bluuebunny/crossref_metadata_2025 huggingface dataset:
63 Longitudinal Decline in Everyday Functioning: Exploring the Incremental Validity of Neuropsychiatric Symptoms in Dementia
Authors: Divers Ross , Calamia Matthew , Reed Christopher , Breaux Eathan , Runk Ashlyn , Rasmussen Lauren
Published: December 2023

Objective:

Decline in everyday function is a hallmark of dementia and is associated with increased caregiver burden, medical spending, and poorer quality of life. Neuropsychiatric symptoms (e.g., apathy, hallucinations) can also occur in those with dementia and have been associated with worse everyday functioning cross-sectionally. However, research on which neuropsychiatric symptoms are most associated with everyday functioning in those with dementia longitudinally has been more limited. Further, it is unknown which neuropsychiatric symptoms may add incremental validity beyond cognition in predicting everyday function longitudinally. The current study aimed to address both of these gaps in the literature by identifying which neuropsychiatric symptoms are most associated with everyday function over time and if symptoms add incremental validity in predicting everyday function beyond cognition in those with dementia.

Participants and Methods:

Older adult participants (N = 4525), classified as having dementia at baseline by the National Alzheimer's Coordinating Center, were examined. Severity of neuropsychiatric symptoms were measured via the Neuropsychiatric Symptoms Questionnaire-Informant. Everyday function was assessed via the Functional Activities Questionnaire-Informant. Memory (Logical Memory immediate and delayed) and executive function (Digit Symbol Test, TMT-A and TMT-B) composites were created to assess cognition. Severity of neuropsychiatric symptoms at baseline were analyzed as predictors of everyday functioning beyond demographic factors and cognition at baseline and over the course of five years using multilevel modeling.

Results:

At baseline, severity of the majority of symptoms, excluding irritability, manic symptoms, and changes in appetite, were associated with everyday function (all p < .05). When examining everyday functioning longitudinally, only severity of hallucinations, apathy, motor dysfunction, and sleep dysfunction were associated with differences in everyday function over time (all p < .01).

Conclusions:

There is heterogeneity in the degree to which neuropsychiatric symptoms are associated with everyday functioning over time in those with dementia. Additionally, our results show that some neuropsychiatric symptoms are associated with longitudinal changes in everyday function beyond domains of cognition show to be associated with function. Clinicians should pay particular attention to which neuropsychiatric symptoms individuals with dementia and their families are reporting to aid with treatment planning and clinical decision making related to autonomy. Future research would benefit from examining pathways through which neuropsychiatric symptoms are associated with everyday functioning over time in this population, and if treatments of neuropsychiatric symptoms may improve everyday function in this population.
69 Verbal Comprehension and PTSD: A Glimpse into Trauma and Resilience
Authors: Bublitz Analisa , Mastan Joshua , Grivois Isabella , Nolty Anne , Amano Stacy
Published: December 2023

Objective:

Many of those who experience the trauma and abuse of sex trafficking also struggle with a variety of physical and mental health issues, a major one of those issues being posttraumatic stress disorder (PTSD). In this study, we explored the relationship between verbal comprehension and a PTSD diagnosis to see if this aspect of intelligence might be stronger for individuals without a diagnosis of PTSD.

Participants and Methods:

Participants included 22 adolescent girls between the ages of 14 and 18 who had experienced sex trafficking. Participants were referred to Fuller Psychological and Family Services for learning difficulties, where they were given comprehensive clinical neuropsychological evaluations, including a Wechsler Intelligence Scale (WISC or WAIS) and a screening for PTSD. WISC or WAIS Full Scale IQ ranged from 75 to 115 (M = 85.1, SD = 11.2).

Results:

Contrary to the hypothesis that those without PTSD would have higher verbal comprehension scores than those with PTSD, the results indicated no difference between the two groups, t(23) = -.86 , p = .40. However, verbal comprehension scores across both groups were significantly below the normal range, suggesting a relationship between trauma and verbal comprehension.

Conclusions:

The diagnosis of PTSD may impact intelligence in ways not anticipated for this population, or perhaps our method of diagnosing PTSD did not adequately nuance the varying responses to trauma. By further exploring the relationships between Verbal Comprehension Indexes and markers of resilience, we may be able to better understand the characteristics of resilience demonstrated by those who become involved in prostitution.
73 Do depression, anxiety, or stress moderate the relationship between simple attention, working memory and verbal learning?
Authors: Laique Aamir , Springer Jessica , Axelrod Jenna , Breting Leslie Guidotti , Geary Elizabeth , Sweet Jerry J
Published: December 2023

Objective:

Working memory is a vital construct in efficient verbal memory encoding (Cotton & Ricker, 2021). Working memory is impacted by attentional capacities (Riccio, Cohen, Garrison, & Smith, 2005). Mood symptoms impact efficient information processing and consolidation of memory (Hubbard, 2016; Lukasik, 2019). This study examines self-reported symptoms of depression, anxiety, and stress as possible moderators of the relationship between working memory and a verbal list-learning task.

