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NAN 2020 Annual Conference | Virtual Edition

Virtual

October 14 – 16, 2020 (Wednesday – Friday)

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01 Dementia Care Ecosystem: Health Care Utilization at Six Months 1384425 Ashley laRoche Ochsner Health Dementia Care Ecosystem: Health Care Utilization at Six Months Aging and Dementia: Alzheimer Objective: This study implemented the University of California, San Francisco (UCSF) Care Ecosystem Program, a Persons with Dementia (PWD)- and Caregiver (CG)-centered model of dementia care designed to improve quality of life and reduce the cost of care associated with emergency department (ED) visits and hospitalizations. Method: Community-dwelling PWD and CGs at a southern regional medical system who had a diagnosis of dementia and at least one hospitalization or ED visit in the previous 12 months were prospectively enrolled in a mixed method study. These dyads (N=54) completed monthly visits for six months, including behavior management, financial and advanced care planning, caregiver well-being, and navigating community and healthcare resources. PWD were predominantly Caucasian (70.4%; 30% African American) and female (53.7%), with an average age of 80.26 (SD=6.99). CGs were demographically similar, but younger [M(SD)=66.18(12.89)]. Results: ED utilization decreased by 41% (51 visits in 6 months prior to enrollment vs. 30 visits post enrollment); [pre-M(SD)=0.94(1.57); post-M(SD)=0.56(1.11); 95% Confidence Interval -0.09 - 0.86; t=1.64, p>.05; Cohen’s d=0.28]. On a paired samples t-test, there was a small effect despite not reaching statistical significance. Hospitalizations decreased by 43% (30 in 6 months prior to enrollment, 17 post enrollment); [pre-M(SD)=0.56(1.09); post-M(SD)= 0.31(0.77); 95% Confidence Interval -0.03 – 0.51; t=1.79, p>.05; Cohen’s d=.26]. Again, there was a small effect despite not reaching statistical significance. Conclusions: Preliminary results suggested a trend toward reduced hospital utilization. Future analysis on cost savings and other benefits of this type of program will be crucial to sustainability.

02 Comparing rate of change in MoCA and MMSE scores over time in an MCI and AD sample 1384430 Anne Carlew UT Southwestern Medical Center Comparing rate of change in MoCA and MMSE scores over time in an MCI and AD sample Aging and Dementia: Alzheimer Objective: The Montreal Cognitive Assessment (MoCA) and Mini-Mental Status Exam (MMSE) are used for tracking cognitive change in mild cognitive impairment (MCI) and Alzheimer’s disease (AD), despite limited empirical support for this purpose. This study compared longitudinal change in MMSE and MoCA scores to investigate their applicability for tracking cognitive change. Method: Inclusion criteria were: diagnosis of MCI or AD (CDR global=.5) by consensus conference, administration of the MoCA and MMSE across ≥3 visits, and no reversion to normal (n=59; Mage=70.81; Meducation=14.97; 56% male; 76.3% Caucasian; 80% MCI at baseline). Testing sessions occurred ~12 months apart (M=12.59, SD=3.43, range 5-28 months). Change in MMSE and MoCA scores was modeled using multilevel regression. A 95% bootstrap confidence interval (BCI) for the slopes of both tests was computed and used to evaluate whether the tests measured significantly different change. Results: Controlling for age and education, the MoCA demonstrated significantly more change over time (95% BCI [-0.06, -0.02]; MoCA Visit 1 M=24.00, Visit 4 M=21.88) than the MMSE (95% BCI [-0.03, 0.01]; MMSE Visit 1 M=27.83, Visit 4 M=27.50). MoCA scores significantly declined over the study period (but did not exceed the reliable change index), while MMSE scores did not. Conclusions: The MMSE did not show significant change over time, while the MoCA did in this heavily MCI sample. Although statistically significant, clinical significance of change in the MoCA is unclear. Increasing MoCA use calls for additional research to understand what constitutes a clinically significant change and whether it is appropriate for tracking cognitive trajectories.

03 Executive and Memory Components of Prospective Memory in Aging and Dementia 1384446 Winter Olmos California State University, Fresno Executive and Memory Components of Prospective Memory in Aging and Dementia Aging and Dementia: Alzheimer Objective: Prospective memory (PM) involves remembering to perform an intended action in the future. PM is critical for older adults’ daily functioning. This ability is not a unitary construct, so in this study, we determined the roles of executive and memory functioning in different subtypes of PM, including simple PM (ability to execute a single action in the future) and complex PM (ability to execute different actions depending on the context). Method: Participants included 58 healthy older adults, 64 persons with mild cognitive impairment (MCI), and 17 participants with Alzheimer’s disease. Simple PM was defined as remembering to ask the examiner for a pill after each neuropsychological test performed. Complex PM was defined as asking for the correct number of pills based on whether the test just completed involved memory (1 pill) or not (2 pills). An Executive composite score included Trail Making Test-B and FAS. The Memory composite score included delayed recall from the California Verbal Learning Test-II and the Brief Visuospatial Memory Test-Revised. Results: Whole group analyses showed that simple PM was significantly correlated with memory functions, and complex PM was significantly correlated with both memory and executive functions. Specific to the MCI group, regression analyses showed that executive and memory skills predicted both simple PM and complex PM. Conclusions: These findings suggest that complex PM requires more executive demands than simple PM. For those with MCI, better executive and memory functions predicted PM generally. These findings indicate that both types of PM may be important for assessing the risk state for dementia.

04 The Relationship of ApoE Status and Cognition in Non-demented Older Adults 1384377 Nanako Hawley Cleveland Clinic Lou Ruvo Center for Brain Health The Relationship of ApoE Status and Cognition in Non-demented Older Adults Aging and Dementia: Alzheimer 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.

05 Dyadic Influence on Levels of Depression in Individuals with Alzheimer’s Disease 1384261 Kaitrin Conniff UW Health at The University of Wisconsin, Madison Dyadic Influence on Levels of Depression in Individuals with Alzheimer’s Disease Aging and Dementia: Alzheimer Objective: Two people who are significantly linked, such as in a husband and wife relationship, are known as a dyad. Dyadic units are helpful to look at as members influence the function of one another. This study looks at families where one member is the caregiver and the other has Alzheimer’s disease and receives care (labeled here as Alzheimer’s disease care recipient or CR). Symptoms of Alzheimer’s include cognitive and functional impairment, social withdrawal, impaired judgment, and mood changes. Notably, there is little research examining how Alzheimer’s dyads influence one another’s level of depression. This study examines how the influence of cognitive and psychosocial variables from the dyad impact depression severity in CRs. Method: Archival data of 670 Alzheimer’s disease community-dwelling care recipients from several major cities throughout the United States from the Resources for Enhancing Alzheimer’s Caregivers Health II (REACH II) study was analyzed. The measures included: Mini Mental State Examination (MMSE), Revised Memory and Behavior Problems Checklist (RMBPL), Activities of Daily Living/Instrumental Activities of Daily Living (IADL), Caregiver Burden, Social Support, and Positive Aspects of Caregiving. Results: A multiple regression found that caregiver burden (β=0.34, p<.001), IADL (β=0.14, p<.001), and positive aspects of caregiving (β=0.10, p=.02) significantly predicted CR depression ratings. Conclusion: Increased positive aspects of caregiving, caregiver burden, and higher levels of CR functional decline were associated with significantly increased levels of depression in CRs. Increased CR depression could correspond with higher levels of awareness during earlier stages of the disease process regarding their impairment and impact on their caregiver.

06 MRI and Neuropsychological Change During Conversion from Normal/MCI to Alzheimer’s Disease 1384458 Jory Paredes Pacific University Oregon MRI and Neuropsychological Change During Conversion from Normal/MCI to Alzheimer’s Disease Aging and Dementia: Alzheimer Objective: Analyze neurocognitive and structural brain changes associated with conversion from normal cognition/MCI to Alzheimer’s disease (AD). Method: Thirty-two participants from the National Alzheimer’s Coordinating Center included 22 women; mean (SD): age = 77.06 (8.1); education = 14.59 (3.5). All had either normal cognition or MCI at first visit when MRI was obtained and were diagnosed with AD at follow-up MRI; mean time between MRI’s = 4.1 years. Imaging of Dementia & Aging lab performed calculations for MRI structural change using Linux-based software. Participants took neuropsychological tests within three months of each MRI visit. Results: MRI structural degeneration occurred in: left (d = .46) and right (d = .47) entorhinal cortical thickness; left (d = .82) and right (d = .95) hippocampal volume; left (d = .74) and right (d = .43) middle temporal gray matter volume; left parahippocampal cortical thickness (d = .55); total white matter volume (d = .55); total brain volume (d = .78); and total CSF volume (d = 1.14). Significant neuropsychological decline included Animal fluency (d = 1.02), Vegetable fluency (d = .69), Digit Symbol (d = .53), Trails B (d = .42), and Digit Span Backward (d = .56). There was not a significant change in Logical Memory. Conclusions: Participants who converted from normal cognition/MCI to AD showed MRI degeneration in medial temporal structures as well as generalized atrophy and white matter loss. These structural changes accompanied a significant decline in semantic verbal fluency, working memory, and processing speed. There was not a significant change in verbal memory.

07 Examining the Performance of Depressed Patients with Transient Ischemic Attack (TIA) on a Delayed Memory Task 1384385 Daniella Lopez Nova Southeastern University Examining the Performance of Depressed Patients with Transient Ischemic Attack (TIA) on a Delayed Memory Task Aging and Dementia: Alzheimer Objective: To determine whether depression plays a role in delayed memory in patients with a history of Transient Ischemic Attacks (TIA). Method: The data from this study was derived from a large de-identified database from the National Alzheimer’s Coordinating Center containing neuropsychological information for transient ischemic attack (TIA) patients (1,585) who completed a Logical Memory-Delay. The sample was divided into two groups: those that related to depression (n=473; mean age=84.61; SD=6.01) as determined by the etiologic diagnosis of the cognitive disorder-Depression and those that did not (n=769; mean age=87.47; SD=6.37). Results: An Independent-sample-t-test showed a performance difference in performance between those who endorsed depressive symptomatology [F(1,043)=4.96,p<0.001], than those who did not report depressive symptoms. Conclusions: These findings suggest a link between Transient Ischemic Attack (TIA), depression and poor performance on delayed memory among older adults. Logical Memory-Delayed assesses long-term narrative memory. Based on research, depressive symptoms endorsed after a TIA can affect cognitive functioning. Specifically, studies have found that a decline in verbal memory can be in part, attributed to late-life depression. This cognitive decline may result from impaired executive functioning during the learning phase of the recall task, which then impacts their delayed recall. Given that cognitive weaknesses and psychological distress can impact considerably a patient after TIA, future studies should focus on understanding their relationship in terms of treatment outcomes. Additionally, since the effects of TIAs are typically short-lasting, future research should examine whether the observed cognitive effects are maintained over time when depression continues to be present.

08 Predictors of Everyday Problem Solving in Subtypes of Mild Cognitive Impairment 1384444 Jasmin Moreno California State University, Fresno Predictors of Everyday Problem Solving in Subtypes of Mild Cognitive Impairment Aging and Dementia: Alzheimer Objective: The Everyday Problems Test (EPT) evaluates problem solving ability needed to complete activities of daily living (ADLs), such as medication and financial management. This study assessed the contributions of executive functioning and subtypes of memory on everyday problem solving in healthy aging, amnestic mild cognitive impairment (MCI), and non-amnestic MCI. Method: Participants included healthy older adults (n=56) and individuals with MCI (amnestic MCI n=25; non-amnestic MCI n=36). Composite scores were derived for Executive Functioning (Trail Making Test-B and FAS), Immediate Memory (short delayed recall scores from the California Verbal Learning Test-II and the Brief Visuospatial Memory Test-Revised) and Delayed Memory (long delayed recall scores from both memory tests). The EPT was the measure of everyday problem solving. Results: We found that for the control group and the entire MCI group (both amnestic and non-amnestic MCI), executive functioning, immediate memory, and delayed memory predicted problem solving. When examining the separate MCI subtypes, executive functioning and delayed memory predicted problem solving in non-amnestic-MCI, but not amnestic MCI. Conclusions: Findings suggest that healthy older adults engage a range of cognitive skills (executive and memory skills) when they engage in everyday problem-solving. Executive and memory skills are also utilized for those with non-amnestic MCI when performing ADLs. Interestingly, in those exhibiting memory impairment and with increased risk for the Alzheimer’s type of dementia, memory and executive functions do not predict ADL problem solving. These findings indicate that people with amnestic-MCI may benefit from being given compensatory strategies to support their memory difficulties when they must perform everyday problem-solving.

09 Concussion history may accelerate cognitive decline in older adults 1384299 Samantha Bell Cleveland Clinic - Lou Ruvo Center for Brain Health Concussion history may accelerate cognitive decline in older adults Aging and Dementia: Alzheimer Objective: Concussion is a common occurrence among older adults, stemming largely from falls. Evidence suggests that history of moderate-severe traumatic brain injury (TBI) increases risk for cognitive decline and dementia; however, long-term outcomes associated with concussion remain unclear. This study aims to investigate longitudinal cognitive change among older adults with self-reported concussion history (CH). Method: Older adults (n=39) enrolled in an observational, longitudinal study by the Center for Neurodegeneration and Translational Neuroscience diagnosed with mild cognitive impairment or Alzheimer’s disease were studied, including 14 with CH. Participants completed baseline and one-year follow-up testing, including the Montreal Cognitive Assessment (MoCA). Repeated measures ANCOVA with age and education covariates assessed change in MoCA Total Scores from baseline to follow-up based on CH. Results: Main effects for age, education, time, and CH were not significant; however, significant interaction for CH by time was revealed, F(1,34)=4.46, p<.05 such that those with CH demonstrated significantly greater decline from baseline to follow-up than those without CH (p<.05). In the CH group, change over time was associated with an effect size of 1.20 (Cohen’s d) compared to an effect size of 0.22 in the non-CH group. Conclusions: History of concussion may lead to accelerated rate of cognitive decline in those diagnosed with MCI and AD over a 1-year period, which is consistent with prior research in moderate-severe TBI. These results preliminarily support the notion that concussion may be associated with significantly worse cognitive outcomes among older adults. Confirmation of our findings in larger samples and prospective validation of the observation are warranted.

10 Traumatic Brain Injury, APOE, and Age at Diagnosis of Alzheimer's Disease 1384371 Claire Alexander Ohio University Traumatic Brain Injury, APOE, and Age at Diagnosis of Alzheimer's Disease Aging and Dementia: Alzheimer Objective: Traumatic brain injury (TBI) is potentially a risk factor for Alzheimer’s disease (AD). This relationship may depend on the severity of TBI as well as other risk factors including APOE. We examined whether TBI status affects age of onset of AD, while improving on prior literature’s methodological issues. Method: Data from the National Alzheimer’s Coordinating Centers were used. Inclusion criteria included: normal cognition at baseline; eventual diagnosis of AD; adults aged 50 and older; at least 3 years of follow-up data. Covariates included age at baseline and history of TIA, stroke, or hypertension. The resulting sample (N=485) was 65.2% female; 89.1% White, 9.1% Black; and 4.5% Hispanic; 8% with TBI; and 42% with APOE4. Average age at baseline was 79.2 (SD=7.6). ANCOVAs were used to determine whether TBI status (no TBI; TBI with brief LOC; TBI with extended LOC) was associated with earlier age of diagnosis for AD, controlling for age at baseline and health factors. APOE status was added to a second ANCOVA. Results: Age at baseline (p<.001), but not health history (p=.777), was related to age of AD diagnosis. TBI status was not associated with age of AD diagnosis (p=.737). When APOE and the interaction between APOE and TBI status were added to the model, neither was significant (p’s=.150, .647). Conclusions: When controlling for baseline cognition, age at baseline, and health factors, there was no relationship between TBI status and age of diagnosis of AD. However, use of more stringent inclusion criteria as compared to previous studies may have reduced power significantly.

11 Stability of Impairment Rating Discrepancies in a Longitudinal Observational Alzheimer’s Study 1384435 Jaeson Kaylegian Cleveland Clinic Lou Ruvo Center For Brain Health - Las Vegas, NV Stability of Impairment Rating Discrepancies in a Longitudinal Observational Alzheimer’s Study Aging and Dementia: Alzheimer Objective: The present study investigated frequency and 12-month persistence of discrepant Clinical Dementia Rating (CDR) and comprehensive neuropsychological assessment ratings of impairment. Methods: We examined CDR and neuropsychological test scores from year 1 and 2 visits of 162 adults enrolled in a longitudinal observational study. Neuropsychological measures included Wide Range Achievement Test, American National Adult Reading Test, Rey Auditory Verbal Learning Test, Brief Visuospatial Memory Test-Revised, Dementia Rating Scale 2nd edition, Boston Naming, Verbal Fluency/Color Word Interference from the Delis-Kaplan Executive Function System, Judgment of Line Orientation, Trail Making Test, Symbol Digit Modalities Test, and Digit Span/Letter Number Sequencing from The Wechsler Adult Intelligence Scale 4th edition. Discrepancies were defined as: CDR=0 and 2 test impairments, CDR=0.5 and >5 or 0 impairments, CDR=1 and 0 impairments. Results: Including all test domains, 40.1% of participants in year 1 and 44.3% in year 2 showed discrepancies. 69% maintained this discrepancy at year 2 and 68% of these showed no change in discrepancy type. Considering only memory tests, 37% of participants in year 1 and 28.4% in year 2 showed discrepancies, with 45% maintaining at year 2 (74% showing no change in discrepancy type). A majority of discrepancies observed in both years 1 and 2 revealed the CDR was under reporting impairment compared to the neuropsychological battery year. Conclusions: The results provide evidence that within our study population, impairment as rated by the CDR frequently does not match the level of measured cognitive impairment and this observation is stable year to year.

12 Meta-analysis of neuropsychological intra-individual variability in dementia and mild-cognitive impairment 1384459 Stephen Aita Geisel School of Medicine at Dartmouth Meta-analysis of neuropsychological intra-individual variability in dementia and mild-cognitive impairment Aging and Dementia: Alzheimer OBJECTIVE: Neuropsychological intra-individual variability (IIV) refers to within-person cognitive fluctuation. It is often measured within-task (i.e., consistency) and across-tasks (i.e., dispersion). This investigation meta-analyzed studies comparing cognitive IIV of dementia and mild cognitive impairment (MCI) participants to normal controls. METHOD: Eight databases within the EBSCO network as well as ProQuest Dissertations & Theses were searched for original research comparing cognitive IIV between clinical and control samples. Studies were coded using a complex multi-comparison, outcome, and subgroup schema. All data were analyzed under random-effects modeling using Comprehensive Meta-Analysis. Main index of effect size was Hege’s g. The Q and I2 statistics were used to formally assess heterogeneity. Continuous and categorical moderator variables were tested using meta-regression and subgroup analysis, respectively. RESULTS: This study was a part of a broader meta-analysis looking at IIV across all clinical samples. The initial search strategy yielded 2,962 results, which were reduced to 87 studies for final inclusion. From which, the current meta-analysis included 28 consistency studies (dementia: k=13, 88 effect sizes; MCI: k=15, 110 effect sizes) and 16 dispersion studies (dementia: k=10, 36 effect sizes; MCI: k=6, 14 effect sizes). Meta-analysis revealed a greater combined effect size for dementia samples (consistency: g=0.92; dispersion: g=1.11) than MCI (consistency: g=0.33; dispersion: g=0.56). Significant between-study heterogeneity was noted across analyses. Age and education were the only notable moderators. CONCLUSIONS: All clinical subgroups demonstrated significantly elevated IIV compared to controls. The extent of IIV was proportionate to neurologic burden. Dispersion-based IIV may be a more sensitive marker of neural integrity than consistency.

13 The Impact of Anxiety and Depressive Disorders on Late-Life Cognitive Functioning 1384422 Mia Delgadillo Palo Alto University The Impact of Anxiety and Depressive Disorders on Late-Life Cognitive Functioning Aging and Dementia: Healthy Aging and Cognition Objective: Research indicates that the presence of psychiatric disorders is predictive of cognitive performance and increases the risk of developing dementia. Some have found that psychiatric disorders decrease cognitive performance while others have found that they increase cognitive performance. The purpose of the present study is to further investigate the relationship between psychiatric disorders and cognitive performance in older Veterans. Method: The convenience sample included 216 older Veterans who were screened at the VA Palo Alto Health Care System (94% male, age = 71.8±8.3). Psychiatric disorders (e.g., mood and anxiety disorders) were assessed using the Mini Neuropsychiatric Interview for DSM-IV. Domains of cognitive performance (e.g., Learning and Memory, Executive Function, Processing Speed, Attention, Visuospatial Ability, and Language) were measured using a comprehensive neuropsychological assessment battery. Results: Results indicated that 25% of the sample had depression (n=56) and 16% had anxiety (n=34). Psychiatric diagnoses largely had no effect on executive function, processing speed, or language. Age was found to moderate the association between depression and learning and memory, though there were no main effects for depression on learning and memory. Anxiety was significantly associated with learning and memory performance, and age was found to further moderate that relationship. Age also moderated the association between depression and attention, though no main effects for depression were seen in the model. Anxiety had no effect on attention. Conclusions: Age and psychiatric diagnoses interact to differentially impact cognitive functioning in late life. These findings support prior research on the complex relationship between psychiatric disorders and late-life cognitive impairment.

14 Positive, but not negative, self-perceptions of aging predict cognitive function in older adults 1384465 Kellie Brown Idaho State University - Psychology Department Positive, but not negative, self-perceptions of aging predict cognitive function in older adults Aging and Dementia: Healthy Aging and Cognition Objective: Self-perceptions of aging (SPA) refer to expectations and attitudes about one’s aging process and are robustly linked to physical health and longevity outcomes. How SPA correlates with cognitive function in older adulthood is less well known. Thus, the present study sought to examine how a multidimensional measure of SPA correlated with older adult’s performance on a comprehensive neuropsychological battery. Method: 136 community-dwelling older adults (Mage=70.18, SDage=5.79 years) from Southeast Idaho were administered a multidimensional measure of SPA; The Brief Ageing Perceptions Questionnaire (B-APQ). This 17-item questionnaire requires participants to rate their agreement with positive and negative statements concerning their aging process. Participants were also administered a demographics form and a comprehensive neuropsychological battery that included measures of memory, attention and executive function. Results: Both positive and negative subscales of the B-APQ were correlated with various aspects of cognitive function. After controlling for age, sex and education, regression analyses revealed that positive subscales of the B-APQ predicted mental status (β = .19, p<.05), short-delay memory (β = .16, p<.05), processing speed (β = -.21, p<.05) and two measures of executive function (β = -.21, p<.01; β = .18, p<.05). The negative subscales of the B-APQ were not predictive of any cognitive domain. Conclusion: This is the first study to demonstrate that independent of selected sociodemographic factors, positive, but not negative dimensions of SPA relate to a wide range of cognitive abilities in older adulthood. We discuss our results in terms of positive psychology and the potential for interventions to improve cognitive function in older adults.

15 Posttraumatic Stress Disorder Symptoms are Associated with Reduced Performance on the MoCA among Vietnam Veterans 1384501 Sarah Prieto The Ohio State University Posttraumatic Stress Disorder Symptoms are Associated with Reduced Performance on the MoCA among Vietnam Veterans Aging and Dementia: Healthy Aging and Cognition Objective: To examine cross-sectional associations between posttraumatic stress disorder (PTSD) symptom severity, number of stressors experienced, and cognitive outcomes in Vietnam War veterans. Methods: 366 adults between the ages of 60-85 years old completed a Vietnam Veterans Alzheimer's Disease Neuroimaging Initiative Project (ADNI-DoD) visit consisting of a clinical interview and neuropsychological assessment. Number of stressful experiences were measured with the Life Stressor Checklist-Revised (LSC-R). Severity scores were assessed via the current Clinician-Administered PTSD Scale (CAPS). Correlations were conducted between selected measures of stress and age, years of education, sex, ethnicity, and race. Demographic variables with significant associations with stress were included as covariates in the hierarchical regressions. Hierarchical linear regressions were conducted to examine the effect of CAPS and LSC-R on baseline Montreal Cognitive Assessment (MoCA) scores. Results: Higher CAPS scores (indicating higher PTSD severity) were associated with worse cognitive outcomes on the MoCA [ΔF(1,269)=15.058, p<0.001, R2=0.116]. By contrast, number of stressful experiences was not associated with cognitive outcomes. Follow up analyses indicated that CAPS severity scores were significantly associated with the memory index and the attention index of the MoCA. Conclusions: In a sample of older veterans, PTSD symptom severity was associated with worse performance on the MoCA. Moreover, further analyses indicated that results within the memory and attention domains are driving these results. As such, treating PTSD symptoms may be helpful in maintaining cognitive function as adults age.

16 The Relationship between Visual Memory and Performance in Virtual Reality Among Older Adults 1384419 Emily Flores University of Texas at Tyler The Relationship between Visual Memory and Performance in Virtual Reality Among Older Adults Aging and Dementia: Healthy Aging and Cognition Objective Over the past fifty years, many traditional paper-and-pencil neuropsychological tests have been translated to new computerized devices (Canini et al., 2014). Virtual reality offers neuropsychologists an opportunity to observe patients’ neurocognitive functioning in an immersive, lifelike environment, rich in visual stimuli (Morganti, 2004), yet relatively little is known about the relationship between visual memory and performance on learning and memory tasks in virtual reality environments. The purpose of this study was to investigate, among older adults, the relationship between visual memory, as measured by a traditional paper-and-pencil test, and procedural learning and memory performance in a virtual reality environment simulating meal preparation tasks. Methods Older adults (N = 73) ages 55-90 (M = 72.77, SD = 7.87) were administered the Weschler Adult Intelligence Scale-Fourth Edition (WMS-IV) Visual Reproduction Immediate Recall and the Virtual Kitchen Protocol (VPK), a virtual reality-based measure of learning and memory for meal preparation tasks. Results Participants performance on the immediate portion of WMS-IV, visual reproduction, correlated with their performance on the VPK teaching trial (r = .65, p = 0.01), immediate recall (r = .51, p = 0.01), delayed recall (r = .58, p = 0.01), and forced choice recognition ( r = ..54, p = 0.01) of Job Sim. Conclusion Results suggest that visual memory aids healthy older adults in procedural learning and memory tasks in the Virtual Kitchen Protocol, a virtual reality environment simulating meal preparation tasks. These results suggest that visual memory ability is germane to performance in virtual reality environments that are rich in visual stimuli.

17 Lifestyle activity engagement and cognition: Findings in healthy controls across the lifespan 1384344 John Randolph Geisel School of Medicine at Dartmouth Lifestyle activity engagement and cognition: Findings in healthy controls across the lifespan Aging and Dementia: Healthy Aging and Cognition Objective: Engagement in physical and intellectual activity has been found to exert an impact on processing speed and executive functioning. One critical issue that remains unclear is at what point in the lifespan self-reported lifestyle factors impact cognition. Method: A community sample of nondepressed adults aged 18-74 (N=176) was administered measures assessing activity engagement (Cognitive Health Questionnaire), processing speed (SDMT), and executive functioning (PASAT, Oral Trails B). Very physically and intellectually active (over 3 instances/week of activity) participants were compared to those reporting less activity across three age ranges: young adults (YA; age 18-29), middle-aged adults (MA; age 30-55), and older adults (OA; age 56-74). Results: MA participants who frequently engaged in moderate or vigorous physical activity showed better SDMT performance than less active participants (p < .05). YA participants frequently engaging in mild physical activity showed a nonsignificant trend toward better PASAT and SDMT performance than those who were less active. YA and MA participants who reported high use of daily cognitive strategies showed stronger Oral Trails B (p < .05) and SDMT (p = .06) performance, respectively. Very intellectually active YA participants showed better PASAT performance than less active participants (p = .06). While OA participant group comparisons were not significant, small sample sizes for some analyses may have impacted results. Conclusions: We found that individuals with strong lifestyle activity engagement showed better processing speed and executive functioning than less active participants. These findings are consistent with previous research indicating that more robust activity engagement is associated with better cognition.

18 Informant and Participant-Report of Functioning Predicts Performance on Objective Cognitive Screening 1384303 Aaron Stanley Banner Sun Health Research Institute, Midwestern University Informant and Participant-Report of Functioning Predicts Performance on Objective Cognitive Screening Aging and Dementia: Healthy Aging and Cognition Objective: Montreal Cognitive Assessment (MoCA) and Alzheimer’s Disease 8 questionnaire (AD8) are widely used measures for clinical screening of dementia related disorders. Previous research on MoCA and AD8 has been solely focused on participant-report AD8 measures without consideration of informant reports. We hypothesize informant reported AD8 and participant MoCA scores will be inversely related, participant-reported AD8 will be weakly associated with MoCA performance, and informant reported AD8 will more reliably predictor cognitive performance. Methods: Participants (N = 212) were seen from 2018 to 2020 through a free community screening service (Brain Health Check-In) at Banner Sun Health Research Institute in Arizona. First and second hypotheses were analyzed with Spearman’s Rho (r), third hypothesis utilized a linear regression. Results: Both participant and informant reported AD8 directly correlated with overall cognitive performance classification (r = 0.639 [informant] confidence interval [CI] = .0552-0.712, p < .000; r = 0.610 [participant] CI = 0.518-0.688, p < .000). Informant reported AD8 ratings were significantly inversely correlated with MoCA performance (r = -0.497, p < .000). Participant reported AD8 ratings also inversely correlated with overall MoCA scores with a weaker association (r = -0.296, p < .000). Neither participant nor informant reported AD8 were able to reliably predict categorical cognitive performance classification, but informant reported AD8 (r = -.686, p < .000) did emerge as a reliable predictor of MoCA performance. Conclusion(s): This study extends and reaffirms prior research about AD8 and suggests both informant- and participant-reports are valuable; however, informant often provides more clinically useful information related to cognitive functioning.

19 Predictors of Memory Strategy Use in Healthy Older Adults 1384311 Kendra Pizzonia Ohio University Predictors of Memory Strategy Use in Healthy Older Adults Aging and Dementia: Healthy Aging and Cognition Objectives Older adults often use memory strategies to assist with age-associated memory changes, and interventions targeting successful memory strategy use may promote independence. However, individuals vary in their use of memory strategies. We investigated individual difference factors involved in memory strategy use in older adults. Method As part of a larger study on stress and aging, 123 healthy community-dwelling adults over the age of 50 completed various assessments. The present analyses included 91 participants (54% female, mean age 60.80, SD = 8.75) who had completed all measures of interest. Reported external and internal memory strategy use and anxiety about memory ability were measured by the Metamemory in Adulthood (MIA) questionnaire. Psychological variables were measured by the Geriatric Depression Scale, Perceived Stress Scale, and MIA. Memory and working memory performance were assessed using the RBANS, Auditory-Verbal Learning Test, and Auditory Consonant Trigrams. Results Within the context of our model, we found that education (p = .036) and anxiety about memory performance (p = .010) predicted internal memory strategy use, while gender (p = .011), education (p < .001), and anxiety about memory ability (p = .011) predicted external memory strategy use. None of the other variables were related to memory strategy use. Conclusions Though cross-sectional in nature, our results have implications for understanding successful memory strategy use. Regarding demographics, female gender and higher education predicted external memory strategy use, while only education predicted internal memory strategy use. Also, anxiety about memory performance predicted the use of internal and external memory strategies rather than objective memory performance.

20 Advancing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging (ARMADA): Extension of the NIH Toolbox in Healthy Cognitive Aging 86 years and Beyond 1384273 Tatiana Karpouzian Rogers Northwestern University Advancing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging (ARMADA): Extension of the NIH Toolbox in Healthy Cognitive Aging 86 years and Beyond Aging and Dementia: Healthy Aging and Cognition Background: Early detection of cognitive decline in older individuals can be accomplished with brief, computerized measures in diverse settings. The goal of the ARMADA study is to validate the NIH Toolbox for Assessment of Neurological and Behavioral Function (NIHTB) in the neurological aging spectrum from cognitively normal to dementia, and to extend the age range to allow for longitudinal assessment of the oldest individuals. Here, we present baseline data from general population individuals over 85 years of age without cognitive impairment compared with those 65 to 85. Method: ARMADA is a multi-site study recruiting participants from established research cohorts. Participants included cognitively average-for-age individuals between the ages of 65-85 (n = 82) and another group 86 and older (n = 105). Baseline characteristics and preliminary data are presented for the Cognition, Emotion, Motor and Sensation modules of the NIHTB. Results: Analysis of preliminary baseline data revealed that mean uncorrected standard scores of most cognitive, motor, and sensation measures differed among the groups in the expected direction, such that individuals 65-85 had better performance than individuals 86 and older. Conversely, group scores were similar on most emotion measures. Conclusions: This analysis of preliminary baseline data from ARMADA provides initial evidence for the utility of the NIHTB in individuals over age 85 without cognitive impairment, who, as a group, scored lower than those from age 65-85. These results demonstrate the importance of establishing cohort-specific norms relevant to the oldest age group. Longitudinal follow-ups over two years will track cognitive, motor, emotion, and sensory functioning in this group.

21 Normative Data on Montreal Cognitive Assessment Total Scores in Healthy Controls 1384266 Lauren Ratcliffe Mercer University Normative Data on Montreal Cognitive Assessment Total Scores in Healthy Controls Aging and Dementia: Healthy Aging and Cognition The Montreal Cognitive Assessment (MoCA) is considered to be a suitable, sensitive, and specific cognitive screening tool for detecting mild cognitive impairment. Research has reported variable cutoff scores for the MoCA based upon geographical location. The aim of the present study is to provide normative data in a sample of cognitively healthy adults. Data was collected through the National Alzheimer’s Coordinating Center (NACC). A population of healthy adults (N=3610) was examined (66% female, 78% Caucasian, 16% African American, 6% Other). MoCA normative data were derived from age and education, which were found to be weakly but significantly associated with age (r=-.203, p=.000) and more strongly correlated with education (r=.402, p=.000). Total scores (M = 26.25, SD = 2.75) were at the suggested cutoff for impairment (

22 Brief Test of Adult Cognition by Telephone to Examine Changes in Cognitive Functioning 1384447 Jamie Hansel University of Colorado at Colorado Springs Brief Test of Adult Cognition by Telephone to Examine Changes in Cognitive Functioning Aging and Dementia: Healthy Aging and Cognition Objective: The purpose of this study was to examine changes in cognitive function over time as measured by a telephone-delivered cognitive assessment. Method: Cognitive and biomarker data from the Midlife in the United States (MIDUS) study were used. Missing data were excluded through listwise deletion resulting in a final sample of 2,378 adult respondents with MIDUS 2: Cognition data available at baseline (T1; Mage=53.49, SD=10.63) and 9-year follow up (T2; Mage=63.64, SD=11.35). Cognition was measured using Brief Test of Adult Cognition by Telephone (BTACT) composite z-scores (“severe”=-1.00 SD). Results: A Two-Way Repeated Measures ANOVA revealed main effects for time (F1, 2,375=46.73, p<.001) and group (F2, 2,375=499.34, p<.001). BTACT scores at T1 (M=-1.06, 95% CI[-1.21, -0.92]) were significantly lower than scores at T2 (M=-0.70, 95% CI[-0.82, -0.59]). As expected, BTACT scores for the normal group (M=0.39, 95% CI[0.35, 0.42]) were significantly greater than both the mild (M=-1.33, 95% CI[-1.36, -1.30]) and severe (M=-2.25, 95% CI[-2.33, -2.16]) groups. A significant interaction effect was observed between time and group (F2, 2,375=204.10, p<.001). Bonferroni post-hoc comparisons indicated that cognitive function scores significantly declined for those in the normal group, but significantly improved for those in the mild and severe groups (all ps<.001). A regression model using biomarkers as predictors of cognitive change for the impaired groups was nonsignificant. Conclusion(s): Improvement in the mild and severe groups was unexpected and could not be explained by cardiovascular or metabolic risk factors at T1. These findings suggest cautious interpretation of cognition scores obtained via telephone measures.

23 Comparison of Informant Reports of Daily Functioning to Objective Neurocognitive Performances: Activities of Daily Living Questionnaire versus Lawton Activities of Daily Living/Instrumental Activities of Daily Living Scale 1384406 Clara Roberts Neuropsychological Services of New Mexico Comparison of Informant Reports of Daily Functioning to Objective Neurocognitive Performances: Activities of Daily Living Questionnaire versus Lawton Activities of Daily Living/Instrumental Activities of Daily Living Scale Aging and Dementia: Other 1. Objective: Informant reports of daily functioning are often useful when assessing functional skill impairments in neuropsychological dementia evaluations, given potential biases with self-reporting from low insight and/or a reluctance to endorse reduced independence. Two measures of informant functional skill assessments were compared within patients relative to their objective neurocognitive performances. 2. Method: Participants included 19 (32% male, 68% female; 21% Hispanic, 69% Caucasian) outpatient older adult dementia evaluations aged 60 to 90 years (Mean age=74, SD=7.7) who were accompanied by a family member or caregiver informant. The Activities of Daily Living Questionnaire (ADLQ) and the Lawton Activities of Daily Living and Instrumental Activities of Daily Living Scale (ADL/IADL) informant reports were compared relative to performances on the Hopkins Verbal Learning Test delayed recall trial (HVLT), Trail Making Test Part B (TMTB), CLOX: An Executive Clock Drawing Task (CLOX1), and the Controlled Oral Word Association Test, FAS and Animals (COWAT). 3. Results: Simple linear regression analyses indicated the ADLQ significantly predicted both TMTB (β=-.52, 95% CI [-.81, -.23], p<.01; R2=.47) and HVLT (β=-.38, 95% CI [-.67, -.08], p<.01; R2=.31) performances. The ADL/IADL scale significantly predicted TMTB performances (β=-.70, 95% CI [-1.1, -.30], p<.01; R2=.46). A significant correlation was observed between ADLQ and ADL/IADL informant reports (r(17)=.60, p<.01). 4. Conclusion: There was a significant linear relationship between both ADLQ and ADL/IADL informant reports with TMTB performances. The ADLQ reports also significantly predicted HVLT performances. No significant relationships were observed between either ADLQ and ADL/IADL reports, and participants’ CLOX1 or COWAT FAS/Animals performances.

24 The Relationship Between Levels of Insight and Memory Performance in Patients with Dementia 1384395 Cari Cohen Rosalind Franklin University of Medicine and Science The Relationship Between Levels of Insight and Memory Performance in Patients with Dementia Aging and Dementia: Other Objective: Impaired awareness of cognitive and functional decline is common in dementia syndromes. Insight into cognitive changes is often assessed during a clinical interview, questioning of independent activities of daily living, or via self-report measures of functional abilities. Few studies have examined patient insight in a neuropsychological test performance. The current study investigated the relationship between memory performance on the Wechsler Memory Scale Fourth Edition(WMS-IV) and the Hopkins Verbal Learning Test-Revised(HVLT-R) with level of insight in patients with dementia. Insight was determined from the clinician-based insight rating item on the Behavioral Dyscontrol Scale-II(BDS-II). Method: Patients with dementia (ages 50-91) from an outpatient clinic referred for memory testing were divided into groups based on their BDS-II insight score: intact(n=52), moderate(n=30), and none/poor(n=29). One-way ANOVA and post hoc analyses examined the insight differences for immediate recall(IR) and delayed recall(DR) trials on the WMS-IV Visual Reproduction(VRI/II) and Logical Memory(LMI/II) subtests and the HVLT-R. No group differences were found for age or education. Results: Analyses revealed significant group differences on the HVLT-R IR [F(2,96)=5.33,p<.01] and VRI [F(2,100)=4.88,p<.01], with no significant differences for LM. Post hoc analyses demonstrated poorer performance in the none/poor insight group compared to the moderate (HVLT:p<.05,Cohen’s(d)=.95;VR:p<.05,d=.67) and intact insight groups (HVLT:p<.05,d=.75;VR:p<.05,d=.71). Performance between moderate and intact groups did not differ. There were no significant group effects in the three DR measures. Conclusions: Findings suggest that patients with poor insight performed worse on IR measures. The presence of poor insight, in the context of impaired IR performances, may assist in recommendations regarding future functional supports.

25 Subjective Cognitive Decline and Likelihood of Participation Across Home-Based Cognitive Assessment Modalities 1384335 Moriah Splonskowski Pacific University Subjective Cognitive Decline and Likelihood of Participation Across Home-Based Cognitive Assessment Modalities Aging and Dementia: Other Objective: Individuals with subjective cognitive decline (SCD) are approximately twice as likely to develop dementia and less likely to seek cognitive assessment. Home-based cognitive assessment (HBCA) could reduce many practical and emotional barriers associated with in-person cognitive testing. We aimed to explore the relationship between SCD and likelihood of HBCA participation across various modalities. Method: A nation-wide sample of 483 community-dwelling adults age 50 years and older (M=63.61 ±5.47) were recruited via Amazon Mechanical Turk, an online crowdsourcing website, to complete a survey. SCD was measured using the SCD-MyCog Questionnaire. A score of 7/24 endorsed symptoms classified respondents into SCD and non-SCD. Likelihood of participation in HBCA was measured using 4 likert-scale items (e.g., “How likely would you be to participate in HBCA via computer?”). Total likelihood was calculated by summing items. Results: Regression revealed SCD symptom burden predicted likelihood of participation in HBCA [F(1, 481)=12.42, B=.097, [.043 - .150], p<.001, r^2=.025]. Likelihood was higher in SCD (15.25±3.3) than non-SCD (14.23±3.5). When looking at specific HBCA modalities, SCD were more likely than non-SCD to participate in computer and videoconferencing modalities (1.36±0.6 vs1.68±0.87, p<.001; 2.26±1.11 vs 2.58±1.16, p<.001). There was no relationship with iPad or smartphone modalities. Conclusion: SCD endorsement was associated with increased likelihood of engagement in HBCA. It is possible that HBCA can help overcome barriers to help-seeking in this group. SCD may prefer videoconferencing and computer modalities.

26 Older Adults’ Likelihood of Participation in Home-Based Cognitive Assessment: The Role of Age, Geographic Location, and Income 1384448 Moriah Splonskowski Pacific University Older Adults’ Likelihood of Participation in Home-Based Cognitive Assessment: The Role of Age, Geographic Location, and Income Aging and Dementia: Other Objective: Recent implementations of teleneuropsychological services allow cognitive assessment to take place within the individual’s home. Geographic location and financial resources may influence older adults’ decision to access these services. Additionally, the likelihood of older adults’ participation in home-based cognitive assessment (HBCA) is unknown. We aimed to examine the relationship between age, geographic location, income, and likelihood of participation in HBCA. Method: A nation-wide sample of 483 adults ages 50-79 completed an online survey via the crowdsourcing website Amazon Mechanical Turk. Respondents were asked about age, income and geographic location (e.g. rural, urban, suburban). Income was categorically measured in $20,000 increments. Likelihood of participation in HBCA was measured using 4 likert-scale items. Total likelihood was calculated by summing items. Results: Perceived likelihood of participating in HBCA increased with greater household income, B=.087, p=.001 (0-20K: M=13.08±4.19; 20-40K: M=14.76±3.39; 40-60K: M=14.55±3.49; 60-80K: M=14.55±3.38; 80-100K: M=15.11±2.83 and >100K: M=15.48±2.55). Likelihood decreased with age, B=-.061 p=.025 (50-59: M=15.03±3.56; 60-69: M=14.31±3.52, 70-79 M=14.29±3.27). Likelihood was not related to geographic location B=-.005, p=.933 (rural: M=14.52±3.84; suburban: M=14.48±3.31; urban: M=14.48±3.56). Conclusion: Adults aged 50-59 with high income were the group most likely to participate in HBCA. Geographic location does not appear to play a role in acceptance of HBCA. However, this survey was conducted with online respondents. Different results may be obtained with in-person samples.

27 Differentiating HIV-Associated Neurocognitive Disorder from Alzheimer’s Disease: A Neuropsychological Profile 1384502 Deanna Eilenberger Immaculata University Differentiating HIV-Associated Neurocognitive Disorder from Alzheimer’s Disease: A Neuropsychological Profile Aging and Dementia: Other Objective: This meta-analysis examined the potential for executive function, episodic memory, and motor function to differentiate HIV-associated neurocognitive disorder (HAND) from Alzheimer’s disease (AD), in an attempt to aid in accurate differential diagnosis. Data Selection: The literature search identified records investigating neuropsychological test performance associated with HAND and AD. Databases used were: PsycINFO, Academic Search Complete, and Medline with Full Text. Eligibility was assessed using the following inclusion criteria: (a) study examines HAND or AD, (b) diagnosis is determined using standard diagnostic criteria, (c) study contains data regarding executive function, episodic memory, and/or motor function, (d) study published in English, (e) study is quantitative, and (f) study contains statistical information for effect size calculations. A total of 947 relevant studies were initially identified. Twenty studies were included. Data Synthesis: Group difference effect sizes were converted/calculated using Cohen’s d and Cohen’s (1998) conventions. Three weighted effect sizes were calculated for constructs of interest for each disorder. Weighted effect size for executive function was large for each group (HAND d=1.28; AD d=1.57). A large weighted effect size for episodic memory in AD (AD d=-2.17) and a medium effect size for HAND (HAND d=-0.65) were calculated. A large weighted effect size was determined for motor function in AD (d=3.60), while a small effect size was calculated for HAND (d=0.27). Conclusions: Level of impairment in episodic memory and motor function can be used to differentiate HAND from AD. Executive function lacked differences needed for diagnostic differentiation. Future research should be done directly comparing neuropsychological performance between HAND and AD.

28 Utilizing Virtual Reality to Assess the Relationship between Prospective Memory and Processing Speed 1384503 Jennifer Sawyer UT-Tyler Utilizing Virtual Reality to Assess the Relationship between Prospective Memory and Processing Speed Aging and Dementia: Other Objective: Processing speed may partially mediate age-related differences in prospective memory (PM) abilities (West & Craik, 2001). The present preliminary study aimed to further investigate the relationships between prospective memory and processing speed by utilizing a novel virtual reality-based prospective memory measure. The task was designed to assess the impacts of a virtual environment would facilitate a deeper level of processing and enhance prospective memory performance. Method: 49 older adults ( M = 73.87 , SD = 8.24 ) and 39 younger adults( M = 18.87, SD =1.61 ) completed the Coding subtest of the Weschler Adult Intelligence Scale (WAIS- IV) as well as a virtual-reality prospective memory measure that utilized both time-based and event-based cues. Results: Coding was strongly correlated with PM time-based cues (r = .43, p < .01 ) and event-based cues (r = .53 , p < .001 ). There were no correlations between processing speed and prospective memory in the young adult sample. Conclusion: This study suggests that processing speed is strongly related to virtual-reality based PM and suggests that processing speed is a crucial component in prospective memory outcomes in older adults. This novel task virtual reality task may provide construct validity against other prospective memory measures.

29 The Clinical Utility of the Trail Making Test- Part B Efficiency Score in a Memory Disorder Clinic 1384479 Kathryn Grueninger Florida Institute of Technology The Clinical Utility of the Trail Making Test- Part B Efficiency Score in a Memory Disorder Clinic Aging and Dementia: Other Objective: Trail Making Test - Part B (TMTB) is a common neuropsychological instrument measuring aspects of executive functioning such as set shifting and cognitive flexibility. Typically, TMTB is discontinued if not completed within 300 seconds, limiting variability in interpretation for individuals who discontinue. This study aims to alleviate this limitation by examining whether a TMT-B Efficiency (TMT-Be) score can provide useful clinical information in a memory disorder clinic population. Methods: TMTB was administered to 167 patients (101 females, 66 males) as part of a neuropsychological evaluation. Diagnostic groups included: Alzheimer’s Disease (AD; N=83), Mild Cognitive Impairment (MCI; N=58), and Normal Cognition (N=26). Ages ranged from 65-94. Participants completed TMTB according to standardized instructions. TMT-Be scores accounted for time, number of errors, and number of incomplete moves. Results: TMT-Be scores differed significantly across diagnostic groups (ANOVA, F (2, 164)=44.81, p < .001). Post-hoc tests using the Bonferroni correction revealed TMT-Be scores in the AD group (M = 17.48, SD = 9.23) were significantly higher than scores of the MCI group (M = 7.91, SD = 5.68) and WNL group (M= 4.65, SD = 1.67). Significant correlations between TMT-Be score and other neuropsychological measures were also found and will be presented and discussed. Conclusion: Results support clinical utility of TMT-Be scores for diagnostic purposes, such as differential diagnosis of normal cognition, MCI, and AD. Further research with a larger number of participants and other populations may lend further support to the clinical utility of the TMT-Be scoring method.

