bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symposium 13: Addressing Challenges in the Digital Assessment of Cognition: The Mobile Toolbox for Monitoring Cognitive Change
Authors: Nowinski Cindy 
Published: December 2023

Summary Abstract:Cognitive Impairment (CI) is estimated to affect more than 16 million people, the majority of whom are 65 and older (Centers for Disease Control and Prevention, 2011). Moreover, there are about 5.8 million Americans currently living with the most common type of dementia, Alzheimer’s Disease, which is projected to increase to 13.8 million people by 2050 (Alzheimer’s Association, 2020). Clearly, the ability to detect early indicators of and risk factors for brain disease AND differentiate these from typical cognitive aging is crucial to supporting healthy aging. To date, there are few sensitive assessment tools for detecting normal and abnormal cognitive change that can be widely deployed in diverse research designs and populations. In addition, clinicians and researchers struggle to conduct assessments with some of the most vulnerable populations because of access issues (e.g., rural communities, rare disease populations), which exacerbates healthcare disparities for these groups. Remote digital assessments can help overcome these barriers by enabling repeated testing in naturalistic conditions, reducing participant burden and expense, and increasing research accessibility for under-represented populations.This symposium will begin with an overview of the Mobile Toolbox (MTB), an app-based assessment tool and technology platform developed to address challenges in conducting longitudinal cognitive assessments over the adult lifespan. MTB enables completely remote, self-administered assessment using participants’ own smartphones with additional capabilities for study set-up and data management and analysis. Our second presentation describes the initial evidence for the reliability and validity of the eight core Mobile Toolbox Cognitive tests, as well as associations with age in a healthy population. The third presentation will describe one site’s experience using the MTB platform in a large, remote longitudinal study. The final presentation will consider the issues involved when studies utilize both in-person and remote assessment. Using the NIH Toolbox V3 Examiner version, from which several of the MTB tests were inspired, we will review the advantages and disadvantages of including remote assessments alone and in combination with face-to-face examination. To conclude, we will summarize the state of the current research and recommendations for neuropsychologists interested in using MTB in their future work.
4 Continuum of Measurement: Reviewing the Advantages and Disadvantages of Self-Administered Remote Cognitive Tests and Their Examiner Administered Alternatives
Authors: Hook Julie , Nowinski Cindy J. , Gershon Richard 
Published: December 2023

Objective:To describe advantages and disadvantages of using digital assessments remotely and in-person to inform clinical and research practice.Participants and Methods:As part of a larger study,1120 adults completed a battery of remotely administered tests (Mobile Toolbox) and a subset of this sample completed examiner administered in-person testing (NIH Toolbox® Cognition Battery). Attention was given to making the sample reflective of the US 2020 Census during participant recruitment. Of the 1120 participants, the majority of the sample were female (57%) and Caucasian (72%) and had a mean age of 45 (SD = 21). In terms of education, equal percentages had high school (34%) or some college (34%).Results:NIH Toolbox cognitive tests of processing speed, language, executive function, attention, and episodic memory were administered via a trained examiner and correlates of these tests were self-administered remotely via a smartphone. Using examples, we will show which aspects of cognitive assessment had the best correlations between remote self-administration and face-to-face examination and which had lower correlations.Conclusions:Digital remote assessments can help overcome barriers by enabling repeated testing in naturalistic conditions, reducing participant burden and expense, and increasing research accessibility for populations currently under-represented. Moreover, the ubiquity of internet-connected devices vastly increases opportunities to remotely monitor other dimensions relevant to cognition using smartphone apps and wearable sensors. In addition to improving access to testing, digitally administered assessments dramatically improve some individual’s tolerance to testing with shorter tests that can be administered via computer adaptive testing (CAT). Despite these benefits, some aspects of the cognitive assessment cannot be adequately replicated remotely and thus yield lower correlations to their examiner-administered alternatives. Clinical and research implications are discussed.
13 Money versus Feedback: Comparing Reward Types and Frequency on Cognitive Fatigue
Authors: Erani Fareshte , Stoll Harrison , Patel Darshan , Schultheis Maria T , Medaglia John D 
Published: December 2023

