Cross-Validation of the Financial Exploitation Vulnerability Scale

Most of the available clinical tools that detect the experience of financial exploitation (FE) are not practical for use by the many professionals who work with older adults. The available measures are often time-consuming, require specialized training to administer, or focus exclusively on the cognitive aspects of financial decision-making. The need for a brief, standardized measure of contextual risk prompted the development of the Financial Exploitation Vulnerability Scale (FEVS; Lichtenberg et al., 2020). The purpose of this study was to cross-validate the FEVS as a psychometrically sound measure of contextual risk for FE. Participants were recruited from the community (n=95), and through a financial coaching service for older adults who had experienced a financial scam (n=21). A total of 114 older adults were recruited for the study, 33 who had experienced FE and 81 who had not. An independent samples t-test demonstrated that the FEVS total score successfully differentiated older adults based on the experience of financial exploitation. The FEVS total score was correlated with age, but no other demographic factors or collected neurocognitive measures. A ROC curve detecting FE analysis revealed an area under the curve of 0.68. Internal consistency of the FEVS was a=0.80. In a logistic regression model, only the FEVS and word-reading ability were related to FE. The results of this cross-validation study are very similar to the initial study, demonstrating that the FEVS is an accessible, theory-based tool that detects the experience of FE.

A-93 Comorbidity or Concussion: Can we Tell the Difference?

Objective To evaluate athletes with comorbid mood disturbances at baseline (without recent concussion) compared to those without mood symptoms tested post-concussion. This study is predicated upon previous findings showing that athletes with comorbidity at baseline demonstrate greater neurocognitive impairment, and report greater symptomatology, than healthy controls. It is currently unclear how athletes with comorbidity at baseline compare to athletes post-concussion. Method 119 college athletes completed objective neurocognitive testing, including measures of depression and anxiety. Athletes were separated into two groups: those with symptoms of comorbid anxiety/depression at baseline (n = 61,M = 35,F = 26) and those without such mood symptoms tested post-concussion (n = 58,M = 52,F = 6). All post-concussion athletes were tested within 14 days of injury. There were no overlapping athletes in these groups. Groups were compared on neurocognitive performance on mean z-score composites of Attention/Processing Speed (A/PS) and Memory. Results Regression results revealed that, on the A/PS composite, the Baseline Comorbid group (M = −0.15,SD = 0.64) did not differ significantly from the Post-Concussion Healthy Mood group (M = 0.05,SD = 0.62), t(117) = 1.75,p = 0.08, though there was a small effect size, d = 0.32. Additionally, on the Memory composite, the Baseline Comorbid Group (M = -0.12,SD = 0.69) did not differ from the Post-Concussion Healthy Mood group (M = -0.11,SD = 0.84), t(117) = 0.08,p = 0.94,d = 0.01. Conclusions These results suggest that athletes with comorbid anxiety/depression tested at baseline perform similarly to recently concussed athletes without mood disturbance, on objective neurocognitive measures. Thus, despite not experiencing recent injury, athletes with comorbidity present with similar neurocognitive profiles as athletes with recent concussions. These findings highlight the impact of comorbid mood disturbance on cognitive performance and demonstrate the importance of accounting for mood symptomatology when conducting neuropsychological assessments.

Behavioral measures of impulsivity and compulsivity in adolescents with nonsuicidal self-injury

Background Nonsuicidal self-injury (NSSI) is prevalent among adolescents and research is needed to clarify the mechanisms which contribute to the behavior. Here, the authors relate behavioral neurocognitive measures of impulsivity and compulsivity to repetitive and sporadic NSSI in a community sample of adolescents. Methods Computerized laboratory tasks (Affective Go/No-Go, Cambridge Gambling Task, and Probabilistic Reversal Task) were used to evaluate cognitive performance. Participants were adolescents aged 15 to 17 with (n = 50) and without (n = 190) NSSI history, sampled from the ROOTS project which recruited adolescents from secondary schools in Cambridgeshire, UK. NSSI was categorized as sporadic (1-3 instances per year) or repetitive (4 or more instances per year). Analyses were carried out in a series of linear and negative binomial regressions, controlling for age, gender, intelligence, and recent depressive symptoms. Results Adolescents with lifetime NSSI, and repetitive NSSI specifically, made significantly more perseverative errors on the Probabilistic Reversal Task and exhibited significantly lower quality of decision making on the Cambridge Gambling Task compared to no-NSSI controls. Those with sporadic NSSI did not significantly differ from no-NSSI controls on task performance. NSSI was not associated with behavioral measures of impulsivity. Conclusions Repetitive NSSI is associated with increased behavioral compulsivity and disadvantageous decision making, but not with behavioral impulsivity. Future research should continue to investigate how neurocognitive phenotypes contribute to the onset and maintenance of NSSI, and determine whether compulsivity and addictive features of NSSI are potential targets for treatment.

