The Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q) is well validated and commonly used to assess difficulties in everyday functioning regarding dementia. To facilitate interpretation and clinical implementation across different European countries, we aim to provide normative data and a diagnostic cutoff for dementia.

Cross-sectional data from Dutch Brain Research Registry (N = 1,064; mean (M) age = 62 ± 11 year; 69.5% female), European Medial Information Framework-Alzheimer’s Disease 90 + (N = 63; Mage = 92 ± 2 year; 52.4% female), and European Prevention of Alzheimer’s Dementia Longitudinal Cohort Study (N = 247; Mage = 63 ± 7 year; 72.1% female) were used. The generalized additive models for location, scale, and shape framework were used to obtain normative values (Z-scores). The beta distribution was applied, and combinations of age, sex, and educational attainment were modeled. The optimal cutoff for dementia was calculated using area under receiver operating curves (AUC-ROC) and Youden Index, using data from Amsterdam Dementia Cohort (N = 2,511, Mage = 64 ± 8 year, 44.4% female).

The best normative model accounted for a cubic-like decrease of IADL performance with age that was more pronounced in low compared to medium/high educational attainment. The cutoff for dementia was 1.85 standard deviation below the population mean (AUC = 0.97; 95% CI [0.97–0.98]).

We provide regression-based norms for A-IADL-Q and a diagnostic cutoff for dementia, which help improve clinical assessment of IADL performance across European countries.

Alzheimer’s Disease (AD) and dementia present major and escalating public health concerns for the U.S., especially among ethnoculturally diverse (e.g., Latinx, non-Latinx Black [NLB]) populations who represent an increasing percentage of the older adult population in the US and bear greater AD burden compared to non-Latinx Whites (NLWs). Notably, neurocognition and functional status are highly correlated in those with AD. However, little has been done to understand these associations and validate functional measures across geographically diverse, multiethnic samples. The aims of this study were to characterize the neurocognition and functional status of a large, multiethnic sample and subsequently examine any associations between neurocognition and functional status among Latinx, NLB, and NLW older adults.

This cross-sectional, retrospective study utilized archival data drawn from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). ADNI is a national, longitudinal, multi-site, observational study aiming to measure the progression of AD (see https://adni-info.org). Study measures included the: 1) Alzheimer’s Disease Assessment Scale Cognitive subscale (ADAS-cog; 13-items), a global neurocognitive battery evaluating neurocognition in people with AD; 2) Functional Activities Questionnaire (FAQ; 10-item questionnaire) to assess functional status; 3) Geriatric Depression Scale (GDS; 15-item questionnaire) for depression; and 4) American National Adult Reading Test (ANART; 50-word test) for reading level. The sample included 1537 older adults who completed baseline visits for the ADNI study, 1333 of whom were NLW, 123 NLB, and 81 Latinx. The average age of the sample was 73 years, average 16 years of education, and 53% male. Compared to the NLW group, the NLB and Latinx groups were significantly younger and had a higher percentage of female participants. Compared to NLW and Latinx groups, the NLB group also had significantly fewer years of education and lower reading scores. Potential confounds (i.e., demographic variables, depression) were identified a priori based on the literature and subsequently analyzed for inclusion as covariates in the primary analyses. Analyses revealed variables were non-normally distributed, therefore Independent Samples Kruskal-Wallis tests and Spearman’s Correlations were computed to examine differences and correlations between ethnocultural groups.

After controlling for age and education, Latinx and NLB groups had significantly higher ADAS-cog and FAQ scores than the NLW group (Hs = 9.50-21.53, ps < .05). Spearman’s partial correlations controlling for age, education, gender, and depression revealed that higher ADAS-cog scores were associated with higher FAQ scores within Latinx (p=.49, p<.001), NLB (p=.66, p<.001), and NLW (p=.60, p<.001) groups.

Findings indicate that neurocognition is positively associated with functional status and support the ecological and external validity of the ADAS-cog and FAQ for use with NLB and Latinx older adults, in addition to previously established work with more homogenous samples. Study strengths include the overall sample size, geographic diversity, and standardization of research approaches. Study limitations include high education level and low comorbidity rates present in the sample, limiting the generalizability of the results, in addition to the unbalanced ethnocultural groups, further emphasizing the need for increased inclusion efforts of ethnoculturally diverse older adults into brain health research studies.

Ecological momentary assessment (EMA) allows for tracking participant responses across multiple timepoints within the context of typical daily experiences. This study used EMA delivered via smartwatches to investigate dynamic associations between older adults’ fluctuations in cognitive performance as measured by an n-back test and self-reports of current internal (i.e., mental sharpness, fatigue, stress) and external (i.e., environmental distractions, time of day) contextual states over seven days. We hypothesized that 1) cognitive test fluctuations throughout the week would be meaningful beyond average cognitive test scores and 2) cognitive test scores would fluctuate in response to internal and external contexts.

Participants were 28 community-dwelling older adults recruited for a larger clinical trial assessing the influence of lifestyle factors and compensatory strategy use on cognitive health. During week one of the trial, participants received a smartwatch which sent prompts four times a day for seven consecutive days. The prompts included a 45-second one-back shape test, along with Likert-style questions about their current experience. Questions assessing participants’ internal contexts asked about participants’ experience “right now” of mental sharpness, physical fatigue, and stress. External context was assessed via the EMA prompt, “Right now my environment is distracting,” and time of day of the response.

Data was screened such that all data points outside the 7-day prompt window were removed, one participant who did not respond to any prompts was removed, and participants who responded to less than 60% of the shape test prompts were removed (n = 10). The sample used for this preliminary analysis included 17 participants (Age, M = 71.94 years; Education, M = 14 years; 88% Female; 88% White) with an average compliance of 75% (Range = 17 - 26 shape test responses) and an average shape test accuracy of > 92%. Hypothesis 1 was supported by the large fluctuations of the average cognitive test scores across timepoints (M = 24.35, Min = 16, Max = 27, SD = 2.54) and by repeated-measures ANOVA of average cognitive test scores by day (F(1,7) = 5.24, p < 0.01). Hypothesis 2: Cross-correlation lags 0 to 4 were assessed. For internal contexts, cross-correlation showed a medium correlation between mental sharpness and cognition for lags 0 (r = 0.46) and 1 (r = 0.4); a small to medium correlation between physical fatigue and cognition for lags 0 (r = -0.51) and 1 (r = -0.31); and no correlation between stress and cognition (r < 0.2). For external contexts, cross-correlation revealed no correlation between environmental distraction and cognition (r < 0.3), and repeated measures ANOVA revealed no effect of time of day on cognition scores (p > 0.05).

