Insights about personality traits and cognitive performance and decline in adults 51-59 Years old from the Wisconsin longitudinal study.

OBJECTIVES: To delineate midlife personality dimensions of early cognitive change in an age-homogenous sample of U.S. older adults. DESIGN: Longitudinal study of 6133 adults from the Wisconsin Longitudinal Study (WLS). MEASURES: Middle-aged participants (mean age = 53.2; SD = 0.6) from the WLS completed the 'Big-5' personality assessment in 1992. Mixed effects models examined whether midlife personality traits were associated with change in cognitive performance from participant's mid-60s (2004-2005) to early 70s (2011). The cognitive battery assessed abstract reasoning (AR), category fluency (CF), working memory (WM), and delayed verbal memory (DVM). Models adjusted for sex, education, and subjective health. RESULTS: High Openness was a significant predictor of change in AR, CF, and DVM. These cognitive outcomes declined less among those with high Openness, but the effect sizes for Openness by time were small (R2 s < 0.01). AR and CF were characterized by higher overall performance with high Openness, but with relatively parallel change for the highest and lowest Openness quartiles. There was no advantage of Openness to DVM by the second assessment. High Conscientiousness was a predictor of more change for DVM, though the effect size was small (R 2  < 0.01). CONCLUSIONS: None of the midlife personality traits were uniformly associated with change in cognitive performance in early older adulthood. High midlife Openness had the most noteworthy impact on cognition. Interventions designed to target Openness have potential to elevate and maintain a higher threshold of performance in some cognitive domains, but may only have a small impact on cognitive change.

An Integrative Review of Behavioral Disturbances in Veterans With Dementia and PTSD.

OBJECTIVE: Both posttraumatic stress disorder (PTSD) and dementia have been associated with a variety of behavioral changes; however, little is known about the behavioral consequences of comorbid PTSD and dementia. An integrative review was conducted to identify and examine studies reporting on behavioral disturbances in Veterans with PTSD and dementia. METHODS: PubMed and PsychINFO databases were searched for articles on behavioral disturbances in Veterans with comorbid PTSD and dementia. RESULTS: Seven studies met inclusion for this review, sampling a total of 822 Veterans. Preliminary findings suggest that though Veterans with dementia and comorbid PTSD may present with more difficult behavioral symptoms, they do not typically display increased levels of aggression. CONCLUSION: Given the limited study inventory, the key finding from this review highlights the lack of methodologically rigorous empirical studies on this topic. A research agenda is proposed to encourage future studies to address gaps in the literature.

Robust normative standards for the California Verbal Learning Test (CVLT) ages 60-89: A tool for early detection of memory impairment.

Objective: To detect cognitive "impairment," neuropsychologists rely on normative data to compare patient performance to "normal" peers. However, the true normality of normative samples may be called into question given the high prevalence of preclinical proteinopathies amongst clinically normal older adults. Given its common use in memory clinics, we aimed to develop a robust California Verbal Learning Test (CVLT) normative standard reflecting only the most cognitively stable sample of older adults available.Method: Two hundred and twenty-eight older adults (mean age = 69.9, range = 60-89, 91% White, mean education = 17.6 years) who were clinically normal at baseline and demonstrated clinical stability on longitudinal assessment completed the CVLT at baseline. We applied a standardized algorithm to convert raw scores into normalized scaled scores and then regressed on age, sex, and education using fractional polynomial modeling.Results: There were significant main effects of age and sex across CVLT metrics, but not education. Means and standard deviations were higher and less variable in our robust normative data than the data used to create the CVLT-II and CVLT-3 normative standards.Conclusions: These norms set a higher standard for what should be considered "normal" in the spectrum of age-related memory changes and may help clinicians identify patients with memory and potential neurodegenerative changes in the earliest stages, further optimizing clinical management and clinical trial stratification. As with any standard, these robust norms are only appropriately utilized with patients that closely match the demographic profile of the individuals represented in the sample used for this study.

A Case Report of Problem Solving Therapy for Reducing Suicide Risk in Older Adults with Anxiety Disorders.

