Word finding or “naming” difficulty is a symptom of multiple neurological disorders; therefore, naming assessment is an integral component of neuropsychological evaluation. Prior work has found weaker second-language naming in healthy proficient bilingual youth than monolingual youth, and similar findings have been shown in adults with epilepsy. Considering the potential influences of both early onset epilepsy and bilingualism on brain development, we compared naming in English second language (ESL) and monolingual youth with epilepsy. To assess the impact of bilingualism independent of the known effects of seizure laterality (i.e., poor naming in those with left, dominant-hemisphere seizures), we excluded patients with left language dominance and unilateral seizures. We hypothesized that like other groups, naming would be weaker in ESL than in monolingual youth with epilepsy.

Participants included 84 children with seizures that could not be lateralized clinically (n=36), bilateral seizures (n=20), centrotemporal spikes (n=3), and those with unilateral seizures and atypical language dominance (n=25), ages 6-15 years old: 66 monolingual, English (mean age: 10.87 ± 2.70 years) and 18 ESL (mean age: 10.78 ± 2.88 years). Those with FSIQ < 70 and vocabulary SS < 6 were excluded to ensure English proficiency. Independent samples t-tests, multivariate ANOVA, and chi-square tests compared groups on demographic factors and test performance. All measures (FSIQ, WISC/WASI Vocabulary, letter and category fluency, Children’s Auditory (AN) and Visual Naming (VN) Tests) were administered in English.

Monolingual and ESL groups did not differ in: age, sex, SES, seizure type (i.e., non-lateralized, bilateral, centrotemporal spikes, or atypical language dominance), epilepsy onset age, or number of AEDs. Comparisons also showed no differences in FSIQ, vocabulary, letter fluency, or category fluency (all ps > 0.05). By contrast, auditory and visual naming performances were weaker among ESL patients than monolingual patients: AN accuracy, F(1,81) = 10.89, p = 0.001; AN tip-of-the-tongues (TOTs), F(1,81) = 6.35, p = 0.014; AN Summary Scores (SS), F(1,81) = 6.17, p = 0.015; VN accuracy, F(1,81) = 4.66, p = 0.034; VN SS, F(1,81) = 4.87, p = 0.030, with the exception of VN TOTs, which approached significance, F(1,81) = 3.55, p = 0.063.

Consistent with findings in bilingual healthy youth and ESL adults with epilepsy, naming in ESL youth with epilepsy was weaker than in monolingual children. The groups did not differ on other aspects of language. Thus, unlike other expressive verbal functions, naming is adversely affected in the second language of bilingual people with epilepsy across the age span. These results suggest that poor naming in ESL patients cannot be used to infer a naming deficit, and/or left (dominant) temporal lobe dysfunction.

Cognitive disengagement syndrome (CDS; previously known as “sluggish cognitive tempo” or SCT) refers to a set of behavioral symptoms characterized by slowed thinking/behavior, daydreaming, and mental fogginess or confusion. It has been described as related to, yet separate from, symptoms associated with Attention-deficit Hyperactivity Disorder (ADHD) inattention. There is a paucity of research on CDS within pediatric epilepsy populations despite substantial risk factors inherent to the disorder and a large proportion of patients with comorbid ADHD. This study therefore describes CDS as reported by parents for a large sample of children with epilepsy. Relationship between epilepsy variables (e.g., number of antiepileptic drugs [AEDs], seizure frequency, seizure type) and CDS symptoms was explored. Additionally, considering the negative association between CDS and academic performance in other populations, the relationship between parentrated CDS and academic risk factors was examined.

Participants included 151 children with epilepsy (mean age = 11y, range 6-18y; 55% male; IQ>70), referred for outpatient neuropsychological assessment. As part of routine clinical care, parents completed the Penny Sluggish Cognitive Tempo Scale (SCT) and the Colorado Learning Difficulties Questionnaire (CLDQ). Scores and basic demographic information were extracted from an IRB approved clinical database; the IRB granted approval for retrospective chart review to extract additional medical variables. Parent report of CDS included total CDS score and three subdomains: Sleepy/Sluggish, Low Initiation, and Daydreamy. Higher scores represent greater parent-reported difficulties. Independent samples t-tests compared the participants’ means on total CDS and each subdomain to the normative sample. Analysis of variance was conducted to determine differential impact of seizure type (Generalized, Focal, or Multifocal) on total CDS and each subdomain. Correlations between other medical variables, scores on the CLDQ, and parent ratings on the SCT were examined.

Parents of children with epilepsy rated overall CDS total and subdomain scores as significantly higher compared to the normative means with highest elevation in symptoms of Low Initiation (p = <.001). Total CDS was associated with increased parent-reported academic difficulties; however, of the three subdomains, only Low Initiation was significantly associated with concerns for academic functioning. Number of AEDs was associated with increased symptoms on the Sleepy/Sluggish subdomain only. Seizure frequency was associated with total CDS and Sleepy/Sluggish symptoms, though this finding is likely mediated by increased number of AEDs for those with more frequent seizures. Seizure type was not associated with significant differences in Total CDS or CDS subdomains.

Children with epilepsy are at increased risk for experiencing slowed thinking and cognitive disengagement. Low initiation is particularly elevated in pediatric epilepsy populations, which may lead to increased academic difficulties. Potential interventions targeting low initiation may therefore have benefit in the academic setting for children with epilepsy, regardless of epilepsy type.

Pediatric patients with frontal lobe epilepsy (FLE) have higher rates of attention deficit hyperactivity disorder (ADHD), as well as executive functioning (EF) and fine motor (FM) challenges. Relations between these constructs have been established in youth with ADHD and are supported by FM and EF skill involvement in frontal-subcortical systems. Still, they are not well understood in pediatric FLE. We hypothesized that poorer FM performance would be related to greater executive dysfunction and ADHD symptomatology in this group.

47 children and adolescents with FLE (AgeM=12.47, SD=5.18; IQM=84.07; SD=17.56; Age of Seizure OnsetM=6.85, SD=4.64; right-handed: n=34; left-handed: n=10; Unclear: n=3) were enrolled in the Pediatric Epilepsy Research Consortium dataset as part of their phase I epilepsy surgical evaluation. Participants were selected if they had unifocal FLE and completed the Lafayette Grooved Pegboard (GP). Seizure lateralization (left-sided: n=19; right-sided: n=26; bilateral: n=2) and localization were established via data (e.g., EEG, MRI) presented at a multidisciplinary team case conference. Patients completed neuropsychological measures of FM, attention, and EF. Parents also completed questionnaires inquiring about their child’s everyday EF and ADHD symptomatology. Correlational analyses were conducted to examine FM, EF, and ADHD relations.