Participants and Methods:

Archival data from 415 adults (Mage= 56.10, SD=18.05; Medu= 15.5 SD=2.2; 53% female; 73% white) were collected at an outpatient clinic. Sex and race were not available in a small percentage of cases included in analyses. The Wechsler Adult Intelligence Scale 4th Edition Digit Span subtest was given to assess attention and working memory. Although Digit Span Forward is a measure of simple attention, not working memory, it was included in initial analyses because the subtest was given as a whole. The three components of Digit Span total, Forward, Backward, and Sequencing were also investigated separately, with the two latter scores being better representations of working memory. Learning was assessed via the California Verbal Learning Test (CVLT-II) total T-Score (Trials 1-5). Mood was assessed via the Depression Anxiety and Stress Scales (DASS-42).

Results:

Results of a hierarchical linear regression showed a significant effect between total Digit Span performance and total learning on the CVLT-II in the Block 1 (F(3, 411)=14.383, p =<.001 , AR2=.095). Standardized beta weights and p-values for Digit Span Forward, Backward, and Sequencing were (ß=-.50, p=.374), (ß= .159, p=.009), and (ß=.210, p<.001) respectively. In Block 2, when the DASS variables were introduced, the model remained significant F(3,408)=2.602, p=.05 , AR2=.017). The DASS anxiety and stress subscales had significant beta weights in the model (ß=-.172, p=.015) and (ß=.144, p=.039) respectively, with depression being insignificant (ß=--.023, p=.724).

Conclusions:

Mood symptoms have been shown to be an important consideration when assessing working memory and verbal learning performance (Massey, Meares, Batchelor, & Bryant, 2015). Present results demonstrate that when accounting for working memory, anxiety and stress were significant predictors of performance on a measure of verbal learning. Additionally, as the components best representing working memory, Digit Span Sequencing and Backward were significantly correlated with verbal learning, whereas a measure best representing simple attention, Digit Span Forward, was not significantly correlated with verbal learning.
6 Now or Later? Decision-Making Preferences in Community-Dwelling Older Adults
Authors: Halpin Amy , Brown Lily , Boeve Angelica , Michaud Sahvannah , Moore Lauren , MacAulay Rebecca K
Published: December 2023

Objective:

When deciding between now and later, the tendency to devalue later outcomes is known as temporal discounting. The degree of devaluing is known as one’s discounting rate. Steeper temporal discounting rates indicate preferences for immediate gains and delayed losses, reflecting a desire for instant gratification and greater loss aversion, respectfully. Considering that decrements in decision-making abilities may precipitate cognitive dysfunction and decline, a better understanding of decision-making preferences among older adults represents an important endeavor. Thus, the current study aimed to investigate whether differences among temporal discounting rates for gains and losses exist when outcomes are monetary or interpersonal in nature.

Participants and Methods:

One hundred and forty community-dwelling older adults aged 50 to 90 (75% female, Mage=71.6) completed a hypothetical discounting task in which they chose between smaller immediate outcomes and larger delayed outcomes presented at various delay periods of one week, one month, six months, and one year. An iterative algorithm determined the indifference point for each delay period. Indifference points were fit to hyperbolic models using nonlinear regressions to determine discounting rates within each condition. Nonparametric Wilcoxon Signed-Rank tests compared discounting rates.

Results:

Older adults more steeply discounted monetary gains as compared to monetary losses (Z=-6.88, p<.001), as well as for social gains compared to social losses (Z=-4.81, p<.001). They also discounted social gains more steeply than monetary gains (Z=-5.44, p<.001), and social losses more steeply than monetary losses (Z=-4.44, p<.001).

Conclusions:

Preliminary findings suggest older adults displayed a greater desire for instant gratification of rewards, particularly social rewards, yet also displayed lower loss aversion, particularly for monetary losses. Stronger preferences for instant gratification of gains in certain contexts may inform ways in which healthier lifestyle choices or changes could be framed to appeal to older adults.
11 Contributions of Cardiovascular Burden, Peripheral Inflammation, and Brain Integrity on Digital Clock Drawing Performance in Non-Demented Older Adults
Authors: Dion Catherine , Tanner Jared J. , Libon David J. , Price Catherine C.
Published: December 2023

Objective:

Higher cardiovascular burden and peripheral inflammation are associated with small vessel vascular disease, a predominantly dysexecutive cognitive profile, and a higher likelihood of conversion to vascular dementia. The digital clock drawing test, a digitized version of a standard neuropsychological tool, is useful in identifying cognitive dysfunction related to vascular etiology. However, little is known about the specific cognitive implications of vascular risk, peripheral inflammation, and varying levels of overall brain integrity. The current study aimed to examine the role of cardiovascular burden, peripheral inflammation, and brain integrity on digitally acquired clock drawing latency and graphomotor metrics in non-demented older adults.

Participants and Methods:

The final prospectively recruited IRB-consented participant sample included 184 non-demented older adults (age: 69±6 years, education: 16±3 years, 46% female, 94% white) who completed digital clock drawing, vascular assessment, blood draw, and brain MRI. Digital clock drawing variables of interest included: total completion time (TCT), pre-first hand latency (PFHL), digit misplacement, hour hand distance from center, and clock face area (CFA). Cardiovascular burden was calculated using the revised version of the Framingham Stroke Risk Profile (FSRP-10). Peripheral inflammation was operationalized using interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor alpha (TNF-a), and high sensitivity C-reactive protein (hsCRP). The brain integrity composite was comprised of bilateral entorhinal cortex volume, bilateral ventricular volume, and whole brain leukoaraiosis.

