Replicating the classification accuracy of the Verbal Paired Associates and Visual Reproduction recognition trials as embedded performance validity tests

OBJECTIVE

This study was designed to replicate previous research on the clinical utility of the Verbal Paired Associates (VPA) and Visual Reproduction (VR) subtests of the WMS-IV as embedded performance validity tests (PVTs) and perform a critical item (CR) analysis within the VPA recognition trial.

METHOD

Archival data were collected from a mixed clinical sample of 119 adults (MAge = 42.5, MEducation = 13.9). Classification accuracy was computed against psychometrically defined criterion groups based on the outcome of various free-standing and embedded PVTs.

RESULTS

Age-corrected scaled scores ≤ 6 were specific (.89-.98) but had variable sensitivity (.36-.64). A VPA recognition cutoff of ≤ 34 produced a good combination of sensitivity (.46-.56) and specificity (.92-.93), as did a VR recognition cutoff of ≤ 4 (.48-.53 sensitivity at .86-.94 specificity). Critical item analysis expanded the VPA's sensitivity by 3.5%-7.0% and specificity by 5%-8%. Negative learning curves (declining output on subsequent encoding trials) were rare but highly specific (.99-1.00) to noncredible responding.

CONCLUSIONS

Results largely support previous reports on the clinical utility of the VPA and VR as embedded PVTs. Sample-specific fluctuations in their classification accuracy warrant further research into the generalizability of the findings. Critical item analysis offers a cost-effective method for increasing confidence in the interpretation of the VPA recognition trial as a PVT. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Compassion Versus Accuracy: Lenient Scoring of the Spatial Orientation Items on the Mini-mental State Exam Lowers Sensitivity

The Mini-mental State Examination (MMSE) is a commonly used screening tool for cognitive impairment. Lenient scoring of spatial orientation errors (SOEs) on the MMSE is common and negatively affects its diagnostic utility. We examined the effect of lenient SOE scoring on MMSE classification accuracy in a consecutive case series of 103 older adults (age 60 or above) clinically referred for neuropsychological evaluation. Lenient scoring of SOEs on the MMSE occurred in 53 (51.4%) patients and lowered the sensitivity by 7% to 18%, with variable gains in specificity (0% to 11%) to psychometrically operationalized cognitive impairment. Results are consistent with previous reports that lenient scoring is widespread and attenuates the sensitivity of the MMSE. Given the higher clinical priority of correctly detecting early cognitive decline over specificity, a warning against lenient scoring of SOEs (on the MMSE and other screening tools) during medical education and in clinical practice is warranted.

Psychometric properties of the Behavior Rating Inventory of Executive Function, second edition (BRIEF2) self-report form in Iranian adolescents

BACKGROUND

This study investigated the psychometric properties of a Persian translation of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) Self-Report form.

METHOD

Participants were 589 typically developing adolescents (336 girls and 253 boys), ages 11-18 years old (M = 15.16; SD = 2.04), in Iran. They completed the Persian version of the BRIEF2 Self-Report form and Teenage Executive Functioning Inventory (TEXI). The Persian translated BRIEF2 psychometric properties were examined via internal consistency, test-retest reliability, convergent validity via associations with TEXI scores, and internal structure using structural equation modeling (SEM) to evaluate fit of the three-factor structure from the original English version BRIEF2.

RESULTS

Findings indicated the Persian version of BRIEF2 Self-Report form yielded scores with robust reliability, with internal consistency ranging from .87 to .93 and test-retest correlations ranging from .89 to .96, and adequate convergent validity, with correlations with the TEXI ranging from .48 to .79. SEM revealed that a three-factor solution was the best fitting model for the seven subscales of the Persian BRIEF2.

CONCLUSION

These findings support the clinical use of the Persian BRIEF2 in Iranian adolescents, including the interpretation of the BRIEF2 three-factor structure, as well as the multidimensional nature of executive functions.

Replicating a Meta-Analysis: The Search for the Optimal Word Choice Test Cutoff Continues

This study was designed to expand on a recent meta-analysis that identified ≤42 as the optimal cutoff on the Word Choice Test (WCT). We examined the base rate of failure and the classification accuracy of various WCT cutoffs in four independent clinical samples (N = 252) against various psychometrically defined criterion groups. WCT ≤ 47 achieved acceptable combinations of specificity (.86-.89) at .49 to .54 sensitivity. Lowering the cutoff to ≤45 improved specificity (.91-.98) at a reasonable cost to sensitivity (.39-.50). Making the cutoff even more conservative (≤42) disproportionately sacrificed sensitivity (.30-.38) for specificity (.98-1.00), while still classifying 26.7% of patients with genuine and severe deficits as non-credible. Critical item (.23-.45 sensitivity at .89-1.00 specificity) and time-to-completion cutoffs (.48-.71 sensitivity at .87-.96 specificity) were effective alternative/complementary detection methods. Although WCT ≤ 45 produced the best overall classification accuracy, scores in the 43 to 47 range provide comparable objective psychometric evidence of non-credible responding. Results question the need for designating a single cutoff as "optimal," given the heterogeneity of signal detection environments in which individual assessors operate. As meta-analyses often fail to replicate, ongoing research is needed on the classification accuracy of various WCT cutoffs.

Do executive functions differentiate Iranian children with attention-deficit/hyperactivity disorder with and without comorbid obesity?

OBJECTIVE

To compare multiple dimensions of executive function between children with attention-deficit/hyperactivity disorder (ADHD) with and without comorbid obesity.

METHOD

Participants were 90 Iranian children (ages 8-13, 50% female) who were equally dispersed across three study groups: typically developing (TD), ADHD with obesity (ADHD+O), and ADHD without obesity (ADHD-O). Study participants were administered a comprehensive battery of Iranian-adapted "cool" executive function tasks including Digit Span from the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V), Victoria Stroop Test (VST), Wisconsin Card Sorting Test (WCST), Tower of London, and dot-probe task (i.e., a task of attentional bias). Parents completed the Children's Scale for Future Thinking Questionnaire, which assesses future-oriented cognition (e.g., saving, planning, episodic foresight, delay of gratification), aligning more with "hot" executive functions. Groups were compared using multivariate and post-hoc univariate general linear models.

