bluuebunny/crossref_metadata_2025 huggingface dataset:
A - 8 Sleep Complaints Mediate the Relationship between Depression and Cognitive Performance in College Athletes
Authors: Thomas Garrett , Bradson Megan L , Riegler Kaitlin E , Arnett Peter A
Published: October 2023

Objective

Depression and sleep disturbance often co-occur, and both have been found to negatively impact cognitive functioning. This study aims to examine sleep as a potential mediator between depression and cognitive functioning in college athletes.

Method

897 collegiate athletes (F = 230) completed a comprehensive neuropsychological battery including self-reported symptom measures. The Beck Depression Inventory-Fast Screen was used to measure depression, and the Post-Concussion Symptom Scale (PCSS) sleep cluster was used to quantify sleep disturbance. Depression was examined dichotomously (depressed/non-depressed). Neurocognitive functioning was examined via z-score composites of attention/processing speed (A/PS) and memory. Two mediation analyses, with depression as the independent variable, sleep disturbance as the mediator, and A/PS or memory performance as outcomes were conducted using the SPSS PROCESS macro, with 5000 bootstrap samples and 95% confidence interval.

Results

In the first mediation, depression was significantly associated with poorer A/PS performance (ß = -0.13, p = 0.02) and greater sleep disturbance (ß = 1.89, p < 0.001). Sleep disturbance was also negatively associated with A/PS performance (ß = -0.01, p = 0.03). After controlling for sleep disturbance, the relationship between depression and A/PS performance became non-significant (ß = -0.10, p = 0.08, indirect effect = −0.08, 95%CI[−0.057,-0.004]), indicating mediation via sleep disturbance. In the second mediation model, depression was not significantly associated with memory performance, so the mediation was discontinued.

Conclusions

Sleep disturbance fully mediated the relationship between depression and A/PS performance. This suggests that sleep problems account for the relationship between depression and A/PS. Future work should examine interventions aimed at improving sleep in depressed college athletes which may translate to better academic and athletic performance through improved attention and processing speed.
A - 9 The Progressive Supranuclear Palsy Rating Scale Identifies Early Motor Symptoms in Primary Progressive Aphasia
Authors: Morrow Christopher , Kamath Vidyulata , Onyike Chiadi , Pantelyat Alexander
Published: October 2023

Objective

This study examined cross-sectional differences in Progressive Supranuclear Palsy Rating Scale (PSPRS) scores among participants with behavioral variant frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA). We hypothesized that participants with nonfluent/agrammatic PPA (nfPPA) will show the highest (worst) PSPRS scores and greater gray matter atrophy in regions associated with progressive supranuclear palsy (PSP) pathology.

Method

Participants were enrolled in the ARTFL LEFFTDS Longitudinal Frontotemporal Lobar Degeneration consortium (ALLFTD). Analyses were limited to first visit data. Ten anatomic regions of interest were pre-selected for analysis based on previously identified neuroanatomic correlates of PSPRS performance. Differences in participant characteristics and clinical outcomes were compared using pairwise comparison of means. Linear multivariable regression adjusting for age and total intracranial volume was used to examine associations between regional gray matter volumes and diagnosis. The analyses were stratified by disease severity.

Results

Participants with early-stage nfPPA had higher total PSPRS scores compared to those with bvFTD or semantic dementia (SD) and performed more poorly on domains of dysphagia, fine motor movements, falls, postural stability, dysarthria, saccadic eye movements, and motor rigidity. Participants with advanced-stage nfPPA showed greater atrophy in the left putamen, supplementary motor area, and precentral gyrus than those with bvFTD.

Conclusion

Our study highlights the phenotypic complexity of PPA and the utility of the PSPRS in capturing early motor symptoms in nfPPA. These data suggest that the PSPRS may facilitate early intervention in identifying and facilitating treatment of early motor symptoms, decreasing disability and improving quality of life in PPA.
A - 11 Cognitive and Clinical Correlates of Olfactory Function in Adults with Epilepsy
Authors: Yang Xiao , Raman Shreya , Buchholz Alison , Morra Lindsay F , Kang Joon Y , Kim Min Jae , Del Bene Victor A , Kamath Vidyulata
Published: October 2023

Objective

Olfactory dysfunction is well-documented in epilepsy. We recently found that olfactory assessment may have clinical utility in identifying surgical candidates with intractable epilepsy who benefit from magnetic resonance–guided laser interstitial thermal therapy (MRgLiTT). However, the demographic, clinical, and cognitive correlates of olfaction in epilepsy remain unclear and could aid in understanding its potential utility in clinical examinations.

Method

We identified 60 outpatients with epilepsy (mean age = 38.22 ± 13.84 years; 50% male; 89.3% right-handed; seizure location: 45.0% left, 33.3% right, 13.3% bilateral, 8.3% unspecified) referred for neuropsychological evaluation in the Johns Hopkins Division of Medical Psychology Clinic. Neuropsychological evaluation included the 16-item Sniffin’ Sticks Odor Identification Test. Linear regression models were used to examine associations between 1) olfaction and demographic/clinical characteristics (age, sex, education, duration of illness, seizure laterality) and 2) olfaction and cognition (processing speed, language, auditory-verbal and visuospatial memory, executive functioning; adjusted for demographic/clinical characteristics).