30 Sensitivity and Specificity of Measures for Dementia with Lewy Bodies 1384274 Andres Duarte Albizu University Sensitivity and Specificity of Measures for Dementia with Lewy Bodies Aging and Dementia: Other The present review aimed to examine sensitivity and specificity across neuropsychological tests for Dementia with Lewy Body (DLB), to enhance diagnostic utility. A systematic search of the literature was conducted. Databases used: PsycInfo, Discovery Service for Carlos Albizu University-Miami, PsycARTICLES. Data selection criteria entailed articles from 2010-2020. Search terms included: Dementia with Lewy body, sensitivity, specificity, neuropsychological assessment, neuropsychological testing. Original search yielded 27 results, from those, only 8 articles contained sensitivity and specificity regarding DLB. The target population of review were older adults 65 and older. The assessment measures analyzed were the BSID, HVLT, MMSE QSPT, SAI, MMSE, and ICS, and others. Findings of eight studies were evaluated regarding sensitivity and specificity across neuropsychological assessments for DLB. Among the most specific and sensitive measures were the Alba Screening Instrument (ASI; sensitivity 90.7%, specificity 93.6%), and a combination of the Auditory Verbal Learning Test (AVLT) percent retention, Block Design, Trail Making Test--Part A, and Benton Visual Form Discrimination (specificity 96.1% and sensitivity 88.6%). Lower specificity and sensitivity were found in Illusory contour (ICs-4; specificity and sensitivity of 37.1% and 88.6%) and the Minimental State Examination-Pentagon Test (MMSE-QSPT; specificity 78.67% and sensitivity 70.29%). Other tests and combinations were explored. Specificity ranged from 76% to 96.1%, while sensitivity ranged from 37.1% to 90.7% throughout the neuropsychological tests examined. One major limitation across the studies constituted lack of pathological, post-mortem, confirmation. Additionally, while the use of cutoff scores across assessments appeared to enhance the sensitivity and specificity, it seemed to compromise the diagnostic accuracy of AD.

31 Early Childhood Quality of Education and Late-Life Cognitive Function in a Population-Based Sample from Puerto Rico 1384364 Cheyanne Barba University of Alabama at Birmingham Early Childhood Quality of Education and Late-Life Cognitive Function in a Population-Based Sample from Puerto Rico Aging and Dementia: Other Objective: Education quality may be related to disparities in late-life cognition in the U.S. We examined whether years of education and indicators of childhood quality of education (QOE) are associated with cognitive decline and cognitive impairment (CI) in older Puerto Ricans. Method: Participants included 3,883 community-dwelling older adults aged 60+ years from the Puerto Rican Elderly: Health Conditions Study without CI at baseline. A composite of QOE included school year length, student-teacher ratio, attendance, and literacy levels for each municipality from Census and education reports (1926 - 1945). Cognitive functioning was measured by the minimental Cabán (MMC) at baseline and four-year follow-up. CI was assigned when MMC score was <11 points. Covariate-adjusted logistic and linear regression models were used to examine incident CI and decline, respectively. Results: Participants reported 8 years of education on average. Years of education (OR = 0.84; 95% CI = 0.79, 0.90; p = <.0001) was associated with a lower risk of incident CI but QOE was not (p = .37). In covariate-adjusted models, QOE (F(8, 2482) = 96.87, p < .05, R2 = .24) was significantly associated with cognitive decline. However, when years of education was added to the model, QOE was no longer statistically significant (p = .34). Conclusions: This study provides further evidence that years of education and QOE are important factors for understanding risk of negative cognitive outcomes in older age, and that for this older Puerto Rican sample, years of education and literacy largely explained associations between QOE and late-life cognition.

32 The relative contribution of neuropsychological assessment and radiological scans to diagnostic accuracy in Young Onset Dementia. 1384491 Anna MacRae Midlands Partnership Foundation Trust The relative contribution of neuropsychological assessment and radiological scans to diagnostic accuracy in Young Onset Dementia. Aging and Dementia: Other Objective – Younger-onset dementias (YOD) are relatively rare neurodegenerative disorders that often present unique diagnostic challenges to health professionals. These difficulties often result in significant delays to diagnosis and uncertainty in clarifying the aetiology of a client’s presenting problems. In this audit of routine clinical practice, we evaluate the utility of radiological scan reports (Magnetic Resonance Imaging (MRI), Single Photo Emission Computed Tomography (SPECT) and Computerised Tomography (CT) with neuropsychological assessment, and retrospectively evaluate the relative contribution of each approach to diagnostic accuracy. Method – 83 clinical records were reviewed from a regional specialist centre for assessment and diagnosis of YOD in the United Kingdom. Patients were assessed using clinical interview, neuropsychological assessment and neuroradiological diagnosis (MRI, SPECT or CT scan). The correlations between radiologist report, neuropsychological status and neuropsychiatric evaluation were compared to established diagnoses retrospectively. Results – The diagnostic labels identified and highlighted in radiology reports were found to be congruent with the final agreed diagnosis, arrived as a consensus by a multidisciplinary team of clinicians, in 70% of cases. In contrast, neuropsychological opinion was congruent with the final agreed clinical diagnosis in 93% of cases. Substantial differences in congruency between scan report and clinical diagnosis were observed for the different neuroradiological techniques with SPECT showing high rates of false positive abnormality. Conclusion – Overall, neuropsychological opinion concurred with final diagnostic outcomes significantly more frequently than diagnosis indicated by radiology scan report. Results are discussed in terms of both cost-benefit analysis and the clinical utility of both assessments in the diagnosis of YOD.

33 Subjective Cognitive Decline Symptom Burden Predicts Acceptance of Cognitive Assessment 1384315 Moriah Splonskowski Pacific University Subjective Cognitive Decline Symptom Burden Predicts Acceptance of Cognitive Assessment Aging and Dementia: Other

34 Improvement in Cognitive Functioning Post Cardiovascular Event - A Case Study 1384259 Angelina Witbeck Illinois School of Professional Psychology Improvement in Cognitive Functioning Post Cardiovascular Event - A Case Study Aging and Dementia: Other Objective: To evaluate changes in cognitive functioning over time following a cardiovascular event evidenced by a series of neuropsychological evaluations. This data adds to the limited research on episodes of vascular induced dementia and demonstrates how a patient that suffers a cardiovascular event can show improvements in cognitive abilities over time. Methods: Patient A is a 78-year-old, right-handed, Caucasian, male, with a medical history significant for congestive heart failure with subsequent cognitive, emotional, and behavioral changes. Comprehensive neuropsychological evaluations were performed two weeks, three weeks and seven months post cardiovascular event to monitor changes in cognitive functioning. All background information was obtained from a clinical interview with Patient A and his daughter, as well as a review of available medical records. Results: The initial evaluation revealed cognitive deficits across domains, whereas the most recent evaluation showed improvements in all domains except for isolated declines in areas of memory and visual planning and organization. The most recent results evidenced his memory performance was notable for greater encoding deficits for both verbal information and visual information. Attention, executive functioning, language, and visual acuity remained stable or improved from previous evaluations. Conclusions: The series of evaluations showed a general improvement in Patient A’s cognitive functioning, however, isolated declines were noted in memory and visual planning and organization. This data suggests that following a cardiovascular event, an individual’s functioning may improve over time and allow clinicians to see the isolated areas of decline to provide a more accurate and thorough diagnosis.

35 What Make Them Tick? The Clock Drawing Test and correlations between cognitive and functional abilities 1384310 Dov Gold William James College What Make Them Tick? The Clock Drawing Test and correlations between cognitive and functional abilities Aging and Dementia: Other Objective: The Clock Drawing Test (CDT) is among the most researched cognitive measures and is frequently used to screen for neurocognitive disorders (NCDs). No study to date has investigated the relationship between qualitative errors on the CDT and independence in instrumental activities of daily living (IADLs) or discrete cognitive abilities. Therefore, this study sought to evaluate the correlations between qualitative errors on the CDT and IADL status as well as performance in individual cognitive domains. Method: Data were retrospectively collected from patients seen at an outpatient clinic in eastern Massachusetts, including 16 healthy controls, 22 patients with mild NCD, and 35 patients with major NCD. Analyses were performed between qualitative errors on the CDT and patients’ scores on the Lawton IADL Scale, Mattis Dementia Rating Scale-2 (DRS-2), Digit Span Forward and Backward, Trail Making Test (TMT), and the Boston Naming Test (BNT). Results: IADL scores were moderately correlated with CDT error types. DRS-2 scores were strongly correlated commission of qualitative errors. Strong to very strong correlations were observed between TMT parts A & B scores and all qualitative error types. BNT performance was strongly correlated with conceptual deficits and spatial/planning errors. Digit Span Forward and Backward scores showed low correlations with all CDT errors. Conclusions: Functional status appears only moderately correlated with commission of various CDT errors; however, several cognitive measures showed high correlation with various CDT error types. These findings suggest that certain qualitative errors may be indicative of cognitive impairments warranting further workup. Clinical implications and future directions are discussed.

36 Deficit Accumulation Frailty Index as a Predictor of Cognitive Outcomes in HIV+ and HIV- Adults 1384380 Kayla Tureson University of Southern California Deficit Accumulation Frailty Index as a Predictor of Cognitive Outcomes in HIV+ and HIV- Adults Aging and Dementia: Other Objective: Adults aging with HIV face elevated rates of frailty than the general aging population and are frail at younger ages, but associations between frailty and cognition in HIV are not well understood. The study aimed to examine: 1) relationships between frailty index and age, and whether relationships differed by HIV status; 2) relationships between frailty index and cognitive performance, and whether relationships differed by HIV-status. It was hypothesized that 1) the frailty index would significantly predict age in non-infected (HIV-) controls but not HIV-infected (HIV+) adults; 2) higher frailty index scores would significantly predict worse cognitive functioning regardless of HIV-status. Method: Participants included 109 (39.4% HIV+) participants aged ≥45 from a community-based sample in Los Angeles. HIV-status groups did not differ by age, education, or race (p’s >.10). Frailty was assessed using a deficit accumulation frailty index (DAFI) composed of 32 age-related health variables. A comprehensive neurocognitive battery was used to examine motor, processing speed, executive functioning, verbal fluency, learning, memory, and global functioning. Multivariate linear regression was used to assess relationships between the DAFI and age and cognitive performance, and HIV-by-frailty interaction. Results: DAFI scores were higher in HIV+ adults compared to HIV- controls. The DAFI significantly predicted global, motor, and memory performance (p’s <.05), but the effect was only observed in HIV- controls. The DAFI did not significantly predict age in either group. Conclusions: Findings highlight that relationships between frailty and cognition may be complicated in patients with chronic health conditions. Frailty may not predict cognitive dysfunction in aging HIV+ adults.

38 Aggressive Behaviors in Dementia 1384282 Nikki Kaplan Cleveland Clinic Lou Ruvo Center for Brain Health Aggressive Behaviors in Dementia Aging and Dementia: Other Objectives: The present study investigated neural correlates of caregiver-reported aggression/agitation in older adults with memory complaints. We hypothesized that individuals rated as more aggressive/agitated would exhibit poorer executive and daily skills functioning, and show reduced volumes in brain structures implicated in aggressive behavior. Methods: We examined 1207 patients (mean age = 66.91; 587 women) who completed neuropsychological evaluation at the Cleveland Clinic Lou Ruvo Center for Brain Health due to memory complaints. A subset of 252 also had brain MRI scans within six months of neuropsychological testing. Mann-Whitney and Chi Square tests examined association of caregiver-reported agitation/aggression on the Neuropsychiatric Inventory (NPI) with daily skills functioning (Activities of Daily Living Questionnaire), executive function (Delis-Kaplan Executive Function System (D-KEFS) Color-Word Inhibition (CWI), Color-Word Inhibition/Switching (CWIS), Category Switching (CS), and Trail Making Test Part IV (TMT4)), and volume or thickness of brain regions associated with developmental presentations of aggressive behavior, including the hippocampus (HC), amygdala, lateral and medial orbitofrontal cortex (OFC), frontal poles, and insula. Results: Greater caregiver-reported agitation/aggression was associated with poorer multitasking (TMT4: z=-2.222, p=0.026; CS: z=-3.014, p=0.003), inhibition (CWI: z=-4.211, p<0.001), and inhibition with embedded multitasking (CWIS: z=-2.898, p=0.004). More caregiver-reported agitation/aggression also related to poorer daily skills functioning (X2(N=1207,1)=96.454, p<0.001) and thinner bilateral medial OFC (Left: z=-2.040, p=0.041; Right: z=-2.246, p=0.025), right frontal pole (z=-2.993, p=0.003), and right insula (z=-2.185, p=0.029). Conclusions: Present findings show similarities between cognitive and neural correlates of caregiver-reported agitated/aggressive behavior in individuals with memory concerns and individuals with developmental aggressive behavior.

39 Adherence and Executive Functioning in an Elderly Population with Type 2 Diabetes in México 1384359 Cristian Ibarra Benemérita Universidad Autónoma de Puebla Adherence and Executive Functioning in an Elderly Population with Type 2 Diabetes in México Aging and Dementia: Other Objective Diabetes is a prevalent chronic illness that can impact Executive Functioning (EF). Adherence to treatment is an important aspect in diabetes management however little published research addresses the relationship between adherence and EF in individuals with Type 2 Diabetes Mellitus (T2DM). The objectives of this study are: compare the levels of adherence and EF between T2DM and a control group. Analyze the relationship between adherence and EF in individuals with T2DM. Method The present study included 10 participants with T2DM and 10 control participants with Hypertension (HTN) all between the ages of 61-76. Participants were recruited through "Casa del Abue" a public center offering medical/social services to geriatric populations in Puebla, México. Neuropsychological Battery of Executive Functions and Frontal Lobes was administered to all participants, along with adherence measures specific to diagnosis: Summary of Diabetes Self-Care Activities or Hypertension Self-Care Activity Level Effects. Informed consent was obtained prior to participation. Results Results show significant differences in adherence between T2DM and HTN U =1.0 p = <0.001 and also between groups in EF measures related to medial Orbitofrontal cortex (OFC) U=21.0 p=<0.05. The relationship between adherence and EF in T2DM participants was moderately correlated r(10) = 0.32, p=0.36. Descriptive statistics found in Table 1. Conclusion T2DM participants demonstrate significantly lower adherence levels and deficits in EF compared to the control group as expected. Given only a moderate correlation between adherence and EF was found, further research including a larger sample and more precise adherence measures such as HbA1c is suggested to further understand this relationship.

40 Shift as Mediator Between ADHD Status and Internalizing Symptoms 1384253 Zsofia Imre Southern Illinois University At Carbondale - Shift as Mediator Between ADHD Status and Internalizing Symptoms Development and Pediatric: Attention Deficit (Hyperactivity) Disorder Objective Individuals with ADHD are at a higher risk for internalizing disorders such as anxiety (APA, 2013). Some internalizing symptoms are associated with problems in shift (Ajilchi & Nejati, 2017). Individuals with ADHD also often have poor shift (Martel et al., 2007; Shuai et al., 2011). Hence, this project hypothesized shift to be a statistical mediator in the relationship between ADHD status and internalizing symptoms. Method Participants included 257 children from a pre-existing, grant-funded database (R03HD048752, R15HD065627), which is from a community sample. The mean age of participants is 9.54 years, with this sample being 53.7% male and 87.9% Caucasian. Participants included children with ADHD (n=89), Reading Disorder (RD; n=47), comorbid RD/ADHD (n=47), and controls (n=74). Parents completed several questionnaires on their child, including the Behavior Rating Inventory of Executive Function (BRIEF) and the Behavior Assessment System for Children-Second Edition (BASC-2). The BRIEF Shift and BASC-2 Internalizing Problems subscales were used for this project. Results Mediation analysis was run in PROCESS using ADHD status as the predictor variable, BRIEF Shift as the statistical mediator, and BASC Internalizing Problems as the outcome variable. ADHD status was no longer significant when including Shift in the model (from p = .01 to p = .59). Bootstrap estimation with 5,000 samples indicated a significant indirect effect, as the 95% confidence interval did not contain zero [2.66, 6.61]. Conclusions Problems with shift may be a mediator contributing to the higher risk for internalizing problems in children with ADHD. However, this needs to be verified in a longitudinal study.

41 Everyone is worse than average: Base rates of ADHD impairments among college students. 1384267 Ellen Johnson Ohio University Everyone is worse than average: Base rates of ADHD impairments among college students. Development and Pediatric: Attention Deficit (Hyperactivity) Disorder Objective: Individuals presenting with concerns of Attention Deficit Hyperactivity Disorder (ADHD) report non-specific symptoms and may seek academic or disability accommodations. However, simply having a diagnosis is not equivalent to having a disability that justifies accommodations. The legal definition of disability is poorly understood by clinicians. Guidance for determining the need for accommodations promotes self-report as the primary source of information in decision making and suggests using “most people in the general population” as a reference point when making decisions. Unfortunately, this benchmark is not well defined, and the population base rates of functional impairments commonly reported in ADHD evaluations have not been established. The present study sought to evaluate the base rates of commonly self-reported impairments among non-treatment seeking college students. Method: Undergraduate students (N=282; 72.3% female; 90.1% Caucasian) completed an online inventory of 32 education-related functional impairments commonly reported during ADHD evaluations. Students indicated how frequently they experienced symptoms on a 6-point scale (Never to Very Often). Results: College students reported education impairments at a startlingly high rate. Of the 32 impairments, 22 were endorsed as “often” or higher by over 25% of students, and 30 were endorsed as “sometimes” or higher by over 25% of students. Conclusions: Results suggest that functional impairments reported in ADHD evaluations that may be used in accommodation decision making are very common among college students. Common impairments included difficulty focusing or concentrating, needing to study more than others, and difficulty sitting in class. Results shed light on the need for clearer guidelines for determining accommodations.

42 Incongruence Between Self- and Parent- Report Measures of Executive Function on the Behavior Rating Inventory of Executive Function (BRIEF) in Adolescents with Attention Deficit Hyperactivity Disorder 1384309 Ariana Garagozzo University of Chicago Medicine Incongruence Between Self- and Parent- Report Measures of Executive Function on the Behavior Rating Inventory of Executive Function (BRIEF) in Adolescents with Attention Deficit Hyperactivity Disorder Development and Pediatric: Attention Deficit (Hyperactivity) Disorder Objective: Research has demonstrated that adolescents with ADHD show executive dysfunction, although they do not always endorse such difficulties. We investigated inter-rater agreement between parent- and self-reported executive function (EF) in adolescents with ADHD, using the BRIEF. We also sought to investigate the relationship between scores on parent and self-report EF measures with performance on objective EF measures. Method: Utilizing a clinical database, we identified 75 participants (13-17 years; Mage = 14.9; 60% male; 27% African American, 63% White, 3% Hispanic, 7% Other) with a diagnosis of ADHD. We examined inter-rater reliability between parent and self-reported factors on the BRIEF. We then examined the association between parent and self-report BRIEF Inhibition scores and the D-KEFS Color Word Interference (CWI) Inhibition trial, and parent and self-report BRIEF Shift scores and the D-KEFS CWI Inhibition/Switching trial and Trails Letter Number Sequencing trial. Results: Significant associations were found between parent and self-ratings on BRIEF Inhibition (ICC= .22; 95% CI =-.24-.50), Shift (ICC = .24; 95% CI =-.21-.52), Emotional Control (ICC =.45, 95% CI = .137-.655), Plan/Organize (ICC =-.143; 95% CI =-.81–28), and Working Memory (ICC =-.193; 95% CI =-.89-.25) subscales. Correlation comparisons were significant for BRIEF self-report Inhibition and CWI Inhibition (r(73) = -.405, p =.000) only. Conclusion: Results support standing findings regarding poor interrater reliability between parent and self-ratings of daily executive functioning in adolescents with ADHD. Self-report was seen to correlate with performance on objective EF tasks. Clinically, these results highlight the need for multidimensional assessment of ADHD in adolescents.

44 Are Memory Deficits in RD and ADHD Accounted for by Depressed Mood? 1384330 Jennifer Schlak Southern Illinois University-Carbondale Are Memory Deficits in RD and ADHD Accounted for by Depressed Mood? Development and Pediatric: Attention Deficit (Hyperactivity) Disorder Objective: There is a well-established relationship between depression and memory functioning in adults (Perini et al., 2019) and children (Weir et al., 2012). There is a high rate of comorbidity between ADHD, reading disorders (RD; Wilcutt & Pennington, 2000) and depression (Meinzer et al., 2014) as well. Hence, this study sought to determine whether RD and ADHD are still related to short-term (STM)/working memory (WM) functioning when controlling for depressed mood. Method: Participants included 187 children (55% male, 86% Caucasian), ages 8-12 years, with a diagnosis of ADHD, RD, comorbid RD/ADHD or were controls. They participated in a larger, NIH-funded study (R03HD048752, R15HD065627), representing a community sample. Memory was assessed with the WISC-IV LNS and DSF and the CMS Sequences subtests. Mood was measured with CDI Total score. Results: 2x2 MANOVA/MANCOVA was used, with and without controlling for mood. The MANOVA was significant for ADHD (Wilks’ lambda = .93) and RD (Wilks’ lambda = .66; ps<.01); the interaction showed a trend (Wilks’ lambda = .96; p=.07). For ADHD, significance was driven by LNS and Sequences (ps<.01). In contrast, for RD all three variables were significant (ps<.001). The LNS interaction was significant (p=.02). The CDI was related to DSF and LNS (ps<.01). The MANCOVA findings were similar to the MANOVA’s except the significance was slightly reduced overall. Conclusion(s): Findings suggest depressed mood may affect verbal STM and WM performance in children with ADHD and/or RD. As MANCOVA findings were significant, there likely are other factors that affect memory performance in these diagnostic groups as well.

45 Sluggish Cognitive Tempo in Youth: An Examination of Executive Functioning and Self-Reported Internalizing Symptoms 1384510 Nora Coultis Illinois Institute of Technology Sluggish Cognitive Tempo in Youth: An Examination of Executive Functioning and Self-Reported Internalizing Symptoms Development and Pediatric: Attention Deficit (Hyperactivity) Disorder Objective Sluggish cognitive tempo (SCT) is a group of attention-related symptoms that are characterized by slowed behavior and thinking, excessive daydreaming, mental confusion or fogginess, and drowsiness.4 Studies have shown that SCT is related to higher rates of anxiety, depression, and social isolation.4 Additionally, recent publications have indicated that aspects of executive functioning (EF) may be impacted in children with SCT.2,5 Meta-analysis confirmed that most SCT research has focused on parent and teacher report.1,3,4 There is an increased need for studies examining SCT with self-report.5 This study will examine how SCT is related to EF and self-reported internalizing symptoms in youth with Attention-Deficit/Hyperactivity Disorder (ADHD). Method Participants were youth aged 8 to 18-years with ADHD (N = 130) referred for neuropsychological testing. Participant demographics: males (N = 82, 63.1%). Measures included the Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale (WISC-V/WAIS-IV) Processing Speed Index (PSI), Conners Continuous Performance Test (CPT) Hit Reaction Time (HRT), Delis-Kaplan Executive Function System Color Word Identification (CWI) and Tower subtests, Behavior Assessment Systems for Children (BASC) self-report scales, and Personality Assessment Inventory-Adolescent (PAI-A) scales. Results Bivariate correlations showed that the PSI was significantly correlated with CWI Inhibition (r=0.52, p<.01), CWI Inhibition/Switching (r=0.53, p<.01), Tower (r=-0.20, p<.05), and Social Isolation (r=-0.19, p<.05), with Depression approaching significance (p=.06). The CPT HRT was also significantly correlated with CWI Inhibition (r=-0.19, p<.05) and CWI Inhibition/Switching (r=-0.22, p<.05), with Depression approaching significance (p=.05). Conclusions SCT is associated with EF and self-reported internalizing symptoms and should be included when considering interventions.

46 The Need to Regulate Affect and Behavior Before Prescribing Stimulants 1384369 Kayla Chustz The Neuropsychology Center of Louisiana, LLC The Need to Regulate Affect and Behavior Before Prescribing Stimulants Development and Pediatric: Attention Deficit (Hyperactivity) Disorder Objective: The 3q29 Deletion Syndrome, first described in 2005, is a rare chromosomal disorder which results in a wide array of symptoms. Affected individuals present with complex neuropsychiatric profiles. The associated phenotype for this syndrome may include developmental delay, intellectual disabilities, attentional deficits, behavioral disturbances, and social and emotional issues. These individuals are at a higher risk of developing autism or schizophrenia. This case study describes the neuropsychological profiles of two fraternal twin girls, age 7, only one of whom was diagnosed with 3q29 Deletion Syndrome. Methods: Both girls received comprehensive neuropsychoeducational evaluations to compare and contrast the following dimensions: Neurocognitive, Intellectual, Educational, Attentional, School Behavioral, Affective, and Personality Functioning. Results: Twin 1, positive for 3q29 Deletion Syndrome, exhibits significant affective, behavioral, and cognitive difficulties secondary to her chromosomal disorder, which included learning disabled and oppositional presentations and emotional dyscontrol. Twin 2 exhibited superior intellectual and social functioning. Conclusions: This study contributes to the understanding of the clinical presentation of 3q29 Deletion Syndrome by examining the relationship between fraternal twin sisters. Findings are consistent with earlier reports of the chromosomal disorder’s phenotype, yielding neurocognitive, emotional, and behavioral difficulties. Though the twins have widely different neuropsychological profiles, they have a close relationship. Twin 2, who models excellent prosocial behaviors, will be an asset to Twin 1 in all spheres. Ongoing efforts to improve Twin 1’s neuropsychological, social/emotional, and behavioral functioning will be facilitated via both psychological and psychopharmacological interventions.

47 Examining the relationship between Learning Diagnoses and Social Skills Deficit subscales within the Personality Inventory for Children, Second Edition 1384483 Brizel Trinidad Nova Southeastern University Examining the relationship between Learning Diagnoses and Social Skills Deficit subscales within the Personality Inventory for Children, Second Edition Development and Pediatric: Learning Disability Objective: The present study examined the relationship between the Social Skills Deficit (SSD) subscales obtained on the Personality Inventory for Children, second edition (PIC-2), and diagnoses of three major Learning Disorders (LD) of Math, Reading, and Writing. Method: Participants in the present study consisted of 523 children from a mixed clinical sample who were between the ages of 3 to 17 years (M=9.897, SD=3.130). Participants were referred to a south Florida neuropsychology community assessment center and completed a full neuropsychological battery. Males composed 64% of the sample. Measures included SSD subscales, limited peer status and conflict with peers, within the PIC-2. Results: To evaluate the relationship between scores on SSD subscales from the PIC-2 on three LD diagnoses, a Pearson Correlation with 2-tailed significance was used. Limited peer status was significantly correlated with a LD of Reading (r=-.160, p =.001) and Writing (r=-.160, p=.001). Additionally, conflict with peers was significant correlated with a LD of Reading (r=-.139, p=.001) and Writing (r=-.125, p=.004). There were no SSD subscales that were significantly correlated with a diagnosis of LD of Math. Conclusion: From these results, the SSD subscale had the strongest correlation with diagnosis of a LD of Reading followed by LD of Writing. This study explicates the issue of reduced language-based skills and its impact on social skills. Due to the association between reading and writing and social skills, academic intervention should also include social skills training to increased peer interactions and reduce peer conflict.

48 Semantic, not phonetic, working memory performance predicts variation in reading comprehension in a mixed sample 1384308 Lauren Bandel Southern Illinois University - Carbondale Semantic, not phonetic, working memory performance predicts variation in reading comprehension in a mixed sample Development and Pediatric: Learning Disability Objective: Reading comprehension (RC) is the result of a combination of interrelated abilities including decoding, linguistic processing, and higher-order cognitive functions such as working memory (WM). Problems with RC are associated with deficits in verbal WM, especially on tasks involving semantic processing. Hence, this study’s aim was to determine which is the better predictor of RC when controlling for basic reading ability: semantic or phonetic WM. Semantic WM was hypothesized to be the better predictor. Methods: Participants included 258 children (aged 8-13 years) with ADHD, reading disability (RD), or comorbid ADHD/RD, and typically developing controls (53.6% Male, 87.8% Caucasian). Participants completed a neuropsychological battery as part of a larger, grant-funded study (R03HD048752, R15HD065627), including the WJ-III Letter-Word Identification and Passage Comprehension subtests that were utilized to assess basic reading and RC, respectively. Participants also completed the Rhyming Words and Semantic Association subtests of the Swanson-Cognitive Processing Test, which measure phonetic WM and semantic WM, respectively. Results: Hierarchical linear regression analyses revealed that worse performance on the semantic WM task was associated with poorer RC (Beta=0.15; p<0.001) above and beyond basic reading (R2 change=0.02, p<.001). Phonetic WM was not related to RC when decoding was controlled despite the zero-order correlation being significant (p<.001), showing much of phonetic WM’s relationship to RC may be due to basic reading requiring this skill. Conclusion: Findings suggest differences in RC may be related to semantic WM functioning in children with and without RD, but not phonetic WM, when basic reading is controlled. Replication with a longitudinal design is warranted.

49 Cognitive correlates of childhood lead poisoning in a high achieving child 1384278 Jeremy Hertza Neurobehavioural Associates - Cognitive correlates of childhood lead poisoning in a high achieving child Developmental and Pediatric: Other Objective:Individuals exposed to lead often have persistent medical issues, changes in personality, and cognitive decline, with worsening symptoms following chronic exposure. Lead poisoning in children can have lasting effects as they age. This case study examines the correlation between cognitive ability and brain damage, with demyelination, following lead exposure in an academically well performing eight-year-old. Lead poisoning was verified by medical records and neuroimaging showing demyelination is included. Method:The individual was an eight-year-old male who was exposed to lead multiple times in a home environment over the course of one year starting as a two-year-old. Cognitive ability, academic achievement, and emotional development were assessed with clinical interview of the child and his mother and comprehensive test battery including cognitive and emotional measures. Testing also included appropriate imbedded and free-standing validity measures. Results:Cognitive testing showed relative weakness in certain measures of verbal and visuospatial processing speed as well as indications of deficit in sustained attention. These deficits did not reach objective impairment but suggest weakness in these areas in the context of superior overall cognitive ability and academic achievement. Observation showed hyperactivity and anxious behaviors, the individual’s mother reported elevated anxiety and unusually high somatic complaints. Conclusion:This pattern of scores corresponded to what is typically seen in patients with lead poisoning, suggesting an impact of lead poisoning on the individual’s neural development, potentially causing both cognitive and psychiatric deficits. This case is unique because, despite his lead poisoning, the patient performs well academically, suggesting that the brain can compensate for this impairment given the correct environment.

50 Association between Executive Functioning Performance and Resting State Connectivity in Pediatric Survivors of Acute Lymphoblastic Leukemia 1384401 Victoria Seghatol-Eslami University of Alabama at Birmingham Association between Executive Functioning Performance and Resting State Connectivity in Pediatric Survivors of Acute Lymphoblastic Leukemia Developmental and Pediatric: Other Objective: To explore differences between executive functioning (EF) and resting-state functional connectivity (rs-FC) of the executive control network (ECN) in survivors of acute lymphoblastic leukemia (ALL) compared to healthy controls. Method: ALL participants (age 9-18) from Children’s of Alabama Hospital were ≥5 years post-diagnosis treated with chemotherapy only. Eleven ALL survivors and twelve controls were administered the Delis-Kaplan Executive Function Scale (D-KEFS) and Behavior Rating Inventory of Executive Function (BRIEF-2) self- and parent report. Using seed-to-voxel rs-FC analyses, we examined ECN regions (e.g., medial and dorsolateral prefrontal cortex [MPFC; dlPFC]). Within group multiple regression analyses were conducted to correlate EF scores to rs-FC z-scores. Results: No significant differences were found on EF scores between ALL and control groups. rs-FC analyses indicated ECN hyperconnectivity in ALL survivors compared to controls (p < .05, FDR corrected). In ALL survivors, significant positive correlation was found between the average of Inhibit and Shift scores on the BRIEF-2 self-report and the MPFC (r = .926, p = .024), and negative correlation between D-KEFS Verbal Fluency and left dlPFC (r = -.869, p = .012). In controls, significant negative correlation was found between D-KEFS Design Fluency and left dlPFC (r = -.671, p = .012). Conclusions: ALL survivors show hyperconnectivity of the ECN that is also correlated with both subjective and objective measures of EF. However, EF task performance was not significantly different between the two groups. This may indicate increased utilization of network regions to overcome network disruption specific to the ALL group in order to perform similarly to peers.

51 Identifying Autism in Children With a History of Extreme Prematurity: A Case Series 1384500 Briana Brukilacchio Department of Educational Psychology, The University of Texas at Austin Identifying Autism in Children With a History of Extreme Prematurity: A Case Series Developmental and Pediatric: Other Objective: Children with a history of prematurity are at increased risk for neurodevelopmental disorders, including autism. This case series describes four patients with comparable prenatal and divergent neonatal histories who were referred for comprehensive autism evaluations between 21-36 months of age by a NICU follow-up program. Method: Patients were born at approximately 25 weeks gestation (i.e. extremely premature) following otherwise uncomplicated pregnancies and weighed less than 1000 grams at birth (i.e. extremely low birth weight). Patients A and B experienced significant neonatal complications (e.g. hemorrhage, respiratory failure). Children were later evaluated for autism by an interprofessional team affiliated with a children's hospital. Results: Patient A had average intellectual, motor, and language abilities with mild symptoms of autism on a standardized rating scale. Patient B had impaired intellectual, motor, and language abilities with severe symptoms of autism on the same rating scale. Patient C had average intellectual abilities, borderline language and motor abilities, and did not display autism features. Patient D had borderline intellectual abilities, low average receptive and expressive language, and also did not display autism features. Conclusions: All patients presented with developmental delays in at least one domain. Those who experienced complications in the NICU met DSM-5 criteria for Autism Spectrum Disorder. However, patients with similar prenatal histories who did not face additional complications in the NICU presented with comparatively intact social communication and behavior. This case series suggests the relative importance of peri- and neonatal factors in the etiology of autism in children with a history of extreme prematurity.

53 Importance of Neuropsychological Assessment in a Patient with DiGeorge Syndrome 1384452 Alinda Lord Adler University Importance of Neuropsychological Assessment in a Patient with DiGeorge Syndrome Developmental and Pediatric: Other Objective: 22q11.2 Deletion Syndrome, (DiGeorge Syndrome), is a genetic disorder which commonly causes heart defects, a submucosal cleft palate, and other health conditions, in addition to developmental delays. Individuals with DiGeorge Syndrome are more likely to have Attention-Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), with research also supporting a high risk for developing schizophrenia in adulthood. Method: In this case study, a 22-year-old woman presented with DiGeorge Syndrome and trunkus arteriosus at the Department of Human Services (DHS) for employment services. Additionally, the patient’s parents reported concerns about behavioral outbursts and emotional regulation difficulties for the last three years. The patient completed a full neuropsychological, cognitive, and emotional assessment battery to help understand any neurocognitive and psychological limitations in obtaining and maintaining employment. Results: On neurocognitive testing, she performed in the Severely Impaired range on measures of attention, processing speed, working memory, verbal memory, visual memory, visuospatial ability, motor functioning, and nonverbal problem solving. While performing in the Moderately Impaired range for tactile memory, verbal fluency, and cognitive flexibility. However, the patient exhibited a personal strength on the Verbal Comprehension Index of the Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV). On emotional functioning testing, she did not display early signs of schizophrenia nor psychosis. However, the patient did express emotional and behavioral signs of ADHD and ASD. Conclusion: This case study emphasizes the need for neuropsychological testing and ongoing psychological monitoring for individuals with DiGeorge Syndrome, as it relates to treatment recommendations and planning.

57 Deficits in Inhibitory Control Are Associated with Social and Emotional Difficulties Among Children with Congenital Heart Defects 1384450 Daryaneh Badaly Child Mind Institute Deficits in Inhibitory Control Are Associated with Social and Emotional Difficulties Among Children with Congenital Heart Defects Developmental and Pediatric: Other Objective: Research has suggested that children with congenital heart defects (CHD) may experience socioemotional maladjustment because of their often-seen executive dysfunction. However, preliminary work has largely used behavioral ratings of executive functioning. Our study used cognitive assessments of inhibitory control, an executive function key for emotional regulation and social initiative. Method: We prospectively recruited 46 6-to-16 year olds with CHD (M=11.65 years, SD=3.11; 74% male) and 95 healthy controls (M=12.09 years, SD=2.87; 54% male). Children completed face-to-face and computerized tests of inhibitory control (D-KEFS Color-Word Interference Test; NIH Toolbox Flanker Inhibitory Control and Attention Test). Children and their parents also filled out scales assessing emotional and social functioning (Pediatric Quality of Life Inventory [PedsQL]; Harter Self Perception Profile [SPP]). Results: Using regression, controlled for age, children with CHD had greater parent-rated emotional distress than healthy peers (p<.001). Poorer inhibition was associated with greater distress for children with CHD but not (or less so) healthy peers (p<.05). Children across groups rated their emotional functioning similarly; a face-to-face test of inhibition (but not a computerized test) was related with greater emotional health for both groups (p<.05). Children with CHD had poorer parent-rated social functioning than healthy peers on the PedsQL (p<.005) but not the SPP; there were no significant differences for self-reports. Inhibition was associated with social skills only in select models (p<.05). Conclusions: Similar to past research, families reported more maladjustment than children. Regardless, poor inhibition emerged as one potential contributor to socioemotional maladjustment among children with CHD. Interventions targeting executive dysfunction may support socioemotional development.

58 Test-retest reliability of the Grooved Pegboard Test in a pediatric medical population 1384441 Claire David Alberta Children's Hospital, Alberta Health Services Test-retest reliability of the Grooved Pegboard Test in a pediatric medical population Developmental and Pediatric: Other Objective The Grooved Pegboard Test (GPT) is among the most commonly used fine motor tasks, though there is limited data on its basic psychometric properties in children and adolescents with medical conditions. The purpose of this study was to establish test reliability for the GPT within this group. Method Participants (N=44; 22 males, 22 females) were children and adolescents clinically referred for neuropsychological evaluation. Diagnoses included epilepsy (n=24), cardiac conditions (n=13), other (n=5). Each completed the GPT twice: once in the morning and once in the afternoon, ranging from 64-390 minutes apart (x̄=263 min., SD=60 min.). Spearman correlations assessed test-retest reliability for speed of completion for both dominant (DH) and non-dominant hands (NDH) trials and number of peg drops. Paired sample t-test assessed for practice effects between administrations. Results Ages ranged between 6.11 to 18.10 years (x̄=12.52 yrs., SD=3.19 yrs.). GPT raw scores for first presentation ranged from 25-296 seconds (DH x̄=80.91, SD=25.1; NDH x̄=95.34, SD=49.42). The GPT showed high test-retest reliability for DH (ρ=0.80, p<0.001) and NDH (ρ=0.83, p<0.001). Number of drops showed non-significant correlations across trials (DH ρ=-0.03, p=0.87; NDH ρ=0.11, p=0.49). Practice effects were identified for the DH (t=-3.25, p=0.002) but not NDH (t=-1.83, p=0.074). Conclusion Strong test-retest reliability of the GPT speed of completion in this population supports stability of test results over time, though practice effects are seen at short intervals. Number of pegs dropped, however, lacks sufficient retest reliability and may be of lesser clinical utility. Overall, this study provides increased confidence for continued use of the GPT.

59 Gender-Related Behavioral Differences in Children with Partial or Complete Agenesis of the Corpus Callosum: Exploring Attention, Rule Breaking, and Aggressive Behaviors 1384291 Natalia Rich-Wimmer George Fox University Gender-Related Behavioral Differences in Children with Partial or Complete Agenesis of the Corpus Callosum: Exploring Attention, Rule Breaking, and Aggressive Behaviors Developmental and Pediatric: Other Objective: Gender-related connectivity differences result from variability in structure of the corpus callosum in children 8 years and up (Ingalhalikar et al., 2014). However, children with complete or partial agenesis of the corpus callosum (ACC) exhibit structural differences that disrupt the connectivity of cerebral hemispheres, causing behavioral challenges (Young et al., 2019). We explored the relationship of behavioral differences across genders, partial and complete ACC diagnoses, and age. Method: Initial data included the completed Child Behavior Checklist (CBCL) provided by care-providers (ages 2 to 17) diagnosed with ACC. Follow-up data was obtained four-years later from the original sample (n = 29), which included 20 males (12 complete, 8 partial) and 9 females (5 complete, 4 partial). Results: A repeated measures MANOVA was conducted with attention problems, rule-breaking, and aggressive behavior for gender, age, and diagnosis (i.e., partial or complete ACC). A significant interaction diagnosis by gender interaction over time was found for each dependent variable. Conclusion: Results indicate females with partial ACC exhibit worsening attention problems with age, while males with partial ACC decrease over time. Complex social interactions among females pose greater challenges due to difficulties integrating information between cerebral hemispheres. Additionally, females are at higher risk of developing internalizing problems (Eaton et al., 2012) when navigating social interactions. Nevertheless, females with partial ACC exhibited significant reductions in aggressive behaviors over time. This perhaps resulted from lower social tolerance of aggressiveness in females, as well as expectations of compliance and obedience. Consequently, mood-related difficulties decrease executive functioning skills, specifically attention and concentration (APA, 2013).

60 A Developmental Analysis of Auditory Processing and Symptom Severity in Children with Autism Spectrum Disorder 1384353 Mairin Cotter Albert Einstein College of Medicine A Developmental Analysis of Auditory Processing and Symptom Severity in Children with Autism Spectrum Disorder Developmental and Pediatric: Other Objective: Children with Autism Spectrum Disorder (ASD) exhibit abnormal responses to sensory events that interfere with the development of social communication. Previous studies have demonstrated that abnormal auditory processing contributes to this response; however, it remains unclear how this deficit is related to ASD severity throughout development. This cross-sectional study examines the relationship between auditory processing and symptom severity in a developmental sample of children, hypothesizing that auditory sensory event related potentials (ERP) will be associated with ASD severity as measured by the Autism Diagnostic Observation Schedule (ADOS), and that there will be interaction between age and severity. Method: This study included children (ages 6-18) with ASD (n=116, female=21) as diagnosed by the ADOS and typically developing children (n=142, female =76). Exclusion criteria includes Performance IQ below 85, abnormal hearing or vision, and presence of a neurological disorder. Participants performed an audiovisual reaction task in which they pressed a button on a response pad when seeing or hearing the instructed stimuli while recording electroencephalography (EEG). Results: Electrophysiological indices of auditory processing were identified based on peak amplitudes of averaged N1 responses, an early auditory ERP. A positive correlation was found between severity scores and N1 peak amplitudes (N1a (r(85)=.56, p<.001) and N1b (r(85)=.44, p <.001)). Approximately 72% (R2=.716) of symptom severity variance can be accounted for by linear combination of ERPs. A linear model demonstrated a significant age by severity interaction with N1b, B=-2.7, F(2,84)=20.6, p<.001. Conclusions: Abnormal early auditory processing is associated with symptom severity, and this effect is more pronounced throughout earlier ages.

61 Early childhood prefrontal cortex stroke and changes in connections to other regions 1384280 Jeremy Hertza Neurobehavioural Associates - Early childhood prefrontal cortex stroke and changes in connections to other regions Developmental and Pediatric: Other Objective: Sickle-cell anemia is a leading congenital cause of stroke in childhood. Such strokes can lead to cognitive deficits, stroke in the prefrontal cortex leading to inattention, impulsivity, and poor executive control. This case study examines a 23-year-old African American male who suffered from a stroke in his prefrontal cortex at age 3. Neuroimaging confirmed stroke location, but the patient had an atypical pattern of reported cognitive deficits. Method: The patient was assessed in an out-patient practice. The individual was assessed with a clinical interview and comprehensive Neuropsychological Battery. The battery included cognitive and psychological measures with free-standing and imbedded validity measures. Results: Cognitive testing demonstrated significant impairment in visuospatial processing speed, visual abilities, and decision making and executive control. This pattern of impairment suggests that the patient is still suffering from his stroke, which likely damaged the connective tissue of the occipital and parietal lobes, and the prefrontal cortex. The patient was diagnosed with Mild Neurocognitive Disorder in perceptual-motor and executive functioning. Conclusions: These results suggest that despite the neuroplastic abilities of the brain at early ages, the neurodevelopment of individuals who suffer from stroke in early childhood is likely to be altered and contributes to cognitive impairments in early adulthood. Long-term cognitive sequelae in the form of deficits in visual perceptual skills, suggest that frontal connections to other regions in the brain may be impacted. Therefore, this case highlights that even a localized stroke in a child can lead to broader deficits if that area of the brain interacts with other areas.

62 Cognitive profiles in athletes with neurodevelopmental disorders on baseline testing 1384271 Julia Maietta University of Nevada, Las Vegas Cognitive profiles in athletes with neurodevelopmental disorders on baseline testing Developmental and Pediatric: Other Objective: The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a commonly utilized sport concussion assessment. Previous literature examined differences in concussion rates, symptom scores, and invalid baselines between healthy athletes and athletes with neurodevelopmental disorders. There are no current studies that investigate cognitive profiles of athletes with autism. The present study explores possible differences in ImPACT performance for these athletes. Method: Participants included 31,368 high school athletes (mean age=15.0, SD=1.2; mean education=9.0; SD=1.4; 43.9% female) selected from a larger database who completed baseline ImPACT testing from 2008-2016. Self-reported neurodevelopmental history consisted of these distinct groups: attention-deficit/hyperactivity disorder (ADHD; 3.6%), learning disorders (LD; 1.3%), Autism (0.3%), ADHD/LD (0.6%). ImPACT Composite Scores were analyzed using Mixed-model ANCOVA (age and gender covariates)-Verbal Memory (VerbM), Visual Memory (VisM), Visual Motor Speed (VisMot), Reaction Time (RT), and Impulse Control (IC). Composites were standardized and RT was reverse coded. For comparison purposes, individuals from all neurodevelopmental groups were utilized. Results: There was a main effect for Composites and neurodevelopmental history (p<.01). An interaction effect between Composites and neurodevelopmental history was found (p<.01). The Autism group scored significantly lower than healthy athletes on VerbM, VisM, VisMot, and RT. No difference was found for IC. Pattern differences between neurodevelopmental groups will also be reported. Discussion: Results reveal cognitive profile differences for athletes with Autism and other neurodevelopmental disorders. The ImPACT provides normative data for LD and ADHD athletes; however, our results indicate similar pattern differences for Autism and ADHD/LD. Future research should investigate whether separate norms may be beneficial for these groups.

63 Viewer engagement modulates activation of social brain systems: Evidence from a natural viewing fMRI paradigm 1384304 Jordan Pincus Emory University, School of Medicine, Department of Pediatrics, Marcus Autism Center Viewer engagement modulates activation of social brain systems: Evidence from a natural viewing fMRI paradigm Developmental and Pediatric: Other Objective: Engagement is critical for social learning – information that does not engage cognition, even when looked at, will go unprocessed and unlearned. Consequently, atypical engagement can contribute to social disability. Despite its importance, the neural mechanisms underlying engagement remain unknown, largely because no studies have successfully quantified the individualized ways that viewers engage with the world. This study uses patterns of eye-blinking—a novel measure of engagement (Shultz, Klin, Jones, 2011)—to examine how a viewer’s own engagement with social stimuli (e.g. faces) modulates activation of social brain systems. Method: Simultaneous functional MRI and eye-tracking data were collected while children (n=12, ages 8-12) watched naturalistic social videos of children interacting. Eye-fixation and blink patterns were used to identify moments when viewers looked at a face and were ‘highly engaged’ or ‘less engaged’ with those faces. Whole-brain analyses compared brain activation in response to each condition of interest (‘highly engaging faces’, ‘less engaging faces’). Results: Whole-brain analyses (z=2.3, cluster corrected at p

64 Executive Functioning in an Acute Pediatric Neurocritical Care Population Recently Discharged from the PICU: Exploring the Associations among Parent Report and Individual Performance Measures 1384362 Emily Holding Oregon Health and Science University Executive Functioning in an Acute Pediatric Neurocritical Care Population Recently Discharged from the PICU: Exploring the Associations among Parent Report and Individual Performance Measures Developmental and Pediatric: Other Objective: An emerging literature has identified that PICU survivors face a host of long-term physical, cognitive, emotional, and psychosocial difficulties that stem from the underlying concern and side effects of critical care intervention. Research shows that executive functioning (EF) is particularly vulnerable to sequelae. This study sought to understand associations between parent-report of daily life EF and performance-based measures following neurocritical care. Method: Twenty-three children ages 8-16 (M=12.66 years; 39% male) were screened as part of an integrated (neuropsychology and pediatric critical care) acute phase (3-6-week post-discharge) follow-up clinic. Injuries included children with traumatic brain injury (n=19), or acquired brain injury (i.e., anoxic brain injury, AVM, acute cerebellitis, hemorrhagic stroke; n=4). EF outcomes were assessed using the Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2), Delis-Kaplan Executive Function System (D-KEFS) Trail Making Test and Verbal Fluency Test, Children’s Memory Scale Digits Backwards, and Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) Coding and Symbol Search subtests. Bivariate correlations were used to examine associations among parent-report of EF and performance-based measures of EF in our neurocritical care population. Results: Analyses demonstrated significant (=.05) correlations between the WISC-V Coding subtest and the BRIEF-2 Shift scale (r=-.44) and Global Executive Composite (GEC; r=-.59). Correlations between D-KEFS Category Fluency and BRIEF-2 Initiate (r=-.51), Working Memory (r=-.44), and GEC (r=-.55) were significant. Inverse correlations demonstrate agreement. Conclusion: In the acute recovery phase following neurocritical care, parent-report and specific performance-based measures are only moderately associated, demonstrating the importance of multi-method assessment to detect potential acquired deficits to inform rehabilitation.