Neurocognitive Trajectories After 72 Weeks of First-Line Anti-retroviral Therapy in Vietnamese Adults With HIV-HCV Co-infection

Background: Long-term neurocognitive outcomes following first-line suppressive anti-retroviral therapy (ART) remain uncertain for individuals with HIV and hepatitis C (HCV) co-infection. The study examined neurocognitive performance before and after 72 weeks of ART using repeated multivariate analyses and latent trajectory models.Methods: One hundred and sixty adults with chronic, untreated HIV infection (n = 80 with HCV co-infection and n = 80 HIV mono-infected) and 80 demographically similar healthy controls were recruited from the Hospital for Tropical Diseases in Ho Chi Minh City and the surrounding community, respectively. Neurocognitive measures (adapted for use in Vietnam) and liver enzyme tests were compared across groups at baseline. Repeated multivariate and group-based trajectory analyses (GBTA) examined neurocognitive subgroup profiles of the co-infected individuals after 72 weeks of de novo efavirenz- (n = 41) or raltegravir-based (n = 39) ART.Results: Baseline analyses revealed worse motor function in HIV-HCV co-infected individuals compared to both comparison groups. Longitudinal analyses revealed improved neurocognitive performance by week 48 for most participants regardless of treatment arm. GBTA identified a subgroup (35% of HIV-HCV sample) with persistent motor impairment despite otherwise successful ART. Higher HIV viral load and lower CD4+ T cell count at baseline predicted persistent motor dysfunction. Liver indices and ART regimen did not predict neurocognitive outcomes in HIV-HCV co-infected individuals.Conclusions: Most HIV-HCV co-infected individuals achieve normative neurocognitive performance after 48 weeks of de novo suppressive ART. However, individuals with more severe HIV disease prior to ART exhibited motor impairment at baseline and 72 weeks after otherwise successful treatment. Interventions aimed at improving motor symptoms at the time of HIV treatment onset may improve long-term clinical outcomes in HIV-HCV co-infected adults.

Comprehensive Evaluation of the Functional Activities Questionnaire (FAQ) and Its Reliability and Validity

The Functional Activities Questionnaire (FAQ) is a collateral-report measure of difficulties in activities of daily living. Despite its widespread use, psychometric analyses have been limited in scope, piecemeal across samples, and limited primarily to classical test theory. This article consolidated and expanded psychometric analyses using tools from generalizability and item response theories among 27,916 individuals from the National Alzheimer’s Coordinating Center database who completed the FAQ. Reliability was evaluated with internal consistency, test–retest, and generalizability analyses. Validity was assessed via convergence with neurocognitive measures, classification accuracy with impairment stage, and confirmatory factor and item response theory analyses. Demographics did not impact scores and there was strong evidence for reliability (0.52-0.95), though coefficients were attenuated when restricted in range to diagnostic groups (e.g., normal cognition). There were strong correlations with neurocognitive measures ( rs: −.30 to −.59), strong classification accuracy (areas under the curve: .81-.99), and a single-factor model had excellent fit. All items evidenced strong item response theory discrimination and provided significant information regarding functional disability, albeit within a relatively restricted range. The FAQ is a reliable and valid measure of activities of daily living concerns for use in clinical/research settings. It best assesses mild levels of functional difficulty, which is helpful in distinguishing normal cognition from mild cognitive impairment and dementia.

