incorporate factors relevant to diverse populations as the world population continues to rapidly diversify.
A - 47 Characteristics and Outcomes of Older Inpatients Undergoing Neuropsychological Assessment of their Lifestyle Decision-Making Capacity
Authors: Foran Amie , Mathias Jane L , Bowden Stephen C
Published: October 2023

Objective

Assessments of older inpatients’ capacity to make life-style decisions (lifestyle decision-making capacity; LS-DMC) are in high demand due to the increasing prevalence of neurodegenerative disorders and cognitive decline. Few studies have compared the characteristics and outcomes of inpatients who lack LS-DMC with those that don’t.

Method

Older inpatients (≥60 years) underwent neuropsychological assessment (n = 124) and were categorized as either lacking (64%) or not-lacking (36%) LS-DMC. The two groups were compared on information available to referring medical practitioners (demographics, living supports, medical history, Mini-Mental Status Examination; MMSE, and Frontal Assessment Battery; FAB) and the QuickSort cognitive screen. Inpatients’ need for legal hearings to resolve lifestyle decisions and additional living supports, and length of hospital stay and readmissions within 1-year were also investigated.

Results

The QuickSort differentiated between inpatients who lacked/didn’t-lack LS-DMC better than the MMSE, FAB, and other demographic and medical information. Most inpatients who lacked LS-DMC needed additional living supports (92%), with 71% discharged to live in supported care or with family. Length of hospitalization (M = 49.4 SD = 37.8) and 1-year readmission rates (62%) were comparable for both groups. Of the 40% of inpatients requiring legal hearings, most lacked LS-DMC (55%), refused additional living-supports (88%), had surrogate decision-makers appointed (73%), and were hospitalized longer (M = 61.5 SD = 34.1).

Conclusions

The QuickSort provided a more accurate and briefer screen for LS-DMC than the MMSE, FAB and other patient information, suggesting it might be useful for the early detection of inpatients who may lack LS-DMC and need additional living supports, legal hearings to resolve lifestyle decisions and extended hospitalizations.
A - 48 Neuropsychiatric Symptom Severity Predicts Rate of Executive Function Decline
Authors: Goodwin Grace J , Singsank Katie T , Maloy-Robertson Myjae , Tanner Denise , Salva Christine , Briley D A , John Samantha E
Published: October 2023

Objective

Neuropsychiatric symptoms (NPS) are considered diagnostic and prognostic indicators of dementia and are attributable to neurodegenerative processes. NPS are distressing for patients and caregivers and are associated with accelerated functional decline, hospitalization, and institutionalization. Evaluation of NPS effects on disease course may reduce patient and caregiver distress and support development of personalized treatments. We examined whether baseline NPS predicted the rate of executive function (EF) decline among older adults with cognitive impairment.

Method

Older adults (n = 1155) with cognitive impairment and four years of data were selected from the National Alzheimer’s Coordinating Center database v3-v3.2. Overall EF was estimated with a latent factor indicated by scores on Number Span Backward, Letter Fluency, and Trail Making-Part B. Strict temporal invariance was established. A curve of factors (CUFF) latent growth curve model was estimated to examine rate of change. Baseline NPS severity was entered as a predictor to examine its influence on the rate of change in EF over time.

Results

The predicted CUFF model exhibited good fit (χ2[69] = 201.46, p < 0.001; CFI = 0.98, RMSEA = 0.04). EF significantly declined over four waves (slope = −0.53). NPS severity at baseline predicted decline in EF (β = 0.164, p = 0.001), such that those with greater NPS severity demonstrated a more rapid decrease in EF performance over time.

Conclusions

Increased NPS severity at baseline predicts more rapid decline in EF over four years. Findings highlight the prognostic value of NPS on cognitive decline and underscore the importance of targeting NPS at early disease stages. Future research will examine influence of individual NPS on rate of cognitive decline.
A - 49 Neuropsychological and Clinical Features of Ataxia Due to CACNA1A (P.1661H) Mutation: a Case Study
Authors: Hagy Hannah , Hill Gianna , Lacy Maureen
Published: October 2023

Objective

Mutations in CACNA1A gene can cause rare neurodegenerative conditions [spinocerebellar ataxia type 6 (SCA6); episodic ataxia type 2 (EA2)] which are caused by autosomal dominant mutations located on chromosome 19p13. Research suggests triplet repeat mutations in the CACNA1A gene are associated with SCA6 characterized by late onset, slowly progressive cerebellar ataxia. On the other hand, CACNA1A mutation with specific protein variant R1661H involvement is associated with EA2, characterized by early onset ataxia, which may be accompanied by vertigo, diplopia, dysarthria, and generalized weakness. We present a patient with genetically confirmed mutation in CACNA1A (p.1661H), not fitting the phenotype of EA2 despite associated variant.

Method

A retrospective review of the patient’s medical record along with review of neuropsychological and neuroimaging reports.

