The present study characterized heterogeneity in the cognitive profiles of monolingual and bilingual Latino older adults enrolled in the HABS-HD.

A total of 859 cognitively unimpaired older adults completed neuropsychological testing. Raw scores for cognitive tests were converted to z-scores adjusted for age, education, sex, and language of testing. A latent profile analysis (LPA) was conducted for monolingual and bilingual speaker groups. A series of 2–5 class solutions were examined, and the optimal model was selected based on fit indices, posterior probabilities, proportion of sample sizes, and pattern of scores. Identified classes were compared on sociodemographic, psychosocial, and health characteristics.

For the monolingual group (n = 365), a 3-class solution was optimal; this consisted of a Low Average Memory group with low average verbal memory performances on the SEVLT Total Learning and Delayed Recall trials, as well as an Average Cognition group and a High Average Cognition group. For the bilingual group (n = 494), a 3-class solution was observed to be optimal; this consisted of a Low Average Memory group, with low average verbal memory performances on the learning and delayed recall trials of Logical Memory; a Low Average Executive group, where performance on Trails A and B and Digit Substitution were the lowest; and a High Average Cognition group, where performance was generally in the high average range across most cognitive measures.

Cognitive class solutions differed across monolingual and bilingual groups and illustrate the need to better understand cognitive variability in linguistically diverse samples of Latino older adults.

Neuropsychological assessment through VideoTeleConferencing (VTC) can help improve access to diagnostic and follow-up care in memory clinics. This study investigated the stability of performance on VTC assessment in relation to in-person assessment using a test-retest design and explored user experiences of VTC assessment.

Thirty-one patients (62 ± 6.7 years, 45% female, 58% Subjective Cognitive Decline, 42% Mild Cognitive Impairment/dementia diagnosis) were included from the Amsterdam Dementia Cohort between August 2020 and February 2021. Patients underwent a face-to-face neuropsychological assessment followed by a VTC assessment using the same test protocol within 4 months. Reliability coefficients were calculated using intraclass correlation coefficients (ICC). For each test, the proportion of clinically relevant differences in performances between assessment modalities was calculated. User experiences of patients and neuropsychologists were assessed with questionnaires (User Satisfaction and Ease of use [USE] questionnaire and System Usability Scale [SUS]). Neuropsychologists also participated in a focus group.

ICC values were moderate to excellent (0.63-0.93) for all test measures in the total sample. On all tests, most patients did not show clinically relevant performance differences between modalities. Patients and neuropsychologists reported overall positive VTC system usability, although neuropsychologists indicated in the focus group that patients without cognitive impairment required less training for the system and were more independent.

VTC assessment showed adequate to excellent test-retest reliability for a broad range of neuropsychological tests commonly used in practice. Assessment through VTC may be a user friendly method in the memory clinic, especially to monitor individuals at risk for future cognitive decline.

To delineate score differences between the Wechsler Adult Intelligence Scale-IV (WAIS-IV) and the WAIS-IV México in the assessment of balanced bilingual Mexican Americans and to determine the efficacy of five hold measures in predicting summary scores in each version.

Hold measures were WAIS-IV Information, Vocabulary, and Matrix Reasoning subtests, picture vocabulary, and the Test of Premorbid Function (English)/Word Accentuation Test (Spanish). Using a repeated measures design, 60 neurologically intact participants were tested in a counterbalanced order, with WAIS-IV version as the repeated measure (mean intertest interval = 5.68 days). To minimize practice effects, the five visual-perceptual subtests, which contain the same items in each version, were administered only once during the initial session.

All mean WAIS-IV México index/subtest scores were significantly higher than the U.S. equivalents (Full-Scale IQ by about .5 SD). Unexpectedly, most (83%) participants educated in the US to at least a high school level had numerically equal or higher scores on the U.S. version. Means on WAIS-IV language format indices/subtests were lower than those of visual-perceptual format indices/subtests within both versions (excepting Processing Speed Index/subtests in the U.S. version). All hold measures significantly predicted WAIS-IV summary scores for the U.S. version. Similarly for the México version, except for the Word Accentuation Test.