RESULTS

Significant group effects were observed for all executive function variables, broadly with the gradient pattern of TD > ADHD-O > ADHD+O. ADHD+O had poorer performances than ADHD-O for WISC-V Digit Span (d = -0.84), WCST Categories Completed (d = -0.55) and Perseverative Responses (d = 1.15), VST Interference Errors (d = 0.83) and Interference Time (d = 1.38), and Dot-Probe Task (d = 0.84). Relative to the ADHD-O group, ADHD+O had also poorer parent-reported Prospective Memory (d = -0.62), Episodic Foresight (d = -0.63), and Delay of Gratification (d = -0.54).

CONCLUSIONS

Children with ADHD-O have poorer executive functioning than those without obesity. We observed stronger effects for "cool" rather than "hot" domains of executive function, though this could be due to the former being performance-based and the latter parent-reported.

B - 30 A Consultation Model Approach to Working with the Deaf Community: a Neuropsychological Case Report

OBJECTIVE

Neuropsychological evaluation with Deaf individuals is of increasing interest in light of the recent SCOTUS decision in Perez v Sturgis. We describe an evaluation approach with a Deaf patient and his wife (who is deaf blind) using consecutive sign language interpretation and a remote consultant.

METHOD

A 76-year-old Deaf man with 8 years of education presented to a rural Northeastern medical center with memory concerns. An expert in neuropsychological evaluation with Deaf individuals provided remote consultation on relevant background, linguistic, and cultural questions for patient and interpreters, test battery choices that are robust to interpretation, modification of instructions as needed, functional equipment (clear masks, face shields), and optimal testing room setup with both a medical interpreter and a Certified Deaf Interpreter.

RESULTS

Difficulties were noted with visual learning and memory in the context of estimated average perceptual intellectual ability and intact attention, executive functions, and spatial skills. Expressive language (ASL) and memory for ASL signs were intact. Processing speed was variable.

CONCLUSIONS

We present an example of neuropsychological evaluation using expert consultation and both hearing and Deaf interpreters for an individual from the Deaf community. The consultation process, decision making with respect to the test battery, testing room setup and coordination with interpreters, and issues related to interpreting findings in the context of a Deaf patient's educational and medical history are addressed.

A - 122 Coronavirus Anxiety, Mood, and Subjective Cognition in Post-Acute Sequelae of COVID-10

OBJECTIVE

Coronavirus anxiety (CA) is associated with depression, general anxiety, and subjective cognitive dysfunction (SCD) in community samples. Furthermore, individuals with SARS-CoV-2 infection (acute & post-acute) report greater CA and SCD. No study to date has examined CA in patients diagnosed with post-acute sequelae of COVID-19 (PASC). We evaluated the prevalence of CA amongst individuals diagnosed with PASC and its associations with mood and SCD.

METHOD

Participants were 72 patients diagnosed with PASC [M age = 48.8 ± 11.9 years, 72.2% female, 93.1% White] who were referred for clinical neuropsychological evaluation between May 2021 and February 2023. Participants completed the Coronavirus Anxiety Scale (CAS; range = 0-20, clinical cutoff: ≥9), BDI-II, BAI, BRIEF-A, and Neurobehavioral Symptom Inventory (NSI).

RESULT

Overall, CAS scores were low (M = 1.29, SD = 2.69, 4.2% clinically elevated). In contrast, depression scores were high (M = 23.2, SD = 11.2, 72.2% clinically elevated), as were anxiety scores (M = 19.7, SD = 12.2, 72.2% clinically elevated). CAS scores tended to decline over the course of the study; however, scores on the BDI-II or BAI did not. Higher CAS scores were associated with higher scores on the BDI-II (rs = 0.344, p = 0.005), BAI (rs = 0.321, p = 0.009), and BRIEF-A Global Executive Composite (rs = 0.407, p = 0.001) but not for the NSI Cognitive Factor (rs = 0.139, p = 0.256).

CONCLUSION

Findings suggest clinically significant CA is not particularly prevalent in individuals with PASC, but perhaps is more salient for acute infection. Results also highlight the presence of clinically elevated psychiatric distress in patients with PASC and the need for proper screening and intervention.

Accelerated long-term forgetting of recall and recognition memory in people with epilepsy

PURPOSE

Persons with epilepsy (PWE) report memory deficits as one of the most distressing aspects of their disorder. Recently, a long-term memory deficit known as Accelerated Long-Term Forgetting (ALF) has been described in PWE. ALF is characterized by the initial retention of learned information, followed by an accelerated rate of memory decay. However, the rate of ALF varies widely across literature and it is unclear how it impacts different memory retrieval types. The current study aimed to capture the time course of ALF on both free recall and recognition memory using a movie-based task in PWE.

METHODS

A sample of 30 PWE and 30 healthy comparison (HC) subjects watched a nature documentary and were tested on their recall and recognition of the film's content immediately after viewing and at delays of 24 hours, 48 hours, and 72 hours. Participants also rated the confidence they had in their recognition memory trial responses.

RESULTS

For recall, PWE exhibit ALF at 72 hours (β = -19.840, SE = 3.743, z(226) = -5.301, p < 0.001). For recognition, PWE had decreased performance compared to controls at the 24-hour (β = -10.165, SE = 4.174, z(224) = -3.166, p = 0.004), 48-hour (β = -8.113, SE = 3.701, z(224) = -2.195, p = 0.044), and 72-hour (β = -10.794, SE = 3.017, z(224) = -3.295, p = 0.003) delays. The PWE group showed positive correlations (tau = 0.165, p < 0.001) between confidence ratings and accuracy, with higher confidence reflecting successful recognition. PWE were 49% less likely to answer either retrieval type correctly at 72 hours (OR 0.51, 95% CI [0.35, 0.74], p < 0.001). Left hemispheric seizure onset decreased the odds of successful retrieval by 88% (OR 0.12, 95% CI [0.01, 0.42], p = 0.019).

CONCLUSIONS

These findings provide evidence of ALF in PWE, with a differential impact on recall and recognition memory. This further supports the call to include ALF assessments in standard memory evaluations in PWE. Additionally, identifying the neural correlates of ALF in the future will be important in developing targeted therapies to alleviate the burden of memory impairment for PWE.