Cognition in Schizophrenia: Modeling the Interplay between Interleukin-1β C-511T Polymorphism, Metabolic Syndrome, and Sex

<b><i>Introduction:</i></b> Cognitive deficits and metabolic disturbances are among the main determinants of functional impairment and reduced life expectancy in patients with schizophrenia, and they may share underlying biological mechanisms. Among these, interleukin-1β (IL-1β), a key mediator of inflammatory response, is of particular interest. IL-1β C-511T polymorphism has been associated with neuropsychiatric conditions and, in the general population, with cognitive and metabolic alterations. This study aims to evaluate the effects of the IL-1β C-511T polymorphism on both cognition and metabolic syndrome in a sample of patients affected by schizophrenia, with a focus on sex differences. <b><i>Methods:</i></b> 138 patients with schizophrenia were assessed for metabolic parameters and neurocognitive measures by means of the Brief Assessment of Cognition Scale. The effects of IL-1β C-511T polymorphism on cognition and metabolic syndrome were evaluated in the context of general linear models. <b><i>Results:</i></b> The analysis showed a significant interaction between IL-1β genotype and sex on 2 core cognitive domains. In detail, among CC homozygous, females outperformed males on processing speed, while among T carriers, males outperformed females on executive functions. A significant interaction also emerged between metabolic syndrome, sex, and IL-1β genotype for executive functions, with worse performance for T carrier females with metabolic syndrome. No significant direct effect was observed for metabolic syndrome on cognition. <b><i>Conclusion:</i></b> These findings support the hypothesis that IL-1β polymorphism could play a key role in mediating the complex and refined relationship between metabolic syndrome and cognitive performance.

Neurocognitive measures and self-reported symptoms following a short intensive multimodal neurorehabilitation program in individuals with post-concussion syndrome: Retrospective case-series study

ObjectiveThis case-series study investigates the effect of a condensed multi-modal neurorehabilitation program on neurocognitive measures and self-reported symptoms using the C3Logix assessment tool on 137 individuals with diagnosed Post-Concussion Syndrome (PCS).BackgroundIn PCS, neurocognitive dysfunction is typically accompanied by symptoms of the physical, affective, and sleep domains. While most individuals recover within weeks of sustaining a head injury, evidence shows that those who do not recover in 3 months, may never. Recovery methods are usually prescribed with varying success, but the pathophysiologic complexity of concussion may require additional rehabilitation strategies that address the impaired neural networks to accelerate recovery.Design/Methods137 individuals (M: 81, F: 56; mean (SD) age: 32.0 (14.0)) with a diagnosed PCS were treated at an outpatient rehabilitation center specializing in functional neurology. Using the C3Logix platform, individuals were evaluated at the intake and discharge of a 5-day program. Interventions included neuromuscular re-education, vestibular rehabilitation, orthoptics and cognitive training. Neurocognitive components and symptoms were exported and analyzed in Graphpad PRISM v. 8.4.3 using an rmANOVA. Results are reported as difference-of-means (95% CI). An alpha level of 0.05 was considered statistically significant.ResultsThe C3Logix modified Graded Symptom Checklist score (0–150) decreased by 19.45 (15.16–23.75) (p < 0.0001), Trails A and B decreased 3.9 s (2.2–5.5) and 4.8 s (2.1–7.5) (p < 0.0001), respectively. Simple- and Choice Reaction Time decreased 31.3 ms (21.5–41.1) and 50.7 ms (37.9–63.6) (p < 0.0001), respectively. Static and Dynamic Visual Acuity decreased 0.03 LogMAR (0.0085–0.059) (p = 0.0021) and 0.05 LogMAR (0.021–0.073), respectively. Standardized Assessment of Concussion score (0–30) increased 0.8 (0.3–1.3) (p = 0.001) and digit-symbol coding increased 4.6 symbols (3.0–6.2) (p < 0.0001).ConclusionsThe results of the present case-series study suggest clinically relevant improvements in neurocognitive measures and subjective symptoms in individuals with PCS following a multi-modal 5-day rehabilitation program.

Fetal Hemoglobin Mediates the Effect of Beta Globin Gene Polymorphisms on Neurocognitive Functioning in Sickle Cell Disease

