bluuebunny/crossref_metadata_2025 huggingface dataset:
A - 109 Neuropsychiatric Inventory Questionnaire Subfactors and Cognition in Parkinson’s Disease
Authors: Hochuli Maria , Almasri Mike , Moncrief Grant G , Roth Robert M
Published: September 2024

Objective

Patients with Parkinson’s disease (PD) commonly experience neuropsychiatric symptoms, often garnered through informant interview, that may be associated with poorer cognitive functioning. Recently, the Neuropsychiatric Inventory Questionnaire (NPI-Q) was found to have three factors with differential association to cognition in patients with PD. We sought to further examine this relationship in those with the condition.

Method

A sample of 42 patients with PD were seen for neuropsychological evaluation (85.7% male, 97.6% White, mean age 70.88 [SD = 7.16], mean years education 15.74 [SD = 2.99]). A knowledgeable informant completed the NPI-Q. Spearman correlations examined relationships between cognition (Digit Span, BVMT-R, CVLT-3, BNT-2, D-KEFS Color-Word Interference, COWAT, Animal Fluency, Trail Making Test), NPI-Q Total Severity, and severity for three factors (Mood [depression, anxiety, apathy, motor, nighttime behaviors, eating]; Hyperactivity [mania, aggression/agitation, disinhibition, irritability]; Psychotic Symptoms [delusions, hallucinations]).

Results

NPI-Q total severity was generally low (mean = 3.90, SD = 5.12). Total severity and severity of Mood and Hyperactivity were unrelated to cognition. More severe Psychotic Symptoms were related to worse Digit Span (r = −0.41, p = 0.008), BVMT-R Learning (r = −0.33, p = 0.03) and Delayed Recall (r = −0.34, p = 0.03), and D-KEFS Inhibition Time (r = 0.44, p = 0.006).

Conclusions

In a modest sample of patients with PD, severity of psychotic symptoms was related to worse auditory attention/working memory, visual learning and memory, and inhibition. No other NPI-Q score was associated with cognitive functioning. Findings support the utility of the NPI-Q in PD and the importance of considering specific neuropsychiatric factors and their implications for cognitive functioning.
A - 110 Characterization of Mild Cognitive Impairment in Multiple System Atrophy
Authors: Muscat Whitney , Assuras Stephanie
Published: September 2024

Objective

Multiple system atrophy (MSA) is a rare neurodegenerative disorder that primarily impacts movement and balance, as well as the autonomic nervous system. While traditionally not associated with cognitive decline, recent evidence indicates cognitive impairment is part of the disease process, typically manifesting as attentional and executive function deficits, alongside learning/memory impairments. This case contributes to MSA literature by describing mild cognitive changes in a patient with predominant autonomic dysfunction.

Method

A 68-year-old Caucasian man exhibited progressive cognitive changes over 2–3 years, with concerns emerging 5–10 years prior to neurological consultation (e.g., forgetfulness, word-finding difficulties, decline in ability to follow complex instructions). Predominant sensorimotor/physiological changes included chronic constipation, vasovagal episodes, hearing loss, orthostatic hypotension, transient vision loss, and mild dysphagia. Neuroimaging showed nonspecific mild pontine T2/FLAIR hyperintensity. Significant family history of dementia.

Results

Evaluation showed mostly normal cognitive function with some decline in executive functioning (slowed processing, reduced problem-solving, set loss, task rigidity) and mild memory decline. Despite scores within normal limits, performance likely reflects cognitive change consistent with his subjective experience, possibly masked by strong cognitive reserve (high educational and occupational attainment, research interests, social engagement).

Conclusions

Although lacking frank impairment, the patient’s history suggests a neurological process (i.e., synucleinopathy such as MSA) including history of REM sleep behavior disorder, autonomic symptoms/conditions, and neuroimaging findings suggestive of brain stem involvement. Neuropsychological evaluation is critical in differentiating MSA from other Parkinsons’s plus syndromes, as it typically presents with fewer cognitive impairments.
A - 111 Neuropsychological Functioning in those with Chronic Traumatic Encephalopathy
Authors: Iyengar Niyenth , Schaffert Jeff , Lobue Christian , Hart John , Chiang Hsueh-Sheng , Cullum C Munro
Published: September 2024

Objective

To differentiate neurocognitive performance between those with chronic traumatic encephalopathy neuropathologic change (CTE-NC) and matched CTE-negative individuals.

Methods

Data were obtained from the National Alzheimer’s Coordinating Center (NACC). Participants with mild cognitive impairment (MCI) or dementia and CTE-NC (n = 22) were matched approximately 1:3 to those with MCI/dementia but without CTE-NC (n = 64) on demographics (age of initial cognitive diagnosis, education, sex) and postmortem Alzheimer’s and Lewy body neuropathology. ANCOVAs (covarying for symptom duration and cognitive diagnosis) compared neurocognitive measures between groups (MMSE and neuropsychological battery composites of Attention, Executive Function, and Speed [AEFS], Memory, and Language).

