A-77 Nonverbal Memory Dysfunction and Migraine-Related Disability Predict Subjective Cognitive Symptoms in Adults with Migraine

Objective This study investigated the relationship between subjective cognitive symptom reporting and objective cognitive functioning in adults with migraine. Method 88 participants (Mdn age = 46.0 [35.25–56.75]; Mdn years of education = 16.0 [13.0–19.0]; 88.6% female) completed neuropsychological testing and questionnaires assessing migraine disability (Migraine Disability Assessment Scale) and subjective cognition (Sickness Impact Profile-Alertness Behavior Subscale). Participants had primary headache disorder diagnosis of migraine. Bivariate correlations and hierarchical linear regression were performed. Results 83% of participants had episodic migraine (< 15 headache days/month) and 58% reported low or moderate disability (MIDAS ≤21). Subjective cognitive dysfunction was associated with lower education (ρ = −0.254; p = 0.018), higher disability (t(84) = −3.00, p = 0.004); and lower scores on coding (r = −0.224, p = 0.023) TMT-A (r = −0.238, p = 0.029), RCFT- Immediate Recall (r = −0.028, p = 0.010), RCFT- Delayed Recall (r = −0.38, p < 0.001), RCFT-recognition (r = −0.40, p < 0.001), and animal fluency (r = −0.27, p = 0.013). Migraine-related disability and RCFT- Delayed Recall (ß = −0.368, SE = 0.006).) accounted for 45.9% of variance in subjective cognitive symptom reporting. The addition of RCFT-recognition (ß = −0.050, SE = 0.025) increased explanation of variance by 4.1%. Conclusion Nonverbal memory dysfunction and higher disability may predict subjective cognitive complaints. This study contributes to the limited knowledge of objective and subjective cognitive functioning in adults with migraine.

HOW PURE IS PURE ALEXIA? A NEUROPSYCHOLOGICAL ANALYSIS OF A CASE SERIES OF PATIENTS WITH ALEXIA DUE TO LEFT HEMISPHERIC STROKES

The aim of this study was to analyze a case series with acquired alexia after stroke within the posterior areas of the left hemisphere, in the context of the current criteria for pure alexia and their relevance to the set of symptoms observable in clinical practice. Seven patients with ischemic strokes and an initial diagnosis of pure alexia were enrolled for detailed analysis. The evaluation consisted of neuropsychological assessment in the form of standardized tests and non-standardized reading tasks, while oculomotor activity during reading was measured. Language functions, visual object and space perception, verbal and nonverbal memory, and visuospatial constructional ability were among the domains assessed. In five of the participants, pure alexia was recognized based on sig- nificant and specific discrepancies between test scores, indicating primary abnormalities in the visual processing of letter strings as a basic mechanism of the disorder. In most of the patients, coexisting cognitive deficits were revealed; however, these were dispropor- tionately milder and less functionally significant than reading disturbances. Pure alexia is a relatively rare disorder after a stroke, but it considerably affects the quality of everyday independent functioning. Its clinical characteristics in practice rarely meet all the criteria proposed in the subject literature. The differential diagnosis of this form of alexia and other reading disorders requires detailed clinical analysis.

A-04 The Relationship of ApoE Status and Cognition in Non-demented Older Adults

Objective Apolipoprotein (ApoE)-e4 is well established as a genetic risk factor for Alzheimer’s disease (AD) as well as a predictor for the rate of cognitive decline in AD. Among older adults without dementia, some research has found that e4 carriers have worse episodic memory compared to e4 non-carriers, whereas others have not found this association. The present study examined differences in cognitive performance between ApoE-e4 carriers and non-carriers. Method 91 non-demented individuals (age range: 55–87) were genotyped for ApoE (41 e4 carriers, 49 e4 non-carriers) and completed neuropsychological testing as a part of a longitudinal study at the Center for Neurodegeneration and Translational Neuroscience. Cognitively normal (CN) and mild cognitive impairment (MCI) participants were included (41 CN, 49 MCI). Group differences between e4 carriers and non-carriers were compared across cognitive measures after controlling for age, gender, and education. Results In the total sample, e4 carriers performed significantly worse across measures of verbal and nonverbal memory, as well as on the Boston Naming Test and Symbol Digit Modalities Test (all p’s < .05). No significant group differences were observed across visuospatial or executive function tasks. When diagnostic subgroups were examined, e4 carriers had worse verbal memory than non-carriers in the MCI group, but there was no effect of e4 status on cognition among CN participants. Conclusion(s) These findings support that ApoE-e4 positivity is associated with worse cognitive performance, especially on tasks related to medial temporal lobe function, among non-demented older adults. In MCI, worse verbal memory in e4 carriers likely reflects increased progression of underlying AD pathology.

