bluuebunny/crossref_metadata_2025 huggingface dataset:
A - 12 Investigating Relationships between Theory of Mind, Executive Functioning, and Adaptive Functioning in Non-Demented Older Adults
Authors: Sergeyev Nicole , Nester Caroline O , Warren David E , Zatkalik Abigail , Aflagah Erica , Rabin Laura A , Pare Nadia , Beadle Janelle N
Published: October 2023

Objective

Theory of mind (ToM) is a facet of social cognition that relies on the ability to infer the mental states of others and is a cognitive and emotional capacity that may become compromised in the context of neurodegeneration. This may put older adults at greater risk for financial exploitation or susceptibility to scams. We investigated relationships among executive functioning, financial capacity, and ToM in a sample of older adults who did not have a diagnosis of dementia.

Method

Participants were cognitively unimpaired or presented with subjective cognitive decline or mild cognitive impairment. As part of a comprehensive neuropsychological battery, participants completed the Reading the Mind in the Eyes Test (RMET), a measure of ToM in which participants view photos of the eye region of the face and select which social emotion they perceive to be depicted in each photo. Pearson correlations were calculated to test relationships among RMET performance and select measures of executive functioning (D-KEFS Trail Making Test 4, Letter Fluency) and basic financial skills (Financial Capacity Instrument, short form).

Results

Participants’ (n = 72; M age = 75.36; M education = 15.676; 69% female) RMET performance was significantly associated with measures of executive functioning (r = 0.243, p = 0.041), mental flexibility (r = −0.283, p = 0.017), and financial skills (r = 0.291, p = 0.015).

Conclusions

Capacity for ToM is linked with integrity of executive functioning skills and financial capacity in older adults with varying degrees of cognitive compromise. Older adults who demonstrate deficits in aspects of social cognition may be at risk for poor outcomes in key cognitive and adaptive skills in daily life.
A - 15 Elucidating Patterns of Naturalistic Behavior in those with Self-Reported Functional Cognitive Decline
Authors: Tassoni Molly B , Giovannetti Tania
Published: October 2023

Objective

There is relatively little known about the effect of subjective cognitive decline on everyday behaviors in community-dwelling older adults. We investigated use of compensatory strategies, busyness, and engagement in productive activities in older adults with subjective decline versus those without subjective decline.

Method

353 adults (65+ years old) completed an online survey including demographic information, self-reported decline in functional cognition (Everyday Cognition Questionnaire; ECog), subjective busyness (Martin and Park Environmental Demands Questionnaire), engagement in productive activities (Temple Activities Engagement Questionnaire), and use of compensatory strategies (Memory Compensation Questionnaire). Two-tailed t-tests compared these variables amongst two groups: “decliners,” (ECog Score > 1.49) and “non-decliners,” (ND; ECog Score < 1.50).

Results

There were no significant differences in demographics between the decliners (mean age = 76.68, sd = 8.22, p = 3.00; mean edu = 15.55, sd = 3.97, p = 0.91) and ND (mean age = 75.71, sd = 6.93; mean edu = 15.50, sd = 3.19). Decliners reported greater use of compensatory strategies (mean = 95.58, sd = 20.21, p < 0.001) compared to ND (mean = 80.43, sd = 19.56). Decliners also reported greater daily busyness (mean = 14.47, sd = 5.7, p = 0.002) compared to ND (mean = 12.66, sd = 4.19), but no difference in the engagement in productive activities.

Conclusions

Decliners utilize more compensatory strategies in their daily lives (e.g., using external aids, concentrating harder, etc.), and report feeling busier despite no difference in engagement of productive daily tasks. Future work should clarify how compensatory strategies in decliners are used and whether increased busyness reflects increased task demands or the use of compensatory strategies. Psychoeducation should promote compensatory strategies that are effective and alleviate subjective busyness.
A - 19 Cognitive Test Score Dispersion VS. Traditional Memory Composite Scores: Predicting Mild Cognitive Impairment (MCI) & Dementia among Cognitively Impaired, Not MCI Patients
Authors: Fatima Hudaisa , Schaffert Jeff , Lacritz Laura , Cullum C Munro
Published: October 2023

Objective

To compare mild cognitive impairment (MCI) and dementia conversion rates between global neuropsychological dispersion (GD) and traditional memory neuropsychological composite score (MComp) in participants with baseline evidence of cognitive decline but no diagnosis of MCI or dementia.

Methods

Data from the National Alzheimer’s Coordinating Center (NACC) for 364 participants with a CDR of 0.5, no initial diagnosis of MCI or dementia, and five visits were analyzed. GD was the intraindividual standard deviation across baseline normative (NACC norms) neuropsychological performance. MComp was the mean of the four verbal and visual memory normed scores. Multinomial logistic regression models fit statistics compared GD and MComp as predictors of conversion to MCI/dementia, adjusting for age, sex, race, ethnicity, ApoE4 status, and stratified by suspected etiology (Alzheimer’s disease [ad] or no-ad). Lower Akaike Information Criteria (AIC) values indicate better model fit and predictions.