Objectives: Suicide is a global public health problem among older adults. Problem-solving therapy (PST) has demonstrated promise in reducing late-life suicide risk, chiefly in secondary analyses of studies on late-life depression. PST mitigates negative beliefs about one's problem-solving abilities and maladaptive problem-solving styles, which suicidal older adults report. The effects of PST on suicide risk in older adults with primary anxiety disorder diagnoses have not been examined. Anxiety is a risk factor for suicide, but it is less studied in research on suicide compared to depression. This paper describes two cases of older individuals with anxiety disorders and suicidal ideation who completed six sessions of PST. Methods: Assessments of suicide risk, anxiety, depressive symptoms, and problem-solving ability were administered. Results: Both cases exhibited a clinically significant reduction in suicide risk, along with reductions in anxiety, worry, and depressive symptoms by posttreatment. Conclusions & Clinical Implications: Findings highlight the potential for PST as a psychotherapeutic intervention for reducing suicide risk in older adults with anxiety disorders.

Association of Blood and Cerebrospinal Fluid Tau Level and Other Biomarkers With Survival Time in Sporadic Creutzfeldt-Jakob Disease.

IMPORTANCE: Fluid biomarkers that can predict survival time in sporadic Creutzfeldt-Jakob disease (sCJD) will be critical for clinical care and for treatment trials. OBJECTIVE: To assess whether plasma and cerebrospinal fluid (CSF) biomarkers are associated with survival time in patients with sCJD. DESIGN, SETTING, AND PARTICIPANTS: In this longitudinal cohort study, data from 193 patients with probable or definite sCJD who had codon 129 genotyping referred to a tertiary national referral service in the United States were collected from March 2004 to January 2018. Participants were evaluated until death or censored at the time of statistical analysis (range, 0.03-38.3 months). We fitted Cox proportional hazard models with time to event as the outcome. Fluid biomarkers were log-transformed, and models were run with and without nonfluid biomarkers of survival. Five patients were excluded because life-extending measures were performed. MAIN OUTCOMES AND MEASURES: Biomarkers of survival included sex, age, codon 129 genotype, Barthel Index, Medical Research Council Prion Disease Rating Scale, 8 CSF biomarkers (total tau [t-tau] level, phosphorylated tau [p-tau] level, t-tau:p-tau ratio, neurofilament light [NfL] level, ß-amyloid 42 level, neuron-specific enolase level, 14-3-3 test result, and real-time quaking-induced conversion test), and 3 plasma biomarkers (t-tau level, NfL level, and glial fibrillary acidic protein level). RESULTS: Of the 188 included participants, 103 (54.8%) were male, and the mean (SD) age was 63.8 (9.2) years. Plasma t-tau levels (hazard ratio, 5.8; 95% CI, 2.3-14.8; P < .001) and CSF t-tau levels (hazard ratio, 1.6; 95% CI, 1.2-2.1; P < .001) were significantly associated with survival after controlling for codon 129 genotype and Barthel Index, which are also associated with survival time. Plasma and CSF t-tau levels were correlated (r = 0.74; 95% CI, 0.50-0.90; P < .001). Other fluid biomarkers associated with survival included plasma NfL levels, CSF NfL levels, t-tau:p-tau ratio, 14-3-3 test result, and neuron-specific enolase levels. In a restricted subset of 23 patients with data for all significant biomarkers, the hazard ratio for plasma t-tau level was more than 40% larger than any other biomarkers (hazard ratio, 3.4; 95% CI, 1.8-6.4). CONCLUSIONS AND RELEVANCE: Cerebrospinal fluid and plasma tau levels, along with several other fluid biomarkers, were significantly associated with survival time in patients with sCJD. The correlation between CSF and plasma t-tau levels and the association of plasma t-tau level with survival time suggest that plasma t-tau level may be a minimally invasive fluid biomarker in sCJD that could improve clinical trial stratification and guide clinical care.

Intrinsic connectivity networks in posterior cortical atrophy: A role for the pulvinar?