Results

Participants were all male, 89.3% White, and averaged 16.3 years of education. They were, on average, 74.8 years of age (SD = 7.3) when diagnosed with MCI/dementia and had 4.2 years (SD = 4.2) of cognitive symptoms prior to MCI/dementia diagnosis. Rates of comorbid moderate/severe Alzheimer’s or Lewy body pathology were high (n = 13, 54%) in the CTE-NC group. At time of cognitive diagnosis, individuals with CTE-NC performed slightly better on the MMSE (F = 4.510, p = 0.037, CTE-NC+ M = 26.03 [1.05] vs. CTE-NC- M = 23.44 [0.58]). No differences in AEFS [F = 0.280, p = 0.599], Memory [F = 2.265, p = 0.137], or Language [F = 3.424, p = 0.069] were observed between groups.

Conclusions

Those with CTE-NC did not greatly differ in neuropsychological domains, but had relatively higher MMSE scores compared to those without CTE-NC. This is the largest clinicopathological investigation utilizing in-vivo neurocognitive data, though NACC lacks CTE-NC severity/distribution data for sensitivity analyses. Nonetheless, results have implications for CTE clinical criteria frameworks and larger clinicopathological studies are needed to determine if CTE-NC has distinct neurocognitive features.
A - 114 Exploring Alzheimer’s Disease: the Interplay of Depression, Substance Use, and Neurocognition
Authors: Venkataramanan Vaibhavi , Heath Alesha , McNerney Margaret W
Published: September 2024

Objective

Depression and substance use (SU) can significantly impact one’s neurocognition and are potential risk factors for Alzheimer’s Disease (ad). The project aimed to explore whether a history of depression and/or SU could predict baseline performance on neuropsychological assessment among individuals with and without ad.

Method

Data from the National Alzheimer’s Coordinating Center (NACC) was analyzed. N = 9114 participants (41.5% Male, 58.5% Female; 56.7% Normal Cognition, 43.2% ad) at their first visit were selected. A series of linear regression models, separated by presence of ad diagnosis, were run to determine if a history of depression, and/or SU, age, race, sex, education level, and APOE status would predict performance on selected neuropsychological assessments measuring facets of executive functioning (EF) (Trail Making, Digit Span, and Wechsler Adult Intelligence Scale (WAIS)).

Results

Depression was a significant predictor of performance on the WAIS in the normal cognition (β = −0.12,p < 0.001) and ad (β = −0.14,p < 0.001) groups, on Number of Correct Digit Span Backward Trials in the normal cognition (β = 0.09,p < 0.01) and ad (β = −0.10,p < 0.01) groups, and on Number of Correct Digit Span Forward Trials in the ad group (β = −0.11,p < 0.001). SU was a significant predictor of performance on Number of Correct Digit Span Backward Trials in the ad group (β = 0.20,p < 0.01). Demographic variables were also significant.

Conclusions

Depression predicted performance on multiple neuropsychological assessments across diagnostic groups compared to SU. EF facets measured across assessments may have been further impacted by ad and mental health history compared to those with normal cognition endorsing mental health history.
A - 115 Cognitive Predictors of Phosphorylated Skin Nerve α-Synuclein Deposition in Patients with Suspected Synucleinopathy
Authors: Rennie Katie , Kolessar Michael , Gillen Lindsey , Townley Ryan , Pleen Joseph , Parks Adam
Published: September 2024

Objective

Synucleinopathies are a group of neurodegenerative diseases caused by abnormal α-Synuclein aggregates and characterized by motor, autonomic, and cognitive changes, including Parkinson’s disease, Lewy Body disease, and Multiple System Atrophy. Due to variability in presentation, clinical phenotyping is challenging for diagnosis and treatment planning. Phosphorylated α-Synuclein (P-syn) detected in nerve fibers using skin biopsy shows promise in clinical phenotyping of synucleinopathies. However, cognitive predictors of P-syn deposition in synucleinopathies have not been fully explored. This study aimed to examine the utility of cognitive testing in predicting P-syn deposition in a clinical sample.

Method

A chart review of 52 older adults (Mean age = 72.8 years) referred to an outpatient neurology clinic for a diagnostic dementia workup was conducted. Clinical variables were collected, including skin biopsy (Syn-One) and cognitive test scores (Short Test of Mental Status [STMS]). P-syn was detected in 22 patients (42%) and at 68%, 41%, and 55% of central (neck) and distal (thigh and calf) biopsy sites, respectively.

Results

Overall cognition (STMS Total) did not significantly differ between patients with (Mean = 30.5) and without (Mean = 29.6) P-syn (p = 0.51). Within the P-syn positive group, STMS Registration-Trials and Calculation scores significantly predicted distally deposited P-syn (F(1,18) = 7.54, p = 0.01). This relationship was more pronounced in the thigh compared to the calf biopsy sites.

Conclusion

STMS Registration-Trials (immediate recall) and Calculation scores were significantly related to distally deposited P-syn. These findings highlight the importance of how cognitive test performance can potentially impact clinical phenotyping in synucleinopathies. Future research will examine the relationship between cognition, clinical features, and other neurodegenerative disease biomarkers.
A - 116 A Neuropsychological Testing Protocol for Assessing Lecanemab Eligibility for Alzheimer’s Disease: the First Fifty Patients
Authors: Parks Adam , Brunette Amanda , Reinhart Clare , Kreszyn Katelynn , Townley Ryan , Burns Jeffrey
Published: September 2024

Objective

Since the FDA approved lecanemab for Alzheimer’s disease (ad) treatment in 2023, neuropsychology’s role in the treatment eligibility determination process has become increasingly important. Not only is objective evidence of cognitive impairment required for the diagnosis of mild cognitive impairment (MCI) and mild dementia, but testing can be used to measure treatment efficacy and monitor for adverse effects. Our center developed a specialized protocol to assess cognitive and behavioral functioning for assisting in the eligibility determination process.