When evaluating a balanced bilingual Mexican American, opting for the WAIS-IV México version will yield higher scores across the Full-Scale IQ, indices, and all core subtests unless the patient was educated in the US to at least a high school level.

People with bipolar disorder (BD) often show inaccurate subjective ratings of their objective cognitive function. However, it is unclear what information individuals use to formulate their subjective ratings. This study evaluated whether people with BD are likely using information about their crystallized cognitive abilities (which involve an accumulated store of verbal knowledge and skills and are typically preserved in BD) or their fluid cognitive abilities (which involve the capacity for new learning and information processing in novel situations and are typically impaired in BD) to formulate their subjective cognitive ratings.

Eighty participants diagnosed with BD and 55 control volunteers were administered cognitive tests assessing crystallized and fluid cognitive abilities. Subjective cognitive functioning was assessed with the Cognitive Failures Questionnaire (CFQ), daily functioning was rated using the Multidimensional Scale of Independent Functioning (MSIF) and the Global Assessment of Functioning Scale (GAF), and quality of life was assessed with the Quality of Life in Bipolar Disorder scale (QoL.BD).

The BD group exhibited considerably elevated subjective cognitive complaints relative to controls. Among participants with BD, CFQ scores were associated with fluid cognitive abilities including measures of memory and executive function, but not to crystallized abilities. After controlling for objective cognition and depression, higher cognitive complaints predicted poorer psychosocial outcomes.

Cognitive self-reports in BD may represent a metacognitive difficulty whereby cognitive self-appraisals are distorted by a person’s focus on their cognitive weaknesses rather than strengths. Moreover, negative cognitive self-assessments are associated with poorer daily functioning and diminished quality of life.

Cognitive impairment, anxiety, depression, fatigue, and dependence in instrumental activities of daily living (ADL) are common after stroke; however, little is known about how these outcomes may differ following treatment with endovascular clot retrieval (ECR), intravenous tissue plasminogen activator (t-PA), or conservative management.

Patients were recruited after acute treatment and invited to participate in an outcome assessment 90–120 days post-stroke. The assessment included a cognitive test battery and several questionnaires. The COVID-19 pandemic led to significant disruptions in recruitment and data collection, and the t-PA and conservative management groups were combined into a standard medical care (SMC) group.

Sixty-two participants were included in the study (ECR = 31, SMC = 31). Mean age was 66.5 (20–86) years, and 35 (56.5%) participants were male. Participants treated with ECR had significantly higher National Institutes of Health Stroke Scale scores at presentation and significantly lower education. After adjusting for stroke severity, premorbid intellectual ability, and age, treatment with ECR was associated with significantly better performances on measures of cognitive screening, visual working memory, and verbal learning and memory. Participants treated with ECR also experienced less fatigue and were more likely to achieve independence in basic and instrumental ADLs. Despite this, cognitive impairment and fatigue were still common among participants treated with ECR and anxiety and depression symptoms were experienced similarly by both groups.

Cognitive impairment and fatigue were less common but still prevalent following treatment with ECR. This has important practical implications for stroke rehabilitation, and routine assessment of cognition, emotion, and fatigue is recommended for all stroke survivors regardless of stroke treatment and functional outcome.

Neuropsychological assessment of preschool children is essential for early detection of delays and referral for intervention prior to school entry. This is especially pertinent in low- and middle-income countries (LMICs), which are disproportionately impacted by micronutrient deficiencies and teratogenic exposures. The Grenada Learning and Memory Scale (GLAMS) was created for use in limited resource settings and includes a shopping list and face-name association test. Here, we present psychometric and normative data for the GLAMS in a Grenadian preschool sample.

