The current study had two primary objectives: 1) To assess the dose-response relationship between acute bouts of aerobic exercise intensity and performance in multiple cognitive domains (episodic memory, attention, and executive function) and 2) To replicate and extend the literature by examining the dose-response relationship between aerobic exercise intensity and pattern separation.

18 young adults (mean age = 21.6, sd = 2.6; mean education = 13.9, sd = 3.4; 50% female) were recruited from The Ohio State University and surrounding area (Columbus, OH). Participants completed control (no exercise), light intensity, and vigorous intensity exercise conditions across three counterbalanced appointments. For each participant, all three appointments occurred at approximately the same time of day with at least 2 days between appointments. Following the rest or exercise conditions and after an approximately 7 minute delay, participants completed a Mnemonic Similarity Task (MST; Stark et al., 2019) to assess pattern separation. This task was always administered first as we attempted to replicate previous studies and further clarify the relationship between acute bouts of aerobic exercise and pattern separation by implementing an exercise stimulus that varied in intensity. After the MST, three brief cognitive tasks (roughly 5 min each) were administered in a counterbalanced order: a gradual-onset continuous performance task (gradCPT; Esterman et al., 2013), the flanker task from the NIH toolbox, and a face-name episodic memory task. Here we report results from the gradCPT, which assesses sustained attention and inhibitory control. Heart rate and ratings of perceived exertion were collected to validate the rest and exercise conditions. Repeated-measures ANOVAs were used to assess the relationship between exercise condition and dependent measures of sustained attention and inhibitory control and pattern separation.

One-way repeated-measures ANOVAs revealed a main effect of exercise condition on gradCPT task performance for task discrimination ability (d') and commission error rate (p’s < .05). Pairwise comparisons revealed task discrimination ability was significantly higher following the light intensity exercise condition versus the control condition. Commission error rate was significantly lower for both the light and vigorous exercise conditions compared to the control condition. For the MST, two-way repeated-measures ANOVAs revealed an expected significant main effect of lure similarity on task performance; however, there was not a significant main effect of exercise intensity on task performance (or a significant interaction).

The current study indicated that acute bouts of exercise improve both sustained attention and inhibitory control as measured with the gradCPT. We did not replicate previous work reporting that acute bouts of exercise improve pattern separation in young adults. Our results further indicate that vigorous exercise did not detrimentally impact or improve pattern separation performance. Our results indicate that light intensity exercise is sufficient to enhance sustained attention and inhibitory control, as there were no significant differences in performance following light versus vigorous exercise.

Depression is a mood or emotional state that is characterized by feelings of sadness (i.e., a loss of interest in activities, low self-worth) for a minimum of two weeks. Executive function is a set of mental processes that are necessary for cognitive control of behavior to achieve and successfully execute a specific goal (e.g., inhibition). Researchers have reported that people with abnormal symptoms of depression (ASD) demonstrate worse executive functioning abilities (e.g., planning) compared to persons with normal symptoms of depression (NSD). Currently, there is a lack of research studies examining how depressive symptoms influence executive functioning in people that identify as Mexican. The purpose of the present study was to evaluate the influence of depression on executive functioning in a healthy Mexican Spanish speaking population. We hypothesized that participants with NSD would demonstrate better executive functioning abilities compared to participants with ASD.

The sample in the present study consisted of 87 neurologically and psychologically healthy Mexican participants all residing in Mexico. Mean age was 24.71 (SD = 9.66) and 14.78 (SD = 4.50) years of education completed. Participants completed a neuropsychological battery in Spanish and were divided into two groups: NSD (n = 61) and ASD (n = 26). The Stroop Color Word Test - Color-Word (SCWT-CW) task, phonemic verbal fluency task consisting of three trials, and semantic verbal fluency task consisting of one trial were used to evaluate executive functioning. In addition, participants completed the Hospital Anxiety and Depression Scale in Spanish to report the current level of depression. ANCOVAS, controlling for age were used to examine executive functioning performance. We used a threshold of p < .05 for statistical significance.

ANCOVAS revealed the NSD group outperformed the ASD group on the SCWT-CW task, p = .004, np2 = .10. We also found the NSD group outperformed the ASD group on the phonemic verbal fluency task, p = .045, np2 = .05. Finally, no significant differences were found between depression groups on the semantic verbal fluency task.

As we predicted, the NSD group demonstrated better executive functioning abilities compared to the ASD group, except on the semantic verbal fluency task. Our data suggests that the current level of depression have a significant influence on verbal executive functioning abilities in a Spanish speaking population. Future studies with larger sample size should evaluate if current symptoms of depression influence non-verbal executive functioning abilities in a Spanish speaking Mexican population.