Method

Fifty adults (Mean Age = 73.8 years) underwent neuropsychological testing, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), as a part of their eligibility workup. Caregiver questionnaires were used to assess behavioral functioning. Test scores and patient outcomes were explored.

Results

Thirteen patients (26%) were prescribed lecanemab. Another 13 patients were deemed ineligible (five due to their cognitive results), eight patients (16%) were undecided, and 16 patients (32%) had not yet completed their workup. Of those who initiated lecanemab, eight patients (62%) had a diagnosis of MCI and six were diagnosed with mild dementia. Of these patients, eight (82%) showed an amnestic pattern on testing (RBANS Delayed Recall Standard Score Mean = 46.8). Additional analyses involving ad biomarkers, neuroimaging, and APOE status, were conducted.

Conclusion

Over one quarter of patients referred for neuropsychological testing as a part of their eligibility determination initiated lecanemab treatment for ad. Cognitive testing was directly related to determining ineligibility in 10% of patients. This review of an initial lecanemab treatment cohort highlights the importance of neuropsychology in the eligibility determination process.
A - 117 Double Trouble: a Case Study on Cardiac Amyloidosis and Alzheimer’s Disease
Authors: Ismail Hajar , Lacy Maureen
Published: September 2024

Objective

Transthyretin amyloidosis (ATTR) is an increasingly recognized cause of heart failure amongst older adults. The median age upon diagnosis is 75 with 90% of patients reported as men. The amyloidogenic protein is transthyretin (TTR), which is primarily produced in the liver, but is also produced in the choroid plexus and neurons under distress. There are two types of ATTR: an autosomal dominant and a wild-type (wt) variant. ATTRwt is the amyloid precursor in the cardiac depositions found in older adults. We present the first neuropsychological evaluation of a patient with ATTRwt.

Method

An 87-year-old right-handed White woman reported a 2 year history of slowly progressive short term memory decline. Her family noted rapid cognitive decline and paranoia approximately 6 months ago. Medical history was notable for heart failure, along with lumbar stenosis, carpal tunnel syndrome, arthritis, scoliosis, and hyperlipidemia. ATTRwt diagnosis was made during cardiac clearance for lumbar surgery. Neuroimaging documented age-related cerebral atrophy and chronic microvascular ischemic disease.

Results

Inspection of data revealed an amnestic presentation, with impaired confrontational naming, spatial judgment, and processing speed performances. She denied depressogenic and anxiolytic symptoms while family endorsed symptoms of apathy and executive dysfunction.

Conclusions

The relationship between cardiac and nervous systems has garnished increasing attention in the literature and in clinical planning. Overall, the relationship between cardiac TTR amyloid and brain amyloid beta deposition in humans is unclear. Neuropsychologists should be aware of this heart condition that is increasingly recognized in older adults and the intriguing findings implicated around the cardiac-brain axis.
A - 119 Cognitive Impairment in Alzheimer’s Disease: the Impacts on Reasoning and Decision-Making in Healthcare
Authors: Navarro Etiane , Morocho Casey
Published: September 2024

Objective

Alzheimer’s Disease (ad) is a progressive neurodegenerative disease characterized by the presence of amyloid plaques and neurofibrillary tangles. These brain changes negatively affect inter-neuron firing, leading to memory loss and slow cognitive decline. Older adults with ad experience deficits in activities of daily living and an increased need for supervision. This systematic review investigates the cognitive impairments seen in ad patients relative to normal aging, focusing on how the neuropathology of Alzheimer’s affects their reasoning and decision-making abilities in healthcare settings.

Data Selection

Data was gathered from PubMed, PsycINFO, and Google Scholar. Terms used in the literature review included cognitive impairment in ad, executive function in ad, Alzheimer’s and its impact in decision-making, decision-making and cognitive impairment, decision-making and the elderly, caregiver burden and burnout in ad, neuropsychology in ad, neuropsychological assessment in ad, neuropathology in ad. Data search was conducted from January 15–18 and March 3–4 of 2024. Examination of 45 studies were conducted.

Data Synthesis

Patients with ad demonstrate severe brain structure deterioration, leading to cognitive impairment that impacts reasoning and decision-making. Early diagnosis and neuropsychological assessments are crucial to establish a baseline and monitor changes in cognition. Appropriate care management is key to preserving patient self-determination in healthcare decision-making and reducing the burden on caregivers.

Conclusions

ad significantly deteriorates patients’ ability to reason and make informed decisions, necessitating early and precise interventions. Future research should investigate innovative diagnostic tools and intervention strategies to enhance decision-making capabilities, improve patient quality of life, and reduce caregiver burden.
A - 124 A Case of Lewy Body Dementia and Charles Bonnet Syndrome in a Patient with Bilateral Enucleation
Authors: Jimenez Alexis , Newkirk Bailey , Fink Joseph
Published: September 2024

Objective

The patient presented with a history of blindness due to bilateral enucleation (age 10 and 23) and visual hallucinations for approximately 2 years. Approximately 30% of visually impaired individuals are affected by Charles Bonnet syndrome, characterized by complex visual hallucinations in visually challenged patients, possibly stemming from the brain’s attempt to fill the visual void. Additionally, she was diagnosed with Lewy Body dementia (LBD) 2 years prior by her neurologist, and she reported challenges with completing instrumental activities of daily living (IADLs).