Results

Neuropsychological testing revealed a 79-year-old female who demonstrated executive, memory retrieval, construction and fine motor dexterity slowing along with dysfluency and anomia. Neurologic exam documented bilateral blepharospasm, with mild ataxia and speech disturbance (SARA total = 12). Neuroimaging revealed moderate cortical atrophy and chronic small vessel ischemia disease. Behavioral observations were notable for gait ataxia and dysarthria, as well as perseverative responding and anosognosia. She endorsed symptoms indicative of clinical levels of depression, apathy, anxiety and disinhibition. Her partner endorsed more notable executive dysfunction symptoms and functional impairment.

Conclusion

While the motor sequela is well documented, the neuropsychological impact is infrequently discussed in existing literature regarding CACNA1A (p.1661H) mutations. This case expands our understanding of the unique and varied phenotype associated with this unique CACNA1A gene variant.
A - 54 Interdisciplinary Assessment in the Differential Diagnosis of the Phenocopy Syndrome of Behavioral Variant Frontotemporal Dementia: a Case Study
Authors: Kdeiss Bianca , McCuddy William Travis
Published: October 2023

Objective

Phenocopy syndrome of behavioral variant frontotemporal dementia (phFTD) is a clinical syndrome in which the neuropsychiatric criteria of behavioral variant frontotemporal dementia (bvFTD) are fulfilled without demonstration of classic bvFTD neuroimaging abnormalities or clinical progression. We present a case of an individual with atypical bvFTD that was initially characterized as phFTD and discuss clinical considerations for complicated differential diagnosis in a phenocopy syndrome that is still not fully understood.

Method

A 77-year-old male presented to a neurology clinic for a third opinion due to behavior changes, with progressive course, reported by family since 2019. Magnetic resonance imaging (MRI) scan indicated nonspecific volume loss and mild chronic white matter ischemic changes. Fluorodeoxyglucose positron emission tomography (FDG-PET) scan indicated bilateral temporoparietal hypometabolism. Cerebrospinal fluid (CSF) biomarker study was not consistent with pathological changes of Alzheimer’s disease. C9orf72 and other FTD-associated gene mutations were negative.

Results

Neuropsychological test results were grossly normal across two separate evaluations between 2021–2022. A third evaluation in 2023 showed significant executive deficits, including below average to exceptionally low divided attention and set shifting, novel problem solving, and phonemic fluency.

Conclusion

This case underscores the complexity of differentiating between phFTD and bvFTD and highlights the need for interdisciplinary evaluation, including serial neuropsychological assessment. Additionally, it suggests that, in some cases, phFTD may represent prodromal bvFTD. Further research is needed to better understand the underlying mechanisms of phFTD and its relationship to FTD, as well as to develop more effective diagnostic tools and treatments for this challenging clinical syndrome.
A - 56 Examining the Impact of Cognition and Training on Successful Usage of an Assistive Smartphone Application for Older Adults Experiencing Cognitive Decline
Authors: Mckniff Moira E , Hackett Katherine , Pinsky Emma , Lehman Sarah , Tan Chiu , Giovannetti Tania
Published: October 2023

Objective

The SmartPrompt is an assistive smartphone application designed to prompt older adults to remember to do daily tasks and then log task completion in a photo log for later review. Here we examine whether and how cognitive status and performance during training with the SmartPrompt influenced usage of the app over a two-week testing period at Temple University.

Method

Nine community-dwelling older adults (M age = 77 ± 5.60, 67% male, 77% white) with mild cognitive impairment (MCI) or dementia underwent standardized training with the SmartPrompt app that included review and practice responding to SmartPrompt alarms and taking photos for the task log. Training was scored for time and performance accuracy. Following training, participants used the SmartPrompt to facilitate completion of two tasks of their choice every day for two weeks. The number of tasks completed (max =28), average time to respond to the SmartPrompt alarm, and a qualitative rating of the relevance of the photos in the log was scored.

Results

More time spent training was associated with more effective use of the SmartPrompt (task completion; rs = 0.715; p < 0.05; acknowledgement time rs = −0.571). Training performance accuracy was related to the quality of SmartPrompt photos (rs = −0.485) but not to other SmartPrompt measures. Cognitive status (MMSE) was associated with training performance (rs = −0.824; p < 0.01) and photo quality (rs = 0.737; p < 0.05) during testing weeks.

Conclusions

Older adults show improved use of assistive smartphone applications when more time is spent on training and practice, regardless of their training performance accuracy or cognitive status.
A - 57 Virtual Group Dementia Caregiver Intervention for the Management of Neuropsychiatric Symptoms (NPS): 3-Month Follow-Up of a Pilot Study
Authors: O'Connor Maureen K , Shirk Steven , Moo Lauren , McLaren Jaye , Nguyen Andrew H , Pugh Kendra
Published: October 2023

Objective

Pilot test the feasibility and preliminary efficacy of a virtual group dementia caregiver intervention (TeleCARE) in improving depression, anxiety, and distress related to NPS.