Older adults’ cognitive performance on an n-back shape test varied over time with internal contextual states. Cognitive performance was positively associated with feelings of mental sharpness and negatively associated with physical fatigue. Current external environmental distractions and time of day were less influential on cognitive performance. As more data is collected, influences of individual fluctuations in cognitive performance will be investigated.

COVID-19 caused a worldwide restructuring of daily life, necessitating a sharp increase in social distancing, telecommunication, and adherence to rapidly changing public health recommendations. Coping, a response to stressors, is a protective mechanism to increase resiliency against uncertainty and decreased social connectedness. This disruption of daily life has prompted unanticipated and unique research opportunities and allowed researchers to consider whether individuals' primary coping style with the pandemic is associated with cognition. Previous research has found that problem coping, or action-oriented approaches to a stressor, is the most adaptive coping strategy. Emotion-based coping, like venting or humor, varies and depends on the stressor. Avoidant coping, like denial or ignoring the stressor, is generally considered maladaptive (Carver, 1977), which may lead to increased psychosocial disturbance. Executive functioning, responsible for planning, organizing, inhibition, and self-management are theorized to be most impacted by the social and psychological effects of COVID-19 (Pollizi et al., 2021). While some research has examined this question in working parent and older adult populations, we seek to understand this relationship in emerging adults, whose frontal lobes, responsible for executive functioning, are still developing. The present study seeks to examine the association between coping with the COVID-19 pandemic and executive functioning.

College students (N=440; M=19.30 years old, SD=1.42, 76% female) across seven US universities completed self-report questionnaires on SONA, which included Barkley's Deficits in Executive Functioning, Short Form (BDEFS-SF; Barkley, 2011) and the Brief Coping Orientation to Problems Experienced Inventory adapted for coping with the COVID-19 pandemic (Brief COPE; Carver 1989). Items on the BDEFS-SF were summed to create a global executive functioning score. Items on the Brief COPE were combined to create three factors: emotional,, avoidant,, and problem-focused (Dias et al., 2011).

Stepwise linear regression was used to assess whether coping style predicted executive functioning. Results indicate that the use of emotional coping (ß =0.19, p< .001) and avoidant coping (ß =0.33, p< .001) predicted higher scores on the BDEFS (greater deficits in executive functioning). Additionally, the use of problem coping (ß =-0.27, p< .001) predicted lower BDEFS scores (better executive functioning), with this overall model explaining 16.37% of the variance.

Results from this study confirm that COVID-19 coping styles are associated with decreased executive functioning. Specifically, emotional coping and avoidant coping predicted decreased executive functioning, which has been supported in non-pandemic samples. The use of problem-focused coping predicted increased executive functioning, indicating that this may be a protective form of coping with the pandemic. Because tasks necessary for daily life, such as planning, organizing, and judgment, rely on executive functioning, maladaptive coping with COVID-19 may impede college students' daily functioning necessary for successful engagement in schoolwork, emotion regulation, and activities of daily living. This research begins to address the gap in knowledge regarding the relationship between coping with the COVID-19 pandemic and executive functioning. This knowledge can be used in future crises in order to promote the use of problem-focused coping and mitigate the self-observed deficits in executive functioning demonstrated in this population.

Historically, assessment of financial decision making (FDM) has largely relied on self- or informant-reports, and paper-and-pencil tests. However, subjective report is prone to under/over-estimation biases, and most available tests probe increasingly outdated tasks such as writing checks and checkbook management. Advances in technology have made online methods one of the most common and preferred styles of managing money. There is thus a critical need to develop modern and objective methods to assess financial decision making that can be used in clinical settings. The current study aimed to develop and validate a novel, simulated online money management (OMM) credit card task mimicking a real-world task.

Development. The OMM task was conceptualized based on collaborations with a diverse team of experts spanning neuropsychology, geriatrics, computer science, and economics. Administration. The task involves several sub-tasks including logging into a simulated credit card account, navigating a few pages to download a statement for a specific month, answering questions about where certain pieces of information are in the statement, identifying erroneous transactions in the account activity section, and answering questions involving practical aspects of managing a credit card. Pilot phase. Using an iterative process, the task was refined and piloted in ten participants. Validation. Performance was examined in relation to an existing online automated teller machine (ATM) task. Design & Setting. Cross-sectional, community-based prospective study.

OMM task. The newly developed OMM credit card task consists of two broad areas, (i) online navigation and (ii) content-focused (simple literacy, complex literacy, monitoring, awareness). ATM task. This measure consists of sequential tasks such as checking the balance in one’s account, transferring money between accounts, and withdrawing cash. Both the OMM and ATM tasks were administered remotely by a neuropsychologist using Zoom and Team Viewer on a Dell laptop.

Thirty-five cognitively healthy older adults were included with mean age=70.06 years (SD=3.82) and mean education=21.89 (SD=1.76). 72% were women, the majority were White (77%) while 20% were Black and 3% belonged to other races; 91% were non-Hispanic.

Bivariate correlations between the OMM task, ATM task and demographic variables were examined. Time and steps/clicks to complete the OMM task were the primary outcome metrics.

All participants were able to complete the OMM task. No significant associations were found between demographics (age, gender, education) and OMM metrics, and among OMM metrics (time and clicks). Significant associations in the expected direction were present between the OMM and ATM tasks. Time taken to answer the questions on the OMM task was associated with time required to complete the ATM task (r = 0.57, p < 0.001). Increased number of clicks on the OMM task was associated with increased number of errors (r = 0.54, p < 0.001) and increased time to complete the ATM task (r = 0.41, p = 0.01).

This is one of the first studies to develop and demonstrate the validity of a technologically based and practically relevant measure of financial decision making. Studies are ongoing to more comprehensively understand the psychometric properties of this novel task.

Mild decline in independent functioning is a core diagnostic criterion for Mild Cognitive Impairment. Performance-based assessments have been considered the gold standard to identify subtle deficits in functioning. Existing assessments were largely designed using demographically homogenous samples (white, highly educated, middle class) and often assume tasks are performed similarly across populations. The current study aimed to validate the utility of the Performance Assessment of Self-Care Skills (PASS) in determining cognitive status in a sample of predominantly African American, low-income older adults.