66 Recovery in Elementary-Age Children at Three Months Post-Concussion 1384423 Tahnae Tarkenton UT Southwestern Medical Center Recovery in Elementary-Age Children at Three Months Post-Concussion Developmental and Pediatric: Other Objective: Inclusion of broad age ranges in most pediatric concussion studies limits understanding of recovery in elementary-age children. This study’s aim was to investigate the most commonly reported symptoms at 3-months post-concussion in children age 6-10 and determine if factors from initial clinic visit predict prolonged recovery. Methods: Participants (n=73) age 6-10 who reported to clinic within 30 days of concussion (M=10.4, SD=7.8 days) were selected from the North Texas Concussion Registry (ConTex). Chi-square and independent t-test were used to examine symptoms at 3 months. Participants were then divided into early (14 days post-injury, n= 29) and late (1 month post-injury, n=35) recovery groups based on days to symptom resolution. Logistic regression was used to identify significant predictors for prolonged recovery. Variables considered for the final model included sex, ethnicity, presence of LD/ADHD, mechanism of injury, and initial post-concussive symptoms. Results: For the late recovery group, total symptom score at 3 months was 8.3/132 (SD=14.8, Range=0-61). The most common symptoms were heightened emotionality (34.3%), headache (31%), and noise sensitivity (31%). The final logistic regression model (2=15.7(3), p=.003) included mechanism of injury and initial emotional symptoms as significant predictors for prolonged recovery. For every 1-point (out of 5) increase in emotional symptoms, participants were 1.4x more likely to be in the late recovery group. Concussions sustained by hit or fall were 6x more common in the late recovery group (p=.006). Conclusions: Similar to adolescents, emotional symptoms play a role in predicting delayed recovery in elementary-age children. Mechanism of concussion may also impact recovery.

67 Behavior and Blood biomarker differences for children with Fragile X Syndrome and Idiopathic Autism 1384268 Deborah Sokol Indiana University School of Medicine Behavior and Blood biomarker differences for children with Fragile X Syndrome and Idiopathic Autism Developmental and Pediatric: Other Objective:A clearer understanding of behavioral and blood biomarker differences in individuals with Fragile X Syndrome (FXS) and idiopathic autism is necessary as advancement in gene therapies and medication targeted to the FXS single gene abnormality are being trialed in autism. Our primary objective is to determine Autism Diagnostic Interview-Revised (ADIR) item/domain differences in children with FXS and autism, controlling for age, IQ, and autism severity. Our secondary objective is to demonstrate blood protein biomarker group differences. Method:Participants were drawn from a larger study examining amyloid precursor protein (APP) metabolite levels in children with FXS (n=18) and autism (n= 21) from Indiana University Riley Hospital Clinics. Complete data were available for children with full FXS mutations (n=9, and autism (n=9, one girl), matched for age, MSEL IQ, and CARS severity scores. ADI-R was administered to mothers by staff trained to research reliability. Western blot for APP and fragile X mental retardation protein (FMRP) were performed on peripheral blood mononuclear cells. Results:No significant group differences are seen via Mann-Whitney U after Bonferroni multiple comparison, likely due to low power. However, two trends in our data corroborate recent reports: social smiling (item 51) is more intact for FXS [U(18)=20.5,Z=-1.76,p=0.085, 95%CI=-0.15-1.93,r=0.41] and Restricted Behavior Scale [U(18)=21,Z=-1.72,p=0.09,95%CI=-0.57-2.79 ,r=0.40] was more pronounced in autism. Western blot showed variations in APP and FMRP between FXS, autism and controls (Figure 1). Conclusions: Trends in behavioral ADI-R scores and blood biomarker APP differences exist between FXS and idiopathic autism. Further study of these preliminary results should inform appropriate treatment endpoints for autism and FXS.

68 Case Study: Neurodevelopment of Late Identification and Treatment of Nonsyndromic Multisutural Craniosynostosis 1384264 Veronica Chang NeuroBehavioral Associates Case Study: Neurodevelopment of Late Identification and Treatment of Nonsyndromic Multisutural Craniosynostosis Developmental and Pediatric: Other Objective: Craniosynostosis, the premature closure of cranial sutures, is frequently associated with intracranial hypertension, neurocognitive deficits, and neuromotor deficits. Younger age at treatment is associated with improved outcomes. This case study will expand upon the existing literature by characterizing the neurodevelopment of an individual whose nonsyndromic multisutural craniosynostosis was identified and treated late, when the patient was nearly three years old. Method: A 7-year, 1-month old male with a history of bicoronal and sagittal craniosynostosis was seen for neuropsychological assessment. Diagnosis and cranial vault reconstruction occurred just before his third birthday. Evidence of increased intracranial pressure was found on presurgical CT scan, and by the appearance of his dura at surgery. His development after reconstruction was notable for articulation disorder, expressive language disorder, executive dysfunction, and adaptive skills deficits. Results: Assessment revealed average non-verbal cognitive skills and low average verbal cognitive skills. Receptive language was below average. Exceptionally low scores were found on tasks of oromotor sequencing, verbal list learning, and immediate visual memory. Teacher ratings of executive functioning suggest below average skills. Measures of attention and impulsivity suggest mild weaknesses. Academically, he earned below average and exceptionally low scores on measures of reading and writing, with low average to average mathematics scores. Conclusions: The neurodevelopment of children with late diagnosis/treatment of craniosynostosis is not well characterized and may confer increased risks. Late diagnosis is presumed to lead to more significant neurocognitive impairments due to the impact of prolonged intracranial pressure. Neuropsychological assessment and follow-up is critical for monitoring and intervention planning.

69 Comparing Driving Errors in Young Adults with and without Autism Spectrum Disorder 1384433 Maya Showell Drexel University Comparing Driving Errors in Young Adults with and without Autism Spectrum Disorder Developmental and Pediatric: Other Objective: Research has found differences in driving behaviors of individuals with and without autism spectrum disorder (ASD), though it is unclear whether differences translate to poorer driving. This study assessed whether ASD diagnosis, executive functioning, and regulation of driving speed and lane positioning predict errors during a simulated drive. Method: Participants included 88 16-26 year-olds (45 ASD; 73 Male) who completed assessments of executive functioning and a simulated drive. The drive included a rural route without distractions, the same route with secondary tasks, a highway drive, and a residential drive. For the residential drive, coders documented drivers’ errors including driving onto a curb, crossing the center lane, turning from the wrong lane, running a red light or stop sign, illegally changing lanes, and hitting a person or car. A hierarchical regression included stepwise insertion of ASD diagnosis, neurocognitive performance, and speed and lane deviation as predictor variables and the square root of driving errors as the outcome variable. Results: Drivers with ASD committed significantly more errors than non-ASD drivers, p=.03, R2=.06. Neurocognitive performance added significant predictive value, p=.001, R2Adj=.15. Speed and lane regulation also added significant predictive value, p<.001, R2Adj=.39. The full model accounted for 46% of the variance in driving errors. Conclusions: Novice drivers with ASD may be more likely than their peers to make overt, potentially dangerous, errors while driving. Assessment of executive function and less dangerous driving behaviors such as regulation of speed and lane positioning may help to identify individuals at highest risk for committing driving errors and inform driving interventions.

70 Parental Perception of the Utility of Pediatric Neuropsychological Evaluation: A Systematic Review 1384420 Tara DeLuco NYU Langone Child Study Center Parental Perception of the Utility of Pediatric Neuropsychological Evaluation: A Systematic Review Developmental and Pediatric: Other Objective: Pediatric neuropsychological evaluations are intended to support children in their development and ability to function successfully in their everyday settings; however, limited efforts have been made to synthesize the available literature regarding the utility of these evaluations. To improve the impact of pediatric neuropsychological evaluations, a systematic review was conducted to identify components of the assessment and feedback process that are associated with parents’ perception of helpfulness (help parent understand child), usefulness (provide actionable information/elicit change) and overall parent satisfaction. Data Selection: We followed PRISMA guidelines to conduct a systematic review of the literature to identify research on parental perception of the utility of pediatric neuropsychological evaluations for children aged 3 – 21 years. We searched PubMed, PsychINFO, Cochrane Library, and Web of Science databases using the terms “neuropsychology,” “pediatric,” “neuropsychological evaluation,” “neurodevelopmental disorders,” “perceived utility,” and “parental utility.” Data Synthesis: We identified 1,029 abstracts and after full review included 9 articles in our qualitative synthesis. Conclusions: Parents generally reported high levels of satisfaction with their child’s evaluation. The research has also suggested that parents find evaluations and feedback helpful for understanding their child’s pattern of strengths and weaknesses. Recommendations from the neuropsychologists provided useful information for obtaining support and eliciting change. Limitations of the studies reviewed included small sample size, variability in methods, and reduced generalizability of results.

71 Latent Classes of Cognitively Normal Individuals have Unique Relationships between Demographic and Neuropsychological Variables 1384399 William Goette University of Texas Southwestern Medical Center Latent Classes of Cognitively Normal Individuals have Unique Relationships between Demographic and Neuropsychological Variables Diversity Objective: Determine whether clinically normal (CN) individuals represent a single homogeneous group prior to normative adjustment. Method: Data from 1,055 CN participants (Mage=68.0, SD=8.68; Meducation=14.9, SD=2.90; white=92.7%) from the Texas Alzheimer’s Research and Care Consortium were used. Participants had no recorded neurological, cognitive, or psychiatric diagnoses. Raw scores from the AMNART, Animal Fluency, Boston Naming Test (BNT), CERAD verbal learning test, CLOX1 and CLOX2, MMSE, and Trail Making Test (TMTA and B) were examined with finite mixtures of general linear regression models using age, education, race, and gender as predictors. Each test was modeled with up to 10 latent classes with the Bayesian Information Criterion used to select best fit. Results: Animal Fluency, CLOX2, and TMT A errors were best fit by 1 underlying group. The remaining tests required 2 (CERAD, CLOX1, MMSE, and TMT-B errors), 3 (BNT and TMT-A), and 5 (AMNART and TMT-B) latent classes. Generally, latent classes for tests differed in coefficients for race, gender, and intercepts, though results differed from test-to-test (Supporting Figure). Conclusions: Latent classes of CN individuals were identified for which the predictive power of certain demographic variables differed depending on the latent class. Further research is needed to identify who may belong to distinct latent classes so the appropriate regression-based norms are used. Different latent class coefficients for race and gender suggest heterogeneity within these variables that can be addressed to produce more accurate models. Findings suggest that regression-based norms could be improved by identifying latent classes and finding ways of predicting who belongs to which latent class.

72 Neuropsychological Case Study of Behavioral Variant Frontotemporal Neurocognitive Disorder in a Vietnamese Woman in a Community Health Setting 1384366 Jillian Naylor The Wright Institute, Integrated Health Psychology Training Program Neuropsychological Case Study of Behavioral Variant Frontotemporal Neurocognitive Disorder in a Vietnamese Woman in a Community Health Setting Diversity Objective Behavioral variant frontal temporal dementia (bvFTD) is characterized by progressive changes in behavior, personality, and cognition. Little is published on the presentation in non-English-speaking populations. Here is the case of a neuropsychological evaluation in a community health setting where language and cultural considerations were salient. Method A 73-year-old, right-handed, monolingual Vietnamese widowed female homemaker with five years of education and low literacy, was referred after gradual personality changes over five years caused family tension and a need for increased monitoring. History includes cardiovascular disease, hypertension, hypercholesterolemia, cholestatic hepatitis, and depression with remitting psychotic features and suicidal ideation. Neuroimaging shows right temporal encephalomalacia and mild diffuse atrophy commensurate with age. Results A bilingual phone interpreter was used. Test findings revealed low scores across all but two tasks (visuospatial processing speed, recognition memory). Several confrontation naming items were unknown to the patient or culturally irrelevant, per interpreter. Interview with an English-speaking daughter revealed declines in behavior and social comportment (e.g., unsympathetic, demanding, rigid, repetitive, disorganized, compulsive shopping and gaming, confabulatory) and modest declines in activities of daily living. Presentation was notably childlike, overly affectionate, “grabby”, insistent, restless, with poor conversational turn-taking (with interpreter), but generally intact expressive and receptive language. BvFTD was diagnosed. Conclusions Addressing needs of a diverse, multi-cultural population in a community health setting can present significant challenges. This case study highlights the importance of non-psychometric sources of data, including history, observation, and collateral interviews, along with consideration of education, language, and culture on the evaluation process and case conceptualization.

73 Intra-Individual Variability in Stroke and Mixed Neurologic Conditions 1384285 Jeremy Davis University of Utah Intra-Individual Variability in Stroke and Mixed Neurologic Conditions Neurological and Neuropsychiatric Disorders: Cerebrovascular Disease Objective: Intra-individual variability (IIV) has shown utility in characterizing cognitive dysfunction in conditions including traumatic brain injury and dementia, but has been less studied in stroke. This study examined IIV in physical medicine and rehabilitation patients with stroke and mixed neurologic conditions. Method: Participants (N = 95) were 40% female and 83% white with average age and education of 46 (SD = 13) and 14 (SD = 2) years, respectively. Participants completed an outpatient evaluation using a flexible battery of up to 33 common neuropsychological measures. Participants were grouped by diagnosis: stroke and other cerebrovascular events (e.g., aneurysm; 58%), and mixed neurologic conditions (e.g., anoxia, dementia; 42%). Adequate performance validity was determined on the basis of embedded and freestanding validity measures. Test battery scores were converted to T scores. Cases with four or more scores below 36 T were identified as impaired. Measures of IIV were calculated including overall test battery mean (OTBM), test battery standard deviation (SD), kurtosis, skew, range, and unbiased coefficient of variation (UCV). Groups were compared on IIV measures and impairment. Results: Diagnostic groups were not significantly different on IIV measures. Impairment rates were not different in stroke (78%) and mixed (68%) groups. Unimpaired cases showed significantly higher OTBM, and significantly lower SD, range, and UCV (all p’s < .01); kurtosis and skew were not significantly different. Conclusions: IIV markers of cognitive dysfunction in stroke are similar to those observed in dementia and other neurologic conditions. Further study of the clinical application of IIV measures is needed.

74 Evidence of cognitive decline in a patient with CADASIL without major stroke event 1384281 Jeremy Hertza Neurobehavioural Associates - Evidence of cognitive decline in a patient with CADASIL without major stroke event Neurological and Neuropsychiatric Disorders: Cerebrovascular Disease Objective: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a genetic disease that impacts small arteries in the brain and can result in ischemic strokes, seizures, and cognitive decline. This case study of a 61-year-old male illustrates the cognitive profile of an individual with CADASIL who has not suffered a major stroke event. Neuroimaging shows subcortical compromise in a diffuse manner. Methods: The patient was assessed in an out-patient institutional practice. The individual was assessed with a clinical interview and comprehensive Neuropsychological Battery. The battery included cognitive and psychological measures with free-standing and imbedded validity measures. Results: Cognitive testing demonstrated significant impairment in visuo-motor processing speed, executive planning, cognitive flexibility, verbal fluency, decision making, and visual memory, and suggests that the patients abilities show deterioration of subcortical regions, and is consistent with his CADASIL diagnosis. The patient was diagnosed with Mild Neurocognitive Disorder, due to medical condition. Conclusion: Individuals with CADASIL often suffer from ischemic strokes and cognitive impairment. This study suggests that despite no major stroke event, individuals with CADASIL may still exhibit cognitive decline especially in subcortical regions. This case supports the theory that progressive cognitive decline in CADASIL patients does not begin as a result of a major stroke and can continue as a distinct cause of vascular neurocognitive disorder.

75 A Case Study of Anterograde Memory Impairment Following Forniceal Infarct– Neurocognitive Sequelae and Recovery 1384402 Cyrielle Andrew Child and Family Psychological Services A Case Study of Anterograde Memory Impairment Following Forniceal Infarct– Neurocognitive Sequelae and Recovery Neurological and Neuropsychiatric Disorders: Cerebrovascular Disease A Case Study of Anterograde Memory Impairment Following Forniceal Infarct– Neurocognitive Sequelae and Recovery Cyrielle Andrew, Psy.D., and Megan M. Smith, Ph.D., ABPP-CN Objective: To describe neurobehavioral consequences and recovery course in a case of acute infarct of the fornix superimposed on chronic subcortical cerebrovascular disease. Method: We present a right-handed, 72-year-old, African American man with cardiovascular risk factors, chronic kidney disease, and history of CVA with no prior functional or cognitive difficulties. He was evaluated twice, first four days post and again two months post-infarct of the bilateral fornix. Results: Initial inpatient testing revealed impaired verbal memory characterized by rapid forgetting (HVLT-R Delay T = <20) with some benefit from recognition cues, and subtle deficits in constructional praxis and practical judgement. On repeat evaluation at four months post-stroke, he demonstrated memory impairment across modalities (HVLT-R Delay T = <20, BVMT-R Delay T = <20) with marginal benefit from context and cues. He required assistance with multiple instrumental activities of daily living (e.g., financial and healthcare management) and displayed anosognosia of both cognitive and functional deficits. Conclusion: This case illustrates the role of the fornix in the process of memory encoding and self-awareness. Literature describing the neurobehavioral role of the fornix is sparse, however, it has been implicated in episodic memory functions due to hippocampal connectivity. This case study further implicates the fornix in declarative memory formation and will add to the literature by detailing a specific cognitive profile that may inform planning for recovery and rehabilitation.

76 Acute pontine infarction and deep white matter lesioning: Poly-etiologic factors and clinical correlation with neuropsychological impairment and neuroradiographic findings. 1384283 Patricia Pimental Neurobehavioral Medicine Consultants, Ltd., Midwestern University Acute pontine infarction and deep white matter lesioning: Poly-etiologic factors and clinical correlation with neuropsychological impairment and neuroradiographic findings. Neurological and Neuropsychiatric Disorders: Cerebrovascular Disease Objective: Pontine infarction may include motor and sensory disturbances, eye movement disorders, cranial nerve palsies, vestibular system symptoms, dizziness, ataxia, transient loss of consciousness, tetraparesis, acute pseudobulbar palsy, and severe sensory-motor deficits (Kumral, Bayülkem, & Evyapan, 2002). Studies of clinical/ neuroradiological correlation are not abundant in the literature (Kim, Lee, Joo, Im, & Lee, 1996). Methods: The present case involves a 67-year-old, right-handed Caucasian female with a medical history of hypertension, headaches, hypothyroidism, cardiovascular disease (triple bypass), chronic obstructive pulmonary disease, diabetes mellitus, and abdominal aortic aneurysm. She was referred for neuropsychological testing to evaluate deficits related to her acute pontine stroke. Results: Neuropsychological testing revealed neuropsychological impairment characterized by visual-perceptual motor and visual memory deficits, executive dysfunction, lack of concern/awareness of deficits (anosodiaphoria), decreased impulse control and disinhibition. Bi-hemispheric, cortical/subcortical pathway elements, and a preponderance of right hemisphere involvement correlated with neuroradiographic evidence. MRIs revealed a punctate acute infarct within the right paracentral pons, a small focus of gradient susceptibility within the parasagittal right parietal lobe, and a left pons and deep ischemic white matter lesioning of the posterior left frontal lobe. Conclusion: The present case provided a rare look at poly-etiologic factors associated with acute pontine infarct and associated deep ischemic white matter changes. Neuropsychological testing elucidated the severity and type of neuropsychological impairment which correlated with MRI neuroradiographic findings, and was instrumental in patient interventions. Neurocognitive rehabilitation and formal driving evaluation, given the patient’s visual-perceptual motor and visual memory difficulties and lack of concern/awareness of deficits, protected the patient, family and public.

77 Relationship Between Mental Health and Physical Health and Neurocognitive Function among Latinx People Living With HIV 1384319 Elizabeth Breen Fordham University Relationship Between Mental Health and Physical Health and Neurocognitive Function among Latinx People Living With HIV Neurological and Neuropsychiatric Disorders: Other Objective. The relationship between self-reported mental health (MH), physical health (PH), and neurocognition (NC) is vastly understudied among Latinx people living with HIV (PLWH). Evidence of increased somatization in this group suggests that self-reported MH and PH may contextualize cognitive outcomes among Latinx PLWH. Thus, this study examines the relationship between self-reported MH/PH and NC in a sample of Latinx PLWH. Method. This study included 76 Latinx PLWH (33% female; M age=46.0, SD=7.08) who completed the Medical Outcomes Study HIV Health Survey (MOS-HIV) and a comprehensive neurocognitive battery. MH and PH were defined by the MOS-HIV, where higher MH and PH summary scores indicate better perceived health. Demographically-corrected T-scores were used to compute average global NC and domain scores. Results. Within Latinx PLWH, partial correlations controlling for age and education found PH was associated with better processing speed (r=.28, p=.03), and MH was related to better global NC, fluency, learning, and processing speed (ps<.05). A series of multiple regressions (Step 1: age, education, Step 2: MH, PH summary scores) were used to predict NC domain scores. MH (R2=.11-.15) significantly predicted better attention/working memory (β=.26, p=.03) and global NC at the trend level (β=.19, p=.07). PH did not predict any NC domains. Conclusions. Findings indicate that MH and PH correlated with global and domain-specific NC within Latinx PLWH. Better self-reported MH may improve attention/working memory and global NC in Latinx PLWH. Somatization is important when considering MH/PH and cognition within Latinx PLWH; physicians should consider the impact of patients’ self-reported MH/PH on NC in Latinx PLWH.

78 Examining the Neuropsychological Effects of Opioid Use in the Aging Population of People Living with HIV 1384312 Alexander Slaughter Fordham University Examining the Neuropsychological Effects of Opioid Use in the Aging Population of People Living with HIV Neurological and Neuropsychiatric Disorders: Other Objective: People living with HIV (PLWH) exhibit accelerated and premature cognitive aging in comparison to age-matched, seronegative controls. Although opioid use is elevated among PLWH, literature regarding the neurocognitive effects of opioid use across the lifespan of PLWH is limited. This cross-sectional study examines the neurocognitive effects of opioid use across the mid-older adult lifespan of PLWH. Methods: One-hundred fifty-two PLWH (72% Latinx; 71% Male; Mdn(IQR) Age = 47(43, 51) years; M Education = 133 years) completed comprehensive neurocognitive, neuromedical, quality of education (Wide Range Achievement Test- 4 [WRAT-4]), psychiatric/substance-use (Composite International Diagnostic Interview [CIDI]), and urine toxicology assessments. Opioid users were defined by DSM diagnostics for lifetime opioid use disorder. A series of LSR tested the interactive effects of age and opioid use across seven neurocognitive domains. Results: After controlling for covariates (e.g., CD4 cell count; WRAT-4; comorbid substance use), a least-squares regression demonstrated significant interactive effects between age and opioid use upon verbal fluency, such that older opioid users exhibited greater verbal fluency scores (F [11] = 4.28, p < .0001, R² = .33). No significant interactions were detected in other domains. Discussion: The moderate observed effect sizes indicate a positive relationship between older age and lifetime opioid use upon verbal fluency among PLWH. These findings may be representative of a selective survival bias among opioid users within this population. Nonetheless, verbal fluency could serve as a marker of greater survivability among PLWH with opioid use histories. Future directions should examine this interaction longitudinally and evaluate differences in the severity/duration of opioid use.

79 Hand Preference in Men and Women with Parkinson’s Disease: A Preliminary Investigation 1384294 Joseph Ryan University of Central Missouri Hand Preference in Men and Women with Parkinson’s Disease: A Preliminary Investigation Neurological and Neuropsychiatric Disorders: Other Objective: Research has identified common genetic influences on handedness and neurological/mental health phenotypes. It also has been shown there may be increased risk for development of neurological disorders/diseases among individuals naturally left-handed or demonstrating non-right-hand preference. This investigation examined prevalence of right-handed versus non-right-handed individuals with Parkinson’s disease (PD) compared to controls. Method: Participants were 264 patients with PD (mean age = 69.83 years) and 256 control volunteers (mean age = 71.42 years). Mean Dementia Rating Scale composites for the groups were 123.68 and 136.00, respectively. Participants self-identified their dominant hand for writing and usage was confirmed during the session. Results: Proportions of non-right- and right-handed controls (7.0% and 93.0%) versus individuals with PD (6.8% and 93.2%) did not differ. Changes in proportions of non-right- and right-handedness across age ranges were not significant for controls or patients. There was a trend for a larger proportion of women (55.9%) versus men among controls (44.1%),  2 (1) = 3.29, p < .10; whereas, the proportion of men (64.4%) with PD was larger than that of women. (35.6%),  2 (1) = 21.31, p < .001. For controls and patients, non-right and right handedness gender proportions were similar. Conclusions: This study is the first to assess handedness prevalence rates in PD. Results suggest prevalence of non-right handedness is similar in PD and healthy individuals and does not appear to differ markedly by gender or with advancing age. The occurrence of a trend for a larger proportion of women than men among controls is consistent with census-based statistics.

80 Prediction Model for Verbal Memory Decline in Different Epilepsy Surgery Procedures: Temporal Lobectomy vs. Amygdalohippocampectomy 1384408 Karine Hageboutros Barrow Neurological Institute Prediction Model for Verbal Memory Decline in Different Epilepsy Surgery Procedures: Temporal Lobectomy vs. Amygdalohippocampectomy Neurological and Neuropsychiatric Disorders: Other Objective. Mathematical models predicting risk of verbal memory decline after resective epilepsy surgery have been developed for patients undergoing temporal lobectomies. This study was undertaken to determine if application of the Stroup memory loss prediction model was as accurate in foreseeing verbal memory decline after temporal lobectomy as in the less invasive selective amygdalohippocampectomy procedure. Method. This retrospective study examined the verbal memory performances of 40 left temporal lobectomy (ATL), and 16 left subtemporal approach selective amygdalohippocampectomy (SA-H), patients before and after epilepsy surgery using word list learning (Rey Auditory-Verbal Learning Test, Buschke Selective Reminding Test) and story memory (WMS Logical Memory) tests. Patients were assigned to one of four groups using the Stroup multiple regression equation: Minimal Risk (61% risk). To classify memory decline in individual patients, a pre-to-post surgery decrease of >1 SD on at least one memory test constituted memory decline. Results. The prediction model accurately classified 82% (9/11) of ATL, and 75% (3/4) of SA-H, High Risk patients. Verbal memory loss was higher among ATLs than SA-Hs in the Moderate Risk (87% vs. 18%) and Low Risk (71% vs. 0%) groups. Conclusion. The Stroup verbal memory loss risk model under-predicted memory loss among temporal lobectomy patients (71% of Low Risk patients showed memory decline) and over-predicted memory loss among selective amygdalohippocampectomy patients (only 18% of Moderate Risk patients showed memory decline). Results should be considered preliminary due to methodological limitation including small Ns and unequal sample sizes.

81 Cognitive Reserve Factors Influence Neuropsychological Performance in Alcohol Use Disorder 1384509 Shannon McNally University of Georgia Cognitive Reserve Factors Influence Neuropsychological Performance in Alcohol Use Disorder Neurological and Neuropsychiatric Disorders: Other Objective: Cognitive reserve (CR) refers to the brain’s capacity to cope with pathology and preserve functioning. We investigated cognitive performance between individuals with alcohol use disorder (AUD) and healthy controls to examine whether CR, operationalized as education and psychosocial functioning, influences neuropsychological functioning. Method: We recruited 45 AUD (DSM-V criteria) who reported drinking levels exceeding NIAAA guidelines (>14/7 drinks/week for men/women) and 30 healthy controls who did not. MANCOVAs controlling for CR were used to investigate between-group differences in neuropsychological performance, as measured by the NIH Toolbox. A series of linear regression analyses were also performed to evaluate effects of AUD and CR on neuropsychological performance. Psychosocial functioning, education, and AUD status were simultaneously entered as predictors of Flanker, Dimensional Change Card Sort, Picture Sequence, List Sort, and Processing Speed scores. Results: MANCOVAs revealed a significantly slower processing speed in the AUD group compared to controls when controlling for CR (F=4.30, p=.042). There were no significant group differences on other tests. Linear regressions showed only processing speed to be predicted by AUD (β=-.255, p=.042), while CR measures were not. Education predicted Picture Sequence (β=.245, p=.041) and Card Sort (β=.291, p=.009) performance, and psychosocial functioning predicted Flanker (β=.296, p=.021) and Card Sort (β= .316, p=.010) performance. Conclusions: CR appears to contribute to higher-order cognitive functions, regardless of AUD status. Only processing speed, a domain typically susceptible to brain pathology, was significantly related to AUD. Thus, factors linked to CR may serve as important targets for future research and intervention in AUD to promote favorable cognitive outcomes.

82 SPECT Cerebral Blood Flow Differences between Self-Reported Low and High Feelings of Pessimism 1384482 Brizel Trinidad Nova Southeastern University SPECT Cerebral Blood Flow Differences between Self-Reported Low and High Feelings of Pessimism Neurological and Neuropsychiatric Disorders: Other Objective: To assess which brain areas, as measured by SPECT, are related to self-reported feelings of pessimism. Method: Using a symptom checklist, participants were determined based on their self-reported feelings of pessimism. The participants were part of a large archival de-identified database. A total of 7,661 individuals were categorized into a low level of pessimism group (N=3,495) and a high level of pessimism group (N=4,166) who were primarily male (60.7%) with a mean age of 40.00 (SD=15.69). Participants were placed in their respective groups based on whether their responses fell at or below the 25th percentile or at or above the 75th percentile of the sum of responses that indicated having problems related to pessimism. The two groups were then compared in 17 brain areas at baseline. Results: Results from an Independent samples t-test showed mean differences in blood flow. Hyper-perfusion was seen in the group with high level of pessimism in the left Frontal t(7659) = -1.668, p<.007 and bilateral Parietal, left t(7659)=-1.333, p<.001 and right t(7659)=-1.159, p<.013. Conclusion: Results indicate that individuals who report high levels of pessimism have an increased blood flow to several areas, increasing behavioral, cognitive, and emotional arousal. The increase of blood flow to the left frontal area suggests an over activation of cognitive reasoning and judgement, inhibiting a clear understanding of feelings of powerlessness and fear. The overwhelming feelings activate bilateral parietal lobes in carrying out motor behaviors to try and reduce feelings of hopelessness and fear.

83 A lesser form of ADHD? Exploring the neuropsychological profiles of adult ADHD diagnostic subgroups 1384321 Nicole Baggett Pacific University A lesser form of ADHD? Exploring the neuropsychological profiles of adult ADHD diagnostic subgroups Neurological and Neuropsychiatric Disorders: Other Objective: Many individuals experience clinically-elevated symptoms of attention-deficit/hyperactivity disorder in adulthood that were absent, sub-threshold, or unapparent prior to age 12 (late-onset ADHD). These individuals might be experiencing a less-severe form of ADHD. We explored whether the neuropsychological performance profiles of different diagnostic ADHD subgroups of community-dwelling individuals in the Pacific Northwest, USA, supported this form of ADHD. We compared individuals who endorsed clinically-elevated ADHD symptoms in adulthood only (ADHD-A), in both childhood and adulthood (ADHD-CA), and individuals who did not endorse symptoms (None). Method: Subgroup placement was determined based on symptom endorsement on the Adult ADHD Clinical Diagnostic Scale in accordance with DSM-V criteria. Our sample included n=41 placed in the ADHD-CA group (mean age = 39.12, range 18-71), n=12 in the ADHD-A group (mean age=51.83, range 20-73), and n=50 in the None group (mean age=50.52, range 18-86). ANCOVAs with pairwise comparisons were conducted to compare group performance on the CVLT-II, WMS-V Spatial Addition and Visual Reproduction, and D-KEFS Verbal Fluency Letter and Color-Word Inhibition tasks after controlling for age. Result: Group differences were found on the D-KEFS Color-Word Inhibition where the ADHD-A group’s score was higher than that of the ADHD-CA group (d=-0.29, p=.340) but lower than that of the None group (d=-0.28, p=.462). No other group differences were found. Conclusions: Adults with late-onset ADHD may display a less-severe impairment on neuropsychological measures closely related to ADHD symptomology (e.g. inhibitory control) than those meeting full ADHD diagnostic criteria. There is no evidence that this pattern extends to other neuropsychological domains.

84 Magnetic Resonance-Guided Focused Ultrasound for Parkinson’s Disease: A Systematic and Qualitative Review of Nonmotor Cognitive Outcomes Since FDA Approval of ExAblate, 2016-2019 1384252 Jack Lennon Adler University Magnetic Resonance-Guided Focused Ultrasound for Parkinson’s Disease: A Systematic and Qualitative Review of Nonmotor Cognitive Outcomes Since FDA Approval of ExAblate, 2016-2019 Neurological and Neuropsychiatric Disorders: Other 1. Objective: ExAblate received FDA approval for treatment of a range of movement disorders, including tremor-dominant Parkinson’s disease (TDPD), dyskinetic PD, and essential tremor. This incisionless device permits magnetic resonance-guided focused ultrasound (MRgFUS) for ablation of regions of interest. This systematic review sought to 1) determine the extent of literature on nonmotor cognitive outcomes of MRgFUS, 2) investigate differences in postoperative outcomes, 3) suggest future research directions. 2. Data Selection: PubMed, CINAHL, PsycINFO, Cochrane Library databases were searched January 2016 to January 2020. Guidelines for Preferred Reporting Items for Systematic Review and Meta-Analyses were used to review clinical trials comprehensively assessing pre- and postoperative neurocognitive functioning in PD patients undergoing MRgFUS. Due to limited literature, TDPD was expanded to dyskinetic PD. 3. Data Synthesis: Twenty-two abstracts were initially reviewed. After full-text review of eight articles, two studies included comprehensive neuropsychological evaluations of PD patients undergoing MRgFUS thalamotomy/pallidotomy – these occurred in different countries with different normative data, prohibiting quantitative comparison. Most excluded studies used only brief cognitive screeners with unsubstantiated cutoffs. 4. Conclusions: Few studies to-date have administered comprehensive neuropsychological batteries to ascertain MRgFUS risks to neurocognitive functioning in PD and how it compares to deep brain stimulation. Cognitive declines appear to be minimal following MRgFUS, with exceptions being verbal fluency and inhibition. These results are limited by sample size and sample diversity. Studies must extend beyond brief screeners when assessing PD populations vulnerable to decline. Further, consensus on a comprehensive battery would better serve replicability and the ability to engage in useful meta-analyses.

85 Sports Anxiety Scale -2: More Sensitive to College Athlete Anxiety 1384375 Nick Cherry George Fox University Sports Anxiety Scale -2: More Sensitive to College Athlete Anxiety Neurological and Neuropsychiatric Disorders: Other Objective: Concussed student-athletes’ responses on two self-report questionnaires were recorded at two points within the semester in order to evaluate distinguishing changes in psychological symptoms. Methods: A sample of (n = 21) collegiate athletes participated in a pre-post study. Student-athletes were recruited from various sports at a private University through the General Psychology course. The participants (age range 18-22, M=19.38, SD) included 10 females, 11 males.. A pre-post study, mixed-methods experimental design was employed as part of a larger physiological study. The pre-measures included an informed consent, demographic questionnaire, self-report measures (Generalized Anxiety Scale-7 (GAD-7) and the Sports Anxiety Scale-2 (SAS-2)), and 5-time rating scale of performance. All responses were gathered in the neurocognitive lab of the graduate department.. The post-session occurred 5-6 weeks after the initial session, again gathering data on GAD-7 and SAS. Results: A within-subject analysis of the data revealed a main effect for time with a moderate effect size (p =.026) in the decrease of SAS-2 total scores. This significant decrease in SAS-2 total scores occurred across groups and across genders in the post-intervention measures. For the GAD-7 measure, there were no significant changes. Conclusion: The significant findings for the SAS-2 total scores suggest it is a more sensitive measure of anxiety for healthy college athletes who have a concussion history than the GAD-7. Because of the limited number of participants, further research is necessary to confirm the applicability of the SAS-2.

86 When to Consider Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) in Ambiguous Obsessive-Compulsive Disorder (OCD) Presentation 1384457 Morgan Ferris Adler University When to Consider Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) in Ambiguous Obsessive-Compulsive Disorder (OCD) Presentation Neurological and Neuropsychiatric Disorders: Other Objective: Recent literature has illustrated a need for a neuropsychological “endophenotype” in children with OCD. Further, the diagnostic issue of PANDAS appears to be one of the most controversial in the OCD literature. The following case illustrates the lack of diagnostic clarity in a comorbid presentation with ambiguous etiology. Method: A 9-year-old male presented for neuropsychological testing due to difficulty controlling his anger, becoming physically aggressive, sleep disturbances, and a recent decline in academic performance. The patients biological parents noted recent instances of PICA and ritualistic behavior. No clear onset was disclosed. The examiners noticed hyperactivity, poor self-control, sensory seeking behaviors, vocal tics, and the inability to emotionally regulate in intake. Family history was negative for learning, social, or emotional disorders. Medical history was positive for numerous bouts of streptococcal pharyngitis. Results (included but not limited to) T.O.V.A (Attention Performance Index = -3.23). WISC-V: Working Memory Index = 72; 3rd percentile Wisconsin Card Sorting Task: Unable to Complete DKEFS: Trail Making Test: Condition 4 Number-Letter Switching: Profound Deficit WISC-V: Visual Spatial Index = 67, 1st percentile RCFT: Copy = <1st percentile CVLT-C: Correct Recognition Hits = 1/15, <0.1 percentile. Symptoms of OCD are frequently hidden or poorly articulated, especially in younger children. Further, according to the OCD literature, fewer diagnostic issues appear to be as controversial as that of PANDAS. This case illustrates the importance of increasing our diagnostic understanding of PANDAS and the need for diagnostic clarity in co-morbid, severe psychopathology pediatric patients.

87 Socioeconomic Status Moderates the Neurocognitive Implications of Major Depressive Disorder Among People Living with HIV 1384292 Kaleigh Fidaleo Fordham University Socioeconomic Status Moderates the Neurocognitive Implications of Major Depressive Disorder Among People Living with HIV Neurological and Neuropsychiatric Disorders: Other Objective: While low socioeconomic status (SES) and major depression are highly co-occurring among people living with HIV (PLWH), there is a paucity of literature examining how these factors may influence neurocognition. Thus, this study aimed to identify the interactive effects of SES and lifetime major depressive disorder (MDD) within a diverse sample of PLWH. Method: A sample of 119 PLWH (47 with lifetime MDD, 72 without MDD) underwent a comprehensive neurocognitive battery, neuromedical examination, psychiatric/substance use evaluations, and urine toxicology. The Hollingshead Four Factor Index of Social Status served as a proxy for SES. A lifetime MDD diagnosis was determined using the Composite International Diagnostic Interview. After adjusting for covariates (i.e., illicit opiate positive urine toxicology), a series of least squares regression analyses tested the interactive effects of SES and MDD upon seven demographically-adjusted neurocognitive domain T-scores. Results: The interactive effects of SES and MDD were significantly associated with the domain of attention/working memory (F(4, 109) = 4.34, p = .003, R² = .14), such that PLWH and lifetime MDD performed better as SES increased (β = .38, SE = .12, p = .002). SES did not influence performance in attention/working memory among those without MDD. Significant interactive effects were not observed in other domains. Conclusions: Those with higher SES and lifetime MDD performed better across tests of attention/working memory, suggesting heightened access to various resources associated with higher SES could be providing neurocognitive benefits to PLWH and MDD. Future directions should examine this interaction longitudinally and evaluate differences in the severity/duration of MDD.

88 Case Report: Neuropsychological Assessment of Giant Axonal Neuropathy in Adulthood 1384396 Matthew Kloeris Pepperdine University Case Report: Neuropsychological Assessment of Giant Axonal Neuropathy in Adulthood Neurological and Neuropsychiatric Disorders: Other Objective: Giant axonal neuropathy (GAN) is a progressive condition marked by abnormally large/dysfunctional axons. Childhood neurological symptoms (e.g., ataxia, loss of sensation, strength, and reflexes in limbs, and visual and hearing problems) eventually lead to central nervous system impairment (e.g., seizures, paralysis, and cognitive decline). The scant literature on cognition in GAN is mixed, with findings from no impairment all the way to dementia. We present a case of an adult GAN patient with milder symptoms. Method: A 55-year-old Hispanic male with 13 years of education was referred from outpatient neurology for neuropsychological evaluation in a county hospital setting. He was symptomatic in childhood, but was not diagnosed with GAN until 2018. A comprehensive neuropsychological evaluation was conducted. His presentation was notable for anxious and restricted affect, rapid speech, and intense gaze. He appeared immature and at times guarded about his symptoms and history. Results: Cognitive test results were valid and indicated normal-range IQ and generally intact cognitive abilities with mixed performances (and mild deficits) in visual memory and executive functioning. The MMPI-2-RF was invalid due to elevations on multiple validity scales, possibly due to limited insight and/or impression management (L-r highest). Conclusions: The results add to the limited literature on cognition in GAN by describing a milder case. Our patient demonstrated some mixed cognitive difficulties as well as idiosyncrasies in personality that could reflect immaturity and/or reduced insight. In addition to further exploring its cognitive effects, future research into GAN should include the evaluation of personality and insight/metacognition in patients with milder symptoms.

89 The Role of Anxiety Severity and Neurocognitive Functions in Parkinson’s Disease 1384495 Grace Lee Ohio University - Athens, OH The Role of Anxiety Severity and Neurocognitive Functions in Parkinson’s Disease Neurological and Neuropsychiatric Disorders: Other Objective: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor symptoms. While much of the extant literature on neuropsychiatric symptoms and cognitive deficits have focused on depression, comparatively less have examined the role of anxiety among patients with PD. Here, we examined levels of anxiety severity (i.e., minimal, mild, moderate-severe) and cognition in this population. Method: Fifty-six PD patients (M age = 60.8 ± 9.3; 69.6% male) being considered for surgical intervention were evaluated at an outpatient clinic. Inclusion criteria included no history of neurosurgical procedure and no other diagnosis of a neurodegenerative disorder. Participants completed a battery of neuropsychological tests and reported mood symptoms (Geriatric Depression Scale-15, Beck Anxiety Inventory). Those who scored above clinical cutoffs for depressive symptoms were excluded due to high comorbidity with anxiety. Motor symptom severity was rated by neurologists using the Unified Parkinson’s Disease Rating Scale. Results: Analysis of covariance revealed significant group differences on tests of working memory (p = .03), set-shifting (p = .04), problem-solving (p = .05), and phonemic fluency (p = .03) when controlling for motor symptom severity. PD patients with moderate-severe levels of anxiety performed significantly lower than those with minimal or mild anxiety (p’s < .05). There were no other significant group differences in neuropsychological test performance. Conclusions: These findings suggest measurable differences in neurocognitive functions associated with frontostriatal circuits among PD patients with varying levels of overall anxiety. Future work should consider the potential overlap between anxiety and PD symptoms as they relate to cognition.

90 Response time on cognitive measures is associated with motor-based strategy use in a trichotillomania treatment sample 1384494 Emily Carlson American University Response time on cognitive measures is associated with motor-based strategy use in a trichotillomania treatment sample Neurological and Neuropsychiatric Disorders: Other Objective This study used follow-up data from a randomized controlled trial of a cognitive-behavioral therapy intervention for trichotillomania. The aim of this study was to explore the relationship between strategy use and two cognitive measures. Method Thirty participants met diagnostic criteria at the start of the study and completed a follow-up assessment 3- or 6-months post-treatment. The sample was 80% female and the mean age was 34. Participants completed a trichotillomania strategy use form which presents a list of strategies that are organized into 5 categories: sensory (e.g., using a scalp massager), cognitive (e.g., cognitive restructuring), affective (e.g., engaging in pleasurable activities), motor (e.g., using fidget toys), and place (e.g., putting sticky notes on mirrors). Participants were asked to circle any strategies they currently use, and the number of strategies used in each domain was counted. Participants also completed cognitive measures including a stop-signal task and a gambling task. Correlational analyses were conducted comparing the primary outcome variables on the cognitive measures to the number of strategies used in each of the 5 domains. Results Pearson correlations revealed significant negative correlations between the use of motor pulling strategies and mean decision-making time on the gambling task r (28) = -.619, p < .001 and stop signal reaction time r (28) = -.418, p = .022. Spearman rank-order correlations confirmed these results. Conclusion The use of motor coping strategies is associated with faster responses to task relevant stimuli. The current findings indicate that fast motor-based response time may make motor-based strategies more accessible to these individuals.

91 Neuropsychological findings in a Pediatric Case of Rhombencephalosynapsis 1384351 Morgan Engelmann University of Texas at Austin, Dell Children's Medical Group Neuropsychological findings in a Pediatric Case of Rhombencephalosynapsis Neurological and Neuropsychiatric Disorders: Other Objective: Rhombencephalosynapsis (RES) is a rare cerebellar malformation resulting in agenisis/hypogenesis of the vermis. The main clinical features include truncal and/or limb ataxia, neuro-ophthalmological abnormalities, hydrocephalus, and dysmorphic signs, as well as difficulties with attention and emotional/behavioral regulation. This case contributes to the RES literature by providing a pediatric neuropsychological profile of RES with features of Gomez-Lopez-Hernandez syndrome (GLHS) alongside imaging and comparison with related syndromes (e.g. GLHS, Autism, Cerebellar Cognitive Affective Syndrome (CCAS), ADHD). Method: The patient is a 12-year-old male with a complex medical history including hydrocephalus, strabismus, gross/fine motor delays, and bilateral alopecia. Psychiatric history includes anxiety, depression, mood lability, and social difficulties. Incidental imaging findings of rhombencephalosynapsis were found during Neurology consult. Imaging showed stable ventriculomegaly, aqueductal stenosis, and low lying cerebellar tonsils. A comprehensive neuropsychological evaluation was completed to assist with treatment recommendations. Results: Neuropsychological testing demonstrated above average intellectual/reasoning abilities, with relative weaknesses (base rate difference <5%) in attention, working memory, and processing speed. Primary deficits in shifting/flexibility within executive functioning tasks and social/emotional functioning, including rigidity of expectations, poor perspective taking, and all-or-nothing characterization of people and events. Fine motor deficits were also observed. Conclusions: The RES literature is sparse, particularly for pediatric cases with average or better intellectual functioning. This case study provides concurrent neurological and neuropsychological findings which have been implicated in related conditions with cerebellar abnormalities, particularly the a) absence of the vermis and associated emotional lability and b) executive deficits of shifting/flexibility affecting cognitive, social, and emotional functioning.

93 Neuropsychological Functioning in an 8-year-old female with Friedreich's Ataxia 1384317 Elizabeth Marston AMITA Health Neuropsychological Functioning in an 8-year-old female with Friedreich's Ataxia Neurological and Neuropsychiatric Disorders: Other Objective An 8-year old female in the 3rd grade was referred for an evaluation due to concerns surrounding attention, academics, and motor skills in the context of Friedreich’s Ataxia (FA). FA is the most common genetically inherited ataxia (Delatycki et al., 2000). Neurocognitively, deficits in processing and motor speed, visuospatial reasoning, and executive function have been documented in FA (Nieto et al., 2012; Mantovan et al., 2006; Schmahmann et al., 1998). This case study expands on the limited literature on the neuropsychological profile of children with FA. Methods Patient was diagnosed with FA in 2014 following genetic testing significant for over 1,000 repeats of the Frataxin gene. She has experienced a steady decline in her gross-, fine-, and oral-motor skills. Patient requires a personal aide at school to ensure safety ambulating and manage her attention and learning challenges. Results Intellectual ability was estimated as average (WISC-V: GAI= 92). She exhibited significant deficits in reading, writing, and mathematics, clustering around an early 1st grade level (WIAT-III). She presented with attention and executive function impairments (CPT-3, TEA-Ch, NEPSY-II). Motor coordination difficulties were characteristic of FA (WRAVMA, Finger Tapper). Conclusion Patient demonstrated deficits in motor coordination, processing speed, attention, and executive function typical of FA, given its cerebellar pathology and impacted corticocerebellar pathways. The etiology of her learning challenges is unknown, as these domains are not typically impacted in FA. Future investigation of the relationship between FA and other neurocognitive domains is warranted.