Objective:Cognitive fatigue (CF) is a common, yet poorly understood symptom in neurological disorders (e.g., multiple sclerosis, Parkinson’s disease, stroke). Studies show that reward plays a central role in CF. For instance, introducing or increasing reward often improves task performance. It is less clear, however, how reward affects subjective (self-reported) CF (SCF). This study examined the effect of reward type (monetary or performance feedback) and frequency (infrequent or frequent) on SF.Participants and Methods:In an online between-subjects study, 400 participants completed a computerized cognitive switching task and were randomly grouped into one of the five possible groups based on reward condition: [1] infrequent monetary reward, [2] frequent monetary reward, [3] infrequent performancefeedback reward, [4] frequent performance feedback reward, and [5] a no-reward group. SCF was assessed using the Visual Analog Scale of Fatigue (VAS-F) during the task. Mixed effects models were used to estimate the influence of reward type and frequency on task performance and SCF.Results:We found that the monetary groups were significantly faster (p<.001) compared to the feedback and no-reward groups, and that the frequent group was faster (p=.05) compared to the infrequent group. Reward type and frequency did not have a significant effect on VAS-F scores. However, when we looked at each reward group, we found that the monetary-infrequent reward group was associated with a decrease in VAS-F scores on average compared to the no-reward group (p=.04).Conclusions:The type and frequency of reward influence aspects of task performance (response time but not accuracy). Findings suggest that money had a greater effect on response time and may decrease SCF in cognitively healthy individuals when provided infrequently. Future studies should examine how these findings translate to clinical populations. Continued work is needed to understand how and which specific behavioral reward manipulations reduce fatigue, which could eventually lead to improved assessment and our ability to target fatigue across clinical populations.
48 Associations Between Cognitive Function and Social Networks in Older Adults: Quality and not Quantity?
Authors: Timblin Holly , Brown Lily F. , Landry Madison , Mosca Caroline , MacAulay Rebecca K. 
Published: December 2023

Objective:Larger social networks are linked to better cognitive function. However, little is known about the association of cognitive function with the composition of these networks in terms of the varying levels of closeness and supportive relationships. The present study explored whether social network size at different levels was differentially associated with cognitive function in a group of community-dwelling older adults.Participants and Methods:119 older adults (Mage= 70.71) from the Maine Aging Behavior Learning Enrichment Study completed a neuropsychological test battery measuring language, verbal memory, visuospatial memory, working memory, executive function, and processing speed abilities. The number and closeness of participants' relationships was measured using a Hierarchical Mapping Technique based on the Social Convoy model, in which participants included the names of people in their relational network within inner (closest), middle (close), and outer concentric circles.Results:Correlational analyses found that social network size at the total and middle-to-outer levels were statistically associated with education and better performance on measures of language, verbal memory, visuospatial memory, and executive function. However, no relationship emerged between the size of the innermost network level and cognitive function. Furthermore, statistically significant findings did not survive adjustments for the effect of education.Conclusions:Broader levels of support, rather than greater intimacy, were statistically associated with better cognitive performance. Consistent with previous research, greater education was associated with larger social networks. Future research is needed to understand whether higher levels of education or other factors mediate the observed relationship.
2 Vigilant Coping Moderates the Relationship between Discrimination and Memory among Black and Latinx Adults
Authors: Dixon Camryn , Avila-Rieger Justina F. , Manly Jennifer J 
Published: December 2023

Objective:In the U.S, Black and Latinx individuals disproportionately experience daily acts of discrimination. To counteract the psychological distress, many individuals develop coping mechanisms, like vigilant coping, where behaviors are modified to attempt to prevent discriminatory experiences. Researchers have investigated how coping mechanisms moderate the relationship between discrimination and psychological stress, but not their role in the relationship between discrimination and cognitive function. Prior research has shown a link between discrimination and poor episodic memory. The current study examined vigilant coping as a potential moderator in the relationship between discrimination and memory among Black and Latinx people.Participants and Methods:We partnered with 1317 non-Latinx Black (n= 291) and Latinx (n= 1026) individuals who participated in the Offspring Study of Racial and Ethnic Disparities in Alzheimer's Disease. Participants were assessed in English or Spanish, according to their preference. Experiences of discrimination were measured on two scales: Major (civil rights violations) and Everyday (daily hassles), and were coded according to yearly chronicity. Vigilance was measured among people with at least one reported experience of discrimination on either scale, using a 5-item survey which was dichotomized as low and high vigilant coping. The Selective Reminding Test, a 12-item word list task with 6 learning trials and a delayed recall trial, yielded scores for total immediate recall and delayed memory. Linear regression models were used to assess if vigilance moderated the relationship between discrimination and memory, with years of education and age as covariates.Results:Participants ranged in age from 27 to 91, with a mean age of 56.5 (SD=11.0) years, a mean education of 12.7 (SD=3.7) years, and were 67% women. High vigilant coping was associated with more experiences of major (b = 1.7, 95% CI = 0.9,2.5) and everyday (b = 90.3, 95% CI=66.2,114.3) discrimination. Memory was not associated with reported everyday discrimination, but lower delayed recall was observed among people who reported more experiences of major discrimination (b= -0.04, 95% CI = -0.07,-0.01). This relationship was moderated by vigilance, such that among people with low vigilant coping, major experiences of discrimination predicted lower memory (b= -0.06, 95% CI = -0.12,-0.01), but the association between discrimination and memory was weakened among people with high use of vigilant coping (b= -0.02, 95% CI = -0.05,0.01).Conclusions:This study builds on Black researchers' work that laid the foundations for examination of stress and coping in marginalized populations. Future studies on discrimination and cognitive health should consider coping mechanisms as key aspects of pathways linking structural racism and inequalities to cognitive health among Black and Latinx individuals.
5 Meta-Analysis of Cognitive Functioning Following Non-Severe COVID-19 Infection
Authors: Austin Tara A , Hodges Cooper , Darowski Emily , Thomas Michael L , Bergsmans Rachel , Parr Sarah , Lantrip Crystal , Twamley Elizabeth W. 
Published: December 2023