Results

37% progressed to MCI, and 47% to dementia by visit 5. 53% of these were suspected to have ad etiology, and 47% non-ad. MComp showed a better fit with significant predictions of MCI and dementia progression in both suspected ad (AIC: 351.77, p < 0.001) or non-ad etiology (AIC: 215.02, p < 0.004), versus GD was only significant for non-ad etiology (AIC: 385.74, p < 0.003). Better memory performance predicted a lower likelihood of conversion to non-ad MCI (B = -0.65, p = 0.003) and non-ad dementia (B = -1.33, p < 0.001). GD predicted eventual progression to non-ad dementia (B = 2.311, p = 0.004), but not non-ad MCI.

Conclusion

Traditional memory composite score may be a better predictor of MCI and dementia conversion than cognitive dispersion in individuals with early cognitive decline who do not yet meet MCI criteria.
A - 32 Impact of Demographic Factors in African American (AA) Older Adults in Relation to Confrontational Naming Deficits on an Object Naming Task
Authors: Ramirez Sofia , Ortega Alexandra , Hincapie Diana , Haddock Yanelee Perez , Bosworth Brooke , Sosa Jaylene , Ortiz Juliana , Crenshaw Kirsten , Neer Emory , Zheng Diane
Published: October 2023

Objective

Dysnomia, or complaints of word-finding difficulties for names, places, and objects is common in patients with Alzheimer’s Disease (ad). This common characteristic makes confrontational naming a fundamental component of neuropsychological assessment in aging populations. The Multilingual Naming Test (MINT) detects naming impairments at various stages of cognitive decline. However, our understanding of how performance varies based on education, is sparse. Authors evaluated the sensitivity of the MINT in predicting naming impairments in AA in relation to education levels.

Methods

842 cognitively unimpaired (CU) and 413 mild cognitive impairment (MCI) AA elders were administered the MINT as part of the National Alzheimer’s Coordinating Center neuropsychological battery. The MINT consists of 32 items of ascending difficulty that participants must name spontaneously. Semantic and phonemic cues are given in the absence of immediate responses.

Results

A 5-number MEANS analysis was used to measure differences among CU and MCI stratifying by education level. Overall naming scores were consistently lower in cohorts with lower education across diagnosis. Unsurprisingly CU participants outperformed MCI counterparts.

Conclusion

More sensitive tools are needed to detect cognitive functioning changes in individuals with lower education levels. The MINT offers a novel approach in detecting confrontational naming deficits in those at risk of developing ad, but norms accounting for scholastic attainment are necessary to accurately diagnose minority populations with varying education levels. Further research is required to validate the MINT in participants with diverse backgrounds, low literacy levels and other factors that could affect quality of formative education.
A - 38 Variance in Educational Experiences among Older Adults Enrolled in an Alzheimer’s Disease Research Cohort
Authors: Stites Shana D , Halberstadter Kimberly , Schumann Rosalie , Patel Nisha , Mechanic-Hamilton Dawn
Published: October 2023

Objective

In the United States (U.S.), educational experiences can be wide-ranging. We examine educational experiences in an Alzheimer’s disease (ad) research cohort to understand how the representation and distribution of these experiences may affect the generalizability of conclusions in ad research.

Method

An online survey was administered to cognitively unimpaired participants (n = 135) in the UPenn ad Research Center clinical cohort. Self-report questionnaires gather sociodemographic data, including age, race, disability, education, and schooling. We report comparisons to U.S. educational attainment and examine correlations between education variables and executive function as measured by trail making test (TMT) B and digit span backward.

Results

The sample of 135 older adults averaged 74 years old, had about 17 years of schooling, and were mostly women (61%). All had at least a high school degree. About 11% had a high school diploma, about 8% had an associate’s degree, 24% had a 4-year college degree, 33% had a master’s degree, and over 20% had professional degrees. The distribution of educational attainment is not representative of the U.S. older adult population. More education associates with higher performance on TMT-B and digit span (both p < 0.008), particularly among those with the highest attainment.

Conclusion

Our findings suggest older adults enrolled in ad research have more education than the U.S. older adult population and a range of experiences in their schooling. We discuss three ways that the underlying distribution of educational experiences may affect the generalizability of conclusions drawn from ad research cohorts.
A - 40 Assessment of Dementia with Lewy Bodies in a Patient with both Characteristic and Atypical Features
Authors: Banerjee Nikhil , Hicks Cullen , Acosta Lealani
Published: October 2023

Objective

Dementia with Lewy Bodies (DLB) is the second most common neurodegenerative dementia after Alzheimer disease (ad). Its heterogeneous presentation and overlapping features with other dementias result in frequent misdiagnosis, which can delay optimal management. The present case illustrates complex symptomology, comprehensive assessment, and diagnostic challenges in a patient with DLB.

Method

A 64-year-old female presented to an academic medical center neurology clinic with rapid cognitive deterioration over the past 1.5 years accompanied by visual disturbances, psychiatric and behavioral changes, and mild motor symptoms. Initial differential included Creutzfeldt-Jakob disease, atypical parkinsonism, frontotemporal lobar degeneration (FTLD), encephalopathy, and ad. Work-up in included neuropsychological, neuroimaging, cerebral spinal fluid (CSF), electroencephalogram (EEG), and skin biopsy assessments.

Results

Neuropsychological interview revealed fluctuating attention/alertness, visual hallucinations, hyposmia, paranoid and repetitive behaviors, and subtle evidence for dream enactment. Her cognitive profile showed global impairment with pronounced visuospatial and executive deficits. Recognition memory, verbal reasoning, and naming were relatively well-preserved. Magnetic resonance imaging showed mild atrophy; fluorodeoxyglucose positron emission tomography (PET) showed hypometabolism in frontal and temporal regions whereas uptake was highest in the occipital lobes and basal ganglia; skin biopsy was positive for synucleinopathy; CSF and EEG were broadly unrevealing.