Cognition and functional capacity were measured in n=245 older participants (aged 50+ years) who were recruited from a larger community study located in Pittsburgh, PA. Cognitive status was defined by a mean split on the Modified Mini Mental Status Examination (3MS) score (84/100). Participants above the cutoff were classified as unlikely cognitive impairment (UCI) and those below classified as potential cognitive impairment (PCI). Functional capacity was assessed using the number of cues provided on three PASS subtasks: shopping, medication management, and critical information retrieval (higher score = worse functioning). Self-reported cognitive and functional decline was assessed via the Everyday Cognition (ECog) questionnaire (higher score = greater decline). Generalized linear models compared performance scores between groups adjusting for literacy (WRAT3), age, and education. Receiver operating characteristic curve (ROC) analyses were run for select functional performance scores to assess their predictive ability in discriminating between PCI and UCI.

Compared to the UCI group (N = 179), the PCI group (N = 66) was older (68 vs. 65 years, p = 0.05), less educated (11 years vs. 12 years, p < 0.01), had lower WRAT3 z-scores (0.19 vs. -0.55, p < .01), and required more cues on the shopping (4.33 vs. 8.54, p < 0.01) and medication management PASS subtasks (2.74 vs. 6.56, p < .01). Both groups reported elevated levels of subjective cognitive complaints on the ECog (1.46 vs. 1.56, p = .09) and performed similarly on the critical information retrieval PASS subtask (0.25 vs 0.54, p = .06). When discerning between UCI and PCI groups, the PASS Shopping subtask had an optimal cut-off score of 4, sensitivity of 0.86, specificity of 0.47, positive predictive value (PPV) of 0.37, and area under the curve (AUC) of 0.71. PASS Medication Management had an optimal cut-off score of 3, sensitivity of 0.77, specificity of 0.56, PPV of 0.39, and AUC of 0.74.

Subjective functional decline and performance on the critical information retrieval subtask were not associated with cognitive groups. PASS shopping and medication management had moderately high AUCs, suggesting they can reliably distinguish between groups. However, both tasks also exhibited low PPVs, low levels of specificity, and high levels of sensitivity, making them strong “rule-out” tests but poor “rule-in” tests in this sample. Because accurate assessment of functioning is useful for MCI and critical to dementia diagnosis, it is imperative we understand how these tasks function across different populations. Future work should 1) validate measures of functional ability across different populations and 2) develop population-appropriate assessments for use in clinical and research settings.

Approximately 6.5 million Americans ages 65 and older have Alzheimer’s disease and related dementias, a prevalence projected to triple by 2060. While subtle impairment in cognition and instrumental activities of daily living (IADLs) arises in the mild cognitive impairment (MCI) phase, early detection of these insidious changes is difficult to capture given limitations. Traditional IADL assessments administered infrequently are less sensitive to early MCI and not conducive to tracking subtle changes that precede significant declines. Continuous passive monitoring of IADLs using sensors and software in home environments is a promising alternative. The purpose of this study was to determine which remotely monitored IADLs best distinguish between MCI and normal cognition.

Participants were 65 years or older, independently community-dwelling, and had at least one daily medication and home internet access. Clinical assessments were performed at baseline. Electronic pillboxes (MedTracker) and computer software (Worktime) measured daily medication and computer habits using the Oregon Center for Aging and Technology (ORCATECH) platform. The Survey for Memory, Attention, and Reaction Time (SMART; Trail A, Trail B, and Stroop Tests) is a self-administered digital cognitive assessment that was deployed monthly. IADL data was aggregated for each participant at baseline (first 90 days) in each domain and various features developed for each. The receiver operating characteristic area under the curve (ROC-AUC) was calculated for each feature.

Traditional IADL Questionnaires.

At baseline, 103 participants (normal n = 59, Mage = 73.6±5.5; MCI n = 44, Mage = 76.0±6.1) completed three functional questionnaires (Functional Activities Questionnaire; Measurement of Everyday Cognition (ECog), both self-report and informant). The Informant ECog demonstrated the highest AUC (72% AUC, p = <.001).

Remotely monitored in-home IADLs and self-administered brief online cognitive test performance.

Eighty-four had medication data (normal n = 48, Mage = 73.2±5.4; MCI n = 36, Mage = 75.6±6.9). Four features related to pillbox-use frequency (73% AUC) and four features related to pillbox-use time (62% AUC) were developed. The discrepancy between self-reported frequency of use versus actual use was the most discriminating (67% AUC, p = .03).

Sixty-six had computer data (normal n = 38, Mage = 73.6±6.1; MCI n = 28, Mage = 76.6±6.8). Average usage time showed 64% AUC (p = .048) and usage variability showed 60% AUC (p = .18).

One hundred and two completed the SMART (normal n = 59, Mage = 73.6±5.5; MCI n = 43, Mage = 75.9±6.2). Eleven features related to survey completion time demonstrated 80% AUC in discriminating cognition. Eleven features related to the number of clicks during the survey demonstrated 70% AUC. Lastly, seven mouse movement features demonstrated 71% AUC.

Pillbox use frequency combined features and self-administered brief online cognitive test combined features (e.g., completion times, mouse cursor movements) have acceptable to excellent ability to discriminate between normal cognition and MCI and are relatively comparable to informant rated IADL questionnaires. General computer usage habits demonstrated lower discriminatory ability. Our approach has applied implications for detecting and tracking older adults’ declining cognition and function in real world contexts.

Compensatory strategies (CS) can assist in supporting everyday memory and functional independence. Digital compensatory strategies (e.g., calendar and notes apps) are being used more by older adults, but their effectiveness compared to paper-based strategies has been questioned due to their novelty and potential suitability. This study examined whether digital and non-digital strategies vary in quality and lead to accuracy differences in carrying out a set of real-world prospective memory (PM) tasks.

Seventy community-dwelling older adults (Mage= 70.80, SD = 7.87) completed two testing sessions remotely from home via Zoom. Participants were presented four real-world PM tasks (packing for overnight trip, creating physical activity summary, paying bill by due date, and calling lab to leave message) and were encouraged to use their typical CS to support task completion. The type and quality of CS, as well as accuracy of PM task completion, were assessed using lab-developed coding schemas. Quality scores were on a 0-3 point scale per task step (maximum total score = 63), and accuracy scores were on a 0-4 point scale (maximum score = 16). Participants were differentiated into two groups: those who used at least one digital CS (40 participants) and those who did not use digital CS (30 participants). T-tests were examined for group differences in number of CS utilized, CS quality, and PM accuracy. Within each group, correlations between CS quality and PM accuracy were conducted. Group comparisons were also conducted for demographics, cognitive test performances, and questionnaires.