Method

The patient was a left-handed 83-year-old woman, with a history of total blindness and bilateral enucleation, who presented with progressive memory loss 3–4 years prior, along with balance/gait disturbances for 1–1.5 years. The patient and her family sought neuropsychological testing to clarify her cognitive functioning in light of her physical and neurologic symptoms.

Results

Premorbid functioning was estimated in the low average range, with 11 years of education. Due to her total vision loss, neuropsychological evaluation was limited. Her cognitive profile was marked by impairments in immediate memory, delayed memory, recognition, executive functioning, and language.

Conclusions

In light of the patient’s marked cognitive deficits in memory, attention, and executive functioning, along with visual hallucinations (although also attributed to possible Charles Bonnet syndrome), balance/gait disturbances, fluctuating awareness, autonomic dysfunction (i.e., bladder/bowel control), and sleep changes (i.e., acting out dreams), her presentation is consistent with LBD, in the moderate stage of severity. Given the symptomatology, it raises the possibility the patient may be experiencing Charles Bonnet syndrome along with LBD.
A - 125 Exploring the Relationship between the NIH Toolbox-Cognitive Battery & the Alzheimer’s Disease Cooperative Study-Preclinical Cognitive Composite
Authors: Burger Carly N , Conley Michael , McDonald Taylor , Zhang Rong , Cullum C Munro
Published: September 2024

Objective

The computerized NIH Toolbox–Cognitive Battery (NIHTB-CB) is efficient but has not been widely used clinically. The Alzheimer’s Disease Cooperative Study-Preclinical Alzheimer Cognitive Composite (ADS-PACC) has good sensitivity and correlates with amyloid pathology. This study examined the relationship between the NIHTB-CB and ADS-PACC in an aging adult population.

Method

Baseline data from the Risk Reduction for Alzheimer’s Disease (rrAD) study were analyzed. Cognitively intact individuals (n = 511, M MMSE = 29) with hypertension and subjective cognitive complaints and/or a first degree relative with dementia were included (M age = 68.73, 63% female; 84% White, M education = 16.24). Multiple regression examined the relationship between the NIHTB-CB subtests and ADS-PACC composite score.

Results

NIHTB-CB subtests demonstrated small to moderate positive correlations with the ADS-PACC total score (r = 0.19–0.43, p < 0.001). ADS-PACC performance explained 23.5% of the variance for NIHTB-CB Flanker Inhibitory Control/Attention [F, (4, 510) = 40.19, p < 0.001], 18.1% for Pattern Comparison Processing Speed, 13.9% for List Sorting Working Memory [F, (4, 508) = 21.53, p < 0.001], and 13.2% for Dimensional Change Card Sort [F, (4, 510) = 20.43, p < 0.001].

Conclusions

The NIHTB-CB and ADS-PACC showed modest correlations, but PACC scores explained a sizeable amount of variance of NIHTB-CB performance. Previous research supports convergent validity of the NIHTB-CB with other commonly used neuropsychological measures; however, results of this study indicate these batteries may assess different aspects of cognitive functioning. Future research may explore the relationship between the two batteries and their components in the assessment of longitudinal changes in neurocognitive function in individuals with cognitive decline/dementia.
A - 126 Examining Five Point Test Strategy Use on Everyday Problem-Solving Abilities in Mild Cognitive Impairment and Alzheimer’s Disease
Authors: Sidhu Jasman , Baez Abril , Dadawalla Ali , Knutson Heather , Kozuki Jordan , Lent David , Miller Chris , Woo Ellen
Published: September 2024

Objective

Activities of daily living (ADLs) and executive functional abilities are increasingly impaired in mild cognitive impairment (MCI) and Alzheimer’s disease (ad). Impaired individuals adopt executive strategies to aid in executing executive everyday tasks. The Five Point Test measures indices of executive functioning when completing the task. The study examines the role of strategy use in everyday problem-solving in healthy older adults (HOA), MCI, and ad.

Method

Participants included HOA adults (n = 58), persons with MCI (n = 63), and individuals with ad (n = 18). Participants completed a background questionnaire, including the Everyday Problems Test (EPT). In the Five Point Test, using straight lines, participants were instructed to draw various designs in three minutes, avoiding errors across three conditions. The use of the Rotational Strategy is measured by participants generating a new design by rotating the previous spatial configuration. The use of an enumerative strategy was measured by participants generating a pattern by consecutively adding or deleting a line from the previous design.

Results

Linear regressions were conducted to determine the role of strategy use in everyday problem-solving (i.e., rotational and enumerative strategies). It was revealed that the use of the rotational strategy predicted EPT solving in the MCI group. However, problem-solving abilities did not predict EPT solving in HOA and ad.

