Smith, Glenn E.

Background Mild cognitive impairment (MCI) represents a critical window for both pharmacological therapies and non-pharmacological interventions to delay cognitive decline. Objective To evaluate whether combining pharmacotherapy with multicomponent behavioral interventions enhances outcomes relative to behavioral interventions alone. Methods The sample included people with MCI (pwMCI) of any etiology who completed the HABIT Healthy Action to Benefit Independence & Thinking ® program. Baseline pharmacotherapy (acetylcholinesterase inhibitor and/or glutamate regulators) use was dichotomized (yes/no). Multivariate linear mixed-effects models examined changes from baseline in care partner-reported everyday functional skills, quality of life, self-efficacy, anxiety, depression, and HABIT compliance at post-intervention, 6 months, and 12 months, adjusting for baseline cognitive impairment severity and relevant demographic covariates. Results Among 1074 pwMCI, 413 (38.5%) were receiving pharmacotherapy at baseline. Pharmacotherapy use was more prevalent among White than non-White participants (39.4% versus 23.3%, p = 0.01). At baseline, pharmacotherapy users had more severe cognitive impairment and lower utilization of rehabilitation strategies (all p < 0.05). Both groups demonstrated significant improvements across all outcomes at post-intervention. During follow-up (mean score change compared to baseline), pharmacotherapy users showed greater increases in HABIT compliance at 6 months (3.2 versus 2.0) and 12 months (2.1 versus 1.4). In contrast, by 12 months, pharmacotherapy users experienced greater worsening of everyday functional skills related to memory (−2.1 versus −1.3) and executive function (−5.8 versus-3.7). Conclusions pwMCI undergoing pharmacotherapy entered the HABIT program with more advanced cognitive impairment. The pharmacotherapy was not associated with greater intervention-related benefit or attenuation of long-term cognitive decline.

AbstractBackgroundThe Uniform Data Set (UDS) neuropsychological battery, administered across Alzheimer’s Disease Centers (ADC), includes memory tests but lacks a list‐learning paradigm. ADCs often supplement the UDS with their own preferred list‐learning task. Given the importance of list‐learning for characterizing memory, we aimed to develop a harmonized memory score that incorporates UDS memory tests while allowing centers to contribute differing list‐learning tasks.MethodWe applied item‐banking confirmatory factor analysis to develop a composite memory score in 5,287 participants (mean age 67.1; SD = 12.2) recruited through 18 ADCs and four consortia (DiverseVCID, MarkVCID, ALLFTD, LEADS) who completed UDS memory tasks (used as linking‐items) and one of five list‐learning tasks. All analyses used linear regression. We tested whether memory scores were affected by which list‐learning task was administered. To assess construct validity, we tested associations of memory scores with demographics, disease severity (CDR Box Score), an independent memory task (TabCAT Favorites, n = 675), and hippocampal volume (n = 811). We compared performances between cognitively unimpaired (n = 279), AD‐biomarker+ MCI (n = 26), and AD‐biomarker+ dementia (n = 98). In a subsample with amyloid‐ and tau‐PET (n = 49), we compared memory scores from participants with positive vs negative scans determined using established quantitative cutoffs.ResultModel fit indices were excellent (e.g., CFI = 0.998) and factor loadings were strong (0.43‐0.93). Differences in list‐learning task had a negligible effect on scores (average Cohen’s d = 0.11). Higher memory scores were significantly (p’s<.001) correlated with younger age (β = ‐0.18), lower CDR Box Scores (β = ‐0.63), female sex (β = 0.12), higher education (β = 0.19), larger hippocampal volume (β = 0.42), and an independent memory task (β = 0.71, p<0.001). The memory composite declined in a stepwise fashion by diagnosis (cognitively unimpaired>MCI>AD dementia, p<0.001). On average, amyloid‐PET positivity was associated with lower composite scores, but was not statistically significant (β = ‐0.34; p = 0.25; d = 0.40). Tau‐PET positivity was associated with worse performance, demonstrating a large effect size (β = ‐0.75; p<0.002; d = 0.91).ConclusionThe harmonized memory score developed in a large national sample was stable regardless of contributing list‐learning task and its validity for cross‐cohort ADRD research is supported by expected associations with demographics, clinical measures, and Alzheimer’s biomarkers. A processing script will be made available to enhance cross‐cohort ADRD research.

AbstractBackgroundThe use of videoconference platforms for neuropsychological assessment was not as common among mental health practitioners before the COVID‐19 pandemic. However, due to lockdowns and quarantines worldwide, mental health professionals had to find a feasible alternative and shift to virtual evaluations. This increased the use of teleneuropsychology in both at a clinical and research level. Studies conducted during the pandemic provided evidence of the feasibility of virtual assessments, but data from low‐and middle‐income countries is scarce and conclusions from studies in other regions cannot be generalized. The objective of this study is to develop and apply a teleneuropsychological assessment battery on a group of elderly adults in Panama and Hispanics living in the United States.MethodThis is a multicenter study that will gather data from a Panamanian Cohort parallel to the current Florida‐based study Development and Validation of TeleNeuropsychology Normative Data for Older Adults (FLOAT). So far 80 participants over 50 years old have been assessed in Panama and Florida. Inclusion criteria includes passing a screening with TICS‐M for low risk of developing dementia and having basic knowledge and accessibility of electronic devices. Researchers contact potential participants through calls and WhatsApp chats to explain the study and obtain informed consent. Participants are then screened to see if they are eligible to be assessed through the video conference platform. Participants must complete the teleneuropsychological assessment battery from the National Alzheimer’s Coordinating Center (NACC), and different questionnaires to provide socio‐demographic and functional data. All information is gathered with the REDCap platform.ResultOne hundred participants will be assessed with a teleneuropsychology protocol in each cohort. Once all data is collected, it will be analyzed with multivariate statistics methods. We expect to describe the protocol’s feasibility assessing older adults in both locations.ConclusionTo our knowledge this is the first study of its kind in Panama and one of the only ones in the region. The study seeks to generate data that could be shared and applied for future research or clinical practice regarding teleneuropsychological assessments with older adults with similar cohorts.