Dominant hand (DH) manual dexterity (GP) was related to parent-reported EF (Behavior Rating Inventory of Executive Function, Second Edition [BRIEF-2]-Global Executive Composite [GEC]: r(15) =-.70, p<.01, d=1.96). While not statistically significant, medium to large effect sizes were found for GP DH and parent-reported inattention (Behavior Assessment System for Children, Third Edition [BASC-3]-Attention Problems: r(12)=-.39, p=.17, d=.85) and hyperactivity/impulsivity (BASC-3-Hyperactivity: r(11)= -.44, p=.13, d=.98), as well as performance-based attention (Conners Continuous Performance Test, Third Edition -Omission Errors: r(12)=-.35, p=.22, d=.41), working memory (Wechsler Intelligence Scale for Children - Fifth Edition [WISC-V]-Digit Span [DS]: r(19)=.38, p=.09, d=.82) and cognitive flexibility (Delis-Kaplan Executive Function System (D-KEFS) Verbal Fluency Category Switching: r(13)=.46, p=.08, d=1.04); this suggests that these relations may exist but that our study was underpowered to detect them. Non-dominant hand (NDH) manual dexterity was related to performance-based working memory (WISC-V-DS: r(19)=.50, p<.01, d=1.12) and cognitive flexibility (D-KEFS-Trails Making Test Number-Letter Switching: r(17)=.64, p<.01, d=1.67). Again, while underpowered, medium to large effect sizes were found for GP NDH and parent-reported EF (BRIEF-2 GEC: r(15) =-.45, p=.07, d=1.01) and performance-based phonemic fluency (D-KEFS-Letter Fluency: r(13)=.31, p=.20, d=.65).

Our findings suggest that FM, EF, and ADHD are related in youth with FLE; however, these relations appear to vary by skill and hand. We posit that our findings are due in part to the frontal-cerebellar networks given their anatomic proximity between frontal motor areas and the dorsolateral prefrontal cortex - as well as their shared functional involvement in these networks. Future studies should evaluate the predictive validity of initial FM skills for later executive dysfunction and ADHD symptomatology in FLE. If such relations emerge, contributions of early FM interventions on EF development should be examined. Further replication of these findings with a larger sample is warranted.

A rich literature exists on cognitive changes related to focal injury in the adult brain. In contrast, the developing brains of children are less understood. In contrast to adult cases, 20% to 25% of perinatal strokes result in language disorder regardless of lesion lateralization. Existing literature suggests children with perinatal stroke may present with a range of executive functioning and visuospatial processing difficulties. Gross and fine motor challenges are also likely to occur. Furthermore, these children have an increased prevalence of autism spectrum disorder (ASD) and carry the highest risk for epilepsy. Despite growing research on neurodevelopmental profiles in patients with perinatal stroke, published literature is limited.

Our study examines neurodevelopment of a 2-year-old, right-handed male with a history of perinatal ischemic right middle cerebral artery (MCA) stroke, infantile spasms, and left hemiparesis following right hemispherectomy for seizure management who underwent two neurodevelopmental evaluations at our medical center over approximately 3 years.

Findings from the patient’s evaluation with the Mullen Scales of Early Learning revealed overall cognitive ability in the low average range (SS = 89, 23rd percentile); however, notable variability was seen in his performance. His receptive language was average (SS = 98, 45th %tile) and consistent with previous evaluation results, and he has made gains in visual reception (from SS = 75, 5th %tile to SS = 91, 27th %tile) and expressive language (from SS = 55, 0.1st %tile to SS = 70, 2nd %tile). In addition, his gross motor was exceptionally low (SS = 55, 0.1st %tile) and consistent with previous evaluation results. Fine motor was low average (SS = 84, 14th %tile).

Our patient showed cognitive gains in language and visual reception since his prior evaluation despite history of right MCA stroke and right hemispherectomy. Improvements are likely due to a combination of early brain plasticity and intensive therapies he has received. Consistent with published findings in this population, he experienced seizures associated with his stroke. Our results add to the limited literature on neurodevelopmental challenges associated with perinatal stroke and progress that can be made when appropriate supports are provided early and consistently.

To examine whether suboptimal performance as determined by formal validity testing would predict neurocognitive scores in a sample of 83 pre-surgical, non-litigating epilepsy patients.

Participants were 83 patients who underwent comprehensive outpatient neuropsychological testing as part as their evaluation as epilepsy surgery candidates. The sample consisted of 41 females and 42 males, with 72 patients identifying as White, 5 as Black, 2 as Hispanic, 1 as Asian, and 2 as other. Mean age was 36 (SD=12.4) mean FSIQ was 87 (SD=12.7), mean years of education of 12.9 (SD=2.1). Each patient’s assessment included a stand-alone performance validity test (PVTs)— Word Memory Test (WMT), the Test of Memory Malingering (TOMM), or the Medical Symptom Validity Test (MSVT)—as well as two embedded measures of validity—the California Verbal Learning Test Forced Choice (CVLT FC) and WAIS-IV Reliable Digit Span (RDS). Pass/fail rates were analyzed, with valid performance being defined as pass score on at least two of the completed PVTs (N=73 Pass Effort group 86.9%; N=10 Failed Effort group 11.9%). Point-biserial Pearson correlations were conducted to determine the relationship between validity pass/fail status and WAIS-IV FSIQ, VCI, and PRI scores, CVLT-II Trials 1-5 Total T scores, CVLT-II Long Delay Free Recall z scores, WMS-III Logical Memory II T scores, BVMT Total Recall T scores, BVMT Delayed Recall T scores, and Trail Making Test (TMT) B T scores.

Significant relationships were found between Failed Effort group and all neurocognitive scores except BVMT Total Recall. On average, the Failed Effort group obtained significantly lower FSIQ (M=76.57, SD=10.94), VCI (M=80.89, SD=16.03), PRI (M=81.00, SD=14.91), CVLT-II Trials 1-5 Total (M =34, SD=6.89), CVLT-II Long Delay Free Recall (M =-2.44, SD=1.43), WMS-IV Logical Memory II (M =4.83, SD=2.79), BVMT Delayed Recall (M=26.38, SD=6.41), and TMT B (M=29.70, SD=11.46) standard scores compared to the Pass Effort group (FSIQ M=88.09, SD=12.52; VCI M=92.13, SD=13.61; PRI M=91.14, SD=12.06; CVLT-II Trials 1-5 Total M=47.86, SD=12.02; CVLT- II Long Delay Free Recall M=-.44, SD=1.11; WMS-III Logical Memory II M=8.41, SD=3.17; BVMT Delayed Recall M=39.19, SD=12.66; TMT B M=39.34, SD=13.18). Correlation coefficients were r=-.266* (FSIQ), r=-.255* (VCI), r=-.271* (PRI), r=.361**(CVLT-II Total), r=-.474** (CVLT-II LDFR), r=-.298** (WMS-IV LM II), r=-.308** (BVMT DR), and r=-.240* (TMTB). All coefficients were significant at the .05 (*) or .01 (**) level.