Method

Twenty predominately female (80%), spouses (80%), ages 35–88 (M = 70.8), participated in TeleCARE. The CDR-Sum of Boxes for patient dementia severity reflected moderate dementia (M = 11.1, SD = 3.18). Caregiver data was collected at baseline, immediately following the intervention, and 3 months after completion.

Results

Following the intervention, 85% of caregivers understood NPS better, and 90% felt better able to care for the person with dementia (PWD) and manage caregiving. Immediately following the intervention, caregivers reported reductions in depression (BDI: M = 9.55, SD = 7.88 vs. M = 7.75, SD = 7.11), anxiety (BAI: M = 8.65, SD = 7.46 vs. M = 6.75, SD = 7.24), and distress related to NPS (M = 26.60, SD = 11.97 vs. M = 25.10, SD = 11.60). Decreases in depression and anxiety were not maintained at the 3-month follow-up (BDI: M = 8.60, SD = 7.82; BAI M = 8.95, SD = 10.90), but distress related to NPS declined further (M = 24.40, SD = 10.68).

Conclusion

TeleCARE improved the understanding of NPS and the ability to care for the PWD and manage caregiving demands. Reductions were seen in depression, anxiety, and distress related to NPS immediately following the intervention. Reductions in depression and anxiety were not maintained at 3-months, but caregivers showed further reductions in distress related to NPS, suggesting that the targeted NPS intervention had sustained targeted outcomes (distress related specifically to NPS), perhaps resulting from improved understanding of NPS and continued application of taught skills. Adding booster sessions may help sustain reductions in depression and anxiety.
A - 58 Verbal Fluency Word Generation Slope among Older Adults with MS
Authors: Pace Brigitte , Holtzer Roee
Published: October 2023

Objective

The decreasing rate of within-person word generation in verbal fluency (VF) tasks, here referred to as slope, is associated with mild cognitive impairment and with lower grey matter volume in select regions. While VF is sensitive to cognitive decline in Multiple Sclerosis (MS), VF slopes have yet to be assessed in older adults with MS. We, therefore, examined VF slopes in letter and category VF among dementia-free older adults with and without MS.

Method

84 community-dwelling adults with MS (Mage = 64.7) and 86 without MS (Mage = 70.8) completed standard 60-sec letter (F, A, S) and category (fruits, vegetables, animals) VF tasks; responses were recorded in 20-sec intervals for each iteration of the task.

Results

Linear regressions showed that MS was associated with lower total word generation on category, but not letter, VF after accounting for age, sex, race, education, and health status (95% CI, [−2.27, −0.98], p < 0.001). Linear mixed effects models showed that word generation declined during the course of both tasks (all p’s < 0.001) in both groups; MS status did not moderate category or letter VF slopes.

Conclusion(s)

Extant literature on total letter and category VF word generation in MS is mixed. The current study indicates that in community-dwelling older adults MS was associated with lower total word scores in category but not letter VF. Negative word generation slopes were documented in category and letter VF irrespective of group status. These results suggest that time effects on word generation in VF tasks were generalizable to normal aging and MS.
A - 61 The Impact of Metacognition on Everyday Functioning in Mild Cognitive Impairment and Dementia
Authors: Hussein Jaidaa , Sidhu Jasman , Chapp Andrew , Lent David , Wright Matthew , Woo Ellen
Published: October 2023

Objective

The purpose of this study was to evaluate the role of metacognition on everyday functioning in mild cognitive impairment and dementia.

Method

Participants included 44 healthy older controls, 57 individuals with mild cognitive impairment (MCI), and 26 individuals with Alzheimer’s disease (ad). Participants were administered verbal and nonverbal memory tests and a visuospatial test. They made predictions about their performances before taking each test and then made postdictions about their performances after each test. Prediction and postdiction accuracy scores were calculated. Additionally, all participants took the Everyday Cognition (ECog) Scale.

Results

Regression analyses were conducted, separately for each diagnostic group, to determine the roles of prediction and postdiction accuracy on everyday functioning. For healthy older controls, prediction and postdiction accuracy on a visuospatial test significantly impacted overall everyday functioning. In MCI, prediction accuracy on a nonverbal memory test significantly impacted everyday functioning. Finally, in ad, postdiction accuracy on a nonverbal memory test significantly predicted everyday memory.

