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.

Individuals with major depressive disorder (MDD) are observed to have reduced plasma nitrate levels and plasma nitric oxide (NO) metabolites (Chrapko et al., 2004; Garcia et al., 2011). Endothelial cell dependent dilation of vascular smooth muscle function has been observed to be blunted in adults with Major Depressive Disorder (MDD) and mediated by NO-dependent dilation (Greaney et al., 2019). Certain vegetables and fruits are particularly high in dietary nitrates, which is reduced to nitric oxide in the stomach, entering intravascular circulation, and acting as a potent dilator, blood pressure reducing, and vasoprotective substance (Webb et al., 2008). In older adults, dietary nitrates which are found in certain vegetables and fruits (e.g., green leafy vegetables) is shown to increase cerebral blood perfusion in frontal lobe white matter between the dorsolateral prefrontal and anterior cingulate cortex, regions particularly implicated in cognitive functioning (Presley et al., 2011). Recently, Morris et al. (2018) observed that in older adults from the Memory and Aging Project (MAP), the highest quintile of dietary nitrate intake was associated with slower cognitive decline than that of the lowest quintile of nitrate intake. Although viewing the extremes of dietary nitrate intake reveals valuable information, the present study investigated the association of all levels of dietary nitrate intake with cognition and depression among older adults in the same MAP dataset.

The sample included 461 community dwelling older adults (Mage=80; Medu =14.9, 74% female) from the MAP study (Bennett et al., 2012). The measures used for the present study include: the Center for Epidemiological Studies Depression Scale (CESD, depression), a neuropsychological battery (global cognition, perceptual organization and semantic memory), and a dietary nutrient analysis of the food frequency questionnaire (FFQ, nitrate).

Using Pearson correlations we observed that increased dietary nitrate intake was associated with increased global cognition (r(458) = .100, p = .031), perceptual organization (r(448) = .095, p = .04) and semantic memory (r(453) = .142, p = .002). Furthermore, we observed that dietary nitrate intake was associated with lower depression severity (r(459) = -.132, p = .004).

The present study’s results revealed that in a sample of community dwelling older adults, eating more nitrate rich foods is not only associated with improved cognition similar to findings of Morris et al. (2018), it is also associated with lower levels of depression. This further extends the Morris et al. (2018) study by suggesting that it is not only those older adults who eat the highest quantity of nitrate rich foods that can benefit from higher levels of nitrate intake. Overall, this study reveals that older adults who increase their dietary nitrate intake may improve their mood and thinking ability.

Understanding healthcare information is an important aspect in managing one’s own needs and navigating a complex healthcare system. Health numeracy and literacy reflect the ability to understand and apply information conveyed numerically (i.e., graphs, statistics, proportions, etc.) and written/verbally (i.e., treatment instructions, appointments, diagnostic results) to communicate with healthcare providers, understand one’s medical condition(s) and treatment plan, and participate in informed medical decision-making. Cognitive impairment has been shown to impact one’s ability to understand complex medical information. The purpose of this study is to explore the relationship between the degree of cognitive impairment and one’s ability to perform on measures of health numeracy and literacy.

This cross-sectional study included data from 38 adult clinical patients referred for neuropsychological evaluation for primary memory complaints at an urban, public Midwestern academic medical center. All patients were administered a standardized neurocognitive battery that included the Montreal Cognitive Assessment (MoCA), as well as measures of both health numeracy (Numeracy Understanding of Medicine Instrument-Short Version [NUMI-SF]) and health literacy (Short Assessment of Health Literacy-English [SAHL-E]). The sample was 58% female and 60% Black/40% White. Mean age was 65 (SD=9.4) and mean education was 14.4 years (SD=2.5). The sample was further split into three groups based on cognitive diagnosis determined by comprehensive neuropsychological assessment (i.e., No Diagnosis [34%]; Mild Cognitive Impairment [MCI; 29%]; Dementia [34%]).Groups were well matched and did not statistically differ in premorbid intellectual functioning (F=1.96, p=.157; No Diagnosis, M=100, SD=7.92; MCI, M=99, SD=8.87; Dementia, M=94, SD=7.72) ANOVAs were conducted to evaluate differences between clinical groups on the MoCA, NUMI-SF, and SAHL-E. Multiple regressions were then conducted to determine the association of MoCA scores with NUMI-SF and SAHL-E performance.

As expected, the Dementia group performed significantly below both the No Diagnosis and MCI groups on the MoCA (F=19.92, p<.001) with a large effect (ηp2=.540). Significant differences were also found on the NUM-SF (F=5.90, p>.05) and on the SAHL-E (F=6.20, p>.05) with large effects (ηp2=.258 and ηp2=.267, respectively). Regression found that MoCA performance did not predict performance on the NUMI-SF and SAHL-E in the No Diagnosis group (F=2.30, p=.809) or the MCI group (F=1.31, p=.321). Conversely, the MoCA significantly predicted performance on the NUMI-SF and SAHL-E for the Dementia (F=15.59, p=.001) group.

Degree of cognitive impairment is associated with understanding of health numeracy and literacy information, with patients diagnosed with dementia performing most poorly on these measures. Patients with normal cognitive functioning demonstrated a significantly better understanding of health numeracy and health literacy. This study supports the notion that as cognitive functioning diminishes, incremental support is necessary for patients to understand medical information pertaining to their continued care and medical decision-making, particularly as it relates to both numerical and written information.