Conclusion

Interestingly, the rotational strategy was better executed across all groups, while the ad group exhibited limited strategy use. Results suggest that those with subtle cognitive deficits adopt strategies to better execute problem-solving in real-life problems.
A - 130 Effectiveness of Beta-Amyloid Immunotherapy and Monoclonal Antibodies in Patients with Early Onset Alzheimer’s between the Ages of 45–60 Years
Authors: Cortes Edgar J , Morant Rodnie , Martinez Casiano Karla D , Ocasio-Quiñones Idanara T
Published: September 2024

Objective

This comprehensive systematic review examines various therapeutic approaches for Alzheimer’s Disease (ad), with a specific emphasis on immunotherapy targeting beta-amyloid and tau pathology.

Data Selection

Data were sourced from peer-reviewed journals, databases (e.g., PubMed, PsychInfo, Scielo, Google Scholar), and relevant conference proceedings from inception to present. Search terms included variations of “Alzheimer’s disease,” “clinical trials,” “monoclonal antibodies,” “beta amyloid,” “immunotherapy”. Selection criteria emphasized relevance to ad therapy, randomized controlled trials, and clinical outcomes. A total of 24 studies from 2013 to 2023 were reviewed, meeting robust study design, sample size, and therapeutic relevance were chosen. Data extraction followed standardized guidelines for abstracting key information, including study design, participant characteristics, interventions, and outcome measures.

Data Synthesis

The review synthesized recent studies on Alzheimer’s disease (ad) therapy, particularly monoclonal antibodies targeting amyloid beta oligomers. Notable studies such as Avgerinos et al. (2021) and Bateman et al. (2022), showcased significant cognitive decline reductions in ad patients. Positive outcomes were also observed with gantenerumab, lecanemab, and donanemab. Additionally, alternative approaches such as Zanthoxylum caribaeum extract and herbal extracts were explored. The synthesis underscored the complexity of ad treatment and the necessity for continued multidisciplinary research.

Conclusions

This systematic review provides valuable insights into ad therapeutics, guiding future research directions and informing clinical practice to better meet the needs of ad patients and their caregivers. Despite significant advancements, challenges persist in developing effective ad therapies, underscoring the ongoing need for research, particularly in immunotherapy and natural compounds, to address the multifaceted nature of the disease and enhance patient outcomes.
A - 131 Patterns of Functional Decline in Alzheimer Biomarker-Positive Vs. Negative Cognitive Impairment
Authors: Kostadinova Ralitsa V , Bushnell Justin , Clark David G
Published: September 2024

Objective

To contrast longitudinal patterns of functional decline between groups of cognitively impaired individuals with or without biomarker support for Alzheimer’s disease (ad).

Method

We requested data from the National Alzheimer’s Coordinating Center on individuals who underwent serial evaluation with the Functional Activities Questionnaire (FAQ) and those for whom cerebrospinal fluid biomarkers for ad were available. By cross-referencing the two datasets, we identified 570 subjects, 71 of whom were biomarker positive and 499 biomarker negative. Item-level FAQ item-level scores were then entered as predictor variables into lagged mixed-effects regression models with a single FAQ item as the dependent variable in each model (one model for each of the ten FAQ items). Coefficients for statistically significant predictors of follow-up FAQ items were plotted as arcs on a directed graph, with one vertex for each of the ten FAQ items. We repeated this process for biomarker positive and negative individuals and created a map depicting effect size differences, i.e., biomarker positive minus biomarker-negative regression coefficients (Δ = β + − β-) for statistically significant arcs (α = 0.05).

Results

Twelve out of 21 arcs that were significant in the biomarker-positive individuals were significant only for this group. The largest effect size difference was STOVE → STOVE (Δ = 0.233). Twenty of 29 arcs that were significant in the biomarker-negative individuals were significant only for this group. The largest effect size difference was GAMES → GAMES (Δ = −0.168).

Conclusion

ad biomarker status modulated the patterns of longitudinal functional change in this sample.
A - 134 Consistent Failed Performance on Performance Validity Tests in Early-Onset Alzheimer’s Disease Confirmed by Lumbar Puncture
Authors: Kelly Brianna , Schulze Evan
Published: September 2024

Objective

This case study expands the literature of failed performance validity tests (PVTs) in individuals with confirmed biomarkers for early-onset Alzheimer’s disease (ad).

Method

The case presents a 56-year-old right-handed white male with a history of depression and onset of cognitive symptoms beginning in his early 50’s. He reported difficulties remembering appointments, tasks, and events, and difficulties with orientation while driving. Brain PET-MRI displayed mild to moderate atrophy of temporal lobes, and moderate hypometabolism in the bilateral temporal and partial lobes and posterior cingulate gyri. Following neuropsychological testing, a cerebrospinal fluid (CSF) analysis was consistent with ad biomarkers.

Results

Upon neuropsychological testing, the patient obtained below cutoff scores on freestanding and embedded PVTs. The Dot Counting Test (DCT) and the TOMM yielded below cutoff scores. Embedded validity indicators on the WAIS-IV and the RBANS were also suggestive of suboptimal effort. Impaired performances were seen on test of visuomotor speed and set-shifting. In contrast, he obtained scores within normal limits on tasks of visuospatial perception, basic auditory attention, and confrontation naming.