Conclusion(s)

Overall, metacognition predicts everyday functioning in healthy aging, MCI, and ad. For healthy aging and MCI, the ability to both accurately predict and retrospectively evaluate their own cognition impacts overall everyday functioning. With the increased cognitive impairment of ad, only the ability to retrospectively evaluate performances impacts everyday memory.
A - 62 Caregiver Relationship Type Significantly Moderates Association among NPI-Q Symptoms: a Moderated Network Analysis
Authors: Singsank Katie T , Goodwin Grace J , Juthapan Stacey Moeller , Salva Christine , John Samantha E
Published: October 2023

Objective

We investigated the influence of caregiver type (CT; ex. spouse, child, etc.) on the association among neuropsychiatric symptoms using the caregiver-endorsed Neuropsychiatric Inventory Questionnaire (NPI-Q) and a sample from the National Alzheimer’s Coordinating Center database.

Method

The selected sample (n = 12,337) includes those aged 50+ with complete baseline data for the NPI-Q and caregiver relationship. Included participants had ≥1 NPI-Q symptom(s) endorsed and a diagnosis of mild cognitive impairment or dementia with Alzheimer’s disease as the primary or contributing cause. A Moderated Network Model approach estimated whether associations among NPI-Q items depend on CT (moderator variable). Spouse was used as the reference group for all comparisons.

Results

CT significantly moderated the NPI-Q. Interaction effects were found between 3 moderated node pairs: agitation/aggression and disinhibition (edgeweight = 0.02), hallucinations and nighttime behaviors (edgeweight = 0.01), and depression/dysphoria and appetite/eating problems (edgeweight = 0.01). The edgeweights for these node pairs were reduced in the final model due to variance being accounted for by the addition of CT. The association between agitation/aggression and disinhibition was smaller for spouses than children, and larger for spouses than friends and paid caregivers. The association between hallucinations and nighttime behaviors was smaller for spouses than children, and larger for spouses than friends and paid caregivers. The association between depression/dysphoria and appetite/eating problems was smaller for spouses than siblings and friends.

Conclusions

The pairwise dependency between neuropsychiatric symptoms differs as a function of CT. Future research is needed to identify factors that influence symptom reporting, including interpersonal dynamics, amount of time spent together, and overall burden of symptoms.
A - 63 Neuropsychiatric and Cognitive Correlates of Pareidolias in Dementia with Lewy Bodies
Authors: Smith Madeleine P , Wang Jiangxia , Leverenz James B , Heller Nathan H , Magsaman Susan H , Bakker Arnold , Zabetian Cyrus B , Tsuang Debbie W , Oguh Odinachi , Lippa Carol F , Lopez Oscar L , Berman Sarah B , Irwin David J , Galasko Douglas R , Litvan Irene , Fleisher Jori E , Galvin James E , Bozoki Andrea C , Sabbagh Marwan N , Wint Dylan , Cholerton Brenna A , Pantelyat Alexander Y , Kamath Vidyulata
Published: October 2023

Objective

Pareidolias represent visual illusions of meaningful objects in ambiguous stimuli. Prior research has demonstrated phenomenological similarities between pareidolias and visual hallucinations (VH) and the potential clinical utility of pareidolias in discriminating dementia with Lewy bodies (DLB) from Alzheimer’s dementia (ad). Though pareidolias have been linked with VH severity in DLB, the relationships between pareidolias and other neuropsychiatric symptoms have not been explored in large DLB samples.

Method

Individuals meeting 2017 McKeith criteria for probable DLB (n = 114) were enrolled in a multi-site systematic longitudinal study of the US DLB Consortium. Study assessments included an informant-rated psychiatric inventory (NPI), Montreal Cognitive Assessment (MoCA), and Noise Pareidolia Task (NPT). Ninety-five participants completed all clinical assessments. To examine baseline relationships between pareidolias responses (NPT) and the presence of 12 neuropsychiatric symptom dimensions (NPI), we used Poisson regression models with robust standard error estimates adjusted for age, education, disease duration, cognition (MoCA), and cholinesterase inhibitor use.

Results

Contrary to expectation, the presence of VH was not associated with pareidolias in DLB (Incidence Rate Ratio = 1.37, p = 0.275). The presence of both delusions (IRR = 2.11, p = 0.01) and depression (IRR = 1.79, p = 0.015) was associated with greater pareidolias. Additionally, overall cognitive dysfunction was associated with pareidolias (IRR = 0.90, p < 0.001).

Conclusions

Our findings indicate that pareidolias are associated with poorer cognition and neuropsychiatric dimensions beyond VH, including depression and delusions. As pareidolias have been put forth as a surrogate marker of VH in DLB, future studies examining pareidolias in conjunction with comprehensive psychiatric/cognitive assessment and neuroimaging will further elucidate the clinical utility of pareidolia testing.
A - 65 Neuropsychological Sequela of Late-Onset Epilepsy in Older Adults: a Case Study
Authors: Turchmanovych-Hienkel Nataliya , Lacy Maureen
Published: October 2023

Objective

Late-onset epilepsy is increasingly recognized as playing a role in cognitive decline during aging. Late-onset epilepsy and Alzheimer’s disease (ad) appear to share pathological links mediated by vascular changes and tau pathology (Sen et al., 2020). Current literature has established a bi-directional association between ad and epilepsy with each being a risk factor of the other (Zhang et al., 2022). The present case illustrates the complexity of differential diagnosis in older adults presenting with progressive memory decline and late-onset epilepsy.