Results suggest that pass/fail status on formal validity testing predicts depressed performance on a variety of neurocognitive measures. Therefore, predicting surgical outcome of resection/ablation (e.g., compensation of contralateral hemisphere) should not be based upon neuropsychological memory performance alone when there are failures on tests of engagement as memory scores have strong correlations to pass/fail status on formal validity testing. Overall, this emphasizes the importance of routinely integrating PVTs as part of pre-epilepsy surgery neuropsychological evaluations.

Little research exists characterizing the neuropsychological profile of pediatric insular epilepsy. Accurate diagnosis of insular epilepsy is challenging due to difficulties localizing deep brain structures with current non-invasive neurodiagnostic tools, as well as seizure semiology that may mimic temporal, frontal, and parietal seizures for this patient population [1]. Therefore, we investigated trends across neuropsychological data to help characterize the cognitive profile of pediatric insular epilepsy. This is important because studies that could accurately characterize insular epilepsy into cognitive phenotypes could potentially provide supporting evidence for insular localization during epilepsy surgery work-up. The insula is situated underneath the temporal, parietal, and frontal opercula, and has a number of diffuse projections to key brain structures involved in language, executive functioning, motor coordination, and sensory function [2]. Therefore, we hypothesized that children with insular epilepsy will demonstrate particular weaknesses in language and executive functioning skills.

Retrospective medical records review identified 19 children with insular epilepsy who completed neuropsychological assessment (Age: M=8.2 years, SD=3.4) at Boston Children’s Hospital. Insular epilepsy was defined by ictal insular localization on long-term monitoring EEG. The current sample includes 59% males and 41% females. The majority of participants (69%) had left sided lateralization and more than one seizure type (63%). MRI findings were widely distributed across frontal, temporal, and multiple lobes as well as insular and perisylvian brain regions. A lesion was identified on MRI findings for most participants (63%).

Descriptive analyses showed that overall IQ (FSIQ: M=84, SD=12, range=68-102) fell in the Low Average range. Verbal and visual reasoning skills were equally developed in the Low Average range (VIQ: M=88, SD=12, range=70-104; PIQ: M=88, SD=16, range=53-117). Participants exhibited lower performance on speeded expressive language measures, including measures of phonemic fluency (M=5.5, SD=1.5, range=2-8) and semantic fluency (M=6.7, SD=2.5, range=3-11). With regard to executive functioning, reduced cognitive flexibility was observed on D-KEFS Trail Making Test (Trial 4, Number-Letter Switching: M=5.9, SD=4.9, range=1-12). Additionally, working memory skills fell in the Below Average range (WMIQ: M=77, SD=8.5, range=67-88).

Our results indicate that pediatric patients with insular epilepsy present with reduced scores across aspects of speeded expressive language and executive functioning, including working memory and cognitive flexibility. Additional research is needed to replicate these preliminary findings with a larger sample size and determine whether these trends in cognitive profile would help with seizure localization. Future research should investigate whether insular epilepsy has a clearly identifiable and distinct cognitive phenotype that could be helpful in differential diagnostic workup.

Previous studies have demonstrated a high prevalence of social and emotional problems in young adults with a history of childhood epilepsy, with social skill impairment hypothesized to play a significant role in these outcomes. Few studies have examined social skills within children with epilepsy and very few have examined this within the context of other neuropsychological and neurological variables. This study aims to examine the association between social problems and other relevant neuropsychological variables (IQ, adaptive functioning, social skills) within the pediatric epilepsy population.

Participants were 86 epilepsy patients between the ages 5 and 18 years of age who were referred for neuropsychological assessment as a part of their surgical candidacy work-up. Pearson correlation analysis was conducted to examine the correlations between performance on objective measures of full-scale IQ, and parent ratings on questionnaires assessing parent perception of the patients’ overall adaptive functioning, social skills, and social problems.

As expected, earlier age of onset was associated with lower IQ, which itself was associated with weaker overall daily living skills and social skills. Later age of seizure onset was associated greater social problems. Social skills were not correlated with social problems.

The results of this study suggest that children with later age of onset of seizures, are at increased risk of social problems and that these problems may not related to social skill impairment. Implications for clinical practice and future directions are discussed.

Epilepsy is a chronic neurological disease, and surgery is a common treatment option for persons who do not respond to medication. Neuropsychology plays an important role in the epilepsy presurgical workup, characterizing the cognitive functioning of patients with epilepsy as well as assisting in the determination of which hemisphere seizures originate in the brain through testing of different cognitive functions. NeuroQuant is a relatively newer software that analyzes clinical neuroimaging to quantify brain volume. The objective of this study was to determine if changes in left versus right total hippocampal volume predicted changes in verbal versus nonverbal memory performance.

Cognitive performance and NeuroQuant bilateral hippocampal volume were examined in a cross-sectional sample of 37 patients with epilepsy. All patients had undergone a comprehensive presurgical neuropsychological evaluation as well as magnetic resonance imaging (MRI) and these results were analyzed using a series of linear regression analyses.

Total left hippocampal volume was a significant predictor of delayed verbal free recall (RAVLT F(1, 31) = 4.79, p< .036, RA2 = 0.13, and ß=.37, p<.036). Even when controlling for the effects of biological sex, education, and depression, left hippocampal volume remained a significant predictor (ß=.42, p<.025). Total left hippocampal volume did not predict other verbal memory scores. Total right hippocampal volume was a significant predictor of delayed nonverbal figure recall (RCFT F(1, 31)= 6.46, p<.016), RA2 = .17 and ß=.42) p<.016). When controlling for the effects of biological sex, education, and depression, right hippocampal volume remained a significant predictor (ß=.404, p<.026). Total right hippocampal volume did not predict other nonverbal memory scores.