Typically developing children between 36 and 72 months of age, primarily English speaking, were recruited from public preschools in Grenada. Trained Early Childhood Assessors administered the GLAMS and NEPSY-II in schools, homes, and clinics. GLAMS score distributions, reliability, and convergent/divergent validity against NEPSY-II were evaluated.

The sample consisted of 400 children (190 males, 210 females). GLAMS internal consistency, inter-rater agreement, and test-retest reliability were acceptable. Principal components analysis revealed two latent factors, aligned with expected verbal/visual memory constructs. A female advantage was observed in verbal memory. Moderate age effects were observed on list learning/recall and small age effects on face-name learning/recall. All GLAMS subtests were correlated with NEPSY-II Sentence Repetition, supporting convergent validity with a measure of verbal working memory.

The GLAMS is a psychometrically sound measure of learning and memory in Grenadian preschool children. Further adaptation and scale-up to global LMICs are recommended.

The psychometric rigor of unsupervised, smartphone-based assessments and factors that impact remote protocol engagement is critical to evaluate prior to the use of such methods in clinical contexts. We evaluated the validity of a high-frequency, smartphone-based cognitive assessment protocol, including examining convergence and divergence with standard cognitive tests, and investigating factors that may impact adherence and performance (i.e., time of day and anticipated receipt of feedback vs. no feedback).

Cognitively unimpaired participants (N = 120, Mage = 68.8, 68.3% female, 87% White, Meducation = 16.5 years) completed 8 consecutive days of the Mobile Monitoring of Cognitive Change (M2C2), a mobile app-based testing platform, with brief morning, afternoon, and evening sessions. Tasks included measures of working memory, processing speed, and episodic memory. Traditional neuropsychological assessments included measures from the Preclinical Alzheimer’s Cognitive Composite battery.

Findings showed overall high compliance (89.3%) across M2C2 sessions. Average compliance by time of day ranged from 90.2% for morning sessions, to 77.9% for afternoon sessions, and 84.4% for evening sessions. There was evidence of faster reaction time and among participants who expected to receive performance feedback. We observed excellent convergent and divergent validity in our comparison of M2C2 tasks and traditional neuropsychological assessments.

This study supports the validity and reliability of self-administered, high-frequency cognitive assessment via smartphones in older adults. Insights into factors affecting adherence, performance, and protocol implementation are discussed.

We aimed to compare and link the total scores of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), two common global cognitive screeners.

2,325 memory clinic patients (63.2 ± 8.6 years; 43% female) with a variety of diagnoses, including subjective cognitive decline, mild cognitive impairment, and dementia due to various etiologies completed the MMSE and MoCA concurrently. We described both screeners, including at the item level. Then, using linear regressions, we investigated how age, sex, education, and diagnosis affected total scores on both instruments. Next, in linear mixed models, we treated the two screeners as repeated measures and analyzed the influence of these characteristics on the relationship between the instruments’ total scores. Finally, we linked total scores using equipercentile equating, accounting for relevant patient characteristics.

MMSE scores (mean ± standard deviation: 25.0 ± 4.6) were higher than MoCA scores (21.2 ± 5.4), and MMSE items generally showed less variation than MoCA items. Both instruments’ scores were individually influenced by age, sex, education, and diagnosis. The relationship between the screeners was moderated by age (estimate = −0.01, 95% confidence interval = [−0.03, −0.00]), education (0.14 [0.10, 0.18]), and diagnosis. These were accounted for when producing crosswalk tables based on equipercentile equating.

Accounting for the influence of patient characteristics, we created crosswalk tables to convert MMSE scores to MoCA scores, and vice versa. These tables may facilitate collaboration between clinicians and researchers and could allow larger, pooled analyses of global cognitive functioning in older adults.