Objective:To effectively diagnose and treat cognitive post-COVID-19 symptoms, it is important to understand objective cognitive difficulties across the range of acute COVID-19 severity. The aim of this meta-analysis is to describe objective neuropsychological test performance in individuals with non-severe (mild/moderate) COVID-19 cases in the post-acute stage of infection (>28 days after initial infection).Participants and Methods:This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Inclusion criteria were established before the article search and were as follows: (1) Studies using adult participants with a probable or formal and documented diagnosis of COVID-19 in the post-acute stage of infection; (2) Studies comparing cognitive functioning using objective neuropsychological tests in one or more COVID-19 groups and a comparison group, or one group designs using tests with normative data; (3) Asymptomatic, mild, or moderate cases of COVID-19. Twenty-seven articles (n=18,202) with three types of study designs and three articles with additional longitudinal data met our full criteria.Results:Individuals with non-severe initial COVID-19 infection demonstrated worse cognitive performance compared to healthy comparison participants (d=-0.412 [95% CI, -0.718, -0.176)], p=0.001). We used metaregression to examine the relationship between both average age of the sample and time since initial COVID-19 infection (as covariates in two independent models) and effect size in studies with comparison groups. There was no significant effect for age (b=-0.027 [95% CI (0.091, 0.038)], p=0.42). There was a significant effect for time since diagnosis, with a small improvement in cognitive performance for every day following initial acute COVID-19 infection (b=0.011 [95% CI (0.0039, 0.0174)], p=0.002). However, those with mild (non-hospitalized) initial COVID-19 infections performed better than did those who were hospitalized for initial COVID-19 infections (d=0.253 [95% CI (0.372, 0.134)], p<0.001). For studies that used normative data comparisons, there was a small, non-significant effect compared to normative data (d=-0.165 [95% CI (-0.333, 0.003)], p=0.055).Conclusions:Individuals who have recovered from non-severe cases of COVID-19 may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.
7 P-Tau and Education as Moderators of the Relation between APOE4 and Memory Performance in Older Adults with Varying Cognitive Status
Authors: Jean Kharine , Gogniat Marissa , Robinson Talia , Stephen Miller L. 
Published: December 2023

Objective:White matter microstructure (WMM) potentially mediates the relation between APOE4 and memory performance. This study’s purpose was to understand whether p-tau effects this mediation model and whether education level differentially impacts the relations between these genetic and biological biomarkers’ influence on memory.Participants and Methods:Participants included 161 older adults (M=74 years, 40.4% female, 92% White, 74 e4 non-carriers, 87 e4 carriers) with subjective and objective cognitive impairment from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). A composite memory score created by ADNI was used as the outcome variable. Mean fractional anisotropy (FA) and radial diffusivity (RD) values of white matter tracts within regions of interest (i.e., fornix (FX), hippocampal cingulum (CGH)) were individually used as the measures of WMM. A moderated mediation was run to examine whether p-tau was a moderator of the mediation between APOE4, white matter microstructure, and memory. An exploratory dual moderated mediation analysis examined education as a moderator of the moderated mediation. Indirect effects were tested using bootstrapping procedures.Results:In the FA moderated mediation model, APOE4 was significantly related to FA of the fornix and memory performance. FA of the CGH and FX were also related to memory performance. With FA of the fornix as the mediator, the conditional indirect effect was not significant (95% CI[-.0009, .0070]). There was a trend suggesting at low (95% CI[-.2421, -.0140]) and average (95% CI[-.1658, -.0083]) levels of p-tau, FA of the fornix was a significant mediator but was non-significant at high levels of p-tau (95% CI [-.1322, .0341]). The RD moderated mediation model was non-significant. The FA and RD exploratory dual moderated mediation models were non-significant. However, the APOE4 x p-tau interaction with FA of the fornix as the mediator suggested a trend. At low levels of p-tau, increased education was related to a significant moderated mediation.Conclusions:Results suggest that FA of the fornix is a significant mediator between the relation of APOE4 and memory, and this may be dependent upon p-tau levels. When p-tau burden load was high, the path by which APOE4 impacts memory performance was not through white matter microstructure degradation. Additionally, the potential buffering effects of education may be most robust at lower levels of p-tau burden.
35 The Effect of Diagnostic Method on Racial Disparities in Mild Cognitive Impairment and Dementia Diagnosis Using the NACC Database.
Authors: Nosker Jennifer L , Aita Stephen L , Borgogna Nicholas C , Jimenez Tina , Walker Keenan A , Rhoads Tasha , Eloi Janelle M , Resch Zachary J , Del Bene Victor A 
Published: December 2023