Results

Olfactory performance was not significantly associated with demographic or clinical characteristics. Across all participants, better olfactory performance was associated with better auditory-verbal memory (B = 5.04, t(46) = 4.16, p < 0.001) and visual confrontation naming (B = 1.53, t(45) = 4.11, p < 0.001) with correction for multiple comparisons. In a subset with lateralizing epilepsy (n = 47), better odor identification performance remained a significant predictor of the aforementioned cognitive measures with adjustment for demographic and clinical characteristics.

Conclusions

Consistent with work in other neurologic conditions, our preliminary findings indicate that olfactory function is associated with verbally-mediated neuropsychological measures in epilepsy. Future studies utilizing pre-surgical neuroimaging will examine the association between olfaction, cognition, and radiographic markers of tissue integrity in epilepsy.
A - 12 Traumatic Brain Injury Characteristics Are Not Related to Neurocognitive Decline in Older Adults: a Nationwide Longitudinal Cohort Study
Authors: Schaffert Jeff , LoBue Christian , Chiang Hsueh-Sheng , Peters Matthew , Cullum C Munro
Published: October 2023

Objective

Evaluate if traumatic brain injury (TBI) characteristics, age of injury, or recency of injury is related to course of neurocognitive decline in aging and/or increases conversion rates to mild cognitive impairment (MCI) or all-cause dementia later in life.

Methods

Data were obtained from the National Alzheimer’s Coordinating Center for participants 50–85 years old with 3 to 5 visits from 2015–2022. Groups were stratified by: 1) self-reported TBI history (No TBI [n = 2382], Single TBI without loss of consciousness [LOC; n = 102], Single TBI w/LOC [n = 228], Multiple TBI without LOC [n = 36], and Multiple TBI w/LOC [n = 115]), 2) age of most recent TBI (No TBI [n = 2382], TBI = 65 years old [n = 76]), and 3) recency of TBI (no TBI [n = 2382], 15 years ago [n = 301]). Mixed linear models compared normed neuropsychological composite trajectories (executive functioning/attention/speed, language, memory, and overall), co-varying for age, gender, education, apolipoprotein E4 status, and baseline diagnosis (normal aging n = 1720, MCI n = 749, or dementia n = 417). Logistic binary regression examined MCI/dementia conversion rates.

Results

Longitudinal neurocognitive trajectories in composite measures were similar among TBI groups (example figure below). Specific TBI history, age of injury, or recency of injury did not impact neurocognitive trajectories or conversion rates to MCI or dementia (all p’s > 0.01).

Conclusions

TBI history, regardless of injury characteristics, age, or recency, did not worsen neurocognitive decline or MCI/dementia conversion. The mechanism and factors that increase dementia risk after TBI are unclear. Additional longitudinal research in carefully designed longitudinal cohorts is needed.
A - 01 Association between Social Vulnerability and Susceptibility in Non-Demented Older Adults
Authors: Bodek Hannah S , Pare Nadia , Nester Caroline , Warren David E , Wilhelm Anna , Aflagah Erica , Beadle Janelle N , Rabin Laura A
Published: October 2023

Objective

Social vulnerability, conceptualized as an impaired ability to detect or avoid potentially harmful interpersonal interactions, has been associated with the cognitive decline characteristic of neurodegenerative diseases. Social vulnerability is not routinely assessed in clinical evaluations of older adults, despite its potential clinical utility in identifying individuals at risk for poor outcomes.

Method

Participants (age 60 and over) were cognitively unimpaired, or presented with subjective cognitive decline or mild cognitive impairment. Each participant had a knowledgeable informant (i.e., family member or friend) who completed the Social Vulnerability Scale (SVS; Pinsker et al., 2006), a 15-item measure including items such as, “Been deceived by someone who has deceived them before.” Respondents were asked to rate the likely outcome if the participant was, “placed in that situation now,” using a Likert-type scale ranging from never to always (total score range from 0–60). Point biserial correlation was applied to investigate the association between SVS scores and the response to a single item from a COVID-19 questionnaire: “Since the beginning of the Covid-19 pandemic, has your loved one fallen prey or come close to falling prey to scam?”

Results

For the 69 participants (M age = 75.6; M education = 15.7; 70% female), SVS scores were significantly associated with the report of increased susceptibility to a scam (rpb = 0.47, p < 0.001) during the COVID-19 pandemic.

Conclusions

These results highlight the need for attention to social interaction patterns during clinical evaluations, to help identify and mitigate potential harmful outcomes in those most vulnerable. Additional research should clarify the relationship between social vulnerability and falling prey to scams.
A - 03 Emotion Domains and Response to Cognitive Training for Mild Cognitive Impairment
Authors: Johnson Eliza , Hosseini Hadi , Newkirk Saskia
Published: October 2023

Objective

The aim of this study was to examine how various emotional domains predict cognitive changes in older adults with Mild Cognitive Impairment (MCI) following a cognitive training program.

Methods

This study was a single-blind, randomized, placebo-controlled trial in which participants were recruited using mixed methods primarily from aging research registries at Stanford University School of Medicine. During the trial, some participants underwent computerized cognitive training for 20 weeks, consisting of three 20 to 30-minute sessions per week. The final analysis included 20 MCI participants who completed cognitive training with an adherence rate of at least 70% and presented for follow-up neuropsychological assessment. The NIH Toolbox Test Battery was used to evaluate cognition and socioemotional functioning at baseline and follow-up. The battery included measures of cognition, motor, sensation, and emotion, and the NIH Toolbox fluid cognition composite score was used to assess changes in cognitive functioning over the course of training.

