Objectives: Previous research has demonstrated an association between emotion recognition and apathy in several neurological conditions involving fronto-striatal pathology, including Parkinson’s disease and brain injury. In line with these findings, we aimed to determine whether apathetic participants with early Huntington’s disease (HD) were more impaired on an emotion recognition task compared to non-apathetic participants and healthy controls. Methods: We included 43 participants from the TRACK-HD study who reported apathy on the Problem Behaviours Assessment – short version (PBA-S), 67 participants who reported no apathy, and 107 controls matched for age, sex, and level of education. During their baseline TRACK-HD visit, participants completed a battery of cognitive and psychological tests including an emotion recognition task, the Hospital Depression and Anxiety Scale (HADS) and were assessed on the PBA-S. Results: Compared to the non-apathetic group and the control group, the apathetic group were impaired on the recognition of happy facial expressions, after controlling for depression symptomology on the HADS and general disease progression (Unified Huntington’s Disease Rating Scale total motor score). This was despite no difference between the apathetic and non-apathetic group on overall cognitive functioning assessed by a cognitive composite score. Conclusions: Impairment of the recognition of happy expressions may be part of the clinical picture of apathy in HD. While shared reliance on frontostriatal pathways may broadly explain associations between emotion recognition and apathy found across several patient groups, further work is needed to determine what relationships exist between recognition of specific emotions, distinct subtypes of apathy and underlying neuropathology. (JINS, 2019, 25, 453–461)

Objectives: Apathy is a debilitating symptom of Huntington’s disease (HD) and manifests before motor diagnosis, making it an excellent therapeutic target in the preclinical phase of Huntington’s disease (prHD). HD is a neurological genetic disorder characterized by cognitive and motor impairment, and psychiatric abnormalities. Apathy is not well characterized within the prHD. In previous literature, damage to the caudate and putamen has been correlated with increased apathy in other neurodegenerative and movement disorders. The objective of this study was to determine whether apathy severity in individuals with prHD is related to striatum volumes and cognitive control. We hypothesized that, within prHD individuals, striatum volumes and cognitive control scores would be related to apathy. Methods: We constructed linear mixed models to analyze striatum volumes and cognitive control, a composite measure that includes tasks assessing with apathy scores from 797 prHD participants. The outcome variable for each model was apathy, and the independent variables for the four separate models were caudate volume, putamen volume, cognitive control score, and motor symptom score. We also included depression as a covariate to ensure that our results were not solely related to mood. Results: Caudate and putamen volumes, as well as measures of cognitive control, were significantly related to apathy scores even after controlling for depression. Conclusions: The behavioral apathy expressed by these individuals was related to regions of the brain commonly associated with isolated apathy, and not a direct result of mood symptoms. (JINS, 2019, 25, 462–469)

Objectives: To investigate whether the relationship between arm use and motor impairment post-stroke is influenced by the hemisphere of damage. Methods: Right-handed patients with unilateral left hemisphere damage (LHD) or right (RHD) (n=58; 28 LHD, 30 RHD) were recruited for this study. The Arm Motor Ability Test and Functional Impact Assessment were used to derive arm use patterns. The Fugl-Meyer motor assessment scale was used to quantify the level of motor impairment. Results: A significant interaction between patient group and impairment level was observed for contralesional, but not ipsilesional arm use. For lower impairment levels, contralesional (right arm for LHD and left arm for RHD) arm use was greater in LHD than RHD patients. In contrast, for greater levels of impairment, there were no arm use differences between the two patient groups. Conclusions: When motor impairment is significant, it overrides potential effects of stroke laterality on the patterns of arm use. However, a robust influence of hemisphere of damage on the patterns of arm use is evident at lower impairment levels. This may be attributed to previously described arm preference effects. These findings suggest adoption of distinct strategies for rehabilitation following left versus right hemisphere damage in right-handers, at least when the impairment is moderate to low. (JINS, 2019, 25, 470–478)

Objective: Few studies have investigated the assessment and functional impact of egocentric and allocentric neglect among stroke patients. This pilot study aimed to determine (1) whether allocentric and egocentric neglect could be dissociated among a sample of stroke patients using eye tracking; (2) the specific patterns of attention associated with each subtype; and (3) the nature of the relationship between neglect subtype and functional outcome. Method: Twenty acute stroke patients were administered neuropsychological assessment batteries, a pencil-and-paper Apples Test to measure neglect subtype, and an adaptation of the Apples Test with an eye tracking measure. To test clinical discriminability, twenty age- and education-matched control participants were administered the eye tracking measure of neglect. Results: The eye tracking measure identified a greater number of individuals as having egocentric and/or allocentric neglect than the pencil-and-paper Apples Test. Classification of neglect subtype based on eye tracking performance was a significant predictor of functional outcome beyond that accounted for by the neuropsychological test performance and Apples Test neglect classification. Preliminary evidence suggests that patients with no neglect symptoms had superior functional outcomes compared with patients with neglect. Patients with combined egocentric and allocentric neglect had poorer functional outcomes than those with either subtype. Functional outcomes of patients with either allocentric or egocentric neglect did not differ significantly. The applications of our findings, to improve neglect detection, are discussed. Conclusion: Results highlight the potential clinical utility of eye tracking for the assessment and identification of neglect subtype among stroke patients to predict functional outcomes. (JINS, 2019, 25, 479–489)