The technology group (M = 13.90, SD = 5.43) utilized significantly more strategies than the non-technology group (M = 9.50, SD = 4.12), t(68) = -3.71, p < .05, d = 0.91, and the technology group’s strategies (M = 42.48, SD = 10.47) were significantly higher quality than the non-technology groups (M = 33.80, SD = 13.02), t(68) = -3.09, p < .05, d = 0.73. However, the technology (M = 12.30, SD = 2.48) and non-technology (m = 11.87, SD = 3.16) groups completed the four PM tasks with equivalent accuracy, p > .05. Correlational analyses revealed that higher quality strategies were associated with better PM performance for both the technology (r = .67, p < .001) and the non-technology group (r = .71, p < .001). Although the technology group reported higher comfort with technology, both groups reported comparable levels of quality of life and functional independence and performed similarly on cognitive tests. The technology group trended towards being younger and having a higher level of global cognitive status (p = .07), but there were no group differences in education level or premorbid verbal ability.

Digital compensatory strategies resulted in higher CS quality scores and more strategies used, but there was no significant difference in PM accuracy scores between digital and non-digital CS. Regardless of technology use, using high quality CS supported real-world PM performance. Interventions that focus on improving the quality of compensatory strategies being utilized by older adults may enhance everyday functioning.

Management of finances is one of the earliest domains of daily living to decline in the neurodegenerative disease process, and poorer financial literacy is associated with worse cognition even in healthy, normative aging. However, some studies have demonstrated that cognitively normal older adults demonstrate preserved real-world financial outcomes despite the presence of age-related cognitive decline. One account for this discordance posits that older adults rely on intact financial knowledge to circumvent negative effects of declining fluid cognitive abilities. Also important to real-world financial behavior is insight into one’s level of financial knowledge and expertise (i.e., subjective financial confidence), which in some studies has been shown to have an equal or stronger influence on real-world financial behaviors compared to objective financial knowledge. This study investigated older adults’ financial abilities by identifying groups of individuals with discrepancies between objective financial knowledge and subjective financial confidence and exploring cognitive and non-cognitive (demographic, personality) factors associated with discrepancy group membership.

Participants were 4,610 older adults (M age 71.18 ± .91) from the Wisconsin Longitudinal Study who answered 12 true-false questions on financial concepts (accuracy) and rated their confidence on each response. Standardized scores of accuracy and confidence were used to classify participants into three discrepancy groups (1) Overconfident (confidence >1 SD above accuracy), (2) Underconfident (accuracy >1 SD above confidence), and (3) Equal (accuracy and confidence within 1 SD). Logistic regression examined factors associated with discrepancy group membership.

Higher financial accuracy was moderately correlated with greater confidence (r=.42, p<.001). Approximately 29% of participants had standardized accuracy and confidence scores that differed by one standard deviation or more, with 14% of participants belonging to an “Overconfident” group and 15% to an “Underconfident” group. Lower likelihood of Overconfidence group membership was associated with higher levels of education (OR = .87, 95% CI [.82, .93], p<.001) and better cognitive performance on tests of delayed recall (OR = .90, 95% CI [.84, .97], p=.006) and numerical reasoning (OR = .94, 95% CI [.91, .97], p<.001), while higher extraversion was associated with increased likelihood of Overconfidence (OR = 1.03, 95% CI [1.00, 1.05], p=.04). Lower likelihood of Underconfident group membership was associated with better performance on cognitive tests of delayed recall (OR = .90, 95% CI [.84, .96], p=.002), male sex (OR = .60, 95% CI [.47, .77], p<.001), and lower levels of conscientiousness (OR = .95, 95% CI [.92, .99], p<.001), while better letter fluency performance was associated with increased likelihood of Underconfidence (OR = 1.03, 95% CI [1.00, 1.06], p=.04).

Objective financial knowledge and subjective financial confidence are related yet distinct aspects of financial literacy. Discrepancies between financial knowledge and confidence are related to both cognitive and non-cognitive factors, such as personality and differing life experiences associated with educational attainment and sex-related social roles. Results may help clinicians identify profiles of older adults (e.g., high confidence and low knowledge/"Overconfident”) at risk for dysfunctional financial behaviors, including susceptibility to fraud and/or irresponsible financial decision-making.

Decline in everyday function is a hallmark of dementia and is associated with increased caregiver burden, medical spending, and poorer quality of life. Neuropsychiatric symptoms (e.g., apathy, hallucinations) can also occur in those with dementia and have been associated with worse everyday functioning cross-sectionally. However, research on which neuropsychiatric symptoms are most associated with everyday functioning in those with dementia longitudinally has been more limited. Further, it is unknown which neuropsychiatric symptoms may add incremental validity beyond cognition in predicting everyday function longitudinally. The current study aimed to address both of these gaps in the literature by identifying which neuropsychiatric symptoms are most associated with everyday function over time and if symptoms add incremental validity in predicting everyday function beyond cognition in those with dementia.

Older adult participants (N = 4525), classified as having dementia at baseline by the National Alzheimer's Coordinating Center, were examined. Severity of neuropsychiatric symptoms were measured via the Neuropsychiatric Symptoms Questionnaire-Informant. Everyday function was assessed via the Functional Activities Questionnaire-Informant. Memory (Logical Memory immediate and delayed) and executive function (Digit Symbol Test, TMT-A and TMT-B) composites were created to assess cognition. Severity of neuropsychiatric symptoms at baseline were analyzed as predictors of everyday functioning beyond demographic factors and cognition at baseline and over the course of five years using multilevel modeling.

At baseline, severity of the majority of symptoms, excluding irritability, manic symptoms, and changes in appetite, were associated with everyday function (all p < .05). When examining everyday functioning longitudinally, only severity of hallucinations, apathy, motor dysfunction, and sleep dysfunction were associated with differences in everyday function over time (all p < .01).