Results

Multiple regression analyses revealed that negative emotion domains were statistically significant predictors of changes in cognition at the 0.05 level (P = 0.034), while positive emotion domains were not significantly associated (P = 0.550). Among the negative emotion domains, loneliness (P = 0.022) and perceived hostility (P = 0.005) were the most significant predictors.

Conclusions

Higher levels of negative affectivity predict improvement in response to cognitive training, suggesting that cognitive training may be a beneficial treatment for individuals with high levels of negative affectivity, who are at a higher risk of developing MCI according to the extant literature.
A - 06 Sensitivity of Remote App-Based Assessment of Cognition among Older Adults to Fatigue-Mediated Differences in Cognitive Functioning
Authors: Liebenberg Erin , Rovere Rachel , Halberstadter Kimberly , Wolk David , Mechanic-Hamilton Dawn
Published: October 2023

Objective

This study assesses the sensitivity of the mobile cognitive app performance platform (mCAPP), a mobile and engaging cognitive assessment tool, to participant reported fatigue.

Method

The mCAPP includes three gamified tasks: a memory task (“Concentration”), a stroop-like task (“Brick Drop”), and a digit-symbol coding-like task (“Space Imposters”). For all games, shorter reaction times and fewer guesses indicate better performance. The cohort included 55 participants (72.73% female; age = 71.60 ± 4.48; education = 16.71 ± 2.30; 49.1% white; 49.1% Black/African American, 1.8% Multiracial) without cognitive impairment who are enrolled in the Penn ADRC cohort. Performance was analyzed as a whole and grouped into days of high (7+) and low (0–3) fatigue (range 0–10).

Results

The average fatigue rating was 2.61 ± 2.51. Overall, higher reported fatigue was weakly correlated with more time spent (ρ = 0.22) and a higher number of guesses on Concentration (ρ = 0.12; p-values<0.01). There was a significant difference in speed for those with high fatigue (M = 2.825) and low fatigue (M = 2.592; p = 0.018) on Space Imposters, but not on Brick Drop (p = 0.15). On Concentration, those with high fatigue needed a higher number of guesses (M = 5.356) compared to low fatigue (M = 5.095; p = 0.003) and more time was spent on individual guesses for those with high fatigue (M = 17.587) compared to low fatigue (M = 13.357; p < 0.001).

Conclusion

The mCAPP can remotely detect differences in cognitive performance in self-reported high and low fatigue states. Future studies will include looking at sleep data to determine objective measures of fatigue-related behavior and in-depth analysis of performance within-subject.
A - 13 Association between Motivation and Engagement in Healthy Lifestyle Behaviors in Midlife
Authors: Simone Stephanie , Kaplan Marina , Giovannetti Tania
Published: October 2023

Objective

Modifiable risk factors (e.g., cognitive/physical inactivity) account for up to 40% of dementia cases. The impact of risk reduction is strongest in midlife (ages 45–64), but little is known about what motivates middle-aged adults to engage in healthy lifestyle behaviors for dementia risk reduction.

Method

347 participants (M age = 54.67, SD = 5.97; 53% women; 86.5% White; M education = 14.28, SD = 2.25) completed a 30-minute online survey that assessed demographic information, multiple facets regarding motivation to change lifestyle and behaviors for dementia risk reduction (MCLHB-DRR scale: self-efficacy, barriers, etc.), and engagement in healthy lifestyle behaviors, including physical activity (IPAQ), cognitive/leisure activity (CLAS), sleep quality (B-PSQI), and loneliness/social activity (ULS-8). Multivariate linear regressions adjusted for age, sex, and education were conducted to examine the association between motivation (MCLHB-DRR z-scored subscales) and engagement in healthy lifestyle behaviors for dementia risk reduction.

Results

Self-efficacy (B = 0.198, p = 0.003) and education (B = 0.167, p = 0.003) significantly predicted total physical activity (R2 = 0.076, F(10, 336) = 2.767, p = 0.003). Self-efficacy (B = 0.239, p < 0.001) and education (B = 0.307, p < 0.001) also predicted cognitive/leisure activity (R2 = 0.249, F(10, 336) = 11.131, p < 0.001). Perceived barriers (B = 0.256, p < 0.001), general health motivation (B = 0.144, p = 0.015), self-efficacy (B = -0.137, p = 0.030), and age (B = -0.161, p = 0.002) significantly predicted loneliness/social inactivity (R2 = 0.169, F(10, 336) = 6.851, p < 0.001). Self-efficacy (B = -0.152, p = 0.030), education (B = -0.147, p = 0.012), and sex (B = 0.141, p = 0.015) significantly predicted sleep quality (R2 = 0.114, F(10, 292) = 3.753, p < 0.001).

Conclusions

Self-efficacy appears to be a particularly relevant motivator for engagement in healthy lifestyle behaviors for dementia risk reduction in midlife. Empirically supported strategies to improve self-efficacy should be included in preventative lifestyle interventions.
A - 14 Sex Differences in the Associations between Age and Neuroanatomical Correlates of Alzheimer’s Disease in Congolese Older Adults
Authors: Patel Saranya , Hickle Sabrina , Ikanga Jean , Epenge Emmanuel , Gikelekele Guy , Tshengele Nathan , Kavugho Immaculee , Drane Daniel , Qiu Dequiang , Alonso Alvaro
Published: October 2023

Objective

Investigate sex differences in the relationships between age and brain regions typically affected in Alzheimer’s disease (ad) in healthy aging Congolese adults.