Conclusions

The preponderance of data was consistent with diagnostic criteria for probable DLB. Skin biopsy increased diagnostic confidence. Atypical features included relatively rapid cognitive decline, minimal parkinsonism, and PET imaging suggesting FTLD. The present case highlights the utility of a multidisciplinary approach (e.g., neurological exam, detailed symptom screening, neuropsychological testing, and advanced laboratory assessments) in a complex case of DLB.
A - 52 Self-Reports and Informant-Reports of Everyday Functioning as Predictors of Objective Cognition in Mild Cognitive Impairment and Dementia
Authors: Hickman Angela , Kozuki Jordan , Lent David , Wright Matthew , Woo Ellen
Published: October 2023

Objective

The objective of the current study was to investigate self- and informant-reports of everyday functioning and whether they predicted objective cognitive functioning.

Method

Participants included 65 persons with mild cognitive impairment (MCI), 18 individuals with dementia, and 58 healthy older controls. Self-reports and informant-reports were taken on the Everyday Cognition Scales (E-Cog), which included seven subscales: everyday language, memory, executive functioning (EF) planning, EF organization, EF divided attention, visual–spatial/perceptual abilities, and attention. Participants also completed a neuropsychological battery, and composite scores were calculated for each cognitive domain.

Results

Regression analyses revealed that in healthy older controls, self-reported EF organization significantly predicted objective executive functions. Additionally, informant-reported language significantly predicted objective language. In the MCI group, self- and informant-reports on the E-Cog did not predict objective cognition. For the dementia group, informant-reported EF planning, EF organization, and EF divided attention significantly predicted objective executive functions. Furthermore, informant-reported language significantly predicted objective language.

Conclusions

Overall, informant-reports of everyday language predicted objective language in healthy aging and dementia. Self-reports were only predictive of objective cognition in healthy older controls, with self-reported everyday executive functions predicting objective executive functions. Interestingly, in MCI, self- and informant-reports were not predictive of any domain of objective cognitive skill. These results indicate that when the cognitive impairment is more subtle than in dementia, objective neuropsychological assessment will be even more important, as self- and informant-reports are not associated with actual cognitive functioning.
A - 59 Regional Cerebral Metabolism Is Associated with Performance on the Visual Object and Space Perception Battery in those with Posterior Cortical Atrophy
Authors: Richert Mallory , DiRita Victor , Moceri Anthony , Iordan Alexandru , Crowley Samuel , Koeppe Robert , Hampstead Benjamin
Published: October 2023

Objective

Posterior cortical atrophy (PCA) is a relatively rare clinical syndrome characterized by visuoperceptual/spatial dysfunction with relatively preserved memory, language, and insight in the early stages. Thus, PCA provides a unique population through which to evaluate structure–function relationships for commonly used neuropsychological tests. Here, we evaluated relationships between fluorodeoxyglucose (FDG) positron emission tomography (PET) and performance on the Visual Object and Space Perception (VOSP) Battery.

Method

Ten participants with an established diagnosis of PCA underwent baseline neuropsychological testing that included the VOSP, FDG-PET, and structural MRI. We used FreeSurfer to identify anatomical structures in the structural MRI scans, aligned the MRI and PET scans, and then extracted FDG signal from these same regions. Several brain regions relevant for PCA were a priori targeted. We evaluated relationships between the regional FDG values and VOSP performances using Spearman’s rank correlation.

Results

Silhouettes, Dot Counting, and Number Location showed strong relationships with the superior parietal lobule bilaterally. The right superior parietal lobule showed moderate to strong relationships with Incomplete Letters and Progressive Silhouettes, whereas the left superior parietal lobule showed a strong relationship with Object Decision. Incomplete letters showed a strong relationship with the right supramarginal gyrus. Silhouettes showed a strong relationship with the left fusiform gyrus.

Conclusions

These findings from a relatively rare and heterogeneous syndrome provide insight into the regional contributions to visuospatial functioning. Future work will evaluate network-level integrity with these tasks in order to further clarify structure–function relationships.
A - 64 The Neuropsychology of Lost Person Behavior: Case Studies of Lost Persons with Substance Intoxication, Dementia, and Intact Cognitive Status
Authors: Torsney Kathleen
Published: October 2023

Objective

The location of lost persons by Search and Rescue teams is often achieved through statistical analyses based on previous cases, however, the impact of neuropsychological functioning on the behavior of lost persons has not been explored. Information about how the neuropsychological profile of various lost persons can inform the behavior of those persons will substantially assist Search and Rescue efforts.

Method

This poster examines 3 case studies of lost persons: an individual with dementia lost in a small city, an intoxicated man in his 20s lost in the woods, and a cognitively intact middle-aged man lost at the top of a mountain. The author describes each case and how the neuropsychological profile of a person with dementia, an intoxicated individual, and a person without cognitive deficits can inform lost person behavior.

Results

The poster highlights key factors in identifying how neuropsychological functioning in various profiles will influence how the lost person behaves. The results of the lost person behavior and their executive functioning profiles are compared and contrasted.