94 Isocitrate dehydrogenase status and cognition in glioma patients 1384414 Sydney Park UNC Charlotte/Wake Forest Baptist Health Isocitrate dehydrogenase status and cognition in glioma patients Neurological and Neuropsychiatric Disorders: Other Objective: In gliomas, isocitrate dehydrogenase-wildtype (IDH-wt) is associated with poorer prognosis and is correlated with lower brain connectivity, implicating cognitive impairment. Little is known about the impact of IDH-wt on cognition. This study aimed to explore the relationship between IDH-wt and cognition. Method: Thirty-eight patients (Age M = 48.73 ± 14.98; 50% female) diagnosed with a glioma (29% grade II, 16% grade III, 21% grade IV; Karnofsky Performance Status score (KPS) M = 88.75 ± 14.24) were selected from a retrospective data cohort. 34.2% of patients had left hemisphere tumors, 34.2 % of tumors were in the frontal lobes, and 15.8% were temporal lobe tumors. Patients were assessed via abbreviated neuropsychological battery following surgical resection prior to radiation and/or chemotherapy. Results: The overall cognitive composite was not statistically significant via independent samples t-test (IDH-wt+: M = 42.37; IDH-wt-: M = 39.29; p =0.897). Subdomains for attention/executive functioning (p =0.625), memory (p =0.923), and language (p =0.501) were not significantly different. Logistic regression was conducted to investigate how IDH status predicts cognitive status. The coefficient has a Wald statistic equal to 0.042 which is not significant (critical value of 0.837) [df=1]. Of those with IDH-wt+, 57% were impaired and 43% remained intact. Conclusion: We did not find a significant association between IDH status and cognition though sample size is a significant limitation of the present study. More investigations are needed given it is possible that cognitive performance is related to IDH status and knowledge in this area could improve patient care/patient education.

95 Processing Speed Indicators in Juvenile Huntington's Disease: Assessing CAG Repeat, Age of Onset, and Mood 1384403 Nikolaus Goecke University of Iowa Health Care Processing Speed Indicators in Juvenile Huntington's Disease: Assessing CAG Repeat, Age of Onset, and Mood Neurological and Neuropsychiatric Disorders: Other Objective: In adult onset Huntington’s Disease (HD), processing speed deficits and depression can be detected in the prodromal stages. These factors, along with CAG repeat length, may be predictive of age of symptom onset. However, less is known about the relationship between the aforementioned factors for patients diagnosed with Juvenile Huntington’s Disease (JHD). The current study aimed to investigate the relationships between age of symptom onset, CAG repeat, processing speed, and mood to improve prediction of symptom manifestation for JHD patients. Method: Data was analyzed from the Kids HD study and included 30 participants (age at diagnosis M = 13.6, SD = 5.4, CAG repeat mean = 69, SD = 16). Bivariate partial correlations, independent t-tests, and regression analyses examined differences in processing speed across CAG repeat, age of onset, and depressive symptomology. Results: CAG repeat length significantly predicted the natural log of age at diagnosis, β = -.59, t(25) = -3.59, p < .01, and significantly explained variance in the natural log of age at diagnosis, R2 = .35, F(1, 25) = 12.86, p < .01. Finally, results indicated that CAG repeat length also predicted processing speed abilities when controlling for depressed mood symptomology, R2 = .39, F(3,24) = 5.18, p < .01. Conclusion: CAG repeat length holds predictive power for the age of diagnosis and for processing speed, even when accounting for covariate depressive mood indicators. Overall, results indicate evidence of impacted processing speed abilities given expansive CAG repeat numbers. This is consistent with a subcortical neurodegenerative process, such as HD.

96 Reliable Change Indices as a Measure of Neurocognitive Change following Deep Brain Stimulation for Essential Tremor 1384508 Grace Lee Ohio University - Athens, OH Reliable Change Indices as a Measure of Neurocognitive Change following Deep Brain Stimulation for Essential Tremor Neurological and Neuropsychiatric Disorders: Other Objective: Deep brain stimulation (DBS) is a widely used treatment for essential tremor (ET). To assess for neurocognitive decline following DBS, most studies use statistical methods that directly compare changes in test scores between pre- and post-surgical evaluations. By contrast, reliable change scores are calculated using regression-based models that account for practice effect and systematic error that can occur between repeat test administrations. We sought to determine the utility of reliable change scores in monitoring neuropsychological function following DBS. Method: Twenty-eight ET patients (M age = 70.2 ± 6.3, 57% female) completed neuropsychological evaluations at an outpatient clinic 6.4 ± 3.6 months before and 6.7 ± 1.9 months after DBS placement within the ventral intermediate nucleus of the thalamus (71% left-sided). Wilcoxon signed rank tests were used to identify differences in performance using absolute change versus reliable change scores. Results: There were no significant absolute differences between pre- and post-surgery scores on tests of attention, processing speed, executive function, object naming, verbal fluency, or learning and memory. By contrast, significant differences in reliable change scores from zero were identified on tests of phonemic fluency (p < .001), semantic fluency (p = .05), and verbal learning (p = .005). Conclusions: Analyses that used reliable change scores identified post-surgical declines that were not evident in traditional statistical comparisons. Results suggest that reliable change indices are useful tools for monitoring changes in neurocognitive functions that can occur following DBS and related neuromodulation treatments.

97 The phenomenological experience of posttraumatic stress within an electrical injury sample 1384333 Maximillian Obolsky Roosevelt University The phenomenological experience of posttraumatic stress within an electrical injury sample Neurological and Neuropsychiatric Disorders: Psychiatric Illness Objectives: The symptom phenomenology of posttraumatic stress is poorly understood among electrical injury (EI) patients, despite the high prevalence of posttraumatic stress disorder (PTSD) diagnoses after EI. This study explored how EI patients experience posttraumatic stress using the 3 symptom-cluster subscales from the PTSD Checklist-Civilian Version (PCL-C). Method: Cross-sectional analyses measured PTSD symptom severity and frequency using the PCL-C among 19 adult EI patients referred for neuropsychological evaluation. The sample was 79% male, 68.4% Caucasian, 15.8% African American, 15.8% Hispanic, with mean age of 46.3 years (SD=8.45) and mean education of 12.3 years (SD=2.6). Results: Mean PCL-C total score was 54.3 (SD=12.4, range: 31-76). Fifteen participants had total scores exceeding the recommended cut-score of ≥44, indicating that they met criteria for presumptive PTSD diagnoses. On average, Cluster D (hyperarousal) symptoms were the most severe (M=3.5/5) followed by Cluster C (avoidance/numbing) (M=3.3/5) and Cluster B (re-experiencing) (M=2.8/5). The most frequently endorsed symptoms were loss of pleasure (84%), sleep disturbance (84%), and difficulty concentrating (84%), which also were the most severe symptoms (M=4.0/5; M=3.9/5; M=4.0/5, respectively). The two symptoms endorsed least often were repeated disturbing dreams of the stressful experience (42%) and reexperiencing the traumatic event (37%), and they were also the least severe (M=2.6/5; M=2.3/5, respectively). Conclusions: In EI patients, general symptoms of psychological distress were more prominent than more prototypical trauma-related symptoms (e.g., re-experiencing, intrusive thoughts). Future research should examine if these symptoms of distress are unique to EI patients’ experiences of posttraumatic stress compared to other clinical populations.

98 Regional Cerebral Blood Flow in Adults with Autism 1384269 Bailey McDonald Nova Southeastern University - Regional Cerebral Blood Flow in Adults with Autism Neurological and Neuropsychiatric Disorders: Psychiatric Illness Objective: To identify regional cerebral blood flow (rCBF) differences between individuals with Autism Spectrum Disorder and healthy controls. Method: Healthy controls [n=81, Mage=41.9, 53.0% female] and persons diagnosed by psychiatric examination with Autism Spectrum Disorder (ASD) [n=62, Mage=29.8, 75.8% male] were selected from a deidentified adult clinical outpatient database. Those with comorbid diagnoses were included. Significant differences (alpha=.001) were found for gender [χ(2)=13.4] and age [t(141)=-4.8] between groups. Multiple ANCOVA controlled for gender and age on outcomes of rCBF across 17 brain regions from Single-Photon Emission Computed Tomography (SPECT) were analyzed. Results: Significant rCBF differences were noted in the cerebellum [left:F(1,143)=9.43, p=.003; right: F(1,143)=14.2, p<.001] and basal ganglia [left:F(1,143)=8.2,p=.005; right:F(1,143)=10.3, p=.002]. Group means comparisons indicated higher perfusion in the cerebellum and lower perfusion in the basal ganglia in the group with ASD. No significant differences were found bilaterally in limbic system, motor sensory strip, vermis, or occipital, parietal, frontal, or temporal lobes. Conclusion: Results indicated that individuals diagnosed with ASD have diminished rCBF in the basal ganglia and increased rCBF in the cerebellum. Previous research supports these conclusions, as the basal ganglia is linked with repetitive and/or restricted motor behaviors, and the cerebellum aids in understanding gross motor and coordination in ASD, as well as social interactions, and language and communication. By understanding the underlying mechanisms of ASD, interventions focused on sensory-motor abilities, such as sensory enrichment (Woo and Leon, 2013), can show a decrease in motor behaviors and improve cognition. Future studies should control for potential comorbidities, the severity of ASD, and medication usage.

99 Depression as a Factor in Neuropsychological Test Performance 1384246 Carlton Gass Memory Disorders Clinic, Tallahassee Memorial Healthcare Depression as a Factor in Neuropsychological Test Performance Neurological and Neuropsychiatric Disorders: Psychiatric Illness Objective: Evaluate the relation between depression and performance on six widely used tests: the Boston Naming Test, Category Fluency Test, Controlled Oral Word Association Test, Corsi Block Tapping Test, Mazes and Trail Making Test (TMT), Parts Speed, A and B. Method: Participants: 77 women and 33 men referred for a comprehensive neuropsychological examination in an outpatient memory disorders clinic as part of a broader neurodiagnostic workup for memory complaints and possible cognitive decline. Referral sources: neurologists (78%), primary care physicians (21%). Patients’ mean age: 59.3 (SD =12.1); education: 15.1 (SD = 2.7) years. They were screened from a larger sample (N = 175) for any known history of brain disorder or positive neurodiagnostic findings. They met performance and symptom validity criteria (Reliable Digit Span and scores on MMPI-2 validity scales). Diagnostically, 62% of the sample had mood disorders. Using their median score on the Depression scale of the MMPI-2 (T = 70), patients were classified into High and Low Depression groups (ns = 55). The two groups were no different on age, education, or predicted level of intelligence (Test of Premorbid Function). Results: On all six of the neuropsychological tests (eight measures), scores were compared across the two groups. There was no main effect (MANOVA) for group, F(8,101) = 1.03, p = .427. Univariate comparisons revealed no intergroup differences across tests. Conclusion: Results suggest that severity of depressive symptoms is not related to performance on these neuropsychological tests. In cooperative examinees, these tests are valid for assessing brain-based abilities independent of the examinees’ emotional status.

100 Neuropsychological findings in a case involving a rare genetic anomaly (de novo 6q24.2-q25.2 deletion on paternal chromosome 6) associated with intrauterine growth restriction (IUGR), autism, OCD and schizoaffective disorder. 1384497 Leila Bakry-Becker The Bethesda Group Neuropsychological findings in a case involving a rare genetic anomaly (de novo 6q24.2-q25.2 deletion on paternal chromosome 6) associated with intrauterine growth restriction (IUGR), autism, OCD and schizoaffective disorder. Neurological and Neuropsychiatric Disorders: Psychiatric Illness Objective: Individuals with deletions of the long arm of chromosome 6 have been known since 1975 with just over 100 cases reported as of 2015. Individuals with deletions involving band 6q25 have a high incidence of intrauterine growth retardation, intellectual disability, dysmorphic features, growth failure, and medical complications (Stagi et al, 2015). Findings will add to the literature base on this genetic anomaly. Methods: A 21-year-old male was assessed to differentiate between obsessive vs. psychotic thinking. His history was notable for being born weighing 2300 grams at term, and having feeding, learning and social/emotional difficulties which progressed to OCD in later childhood. At age 15, he was determined to have a de novo 3.7Mb microdeletion at 6q24.3. Results: Neuropsychological assessment of attention, motor and executive functions reveal a variable profile with pockets of strengths relative to his own performance as well as significant normative impairment. Findings represented a significant decline from prior testing at age 10. His verbal memory was below average and his overall attention capacity was impaired. JT’s executive functioning, visual-motor integration, motor speed, and his verbal abstract reasoning were all below average. His non-verbal abstract reasoning and visual perception were intact. On results of objective, projective and neurocognitive testing, JT met criteria for diagnoses of Autism, Obsessive Compulsive Disorder, and Schizoaffective Disorder. Conclusions: JT’s developmental history and symptom presentation are complex, revealing significant comorbidity; this case study describes the progression of JT’s difficulties over his lifespan, beginning with feeding difficulties, diagnoses of autism and OCD and progressing to a psychotic disorder.

101 PTSD and Personality Traits Influence the Relationship Between Memory Complaints and Memory Performance 1384473 Patrick Armistead-Jehle Munson Army Health Center PTSD and Personality Traits Influence the Relationship Between Memory Complaints and Memory Performance Neurological and Neuropsychiatric Disorders: Psychiatric Illness Objective: Previous research has shown that post-traumatic stress disorder (PTSD) symptomatology may mediate the association between subjective cognitive complaints and objective cognitive performance, however, the precise nature of this mediation is not well understood. The present study aims to expand on these findings by focusing on memory processes and exploring the influence that personality variables may have on the mediational role of PTSD symptoms. Methods: In a sample of 196 U.S. military service members and veterans, we administered the PTSD checklist (PCL), Personality Assessment Inventory (PAI), Memory Complaints Inventory (MCI), and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results: Overall MCI score (reflecting subjective memory complaints) was associated with both RBANS immediate (𝛽= -0.15, SE= 0.06, p= 0.01) and delayed memory performance (𝛽= -0.13, SE= 0.06, p= 0.02), but PTSD severity mediated both of these relationships (95% CI -0.14, -0.01; 95% CI -0.14, -0.02, respectively). Trait depression moderated the mediation path between subjective memory complaints and PTSD severity (𝛽= -0.02, SE= 0.004, p.05). Conclusion: Results suggest that targeting PTSD and depressive symptoms may be a promising treatment for those with subjective memory complaints.

102 The Relationship Between Retinal and Cognitive Functioning in Schizophrenia 1384477 Docia Demmin Rutgers, The State University of New Jersey The Relationship Between Retinal and Cognitive Functioning in Schizophrenia Neurological and Neuropsychiatric Disorders: Psychiatric Illness Objective: The retina may provide a unique window into brain structure and function as an accessible part of the central nervous system. Abnormalities in retinal cell structure and function have been associated with brain pathology (e.g., brain volume loss, cognitive impairment) in several neuropsychiatric disorders (e.g., MS, Alzheimer’s disease, Parkinson’s disease). A number of prior studies using flash electroretinography (fERG) have reported reduced retinal cell activity in schizophrenia (SZ). Impairments in cognitive functioning are a core feature of SZ and deficits in executive control processes involving prefrontal cortex (PFC) activity are strong predictors of functional capacity. This study examined whether retinal cell functioning is related to brain function, as indexed by cognitive function, in SZ, and if these relationships were stronger in particular domains (e.g., PFC dependent functions vs. less PFC dependent functions). Method: Twenty-six SZ participants and 24 healthy controls (HC) completed fERG and cognitive testing. fERG measurements included a-wave (photoreceptor cells), b-wave (bipolar-Müller cells), and oscillatory potential (OP; amacrine cells) amplitudes and implicit times. Cognitive tests assessed executive control processes (i.e., attention/processing speed, behavior initiation, response inhibition, working memory), and non-executive control processes (i.e., emotion recognition/discrimination). Results: In the HC group, a-wave amplitude was correlated with cognitive test scores and OP amplitude was related to cognitive performance in the SZ group. However, overall, retinal cell activity did not appear to be strongly related to scores on cognitive tasks, regardless of whether or not they involved frontal brain regions. Conclusion: Impairments in retinal and cognitive functioning may reflect distinct disease mechanisms in schizophrenia.

103 Normative Reference Values and Item-Level Symptom Endorsement for the PROMIS® v2.0 Cognitive Function-8-Item Short Form in Adults with Mental Health Problems 1384354 Jacqueline Marsh Department of Psychiatry, Harvard Medical School & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program Normative Reference Values and Item-Level Symptom Endorsement for the PROMIS® v2.0 Cognitive Function-8-Item Short Form in Adults with Mental Health Problems Neurological and Neuropsychiatric Disorders: Psychiatric Illness Objective: The purpose of the study is to present normative data and reliability statistics for the PROMIS® v2.0 Cognitive Function-8-Item Short Form for the total normative sample and subgroups with mental health problems. Method: The PROMIS® v2.0 Cognitive Function 8-Item Short Form measures subjective cognitive difficulties (raw score range=8-40). We stratified the normative sample from the US general population (n=1,009; 51.1% women) by gender, self-reported history of a depression or anxiety diagnosis, and recent mental health symptoms (i.e., endorsed frequent anxiety or depression symptoms in the last week) and examined cognitive symptom reporting. Results: Those with past or present mental health difficulties obtained lower raw scores on the measure, reflecting greater cognitive symptom reporting. This was apparent in men (all men, M=31.06, SD=7.68; depression group, M=26.74, SD=8.09; anxiety group, M=26.95, SD=7.54; mental health group M=24.73, SD=7.79) and women (all women M=33.23, SD=7.32; depression group, M=29.78, SD=8.57; anxiety group, M=30.19, SD=7.81; mental health group, M=28.60, SD=8.61). The base rates for endorsing three or more cognitive symptoms was greater in those with mental health problems (men: full sample=19.7%; depression group=37.1%; anxiety group=32.8%; mental health group=45.7%; women: full sample=10.1%; depression group=22.8%; anxiety group=19.4%; mental health group=24.8%). Internal consistency, as measured by Cronbach's alpha, ranged from 0.92 to 0.95. Conclusions: The PROMIS® v2.0 Cognitive Function-8-Item Short Form is a reliable measure of subjective cognitive functioning across genders and mental health status. Those with past or present mental health difficulties report a greater number of cognitive symptoms. It may be important to address these difficulties in clinical practice.

104 Meta-analysis of neuropsychological intra-individual variability in mild- and moderate/severe-traumatic brain injury 1384462 Stephen Aita Geisel School of Medicine at Dartmouth Meta-analysis of neuropsychological intra-individual variability in mild- and moderate/severe-traumatic brain injury Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury OBJECTIVE: Intra-individual variability (IIV) applied to cognition refers to scatter of performances at the individual level. This study meta-analyzed research that examined consistency (i.e., within-task) IIV in mild-traumatic brain injury (mTBI) and moderate/severe-traumatic brain injury (msTBI) compared to normal controls. METHOD: Using PRISMA-guided search parameters, eight databases within the EBSCO network as well as ProQuest Dissertations & Theses were searched for studies comparing cognitive IIV between TBI and control samples. Random-effects modeling was used for all analyses. Hedge’s g was used as the index of combined effect size, and Q and I2 were evaluated for heterogeneity analyses. RESULTS: This study was a part of a broader meta-analysis looking at IIV across all clinical samples. The initial search strategy yielded 2,962 results, which were reduced to 87 studies for final inclusion. This meta-analysis included 12 studies (mTBI: k=9, 64 effect sizes; msTBI: k=5, 10 effect sizes). Meta-analysis resulted in a significant combined effect size across all TBI studies (g=0.45, Q=23.49, I2=53.17). When stratifying for TBI severity, msTBI samples yielded a greater combined effect size (g=0.66, Q=10.70, I2=62.61) than mTBI (g=0.39, Q=10.49, I2=23.74). Highest degree of between-study heterogeneity was noted in the msTBI studies. CONCLUSIONS: Broad TBI as well as mTBI and msTBI studies yielded significant combined effect sizes, consistently showing elevated cognitive IIV in TBI samples compared to healthy controls. The combined effect size approximately doubled from mTBI to msTBI. This provides evidence that consistency-based IIV is sensitive and possibly specific to neurologic/pathologic burden. This supports prior literature framing IIV as an index of neurological health.

105 Post-Concussive Symptom Endorsement and Symptom Attribution Following Remote Mild Traumatic Brain Injury in Combat-Exposed Veterans 1384314 Victoria Merritt VA San Diego Healthcare System Post-Concussive Symptom Endorsement and Symptom Attribution Following Remote Mild Traumatic Brain Injury in Combat-Exposed Veterans Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury

106 Analysis of Switching and Clustering Performance in Anglo-Americans and Hispanic Traumatic Brain Injury Survivors and Healthy Comparison Adults 1384346 Sarah Fatoorechi Lundquist Institute at Harbor-UCLA Medical Center Analysis of Switching and Clustering Performance in Anglo-Americans and Hispanic Traumatic Brain Injury Survivors and Healthy Comparison Adults Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Research shows traumatic brain injury (TBI) survivors underperform compared to healthy comparison participants (HC) on verbal fluency tasks. Verbal fluency is typically comprised of two tasks: letter fluency and semantic fluency. During verbal fluency trials, participants often cluster responses and switch between clusters, which can serve as measures of executive control and organization. Also, research shows that Anglo-Americans (AA) outperformed ethnic minorities on various aspects of cognitive functioning. We examined the relationship between TBI and ethnic diversity on letter fluency, semantic fluency, switching, and clustering. Method: The sample included 45 HC adults (21 Hispanics; 24 AA), 33 acute TBI adults (ATBI; 11 Hispanics; 22 AA), and 26 chronic TBI adults (CTBI; 9 Hispanics; 17 AA). Results: The groups were well matched, with the exception of gender. ANCOVAs, controlling for gender, revealed HC outperformed ATBI participants on letter fluency, p=.007, ηp²=.10, letter switching, p=.006, ηp²=.10, and semantic switching, p=.018, ηp²=.08. We also found HC outperformed both TBI groups in sematic fluency performances, p=.000, ηp²=.15. Next, we found Hispanics outperformed AA on letter clustering, p=.003, ηp²=.09 and semantic clustering, p=.010, ηp²=.07. Finally, an interaction emerged in letter clustering, p=.044, ηp²=.06, with the Hispanic ATBI outperforming the AA ATBI group. Conclusion: The HC group outperformed both TBI groups only on semantic fluency, but they outperformed the ATBI survivors on letter fluency, letter switching, and semantic switching. Hispanics outperformed AA on letter clustering and semantic clustering, suggesting the use of clustering over switching strategies to provide verbal fluency responses in this group.

107 History of Remote Mild TBI Predicts Poor Health-Related Quality of Life Outcomes in Military Veterans 1384426 McKenna Sakamoto VA San Diego Healthcare System History of Remote Mild TBI Predicts Poor Health-Related Quality of Life Outcomes in Military Veterans Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: We examined health-related quality of life (QOL) in military Veterans with and without a history of mild traumatic brain injury (mTBI). Additionally, we investigated how mTBI injury characteristics modify health-related QOL. Method: Veterans with a history of remote mTBI (n=81) and military controls (MCs) without a history of mTBI (n=62) completed self-report questionnaires measuring combat exposure, posttraumatic stress disorder (PTSD) and neurobehavioral symptoms, and health-related QOL. Primary outcomes included the eight subscales of the 36-Item Short-Form Survey (SF-36). Results: ANCOVAs adjusting for combat exposure and PTSD symptoms found that the mTBI group demonstrated significantly more health-related QOL symptoms when compared to MCs across the following SF-36 subscales: General Health, Vitality, Bodily Pain, Physical Role Functioning, and Social Functioning (p=.001-.045, ηp2=0.03-0.07). Within the mTBI sample, repetitive mTBI, combat exposure, and PTSD and neurobehavioral symptoms collectively significantly predicted all five QOL subscales (all p’s<.001), accounting for roughly 33-53% of the total variance. Greater neurobehavioral symptoms were associated with lower Physical Role Functioning, Vitality, and Social Functioning scores; repetitive TBI was associated with higher Bodily Pain scores; greater PTSD symptoms were associated with lower Social Functioning scores; and greater combat exposure was associated with lower General Health scores. Conclusions: Results suggest that, over and above PTSD and combat exposure, mTBI status independently contributes to health-related QOL. Moreover, specific dimensions of health-related QOL are influenced by different factors, with affective and vestibular-related neurobehavioral symptoms showing the strongest negative associations with health-related QOL. Findings highlight the need for comprehensive assessment and multimodal treatment within this vulnerable population.

108 Differential Change in Eye Movement Performance Among Male Collegiate Athletes With Variable Exposure to Head Impacts 1384464 Virginia Gallagher Northwestern University Differential Change in Eye Movement Performance Among Male Collegiate Athletes With Variable Exposure to Head Impacts Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: The primary aim of this study was to evaluate the use of eye movement testing to detect change in cognitive and sensorimotor processing among male club collegiate athletes following a season of participation in collision sports of variable exposure. We predicted that collision sport athletes (COLL) exposed to subconcussive head trauma would demonstrate longer reaction times (latency) on saccadic eye movement tasks with executive demands (antisaccade and memory-guided saccade [MGS] tasks), greater antisaccade inhibitory errors, and poorer MGS accuracy, a measure of spatial working memory, from pre-season to post-season, whereas non-collision sport athletes (NON-COLL) would demonstrate stability overtime. We predicted that longitudinal change in eye movement performance would be greater than change observed on ImPACT (Immediate Post-Concussion Assessment and Cognitive Test). Method: Collegiate club athletes with variable exposure to contact sports participation [COLL-High Dose, n = 8; COLL-Low Dose, n = 9; NON-COLL, n = 17] completed eye movement and ImPACT assessments pre-season and post-season. Results: NON-COLL demonstrated shorter post-season versus pre-season antisaccade and MGS latencies, whereas COLL groups showed stable, longer, or more attenuated (relative to NON-COLL) shorter latencies (ps ≤ .001). NON-COLL demonstrated improved MGS spatial accuracy over the season, whereas COLL groups showed poorer or stable accuracy (ps < .05). No differential change was observed in pre-season to post-season ImPACT performance among groups. Conclusions: This pilot study provides preliminary evidence for the use of eye movement testing as a sensitive marker of subtle changes in attentional control and working memory resulting from participation in collision sports.

109 Anxiety Influences Traumatic Brain Injury Survivors and Healthy Comparison Adult Bilinguals Stroop Color Word Test Performance 1384379 Erika Torres Lundquist Institute Anxiety Influences Traumatic Brain Injury Survivors and Healthy Comparison Adult Bilinguals Stroop Color Word Test Performance Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: We evaluated symptoms of anxiety (via the Hospital Anxiety and Depression Scale; HADS, HADS-A) on Stroop Color Word Test (SCWT) performances in traumatic brain injury (TBI) survivors, as compared to healthy comparison participants (HC). Method: The sample consisted of 40 acute TBI survivors [ATBI; 30 normal symptoms of anxiety (NSA); 10 abnormal symptoms of anxiety (ASA)], 30 chronic TBI survivors (CTBI; 16 NSA; 14 ASA), and 50 HC’s (28 NSA; 22 ASA). All participants passed performance validity testing. The SCWT included the word (SCWT-W), color (SCWT-C), and color-word (SCWT-CW) conditions. A series of ANOVAs were used to evaluate SCWT performances. Results: ANOVA revealed a main effect group on the SCWT-C, p=.011, and SCWT-CW, p=.018, with HC’s outperforming the ATBI group. Furthermore, HC outperformed both TBI groups on the SCWT-W, p=.004. We also found that the ASA outperformed the NSA group on the SCWT-W, p=.036. No interactions emerged between group and anxiety. Conclusion: The HC group outperformed both TBI groups on the SCWT-W, but only the ATBI group on SCWT-C and SCWT-CW. Furthermore, we found that there were only differences between the anxiety groups on the SCWT-W. Our findings highlight that anxiety impacts HC and TBI groups differently on the SCWT.

110 Are invalid baselines more frequent in those with concussion history? 1384270 Julia Maietta University of Nevada, Las Vegas Are invalid baselines more frequent in those with concussion history? Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a commonly utilized measure for sports concussion. Across the literature we have reviewed there is an abundance of information that focuses on invalid baselines and the effects of concussions. Yet, no previous studies have investigated the effect of a history of concussion on frequency of invalid baselines. The current study examined these effects within high school athletes. Methods: Participants included 47,874 high school athletes (mean age=15.0, SD=1.2; mean education=9.0; SD=1.5; 42.6% female). These athletes were selected from a larger database of athletes who completed baseline ImPACT testing from 2008-2016. Self-reported history of concussion (none vs. 1+) was obtained from the demographic section of the ImPACT. Invalid performance was based on standard ImPACT criteria (“Baseline++”). Results: Chi-square tests of homogeneity were performed to assess differences in invalid baselines between those with and without a history of concussion. Results revealed significantly more invalid baselines for those with a history of concussion (p<.01). Conclusions: Results indicate that high school athletes with a self-reported history of concussion may be more likely to have invalid baseline test performance. Based on these preliminary results, clinicians who are managing return-to-play decisions may want to take into account concussion history when interpreting baseline data. Future research should, of course, investigate whether this result is consistent in other samples and, if so, whether alternative validity criteria may be needed. Future investigations of athletes with confirmed clinical diagnosis of concussion is an important next step in investigating differences in rates of invalid baselines.

111 The Relationship between Bilingualism and Perceived Workload on the Symbol Digit Modalities Test in Traumatic Brain Injury Survivors 1384382 Daniel Walter Lopez-Hernandez Lundquist Institute The Relationship between Bilingualism and Perceived Workload on the Symbol Digit Modalities Test in Traumatic Brain Injury Survivors Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: We evaluated perceived workload (measured by the NASA Task Load Index; NASA-TLX) as related to Symbol Digit Modalities Test (SDMT) performances in monolingual and bilingual traumatic brain injury (TBI) survivors and healthy comparison participants (HC). Method: The sample consisted of 28 TBI survivors (12 monolinguals & 16 bilinguals) and 50 HC (20 monolinguals & 30 bilinguals). SDMT written (SDMT-W) and SDMT oral (SDMT-O) were used to evaluate group differences. Results: ANCOVA, controlling for age, revealed that the HC group outperformed the TBI group on SDMT-W, p=.001, and SDMT-O, p=.047. Furthermore, bilinguals outperformed monolinguals on SDMT-W, p=.017. On the NASA-TLX, an interaction emerged on temporal demand rating, p=.023, with TBI bilinguals reporting higher temporal demand on SDMT tasks compared to TBI monolinguals, while the HC monolingual participants reported higher temporal demands ratings compared to HC bilingual participants. Furthermore, monolingual participants showed higher levels of frustration with regard to the SDMT task compared to bilingual participants, p=.029. Conclusion: Our data revealed TBI survivors underperformed on both SDMT trials compared to the HC participants. Also, bilingual participants demonstrated better SDMT-W performances compared to monolingual participants. Furthermore, our TBI bilingual sample reported themselves to be more rushed to complete the SDMT compared to monolingual TBI sample, but they were less frustrated. Meanwhile, our HC monolingual sample felt more rushed to complete the SDMT tasks compared to HC bilingual participants, but they were less frustrated. While we observed differences in workload ratings between language groups, it is unclear if language use, and/or other variables are driving these results.

112 Validity of In-Person Assessment of Traumatic Brain Injury Inpatients Using the Brief Test of Adult Cognition by Telephone 1384393 Christina DiBlasio University of Alabama at Birmingham (UAB) Validity of In-Person Assessment of Traumatic Brain Injury Inpatients Using the Brief Test of Adult Cognition by Telephone Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective. Examine the correlation of the Brief Test of Adult Cognition by Telephone (BTACT) with established neuropsychological tests in an inpatient traumatic brain injury (TBI) population. Method. Participants were 55 patients aged 18-76 years (M age = 37 years; 69% male) receiving inpatient rehabilitation for new-onset TBI at a level I trauma center, acute inpatient rehabilitation hospital. The BTACT is a brief cognitive test battery consisting of the following subtests: Word List Immediate and Delayed Recall (episodic verbal memory), Digits Backward (working memory), Number Series (inductive reasoning), Animal Fluency (verbal fluency), and Backward Counting (processing speed). With the intention of mirroring cognitive functions measured by the BTACT, the neuropsychological battery was comprised of the California Verbal Learning Test-2 (CVLT-2), Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span, Trail Making Test (TMT), semantic fluency, phonemic fluency, Symbol Digit Modalities Test, and Wisconsin Card Sorting Test. Results. The BTACT was related to established neuropsychological tests across composite scores of overall cognition (r=.64, p<.001), episodic verbal memory (r=.66, p<.001), and executive function (r=.56, p<.001). For BTACT subtests, Word List Immediate Recall and Word List Delayed Recall were correlated with CVLT-2 learning trials total (r=.57, p<.01) and long delay free recall (r=.60, p<.001), respectively. BTACT Digits Backward correlated with WAIS-IV Digit Span (r=.51, p<.01). BTACT Animal Fluency was related to semantic fluency (r=.65, p<.01), phonemic fluency (r=.60, p<.01), and TMT-B (r=.39, p<.01). Conclusion. BTACT composite scores of overall cognition, verbal memory, and executive function are valid measures in a TBI inpatient population.

113 A Case Study: Utilization of C3 Logix in Serial Evaluation of Concussion in a Multidisciplinary Medical Setting 1384257 Rebecca Zill Allegheny Health Network A Case Study: Utilization of C3 Logix in Serial Evaluation of Concussion in a Multidisciplinary Medical Setting Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: C3 Logix is a concussion assessment and management system addressing patient care, return to play standards, and rehabilitation or understanding of concussion. This case study demonstrates the utility of the C3 Logix screening measure with a concussion patient in a multidisciplinary medical setting. Repeat C3 Logix screening data was compared to reported symptoms on the Post-Concussion Symptom Scale (PCSS) and interpreted by a physician in medical setting. This case highlights the comparison of C3 Logix findings and a neuropsychological profile in a young adult with history of traumatic closed head injury. Method: 25-year old, right-handed, Caucasian man with no significant medical history prior to sustaining a parenchymal hemorrhage along the left anterior inferior frontal lobe and left temporal lobe, as well as a left anterior frontal subdural hematoma in 2019. The patient reported a premorbid history of generalized anxiety with panic, and elevated emotionality post-injury. Results: Estimated premorbid verbal functioning was average, consistent with his score as predicted by demographic variables. The patient exhibited decreased concussion symptom severity and improved cognitive performance across repeat C3 Logix administrations. On comprehensive neuropsychological evaluation, he demonstrated intact performance across cognitive domains, with relative weakness consistent with localization of injury, sustained eye injury, and expected recovery duration. Conclusions: Repeat cognitive screenings were generally consistent with comprehensive neuropsychological evaluation results. This case study highlights that the C3 Logix tool should be further considered as a brief cognitive screening measure to inform treatment of traumatic head injuries within a multidisciplinary medical setting.

114 Predicting Long-Term Cognitive Outcomes From Acute Orientation Performance After Traumatic Brain Injury 1384394 Christina DiBlasio University of Alabama at Birmingham (UAB) Predicting Long-Term Cognitive Outcomes From Acute Orientation Performance After Traumatic Brain Injury Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective. To evaluate how initial orientation, rate of change in orientation, and duration of post-traumatic amnesia (PTA) during inpatient rehabilitation predict cognitive functioning (overall cognition, episodic verbal memory, and executive function) 1 year and 2 years after sustaining a moderate-to-severe traumatic brain injury (TBI). Methods. Participants were 101 adults aged 18-81 years (M age = 39 years; 67% male) receiving inpatient rehabilitation following new-onset moderate-severe TBI at a level I trauma center, acute inpatient hospital. Orientation data (initial orientation, rate of change in orientation, and duration of PTA) were collected during inpatient rehabilitation where each participant received serial assessments of their orientation with the Orientation Log (O-Log) during bedside rounds. The Brief Test of Adult Cognition by Telephone (BTACT) was administered to participants over the telephone at 1 year and 2 years post-injury to assess cognitive outcomes. Results. Initial orientation during acute inpatient rehabilitation was significantly associated with overall cognition (p < .01), episodic verbal memory (p < .01), and executive function abilities (p < .01) at 1 year post-injury. Duration of PTA and rate of change in orientation were not significant predictors, and none of the orientation factors predicted cognition at 2 years post-injury. Conclusion. Initial level of orientation is important to consider in the prediction of cognitive impairments one year following moderate-severe TBI. This supports the need to assess orientation early in the recovery process, particularly upon admission to acute rehabilitation.

115 Predictors of Depressive Symptoms in Adolescent Patients Following Concussion 1384411 Abigail Feder UPMC Sports Medicine Concussion Program Predictors of Depressive Symptoms in Adolescent Patients Following Concussion Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury OBJECTIVE The present study sought to examine specific predictors and factors associated with depressive symptoms at initial(V1) and subsequent(V2) visits following concussion in adolescents. METHODS This study enrolled adolescents aged 10-18 (14.5±2.2 years) within 30 days of a diagnosed concussion. Patients completed Mood and Feelings Questionnaire-Short-Child Report (MFQC), Postconcussion Symptom Scale (PCSS), neurocognitive testing(ImPACT), and Vestibular-Ocular Motor Screening. Logistic regression (LR) analyses evaluated risk factors and clinical presentation as predictors of post-injury MFQP scores above a cutpoint of 8. RESULTS Participants included 113 adolescents (50.4% male; 77% sport-related) who presented for V1 8.9±6.2 days post-injury and V2 18.43±11.9 days after V1. Overall, 5.3% reported pre-injury depression and 15.8% reported post-injury depressive symptoms above clinical cutoff on the MFQC. The LR model predicting increased depressive symptoms at V1 was significant (R2=45.0%, p=.007), supporting post-traumatic amnesia(PTA; OR=3.15, 1.01-9.88) as a predictor. The LR model predicting depressive symptoms at V2 was significant (R2=62.2%, p=.021), supporting history of depression(OR=25.5, 3.86-168.2) as the only significant predictor. Those scoring above 8 on the MFQC at V1 were more likely to have a prolonged recovery(over 30 days; OR=10.4, 1.29-83.6). CONCLUSIONS The primary findings indicated that PTA was associated with increased depressive symptoms earlier, whereas a history of depression was associated with increase depressive symptoms later following concussion. Patients scoring higher on depressive symptoms were 10 times more likely to have a prolonged recovery. Together, these findings highlight the importance of evaluating depressive symptoms and factors that are associated with these symptoms to inform prognosis and earlier treatment for depressive symptoms following concussion.

116 Predicting Chronic Neurobehavioral Symptoms based on Acute Injury Characteristics and Symptoms in U.S. Military Service Members with and without history of TBI 1384507 Sara Lippa Walter Reed National Military Medical Center Predicting Chronic Neurobehavioral Symptoms based on Acute Injury Characteristics and Symptoms in U.S. Military Service Members with and without history of TBI Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Recovery following traumatic brain injury (TBI) is complex. Often following mild TBI, recovery occurs within days or weeks, though this is not always the case. Following more severe TBI, some recover quickly, while many never fully recover. This study examines acute predictors of chronic neurobehavioral symptoms in U.S. military service members (Age: M=33.9 years, SD=10.2) without injury (n=86), or with history of uncomplicated mild traumatic brain injury (TBI; n=56), complicated mild, moderate, or severe TBI (mod-sev TBI; n=43), or bodily injury (n=25). Method: Participants completed the Neurobehavioral Symptom Inventory (NSI), Posttraumatic Stress Disorder Checklist, Alcohol Use Disorder Checklist, Combat Exposure Scale, and TBI Quality of Life and passed symptom validity tests at 0-8 months and ≥2 years post-injury. Forward stepwise logistic regression included 26 potential predictors (demographics, injury characteristics, military characteristics, and self-report measures at baseline) of International Statistical Classification of Diseases and Related Health Problems-10 Postconcussional Syndrome (PCSy) at follow-up. Results: Cognitive Concerns (Exp(B)=.896, p=.001), Sleep (Exp(B)=1.874, p<.001), Somatosensory Symptoms (Exp(B)=1.194, p=.012), and mod-sev TBI (Exp(B)=2.959, p=.045) significantly predicted follow-up PCSy. When baseline NSI symptoms were removed from the model, Cognitive Concerns (Exp(B)=.902, p<.001), Post-traumatic stress (Exp(B)=1.173, p=.001), and Resilience (Exp(B)=.950, p<.031) significantly predicted PCSy. For all included measures in both models, higher symptoms at baseline predicted increased likelihood of follow-up PCSy. Both models correctly classified 81.3% of participants. Conclusion: Findings suggest patients reporting psychological distress and cognitive concerns acutely should be targeted for treatment to mitigate prolonged neurobehavioral symptoms.

117 Sleep Disruption has a Stronger Influence on Self-reported Neurobehavioral Status than Traumatic Brain Injury in U.S. Military Service Members and Veterans 1384417 Rael Lange DVBIC Sleep Disruption has a Stronger Influence on Self-reported Neurobehavioral Status than Traumatic Brain Injury in U.S. Military Service Members and Veterans Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: To examine the relation between sleep disruption and neurobehavioral outcome following mild, moderate, and severe traumatic brain injury (TBI). Methods: Participants were 509 U.S. military service members/veterans divided into four groups: uncomplicated mild TBI (n=183; MTBI); complicated mild TBI and moderate-severe TBI (n=96; STBI); injured controls (n=138; IC); and non-injured controls (n=92; NIC). Participants completed a 2-hour neurobehavioral test battery 12 or more months post-injury that included the PTSD Checklist and 13 scales from the TBI-Quality of Life (TBI-QOL). Using the TBI-QOL Sleep Disturbance scale, participants were classified into two ‘Sleep’ subgroups: Poor Sleep (55T or higher) or Good Sleep (50T or lower). Results: A higher proportion of the MTBI group was classified as having Poor Sleep (79.2%) compared to the IC (64.5%) and STBI (58.3%) groups; and all were higher than the NIC group (40.2%). In each group separately, participants with Poor Sleep had significantly worse scores on all TBI-QOL scales compared to those with Good Sleep (all p’s<.001, d=.68 to d=1.98). Participants with Poor Sleep consistently had worse TBI-QOL scores regardless of TBI severity or the presence/absence of TBI (all p’s <.05). Additionally, there was a significant interaction between Sleep and PTSD. Both factors combined resulted in worse outcome than either factor alone (p’s<.05). Conclusions: Poor Sleep had a very strong influence on self-reported neurobehavioral outcome, and a greater influence on outcome than TBI severity or the presence/absence of TBI. Poor Sleep may be a useful ‘risk factor’ that can be used clinically to identify individuals in need of early intervention.

118 SCAT5 Cognitive Screening Performance by Athlete Sex: Implications for Clinical Interpretation. 1384471 Christopher Bailey Case Western Reserve University School of Medicine SCAT5 Cognitive Screening Performance by Athlete Sex: Implications for Clinical Interpretation. Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: To examine sex differences in performance on SCAT-5 Cognitive Screening indices. Method: A multisport baseline sample was composed of 727 uninjured Division I collegiate athletes (52% female) who were administered the SCAT5 before the 2017-2018 seasons. Repeat baseline testing was completed by 273 uninjured athletes (48% female) at 1 year (days M=352.56;SD=56.03) who were then included in the repeated measure analyses. SCAT5 Cognitive Screening indices included the SAC Total, Immediate Recall, and Delayed Recall, at both baseline testing sessions. Results: A 3-factor mixed repeated measure MANOVA (SCAT5 Cognitive Index x baseline administration x sex) was completed. Significant between-subject differences were noted across SCAT5 measures and baselines by sex (F(1, 271)=26.38,p<.001,partialη2= 0.09). Significant practice effects on all SCAT5 indices between Baseline administrations were observed for all athletes (F(1,271)=103.68,p<.001,partialη2= 0.28) and a small but significant interaction was noted where females demonstrated slightly larger practice effects than males (F(1,271)=6.24,p=.015,partialη2= 0.02). Descriptive statistics for SCAT Total highlight these findings: males (M=34.10,SD=5.10) and females (M=36.05,SD=4.66) at Baseline 1; males (M=36.07,SD=4.59) and females (M=38.90,SD = 4.79) at Baseline 2. Conclusions: Significant differences on the SCAT5 Cognitive Screening between male and female athletes were evident, with the females generally outperforming their male counterparts (medium effect). Substantial practice effects were noted for all athletes (large effect), with slightly larger practice effects noted for female athletes relative to males (small effect). These findings support the use of sex-specific SCAT5 normative data for interpretation, which may be of increased importance if using reliable change methodology requiring multiple administrations.

119 Neurocognitive profile of adult patient with shaken baby syndrome 1384279 Jeremy Hertza Neurobehavioural Associates - Neurocognitive profile of adult patient with shaken baby syndrome Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective:Shaken baby syndrome is a form of traumatic brain injury which occurs following physical shaking of an infant. This commonly leads to lasting neurological symptoms, such as seizures, cognitive deficits, with full symptoms often not apparent until later in life. The objective of this case study is to examine the correlation between a single episode of verified shaking as a 17-month-old child and corresponding cognitive functioning in a young adult individual. Neuroimaging confirming significant brain trauma will be included Method:The individual was shaken once as a 17-month-old and had sequalae life-long cognitive deficits. Cognitive ability was assessed with a clinical interview, neurobehavioral observations, comprehensive Neuropsychological Battery. Emotional functioning was assessed by questionnaires given to the individual’s grandmother. Results:Neuropsychological testing indicated severe and pervasive cognitive deficits. The individual could not write letters or numbers and had difficulty following basic instructions, despite being cooperative with testing, due to severe attentional issues. Functionally the patient could not care for himself and needed assistance with activities of daily living. Despite his cognitive impairment, the individual had a positive attitude. Clinical interview with the patient’s family indicated a strong supportive network for the individual. Conclusion:This case highlights the destructive and life-long effects of shaken baby syndrome, but also demonstrates the importance of a supportive environment for such an individual. A single instance of shaking rendered the individual unable to function independently and severely cognitively impaired. However, because of the individual’s social support, he maintains a high quality of life and is set to graduate high school at a delayed pace.

120 Practice Effects on Repeat Neuropsychological Assessment of Adults with Chronic Severe TBI 1384505 Danielle Stepien Bancroft NeuroRehab Practice Effects on Repeat Neuropsychological Assessment of Adults with Chronic Severe TBI Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: This study examined whether practice effects caused by repeated exposure to test materials during serial assessment significantly impacts the performance of adults with chronic severe traumatic brain injury (sTBI), given the severe memory impairment typical of this population. This study sought to describe the pattern of practice effects on repeat neuropsychological testing for this population. It was hypothesized that practice effects would be diminished for individuals with chronic sTBI. Method: This study utilized longitudinal archival data collected as part of an annual neuropsychological assessment battery administered to 43 individuals receiving post-acute rehabilitation services at a structured multisite day treatment program. Each participant was tested at two time points which differed by an average of 13 months. The battery consisted of the Texas Functional Living Scale (TFLS), Trail Making Test (TMT), Brief Mood Survey, Neuropsychological Assessment Battery (NAB) Screening Module (NAB-SN), and Judgment subtest from the NAB Executive Functions Module (NAB Judgment). Results: A paired-samples t-test was conducted to compare differences in test scores from T1 and T2. There was a significant and reliable increase at T2 for NAB Attention, t(38) = 2.35, p < .05, d = 0.38, and TFLS Total Score, t(37) = 2.93, p< .01, d = 0.42. NAB Judgment subtest approached significance, t(34) = 1.82, p = 0.78, d = 0.29. Conclusion: This study indicates that adults with chronic sTBI demonstrate significant practice effects primarily on measures associated with functional living skills. These findings suggest that repeat testing in this population may be less susceptible to the influence of practice effects.

121 Verbal Learning in Veterans with Mild Traumatic Brain Injury, Posttraumatic Stress Disorder, and Co-occurring Conditions 1384445 Vanessa Jessie Adler University Verbal Learning in Veterans with Mild Traumatic Brain Injury, Posttraumatic Stress Disorder, and Co-occurring Conditions Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: The study examined how veterans with PTSD only, mTBI only, and co-occurring mTBI and PTSD acquire, encode, and consolidate verbal information at least three months post mTBI. Method: This retrospective study examined 57 veterans (15 mTBI only, 6 PTSD only, 19 mTBI + PTSD, and 17 veteran controls) from a VA setting who were recruited through: polytrauma clinic referrals, introductory letters, and study flyers. The sample included male and female OIF/OEF veterans aged 18 to 70. Inclusion and exclusion criteria of participants were determined by the following measures: (a) Structured Interview for TBI Diagnosis, (b) Clinician-administered PTSD Scale, and (c) Letter Memory Test. One-way ANOVA evaluated group differences between the mTBI only, PTSD only, and mTBI + PTSD groups. A two-way ANOVA evaluated group differences between veterans with and without PTSD. Results: The two-way ANOVA revealed that veterans with PTSD perform below the mTBI only and veteran control groups (F = 6.59, p = 0.01) on serial clustering forward strategy. The one-way ANOVA demonstrated that the mTBI + PTSD group performed below the mTBI only group on Trial 1 (F = 3.61, p = 0.04). Conclusions: The mTBI + PTSD group performed worse than the mTBI only group on their ability to acquire verbal information. This result may suggest that the co-occurring effects of mTBI and PTSD negatively attribute to a veteran’s ability to focus and attend to new information. Veterans without PTSD were more likely to use a serial clustering strategy to recall information compared to Veterans with PTSD.