Mild cognitive impairment (MCI) is characterized by subjective and objective memory concerns, though additional cognitive concerns are commonly reported, including changes in executive functions (EF). Rabin et al. (2006) showed that a sample of research participants with MCI endorsed problems with their EFs, especially working memory. Similarly, those with subjective cognitive dysfunction (SCD) also reported greater difficulty with aspects of their EF than a healthy comparison sample of older adults (HC). In the present study, we investigated subjective EF in clinical samples of older adults with MCI or SCD, which represents a more naturalistic sample relative to a research sample. Furthermore, we evaluated whether subjective EF varied in these groups depending on whether patients were "young-old" versus "old-old" given prior research indicating objective cognitive differences between these age groups.

Participants were 135 older adults (53 MCI, 52 SCD, and 30 HC) matched for age (p = .116) and education (p = .863). Dichotomous categorization of age used the sample median (72 years) as cutoff score with 72 participants in the young-old group (mean age = 65.8 ± 4.7 years) and 63 in the old-old group (mean age = 78.1 ± 3.7 years). Participants completed the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A), assessing executive functions in everyday life over the past month. The BRIEF-A yields an overall score (Global Executive Composite [GEC]) composed of two index scores (Behavioral Regulation Index [BRI] and Metacognition Index [MI]) and nine clinical scales (Inhibit, Shift, Emotional Control, Self-Monitor, Initiate, Working Memory, Plan/Organize, Task Monitor, and Organization of Materials). A diagnosis by age-group multivariate analysis of variance (MANOVA) with post-hoc comparisons for diagnosis using a Tukey HSD correction was conducted using SPSS Version 24.

MCI and SCD groups endorsed worse EF on all three index scores (ps < .005) and all nine clinical scales (ps < .05) relative to the HC group, and the MCI group reported worse initiation relative to the SCD group. Additionally, worse executive functions on all three index scores (ps < .05) and four clinical scales (ps < .05; emotional control, self-monitoring, planning/organization, and task monitoring) were reported by the young-old group relative to the old-old group. No diagnosis by age-group interactions were observed.

Problems with aspects of EF were endorsed by older adults with MCI and SCD compared to HCs across all indices and clinical scales; however, only initiation was reported to be worse in MCI than those with SCD. Additionally, the young-old group endorsed having worse EF than the old-old group across BRIEF-A indices and several more specific aspects of EF, without a moderating effect of diagnosis. These findings highlight the importance of assessing subjective EF in older adults, as they may be early indicators of cognitive change, prior to objective evidence of cognitive decline. Furthermore, results also point to differences in how the young-old and old-old perceive their EF in everyday life.

This study evaluated the relation between five-factor model (FFM) personality traits and intra-individual variability (IIV) in executive functioning (EF) using both subjective self-report and objectives measures of EF.

165 university participants (M=19 years old, SD=1.3; 55.2% White, 35.2% African American, 72.7% female) completed the Barkley Deficits in Executive Functioning Scale-Long Form (BDEFS), IPIP-NEO Personality Inventory, Trail-Making Test (TMT) Parts A and B, and the Neuropsychological Assessment Battery (NAB) EF module. A participant’s IIV was calculated as the standard deviation around their own mean performance. Objective EF IIV was computed from T-scores for performance on Trails A, Trails B, and the NAB EF module. Subjective EF IIV was computed from T-scores for performance across BDEFS domains.

Pearson r correlations were used to evaluate the relation between subjective and objective IIV and FFM traits of personality. Subjective EF IIV was positively correlated with FFM neuroticism [r=.48; p<.001] and negatively correlated with FFM conscientiousness [r=-.43; p<.001], extraversion [r=-.18; p=.023] and agreeableness [r=-.22; p=.004]. There were no significant associations between FFM traits and objective EF IIV performance. There was additionally no significant relation between subjective EF IIV performance and objective EF IIV.

Personality traits were associated with individual variability on a self-reported measure of EF but not on performance-based EF measures. These results suggest that IIV for the BDEFS was influenced by personality traits, particularly neuroticism and conscientiousness, and may reflect method variance. It was notable that IIV was not correlated between subjective and objective EF measures.

Psychosocial stress has been associated with impaired cognition and risk for neurodegenerative disease. However, the intermediate pathways underlying this relationship are not yet well understood. Chronic exposure to stress causes endocrine and immune dysregulation that can lead to heightened systemic inflammation. Moreover, chronic, low-grade inflammation has been linked to neurodegeneration, impaired neurogenesis and cognitive decline. Given the strength of the individual links between stress, inflammation and cognition, the current study tested the hypothesis that inflammatory biomarkers would mediate the relationship between perceived stress and executive functions.

Data from the Midlife in the United States Study (MIDUS) (N=863; Mean age= 52.72) provided measures of perceived psychological stress, inflammatory biomarkers [C-reactive protein (CRP) and interleukin-6 (IL-6)] and executive functions. Structural equation modeling (SEM) was used to test for the mediating effect of inflammation on the relationship between perceived stress and executive functions. Exploratory analyses were conducted to investigate whether sex-differences were driving these relationships. Mediation analyses adjusted for age and history of smoking.