Conclusion

The author provides information about how neuropsychological profile of individuals with dementia, intoxication, and intact functioning influence how these persons behave when lost. This information may be used to assist Search and Rescue teams in more quickly and efficiently finding lost persons.
A - 67 Does Cognitive Set-Shifting in Multilinguals Serve as a Protective Factor against Depressive Rumination?
Authors: Caviasco Annalise , Storbeck Justin
Published: October 2023

Objective

The purpose of this study is to assess whether multilinguals’ advantage in cognitive flexibility serves as a protective factor against ruminative tendencies common in depressed mood. We compared monolinguals and multilinguals in a backward inhibition task during negative and neutral moods. It was hypothesized that monolinguals compared with multilinguals would perform worse on inhibition trials compared to control when induced into a negative mood.

Method

96 undergraduates from Queens College, a population with high linguistic diversity, were recruited from Psychology 101 courses. Participants were monolingual (n = 47) or multilingual (2+ languages; n = 49). Participants responded to questions about their language and social background before undergoing mood induction to either neutral or negative (sad) affective states. They then completed a computerized cognitive set-shifting task measuring reaction time (RT) and accuracy.

Results

A two-way ANOVA was conducted examining the effect of mood condition and mono/multilingualism status on RT and accuracy on the set-switching task for backward inhibition trials. There was a statistically significant interaction between the effects of mood condition and mono/multilingualism on RT, F(1, 92) =6.062, p = 0.002, such that multilinguals had a higher RT compared to monolinguals when induced into a negative mood. The main effects of mono/multilingualism and mood condition were not statistically significant. Difference in accuracy between groups was not statistically significant.

Conclusions

Contrary to our hypothesis, bilinguals took longer to respond than monolinguals in a sad mood, specifically for lag inhibition trials. Additional research is needed to determine how sociocultural factors may explain multilinguals’ slowed response in a negative mood.
A - 68 Brain Health Clinic’: a Neuropsychometric Screening & Triage Model
Authors: Hicks Cullun , Banerjee Nikhil , Pilote Kristen , Romano Raymond , Considine Ciaran
Published: October 2023

Objective

Cognitive symptoms are frequently not diagnostic for underlying brain damage or disease, but secondary to other treatable medical/psychiatric factors. Neuropsychological evaluation can inform the differential, but is limited by access issues and reduced diagnostic certitude in the setting of unmanaged secondary factors. Development and implementation of a neuropsychometric screening and triage model to address these issues has flexible application across different clinical settings.

Data Selection

Literature on cognitive/behavioral/somatic screening methods were reviewed. Measures and associated cut-offs were selected based on open-source availability, clinical domain/condition relevance, intended population, and time to administer/interpret. Consultation with first-line clinicians in general neurology and non-neurology clinics guided refinement. Consultation with Neurologists informed triage guidelines. Recent CPT/CMS guidance on e-consultation billing was reviewed and integrated.

Data Synthesis

A “Brain Health Clinic” model composed of neuropsychometric screening with empirically-derived cut-off scores, along with expert consensus first-line intervention and triage, was piloted with advanced practice providers in a Cognitive Neurology Clinic. E-consultation support was provided by Neuropsychology. Practice findings and refinements are discussed. Adaptations to the model designed for a post-COVID clinic, Concierge Medicine clinic, and Primary Care Practice with integrated Neuropsychologist are reviewed.

Conclusions

Upstream extension of neuropsychological expertise via screening and triage with appropriate remote involvement of the neuropsychologist has the potential to resolve cognitive complaints prior to referral, or, optimization of confounding medical/psychiatric factors in those patients eventually escalated for full evaluation. New CPT/CMS billing options make this a viable approach for neuropsychologists across different clinical settings. Empirically-based refinement and assessment of outcomes in the future is indicated.
A - 69 Examining Differences in Neuropsychological Test Performance Based on Deployment Era and Years Served in United States Veterans
Authors: Engel David , Smith Cassandra , Courtwright Kylie , Callahan Megan
Published: October 2023

Objective

To determine the influence of years of military service and deployment era on neurocognitive performance.

Method

Archival data included 316 veterans (89.6% male; 94.3% White) seen for neuropsychological evaluation at the Portland VA (M/SD: age = 55.54/14.39; education = 13.32/2.44). Participants were administered a comprehensive neuropsychological battery. Two-way between-subjects analyses of variance (ANOVAs) examined the effects of years of service and deployment era on test performance. Bonferroni post-hoc tests compared differences between groups when a significant main effect was observed.

Results

Significant main effects were found for deployment era on TOMM Retention trial (F(4, 20) = 4.39, p = 0.04), WAIS-IV Block Design (F(5, 244) = 2.45, p = 0.04), WMS-IV Logical Memory I (F(5, 230) = 3.79, p < 0.01), Trail Making Test Part A (F(5, 242) = 3.54, p < 0.01), Trail Making Test Part B (F(5, 227) = 3.38, p < 0.01) and Grooved Pegboard for nondominant hand (F(4, 86) = 3.22, p < 0.05). Significant main effects were also observed for years of service for Trail Making Test Part A (F(4, 242) = 2.81, p < 0.05) and DKEFS Color-Word Trial 2 (F(4, 77) = 2.67, p < 0.05). A significant interaction was found between deployment era and years served on the BVMT-R total recall score (F(15, 213) = 1.92, p < 0.05). Post-hoc analyses did not reveal significant variance accounted for on neuropsychological tests.