Method

Clinical interviews with the patient and his wife, a review of medical records including neuroimaging results, neuropsychological history questionnaire, and neuropsychological assessment.

Results

59-year-old male with a three-to-four-year history of focal seizures and slowly progressive memory decline. Medical history was void of vascular risk factors. Family history of memory disorders was denied. Brain MRI scans were read as unremarkable. However, video EEG revealed independent sharp waves from bilateral temporal areas. Neuropsychological assessment revealed deficits in verbal memory, confrontation naming, and semantic fluency but otherwise intact cognition. Per family, the patient displayed increased irritability, apathy, disinhibition, and executive dysfunction.

Conclusion

Clinicians need to be increasingly aware of the growing incidence of late-onset epilepsy with aging and its symbiotic role in the risk for ad. Mechanistic evidence will be reviewed such as similar network hyperexcitability along with the accumulation of amyloid and hyperphosphorylated tau-protein.
A - 71 Cognitive Complaints and Neuropsychological Performance in Cancer: the Role of Affect
Authors: Lemos Raquel , Sousa Berta , Manica Isabel , Frasquilho Diana , Cardoso Fátima , Oliveira-Maia Albino J
Published: October 2023

Objective

To examine the impact of cancer treatments in affect and in cognition.

Method

The study evaluated 115 breast cancer patients before- and 6 months after-treatment, and a group of 90 cognitively healthy subjects paired for age and education at matched intervals. All participants performed a comprehensive assessment with measures of affect (HADS and PANAS), subjective complaints (FACT-Cog), and a battery of neuropsychological tests comprising memory, attention, and executive functioning domains. Comparisons were done between-groups pre-treatment, and within-groups between timepoints. Correlations between psychological and cognitive measures were made at 6 months.

Results

Before treatment, patients exhibited significant lower levels of positive affect (PANAS, p = 0.003), but no complaints or cognitive impairment, when compared to controls. Longitudinal analyses revealed an effect of time, towards improvement, in HADS anxiety (p = 0.0006) and PANAS negative (p < 0.0001), in the clinical group, and a small but significant increase in subjective complaints for both groups (p < 0.001). No objective cognitive decline was found in any group across time. A pattern of significant negative correlations between HADS measures and subjective cognitive assessment was found in the two groups, suggesting that higher affective symptoms are related to more cognitive complaints. No correlations were found between affect and neuropsychological performance, or between subjective and objective cognitive assessments, in any group.

Conclusion

Our data showed that there is a discrepancy between cognitive complaints and objective scores due to the presence of affective symptoms in breast cancer patients. Importantly, the similar pattern in matched controls assessed in the same timepoints shows that it is not attributable to cancer treatments.
A - 73 The Impact of Posttraumatic Stress Disorder on Cognitive Health in 9/11 Responders: the Role of Sleep Disturbances
Authors: Schultz Elaine , Heilbronner Robert , Hill Scot , Kotov Roman , Waszczuk Monika
Published: October 2023

Objective

PTSD is known to have a long-term impact on cognitive health, specifically executive dysfunction. However, most studies have not tested possible mechanisms underpinning this association. Sleep disturbances have emerged as a potential pathway between PTSD and cognitive functioning. This study aimed to investigate whether sleep disturbances account for the association between PTSD and executive dysfunction in trauma-exposed first responders.

Method

Participants consisted of 9/11 WTC responders (N = 452, mean age = 55.22, SD = 8.73, 89% male, 90% White). Data collection occurred across 3 time points, each 1 year apart. Measures included self-reported PTSD and insomnia symptoms, two weeks of Ecological Momentary Assessment of sleep duration and sleep quality, and the Trail Making Test part B. Due to high stability across 3 years, the present study focused on mean, trait-like variables. Analyses adjusted for demographics, BMI, and trauma exposure severity.

Result

PTSD was associated with Trail Making Test part B (r = 0.10, p = 0.03), as well as insomnia (r = 0.63, p < 0.00) and sleep quality (r = −0.45, p < 0.00), but not sleep duration. Mediation analyses revealed that sleep quality fully accounts for the significant association between PTSD and executive functioning (indirect effect β = 0.056, p = 0.041, 95% CI [0.009, 0.108]).