There is heterogeneity in the degree to which neuropsychiatric symptoms are associated with everyday functioning over time in those with dementia. Additionally, our results show that some neuropsychiatric symptoms are associated with longitudinal changes in everyday function beyond domains of cognition show to be associated with function. Clinicians should pay particular attention to which neuropsychiatric symptoms individuals with dementia and their families are reporting to aid with treatment planning and clinical decision making related to autonomy. Future research would benefit from examining pathways through which neuropsychiatric symptoms are associated with everyday functioning over time in this population, and if treatments of neuropsychiatric symptoms may improve everyday function in this population.

Explore the relationship between a motor programming and sequencing procedure and informant rating of patients' functional abilities, especially driving. The Fist-Edge-Palm (FEP; Luria, 1970; 1980) task has previously demonstrated merit distinguishing between healthy controls and those with neurodegenerative processes (Weiner et al., 2011). However, associations between FEP performance and informant-rated functional status, particularly driving ability, have been minimally reported. This exploratory review examined the relationship between FEP, informant-rated driving ability, overall functional impairment, and neurocognitive diagnostic severity.

41 Veterans seen in a South-Central VA Memory Clinic between 08/2020 and 07/2022 served as participants. Neuropsychological assessment included gathering demographic information, chairside neurobehavioral examination (including FEP), cognitive testing, and collateral informant completed Functional Activities Questionnaire (FAQ). Diagnostic severity [no diagnosis, mild cognitive impairment (MCI), dementia (MNCD)] was determined based on the patient's cognitive and functional deficits as measured by neuropsychological testing and informant-rated functional deficits. Correlational analyses were conducted to examine the strength of possible relationships between FEP performance, diagnostic severity, informant-rated functional status including driving impairment. Linear regression analyses determined the extent to which diagnostic severity and FEP performance predict informant-reported driving and ADL impairments

Participants were 97.5% male, 78% white, 22% black. Diagnostically, 3 patients received no diagnoses, 14 with MCI, and 24 with MNCD. Spearman rank correlations were computed; FEP performance was moderately negatively correlated with diagnostic severity [rho = -.35; p < .05] and driving impairment [rho = -.31; p < .05]. Diagnostic severity was moderately positively correlated with driving [rho= .44; p < .05] and total functional [rho = .65; p < .05] impairment. Total functional impairment positively correlated with reported driving impairment [rho = .58; p < .05]. Simple linear regressions tested if FEP performance and diagnostic severity independently predicted informant-reported driving and functional impairment. FEP performance predicted diagnostic severity (R2 = .12, p < .05) and reported driving impairment severity (R2 = .10, p <.05) but did not predict total functional impairment severity (R2 = .06, p = .14). Diagnostic severity predicted both informant-reported driving impairment severity (R2 = .16, p <.05) and functional severity (R2 = .30, p < .05). Multiple regression tested if diagnostic severity and FEP performance together was more predictive of driving and functional impairment than individually; the overall model was predictive of driving (R2 = .19, p < .05) and total functional (R2 = .30, p < .05) impairment, but only diagnostic severity significantly predicted reported driving (B = .63, p < .05) and functional (B = 6.25, p < .05) impairments.

FEP performance was associated with diagnosis and collateral informant concerns of patient driving ability but not statistically related to overall functional impairment or nondriving related ADLs. FEP demonstrates utility in identification of patients demonstrating concerning driving fitness per collateral informants and diagnostic severity due to rapidity of administration, ease of instructing providers, and implementation in a wide variety of clinical settings when a caregiver or informant may not be available. Future directions include explaining the relationship between FEP and driving ability and exploring associations between FEP and other neuropsychological instruments.

Social determinants of health (SDoH) are structural elements of our living and working environments that fundamentally shape health risks and outcomes. The Healthy People 2030 campaign delineated SDoH into five distinct categories that include: economic stability, education access/quality, healthcare access, neighborhood and built environment, and social and community contexts. Recent research has demonstrated that minoritized individuals have greater disadvantage across SDoH domains, which has been linked to poorer cognitive performance in older adulthood. However, the independent effects of SDoH on everyday functioning across and within racial groups remains less clear. The current project explored the association between SDoH factors and 10-year change in everyday functioning in a large sample of community-dwelling Black and White older adults.

Data from 2,505 participants without dementia enrolled in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (age M=73.5; 76% women; 28% Black/African American). Sociodemographic, census, and industry classification data were reduced into five SDoH factors: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community contexts. The Observed Tasks of Daily Living, a performance-based measure of everyday functioning with tasks involving medication management, finances, and telephone use, was administered at baseline, 1-, 2-, 3-, 5, and 10-year follow up visits. Mixed-effects models with age as the timescale tested (1) racial group differences in OTDL trajectories, (2) race x SDOH interactions on OTDL trajectories, and (3) associations between SDoH and OTDL trajectories stratified within Black and White older adults. Covariates included sex/gender, vocabulary score, Mini-Mental Status Examination, depressive symptoms, visual acuity, general health, training group status, booster status, testing site, and recruitment wave.

Black older adults had a steeper decline of OTDL performance compared to Whites (linear: b = -.25, quadratic b=-.009, ps < .001). There was a significant race x social and community context interaction on linear OTDL trajectories (b =.06, p=.01), but no other significant race x SDoH interactions were observed (bs =-.007-.05, ps=.73-.11). Stratified analyses revealed lower levels of social and community context were associated with steeper age-related linear declines in OTDL performance in Black (b = .08, p=.001), but not White older adults (b =.004, p=.64). Additionally, lower levels of economic stability were associated with steeper age-related linear declines in OTDL performance in Black (b =.07, p=.04), but not White older adults (b =.01, p=.35). Finally, no significant associations between other SDoH and OTDL trajectories were observed in Black (bs = -.04-.01, ps =.09-.80) or White (bs = -.02-.003, ps=.07-.96) older adults.

SDoH, which measure aspects of structural racism, play an important role in accelerating age-related declines in everyday functioning. Lower levels of economic and community-level social resources are two distinct SDoH domains associated with declines in daily functioning that negatively impact Black, but not White, older adults. It is imperative that future efforts focus on both identifying and acting upon upstream drivers of SDoH-related inequities. Within the United States, this will require addressing more than a century of antiBlack sentiment, White supremacy, and unjust systems of power and policies designed to intentionally disadvantage minoritized groups.

Self-reported mild functional difficulties are one of the most salient predictors of future cognitive decline in older adults. However, few measures of objective assessment of mild functional difficulties are available. This study explored the validity and stability of novel, performance-based measures of subtle functional difficulties in older adults without dementia using an objective and standardized test, called the Naturalistic Action Test (NAT), which has been used for people with dementia.