Conclusions

While there were significant differences between multiple measures, deployment era and years of service do not impact veteran’s cognitive performance.
A - 78 Characterization of Post-Stroke Cognitive and Mood Impairment within 1-Year Post-Stroke after Hospital Discharge
Authors: Saurman Jessica L , Nahab Fadi , Barrett A M , Belagaje Samir , Henriquez Laura , Starnes Danielle , Christopher Hannah , Blanke Debra , Loring David W
Published: October 2023

Objective

To demonstrate the feasibility of cognitive and psychological characterization after stroke during post-discharge neurology visit as part of standard care.

Method

From January 1, to April 29, 2023, 33 patients were evaluated using the MoCA and screening tests for aphasia, spatial neglect, depression, and anxiety during their neurology outpatient visit. Neuropsychological measures evaluating attention, processing speed, language, visuospatial, memory, and executive function abilities were also administered. Patients were aged 30–87 years (Mage = 64.8, SDage = 14.2). The sample included 37.1% women and was primarily Black/African American (37.1%) and White (54.3%). The average level of education was some college (Medu = 14.7, SDedu = 32.7). Time between stroke and testing ranged from 0–11 months (Melapsed = 2.8, SDelapsed = 3.1 and 88.6% of patients experienced ischemic stroke.

Results

Over 68% of patients examined demonstrated global cognitive impairment on the MoCA (MMoCA = 21.2, SDMoCA = 5.1). 5.7% of patients met criteria for spatial neglect and 5.7% met criteria for aphasia. A higher percentage demonstrated impairments within visuospatial or language domains (51.4% visuospatial and 34.3% language, respectively. Further, impairments were observed across all other domains assessed, including attention (22.9%), processing speed (31.4%), verbal memory (62.9%), visual memory (54.3%), and executive function (51.4%). Depression and anxiety were present in 42.9% and 37.1% of the sample, respectively. Elapsed time, type of stroke, lateralization of stroke, sex, or mood scores were not associated with lower performance on the MoCA.

Conclusions

Cognitive and behavioral deficits following stroke can be identified as part of standard neurologic care that may otherwise have been missed, providing an opportunity to intervene and maximize recovery in stroke patients.
A - 89 Cognitive Evaluation of Suspected Wernicke- Korsakoff’s Encephalopathy in a Woman with Complicated Hyperemesis Gravidarum
Authors: González Marela Firpi , Facchini Ronda , McGinley John , Bronshteyn Diana , Stimmel Marnina , Weiss Erica F
Published: October 2023

Objective

Wernicke-Korsakoff syndrome (WKS) is a neurological disorder caused by the lack of thiamine (vitamin B1) and includes Wernicke encephalopathy and the later stage of Korsakoff amnesic syndrome. WKS could be secondary to malnutrition, including Hyperemesis Gravidarum (HEG), which is characterized by severe vomiting during pregnancy. We present a case of HEG resulting in suspected WKS where neuropsychological evaluation clarified cognitive status with complex cultural, language, and educational factors.

Method

Repeat evaluations of a 29-year-old West-African* woman with mental status change, decreased verbal output, agitation, and inability to walk in the context of HEG. Initially referred for inpatient neuropsychological evaluation at 21 weeks gestation. MRI demonstrated mild diffuse cerebral atrophy and symmetric foci of T2 FLAIR hyperintensities in periaqueductal gray matter, hypothalamus, bilateral thalami, perirolandic cortex, and bilateral mammillary bodies.

Results

Initial inpatient testing with a face-to-face language congruent interpreter demonstrated notable multidomain impairment. Possible Intellectual Disability was considered by the referring team and test performances. Attempts at re-evaluation were limited by medical complications and prolonged hospitalization. Repeat inpatient evaluation 5 months later following birth of healthy child and initiation of stimulant medication, demonstrated profound memory impairment but otherwise improved cognitive capacity and engagement. Results aided in discharge planning including cognitive remediation with goal of improving functional independence.

Conclusions

Wernicke-Korsakoff syndrome due to Hyperemesis Gravidarum is an uncommon but known complication that can have profound acute and long-term consequences. This case demonstrates that repeat neuropsychological evaluations can clarify cognitive status in complex medical/cultural/language situations. *(country of origin and primary language not provided for patient privacy).
A - 99 Older Adult Male with Idiopathic Normal Pressure Hydrocephalus (iNPH): Neuropsychological Case Study
Authors: Kim Doyen , Kearns Kelly A
Published: October 2023

Objective

Idiopathic normal pressure hydrocephalous (iNPH) is a potentially reversible syndrome characterized by ventriculomegaly. Parkinsonism is an often-overlooked clinical feature of iNPH. Mostile et al. (2022) argued that the diagnostic iNPH “triad” should be reconsidered as a “tetrad” including parkinsonism. This case will discuss iNPH presenting with parkinsonism. Patient is an 81-year-old male with a history of iNPH with Hakim’s triad. His medical history includes hyperlipidemia, hypertension, deep vein thrombosis, benign prostatic hyperplasia, total knee replacement, and chronic depression. Presenting concerns were continued cognitive and gait impairments.

Method

Patient was referred from his physiatrist for evaluation of his cognitive functioning and assistance with discharge planning in an acute inpatient rehabilitation hospital. Patient was neuropsychologically evaluated to clarify the etiology of his cognitive presentation.