Premorbid tests estimate cognitive ability prior to neurological condition onset or brain injury. Tests requiring oral pronunciation of visually presented irregular words, such as the National Adult Reading Test (NART), are commonly used due to robust evidence that word familiarity is well-preserved across a range of neurological conditions and correlates highly with intelligence. Our aim is to examine the prediction limits of NART variants to assess their ability to accurately estimate premorbid IQ.

We examine the prediction limits of 13 NART variants, calculate which IQ classification system categories are reachable in principle, and consider the proportion of the adult population in the target country falling outside the predictable range.

Many NART variants cannot reach higher or lower IQ categories due to floor/ceiling effects and inherent limitations of linear regression (used to convert scores to predicted IQ), restricting clinical accuracy in evaluating premorbid ability (and thus the magnitude of impairment). For some variants this represents a sizeable proportion of the target population.

Since both higher and lower IQ categories are unreachable in principle, we suggest that future NART variants consider polynomial or broken-stick fitting (or similar methods) and suggest that prediction limits should be routinely reported.

Older adults are identified to have reduced social cognitive performance compared to younger adults. However, few studies have examined age-associations throughout later life to determine whether these reductions continue with advancing age.

This study assesses cross-sectional associations of emotion perception, cognitive and affective theory of mind (ToM), and emotional empathy in a healthy sample of 157 adults aged 50–89 years (M = 65.31, SD = 9.00, 68% female sex). Emotion perception, cognitive ToM, and affective ToM were measured using The Awareness of Social Inference Test Short Form (TASIT-S), while affective ToM was also measured using Reading the Mind in the Eyes Revised (RME-R). Emotional empathy was measured using the Empathy Quotient.

Multiple regression analyses, adjusting for multiple comparisons, revealed a moderate negative association between age and emotion perception for all emotions combined, as well as for sad and revolted expressions, but not happy, neutral, anxious, or angry expressions. Age had a negative, moderate association with first-order cognitive, second-order cognitive, and affective ToM measured using TASIT-S, but not RME-R. Age was not significantly associated with emotional empathy.

This study contributes to the limited understanding of age-related associations of social cognitive performance throughout later life. This knowledge can inform future research examining the clinical utility of including social cognitive measures in neuropsychological screening and diagnostic tools for later-life neurological disorders.

While factors such as age and education have been associated with persistent differences in functional cognitive decline, they do not fully explain observed variations particularly those between different racial/ethnic and sex groups. The aim of this study was to explore the association between allostatic load (AL) and cognition in a racially diverse cohort of young adults.

Utilizing Wave V of the National Longitudinal Study of Adolescent to Adult Health – a nationally representative, longitudinal survey of adults aged 34–44, this study utilized primary data from 10 immune, cardiovascular, and metabolic biomarkers to derive an AL Index. Cognition was previously recorded through word and number recall scores. Regression analysis evaluated the association between cognitive recall, AL, age, sex, and race/ethnicity.

Regression results indicated statistically higher AL scores among Blacks (IRR = 1.09, CI = 1.01, 1.19) compared to Whites and lower AL score among females compared to males (IRR = 0.76, CI = 0.72, 0.81). At zero AL, Blacks (IRR = 1.2399, CI = 1.2398, 1.24) and Other races (IRR = 1.4523, CI = 1.452, 1.4525) had higher recall while Hispanics (IRR = 0.808, CI = 0.8079, 0.8081) had lower recall compared to Whites. Relative to males, females had higher number recall (IRR = 1.1976, CI = 1.1976, 1.1977). However, at higher, positive levels of AL, Blacks (IRR = 0.9554, CI = 0.9553, 0.9554), Other races (IRR = 0.9479, CI = 0.9479, 0.9479) and females (IRR = 0.9655, CI = 0.9655, 0.9655) had significantly lower number recall than Whites and males respectively.

Race and sex differences were observed in recall at different levels of AL. Findings demonstrate the need for further exploration of cognition in young adults across diverse populations that includes examination of AL.