In the full sample of men and women, there was a significant indirect effect of perceived stress on executive functions through inflammation [ß=-0.021, z=-2.841, p=0.005]. Further examination revealed that this effect was present in women [B=-0.039, z=-2.680, p=0.007] but not men [ß=-0.003, z=-0.558, p=0.577]. While inflammation was negatively associated with executive functions in both men and women [ß=-0.126, z=-1.930, p=0.050; ß=-0.279, z=-0.558, p>0.001], pathways linking perceived stress to inflammation and executive functions were only significant in women [ß=0.014, z=-3.190, p=0.001; ß=-0.192, z=-3.355, p=0.001].

These findings suggest that inflammatory biomarkers are a viable pathway for explaining how experiencing stress can negatively affect executive functions. Results indicate that women may be particularly vulnerable to the inflammatory and cognitive consequences of stress. As such, psychosocial stress and associated inflammation may be important targets for improving cognitive health outcomes, particularly in women.

Hippocampal and medial temporal lobe structure atrophy is commonly observed in patients with mild neurocognitive disorders and dementias of various neurodegenerative conditions, with the degree of atrophy in these regions correlating with cognitive performance on memory tasks. This research has been conducted largely in western and educated countries. As cognitive aging, risk factors, clinical course, and neuropathology can differ between individuals of different races and ethnicities, our goal is to determine whether these findings also generalize to patients with suspected dementias living in the Democratic Republic of the Congo (DRC).

Neuroimaging and cognitive data have been collected on 40 subjects with probable dementia from the DRC and 40 age-, education-, and gender-matched controls. Patients were classified into groups based on scores on the Community Screening Instrument and the Alzheimer's Questionnaire. All participants completed the African Neuropsychological Battery. T1 MPRAGE images were acquired on Siemens 1.5T scanner. Freesurfer was used to derive volumes and cortical thickness of medial temporal lobe regions. Volumes of structures were divided by intracranial vault volumes to adjust for head size. T-tests were used to compare hippocampal volumes, entorhinal cortex thickness, and perirhinal cortex thickness between subjects with probable dementia compared to healthy age-, gender-, and education-matched controls. Bivariate correlations were conducted to determine whether the volumes of these structures correlate significantly with learning and memory measures on the ANB.

Results will be determined by the methods described previously.

Results from this study will demonstrate whether structural brain changes commonly seen in individuals with dementia living in western and educated countries also are observed in the DRC. Results will also demonstrate whether these brain changes coincide with the degree of impairments on tasks of memory, and whether these structures can be used to aid in clinical diagnosis of patients with dementia and support the use of the ANB and neuroimaging in clinical detection of dementias in the DRC.

Given the lack of comprehensive neuropsychological tools and neuropsychological services in Sub-Saharan Africa (SSA), cognitive screeners for dementia can be useful tools to screen for suspected dementia at the population level. However, most available screeners have not been developed or validated in SSA populations. The Community Screening Instrument for Dementia (CSID) was developed for cross-cultural use, and it has a cognitive testing component and informant interview. We have previously demonstrated that lower years of education and female sex are associated with lower scores on the CSID. Here, we examine the utility of demographically adjusted CSID scores in a community sample of Congolese older adults.

354 participants (mean age=73.6±6.7, mean education (years) =7.3±4.7; 50% female) were randomly recruited in Kinshasa, Democratic Republic of the Congo, and completed the CSID and the Alzheimer's Questionnaire (AQ) to examine functional abilities. Raw scores were demographically adjusted for education and sex by adding 1 point for <12 years of education and 1 point for female. Cognitive impairment was classified as a total score below 25.5. Rates of impairment were compared between raw scores and demographically-adjusted scores. Demographic profiles were examined between both classifications

Average raw CSID scores were 25.23 (SD=4.19) and average demographically-adjusted scores were 26.59 (SD= 4.09). Approximately 43.1% of the sample was impaired based on the raw CSID scores compared to 30.4% with the demographically-adjusted scores (x2= 12.334, p<.001). There was a higher proportion of females (n=95; 26.8%) classified as impaired with the raw SCID scores compared to the demographically-adjusted scores (n=62; 17.5%; x2= 8.87, p=0.003). Approximately 27.4% (n=97) of the participants classified as impaired with the raw SCID scores had primary education or less (i.e., 1-6 years) compared to 18.9% with the demographically-adjusted scores (n=67; (x2= 107.77, p<.001). Forty-five participants were re-classified as not impaired with the demographically-adjusted scores with the majority of these participants being female (73.3%), having primary education (66.7%), and being functionally unimpaired on the AQ (91.1% unimpaired).

We demonstrate that raw scores on the CSID can lead to misclassification of impairment in females and in individuals with lower years of education. Demographically-adjusted scores on the CSID can help properly capture those with suspected dementia while reducing false positives. Given the effects of education and sex on performance, future studies should examine if demographically adjusted scores improve the sensitivity and specificity of the CSID in Congolese populations and compare its performance to other screening tools to determine the most appropriate screener for this population.