Results

Patient’s cognitive profile was impaired in areas of attention, executive functioning, processing speed, visuoperception, and displayed a subcortical memory profile. Patient had intact functioning in areas of oral reading, naming, and working memory. Motor examination was evident for apraxia, task-specific tremor, and micrographia.

Conclusions

This case report provides additive findings for common presentation of iNPH including parkinsonism presenting with comorbid psychiatric and medical confounders, highlighting the need for further research on neuropsychological profile of iNPH post shunt procedure. It also accentuates the need to accept parkinsonism as one of the common presentations of iNPH. Akinesia has been reported in nearly 70% of iNPH cases (Krauss et al, 1997), with bradykinesia and postural instability being the main parkinsonian features. Asymmetry and resting tremor were seen to be uncommon (Molde et al., 2017).
A - 114 Long Term Cognitive Sequela of Intracranial Radiation Therapy in a Pediatric Cerebellar Medulloblastoma Survivor
Authors: Strebler Pelin , Schmitt Andrew
Published: October 2023

Objective

Intracranial radiation therapy (IRT) for pediatric brain tumors is associated with late delayed brain injury due to cerebrovascular abnormality, white matter necrosis, demyelination, and gliosis which are irreversible. As a result, persistent cognitive deficits in adulthood emerge which are aggravated by younger age at diagnosis, higher radiation dose, whole brain radiation (WBR), and concurrent chemotherapy. The case is a childhood brain tumor survivor seen 18 years post treatment who displayed cognitive deficits reflecting the cognitive sequela of WBR that overlapped with the anatomical distribution of white matter damage sustained.

Method

23-year-old Black male with a history of childhood cerebellar medulloblastoma diagnosed at age 4, tumor resection, WBR, chemotherapy, more recent seizure disorder and medullary stroke, diabetes, and hypertension was seen for a neuropsychological evaluation due to memory complaints. His neuroimaging showed white matter hyperintensities in bilateral temporal and occipital lobes, bilateral cerebellar hemispheres, bilateral frontal lobes, medial posterior right cerebellar cyst, and 10 x 5 mm cyst in the left temporal lobe.

Results

Results showed FSIQ = 59 and deficits in language, processing speed, visuospatial abilities, executive functioning, and verbal memory. His auditory working memory and visual memory were preserved. Based on his numerous adaptive limitations, moderate intellectual development disorder diagnosis was given.

Conclusions

Deficits across several cognitive domains were consistent with multi-focal white matter lesions seen in patient’s neuroimaging which reflect radiographic findings related to long-term sequela of previous intracranial radiation. A unique finding was relatively preserved visual memory as findings related to asymmetrical memory dysfunction in childhood medulloblastoma survivors are scarce.
A - 115 Do Patients with Dementia and Mild Cognitive Impairment Perform Differently on the Clock Drawing Test?
Authors: Sylvester Doug , Morales Sandra , Berry Matt , Stoll Matt , Renteria Laura , White Natasha
Published: October 2023

Objective

The Clock Drawing Test (CDT) is an effective screening tool for assessing cognitive dysfunction. Many studies have examined differences in CDT performance between individuals with dementia and normal controls. The current study expands on this research by comparing individuals with dementia and mild cognitive impairment (MCI). We utilized the ten-point scoring system created by Libon and colleagues (1996) as we were interested in looking at differences in error type.

Methods

Data were retrospectively collected from a sample of patients (n = 59, mean age = 76.8, mean education = 14.8 years, 45.8% MCI, 54.2% dementia) seen at a private practice in the Portland, Oregon metropolitan area. Patients with a history of moderate-to-severe TBI, severe psychiatric history, or undergoing re-evaluation were excluded.

Results

Mann–Whitney U tests did not reveal a statistically significant difference in total CDT errors between dementia and MCI groups across command and copy conditions. There was no statistically significant difference between groups on error type (graphomotor, hand/number placement, executive control) on either the command or copy condition, with one exception. The dementia group (mean rank = 32.63) made significantly more copy condition graphomotor errors than the MCI group (mean rank = 24.96), U = 296, p = 0.046, r = −0.26.

Conclusion(s)

Our results demonstrate that CDT scores in patients with dementia and MCI are not significantly different. As a screening tool, CDT errors are suggestive of cognitive impairment, however, to achieve greater clarity in degree of impairment and presumed etiology, additional comprehensive cognitive assessment is needed.
A - 122 Coronavirus Anxiety, Mood, and Subjective Cognition in Post-Acute Sequelae of COVID-10
Authors: Darwazah Hannah , Hammond Jared B , Lichtenstein Jonathan D , Moncrief Grant G , Roth Robert M , Thompson Ryan C
Published: October 2023

Objective

Coronavirus anxiety (CA) is associated with depression, general anxiety, and subjective cognitive dysfunction (SCD) in community samples. Furthermore, individuals with SARS-CoV-2 infection (acute & post-acute) report greater CA and SCD. No study to date has examined CA in patients diagnosed with post-acute sequelae of COVID-19 (PASC). We evaluated the prevalence of CA amongst individuals diagnosed with PASC and its associations with mood and SCD.