Conclusions

The current results highlight the important role that disturbances in sleep may have on cognitive health outcomes. Improving sleep, in the context of PTSD, could attenuate cognitive symptoms, and possibly protect against further decline. Future research conducted in the acute phase of trauma-exposure and PTSD is needed to clarify the directionality of these relationships, with longitudinal analyses that will allow form modeling cognitive decline.
A - 77 Case Study of Bilateral Thalamic Infarction with Persistent Cognitive and Behavioral Symptoms
Authors: Matyi Joshua , O'Hara John , Castellon Marco Gonzalez , Phatak Vaishali
Published: October 2023

Objective

Bilateral thalamic infarction due to artery of Percheron (AOP) occlusion is rare (0.01–2% of all ischemic strokes) and neuropsychological sequelae are not well-defined. We present the case of a 50-year-old, right-handed, Caucasian woman, with 12 years of education, who presented with cognitive and behavioral symptoms following AOP stroke.

Method

Following AOP stroke, the patient experienced seven-day hospitalization and one-month subacute rehabilitation. Symptoms after discharge from the latter included vertical gaze palsy, mild balance difficulties, impulsivity, and amnesia (retrograde and anterograde). Compared to neuroimaging five days after stroke, follow up imaging at three months revealed bilateral thalamic encephalomalacia (Figure 1), as well as small bilateral cerebellar infarcts. Neuropsychology was consulted six months post-stroke to evaluate persistent cognitive and emotional/behavioral symptoms.

Results

(Test results in Table 1). Test results demonstrated average estimated premorbid functioning, amnesia (anterograde and retrograde) and executive dysfunction (including emotional lability, stimulus bound behaviors), which interfered with performances on processing speed and verbal fluency tasks. Attention, working memory, and core language/visuospatial skills were spared. These symptoms contributed to difficulty navigating/exacerbation of psychosocial stress and necessitated external support for daily functions. Neuropsychological evaluation data were used to identify strategies to optimize patient coping and reduce caregiver burnout. At 16-months post-stroke, persistent amnesia and reduced emotional lability were reported by her family.

Conclusions

This case highlights the presence and need to characterize cognitive and behavioral deficits following bilateral thalamic infarction. Additionally, this case demonstrates the role of neuropsychology in characterization of cognitive and neuropsychiatric sequelae, including identification of relevant interventions/recommendations to inform treatment planning.
A - 80 The Role of Adverse Childhood Events and Personality Traits Among Individuals with Functional Neurological Symptom Disorder (FND).
Authors: Carns Danielle , Orr Stephen , Jain Rishabh , Israel Alex , Rupert Petra
Published: October 2023

Objective

There is an established link between early life trauma and avoidant and anxious attachment in patients with FND.1,2,3 These attachment styles are linked to histrionic (HPD), avoidant (APD), borderline (BPD), and dependent personality disorders (DPD)0.5 The current study seeks to explore the relationship between adverse childhood experiences and personality characteristics among individuals diagnosed with FND.

Methods

A retrospective analysis of patients diagnosed with FND who completed neuropsychological evaluation was conducted. The outcome measures include the Adverse Childhood Experiences Scale (ACES) and Minnesota Multiphasic Personality Inventory, 3rd Edition (MMPI-3). Composite scores for the ACES and BPD, HPD, APD, and DPD were obtained by calculating equally weighted sum of predetermined component scores on the MMPI-3 based on the DSM-5.6 Spearman correlations were calculated to determine the association between ACES and PD composites.

Results

Analysis was conducted with 21 patients, 86% were female, 71% identified as white, and mean sample age was 41.59 years (SD = 12.48). 57.14% had elevated ACES score. Mean composite PD scores were BPD – 55.97 (SD = 7.58), HPD – 53.93 (SD = 9.17), APD – 59.26 (SD = 9.71), and DPD – 59.75 (SD = 10.80). The correlations were positive and statistically significant (p < =0.05) across all four PD for ACES Q1 (emotional abuse) and Q4 (unsupportive environment).

Conclusions

The results highlight that the ACES can be beneficial in identifying patients with FND who may have, or are at risk, of developing PD. These results also provide targets for treatment including maladaptive attachment styles.
A - 82 Perceived Social Support Is Associated with Cognition but Not Physical Functioning in Older Adults with and without Multiple Sclerosis
Authors: Cohen Hannah R , Holtzer Roee
Published: October 2023

Objective

To examine the association between perceived social support, cognition, and physical functioning in older adults with and without Multiple Sclerosis (MS).

Method

Participants were dementia-free older adults with MS (N = 89; M age = 64.75, SD + 4.25 years; 66.3% female) and community-residing older adults (N = 102; M age = 68.74, SD + 7.12 years; 62.7% female). The medical outcomes study modified social support survey (MSSS), oral symbol digit modalities test (SDMT) and timed-25-foot-walk-test (T25FW) served as outcome measures. Linear regressions stratified by group status assessed the associations between PSS, cognition, and physical functioning.