The number of test translations and adaptations has risen exponentially over the last two decades, and these processes are now becoming a common practice. The International Test Commission (ITC) Guidelines for Translating and Adapting Tests (Second Edition, 2017) offer principles and practices to ensure the quality of translated and adapted tests. However, they are not specific to the cognitive processes examined with clinical neuropsychological measures. The aim of this publication is to provide a specialized set of recommendations for guiding neuropsychological test translation and adaptation procedures.

The International Neuropsychological Society’s Cultural Neuropsychology Special Interest Group established a working group tasked with extending the ITC guidelines to offer specialized recommendations for translating/adapting neuropsychological tests. The neuropsychological application of the ITC guidelines was formulated by authors representing over ten nations, drawing upon literature concerning neuropsychological test translation, adaptation, and development, as well as their own expertise and consulting colleagues experienced in this field.

A summary of neuropsychological-specific commentary regarding the ITC test translation and adaptation guidelines is presented. Additionally, examples of applying these recommendations across a broad range of criteria are provided to aid test developers in attaining valid and reliable outcomes.

Establishing specific neuropsychological test translation and adaptation guidelines is critical to ensure that such processes produce reliable and valid psychometric measures. Given the rapid global growth experienced in neuropsychology over the last two decades, the recommendations may assist researchers and practitioners in carrying out such endeavors.

Cognitive function may contribute to variability in older adults’ ability to cope with chronic stress; however, limited research has evaluated this relationship. This study investigated the relationship between theoretically derived coping domains and cognitive function in 165 middle-to-older adults during the Omicron stage of COVID-19.

Participants completed a clinical interview and self-report measures of health. The National Alzheimer’s Coordinating Center Uniform Data Set neuropsychological battery was used to evaluate memory, language, executive function/speed, and working memory. Structural equation modeling evaluated the underlying factor structure of the Brief COPE adapted for COVID-19.

The data supported the proposed second-order Approach factor comprised of Problem-Solving and Emotion Regulation (ER) strategies and a first-order Avoidance factor. Higher Avoidance was associated with greater depression symptoms, lower income and worse memory, executive function, working memory, and verbal fluency performance. Higher Problem-Solving was associated with better verbal fluency performance. ER strategies were not significantly associated with cognitive function. The use of Problem-Solving was not associated with less Avoidance. Greater use of Problem-Solving, ER, and Avoidance were all associated with higher levels of stress. Post-hoc analyses found that higher Acceptance was the only coping strategy associated with less stress.

These findings demonstrate that older adults with worse cognitive function were more likely to use Avoidance during the pandemic, which could result in prolonged stress and adverse health consequences. Future research is warranted to investigate whether acceptance-based interventions reduce the avoidance and impact of stress on health in vulnerable older adults.

To capture the distortion of exploratory activity typical of patients with spatial neglect, traditional diagnostic methods and new virtual reality applications use confined workspaces that limit patients’ exploration behavior to a predefined area. Our aim was to overcome these limitations and enable the recording of patients’ biased activity in real, unconfined space.

We developed the Free Exploration Test (FET) based on augmented reality technology. Using a live stream via the back camera on a tablet, patients search for a (non-existent) virtual target in their environment, while their exploration movements are recorded for 30 s. We tested 20 neglect patients and 20 healthy participants and compared the performance of the FET with traditional neglect tests.

In contrast to controls, neglect patients exhibited a significant rightward bias in exploratory movements. The FET had a high discriminative power (area under the curve = 0.89) and correlated positively with traditional tests of spatial neglect (Letter Cancellation, Bells Test, Copying Task, Line Bisection). An optimal cut-off point of the averaged bias of exploratory activity was at 9.0° on the right; it distinguished neglect patients from controls with 85% sensitivity.

FET offers time-efficient (execution time: ∼3 min), easy-to-apply, and gamified assessment of free exploratory activity. It supplements traditional neglect tests, providing unrestricted recording of exploration in the real, unconfined space surrounding the patient.