40 older adults (Healthy Controls (HC), Mild Cognitive Impairment (MCI)) completed the NAT at baseline and again after one-month. The NAT requires participants to make a breakfast and a lunch using objects presented on a table. Standard cognitive tests (memory, language, etc.) also were administered at baseline only and were used to compute intraindividual cognitive variability (IIV), a sensitive measure of cognitive ability level. NAT scores reflecting micro-errors and completion time were obtained from video recordings. Micro-errors are inefficient actions that include misreaching toward the wrong object and moving objects around the table without a clear purpose. Validity of the NAT measures was evaluated in correlations with IIV, and the stability of NAT performance was evaluated using within-sample t-tests and correlations between measures at baseline and one-month.

In the full sample (N =40), greater micro errors were significantly correlated with greater IIV at baseline (r=.512, p<.001) and one month followup (r=.327, p=.039). Among HC, paired t tests showed that there were no significant differences in micro-errors over one month; however, completion time was significantly slower at baseline (Md=16.06, SD=24; t(32)=3.76, p<.001). MCI participants showed a significant decrease in micro-errors (M=3.86, SD=4.4; t(6)=2.33, p=.029), but no difference in completion time. Among HC and MCI, micro errors (r=.506, p<.001), and completion time (r=.899, p<.001) were significantly correlated across time points.

Results show promise for novel NAT measures (time, micro-errors) as valid, objective indicators of subtle cognitive difficulties that affect everyday function. Analyses of stability of scores over time showed evidence of practice effects over time, which along with predictive validity, should be explored in future work.

Cognitive impairment can affect an individual’s ability to perform routine tasks. In this study, we investigate how cognitive abilities relate to the accuracy and efficiency of performance on a naturalistic cooking task completed in older adults’ home environments. We hypothesized a positive association between task accuracy and global cognitive status, and task efficiency and executive functioning. We further hypothesized a negative association between omission errors and immediate and delayed memory recall.

Fourteen community-dwelling older adults (Age, M = 73.92 years; Female = 9; Education, M = 16.38 years) along the continuum from normal aging to mild dementia completed a “Cooking Task” in their home environment. Specifically, participants were instructed to fry or scramble an egg, prepare slice of toast with jelly, serve side of sliced apple, pour glass of water, bring prepared items to table, and clean dishes used. Participants received ingredients necessary for task completion and a task list to reference. The task efficiency score (range 0-6) was based on multi-tasking and organizational skills (e.g., beginning the egg task early in session, plating items as prepared). Overall accuracy was computed by identifying error types (e.g., inefficiencies, substitutions, omissions, and subtasks attempted) and scaling accuracy (range 1-5) for each subtask, then summing all six subtask accuracy scores to get overall accuracy (range 6-30). Participants also completed a range of neuropsychological assessments, which included the Telephone Interview for Cognitive Status, Letter and Category Fluency from the Delis-Kaplan Executive Function System, and immediate and delayed recall measures from the Repeatable Battery for the Assessment of Neuropsychological Status. Due to the small sample size, findings are preliminary, and scatterplots were evaluated for outliers that might influence findings.

Consistent with hypotheses, as overall accuracy on the Cooking Task increased so did performance on the global cognitive measure (TICS: r = 0.61, p = 0.02). Lower rates of omission errors were also associated with better performance on both immediate (r = -0.75, p < 0.01) and delayed (r = -0.55, p = 0.04) recall indices. However, these findings were not specific, as overall accuracy also significantly correlated with the memory indices and verbal fluency measures (ps < 0.05). Additionally, lower rates of omission errors significantly correlated with performance on the TICS and the D-KEFS Letter Fluency (ps < 0.05). Contrary to our hypothesis, no significant associations were found between cooking task efficiency and executive functioning (D-KEFS subtests). There were also no significant correlations between cooking task efficiency and global cognitive status or memory.

The present study supported our hypotheses that better overall task accuracy is associated with higher cognitive status and lower rates of omission errors correlate with better immediate and delayed recall abilities. However, the findings were not specific to these domains of functioning but rather suggest that clinical assessments measuring a range of cognitive abilities are related to the accuracy of daily task performance and omission errors on routine daily tasks. Future research will explore the validity of the efficiency measure.

Attention concerns, particularly difficulties with focusing and regulating attention, are reported in diverse clinical contexts. The Ruff 2&7 Selective Attention Test (Ruff 2&7; Ruff & Allen, 1996) is a measure of sustained and selective attention that assesses automatic detection and effortful processing. The goal of this study was to create an internal consistency metric within this test and to determine cognitive predictors by evaluating associations with executive control of attention and other cognitive skills. It was hypothesized that those who are more consistent across Ruff 2&7 performance would have more robust executive functioning skills, particularly those related to regulating and directing attention and the planning and utilization of cognitive resources.

The current study examined a clinical sample of 98 United States veterans with a history of mild traumatic brain injury. After excluding invalid cases (n=24), the final sample consisted of 74 veterans (Age=38.5 (8.9) years old; 13.9 (2.2) years of education; 78% male; 82% white, 7% Black, 8% Hispanic, 2% Asian). A consistency score was defined as the absolute value of the intertrial change in target hits plus errors across each pair of trials of the same stimulus type (Automatic Detection, AD, and Controlled Search, CS). Hierarchical linear regression modeling was used to evaluate the relative contributions of memory and executive functions (Rey Auditory Verbal Learning Test, Delis-Kaplan Executive Function System Tower Test, phonemic fluency, Trail Making Test B) and subjective symptom report (PTSD Checklist for DSM-5, Barkley Adult ADHD Rating Scale for DSM-IV).

The mean deviation scores for the two trial types were similar (AD mean=13.6, SD=5.9; CS mean=13.6, SD=5.3). In predicting consistency across AD trials, delayed recall contributed 11% unique variance (p=.013), while no other block was statistically significant. For CS trials, self-reported PTSD and inattention symptoms contributed a combined 20% of unique variance to the model (p=.007), while there were no statistically significant cognitive predictors in this model.