Results:

Over and above age and cognitive reserve, hierarchical regressions showed FSRP-10, inflammatory markers, and brain integrity explained an additional 13.3% of the variance in command TCT (p< 0.001), with FSRP-10 (p=0.001), IL-10 (p= 0.019), and hsCRP (p= 0.019) as the main predictors in the model. FSRP-10, inflammatory markers, and brain integrity explained an additional 11.7% of the variance in command digit misplacement (p= 0.009), with findings largely driven by FSRP-10 (p< 0.001).

Conclusions:

Overall, in non-demented older adults, subtle behavioral nuances seen in digital clock drawing metrics (i.e., total completion time and digit misplacement) are partly explained by cardiovascular burden, peripheral inflammation, and brain integrity over and above age and cognitive reserve. These nuanced behaviors on digitally acquired clock drawing may associate with an emergent disease process or overall vulnerability.

Funding sources: Barber Fellowship; K07AG066813; R01 AG055337; R01 NR014810; American Psychological Foundation Dissertation Award; APA Dissertation Research Award
36 Regional Amyloid and Memory in Amyloid Positive and Negative Older Adults
Authors: Cummings Kyla G. , Morales Clarissa D. , Cotton-Samuel Dejania , Lao Patrick J. , Deters Kacie D. , Zimmerman Molly E. , Brickman Adam M.
Published: December 2023

Objective:

Alzheimer’s disease (AD) pathophysiology, including β-amyloid (Aβ), can be appreciated with molecular PET imaging. Among older adults, the distribution of Aβ standard uptake value ratios (SUVR) is typically bimodal and a diagnostic cut is applied to define those who are amyloid ‘positive’ and ‘negative’. However, it is unclear whether the dynamic range of SUVRs in amyloid positive and negative individuals is meaningful and associated with cognition. Previous work by Insel and colleagues (2020) used screening data from the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s (A4) trial to demonstrate subtle associations between a cortical summary SUVR and cognition, particularly on the Free and Cued Selective Reminding Test (FCSRT). We followed up this study to determine the extent to which regional SUVR is associated with performance on the FCSRT in amyloid positive and negative participants screened for participation in the A4 study.

Participants and Methods:

We accessed regional Aβ SUVR, including anterior cingulate, posterior cingulate, parietal, precuneus, temporal, and medial/orbital frontal regions, along with FCSRT15 and demographic data from 4492 A4 participants at screening. Participants were coded as amyloid positive (n=1329; 30%) or amyloid negative (n=3169; 70%) based on a summary SUVR of greater than or equal to 1.15. We used separate general linear models to examine the association of total or regional SUVR, amyloid positivity status, and the interaction of SUVR and amyloid status with FCSRT scores. We compared model fits across regions with the Akaike Information Criterion (AIC). We ran post hoc correlational analyses examining the relationship between SUVR and FCSRT scores stratified by amyloid status in the case of significant interactions. Results were similar with and without demographic adjustment.

Results:

There was a significant interaction of summary and all regional SUVR with FCSRT scores in addition to main effects of amyloid positivity. In all models, there were small negative associations between SUVR and memory in amyloid positive individuals. For amyloid negative individuals, there was a significant and very small negative association between SUVR and FCSRT scores only in the parietal lobes and precuneus regions. Model fits were generally similar across the different analyses.

Conclusions:

In this sample of individuals screened for a secondary prevention trial of AD, there were consistent associations between Aβ SUVR in all regions and memory for those considered amyloid positive. However, for individuals considered amyloid negative, there were only very small associations between SUVR and memory in parietal and precuneus regions. We conclude that the dynamic range of amyloid may be relevant among those with diagnostic evidence of amyloidosis, but that subtle Aβ accumulation in posterior regions may relate to declining memory in “subthreshold” states.
71 Effect of Dementia Experience on the Relationship Between Dementia Worry, Knowledge of Dementia, and Age
Authors: Lambertus Taylor D , Calamia Matthew R , Suhr Julie A
Published: December 2023

Objective:

Dementia worry (DW) is anxious rumination about personal risk for dementia. Personal experience with dementia may affect DW, such that individuals with personal experience with dementia may have higher worry about developing dementia themselves. Further, dementia knowledge (DK), including what may increase one’s dementia risk as well as treatment options for dementias, may be influenced by one’s dementia experience. Prior studies have suggested that personal experience alters the relationship of age to DW; no prior studies have examined this for DK. In the present study, we examined whether DW and/or DK were differentially related to age in older adults.

Participants and Methods:

Adults (≥ 50 years old; N=252) in Ohio and Louisiana completed an online survey. 94 participants reported no personal dementia experiences, and 158 participants endorsed having a biological relative with dementia. The sample ranged in age from 23 to 92 (M=65, SD=9.3), with 96% identifying as White and 76% holding advanced degrees. DW was measured with the Dementia Worry Scale. Dementia knowledge was measured with true or false questions about causes and treatments for dementia.