122 Intra-Individual Variability in Traumatic Brain Injury and Questionable Performance Validity 1384275 Jeremy Davis University of Utah Intra-Individual Variability in Traumatic Brain Injury and Questionable Performance Validity Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Intra-individual variability (IIV) has been associated with cognitive dysfunction and traumatic brain injury (TBI) severity. This study examined IIV in physical medicine and rehabilitation patients grouped by TBI severity and performance validity. Method: Participants (N = 213) were 32% female and 90% white with average age and education of 42 (SD = 13) and 14 (SD = 2) years, respectively. Participants completed an outpatient evaluation using a flexible battery of up to 33 common neuropsychological measures. Participants were grouped by TBI severity and validity: mild (32%), moderate (14%), severe (32%), and questionable performance validity (QPV; 22%). QPV was determined on the basis of embedded and freestanding validity measures. Test battery scores were converted to T scores. Cases with four or more scores below 36 T were identified as impaired. Measures of IIV were calculated including overall test battery mean (OTBM), test battery standard deviation (SD), kurtosis, skew, range, and unbiased coefficient of variation (UCV). IIV measures were compared across groups. Results: Groups were significantly different in OTBM (p < .001), kurtosis (p < .03), and UCV (p < .001). In valid cases, TBI severity was associated with OTBM (rho = -.31), SD (.19), kurtosis (-.16), and UCV (.33). Impaired and unimpaired cases were significantly different in OTBM (p < .001), SD (p < .001), range (p < .01), and UCV (p < .001). QPV cases were similar to impaired cases on measures of IIV. Conclusions: IIV measures have potential clinical utility in characterizing cognitive deficits in TBI and warrant further study.

123 Effects of Ethnicity, Educational Attainment, and Severity of Traumatic Brain Injury on Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Index Scores 1384265 Joseph Ryan University of Central Missouri Effects of Ethnicity, Educational Attainment, and Severity of Traumatic Brain Injury on Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Index Scores Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: This study utilized a culturally diverse sample with traumatic brain injury (TBI) to examine effects of ethnicity on the Verbal Comprehension (VCI), Perceptual Reasoning (PRI), Working Memory (WMI), and Processing Speed (PSI) indices of the Wechsler Adult Intelligence Scale-Fourth Edition while controlling for education and injury severity. Hypotheses were that education and ethnicity would significantly influence all indices, the latter to a lesser extent, and injury severity would most strongly affect PSI scores. Method: Participants were 43 trauma center admissions with documented head injury. Mean age and education were 32.16 and 13.88 years, respectively. There were 14 Euro-, 17 Hispanic-, and 12 African-Americans. Results: ANCOVAs revealed significant effects for education across indices. Significant effects were found for ethnicity on the VCI and PRI and injury severity on the PSI. Post hoc comparisons indicated Euro- and Hispanic-Americans did not differ on VCI but performed significantly higher than African-Americans. Euro-Americans performed significantly better than African-Americans on the PRI, but comparable performance emerged between Euro- and Hispanic-Americans and between African- and Hispanic-Americans. Groups did not differ on the WMI or PSI. Conclusions: Education and ethnicity accounted for most of the variance in VCI and PRI. Analysis of the WMI revealed education produced a significant effect, but ethnicity and injury severity did not. On the PSI, education and injury severity had significant effects. PSI was the only composite to which injury severity made a statistically significant contribution. Despite the small sample size, findings have important implications in the intellectual assessment of individuals with TBI.

124 Acute Predictors of Chronic PTSD symptoms following TBI in U.S. Military Service Members 1384506 Sara Lippa Walter Reed National Military Medical Center Acute Predictors of Chronic PTSD symptoms following TBI in U.S. Military Service Members Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Post-Traumatic Stress Disorder (PTSD) has been shown to be a major contributor to poor outcome after Traumatic Brain Injury (TBI). Understanding the factors that contribute to PTSD symptoms may lead to improved clinical management of PTSD and TBI. This study examines acute predictors of self-reported PTSD symptoms after TBI in military service members. Method: Participants included 210 U.S. military service members (Age: M=33.9 years, SD=10.2) without injury (n=86), or with history of uncomplicated mild TBI (n=56), complicated mild, moderate, or severe TBI (n=43), or bodily injury (n=25) assessed at 0-8 months and ≥2 years post-injury. At both assessments, participants completed the PTSD Checklist (PCL-C), Neurobehavioral Symptom Inventory, Alcohol Use Disorder Checklist, Combat Exposure Scale, and TBI Quality of Life and passed symptom validity tests. Stepwise linear regression included 26 potential predictors (demographics, injury characteristics, military characteristics, and self-report measures at baseline) of PCL-C Total at follow-up. Results: In this model, (F(4,188)=68.0; p<.001; R2=.591), baseline PCL-C (R2Δ=.52) was the main predictor of follow-up PCL-C Total, followed by Cognitive Concerns (R2Δ=.04), number of deployments (R2Δ=.01), and injury severity (R2Δ=.02). When baseline PCL-C was excluded as a predictor, somatosensory symptoms (R2Δ=.361), Emotional/Behavioral Dyscontrol (R2Δ=.067), Sleep (R2Δ=.033), Combat Exposure (R2Δ=.024), and Cognitive Concerns (R2Δ=.017) predicted follow-up PCL-C (F(5,187)=37.7; p<.001; R2=.502). Semipartial correlations revealed that most of the explained variance was shared among self-report predictors. Conclusion: Findings suggest acute psychological distress impacts future PTSD symptomatology, whereas TBI characteristics, such as TBI severity and number of TBIs, have minimal influence.

125 An analysis of the traumatic brain injury outcomes and needs of people in urban, rural and remote areas. 1384248 Karen Sullivan Queensland University of Technology An analysis of the traumatic brain injury outcomes and needs of people in urban, rural and remote areas. Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Little is known about the traumatic brain injury (TBI) outcomes for people returning to urban versus rural communities. These communities typically differ in terms of the availability of formal and informal supports. We compared patient-reported TBI outcomes for three communities (urban, rural, and remote) and modelled their predictors. Method: Six hundred and sixty-two cases with mild-to-severe TBI were identified from hospital records. These individuals received a mail-out survey comprised of standardized outcome measures. The measures assessed: symptoms, quality-of-life, service obstacles, unmet needs, mental health, and community integration. Ninety-one people who were less than two years post-injury returned a usable survey (18% response rate). The location of communities was coded using the Accessibility Remoteness Index of Australia (urban n=22, rural n=43, remote n=26). Results: There were no differences in the outcomes due to location (p’s >.05). The significant individual predictors of five of the six outcomes were the participant’s sex, age, and the injury severity; but location did not play a role. TBI outcomes were typically worse if the injury was severe, or if the injured person was older or female. For one outcome (community integration) males fared worse than females. Conclusion: Contrary to expectations, location did not affect patient-reported TBI outcomes. This could indicate that the same supports are available to patients, despite their location or; that the different supports were relied on to achieve the same outcomes. The overall findings urge continued investment in TBI rehabilitation, particularly for the subgroups that experienced the worst outcomes.

126 Clinical Utility of Risk Factors to Predict Self-reported Neurobehavioral Outcome Following Traumatic Brain Injury: PTSD, Sleep, Resilience, and Lifetime Blast Exposure 1384416 Rael Lange DVBIC Clinical Utility of Risk Factors to Predict Self-reported Neurobehavioral Outcome Following Traumatic Brain Injury: PTSD, Sleep, Resilience, and Lifetime Blast Exposure Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: To examine the clinical utility of PTSD, Sleep, Resilience, and Lifetime Blast Exposure as ‘Risk Factors’ for predicting poor neurobehavioral outcome following traumatic brain injury (TBI). Methods: Participants were 993 service members/veterans evaluated following an uncomplicated mild TBI (MTBI), moderate-severe TBI (ModSevTBI), or injury without TBI (Injured Controls; IC); divided into three cohorts: (1) <12 months post-injury, n=237 [107 MTBI, 71 ModSevTBI, 59 IC]; (2) 3-years post-injury, n=370 [162 MTBI, 80 ModSevTBI, 128 IC]; and (3) 10-years post-injury, n=386 [182 MTBI, 85 ModSevTBI, 119 IC]. Participants completed a 2-hour neurobehavioral test battery. Odds Ratios (OR) were calculated to determine whether the ‘Risk Factors’ could predict ‘Poor Outcome’ in each cohort separately. Sixteen Risk Factors were examined using all possible combinations of the four risk factor variables. Poor Outcome was defined as three or more low scores (<1SD) on five TBI-QOL scales (e.g., Fatigue, Depression). Results: In all cohorts, the vast majority of risk factor combinations resulted in ORs that were ‘clinically meaningful’ (ORs>3.00; range=3.15 to 32.63, all p’s <.001). Risk factor combinations with the highest ORs in each cohort were PTSD (Cohort 1 & 2, ORs=17.76 and 25.31), PTSD+Sleep (Cohort 1 & 2, ORs=18.44 and 21.18), PTSD+Sleep+Resilience (Cohort 1, 2, & 3, ORs=13.56, 14.04, and 20.08), Resilience (Cohort 3, OR=32.63), and PTSD+Resilience (Cohort 3, OR=24.74). Conclusions: Singularly, or in combination, PTSD, Poor Sleep, and Low Resilience were strong predictors of poor outcome following TBI of all severities and injury without TBI. These variables may be valuable risk factors for targeted early interventions following injury.

127 Changes in frequency of ImPACT assessments over time 1384442 Hana Kuwabara University of Nevada, Las Vegas Changes in frequency of ImPACT assessments over time Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Assessment, management, and rates of sport concussion have changed significantly over the past decade. The present cross-sectional study investigated rates of ImPACT baseline and post-concussion assessments and self-reported concussion history (CH) to gain insight on patterns of change between 2008, 2012, and 2016. Methods: Participants included 14,129 high-school athletes (Mage=15.11; 42.9% male) in Nevada who completed ImPACT baseline and post-concussion assessments in 2008 (n= 677), 2012 (n=8315), and 2016 (n= 5137). Chi-square analyses were conducted to examine frequencies of ImPACT tests by year (i.e., baseline, initial post-concussion test, and post-concussion follow-up). Further analyses investigated gender differences and changes in self-reported CH. Results: There were significant differences in rates of all ImPACT tests (p.05). Conclusions: The present study found an increase in the rate of post-concussion assessments; however, no increase in self-reported CH were evident. It is possible that an increase in awareness and preventative efforts could account for the increased utilization of post-concussion assessments. Results also indicated that female athletes took more post-concussion assessments over time suggesting an increase in concussions or prevention efforts for females. Future research should continue exploring possible risk factors to ensure proper intervention and implementation of prevention protocols where applicable.

128 Age of First Exposure to Football is not Associated with Midlife Brain Health Problems 1384343 Grant Iverson Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Spaulding Research Institute; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program Age of First Exposure to Football is not Associated with Midlife Brain Health Problems Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: This study examined if earlier age of first exposure (AFE) to football is associated with worse brain health in middle-aged men who played high school football. Method: Using an online crowdsourcing platform, we recruited 123 men ages 35-55 who played high school football. Participants completed self-report measures that assessed (i) demographic information; (ii) medical history, sport participation, and concussion history; (iii) current depression symptomatology (i.e., Patient Health Questionnaire-8; PHQ-8); and (iv) current concussion-like symptoms (i.e., the British Columbia Post-Concussion Symptom Inventory; BC-PSI). Approximately half (n=62; 50.4%) reported football participation starting before the age of 12 (AFE12 years). The two groups were compared using chi-squared and Mann-Whitney U-Tests. Results: Former high school football players who began playing football before age 12 did not differ in the rates at which they had been prescribed medications for psychological problems or in the rates at which they had recently experienced symptoms of anxiety, depression, memory loss, chronic pain, or headaches compared with former high school football players who began playing football at or after age 12. Additionally, there were no group differences in lifetime history of treatment by a mental health professional (χ2=0.20, p=.66) or regarding the PHQ-8 (U=1,839.0, p=.791) or BC-PSI total scores (U=1828.5, p=.751). Conclusion: These findings suggest that earlier AFE to football is not associated with worse brain health in middle-aged men in this sample who played high school football.

129 An Effect of Pre-injury Factors on the Relationship between Severity of Acute Symptoms and Sleep Quality Among Recovered and Non-Recovered Adolescents following Concussion 1384345 Hudaisa Fatima UT Southwestern Medical Center Christian LoBue The University of Texas Southwestern Medical Center Natalia David Tawny Meredith-Duliba UT Southwestern Medical Center Dallas Stephen Bunt Hynan Linda Todd Caze Munro Cullum University of Texas Southwestern Medical Center An Effect of Pre-injury Factors on the Relationship between Severity of Acute Symptoms and Sleep Quality Among Recovered and Non-Recovered Adolescents following Concussion Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Sleep disturbance following concussion has been linked to more severe symptoms and longer recovery times. However, it is unclear whether this association may be affected by pre-injury and mood factors. This study examines whether acute symptom severity was associated with poorer sleep quality among recovered vs not-yet-recovered adolescents at 3-months following injury after adjusting for age, sex and anxiety. Method: Adolescents aged 12-18 (N=449) presenting 7days to ConTex specialty concussion clinics were studied. Of these, 60 reported not being recovered at 3-month follow-up (Mage=15.23, Nmales=27, Nfemales=33). Participants completed the Sport Concussion Assessment Tool-3rd Edition (SCAT-3) Symptom Checklist, Pittsburgh Sleep Quality Index (PSQI), and General Anxiety Disorder-7 (GAD-7). Hierarchical linear regressions assessed if initial symptoms as measured by the SCAT-3 total symptom score, predicted sleep quality at 3-month follow-up, controlling for initial data of age, sex, PSQI, and GAD-7. Results: Initial total symptom scores did not predict higher PSQI scores at 3-months for either recovered or non-recovered subjects [F (1, 362, p=.550 and F (1,48), p=.307, respectively]. For recovered subjects, initial sleep ratings (p<.001) predicted 3-month sleep quality, while there was a trend for age (p=.054). For non-recovered subjects, only sex was associated with lower sleep quality at 3-months (p=.034). Conclusions: Sleep disturbance was not associated with severity of concussion symptoms when accounting for age, sex, and initial sleep quality. These findings do suggest, however, that females were more likely to report lower sleep quality when experiencing longer recovery.

130 An Exploratory Analysis of the Impact PTSD Related Sleep Disturbance has on Language Generativity in Veterans with mTBI 1384295 Nicole Walker VA Palo Alto Health Care System Sierra Pacific Mental Illness Research Education Clinical Centers of Excellence, Alliant International University An Exploratory Analysis of the Impact PTSD Related Sleep Disturbance has on Language Generativity in Veterans with mTBI Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Reviewed literature suggests that individuals with Posttraumatic Stress Disorder (PTSD) demonstrate cognitive deficits in attention, learning/memory, and executive functions. Less is known regarding the relationship between sleep disturbance and language abilities among individuals with PTSD. We hypothesized that subjective perceptions of PTSD-related sleep disturbance would impact language generativity in Veterans with PTSD. Methods: 38 individuals (mean age = 46.58, SD = 13.55; 10% female) were administered a brief neurocognitive battery including measures of verbal generativity [i.e., Delis-Kaplan Executive Function System: Verbal fluency subtest], PTSD symptoms (i.e., clinically significant PTSD = > 35 on the PTSD Checklist for DSM-IV), self-report measures of sleep quality (Pittsburgh Sleep Quality Inventory; PSQI), and PTSD-related sleep disturbances (PSQI – Addendum for PTSD). All participants had a history of mild traumatic brain injury (mTBI). An analysis of covariance was used to assess the contribution of PTSD-related sleep disturbance on verbal fluency in Veterans with PTSD. Post-hoc analyses were conducted. Results: Those without PTSD performed better on letter fluency than those with PTSD (p=.019). There was no significant effect of PTSD (presence or absence) on letter fluency performance after controlling for subjective sleep quality, F(1, 35) = 1.43, p = .239. Follow up analyses failed to show any associations between PTSD and other cognitive measures. Conclusions: PTSD related sleep disturbance accounts for a significant portion of the variance in the relationship between PTSD and verbal generativity. Individuals with a history of mTBI and current PTSD symptoms, may have worse verbal generativity but is partially accounted for by PTSD related sleep disturbance.

131 Clinical Utility of the Child & Adolescent Memory Profile in Children with TBI 1384469 Jacobus Donders Mary Free Bed Rehabilitation Hospital Clinical Utility of the Child & Adolescent Memory Profile in Children with TBI Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: To evaluate the sensitivity of The Child and Adolescent Memory Profile (ChAMP), a relatively new test of learning and memory, to traumatic brain injury (TBI). Method: The ChAMP was administered to 61 6-16 year-old children with TBI within 1-12 months post injury. The sample was 64% male and 75% Caucasian, with a median parental level of education of 13 years. Twenty-nine children had uncomplicated mild TBI whereas 32 children had either intracranial lesions on neuroimaging or coma of at least 24 hrs, or both. The findings from the complete TBI group were compared to those from a demographically matched control group, obtained from the ChAMP standardization sample. Results: Within the TBI group, the Visual Memory, Immediate Memory, Total Memory and Screening Index scores all demonstrated statistically significant correlations with length of coma. After applying a Benjamini-Hochberg adjustment to correct for the effect of multiple comparisons, the performance of the matched control group was still statistically significantly better than that of the children with TBI on all of the ChAMP Index scores. Effect sizes ranged from small to medium. At the subtest level, Places and Places Delayed showed the greatest group differences. Conclusion: These findings supported the clinical utility of the ChAMP in the evaluation of learning and memory in children with TBI.

132 MMPI-2 Clinical Scales Relation to Acquired Brain Injury 1384481 Lisa Stebbins Nova Southeastern University MMPI-2 Clinical Scales Relation to Acquired Brain Injury Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: To determine whether MMPI-2 clinical scales are related to Acquired Brain Injury(ABI) compared to Healthy individuals. Methods: Participants were selected by DSM-IV diagnoses from a de-identified, archival database. The sample(n=75) included an ABI group(n =34, Mage=43, Medu=13.4, 58.8% Males, 64.7% Cau.) that have had long-term chronic traumatic brain injury(TBI) and a control group(n =41, Mage=33, Medu=14.2, 63.4% Males, 58.5% Cau.). Results:Independent samples t-test analysis determined statistically significant differences between groups(p≤.01). Results revealed increases on clinical scale-1 (hypochondriasis; t(1,73)=2.839, p=.006), scale-2 (depression; t(1,73)=2.628, p=.01), and scale-8 (schizophrenia; t(1,73)=2.570, p=.01) in ABI group compared to control group. No other significant differences were found. Conclusion:Research has shown that TBI’s can create neurological and emotional dysfunction. The current elevations may be residual symptoms from the TBI. Research shows as a result of having a TBI, individuals suffer from depression, anxiety, PTSD, and substance abuse, which is analogous to current findings. For instance, scale-2 relates to symptoms of depression and worry and scale-1 to somatic and health complaints. These can be indirect symptoms of a TBI, in which individuals can have persistent symptoms related to physical health leading to problems with daily functioning and ultimately producing emotional distress. Additionally, research shows that individuals with persistent TBI often present with neurocognitive deficits in attention regulation, executive functioning, and memory. This can create increases in scale-8 that shows concerns related to impaired concentration/memory, impulse control, and motor/sensory complaints. Treatment of ABI's should not only include cognitive rehabilitation, but also individual therapy due to the impact of traumatic injury on emotional functioning.

133 Understanding caregiver anxiety after traumatic brain injury 1384332 Carly Burger Mercer University Understanding caregiver anxiety after traumatic brain injury Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: After an individual sustains a severe traumatic brain injury (sTBI), the recovery process continues, as there are often long-standing difficulties in cognitive, behavioral, and physical abilities. People who care for individuals living with sTBI experience unique challenges. The term to best explain these challenges is caregiver burden. More often than not in research, caregiver burden combines stress and the emotional toll with the most challenging behaviors they encounter. This systematic review aims to assess anxiety for sTBI caregivers. Methods: A search for recent, peer-reviewed publications was conducted using GALILEO, which encompasses PsychINFO and PubMed, with the terms “caregiver burden,” “care recipient,” “caregiver,” “burden,” “anxiety,” “stress,” “strain,” “traumatic brain injury” which resulted in N=1,013 total articles. After excluding irrelevant studies lacking anxiety and sTBI, N=8 articles remained. Results: A review of relevant studies revealed many psychosocial factors that contribute to anxiety including perceived stress/strain management, coping style, and level of care. When an individual had a dual diagnosis of sTBI and psychiatric disorder (e.g., depression) combined with behavioral disturbances (e.g., anger), caregivers showed increased anxiety. Similarly, caregivers’ anxiety increased depending on military career, gender, and relationship status. Protective factors for caregivers included social support and psychotherapeutic interventions, specifically brief structured psychoeducation. Conclusions: The results of this systematic review highlight the specific challenges sTBI caregivers face and subsequent anxiety. Individuals with sTBI experience adjustment phases post-injury, and the caregivers experience the transitions alongside the survivor. Future research should investigate how to increase caregiver protective factors and manage the impact of caregiver anxiety on individuals with sTBI.

134 A Comparison Between English-Speaking and Mandarin-Speaking Adolescent Student Athletes on Baseline Preseason ImPACT® Neurocognitive Performances and Symptom Reporting 1384496 Grant Iverson Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Spaulding Research Institute; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program A Comparison Between English-Speaking and Mandarin-Speaking Adolescent Student Athletes on Baseline Preseason ImPACT® Neurocognitive Performances and Symptom Reporting Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Student athletes commonly complete baseline preseason assessments of neurocognitive performances and symptom reporting using ImPACT®. Some past researchers have examined differences in performances and symptoms based on language of administration and racial/ethnic identity. This study examines differences between Mandarin-speaking and English-speaking student athletes on ImPACT® at preseason assessments. Method: Participants included 252 adolescent student athletes who completed preseason baseline ImPACT® testing in Mandarin and 252 participants who completed testing in English, matched on age, gender, and health and academic history. These groups were compared on neurocognitive composite scores and symptom ratings. Results: Mandarin-speaking athletes performed modestly better on one of five neurocognitive composite scores (Visual Motor Speed, p<.001, d=.37). Language groups did not differ in total symptom severity, but Mandarin-speaking boys endorsed multiple physical symptoms at higher rates than English-speaking boys. Conclusions: These results suggest that the current ImPACT® neurocognitive normative data are reasonably appropriate for use with Mandarin-speaking adolescents. When back translated, a few Mandarin-language symptoms were not semantically equivalent to their corresponding English-language symptoms, but no group differences were observed for these symptoms. Modest language group differences were observed in physical symptom reporting, more so in boys than girls. Individuals of Asian descent are more likely to express their mental health concerns in somatic terms, and greater physical symptoms in Mandarin-speaking boys could correspond to an expression of psychological distress. Clinicians should be mindful of psychological functioning at baseline testing and post-concussion evaluations because students who do not identify with the dominant culture of their sporting environment might experience acculturative stress.

135 The interceding effects of social cognition and “cold” cognition in emotional functioning post-TBI. 1384245 Derek Ream Albizu University The interceding effects of social cognition and “cold” cognition in emotional functioning post-TBI. Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: This review examines studies that have identified both social and “cold” cognition in moderating emotional functioning as an outcome in individuals post-traumatic brain injury (TBI). Data Selection: A systematic search of the literature was conducted using the keywords: social cognition, hot cognition, cognitive processes, emotions, emotional functioning, TBI, ABI, brain injury. The search included five databases: (1) EBSCOhost, (2) Google Scholar, (3) ScienceDaily, (4) PubMed, (5) World Health Organization. Inclusion criteria consisted of peer-reviewed articles published in English between 2013-2019 that utilized measures examining aspects of “cold cognition,” measures that investigated social cognition, and, outcome measures of emotional functioning in individuals who sustained a TBI. Data Synthesis: A total number of 27 studies were identified through database searching with 16 papers selected. Three studies explained the function and implication of social cognition in individuals post-TBI. Additionally, 4 articles integrated statistical and demographic analyzes on individuals who suffered a TBI, and 9 studies exposed the relationship between “hot” and “cold” cognitions after sustaining a TBI. Conclusions: Our results suggest that individuals with a TBI often exhibit difficulties in social cognition that is linked to changes in emotional functioning. Several studies pointed to the limbic system as an area influenced by both social and “cold” cognition regarding emotional output and experiences. Conversely, this system is often impacted in TBI. Other studies emphasized the relationship between attention and perception regarding one’s ability to adequately engage in empathy, emotional resonance, and sensitivity. Additionally, these studies outlined how impaired executive functioning influences empathy, attention, decision-making, and Theory of Mind.

136 Effect of Language Ability on Processing Speed in TBI 1384250 Derek Ream Albizu University Effect of Language Ability on Processing Speed in TBI Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury

137 Increased symptom burden during baseline concussion testing: What does it mean? 1384302 Kaitlin Riegler The Pennsylvania State University Increased symptom burden during baseline concussion testing: What does it mean? Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury

138 Lifetime Repetitive Blast Overpressure Exposure Has Negative Impact on Quality of Life after Traumatic Brain Injury 1384305 Jason Bailie Defense And Veterans Brain Injury Center Lifetime Repetitive Blast Overpressure Exposure Has Negative Impact on Quality of Life after Traumatic Brain Injury Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury

139 Knowledge of concussion is determined by concussion education but not prior concussion or participation in contact sport. 1384256 Sally Kinmond Queensland University of Technology Knowledge of concussion is determined by concussion education but not prior concussion or participation in contact sport. Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: In order to prevent concussion and promote help-seeking behaviour, this study sought to establish baseline concussion knowledge scores in the general population and to better understand the factors that influence variations in these scores. Data selection: Participants were (N = 223) individuals over the age of 18 years (M = 35.21, SD = 14.31) recruited from the general population via an online questionnaire. Designed to measure knowledge of concussion, the questionnaire contained demographics, grouping variables (previous concussion education, n = 74; history of concussion, n = 72; and participation in contact sport, n = 36), and 37-items from the Concussion Knowledge Index (CKI) of the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS). Results: Concussion knowledge was higher than expected with 79.12 % of participants responding correctly to CKI items. Group comparisons found individuals with prior concussion education to be significantly higher than individuals without U = 4382.50, z = -2.526, p = .01 (two-tailed), the effect was small r = .21. There was no difference in knowledge scores for gender, participants with a history of concussion or those who participate in contact sport. Conclusion: When compared to similar studies sampling contact sports players, concussion knowledge was higher than expected. High-risk groups within the study (history of concussion and contact sport) were similarly informed than the general population. Further research is needed to understand whether higher knowledge translates to increased injury reporting and safer behaviour.

140 Single-Item Screening for Anxiety and Depression using the Neurobehavioral Symptom Inventory 1384468 Summer Rolin University of Utah Single-Item Screening for Anxiety and Depression using the Neurobehavioral Symptom Inventory Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Previous research in a Veterans Affairs sample proposed using single items on the Neurobehavioral Symptom Inventory (NSI) to screen for anxiety (item 19) and depression (item 20). This study examined the approach in an outpatient physical medicine and rehabilitation sample. Method: Participants (N=84) underwent outpatient neuropsychological evaluation using the NSI, BDI-II, GAD-7, MMPI-2-RF, and Memory Complaints Inventory (MCI) among other measures. Anxiety and depression were psychometrically determined via cutoffs on the GAD-7 (>4) and MMPI-2-RF ANX (>64T), and BDI-II (>13) and MMPI-2-RF RC2 (>64T), respectively. Analyses included receiver operating characteristic analysis (ROC) and logistic regression. Logistic regression models used dichotomous anxiety and depression as outcomes and relevant NSI items and MCI average score as predictors. Results: ROC analysis using NSI items to classify cases showed area under the curve (AUC) values of .77 for anxiety and .85 for depression. The logistic regression model predicting anxiety correctly classified 80% of cases with AUC of .86. The logistic regression model predicting depression correctly classified 79% of cases with AUC of .88. Conclusion: Findings support the utility of NSI anxiety and depression items as screening measures in a rehabilitation population. Consideration of symptom validity via the MCI improved classification accuracy of the regression models. The approach may be useful in other clinical settings for quick assessment of psychological issues warranting further evaluation.

141 An inclusive recruitment strategy can help to improve mTBI research 1384272 Kannan Singaravelu Jaganathan Queensland University of Technology An inclusive recruitment strategy can help to improve mTBI research Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Participant recruitment for mild traumatic brain injury (mTBI) research is challenging due to confounding factors and other documented selection biases. The strict application of typical inclusion and exclusion criteria has raised questions about the generalizability of mTBI research. This study explored the effect of applying commonly employed selection criteria on eligibility for mTBI research. Method: Between July and October 2019, a trained research nurse performed a weekly review of a tertiary hospital emergency department treatment registry. Three hundred and eight cases coded as “minor head injury” were identified (Mage = 43.7, SDage = 25.6). The case records underwent formal data extraction. Extracted clinical and demographic data were mapped against commonly applied mTBI research selection parameters. The presence of persistent postconcussion symptoms (PPCS) was established via telephone administration of the Rivermead Postconcussion Symptom Questionnaire, 7-19 days post injury. Results: Analysis revealed that 23% of patients met the World Health Organization operational definition of an mTBI. The failure to meet this criterion was primarily due to missing or incomplete information for post-traumatic amnesia. The application of exclusion criteria left just 5.5% of the initial pool eligible for mTBI research. Of these participants, ongoing PPCS could not be established in any individuals. Conclusion: Participant recruitment for mTBI research could be improved by establishing a dedicated patient management system that streamlines and augments the quality of vital clinical data. An inclusive recruitment strategy that handles patient heterogeneity using statistical methods as opposed to exclusion from research could enhance the generalisability of mTBI research.

142 Examining the Impact of the Recent New Dot Counting Test Cut-Off Score in Bilingualism and Traumatic Brain Injury Survivors 1384376 Nick Graub Lundquist Institute Examining the Impact of the Recent New Dot Counting Test Cut-Off Score in Bilingualism and Traumatic Brain Injury Survivors Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: McCaul et al. (2018) recently revised the Dot Counting Test (DCT) cut-off score from ≥17 to 13.80; we evaluated the new cut-off in monolingual and bilingual traumatic brain injury survivors (TBIS) and healthy comparison participants (HCP). Method: The sample consisted of 43 acute TBI [ATBI; 23 English monolinguals (EM); 11 English first language bilinguals (EFLB); and 9 English second language bilinguals (ESLB)]; 30 chronic TBI (CTBI; 13 EM; 9 EFLB; 8 ESLB), and 56 HCP (23 EM; 11 EFLB; 22 ESLB). Results: An ANCOVA, controlling for age and education, revealed an interaction where ATBI-EFLB had higher E-scores than the other groups and the CTBI-EFLB had lower E-scores than the other groups. Both the conventional and proposed new cut-off (PNC) scores had different failure rates in ATBI (conventional cut-off: 9%; PNC: 28%), CTBI (conventional cut-off: 10%; PNC: 20%), and HCP (conventional cut-off: 11%; PNC: 13%). For language groups, EM (conventional cut-off: 14%; PNC: 22%), EFLB (conventional cut-off: 10%; PNC: 26%), and ESLB (conventional cut-off: 5%; PNC: 10%) demonstrated different failure rates across cut-off scores. Group differences were found with McCaul et al. (2018) cut-off, but not the conventional cut-off score. Also, chi-squared analysis revealed ATBI EFLB and EM had greater failure rates than ATBI ESLB. Conclusion: Unfortunately, the new DCT cut-off score resulted in greater failure rates in TBIS. Furthermore, ATBI EM and EFLB were impacted more by the new cut offs than ATBI ESLB who learned English later in life, although the reason for this finding is unclear and requires additional study.

143 Neurocognitive Effects of Comorbid Affective Disorders in College Athletes 1384329 Garrett Thomas Pennsylvania State University Neurocognitive Effects of Comorbid Affective Disorders in College Athletes Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: The objective of the current study is to examine the effects of depression, anxiety, and comorbid depression/anxiety on neurocognitive performance in college athletes. We hypothesized a priori that the mood disorder groups would perform worse than healthy controls, with the comorbid group performing worst overall. Method: 831 (M=620, F=211) collegiate athletes completed a comprehensive neuropsychological test battery at baseline which included self-report measures of anxiety and depression. Athletes were separated into 4 groups (Healthy Control (HC) (n=578), Depression Only (n=137), Anxiety Only (n=54), Comorbid Depression/Anxiety (n=62)) based on their anxiety and depression scores. Athletes’ neurocognitive functioning was analyzed via z-score composites of Attention/Processing Speed, Memory, and Global Functioning. Results: A one-way ANOVA comparing the means of the four groups revealed that, compared to athletes in the HC group (e.g. those with no affective symptoms), those in the depression only and anxiety only groups were not significantly different from one another or the HC group on neurocognitive outcomes. However, the comorbid group performed significantly worse than the HC group on Attention/Processing Speed, t(827)=-2.28, p=0.023, d=0.30, and Global Functioning, t(827)=-2.32, p=0.020, d =0.30, but not on the Memory composite. Conclusions: Athletes in the comorbid group performed significantly worse than HCs on composites of Attention/Processing Speed and Global Functioning. These results show that collegiate athletes tested at baseline who have comorbid depression and anxiety should be identified, as their poorer cognitive performance at baseline could skew future/post-concussion comparisons.

144 Mild Traumatic Brain Injury and Sleep Disturbances in Military Service Members as Predictors of Days Missed from Duty 1384472 Jessica Higa Brooke Army Medical Center Mild Traumatic Brain Injury and Sleep Disturbances in Military Service Members as Predictors of Days Missed from Duty Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: Duty-limiting pain impacts military readiness. Conditions such as mild traumatic brain injury (mTBI), stress-related disorders (Acute Stress Disorder (ASD)/PTSD), depression, anxiety and sleep disturbance occur frequently among military service members and can be associated with pain-related time off from duty. The purpose of this study was to explore which of these conditions best predict time off duty. Method: Time off duty was categorized into low (0-3 days), medium (3-30 days) and high (more than 30 days). After excluding participants undergoing a Medical Evaluation Board (MEB) or with potentially invalid symptom reporting, 364 military service members were included. An ordinal regression analysis was conducted with presence or absence of mTBI, ASD/PTSD, depression/anxiety and sleep disturbance as predictors. Results: The regression model was significant (χ2=21.93, p<.001), with mTBI status and sleep disturbance emerging as significant predictors of pain-related time off duty. Those with a history of mTBI were five times more likely to miss duty days than those without mTBI (Odds Ratio (OR)=5.09 [p=.04]). Presence of ongoing sleep disturbance conveyed two times the risk of more missed duty (OR=2.09 [p=.04]). Conclusion: This suggests that treating mTBI and sleep disturbances in military service members can reduce pain-related absenteeism and consequently improve military readiness.

145 Evaluating Attention and Processing Speed and Executive Functioning Abilities in Hispanic Traumatic Brain Injury Survivors and Healthy Adults 1384347 Winter Olmos CSU Fresno Evaluating Attention and Processing Speed and Executive Functioning Abilities in Hispanic Traumatic Brain Injury Survivors and Healthy Adults Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: We examined the effects of attention/processing speed (APS) and executive functioning (EF) in Hispanic and Caucasian traumatic brain injury (TBI) survivors and healthy comparison participants (HC). Method: The sample consisted of 45 HC (21 Hispanics & 24 Caucasian), 28 acute TBI (ATBI; 10 Hispanics & 18 Caucasians), and 26 chronic TBI (CTBI; 9 Hispanics; 17 Caucasians) participants. ATBI participants were tested 6 months post-injury; CTBI participants were tested 12 months or more post-injury. Symbol Digit Modalities Test (SDMT) Oral, SDMT Written, Stroop Word, Stroop Color, and Trail Making Test (TMT) part A were used to create an APS composite (APSC) score. Stroop color-word, TMT part B, Delis-Kaplan Executive Function System verbal fluency composite score, and design fluency composite score were used to create an EF composite (EFC) score. Results: ANOVAs were used to evaluate group differences. Main effects were found on APSC, p=.000, with HC and CTBI outperforming the ATBI group. Also, we found the HC group outperformed both TBI groups on EFC, p=.000. Furthermore, we found differences between racial/ethnic groups, with Caucasians outperforming Hispanics on EFC performance, p=.029. No interactions were found. Conclusion: Overall, HC demonstrated better EF compared to both TBI groups, but only APS compared to the ATBI group. Also, CTBI survivors demonstrated better APS abilities compared to ATBI survivors. Our findings suggest improvement in APS during the later stages of TBI recovery. Finally, Caucasians demonstrated better EF compared to Hispanics.

146 A Comparison of Neuropsychological Assessment Results and Self-Reported Cognitive Deficits in Traumatic Brain Injury Patients with Variable Neurocognitive Impairment Severity 1384451 Katelyn Coddaire Midwestern University - Glendale, AZ A Comparison of Neuropsychological Assessment Results and Self-Reported Cognitive Deficits in Traumatic Brain Injury Patients with Variable Neurocognitive Impairment Severity Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: This study aimed to determine the relationship between symptom self-report accuracy and objective cognitive functioning in multiple cognitive domains for varying neurocognitive impairment (NCI) subsequent to Traumatic Brain Injury (TBI). Specifically, the discrepancy between self-report and objective findings among participants with mild, moderate, and severe NCI was examined within the cognitive domains of Attention, Executive Functioning, Learning/Memory, and Speech/Language. Method: The sample included archival data consisting of neuropsychological scores and self-reported Ruff Neurobehavioral Inventory (RNBI) results of 135 adult TBI patients with mild, moderate, or severe NCI who received neuropsychological assessment at a private practice. Patients were grouped based on level of impairment using Halstead Impairment Index criteria. Results: No main effect was found for Attention. Patients with severe NCI had greater discrepancies in Executive Functioning (p=0.015), Learning/Memory (p=0.015), and Speech/Language (p<0.001) function, when compared to those with mild NCI. Additionally, patients with severe NCI demonstrated greater discrepancies in Speech/Language (p<0.001) function when compared to those with moderate NCI. Conclusion: These findings indicate as severity of neurocognitive impairment increases for TBI patients, self-reported cognitive symptomatology – specifically executive functioning, learning/memory, and speech/language – will become less accurate. Clinically, these findings suggest that when working with patients who have severe neurocognitive deficits subsequent to TBI, it is important to consider objective testing as self-reporting may not be accurate. Understanding patient’s genuine deficits will foster patient awareness and acceptance of TBI-related cognitive deficits with increased investment in treatment and improved neurorehabilitation outcomes.

147 Post-Concussive Symptoms in Adolescent Athletes with Premorbid Psychiatric History: A Matched Case-Control Study 1384431 Chase Presley UT Southwestern Medical Center Post-Concussive Symptoms in Adolescent Athletes with Premorbid Psychiatric History: A Matched Case-Control Study Neurological and Neuropsychiatric Disorders: Traumatic Brain Injury Objective: To examine sport-related concussion (SRC) symptoms in adolescent athletes with premorbid psychiatric history (PPH+) compared to a matched control sample without such history (PPH-). It was hypothesized that adolescents with PPH+ would report higher symptom severity both initially and at 3-month follow-up. Method: Participants aged 13-18 (M age=14.9) who reported a psychiatric history (N=29) presented to clinic within 7 days of sustaining a SRC. Subjects were matched to those without premorbid psychiatric history (N=29) by age, sex, race, sport, and time to clinic ( 1 day). All participants (N=58) completed the Post-Concussion Symptom Scale (PCSS) at initial visit and 3-month follow-up as part of the North Texas Concussion Registry (ConTex). Independent sample T tests compared PCSS total and cognitive/fatigue, vestibular, ocular, posttraumatic migraine, and anxiety/mood domain scores between groups across time points. Results: Consistent with our hypothesis, the PPH+ group reported significantly higher PCSS total (M=41.0/132 vs. M=27.7/132; p=.02), posttraumatic migraine domain (M=3.5/6 vs. M=2.5/6; p=.03), and anxiety domain (M=1.1/6 vs. M=0.4/6; p=.002) severity at the initial evaluation. However, there were no significant differences in PCSS total (PPH+ M=4.1/132 vs. PPH- M=3.3/132) or domain scores at 3-month follow-up. Conclusion(s): After matching by age, sex, race, sport, and time to clinic, adolescents with self-endorsed PPH+ reported higher total symptom, posttraumatic migraine, and anxiety domain symptom severity immediately following SRC but not at 3-month follow-up. Findings suggest that adolescents with PPH+ may experience higher subjective levels of distress following SRC, although further research is needed to understand the role of recovery in this population.

148 The Experiences of Partners of Elite Athletes Diagnosed with Post-Concussion Syndrome (PCS) 1384456 Bryanna Bruger St. Louis University School of Medicine The Experiences of Partners of Elite Athletes Diagnosed with Post-Concussion Syndrome (PCS) Neurological and Neuropsychiatric Disorders: Treatment and Rehabilitation Objective: This study explored partners’ experiences of caring for an elite athlete who has post-concussion syndrome (PCS) or lingering symptoms of concussion. Until this point, the concussion literature has focused mostly on experiences of athletes (McCrory et al, 2017) and caregivers of non-athletes with brain injury. Literature on partners of athletes with PCS is woefully underrepresented. The purpose of this study is to examine the experience of partners of elite athletes with PCS to add to current concussion and caretaker literature. Method: Conventional content analysis of semi-structured interviews was used for the inductive identification of common themes in the participants experience, with the coding categories directly derived from the text data. Results: Major themes created from the coding of interviews included a) the lack of literature available and provided to the general public on concussions and PCS is minimal, b) there is a sense of ambiguity for partners and their post-concussed loved ones regarding duration of symptoms and what to expect, c) partners turned to non-credible sources of information and at times, adding undue stress, and d) feeling as if the dynamics of their relationship had not changed, and if they had, quite minimally, following a concussion(s) sustained by their loved one. Evidence for mild caregiver burden was found and participants identified unexpected and exhausting emotional difficulties. Conclusion: Findings were consistent with current literature on caregivers of non-athletes with brain injury. This study extended current literature to include literature on partners of athletes with PCS.

152 Long-term Outcome Profiles of Survivors of Traumatic Brain Injury and Stroke After Holistic Milieu-Oriented Neurorehabilitation 1384478 Spring Johnson Barrow Neurological Institute Long-term Outcome Profiles of Survivors of Traumatic Brain Injury and Stroke After Holistic Milieu-Oriented Neurorehabilitation Neurological and Neuropsychiatric Disorders: Treatment and Rehabilitation Objective: The present study examined the outcome profiles of survivors of traumatic brain injury (TBI) and stroke up to 30 years after completing holistic milieu-oriented neurorehabilitation. Method: Participants included 99 individuals with acquired brain injury (TBI n=70; stroke n=29) who attended holistic milieu-oriented outpatient neurorehabilitation between 1986 and 2016. On average, time of discharge to follow-up was 9.3 years with a range of 0 to 29.3 years. Data are a part of a larger ongoing follow-up survey using the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a psychosocial outcome questionnaire developed for this study. Results: Independent-samples t-tests revealed that the TBI group was significantly younger than the stroke group on factors of age at the time of injury and age at the time of follow-up. However, the groups did not differ on factors of duration between discharge and follow-up as well as between injury and treatment. Regarding functional outcomes, analysis of covariance (ANCOVA) revealed no significant differences between the two groups on the MPAI-4 (Total Score and Subscales) while controlling for age at injury and age at the time of the study. Furthermore, 90% of TBI and 88% of stroke participants were productive (i.e., working/school full-time, part-time, or volunteering); whereas, 10% of TBI and 12% of stroke survivors were unemployed. Conclusion: Overall, the findings suggest that both groups’ long-term functional outcomes are similar and very positive. Specifically, both stroke and TBI participants were able to successfully maintain functional and productive activities even close to 30 years after discharge from holistic milieu-oriented neurorehabilitation.

153 Working Memory Performance and Brain Activity in the context of Opioid Withdrawal and Relapse. 1384331 Britni Surprenant University of Georgia Working Memory Performance and Brain Activity in the context of Opioid Withdrawal and Relapse. Neurological and Neuropsychiatric Disorders: Treatment and Rehabilitation Objective: Working memory (WM) deficits are associated with opioid use disorder (OUD). However, little research addresses WM during withdrawal. We used the N-back WM paradigm to assess whether differences exist between persons in withdrawal versus stable opioid doses. We also examined whether N-back performance or associated brain activity during either withdrawal or satiation predict subsequent abstinence versus relapse. Method: We evaluated N-Back performance and associated brain function of 20 OUD patients during 3T fMRI. Participants were actively using opioids during the first scan (SOWS M=8.10, SD=9.22) and abstained 24 hours before the second scan (SOWS M=28.26, SD=11.64), buprenorphine treatment began afterwards. Twelve participants (age: M=33.92, SD=5.99) completed both scans and were included in within-subject contrasts. Sixteen participants (age: M=34.38, SD=5.38) completed at least one scan and were evaluated on whether brain activation or performance was associated with relapse. Results: Paired-sample t-tests revealed no significant difference on N-back accuracy (0-back: t=0.78, p=.45, d=0.23; 2-back: t=-0.28, p=.78, d=0.08) or brain activation (2-back versus 0-back) across regions of interest (ROIs) associated with WM in prior studies between satiated and abstinent assessments (ts.05). Contrasting relapsing and abstinent groups at follow-up revealed no significant difference in N-back accuracy (0-back: t=-0.30, p=.77, d=0.14; 2-back: t=0.43, p=.67, d=0.22) or associated ROI brain activation (ts.05). Conclusion: This is the first investigation of brain and behavioral measures of WM in opiate withdrawal and relapse. No significant differences were found, and effect sizes were small. Further research that investigates direct (compensatory activation) and task-indirect systems (default network, motivation) during cognitive challenges is needed.

155 Association of Feigned Attentional Symptoms with Intra-Individual Variability in Intellectual Functioning 1384449 Melissa Myers University of South Alabama Association of Feigned Attentional Symptoms with Intra-Individual Variability in Intellectual Functioning Neuropsychological Domains: Attention Objective: The association between feigned Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms and intellectual functioning was examined in a sample of undergraduate students instructed to simulate ADHD. Method: 90 undergraduate students completed the Wechsler Adult Intelligence Scale (WAIS-IV), b Test, and Green’s Word Memory Test (WMT) as part of a larger study [mean age 19.23 years (SD 1.67), range 17-26 years old; mean 12.47 years of education (SD .86); 58.9% female; 58.9% Caucasian, 32.2% African American, 8.9% Other]. Intra-individual variability (IIV) was calculated as standard deviation of the overall test battery mean for the 10 core WAIS-IV subtests. Results: A moderate association was found between WAIS-IV IIV and b Test E-score (r = .397, p < .05). WAIS-IV IIV was also moderately associated with b Test errors (d errors r = .299, p < .05; commissions r = .284, p < .05; omissions r = .463, p < .01) and completion time (r = .332, p < .05). No significant relationships were found between WAIS-IV IIV and WMT performance. Conclusions: Given that IIV within intellectual functioning was correlated with performance on b Test but not WMT, this suggests the variability in objectively measured intelligence for simulators is associated with feigned attentional symptoms but not feigned memory symptoms. These findings implicate detection of malingered symptom presentation for ADHD to be more sensitive in the attentional domain compared to memory. Therefore, performance validity tests assessing attentional abilities may be more applicable in diagnostic settings aimed at detection of ADHD.

156 SPECT Imaging Differences During Connors’ CPT Task in Adult Males Versus Females with ADHD Combined Type 1384476 Lisa Stebbins Nova Southeastern University SPECT Imaging Differences During Connors’ CPT Task in Adult Males Versus Females with ADHD Combined Type Neuropsychological Domains: Attention Objective: To examine whether ADHD-Combined-Type in males and females alters brain activity at concentration. Method: Participants were selected by DSM-IV diagnoses from a de-identified, archival database. Sample(n=154) included a male(n=97, Mage=33.29, 67% Cau.) and female group(n =57, Mage=34.54, 71.9% Cau.). Exclusion criteria were most comorbid mood and neurological disorders. Cerebral blood flow(CBF) was assessed using SPECT during a concentration task(Conners’CPT) in 17-brain areas. Independent samples t-tests were performed to determine significant differences between groups (p<.001). Results: Analysis determined statistically significant CBF differences between the female and male groups at concentration. Chi-square showed no significant associations with age(0.349).The analysis yielded an increase CBF in female group compared to male group in the Bilateral Limbic-System(left area:t(152)=4.418, p<.0001; right:t(152)=4.113, p<.001), Bilateral Basal Ganglia(left:t(152)=5.948, p<.0001; right:t(152)=5.653, p<.001), Left Motor-Sensory area(t(152)=4.838, p<.0001), and Vermis(t(152)=4.414, p<.0001). Male group had increased CBF in the Bilateral Cerebellum(left:t(152)=6.592, p<.0001; right:t(152)=7.172, p<.001) and Right Occipital(t(152)=4.895, p<.0001) and Temporal lobes(t(152)=3.904, p<.0001). Conclusions: The female group, showed increases in CBF in the limbic system suggesting cognitive deficits related to emotional disturbances. While in the male group, the emotional control and auditory processing of information deficits can be related to the increased CBF in temporal area. Increased CBF in basal ganglia, vermis, and motor-sensory areas in the female group suggests increased activity related to integration of motor movements. Likewise, the male group showed deficits in motor movements, but also included deficits in balance and analyzation of objects/movement (increased CBF in cerebellum and occipital). Treatment of ADHD-Combined-Type can target discrete brain systems related to these differences in cognitive activity.