Results

Higher total MSSS scores were associated with higher SDMT scores in the MS group (β = 0.24, p = 0.02) and in the control group (β = 0.26, p = 0.005). Positive social interaction (β = 0.27, p = 0.011) was associated with SDMT performance in the MS group. Emotional/informational support (β = 0.27, p = 0.003) and positive social interaction (β = 0.25, p = 0.007) were associated with SDMT performance in the control group. Depression scores attenuated associations between perceived social support and SDMT performance in the MS group (p > 0.05) but not the control group. In contrast, higher MSSS scores were not associated with higher T25FW scores in either group.

Conclusions

Among older adults with and without MS, perceived social support was associated with cognition but not physical functioning. Depressive symptoms attenuated associations between perceived social support and cognition in the MS group only.
A - 85 Neuropsychological and Cultural Elements in the Assessment of Competency to Stand Trial
Authors: O'Connell Olivia , O'Connell Michael
Published: October 2023

Objective

Research has highlighted how key cognitive functions underlie abilities within the construct of Competency to Stand Trial (CST). This case study examines the impacts of Mild Neurocognitive Disorder and culture on a physician found incompetent to stand trial.

Method

A 62-year-old African-born male physician charged with Health Fraud who was referred for an examination of his CST. His attorneys raised concerns about his rational understanding of the proceedings and his ability to collaborate constructively with them. The client underwent comprehensive forensic, neuropsychological and neurological assessment.

Results

Neuropsychological testing revealed low-average intellectual abilities which likely reflected a decline from estimated premorbid levels. Contrary to expected performance given cultural factors, nonverbal intellectual abilities were markedly lower than verbal intellectual abilities. Compromises in multiple domains of cognition including memory were also noted. A referral to neurology revealed moderate atrophy and a mass in the right temporal fossa, in line with a diagnosis of Mild Neurocognitive Disorder with Multiple Etiologies. A causal connection between his cognitive deficits (e.g., compromised reasoning) and competence-relevant abilities (e.g., capacity to waive constitutional rights) was established. The subject was adjudicated incompetent to stand trial and, largely due to neurologic findings, unlikely to attain competency (i.e., non-restorable).

Conclusions

This study demonstrates the value of neuropsychological assessment in both the clinical recognition of brain pathology and cognitive dysfunction in the setting of complex legal and cultural issues. Guidelines to address complex competency cases that warrant comprehensive assessment are needed.
A - 86 Using Virtual Reality Driving Simulation to Determine Cognitive Correlates of Turning Behaviors among Drivers with and without Multiple Sclerosis
Authors: Dheer Suhani , Ang Jocelyn , Devlin Kathryn , Schultheis Maria
Published: October 2023

Objective

This study uses a virtual reality driving simulator (VRDS) to 1) compare turning behavior between adults with or without MS; 2) identify cognitive correlates of turning behavior.

Method

64 community-dwelling adult drivers, including 38 people with MS (PwMS) and 26 healthy controls (HCs) (ages 21–60, 78% women, 69% White), completed neuropsychological and VRDS assessments. Key VRDS turning variables were lane position, speed, acceleration, and braking. Cross-sectional analyses included 1) analysis of variance and chi-square tests; 2) Pearson and Spearman’s correlations.

Results

HCs took sharper left turns than PwMS (p < 0.05, η2 = 0.08). There were no other between-group differences. Weaker visuospatial functioning [r = −0.301, 95% CI = (−0.512,-0.050), p = 0.018], and slower gait [r = 0.0328, CI = (0.063,0.55), p = 0.014], manual motor speed [r = 0.378, CI = (0.130,0.582), p = 0.03], and psychomotor speed [r = −0.334, CI = (−0.545,-0.077), p = 0.011] were associated with greater lane position variability. Greater relative acceleration before the turn was linked to worse performance in psychomotor speed [r = 0.397, CI = (0.148,0.593), p = 0.002], time-based working memory [r = 0.452, CI = (0.221,0.631), p < 0.001], and visuoperceptual judgment time [r = −0.482, CI = (−0.660,-0.244), p < 0.001]. Slower cognitive/motor speed and poorer visuospatial abilities/memory were associated with slower driving and more braking (all p < 0.05).

Conclusion

Drivers with and without MS exhibited similar turning behavior, but PwMS were more cautious during left turns, possibly reflecting a compensatory strategy. Despite few group differences, several cognitive domains commonly affected by MS were associated with turning behaviors. Slower cognitive/motor speed and worse visuospatial abilities were associated with less smooth control of spatial position and less safe turn preparation, but slower driving. Future studies will include larger samples and other clinical populations and may inform clinical driving recommendations.
A - 87 A Neuropsychological Case Study of Primary Progressive Apraxia of Speech Versus Agrammatic Primary Progressive Aphasia
Authors: Erani Fareshte , Espinal Elizabeth , Minniti Nancy
Published: October 2023

Objective

Primary progressive apraxia of speech (PPAOS) is a lesser-known neurodegenerative disorder characterized by progressive speech production loss, affecting word articulation. Apraxic speech commonly occurs in primary progressive aphasias (PPAs) and as a result, is often misdiagnosed as agrammatic PPA (aPPA). The current case highlights the importance of neuropsychological evaluations and behavioral observations in delineating PPAOS from aPPA.