Background: Fetal hemoglobin (HbF) is the most influential modifier of the clinical and hematologic phenotype of sickle cell disease (SCD) and is highly heritable. Low HbF is independently associated with increased white matter changes on brain imaging and poorer performance on neurocognitive measures (Ruffiuex, Child Neuropsychology, 2013). Our previous work has shown that 11 SNPs in three genes (BCL11A, MYB, and β-globin), contribute over 20% of the variance in HbF (Rampersaud, Kang. et al., 2020, under review). Clinically, these HbF-associated SNPs are associated with disease severity and frequency of pain events. However, the neurocognitive implications of these SNPs have yet to be explored. As part of a prospective longitudinal cohort study, the Sickle Cell Clinical Research and Intervention Program (SCCRIP), we evaluated the relationship between HbF-associated SNPs and neurocognitive functioning in SCD patients. Methods: We included 257 patients with SCD (69% HbSS/HbSβ0-thalassemia). The median age of participants was 13 years (range 4 - 25). We extracted genotypes for the 11 HbF-associated SNPs from whole genome sequencing data and analyzed them based on an additive genetic model. Following informed consent, patients completed a battery of gold-standard neurocognitive measures, supervised by a psychologist, assessing IQ, verbal and perceptual reasoning, working memory, processing speed, sustained attention, and executive functioning skills. HbF was the average value of measurements collected within 3 months of neurocognitive assessment, or the closest value. In univariate analyses, Kruskal-Wallis rank sum test was used to assess the associations of the 11 HbF-associated SNPs with neurocognitive measures. Linear regression was used to examine these associations adjusting for age, sickle genotype, hydroxyurea exposure, socioeconomic status (index of social vulnerability) and 5 principal components to adjust for population stratification. Benjamini and Hochberg false discovery rate (FDR) was used for multiple corrections and FDR adjusted p (pFDR)&lt;0.05 was considered significant for all analyses. Mediation analyses (Imai, Psychological Methods, 2010) were used to evaluate the indirect effects of HbF-associated SNPs on neurocognitive outcomes via HbF. Results: One SNP in the β-globin gene, rs968857, was associated with performance on measures of IQ, verbal reasoning, working memory, and executive functioning by Kruskal-Wallis rank sum test (Figure 1) and by linear regression adjusting for covariates listed above at pFDR &lt;0.05. HbF expression was positively associated with IQ and verbal reasoning scores at pFDR &lt;0.05 using linear regression adjusting for age, sickle genotype, hydroxyurea exposure, and socioeconomic status. HbF mediated the relationship between rs968857 and scores on IQ and verbal reasoning measures at pFDR &lt;0.05 (Figure 2). The direct effect of rs968857 on neurocognitive functioning remained significant following inclusion of HbF at pFDR &lt;0.05, indicating partial mediation. Full linear regression models with rs968857, HbF, and covariates accounted for 10.8%, 14.5%, 6.4%, and 8.3% of the variance in IQ, verbal reasoning, working memory, and executive functioning measures, respectively. Conclusions: This is the first study to demonstrate a relationship between genetic modifiers of SCD and neurocognitive functioning. Beyond findings on neuroimaging and sociodemographic factors, there is little known about risk for neurocognitive deficits in SCD. The present results suggest an influence of SNP rs968857 on cognitive function, which was partially mediated by expression of HbF. rs968857, is one of four SNPs that defines almost all β-globin gene cluster haplotypes and influences HbF levels in SCD. How this SNP effects HbF and neurocognition is unknown and requires further investigation of its mechanism. The highly heritable nature of HbF may allow for future use of precision medicine. SCD patients could be stratified according to risk for neurocognitive deficits to utilize early intervention strategies, informed by genetic polymorphisms. Correlation with neuroimaging will help further elucidate the relationship between genetic modifiers and neurocognitive functioning. Future trials with larger samples are needed to validate our findings and investigate if the observed relationships differ by age or hydroxyurea treatment status. Disclosures Estepp: Daiichi Sankyo, Esperion, Global Blood Therapeutics: Consultancy; Global Blood Therapeutics, Forma Therapeutics, Pfizer, Eli Lilly and Co: Research Funding; ASH, NHLBI: Research Funding. King:Amphivena Therapeutics: Research Funding; Bioline: Consultancy; Celgene: Consultancy; Cell Works: Consultancy; Incyte: Consultancy; Magenta Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novimmune: Research Funding; RiverVest: Consultancy; Tioma Therapuetics: Consultancy; WUGEN: Current equity holder in private company. Hankins:Novartis: Research Funding; National Heart, Lung, and Blood Institute: Honoraria, Research Funding; UptoDate: Consultancy; Global Blood Therapeutics: Consultancy, Research Funding; MJH Life Sciences: Consultancy, Patents & Royalties; American Society of Pediatric Hematology/Oncology: Honoraria; LINKS Incorporate Foundation: Research Funding.