Method

76 individuals, including 40 male [age: M(SD) = 70.5(9.1)] and 36 female [age: M(SD) = 74.4(6.1)] were recruited from the Democratic Republic of Congo and underwent structural magnetic imaging on a 1.5 T scanner. Freesurfer was utilized to segment 3D T1w images. Pearson correlations were used to examine the relationship between age and brain volumes in hippocampal and superior frontal regions of interest and total gray matter and overall brain volumes.

Results

Age had moderate, statistically significant negative correlations with left and right hippocampal (r = −0.50, −0.48), left and right superior frontal (r = −0.44, −0.41) total gray matter (r = −0.49) and overall brain (r = −0.48) volumes. When separated by sex, age continued to show moderate negative correlations with all regions in males. However, in females, associations only remained significant for both hippocampal (left: r = −0.37, right: r = −0.44) hippocampal, left superior frontal (r = −0.37), and total gray matter (r = −0.40) volumes.

Conclusions

Healthy Congolese older adults demonstrate associations between age and known ad brain regions, and all associations remained significant for males, while only a few remained significant for females. Similar to Western cohorts, there are aging effects in Congolese older adults and associations between age-related brain volume loss seen in healthy male individuals. Gender stratification may be important in determining risk and progression of pre-clinical and clinical populations and understanding resilience to pathophysiological processes of ad in aging Congolese adults.
A - 16 Performance on the SDMT Predicts Functionality in Older Adults
Authors: Uy Naomi G , Stimmel Marnina , Ayers Emmeline , Verghese Joseph , Weiss Erica F
Published: October 2023

Objective

The Symbol Digit Modalities Test (SDMT) is a task of processing speed and executive functioning that is widely used to evaluate individuals with Multiple Sclerosis (MS) and has been shown to predict various instrumental activities of daily living. The relationship between SDMT and daily functioning has not been well explored in the aging population. The Activities of Daily Living-Prevention Instrument (ADL-PI) is a self-report measure that assesses changes in functioning and instrumental activities of daily living (IADLs). We evaluate the relationship between SDMT and ADL-PI in older adults with subjective cognitive complaints in an urban, multi-ethnic, primary care population in Bronx, New York.

Methods

300 participants (50.7% Hispanic, 43.7% non-Hispanic Black; 37% assessed in Spanish) completed the SDMT and ADL-PI as part of a larger study seeking to improve detection of cognitive impairment in primary care. The mean age of the sample was 71.35 ± 5.76 years and participants had a mean 12.26 ± 3.76 years of education. Pearson correlations were used to examine the relationship between SDMT and IADLs.

Results

SDMT performance was weakly albeit significantly correlated with self-report of functional difficulties on the ADL-PI (r = −0.312, p < 0.001). The relationship between SDMT (Range = 1–51, M = 25.39) and ADL-PI was significant in both English (p < 0.0011) and Spanish (p = 0.004) speaking participants and remained significant when controlling for age, education, and depression (p = 0.002).

Conclusion

Consistent with MS literature, the SDMT is a useful tool for predicting self-report of instrumental activities of daily living of older adults with cognitive concerns.
A - 17 Preliminary Neuropsychological Outcomes in a Randomized Controlled Trial of High-Definition Transcranial Direct Current Stimulation in Alzheimer’s Clinical Syndrome
Authors: Ahmed Danyah , Helphrey Jessica , Cabrera Hannah , Neaves Stephanie , Mcclintock Shawn S , Hart John , Chiang Hsueh-Sheng , Lacritz Laura , Cullum Munro C , LoBue Christian
Published: October 2023

Objective

The Alzheimer’s Clinical Syndrome (ACS) is marked by global cognitive decline, and neural circuit dysfunction involving the dorsal anterior cingulate cortex (dACC) has been associated with some of the episodic memory and non-memory deficits in ACS. High-definition transcranial direct current stimulation (HD-tDCS) is a promising noninvasive treatment to lessen cognitive deficits in ACS, and this preliminary double-blinded trial examined whether HD-tDCS targeting the dACC could improve cognitive performance in ACS.

Methods

Ten patients diagnosed with ACS (M age = 71.500; SD = 9.755) were randomized to receive sham (n = 2), 1 mA (n = 5), or 2 mA (n = 3) multi-electrode (4 cathodes x 1 anode) HD-tDCS for 10 daily sessions. Episodic memory, language, attention, and executive function measures were administered pre- and immediately post-treatment, and composite memory and non-memory scores were calculated. Paired samples t-tests examined significant differences (p < 0.05) between pre-treatment and post-treatment scores for each HD-tDCS group.

Results

For all three HD-tDCS groups, there were no significant improvements between pre-treatment and post-treatment scores for memory or non-memory abilities (p’s > 0.05).