Method

The patient is a 71-year-old right-handed White female who presented with a 2-year history of language difficulties beginning with a lisp and progressing to an inability to produce words. MRI of the brain showed moderate white matter disease.

Results

Her neurocognitive profile was notable for primary deficits in expressive language, including oral/written production, verbal fluency, and repetition. Milder deficits were observed in aspects of executive functioning. Observed spontaneous speech was notable for impaired and effortful articulation with syllabically segmented prosodic speech patterns, some distortions and prosody alterations, and slow rate. All other cognitive domains were intact.

Conclusions

Patients with PPAOS and aPPA typically score in the impaired range on tests that depend on rate and accuracy of speech. Apraxia was her most salient feature reported and observed on testing. We did not find learning and memory difficulties, which are more common in aPPA. Moreover, she had trial-and-error articulatory attempts, groping, and distorted substitutions, which are more commonly seen in PPAOS. Her speech was also devoid of grammatical errors which is another distinguishing feature. While subtle and confounded by her alcohol use and orthopedic injuries, her profile altogether appeared most consistent with PPAOS.
A - 92 Neuropsychological Testing and Cognitive Outcomes in Autoimmune Encephalitis
Authors: Grezmak Tiffany , Swetlik Carol , Abbatemarco Justin , Kunchok Amy , Galioto Rachel
Published: October 2023

Objective

This review examines the use and outcomes of neuropsychological tests (NPT) in adults with autoimmune encephalitis (AE) with the objective of providing recommendations for NPT for clinical practice, observational research, and clinical trials.

Data Selection

PubMed search from inception to February 2023 yielded 8858 results which were screened for inclusion/exclusion criteria: ≥ one comprehensive NPT with comparison/normative reference value available of individual NPT scores, NPT reported within specific neuronal antibody group, English manuscript available, and sample size >5 (no case reports). 24 were included and involved anti-NMDA-R (k = 11), anti-LGI-1(k = 9), anti-GABAB-R (k = 2), anti-GAD-65 (k = 4), and anti-CASPR2 (k = 2). Data extracted included neuronal antibody, follow up time, sample size, and NPT.

Data Synthesis

List learning, figural memory, digit span, processing speed, response inhibition and semantic fluency tasks were most commonly administered. Impairments were most common in attention/working memory, processing speed, aspects of executive functions and episodic (60–100%). Differences emerged between antibody groups. For example, list learning impairments were common in anti-LGI-1(100%) and anti-NMDA-R (87.5%) but less common in other groups, while 67% of anti-LGI-1 studies showed impaired phonemic fluency compared to 0% of anti-NMDA-R studies, while rates of semantic fluency impairment were similar between those two groups (50–60%). Other group differences will be discussed.

Conclusions

We outline the most commonly administered and most impaired NPT in AE patients. Differences appeared in cognitive outcomes between antibody groups. Further use of NPT may better characterize these antibody-specific differences and support inclusion of standardized measures for clinical trial outcomes.
A - 94 A Case of New Onset Refractory Status Epilepticus (NORSE) Associated with COVID-19
Authors: Hromas Gabrielle , Morgan Lola , Werry Amy
Published: October 2023

Objective

New Onset Refractory Status Epilepticus (NORSE) is a rare condition of prolonged medication-refractory seizures potentially due to elevated inflammatory molecules in the brain. NORSE can be triggered by a viral infection and is a documented neurologic consequence of COVID-19.

Method

A 74-year-old, left-handed, Hispanic male was in his usual state of health until experiencing 1–2 weeks of speech decline, which culminated in an episode of altered mental status (disorientation and mumbling speech). He presented to the Emergency Department with drowsiness and complaints of a “funny feeling” on the left side of his head. Upon arrival, he was found to be COVID-19 positive and hyperglycemic with normal CT, MRI, lumbar puncture, and bloodwork. An EEG showed “focal temporal activity” and he was diagnosed with non-convulsant status epilepticus. Hospitalization and medical sedation lasted 2 months followed by 8 months of inpatient rehabilitation. The patient was discharged shortly before presenting for neuropsychological evaluation.

Results

Neuropsychological evaluation showed weaknesses in learning and free recall, visuospatial skills (due to disorganization and poor attention to details), processing speed, and executive functioning. The patient reported elevated anxiety symptoms. Collateral report indicated severe declines in executive organizational abilities, as well as mild memory and divided attention declines.

Conclusions

Results suggest frontal cortical and subcortical impairments affecting multiple areas of cognition and functional decline consistent with a diagnosis of major neurocognitive disorder. Similar to the literature, status epilepticus was attributed to inflammatory meningoencephalitis triggered by the prior COVID-19 infection. Interdisciplinary care was an integral factor in this case.