Univariate and Multivariate Base Rates of Score Elevations, Reliable Change, and Inter-Rater Discrepancies in the BRIEF-A Standardization Samples

The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is a standardized rating scale of subjective executive functioning. We provide univariate and multivariate base rates (BRs) for scale/index scores in the clinical range (T scores ≥65), reliable change, and inter-rater information not included in the Professional Manual. Participants were adults (ages = 18-90 years) from the BRIEF-A self-report (N = 1,050) and informant report (N = 1,200) standardization samples, as well as test-retest (n = 50 for self, n = 44 for informant) and inter-rater (n = 180) samples. Univariate BRs of elevated T scores were low (self-report = 3.3%-15.4%, informant report = 4.5%-16.3%). Multivariate BRs revealed the common occurrence of obtaining at least one elevated T-score across scales (self-report = 26.5%-37.3%, informant report = 22.7%-30.3%), whereas virtually none had elevated scores on all scales. Test-retest scores were highly correlated (self = .82-.94; informant = .91-.96). Inter-rater correlations ranged from .44 to .68. Significant (p < .05) test-retest T-score differences ranged from 7 to 12 for self-report, from 6 to 8 for informant report, and from 16 to 21 points for inter-rater T-score differences. Applications of these findings are discussed.

Domain-aware Intermediate Pretraining for Dementia Detection with Limited Data

Detecting dementia using human speech is promising but faces a limited data challenge. While recent research has shown general pretrained models (e.g., BERT) can be applied to improve dementia detection, the pretrained model can hardly be fine-tuned with the available small dementia dataset as that would raise the overfitting problem. In this paper, we propose a domain-aware intermediate pretraining to enable a pretraining process using a domain-similar dataset that is selected by incorporating the knowledge from the dementia dataset. Specifically, we use pseudo-perplexity to find an effective pretraining dataset, and then propose dataset-level and sample-level domain-aware intermediate pretraining techniques. We further employ information units (IU) from previous dementia research and define an IU-pseudo-perplexity to reduce calculation complexity. We confirm the effectiveness of perplexity by showing a strong correlation between perplexity and accuracy using 9 datasets and models from the GLUE benchmark. We show that our domain-aware intermediate pretraining improves detection accuracy in almost all cases. Our results suggested that the difference in text-based perplexity values between patients with Alzheimer's Disease (AD) and Healthy Control (HC) is still small, and the perplexity incorporating acoustic features (e.g., pause) may make the pretraining more effective.

A-215 Comparability of BRIEF2 and BRIEF-A Self-Report in Young Adults

Objective: The Behavior Rating Inventory of Executive Function (BRIEF) captures perceptions of an individual’s executive functioning in their everyday environment. Two self-report forms span late adolescence into early adulthood: BRIEF2 (ages 11-18) and BRIEF-Adult (ages 18-90). We compared responses on these forms in young adults to evaluate their continuity in this transitional age range.

Method: Participants were 77 college students [age M(SD)= 18.45(0.64), 66% female], without psychiatric or serious medical conditions, who completed the BRIEF2 and BRIEF-A forms in counterbalanced order. Mean scores on shared clinical scales (Inhibit, Self-Monitor, Shift, Emotional Control, Working Memory, Plan/Organize) and Global Executive Composite (GEC) were examined using MANOVA and correlations; T scores were examined in the subsample of 18-year-olds (n=47).

Results: For mean ratings, planned univariate follow-up tests with Bonferroni correction were significant only for the Inhibit scale [F(1,76) = 14.69, p &lt; .001, Cohen’s d = -0.44]. Other effect sizes were &lt; 0.3. Scales correlated well (r range .63 to .82, p &lt; .001). T-score analyses yielded similarly strong relationships (r range .58 to .84), but with significant differences on Emotional Control (d = 0.53) and Plan/Organize (d = -0.47).

Conclusions: Results indicate good correspondence between self-report on the BRIEF2 and BRIEF-A in young adults, with few differences and generally small effect sizes. Nonetheless, statistical corrections should be employed if merging datasets using both BRIEF2 and BRIEF-A, or when examining changes in individuals followed from adolescence into adulthood using the two forms of the BRIEF.

Critical item (CR) analysis expands the classification accuracy of performance validity tests based on the forced choice paradigm-Replicating previously introduced CR cutoffs within the Word Choice Test

OBJECTIVE

This study was designed to replicate previous research on critical item analysis within the Word Choice Test (WCT).

METHOD

Archival data were collected from a mixed clinical sample of 119 consecutively referred adults (M_age = 51.7, M_education = 14.7). The classification accuracy of the WCT was calculated against psychometrically defined criterion groups.

RESULTS

Critical item analysis identified an additional 2%-5% of the sample that passed traditional cutoffs as noncredible. Passing critical items after failing traditional cutoffs was associated with weaker independent evidence of invalid performance, alerting the assessor to the elevated risk for false positives. Failing critical items in addition to failing select traditional cutoffs increased overall specificity. Non-White patients were 2.5 to 3.5 times more likely to Fail traditional WCT cutoffs, but select critical item cutoffs limited the risk to 1.5-2.

CONCLUSIONS

Results confirmed the clinical utility of critical item analysis. Although the improvement in sensitivity was modest, critical items were effective at containing false positive errors in general, and especially in racially diverse patients. Critical item analysis appears to be a cost-effective and equitable method to improve an instrument's classification accuracy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Behavior Rating Inventory of Executive Function - adult version (BRIEF-A) in Iranian University students: Factor structure and relationship to depressive symptom severity

Major depressive disorder is the most common psychiatric illness in Iran, and depression is common among university students in the country. The presence of depression is frequently associated with problems in executive functioning. The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is a questionnaire measure designed to assess executive functioning in everyday life in clinical and non-clinical populations. Currently, there is limited empirical validation of the measure for use in Iran. This study evaluated the psychometric properties of a Persian-language BRIEF-A in a sample of Iranian university students (n = 300). The factor structure of the BRIEF-A was examined via a confirmatory factor analysis. We also evaluated whether BRIEF-A scores differed among university students varying in severity of depressive symptoms (Minimal, Mild, Moderate, Severe) as measured by the Beck Depression Inventory - II. Results indicated that a two-factor model structure best fit the data for the BRIEF-A. Acceptable internal consistency was also observed. Furthermore, poorer subjective executive functioning was endorsed by the three depressive subgroups relative to the Minimal symptoms group. Together, these findings support a two-factor model for the Persian translation of the BRIEF-A, and indicate that more severe depressive symptoms in Iranian university students is associated with worse subjective executive functioning.