Cognitive reserve and health-related fitness are associated with favorable cognitive aging, but Black/African American older adults are underrepresented in extant research. Our objective was to explore the relative contributions and predictive value of cognitive reserve and health-related fitness metrics on cognitive performance at baseline and cognitive status at a 4-year follow up in a large sample of Black/African American older adults.

Participants aged 65 years and older from the Health and Retirement Study (HRS) who identified as Black/African American and completed baseline and follow-up interviews (including physical, health, and cognitive assessments) were included in the study. The final sample included 321 Black/African American older adults (mean age = 72.8; sd = 4.8; mean years of education = 12.3; sd = 2.9; mean body mass index (BMI) = 29.1; sd = 5.2; 60.4% identified as female). A cross-sectional analysis of relative importance – a measure of partitioned variance controlling for collinearity and model order – was first used to explore predictor variables and inform the hierarchical model order. Next, hierarchical multiple regression was used to examine cross-sectional relationships between cognitive reserve (years of education), health-related fitness variables (grip strength, lung capacity, gait speed, BMI), and global cognition. Multiple logistic regression was used to examine prospective relationships between predictors and longitudinal cognitive status (maintainers versus decliners). Control variables in all models included age, gender identity, and a chronic disease index score.

Cross-sectional relative importance analyses identified years of education and gait speed as important predictors of global cognition. The cross-sectional hierarchical regression model explained 33% of variance in baseline global cognition. Education was the strongest predictor of cognitive performance (β = 0.48, p < 0.001). Holding all other variables constant, gait speed was significantly associated with baseline cognitive performance and accounted for a significant additional amount of explained variance (ΔR = 0.01, p = 0.032). In a prospective analysis dividing the sample into cognitive maintainers and decliners, a single additional year of formal education increased chances of being classified as a cognitive maintainer (OR = 1.30, 95% CI = 1.17-1.45). There were no significant relationships between rate of change in health-related fitness and rate of change in cognition.

Education, a proxy for cognitive reserve, was a robust predictor of global cognition at baseline and was associated with increased odds of maintaining cognitive ability at 4-year follow up in Black/African American older adults. Of the physical performance metrics, gait speed was associated with cognitive performance at baseline. The lack of observed association between other fitness variables and cognition may be attributable to the brief assessment procedures implemented in this large-scale study.

Mind-wandering is defined as a spontaneous shift of attention away from the external environment to inner thoughts. With mind-wandering being a ubiquitous phenomenon, there has been increasing interest in examining the role these spontaneous, and often unintentional, thought processes may have for metrics of cognitive and psychological health. However, much of this literature is mired with inconsistencies, potentially stemming from the use of variegated experimental methods and quantification of mind-wandering through different metrics. For example, mind-wandering has been investigated through endorsement of self-report probes embedded in tasks of sustained attention, with participants asking to endorse whether they were engaging in task-unrelated thoughts or task-related, but evaluative thoughts about the task (task-related interference). Other studies have instead focused on behavioral metrics of task performance, like omission and commission errors, the variability in response time (RTCV), and speeding or slowing prior to errors to quantify mind-wandering. In this study, employing a large sample of older adults, and implementing the novel technique of partial least squares regression, we examined the combined and simultaneous effect of different mind-wandering metrics in explaining variance in fluid cognition and psychological health in older adults.

One hundred and fifty older adults with normal cognition or mild cognitive impairment were administered a Go/No-Go Task (GNG) with embedded mind-wandering probes, the Conners CPT-3, the NIH Toolbox-Cognition Battery, and the WHO Quality of Life Assessment Brief Version at baseline in a clinical trial examining the impact of two mind-body interventions on aging. Based on previous research, the following variables were considered behavioral measures of mind-wandering: quantity of omission and commission errors, RTCV, pre-error speeding, and post-error slowing. Percentage of self-reported task-related interference (i.e. evaluating current performance) and task-unrelated thoughts were included as self-report measures of mind-wandering. These mind-wandering measures, along with demographic variables (age, sex, and education), were regressed using Partial Least Squares Regression to determine the impact of mind-wandering measures on fluid cognition (NIHT-CB) and perceived psychological well-being (WHOQOL-BBREF). Validation tests were completed to assess model fit.

A single latent factor explained 26% of the variance in fluid cognition (p=0.0001). Higher levels of age, errors of omission on both tasks, and task-related interference were all associated with worse fluid cognition, whereas task-unrelated thoughts were associated with better fluid cognition.

A two-factor latent model explained 12% of the variance in perceived psychological well-being (p=0.0004). Age and task-unrelated thoughts were positively associated with psychological well-being. In contrast, errors of omission on both tasks, response time variability on the CPT, and task-related interference were negatively associated with perceived psychological well-being.

Mind-wandering is associated with fluid cognition and perceived psychological well-being in older adults. Select behavioral measures were better than self-report measures at linking mind-wandering to fluid cognition and perceived psychological well-being. Interestingly task-unrelated thoughts, but not task-related interference, was positively associated with fluid cognition, supporting the cognitive resource-based account of mind-wandering. The result of our study provides novel insights into differential relationships between various metrics of mind-wandering and cognitive and psychological health.