Conclusion

Failures on multiple PVT’s were evidenced on testing with no apparent external motivating factors. While below cutoff PVT performances are concerning for suboptimal engagement, positive CSF markers for ad raise concern for possible false positive classification of suboptimal effort vs genuine cognitive impairment. This case provides further insight into PVT performance in early ad, especially with symptom onset at a younger age.
A - 137 An Item-Level Analysis of the Boston Naming Test in a Sample of Veterans as it Relates to Age and Education
Authors: Paglini Sarah A , Baldini Daniel , Moses James
Published: September 2024

Objective

The Boston Naming Test (Kaplan et al., 1983) is a 60-item test designed to measure confrontational naming ability. Word-finding difficulty is a prominent feature of aphasias, with picture-naming ability being a reliable predictor of lexical retrieval ability (Herbert et al., 2008). Lower performance on the BNT is found among older age groups and individuals with lower educational attainment (Zec et al., 2007). Notably, an item-level analysis of the BNT has not been analyzed in a Veteran population. There is great importance in properly accounting for demographic variables when interpreting patient test results.

Methods

An item-level confirmatory factor analysis examined mean BNT scores in a veteran sample (n = 517) ages 20–79 (M = 51) with years of educational attainment (M = 13). The purpose of this study was to conduct an item-level factor analysis of the unique cohort effects of both age and education on the Boston Naming Test within a Veteran population.

Results

The BNT solution explained 60.95% of the variance, and components reflected early and late trials. Within the rotated components matrix, education contributed to late items (36–60) whereas age contributed to early items (11–45).

Conclusions

These results indicate the importance of properly accounting for demographic variables such as age and educational attainment when interpreting test results unique to a Veteran population. Higher educational attainment is associated with increased performance on later items, whereas older age is associated with decreased performance on earlier items. It may be informative to consider item-level performance when assessing confrontational naming ability.
A - 139 A Neuropsychological Case Study of an Individual Diagnosed with Langerhans Cell Histiocytosis
Authors: Cox Nathaniel , Willis Pamelia
Published: September 2024

Objective

Langerhans cell histiocytosis (LCH) is a rare, idiopathic, cancer-like condition resulting from an overproduction of Langerhans cells. Disseminated LCH can spread across various anatomical systems, and prognosis is mainly dependent on organ involvement. Due to the rarity of this condition, potential neuropsychological effects are not fully understood. However, current research suggests that individuals with LCH are prone to develop various comorbid neuropsychiatric problems such as depression, anxiety, and impaired intellectual functioning.

Method

The current case is an 18-year-old, right-handed, Hispanic female who was diagnosed with LCH (brain and bone) in 2020. Cognitive symptoms began in 2016 at age 11. She was initially diagnosed with a low-grade glioma after a biopsy of a supracellular mass in 2017 but has developed various comorbid conditions since then. These include panhypopituitarism, NMDA encephalitis with behavioral disturbance, encephalomalacia, and epilepsy. She has undergone two 9-month rounds of chemotherapy and has been followed for neuroimaging with MRI and CT since 2017.

Results

Neuropsychological test findings from January 2024 indicated global deficits in intellectual functioning. Severe disruptions in sleep–wake cycle were also evident during testing. Although language abilities were relatively well preserved, abstract reasoning and executive functioning were greatly impaired. Psychological screeners also suggested anxiety and depression.

Conclusions

This case provides evidence of neurocognitive and psychiatric symptoms that can occur as a result of LCH and frequent comorbid health conditions. Neuropsychological testing can help monitor these effects on individuals with LCH across the lifespan.
A - 140 The Association between Executive Functioning and Adaptive Outcomes in Pediatric Brain Tumor Survivors
Authors: Thomas Christina , Okeke Chioma , Walsh Karen
Published: September 2024

Objective

Pediatric brain tumor (PBT) survivors are at high risk for cognitive and adaptive challenges. We aimed to examine the relationship between executive functioning (EF) and adaptive functioning in PBT survivors to identify critical cognitive skills that are associated with functional impact to inform intervention and transition to adulthood.

Method

Retrospective neuropsychological data was collected for 95 clinically referred PBT survivors (8–24 years). A composite EF measure was created based on the average of selected EF subtest scores. The associations between EF skills, parent-report of child adaptive functioning, and full-scale IQ were analyzed using descriptive statistics, correlations, and multiple regression.

Results

Adaptive functioning was significantly related to parent (r = −0.701, p < 0.001) and teacher ratings (r = −0.372, p = 0.004) of EF, the testing composite measure of EF (r = 0.455, p = 0.033), as well as FSIQ (r = 0.386, p < 0.001), general cognitive ability (r = 0.328, p = 0.003), working memory (r = 0.279, p = 0.007), and processing speed (r = 0.425, p < 0.001). Parent reports of EF were not significantly related to the EF testing composite score, but both significantly predicted adaptive functioning (p < 0.001). Of parent-reported domains of EF, self-monitoring was most predictive of overall adaptive functioning (B = −0.415, p = 0.017). FSIQ and age did not impact the relationship between parent reports of EF and adaptive functioning.