Method

Participants were 72 patients diagnosed with PASC [M age = 48.8 ± 11.9 years, 72.2% female, 93.1% White] who were referred for clinical neuropsychological evaluation between May 2021 and February 2023. Participants completed the Coronavirus Anxiety Scale (CAS; range = 0–20, clinical cutoff: ≥9), BDI-II, BAI, BRIEF-A, and Neurobehavioral Symptom Inventory (NSI).

Result

Overall, CAS scores were low (M = 1.29, SD = 2.69, 4.2% clinically elevated). In contrast, depression scores were high (M = 23.2, SD = 11.2, 72.2% clinically elevated), as were anxiety scores (M = 19.7, SD = 12.2, 72.2% clinically elevated). CAS scores tended to decline over the course of the study; however, scores on the BDI-II or BAI did not. Higher CAS scores were associated with higher scores on the BDI-II (rs = 0.344, p = 0.005), BAI (rs = 0.321, p = 0.009), and BRIEF-A Global Executive Composite (rs = 0.407, p = 0.001) but not for the NSI Cognitive Factor (rs = 0.139, p = 0.256).

Conclusion

Findings suggest clinically significant CA is not particularly prevalent in individuals with PASC, but perhaps is more salient for acute infection. Results also highlight the presence of clinically elevated psychiatric distress in patients with PASC and the need for proper screening and intervention.
A - 124 The Impact of Attention-Deficit/Hyperactivity Disorder (ADHD) on Cognition and Function in Post-9/11 Veterans with Post-Traumatic Stress Disorder (PTSD)
Authors: Knight Arielle , Kim Sahra , Currao Alyssa , Sablone Caroline , Milberg William , Fortier Catherine
Published: October 2023

Objective

The study examines the impact of ADHD on cognitive and functional abilities in post-9/11 Veterans with PTSD.

Method

313 Veterans from the Translational Research Center for TBI and Stress Disorders at VA Boston with PTSD only (44.73%), with ADHD only (3.51%), with both PTSD+ADHD (8.63%), and without either condition (43.13%) were evaluated. PTSD was assessed by the Clinician-Administered PTSD Scale (CAPS-IV). ADHD was assessed by the Wender Utah Rating Scale for ADHD (WURS ≥46). WHO Assessment Schedule (WHODAS) measured general functioning. Linear regression models analyzed differences in neuropsychological (Digit Span, Stroop, FAS, Trails, Coding, California Verbal Learning Test, and the Brief Visuospatial Memory Test) and general functioning among the four groups.

Results

Veterans with PTSD only performed significantly worse than all other groups on Stroop–Color Naming (β = −0.77, p = 0.022), and FAS–Category Fluency (β = −1.10, p = 0.014). Veterans with both ADHD+PTSD performed significantly slower than all other groups on Trails–Number Sequencing (β = −1.65, p = 0.003). Veterans with PTSD only and with PTSD+ADHD reported significantly worse functional status (β’s = 13.56–24.74, p’s < 0.0001), mood (β’s = 7.87–17.30, p’s < 0.0001), sleep quality (β’s = 5.06–6.73, p’s < 0.0001), and neurobehavioral symptoms (β’s = 16.37–25.36, p’s < 0.0001) compared to other groups.

Conclusion

These findings suggest that PTSD has a larger impact on cognitive performance, specifically processing speed, and functioning than ADHD alone. However, when combined, ADHD compounds the effects of PTSD, resulting in worse functioning across multiple domains compared to Veterans who have only ADHD or PTSD.
A - 127 Unveiling Discrepancies in Identifying Depression in Dementia: a Comparative Analysis of Caregiver and Patient Self-Report Measures
Authors: Ortiz Bailey L , Callahan Patrick , Shdo Suzanne , Hebron Liberty , Rijpma Myrthe , Antoniou Rea , Miller Bruce L , Rankin Katherine P
Published: October 2023

Objective

Standard assessment of depression in research and clinical care with persons with dementia (PWD) relies on caregiver report, and views of PWD are typically not incorporated due to concerns that they lack insight into their own neuropsychiatric status. This study explored the discrepancies between self-reported and caregiver-reported depression among PWD.

Method

Participants included 373 PWD who met criteria for Alzheimer’s disease, behavioral variant frontotemporal dementia, semantic variant primary progressive aphasia, and progressive supranuclear palsy. Each PWD self-reported depressive symptoms using the Geriatric Depression Scale (GDS), including subscales of dysphoria, withdrawal, worry, worthlessness, and cognitive concern. Caregivers described the PWD using the Neuropsychiatric Inventory (NPI) depression and apathy subscales.

Results

Of the total sample, 112 (30%) patients were positive for depression on both their self-report (GDS total > =13) and their informant report (NPI depression = yes). However, 226 (60.5%) patients self-reported depression on the GDS, including dysphoria and hopelessness, but their caregivers reported no depression. Additionally, 110 (49%) patients who self-reported depression but whose informants reported no depression were described as apathetic by their informants, compared to 43 (19%) of these depressed patients whose informants did not report depression or apathy.