Conclusion

This preliminary study showed that HD-tDCS applied over the dACC was unassociated with cognitive improvement in ACS. Future research with a larger sample will be needed to inform if this configuration of HD-tDCS could ameliorate cognitive deficits in ACS. Moreover, evaluation of HD-tDCS applied over other brain regions may yield additional insights, and a critical step will be to identify whether any clinical characteristics such as disease stage may influence the response to stimulation in ACS.
A - 21 Sex Differences in Cortical Thickness and Cognition in Individuals with Autosomal Dominant Alzheimer’s Disease
Authors: Giudicessi Averi , Fox-Fuller Joshua T , Chen Yinghua , Su Yi , Banea Ana , Martinez Jairo E , Pluim Celina , Angella Stephanie , Cronin-Golomb Alice , Castelar Clara Vila , Restrepo Francisco Lopera , Quiroz Yakeel T
Published: October 2023

Objective

Cortical thinning is a marker of neurodegeneration. Individuals with autosomal dominant Alzheimer’s disease (ADAD) develop early-onset dementia with virtually 100% certainty. Cortical thickness fluctuates across the ADAD lifespan, from early-life increased thickness to atrophy proximal to clinical onset. Females have higher cortical thickness and better cognition than males as they age. We examined sex differences in cortical thickness and cognitive performance in adults with ADAD.

Method

We assessed 85 Presenilin-1 E280A mutation carriers (74 cognitively-unimpaired, 11 mildly-impaired) from the Colombia-Boston Biomarker Study of ADAD. Mean age was 35.7 (SD = 10), education 10.2 (SD = 9), and 55 were female. Global cognition was measured using Mini-Mental State Examination (MMSE), and memory using CERAD Word List Delayed Recall. Participants underwent structural brain MRI. T-tests assessed between-group differences. Pearson correlations examined associations between cortical thickness and cognition.

Results

There were no sex differences in cortical thickness or cognitive performance (all ps > =0.05). For carriers, greater cortical thickness was associated with higher MMSE (r = 0.40, p < 0.001) and memory recall scores (r = 0.43, p < 0.01). Female carriers drove this effect, where greater cortical thickness was associated with higher MMSE (r = 0.46, p < 0.001) and memory recall scores (r = 0.47, p < 0.001); these associations were non-significant in male carriers alone. In cognitively-unimpaired female carriers, increased cortical thickness was associated with worse MMSE (r = −0.44, p < 0.001).

Conclusions

We found sex differences in the relation between cortical thickness and cognition in ADAD carriers, which may be relevant to the differential vulnerability and progression of ad in females and males. Future work should investigate potential underlying mechanisms contributing to this sex difference.
A - 23 Neuropsychological Assessments Are Highly Predictive of Β-Amyloid Positive Alzheimer’s Disease
Authors: Horne Lucy K , Schantell Mikki , Mansouri Amirsalar , Springer Seth D , Wiesman Alex I , Johnson Hallie J , Okelberry Hannah J , May Pamela E , Wilson Tony W
Published: October 2023

Objective

Alzheimer’s disease (ad) is the most common cause of dementia, but it is often difficult to accurately diagnose. The current gold standard is β-amyloid positivity on a positron emission tomography (PET) scan. However, these scans are not covered by insurance and are cost prohibitive, making them infeasible for many patients. The aim of this study was to quantitatively assess the accuracy of a neuropsychological battery in distinguishing people with biomarker-confirmed ad versus people who are amyloid-negative.

Method

In total, 60 participants completed a full neuropsychological assessment and Florbetapir-PET imaging. We then used linear discriminant analysis to assess the extent to which a neuropsychological battery could accurately distinguish the biomarker-confirmed groups. Sensitivity, specificity, positive and negative likelihood ratio, area under the curve (AUC), and accuracy were computed for each model using the classification results based on neuropsychological assessments versus Florbetapir-PET imaging.

Results

Participants between the ages of 55–84 years (M = 70.17, SD = 6.65), including 37 with amyloid-positive ad and 23 amyloid-negative participants, completed all aspects of the present study. Overall, the sensitivity of the model was 94.59% (95% CI: 81.81%–99.34%), specificity was 91.30% (95% CI: 71.96%–98.93%), the AUC was 0.93 (95% CI: 0.85–1.00), the positive likelihood ratio was 10.88 (95% CI: 2.89–40.99), and the negative likelihood ratio was 0.06 (95% CI: 0.02–0.23).

Conclusions

Assessments from a neuropsychological battery accurately discriminated β-amyloid positive participants with ad from β-amyloid negative participants. These findings represent a potential alternative, cost-effective method for confirming ad status. Further research is warranted to investigate the most optimal neuropsychological battery for ad diagnosis.
A - 27 Early-Onset Alzheimer’s Disease: Indications of Psychosis Severity and Disease Progression
Authors: Muscat Whitney M , Arleo Kayla
Published: October 2023

Objective

Early-onset Alzheimer’s disease (EOAD) comprises about 5% of ad cases and is associated with delays in diagnosis and aggressive course. Psychotic symptoms are frequent in ad and often include delusions of infidelity and hallucinations. When present, ad with psychosis is accompanied by elevated levels of depression and greater functional impairment. This case expands upon the existing literature on EOAD through the timeline of a complex psychosis presentation accompanied by rapid cognitive decline.

Method

63-year-old, Hispanic, woman with progressive cognitive changes (e.g., confusion, forgetfulness, word-finding difficulties, disorganization) that emerged 5 years prior to seeking neurological consultation. Psychosis symptoms (i.e., auditory/visual hallucinations, delusions), in the context of real events (i.e., husband’s previous infidelity), developed simultaneously. These pervasive symptoms have contributed to social withdrawal, persistent suicidal tendencies, and impaired IADLs. Neuroimaging suggested hypometabolism in the parietotemporal regions with precuneus and posterior cingulate gyri involvement.