Contrary to expectation, executive function measures did not explain statistically significant variance in performance across either trial type. Less consistent performance on AD trials was associated with weaker verbal memory. Less consistent performance on CS trials, which theoretically require greater executive control, was not associated with any cognitive scores, but was associated with more severe self-reported psychological and inattention symptoms. These findings buttress the conceptual distinction between AD and CS trial types, and they point to both cognitive and non-cognitive underpinnings of performance consistency.

Although health problems are often a natural consequence of aging, many older adults struggle to manage their health care problems. Health literacy refers to the ability to access, process, and use health information to make appropriate decisions to promote good overall health. Low levels of health literacy are associated with a host of negative outcomes such as less efficient use of healthcare services, higher healthcare costs, increased mortality, and poorer self-rated health. In those with medical conditions (e.g., diabetes), lower health literacy is linked with higher levels of depression. It is important to investigate whether mental health is linked to health literacy as understanding these links has the potential to identify those at risk for negative outcomes and thus implement protective strategies. Therefore, the current study sought to determine the extent to which various mental health constructs such as happiness, well-being, anxiety and depression are related to health literacy in a community-based sample of cognitively healthy individuals. We hypothesized that higher levels of health literacy would be associated with higher self-reported well-being, happiness, and lower anxiety and depression.

Design - Cross-sectional, prospective study. Setting - Community-based. 93 individuals were included with mean age=59.02 years (SD=15.12) and mean education=15.70 (SD=2.39). 60% were women, the majority were White (55%) while 38% were Black and 7% belonged to other races; 90% were non-Hispanic.

Health Literacy - Health literacy was measured by an 8-item instrument in the Rush Memory and Aging Project that examined the participant’s understanding of health care, treatment, and related behaviors. Happiness - Happiness was measured by 5 items from the Satisfaction with Life Scale using a 7-point scale (1 = strongly agree; 7 = strongly disagree). Higher scores indicated lower levels of happiness. Well-being - Well-being was measured with an 18-item instrument from the Rush Memory and Aging project, with higher scores indicating better well-being. Statistics: Bivariate correlations between age, education, and mental health measures and health literacy were examined.

Higher level of health literacy was significantly associated with age (r = .282 p = .009) and education (r = .228 p = .039). Contrary to our hypothesis, health literacy was not significantly associated with happiness (r = .002 p = .987), well-being (r = .037 p = .742), depression (r = .005 p = .962) or anxiety (r = -.064 p = .568). Even after controlling for age and education, these associations remained significant.

Higher level of healthy literacy was associated with older age and higher level of education. However, no significant association was found between health literacy and mental health measures of happiness, well-being, depression, and anxiety in cognitively healthy individuals, even after controlling for demographics. The lack of such associations in this study was unexpected and suggests that other factors such as the presence of health conditions (e.g., diabetes, cancer) might critically contribute to such associations. Future studies should examine these associations in a larger context to better understand how to promote healthy self-care behaviors.

Cognitive difficulties in Multiple Sclerosis (MS) are important contributors to impairment in instrumental activities of daily living. A non-randomised controlled trial was conducted to explore the effects of a cognitive rehabilitation protocol on MS patients' daily life functionality.

Seventy-five relapsing-and-remitting MS patients were recruited. Intervention Group (IG, n=31) underwent 16 individual rehabilitation sessions (1hx2/week; weeks 2-10), which included paper and pencil cognitive stimulation exercises and training memory strategies and external memory aids; and a booster session (week 37). Control Group (CG, n=44) received care as usual. These primary outcome measures were applied at baseline and at weeks 11, 36, and 62: Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ), Mental Slowness Questionnaire (MSQ), Mental Slowness Observation Test (MSOT), and Sydney Psychosocial Reintegration Scale-2 (SPRS-2). Score differences from baseline were calculated for all measures and follow-up time points except for SPRS-2, which was only applied twice (baseline and week 62). Linear regressions fitted with generalized estimating equations (GEE) were performed to verify the effects of time and group on the outcome measures. Baseline scores were included in the model as covariates for all outcome measure except SPRS-2. Chi-square and Mann-Whitney tests were applied to compare demographic and clinical characteristics of the groups.

Groups had similar demographic (i.e., sex, age, and education) and clinical (i.e., age at disease onset, disease duration, disease modifying treatments, and Expanded Disability Status Scale score) characteristics. IG's MSQ score progressively improved, whereas CG's score did not change from baseline (group x time effect: p<0.001) throughout follow-up. IG's MSNQ score improved from baseline at weeks 11 and 36, but not at week 62. CG's MSNQ score did not change from baseline throughout follow-up (group x time effect: p=0.025). Both IG's and CG's performance on the MSOT improved (time effects). Though, the IG showed greater improvement at follow-up (group effects) on MSOT score and time (both p<0.001). IG's SPRS-2 improved, whereas CG's score declined (group x time effect: p<0.001).

Combining restorative techniques with strategy-based compensatory techniques may produce significant and persistent effects on MS patients' self-reported everyday functioning and on their objective performance of instrumental tasks.

Children with post-acute sequelae of COVID-19 (PASC) often report fatigue, attention problems, anxiety, and low mood. Sluggish cognitive tempo (SCT) is a constellation of behavioral symptoms (e.g., drowsiness, moving slowly, mental fogginess, daydreaming, confusion, or inattention) often associated with but distinct from attention-deficit/hyperactivity disorder (ADHD), executive function deficits and depressive symptoms. Given the apparent overlapping symptoms of PASC and SCT, this retrospective chart review aimed to 1) characterize SCT symptoms among pediatric patients with PASC relative to published normative and clinically referred samples, and 2) examine associations between subscales of SCT with ADHD symptoms, depression, anxiety, and functional impairment in this clinical sample.

This study included retrospective data from 25 patients with PASC (17 females; Mean age=13.73 years, SD=2.07, range=8-19) who were referred for a neuropsychological evaluation following a multidisciplinary visit at a post-COVID-19 rehabilitation clinic within an academic medical center. Patients’ caregivers completed the SCT Scale, ADHD Rating Scale 5 (ADHD-RS-V),

Conners Comprehensive Behavior Rating Scale (CBRS), and Impairment Rating Scale (IRS). Higher scores on the SCT, CBRS, and IRS total reflect more problems in the specified area. Welch’s t-tests were utilized to compare SCT scores from our cohort of pediatric patients with PASC relative to a normative community sample (Penny et al., 2009) and a heterogeneous clinically-referred sample (Koriakin et al., 2015). Bivariate correlations were computed to examine associations between SCT (Daydreamy, Low Initiation, Sluggish/Sleepy), ADHD (Inattention and Hyperactivity subscales from the ADHD-RS-V), affective symptoms (Major Depressive Episode (MDE) and Generalized Anxiety Disorder (GAD) scales from the CBRS), and functional impairment (average score from IRS). Multiple linear regressions were used to determine whether SCT factors independently contribute to variance in functional deficits after accounting for age of evaluation, low mood, and anxiety.