Towards Interpretability of Speech Pause in Dementia Detection Using Adversarial Learning

Speech pause is an effective biomarker in dementia detection. Recent deep learning models have exploited speech pauses to achieve highly accurate dementia detection, but have not exploited the interpretability of speech pauses, i.e., what and how positions and lengths of speech pauses affect the result of dementia detection. In this paper, we will study the positions and lengths of dementia-sensitive pauses using adversarial learning approaches. Specifically, we first utilize an adversarial attack approach by adding the perturbation to the speech pauses of the testing samples, aiming to reduce the confidence levels of the detection model. Then, we apply an adversarial training approach to evaluate the impact of the perturbation in training samples on the detection model. We examine the interpretability from the perspectives of model accuracy, pause context, and pause length. We found that some pauses are more sensitive to dementia than other pauses from the model's perspective, e.g., speech pauses near to the verb "is". Increasing lengths of sensitive pauses or adding sensitive pauses leads the model inference to Alzheimer's Disease (AD), while decreasing the lengths of sensitive pauses or deleting sensitive pauses leads to non-AD.

Evaluating Voice-Assistant Commands for Dementia Detection

Early detection of cognitive decline involved in Alzheimer's Disease and Related Dementias (ADRD) in older adults living alone is essential for developing, planning, and initiating interventions and support systems to improve users' everyday function and quality of life. In this paper, we explore the voice commands using a Voice-Assistant System (VAS), i.e., Amazon Alexa, from 40 older adults who were either Healthy Control (HC) participants or Mild Cognitive Impairment (MCI) participants, age 65 or older. We evaluated the data collected from voice commands, cognitive assessments, and interviews and surveys using a structured protocol. We extracted 163 unique command-relevant features from each participant's use of the VAS. We then built machine-learning models including 1-layer/2-layer neural networks, support vector machines, decision tree, and random forest, for classification and comparison with standard cognitive assessment scores, e.g., Montreal Cognitive Assessment (MoCA). Our classification models using fusion features achieved an accuracy of 68%, and our regression model resulted in a Root-Mean-Square Error (RMSE) score of 3.53. Our Decision Tree (DT) and Random Forest (RF) models using selected features achieved higher classification accuracy 80-90%. Finally, we analyzed the contribution of each feature set to the model output, thus revealing the commands and features most useful in inferring the participants' cognitive status. We found that features of overall performance, features of music-related commands, features of call-related commands, and features from Automatic Speech Recognition (ASR) were the top-four feature sets most impactful on inference accuracy. The results from this controlled study demonstrate the promise of future home-based cognitive assessments using Voice-Assistant Systems.

Cardio-ankle vascular index of increased arterial wall stiffness is associated with neurocognitive impairment in well-controlled HIV

OBJECTIVES

HIV-associated neurocognitive disorders (HAND) remain prevalent in people living with HIV (PLWH) despite widespread use of combined antiretroviral therapy (ART). Vascular disease contributes to the pathogenesis of HAND, but traditional vascular risk factors do not fully explain the relation between vascular disease and HAND. A more direct measure of vascular dysfunction is needed. This cross-sectional study tested whether the cardio-ankle vascular index (CAVI), a novel method to assess arterial stiffness, is associated with HAND among PLWH.

METHODS

Participants included 75 non-diabetic adults with well-controlled HIV from an outpatient HIV clinic. We assessed the relation between CAVI and neurocognitive impairment (NCI). The latter was primarily characterized by the Frascati criteria and secondarily (post hoc) using the Global Deficit Score (GDS). Logistic regression models tested whether high CAVI (≥ 8) was independently associated with NCI when controlling for potential confounders.

RESULTS

Participants (M_age  = 45.6 ± 8.3 years; 30.1% male) had few traditional cardiovascular disease (CVD) risk factors (hypertension, n = 7; dyslipidaemia, n = 34; body mass index ≥ 25 kg/m² , n = 12; smoking history, n = 13; 2.2% mean 10-year risk of CVD or stroke). Twelve (16%) participants had high CAVI, which was independently associated with meeting Frascati criteria for NCI [n = 39, odds ratio (OR) = 7.6, p = 0.04], accounting for age, education, gender, income, CD4 nadir, recent CD4 and traditional CVD risk factors. High CAVI was also associated with NCI as reflected by higher GDS (OR = 17.4, p = 0.02).

CONCLUSIONS

Cardio-ankle vascular index is a promising measure of vascular dysfunction that may be independently associated with NCI in relatively healthy PLWH. Larger studies should test the utility of CAVI in predicting NCI/decline in PLWH.

Enhanced interpretation of the BRIEF2: multivariate base rates of elevated scores in the standardization samples

The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) is a standardized rating (self, parent, and teacher) scale of executive functioning in children and adolescents. Here, we provide multivariate base rate (MBR) information (for the Self, Parent, and Teacher forms), which is not included in the BRIEF2 Professional Manual. Participants were children and adolescents for the BRIEF2 Self-Report (ages = 11-18; N = 803), Parent-Report (ages = 5-18; N = 1,400), and Teacher-Report (ages = 5-18; N = 1,400) standardization samples. We focused on cumulative (e.g., % of sample with oneor more elevated scores) MBRs across scales, which were examined at three elevation levels on each form: T≥ 60, ≥65, and ≥70. Across forms, MBRs predictably decreased with increasing number of elevated scores and at higher cutoffs. The cumulative MBR of having at least one score at T≥ 60 was common (37.5-42.2%), but less frequent at T≥ 70 (15.4-17.4%). The probability of having elevated scores on all scales was very low, irrespective of form, age, or elevation threshold (T≥ 60 = 2.4-4.4%; T≥ 65 = 1.0-1.4%; T≥ 70 = 0.0-0.7%). There was no clinically meaningful relation between demographic factors (age, gender, race, and parental education) and MBRs. These data provide clinicians and researchers with an enhanced way of concurrently interpreting multiple BRIEF2 scales.

Stability of Subjective Executive Functioning in Older Adults with aMCI and Subjective Cognitive Decline

OBJECTIVE

Subjective memory concerns are characteristic of individuals with amnestic mild cognitive impairment (aMCI) and subjective cognitive decline (SCD), though subjective changes in executive functions have also been reported. In a cohort study, we examined the temporal stability of subjective report of executive functioning in a high education (mean = 16.8 years) sample of cognitively normal (CN) older adults and those with aMCI or SCD.

METHOD

Participants (CN, n = 22; aMCI, n = 21; SCD, n = 24) and their informants completed the BRIEF-A and neuropsychological tests at two time points separated by approximately 1 year.