These findings validate prior research demonstrating the importance of the left hippocampus in verbal memory and right hippocampus in nonverbal memory. Findings also demonstrate the clinical utility of neuropsychological evaluation in determining laterality in the epilepsy presurgical workup process, as well as support NeuroQuants’ inclusion as an additional consideration in that process.

Approximately half of all children and adults newly diagnosed with epilepsy also show behavioral and/or cognitive difficulties upon evaluation. While neuropsychological screening is recommended as a routine part of care at seizure onset, in reality, access to care is often restricted by many factors. In order to better define the extent of the problem, we developed a survey to understand how frequently youth with new onset epilepsy currently undergo neuropsychological evaluation or screening and whether virtual assessment tools are used to extend access to care.

We created an online survey to better understand new onset epilepsy care provided within neuropsychological practice settings in the United States and Canada. The survey was disseminated via multiple listservs (e.g., AACN listservs, APPCN, PERF neuropsychologists) and respondents included 45 neuropsychologists. Survey questions were grouped by the following domains: 1) location characteristics (e.g., urban versus rural location, type of practice, affiliation with comprehensive epilepsy center); 2) volume of new onset epilepsy patient cases (e.g., number of neuropsychologists within practice who see new onset patients, percentage of new onset cases who received neuropsychological evaluations/screeners, wait time), and 3) tele-neuropsychology procedures (e.g., use of virtual testing, frequency of virtual testing, frequency of virtual intakes/feedbacks).

Practice locations of the 45 respondents included academic medical center (n=34, 75.6%), community medical center (n=10, 22.2%), and private practice (n=1, 2.2%). All but one respondent practiced in an urban setting. Respondents were generally affiliated with Comprehensive Epilepsy Centers (level 3 or 4) (n=39, 86.7%). Practice settings typically included < 3 epilepsy neuropsychologists (n=29, 65.9%). Of interest, neuropsychological evaluation of new onset pediatric epilepsy patients generally ranged from 0-25% of cases (n=32, 71%; mode=11-25%). Reported barriers included: insurance, poor access to rural populations, interdisciplinary communication, departmental referral patterns, limited number of providers, and need to prioritize pre-surgical patients. In terms of access, neuropsychology waitlist times for patients with nonsurgical epilepsy ranged from <1 to 6 months (n=34, 75%) with an equal proportion of patients waiting 1-3 months (33%) and 4-6 months (33%). Telehealth was not frequently utilized in non-surgical epilepsy test administration (Do not use, n=39; 86.7%), but frequently incorporated for non-testing purposes (i.e., intakes, feedbacks) (n=40, 88.9%).

Results of this provider survey indicate that children with new-onset epilepsy do not routinely undergo neuropsychological evaluation (< 25%). Barriers included prioritizing presurgical workups, referral patterns, access to care, and limited provider bandwidth. Clearly, there is a need to improve access to care. Possible solutions include developing more time efficient screening batteries with measures most sensitive to early cognitive and psychosocial deficits, and incorporating the use of virtual technology all in the service of improving the lives of children with epilepsy.

Periventricular nodular heterotopia (PVNH) is a malformation of cortical development (MCD) characterized by aggregates of gray matter adjacent to the lateral ventricular walls. Clinical presentation is heterogeneous with higher rates of seizures and reading impairments typically in the setting of average IQ (Felker et al. 2011). The majority of neuropsychological inquiry has focused on reading fluency, though a single case study showed a neurocognitive profile consistent with nonverbal learning deficits in a 7-year old boy with suspected autosomal dominant bilateral heterotopia (McCann et al., 2008). Given the periventricular focus and potential for unilateral presentations, non-linguistic neurocognitive sequelae may be expected in cases affecting the non-dominant hemisphere, yet this remains largely unexplored. Surgical ablation by laser interstitial thermal therapy (LITT) is increasingly used for epilepsy management in PVNH (Thompson et al., 2016, Whiting et al. 2020). However, there are no reported studies exploring cognitive outcomes following LITT of focal PVNH.

A 46-year-old, right handed, Black female with 16 years of education presented for management of medically refractory epilepsy. Epilepsy monitoring captured intermittent slow waves in the right temporal lobe, interictal polyspikes in the right temporal lobe, and three epileptic events all emanating from the right temporal lobe. MRI showed extensive migrational anomalies involving the right hemisphere posteriorly consistent with PVNH with no associated mesial temporal sclerosis. Pre-surgical neuropsychological evaluation showed a significant split in IQ, with verbal IQ = 99 and performance IQ = 76. Testing indicated circumscribed deficits in visuoperceptual judgement, visuoconstruction, visuospatial reasoning, non-verbal recall, and several executive weaknesses in the context of otherwise average neurocognitive functioning. Fine motor speed was impaired bilaterally. Her profile was suggestive of non-dominant fronto-parieto-temporal dysfunction, concordant with the remainder of her work-up. By history she reported longstanding academic weaknesses in math and organization with strong verbal and reading abilities.

The patient underwent partial LITT of right PVNH sparing areas involved in visual function. At 6-month follow-up she was seizure free (Engel outcome 1A). Post-surgical neuropsychological evaluation showed reliable improvements in perceptual reasoning, aspects of learning/memory, and verbal naming. Visuoconstruction remained impaired but qualitatively improved. She also reported subjective experience of improved mental clarity and was applying for jobs after regaining driving privileges.

This case demonstrates symptoms and history concerning for a nonverbal learning disorder in an adult woman with epilepsy secondary to right hemisphere PVNH and underscores the importance of exploring the range of neurocognitive profiles in MCD. Her notable neurocognitive and functional improvements following surgical ablation and seizure freedom suggest a possible release of function in the absence of inhibitory neurophysiological influences. This raises interesting questions about the endurance of her developmental profile. This case report contributes to our understanding of neuroanatomical correlates of neurocognitive and neurodevelopmental presentations. Future investigations should explore neuropsychological changes following LITT for PVNH.

“Brain fog” is one of the most common consequences of developing COVID-19. The available research focuses mainly on the decline in overall cognitive performance. Much less papers refers to the evaluation of particular cognitive domains, and when it does, it focuses particularly on attention and memory disorders. The available data on the effects of COVID-19 infection on visuospatial functions is sparse, so the aim of this study was to investigate the level of visuospatial functioning in adults who have a history of COVID-19 infection. It was also intended to explore whether there is a protective effect of vaccination on the cognitive functioning after COVID-19.