Results:

Groups did not differ in age (p=.73), education (p=.50), or perceived SES (p=.28), but did differ in gender (p=.06). The experience group had higher dementia knowledge (p=.02). In those with biological dementia experience, lower age was related to higher dementia worry (r=-.24, p=.003) and greater dementia knowledge (r=-.18, p=.03). However, in those with no experience, age was not related to either dementia worry (r=.04) or to dementia knowledge (r=.16). Dementia worry did not relate to dementia knowledge in either group (no experience r=.03, experience r=.13).

Conclusions:

Findings suggest that younger individuals who have personal experience with dementia are highly worried about personal risk for dementia, despite having higher knowledge of dementia. Further, these results demonstrate that dementia knowledge is not related to dementia worry in older individuals with or without biological dementia experience. Findings may be important for informing dementia prevention education efforts.
86 Dementia Caregiver Burden associated with COVID-19 quarantine: A South American Cohort Study
Authors: Arruabarrena Micaela María , Fernandez Rodrigo , Canyazo Carlos Alberto Martinez , Corvalan Nicolas , Keller Greta , Carello Agostina , Sevlever Gustavo Emilio , Allegri Ricardo Francisco , Crivelli Lucía
Published: December 2023

Objective:

The objective of this study is to explore the impact on the mental health of caregivers of people with dementia during the period of mandatory preventive social isolation (ASPO) and to study which of these factors were predictors of caregiver overload.

Participants and Methods:

During the first 3 months of the ASPO (June 2020 to september 2020). A sample of 112 caregivers (75.89% female; age 58.65 ± 14. 30) of patients with dementia from a Memory Center answered, remotely (online or telephone) a survey with the following questionnaires: the Zarit Caregiver Overload Scale (ZBI), Weekly hourly load dedicated to the care of patients with dementia), the use of time in unpaid activities through an activity diary, provided by Argentine National Institute of Statistics and Census (INDEC), the Caregiver Activities Survey (CAS) and the Anxiety, Depression and Stress Scale (DASS-21). These questionnaires evaluate the conditions and characteristics of caregiving tasks and their impact on the caregiver in the context of ASPO. Additionally, it was recorded whether the person with dementia, the caregiver, or persons living with them had had COVID-19.

Results:

Descriptively, a disparity in frequency was observed in the gender of caregivers of persons with dementia, i.e., caregiving is inequitably distributed between men (24.11%) and women (75.89%). This difference hinders direct comparison between men and women. A regularized L2 regression was performed for the identification of predictors of caregiver overload identifying the number of caregiving hours (β=0.090), DAS depression (β=0.085), DASS anxiety (β=0.099) DASS stress (β=0.164), fear of Covid (0.141) and lower patient cognitive performance according to MMSE (β=-0.41) and to lesser extent sex as the greatest contributors to patient overload. Additionally, a mediation analysis was performed in which the factors number of caregiving hours (CAS; r= 0.254,r= 0.292,r= 0.252,r= 0.252,r= -0.37), being a primary caregiver and fear of Covid-19 (r= 0.335,r= 0.432,r= 0.402,r= -0.496) were found to be mediators of the effect between anxiety, depression, stress (DASS) and overload (ZBI).

Conclusions:

Caregivers of patients with dementia have suffered sequelae such as anxiety, stress, depression, and overload (caregivers’ burden) in the context of the COVID-19 virus spread and during mandatory preventive social isolation. Being a primary caregiver, dedicating more hours to caregiving, and fear of Covid-19 are factors that contribute significantly to caregiver burden and mediate between this burden and mood variables. Public policies to support caregivers and information about the disease could modify these variables and reduce caregiver burden.
95 Fear of Falling Associated with Decreased Attention and Executive Functioning in Caregivers
Authors: Thompson Sheila M , Morgan Eliza , Fairchild J Kaci
Published: December 2023

Objective:

Fear of falling is an anxiety-related phenomenon that is associated with increased risk of morbidity and mortality in older adults. Furthermore, a growing body of research has established the relationship between fear of falling and decreased cognitive functioning within various populations (i.e., older adult, multiple sclerosis, stroke survivors). Yet there is little information on the relationship between fear of falling and cognition outside of a geriatric context, with no publications investigating this relationship within informal caregivers. It is important to understand this relationship within caregiver populations because fear of falling may negatively impact caregivers’ ability to take care of themselves and their care recipients. The present study examines the relationship between fear of falling and cognitive function in informal caregivers.

Participants and Methods:

Fifty informal caregivers (86% female; 58% White; 10% Hispanic or Latino; 82% married; 53% with at least a bachelor’s degree; mean age = 57.76 ± 16.60 years) were assessed at the VA Palo Alto Health Care System in Palo Alto, CA. Fear of falling was measured via the Short Falls Efficacy Scale. Areas of cognitive functioning included verbal attention (Rey Auditory Verbal Learning Task [RAVLT] Trial 1), learning and memory (RAVLT Trials 1-5), delayed memory (RAVLT Delayed Recall), visual attention (Stroop Color, Stroop Word), and executive function (Stroop Color Word). Analyses included linear regressions with age as a covariate in all models.