Objectives: Visual-spatial neglect is a common attentional disorder after right-hemisphere stroke and is associated with poor rehabilitation outcomes. The presence of neglect symptoms has been reported to vary across personal, peripersonal, and extrapersonal space. Currently, no measure is available to assess neglect severity equally across these spatial regions and may be missing subsets of symptoms or patients with neglect entirely. We sought to provide initial construct validity for a novel assessment tool that measures neglect symptoms equally for these spatial regions: the Halifax Visual Scanning Test (HVST). Methods: In Study I, the HVST was compared to conventional measures of neglect and functional outcome scores (wheelchair navigation) in 15 stroke inpatients and 14 healthy controls. In Study II, 19 additional controls were combined with the control data from Study I to establish cutoffs for impairment. Patterns of neglect in the stroke group were examined. Results: In Study I, performance on all HVST subtests were correlated with the majority of conventional subtests and wheelchair navigation outcomes. In Study II, neglect-related deficits in visual scanning showed dissociations across spatial regions. Four inpatients exhibited symptoms of neglect on the HVST that were not detected on conventional measures, one of which showed symptoms in personal and extrapersonal space exclusively. Conclusions: The HVST appears a useful measure of neglect symptoms in different spatial regions that may not be detected with conventional measures and that correlates with functional wheelchair performance. Preliminary control data are presented and further research to add to this normative database appears warranted. (JINS, 2019, 25, 490–500)

Objective: Post-stroke cognitive impairment is common, but mechanisms and risk factors are poorly understood. Frailty may be an important risk factor for cognitive impairment after stroke. We investigated the association between pre-stroke frailty and acute post-stoke cognition. Methods: We studied consecutively admitted acute stroke patients in a single urban teaching hospital during three recruitment waves between May 2016 and December 2017. Cognition was assessed using the Mini-Montreal Cognitive Assessment (min=0; max=12). A Frailty Index was used to generate frailty scores for each patient (min=0; max=100). Clinical and demographic information were collected, including pre-stroke cognition, delirium, and stroke-severity. We conducted univariate and multiple-linear regression analyses with covariates forced in (covariates included were: age, sex, stroke severity, stroke-type, pre-stroke cognitive impairment, delirium, previous stroke/transient ischemic attack) to investigate the association between pre-stroke frailty and post-stroke cognition. Results: Complete data were available for 154 stroke patients. Mean age was 68 years (SD=11; range=32–97); 93 (60%) were male. Median mini-Montreal Cognitive Assessment score was 8 (IQR=4–12). Mean Frailty Index score was 18 (SD=11). Pre-stroke cognitive impairment was apparent in 13/154 (8%) patients. Pre-stroke frailty was significantly associated with lower post-stroke cognition (Standardized-Beta=−0.40; p<0.001) and this association was independent of covariates (Unstandardized-Beta=−0.05; p=0.005). Additional significant variables in the multiple regression model were age (Unstandardized-Beta=−0.05; p=0.002), delirium (Unstandardized-Beta=−2.81; p<0.001), pre-stroke cognitive impairment (Unstandardized-Beta=−2.28; p=0.001), and stroke-severity (Unstandardized-Beta=−0.20; p<0.001). Conclusions: Pre-stroke frailty may be a moderator of post-stroke cognition, independent of other well-established post-stroke cognitive impairment risk factors. (JINS, 2019, 25, 501–506)