Cognitive reserve (CR) is typically operationalized as episodic memory residualized on brain health indices. The dimensionality of more generalized models of CR has rarely been examined.

In a sample of N = 113 dementia-free older adults (ages 62–86 years at MRI scan; 58.4% women), the domain-specific representation of general cognition (COG) before vs. after residualization on brain indices (brain volume loss, cerebral blood flow, white matter hyperintensities) was compared (i.e., COG vs. CR). COG and CR were assessed by 15 tasks spanning five domains: processing speed, verbal memory, visuospatial memory, fluid reasoning, and vocabulary. Measurement invariance and item-construct representation were tested in a series of structural factor analyses. COG and CR were then examined in relation to 22 risk and protective factors and dementia status at time of death.

Item-factor loadings differed such that CR more strongly emphasized fluid reasoning. More years of education, higher occupational class, more hobbies/interests, and fewer difficulties with personal mobility similarly predicted better COG and CR. Only the sub-domain of visuospatial memory (both before and after residualization) was associated with conversion to dementia by end-of-life (r = −.30; p = .01).

Results provide tentative support for the role of fluid reasoning (intelligence) as a potential compensatory factor for age- and/or neuropathology-related reductions in processing speed and memory. Intellectually stimulating work, efforts to preserve personal mobility, and a diversity of hobbies and interests may attenuate age- and/or pathology-related reductions in cognitive functioning prior to dementia onset.

Normal aging often leads to cognitive decline, and oldest old people, over 80 years old, have a 15% risk of developing neurodegenerative diseases. Therefore, it is important to have appropriate tools to assess cognitive function in old age. The study aimed to provide new norms for neuropsychological tests used to evaluate the cognitive abilities in people aged 80 years and older in France, focusing on the impact of education and gender differences.

107 healthy participants with an average age of 85.2 years, with no neurological history or major cognitive deficits were included. A comprehensive neuropsychological assessment was performed, covering several cognitive functions such as memory, visuospatial abilities, executive functions, attention, processing speed, and praxis.

Individuals with lower levels of education performed poorly on some tests and took longer to complete. Gender differences were observed, with women outperforming men in verbal episodic memory, while men showed better performance in visuoconstructive tasks. The participants showed lower performance in verbal episodic memory compared to norms established in previous French studies. In relation to executive functions, participants were slower to perform complex tasks than participants in previous studies.

This study provides cognitive norms specifically adapted to the oldest old population, which differ from established norms for younger aging adults. It highlights the importance of including these norms in future clinical and scientific investigations. The findings underscore the importance of education on cognitive abilities and emphasize the need to consider gender differences when assessing cognitive functions in aging populations.

Functional neurological symptom disorder (FNSD) is a neuropsychiatric condition characterized by signs/symptoms associated with brain network dysfunction. FNSDs are common and are associated with high healthcare costs. FNSDs are relevant to neuropsychologists, as they frequently present with chronic neuropsychiatric symptoms, subjective cognitive concerns, and/or low neuropsychological test scores, with associated disability and reduced quality of life. However, neuropsychologists in some settings are not involved in care of patients with FNSDs. This review summarizes relevant FNSD literature with a focus on the role of neuropsychologists.

A brief review of the literature is provided with respect to epidemiology, public health impact, symptomatology, pathophysiology, and treatment.

Two primary areas of focus for this review are the following: (1) increasing neuropsychologists’ training in FNSDs, and (2) increasing neuropsychologists’ role in assessment and treatment of FNSD patients.

Patients with FNSD would benefit from increased involvement of neuropsychologists in their care.

Previous studies have found deficits in imaginative elaboration and social inference to be associated with agenesis of the corpus callosum (ACC; Renteria-Vasquez et al., 2022; Turk et al., 2009). In the current study, Thematic Apperception Test (TAT) responses from a neurotypical control group and a group of individuals with ACC were used to further study the capacity for imaginative elaboration and story coherence.