Prefrontal GABA Levels Correlate with Memory in Older Adults at High Risk for Alzheimer’s Disease

γ-Aminobutyric acid (GABA), a primary inhibitory neurotransmitter in the brain, plays a significant role in aging and in neurodegenerative disorders, including Alzheimer’s disease (AD). We investigated the relationship between GABA levels in the dorsomedial/dorsoanterolateral prefrontal cortex (DM/DA-PFC) and memory in high-AD risk participants. Thirty-eight participants (14 Cognitively Normal [CN], 11 with Subjective Cognitive Decline (SCD), and 13 Mild Cognitive Impairment [MCI]) underwent magnetic resonance spectroscopy at 3 Tesla. SCD and MCI participants were grouped together to form a single high-AD risk group (N = 24) for the purposes of statistical analyses. Partial correlations of GABA+/Cr level with verbal memory, assessed on California Verbal Learning Test-II, and nonverbal memory, assessed on Brief Visuospatial Memory Test and Rey-Osterrieth test, were examined separately within the high-AD risk and CN groups. GABA+/Cr levels were positively correlated with long-delayed verbal memory (r = 0.69, P = 0.009) and immediate nonverbal memory (r = 0.97, P = 0.03) in high-AD risk, but not in CN participants. These results remained significant after controlling for depression. These preliminary findings, which require replication due to the limited sample sizes, are the first report of an association between GABA+/Cr levels within the DM/DA-PFC and memory performance in high-AD risk individuals.

The visual nonverbal memory trace is fragile when actively maintained, but endures passively for tens of seconds

Despite attempts at active maintenance in the focus of attention, the fragile nature of the visual nonverbal memory trace may be revealed when the retention interval between target memoranda and probed recall on a trial is extended. In contrast, a passively maintained or unattended visual memory trace may be revealed as persisting proactive interference extending across quite extended intervals between trials in a recent probes task. The present study, comprising five experiments, used this task to explore the persistence of such a passive visual memory trace over time. Participants viewed some target visual items (for example, abstract colored patterns) followed by a variable retention interval and a probe item. The task was to report whether the probe matched one of the targets or not. A decaying active memory trace was indicated by poorer performance as the memory retention interval was extended on a trial. However, when the probe was a member of the target set from the preceding trial, task performance was poorer than a comparison novel probe, demonstrating proactive interference. Manipulations of the intertrial interval revealed that the temporal persistence of the passive memory trace of an old target was impressive, and proactive interference was largely resilient to a simple ‘cued forgetting’ manipulation. These data support the proposed two-process memory conception (active–passive memory) contrasting fragile active memory traces decaying over a few seconds with robust passive traces extending to tens of seconds.

A-44 Categorical Errors on the Benton Visual Retention Test are Systemically Related to Specific Factorial Components of Intelligence

Objective We investigated the factorial relationship of the six categories of memory errors of the BVRT to the four factorial variables of the WAIS to determine the relationship between cognitive and nonverbal memory variables. Methods A sample of 134 diagnostically mixed ambulatory American Veteran patients with a wide variety of mixed neuropsychiatric diagnoses and with or without general medical problems who had completed the WAIS-3, and the BVRT were examined. There were no demographic or diagnostic exclusion criteria. Results The 6 types of BVRT memory errors (omissions, distortions, perseverations, rotations, misplacements, and size errors) were factored using principal component analysis. The four WAIS 3 and six BVRT components were jointly factored to examine for systematic relationships between memory and cognitive domains. The analysis identified specific factorial relationships of BVRT error type to each of the four factorial components of the WAIS. POI was related to rotation errors, VCI was related to size errors, PSI specifically related to omissions and WMI to distortions. Misplacement and perseveration errors were related to each other but not to factorial constructs of the WAIS. Conclusions There are specific and robust relationships among BVRT errors and dimensional cognitive variables.