Late-life depression is a complex condition impacted by both mental and physical health outcomes and psychosocial factors. Psychosocial predictors of depression are reliant on cultural factors including socioeconomic variables, stigmas, and cultural values. Most research on late-life depression and its effect on cognitive functioning has been completed in so-called Western, Educated, Industrialized, Rich, and Democratic (WEIRD) populations and findings may not generalize to older adults living in other areas of the world. The current study explored predictors of depressive symptoms as well as the association between depressive symptoms and neuropsychological functioning in Congolese older adults.

A total of 319 participants (mean age=72.7±6.15, mean education in years=7.6±4.56; 47% female) were randomly recruited. Depressive symptoms were assessed with the Geriatric Depression Scale. Given the exploratory nature of the current study, forward stepwise linear regression models were run to assess predictors of depressive symptoms. The independent variables assessed as potential predictors included age, years of education, gender, participant income, parental income, living arrangement (i.e., alone or with others), functional abilities (FAQ), fragility, and self-rated overall health. Analyses were run in the overall sample as well as stratified by gender. The association between depressive symptoms and performance on the Community Screening Instrument for Dementia (SCID) was also explored.

Higher depressive symptoms were found in women (ß=.228, p=0.036), those with lower parental income (ß=-.156, p=.005), higher fragility (ß=-.237, p<.001), and worse overall health (ß=-.311, p=.020). Among women, lower parental income, (ß=-.230, p=.002), higher fragility (ß=-.312, p<.001), and lower overall health (ß=-.235, p=.004) predicted higher depressive symptoms, while in men only higher fragility (ß=-.164, p=.041) and living alone (ß=-.184, p=.022) predicted higher depressive symptoms. There was also a significant association between depressive symptoms and lower scores on the CSID (ß=-.189, p=.001)

Similar to results in WEIRD populations, general health and fragility predicted depressive symptoms in Congolese older adults. However, parental income (more so than participant income) also predicted depressive symptoms in Congolese older adults, particularly in women, while living alone was a predictor in Congolese older men. It is possible that the difference in depressive symptoms between men and women is driven by underreporting of depressive symptoms among men. Our results also showed that there was an association between depressive symptoms and global cognitive functioning similar to prior findings in WEIRD populations. Our results are important for clinicians assessing depressive symptoms in patients in or from Congo or sub-Saharan Africa.

Cognitive change affecting patients after anesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterward. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. This study aimed to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anesthesia and surgery.

A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions. Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anesthesia and surgery and may be useful for the inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature.

The working group recommends that 'perioperative neurocognitive disorders (PND)' be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of the acute event (postoperative delirium) and cognitive and functional decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery (dNCR)) and up to 12 months (postoperative neurocognitive disorder (postoperative NCD).1 Further, the working group has undergone a further Delphi process to expand these recommendations for research purposes which will also be covered.

Perioperative neurocognitive disorders are the most common complication for patients aged 65y or more undergoing anesthesia and surgery. Moreover, they are associated with significant morbidity, mortality, loss of functional independence and extreme economic costs. A multi-disciplinary approach to PND, including neuropsychologists, is critical to reducing and preventing these disorders. Evered L, Silbert B, Knopman DS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Br J Anaesth 2018; 121: 1005-12

Postoperative neurocognitive disorder is common after all forms of surgery in older adults. The mechanisms are multifactorial, and probably require pre-existing neuropathology, whether the patient is symptomatic or not. In Alzheimer's disease (AD) and other tauopathies, the microtubule-associated protein tau can undergo aberrant hyperphosphorylation potentially leading to the development of neurofibrillary pathology, one of the neuropathological hallmarks of the disease. Preclinical and human CSF studies suggest that anesthesia and surgery elicits an increment in CNS tauopathy, which may accelerate any preexisting neuropathology and produce a risk of delirium and the commonly reported changes in cognition.

In this session, the author will present a bench to beside review of how tau protein is altered by perioperative factors and its potential relationship to the impairment of cognition after surgery and anesthesia. Published and ongoing studies will be reviewed to result in a discussion as to why changes in tau protein are concerning in perioperative disorders of cognition.

The presenter will initially review pre-clinical studies focusing on the impact of anesthetics and surgery-induced inflammation on tau pathology and how the impairment of resolution of surgery-induced inflammation, notably decreased lipoxin A4 signaling, is altered by aging, gender, or an increase in the tau pathology burden. These preclinical studies have partially informed a multi-center federally funded observational clinical study, currently in progress, involving neuroimaging to determine whether pre-operative CNS tauopathy, as reflected by PET imaging, predicts delirium and other cognitive and functional outcomes. This translational study will also examine whether anesthesia and spine surgery produces a longitudinal change in the brain tau burden in older adults, as compared to control, nonoperative patients.

Bench to bedside research is needed in order to promote evidence-based care for patients at risk for ADRD.