The group included sixty volunteers (age: M = 40.12, SD = 16.78; education: M = 12.95 SD = 2.25; sex: M = 20, F = 40) - thirty seven with a history of COVID-19 and twenty three who were never infected with SARS-COV-2. Of those with a history of COVID-19, twenty-four were vaccinated at the time of the disease, and thirteen were not. Subjects from individual groups did not differ demographically. Participants were examined with a set of neuropsychological tests to assess: a) general cognitive functioning - Montreal Cognitive Assessment (MoCA), b) attention - d2 Test of Attention, memory - Rey-Osterieth Complex Figure - delayed recall, and c) visuospatial functions - Rey-Osterieth Complex Figure - copy, Block Design - subtest of WAIS-R and three experimental tasks consisting of: incomplete pictures, rotating puzzles, counting cubes in a 3D tower.

Subjects who had a history of COVID-19 achieved significantly lower scores in the MoCA test (p = 0.033) compared to those who did not suffer from COVID-19. They also needed more time in mental rotation task (p = 0,04). Statistically significant differences were also found in the d2 Test of Attention GP score (p = 0.001). Moreover, in group of adults who had a history of COVID-19, statistically significant differences were found between the vaccinated and unvaccinated subjects. It turned out that those who were vaccinated during their illness performed significantly better than those who were unvaccinated in the following cognitive domains: attention (d2 Test of Attention) and visuospatial functions (Rey-Osterieth Complex Figure test - copy, Block Design from WAIS-R, as well as experimental trials: incomplete pictures, rotating puzzles, counting cubes).

Among adults who have been infected with COVID-19, there is a decrease in general cognitive performance, but also in individual cognitive abilities, including visuospatial functions. Vaccination significantly reduces the risk of cognitive impairment.

Growing evidence indicates that COVID-19 infection adversely impacts cognitive functioning, with COVID-19 patients demonstrating high rates of objective and subjective cognitive impairments (Daroische et al., 2020; Miskowiak et al., 2021). Given the prevalence and potentially debilitating nature of post-COVID-19 cognitive symptoms, understanding factors that mitigate the impact of COVID-19 infection on cognitive functioning is paramount to developing interventions that facilitate recovery. Resilience, the ability to cope with and grow from challenges, has been associated with improved cognitive performance in healthy adults and linked to decreased perceived cognitive difficulties in post-COVID-19 patients (Connor & Davidson, 2003; Deng et al., 2018; Jung et al., 2021). However, resilience has not yet been examined as a potential attenuator of the relationship between COVID-19 and either perceived or objective cognitive function. This study aims to investigate the role of resilience as a protective factor against experience of cognitive function difficulties in COVID-19 patients by probing the role of resilience as a moderator of the relationship between COVID-19 diagnosis and cognitive functioning (both perceived and objective).

Participants (mean age=36.93, 30.10% male) were recruited from British Columbia and Ontario. The sample included 53 adults who had never been diagnosed with COVID-19 and 50 adults diagnosed with symptomatic COVID-19 at least three months prior and not ventilated. Participants completed online questionnaires (n=103) to assess depression (the Center for Epidemiological Studies Depression Scale), anxiety (7-item Generalized Anxiety Disorder Scale), subjective cognitive functioning (The Subjective Cognitive Decline Questionnaire), and resilience (2-item Connor-Davidson Resilience Scale). Participants then completed neuropsychological tests (n=82) measuring attention, processing speed, memory, language, visuospatial skills, and executive function via teleconference, with scores averaged to create a global objective cognition score. Moderated multiple regression was employed to assess the impact of resilience on the relationship between COVID-19 diagnosis and both objective and perceived cognition, controlling for gender, ethnicity, income, age, anxiety, and depression.

Average scores in the COVID-19 group exceeded diagnostic cut-offs for clinical depression (M=16.67, SD=10.77) and mild anxiety (M=5.27, SD=4.99), while the control group scored below diagnostic thresholds for depression (M=11.96, SD=9.76) and mild anxiety (M=4.48, SD=5.07). Controlling for sociodemographic and mental health characteristics, COVID-19 diagnosis was not associated with objective global cognitive functioning (b=-.07, se=1.71, p=.624) or subjective cognitive functioning (b=.16, se=1.32, p=.12), nor was resilience associated with objective global cognitive functioning (b=.19, se=1.50, p=.44) or subjective cognitive functioning (b=-.02, se=1.09, p=.89).

Findings indicate that COVID-19 patients may be at risk for depression and anxiety. Results of this study fail to support a relationship between COVID-19 and cognitive functioning beyond the impact of sociodemographic and mental health variables. Thus, the role of resilience as a protective factor against COVID-19 related cognitive difficulties could not be fully explored. However, findings should be considered in the context of study limitations, including a small sample size. Future research should employ larger samples to further examine the relationship between COVID-19 infection and cognition, focusing on mental health characteristics and resilience as potential risk and protective factors.

Central nervous system (CNS) infections with the dematiaceous fungus Cladophialophora bantiana (C. bantiana) are extremely rare, with approximately 120 confirmed cases reported as of 2016. C. bantiana is a highly neurotropic and thermotolerant fungus found in soil worldwide. The mode of entry into the CNS remains unknown, but inhalation of fungal spores or subcutaneous trauma have been suggested. Entry of fungal spores can cause cerebral phaeohyphomycosis with the main clinical manifestation of a brain abscess. Symptoms are non-specific and can include headache, fever, hemiparesis, aphasia, visual disturbances, and confusion. C. bantiana cerebral phaeohyphomycosis occurs in both immunocompetent and immunocompromised individuals, with a slightly higher prevalence in immunocompetent males for unknown reasons. Diagnosis is often delayed due to its nonspecific presentation and prevalence in individuals without pre-existing immunological disease. Prognosis is poor, with mortality rates of approximately 70% despite aggressive treatment. Treatment is not standardized but may include several anti-fungal agents and surgical intervention. Case reports documenting the variability seen with cerebral phaeohyphomycosis by C. bantiana can provide valuable insight into this emerging disease. C. bantiana’s neurotropic propensity also warrants cognitive investigation of the disease; however, there are currently limited descriptions of cognitive findings in published case reports of C. bantiana CNS infections.

Here, we describe a case of a 35-year-old immunocompetent, college educated male with a CNS C. bantiana infection, presumably following a fall while biking in Costa Rica. First symptoms included left sided facial palsy, headache, and hand weakness, prompting extensive diagnostic workup, with diagnosis of C. bantiana infection confirmed 8 months after symptom onset. Initial treatment included anti-fungal agents and steroids, but his course of infection was complicated by infectious vasculitis with posterior circulation infarcts and obstructive hydrocephalus requiring ventriculoperitoneal shunt placement two years following the fungal infection diagnosis. The most recent brain MRI revealed encephalomalacia in global periventricular areas, two small masses, likely representing small fungal phlegmons, and enhancing lesions in the upper cervical spinal canal.