BACKGROUND: Posterior cortical atrophy (PCA) is a clinical variant of Alzheimer's disease (AD) that presents with progressive visuospatial symptoms. While amnestic AD is characterized by disrupted default mode network (DMN) connectivity with corresponding increases in salience network (SN) connectivity, a visuospatial network appears to be disrupted early in PCA. Based on PCA patients' clinical features, we hypothesized that, in addition to early decreased integrity within the visuospatial network, patients with PCA would show increases in SN connectivity despite relative preservation of DMN. As the lateral pulvinar nucleus of the thalamus has direct anatomical connections with striate and extrastriate cortex and DMN, and the medial pulvinar is anatomically interconnected with SN, we further hypothesized that lateral and medial pulvinar nuclei might be implicated in intrinsic connectivity changes in PCA. METHODS: 26 patients with PCA and 64 matched controls were recruited through UCSF Memory and Aging Center research programs. Each completed a standardized neuropsychological battery, structural MRI, and task-free fMRI. Seed-based functional correlations were used to probe networks of interest, including those seeded by the medial and lateral pulvinar thalamic nuclei, across the whole brain, and functional data analyses were adjusted for brain atrophy. RESULTS: Patients with PCA showed disproportionate deficits in the visuospatial domain; they also showed preserved social sensitivity and endorsed more depressive symptoms than HCs. PCA patients had significant parietooccipital atrophy accompanied by widespread connectivity decreases within the visuospatial network, enhanced connectivity between some structures in SN, and enhanced connectivity between key nodes of the DMN compared to controls. Increased SN connectivity correlated with a measure of social sensitivity, and increased DMN connectivity correlated with short-term memory performance. Medial pulvinar connectivity increases in PCA were topographically similar to SN (anterior insula) connectivity increases, while lateral pulvinar connectivity increases were similar to DMN (posterior cingulate) connectivity increases. CONCLUSIONS: PCA is characterized by preserved to heightened connectivity in the SN and DMN despite decreased visuospatial network connectivity. The spatial similarity of medial and lateral pulvinar connectivity changes to those seen in the SN and DMN suggests a role for the pulvinar in intrinsic connectivity network changes in PCA.

Attentional effects of hand proximity occur later in older adults: Evidence from event-related potentials.

Research with young adults has shown hand proximity biases attention both early (by the time stimuli are categorized as relevant for action) and later, selectively for goal-relevant-stimuli. We examined age-related changes in this multisensory integration of vision and proprioception by comparing behavior and event-related potentials (ERPs) between younger and older adults. In a visual detection task, the hand was placed near or kept far from target and nontarget stimuli matched for frequency and visual features. Although a behavioral hand proximity effect-faster response times for stimuli appearing near the hand-was found for both age groups, a proportionately larger effect was found for younger adults. ERPs revealed age-related differences in the time course of the hand's effect on visual processing. Younger adults showed selective increases in contralateral N1 and parietal P3 amplitudes for targets near the hand, but older adults only showed hand effects at the P3 which were accompanied by concurrent neural activity in bilateral frontal regions. This neural pattern suggests that compared with younger adults, older adults may produce the behavioral hand proximity effect by integrating hand position and visual inputs relying more on later, task-related, frontal attentional mechanisms and less on early, posterior, multisensory integration. (PsycINFO Database Record

A Preliminary Evaluation of Functional Communication Training Effectiveness and Language Preference When Spanish and English are Manipulated.

We evaluated whether differences in treatment effectiveness or preference between languages emerged across Spanish and English during functional communication training (FCT) for young children with developmental disabilities exposed to Spanish and English in the home environment. Participants were 2 young children with developmental disabilities who displayed destructive behavior maintained by social contingencies and whose families spoke Spanish and English at home. All procedures were conducted in the participants' homes by their mothers with coaching from the investigator. The effectiveness of FCT was evaluated within a reversal design across baseline, FCT, and extinction conditions. A multielement design across language type (Spanish and English) was embedded within the reversal design during the extinction and FCT conditions to evaluate differences in treatment effectiveness across type of language. Finally, during all FCT sessions, a concurrent schedules design was used to evaluate participant preference for type of language. Results suggested that FCT was effective in reducing destructive behavior, increasing manding, and/or increasing task completion for these 2 participants across Spanish and English treatment conditions. Preference for the type of language did not emerge for either participant during FCT. Results are discussed in terms of the merits of systematically evaluating language variables when working with culturally and linguistically diverse families and children.