Recent work has shown that dysfunctional brain EEG responses to anesthetic drugs can be an indicator of both preoperative cognitive impairment and postoperative delirium risk. However, since excessive anesthetic dosage can also cause abnormal EEG brain responses, it is unclear how to tell to what extent such abnormal brain EEG responses reflect latent neurocognitive impairment versus excessive anesthetic dosage. Further, it is unclear what underlying mechanisms might underlie the link between phenotypes (such as delirium and cognitive impairment) and these abnormal neurophysiologic responses to anesthetic drugs.

Dual center prospective cohort design. 139 total older surgical patients from two academic centers underwent intraoperative EEG monitoring with the bispectral index (BIS) EEG monitor during anesthesia and surgery, and postoperative delirium screening by geriatrician interview (Duke cohort) or by trained research staff (Mt Sinai cohort). We developed the Duke Anesthesia Resistance Scale (DARS), defined as the average BIS EEG values divided by the quantity 2.5 minus the age adjusted end tidal anesthetic gas concentration). We then examined the relationship between the DARS and postoperative delirium risk using the Youden index to identify an optimal low DARS threshold for delirium risk, and we used multivariable logistic regression to control for potential confounders.

Neither BIS scores nor inhaled anesthetic dosage differed significantly between patients with vs without postoperative delirium. Yet, patients with delirium had lower DARS scores than those who did not develop delirium (27.92 vs 32.88, p=0.015). A DARS threshold of 28.7 maximized the Youden index for the association between the DARS and delirium. In multivariable models adjusting for site (Duke vs Mt Sinai) and individual patient risk factors, DARS values <28.7 were associated with a 3.79 fold increased odds ratio (95% CI 1.63-9.10; p=0.03) for postoperative delirium. These results remained unchanged after adjusting for intraoperative medications including opioids, benzodiazepines, propofol, phenylephrine and ketamine. Patients with structural/functional MRI or CSF biomarker evidence of preclinical/prodromal Alzheimer's disease and/or neurovascular pathology were more likely to show altered anesthetic-induced EEG activity patterns.

Lower scores on a processed EEG-based scale of neurophysiologic resistance to anesthetic induced brain activity changes were independently associated with a nearly 4 fold increased delirium risk. The altered anesthetic-induced brain EEG patterns in patients who go on to develop postoperative delirium may reflect latent pre-clinical/pro-dromal Alzheimer's disease and/or neurovascular pathology.

Older adults represent 50% of surgical patients and are disproportionately at risk of poor cognitive outcomes after surgery including delirium, accelerated cognitive decline, and dementia. Delirium alone is estimated to occur in up to 50% of older adults postoperatively, while research indicates it is preventable in 30-40% of cases. Individuals with pre-existing cognitive impairments or neurodegenerative diseases are at the highest risk of such outcomes, but (1) cognitive diagnoses are grossly underrepresented in patients' medical records, and (2) routine preoperative cognitive clearance remains rare. The purpose of this presentation is to demonstrate the extent and nature of cognitive vulnerability in older adults preparing for elective surgery within a tertiary care hospital. A case series is also reviewed to illustrate varying surgical outcomes with and without consideration of preoperative cognitive risk.

This presentation incorporated IRB-approved and data honest broker management to assess diagnoses and cognitive profiles of adults age 65 and older electing surgery with anesthesia between January 2018 and December 2019. Data were assessed across two phases of the Perioperative Cognitive Anesthesia Network (PeCAN) program within the University of Florida and UF Health. First, data from the preoperative anesthesia clinic were reviewed for the percentage of patients with cognitive difficulties within the patient problem list. Second, based on neuropsychological domains, the cognitive profiles of patients assessed by neuropsychologists within the preoperative anesthesia clinic were divided into primary attention, primary memory, or combined memory attention. From these patients, the presenter highlight cases to demonstrate how individuals with cognitive difficulties can be provided care by a multidisciplinary team to mitigate the presence of postoperative complications.

Of 14,794 older adults entering the tertiary care medical center for surgical procedures, 4% (n=591) of the sample had ICD cognitive or neurodegenerative codes in the record. When a comprehensive neurobehavioral assessments were conducted on 1,363 of these presurgical patients, 70% had confirmed cognitive deficits on neuropsychological testing. These deficits included primary attention and executive deficits (12%), primary memory impairment (27%), or both attention and memory impairment (31%). Cases from these patients are reviewed and highlight how preoperative cognitive risk status can inform conservative perioperative practices including opioid-sparing analgesia, depth of anesthesia monitoring, and postoperative inpatient geriatric medicine consultation.

Medical records listed cognitive diagnoses in 4% of hospital preoperative medical records, yet neuropsychological assessment of a subset of cases revealed a markedly higher rate of impairment. Patients with preoperative cognitive assessment show cognitive symptoms consistent with known neurological disorders of aging including Alzheimer's disease and cerebrovascular disease. Appreciation of pre-existing neurocognitive disorders can alter perioperative practices to prevent or reduce the risk of delirium and other postoperative neurocognitive changes. These data and cases reviewed will highlight how neuropsychology can be involved in perioperative care and champion perioperative interventions for perioperative "rescues".