The patient reported cognitive changes following the infarcts and shunt placement including difficulties with spatial navigation, following directions, and articulating thoughts. Memory concerns and lapses in judgment were also reported. Results from a neuropsychological evaluation revealed high average baseline intellectual abilities with decrements in visuospatial processing, processing speed, executive functioning, and aspects of memory stemming from his executive dysfunction. At the time, his cognitive profile suggested parietal and frontosubcortical systems disruption meeting criteria for mild cognitive impairment. Two years later, the patient reported continuing cognitive difficulties prompting a follow-up neuropsychological evaluation. Results were similar to his first evaluation, revealing deficits in aspects of visuospatial processing, decreased verbal and visual learning, bradyphrenia and processing speed deficits, and difficulties with visual planning and organization. Minimal anxiety and depression, but increased apathy and executive dysfunction were endorsed on self-report measures.

This case report highlights neurological sequela resulting from CNS infection with C. bantiana, -with a course complicated by subsequent strokes, hydrocephalus, and cognitive impairment-, and contributes additional insight into the relatively limited existing reports of an extremely rare but emerging disease.

Olfactory dysfunction can influence nutritional intake, the detection of environmental hazards, and quality of life. Prior research has found discordance between subjective and objective measures of olfaction. In people living with HIV (PLWH), olfactory dysfunction is widely reported; however, few studies have examined concordance between subjective olfactory self-ratings and performance on an objective psychophysical measure of olfaction and associated factors in men living with HIV (MLWH).

MLWH (n=51, mean age=54 years, 66.7% Black) completed two subjective olfaction ratings (two 5-point Likert scales), the Smell Identification Test (SIT), cognitive measures (HVLT-R, TMT), and self-report questionnaires assessing smell habits, mood, cognitive failures, and quality of life. Participants were categorized into one of four groups: true positives (TP; impaired subjective olfaction and objective olfaction dysfunction), false negatives (FN; intact subjective olfaction and objective olfaction dysfunction), false positives (FP; impaired subjective olfaction and objective normosmia), and true negatives (TN; intact subjective olfaction and normosmia). Established formulas were used to calculate the sensitivity and specificity of subjective olfaction, and t-tests and ANOVA were used to examine potential demographic, clinical, and cognitive factors contributing to discordance between subjective and objective olfaction dysfunction.

Across both subjective self-report items, 35.3% reported olfactory dysfunction, whereas 60.8% had objective olfaction dysfunction on the SIT (score < 33). Black MLWH had significantly higher rates of subjective (Black 41.2% vs. White 35.3%) and objective (Black 73.5% vs. White 35.3%) olfactory dysfunction (X2(1)=9.22, p=.002). We found discordance between subjective and objective olfaction measures, with 29.4% of the sample having objective olfaction dysfunction and not recognizing it (FN). In comparison, 3.9% with self-rated olfaction impairment had normal objective olfaction scores (FP). Additionally, there was concordance in subjective self-reports compared with objective olfaction, with 35.3% correctly identifying normal olfaction (TN) and 31.4% correctly identifying olfactory dysfunction (TP). Those unaware of olfaction dysfunction (FN) reported using less scented products in daily life on the Smell Habits Questionnaire. Although the FN group had faster TMT scores, these findings were no longer significant after the removal of three outliers in the TP group (e.g., time to complete greater than 350 seconds).

Our findings cohere with work in healthy older adults, traumatic brain injury, and Parkinson’s disease, documenting that subjective olfaction may inadequately capture the full range of a person’s olfactory status. We extend these findings to a sample of MLWH, in which discordance rates ranged from 35-61% for subjective and objective olfactory dysfunction. Unawareness of olfactory dysfunction in MLWH was associated with less daily smell habits and paradoxically faster TMT performance. A higher number of smell habits in the TP group indicate that more frequent odor exposure may increase sensitivity to olfactory declines. Future studies with larger samples will be helpful in understanding the full nature of these relationships. Lastly, given that one-third of the sample had discordance between subjective and objective olfaction, objective olfaction measures may be useful to consider in the neuropsychological assessment and standard clinical care for PLWH.

Published results focusing on language assessment in acutely recovered COVID-19 patients have shown communication problems in this group, including significant cognitive-linguistic disruptions in verbal fluency (Cummings, 2022). Extant research also indicates that poorer health-related outcomes, such as reduced physical functioning and quality of life, co-occur with cognitive difficulties post-COVID-19 infection (Mendez et al., 2021; Tabacof et al., 2022). Understanding what factors may worsen the impact of COVID-19 on cognition, and aspects of language function specifically, is necessary to determine who is at greatest risk of adverse outcomes following infection. Our goal was to examine the effect of health-related outcomes on language abilities, specifically verbal fluency, post-COVID-19 infection.

37 adults 19 years and older (M age = 38.78, 67.5% female, 92.5%> high school education) were recruited from British Columbia and Ontario, Canada. Participants provided documentation indicating they had had a COVID-19 infection at least 3 months prior to participation. Participants completed a series of online questionnaires, including the Short Form Health Survey (SF-20), to measure aspects of health-related quality of life. The SF-20 measures dimensions of functioning (physical, social, role) and well-being (mental health, health perception, pain). For each parameter except pain, higher scores indicate better functioning/well-being; for pain higher scores indicate greater pain levels. Participants also completed neuropsychological tests, including measures of verbal fluency, via teleconference. Animals and F-A-S total scores were combined to represent verbal fluency (semantic and phonemic, respectively) performance. To assess the impact of health outcomes on verbal fluency performance, hierarchical regression analyses were conducted. The six SF-20 subscale scores were entered as predictors and verbal fluency score (sum) as the outcome. Age and sex (Male/Female) were controlled for in the model.

Age and sex were not significantly related to verbal fluency scores in our sample. After controlling for these demographics, the overall model including SF-20 subscales did not significantly predict fluency performance (F (8, 28) = 1.04, p = .433). However, Pain scores did individually predict verbal fluency performance (B = 5.60, t = 2.53, p = <.05). Unexpectedly, pain ratings were positively associated with fluency scores, such that each increase in pain rating (e.g., “none” to “mild”) was associated with a fluency score increase of 5.60 points (i.e., 5.6 more words stated across administered tasks).