Results:

Analyses revealed that fear of falling was significantly associated with decreased verbal attention (RAVLT Trial 1: ß=-0.34, p = 0.02, t = -2.35, CI = [-0.659, -0.051]) and with decreased executive functioning (Stroop Color Word: ß = -0.35, p < 0.001, t = -3.10, CI = [-4.097, -0.874]). Fear of falling was not significantly associated with learning and memory or visual attention.

Conclusions:

Fear of falling negatively impacts verbal attention and executive functioning, regardless of age. To our knowledge, this is the first study to examine the relationship between fear of falling and cognition outside of a geriatric population and within a caregiver sample. Findings suggest a need for additional assessment, research, and treatment of fear of falling within informal caregivers. Caregivers may need to be assessed for anxiety-related symptoms such as fear of falling on a more regular basis. A caregiver experiencing fear of falling, as well as difficulties with attention and executive functioning, can result in increased risk of functional and cognitive decline for both the caregiver and their care recipient. It is integral that future research investigates this relationship longitudinally to identify if the negative impact of fear of falling on cognition is reversible.
17 Performance Validity and Ethnicity
Authors: Hromas Gabrielle A. , Majors Emma , Davis Jeremy J.
Published: December 2023

Objective:

This study examined false positive rates of performance validity test (PVT) failure in a group of monolingual (English-speaking) White non-Hispanic/Latinx (non-HL), monolingual (English-speaking) Hispanic/Latinx (HL), and bilingual (English- and Spanish-speaking) HL patients evaluated at an academic medical center. Research on classification accuracy of embedded performance validity tests (PVTs) is limited in HL and bilingual populations. Cultural test biases or language differences could inaccurately cause scores below PVT cutoff levels.

Participants and Methods:

The project involved secondary analysis of a deidentified dataset (N=391). Participants were included if they were between the ages of 18 and 64, had data from the initial visit, had an IQ greater than or equal to 70, were not diagnosed with dementia or major or mild cognitive impairment, and identified as either White non-HL or HL. Participants were required to have completed at least two PVTs. Participants who were not administered the Test of Memory Malingering (TOMM; n=95) or who scored below a highly sensitive Trial 1 cutoff (<46; n=86) were excluded. The final sample included 210 participants, which included monolingual non-HL participants (n=114), monolingual HL participants (n=44), and bilingual HL participants (n=52). Failure rates on eight PVTs were examined by participant group: Reliable Digit Span (RDS), Auditory Verbal Learning Test Recognition (AVLT), Logical Memory Recognition (LM), Visual Reproduction Recognition (VR), Trail Making Test Ratio (TMT rat), Rey Complex Figure Test Recognition (RCFT), Semantic Word Generation (animals; SWG), and Finger Tapping (TAP).

Results:

Groups were not significantly different in age. Monolingual non-HL participants had completed more years of education than monolingual and bilingual HL groups (13.7, 12.7, and 12.8 years respectively). In the whole sample, 8.6% (n=18) failed two or more PVTs. In the monolingual non-HL group, 8.8% (n=10) failed two or more PVTs, while 9.1% (n=4) of the monolingual HL group and 7.7% (n=4) of the bilingual HL group failed two or more PVTs (n.s.). Within the monolingual non-HL test set, failure rates were above 10% on SWG (12.73%) and TAP (17.7%). Failure rates above 10% in the monolingual HL set were found on SWG (11.6%). Failure rates above 10% in bilingual HL measures were observed on SWG (13.5%) and TAP (10.8%).

Conclusions:

Total PVT failure rates did not significantly differ between groups. Across groups, performance was above a common false positive threshold of 10% on SWG. Monolingual non-HL and bilingual participants also had elevated failure rates on TAP.
53 Change in Cerebral Metabolite Concentrations Following Bariatric Surgery
Authors: Bottari Sarah , Cohen Ronald , Friedman Jeffrey , Porges Eric , Chen Alexa , Gunstad John , Woods Adam , Williamson John
Published: December 2023

Objective:

Obesity is associated with adverse effects on brain health, including increased risk for neurodegenerative diseases. Changes in cerebral metabolism may underlie or precede structural and functional brain changes. While bariatric surgery is known to be effective in inducing weight loss and improving obesity-related medical comorbidities, few studies have examined whether it may be able to improve brain metabolism. In the present study, we examined change in cerebral metabolite concentrations in participants with obesity who underwent bariatric surgery.

Participants and Methods:

35 patients with obesity (BMI > 35 kg/m2) were recruited from a bariatric surgery candidate nutrition class. They completed single voxel 1H-proton magnetic resonance spectroscopy at baseline (pre-surgery) and within one year post-surgery. Spectra were obtained from a large medial frontal brain region. Tissue-corrected absolute concentrations for metabolites including choline-containing compounds (Cho), myo-inositol (mI), N-acetylaspartate (NAA), creatine (Cr), and glutamate and glutamine (Glx) were determined using Osprey. Paired t-tests were used to examine within-subject change in metabolite concentrations, and correlations were used to relate these changes to other health-related outcomes, including weight loss and glycemic control.