157 How Important Is Sustained Attention in Reversal Learning and Visual Task Shifting Abilities: A Canonical Correlation Analysis in Adults 1384340 Enrique Gracian UCLA How Important Is Sustained Attention in Reversal Learning and Visual Task Shifting Abilities: A Canonical Correlation Analysis in Adults Neuropsychological Domains: Attention Objective: We used canonical correlation analysis (CCA) to examine the relationship between performance on cognitive neuroscience measures of sustained attention, deterministic reversal learning (DRLT), and visual task-shifting (VTS). We evaluated whether DRLT and VTS predicted performance on the Continuous Performance Test-II (CPT-II). Method: Participants were 1011 adults from the Consortium for Neuropsychiatric Phenomics. The first CCA was conducted between four VST variables (set 1) and three CPT-II variables (set 2). The second CCA was conducted using eight Reversal Learning variables (set 1) and three CPT-II variables (set 2). Results: Our first CCA suggests that accuracy of performance in VTS predicts CPT-II measures, Rc = 0.33, Wilks’s λ = 0.86, F(12, 2646) = 1.92, p < .001. The analysis revealed a positive relationship with Hits (=0.87) and a negative relationship with FA (=-0.76), consistent with sustained attention. The second CCA revealed that acquisition trials and RT on reversal trials significantly predicted less FA and more hits on the CPT-II, Rc = 0.23, Wilks’s λ = 0.90, F(24, 1273) = 1.92, p = .005. Conclusion: Our multivariate findings confirm that attention is significantly involved in executive and mnemonic processes. To our knowledge, we are the first neuroscientific group to report multivariate evidence from a large data set that confirms sustained attention plays a significant role in reversal learning and task-shifting. Our results show that the CPT-II FA and mean RT variables specifically are important predictors of reversal learning and task-shifting, strengthening the concurrent validity of our experimental measures.

159 Effects of Sleep and Mood on Attentional Functioning in Pediatric Cancer Survivors 1384392 Grace Lozano University of Texas Southwestern Medical Center Effects of Sleep and Mood on Attentional Functioning in Pediatric Cancer Survivors Neuropsychological Domains: Attention Objective: Sleep-related problems have been shown to adversely affect pediatric cancer survivors’ mood, behavior, and quality of life (Litsenburg et al., 2011). Depressed mood also contributes to decreased quality of life in pediatric leukemia survivors (Jankowska-Polańska et al., 2019). However, minimal research has considered how sleep and mood affect cognitive outcomes in pediatric cancer survivors. The present study utilized both direct assessment and parent report to investigate how sleep and mood affect attentional functioning in this population. Method: Parents of 54 pediatric cancer survivors (59% Caucasian, 44% female, mean age at testing=11.27 years) referred for clinical evaluation completed the Behavior Assessment System for Children-3 (BASC-3) and Patient-Reported Outcomes Measurement Information System (PROMIS). A subset of survivors also completed the Conners Continuous Performance Test-3 (CPT-3). Variables selected for analysis were BASC-3 Depression, Hyperactivity, Attention Problems; PROMIS Sleep Impairment, Fatigue; CPT-3 Omissions. Results: Multiple linear regressions found that patients whose parents rated them higher on Depression and Sleep Impairment demonstrated more Omission errors (ΔR2 = .265, ΔF[4,42]=3.785, p=.01). Similarly, multiple linear regressions found that parents who rated their children higher on Depression, Fatigue, and Sleep Impairment were more likely to rate their children high on Hyperactivity (ΔR2 = .182, ΔF[4,49]=2.725, p<.05). Higher Depression ratings also predicted ratings of worse Attention Problems (r[53]=.330, p=.007). Conclusions: Findings suggest that both depressive symptoms and sleep impairment may adversely affect attention functioning following pediatric cancer treatment. This highlights the importance of addressing mood and sleep in interventions to address attention difficulties in pediatric oncology survivors. Future directions for research are discussed.

160 Understanding the Validity of the Digit Span Sequencing Task: A Least Executive Demand Model 1384488 Jennifer A Romano Morris University of Virginia Health Systems Understanding the Validity of the Digit Span Sequencing Task: A Least Executive Demand Model Neuropsychological Domains: Attention Objective: This study aimed to explore the patterns of Longest Digit Span from the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V), including understanding the newest sequencing condition. While there is a large body of research discriminating the cognitive demands of the forward and backward conditions, there is less literature devoted to the cognitive underpinnings of the sequencing task, and no studies looking at the applicability of this task with children. Patterns observed clinically on these conditions have suggested that the sequencing condition may involve less executive demand than the backwards condition (Least Executive Demand model). Therefore, it was predicted that Longest Digit Span Backwards (LDSB) would predict the most amount of variance in Working Memory scores on the Comprehensive Executive Functioning Inventory (CEFI). Method: Hierarchal multiple regression analysis controlling for FSIQ was completed utilizing an archival database (n=38) of children and adolescences (ages 6-15) referred to a university-based neuropsychological assessment clinic. Results: Longest digit span scores were not significant predictors of Working Memory scores on the CEFI [F (4, 27) =1.746, p=.169]. However, digit span capacity was weakly predictive of CEFI Attention scores [F (4, 27) = 2.818, p<.05; R2=.295]; with sequencing capacity as the only significant predictor (beta= .62, p<.05). Conclusions: While there was no evidence that working memory capacity predicts real world working memory skills, there was evidence that digit sequencing capacity is predictive of parent reported attentional difficulties. Poor performance on DSS in children may be due to difficulties concentrating, sustaining attention or with avoiding distractions.

161 Corticomedial amygdala volume significantly predicts cognitive flexibility in an older adult sample 1384301 Emma Jones University Of Georgia - Corticomedial amygdala volume significantly predicts cognitive flexibility in an older adult sample Neuropsychological Domains: Executive Functions Objective: The present study examined the relationship between anxiety, corticomedial and basolateral amygdala volume, and cognitive flexibility among older adults (OA). We hypothesized that higher subclinical Beck Anxiety Inventory (BAI) scores would be associated with lower cognitive flexibility, assessed using the Delis-Kaplan Executive Function System (D-KEFS) verbal fluency. Additionally, we hypothesized that basolateral amygdala volume would negatively correspond to anxiety scores and exhibit a positive relationship with cognitive flexibility. Method: Sixty-three OA (M age: 65; SD: 9; 59% female) were recruited via community advertising and cardiac clinics for a parent study on cardiovascular disease. Participants completed the D-KEFS and BAI as part of a comprehensive neuropsychological assessment prior to magnetic resonance imaging (MRI). Amygdala segmentation was completed with FreeSurfer version 6.0, using T1-weighted MPRAGE and T2-weighted FLAIR images. Data was analyzed using hierarchical multiple regression, controlling for age, sex, years of education, and intracranial volume. Results: No significant relationship emerged between basolateral amygdala volume and BAI scores (r=.11, p=.41) or cognitive flexibility (r=.04, p=.76). However, a significant positive relationship was observed between corticomedial amygdala volume and cognitive flexibility after controls (β=0.37, p<.01). Conclusions: The previously reported relationship between high anxiety and basolateral amygdala volume does not appear to extend to subclinical levels. We conjecture that the significant relationship between the corticomedial amygdala and cognitive flexibility represents the upward slope between arousal and cognitive performance on the Yerkes-Dodson curve. These findings newly implicate corticomedial amygdala volume as a representative measure linking emotional arousal and cognitive performance in OA.

162 Neurocognitive Functioning in Youth with Neurofibromatosis Type 1: Examining Relations between Executive Functions and Academic Achievement 1384337 Claire Friedhoff Roosevelt University Neurocognitive Functioning in Youth with Neurofibromatosis Type 1: Examining Relations between Executive Functions and Academic Achievement Neuropsychological Domains: Executive Functions Objective: Neurofibromatosis Type 1 (NF1) is an autosomal dominant genetic disorder affecting approximately 100,000 people in the U.S. It is commonly associated with neurofibromas, café-au-lait spots, and optic gliomas. It has also been linked to neurocognitive deficits, including learning disabilities and ADHD. This study examined relationships among executive functions (EF) and academic achievement in children diagnosed with NF1. Methods: Participants included 29 children (ages 2-21; M=9.28, SD=5.50) diagnosed with NF1 referred for neuropsychological evaluation as part of standard clinical care. A battery of tests was administered, including measures of intelligence (Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition; Wechsler Intelligence Scale for Children, Fifth Edition; Wechsler Adult Intelligence Scale, Fourth Edition), attention (Conners’ Continuous Performance Test II), EF (Delis-Kaplan Executive Function System), academic achievement in reading and math (Wechsler Individual Achievement Test, Third Edition), and parent rating scales examining EF in the home environment (Behavior Rating Inventory of Executive Function, Second Edition). Results: Relations between attention, EF, and academic achievement were examined using bivariate Pearson correlations. Lower scores on measures of EF (e.g., inhibition of prepotent responses) were linked to lower math achievement scores (r=.73, p<.05). Difficulties with sustained attention were associated with lower performance on measures of reading (r=-.60, p<.05) and math achievement (r=-.59, p<.05). Parent report of EF difficulties was correlated with lower reading scores (r=-.68, p<.05). Conclusions: Results suggest that children with NF1 are at risk for deficits in EF and academic achievement. Problems in these two domains are likely to co-exist. Thus, interventions targeting these skills should be well integrated.

163 APOE ε4 Alters Self-Awareness of Executive Function in Cognitively Intact Middle Aged and Older Adults 1384339 Sarah Evans Department of Psychology, Marquette University APOE ε4 Alters Self-Awareness of Executive Function in Cognitively Intact Middle Aged and Older Adults Neuropsychological Domains: Executive Functions Objective: Subjective cognitive complaints (SCC) may be an early indicator of future cognitive decline. Although early executive function (EF) decline in Alzheimer’s disease (AD) may be a sensitive predictor, the predicative utility of SCCs specific to EF is unknown. Thus, this study examined whether EF performance predicts SCCs of EF in healthy, well-educated middle aged and older adults, and whether carrying of APOE ε4 alters that prediction. Method: Fifty-five cognitively intact middle aged to older adults (Mage=64.1, range=48-84, 19 e4+) completed the Frontal Systems Behavior Scale (FrSBe) Executive Dysfunction Scale (EXECDYS) to measure SCCs and an EF battery (Trail-making A&B, Symbol-digit Modalities Test, verbal fluency (letter, category), which principal components analysis (varimax rotation) reduced to a single EF factor. We examined whether SCCs (EXECDYS) were predicted by EF performance (age, depression covaried), and whether ε4 moderated that prediction (PROCESS 3.0). Results: The model was significant (R2=0.31; p=0.002), with a significant EXECDYS X ε4 interaction (ß=4.24, t(55)=2.37; p=.02), indicating that EF performance predicted EXECDYS, but in ε4-carriers only, those with poorer EF were less aware of that dysfunction. Conclusions: Amongst APOE ε4-carriers, a group with high risk for AD, those with poorer EF had less accurate self-awareness of their EF, suggesting earlier formal assessment is needed in ε4-carriers to detect decline. Furthermore, as our study examined healthy, well-educated, cognitively intact adults from middle age, these findings suggest ε4-carriers are at particularly high risk for AD if their self-awareness and performance of EF are both low. Combining EF assessment with self-appraisal of EF may aid AD diagnostics.

164 Influence of Executive Function, Partner Support, and Environmental Structure on Behavioral Weight Management Outcomes 1384277 Katelyn Gettens Harvard Medical School, Massachusetts General Hospital Influence of Executive Function, Partner Support, and Environmental Structure on Behavioral Weight Management Outcomes Neuropsychological Domains: Executive Functions Objective: Executive functions (EF) are crucial to successful weight management, yet few studies have prospectively explored the influence of social-environmental factors on the EF-weight loss (WL) link. This study examined interactions between EF, partner support, and household structure on weight loss outcomes in a couples-based intervention, grounded in Self-Determination Theory (SDT). Method: Cohabitating dyads attended weekly weight loss groups (Ncouples = 64), Mage =54.0 ±9.5, MBMI=34.2±5.4kg/m2, 50% female, 88.8% Caucasian). Weight was measured at baseline and 6 months. The Behavior Rating Index of Executive Functions-Adult assessed 9 EF domains; higher scores indicate greater difficulty. Partner autonomy support (AS) was measured using the Important Other Climate Questionnaire, household structure with the Confusion, Hubbub, and Order Scale (CHAOS), IQ with the WASI-II 2-subscale estimate. Results: Multilevel models were specified with MIXED linear function in SPSS to account for dyadic interdependence, controlling for age, education, IQ and group. Moderators (AS and CHAOS) were grand-mean centered. High and low levels were created at +1SD and -1SD. At high levels of AS, Shifting (B = 1.50, p=.01) and Inhibition (B = 2.23, p=.01) were associated with greater 6-month WL. At low levels of AS, Working Memory was associated with greater WL (p<.01). Self-Monitoring was associated with greater WL at high chaos (B = .43, p =.01), but not low chaos (p=0.1). Conclusions: Findings suggest that context matters; recruiting specific EFs may promote more WL for individuals embedded in low support or chaotic home environments. Future interventions should address the complexity of successful weight management, targeting both individual and social-interpersonal factors.

165 Letter versus object naming: Exploring the relationship between rapid naming and fluid reasoning ability 1384412 Sarah Pieciak Southern Illinois University, Carbondale Letter versus object naming: Exploring the relationship between rapid naming and fluid reasoning ability Neuropsychological Domains: Executive Functions Objective: Fluid reasoning is associated with rapid naming (RN) ability in multiple studies (e.g., Mano et al., 2019), but less is known about which aspects of RN may be driving this relationship. Hence, the purpose of this study was to determine which is better associated with fluid reasoning ability: letter or object naming. Method: Participants comprised 226 children, ages 8-12 years (88.5% Caucasian, 53.1% Male), who completed a larger, NIH-funded study (R03HD048752, R15HD065627), representing a community sample. They encompassed children with ADHD, reading disability (RD), RD/ADHD and controls. Measures administered included the CTOPP Letter and Object Naming subtests and the Test of Nonverbal Intelligence, Third Edition (TONI-3). Results: Linear regression revealed RN predicted TONI-3 scores, F(2, 223)=7.44, p=.001, but only object naming was significant (Beta=.26, p=.002). Separate regressions demonstrated that RN was not related to TONI-3 performance for controls (p=.12), nor for children with ADHD (p=.58). It displayed a trend for children with RD, F(2, 45)=2.99, p=.06, with only object naming being significant (Beta=.44, p=.02). Conclusions: Rapid object naming, but not rapid letter naming, is related to fluid reasoning ability in a mixed sample of children. Further analysis suggests that these findings were driven by children with RD. Future research should investigate whether the semantic or visual aspect of object naming, or both, is driving this relationship.

166 The Role of Apathy on Executive Functioning After Stroke 1384404 Ana Lopez Nova Southeastern University The Role of Apathy on Executive Functioning After Stroke Neuropsychological Domains: Executive Functions Objective: This study examined the role of apathy on performance of an executive functioning task. Method: The data for this study was derived from the National Alzheimer's Coordinating Center's Uniform Data Set containing neuropsychological information for stroke patients (n=317) who completed the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and the Trail Making Test (Part B). The sample was divided into two groups. One which endorsed feelings of apathy in the last month (n=102; mean age=84,SD=8.33) and a second group which denied feelings of apathy within the last month (n=215; mean age=86, SD=8.02). Results: After controlling for depression [as measured by the Geriatric Depression Scale (GDS)], age, gender, and motor impairment, the results of an ANCOVA showed that those who reported apathy performed significantly slower on the Trail Making Test – Part B than those who did not report it [F(1,312=6.01, p=.02]. Conclusions: It has previously been found that cognitive performance can be impacted by depression on stroke patients. However, recently, it has been identified that apathy specifically, can have an effect on cognitive domains such as verbal learning, short-term, and long-term memory. The present study further supports that apathy may play a role in overall cognitive performance. Therefore, even if patients do not meet criteria for depression, the presence of apathy should still be taken into account. Future research should examine other possible contributing factors such as processing speed should be taken into account as they could be affecting the scores. Finally, researchers should utilize additional measures of executive functioning as only one was available for this study.

167 The Relationship Between Judgement/Reasoning and Global Mental Status 1384348 Jillian Keener VA Maine Healthcare Systems The Relationship Between Judgement/Reasoning and Global Mental Status Neuropsychological Domains: Executive Functions Objective: The purpose of this study was to gather information on the relationship between judgement/reasoning and global mental status (HC=healthy controls, MCI=Mild Cognitive Impairment, and MND=Major Neurocognitive Disorder) by examining the relationship between performance on the Test of Practical Judgment (TOP-J) and mental status screening in a Veteran population. Method: The retrospective data sample consisted of 218 Veterans, aged 28-96 (M=69.67, SD= 12.9434), 95.87% male, 98.62% Caucasian, with a mean education of 12.55 years (SD=2.32). Mental status screening consisted of the raw scores of Mini-Mental Status Examination-2nd edition (MMSE-2) and the Mini-Mental State Examination (3MS, using MMSE equivalent scores). Participants were placed into three categories based on mental status scores: HC (n=79), MCI (n=75), and MND (n=64). TOP-J scores consisted of raw score across 9 items. Results: TOPJ and mental status were mildly correlated for HC (r=.27) and MND (r=0.34); however, there was minimal correlation for Veterans identified as MCI (r=0.18). Conclusion: A relationship between judgement/reasoning and global mental status was remarkable for HC and MNC but not for MCI. This may be related to the fact that deficits in judgement/reasoning, by definition, tend to be subtle or non-existent for individuals with MCI. Additionally, studies have revealed the MMSE-2 and TOP-J both have limited specificity in accurately identifying MCI patients.

168 Do family members’ subjective perceptions of decline in executive functioning skills reflect objective cognitive dysfunction? 1384434 Hilary Clark Wichita State University Do family members’ subjective perceptions of decline in executive functioning skills reflect objective cognitive dysfunction? Neuropsychological Domains: Executive Functions Objective: On behavior rating scales completed by family members, executive functioning is often operationalized in terms of subdomain abilities (e.g., problem-solving, multitasking, and organizing). It is unclear, however, how well collateral assessments of these abilities reflect patients’ actual executive functioning. The current study investigated the relationship between family members’ reported perceptions of change in patients’ problem-solving, multitasking, and organizing abilities and objective neuropsychological test findings. Method: Patients undergoing dementia evaluations (n=56, mean age=71.4, mean education=13.0 years) minimally completed subtests from the Delis-Kaplan Executive Function System (D-KEFS; Trail Making, Verbal Fluency, Color-Word, Tower) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Information from family members was obtained via a questionnaire asking about degrees of change (no change, mild change, moderate change, or severe change) in problem-solving, multitasking, and organizing. Spearman correlations were calculated between family members’ perceptions of change and cognitive dysfunction, as measured by D-KEFS (subtests and combined averaged scaled score) and RBANS index scores. Results: Perceived changes in problem-solving, multitasking, and organizing did not significantly correlate at p<.05 with either D-KEFS subtest scores or the combined scaled score. Perceived changes significantly correlated with RBANS Immediate Memory (problem-solving: rs=-.338, p=.014; multitasking: rs=-.323, p=.017; organizing: rs=-.293, p=.028) and Language (problem-solving: rs=-.306, p=.027) indices. Conclusions: Family members’ perceptions of change in problem-solving, multitasking, and organizing did not correspond with objective executive dysfunction observed on neuropsychological testing. Future research should attempt to cross-validate these findings. If cross-validated, results would suggest limited utility in using these terms to operationalize executive functioning on behavior rating scales.

169 Sleep in Children with Fetal Alcohol Spectrum Disorders (FASD) 1384474 Kiryl Shada University Hospitals Rainbow Babies & Chidren's Sleep in Children with Fetal Alcohol Spectrum Disorders (FASD) Neuropsychological Domains: Executive Functions Objective: Sleep problems in children with FASD have not been well characterized. This study predicts that children with FASD and sleep problems will have more attention [Conner’s Continuous Performance Test (CPT)] and executive functioning [Brief Rating Inventory of Executive Functioning (BRIEF)] difficulties. Methods: Data from 46 children (ages 3-14) diagnosed with an Alcohol Related Neurobehavioral Disorder whose parents completed the Sleep Disturbance Scale for Children (SDSQ) were reviewed. The sample was divided into two groups: low-sleep (T-score 65) using the SDSQ Disorders of Initiating and Maintaining Sleep subscale. Results: The FASD clinical population showed more sleep problems than average, t(45)=6.64, p

170 The Effects of Mindfulness-Based Interventions on Cognitive Control and Complex Visual Attention: A Meta-Analysis. 1384276 Austin Simpson Portland Veterans Affairs Medical Center & Oregon Health and Science University The Effects of Mindfulness-Based Interventions on Cognitive Control and Complex Visual Attention: A Meta-Analysis. Neuropsychological Domains: Executive Functions Objective: The primary objective of this review is to expand upon a previous meta-analysis that found small to medium effect sizes (ES) for mindfulness-based interventions (MBIs) on cognitive control of adults. In addition to cognitive control, we examined other aspects of complex visual attention and whether duration or intervention type moderates the relationship between MBIs and cognitive performance. Data Selection: Three databases were searched for studies from 2000 - 2020, yielding 82 initial articles. After systematic filtering of peer-reviewed, pretest-posttest designs, ES from 17 studies were retained. Data Synthesis: The average ES across all studies was small (Hedge’s g = 0.23; SE = .05; CI [.13, 0.32]). By individual domain, ES were small to medium for inhibition (Hedge’s g = 0.31; SE = .09; CI [0.14, 0.48]) and sustained attention (Hedge’s g = 0.40; SE = .09; CI [0.21, 0.58]), but negligible for set-shifting (Hedge’s g = -0.0009; SE = .11; CI [-0.22, 0.20]) and weak for complex processing speed (Hedge’s g = 0.14; SE = .09; CI [-0.23, 0.32]). Moderator analyses revealed that interventions utilizing mindfulness-based cognitive training (MBCT) had significantly higher ES (Hedges g = 0.82; SE = 0.19; CI [0.44, 1.19] than other interventions. However, intervention duration did not explain variability in ES. Conclusion: This meta-analysis confirmed previous research that MBIs have small to medium ES for complex visual attention/cognitive control, but only for inhibition and sustained attention. Across trainings, MBCT was the most effective in improving cognitive functioning. Future research should explore critical facets of MBCT and neurophysiological correlates of improvement.

172 Monolingual Advantage in Visual Task-Shifting in English-Speaking Individuals When Compared to English-and-Spanish-Speaking Bilingual Individuals 1384293 Adam Chester Penn Medicine Lancaster General Health Monolingual Advantage in Visual Task-Shifting in English-Speaking Individuals When Compared to English-and-Spanish-Speaking Bilingual Individuals Neuropsychological Domains: Executive Functions Objective: Researchers reported that bilinguals have an advantage in visual task-shifting (VTS) and associated this advantage with executive functions (EF). We found self-reported monolinguals were faster than bilinguals when comparing switch (SW) and no-switch (NSW) incongruent trials on VTS, and that memory and age were significant predictors, not EF. Our aim is to repeat previous analyses with a sample of individuals matched on language fluency. Method: Participants were 881 adults (Age: M=31.64±8.64; Men=517; Monolingual=646; Bilingual=235; Education: M=14.92±2.05) from the Consortium for Neuropsychiatric Phenomics (UL1DE019580, PL1MH083271). Participants completed VTS, Memory, and EF tasks, including English Letter Fluency and, if bilingual, Spanish. Participants were dichotomized into the monolingual group if English letter fluency was at least low average, and the bilingual group if English/Spanish letter fluencies were at least low average. Results: Response times (RTs) for short and long incongruent trials were computed in two-way ANCOVAs with Group (monolingual, bilingual) as between-participant and Trial Type (SW, NSW) as within-participant factors, and Age and Education as covariates. Short trials revealed main effects of Group (p=.034), as monolinguals achieved faster RTs than bilinguals, and main effects of Trial Type (p.05). Hierarchical stepwise regressions revealed EF (p=.032) and Age (p=.004) significantly predicted Primary and Residual VTS performance. Conclusions: Our results are inconsistent with literature. We found English monolinguals were faster than English/Spanish bilinguals when controlled for Age and Education. Further, the neuropsychological correlates revealed Age and EF are important predictors of VTS that should be further examined.

175 Logopenic Variant of Primary Progressive Aphasia in a 66-Year Old Female - A Case Study 1384378 Natalie Kurniadi University of Utah School of Medicine Logopenic Variant of Primary Progressive Aphasia in a 66-Year Old Female - A Case Study Neuropsychological Domains: Language and Aphasia Objective: The semantic, logopenic, and nonfluent/aggramatic variants of primary progressive aphasia (PPA) have distinct clinical profiles. However, much overlap exists and many questions remain regarding the nature of language impairments in each variant. This case study seeks to contribute to our understanding of the neuropsychological profile, syntactic, and phonological processes involved in logopenic variant PPA (lvPPA). Method: The current case study was of a 66-year old female who gradually developed symptoms consistent with lvPPA during the prior four-year period, with marked worsening in the last few months. A collateral informant indicated that she was independent for basic and advanced activities of daily living. Brain/head imaging had not been conducted; medical history was unremarkable. Results: Speech was notable for frequent pauses due to word-finding difficulty, circumlocution, and impaired naming, repetition, and verbal abstraction; fluency and comprehension were intact. Test data revealed significant impairments in tasks mediated by language including verbal processing speed, semantic knowledge, phonemic and semantic fluency, verbal learning and memory, verbal set-shifting, and judgment. Comprehension, non-verbal attention and processing speed, recognition for visual information, and performance on tasks of non-verbal executive functioning were intact. Depression and anxiety were denied. Conclusions: Findings were notable for prominent language deficits, with preserved articulation, basic comprehension, and no evidence of visual agnosia. Her progression of symptoms, medical history, and test data were not consistent with a typical Alzheimer’s or vascular process, but were most consistent with lvPPA. Neurology consultation, MRI brain with volumetric analysis, and speech therapy were recommended.

177 Relationship between family members’ subjective ratings of memory decline and objective neuropsychological test performance 1384436 Hilary Clark Wichita State University Relationship between family members’ subjective ratings of memory decline and objective neuropsychological test performance Neuropsychological Domains: Memory and Amnesia Objective: In cognitive domains such as memory, decline can manifest in several ways. The current study investigated how different memory changes reported by family members on a behavior rating scale were related to neuropsychological test performance. The study also examined if reported memory problems reflected memory impairment specifically, versus general cognitive dysfunction. Method: Patients (n=87, mean age=73.0, mean education=13.1 years) minimally completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) during dementia evaluations. Information from patients’ family members was obtained via a questionnaire asking about degrees of perceived change (no change, mild change, moderate change, or severe change) in “remembering conversations,” “repeating self,” and “misplacing items.” Spearman correlations were calculated between family members’ perceptions of change and cognitive dysfunction, measured by RBANS index scores. Results: Perceived changes in misplacing items significantly correlated with RBANS Immediate Memory (rs=-.291, p=.008) and Delayed Memory (rs=-.261, p=.018) indices. The only other correlations that approached statistical significance were between remembering conversations and Immediate Memory (rs=-.209, p=.052) and repeating self and Delayed Memory (rs=-.208, p=.056). No correlations with other RBANS index scores approached statistical significance at p<.05. Conclusions: While not all results were statistically significant, trends among correlations between RBANS index scores and family-reported changes in patients remembering conversations, repeating themselves, and misplacing items suggest that when these terms are utilized on behavior rating scales, they possess both convergent and discriminant validity. Since misplacing items significantly correlated with both immediate and delayed memory dysfunction, changes in this area might be the most useful to assess on behavior rating scales.

178 Characterizing Memory Measurement in Cognitively Normal Individuals Using Latent State Trait Modeling of Neuropsychological Tests 1384405 William Goette University of Texas Southwestern Medical Center Characterizing Memory Measurement in Cognitively Normal Individuals Using Latent State Trait Modeling of Neuropsychological Tests Neuropsychological Domains: Memory and Amnesia Objective: Characterize trait and state measurement of memory in a longitudinal, cognitively normal (CN) sample. Method: Data were taken from 515 participants (81.17% white; Mage=64.78, SD=8.20; Medu= 13.04, SD = 4.39; 73.40% female) deemed CN for 5 consecutive visits in the Texas Alzheimer’s Research and Care Consortium. The memory trait was measured by the CERAD (total learning and delayed recall) and WMS-III Logical Memory (LM) and Visual Reproduction (VR) I and II subtests. Multiple-indicator growth models were used as the primary analysis. Results: Assumption screening revealed the memory trait was characterized by three domain factors: list learning (CERAD learning and recall), story memory (LM I and II), and visual memory (VR I and II). Generalized second-order growth models demonstrated best overall fit. Scores demonstrated a positive latent growth process such that trait memory scores actually increased over time. Consistency and specificity coefficients suggest less situation-specific error occurs as individuals are tested over time with the first evaluation having the largest portion of situation-specific measurement error (Supporting Figure). Conclusions: Measurement accuracy of memory in CN individuals improved over repeated administrations. Accurate identification of cases with normal memory in memory disorders research may require serial assessments to account for (a) improved measurement accuracy of the trait after multiple assessments and (b) reducing the influence of state-specific sources of error that are greatest at the first assessment time. Further research is needed to determine whether the observed positive growth in trait scores is unique to CN samples and whether measurement accuracy changes in cognitive domains other than memory.

179 The Relationship Between Self-Rated Everyday Memory and Cognitive Status Among Older Adults 1384355 Melany Vasquez University of Texas at Tyler The Relationship Between Self-Rated Everyday Memory and Cognitive Status Among Older Adults Neuropsychological Domains: Memory and Amnesia Objective: Neuropsychologists often supplement performance-based measures of cognition with self-report questionnaires. One questionnaire – the Measurement of Everyday Cognition (ECog) – has shown promise in differentiating between impaired and non-impaired populations; however, little research has been done specifically on the memory items from the shortened version: the ECog-12. The purpose of this study was to examine the extent to which the Ecog-12 Memory subscale can predict actual cognitive function as measured by a performance-based screening test. Method: Older adults (ages 55-90; n = 74) completed the ECog-12 and were administered the Mini-Mental Status Exam – 2nd Edition (MMSE-2), with scores dichotomized into normal function and impaired function. Results: Binary logistic regression found that the ECog-12 Memory subscale items explained between 57% and 87% of variance in normal/impaired MMSE-2 scores and accurately classified 79.7% of cases. Conclusion: Brief self-report measures of everyday memory functioning are sensitive to cognitive decline among older adults.

180 A Preliminary Study of Prospective Memory Performance and Medication Adherence Among Young Adults 1384410 Trisha Glover The University of Texas at Tyler A Preliminary Study of Prospective Memory Performance and Medication Adherence Among Young Adults Neuropsychological Domains: Memory and Amnesia Objective: Medication adherence is a significant problem concerning the proliferation of many illnesses, and prospective memory – that is, memory to carry out an intended future action – may play a role in whether individuals take their medications (Osterberg & Blaschke, 2005; Zogg, Woods, Sauceda, Wiebe, & Simoni, 2012). Current research on prospective memory and medication adherence suggests that individuals take medication more efficiently when associated with a specific event, rather than when associated with the passage of time (Zogg et al., 2012). The purpose of this preliminary study was to investigate the relationship between prospective memory and medication adherence. Method: Young adults (N = 16, 18–30 years) who identified as regularly taking prescription medications completed the Morisky Medication Adherence Scale (MMAS) and the Virtual Kitchen Protocol, which includes prospective memory tasks with both event-based and time-based cues. Results: Higher scores on event-based cues were associated with better medication adherence among young adults (p = .005). However, performance on time-based cues was not associated with medication adherence. Conclusions: Event-based prospective memory cues are associated with higher medication adherence among young adults. Furthermore, event-based prospective memory cues may be more indicative of medication adherence in young adults, when compared to time-based prospective memory cues. Individuals are generally better at event-based cues, particularly because they involve automatic retrieval processes (Zogg et al., 2012). On the other hand, time-based cues require more monitoring and greater time estimation (Zogg et al., 2012). Overall, it is evident that prospective memory is an important contributor to medication adherence among young adults.

181 Comparing Virtual Reality and Analog Prospective Memory Performance 1384424 Allyson Coldiron The University of Texas at Tyler Comparing Virtual Reality and Analog Prospective Memory Performance Neuropsychological Domains: Memory and Amnesia Objective: A virtual reality-based prospective memory task was designed to examine whether a virtual environment would allow for a deeper level of processing and aid prospective memory performance. The purpose of this study was to compare young adults’ performance on analog and virtual reality-based prospective memory tasks. Method: Young adult college students (N = 40; ages 18-26) completed both analog and virtual reality prospective memory tasks in the Virtual Kitchen Protocol. Results: A within-subjects analysis of variance found that participants performed better on the analog prospective memory task than in virtual reality, F(1,39) = 12.46, p = .001. Conclusions: Results suggest that the virtual environment served as a source of distraction rather than a memory aid for young adults’ prospective memory ability. However, this added level of distraction may mimic everyday prospective memory settings better than traditional analog tasks, suggesting that virtual prospective memory tasks may be able to better assess everyday prospective memory abilities.

182 Convergent and Divergent Validity of the ChAMP with the CVLT-C and RCFT in Children with Epilepsy 1384512 Claire David Alberta Children's Hospital, Alberta Health Services Convergent and Divergent Validity of the ChAMP with the CVLT-C and RCFT in Children with Epilepsy Neuropsychological Domains: Memory and Amnesia Objective As new measures of memory become available, clinicians may be cautious to adopt them without evidence supporting their validity. The present study assesses the convergent and divergent validity of the Child and Adolescent Memory Profile (ChAMP), with the California Verbal Learning Test Children’s (CVLT-C) and the Rey Complex Figure Test (RCFT) in children with epilepsy. Method Twenty four clinically referred children (16 female, 8 male, x̄ age=12.37 years, SD=2.68) completed the ChAMP, CVLT-C, and RCFT. Pearson correlations assessed the ChAMP’s convergent and divergent validity with the CVLT-C and the RCFT. Base rate of impairment was calculated for scores ≤2nd percentile. Results The ChAMP verbal tasks demonstrated strong relations with CVLT-C (lists; r=0.678 p=<.001, instructions; r=0.724 p=<.001 with CVLT-C learning trials and ChAMP lists free recall with CVLT-C long delay r=0.580 p=.003). The ChAMP visual tasks correlated strongly with the RCFT delay (objects; r=0.570 p=.004, places; r=0.619 p=.001, Visual Memory Index; r=0.657 p=<.001). However, divergent validity was limited as ChAMP Verbal Memory Index correlated with RCFT delay (r=0.550 p=.005) and ChAMP Visual Memory Index with CVLT-C delay (r=0.606 p=.002). Eight percent were deemed impaired on ChAMP lists delay similar to the CVLT-C delay (13%), however, ChAMP places delay identified 21% impaired, compared to the RCFT delay (42%). Conclusions ChAMP scores are strongly correlated with older established measures, but identify fewer cases as clinically impaired. This may reflect the more contemporary normative data or the fact that ChAMP tasks are less multifactorial in nature than are the CVLT-C and RCFT.

183 A Preliminary Study of Comfort with Computers and Analog Tasks in Relation to Older Adults’ Performance in Virtual Reality 1384361 Lacye Williams UT Tyler A Preliminary Study of Comfort with Computers and Analog Tasks in Relation to Older Adults’ Performance in Virtual Reality Neuropsychological Domains: Memory and Amnesia Objective: Neuropsychologists are using virtual reality to simulate everyday activities in order to increase ecological validity in neuropsychological assessments (Kane & Parsons, 2017). However, relatively little is known about the extent to which comfort with computers and analog tasks influences older adults’ performance on virtual reality-based tasks. Methods: Healthy older adults (N = 42) rated how comfortable they are with computers and cooking meals in daily life and completed the Virtual Kitchen Protocol, a measure of procedural learning and memory for meal preparation tasks. Results: Both higher comfort with cooking meals in a real kitchen and higher comfort with computers were associated with better learning, immediate recall, and delayed recall of the procedural task in virtual reality. However, comfort with computers did not explain a significant amount of variance in performance beyond comfort cooking in a real kitchen. Conclusion: While both comfort with computers and analog versions of tasks may relate to older adults’ learning and memory in virtual reality, performance may be primarily related to analog abilities.

184 Comparison of Performance on the Virtual Environment Grocery Store and the CVLT-II 1384418 Sydni Shorter University of Texas at Tyler Comparison of Performance on the Virtual Environment Grocery Store and the CVLT-II Neuropsychological Domains: Memory and Amnesia Objective: The Virtual Environment Grocery Store (VEGS) was created to measure memory and everyday functional abilities (Parsons & McMahan, 2017). The objective of this study was to compare young adults’ recall of the VEGS shopping list with the CVLT-II in order to investigate what impact the virtual environment has on recall. Methods: Young adults (ages 18-26, M = 18.90, SD = 1.60; N = 39) completed the VEGS and the CVLT-II. Results: Young adults had higher recall on the CVLT-II than VEGS for immediate recall and delayed free recall, but there were no differences on delayed cued recall and delayed recognition. Conclusion: Immediate and delayed free recall on the VEGS may be more difficult on the VEGS than the CVLT-II, perhaps reflecting the word length effect. The virtual environment may have allowed for deeper levels of processing, explaining the lack of differences on delayed cued recall and delayed recognition.

185 Are Undergraduate Students Able to Effectively Utilize Learning Strategies? 1384475 Jennifer Henry Widener University Are Undergraduate Students Able to Effectively Utilize Learning Strategies? Neuropsychological Domains: Memory and Amnesia Objective: Professors generally use less structured and organized methods of teaching than high school teachers, even though undergraduate brains are still developing, making the transition more difficult. The purpose of this study was to see whether undergraduate students could use explicitly taught methods of organization to remember more words on free recall trials of the CVLT-II. Method: Inclusion criteria: undergraduate students enrolled at Widener University, between the ages of 18-24. Participants included 34 undergraduate students recruited via mass email. The groups had 18 women and 16 men aged 18-22 (M = 20.32, SD = 1.15). They were randomized evenly in two groups: a control group (standardized instructions) and an experimental group (explicit semantic clustering instruction). Variables used were semantic clustering, immediate and delayed free recall. Results: There were strong positive correlations between semantic clustering and number of words recalled at the immediate (r = .76, p < .0005) and delayed free recall trials (r = .7, p < .0005) for both groups. The experimental group (M = 3.94, SD = 3.21) used more semantic clustering than the control group (M = 2.13, SD = 2.35); t(32) = -1.87, p = .04 (one-tailed) (Cohen’s d = .64). However, the experimental group did not freely recall significantly more words than the control group at either of the free recalls (immediate = t(32)= -.636, p = .26; delay = t(32) = -1.086, p = .14). Conclusion: This may indicate that although undergraduate students can learn helpful strategies, they may not necessarily be able to implement taught strategies effectively.

186 An Enhanced Delayed Recognition Measure for the WMS-IV Logical Memory Subtest 1384336 Carlton Gass Memory Disorders Clinic, Tallahassee Memorial Healthcare An Enhanced Delayed Recognition Measure for the WMS-IV Logical Memory Subtest Neuropsychological Domains: Memory and Amnesia Objective: We introduce a supplemental measure based on the Logical Memory (LM) subtest of the Wechsler Memory Scale – IV (Wechsler, 2008) to assist in distinguishing deficient memory storage from compromised retrieval operations. A 20-item five-option multiple choice delayed recognition test for the LM stories is described, followed by descriptive data based on a normative sample of 168 female and 105 male neurologically normal outpatient referrals to a neuropsychology clinic. Method: Ten 5-option items were developed for each of the three LM stories (A, B, and C) reflecting the stories’ narrative content, yielding 20 items for administration to examinees under 70 (Stories B and C) and older than 69 (Stories A and B). Four distractor options for each item were designed to be “plausible” alternatives for the examinee who had little or no recollection of the narrative material. Examinees (N=360), screened for performance validity (effort), completed the LM Recognition test immediately after delayed LM free recall. Results: Internal consistency (Cronbach alpha) was acceptable for both 20-item LM Recognition tests. Individuals’ scaled scores on LM-Recognition were compared with LM-II (free recall). Recognition was superior (> one SD) to free recall performance in 43% (age 18 to 69) and 48.2% (age 70+). Conclusion: Delayed free recall scores often underestimate a person’s ability to encode and store new information. For clinical application, separate LM Recognition norms were derived for older (Stories A and B) and younger examinees (stories B and C). This 20-item measure assists clinicians in differentiating between storage and retrieval deficits on the Logical Memory subtest.

187 Is Once Enough? First Trial Performance on the Free and Cued Selective Reminding Test in a Clinical Sample of Older Adults with Neurocognitive Disorders 1384443 Katelyn Gettens Harvard Medical School, Massachusetts General Hospital Is Once Enough? First Trial Performance on the Free and Cued Selective Reminding Test in a Clinical Sample of Older Adults with Neurocognitive Disorders Neuropsychological Domains: Memory and Amnesia Objective: There is urgent need for tools that quickly identify neurocognitive disorders (NCD). The Free and Cued Selective Reminding Test (FCSRT) has high sensitivity for detecting NCD severity (Mild vs. Major) and type (amnestic vs. non-amnestic). However, full administration of three learning trials makes it relatively lengthy. We examined whether first trial performance detects NCD type and severity. Method: 187 patients (Mage=74.7±6.9, Medu=16±3.1; 58% male) were clinically evaluated. Diagnoses were Mild NCD - amnestic (N = 55), Mild NCD - non-amnestic (N = 67), Major NCD -amnestic (N = 23), and Major NCD –non-amnestic (N = 42). Free recall accuracy (FRA) [number freely recalled/16 *100] and cued recall accuracy (CRA) [(number of cues provided – number recalled with cues)/16 *100] were calculated for each of 3 learning trials. Results: First trial performance predicted NCD severity (2 (2) = 7.84, p < .03) and type (2 (1) = 59.0, p < .001). First trial FRA predicted NCD severity (B = -3.29, p < .01). First trial FRA and CRA predicted NCD type (CRA better than FRA, (B = -4.54, p < .001). Third trial accuracy did not predict NCD severity [2 (2) = 5.75, p =.06). Third trial accuracy predicted NCD type [2 (2) = 56.6, p < .001]; third trial FRA performed similarly to first trial FRA. Conclusions: Our results suggest that first trial FCSRT performance may be enough to screen for neurocognitive disorders. Findings identify free recall accuracy as a better predictor of type and cued recall accuracy a better predictor of NCD severity.

188 Psychometric Characteristics of the Cognitive Difficulties Scale in a Clinical Referral Sample 1384334 Carlton Gass Memory Disorders Clinic, Tallahassee Memorial Healthcare Psychometric Characteristics of the Cognitive Difficulties Scale in a Clinical Referral Sample Neuropsychological Domains: Memory and Amnesia Objective: Evaluate the psychometric characteristics of the Cognitive Difficulties Scale (CDS; McNair & Kahn, 1983), a 39-item Likert-type self-report instrument that requires a fifth-grade reading level. The CDS is a popular instrument that has been shown to predict cognitive decline. Evaluation included an exploratory factor analysis, measures of internal consistency, relation to demographics, criterion validity, and normative table for raw to T score/percentile transformation. Method: Participants were 643 consecutive referrals (71% women, mean age 60.6 and education 14.6 years) for a neuropsychological examination in a memory disorders clinic as part of a broader neurodiagnostic workup for cognitive decline. A principal components analysis was conducted followed by varimax rotation (Kaiser). Factor scores were investigated in relation to multiple internal and external criteria. Results: Six dimensions of cognitive complaint emerged accounting for 64% of the variance: Attention/Concentration, Fine Motor Skill, Prospective Memory, Speech Problems, Memory for Names, and Temporal Orientation. Factors showed good internal consistencies (alphas > .850). Correlations with Logical Memory, Visual Reproduction, and Digit Span were all nonsignificant. CDS factor scores were highly predictive of MMPI-2 measures of anxiety, depression, and somatic preoccupation. Percentiles and T-scores were derived for the CDS total score and its six component scales. Conclusion: The CDS is a multidimensional measure of subjective cognitive complaints that provides clinicians with a psychometrically sound basis for deriving a profile with six subscale scores. The test has substantial clinical utility, and is a potentially useful tool in exploring subjective cognitive decline as a prodrome to dementia.

189 Exploring the Effects of EEG Neurofeedback Training on Verbal Episodic Memory in a TBI Sample 1384370 Alyssa Kaser VISN 17 Center of Excellence for Research on Returning War Veterans Exploring the Effects of EEG Neurofeedback Training on Verbal Episodic Memory in a TBI Sample Neuropsychological Domains: Memory and Amnesia Objective: Traumatic brain injuries (TBI) are commonly characterized by neural changes that impair physical, behavioral, and cognitive functioning across diverse ages and demographics. Cognitive complaints frequently include memory difficulties, with deficits in episodic memory greatly impairing daily functioning and future planning. Although various interventions and rehabilitation techniques have been implemented for TBI, limited treatment options are available for TBI-driven memory complaints. Recent research has explored the use of neurofeedback training (NFT) to improve cognitive functioning in TBI patients, yet it remains unclear whether this intervention may be successful in improving these memory deficits. Method: In this double-blind, placebo-controlled pilot study, the use of EEG neurofeedback training (NFT) on verbal episodic memory was explored in 12 veterans with TBI. Participants were randomized to active treatment or sham treatment, and they completed 20 sessions of NFT. Clinical assessments and functional magnetic resonance imaging (fMRI) data were collected pre and post treatment to measure any changes in resting-state functional connectivity or cognitive functioning. Results: Findings suggest that immediate recall scores improved following active NFT, as measured by the California Verbal Learning Task-II. We also observed increased resting-state functional connectivity between the ventromedial prefrontal cortex and the inferior temporal lobe following NFT (Fig. 1), which may represent an underlying mechanism of memory improvement. Conclusions: These exploratory findings may hold promise for future research on the use of NFT for memory enhancement in various populations.

190 Neuropsychological profile of adolescent with 22q11.2 Deletion Syndrome 1384365 Marsha Smith Montefiore Medical Center Neuropsychological profile of adolescent with 22q11.2 Deletion Syndrome Neuropsychological Domains: Other Objective: 22q11.2 deletion syndrome (22q11DS) is a genetic microdeletion disorder linked to various adverse medical and psychiatric outcomes affecting 1 in every 1,000 to 4,000 births. 22q11DS results from a meiotic deletion of DNA at the q11.2 site on chromosome 22, contributing to cognitive impairments resulting from a range of congenital anomalies. While data are inconsistent and the 22q11DS profile is incomplete - research suggests neuropsychological impairments with receptive language and attention. We describe the neuropsychological findings of a young woman with stronger than expected receptive language and atypical attention profile. Thus, we will highlight the cognitive profile of 22q11DS and the critical role of neuropsychological evaluation in clarifying cognitive performances. Methods: This adolescent was diagnosed with 22q11DS at age 10, and various professionals made prior diagnoses of ADHD, ODD, Anxiety, ID, developmental delay, and learning delay without previous formal neuropsychological evaluation. Results: Evaluation revealed low overall performances (WISCV- FSIQ=66) with relative strengths on tasks of category fluency and receptive vocabulary, with stronger than expected receptive language. Her attention profile was not consistent with ADHD, although by history, ADHD criteria would have been met previously. Qualitatively, even with a low IQ, she did not present as someone with an ID. Conclusion: This case of a young woman with 22q11DS with several prior diagnoses demonstrated a slightly atypical cognitive profile supporting the need for formal neuropsychological evaluation. Furthermore, the patterns of her performances add to the literature of 22q11 deletion syndromes and raise important questions regarding differences in cognitive development in individuals with 22q11DS.