Results

The evaluation revealed fairly generalized cognitive decline. Basic attention, working memory, visual abstract reasoning, and phonemic fluency were intact. Visual integration/visuoconstruction were reduced. Impairments emerged in processing speed, rapid cognitive flexibility, cognitive inhibition, conceptualization, visuospatial orientation, semantic fluency, confrontation naming, and visual and verbal encoding and retention (with rapid forgetting). She endorsed moderately elevated symptoms of depression and anxiety.

Conclusions

The pattern of cognitive and functional deficits are all suggestive of an ad process. Her age, sex, significant neuroimaging findings, report of earliest cognitive symptoms, and family history reinforce an EOAD etiology. Significant behavioral changes are often associated with increased cognitive impairment and in turn, may mark the progression/stage of the disease.
A - 28 Serial Evaluations of an Older Adult with Epilepsy and Incidental Findings of Early-Onset Alzheimer’s Disease: a Case Study
Authors: O'Hara John B , Garlinghouse Matthew
Published: October 2023

Objective

Patients with Temporal Lobe Epilepsy (TLE) and Alzheimer’s Disease (ad) demonstrate increased β-amyloid and tau deposition, relative to patients with either TLE or ad. Presentation of ad may be atypical and more rapid in patients with both disorders. We present four serial neuropsychological evaluations (NPE) of a 68-year-old, right-handed woman with history of epilepsy (which became treatment refractory), neurosurgical resection, and incidental neuropathological findings of early-onset ad.

Method

History included generalized tonic–clonic seizure in adolescence and numerous complex partial seizures, managed for ~20 years on valproic acid. At age 63, she reported memory changes. Neurophysiological work-up revealed right frontotemporal seizure foci, and neuroimaging studies revealed amyloid angiopathy. She underwent right anterior temporal lobectomy and amygdalohippocampectomy. Afterwards, seizure control and perceived memory function improved. Post-surgical pathological analysis detected neurofibrillary tangles, neuritic plaques, angiopathy, anoxic changes, and gliosis. Later, she and family described memory decline and behavioral disinhibition. Follow-up CSF analysis identified p-tau/β-amyloid ratio consistent with ad.

Results

Presurgical NPE was largely intact. Post-surgical NPE revealed stable/improved executive functioning (EF), visuospatial skills (VS), and memory, with variability in language. Follow-up NPE 10 months later identified general stability with some variability (e.g., source memory difficulties). Follow-up NPE 16 months after that revealed declines in several domains, with sparing of VS and language.

Conclusions

We present the cognitive trajectory of an individual with refractory TLE and early-onset ad, complicated by cognitive/neuropsychiatric sequelae of neurosurgical resection. This case highlights the potential benefits of serial re-evaluation in assessing for cognitive change suggestive of ad in aging populations with refractory TLE.
A - 33 Clock Drawing Performance Differences in World Trade Center Responders at Midlife
Authors: Santiago-Michels Stephanie , Clouston Sean , Rabin Laura A , Kritikos Minos , Pellecchia Alison , Scott Veronica , Carr Melissa , Luft Benjamin
Published: October 2023

Objective

World Trade Center (WTC) responders demonstrate elevated risk for cognitive impairment (CI) consistent with Alzheimer’s Disease and Related Dementias (ADRD). Neuropsychological test performance is valuable in early detection efforts and non-invasive longitudinal tracking of populations at risk of ADRD. We hypothesized that WTC-CI would be associated with a greater number of errors on the clock drawing task (CDT).

Method

The CDT was administered to responders with/without CI who participated in a case/control study. WTC-CI was diagnosed following NIA-AA guidelines for diagnosing early-onset ADRD (ages <66 years). CDT performance was evaluated using subsets of clock errors derived from four existing variations in CDT evaluation measuring the number of errors. An ANOVA was conducted to compare mean differences in clock characteristics.

Results

From 99 participants, responders with CI (n = 50, Mage = 55.82) had more errors when compared to responders without CI (n = 49, Mage = 55.94) in the following CDT components: contour (p = 0.006), hands (p < 0.001), hands similarity (p = 0.005), moderate graphical errors (p = 0.042), left-side number crowding (p = 0.038), time incorrectness (p < 0.001), and extra marks on clock face (p = 0.006).

Conclusion

In this study, we demonstrated that CDT performance decline is associated with WTC-CI. CDT can be used as a non-invasive investigative tool that can track cognitive performance longitudinally, which can better aid in the early detection, monitoring, and intervention strategies when dealing with the emergence of encephalopathy in high-risk ADRD populations, such as the WTC cohort. Future research should evaluate additional measures that can address other comorbid issues that can arise in such populations, such as post-traumatic stress disorder (PTSD).
A - 34 A Suspected Case of Early-Onset Frontal Variant of Alzheimer’s Disease in a 64-Year-Old Male
Authors: Smith Alphonso , Bledsoe Xavier
Published: October 2023

Objective

Early-onset frontal variant of Alzheimer’s disease (fvAD) is characterized by apathy, disinhibition, and executive dysfunction. As such, fvAD is often difficult to clinically distinguish from behavioral variant frontotemporal dementia (bvFTD). However, research suggests that a differentiating feature among the two conditions is that fvAD typically presents with more pronounced memory impairment. Therefore, neuropsychological testing in the context of a comprehensive multidisciplinary assessment can be a valuable tool to aid with differential diagnosis.

