Locke, Dona E.C.

AbstractBackgroundThe American Academy of Neurology Practice Guidelines recommends physical exercise to help maintain cognition in people with Mild Cognitive Impairment (pwMCI). We previously demonstrated yoga’s benefit in maintenance of memory related activities of daily living at one year follow‐up in pwMCI (Chandler et al., 2019), and yoga may be beneficial in offsetting a sense of burden in care partners at 12 months (Amofa et al., submitted). In this analysis, we sought to examine the impact of yoga training on physical performance in pwMCI and their care partners.MethodIn this multisite, randomized clinical trial, we enrolled 272 patients meeting National Institute on Aging–Alzheimer’s Association criteria for MCI and a care partner. The intervention program was modeled on the 10 day Mayo Clinic HABIT Healthy Action to Benefit Independence and Thinking® program. Of 5 possible interventions (memory compensation training, computerized cognitive training, yoga, patient and partner support groups, and wellness education), 1 of 5 interventions was randomly selected to be withheld for each intervention group, thus allowing us to examine comparative effectiveness. Participants and their partners had 1‐day booster sessions at 6 and 12 months after intervention. The Short Physical Performance Battery (SPPB), a measure of balance, gait speed, and repeated chair stands was used to assess physical function outcomes.ResultThere was a general pattern of physical decline on the SPPB over the year in pwMCI, regardless of yoga training (d=‐0.04, p=0.78) (Figure 1, Panel A). Among care partners, those randomized to the no yoga group had a worse decline in physical function compared to those receiving yoga (d=‐0.31, p=0.034) (Figure 1, Panel B). While not reaching statistical significance in subgroup comparisons, yoga training tended to have a greater effect on SPPB than computerized cognitive training (d = 0.35, p = .06) or wellness education (d = 0.32, p =.09) (Table 1).ConclusionParticipation in yoga had a positive impact on physical performance outcomes at one year for care partners, but did not counteract general physical decline in pwMCI.

AbstractBackgroundOne nonpharmacological intervention for persons with amnestic Mild Cognitive Impairment (MCI) is development of a compensatory memory notebook/planner system. De Wit et al. (2019) showed that global cognitive status is the primary predictor of learning success with training on a memory notebook system and that learning success predicts ongoing adherence to the tool. The purpose of our work is to validate their analysis in a new sample and evaluate whether or not patient or partner personality traits predict learning success over and above that explained by cognitive status.MethodTraining in the Memory Support System (MSS) is one component of the multi‐disciplinary behavioral intervention program called Healthy Action to Benefit Independence and Thinking (HABIT) offered at Mayo Clinic. 183 patient and partner dyads completed the HABIT program and enrolled in our IRB approved ongoing research registry to allow use of their clinical data for research purposes. Personality traits were measured with the self‐report Ten Item Personality Inventory (TIPI) based on the five‐factor model of personality (Agreeableness, Conscientiousness, Emotional Stability, Openness, and Extraversion) completed by both the patient and the partner. For our analyses, we fit logistic regression models to predict full MSS mastery at the end of the two‐week program and dichotomized TIPI into “high” or “low” for each trait based on its median (low was the reference group).ResultConsistent with De Wit et al. (2019), global cognitive status again was the only significant predictor of MSS learning mastery when considering age, education, baseline depression score and baseline global cognitive status (Table 2). When adding patient personality traits, only openness significantly added to the model with higher openness predicting learning success (Table 3). Adding both patient and partner personality traits resulted in a significant interaction between patient and partner openness (Table 4). The direction of this interaction indicates that learning success is highest when either the partner or patient is high in openness (but not both).ConclusionHigh openness to experience in the patient with MCI or their partner (but not both) significantly improves learning success for a cognitive rehabilitation memory support tool in patients with MCI.

Background: Whether brain-derived neurotrophic factor (BDNF) Met carriage impacts the risk or progression of Alzheimer’s disease (AD) is unknown. Objective: To evaluate the interaction of BDNF Met and APOE4 carriage on cerebral metabolic rate for glucose (CMRgl), amyloid burden, hippocampus volume, and cognitive decline among cognitively unimpaired (CU) adults enrolled in the Arizona APOE cohort study. Methods: 114 CU adults (mean age 56.85 years, 38% male) with longitudinal FDG PET, magnetic resonance imaging, and cognitive measures were BDNF and APOE genotyped. A subgroup of 58 individuals also had Pittsburgh B (PiB) PET imaging. We examined baseline CMRgl, PiB PET amyloid burden, CMRgl, and hippocampus volume change over time, and rate of change in cognition over an average of 15 years. Results: Among APOE4 carriers, BDNF Met carriers had significantly increased amyloid deposition and accelerated CMRgl decline in regions typically affected by AD, but without accompanying acceleration of cognitive decline or hippocampal volume changes and with higher baseline frontal CMRgl and slower frontal decline relative to the Val/Val group. The BDNF effects were not found among APOE4 non-carriers. Conclusion: Our preliminary studies suggest that there is a weak interaction between BDNF Met and APOE4 on amyloid-β plaque burden and longitudinal PET measurements of AD-related CMRgl decline in cognitively unimpaired late-middle-aged and older adults, but with no apparent effect upon rate of cognitive decline. We suggest that cognitive effects of BDNF variants may be mitigated by compensatory increases in frontal brain activity—findings that would need to be confirmed in larger studies.