RESULTS

Analyses focused on those with diagnostic stability (95.7%). Participants with aMCI and SCD, and their informants, endorsed worse executive functions relative to CN at both time points. No group by time interaction was observed for subjective or objective measures of executive function.

CONCLUSIONS

Diagnostically stable CN older adults, and those with prodromal dementia conditions, report stable executive functioning at 1-year follow-up.

WavBERT: Exploiting Semantic and Non-semantic Speech using Wav2vec and BERT for Dementia Detection

In this paper, we exploit semantic and non-semantic information from patient's speech data using Wav2vec and Bidirectional Encoder Representations from Transformers (BERT) for dementia detection. We first propose a basic WavBERT model by extracting semantic information from speech data using Wav2vec, and analyzing the semantic information using BERT for dementia detection. While the basic model discards the non-semantic information, we propose extended WavBERT models that convert the output of Wav2vec to the input to BERT for preserving the non-semantic information in dementia detection. Specifically, we determine the locations and lengths of inter-word pauses using the number of blank tokens from Wav2vec where the threshold for setting the pauses is automatically generated via BERT. We further design a pre-trained embedding conversion network that converts the output embedding of Wav2vec to the input embedding of BERT, enabling the fine-tuning of WavBERT with non-semantic information. Our evaluation results using the ADReSSo dataset showed that the WavBERT models achieved the highest accuracy of 83.1% in the classification task, the lowest Root-Mean-Square Error (RMSE) score of 4.44 in the regression task, and a mean F1 of 70.91% in the progression task. We confirmed the effectiveness of WavBERT models exploiting both semantic and non-semantic speech.

Self-rated executive dysfunction in adults with epilepsy and effects of a cognitive-behavioral intervention (HOBSCOTCH)

RATIONALE

Cognitive problems are common in adults with epilepsy and significantly affect their quality of life. HOBSCOTCH (HOme Based Self-management and COgnitive Training CHanges lives) was developed to teach problem-solving and compensatory memory strategies to these individuals. This study examined whether HOBSCOTCH is associated with improvement in specific aspects of subjective executive functions.

METHODS

Fifty-one adults, age 18-65, with epilepsy and subjective cognitive concerns were randomized to receive HOBSCOTCH (n = 31) or a care-as-usual control sample (n = 20). Participants completed the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), as well as the Patient Health Questionnaire-9 (PHQ-9) to assess depression. Rates of elevated (i.e., T ≥ 65, impaired) BRIEF-A scores at baseline, as well as pre-post score changes for the BRIEF-A clinical scales were evaluated. Significance was set at α = 0.05, one-tailed, given our directional hypothesis.

RESULTS

At baseline, a considerable percentage of patients in the overall sample endorsed executive dysfunction on BRIEF-A scales: Inhibit = 28%, Shift = 51%, Emotional Control = 45%, Self-Monitor = 33%, Initiate = 35%, Working Memory = 88%, Plan/Organize = 45%, Task Monitor = 47%, Organization of Materials = 28%. Significant improvement was seen in mean T-scores for Inhibit, Shift, Initiate, and Working Memory in the treatment group, but only Working Memory improved in the control group. The control group endorsed worse task monitoring and organization of materials at baseline and follow-up. Change in depression was not observed for either group, and there was no association between changes in depression and BRIEF-A scores.

CONCLUSIONS

A sizeable subset of adults with epilepsy reported experiencing executive dysfunction in their everyday lives, especially for working memory. HOBSCOTCH resulted in amelioration of subjective executive functioning independent of changes in mood.

Psychometric utility of the international HIV dementia scale and Montreal Cognitive Assessment in HIV-associated asymptomatic neurocognitive impairment

There is a growing need for brief screening measures for HIV Associated Neurocognitive Disorders (HAND). We compared two commonly used measures (the Montreal Cognitive Assessment [MoCA] and the International HIV Dementia Scale [IHDS]) in their ability to identify asymptomatic HAND (i.e., asymptomatic neurocognitive impairment [ANI]). Participants included 74 Thai PLWH: 38 met Frascati criteria for ANI and 36 were cognitively normal (CN). Participants completed Thai language versions of the MoCA (MoCA-T) and IHDS, and a validated neurocognitive battery. We examined between-group differences for MoCA-T and IHDS total scores, and scale subcomponents. We also conducted receiver operating characteristic (ROC) analyses to determine the ability of the MoCA-T and IHDS to discriminate between CN and ANI groups, and compared their area under the curve (AUC) values. Results revealed lower MoCA-T total score, as well as the Visuospatial/Executive and Delayed Recall subtask scores, in the ANI relative to CN group. Groups did not differ on the IHDS. For ROC analyses, the MoCA-T, but not the IHDS, significantly differentiated the ANI from CN group, and there was a significant difference in AUC values between the MoCA-T (AUC = .71) and IHDS (AUC = .56). Sensitivity and specificity statistics were poor for both screening measures. These data indicate while the MoCA-T functions better than the IHDS in detecting Thai PLWH with ANI, the mildest form of HAND, neither cognitive screener, showed strong utility. Our findings reflect the limited efficacy of common screening measures in detecting subtler cognitive deficits among Thai PLWH, and highlight the need for better screening tools.

Modified STEADI Fall Risk Categories Predict Incident Cognitive Impairment

BACKGROUND/OBJECTIVES

It is unknown whether older adults at high risk of falls but without cognitive impairment have higher rates of subsequent cognitive impairment.

DESIGN

This was an analysis of cross-sectional and longitudinal data from National Health and Aging Trends Study (NHATS).

SETTING

NHATS, secondary analysis of data from 2011 to 2019.

PARTICIPANTS

Community dwelling adults aged 65 and older without cognitive impairment.

MEASUREMENTS

Participants were classified at baseline in three categories of fall risk (low, moderate, severe) using a modified algorithm from the Center for Disease Control's STEADI (Stop Elderly Accidents, Deaths, and Injuries) and fall risk from data from the longitudinal NHATS. Impaired global cognition was defined as NHATS-derived impairment in either the Alzheimer's Disease-8 score, immediate/delayed recall, orientation, clock-drawing test, or date/person recall. The primary outcome was the first incident of cognitive impairment in an 8 year follow-up period. Cox-proportional hazard models ascertained time to onset of cognitive impairment (referent = low modified STEADI incidence).