Topic modeling was employed utilizing Latent Diritchlet Allocation to characterize the narrative responses to the pictures used in the TAT. A measure of the difference between models (perplexity) was used to compare the topics of the responses of individual participants to the common core model derived from the responses of the control group. Story coherence was tested using sentence-to-sentence Latent Semantic Analysis.

Group differences in perplexity were statistically significant overall, and for each card individually (p < .001). There were no differences between the groups in story coherence.

TAT narratives from persons with ACC were normally coherent, but more conventional (i.e., more similar to the core text) compared to those of neurotypical controls. Individuals with ACC can make conventional social inferences about socially ambiguous stimuli, but are restricted in their imaginative elaborations, resulting in less topical variability (lower perplexity values) compared to neurotypical controls.

Brain areas implicated in semantic memory can be damaged in patients with epilepsy (PWE). However, it is challenging to delineate semantic processing deficits from acoustic, linguistic, and other verbal aspects in current neuropsychological assessments. We developed a new Visual-based Semantic Association Task (ViSAT) to evaluate nonverbal semantic processing in PWE.

The ViSAT was adapted from similar predecessors (Pyramids & Palm Trees test, PPT; Camels & Cactus Test, CCT) comprised of 100 unique trials using real-life color pictures that avoid demographic, cultural, and other potential confounds. We obtained performance data from 23 PWE participants and 24 control participants (Control), along with crowdsourced normative data from 54 Amazon Mechanical Turk (Mturk) workers.

ViSAT reached a consensus >90% in 91.3% of trials compared to 83.6% in PPT and 82.9% in CCT. A deep learning model demonstrated that visual features of the stimulus images (color, shape; i.e., non-semantic) did not influence top answer choices (p = 0.577). The PWE group had lower accuracy than the Control group (p = 0.019). PWE had longer response times than the Control group in general and this was augmented for the semantic processing (trial answer) stage (both p < 0.001).

This study demonstrated performance impairments in PWE that may reflect dysfunction of nonverbal semantic memory circuits, such as seizure onset zones overlapping with key semantic regions (e.g., anterior temporal lobe). The ViSAT paradigm avoids confounds, is repeatable/longitudinal, captures behavioral data, and is open-source, thus we propose it as a strong alternative for clinical and research assessment of nonverbal semantic memory.

To determine whether poorer performance on the Boston Naming Test (BNT) in individuals with transactive response DNA-binding protein 43 pathology (TDP-43+) is due to greater loss of word knowledge compared to retrieval-based deficits.

Retrospective clinical-pathologic study of 282 participants with Alzheimer’s disease neuropathologic changes (ADNC) and known TDP-43 status. We evaluated item-level performance on the 60-item BNT for first and last available assessment. We fit cross-sectional negative binomial count models that assessed total number of incorrect items, number correct of responses with phonemic cue (reflecting retrieval difficulties), and number of “I don’t know” (IDK) responses (suggestive of loss of word knowledge) at both assessments. Models included TDP-43 status and adjusted for sex, age, education, years from test to death, and ADNC severity. Models that evaluated the last assessment adjusted for number of prior BNT exposures.

43% were TDP-43+. The TDP-43+ group had worse performance on BNT total score at first (p = .01) and last assessments (p = .01). At first assessment, TDP-43+ individuals had an estimated 29% (CI: 7%–56%) higher mean number of incorrect items after adjusting for covariates, and a 51% (CI: 15%–98%) higher number of IDK responses compared to TDP-43−. At last assessment, compared to TDP-43−, the TDP-43+ group on average missed 31% (CI: 6%–62%; p = .01) more items and had 33% more IDK responses (CI: 1% fewer to 78% more; p = .06).

An important component of poorer performance on the BNT in participants who are TDP-43+ is having loss of word knowledge versus retrieval difficulties.