Post-stroke depression (PSD) and anxiety disorders are the most common psychiatric issues that occur after cerebrovascular accident (CVA), with prevalence rates of up to 50%. Less studied, post-stroke apathy and pseudobulbar affect (PBA) also occur in a subset of individuals after CVA leading to reduced quality of life. Cognitive impairments also persist, especially memory, language, and executive difficulties. Residual cognitive and emotional sequelae after CVA limit return-to-work with between 20-60% becoming disabled or retiring early. This study examined the frequency and relative contribution of cognitive, behavioral and emotional factors for not returning-to-work after CVA.

Participants included 242 stroke survivors (54% women, average age of 59.2 years) who underwent an outpatient neuropsychological evaluation approximately 13 months after unilateral focal CVA. Exclusion criteria were a diagnosis of dementia, comprehension issues identified during assessment, multifocal or bilateral CVA, and inpatients. Predictors of return-to-work included in logistic regression analyses were psychological (depressive and anxiety disorders, apathy, PBA, history of psychiatric treatment before stroke) and neuropsychological (memory, executive functioning) variables. Depression and anxiety were diagnosed using DSM-IV-TR or -5 criteria. Apathy was operationalized as diminished goal-directed behavior, reduced initiation and decreased interest that impacted daily life more than expected from physical issues after stroke (including self- and family-report using the Frontal Systems Behavior Scale [FrSBe]). PBA was defined by the Center for Neurologic Study-Lability Scale and clinical judgment based on chart review.

Post-stroke apathy persisted in 27.3% of patients 13 months after stroke, PBA persisted in 28.2% of patients (i.e., uncontrollable crying spellings not simply attributable to depression alone, uncontrollable laughing spells), anxiety disorders persisted in 18.6% of patients (mainly panic attacks), and PSD persisted in 29.8% of patients. Memory loss persisted in 67.4% of patients and executive difficulties persisted in 74.4% of patients. Thirteen months after stroke, 34.7% of individuals had returned-to-work and 47.1% had not returned-to-work. The other 18.2% were not working either at the time of their stroke or after the stroke. Logistic regression indicated that post-stroke apathy, PBA, and memory loss were significant predictors of not returning-to-work (odds ratio p < 0.001). Patients who experienced post-stroke apathy were 7.1 times more likely to not return-to-work after stroke (p=0.008), those who suffered from PBA were 4.8 times more likely to not return-to-work (p=0.028), and those with memory loss were 6.6 times more likely to not return-to-work (p=0.005). PSD, history of treatment for psychiatric issues before the stroke, presence of an anxiety disorder after stroke, and executive difficulties were not significant predictors (p’s>0.05).

Results replicate the finding that return-to-work is hindered by residual cognitive deficits after stroke and extends previous research by clarifying the multifactorial emotional and behavioral barriers to not returning-to-work. Results highlight the importance of quantifying post-stroke apathy and pseudobulbar affect in a standard neuropsychological work-up after stroke to identify candidates for services to facilitate efforts in returning to work (e.g., vocational rehabilitation services, psychotherapy, interventions for decreased initiation).

Traumatic brain injury and cardiovascular disease (CVD) are modifiable risk factors for cognitive decline and dementia. Greater concussion history can potentially increase risk for cerebrovascular changes associated with cognitive decline and may compound effects of CVD. We investigated the independent and dynamic effects of CVD/risk factor burden and concussion history on cognitive function and odds of mild cognitive impairment (MCI) diagnoses in older former National Football League (NFL) players.

Former NFL players, ages 50-70 (N=289; mean age=61.02±5.33 years), reported medical history and completed the Brief Test of Adult Cognition by Telephone (BTACT). CVD/risk factor burden was characterized as ordinal (0-3+) based on the sum of the following conditions: coronary artery disease/myocardial infarction, chronic obstructive pulmonary disease, hypertension, hyperlipidemia, sleep apnea, type-I and II diabetes. Cognitive outcomes included BTACT Executive Function and Episodic Memory Composite Z-scores (standardized on age- and education-based normative data), and the presence of physician diagnosed (self-reported) MCI. Concussion history was discretized into five groups: 0, 1-2, 3-5, 6-9, 10+. Linear and logistic regression models were fit to test independent and joint effects of concussion history and CVD burden on cognitive outcomes and odds of MCI. Race (dichotomized as White and Non-white due to sample distribution) was included in models as a covariate.