192 The General Ability Measure for Adults Underrepresents True IQ in a High-Functioning Aviation Population 1384485 Andrew DaCosta Florida Tech The General Ability Measure for Adults Underrepresents True IQ in a High-Functioning Aviation Population Neuropsychological Domains: Other Objective: The General Ability Measure for Adults (GAMA) is a brief nonverbal assessment of general intellectual ability (Naglieri & Bardos, 1997). Previous research supports use of the GAMA as a screening measure of cognitive ability in neurological populations (Davis, Bados & Woodward, 2005). However, there is a lack of research involving the use of the GAMA in high functioning populations commonly referred for neuropsychological evaluation (i.e. aviation pilots). Method: Aviation pilots (n = 59; mean age = 44.90, SD = 9.78) were referred for a neuropsychological evaluation and were concluded to be cognitively intact. They were administered a battery that included the GAMA and Wechsler Adult Intelligence Scale - 4th edition (WAIS-IV) among other measures. Results: A paired samples t-test revealed that IQ scores on the GAMA (M = 118.19, SD = 11.51) were significantly lower than IQ scores on the WAIS-IV (M = 125.73, SD = 10.12; p < .001), with WAIS-IV IQ being 7.54 points higher on average. A Chi-square test of independence determined there was disagreement in score classification between the two tests (χ2(9) = 15.463, p = .079) Conclusions: The GAMA appears to significantly underrepresent true IQ in both score and classification when compared to a more robust measure of intellectual assessment. Clinically, this suggests that IQ screeners, such as the GAMA, may not be appropriate for assessing patients who are suspected to be of higher premorbid functioning. Future research should expand on these results to assess the validity of verbal-based IQ screening measures in high-functioning populations.

193 Comprehensive neuropsychological assessment of a nine-year-old child with a rare congenital growth hormone deficiency: A case study of cognitive dysfunction accompanying the IGF-1-R mutation 1384363 Brandon Tross Western Michigan University Comprehensive neuropsychological assessment of a nine-year-old child with a rare congenital growth hormone deficiency: A case study of cognitive dysfunction accompanying the IGF-1-R mutation Neuropsychological Domains: Other Objective: The insulin growth factor 1 receptor (IGF-1-R) gene plays a pivotal role in human growth and development (Kannian & Ryan, 2019). Heterozygous IGF-1-R mutations represent a rare subtype of congenital growth hormone deficiencies (Abuzzahab et al., 2003). The very few cases that have been reported implicate lower volume in brain structures that include the splenium, right global pallidus, hippocampus, and left thalamus (Webb et al., 2012). As a result, physical anomalies in children are expressed through short stature, microcephaly, and atypical facial morphology, as well as intellectual and academic deficits (Essakow et al., 2016; Webb et al., 2012). Given the limited case studies of this gene mutation, the neuropsychological implications are unclear (Yang et al., 2019). Method: This case study is of a nine-year-old male child with mild physical anomalies, fine motor deficits, inattention, and cognitive delay, referred by pediatrics for differential diagnoses of impaired cognition vs. amotivation vs. emotional-behavioral problems. Impairment on an initial educational screening evaluation indicated the need for a more comprehensive and broad-based assessment which is presented here. Results: Findings revealed cognitive impairment on measures of intellect, fine motor integration, complex and sustained attention and vigilance, executive functioning, memory, learning, language comprehension, phonological knowledge, encoding, decoding, reading comprehension, and arithmetic. Emotional testing was normal. Conclusion: Neuropsychological assessment provided detailed information for pediatricians, parents, teachers, and allied health providers for treatment planning, and led to genetic testing that confirmed the diagnosis of the rare IGF-1-R mutation and furthered clinical understanding of this child’s social, academic, and neuropsychological needs.

194 The Impact of Emodiversity on Mental and Physical Health 1384360 Rita Rivera Albizu University The Impact of Emodiversity on Mental and Physical Health Neuropsychological Domains: Other Objective The purpose of this systematic review was to examine how emodiversity affects mental and physical health. Emodiversity has been described as an integral component of the human emotional ecosystem that can serve as a predictor for mental and physical health. Data Selection This review was conducted using the following databases: Taylor & Francis, Science Direct, Google Scholar, and ProQuest Central. Inclusion criteria consisted of peer-reviewed articles published in English between the years of 2011-2019. Keywords for the search included emodiversity, emotional diversity, emotion, neuroscience, physical health, and mental health. A total number of 20 articles were reviewed and 8 articles were retained. Data Synthesis Research indicated that lack of differentiated emotional experiences, specifically the continuity of negative emotional states, stimulates inflammatory responses that are associated with negative moods and traits, such as depression and anxiety. Furthermore, heightened systemic inflammation has been associated with poor health conditions, such as Type II Diabetes, insulin resistance, rheumatoid disease, and oxidative stress. On the other hand, the presence of differentiation in emotions may lead to adaptive coping and adjustment. Emodiversity is also considered a predictor of habits that may contribute positively to physical health, such as healthy diets, regular exercise, and refraining from smoking. Conclusion Articles reviewed suggest that emodiversity is a fundamental criterion for evaluating the human emotional ecosystem. Reviewed literature showed that the absence of emodiversity may be related to different mental health conditions and physical illnesses. Studies have shown that diverse emotional experiences are beneficial for mental and physical health.

195 Emotional Factors in Performance on Halstead-Reitan/Halstead-Russell Neuropsychological Tests 1384247 Carlton Gass Memory Disorders Clinic, Tallahassee Memorial Healthcare Emotional Factors in Performance on Halstead-Reitan/Halstead-Russell Neuropsychological Tests Neuropsychological Domains: Other Abstract Objective: Evaluate the relation between depression and performance on eight widely used tests: Revised Category Test, Trail Making Test, Part B Tactual Performance Test, TPT Memory, TPT Location, Aphasia Screening Test, Seashore Rhythm Test and Speech Perception Test. Method: Participants: 116 women, 71 men referred for comprehensive neuropsychological evaluation in an outpatient memory disorders clinic as part of a broader neurodiagnostic workup for memory complaints and cognitive decline. Referral sources: neurologists (78%), primary care physicians (21%). Patients’ mean age: 59.0 (SD =13.8); education: 14.9 (SD = 2.6) years. They were screened from a larger sample (N = 214) for brain disorder or positive neurodiagnostic findings. All participants satisfied performance and symptom validity criteria. Diagnostically, 62% had mood disorders. Based on Scale D scores, 65 middle-range scorers were excluded and 122 patients were classified into High and Low Depressive Symptom groups (ns = 61). The two groups were no different on age, education, Average Impairment Rating or predicted level of intelligence (Test of Premorbid Function). Results: On all eight of the neuropsychological tests, scores were compared across the two groups. There was no main effect (MANOVA) for group, F(8,98) = 1.56, p = .147. Univariate comparisons revealed a trend on TPT Location but no statistically significant effects of depression severity on any of these tests. Conclusion: Results suggest that severity of depressive symptoms is unrelated to performance on these neuropsychological tests. In cooperative examinees, these tests are valid for assessing brain-based abilities independent of depressive symptom severity.

197 Utility of the Addenbrooke’s Cognitive Examination – Third Edition (ACE-III) to Predict Neuropsychological Test Performance in Older Adults Referred for Neurocognitive Evaluation 1384290 Giuliana Zarrella Massachusetts General Hospital - Boston, MA Utility of the Addenbrooke’s Cognitive Examination – Third Edition (ACE-III) to Predict Neuropsychological Test Performance in Older Adults Referred for Neurocognitive Evaluation Neuropsychological Domains: Other Objective. The ACE-III is a brief cognitive screener with high sensitivity and specificity in detecting neurocognitive disorders. We examined the utility of ACE-III subscale scores (Attention/Orientation, Memory, Fluency, Language, Visuospatial) to predict performance on expanded neuropsychological evaluation and detect diagnostic group differences. Data Selection. 217 patients (Mag=74.0, Medu=15.78) with neurocognitive concerns completed the ACE-III followed by a comprehensive neuropsychological evaluation, including Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Digit Span Backward (DSB), Trail Making Test Part B (TMT B), Boston Naming Test (BNT), Controlled Oral Word Association Test (COWAT), Category Fluency (Vegetables), Wechsler Memory Scale-IV (WMS-IV) Logical Memory (LM), and WAIS-IV Block Design (BD). Patients were diagnosed as having Normal Cognition (NC), Mild Cognitive Impairment (MCI), or Major Neurocognitive Disorder (MND) from clinical history and overall performance (67-NC, 105-MCI, 45-MND). Within-construct performances on comprehensive testing were regressed on ACE-III subscales. Group differences in ACE-III subscales and total scores were also examined. Data Synthesis. Each ACE-III subscale score predicted within-construct performance on expanded testing with moderate-strong effects (p’sMCI>MND; p’s<.001). Conclusions. Across severity of cognitive impairment, ACE-III subscales are predictive of within-construct performance on expanded testing. The ACE-III may be a useful proxy for a comprehensive neuropsychological evaluation and demonstrates diagnostic utility in distinguishing different levels of cognitive impairment in older adults referred for neurocognitive concerns.

198 Major Errors on BVRT Determine Specific Cognitive Deficit in a Veteran Sample 1384297 Aidan Boese Palo Alto University Major Errors on BVRT Determine Specific Cognitive Deficit in a Veteran Sample Neuropsychological Domains: Other Objective: The goal of the study is to examine the underlying conceptual factors that account for major performance errors of the Benton Visual Retention Test (BVRT) using indices of the Weschler Adult Intelligence Scale, 3rd Edition (WAIS-III) as gold-standard comparison variables. Method: One hundred thirty participants with mixed cognitive and psychiatric diagnoses who were referred to the neuropsychological assessment clinic at the VA Palo Alto Health Care System and completed the BVRT and WAIS-III measures were included in the analysis of the data. Factor Analysis of BVRT major memory and copy errors (rotations, distortions, and perseverations) and WAIS-III indices were conducted using SPSS 25. Results: BVRT major memory and copy errors factored onto WAIS-III index variables using Principal Components Analysis with Equamax rotation yielded a four-factor model explaining 79% of total variance. Major errors on the immediate recall trial of the BVRT were found to be specifically and inversely related to performance on the WAIS-III Perceptual Organization and Processing Speed Indices. Major errors on the copy trial of the BVRT showed an inverse relationship with performance on the WAIS-III Verbal Comprehension and Working Memory Indices. Conclusions: BVRT recall errors are related to failures in visual perceptual processing. Conversely, copy errors on the BVRT are potentially attributable to deficits in auditory-verbal-attentional information processing. The results of the study provide evidence for the BVRT as a viable measurement tool to determine domain-specific cognitive impairment when considering error types on recall and copy trials.

200 Which domains of neuropsychological functioning are most strongly related to impairment in instrumental activities of daily living? 1384437 Hilary Clark Wichita State University Which domains of neuropsychological functioning are most strongly related to impairment in instrumental activities of daily living? Neuropsychological Domains: Other Objective: The current study investigated relationships between neuropsychological test findings and instrumental activities of daily living (IADLs) in a mixed sample of Mild and Major Neurocognitive Disorder (NCD). Method: Archival data from a memory disorder clinic were analyzed. Patients (n=68, mean age=72.3, mean education=13.2 years, 26.5% Mild NCD, 73.5% Major NCD) minimally completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Delis-Kaplan Executive Function System (D-KEFS). Information on IADLs was obtained from family members via the Functional Activities Questionnaire (FAQ). Spearman correlations were calculated between individual IADLs from the FAQ, total FAQ ratings, RBANS index scores, and a composite executive functioning score (average scaled score on DKEFS Trail Making, Verbal Fluency, and Tower). Results: Executive functioning was the only cognitive domain that significantly correlated (p<.05) with total FAQ ratings. However, all cognitive domains except language significantly correlated with individual IADLs. Tracking current events correlated with immediate memory, while financial management correlated with delayed memory. Attending to, understanding, and discussing TV, books, and magazines correlated with executive functioning and immediate and delayed memory. Remembering events correlated with attention and executive functioning. Shopping alone correlated with immediate memory, attention, and executive functioning, while operating basic kitchen appliances correlated with visuospatial skills, attention, and executive functioning. Traveling also correlated with visuospatial skills and executive functioning. Conclusions: Executive functioning was the only domain associated with overall daily functioning; however, all domains except language corresponded with individual IADLs. Current findings highlight the utility of neuropsychological test findings in understanding the nuances of deficits in daily functioning.

202 A Normative Study of Neuropsychological Functioning in a Clinical Sample of Aviation Pilots 1384487 Andrew Crane Florida Institute of Technology A Normative Study of Neuropsychological Functioning in a Clinical Sample of Aviation Pilots Neuropsychological Domains: Other Objective: Neuropsychological evaluations are mandated by the Federal Aviation Administration (FAA) to ensure that pilots with certain known or suspected medical/neurological or psychiatric conditions do not have neurocognitive sequelae that would impair their ability to safely carry out their responsibilities (Federal Aviation Administration, 2020). However, intact pilots’ performance on cognitive measures appears unique compared to the general population (Causse, Dehias, Arexis, & Pastor, 2011). In an effort to make appropriate comparisons, the current study thus presents normative data on the FAA core neuropsychological test battery. Method: Sixty-three aviation pilots (age 25-62, M = 44.9, SD = 0.235) underwent neuropsychological testing using the FAA core battery following referral for alcohol utilization. All participants were considered to be cognitively intact at the time of their evaluations. Results: Participants’ average IQ on the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV) fell in the Superior range using traditional norms (M=125.29, SD=10.04). Pilots performed better than “average” across a number of neuropsychological measures. For example, pilots completed Trails-A in 19.38 seconds (SD = 4.10) and Trails-B in 40.73 seconds (SD = 10.56), which is approximately 10 seconds faster than average among individuals aged 35-44 years. Meanwhile, pilots recalled an average of 15.08 out of 16 words on the California Verbal Learning Test Version 2 (CVLT-II) short delay and 15.34 words on the CVLT-II long delay. Conclusion(s): This study provides comparison data for future neuropsychological evaluations of pilots with alcohol concerns. The data suggests that pilots generally outperform the civilian population across neuropsychological tests.

203 Method matters: Measures of social communication ability disagree in women with autistic traits 1384461 Jonathan Beck Rush University Medical Center Method matters: Measures of social communication ability disagree in women with autistic traits Neuropsychological Domains: Other Objective: Increasing evidence suggests that many women with autism spectrum disorder (ASD) may be undiagnosed and thus denied access to supports and interventions. Evaluating suspected ASD involves assessing social communication abilities, and many potentially helpful tools exist. We sought to compare various social communication measures (self-report, clinician-rated, and behavioral) in a sample of women with autistic traits. Method: Our sample includes women without intellectual impairment (N = 66; age M = 25 years; IQ M = 114; 63 White) who reported impairing symptoms associated with ASD (BAPQ total score > 3). One third (n = 22) had been diagnosed with ASD. Participants were recruited through local clinics, a university counseling center, and social media. Participants completed the SRS-2 (self-report), ADOS-2 (clinician rating of autistic traits), and TASIT-S (video-based test of social cognition). Results: As expected, women with a previous diagnosis of ASD showed significantly more social communication difficulties on the ADOS-2, t(64) = -4.88, p < .001, and TASIT-S, t(64) = 2.23, p = .03. Observable social difficulties on the ADOS-2 were significantly associated with poor performance on the TASIT-S (rS = -.27, p = .03). However, women with an ASD diagnosis did not report more social communication problems on the SRS-2, and SRS-2 scores were not associated with ADOS-2 or TASIT-S scores. Conclusions: These findings highlight the importance of using a multi-method approach when assessing social communication abilities in women with suspected autism, as self-report measures may not discriminate well mild from more severe impairment, and may disagree with clinician ratings and/or behavioral measures.

204 Cross-validation of the Dot Counting Test in a nonclinical sample 1384489 Karen Martinez Wichita State University Cross-validation of the Dot Counting Test in a nonclinical sample Professional Issues: Effort and Motivation Objective: Studies have indicated that nonclinical participants in neuropsychological research do not always perform validly on testing (e.g., An, Zakzanis, & Joordens, 2012). As such, we cross-validated a brief yet well-researched performance validity test, the Dot Counting Test (DCT), in a validly performing nonclinical sample. Method: Participants were 50 college students (mean age=19.92; mean education=14.10) who completed a neuropsychological test battery under the instruction to provide their best effort on all tests. Freestanding performance validity tests included the Test of Memory Malingering (TOMM) and DCT. To ensure that only valid participants were included in the study, it was required that participants pass all examined TOMM validity indices (i.e., Trial 1, Trial 2, Retention, Albany Consistency Index, and Invalid Forgetting Frequency Index; no participant failed any of these indices). Results: The first DCT E-score cutoff at which 90% specificity was obtained was >13. At a cutoff of >17 (a previously established clinical group cutoff), 98% specificity was obtained. At a cutoff of >21, 100% specificity was obtained. Conclusions: Results cross-validate the DCT for use in a nonclinical sample. Multiple cutoffs are reported, along with corresponding specificity rates. Researchers can now choose the cutoff, which corresponds to their desired specificity rate, to use in nonclinical research studies to help ensure that invalidly performing participants are excluded from future research.

205 Digit Span Raw, a newly derived embedded performance validity test 1384498 Ryan Schroeder University of Kansas School of Medicine - Wichita Digit Span Raw, a newly derived embedded performance validity test Professional Issues: Effort and Motivation Objective: Outside of Reliable Digit Span (RDS), there has been minimal research examining the utility of Digit Span (DS) score combinations from the Wechsler Adult Intelligence Scale – 4th Edition (WAIS-IV) as possible performance validity tests (PVTs). We sought to determine if other DS scores/score combinations might work more effectively than RDS as a PVT. Method: Patients included 318 individuals who completed neuropsychological evaluations. Individuals were excluded if they were not administered DS; were not administered at least 4 criterion PVTs; had diagnoses of dementia, intellectual disability, or left hemisphere cerebrovascular accident; or had indeterminate validity results (i.e., failure of one PVT). Valid performers (n=248) were those who passed all criterion PVTs while invalid performers (n=70) failed two or more criterion PVTs. Receiver operating characteristic curves were conducted for multiple DS indices. Results: Area under the curve (AUC) was highest for the DS index that combined raw scores from all three trials (Digit Span Raw; AUC=.821). Likewise, when examining cutoffs that maintained 90% specificity for each DS index, a Digit Span Raw cutoff of

206 "Mittenberg-Type formula for Identifying Feigned ADHD Using WAIS-IV” 1384463 Murphy Harrell Univeristy of South Alabama "Mittenberg-Type formula for Identifying Feigned ADHD Using WAIS-IV” Professional Issues: Effort and Motivation Objective: This study utilized logistic regression to determine whether performance patterns on the WAIS-IV subtests could differentiate between genuine-effort and simulated ADHD groups. Method: Participants were 355 college students (55.3%% female; 65.7% Caucasian, 23.9% African American, 4.2% Asian; age range 17 – 51 years, Mage = 20.93 years, SD = 4.63; 76.4% no psychological diagnosis) who completed the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Mean FSIQ for control group was 102.35 and 87.48 for the simulator group. Eighty participants (22.5%) simulated ADHD symptoms, while 276 participants (77.5%) provided genuine effort. Results: A logistic regression analysis was performed with known group as the dependent variable and WAIS-IV subtest scaled scores as predictor variables. The final model of five predictor variables (Similarities, Information, Digit Span, Symbol Search, and Coding) significantly predicted group status (χ2 = 140.91, df = 5, N = 355, p < .001). The model accounted for 33% to 50% of the variance (Cox and Snell R2 = .33; Nagelkerke R2 = .50) in performance classification with overall 86% of individuals correctly predicted to their known group. At a cut value of .65 the sensitivity was 69.6% and the specificity was 90.6%. A cut value of.55 the sensitivity was 53.2% and the specificity was at 94.6%. Conclusions: These findings are consistent with prior research suggesting discriminant function analysis derived from clinical measures (e.g., WAIS-IV) can be useful as embedded validity measures in distinguishing suspicious and genuine performance. Sensitivity, specificity, and predictive power of the WAIS-IV subtests were acceptable at 5% and 10% false positive rates.

207 Applying the Hartford Consistency Index to the Brief Visuospatial Memory Test – Revised for Assessing Performance Validity in an Outpatient Sample: A Pilot Study 1384454 Kameron Sheikh University of Hartford Applying the Hartford Consistency Index to the Brief Visuospatial Memory Test – Revised for Assessing Performance Validity in an Outpatient Sample: A Pilot Study Professional Issues: Effort and Motivation OBJECTIVE Prior studies have examined indices within the Brief Visuospatial Memory Test – Revised (BVMT-R) as potential embedded performance validity tests (PVT). Findings from these studies, however, are limited and with mixed results. Therefore, the purpose of the current study was to compare the classification accuracy of the Hartford Consistency Index (HCI) with published BVMT-R performance validity measures in an outpatient sample. METHOD A total of 115 archival files met study inclusion criteria: a) ≥ 18 years-old; b) administered >2 PVTs (Reliable Digit Span, Dot Counting Test, and Test of Memory Malingering); and c) no diagnoses of intellectual disability or dementia. Utilizing standard cutoffs, participants were classified as ‘Valid’ (n = 94) or ‘Invalid’ (n = 21). ‘Valid’ profiles passed all PVTs and were free of known external incentives while ‘Invalid’ profiles failed ≥ 2 PVTs. RESULTS An HCI cutoff of 90% specificity, but sensitivity rates were <40% and AUCs were consistently <.70. Similarly, the Recognition Discrimination (≤4) cutoff revealed inadequate specificity (84%), but acceptable sensitivity (63%), and AUC (.73). CONCLUSIONS Results from our study support the use of the HCI as an embedded PVT within the BVMT-R for non-demented outpatient samples. Furthermore, the HCI outperformed other embedded PVTs examined. Limitations of our study and future directions are discussed.

208 The effect of language on invalid baselines in ImPACT 1384440 Hana Kuwabara University of Nevada, Las Vegas The effect of language on invalid baselines in ImPACT Professional Issues: Effort and Motivation Objective: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized assessment of cognitive abilities used for management of sport-concussion that has been translated into 22 languages. Research suggests that language of administration may affect ImPACT performance in bilingual individuals. This study examined the rate of invalid baselines in bilingual/monolingual athletes and in different languages of administrations to explore any potential language biases in ImPACT’s validity index. Methods: Participants included 47,677 athletes (Mage=15.11; 57.37% male) from across Nevada who completed a baseline assessment. There were 90 different languages reported among 10,798 bilingual athletes (22.65%). Chi-square analyses were conducted to examine group differences in rate of invalid baselines by language (monolingual/bilingual) and administration language. Results: Overall, 6.2% of athletes produced invalid baselines. There were no significant differences in the rate of invalid baselines in self-reported monolingual (6.1%) and bilingual athletes (6.4%; p>.05). There were 12 different languages of administration; however, due to small sample sizes of some administration languages, further analyses were only conducted with English and Spanish administrations. There were no significant differences in invalid baselines in English (6.2%) and Spanish administrations (7.3%; p>.05). Additionally, among the bilingual Spanish/English speakers, there were no significant differences in invalid baselines in English (6.4%) and Spanish administrations (6.5%; p>.05). Conclusion: The current study demonstrates that rates of invalid baselines do not differ based on monolingualism/bilingualism or administration language. This is promising given the high demand for baseline testing, an increase in athletes’ diverse language abilities, and various available languages of ImPACT administration.

209 The relationship between performance on the Test of Memory Malingering (TOMM) Trial 1 and neurocognitive, emotional, and behavioral functioning in a pediatric concussion population. 1384374 Alphonso Smith Southern Illinois University School of Medicine The relationship between performance on the Test of Memory Malingering (TOMM) Trial 1 and neurocognitive, emotional, and behavioral functioning in a pediatric concussion population. Professional Issues: Effort and Motivation Objective: In concussion populations, suboptimal effort on performance validity tests (PVTs) has been associated with poorer neuropsychological scores and greater post-concussive complaints. This study examined if performance on TOMM Trial 1 was associated with increased cognitive deficits, post-concussive symptoms, and emotional concerns in a pediatric concussion population. Method: This study utilized archival data from 93 patients (mean age = 14.56, SD = 2.01) with a history of concussion who were assessed at approximately 40 days post-injury. Individuals were divided into “Pass” and “Fail” groups based on their TOMM Trial 1 performance using the established cut-off. The testing battery included Auditory Consonant Trigrams, CPT-II and III, HVLT-R, WJ-III and IV, ImPACT, BASC-2, and BRIEF. Results: The overall pass rate on Trial 1 was 70% (mean = 46.04, SD = 4.55). There were no significant correlations with Trial 1 and age, grade, gender, prior history of concussion, or mechanism of injury. The Fail group scored lower across domains of attention, memory, and processing speed when compared to the Pass group (p

210 Does Rounding Matter? Cross-Validation of E-Score Calculation Method for the Dot Counting Test 1384296 Tasha Rhoads Rosalind Franklin University of Medicine and Science Does Rounding Matter? Cross-Validation of E-Score Calculation Method for the Dot Counting Test Professional Issues: Effort and Motivation Objective. Recent evidence suggested the traditional “rounding” procedure used to calculate Dot Counting Test (DCT) E-score cut-offs provides little advantage and may inadvertently lower test sensitivity. This study examined whether DCT psychometric properties differ when E-score values are rounded. Method. This cross-sectional study included 132 mixed neuropsychiatric patients who completed the DCT during outpatient evaluation. The sample was 55% female/45% male and 36% Caucasian/35% African American/20% Hispanic/7% Asian/2% other, with mean age of 44.4 (SD=16.1), and mean education of 14.0 years (SD=2.5). In total, 105 (80%) had valid neuropsychological test performance and 27 (20%) had invalid performance based on 4 independent criterion performance validity tests. Results. In the overall sample, receiver operating characteristic (ROC) curve analyses yielded significant areas under the curve (.802-.817) for both rounded and unrounded E-score values with respective optimal cut-scores of ≥19 and ≥19.73, both producing 44% sensitivity/93% specificity. Among cognitively impaired patients, ROC curve analyses yielded significant AUCs (.756-.764), and suggested the same cut-scores and sensitivities, albeit with minimally reduced specificity (traditional: 91%; unrounded: 92%). In contrast, more liberal cut-scores of ≥13 (traditional) and ≥13.745 (unrounded) were indicated among cognitively unimpaired patients (AUCs: .880-.906), and sensitivity was notably improved (traditional: 74%; unrounded: 67%) with equivalent specificity (90%). Conclusions. Findings from the overall sample suggested marginally better classification accuracy for the traditional E-score, though both methods demonstrated comparable psychometric properties. The optimal cut-score for cognitively unimpaired patients replicated findings from prior literature, but a higher cut-score was indicated for cognitively impaired patients.

211 Examination of the Personality Assessment Inventory and Performance Validity Tests: Correlation between Response Styles, Performance Effort, and Somatic Complaint. 1384255 Chi Chan Allegheny General Hospital Examination of the Personality Assessment Inventory and Performance Validity Tests: Correlation between Response Styles, Performance Effort, and Somatic Complaint. Professional Issues: Effort and Motivation Objective: Correlation between the performance validity measures from the Advanced Clinical Solution (ACS) package and select scales from the Personality Assessment Inventory (PAI) were examined to investigate relationships between performance effort and response styles involving negative impression (NIM), inconsistency (ICN), infrequency (INF), and somatic compliant (SOM) scales. Theoretical differences between symptom validity based on self-report questionnaires and credibility of performance on a performance validity tests (PVTs) were considered. Method: Archival data from clinical neuropsychological evaluations between the years 2015-2018 were reviewed, and 120 consecutive adult cases involving 68 males and 52 females between the ages of 19-69 were collected. Examined measures included: ACS – Word Choice Test (WCT), Reliable Digit Span, Visual Reproduction II Recognition, Logical Memory II Recognition, and the PAI. Spearman’s rank-order correlation and point-biserial correlation analyses were conducted to examine the relationship between variables. Results: WCT had significant negative correlations with the NIM scale (rs(118) = -.203, p = .013). Modest correlations were found between SOM and WCT when examining PVT raw score (rs (118) = -.192, p = .018) and base rate performance (rs(118) = -.222, p = .007). Point-biserial serial analysis found a weak negative correlation between performance credibility and the SOM scale, which was statistically significant (rpb = -.221, n = 120, p = .008). Conclusions: NIM T-scores appear to be correlated with lower performance on the WCT, suggesting that an exaggerated or distorted impression of the self is associated with higher risk of poorer performance the stand-alone PVT. Correlation between embedded PVTs and PAI scales were inconsistent.

212 The Relationships between PAI over-reporting SVTs and PVTs in a Military Sample 1384358 Patrick Armistead-Jehle Munson Army Health Center The Relationships between PAI over-reporting SVTs and PVTs in a Military Sample Professional Issues: Effort and Motivation OBJECTIVE: Recent research has worked to explore the relationships between symptom and performance validity testing. The current study sought to examine the association between PAI over-reporting SVTs and well validated stand-alone and embedded PVTs. METHODS: Retrospective review of 468 active duty Army cases referred for outpatient neuropsychological testing at a Military Health Center. Each subject was administered the PAI, MSVT, NV-MSVT, and RBANS Effort Index. Groups were defined in two ways, as valid (0 PVT failures) or invalid (1 or more PVT failures) and based on the number of failed PVTs (0, 1, 2, and 3). Results: Partial results are summarized here for the valid/invalid analysis. The PAI Negative Impression Management (NIM), Multi-Feigning Index (MFI), and Malingering Index (MAL) differed significantly as a function of PVT performance (p<.05). Differences on Rogers Discriminant Function were not significant. AUC for NIM, MAL, and MFI were .69, .66, and .54 (respectively). AUC for RDF was unacceptable at .49. At a T-score of 64 the NIM scale had specificity of .91, sensitivity of .32 and at a T-score of 59 the MAL had specificity of .91 and sensitivity of .14. Conclusions There appears an association between PVTs and PAI over-reporting scales, such that elevations on the NIM, MAL, and MFI scales are related to PVT failure. However, the sensitives of these scales are limited in predicting PVT failure. To this end, the current data are in line with previous studies that indicate the need to administer both performance and symptom validity scales.

213 Comparing WAIS-IV Reliable Digit Span and Age Corrected Scaled Score’s Performance Validity Cutoffs when Patients’ Effort is Determined by One or More Performance Validity Tests (PVTs) 1384318 Julia Livingstone University of Texas Southwestern Medical Center Comparing WAIS-IV Reliable Digit Span and Age Corrected Scaled Score’s Performance Validity Cutoffs when Patients’ Effort is Determined by One or More Performance Validity Tests (PVTs) Professional Issues: Effort and Motivation 1. Objective: The purpose of the present study was to compare Wechsler Adult Intelligence Scale-IV (WAIS-IV) Reliable Digit Span (RDS) and Digit Span Age-Corrected Scaled Score (DS-ACSS) sensitivity and specificity, when the effort criterion was determined by between one and five performance validity test (PVT) cut scores. 2. Method: Data were collected from 82 adults (18-49) referred for clinical questions of multiple sclerosis, mild traumatic brain injury, and attention deficit hyperactivity disorder. Patients were administered full neuropsychological batteries ,with different combinations of PVTs (including Advanced Clinical Solutions Word Choice, Animals raw score, Trails A T-score, Wisconsin Card Sorting Test [WCST; Suhr & Boyer] equation, and California Verbal Learning Test-II Forced Choice). Chi-square and receiver operating characteristic (ROC) analyses were utilized. 3. Results: Using established RDS (≤7) and DS-ACSS (≤6) cut scores, specificity was highest (90% and 86%, respectively), with equivalent sensitivity (90%), when effort was determined by WCST (Suhr & Boyer) equation failure alone. Related area under the curve for RDS was .90 (CI=.76-1.0) and for DS-ACSS was .88 (CI=.74-1.0) 4. Conclusions: In this clinical sample, the highest sensitivity and specificity were observed when the RDS cut score was utilized, and effort was based on the WCST criterion. However, the DS-ACSS cut score resulted in strong sensitivity/specificity combinations across more effort classification groups.

214 Multiple Assessments of Effort in Retired NFL Players Seeking Compensation 1384373 Damin Hadorn-Papke Nova Southeastern University Multiple Assessments of Effort in Retired NFL Players Seeking Compensation Professional Issues: Effort and Motivation Objective: Determining the effort level allocated during a neuropsychological evaluation is essential, as effort has been shown to predict performance. Method: One hundred and thirty-seven former NFL players were given the Test of Memory Malingering (TOMM) and Green’s Medical Symptoms Validity Test (MSVT) as part of a comprehensive neuropsychological evaluation. Results: Based on established “cutoff” scores, 42 of the 137 individuals failed the TOMM (Trial 2, raw score<45). Using the recommended “cutoff” scores, (Immediate recall, Delayed recall, Consistency <=85%, Paired Associated <=70%, Free recall<=50%), 74 individuals failed the MSVT. Together, the TOMM and the MSVT identified 81 individuals with sub-optimal effort and likely invalid neuropsychological test data, as both the TOMM and MSVT are passed by groups with known traumatic brain injury and other impairments. Conclusions: We conclude that 59.1% of the Former NFL players put forth inadequate effort during testing. While the reasons for PVT failure are known only by the test-takers themselves, the validity of the results is highly questionable regardless and must be interpreted in this context.

215 The Utility of the First Ten Items of the Warrington Recognition Memory Test as a Performance Validity Test 1384429 Jessica Fett Tennessee Valley HealthCare System The Utility of the First Ten Items of the Warrington Recognition Memory Test as a Performance Validity Test Professional Issues: Effort and Motivation Objective: Performance validity tests (PVTs) are widely used in neuropsychological evaluations but are often lengthy and time-consuming. Therefore, development of more efficient PVTs is critical. The current study evaluated the utility of the first 10 items of the Warrington Recognition Memory Test (RMT) as an indicator of performance validity. Methods: This study utilized archival data from 134 veterans presenting for a clinical neuropsychological evaluation at a southeastern Veterans Affairs hospital. Patients were deemed “credible” if they failed less than two unrelated PVT measures, had a FSIQ >70, and did not carry a diagnosis of dementia. This resulted in 103 patients in the credible group [Mage = 49.76(11.67); Meducation = 14.09(2.88); 77.67% Male]. The 31 patients in the non-credible group met Slick et al. (1999) criteria[Mage = 45.13(11.18); Meducation = 12.77(2.53); 87.10% Male]. Frequency counts were run to determine sensitivity and specificity values at established cut-offs and to create new cut-offs for the first 10 items. Results: Using established cut-off scores, the RMT total score had adequate specificity (91%) with a corresponding sensitivity of 84%, and the RMT time score had adequate specificity (93%) with a corresponding sensitivity of 34%. When examining the first 10 items on the RMT, a score of <8 resulted in 96% specificity and 61% sensitivity. Conclusions: The established cutoffs for the RMT performed well in this patient sample. Additionally, using a cutoff score of ≤ 8 on the first 10 items of the RMT may be a useful indicator of probable failure on the RMT, significantly reducing test administration time.

216 The relationship between cognitive performance on a sports-concussion assessment battery and the Motivation Behaviors Checklist (MBC) 1384313 Erin Guty The Pennsylvania State University The relationship between cognitive performance on a sports-concussion assessment battery and the Motivation Behaviors Checklist (MBC) Professional Issues: Effort and Motivation Objective: The Motivation Behaviors Checklist (MBC) was designed as an observational rating scale to assess effort during baseline evaluations (Rabinowitz, Merritt, and Arnett, 2016). This study aims to explore the MBC in relation to a comprehensive battery of neuropsychological tests, including paper-and-pencil tests. Method: Participants included 291 (M = 213, F = 78) student-athletes from a Division I University sports concussion program. Seventeen neuropsychological test indices were used to create a neurocognitive composite. The 18-item MBC was scored such that higher values indicate greater motivation/effort. Across test indices, the number of impaired scores (below the 80th percentile) was also calculated. Individuals were placed into impairment groups (Impaired ≥ 3 impaired scores) and motivation groups based on their MBC scores (High Motivation = score greater than the median of 49). Results: Bivariate correlations demonstrated a significant relationship (ρ = .39, p < .001) between cognitive performance and the MBC total score. Chi-square analysis demonstrated that significantly more of the 81 individuals in the Impaired group were also in the Low Motivation group (n = 56, 69%), χ2 (1, N = 291) = 18.53, p < .001, Φ = -.25. Conclusions: Higher motivation scores on the MBC are related to better cognitive performance. Compared with cognitively intact individuals, those who were cognitively impaired were significantly more likely to score below the cut off score of 49 on the MBC. Future work will explore different cutoff values that maximize sensitivity and specificity for test performance in order to provide guidelines for clinicians wishing to utilize the MBC.

217 Associations among Symptom Validity Tests in Combat Veterans 1384383 Robert Shura MA-MIRECC Associations among Symptom Validity Tests in Combat Veterans Professional Issues: Effort and Motivation Objective: The Neurobehavioral Symptom Inventory (NSI) is a 22-item self-report measure of non-specific cognitive and somatic symptoms, which contains an embedded measure of symptom validity (Validity 10 scale [V-10]). The mild brain injury atypical symptom (mBIAS) is a separate 5-item measure of symptom validity designed for use in mild traumatic brain injury evaluation. The current study evaluated the NSI V-10 and mBIAS in relation to the Structured Inventory of Malingered Symptomatology (SIMS) Total score and subtest scores. Method: Participants were 338 veterans who completed a parent study at a VA Medical Center. All participants deployed to Iraq and/or Afghanistan, did not have a history of moderate or severe traumatic brain injury, and did not have significant neurological or psychiatric conditions. Participants completed the SIMS and the NSI with mBIAS as part of a larger battery. The sample was 86% male and 57% White, with a mean age of 42 years and education of 15 years. Results: AUC values using a higher SIMS Total cutoff score were .887 for the V-10 and .735 for the mBIAS; diagnostic accuracy data at various cutoff scores are presented. For SIMS subscales, the mBIAS had higher correlations to the Psychosis (r = .48) and Low Intelligence (r = .31) scales, whereas the V-10 had higher correlations to the Neurologic Impairment (r = .73), Amnestic Disorders (r = .66), and Affective Disorders (r = .59) scales. Conclusion: Current data suggest that the V-10 and mBIAS measure different symptom validity constructs and could therefore be employed in a complimentary manner.

219 Cross-validation of a Delis-Kaplan Executive Function System Color Word Interference Test embedded performance validity test 1384499 Ryan Schroeder University of Kansas School of Medicine - Wichita Cross-validation of a Delis-Kaplan Executive Function System Color Word Interference Test embedded performance validity test Professional Issues: Effort and Motivation Objective: Eglit and colleagues (2019) found that the sum of the four age-corrected scaled scores from the Color Word Interference Test (CWIT) of the Delis-Kaplan Executive Function System (D-KEFS) could act as a useful embedded performance validity test (PVT). As such, we attempted to cross-validate their findings. Method: Patients included 312 individuals who completed neuropsychological evaluations. Individuals were excluded if they were not administered CWIT, were not administered at least 4 criterion PVTs, had diagnoses of dementia or intellectual disability, or had indeterminate validity results (i.e., failure of one PVT). Valid performers (n=231) were those who passed all criterion PVTs while invalid performers (n=81) failed two or more criterion PVTs. A receiver operating characteristic curve was conducted for the CWIT embedded PVT. Results: Area under the curve (AUC) was .804. At a cutoff of

220 Screening for Cognitive Over-Reporting with the Neurobehavioral Symptom Inventory 1384467 Summer Rolin University of Utah Screening for Cognitive Over-Reporting with the Neurobehavioral Symptom Inventory Professional Issues: Effort and Motivation Objective: Considerable research in veteran and military populations has focused on the development of embedded symptom validity indicators on the Neurobehavioral Symptom Inventory (NSI) including the low frequency (LOW6), negative impression management (NIM5), and validity (VAL10) scales. These measures have been less studied in other clinical settings. This study examined embedded NSI validity scales in a rehabilitation setting. Method: Participants (N=94) underwent outpatient neuropsychological evaluation using the NSI, MMPI-2-RF, and Memory Complaints Inventory (MCI), among other measures. Cognitive symptom over-reporting was psychometrically determined if the MCI (average score>39) and MMPI-2-RF (RBS>79T or FBS>79T) were elevated. Results: Thirty-four participants (36%) met over-reporting criteria. NSI total scores were significantly different between over-reporting (M=48.7, SD= 12.2) and non-over-reporting (M=28.1, SD=14.3) groups (p18) showed sensitivity of 56% and 90% specificity. VAL10 scores of 4 or below demonstrated 100% sensitivity and may be considered evidence that additional assessment of cognitive over-reporting is not needed. Conclusion: Findings support the utility of NSI validity indicators to screen for cognitive over-reporting in a rehabilitation setting.

221 The Impact of Visuospatial Memory Impairment on Rey 15-Item Test and Test of Memory Malingering Performance: Implications for Performance Validity Assessment 1384338 Dustin Carter University of Illinois at Chicago The Impact of Visuospatial Memory Impairment on Rey 15-Item Test and Test of Memory Malingering Performance: Implications for Performance Validity Assessment Professional Issues: Effort and Motivation Objective: This study examined Rey 15-Item Test (RFIT), RFIT/Recognition Trial, and Test of Memory Malingering-Trial 1 (TOMM-T1) performance as a function of increasing visual memory impairment to assess the effect of bona fide memory deficits on these performance validity tests (PVTs). Method: Cross-sectional data from 146 patients who were administered the RFIT, TOMM-T1, and Brief Visuospatial Memory Test-Revised Delayed Recall (BVMT-R DR) trial were examined. In total, 120/146 (82%) were classified as valid and 26/146 (18%) as invalid per 4 independent criterion PVTs. The valid sample was 55% female/45% male, 39% Caucasian, 33% African American, 19% Hispanic, 7% Asian, and 3% other, with mean age of 46.2 (SD=16.7) and education of 14.0 years (SD=2.6). BVMT-R DR memory impairment bands were defined as ≥40T (unimpaired; N=70), 30-39T (mild impairment; N=26), and ≤29T (severe impairment; N=24). Results: Multivariate analysis of variance with memory impairment bands as the fixed factor was significant, (p<.001, np2=.21). Follow-up ANOVAs for RFIT (p<.001, np2=.29) and RFIT/Recognition (p<.001, np2=.34) were significant with large effect sizes, whereas TOMM-T1 (p<.05, np2=.07) exhibited significant, albeit smaller, differences across memory bands. Post-hoc comparisons showed the unimpaired group outperformed the mild and severe impairment groups on the RFIT and RFIT/Recognition, whereas nonsignificant TOMM-T1 differences emerged between the three memory groups. Finally, significantly more patients with memory impairment failed the RFIT (X2=18.01, p<.001), and RFIT/Recognition (X2=23.70, p<.001), but not TOMM-T1 (X2=3.70, p=.16). Conclusions: Results showed the RFIT and RFIT/Recognition were more highly affected by memory impairment and yielded significantly greater false positives with increasing memory impairment compared to TOMM-T1.

222 Efficacy of D–KEFS Trail Making Test Conditions 1–5 Using Age-Corrected Scaled Score Cutoffs as Embedded Validity Indicators in a Sample of Youth Athletes 1384453 Ryan Thompson Palo Alto University Efficacy of D–KEFS Trail Making Test Conditions 1–5 Using Age-Corrected Scaled Score Cutoffs as Embedded Validity Indicators in a Sample of Youth Athletes Professional Issues: Effort and Motivation Objective: Embedded validity indicators (EVI) assist in the evaluation of performance validity across a neuropsychological battery without increasing the time or cognitive demand on patients during testing. Erdodi et al. (2018) evaluated Delis–Kaplan Executive Function System (D–KEFS) Trail Making Test Conditions 1–5 (TMT1–5) as EVIs in adults using age-corrected scaled score (ACSS) cutoffs, demonstrating adequate specificity but inadequate sensitivity. This study assessed the TMT1–5 as EVIs in children using a specificity threshold of >.89 (Boone, 2013). Method: Youth athletes (n = 134, M age = 12.2) completed a two-hour neuropsychological battery that included TMT1–5 and TOMM during a larger sport-related concussion clinical research evaluation. Specificity, sensitivity, and area under the curve (AUC) were calculated for TMT1–5 using ACSS cutoffs to predict TOMM Trial 2 (TOMM2) pass/fail performance. Results: When predicting TOMM2 (cutoff.89) and inadequate sensitivity (.00), with TMT3 and TMT4 having the highest AUC (.81 and .74, respectively). The following ACSS cutoffs met the specificity threshold (>.89): TMT1 ACSS<7, TMT2<9, TMT3<6, TMT4<7, and TMT5.79, we increased sensitivity for TMT1–3 (.33). Conclusion: D–KEFS TMT1–5 achieved excellent specificity (>.89) when predicting TOMM2 performance but demonstrated inadequate sensitivity. Lowering the specificity threshold slightly still yielded low sensitivity. These data suggest that D–KEFS TMT3 and TMT4 were most effective at detecting adequate effort, but should be supported with other validity measures when assessing performance validity across a neuropsychological battery.

223 Hopkins Verbal Learning Test-Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R) Embedded Performance Validity Analyses in a Healthy Non-Clinical Sample 1384342 Anna Arzuyan California School of Professional Psychology Hopkins Verbal Learning Test-Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R) Embedded Performance Validity Analyses in a Healthy Non-Clinical Sample Professional Issues: Effort and Motivation Objective: The Hopkins Verbal Learning Test–Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R) are memory tests with embedded measures of performance validity (Recognition Discrimination [RD] and Discrimination Index [DI], respectively). We evaluated whether cognitive ability and age influenced embedded measures of effort. Methods: Participants included 30 young adults (YA) and 29 older adults (dichotomized into unimpaired [OAu] and impaired [OAi]). Participants completed a medication management ability assessment (MMAA), daily memory lapses survey (DM), digit span, and the Transverse Patterning (TP) and Reversal Learning (RL) computerized tests. Two Repeated-Measures MANOVAs were conducted to determine if Passing PVT and Age/Cognitive Ability influenced performance. An ROC analysis was conducted for HVLT-RD and BVMT-DI to determine pass/fail, and false positives/negatives on embedded measures. Results: Those in the YA group who failed RDS (YA-fail), performed better than OAi-fail and OAi-pass groups on RT Errors (p<.0001). On TP Errors, the YA group differed from all four OA groups (p<.0001). On MMAA a significant difference was observed between OAi-fail and all other groups (p<.001). On RD, YA groups differed from both OAi groups (p=.0008). On DI, the YA groups differed from the OAi-fail group (p=.002). A logistic regression classified 43/57 participants successfully into the three cognitive groups using the six predictors (2=55.73, p<.0001, R2=.468). RT Errors and TP were significant (Likelihood 2=7.25, p=.027). Conclusion: HVLT-RD failed to detect validity for OAi, as did BVMT-DI for YA and OAu. Instead, impairment effects are seen on HVLT-RD and BVMT-DI where YA groups differed from some combination of both/one of the OA groups.

224 Clinical Utility of Grooved Pegboard as an Additional Embedded Measure of Performance Validity 1384300 Jared Link Brooke Army Medical Center, JBSA-Ft. Sam Houston, TX Clinical Utility of Grooved Pegboard as an Additional Embedded Measure of Performance Validity Professional Issues: Effort and Motivation Objective: Previously, the Grooved Pegboard Test (GPB) has shown potential as an embedded measure of performance validity (PVT) using a T-score cutoff for either hand (≤ 29) or both hands (≤ 31). This study sought to validate these cutoffs with established PVTs (Medical Symptom Validity Test [MSVT], Non-Verbal Medical Symptom Validity Test [NV-MSVT], and Reliable Digit Span [RDS]). Method: Subjects (N=190) were primarily Caucasian (85%) and male (81%). Average age and education were 41 (SD = 11.62) and 16 years (SD = 2.35), respectively. Participants were stratified as GPB “pass or fail” based on previously proposed cutoff criteria. MSVT, NV-MSVT, and RDS were also dichotomized as pass or fail based on manual or conventional recommendations. Results: Chi-Square analyses revealed significant associations between GPB “fails” for both hands and MSVT, NV-MSVT, and RDS (χ2 (1, n=190) ranging from 5.80 to 15.98, Phi ranging from .18 to .29, p ranging from <.05 to <.0001). Similar findings were observed for dominant hand “fails”; however, non-dominant hand was only related to the MSVT. Sensitivity and specificity values from the GPB measures ranged from .47 to .58 and from .89 to .92, respectively. Positive and negative predictive power ranged from .38 to .45 and .93 to .94, respectively. Conclusion: These data demonstrate the relative utility of the GPB as an embedded PVT. In particular, dominant and both hand cutoffs are likely to be more clinically useful in determining sub-optimal performance. However, as sensitivity is relatively low, this measure should not be employed as the sole PVT administered.