Certain contextual factors, including non-restorative sleep (Niermeyer & Suchy, 2020), sleep deprivation (Lim & Dinges, 2010), burdensome emotion regulation (Franchow & Suchy, 2017), and pain interference (Boselie, Vancleef, & Peters, 2016) have been shown to contribute to temporary declines in executive functioning (EF). Contextually-induced decrements in EF in turn have been associated with temporary decrements in performance of instrumental activities of daily living (IADLs) among healthy older adults (Brothers & Suchy, 2021; Suchy et al., 2020; Niermeyer & Suchy 2020). Furthermore, some evidence suggests that higher variability in levels of contextual factors across days (i.e., deviations from routine) may contribute to IADL lapses above and beyond average, albeit high, levels of these contextual burdens (Bielak, Mogle, & Sliwinksi, 2019; Brothers & Suchy, 2021). Taken together, these findings highlight the importance of accounting for transient contextual burdens when assessing EF and IADL abilities in older adults.

Poor sleep quality has been associated with poor IADL performance (Fung et al., 2012; Holfeld & Ruthing, 2012) when assessed in a single visit. However, the potential contributions of variable sleep quantity and quality on IADL performance have not been assessed in healthy older adults using longitudinal methods. Accordingly, the aim of this study was to examine the impact of fluctuations in sleep quantity and quality, assessed daily, above and beyond average levels, on at-home IADL performance across 18 days in a group of community-dwelling older adults.

Fifty-two non-demented community-dwelling older adults (M age = 69 years, 65% female) completed 18 days of at-home IADL tasks, as well as daily ecological momentary assessment (EMA) measures of EF, sleep hours, and restfulness questions. An 18-day mean EMA EF score was computed controlling for practice effects. Mean levels of and variability in EMA sleep hours and EMA restfulness ratings were computed. IADL scores were computed for timeliness and accuracy across the 18 days.

A series of hierarchical linear regressions were run using separate IADL timeliness and accuracy as the dependent variable. In the first step, demographics (age, sex, education) were entered. Then, EMA EF was entered, followed by mean EMA sleep hours and EMA mean restfulness, and lastly, variability in EMA sleep hours and EMA restfulness. EMA EF was found to significantly predict both IADL accuracy (B = .46, p = .001) and timeliness (B = .45, p = .005). Variability in EMA sleep hours (B = .40, p = .008) and restfulness (B = -.29, p = .043) both predicted IADL accuracy beyond other variables, while mean levels did not. Additionally, variability in sleep hours and restfulness substantially improved the prediction of IADL accuracy above and beyond other variables in the model, accounting for an additional 16% of variance (F (2) = 3.80, ∆ R2 = .16, p = .006). Neither mean levels of or variability in sleep hours or restfulness predicted IADL timeliness.

Results suggest that greater fluctuations in the amount and quality of sleep across days may render healthy older adults more susceptible to lapses in daily functioning abilities, particularly the accuracy with which IADL tasks are completed.

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.

Accurate early detection of subtle cognitive difficulties is critical for optimizing treatment of neurodegenerative disease. Those who speak English as a second language (ESL) in the US may be at a disadvantage on Englishwritten neuropsychological tests, increasing the potential for error, particularly when cognitive difficulties are mild and/or when informants are not available/unreliable. This study examined the utility of a standardized, performance-based test of everyday function for the assessment of cognition in ESL older adults.

Five ESL participants (Mage=83 years; range 65-84 years old) were recruited along with 43 cognitively healthy, native English speakers (controls) as part of a larger study of functional assessment in community-dwelling older adults. Participants were required to identify a study partner to answer questions about their cognitive abilities and everyday functioning. ESL participants reported diverse native languages: Cantonese, Mandarin, Gujarati/Hindi, Farsi, and Azeri. One of the 5 ESL participants reported a diagnosis of MCI. Participants completed the Mini-Mental Status Exam, Trail Making Tests, Digit Span, Boston Naming Test, Hopkins Verbal Learning Test, and Brief Visual Memory Test, resulting in 15 test scores. Participants also completed the Naturalistic Action Test (NAT), a performance-based tests that requires preparation of a breakfast and lunch using standardized objects presented on a table. Recordings of NAT performance were scored by two coders for time to completion, accomplishment of task steps, and errors (overt, micro-error, motor), resulting in 10 scores for the Breakfast and the Lunch tasks. Any discrepancies amongst the two coders were resolved by our lab. Informant-report questionnaires included the Functional Assessment Questionnaire (FAQ), Everyday Cognition Questionnaire (ECog) and IADL-C. Total scores from the cognitive tests, NAT, and informant reports for each ESL participant were compared against the scores of Controls by computing T-scores using the Control M and SD. Low/impaired test scores were defined as <1.5 SD.

Informants reported intact everyday function (FAQ, IADL-C) for all ESL participants. Informant-reported ECog scores varied as expected; with mild decline reported for the participant with MCI. On traditional cognitive tests, ESL participants showed variable performance, such that low scores were obtained on up to 9 of the 15 scores. The ESL participant with MCI obtained low scores on 11/15 scores. On the NAT, all of the ESL participants without MCI showed scores on the Breakfast (accomplishment, errors) that were comparable to Controls. Completion time for both Breakfast and Lunch and Lunch scores (accomplishment, errors) were variable, with low across observed in ESL participants with healthy cognition.