Objective:Population studies have shown that Black individuals are at higher risk for MCI and dementia than White individuals but are more likely to be underdiagnosed or misdiagnosed. Although multiple contributory factors have been identified in relation to neurocognitive diagnostic disparities among persons of color, few studies have investigated race-associated differences in MCI and dementia classification across diagnostic methods. The current study examined the agreement of cognitive classification made via semi-structured interview and neuropsychological assessment.Participants and Methods:Only participants assigned normal cognitive status or cognitive impairment with presumed Alzheimer’s etiology were included in the study. Baseline visit data in the National Alzheimer’s Coordinating Center (NACC) dataset was collected to compare correspondence of cognitive classification (normal cognition, MCI, dementia) via semi-structured interview (Clinical Dementia Rating; CDR) with formal NACC diagnostic determination. NACC diagnostic determination was further separated by single clinician and consensus diagnostic methods. Inter-rater agreement was evaluated using chi-squared tests, and respective analyses were stratified for race (Black vs White), ethnicity (Hispanic vs Non-Hispanic), and education (<12 years vs. >12 years).Results:The sample size included 4,739 Black and 26,393 White participants across 43 Alzheimer’s Disease Research Centers (ADRCs). Inter-rater analyses between CDR (semi-structured interview) versus single-clinician and formal consensus NACC diagnostic methods showed strong (all (pc>.70) consistency in cognitive diagnoses overall, irrespective of race, ethnicity, and education. The percentage of agreement between diagnostic methods was nearly 100% for those categorized as cognitively normal or with dementia. However, the agreement for MCI was considerably lower (ranging from 28-74%) and revealed a disparity in diagnostic method between Black and White individuals. White individuals diagnosed with MCI via CDR (CDR total =0.5) were more likely to be labeled as having dementia regardless of NACC diagnostic method. However, Black individuals diagnosed with MCI via CDR were equally likely to be diagnosed as cognitively normal or with dementia via the formal consensus method.Conclusions:Irrespective of race and other demographic variables, diagnostic methods had high agreement for groups labeled with normal cognition and dementia. Agreement was consistently lower for the group labeled with MCI, with Black individuals having greater variability in diagnostic differentials when diagnosed via formal consensus method. The results of the study suggest that neuropsychological assessment continues to be an integral component of diagnosing individuals with MCI, reducing possible sources of bias.
Spirituality moderates the relationship between cancer caregiver burden and depression
Authors: La In Seo , Johantgen Meg , Storr Carla L. , Zhu Shijun , Cagle John G. , Ross Alyson 
Published: December 2023

AbstractObjectivesCancer has become a chronic disease that requires a considerable amount of informal caregiving, often quite burdensome to family caregivers. However, the influence of spirituality on the caregivers’ burden and mental health outcomes has been understudied. This study was to examine how caregiver burden, spirituality, and depression change during cancer treatment and investigate the moderating role of spirituality in the relationship between caregiver burden and depression for a sample of caregivers of persons with cancer.MethodsThis secondary analysis used a longitudinal design employing 3 waves of data collection (at baseline, 3 months, and 6 months). Family caregivers completed the Caregiver Reaction Assessment, Spiritual Perspective Scale, and the PROMIS® depression measure. Linear mixed model analyses were used, controlling for pertinent covariates.ResultsSpirituality, total caregiver burden, and depression remained stable over 6 months. More than 30% of the caregivers had mild to severe depressive symptoms at 3 time points. There was evidence of overall burden influencing depression. Of note was a protective effect of caregivers’ spirituality on the relationship between depression and caregiver burden over time (b = −1.35, p = .015). The lower the spirituality, the stronger the relationship between depression and burden, especially regarding subscales of schedule burden, financial burden, and lack of family support.Significance of resultsSpirituality was a significant resource for coping with caregiving challenges. This study suggests that comprehensive screening and spiritual care for cancer caregivers may improve their cancer caregiving experience and possibly influence the care recipients’ health.