RESULTS

Of the 7,146 participants (57.8% female), the median age category was 75 to 80 years. Prevalence of baseline fall modified STEADI risk categories in participants was low (51.6%), medium (38.5%), and high (9.9%). In our fully adjusted model, the risk of developing cognitive impairment was hazard ratio (HR) 1.18 [95% CI = 1.08, 1.29] in the moderate risk category, and HR 1.74 [95% CI = 1.53, 1.98] in the high-risk category.

CONCLUSION

Older, cognitively intact adults at high fall risk at baseline had nearly twice the risk of cognitive decline at 8 year follow-up.

Exploring Deep Transfer Learning Techniques for Alzheimer's Dementia Detection

Examination of speech datasets for detecting dementia, collected via various speech tasks, has revealed links between speech and cognitive abilities. However, the speech dataset available for this research is extremely limited because the collection process of speech and baseline data from patients with dementia in clinical settings is expensive. In this paper, we study the spontaneous speech dataset from a recent ADReSS challenge, a Cookie Theft Picture (CTP) dataset with balanced groups of participants in age, gender, and cognitive status. We explore state-of-the-art deep transfer learning techniques from image, audio, speech, and language domains. We envision that one advantage of transfer learning is to eliminate the design of handcrafted features based on the tasks and datasets. Transfer learning further mitigates the limited dementia-relevant speech data problem by inheriting knowledge from similar but much larger datasets. Specifically, we built a variety of transfer learning models using commonly employed MobileNet (image), YAMNet (audio), Mockingjay (speech), and BERT (text) models. Results indicated that the transfer learning models of text data showed significantly better performance than those of audio data. Performance gains of the text models may be due to the high similarity between the pre-training text dataset and the CTP text dataset. Our multi-modal transfer learning introduced a slight improvement in accuracy, demonstrating that audio and text data provide limited complementary information. Multi-task transfer learning resulted in limited improvements in classification and a negative impact in regression. By analyzing the meaning behind the AD/non-AD labels and Mini-Mental State Examination (MMSE) scores, we observed that the inconsistency between labels and scores could limit the performance of the multi-task learning, especially when the outputs of the single-task models are highly consistent with the corresponding labels/scores. In sum, we conducted a large comparative analysis of varying transfer learning models focusing less on model customization but more on pre-trained models and pre-training datasets. We revealed insightful relations among models, data types, and data labels in this research area.

Boston Naming Test: Lose the Noose

OBJECTIVE

Administering the noose item of the Boston Naming Test (BNT) has been questioned given the cultural, historical, and emotional salience of the noose in American culture. In response, some have modified the BNT by skipping/removing this item and giving the point as if the examinee responded correctly. It is unknown, however, whether modifying standardized administration and scoring in this manner affects clinical interpretation. In the present study, we examined the prevalence of noose item failure, whether demographic and clinical characteristics differed between those who responded correctly versus failed the item, and whether giving a point to those who failed affected clinical interpretation.

METHOD

Participants included a mixed clinical sample of 762 adults, ages 18-88 years, seen for neuropsychological evaluation at one of five sites within the USA.

RESULTS

Those who failed the item (13.78%) were more likely to be female, non-White, and have primary diagnoses of major neurocognitive disorder, epilepsy, or neurodevelopmental disorder. Noose item failure was associated with lower BNT total score, fewer years of education and lower intellectual functioning, expressive vocabulary, and single word reading. Giving a point to those who failed the item resulted in descriptor category change for 17.1%, primarily for patients with poor overall BNT performance.

CONCLUSIONS

Only a small percentage of patients fail the noose item, but adding a point for these has an impact on score interpretation. Factors associated with poorer overall performance on the BNT, rather than specific difficulty with the noose item, likely account for the findings.

Impact of Diet and Exercise on Weight and Cognition in Older Adults: A Rapid Review

OBJECTIVE

To determine where the current literature stands in regard to diet/exercise interventions on cognition in overweight or obese individuals.

DATA SOURCE

A rapid review was conducted of English-language studies published in Medline from January 1965 to January 2020.

STUDY INCLUSION AND EXCLUSION CRITERIA

Included studies were intervention studies lasting ≥12 weeks, with participants aged ≥65 years, with a body mass index ≥25 kg/m².

DATA EXTRACTION

Data extracted included study population, duration, intervention design, outcomes, and results.

DATA SYNTHESIS

Outcomes were qualitatively measured due to paucity of RTC.

RESULTS

1845 citations were identified, 31 full-text articles were reviewed, and 5 studies were included. Studies had usual care control groups and combined exercise/diet intervention groups with 31-3,526 participants randomized to each arm. Mean age of participants was 69.2-83.4 years. Studies reporting on cognitive changes showed marginally significant positive changes in cognition, and those that reported BMI indicated potential improvements in cognition.

CONCLUSIONS

The number of interventions assessing the combined effects of both diet and exercise is low. Future studies should evaluate the impact of combined effects to ascertain whether cognitive decline may be reversed in older adults with a BMI ≥25 kg/m².

The Impact of THC and CBD in Schizophrenia: A Systematic Review

Background: People with schizophrenia are more likely to develop cannabis use disorder (CUD) and experience worse outcomes with use. Yet as cannabis is legalized for medical and recreational use, there is interest in its therapeutic potential. Objectives: To conduct a systematic review summarizing the design and results of controlled trials using defined doses of THC and CBD in schizophrenia. Method: A keyword search of eight online literature databases identified 11 eligible reports. Results: One placebo controlled trial (13 stable patients without CUD) found that intravenous THC increased psychosis and worsened learning/recall. Two reports of a functional magnetic resonance (fMRI) study of smoked or oral THC in 12 abstinent patients with schizophrenia and CUD found no change in symptoms and cognition, and an amelioration of impaired resting state brain function in areas implicated in reward function and the default mode network. One 4 week trial in acutely psychotic inpatients without CUD (mean age 30 y) found 800 mg CBD to be similarly efficacious to amisupride in improving psychosis and cognition. Two 6 week studies of CBD augmentation of antipsychotics in stable outpatients reported mixed results: CBD 600 mg was not more effective than placebo; CBD 1,000 mg reduced symptoms in a sample that did not exclude cannabis use and CUD. A brain fMRI and proton magnetic resonance spectroscopy study of single dose CBD in a sample that did not exclude CUD and cannabis use found that CBD improved symptoms and brain function during a learning/recall task and was associated with increased hippocampal glutamate. Discussion: There is substantial heterogeneity across studies in dose, method of drug delivery, length of treatment, patient age, whether patients with cannabis use/CUD were included or excluded, and whether patients were using antipsychotic medication. Conclusion: There is insufficient evidence for an effect of THC or CBD on symptoms, cognition, and neuroimaging measures of brain function in schizophrenia. At this time, research does not support recommending medical cannabis (THC or CBD) for treating patients with schizophrenia. Further research should examine THC and CBD in schizophrenia with and without comorbid CUD and consider the role of CBD in mitigating symptom exacerbation from THC.