Older participants with ESL and healthy cognition showed highly variable scores on traditional, neuropsychological tests. However, on one item from a performance-based assessment of everyday function (NAT Breakfast), ESL participants with healthy cognition consistently performed well compared to healthy Controls. Performance was less consistent for completion time across both NAT tasks and on all measures from the Lunch task, for which the steps and objects may have been less familiar to ESL participants. Thus, performance-based testing holds promise for informing neuropsychological assessment of ESL older adults, but care should be taken in selecting test items that are highly familiar and outcome measures that are most meaningful across a range of cultures.

As the older adult population increases in the coming decades, the number of persons that develop dementia of the Alzheimer’s type (DAT) will increase accordingly. Though curative treatment for Alzheimer’s disease remains elusive, early detection of cognitive decline allows for initiation of pharmacological treatment to slow disease progression and non-pharmacological approaches to support quality of life and well-being of affected individuals and their care partners. Streamlined approaches that bridge the gap between brief screenings and comprehensive neuropsychological evaluation are needed. The NIH Toolbox Cognition Battery (NIHTB-CB) is a brief, easily administered, computerized cognitive battery that assesses various aspects of both fluid and crystallized cognitive abilities. ARMADA (Advancing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging) is a multi-site study that aims to validate the NIHTB across the spectrum from normal aging to DAT. The current study utilized longitudinal data from ARMADA to determine whether performance on the NIHTB-CB detects cognitive decline in persons with normal cognition (NC), mild cognitive impairment (MCI), and mild DAT over the span of two years. We predicted that scores would decline for the MCI and DAT groups, but not for the NC group.

Participants were 191 participants drawn from the larger ARMADA cohort aged 65-84 (nNC = 118, nMCI = 47, nDAT = 26) that completed the NIHTB-CB at baseline and 12 months. The clinical groups were significantly older than the NC group at baseline (MNC = 72.72, MMCI = 76.63, MDAT = 75.42; p < .001) and the NC and MCI groups had significantly more years of education than the DAT group (MNC = 17.03, MMCI = 16.83, MDAT = 15.54; p = .008).

Mixed model ANOVAs determined differences in uncorrected NIHTB-CB scores between clinical groups at baseline and 12 months, controlling for age and education. There were significant interactions between time and clinical group for Flanker (p < .001), Pattern Comparison (p < .001), and Picture Vocabulary (p = .001), such that the DAT group demonstrated a more negative slope of change than the NC and MCI groups. For Oral Reading, the MCI group demonstrated a more negative slope of change than the NC and DAT groups (p = .01).

Differential score trajectories were found for the Flanker task, with a more negative pattern of change in scores in the DAT group compared to the NC and MCI groups. Contrary to expectation, scores decreased for the two crystallized subtests across groups, which may reflect regression to the mean given high baseline scores, especially for Picture Vocabulary; however, these results were also moderated by group with less decline in scores in the NC group, which may indicate involvement of non-crystallized abilities in executing a single word comprehension task. Group differences were subtle, which may in part reflect the relatively short period of follow up. The Flanker task appears to be most sensitive to decline in mild DAT compared to MCI and NC. Results provide preliminary support for the utility of NIHTB-CB in detecting cognitive decline along the cognitive aging to DAT spectrum.

Cognitive function may underlie the use of more adaptive as compared to maladaptive coping strategies to manage pandemic-related stress in older adults. As the composition of coping strategies varies with context, we investigated the factor structure of 14 established coping strategies. We then aimed to determine whether specific coping strategies were associated with cognitive function.

141 adults aged 50-90 years old completed the study via Zoom. The National Alzheimer’s Coordinating Center TCog battery assessed cognitive function. The Brief Cope, adapted to evaluate COVID-19, measured 14 specific coping strategies.

Based on our factor analyses, Avoidant (e.g., denial and substance use) and Approach (e.g., planning, instrumental and emotional support systems) coping composite scores were formed. Regression analyses, adjusted for age and education, indicated that 12.9% of the variance in the use of Avoidance coping strategies was explained by worse performance on measures of episodic memory, executive attention/processing speed, working memory, and verbal fluency. A closer examination indicated that verbal fluency was not a statistically significant contributor to the model. 9.1% of the variance in Approach coping strategies was related to cognitive function with working memory and verbal fluency being statistically significant contributors to the model.

Older adults with better performance on higher-order cognitive testing may utilize more effective coping strategies in older adults. These results have implications for attenuating pandemic-related stress and warrant developing brief interventions to help facilitate problem-solving and reduce emotional distress in those with lower cognitive resources.

Cognitive training is a non-pharmacological intervention aimed at improving cognitive function across a single or multiple domains. Although the underlying mechanisms of cognitive training and transfer effects are not well-characterized, cognitive training has been thought to facilitate neural plasticity to enhance cognitive performance. Indeed, the Scaffolding Theory of Aging and Cognition (STAC) proposes that cognitive training may enhance the ability to engage in compensatory scaffolding to meet task demands and maintain cognitive performance. We therefore evaluated the effects of cognitive training on working memory performance in older adults without dementia. This study will help begin to elucidate non-pharmacological intervention effects on compensatory scaffolding in older adults.