These preliminary findings suggest that participants’ self-reported pain severity was positively associated with verbal fluency task performance in our sample (i.e., greater pain severity predicting better fluency). These findings are contrary to substantial evidence showing the deleterious effects of pain on cognitive functions in other populations (Khera & Rangasamy, 2021). It is possible that findings may be explained by a potential unknown intervening variable not included in our model. This is the first study to our knowledge to examine associations between experienced pain and verbal fluency performance post-COVID-19 infection. It will be important for future work to not only utilize more robust measures of pain experiences and explore more areas of cognition and language, but also to employ larger samples and examine a broader set of covariates.

Acute cognitive complications following COVID-19 infection have been appreciated in a subset of patients since the early months of the global pandemic. Emerging data reveal that some patients go on to experience cognitive improvement, whereas others may experience further cognitive decline. We aimed to assess trajectories and predictors of cognitive change in a sample of post-COVID-19 patients.

This prospective cohort study assessed longitudinal cognitive change in adults receiving care for COVID-19 in the Johns Hopkins Post-Acute COVID-19 Team (JH PACT) clinic. Participants self-administered the Digital Automated Neurobehavioral Assessment (DANA) battery of seven cognitive tests and a performance-based measure of cognitive fatigue on up to six occasions over six weeks. Improvement or decline between the first and last assessment was defined as change of >1 standard deviation of the baseline mean of each outcome. Potential predictors of change included demographic features (age, sex, race/ethnicity, education), COVID-19 illness characteristics (hospitalization or ICU stay, months since symptom onset), and comorbid disease burden. Analyses included measures of central tendency, independent samples t-tests, and chi-square tests of independence.

Of the 36 enrolled participants, 29 (81%) completed at least one DANA assessment (M = 4.7 assessments, SD = 1.8). Those completing at least three assessments (n = 24, 66.7%) were included in the present analyses (71% female; 58% white; M age = 54 years, SD = 10.9; M education = 14.6 years, SD = 2.4; M months since COVID-19 symptom onset at recruitment = 9.8, SD = 4.7; M comorbidities = 2.8, SD = 2.0). Fatigue was the most frequently improved outcome measure, with 41.7% of participants scoring >1 standard deviation above the baseline mean fatigue score at their final assessment. Among cognitive outcomes, the greatest frequency of improvement was observed on tests assessing rapid spatial processing (37.5%), processing speed (33.3%), and memory (33.3%). There were no consistent predictors of improvement, but several subtest-specific findings emerged. Specifically, (a) more comorbidities were positively associated with rate of fatigue reduction (p = .04), (b) longer duration since COVID-19 illness was positively associated with rates of memory improvement (p = .02), (c) older age, male sex, and more comorbidities were positively associated with rate of improvement in reaction time (ps < .05), and (d) more assessments completed was positively associated with rates of improvements in working memory (ps < .05). Response inhibition (12.5%), simple reaction times (16.7%), and working memory (16.7%) showed the lowest rates of improvement over time. Declines in cognition were infrequent, with 4.2 - 8.3% (n = 1 to 2) declining on measures of procedural reaction time, spatial processing, inhibitory control, or working memory.

At an average of >9 months following acute COVID-19 illness, we observed longitudinal improvements in cognitive fatigue as well as processing speed, memory, and spatial reasoning. Consistent predictors of recovery were not identified, although age, sex, comorbid conditions, and time since illness predicted rates of improvement in select domains. Further analyses with a larger sample size and more stringent analyses are needed to confirm and extend these findings.

Many individuals with COVID-19 develop mild to moderate physical symptoms that can last days to months. In addition to physical symptoms, individuals with COVID-19 have reported depressive symptoms and cognitive decline, posing a long-term threat to mental health and functional outcomes. Few studies have examined the presence of co-occurring depression and subjective cognitive decline in individuals who tested positive for COVID-19. The current study examined whether having COVID-19 is subsequently associated with greater depressive symptoms and subjective cognitive decline when compared to healthy individuals. Our study also examined differential associations between symptoms of depression and subjective cognitive decline between individuals who have and have never had COVID-19.

Adults (N = 104; mean age = 37 years, 69% female) were recruited online from Ontario and British Columbia, Canada. Participants were categorized into two groups: (1) persons who tested positive for COVID-19 at least three months prior, had been symptomatic, and had not been ventilated (N = 50); and (2) persons who have never been suspected of having COVID-19 (N = 54). The Center for Epidemiological Studies Depression Scale (CES-D) and the Subjective Cognitive Decline Questionnaire (SCD-Q) were administered to both groups as part of a larger clinical neuropsychological evaluation. Two separate linear regression analyses were conducted to examine the association of COVID-19 with depressive symptoms and subjective cognitive decline. A moderation analysis was performed to examine whether depressive symptoms were associated with subjective cognitive decline and the extent to which this differed by group (COVID-19 and controls). Participants’ age, self-reported sex, and history of depression were included as covariates.

The first regression model explained 17.2% of the variance in CES-D scores. It was found that the COVID-19 group had significantly higher CES-D scores (ß = .20, p = .03). The second regression model explained 35.9% of the variance in SCD-Q scores. Similar to the previous model, it was found that the COVID-19 group had significantly higher SCD-Q scores compared to healthy controls (ß = .22 p = .01). Lastly, the moderation model indicated that higher CES-D scores were associated with higher SCD-Q scores (ß = .43, p < .01), but there was no statistically significant group X CES-D score interaction.

These findings suggest that individuals who previously experienced a mild to moderate symptomatic COVID-19 infection report greater depressive symptom severity as well as greater subjective cognitive decline. Additionally, while more severe depressive symptoms predicted greater subjective cognitive decline in our sample, the magnitude of this association did not vary between those with and without a previous COVID-19 infection. While the underlying neurobiological and social mechanisms of cognitive difficulties and depressive symptoms in persons who have had COVID-19 have yet to be fully elucidated, our findings highlight treatment for depression and cognitive rehabilitation as potentially useful intervention targets for the post COVID-19 condition.

Rates of HIV are disproportionately high among Black individuals in the United States (CDC, 2020). Black individuals are at increased risk for neurocognitive impairment due to HIV (Marquine et al., 2016) and experience health disparities including increased morbidity and mortality (Asari, 2018; Manly et al., 1998). We sought to examine the relationship between perceived quality of healthcare and neuropsychological functioning among people living with HIV (PLWH) who identify as Black compared to those who are non-Black.