Method

A 64-year-old male with gradually progressive difficulties in cognition and behavioral-emotional functioning over the past 8–9 years presented to a multidisciplinary neurology clinic. MRI showed mild atrophy in the frontal, temporal, and parietal lobe regions. Concerns were raised by his neurologist for early-onset ad versus bvFTD so the patient was referred for neuropsychological evaluation.

Results

Neuropsychological testing showed a largely amnestic memory profile along with deficits in executive functioning and semantic fluency. His spouse endorsed concerns for apathy and executive dysfunction on a frontal system rating questionnaire in addition to concerns for disinhibition during the clinical interview. Taken together, the patient’s profile appeared to be consistent with early-onset fvAD. Follow-up FDG-PET scan showed decreased uptake in the anteromesial temporal lobes, posterior cingulate cortices, and posterior temporoparietal regions which was consistent with an ad profile.

Conclusions

Early-onset fvAD and bvFTD are often difficult to clinically distinguish from each other. However, neuropsychological testing in conjunction with comprehensive multidisciplinary assessment can serve an important role in helping to facilitate differential diagnosis for these two neurodegenerative disorders with overlapping features.
A - 36 Neuroprotective and Resilience Factors in an Individual with Positive ad Biomarkers
Authors: Weinstein Morgan , Bradley Hannah , Martin Jane , Pereira Ana , Sutton Leah C
Published: October 2023

Objective

There is conflicting research on risk indicators relating to the diagnosis of early-onset Alzheimer’s disease (EOAD). We assessed an individual with numerous factors that are associated with EOAD including the presence of two APOE e4 alleles, family history of EOAD, and positive biomarkers (i.e., Amyloid PET Scan; CSF). Longitudinal neuropsychological data reflect minimal cognitive decline through age 73, suggesting substantial mediating effects of cognitive reserve and neuroprotective measures: aerobic exercise, cognitive stimulation, and psychological health.

Method

A 73-year-old man was seen for repeat neuropsychological evaluation in 2022 at an academic medical center following his baseline evaluation in 2019, which did not reveal cognitive deficits. Testing was conducted and interpreted by a clinical neuropsychologist in the context of available neuroimaging and neurodiagnostic information.

Results

Results of the neuropsychological assessment were interpreted in the context of High Average to Superior premorbid functioning, a significant family history of EOAD, a positive Amyloid PET scan and two ApoE4 alleles (4/4). Results of his 2022 evaluation remain consistent or improved from 2019 and do not suggest mild cognitive impairment (MCI). Functionally, this individual is fully independent in IADLs and does not report significant subjective cognitive concerns.

Conclusion

Phenotypic expression of ad symptoms are delayed in this individual despite his genetic risk and pathologic biomarkers; the reason is likely multifactorial but includes several resilience factors, including good cardiovascular health (i.e., aerobic exercise 5x/week), continued cognitive stimulation, and psychological health. These are areas worthy of further research.
A - 37 Measuring Experiences of Discrimination in Older Adults Enrolled in an Alzheimer’s Disease Research Cohort
Authors: Patel Nisha , Halberstadter Kimberly , Schumann Rosalie , Mechanic-Hamilton Dawn , Stites Shana D
Published: October 2023

Objective

Discrimination can affect healthy brain aging and Alzheimer’s disease (ad) outcomes. To advance this area of research, we characterized experiences of discrimination in a cohort of older adults, contributing data to a national research sample.

Method

An electronic survey was completed by cognitively unimpaired participants (n = 135) in the UPenn ad Research Center clinical cohort. The Everyday Discrimination Scale (EDS) asks 10 questions about lifetime experiences with discrimination. Self-report questionnaires gathered sociodemographic data, including age, race, disability, sex, sexual orientation, and gender identity. Associations between EDS items and sociodemographic characteristics were examined.

Results

The sample of 135 older adults averaged 74 years old, had 17 years of schooling, and were mostly women (61%) and white (71%). Half (49%) reported having discriminatory experiences including receiving less respect (35%), lower quality service (35%), less courtesy (34%), and being treated as inferior (35%) or less smart (22%). The most common reasons for discrimination were race (29%), gender (22%), skin color (18%), age (17%), and ancestry (16%). Black participants comprised the majority who reported receiving lower service (68%), being treated as less smart (60%), and with less courtesy (56%).

Conclusions

Our findings suggest older adults enrolled in brain aging research experience many types of discrimination, which disproportionately affect Black individuals. Their experiences make a valuable contribution to ad science, helping researchers to study how discrimination may correspond to ad outcomes. They also highlight the importance of researchers being well-trained to be culturally informed when interacting with individuals who have been, and may continue to be, impacted by discrimination.
A - 41 The Association between Education, Literacy, and Performance on the Loewenstein-Acevedo Scale for Semantic Interference and Learning (LASSI-L) in African American (AA) Older Adults
Authors: Bosworth Brooke , Neer Emory , Ramirez Sofia , Sosa Jaylene , Hincapie Diana , Ortega Alexandra , Crenshaw Kristen , Curiel Rosie , Loewenstein David
Published: October 2023

Objective

The LASSI-L, a cognitive challenge test, has been found to be highly discriminative between AA elders with amnestic mild cognitive impairment (aMCI) versus cognitively unimpaired (CU) counterparts. Given potentially lower levels of formal education and literacy in some AA groups, it is important to determine whether such factors might adversely influence performance.