48 participants were recruited for a Phase III randomized clinical trial (Augmenting Cognitive Training in Older Adults [ACT]; NIH R01AG054077) conducted at the University of Florida and University of Arizona. Participants across sites were randomly assigned to complete cognitive training (n=25) or an education training control condition (n=23). Cognitive training and the education training control condition were each completed during 60 sessions over 12 weeks for 40 hours total. The education training control condition involved viewing educational videos produced by the National Geographic Channel. Cognitive training was completed using the Posit Science Brain HQ training program, which included 8 cognitive training paradigms targeting attention/processing speed and working memory. All participants also completed demographic questionnaires, cognitive testing, and an fMRI 2-back task at baseline and at 12-weeks following cognitive training.

Repeated measures analysis of covariance (ANCOVA), adjusted for training adherence, transcranial direct current stimulation (tDCS) condition, age, sex, years of education, and Wechsler Test of Adult Reading (WTAR) raw score, revealed a significant 2-back by training group interaction (F[1,40]=6.201, p=.017, η2=.134). Examination of simple main effects revealed baseline differences in 2-back performance (F[1,40]=.568, p=.455, η2=.014). After controlling for baseline performance, training group differences in 2-back performance was no longer statistically significant (F[1,40]=1.382, p=.247, η2=.034).

After adjusting for baseline performance differences, there were no significant training group differences in 2-back performance, suggesting that the randomization was not sufficient to ensure adequate distribution of participants across groups. Results may indicate that cognitive training alone is not sufficient for significant improvement in working memory performance on a near transfer task. Additional improvement may occur with the next phase of this clinical trial, such that tDCS augments the effects of cognitive training and results in enhanced compensatory scaffolding even within this high performing cohort. Limitations of the study include a highly educated sample with higher literacy levels and the small sample size was not powered for transfer effects analysis. Future analyses will include evaluation of the combined intervention effects of a cognitive training and tDCS on nback performance in a larger sample of older adults without dementia.

Aging older adults and individuals with mild cognitive impairment (MCI) experience changes in ability to self-monitor errors. Difficulties with accurate self-monitoring of errors can negatively impact everyday functioning. Without proper error recognition, individuals will continue to make mistakes and not implement compensatory strategies to prevent future errors. A modified Sustained Attention to Response Task (SART; Robertson et al., 1997) has previously been used to assess self-monitoring by the number of errors individuals were able to recognize. The current study sought to examine the relationship of this laboratory-based error-awareness task with everyday functional abilities as assessed by informants and with real-world error-monitoring. We hypothesized that self-monitoring would be significantly related to real-world error-monitoring and everyday functional abilities.

135 community-dwelling participants (110 healthy older adults (HOA) and 25 individuals with MCI) were included from a larger parent study (mean age = 67.73, SD = 8.89). A modified SART was used to measure error-monitoring and create a self-monitoring variable by dividing accurately recognized errors by the total number of errors. Participants also completed simple and complex everyday tasks of daily living (e.g., making lemonade, cooking oatmeal, cleaning, filling medication pillbox) in a university campus apartment. Examiners coded both number of errors committed and self-corrections that were made during task completion. To examine real world error awareness, total self-correct errors were divided by the total number of errors. Knowledgeable informants (KI) completed the Everyday Cognition (ECog) scale, where they rated the participant on domains of memory, language, spatial abilities, planning, organization, and divided attention, to capture changes in everyday function. Pearson correlations were used to examine the relationship between SART self-monitoring and real-world error-monitoring, and changes in everyday functions as rated by their informants.

As self-monitoring scores on the SART increased, so too did real-world error awareness scores, r(133) = .18, p = .04. Higher self-monitoring scores on the SART were also significantly positively associated with functional performance abilities on the Ecog total (r(96) = -.24, p = .02). Further, higher self-monitoring on the SART was related to better functional performance within the Ecog domains of everyday memory (r(96) = -.23, p = .02), everyday language (r(96) = -.24, p = .02), everyday spatial abilities (r(96) = -.23, p = .02), and everyday planning (r(96) = -.21, p = .04). SART self-monitoring was not significantly related to everyday organization or divided attention domains.

The findings revealed that better error-monitoring performance on a laboratory-based task was related to better error-monitoring when completing real-world activities, and less overall impairment in everyday function as reported by informants. Results support the ecological validity of the SART error-monitoring score and suggest that error-monitoring performance on the modified SART may have important clinical implications in predicting real-world error-monitoring and everyday function. Future research should consider how SART error-monitoring may predict everyday functioning, over and above other clinical measures.

In the context of primary care, cognitive screenings are brief, non-diagnostic tests that clinicians can administer in order to provide appropriate referrals to neuropsychologists. Annual cognitive screening for adults over age 65 (“older adults”) can help monitor cognitive functioning over time and ensure more patients with cognitive impairments receive neuropsychological assessment and care earlier. Unfortunately, time constraints and lack of training present major barriers to cognitive screening in primary care, and less than half of cognitive impairment cases are identified in these settings. A remote cognitive screening mobile app has the potential to save primary care clinics time, particularly for the majority of older adults who are cognitively healthy. Moreover, a screening app well-validated for remote clinical use can replace the inadequate or nonexistent screening practices currently employed by many primary care clinics. In order to achieve their potential, remote smartphone-enabled cognitive screening paradigms must be acceptable and feasible for both patients and clinical end users. With this goal in mind, we describe the collaborative, human-centered design process and proposed implementation of MyCog Mobile (MCM), a self-administered cognitive screening app based on well-validated NIH Toolbox measures.