Conclusions

Overall, EF on both parent reports and testing, especially self-monitoring, was predictive of adaptive functioning in PBT survivors, regardless of age and overall intellectual functioning. Future research should further examine the impact of individual and treatment factors.
A - 142 Exploratory Analysis of the Cognitive Outcomes of Cognitive Behavioral Therapy for Insomnia (CBT-I) in Patients with Primary Brain Tumor
Authors: Fox Amber M , Lanoye Autumn , Zarrella Giuliana , Willis Kelcie D , Braun Sarah E , Loughan Ashlee R
Published: September 2024

Objective

Patients with primary brain tumor (PBT) experience declines in cognitive functioning and frequently endorse sleep disturbance. Our single-arm proof-of-concept trial of Cognitive Behavioral Therapy for Insomnia (CBT-I) in patients with PBT demonstrated clinically significant improvements in self-reported insomnia symptoms. The present study explored changes in patients’ subjective and objective cognitive functioning following completion of the six-week CBT-I intervention.

Methods

Participants with PBT and clinical insomnia (N = 35; Mage = 51.6 ± 11 years; 54.03 female) enrolled in a 6-week group-based telehealth CBT-I intervention. Participants completed pre-post-intervention subjective and objective cognitive assessments (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC QLQ-C30]; Hopkins Verbal Learning Test–Revised [HVLT-R], Oral Trail Making Test-B [OTMT-B], and Controlled Word Association Test [COWAT]). Within-group cognitive change was examined using established minimally important differences and reliable change indices.

Results

All participants demonstrated clinically stable subjective cognitive functioning from pre-to-post intervention. Individual analyses showed that 32 participants (91.4%) demonstrated clinically stable or improved verbal memory, 30 participants (85.7%) demonstrated clinically stable or improved divided attention, and all participants (100%) demonstrated clinically stable or improved phonemic fluency. Few participants demonstrated clinically significant decline in verbal memory (n = 2, 5.7%) or divided attention (n = 5, 14.3%).

Conclusions

Changes in both subjective and objective cognitive functioning were predominantly positive following a behavioral intervention for insomnia (CBT-I) among patients with PBT; however, these results should be viewed as preliminary. We will more thoroughly examine cognitive outcomes with a longer follow-up period in an upcoming randomized pilot trial of CBT-I in PBT.
A - 143 Organic Psychiatric Disorders Due to Frontal Lobe Neoplasms
Authors: Dabbagh Dania , Brett Jonathan
Published: September 2024

Objective

This current study seeks to explore the presentation of psychiatric disorders as a preliminary symptom in individuals who suffer from frontal lobe neoplasms.

Data Selection

The primary sources of information for this literature review were Google Scholar, PubMed, ScienceDirect, and the National Institute of Health (NIH). Search terms included frontal lobe tumors/neoplasms, primary brain tumors, psychiatric/psychological, acquired disorders, and pseudo-depression/mania. This search was limited to articles published in English from January 2014 to December 2023. Inclusion criteria were studies that focused on frontal lobe tumors and psychiatric manifestations as a result of illness. Exclusion criteria were studies older than nine years or studies that explored traits of psychiatric illness (i.e., aggression) as opposed to a psychiatric diagnosis.

Data Synthesis

Frontal lobe neoplasms, accounting for a significant percentage of PTBs, have been found to impact the psychological well-being of patients, leading to a range of psychiatric manifestations that may appear before physiological symptoms. These include mood disorders (i.e., depression, manic episodes), psychotic episodes, and personality disorders. Due to the complexities of the frontal lobe, these manifestations are not linearly linked to frontal lobe lesions.

Conclusion

This study’s findings advocate for a multidisciplinary approach to treatment, emphasizing the need for neuropsychological evaluations pre- and post-tumor resection. It calls for heightened awareness among clinicians to consider organic causes behind psychiatric presentations, especially in atypical cases or when traditional treatments fail. Ultimately, this research contributes to a deeper understanding of the neuropsychiatric consequences of frontal lobe neoplasms and paves the way for more targeted and effective interventions.
A - 144 Catfishing, Financial Fraud and Neuropsychological Mitigation
Authors: Clem Matthew
Published: September 2024

Objective

Literature implicates cognitively impaired older adults as vulnerable to financial fraud victimization. This case illustrates neuropsychological factors predisposing a younger adult to victimization in a romance scam and later involvement in a financial fraud scam.

Method

A 51-year-old female charged with theft, money laundering, and fraudulent schemes was referred by defense counsel due to apparent memory difficulties. She had been victimized via romance scam and then engaged in a financial fraud scam involving older adults. She had a history of anxiety and multiple previous dysfunctional/abusive romantic relationships. Neuropsychological history included benzodiazepine and alcohol abuse over the past 10–20 years with recent declines in memory, attention, processing speed, and decision-making. Recent head CT showed mild microvascular changes and sulci/ventricle enlargement.

Results

Performance validity testing was entirely within normal limits. Cognitive testing revealed mild to moderate decrements in verbal memory, novel problem-solving, and mental flexibility. Her profile was consistent with long-term alcohol abuse and benzodiazepine dependence. Symptom validity testing indicated significant minimization and positive impression management. Psychological testing revealed maladaptive personality traits with dependent and borderline features.