Conclusion

These results suggest that overreliance on caregivers’ reports of depression may seriously underrepresent rates of depression in PWD and mischaracterize patients’ experience. Difficulty distinguishing depression from apathy accounted for only part of this PWD-caregiver discrepancy. Prioritizing PWD self-report of mood, and broadening caregiver education about depression, may improve care and quality of life for PWD.
A - 137 Head Injury Due to Intimate Partner Violence: Pain Severity and Interference
Authors: Leong Sharon E , Logan T K , Karr Justin E
Published: October 2023

Objective

This study examined pain severity and interference in women survivors of intimate partner violence (IPV) with and without head injuries (HIs), including women with IPV-related and non-IPV-related HIs. Hypotheses were (1) women with IPV-related HIs would report greater pain severity than women without HIs, but comparable severity to women with non-IPV-related HIs, and (2) women with IPV-related HIs would report greater pain interference than women without HIs and women with non-IPV-related HIs.

Method

Among women IPV survivors, 268 reported no HIs (M(age) = 30.9 ± 9.8 years-old, 77.2% White), 113 reported non-IPV-related HIs (M = 31.5 ± 9.2, 88.5% White), and 251 reported IPV-related HIs (M = 32.9 ± 8.9; 88.0% White). Participants reported pain severity and interference in past week.

Results

Women with IPV-related HIs reported higher pain severity than women without HIs (p < 0.001, d = 0.49 [95% CI: 0.32, 0.66]), but comparable severity to women with non-IPV-related HIs (p = 0.233, d = 0.24 [0.02, 0.46]). Women with IPV-related HIs reported more pain interference than women without HIs (p < 0.001, d = 0.60 [0.42, 0.77]) and women with non-IPV-related HIs (p = 0.017, d = 0.34 [0.12, 0.56]); however, after controlling for covariates (demographics, physical/sexual violence), the HI groups reported similar pain interference (p = 1.00).

Conclusions

Women with IPV-related HIs reported the highest pain severity and interference, although this difference became non-significant after controlling for lifetime IPV severity. Pain interference among women with IPV-related HIs may be related to more severe physical violence, coercive control, and emotional trauma.
A - 140 Relationships between Childhood Traumatic Brain Injury and Impulsivity, Aggression, and Incarceration in Adulthood
Authors: Dorman Katherine , LaDuke Casey
Published: October 2023

Objective

A traumatic brain injury (TBI) can lead to impaired self-regulatory behaviors such as impulsivity, aggression, and poor decision making. It was hypothesized that childhood TBI would relate to higher impulsivity, aggression, and incarceration in adulthood.

Method

The current study analyzes an archival dataset of 95 incarcerated men from a correctional facility. Composite scores were created for impulsivity self-report, impulsivity neurobehavioral, and aggression. The measures used to assess each of these were Barkley Adult ADHD Rating Scale, Dysexecutive Questionnaire, Triarchic Psychopathic Measure Disinhibition scale and Meanness scale, Porteous Maze Task, Color-Word Interference Test, Aggression Questionnaire, and Institutional records. Hypothesis testing was based on a series of analyses of covariance. Age was entered as the covariate for all analyses.

Results

Non-significant effects were observed between TBI with LOC before the age of 15 and impulsivity, F(1, 82) = 0.59, p = 0.45, ηp2 = 0.007;, F(1, 84) = 0.13, p = 0.72, ηp2 = 0.002, aggression, F(1, 83) = 0.27, p = 0.60, ηp2 = 0.003, and adult incarceration, F(1, 78) = 0.76, p = 0.39, ηp2 = 0.01. The covariate of age was found to be statistically significant with a medium effect in the incarceration model, F(1, 78) = 11.44, p = 0.001, ηp2 = 0.13.

Conclusion

Prior literature provides support for the hypotheses even though the results of this study didn’t. With greater research on TBI in childhood, we can discover and implement strategies to help children after they have had a TBI to boost development and prevent potential negative outcomes.
A - 149 Association between Brain Network Organization and Symptom Severity from Baseline to Post-Concussion
Authors: Laing Julia M , Bouchard Heather C , Higgins Kate L , Maerlender Arthur , Neta Maital , Savage Cary R , Schultz Douglas H
Published: October 2023

Objective

Concussions have been associated with functional connectivity changes that impact physical and psychiatric health. Previous research has focused on the relationship between average network functional connectivity changes following concussion and symptom severity, but this approach may be insensitive to subtle nodal changes that still result in the disruption of within network organization, and therefore, impact symptom severity. We hypothesized that individuals who exhibit more disruptions in brain network organization post-concussion (~48 hrs post-diagnosis) would self-report a higher symptom load acutely post-injury.

Method

Resting state functional magnetic resonance imaging data were obtained for collegiate football players (n = 37; Mage = 19.8, SDage = 1.85) at baseline and acute post-concussion. Functional connectivity matrices were constructed using 264 regions (Power et al., 2011). We calculated normalized betweenness centrality (BCnorm) for all DMN nodes at both time-points. Then similarity of pre-post patterns for BCnorm in the DMN were calculated. Symptom load was baseline-post concussion difference severity score from Post-Concussion Symptom Scale clusters (affective, cognitive, sleep, somatic) (Collins et al., 2012). Finally, correlations were calculated of DMN-BCnorm similarity with symptom cluster changes.

Results

Athletes who have more disruptions to brain network organization in the DMN from baseline to post-concussion report more somatic symptoms acutely post-concussion. We did not find any relationships between disruption of brain network properties in the DMN and changes in other symptom clusters.

Conclusions

Athletes who exhibit more disruptions in the DMN report more somatic symptoms following concussion. These results suggest that examining patterns of brain network organization may be more sensitive than network average when relating brain changes to symptom change.