We conducted foundational interviews with primary care clinicians (N=5) and clinic administrators (N=3) and created user journey maps of their existing and proposed cognitive screening workflows. We then conducted individual semi-structured interviews with healthy older adults (N=5) as well as participated in a community stakeholder panel of older adults and caregivers (N=11). Based on the data collected, we developed high-fidelity prototypes of the MCM app which we iteratively tested and refined with the older adult interview participants. Older adults rated the usability of the prototypes on the Simplified System Usability Scale (S-SUS) and After Scenario Questionnaire (ASQ).

Clinicians and administrators were eager to use a well-validated remote screening app if it saved them time in their workflows and were fully integrated into their EHR. Clinicians prioritized easily interpretable score reports tied to automated best practice guidelines. Findings from interviews and user journey mapping further informed the details of the proposed implementation and core functionality of MCM. Older adult participants were motivated to complete a remote cognitive screener to ensure they were cognitively healthy, save time during their in-person visit, and for privacy and comfort reasons. Older adults also identified several challenges to remote smartphone screening which informed the user experience design of the MCM app. The average rating across prototype versions was 91 (SD 5.18) on the SSUS and 6.13 (SD 8.40), indicating above average usability.

Through our iterative, humancentered design process, we were able to develop a viable remote cognitive screening app and proposed implementation for primary care settings optimized for multiple stakeholders. Next steps include validating MCM in clinical and healthy populations, collaboratively developing best practice alerts for primary care EHRs with neuropsychologists, and piloting the finalized app in a community clinic. We hope the finalized MCM app will promote broader screening practices within primary care and improve early assessment and diagnosis of cognitive impairment for older adults.

Prior work on associations between self-reported cognition and objective cognitive performance in Veterans has yielded mixed findings, with some evidence indicating that mild traumatic brain injury (TBI) may not impact the associations between subjective and objective cognition. However, few studies have examined these relationships in both mild and moderate-to-severe TBI, in older Veterans, and within specific cognitive domains. Therefore, we assessed the moderating effect of TBI severity on subjective and objective cognition across multiple cognitive domains.

This study included 246 predominately male Vietnam-Era Veterans (age M=69.61, SD=4.18, Range = 60.87 – 85.16) who completed neuropsychological testing and symptom questionnaires as part of the Department of Defense-Alzheimer’s Disease Neuroimaging Initiative (DoD-ADNI). Participants were classified as having history of no TBI (n=81), mild TBI (n=80), or moderate-tosevere TBI (n=85). Neuropsychological composite scores in the domains of memory, attention/executive functioning, and language were included as the outcome variables. The Everyday Cognition (ECog) measure was used to capture subjective cognition and, specifically, the ECog domain scores of memory, divided attention, and language were chosen as independent variables to mirror the objective cognitive domains. General linear models, adjusting for age, education, apolipoprotein E ε4 carrier status, pulse pressure, depressive symptom severity, and PTSD symptom severity, tested whether TBI severity moderated the associations of domain-specific subjective and objective cognition.

Across the sample, subjective memory was associated with objective memory (β=-.205, 95% CI [-.332, -.078], p=.002) and subjective language was associated with objective language (β=-.267, 95% CI [-.399, -.134], p<.001). However, the main effect of subjective divided attention was not associated with objective attention/executive functioning (p=.124). The main effect of TBI severity was not associated with any of the objective cognitive domain scores after adjusting for the other variables in the model. The TBI severity x subjective cognition interaction was significant for attention/executive functioning [F(2,234)=5.18, p=.006]. Specifically, relative to Veterans without a TBI, participants with mild TBI (β=-.311, 95% CI [-.620, -.002], p=.048) and moderate-to-severe TBI (β=-.499, 95% CI [-.806, -.193], p=.002) showed stronger negative associations between subjective divided attention and objective attention/executive functioning. TBI severity did not moderate the associations between subjective and objective cognition for memory or language domains. The pattern of results did not change when the total number of TBIs was included in the models.

In this DoD-ADNI sample, stronger associations between subjective and objective attention were evident among individuals with mild and moderate-to-severe TBI compared to Veterans without a TBI history. Attention/executive functioning measures (Trails A and B) may be particularly sensitive to detecting subtle cognitive difficulties related to TBI and/or comorbid psychiatric symptoms, which may contribute to these attention-specific findings. The strongest associations were among those with moderate-to-severe TBI, potentially because the extent to which their attention difficulties are affecting their daily lives are more apparent despite no significant differences in objective attention performance by TBI group. This study highlights the importance of assessing both subjective and objective cognition in older Veterans and the particular relevance of the attention domain within the context of TBI.

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.

Daily driving behavior is ultimate measure of cognitive functioning requiring multiple cognitive domains working synergistically to complete this complex instrumental activity of daily living. As the world’s population continues to grow and age older, motor vehicle crashes become more frequent. Cognitive and brain reserve are developing constructs that are frequently assessed in aging research. Cognitive reserve preserves functioning in the face of greater loss of brain structure as experienced during cognitive impairment or dementia. This study determined whether cognitive reserve and brain reserve predict changes in adverse driving behaviors in cognitively normal older adults.