Results:

Bariatric surgery was associated with a reduction in cerebral Cho (f[34j = -3.79, p < 0.001, d = -0.64) and mI (f[34] = -2.81, p < 0.01, d = -0.47) concentrations. There were no significant changes in NAA, Glx, or Cr concentrations. Reductions in Cho were associated with greater weight loss (r = 0.40, p < 0.05), and reductions in mI were associated with greater reductions in HbA1c (r = 0.44, p < 0.05).

Conclusions:

Participants who underwent bariatric surgery exhibited reductions in cerebral Cho and mI concentrations, which were associated with improvements in weight loss and glycemic control. Given that elevated levels of Cho and mI have been implicated in neuroinflammation, reduction in these metabolites after bariatric surgery may reflect amelioration of obesity-related neuroinflammatory processes. As such, our results provide evidence that bariatric surgery may improve brain health and metabolism in individuals with obesity.
60 Neural Correlates of the Self-Reference Effect: Neuronal Mechanisms Supporting Self-Referential Encoding
Authors: Hampton Andreina , Tacikowski Pawel , Fried Itzhak
Published: December 2023

Objective:

Self-concept is a mental representation of the self—an internal sense of personal identity. This complex representation is unique to the human mind. Behavioral studies on self-concept have demonstrated that self-relevant information is remembered better than other types of information, a phenomenon commonly known as the “self-reference effect” (SRE). However, the underlying neural mechanisms of SRE remain largely unknown.

Participants and Methods:

Here, we recorded neural activity from ∼600 neurons from 15 neurosurgical epilepsy patients, who were implanted with depth electrodes for seizure monitoring. The SRE paradigm consisted of an incidental learning (encoding) task and subsequent memory recognition test. During the incidental learning task, participants were asked to rate various personality traits in three distinct encoding conditions: the self, a friend, and a celebrity. In the recognition part of the task, participants were asked to distinguish between traits that were presented during the encoding phase (old) and traits that were not presented (new).

Results:

Our behavioral findings showed the highest memory accuracy on the recognition test for traits that were associated with the “self” condition, which is consistent with previous studies on SRE. Additionally, we found that traits associated with the “friend” category were more accurately recognized than those associated with a celebrity, indicating that personally familiar information—even if not self-related— improves memory recognition. Through single-unit analyses from target brain regions, including the medial temporal lobe (MTL) and medial prefrontal cortex (mPFC), we identified unique patterns of neural activity during the memory encoding phase, specifically increased responses during self-referential encoding in a subset of the neuronal population.

Conclusions:

Future analyses will explore the relationship between increased MTL activity during self-referential encoding and improved memory recognition of traits rated in relation to the self, and network interactions between MTL and mPFC in self-oriented memory processes.
63 A Literature Review of Cortical Mapping, fMRI, and Standards of Care in Pediatric Epilepsy Surgical Workup
Authors: Cernokova Ivana , Owens Ronnise D , del Valle Martinez Eva , Semaan Nicole , Bergeron Coralie , Bearden Donald J. , Ono Kim E
Published: December 2023

Objective:

Epilepsy includes recurrent, unprovoked seizures and affects 470,000 children in the US, of which 7% have drug-resistant epilepsy due to failing two or more antiseizure medication trials. For some patients with drug-resistant epilepsy, surgery has been successful in reducing seizure burden. Functional MRI (fMRI) and intracranial mapping of neurocognitive functions, especially language, are increasingly done to assess potential functional loss from epilepsy surgery. However, these procedures vary by medical institute. The purpose of this review was to examine published literature on fMRI and intracranial mapping procedures for pediatric epilepsy surgery workup toward development of a standardized protocol that can be used across institutes as a guide to standard-of-care best practices for predicting loss of function associated with epilepsy surgery.

Participants and Methods:

Our literature review includes information from 8 electronic databases for peer-reviewed, English language studies of evaluation for pediatric epilepsy surgery candidacy. Thirty-one studies were selected based on inclusion criteria. Only studies including fMRI and intracranial mapping conducted with pediatric patients being worked up for epilepsy surgery were selected.

Results:

Our review revealed that the most common task used in fMRI and intracranial mapping procedures is visual-object naming, but type of naming tasks and the way they are administered varies widely across medical institutes and includes published measures and those created on site. Variability makes examining findings across studies and designing best practice for these procedures challenging.

Conclusions:

Creating gold-standard procedures for fMRI and intracranial mapping administration for epilepsy surgery evaluations is critical in optimizing treatment and functional outcomes for our pediatric patients. Our review is an initial step in this process.
67 Blinding and Double-Blinding of HD-tDCS in Double-Blind, Randomized Controlled Trials
Authors: Harrie Ashley , El Jamal Carine , Padgett Michael , Rahman-Filipiak Annalise , Hampstead Benjamin M
Published: December 2023

Objective:

High-definition transcranial direct current stimulation (HD-tDCS) is a non-invasive brain stimulation technique shown to modulate neuronal networks. In order for HD-tDCS to be used in randomized, placebo-controlled clinical trials, it is critical to have methods that enable blinding. Some research has shown that sham stimulation is an effective blind in tDCS. However, few studies have investigated the double-blinding of HD-tDCS, especially at intensities greater than 2mA. We address this knowledge gap by examining the blinding and double-blinding of HD-tDCS among a mixed neurologic sample of older adults.