ObjectivesWe adapted a self‐efficacy measure for managing chronic illness to be specific to persons with mild cognitive impairment (pwMCI). The aim of this study was to investigate the psychometric properties of the scale, the self‐efficacy for managing MCI scale, for use in research.MethodsAnalyses involved data from pwMCI enrolled in a behavioral intervention study that completed the measure five times from intervention enrollment to 18‐month post‐intervention. Factor structure, construct validity, internal consistency, and test‐retest reliability were analyzed.ResultsFactor analysis identified two factors, related to self‐efficacy for daily activities and managing MCI, which corresponded with domains from the original chronic illness self‐efficacy scale. Consistent with prior research, construct validity analysis suggested an association between memory‐loss self‐efficacy and psychosocial distress, but not cognitive or functional ability. Further analyses supported the scale's internal and test‐retest reliability.ConclusionsCurrently, no “gold standard” scale of memory‐loss self‐efficacy for pwMCI exists, despite the positive impact self‐efficacy may have on modifiable health behaviors. Overall, results supported the notion that the scale is a valid and reliable measure of memory‐loss self‐efficacy for pwMCI.

8583 Background: Patient QOL assessment requires balancing the detail provided by multi-item assessments with the reduced burden of single-item assessments. We investigated the psychometric properties of single-item LASA assessments used in 3 North Central Cancer Treatment Group (NCCTG) phase II trials for patients with newly diagnosed high-grade gliomas. Methods: Measures included QOL LASAs (overall, physical, emotional, spiritual, intellectual), Symptom Distress Scale (SDS), Profile of Mood States (POMS), and Functional Assessment for Cancer Therapy (FACT; overall, physical, emotional). Association of LASA measures with SDS, POMS, and FACT domains and with ECOG performance score (PS) and MMSE was assessed with Spearman’s correlation. Repeated measures ANOVA models compared the change over time of LASAs and SDS, POMS, and FACT. Cox regression modeled the association of baseline QOL and survival. Results: 205 patients completed the QOL assessments across 3 time points. LASA mean scores ranged from 60–78; SDS, POMS, and FACT ranged from 68–81. No significant changes across time for overall and emotional scores were observed. FACT physical decreased over time (p<0.001) as did LASA physical (p=0.08). LASA scales were strongly associated with corresponding scales on SDS, POMS, and FACT (0.44<rho<0.65; p<0.001). LASA was negatively associated with PS and positively with MMSE. Baseline scores for overall FACT (p=0.005) and LASA physical (p=0.015) were associated with better survival. Conclusions: The single-item LASA assessments have comparable psychometric properties as longer assessments for the same constructs. Correlations with PS and MMSE were as expected (convergent/concurrent validity). The discriminant validity and prognostic ability of LASA items were similar to the multi-item instruments. Collectively, the data suggest that the single item LASA scales are valid for assessing QOL in patients with newly diagnosed high grade gliomas and are an appropriate alternative when a shorter instrument is warranted. No significant financial relationships to disclose.

Recent findings suggest that compromised patient effort occurs in nonlitigious settings, but the nature and base rate of suboptimal effort in these settings remains poorly understood. In the treatment-seeking, acquired brain injury, outpatient rehabilitation sample included in this investigation, 21.8% of the patients scored below recommended cutting scores for suboptimal effort on the Test of Memory Malingering (TOMM). Disability status was the only variable explored in this study to be associated with suboptimal effort. It should be noted, however, that the proportion of patients on disability was large in both the optimal and suboptimal effort groups, suggesting that failure on the TOMM may not be a specific predictor of disability status in this sample. Importantly, performance on the TOMM was unrelated to age, education, time from injury to evaluation, and injury severity. Depression and anxiety were also shown to be unrelated to TOMM performance in this rehabilitation sample. As expected, performance on neurocognitive testing was significantly lower in the suboptimal effort group. This study suggests that reduced effort occurs outside forensic settings, is related to neuropsychometric performance, and urges further research into effort across various settings.

Abstract Introduction Some Alzheimer's disease biomarker studies found amyloid changes 20 years or more in advance of expected symptoms, while cognitive changes lagged for more than a decade, but this apparent lag might reflect the sensitivities of the biomarker and cognitive assays used. How far in advance of incident amnestic mild cognitive impairment (MCI) does cognition begin to decline? Methods Longitudinal neuropsychological study of an apolipoprotein E e4 enriched cohort of cognitively normal individuals at entry. Linear mixed models for MCI converters (n = 65) and nonconverters (n = 719) fitted for each neuropsychological measure; annual changes compared between groups before and after linear model intersections (inflection points). Results 34 of 35 cognitive measures and 9 of 18 behavioral measures declined faster post‐inflection in the MCI converters; the earliest cognitive inflection point was nearly 20 years in advance of MCI diagnosis. Discussion The preclinical duration of cognitive and behavioral changes approaches the earliest reported biomarker changes.