Cognitively normal participants (Clinical Dementia Rating 0) were enrolled from longitudinal studies at the Knight Alzheimer’s Disease Research Center at Washington University. Participants (n=186) were ≥ 65 years of age, required to have Magnetic Resonance Imaging (MRI) data, neuropsychological testing data, as well as one full year of naturalistic driving data prior to the beginning of COVID-19 lockdown in the United States (March 2020). Naturalistic driving behavior data was collected via the Driving Real World In-vehicle Evaluation System (DRIVES). DRIVES variables included idle time, over speeding, aggression, number of trips, including those at day and night. MRI was performed on 3T Tesla using a research imaging protocol based upon ADNI that includes a high-resolution T1 MPRAGE for assessment of brain structures to produce normalized whole brain volume (WBV) and hippocampal volume (HV). WBV and HV were each assessed using tertiles comparing the top 66% with the bottom 33% where the bottom represented increased atrophy. The Word Reading subtest of the Wide Range Achievement Test 4 (WRAT 4) was utilized as a proxy for cognitive reserve. WRAT 4 scores were compared with the top 66% and the bottom 33% where the bottom were poor performers. Linear-mixed-effect models adjusted for age, education, and sex.

Participants on average were older (73.7±4.9), college educated (16.6±2.2), and similar sex distribution (males=100, females=86). Analyses showed statistically significant differences in slopes where participants with increased hippocampal and whole brain atrophy were less likely to overspeed (p=0.0035; p=0.0003), drive aggressively (p=0.0016; p<0.0001), and drive during the daytime (p<0.0001; p<0.0001). However, they were more likely to spend more time idling (p=0.0005; p<0.0001) and drive during the nighttime (p=0.003; p=0.0002). Similar findings occurred with the WRAT 4 where participants with lower scores were less likely to overspeed (p=0.0035), drive aggressively (p=0.0024), hard brake (p=0.0180), and drive during the daytime (p<0.0001) while they were more likely to also spend more time idling (p=0.0012) and drive during the nighttime (p=0.0004).

Numerous changes in driving behaviors over time were predicted by increased hippocampal and whole brain atrophy as well as lower cognitive reserve scores proxied by the WRAT 4. These changes show that those with lower brain and cognitive reserve are more likely to restrict their driving behavior and adapt their daily behaviors as they age. These results suggest older adults with lower brain and cognitive reserve are more likely to avoid highways where speeding and aggressive maneuvers are more frequent.

Engagement in activities that promote overall brain health and well-being is often a key step in reducing risks to cognitive health in older adults. Given that higher health literacy has been found to be associated with healthier lifestyles, it is unsurprising that it has been the focus of many studies and programs aimed at improving the health outcomes of older adults. An equally important factor to consider when it comes to such efforts is the role of moderating variables in the relationship between health literacy and engagement in healthy behaviors. The present study examined the moderating effect of self-efficacy, a variable that has been shown to be positively associated with both health literacy and health behaviors. We hypothesized that increased self-efficacy will strengthen the relationship between health literacy and healthy activity engagement in a sample of community-living older adults.

Forty-nine older adults (age: M = 64.35, SD = 8.00; education: M = 16.39, SD = 2.37; 87.76% female) completed a health literacy measure (Newest Vital Sign; NVS), a self-efficacy questionnaire (General Self-Efficacy Scale; GSE), and a lifestyle behaviors questionnaire (Healthy Aging Activity Engagement Scale; HAAE). The NVS is a performance-based measure in which participants are asked to interpret the verbal and numerical information of a nutrition label to make health-related decisions. The GSE is a self-report measure that evaluates one’s belief in their ability to handle challenges, solve problems, and accomplish goals. The HAAE is a self-report measure that assesses one’s engagement in healthy activities across multiple health domains.

To examine whether self-efficacy moderates the relationship between health literacy and healthy activity engagement, a moderation analysis was conducted using Hayes’ PROCESS macro for SPSS with age and education included in the model as covariates. The results revealed no significant interaction between health literacy and self-efficacy, b = 0.23, p = .59, 95% CI [-0.60 to 1.05].

Contrary to expectations, in the present sample, the degree of self-efficacy was not a condition under which level of health literacy exerted its influence on healthy activity engagement in older adults. Future studies with larger and more nationally representative samples are needed to explore self-efficacy and other potential moderating factors in order to identify individual characteristics that support older adults’ adoption and engagement in health-promoting behaviors.

Prior research supports retirement may negatively impact cognitive functioning. The current study examined the relationship between retirement status and the level of cognitive dysfunction amongst individuals with Alzheimer’s disease (AD). For the purpose of this study, it was predicted that there would be significantly higher levels of cognitive dysfunction in retired participants after controlling for age.

Participants (ages 65 to 91) were drawn from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). The sample included 110 participants who were retired and 111 participants who were not retired. Cognitive dysfunction was assessed using the cognitive subscale of the modified Alzheimer’s Disease Assessment Scale (ADAS). A one-way ANCOVA analysis was conducted with cognitive dysfunction as the dependent variable and the age of the participants as a covariate.

The results of the one-way ANCOVA showed being retired was a significant predictor of greater cognitive dysfunction amongst individuals with AD after controlling for age (F(df=1, 218) = 231.143, p = < .001, p < .05) and accounted for 52% of the variance in the level of cognitive dysfunction.

Being retired is associated with higher levels of cognitive dysfunction in AD after accounting for the effects of age. As such, continued cognitive activity may slow the progression of cognitive declines amongst individuals with AD who are retired. There is a need for future longitudinal research to determine how late retirement may delay the progression of cognitive decline in AD by controlling for other moderator factors such as genetics and work-related stress.