Objectives: Studies of neurocognitively elite older adults, termed SuperAgers, have identified clinical predictors and neurobiological indicators of resilience against age-related neurocognitive decline. Despite rising rates of older persons living with HIV (PLWH), SuperAging (SA) in PLWH remains undefined. We aimed to establish neuropsychological criteria for SA in PLWH and examined clinically relevant correlates of SA. Methods: 734 PLWH and 123 HIV-uninfected participants between 50 and 64 years of age underwent neuropsychological and neuromedical evaluations. SA was defined as demographically corrected (i.e., sex, race/ethnicity, education) global neurocognitive performance within normal range for 25-year-olds. Remaining participants were labeled cognitively normal (CN) or impaired (CI) based on actual age. Chi-square and analysis of variance tests examined HIV group differences on neurocognitive status and demographics. Within PLWH, neurocognitive status differences were tested on HIV disease characteristics, medical comorbidities, and everyday functioning. Multinomial logistic regression explored independent predictors of neurocognitive status. Results: Neurocognitive status rates and demographic characteristics differed between PLWH (SA=17%; CN=38%; CI=45%) and HIV-uninfected participants (SA=35%; CN=55%; CI=11%). In PLWH, neurocognitive groups were comparable on demographic and HIV disease characteristics. Younger age, higher verbal IQ, absence of diabetes, fewer depressive symptoms, and lifetime cannabis use disorder increased likelihood of SA. SA reported increased independence in everyday functioning, employment, and health-related quality of life than non-SA. Conclusions: Despite combined neurological risk of aging and HIV, youthful neurocognitive performance is possible for older PLWH. SA relates to improved real-world functioning and may be better explained by cognitive reserve and maintenance of cardiometabolic and mental health than HIV disease severity. Future research investigating biomarker and lifestyle (e.g., physical activity) correlates of SA may help identify modifiable neuroprotective factors against HIV-related neurobiological aging. (JINS, 2019, 25, 507–519)

Objectives: The Tower of London (TOL) test has probably become the most often used task to assess planning ability in clinical and experimental settings. Since its implementation, efforts were made to provide a task version with adequate psychometric properties, but extensive normative data are not publicly available until now. The computerized TOL-Freiburg Version (TOL-F) was developed based on theory-grounded task analyses, and its psychometric adequacy has been repeatedly demonstrated in several studies but often with small and selective samples. Method: In the present study, we now report reliability estimates and normative data for the TOL-F stratified for age, sex, and education from a large population-representative sample collected in the Gutenberg Health Study in Mainz, Germany (n=7703; 40–80 years). Results: The present data confirm previously reported adequate indices of reliability (>.70) of the TOL-F. We also provide normative data for the TOL-F stratified for age (5-year intervals), sex, and education (low vs. high education). Conclusions: Together, its adequate reliability and the representative age-, sex-, and education-fair normative data render the computerized TOL-F a suitable diagnostic instrument to assess planning ability. (JINS, 2019, 25, 520–529)

Objectives: Individuals aged 90 or older (oldest-old), the fastest growing segment of the population, are at increased risk of developing cognitive impairment compared with younger old. Neuropsychological evaluation of the oldest-old is important yet challenging in part because of the scarcity of test norms for this group. We provide neuropsychological test norms for cognitively intact oldest-old. Methods: Test norms were derived from 403 cognitively intact participants of The 90+ Study, an ongoing study of aging and dementia in the oldest-old. Cognitive status of intact oldest-old was determined at baseline using cross-sectional approach. Individuals with cognitive impairment no dementia or dementia (according to DSM-IV criteria) were excluded. Participants ranged in age from 90 to 102 years (mean=94). The neuropsychological battery included 11 tests (Mini-Mental Status Examination, Modified Mini-Mental State Examination, Boston Naming Test – Short Form, Letter Fluency Test, Animal Fluency Test, California Verbal Learning Test-II Short Form, Trail Making Tests A/B/C, Digit Span Forward and Backwards Test, Clock Drawing Test, CERAD Construction Subtests), and the Geriatric Depression Scale. Results: Data show significantly lower scores with increasing age on most tests. Education level, sex, and symptoms of depression were associated with performance on several tests after accounting for age. Conclusions: Provided test norms will help to distinguish cognitively intact oldest-old from those with cognitive impairment. (JINS, 2019, 25, 530–545)

Objective: Increased levels of worry, age, and presence of the apolipoprotein-E (ApoE)-ε4 allele are associated with the risk of developing cognitive declines and Alzheimer’s disease (AD). Odor memory performance has been shown to vary as a function of age and ApoE genotype, and odor memory tests are sensitive to preclinical AD. Worry is known to influence verbal memory; however, its effects on odor memory are unknown. This study aimed to assess the relationships between worry, age, and ε4 status on odor memory. Method: Worry was evaluated for young (n = 53) and older (n = 45) adults using the Penn State Worry Questionnaire. Odor memory was assessed using the California Odor Learning Test, an olfactory analogue to the California Verbal Learning Test. Results: A significant main effect of worry on long-delay free recall was found, such that increasing worry was associated with better recall across age and ε4 status. A significant interaction effect between ε4 status and worry on both short-and long-delay cued recall was found, such that across age, higher worry was associated with increased cued recall scores among ε4-negative adults, and decreased scores among ε4-positive adults. Conclusions: Findings demonstrated that worry influences odor memory and exerts a particular effect on cued recall among ε4 carriers who are at a greater risk of developing AD. Worry is a modifiable predictor of cognitive decline and risk of dementia in aging. Future studies on the effects of treatments aimed at reducing worry (e.g., cognitive behavioral therapies for anxiety) on changes in cognitive functioning are warranted.