Methods

41 AA adults (53.7% males), with a mean age of 63.9 (SD = 5.1 years, range = 54–83) were deemed to be CU after a clinical interview resulted in a CDR = 0, and scores from a neuropsychological battery were deemed normal by experienced neuropsychologists. The LASSI-L was not used in diagnosis.

Results

Level of educational attainment was 13.3 (SD = 2.3 years: range = 9–20). Level of reading literacy, as assessed by the WRAT-4, yielded an average grade equivalent (GE) of 9.6 (SD = 3.5 range = 2.0–12.9); substantially lower than reported educational attainment. Association between formal education and literacy was 0.52 which accounted for 27% of the shared variance. There were no statistically significant correlations between formal education or WRAT-4 scores in any LASSI-L variables, including initial learning (Cued Recall 2 List A), proactive semantic interference (PSI) (Cued List B1-List B2), failure to recover from PSI, or semantic intrusion errors.

Conclusions

Performance on the LASSI-L among AA-CU did not suggest biases associated with formal education or word literacy, making it a promising tool for research. Many neuropsychological measures do not have acceptable diagnostic accuracy when used among individuals that are racially diverse, have lower-education levels, and lower socioeconomic status. This is important in consideration for potential use of LASSI-L in clinical settings.
A - 42 Neuropsychological Improvement in Amnestic Mild Cognitive Impairment Following Noninvasive Transcranial Electrical Stimulation: a Case Report
Authors: Cabrera Hannah , Helphrey Jessica , Neaves Stephanie , Ahmed Danyah , Chiang Hsueh-Sheng , McClintock Shaun M , Cullum C Monroe , Hart John , Didehbani Nadeyah , LoBue Christian
Published: October 2023

Objective

Amnestic Mild Cognitive Impairment (aMCI) is often a prodromal stage for Alzheimer’s disease, and the few treatments available have limited efficacy in lessening the neuropsychological deficits. Transcranial direct current stimulation (tDCS) is a noninvasive electrical stimulation method with therapeutic potential found in aMCI, but high-definition tDCS (HD-tDCS) is a recent advancement allowing for improved targeting in stimulation and possibly prolonged treatment effects. We present a case report that investigates HD-tDCS-induced neuropsychological changes in aMCI.

Method

A 78-year-old male with aMCI received 10 HD-tDCS sessions at 1 mA for 20 minutes targeting the dorsal anterior cingulate cortex. He was stable on rivastigmine throughout the trial. Eight neuropsychological tests assessing episodic memory (verbal and visual), attention, executive functioning, and language were completed at baseline, after the 10th session and 3-months later. A change of +/− 10 T-score points from baseline was considered a clinically meaningful difference.

Results

Significant improvements were observed immediately after HD-tDCS on 4/8 tests, including the Brief Visuospatial Memory Test-Revised (BVMT-R; immediate recall +14; delayed recall +24), semantic fluency (Animals +17), Trail Making Test B (+14), and Stroop Color and Word Interference Trial (+21). At the 3-month follow-up, only the BVMT-R immediate recall remained higher (+16), while the rest were similar to baseline scores.

Conclusions

Clinically meaningful improvement in neuropsychological functioning was seen following HD-tDCS in this patient with aMCI. However, nearly all the enhancements were diminished 3-months later, returning to baseline. A randomized sham-controlled trial is warranted to confirm the therapeutic effects of HD- tDCS and examine how long effects may persist.
A - 43 Examining the Utility of the Adaptive Behavior Scale-3rd Edition (ABAS-3) in Capturing Age-Related Changes in Daily Functioning for Neurodiverse Populations
Authors: Colantuono Valerie , Lindgren Karen , Robins Diana L , Vivanti Giacomo
Published: October 2023

Objective

Current guidance for the assessment of cognitive decline for mild cognitive impairment or dementia lacks sufficient information for assessing neurodiverse populations (Janicki et. al, 2022), and standardized scores often have floor effects. This study investigated the utility of the Adaptive Behavior Scale-3rd Edition (ABAS-3) in characterizing age-related changes in daily functioning for individuals with autism and other intellectual and developmental disability (I/DD).

Method

Participants (20–76 years old) resided in community-based residential programs (CBRPs) for individuals with I/DD. Aim 1 examined mean ABAS-3 raw scores for participants with at least 1 ABAS-3 (N = 171, autism n = 115, other I/DD n = 56). Aim 2 examined changes in ABAS-3 raw scores over 2 years (N = 61, autism n = 37, other I/DD n = 24). ABAS-3 scales included “home-living” (HL), “self-care” (SC) and “health and safety” (HS).

Results

Aim 1 indicated variability within and across diagnostic groups, with lower performance for autistic versus other I/DD participants (p < 0.001, large effect size across all subscales). Aim 2 found varying patterns of loss, gain, and stable scores across timepoints. HL (autism loss 24.3%, gain 16.2%, stable 59.5%; I/DD loss 16.7%, gain 33.3%, stable 50.0%), SC (autism loss 29.7%, gain 16.2%, stable 54%; I/DD loss 12.5%, gain 33.3%, stable 54.2%), HS (autism loss 24.3%, gain 16.2%, stable 59.5%; I/DD loss 16.7%, gain 33.3%, stable 50.0%).

Conclusions

This proof-of-concept study demonstrates feasibility in characterizing ADLs of individuals with autism and I/DD living in CBRPs. Future research will assess distal ABAS-3 raw score changes to track cognitive decline in individuals with autism and other I/DD.