Understanding the factors contributing to optimal cognitive function throughout the aging process is essential to better understand successful cognitive aging. Processing speed is an age sensitive cognitive domain that usually declines early in the aging process; however, this cognitive skill is essential for other cognitive tasks and everyday functioning. Evaluating brain network interactions in cognitively healthy older adults can help us understand how brain characteristics variations affect cognitive functioning. Functional connections among groups of brain areas give insight into the brain’s organization, and the cognitive effects of aging may relate to this large-scale organization. To follow-up on our prior work, we sought to replicate our findings regarding network segregation’s relationship with processing speed. In order to address possible influences of node location or network membership we replicated the analysis across 4 different node sets.

Data were acquired as part of a multi-center study of 85+ cognitively normal individuals, the McKnight Brain Aging Registry (MBAR). For this analysis, we included 146 community-dwelling, cognitively unimpaired older adults, ages 85-99, who had undergone structural and BOLD resting state MRI scans and a battery of neuropsychological tests. Exploratory factor analysis identified the processing speed factor of interest. We preprocessed BOLD scans using fmriprep, Ciftify, and XCPEngine algorithms. We used 4 different sets of connectivity-based parcellation: 1)MBAR data used to define nodes and Power (2011) atlas used to determine node network membership, 2) Younger adults data used to define nodes (Chan 2014) and Power (2011) atlas used to determine node network membership, 3) Older adults data from a different study (Han 2018) used to define nodes and Power (2011) atlas used to determine node network membership, and 4) MBAR data used to define nodes and MBAR data based community detection used to determine node network membership.

Segregation (balance of within-network and between-network connections) was measured within the association system and three wellcharacterized networks: Default Mode Network (DMN), Cingulo-Opercular Network (CON), and Fronto-Parietal Network (FPN). Correlation between processing speed and association system and networks was performed for all 4 node sets.

We replicated prior work and found the segregation of both the cortical association system, the segregation of FPN and DMN had a consistent relationship with processing speed across all node sets (association system range of correlations: r=.294 to .342, FPN: r=.254 to .272, DMN: r=.263 to .273). Additionally, compared to parcellations created with older adults, the parcellation created based on younger individuals showed attenuated and less robust findings as those with older adults (association system r=.263, FPN r=.255, DMN r=.263).

This study shows that network segregation of the oldest-old brain is closely linked with processing speed and this relationship is replicable across different node sets created with varied datasets. This work adds to the growing body of knowledge about age-related dedifferentiation by demonstrating replicability and consistency of the finding that as essential cognitive skill, processing speed, is associated with differentiated functional networks even in very old individuals experiencing successful cognitive aging.

Repetition priming is a form of implicit memory in which prior exposure to a stimulus facilitates the subsequent processing of that stimulus. While explicit memory has consistently been shown to decline with age, the effect of age on implicit memory remains unresolved. Most studies examining age-related effects on priming have utilized words or pictures of real objects with pre-existing representations that may differentially involve implicit and explicit memory processes across age groups. Repetition priming may also be influenced by attentional processes during encoding that are differentially affected by age. In a previous study using word-stem completion, we found that individual differences in cortical arousal, but not spatial attention, influenced the magnitude and temporal dynamics of conceptual priming in healthy older adults. The objective of this study is to investigate whether cortical arousal and spatial attention play differential roles in the magnitude and temporal dynamics of repetition priming in young and older adults using novel shapes that do not have pre-existing representations within memory.

Healthy young (n=25, M age=19.4) and older adults (n=54, M age=70.0) completed a perceptual repetition priming task that was followed by a recognition memory test and an alerting/spatial orienting task from which behavioral measures of cortical arousal and spatial attention were derived. Older adults also completed a battery of neuropsychological tests. In the perceptual priming task, participants made a speeded judgment on whether novel nonverbal shapes had “closed” or “open” perimeters. Each shape was presented twice: half following the first presentation (immediate repetition) and half after three intervening items (delayed repetition). Participants were then shown closed and open versions of each shape and asked to identify which version was presented in the previous task. In the alerting/orienting task, participants made a speeded response to the location of a visual target; on a subset of trials, either nonspatial alerting or spatial orienting cues were presented 300ms prior to the target.

Response times were slower and judgment accuracy greater in older adults (ps<0.05). However, the groups showed comparable levels of immediate and delayed repetition priming along with chance levels of recognition memory accuracy. Cortical arousal was reduced (p<0.001) and costs associated with spatial attention were larger (p<0.01) in the older adults. Despite comparable priming, cortical arousal and spatial attention were differentially related to priming across groups. In the young group, lower cortical arousal was associated with greater delayed priming (r=-.47, p=0.017) and slower decay rate (r=.44, p=0.03). In the older group, higher cost of spatial orienting was associated with greater immediate priming (r=.40, p=0.003) and faster decay rate (r=.29, p=0.03). Better category fluency performance was also associated with greater immediate priming (r=.32, p=0.035) and faster decay rate (r=.34, p=0.025) in older adults.

These findings suggest that different attentional systems support repetition priming across age groups. Priming is modulated by the efficiency of cortical arousal in young adults, but by the costs of spatial attention in older adults with reduced cortical arousal, consistent with a shift from bottom-up to top-down attentional processes and broader attentional scope with age.