Greater CVD burden (unstandardized beta [standard error]; B=-0.10[0.42], p=.013, and race (B=0.622[0.09], p<.001), were associated with lower executive functioning. Compared to those with 0 prior concussions, no significant differences were observed for those with 1-2, 3-5, 6-9, or 10+ prior concussions (ps >.05). Race (B=0.61[.13], p<.001), but not concussion history or CVD burden, was associated with episodic memory. There was a trend for lower episodic memory scores among those with 10+ prior concussion compared to those with no prior concussions (B=-0.49[.25], p=.052). There were no significant differences in episodic memory among those with 1-2, 3-5, or 6-9 prior concussions compared to those with 0 prior concussions (ps>.05). CVD burden (B=0.35[.13], p=.008), race (greater odds in Non-white group; B=0.82[.29], p=.005), and greater concussion history (higher odds of diagnosis in 10+ group compared to those with 0 prior concussions; B=2.19[0.78], p<.005) were associated with higher odds of MCI diagnosis. Significant interaction effects between concussion history and CVD burden were not observed for any outcome (ps >.05).

Lower executive functioning and higher odds of MCI diagnosis were associated with higher CVD burden and race. Very high concussion history (10+) was selectively associated with higher odds of MCI diagnosis. Reduction of these modifiable factors may mitigate adverse outcomes in older contact sport athletes. In former athletes, consideration of CVD burden is particularly pertinent when assessing executive dysfunction, considered to be a common cognitive feature of traumatic encephalopathy syndrome, as designated by the recent diagnostic criteria. Further research should investigate the social and structural determinants contributing to racial disparities in long-term health outcomes within former NFL players.

Abusive head trauma (AHT) is a form of inflicted brain injury that is associated with significant neurological impairment. Given that injuries occur during infancy, cognitive deficits may not become fully apparent for years. It is useful to understand injury factors related to outcomes. A recent study by Eismann et al. (2020) used length of PICU stay as a measure of injury severity and found that it is predictive of short-term and long-term outcomes in AHT. The current study aimed to examine injury severity factors related to acute outcomes (<3 months since injury) within a population of infants admitted to an inpatient rehabilitation unit (IRU).

The sample consisted of 45 infants (32 male, 13 female) hospitalized with suspected AHT. Age at injury was 0-21 months (MED= 4.89 months, SD = 5.48). The majority of patients (93%) had moderate to severe injury based on length of PICU stay (4+ days) [3]. Patients were administered the Mullen Scales of Early Learning (MSEL) during IRU admission, within 3 months of injury (range: 13-68 days; MED: 31 days). Pearson bivariate correlations were used to examine the relationship between MSEL subscales (ELC: Early Learning Composite; VR: Visual Reception; RL: Receptive Language; EL: Expressive Language; FM: Fine Motor; GM: Gross Motor) and the following factors: days since injury and hospitalization time (days in PICU, PICU/General Pediatrics, IRU, total hospitalization). P-values less than .05 were considered significant.

Scores on the MSEL Early Learning Composite ranged from exceptionally low to high average (Standard Score Range: <49-111; MED: 82; SD = 18.79). Unlike prior studies, time in PICU and time in PICU/General Pediatrics were not associated with any MSEL subscales. MSEL was moderately correlated with days in IRU (ELC: r = -.44; VR: r = -.37; RL: r = -.32; EL: r = -.36; GM: r = -.29) and total hospitalization time (ELC: r = -.46; VR: r = -.42; RL: r = -.36; EL: r = -.37; GM: r = -.31), such that longer hospitalization was associated with lower scores. Greater days since injury was also associated with lower MSEL scores (ELC: r = -.45; VR: r = -.42; RL: r = -.40; EL: r = -.36; FM: r = -.33; GM: r = -.35).

These results suggest that within an inpatient rehabilitation setting, longer total hospitalization time (including time on IRU) is moderately associated with worse acute neurobehavioral outcomes. While length of PICU stay has been associated with short-term outcomes in the outpatient setting (Eismann et al., 2020), this was not found in the current inpatient sample which had more severe injuries (longer PICU stay, inpatient rehabilitation admission). Interestingly, children assessed further out from injury had worse scores on the MSEL, which has previously been noted. Though this seems counterintuitive, it may reflect that participants with more severe injuries had a longer delay before they were capable of engaging in a neurodevelopmental assessment. These findings have implications for prognosticating early outcomes of AHT in an inpatient rehabilitation setting.

To explore the use of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Heart Rate Variability (HRV) tests in the follow-up of concussions among college athletes. To provide a foundation for interpreting changes following a concussion by exploring the effects of self reported biological sex at birth on ImPACT and HRV values at baseline and after a concussion.

Data was prospectively collected within a pre-existing concussion management program. Baseline assessment (T1) included psychological questionnaires, the ImPACT test, and six minutes of HRV recording (standing, sitting, following a pacer). When a concussion occurred, the athlete was re-tested within 72 hours (T2) and tested again before returning to play (T3). 169 (55 females) athletes aged 16 to 22 years old completed the baseline testing and 30 (8 females) concussion cases were followed.

At baseline, females had higher Total Symptom scores, Sleep-Arousal Symptoms scores and Affective Symptoms scores (p ≤ 0.001). They also displayed significantly higher relative power of the very low-frequency bands (%VLF) (p < 0.05) in sitting position compared to males. There were no significant sex-related differences for any of the five ImPACT Index scores (Verbal Memory, Visual Memory, Impulse Control, Visual Motor, Reaction Time).