Participants and Methods:

A sample of 240 older adults (Mage = 72.21±8.94) with various clinical diagnoses (Normal Cognition = 34, Amnestic MCI [aMCI] = 172, Dementia-Alzheimer’s Type [DAT] = 27, Other = 7) were recruited through five double-blind, randomized controlled trials. All participants were stimulation naive at their first session and received one to thirty sessions of 20- or 30-minutes of active (n=1472) or sham (n=681) stimulation at total amplitudes of 2mA, 4mA, or 6mA. At the start of each stimulation session, a study team member entered a code into the tDCS unit, and the electrical current was gradually ramped up to the specified (blinded) amplitude over a period of 30 seconds. The current remained at this level for the specified amount of time in the active condition (e.g., 20-minutes) but was ramped down over the next 30 seconds for those in the sham condition. This ramp up/down process was repeated in the final minute (e.g., 20th minute) in the sham session to provide both primacy and recency effects. After each active or sham session, participants were asked whether they received 'real’ or sham stimulation. One study also asked a study team member if they believed the participant received real or sham stimulation at two primary outcome endpoints.

Results:

We used Fisher’s Exact tests to evaluate the efficacy of our blinding and double-blinding procedures. In stimulation naive participants receiving their first session, there were no differences in accuracy, suggesting adequate blinding. We also examined participant blinding across all sessions to determine whether repeated HD-tDCS exposure might impact blinding. Across all sessions, participants in the sham condition were more likely to endorse being in the 'real’ (active) condition, again suggesting adequate blinding. There were no significant group differences for active versus sham in the frequency of the study team correctly stating the participant’s condition, suggesting sufficient double-blinding. No significant differences were found in study team blinding when data from the 2mA versus 4mA to 6mA were analyzed separately.

Conclusions:

These results suggest that the HD-tDCS sham method is an effective blind and double-blind for HD-tDCS in clinical trials, even at total amplitudes as high as 6mA.
68 Preliminary Evidence of a Therapeutic Effect of Electrical Neuromodulation on Cognitive Deficits in Patients with Mild Cognitive Impairment
Authors: LoBue Christian , Nyaz Didehbani , Chiang Hsueh-Sheng , Hart John , Helphrey Jessica , Conley Michael , Smernoff Eric , Lacritz Laura , Reese Caitlin , Cullum C M , Marshall Cindy , Nguyen Trung , Kelley Brendan J , Khera Alka , Frolov Alex , Martinez Natalie , Logan Rebecca
Published: December 2023

Objective:

Episodic memory functioning is distributed across two brain circuits, one of which courses through the dorsal anterior cingulate cortex (dACC). Thus, delivering non-invasive neuromodulation technology to the dACC may improve episodic memory functioning in patients with memory problems such as in amnestic mild cognitive impairment (aMCI). This preliminary study is a randomized, double-blinded, sham-controlled clinical trial to examine if high definition transcranial direct current stimulation (HD-tDCS) can be a viable treatment in aMCI.

Participants and Methods:

Eleven aMCI participants, of whom 9 had multidomain deficits, were randomized to receive 1 mA HD-tDCS (N=7) or sham (N=4) stimulation. HD-tDCS was applied over ten 20-minute sessions targeting the dACC. Neuropsychological measures of episodic memory, verbal fluency, and executive function were completed at baseline and after the last HD-tDCS session. Changes in composite scores for memory and language/executive function tests were compared between groups (one-tailed t-tests with a = 0.10 for significance). Clinically significant change, defined as > 1 SD improvement on at least one test in the memory and non-memory domains, was compared between active and sham stimulation based on the frequency of participants in each.

Results:

No statistical or clinically significant change (N-1 X2; p = 0.62) was seen in episodic memory for the active HD-tDCS (MDiff = 4.4; SD = 17.1) or sham groups (MDiff = -0.5; SD = 9.7). However, the language and executive function composite showed statistically significant improvement (p = 0.04; MDiff = -15.3; SD = 18.4) for the active HD-tDCS group only (Sham MDiff = -5.8; SD = 10.7). Multiple participants (N=4) in the active group had clinically significant enhancement in language and executive functioning tests, while nobody in the sham group did (p = 0.04).

Conclusions:

HD-tDCS targeting the dACC had no direct benefit for episodic memory deficits in aMCI based on preliminary findings for this ongoing clinical trial. However, significant improvement in language and executive function skills occurred in response to HD-tDCS, suggesting HD-tDCS in this configuration has promising potential as an intervention for language and executive function deficits in MCI.
75 Mood and Quality of Life after Responsive Neurostimulation (RNS) in Epilepsy Patients
Authors: Mejias Stephanie Santiago , Haneef Zulfi , Strutt Adriana M. , York Michele K. , McCauley Stephen R. , Henry Samantha K. , Stinson Jennifer M.
Published: December 2023

Objective:

Poor mood and quality of life is common among patients with medically intractable seizures. Many of these patients are not candidates for seizure focus resection and continue to receive standard medical care. Responsive neurostimulation (RNS) has been an effective approach to reduce seizure frequency for nonsurgical candidates. Previous research using RNS clinical trial participants has demonstrated improved mood and quality of life when patients received RNS-implantation earlier in their medically resistant epilepsy work-up (Loring et al., 2021). We aimed to describe the level of depression and quality of life in adults with medical resistant epilepsy, treated with RNS, presenting to an outpatient clinic.