Sluggish/Sleepy and Low Initiation were elevated in our cohort with PASC as compared to normative and mixed clinical samples from Penny et al. and Koriakin et al. (t>4.36, p<0.001). Patients with PASC had lower scores on the Daydreamy SCT scale than the clinically referred cohort (t=2.06, p=0.049), but similar to the normative sample (t=1.48, p=0.15). After controlling for age of testing, of the SCT subscales, only Low Initiation was associated with MDE (r=0.62, p=0.005), GAD (r=0.56, p=0.01) and overall Functional Impairment (r=0.48, p=0.04). Low Initiation was not correlated with Inattention or Hyperactivity. Notably, multiple regressions revealed Low Initiation scores were not associated with functional impairment when accounting for depression and anxiety symptoms(Low Initiation: ß=0.48, p=0.04; Low Initiation when depression and anxiety are included in independent regression models: ßs=0.13 and 0.29, ps=0.58 and 0.27 respectively).

Children and adolescents with PASC demonstrate more sluggish/sleepy presentation and difficulties with initiating activities or directing effort, as compared to normative and mixed clinically referred samples. Low initiation was associated with symptoms of MDE and GAD and functional impairment, but not with symptoms of ADHD. Depression and anxiety may moderate the association between poor initiation with functional impairment, highlighting the importance of psychological interventions to address mental health among youth with PASC and behavioral/cognitive concerns.

While attention-deficit/hyperactivity disorder (ADHD) symptoms, including inattention, hyperactivity, and impulsivity, are normally distributed within the population, features of ADHD have been associated with poor functional outcomes across various domains of life, such as academic achievement and occupational status. However, some individuals with even strong ADHD features show normal or above-average success within these functional domains. Executive dysfunction and emotion regulation abilities are associated with educational attainment and occupational status and may therefore explain some of the heterogeneity in functional outcomes in individuals with mild, moderate, and high levels of ADHD symptoms. In this study, we investigated whether emotion regulation strategy use (i.e., emotion suppression or cognitive reappraisal) and executive function abilities moderate the relationship between ADHD symptoms and occupational status and education attainment in adults.

Data were collected from 109 adults aged 18 - 85 (M = 38.08, SD = 15.54; 70.6% female) from the Nathan Kline Institute Rockland Sample. All participants completed measures of ADHD symptoms (Conners Adult ADHD Rating Scale), emotion regulation strategy use (Emotion Regulation Questionnaire), and executive functioning (composite scores of inhibition, shifting and fluency from the standardized Delis-Kaplan Executive Function System). In this study, executive function abilities and emotion regulation strategy use were tested as potential moderators of the relationship between ADHD symptoms and functional outcomes using hierarchical regression models.

Several two- and three-way interactions predicting occupational status and educational attainment were observed. Education attainment was predicted by hyperactivity and reappraisal (ß = -0.26, p = .006); inattention, shifting, and reappraisal (ß = -0.52, p = .029); inattention, shifting, and suppression (ß = -0.40, p = .049); inattention, fluency, and reappraisal (ß = 0.24, p = .038); hyperactivity, fluency, and reappraisal (ß = 0.27, p = .034); and impulsivity, fluency, and reappraisal (ß = 0.44, p = .004). Occupational status was predicted by inattention and reappraisal, (ß = -0.27, p = .032), hyperactivity and reappraisal (ß = -0.26, p = .004); and impulsivity, fluency, and reappraisal (ß = 0.35, p = .031). Fluency was positively associated with educational attainment when controlling for inattention and impulsivity.

Consistent with the hypothesis, the association between ADHD symptoms and both occupational status and educational attainment were moderated by the interaction between emotion regulation strategy use, executive function abilities domains. The observed interactions suggest that both occupational status and educational attainment may depend heavily on one’s intrinsic abilities and traits. Contrary to previous literature, we found no evidence that ADHD symptoms, emotional regulation strategies were independently associated with either educational attainment or occupational status, but this should be validated in a sample with greater representation of adults with clinically significant ADHD.

The relation between depressed mood and functional difficulties in older adults has been demonstrated in studies using self-report measures and has been interpreted as evidence for low mood negatively impacting everyday functional abilities. However, few studies have directly examined the relation between mood and everyday function using performance-based tests. This study included a standardized, performance-based measure of everyday action (Naturalistic Action Task, NAT) to test the prediction that report of depression symptoms are associated with self-report and performance-based tests of everyday function. Associations with anxiety symptoms and motivation/grit and everyday function also were explored.

68 older adults without dementia were screened and recruited (n = 55, M age = 74.21, SD= 6.80, age range = 65 to 98) from the community and completed self-report measures of depression symptoms (GDS), anxiety (GAI), motivation (Short Grit-S), and everyday functioning (FAQ). Participants also performed the NAT, which requires completion of a breakfast and lunch task and is scored for task accomplishment, errors (micro-errors, overt, motor), and total time. Additionally, an informant also reported on the participant’s everyday function. Spearman correlations were performed and results showing a medium effect size or greater are reported.

Participant mood (GDS) was associated with self-reported function (FAQ; r =.45) but not performance-based measures of everyday function (NAT). Self-reported anxiety and motivation were not meaningfully associated with either self-reported or performance-based everyday function. Participant self-report (FAQ) and informant report of participant’s function (IFAQ) supported the validity of performance-based assessment as both were meaningfully associated with NAT performance (FAQ x NAT overt errors r = .34; I-FAQ x NAT micro-errors r = .34; I-FAQ x NAT motor errors r = .49).

Mood, but not anxiety or motivation, was associated with self-reported everyday function but not performance-based function. When considered alongside the meaningful relations between self/informant-report of function and everyday task performance, results suggest mood does not impact everyday function abilities in community-dwelling older adults without dementia. We suggest that frameworks to be reconceptualized to consider the potential for mild functional difficulties to negatively impact mood in older adults without dementia. Additionally, interventions and compensatory strategies designed to improve everyday function should examine the impact on mood outcomes.