225 The Rey Dot Counting Test as a Tool for Detecting Suboptimal Performance in Athlete Baseline Testing 1384484 Andrew DaCosta Florida Tech The Rey Dot Counting Test as a Tool for Detecting Suboptimal Performance in Athlete Baseline Testing Professional Issues: Effort and Motivation Objective: The limitations of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)’s embedded validity measures (EVMs) are well-documented, as estimates suggest up to 35% of invalid baseline performances go undetected (Gaudet & Weyandt, 2017). Few studies have examined standalone performance validity tests (PVT) as a supplement to ImPACT’s EVMs (Gaudet & Weyandt, 2017). Method: College athletes (n = 1,213) were administered a preseason baseline assessment that included ImPACT and the Rey Dot Counting Test (DCT), a standalone PVT, among other measures. Results: Sixty-nine athletes (5.69%) met criteria for suboptimal effort on either ImPACT or the DCT. The DCT detected more cases of suboptimal effort (n = 50) than ImPACT (n = 21). A χ2 test of independence detected significant disagreement between the two measures, as only 2 individuals produced suboptimal effort on both (χ2(2) = 1.568, p = .210). Despite this disagreement, there were significant differences between the suboptimal effort DCT group and the adequate effort DCT group across all four ImPACT neurocognitive domains (U = 19225.000, p < .001; U = 17859.000, p < .001; U = 13854.000, p < .001; U = 17850.500, p < .001). Conclusions: The DCT appears to detect suboptimal effort otherwise undetected by ImPACT’s EVMs.

226 Identifying Performance Validity Indices within the NIH Toolbox 1384307 Sarah Monaghan John Jay College of Criminal Justice Identifying Performance Validity Indices within the NIH Toolbox Professional Issues: Effort and Motivation Objective: The National Institute of Health Toolbox–Cognitive Battery (NIHTB-CB) is a rigorously developed, state-of-the-art neuropsychological screening battery. However, one of its current limitations is the lack of any embedded measures of performance validity. To address this critical gap, the current project explored the relevant literature to determine which NIHTB-CB indices might be most suitable for further investigation. Data Selection: A targeted literature review was conducted to explore the development of embedded indicators of performance validity within contemporary neuropsychological batteries. The most foundational and scientifically rigorous literature was gathered using targeted search terms in PsycInfo and Google Scholar. Data Synthesis: This selected literature base was reviewed and compared to relevant NIHTB-CB indices. The most suitable indices within the NIHTB-CB appear to include: (1) a pattern of responding on the recognition trial for the Picture Sequence Memory Test that is inconsistent with that of individuals with known brain damage; (2) a severely impaired score on the Picture Vocabulary Test and the Oral Reading Recognition Test; (3) the frequency and length of unusual reaction time differences on the Pattern Comparison Processing Speed Test; and (4) overall performance comparisons with groups with known brain injury or illness. Conclusions: Several indices within the NIHTB-CB hold great promise as performance validity indicators. Future research is needed to establish the validity of these indices using simulation and known-group designs. Establishing indicators of performance validity within the NIHTB-CB will result in more rigorous clinical research and improved clinical practice.

227 Boston Naming Test as an Embedded Performance Validity Test: A Replication Study 1384263 Dayna Abramson University of Illinois at Chicago Boston Naming Test as an Embedded Performance Validity Test: A Replication Study Professional Issues: Effort and Motivation Objective: The Boston Naming Test (BNT) has recently been proposed as an embedded performance validity test (PVT) with high specificity/low sensitivity; however, this has not been replicated. This study therefore aimed to cross-validate findings in a mixed clinical neuropsychiatric sample. Method: This cross-sectional study of 136 primary monolingual English-speaking patients who completed the BNT during outpatient evaluation was 57% female/43% male, 38% Caucasian, 39% African American, 16% Hispanic, and 6% Asian with mean age of 47.7 years (SD=16.6) and mean education of 14.0 years (SD=2.7). In total, 109/136 (80%) were classified as valid and 27/136 (20%) as invalid based on 4 independent criterion PVTs. Results: Respective mean BNT raw/T-scores were 49.5 (SD=9.2)/45.3 (SD=10.9) for the valid group and 45.8 (SD=8.2)/41.1 (SD=7.8) for the invalid group. Analyses of variance fell just above significance for both BNT raw F(1, 134)=3.75, p=.05 and T-scores F(1, 134)=3.55, p=.06. Receiver operator characteristic curve analysis for the raw score was significant, with an area under the curve (AUC) of .67 (p<.01) and an optimal cutoff of ≤35 (4% specificity/90% sensitivity). BNT raw scores remained significant after removing bilingual participants, (AUC=.68; p<.01), with identical psychometric properties. In contrast, analysis of BNT T-scores (AUC=.61; p=.08) were nonsignificant. Conclusions: Overall, results showed that the BNT cannot psychometrically distinguish valid versus invalid performance and therefore has questionable utility as a PVT in a mixed clinical setting. Findings contribute to a growing literature base cautioning against the indiscriminate use of measures of actual cognitive ability as validity indicators, particularly in populations with cognitive impairment.

228 Are Those Who Fail Performance Validity Measures High Utilizers of Healthcare? 1384480 Callie Cooper Brooke Army Medical Center Are Those Who Fail Performance Validity Measures High Utilizers of Healthcare? Professional Issues: Effort and Motivation Objective: One study reported that suboptimal effort on performance validity tests (PVTs) is associated with higher healthcare utilization within a VA setting, defined as the number of Emergency Department visits and inpatient hospitalizations. The current study sought to expand on this by examining whether PVT failure is associated with higher number of outpatient visits in a military sample with a history of mild traumatic brain injury (mTBI). Method: The medical records of 43 participants, 13 of whom failed the PVT Green’s Word Memory Test (WMT), were reviewed for the number of encounters since the mTBI and the reason for the encounter. The two groups (passed vs. failed) did not differ significantly on demographic variables (39 males, mean age 39, 65% Caucasian). Results: The overall number of medical encounters was not significant between the two groups after controlling for years since the mTBI (F(1, 40) = 2.67 , p = .11 ); however, once three participants with (>2 years) missing records were excluded (final n=40), the PVT failure group was seen significantly more often, (F(1, 37) = 8.23 , p = .01). The PVT failures had a higher number of encounters with physical therapy (t(38) = -2.79, p = .01) and orthopedics (t(38) = -2.10, p = .04). Conclusions: Preliminary results suggest that suboptimal effort is not associated with higher healthcare utilization; however, when participants with more than two years of missing records were excluded, those who failed PVTs were seen more frequently by physical therapy and orthopedic specialties. Limitations for future investigations are highlighted.

229 Is the multitude proficiently able to elucidate the imperative substance and subsequently able to identify the applicable inferential material to adequately utilize assessments: Can people read and understand our reports? 1384356 Genni Newsham Southern Illinois University Is the multitude proficiently able to elucidate the imperative substance and subsequently able to identify the applicable inferential material to adequately utilize assessments: Can people read and understand our reports? Professional Issues: Ethics Objective: Many U.S. adults read at an eighth-grade level (Safeer, R., 2005). Thus, neuropsychological reports’ technical language might present a challenge for average readers. However, there are no professional guidelines on report readability and little formal research on the topic. Hence, the study’s objective was to investigate the average readability of psychological and neuropsychological reports from a local university clinic and to provide suggestions for improving the readability of reports. Method: 73 psychological reports and 34 neuropsychological reports were analyzed using the readability feature in Microsoft Word. This feature provides two outcomes of interest: the Flesch Reading Ease score (a 100-point scale with higher numbers indicating easier readability) and the Flesch-Kincaid Grade Level Score (which provides a U.S. grade-level equivalence). Documents are considered readable with a reading ease score of 60 and a grade level score of 8.0. The average and range of scores for each report type were calculated. Results: In general, psychological reports were written at a 13.2 (12-14.8) grade level, with a readability score of 34.3 (24.2-41.4). Neuropsychological reports were written at a 12.6 (11.2-14.5) grade level, with a readability score of 36.3 (25.5-42.7). Conclusion(s): The reports reviewed are functionally unreadable to many in the general public, which has important implications for clinical practice. This could be addressed by altering the reading level at which reports are written, including “plain-language” inserts, or altering specific parts of reports that have the most relevance to clients (e.g. summary and recommendations) to increase comprehension. Feedback on these ideas will be garnered at the poster.

230 Symptom Validity and MMPI-2-RF Somatic/Cognitive Scales 1384341 Summer Rolin University of Utah Symptom Validity and MMPI-2-RF Somatic/Cognitive Scales Professional Issues: Forensic Practice Objective: In addition to the standard validity scales, the MMPI-2-RF Somatic/Cognitive Scales (SCS) are associated with symptom validity in veteran and epilepsy samples. The Neurobehavioral Symptom Inventory (NSI) is a self-report questionnaire with an embedded symptom validity index (Validity-10) developed by examining endorsement on atypical neurological items. The current study examined relationships among symptom validity and SCS in a physical medicine and rehabilitation sample. Method: Participants underwent outpatient evaluation with the MMPI-2-RF and NSI among other measures. Cases with invalid MMPI-2-RF (TRIN or VRIN>79; Cannot Say>14) were excluded (n=5). The sample (N=120) was 43% female and 96% white with average age and education of 41 (SD=13) and 14 (SD=2) years, respectively. A linear regression model was examined with Valdity-10 as outcome and SCS as predictors. Participants were grouped by Validity-10 cutoff (>18). SCS were examined with receiver operating characteristic analysis and compared to the MMPI-2-RF Symptom Validity Scale (FBS). Results: A regression model predicting Validity-10 was significant (p<.001; R-squared=.51). Gastrointestinal complaints and neurologic complaints (NUC) scales made independent contributions with standardized beta-weights of .18 and .43, respectively. Twenty-seven percent of participants scored above cutoff on the Validity-10. NUC showed area under the curve (AUC) of .78 predicting Validity-10 status, which was not significantly different from the FBS AUC of .81. A NUC cutoff of 91 or higher showed 34% sensitivity and 93% specificity. Conclusion: MMPI-2-RF SCS are associated with symptom validity as determined by the NSI Validity-10. In this rehabilitation sample, NUC was comparable to FBS in classifying participants grouped by symptom validity.

231 Using Rates of Low Scores to Assess Agreement between CogState and a Traditional Battery of Neuropsychological Tests 1384324 Brian Ivins Defense and Veterans Brain Injury Center Using Rates of Low Scores to Assess Agreement between CogState and a Traditional Battery of Neuropsychological Tests Professional Issues: Test Development and Methods Objective: CogState is a brief computerized test battery used to assess cognitive function. We compare intra-individual agreement between CogState and a battery of traditional neuropsychological tests using rates of low scores. Methods: Complete and valid data from 246 healthy soldiers and 177 soldiers ≤7 days from sustaining mild TBI (mTBI) were used in this analysis. All soldiers were consecutively administered CogState and a traditional test battery consisting of: TOPF, WAIS-IV, CVLT-II, RCFT, DKEFS, and CPT-II. We performed base rate analyses of both batteries to determine the proportions of soldiers who had various numbers of scores that were 1.0+, 1.5+, and 2.0+ standard deviations below the normative mean. We used those rates to place Soldiers into a “low score hierarchy” ranging from the least poor (i.e. ~>10th %ile) to the worst overall performance (i.e. ~≤10th %ile). We then compared agreement between the batteries at each of those levels. Results: More soldiers with mTBI had low scores than healthy soldiers on both batteries. Of the soldiers who performed at the worst level on one battery, 95.1% from CogState and 70.6% from traditional had some level of poor performance on the other battery. However, of the soldiers who performed at the worst level on either battery, only 31.7% from CogState and 38.2% from traditional also performed at the worst level on the other battery. Conclusion: These batteries similarly identify poor performance to a degree, though with some potentially meaningful differences still present.

232 Using Rates of Low Scores to Assess Agreement between ImPACT and a Traditional Battery of Neuropsychological Tests 1384325 Brian Ivins Defense and Veterans Brain Injury Center Using Rates of Low Scores to Assess Agreement between ImPACT and a Traditional Battery of Neuropsychological Tests Professional Issues: Test Development and Methods Objective: ImPACT is a brief computerized test battery used to assess cognitive function most often following sports concussion. We compare intra-individual agreement between ImPACT and a battery of traditional neuropsychological tests using rates of low scores. Methods: Complete and valid data from 246 healthy soldiers and 177 soldiers ≤7 days from sustaining mild TBI (mTBI) were used in this analysis. All soldiers were consecutively administered ImPACT and a traditional test battery consisting of: TOPF, WAIS-IV, CVLT-II, RCFT, DKEFS, and CPT-II. We performed base rate analyses of both batteries to determine the proportions of soldiers who had various numbers of scores that were 1.0+, 1.5+, and 2.0+ standard deviations below the normative mean. We used those rates to place Soldiers into a “low score hierarchy” ranging from the least poor (i.e. ~>10th %ile) to the worst overall performance (i.e. ~≤10th %ile). We then compared agreement between the batteries at each of those levels. Results: More soldiers with mTBI had low scores than healthy soldiers on both batteries. Of the soldiers who performed at the worst level on one battery, 100.0% from ImPACT and 73.1% from traditional had some level of poor performance on the other battery. However, of the soldiers who performed at the worst level on either battery, only 42.9% from ImPACT and 34.6% from traditional also performed at the worst level on the other battery. Conclusion: These batteries similarly identify poor performance to a degree, though with some potentially meaningful differences still present.

234 Weight for It: Comparing Statistical Methods for Aggregating Cognition Data 1384327 Brian Ivins Defense and Veterans Brain Injury Center Weight for It: Comparing Statistical Methods for Aggregating Cognition Data Professional Issues: Test Development and Methods Objective: In statistics, larger sample studies are assumed to more accurately reflect the population mean and thus assumed to have less random error. We use an overall test battery mean (OTMB) from the D-KEFS taken from two different studies to evaluate two methods of weighting means when aggregating data: Method 1, assuming that larger studies have less error and thus giving their variances more weight and Method 2, assuming equal error and uncertainty across studies and assigning equal weight to variances from all studies. Methods: The OTBM from seven D-KEFS achievement scores was calculated from a D-KEFS normative sample (n=854), and aggregated with the same D-KEFS OTBM from a healthy military sample (n=246). Weighted averages were calculated for selected points from the distributions of scores (e.g., mean, median, etc.). Variances, standard errors, and 95% confidence intervals for the weighted means were calculated using Method 1 and Method 2, as described above. Results: The weighted mean OTBM from both samples was 51.48. The variance, standard error, and confidence interval using Method 1 were 11.63, 2.41, and 46.76-56.21, respectively, and using Method 2 were 16.74, 4.09, and 43.6-59.50, respectively. Conclusion: Method 1 results in weighted means with less variability, though may result in larger studies disproportionately reducing measurement error. Method 2 results in greater variances, standard errors, and wider confidence intervals and somewhat mutes the impact of larger studies. Researchers should consider the implications for their results when choosing a method for assessing the precision of their weighted means.

236 Concurrent validity of the Paper-Match in a diverse population 1384504 Crismeldy Veloz Albert Einstein College of Medicine Concurrent validity of the Paper-Match in a diverse population Professional Issues: Test Development and Methods Introduction: Symbol and digit substitution tasks are key instruments in the evaluation of attention, speed of processing, executive functioning, and cognitive dysfunction. The Match is an electronic (app-based) substitution task developed as part of the University of California San Francisco Brain Health Assessment that has been used to demonstrate cognitive impairment. We describe the paper-based oral symbol/number substitution task (Paper-Match), which was developed as part of the 5-Cog battery to assess for cognitive impairment including dementia and demonstrate it’s use in an urban, multi-ethnic, socioeconomically disadvantaged primary care population in Bronx NY. Method: 109 participants, mean age 72.61 SD 6.42 and education 11.70 SD 3.82 years, 81% female, 48.6% Hispanic/Latino and 47.7% African American seen as part of 5-Cog. Participants (36.7% tested in Spanish) completed the Paper-Match (scored based on the number of correct matches in 90 seconds) and a comprehensive neuropsychological battery. Descriptive and correlational analysis were conducted. Results: Mean Paper-Match score was 38.24 SD 11.83 items correct (range 4-51). Paper-Match performance was highly correlated with performance on the Symbol Digit Modalities Test (r=.819, p<.001) and moderately correlated with performance on the Montreal Cognitive Assessment (MOCA; r=.604, p<.001). Years of education and primary language impacted performances. Conclusion: The results of this study provide the initial description and validation of the Paper-Match an oral symbol digit substitution task and its use in a diverse population of older primary care patients. Further research on the psychometric properties and construct validity of the Paper-Match are needed.

237 Investigating the Reliability and Item-Level Symptom Endorsement for the PROMIS® v2.0 Cognitive Function-8-Item Short Form 1384350 Grant Iverson Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Spaulding Research Institute; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program Investigating the Reliability and Item-Level Symptom Endorsement for the PROMIS® v2.0 Cognitive Function-8-Item Short Form Professional Issues: Test Development and Methods Objective: We present the normative reference values, item level endorsement, and the internal consistency reliability of the PROMIS® v2.0 Cognitive Function-8-Item Short Form. Method: The PROMIS® v2.0 Cognitive Function 8-Item Short Form measures subjective cognitive difficulties (raw score range=8-40). A cohort of 1,009 adults (51.1% women) from the US population completed this measure. The total sample was stratified by gender and health status for analyses. A healthy subgroup (n=475; 49.5% women) reported no personal history of mental health, neurological, or sleep disorders and rated their overall health, functioning, and quality of life as “good” or better. Results: The healthy group reported less cognitive symptoms (i.e., higher raw score) than the total sample (total sample, M=32.17, SD=7.57, Md=34; healthy sample, M=35.02, SD=5.94, Md=38). This pattern was shown in men [all men, M=31.06, SD=7.68, Md=32; healthy men, M=33.95, SD=6.34, Md=36] and women [all women, M=33.23, SD=7.32, Md=36; healthy women, M=36.12, SD=5.30, Md=39]. The base rates for endorsing three or more cognitive symptoms were consistently lower among the healthy samples (total sample=14.8%, total healthy sample=4.8%, all men=19.7%, healthy men=7.5%, all women=10.1%, and healthy women=2.1%). Internal consistency, as measured by Cronbach’s alpha, ranged from 0.89 to 0.95 depending on subgroup. Conclusions: The PROMIS® v2.0 Cognitive Function 8-Item Short Form is a reliable self-report measure of cognitive difficulties. Participants who reported their overall health status to be good tended to report less cognitive difficulties. The presented normative reference values can be useful in both research and clinical practice when assessing cognition in the general population.

238 Psychometric Equivalence of Prorated Boston Naming Test Scores after Noose Item Removal 1384288 J. Attridge University of Utah Psychometric Equivalence of Prorated Boston Naming Test Scores after Noose Item Removal Professional Issues: Test Development and Methods Objective: The Boston Naming Test (BNT) noose item may offend some examinees. One solution is to omit the item, but the equivalence of prorating the BNT has not been established. This study compared prorated BNT (BNT-P) and standard administration (BNT-S) in physical medicine and rehabilitation patients. Method: Participants (N=480) completed the BNT-S in an outpatient evaluation. The sample was 34% female and 91% white with average age and education of 46 (SD=15) and 14 (SD=3) years, respectively. Diagnoses included traumatic brain injury (62%), mixed neurologic conditions (21%), and stroke (17%). Item level data were entered; items below the start or basal point were entered as correct. BNT-P was calculated by summing correct responses excluding item 48 and then using cross multiplication and division to estimate the 60-item score equivalent. BNT-P and BNT-S scores were compared via Spearman and concordance correlation (CC) coefficients; reflected and log transformed data were examined with paired t-tests and Westlake equivalence tests. BNT-P and BNT-S difference and scaled scores were examined descriptively. Results: BNT-P (M=52.7, SD=7.0, Mdn=54) and BNT-S (M=52.6, SD=7.1, Mdn=54) raw scores showed very strong associations (rho=.99; CC=.99). Transformed scores were not significantly different (p=.20) and demonstrated equivalence (+/-1.5 points). Score differences (M=0.01, SD=0.30; range -0.5-1) rounded to 0 in 88% of cases. Scaled scores based on prorated raw scores were the same in 96% of cases with a one-point difference observed in 15 cases and a two-point difference in 2 cases. Conclusion: Findings support the utility of prorated BNT scores in rehabilitation patients.

239 Cost of Neuropsychological Evaluation Comparable to Neuroimaging in the Eastern USA 1384470 Natalie Kurniadi University of Utah School of Medicine Cost of Neuropsychological Evaluation Comparable to Neuroimaging in the Eastern USA Professional Issues: Test Development and Methods Objective: Anecdotal evidence indicates a belief among physicians that neuropsychological evaluation is more expensive than brain imaging procedures. Another concern is that neuropsychological evaluations are a limited resource to be utilized sparingly, likely due to insurance limits on the annual allowable units of neuropsychological evaluation. This study aimed to contextualize the cost of neuropsychological evaluation relative to common neuroimaging studies used in conditions seen by neuropsychologists. Data Selection: Publically available fee schedules from 27 hospitals in the eastern U.S. were reviewed to identify standard costs of head CT, brain MRI, and 5- and 8-hour neuropsychological evaluations conducted with technicians. Data Synthesis: Head CT averaged $2963 (range $282-$6007) and brain MRI averaged $4857 (range $834-$11,524). Five-hour evaluations using technicians averaged $2080 (range $698-$4165). Eight-hour evaluations using technicians averaged $3289 (range $1104-$6657). Conclusions: Contrary to anecdotal concerns, neuropsychological evaluations do not appear more expensive than brain neuroimaging procedures in several eastern U.S. hospitals. Focused neuropsychological evaluations comparable to or less than head CT procedure cost. Comprehensive neuropsychological evaluations are comparable to or less than MRI brain procedure cost. These preliminary findings may dispel the notion that neuropsychological evaluations are more costly than brain imaging. Additional research is needed in all regions of the U.S.

240 Enhanced Interpretation of the Behavior Rating Inventory of Executive Function–Adult Version (BRIEF-A) 1384298 Sue Trujillo PAR, Inc. Robert Roth Enhanced Interpretation of the Behavior Rating Inventory of Executive Function–Adult Version (BRIEF-A) Professional Issues: Test Development and Methods Objective: The Behavior Rating Inventory of Executive Function®—Adult Version (BRIEF-A) is a standardized measure that captures an adult’s executive functions in his or her everyday environment. The current study provides additional statistical evidence to support interpretation of BRIEF-A scores across raters and over time. Method: Participants were adults, ages 18 to 90 years, from the BRIEF-A Self-Report (N = 1,050) and Informant-Report (N = 1,200) standardization samples, as well as an interrater sample (n = 180) and test-retest samples (n = 50 for Self, n = 44 for Informant). Interrater correlations, base rates of interrater differences, and score differences required for statistical significance were examined. Test-retest correlations and score differences required for statistical significance were examined. Base rates of elevated T scores (≥ 65) were calculated for the standardization samples across age groups. Results: Interrater correlations ranged from .44 to .68 with an interrater difference of 17-20 T-score points considered significant at p < .05. Approximately 55-73% of raters reported scores within 10 T-score points. Test-retest scores were highly correlated (Self: r = .82-.94; Informant: r = .91-.96), with a between-test difference of 7-11 T-score points considered significant at p < .05. Base rates of elevated T- scores ranged from 3.3% to 15.4% for the Self-Report Form and 4.5% to 16.3% for the Informant-Report Form across the scales/indexes. Conclusions: These data allow clinicians to interpret BRIEF-A scores across raters and over time by determining the statistical significance of BRIEF-A score differences, as well as quantifying the frequency of the observed differences.

241 Five Point Test: Reliability, Validity, and Test Performance in Cognitively Intact Adults 1384320 Zarah Chaudhary University of British Columbia Five Point Test: Reliability, Validity, and Test Performance in Cognitively Intact Adults Professional Issues: Test Development and Methods Objective: Reliability and validity evidence related to the Five Point Test (FPT) scores is severely limited. The primary purpose of this study was to examine psychometric evidence related to two commonly used FPT scores (number of unique designs (UD), percentage of repetitions (PR)) using one-week test-retest reliability, correlations with demographic and neuropsychological variables, and convergent validity in line with a regression-based explanation-focused view of validity. Methods: The sample consisted of 86 cognitively intact, non-depressed adult men and women ages 21-82 years (M=52.7, SD=17.7) with 7-21 years of education (M=14.2, SD=3.13) recruited from the general community and tested individually. Results: UD ranged from 8-60 (M=35.4) and PR ranged from 0-45% (M=6.9%). Test-retest coefficients were .83 for UD but only .43 for PR. Age was significantly correlated with UD (r=-.59) and PR (r=.23). Education was significantly correlated with UD (r=.26) but not PR (r=-.10). There were no gender differences. UD showed significant bivariate correlations with WAIS-III Block Design, Trail-Making Test (TMT) A, TMT-B, Bicycle Drawing Test, and FAS Verbal Fluency but, together in a regression, only age and TMT-B remained significant. PR scores did not correlate significantly with any neuropsychological variables. Conclusion: UD showed strong test-retest reliability. UD performance tends to be poorer with older age and less education. The meaning and interpretation of UD performance using a regression-based explanation-focused view of validity will be discussed. PR reliability is poor even over a short interval and attenuates subsequent statistical findings. Use of PR is not recommended in research or practice.

242 Examining Normative Reference Values and Item-Level Symptom Endorsement for the Neuro-QoLTM v2.0 Cognitive Function-Short Form 1384349 Grant Iverson Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Spaulding Research Institute; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program Examining Normative Reference Values and Item-Level Symptom Endorsement for the Neuro-QoLTM v2.0 Cognitive Function-Short Form Professional Issues: Test Development and Methods Objective: We examined the normative reference values, item-level symptom endorsement, internal consistency reliability, and the base rates of symptoms endorsed for the Neuro-QoLTM v2.0 Cognitive Function-Short Form. Method: The Neuro-QoLTM v2.0 Cognitive Function-Short Form is a fixed 8-item scale that measures subjective cognitive functioning. Raw scores range from 8-40, with higher scores indicating less cognitive concerns. Adults from the general US population completed the scale. The sample was stratified by gender and health status. Individuals were included in the healthy subgroup if they reported no personal history of mental health, neurological, or sleep disorders and rated their overall health, functioning, and quality of life as “good” or better. Results: A normative sample of 1,009 adults completed this scale and their mean score was 32.60 (SD=6.89). The healthy subgroup (n=475) had a higher mean, suggesting less perceived cognitive difficulties (M=35.12, SD=5.57). This pattern was consistent for men (all men, M=31.26, SD=7.10; healthy men, M=33.86, SD=5.95) and women (all women, M=33.89, SD=6.43; healthy women, M=36.42, SD=4.85). The base rates of those who reported zero cognitive symptoms were consistently higher among the healthy samples (healthy men=79.2%; all men=63.9%; healthy women=90.2%; all women=80.0%). Internal consistency was measured using Cronbach’s alpha and ranged from 0.87 to 0.94 across groups. Conclusions: The Neuro-QoLTM v2.0 Cognitive Function-Short Form is a brief, efficient, and reliable measure of perceived cognitive difficulties. The subgroup normative reference values and base rate analyses of individual symptom endorsement presented herein can be used by clinicians and researchers for a more refined interpretation of the scale.

243 Cross-validation of the Dissimulation ADHD scale in an outpatient veteran sample 1384389 Anthony Andrews Va Maine Cross-validation of the Dissimulation ADHD scale in an outpatient veteran sample Professional Issues: Test Development and Methods Objective: The Dissimulation ADHD (Ds-ADHD) scale for the Minnesota Multiphasic Personality Inventory-2-Restructured Form was developed by Robinson and Rogers (2017) using college students. The authors reported good discriminant validity and a 3% false positive (FP) rate when used in a sample of people with genuine ADHD. The objective of this study was to see if the FP rate would remain low when used in a sample of U.S. military veterans. Method: Archival data was gathered from ADHD assessments conducted at an outpatient VA medical center. Participants were excluded if they did not meet DSM-5 diagnostic criteria for ADHD (as a child and at time of assessment), or if they produced invalid scores on symptom validity measures from any of the self-report measures given at the time of the assessment. The final sample included 58 participants (mean age and education were 42 and 14, respectively; 91% male and 90% Caucasian). Results: Using the published cutoff of

244 Examining the Effects of Computer Operating Configuration on Automated Neuropsychological Assessment Metrics V 4.0 (ANAM4) Reaction Time: A Repeated Measures Approach with Clinical and Research Implications 1384328 Wesley Cole Womack Army Medical Center Examining the Effects of Computer Operating Configuration on Automated Neuropsychological Assessment Metrics V 4.0 (ANAM4) Reaction Time: A Repeated Measures Approach with Clinical and Research Implications Professional Issues: Test Development and Methods Objective: Computerized cognitive tests are vulnerable to measurement error due to hardware and software configurations of the administration computer. Though automatic score corrections are often provided to account for this, they may mask subtle individual variations in test performance. We investigated the group and individual impact of correcting for measurement error while accounting for possible order effects using data from a larger study of computer platform effects on reaction time measurement. Methods: ANAM4 TBI Military’s Simple Reaction Time (SRT) subtest was administered repeatedly on three different computer platforms. We compare two of those platforms: Platform 1, a Dell D630 configured for ANAM4 TBI Military administration; Platform 3, a Dell E6540 with default settings. A mechanical arm with a preset RT was first used to capture measurement error on each platform. SRT was then administered to healthy US Army soldiers in a randomly selected administration order, such that platform 1 was first and platform 3 was third for n=58 and platform 3 was first and platform 1 second for n = 53. Results: Platform 3 was on average 43.06 ms slower than Platform 1. Group analyses suggested applying a 43.06 ms correction to Platform 3 scores resulted in scores similar to Platform 1. However, it appears there were subtle practice and fatigue effects for some individuals that were possibly masked by the score correction. Conclusion: Correcting for error due to computer configurations is important in RT measurement, though there may be subtle individual statistical and clinical implications that are lost at a group analysis level.

245 So What's the Damage? The Effect of the WISC-V Digitization Debacle 1384438 William MacAllister Alberta Children's Hospital - So What's the Damage? The Effect of the WISC-V Digitization Debacle Professional Issues: Test Development and Methods Objective: The WISC-V can now be administered in paper format or digitally. Though most subtests are comparable, Processing Speed Index (PSI) subtests, Coding and Symbol Search required complete redesign for digital presentation. We initially collected data to assess comparability of paper versus digital PSI tasks for future use. However, in March of 2020, Pearson issued an alert stating that, due to a programming error, Coding scores may be inflated secondary to timing inaccuracy; they advised against further use of digital Coding. We refocused our analyses to assess the degree to which inaccurate digital Coding impacted overall test results. Method: Children with neurological disorders (N=104) received both versions of the PSI subtests (order randomized). Correlational analyses assessed relations between versions, t-tests assessed for administration order effects, and Kappa coefficients assessed agreement across platforms. Results: Correlations between paper and digital subtests (r=.570 to .853) and composites (r=.848 to .987) were robust. As expected, Coding was higher digitally (difference=1.91, p.05). Given evident practice effects, subsequent analyses considered “first administered” versions and score range agreement was best when PSI tasks were administered digitally first (Kappa=.452, p<.001) versus paper first (Kappa=.153, p=.023). Agreement was strong for FSIQ regardless of order (Kappa≥.760, p<.001). Importantly, in highest stakes evaluations (i.e., presence versus absence of intellectual disability), agreement was extraordinarily strong (Kappa≥.93, p<.001). Conclusions: Digital Coding scores are inflated in comparison to traditional paper version, but the impact of this programming error was minimal at the level of PSI and FSIQ.

246 Comparing Boston Naming Test Short Forms in a Rehabilitation Sample 1384289 Danielle Zimmerman University of Utah Comparing Boston Naming Test Short Forms in a Rehabilitation Sample Professional Issues: Test Development and Methods Objective: The Boston Naming Test (BNT) has several short forms do not include the noose item. These short forms have been mainly examined in dementia populations. This study compared BNT short forms with standard administration (BNT-S) in physical medicine and rehabilitation patients. Method: Participants (N=480) completed the BNT in an outpatient evaluation. The sample was 34% female and 91% white with average age and education of 46 (SD=15) and 14 (SD=3) years, respectively. Diagnoses included traumatic brain injury (62%), mixed neurologic conditions (21%), and stroke (17%). Five 15-item short forms were calculated: Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-15); Lansing; and Mack 1, 2, and 4 (Mack-15.1, -15.2). Three 30-item short forms were calculated: Mack A, Saxon A, and BNT odd items. Short forms and BNT-S were compared with Spearman correlations. Cronbach’s alpha was calculated for all forms. Impaired BNT scores were determined using norm-referenced scores (T<36). Area under the curve (AUC) values were compared across short forms with impaired BNT as criterion. Results: BNT-S showed strong correlations with 30-item (rho=.92-.93) and 15-item short forms (rho=.80-.87) except for CERAD-15 (rho=.69). Internal consistency was acceptable for 15-item (alpha=.72-.80) and 30-item short forms (alpha=.85-.86). BNT was impaired in 17% of participants. AUC values were not significantly different in 15-item (AUC=.83-.89) and 30-item (AUC=.91-.92) groups. CERAD-15 (.83), Mack-15.1 (.87), and Mack-15.2 (.87) AUC values were significantly lower than 30-item short form AUC values. Conclusion: BNT 30-item and 15-item short forms showed outstanding and excellent classification accuracy, respectively. BNT short forms warrant further study in rehabilitation settings.

247 Overall Test Battery Means from ANAM4 TBI-MIL and D-KEFS: A Within-Subject Comparison of a Traumatic Brain Injury Cognition Composite Score 1384326 Brian Ivins Defense and Veterans Brain Injury Center Overall Test Battery Means from ANAM4 TBI-MIL and D-KEFS: A Within-Subject Comparison of a Traumatic Brain Injury Cognition Composite Score Professional Issues: Test Development and Methods Objective: Several cognition composite scores have been developed for potential use in traumatic brain injury clinical trials. This analysis examined the equivalence of overall test battery mean (OTBM) from two different test batteries administered consecutively to the same subjects. Methods: Soldiers were administered the Automated Neuropsychological Assessment Metrics (version 4) TBI-MIL (ANAM4) computerized battery and D-KEFS as part of a larger study comparing within-subject performance from different neuropsychological test batteries. Data from 121 soldiers with complete and valid data on both ANAM4 and D-KEFS and no recent TBI were used in this analysis. OTBMs were calculated for ANAM4 and the seven D-KEFS achievement scores. The OTBMs from the 121 soldiers were ranked from lowest to highest and the percentile rankings from each battery were compared. For each soldier, the differences between the percentile ranks from each battery were also calculated. Results: Only 53.8% of soldiers who scored below the 20th percentile on ANAM4 also scored below the 20th percentile on D-KEFS. Furthermore, only 47.8% of soldiers who scored at or above the 80th percentile on ANAM4 also scored in that range on D-KEFS. Some soldiers’ performance on each battery diverged by large amounts, for example from 59.5 to 82.6 percentage points. Correlation analysis revealed that the OTBMs and percentile rankings from both batteries were modestly correlated (OTBM r=0.515, p<0.001, percentile rank r=0.499, p<0.001). Conclusion: These results suggest that comparing similar cognition composites from different neuropsychological test batteries from different studies in a meta-analytic manner may not be feasible due to psychometric difference between batteries.

248 Using Rates of Low Scores to Assess Agreement between CNSVS and a Traditional Battery of Neuropsychological Tests 1384323 Brian Ivins Defense and Veterans Brain Injury Center Using Rates of Low Scores to Assess Agreement between CNSVS and a Traditional Battery of Neuropsychological Tests Professional Issues: Test Development and Methods Objective: CNSVS is a brief computerized test battery used to assess cognitive function. We compare intra-individual agreement between CNSVS and a battery of traditional neuropsychological tests using rates of low scores. Methods: Complete and valid data from 246 healthy soldiers and 177 soldiers ≤7 days from sustaining mild TBI (mTBI) were used in this analysis. All soldiers were consecutively administered CNSVS and a traditional test battery consisting of: TOPF, WAIS-IV, CVLT-II, RCFT, DKEFS, and CPT-II. We performed base rate analyses of both batteries to determine the proportions of soldiers who had various numbers of scores that were 1.0+, 1.5+, and 2.0+ standard deviations below the normative mean. We used those rates to place Soldiers into a “low score hierarchy” ranging from the least poor (i.e. ~>10th %ile) to the worst overall performance (i.e. ~≤10th %ile). We then compared agreement between the batteries at each of those levels. Results: More soldiers with mTBI had low scores than healthy soldiers on both batteries. Of the soldiers who performed at the worst level on one battery, 95.9% from CNSVS and 80.0% from traditional had some level of poor performance on the other battery. However, of the soldiers who performed at the worst level on either battery, only 38.8% from CNSVS and 63.3% from traditional also performed at the worst level on the other battery. Conclusion: These batteries similarly identify poor performance to a degree, though with some potentially meaningful differences still present.

251 3q29 Deletion Syndrome and Neuropsychological Functioning: Fraternal Twin Case Study 1406147 Darlyne Nemeth The Neuropsychology Center of Louisiana, LLC. 3q29 Deletion Syndrome and Neuropsychological Functioning: Fraternal Twin Case Study Pediatric Ground Rounds Objective: The 3q29 Deletion Syndrome, first described in 2005, is a rare chromosomal disorder which results in a wide array of symptoms. Affected individuals present with complex neuropsychiatric profiles. The associated phenotype for this syndrome may include developmental delay, intellectual disabilities, attentional deficits, behavioral disturbances, and social and emotional issues. These individuals are at a higher risk of developing autism or schizophrenia. This case study describes the neuropsychological profiles of two fraternal twin girls, age 7, only one of whom was diagnosed with 3q29 Deletion Syndrome. Methods: Both girls received comprehensive neuropsychoeducational evaluations to compare and contrast the following dimensions: Neurocognitive, Intellectual, Educational, Attentional, School Behavioral, Affective, and Personality Functioning. Results: Twin 1, positive for 3q29 Deletion Syndrome, exhibits significant affective, behavioral, and cognitive difficulties secondary to her chromosomal disorder, which included learning disabled and oppositional presentations and emotional dyscontrol. Twin 2 exhibited superior intellectual and social functioning. Conclusions: This study contributes to the understanding of the clinical presentation of 3q29 Deletion Syndrome by examining the relationship between fraternal twin sisters. Findings are consistent with earlier reports of the chromosomal disorder’s phenotype, yielding neurocognitive, emotional, and behavioral difficulties. Though the twins have widely different neuropsychological profiles, they have a close relationship. Twin 2, who models excellent prosocial behaviors, will be an asset to Twin 1 in all spheres. Ongoing efforts to improve Twin 1’s neuropsychological, social/emotional, and behavioral functioning will be facilitated via both psychological and psychopharmacological interventions.

252 New onset severe epilepsy in a child with existing cerebral palsy: Neuropsychological findings inform medical management 1406148 Christine Mullen University of Utah New onset severe epilepsy in a child with existing cerebral palsy: Neuropsychological findings inform medical management Pediatric Ground Rounds 1.Objective: Pediatric epilepsy is associated with a wide range of neurodevelopmental challenges. Few studies have established children’s cognitive function prior to seizure onset making study of the direct impact of seizures challenging. This is especially true in cases with preexisting neurological disorders. The present case provides insight into the impact that new onset of seizures (including status epilepticus) have on cognitive development and illustrates how documented cognitive change informs clinical decision-making. 2.Method: The patient is a 10-year-old boy with a history of cerebral palsy who initially completed neuropsychological testing in the fall of 2018. New onset of drug-resistant seizures presented in January 2019, including episodes of status epilepticus leading to repeat neuropsychological evaluation in the fall of 2019. EEG studies in infancy showed poorly regulated background rhythm and MRI showed dysplastic corpus callosum and bilateral occipital heterotopias. Following the onset of seizures EEG showed independent seizure foci over temporal regions bilaterally. MRI showed extensive bilateral temporal and occipital subependymal gray matter heteropi, and dysgenesis of the corpus callosum, cerebral vermis, and anterior commissure. 3.Results: Repeated neuropsychological assessment documented significant declines in intellectual function, visual and verbal memory (visual worse than verbal), and executive function, with limited academic progression. Persistent epileptic symptoms throughout testing complicated interpretation. 4.Conclusions: Findings were highly concerning for cognitive deterioration and the neurosurgical team deemed him as high risk for sudden unexpected death in epilepsy. He underwent right anterior temporal lobectomy and left stereoelectroencephalography placement in January 2020. Scheduled repeat neuropsychological evaluation will further monitor neurocognitive functioning post neurosurgical intervention.

253 A Case Study of Anterograde Memory Impairment Following Forniceal Infarct– Neurocognitive Sequelae and Recovery 1406149 Cyrielle Andrew Child and Family Psychological Services A Case Study of Anterograde Memory Impairment Following Forniceal Infarct– Neurocognitive Sequelae and Recovery Geriatric Grand Rounds A Case Study of Anterograde Memory Impairment Following Forniceal Infarct– Neurocognitive Sequelae and Recovery Cyrielle Andrew, Psy.D., and Megan M. Smith, Ph.D., ABPP-CN Objective: To describe neurobehavioral consequences and recovery course in a case of acute infarct of the fornix superimposed on chronic subcortical cerebrovascular disease. Method: We present a right-handed, 72-year-old, African American man with cardiovascular risk factors, chronic kidney disease, and history of CVA with no prior functional or cognitive difficulties. He was evaluated twice, first four days post and again two months post-infarct of the bilateral fornix. Results: Initial inpatient testing revealed impaired verbal memory characterized by rapid forgetting (HVLT-R Delay T = <20) with some benefit from recognition cues, and subtle deficits in constructional praxis and practical judgement. On repeat evaluation at four months post-stroke, he demonstrated memory impairment across modalities (HVLT-R Delay T = <20, BVMT-R Delay T = <20) with marginal benefit from context and cues. He required assistance with multiple instrumental activities of daily living (e.g., financial and healthcare management) and displayed anosognosia of both cognitive and functional deficits. Conclusion: This case illustrates the role of the fornix in the process of memory encoding and self-awareness. Literature describing the neurobehavioral role of the fornix is sparse, however, it has been implicated in episodic memory functions due to hippocampal connectivity. This case study further implicates the fornix in declarative memory formation and will add to the literature by detailing a specific cognitive profile that may inform planning for recovery and rehabilitation.

254 A pediatric case study of Mild Intellectual Disability in the context of complex Chiari malformation, hydrocephalus, cleft palette, and complex psychosocial environment 1406150 Christopher Haak AMITA Health A pediatric case study of Mild Intellectual Disability in the context of complex Chiari malformation, hydrocephalus, cleft palette, and complex psychosocial environment Pediatric Ground Rounds Objective: Chiari malformation is a congenital condition involving structural skull defects, causing brain tissue herniation and likely resulting in hydrocephalus. People with these medical conditions are at risk for varied cognitive impairments. Recently, emerging evidence has suggested the co-occurrence of Chiari malformation and cleft palette contributing to increased cognitive challenges, highlighting the importance of introducing interventions in a timely manner. Method: This case study presents on the neuropsychological profile of an 11-year-old girl with a medical history of complex Chiari malformation with accompanying hydrocephalus and syringomyelia, and lymphangioma born with cleft palette. Relevant social history includes recent parent separation and unstable home life. Presenting concerns included intermittent hand weakness and headaches status post 5 surgeries related to Chiari malformation and hydrocephalus, inattention/impulsivity, learning difficulties, and increased emotional and behavioral dysregulation. Results: Neuropsychological testing revealed impairments in intellectual functioning (WISC-V FSIQ = 64), adaptive skills, attention/executive functioning, language, visuomotor skills, memory, and academic skills. Significant emotional and behavior adjustment problems were indicated, secondary to medical treatment, resulting physical limitations, and psychosocial stressors. Finally, staring spells episodes were observed that were concerning for possible seizure activity. Conclusions: Recommendations were given to aid in treatment planning for her referring neurosurgeon alongside clinical interventions (e.g., psychotherapy, social work, speech/language, and occupational therapy). Recommendations related to continued intensive special education services were also provided. This case study demonstrates the need for further understanding cognitive impairment in the context of Chiari malformation with co-occurring hydrocephalus and cleft palette. Multidisciplinary collaboration is essential to facilitate the prompt introduction of appropriate clinical interventions.

255 Severe Psychological Dysfunction in a Neurologically Complex Patient during a Pre-Surgical Evaluation for Normal Pressure Hydrocephalus Shunt Implantation 1406151 Amanda Wisinger The University of Chicago Severe Psychological Dysfunction in a Neurologically Complex Patient during a Pre-Surgical Evaluation for Normal Pressure Hydrocephalus Shunt Implantation Geriatric Grand Rounds Objective: Psychological syndromes like depression and anxiety are common in neurological conditions and lead to poorer quality of life and disability. However, these syndromes are often under-recognized in neurologic patients and are thus under-diagnosed due to overlapping symptomatology. Here, we report on a patient with a complex neurological history as well as clinically significant affective symptoms. Participants: The patient is a 69-year-old Caucasian female recently diagnosed with normal pressure hydrocephalus. Relevant medical history was significant for focal epilepsy with complex seizures, obstructive sleep apnea, and cerebrovascular accident. She underwent neuropsychological evaluation as part of a pre-surgical workup for shunt implantation. Results: The patient’s neurocognitive profile was marked by significant impairments in most cognitive domains and she was not independent in activities of daily living. On self-report measures of current emotional functioning, she reported clinically severe levels of depression, anxiety, apathy, executive dysfunction, and disinhibition. During the clinical interview, she reported experiencing passive suicidal ideation as well as a significant history of traumatic experiences. Conclusion: The psychological symptoms the patient was experiencing undoubtedly impacted her neurocognitive status and functioning abilities, though she was receiving no treatment for these symptoms. Addressing symptoms resulting from psychological syndromes in patients with neurological conditions is an important role for neuropsychologists, as accurate diagnosis of psychological syndromes can inform treatment recommendations and improve patient outcomes. This case illustrates the importance of documenting a thorough clinical history, including past psychiatric history, as well as a detailed examination of self-reported current psychological functioning as part of a comprehensive neuropsychological case formulation.

256 A Unique Bilingual Phenotype in the Context of Late Onset MELAS 1406152 Yayci Patino University of California Los Angeles A Unique Bilingual Phenotype in the Context of Late Onset MELAS Diversity Objective: Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) is a progressive disease with typical onset before age 40 characterized by eventual neurocognitive deterioration. This case study highlights bilingual-bicultural neuropsychological principles within the Socially Responsible Neuropsychology (SRN) model to illustrate the phenotypic presentation of bilingual late-onset MELAS. Method: The case is a 56-year-old, right-handed, bilingual Latino male (L1 Spanish, L2 English) with 16 years of education in his country of origin and 22 years as an industrial engineer in the U.S. At age 52, he was diagnosed with MELAS after an abrupt episode of olfactory hallucinations and dysgraphia in both languages. MRI revealed acute infarcts in the right parietal lobe and left cerebellum. He was referred for neuropsychological assessment 4 years later to evaluate reported neurocognitive decline and deterioration of L2, and to assist in targeted treatment planning. Results: The clinical interview revealed significant decline in both receptive and expressive L2 English language capabilities, particularly relative to baseline as an industrial engineer, with relative sparing of L1 Spanish. Consistent with prior acute right hemisphere strokes, the neurocognitive profile also revealed lateralized impairment in visuospatial skills and memory. Notably verbal learning and memory in the mesial temporal system was preserved. Conclusions: This case study illustrates how late L2 acquisition can lead to bilateral language representation, altering the phenotype of late-onset MELAS. Application of the SRN model highlights the importance of including background information regarding language acquisition and current language use to illustrate a unique bilingual MELAS phenotype and its impact on language loss and recovery.

257 Use of inpatient tele-neuropsychological evaluation to assist neurological management of a complex Spanish-speaking patient in the time of COVID-19 1406153 Deborah Gonzalez Montefiore Medical Center Use of inpatient tele-neuropsychological evaluation to assist neurological management of a complex Spanish-speaking patient in the time of COVID-19 Adult Grand Rounds Objective: The COVID-19 pandemic has impacted traditional neuropsychological practices as in-person evaluations have been postponed. Controversy and ongoing discussion remains about the validity and appropriateness of teleneuropsychology, but provider and patient risk associated with in-person testing needs to be considered when cognitive evaluation is warranted. We describe the remote evaluation of a man hospitalized with altered mental status and positive COVID-19 infection and the effectiveness of teleneuropsychology in clarifying cognition/assisting clinical management in a non-English-speaking individual with limited formal education. Method: 35 year old Spanish-speaking male with no formal education referred for inpatient neuropsychological consultation to rule in/rule out possible encephalopathy and confirm premorbid cognitive functioning. Cognitive evaluation completed using iPad and Zoom technology at bedside. Results: Tele-neuropsychology was conducted in the patient’s primary language without the necessity for PPE, which enabled improved engagement. Although testing had to be modified; the environment could not be controlled; and all cognitive domains could not be evaluated – remote evaluation confirmed fluctuations and variability, both within and between tasks, with notable fluxes in attention, comprehension and speech. Results aided in the management and care of the patient. Conclusion: Tele-neuropsychological evaluation in the inpatient setting, while not a replacement for traditional in-person assessment, can play an important role in the management and care of culturally and educationally diverse patients.

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