Incident Impaired Cognitive Function in Sarcopenic Obesity: Data From the National Health and Aging Trends Survey

Objectives

The prevalence of obesity with sarcopenia is increasing in adults aged ≥65 years. This geriatric syndrome places individuals at risk for synergistic complications that leads to long-term functional decline. We ascertained the relationship between sarcopenic obesity and incident long-term impaired global cognitive function in a representative US population.

Design

A longitudinal, secondary data set analysis using the National Health and Aging Trends Survey.

Setting

Community-based older adults in the United States.

Participants

Participants without baseline impaired cognitive function aged ≥65 years with grip strength and body mass index measures.

Methods

Sarcopenia was defined using the Foundation for the National Institutes of Health Sarcopenia Project grip strength cut points (men <35.5 kg; women <20 kg), and obesity was defined using standard body mass index (BMI) categories. Impaired global cognition was identified as impairment in the Alzheimer's Disease-8 score or immediate/delayed recall, orientation, clock-draw test, date/person recall. Proportional hazard models ascertained the risk of impaired cognitive function over 8 years (referent = neither obesity or sarcopenia).

Results

Of the 5822 participants (55.7% women), median age category was 75 to 80, and mean grip strength and BMI were 26.4 kg and 27.5 kg/m², respectively. Baseline prevalence of sarcopenic obesity was 12.9%, with an observed subset of 21.2% participants having impaired cognitive function at follow-up. Compared with those without sarcopenia or obesity, the risk of impaired cognitive function was no different in obesity alone [hazard ratio (HR) 0.98; 95% confidence interval (CI) 0.82-1.16]), but was significantly higher in sarcopenia (HR 1.60; 95% CI 1.42-1.80) and sarcopenic obesity (HR 1.20; 95% CI 1.03-1.40). There was no significant interaction term between sarcopenia and obesity.

Conclusions

Both sarcopenia and sarcopenic obesity are associated with an increased long-term risk of impaired cognitive function in older adults.

Antiepileptic drug effects on subjective and objective cognition

RATIONALE

Cognitive impairment is one of the most common complaints for persons with epilepsy (PWE). These impairments are not only associated with seizures, but are also regularly reported as adverse effects of antiepileptic drugs (AEDs). Previous studies have examined cognitive effects of both AED monotherapy and polytherapy, yet there is limited research on these differences with respect to both subjective and objective cognition. The current study uses data from previous research conducted by the Centers for Disease Control and Prevention (CDC)-sponsored Managing Epilepsy Well (MEW) Network collaborative. We used three distinct archival datasets from the following: (1) the HOBSCOTCH efficacy trial at Dartmouth-Hitchcock Medical Center (HOB-1), (2) the multisite replication trial (HOB-2), and (3) epilepsy self-management research conducted at the NYU School of Medicine.

METHODS

This retrospective analysis combined baseline data from three datasets to determine how the number of AEDs and the type of AEDs were associated with subjective (patient-reported) and objective (examiner-assessed) cognition. Subjective cognition was captured using the cognitive subscale of the Quality of Life in Epilepsy Inventory (QOLIE-31) in all three datasets (n = 224), while objective cognition was measured using the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) in the HOB-1 dataset (n = 65) and the Brief Test of Adult Cognition by Telephone (BTACT) in the HOB-2 dataset (n = 91). Multivariable linear regression was utilized for our initial assessments, followed by propensity score matching to provide stronger control of covariates. Matching was based on significantly different covariates, such as education, depression, and history of prior epilepsy surgery. Nonparametric statistical tests were utilized to compare these matched subjects.

RESULTS

Subjective cognitive impairment was significantly worse among individuals on polytherapy (2 + AEDs) compared with those on monotherapy (1 AED) (adjusted p  =  0.041). These findings were consistent with our propensity score matched comparison of monotherapy and polytherapy, which indicated that polytherapy was associated with worse overall subjective cognition (adjusted p = 0.01), in addition to impairments on the RBANS (Total score p = 0.05) and specific subdomains of the BTACT (Episodic Verbal Memory p < 0.01, Working Memory p < 0.01, Processing Speed p < 0.01). Interestingly, older generation AEDs were associated with better language performance than newer generation and combined generation AED therapy (RBANS Language p = 0.03). These language-specific findings remained significant after controlling for the effects of topiramate and zonisamide (p = 0.04).

CONCLUSIONS

A greater number of AEDs is significantly and negatively associated with subjective and objective cognition in PWE, and is in line with previous research. Antiepileptic drug type did not, in itself, appear to be associated with subjective cognition. Our findings suggest that ineffective AEDs should be replaced, rather than introducing additional AEDs to a treatment regimen. Further, while subjective and objective cognition assessments were both sensitive at detecting differences based on AED status, the neuropsychological objective subdomains offer additional and specific insights into how cognition is impaired with AEDs.

Potent Dopamine D2 Antagonists Block the Reward-Enhancing Effects of Nicotine in Smokers With Schizophrenia

Antipsychotics that are potent dopamine (DA) D2 receptor antagonists have been linked to elevated levels of nicotine dependence in smokers with schizophrenia. Because activation of D2 receptors mediates motivation for nicotine, we examined whether potent D2 antagonists would diminish nicotine's ability to stimulate reward processing-a mechanism that may drive compensatory increases in smoking. Smokers with schizophrenia (n = 184) were recruited and stratified into medication groups based on D2 receptor antagonist potency. The effects of smoking on reward function were assessed using a probabilistic reward task (PRT), administered pre- and post-smoking. The PRT used an asymmetrical reinforcement schedule to produce a behavioral response bias, previously found to increase under conditions (including smoking) that enhance mesolimbic DA signaling. Among the 98 participants with valid PRT data and pharmacotherapy that could be stratified into D2 receptor antagonism potency, a medication × smoking × block interaction emerged (P = .005). Post-hoc tests revealed a smoking × block interaction only for those not taking potent D2 antagonists (P = .007). This group exhibited smoking-related increases in response bias (P < .001) that were absent in those taking potent D2 antagonists (P > .05). Our findings suggest that potent D2 antagonists diminish the reward-enhancing effects of nicotine in smokers with schizophrenia. This may be a mechanism implicated in the increased rate of smoking often observed in patients prescribed these medications. These findings have important clinical implications for the treatment of nicotine dependence in schizophrenia.