Conclusion

Psychological, neurocognitive, and interpersonal factors predisposed her to victimization in a romance scam, making her an “easy mark.” Despite having no financial incentive, she later became a “middle-man” in an international financial fraud scheme via her online romantic partner (i.e., handler). She was easily convinced and placated when she raised concerns about her involvement due to her neurocognitive deficits and dependent tendencies. Neuropsychological mitigation was presented, and the defendant was referred to a mental health diversion court and substance abuse treatment program.
A - 145 Cognitive Disengagement Syndrome in ALL Survivor
Authors: Nigro Sarah
Published: September 2024

Objective

Cognitive disengagement syndrome (CDS), previously known as sluggish cognitive tempo (SCT), presents with symptoms like mind-wandering, hypoactivity, and mental fogginess. There is a relatively high prevalence (23.7%) of CDS in survivors of acute lymphoblastic leukemia (ALL), although the neuropathology remains poorly understood, potentially involving autonomic nervous system dysfunction. Cognitive late effects, including slowed speed, inattention and executive dysfunction can occur post-cancer treatment. This case highlights the need for regular assessment of CDS, particularly in the pediatric cancer population. Given the symptom overlap it is important to discuss onset, duration, and variability of symptom presentation to rule-in/out the role of cognitive late effects.

Method

“Alex,” a 14-year-old, B cell ALL survivor, was struggling academically nine years post-treatment. She and parents reported slowness, fatigue, trouble concentrating, and social withdrawal, despite medical stability. She received two years of psychotherapy for anxiety and depression without improvement.

Results

Alex had average intellectual and cognitive functioning, with mild executive dysfunction. Despite reported slowness in daily activities, processing speed was average. Parent and self-report forms indicated significant problems with executive functioning, somatic symptoms, and inattention. Parents indicated significant symptoms on the SCT scale. Alex’s cognitive profile suggested ADHD-I with features consistent with CDS.

Conclusions

Discrepancies between testing scores and daily life challenges were inconsistent with cognitive late effects. Her physical symptoms (e.g., fatigue, social withdrawal) did not improve with mood as expected with depression. Identifying these discrepancies and symptom timeline was crucial in diagnosing CDS and guiding interventions, leading to a sense of relief and direction for Alex and her family.
B - 3 The Role of Artificial Intelligence: Utilization of the Meyers Battery for Diagnostically Differentiating a Complex Neuropsychological Case
Authors: Sica Robert B , Greco Steven P , Gallagher Eleonora , Scimemi Gianna
Published: September 2024

Objectives

As medical technology progresses, artificial intelligence (AI) is becoming a common method for providing diagnostic information to patients. In neuropsychology, the Meyers Neuropsychological Battery (MNB) provides impartial data through artificial intelligence. The following case illustrates how AI provided diagnostic clarity and aided in treatment planning.

Method

A 65-year-old female was referred by her neurosurgeon due to cognitive decline, delusions and hallucinations, and episodes of aggression toward her caretaker. A full, comprehensive neuropsychological examination was administered. Her medical history was remarkable for hypertension, hypercholesterolemia, thyroid cancer, two cerebrovascular accidents, traumatic brain injury, and multiple ischemic strokes. The patient’s most recent imaging was remarkable for chronic encephalomalacia involving the R basal ganglia, mild chronic small vessel ischemic changes, a ventricular shunt within the anterior horn of the R lateral ventricle, and post-coil embolization of a right supraclinoid artery.

Results

The patient was administered the MNB along with psychological measures. Results were consistent with diffuse and lateralized (RCH > LCH) neuropsychological impairment. Employing the MNB algorithms and AI, this patient’s data matched statistically with Multi-Infarct Dementia, Hydrocephalus, and Lewy Body Dementia.

Conclusion

These independent applications and AI enable neuropsychologists to respond beyond the “referral question” and provide an objective perspective unique to the patient’s neuropsychological profile. AI is not applied as the only diagnostic approach but rather provides the patient’s medical team with an alternative perspective regarding the entire neuropsychological picture. MNB’s AI not only aids in “matching” neurological conditions to the patient’s profile but also excludes proposed diagnoses in question and underscores a realistic treatment plan.
B - 8 Preemie-Pediatric Left Middle Cerebral Arterial Cerebrovascular Accident and Comorbid Focal Left Central Epilepsy: a Case Study
Authors: Nelson Fletcher , Smyth Chelsie
Published: September 2024

Objective

Literature regarding neurocognitive functioning in pediatric middle cerebral arterial (MCA) is limited. The aim of this study was to enhance the field’s knowledge and understanding of the presentation and impact of preemie-pediatric left MCA in utero with comorbid left-brain epilepsy in overall neurocognitive and behavioral functioning.

Method

The subject is a 12-year-old left-handed male with history of previously described events. The purpose of this evaluation was to determine current levels of neurocognitive and behavioral functioning as it relates to his medical history, treatment planning, and prognosis. Data collection was part of a pre-surgical consult to reduce epileptic activity.

Results

Results suggest overall cognitive functioning fell within the average range. However, relative difficulties in areas of attention and executive functioning were indicated. While all other domains were grossly intact, his profile indicates strengths in visual compared to verbal memory. Interestingly, the patient performed better on verbal tasks after a delay both with and without cuing. This suggests the presentation of a unique trait of pediatric epilepsy in that due to slowed processing speed as seen on the WISC, this patient is likely to remember more information over time. His academic achievements also fell within age-expectations.

Conclusions

This study impresses the importance of prompt neuropsychological evaluation in providing insight to the patient’s impairments and contribute to adaptive neurocognitive functioning moving forward. While idiopathic, this case demonstrates the need for continued research in pediatric-infantile infarct and provides the opportunity to improve the field’s understanding of the interpretation of similar cases.