Participants and Methods:

This pilot study was conducted among 11 adult epilepsy patients treated with RNS at the epilepsy specialty clinic at Baylor College of Medicine. Ages of participants ranged from 18-56 (M=32.01, SD=12.37) with a mean education of 12.43 (SD=0.85). The majority of the participants identified as White (White=72.2%; Hispanic/Latino/a=14.3%, Other=7.1%). We also present pre- and post-RNS preliminary results of a subset of 4 patients for whom pre and post implantation data was available. Depression symptoms were assessed through the Beck Depression Inventory, 2nd Edition (BDI-II) and quality of life was determined using the Quality of Life in Epilepsy (QoLiE-31).

Results:

Patients reported minimal symptoms of depression (M=5.45, SD=4.03) and good overall quality of life (M=71.18, SD=14.83) after RNS. Participants’ scores on their overall quality of life ranged from 50 to 95 (100=better quality of life). The QoLiE-31 showed high scores on emotional wellbeing (M=69.45, SD=14.56) and cognitive functioning (M=65.36, SD=16.66) domains. Post-hoc analysis revealed a significant difference in the cognitive functioning domain of QoLiE-31 before (M=44.75, SD=12.58) and after (M=51.0, SD=11.58) RNS implantation(t(3)=-3.78, p=0.016. Additionally, overall QoLiE score approached statistical significance when comparing pre-RNS (M=44.75 SD=9.29) to post-RNS (M=49.75 SD=11.62; t(3)=-2.01, p = 0.069). No significant differences were evident on seizure worry, energy/fatigue, medication effects, and social functioning domains of QoLiE-31 before and after RNS treatment.

Conclusions:

These pilot study results suggest low levels of depression with this population post-RNS implantation. Additionally, there is preliminary evidence to suggest improved patient-rated cognitive functioning and overall quality of life. While this is a small study population, the results have important implications for patients with intractable epilepsy, even with those form who surgical resection may not be possible. Future studies with large enough samples to examine moderating and mediating factors to mood and quality of life changes post-RNS will be important.
Plenary B: The Pons is a Significant Neural Correlate of Affective Processing
Authors: Lee Tatia M.C.
Published: December 2023

Abstract & Learning Objectives:

Research on the role of the Pons in affective processing has been scarce. Recent animal work has shown that the direct projection from the eyes to the dorsal raphe nucleus modulates affective behaviours. Our previous human work has confirmed a functionally analogous pathway between the optic chiasm and the Pons, which facilitates the processing of negative affective information. Our other studies have further identified that the Pons (1) works with the distributed corticolimbic system to shape an individual's affective states and reactivity and (2) responds to short-term meditation training to modulate affective processing. These findings offer significant insight into the role of the Pons in affective processing and regulatory mechanisms.

Upon conclusion of this course, learners will be able to:

1.

Discuss the functional roles of the pons in affective processing

2.

Recognize that the pons is a significant neural correlate of affective processing

3.

List major neural correlates of the affective processing network
CE Workshop 09: Cast Aside Traditional Notions of Statistical Significance, and Focus Instead on Characterizing the Magnitude of Effects that are Clinically or Scientifically Relevant
Authors: Ploutz-Snyder Robert
Published: December 2023

Abstract & Learning Objectives

There is an ongoing debate among statisticians and discipline scientists about the consequences of our persistent, dogmatic reliance on evaluating all statistical results as meaningful if and only if "p<0.05," regardless of context. This was never the intended goal of Ronald Fisher, nevertheless scientists have adopted it as a convenience, and the decades long dependence on "p<0.05" has had important negative consequences. In this presentation, I review common misconceptions about interpreting p-values, why we should consider de-emphasizing p-values, and why scientists should rely more on practical, clinical, or scientifically meaningful differences over arbitrary cut-offs. I will present several different metrics for evaluating and reporting effect magnitude, and whether or not data support the null vs. alternative hypothesis, under the frequentist paradigm, how Bayesian methods can augment or replace frequentist analyses, and a few options that help to clarify how important a finding may be. Throughout this talk, I advocate that discipline scientists take charge of sharing scientific results that are not based merely on arbitrary p-value cutoffs and other default logic, but instead based on their content expertise, in light of all of the specific relevant aspects of experimental design and experimental data, balancing the consequences of Type I vs Type II errors appropriately, and focusing on characterizing effects, rather than dichotomizing research into only two categories of importance (significant vs. not).

Upon conclusion of this course, learners will be able to:

1.

Discuss what p-values mean and how they are commonly misinterpreted.

2.

Explain the leading arguments promoted by the American Statistical Association with regard to why science should carefully reconsider if and how p-values should continue to dominate our decisions about what research should be published, and how scientists should be evaluating its worth.

3.

Apply new practices in how to evaluate and publish their own research, as well as how to evaluate research appearing in peer-reviewed journals, whether as consumers, reviewers, or editors.