Neuropsychological Functioning in Older Adults with Obesity: Implications for Bariatric Surgery

Bariatric surgery is the most effective approach to treating morbid obesity, resulting in decreased morbidity, mortality, and improved quality of life. Research on outcomes has generally been restricted to young and middle-aged adults, despite a growing epidemic of obesity in older adults. The use of bariatric surgery has been limited in older individuals, in part due to concerns that preexisting cognitive dysfunction increases the risk of poor post-surgical outcomes, including cognitive decline. The literature on the relationship between obesity and cognition in older adults is emerging, but fraught by several methodological limitations. While there is insufficient research to determine the nature of cognitive outcomes following bariatric surgery in older adults, the aim of this paper is to review the existing evidence and make the case for further study.

The doubtful benefits of giving the benefit of the doubt: Lenient scoring of the spatial orientation items on the mini-Mental Status Exam increases false negative rates

Lenient scoring of spatial orientation errors (SOE) on the Mini-Mental State Exam (MMSE) is common practice, even though it deviates from standard protocol and may compromise its diagnostic power. This study was designed to empirically evaluate the effect of lenient scoring on the MMSE's classification accuracy. Participants were 113 community dwelling older adults recruited for a research study, representing a wide range of range of neurological status from cognitively healthy to Alzheimer's disease. Clinical classification was determined by expert assessors based on multiple sources of clinical evidence. Lenient scoring significantly inflated MMSE total scores (d = .88, large effect), and suppressed failure rates (from 26% to 14%). Standard scoring produced superior overall classification accuracy (75% vs. 67%) over lenient scoring and, more importantly, increased sensitivity from .33 to .53, with minimal loss in specificity (from 1.00 to .95). SOEs are empirical markers of cognitive decline and should not be adjusted based on clinical judgment. Results indicate that diminished sensitivity to cognitive impairment is an unintended consequence of lenient scoring and argue against this practice.

Understanding marijuana's effects on functional connectivity of the default mode network in patients with schizophrenia and co-occurring cannabis use disorder: A pilot investigation

Nearly half of patients with schizophrenia (SCZ) have co-occurring cannabis use disorder (CUD), which has been associated with decreased treatment efficacy, increased risk of psychotic relapse, and poor global functioning. While reports on the effects of cannabis on cognitive performance in patients with SCZ have been mixed, study of brain networks related to executive function may clarify the relationship between cannabis use and cognition in these dual-diagnosis patients. In the present pilot study, patients with SCZ and CUD (n=12) and healthy controls (n=12) completed two functional magnetic resonance imaging (fMRI) resting scans. Prior to the second scan, patients smoked a 3.6% tetrahydrocannabinol (THC) cannabis cigarette or ingested a 15mg delta-9-tetrahydrocannabinol (THC) pill. We used resting-state functional connectivity to examine the default mode network (DMN) during both scans, as connectivity/activity within this network is negatively correlated with connectivity of the network involved in executive control and shows reduced activity during task performance in normal individuals. At baseline, relative to controls, patients exhibited DMN hyperconnectivity that correlated with positive symptom severity, and reduced anticorrelation between the DMN and the executive control network (ECN). Cannabinoid administration reduced DMN hyperconnectivity and increased DMN-ECN anticorrelation. Moreover, the magnitude of anticorrelation in the controls, and in the patients after cannabinoid administration, positively correlated with WM performance. The finding that DMN brain connectivity is plastic may have implications for future pharmacotherapeutic development, as treatment efficacy could be assessed through the ability of therapies to normalize underlying circuit-level dysfunction.

Subjective rating of executive functions in mild Alzheimer's disease

OBJECTIVES

Subjective cognitive decline is considered to be a core feature of pre-Alzheimer's disease (AD) conditions, the vast majority of literature having focused on memory concerns. Neuropsychological studies have implicated executive dysfunction on objective performance measures in AD, but no research has evaluated whether individuals with AD have concerns about their executive functions and whether it differs from their caregiver's concerns. In the present study, we sought to evaluate self- and informant ratings of executive functioning in patients with mild AD.

METHOD

Participants were 23 patients with mild AD and 32 healthy elderly controls (HC) and their informants who completed the Behavior Rating Inventory of Executive Function - Adult version.

RESULTS

Patients with AD and their informants reported greater executive dysfunction than the HC group and their informants, respectively, and patients reported greater difficulty than their informants. The largest effect size for both self- and informant ratings was obtained for the Working Memory scale.

CONCLUSIONS

These findings indicate that subjective cognitive concerns in mild AD extend beyond the memory domain to executive functions. That greater difficulty was endorsed by patients than their informants suggests that at least in the mild stage of AD some awareness of executive dysfunction may be maintained in some patients. Implications for clinical care are discussed.

Association of psychological, cognitive, and functional variables with self-reported executive functioning in a sample of nondemented community-dwelling older adults

Subjective executive functioning (EF) measures provide valuable information about real-world difficulties, although it is unclear what variables actually associate with subjective EF scores. We investigated subjective EF in 245 nondemented, community-dwelling older adults (aged 70 and above) from the Einstein Aging Study. Partial correlational analyses controlling for age were performed between the nine Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) clinical scales and objective EF tests, self-reported mood and personality, and informant-reported activities of daily living. The significance level was set at p < .006 for all analyses (two-tailed). Most notably, higher worry/oversensitivity, physiological anxiety, and fear of aging were significantly associated with increased EF difficulties on all nine BRIEF-A scales. Additionally, increased EF difficulties on five or more BRIEF-A scales were significantly associated with lower conscientiousness, higher neuroticism, and higher depressive symptom scores. The only objective neuropsychological test that significantly correlated with increased EF difficulties (on four BRIEF-A scales) was a measure of practical judgment. Overall, results indicate that interpretation of subjective EF scores must account for self-report of mood and personality. Moreover, the BRIEF-A only minimally taps objective EF as measured by performance-based measures. We discuss the theoretical and practical implications of these findings.