A-45 Systematic Relationships of the Benton Visual Retention Test to Intelligence, Language and Demographics

Objective We investigated the factorial relationships of WAIS 3, BVRT, Visual Naming and demographic variables to better understand factorial relationships among those variables. Methods A sample of 126 ambulatory American Veteran patients who presented for clinical evaluation with a wide variety of mixed neuropsychiatric diagnoses and general medical diagnoses were studied. There were no demographic or diagnostic exclusion criteria. Results Our first analysis demonstrated robust independent relationships of age to a late occurring BVRT item group and education to an early occurring BVRT item group. A two factor solution for the items of the multilingual aphasia exam visual naming subtest from previous research showed systematic and robust relationships of one visual naming factor to VCI and the other visual naming factor to PSI only. Factor scales were computed to represent the orthogonal factors for the new variables in each of these analyses. Factor scales from the first two analyses were factored together to produce a four-part solution that explained 86% of the variance. POI was related to the late BVRT item group and age. The early BVRT item grouping was related to educational level, VCI, PSI and both visual naming components. WMI was independent of demographic, linguistic and BVRT variables. Conclusions There are factorial relationships between factorial components of nonverbal memory, intelligence, naming and demographic variables.

Dissociable cognitive patterns related to depression and anxiety in multiple sclerosis

Background: Individuals with multiple sclerosis (MS) frequently present with depression and anxiety, as well as cognitive impairment, challenging clinicians to disentangle interrelationships among these symptoms. Objective: To identify cognitive functions associated with anxiety and depression in MS. Methods: Mood and cognition were measured in 185 recently diagnosed patients (Reserve Against Disability in Early Multiple Sclerosis (RADIEMS) cohort), and an independent validation sample (MEM CONNECT cohort, n = 70). Partial correlations evaluated relationships of cognition to anxiety and depression controlling for age, sex, education, and premorbid verbal intelligence. Results: In RADIEMS cohort, lower anxiety was associated with better nonverbal memory ( rp = –0.220, p = 0.003) and lower depression to better attention/processing speed ( rp = –0.241, p = 0.001). Consistently, in MEM CONNECT cohort, lower anxiety was associated with better nonverbal memory ( rp = –0.271, p = 0.028) and lower depression to better attention/processing speed ( rp = –0.367, p = 0.002). Relationships were unchanged after controlling for T2 lesion volume and fatigue. Conclusion: Consistent mood–cognition relationships were identified in two independent cohorts of MS patients, suggesting that cognitive correlates of anxiety and depression are separable. This dissociation may support more precise models to inform treatment development. Treatment of mood symptoms may mitigate effects on cognition and/or treatment of cognition may mitigate effects on mood.

Effects of Bilingualism on Verbal and Nonverbal Memory Measures in Mild Cognitive Impairment

Objectives:Maintaining two active languages may increase cognitive and brain reserve among bilingual individuals. We explored whether such a neuroprotective effect was manifested in the performance of memory tests for participants with amnestic mild cognitive impairment (aMCI).Methods:We compared 42 bilinguals to 25 monolinguals on verbal and nonverbal memory tests. We used: (a) the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L), a sensitive test that taps into proactive, retroactive, and recovery from proactive semantic interference (verbal memory), and (b) the Benson Figure delayed recall (nonverbal memory). A subsample had volumetric MRI scans.Results:The bilingual group significantly outperformed the monolingual group on two LASSI-L cued recall measures (Cued A2 and Cued B2). A measure of maximum learning (Cued A2) showed a correlation with the volume of the left hippocampus in the bilingual group only. Cued B2 recall (sensitive to recovery from proactive semantic interference) was correlated with the volume of the hippocampus and the entorhinal cortex of both cerebral hemispheres in the bilingual group, as well as with the left and right hippocampus in the monolingual group. The memory advantage in bilinguals on these measures was associated with higher inhibitory control as measured by the Stroop Color-Word test.Conclusions:Our results demonstrated a superior performance of aMCI bilinguals over aMCI monolinguals on selected verbal memory tasks. This advantage was not observed in nonverbal memory. Superior memory performance of bilinguals over monolinguals suggests that bilinguals develop a different and perhaps more efficient semantic association system that influences verbal recall. (JINS, 2019, 25, 15–28)