151 PLWH in the Los Angeles area (52% Black, age = 49.85 ± 10.54, education = 13.23 ± 2.11; 87% cisgender men, 8% cisgender women, 1% transgender men, 3% transgender women) completed comprehensive neuropsychological (NP) assessments (from which demographically-corrected domain and global T-scores were derived), psychiatric and sociodemographic interviews, and self-report questionnaires, including a measure of perceived healthcare quality (i.e., QUOTE-HIV). Statistical analyses included chi-square, t-test, ANOVA, and stepwise linear regression.

Only 14% of Black PLWH had private healthcare insurance (versus Medicare/Medicaid) compared to 33% of nonBlack PLWH (x2=11.33, p<.01). Black participants were significantly older than nonBlack participants (p<.01), but did not differ on gender, education, income, CD4 count, or HIV viral load. Younger Black participants (based on a median split for age; n = 23) reported the lowest perceived quality of healthcare (i.e., QUOTE-HIV total performance score), while older Black participants (n = 56) reported the highest perceived care (F = 3.80, p = .01), but the same relationship was not observed in nonBlack participants. In a stepwise multivariate regression model, including demographic and virological factors as well as healthcare quality, only household income and overall perceived healthcare quality (i.e., QUOTE-HIV total performance score) were significantly associated with Global NP T-scores among Black PLWH (R2=.12, F(1, 66)=4.46, p=.02).

When assessing healthcare quality and healthcare experiences among people living with HIV, race and age are important to consider. Private healthcare coverage may be less accessible to people of color, and in a multivariate model, only income and healthcare quality significantly predicted neuropsychological functioning in Black PLWH. When examining HIV and health outcomes, the complex relationships among quality of healthcare and health disparities, neuropsychological functioning, and structural racism warrant further investigation.

PLWH report using cannabis for both recreational reasons and HIV symptom management (e.g., nausea, pain, depression/anxiety). Recent literature suggests that cannabis may attenuate HIV symptoms and neuroinflammation, which are strongly related to neurocognition. Additionally, older adults who are particularly vulnerable to cognitive impairment experience a decline in the endogenous cannabinoid system with age. Therefore, the aims of the present study were 1) to determine if cannabis use is associated with cognitive performance in PLWH, 2) to determine if age moderates the relationship between cannabis use and cognition in PLWH, and 3) to determine if there are differences in cognition in cannabis non-users, occasional users, and daily users among PLWH.

The sample included 225 PLWH (78% undetectable; 51% female, Mean age=49.10) who were classified as non-users (n=52), occasional users (n=53), or daily users (n=120). Cannabis use was measured via the Timeline Follow-back (TLFB). Cognition was examined using the NIH Toolbox Cognition Battery, which included measures of attention, working memory, executive function, processing speed, and episodic memory, as well as a fluid cognition composite score.

Increased frequency of cannabis use was weakly positively associated with episodic memory performance, r(224) = 0.15, p<0.05. Results of the multiple regression indicate that frequency of cannabis use was not significantly associated with any of the six cognitive domains. However, there was a significant interaction between age and cannabis use in the domains of attention (ß= 0.13, p < 0.05), working memory (ß= 0.12, p < 0.05), and episodic memory (ß= 0.15, p < 0.05), suggesting worse cognitive performance in older adults who use cannabis as compared to younger adults in this sample. When participants were grouped based on use status, there were no significant main effects of group.

After controlling for the effects of demographic factors and HIV disease severity, no significant negative associations between cannabis use and cognition were observed, suggesting that cannabis use is not related to cognitive impairment in PLWH. However, results were clarified by a significant interaction, indicating that older adults who use cannabis perform worse in the domains of attention, working memory, and episodic memory compared to younger adults, suggesting synergistic cognitive effects of age and cannabis use. We additionally found preliminary evidence for a potential positive effect of cannabis use on episodic memory in the overall sample. Future studies examining biological and behavioral mechanisms of improvement will be necessary to better examine this relationship.

Health disparities among African Americans (AAs) in the United States are evident, especially among older adults and people living with HIV (PLWH). These health disparities include worse cognitive functioning among AAs than White counterparts. Though disparities in health literacy among AAs impact health outcomes across clinical populations, less is known on the mechanistic role health literacy may play in explaining racial differences in cognitive functioning among older PLWH. The current study investigated the association between health literacy and global cognitive functioning among middle-aged and older AA and White adults with and without HIV in the Deep South.

Two hundred and seventy-three people (170 PLWH: 146 AA, 24 White; 103 HIV-negative: 67 AA, 36 White) were enrolled in an observational study and completed measures of sociodemographic characteristics, as well as the reading subtest of the Wide Range Achievement Test-3rd Edition to assess verbal IQ. A composite score of socioeconomic status (SES) was created using total years of education and annual household income. Neurocognitive functioning was assessed using a comprehensive cognitive battery (i.e., verbal, attention/working memory, executive function, learning, recall, speed of processing, and motor), from which a sample-based global Z-score composite was created. Health literacy was measured using a sample-based composite Z-score derived from the Rapid Estimate of Adult Literacy in Medicine, Test of Functional Health Literacy in Adults Reading Comprehension, Newest Vital Sign, and Expanded Numeracy Scale. First, multivariable linear regression analyses were performed within both PLWH and HIV-negative samples examining the association between race, SES, verbal IQ, and health literacy with cognitive functioning. These results informed two bootstrap confidence interval mediation analyses to determine whether health literacy mediated the association between race and global cognitive functioning.

In both PLWH and HIV-negative individuals, linear regressions showed that Whites had better global cognitive functioning, health literacy, and verbal IQ than AAs. Linear regressions showed that health literacy had an independent association with cognitive function when accounting for verbal IQ and SES. Mediations showed that health literacy significantly mediated the association between race and global cognitive functioning in both samples, independent of verbal IQ (PLWH: b = .07, 95% CI [0.0096, 0.2149]; HIV-negative: b = .15, 95% CI [0.0518, 0.2877]), indicating that Whites were expected to obtain higher global cognitive Z-scores than AAs in both PLWH and HIV-negative samples, through the mediating effect of better health literacy.

Health literacy significantly mediated the association between race and global cognitive functioning among middle-aged and older adults with and without HIV, underscoring the importance of health literacy in explaining racial disparities in cognitive outcomes among AAs in the Deep South. Findings have implications for guiding clinicians and healthcare providers in developing interventions that promote health literacy in these underserved populations, which may have downstream impacts on cognitive functioning. Future work is needed to examine mechanisms whereby health literacy impacts neurocognition among AA PLWH.