Mixed model repeated measure ANOVAs were performed within the concussed group. Significant differences were found between T1 and T2 as well as between T2 and T3 for Vestibular-Somatic Symptoms scores (p < 0.05); as expected, athletes displayed higher scores at T2 and scores were similar at T1 and T3. Total Symptoms scores and Cognitive-Sensory Symptoms scores were only found significantly higher at T2 compared to T3. Affective Symptoms scores were significantly higher at T1 and T2 compared to T3. < 0.05). There was no significant influence of sex on symptom scores. Of the ImPACT scores, the Visual Memory Index score showed a significant increase after concussion (T2 vs T1) (p < 0.05), with no significant difference between T2 and T3. For HRV, concussion showed a significant effect on %High Frequency (HF) HRV value sitting (p < 0.05) where T2 was significantly lower than T3.There was also a significant effect of sex on %HF when time and position were considered, with males having higher %HF values at T1 and lower %HF at T2 and T3 than females.

At baseline, females displayed higher symptoms scores than males but after a concussion there were no significant differences in symptoms scores. No sex-related differences were found for any of the ImPACT scores at baseline nor after a concussion. Before concussion, female athletes had higher HRV %VLF while sitting, suggesting more activation of their sympathetic nervous system and stress. For concussed athletes, Vestibular-Somatic Symptoms seemed to be the most stable and reliable when assessing symptoms at baseline and before returning to play. For ImPACT, Visual Memory Index was decreased significantly after a concussion. HRV %HF values showed significant variations according to sex after a concussion. HF values are thought to reflect parasympathetic nervous system activation. Our results support the idea that the activity of the autonomic nervous system can be disturbed in the days/weeks following a concussion.

Traumatic brain injury is one of several recognized risk factors for cognitive decline and neurodegenerative disease. Currently, risk scores involving modifiable risk/protective factors for dementia have not incorporated head injury history as part of their overall weighted risk calculation. We investigated the association between the LIfestyle for BRAin Health (LIBRA) risk score with odds of mild cognitive impairment (MCI) diagnosis and cognitive function in older former National Football League (NFL) players, both with and without the influence of concussion history.

Former NFL players, ages ≥ 50 (N=1050; mean age=61.1±5.4-years), completed a general health survey including self-reported medical history and ratings of function across several domains. LIBRA factors (weighted value) included cardiovascular disease (+1.0), hypertension (+1.6), hyperlipidemia (+1.4), diabetes (+1.3), kidney disease (+1.1), cigarette use history (+1.5), obesity (+1.6), depression (+2.1), social/cognitive activity (-3.2), physical inactivity (+1.1), low/moderate alcohol use (-1.0), healthy diet (-1.7). Within Group 1 (n=761), logistic regression models assessed the association of LIBRA scores and independent contribution of concussion history with the odds of MCI diagnosis. A modified-LIBRA score incorporated concussion history at the level planned contrasts showed significant associations across concussion history groups (0, 1-2, 3-5, 6-9, 10+). The weighted value for concussion history (+1.9) within the modified-LIBRA score was based on its proportional contribution to dementia relative to other LIBRA risk factors, as proposed by the 2020 Lancet Commission Report on Dementia Prevention. Associations of the modified-LIBRA score with odds of MCI and cognitive function were assessed via logistic and linear regression, respectively, in a subset of the sample (Group 2; n=289) who also completed the Brief Test of Adult Cognition by Telephone (BTACT). Race was included as a covariate in all models.

The median LIBRA score in the Group 1 was 1.6(IQR= -1, 3.6). Standard and modified-LIBRA median scores were 1.1(IQR= -1.3, 3.3) and 2(IQR= -0.4, 4.6), respectively, within Group 2. In Group 1, LIBRA score was significantly associated with odds of MCI diagnosis (odds ratio[95% confidence interval]=1.27[1.19, 1.28], p <.001). Concussion history provided additional information beyond LIBRA scores and was independently associated with odds of MCI; specifically, odds of MCI were higher among those with 6-9 (Odds Ratio[95% confidence interval]; OR=2.54[1.21, 5.32], p<.001), and 10+ (OR=4.55;[2.21, 9.36], p<.001) concussions, compared with those with no prior concussions. Within Group 2, the modified-LIBRA score was associated with higher odds of MCI (OR=1.61[1.15, 2.25]), and incrementally improved model information (0.04 increase in Nagelkerke R2) above standard LIBRA scores in the same model. Modified-LIBRA scores were inversely associated with BTACT Executive Function (B=-0.53[0.08], p=.002) and Episodic Memory scores (B=-0.53[0.08], p=.002).

Numerous modifiable risk/protective factors for dementia are reported in former professional football players, but incorporating concussion history may aid the multifactorial appraisal of cognitive decline risk and identification of areas for prevention and intervention. Integration of multi-modal biomarkers will advance this person-centered, holistic approach toward dementia reduction, detection, and intervention.