Individuals living with HIV may experience cognitive difficulties or marked declines known as HIV-Associated Neurocognitive Disorder (HAND). Cognitive difficulties have been associated with worse outcomes for people living with HIV, therefore, accurate cognitive screening and identification is critical. One potentially sensitive marker of cognitive impairment which has been underutilized, is intra-individual variability (IIV). Cognitive IIV is the dispersion of scores across tasks in neuropsychological assessment. In individuals living with HIV, greater cognitive IIV has been associated with cortical atrophy, poorer cognitive functioning, with more rapid declines, and greater difficulties in daily functioning. Studies examining the use of IIV in clinical neuropsychological testing are limited, and few have examined IIV in the context of a single neuropsychological battery designed for culturally diverse or at-risk populations. To address these gaps, this study aimed to examine IIV profiles of individuals living with HIV and who inject drugs, utilizing the Neuropsi, a standardized neuropsychological instrument for Spanish speaking populations.

Spanish speaking adults residing in Puerto Rico (n=90) who are HIV positive and who inject drugs (HIV+I), HIV negative and who inject drugs (HIV-I), HIV positive who do not inject drugs (HIV+), or healthy controls (HC) completed the Neuropsi battery as part of a larger research protocol. The Neuropsi produces 3 index scores representing cognitive domains of memory, attention/memory, and attention/executive functioning. Total battery and within index IIV were calculated by dividing the standard deviation of T-scores by mean performance, resulting in a coefficient of variance (CoV). Group differences on overall test battery mean CoV (OTBMCoV) were investigated. To examine unique profiles of index specific IIV, a cluster analysis was performed for each group.

Results of a one-way ANOVA indicated significant between group differences on OTBMCoV (F[3,86]=6.54, p<.001). Post-hoc analyses revealed that HIV+I (M=.55, SE=.07, p=.003), HIV-I (M=.50, SE=.03, p=.001), and HIV+ (M=.48, SE=.02, p=.002) had greater OTBMCoV than the HC group (M=.30, SE=.02). To better understand sources of IIV within each group, cluster analysis of index specific IIV was conducted. For the HIV+ group, 3 distinct clusters were extracted: 1. High IIV in attention/memory and attention/executive functioning (n=3, 8%); 2. Elevated memory IIV (n=21, 52%); 3. Low IIV across all indices (n=16, 40%). For the HIV-I group, 2 distinct clusters were extracted: 1. High IIV across all 3 indices (n=7, 24%) and 2. Low IIV across all 3 indices (n=22, 76%). For the HC group, 3 distinct clusters were extracted: 1. Very low IIV across all 3 indices (n=5, 36%); 2. Elevated memory IIV (n=6, 43%); 3. Elevated attention/executive functioning IIV with very low attention/memory and memory IIV (n=3, 21%). Sample size of the HIV+I group was insufficient to extract clusters.

Current findings support IIV in the Neuropsi test battery as clinically sensitive marker for cognitive impairment in Spanish speaking individuals living with HIV or who inject drugs. Furthermore, the distinct IIV cluster types identified between groups can help to better understand specific sources of variability. Implications for clinical assessment in prognosis and etiological considerations are discussed.

Older people with HIV (PWH) are at-risk for Alzheimer’s disease (AD) and its precursor, amnestic mild cognitive impairment (aMCI). Identifying aMCI among PWH is challenging because memory impairment is also common in HIV-associated neurocognitive disorders (HAND). The neuropathological hallmarks of aMCI/AD are amyloid-ß42 (Aß42) plaque and phosphorylated tau (p-tau) accumulation. Neurofilament light chain protein (NfL) is a marker of neuronal injury in AD and other neurodegenerative diseases. In this study, we assessed the prognostic value of the CSF AD pathology markers of lower Aß42, and higher p-tau, p-tau/Aß42 ratio, and NfL levels to identify an aMCI-like profile among older PWH and differentiating it from HAND. We assessed the relationship between aMCI and HAND diagnosis and AD biomarker levels

Participants included 74 PWH (Mean age=48 [SD=8.5]; 87.4% male, 56.5% White) from the National NeuroAIDS Tissue Consortium (NNTC). CSF Aß42, Aß40, p-tau and NfL were measured by commercial immunoassay. Participants completed a neurocognitive evaluation assessing the domains of learning, recall, executive function, speed of information processing, working memory, verbal fluency, and motor. Memory domains were assessed with the Hopkins Verbal Learning Test-Revised and the Brief Visuospatial Memory Test-Revised, and aMCI was defined as impairment (<1.0 SD below normative mean) on two or more memory outcomes among HVLT-R and BVMT-R learning, delayed recall and recognition with at-least one recognition impairment required. HAND was defined as impairment (<1.0 SD below normative mean) in 2 or more cognitive domains. A series of separate linear regression models were used to examine how the levels of CSF p-tau, Aß42, p-tau/Aß42 ratio, and NfL relate to aMCI and HAND status while controlling for demographic variables (age, gender, race and education). Covariates were excluded from the model if they did not reach statistical significance.

58% percent of participants were diagnosed with HAND, 50.5% were diagnosed with aMCI. PWH with aMCI had higher levels of CSF p-tau/Aß42 ratio compared to PWH without aMCI (ß=.222, SE=.001, p=.043) while controlling for age (ß=.363, p=.001). No other AD biomarker significantly differed by aMCI or HAND status.

Our results indicate that the CSF p-tau/Aß42 ratio relates specifically to an aMCI-like profile among PWH with high rates of cognitive impairment across multiple domains in this advanced HIV disease cohort. Thus, the p-tau/Aß42 ratio may have utility in disentangling aMCI from HAND and informing the need for further diagnostic procedures and intervention. Further research is needed to fully identify, among a broader group of PWH, who is at greatest risk for aMCI/AD and whether there is increased risk for aMCI/AD among PWH as compared to those without HIV.

COVID-19 has significantly impacted society for over 2.5 years, and Long COVID is concerning for its long-term impact on the healthcare system. Further, cognitive and emotional functioning in Long COVID has limited research, but 2 recent studies (Whiteside et al., 2022a, Whiteside et al., 2022b) examined cognitive and emotional functioning in Long COVID patients approximately 6 months post-diagnosis. The studies found limited cognitive deficits, but significant depression and anxiety, which in turn were the best predictors of low average cognitive scores. Further, the mean Personality Assessment Inventory (PAI) profile included highest mean elevations on somatic preoccupation (SOM) and depression (DEP) subscales. To further explore personality functioning in Long COVID, this study compared PAI profiles of Long COVID patients with a potentially similar group with post-concussion syndrome (PCS) which has been shown to have a strong psychological component.

Participants included 44 consecutive outpatients (Mean age = 47.89, SD = 13.05, 84% Female, 75% Caucasian) referred from a Long COVID clinic with cognitive complaints related to COVID, while the comparison group of PCS patients included 50 consecutive referrals (Mean age = 38.82, SD = 16.24, 52% Female, 90% Caucasian) related to cognitive complaints attributed to PCS. A series of t-tests between the 2 groups was conducted on the PAI validity, clinical, interpersonal, and treatment consideration scales. PAI clinical subscales were also compared. To control for multiple comparisons, p < .01 was utilized and effect sizes were compared.

The results demonstrated that both Long COVID (SOM M = 68.66, SD = 12.56; DEP M = 63.39, SD = 12.70) and PCS groups (SOM M = 65.28, SD = 12.06; DEP M = 70.32, SD = 16.15) displayed the highest mean elevations on PAI SOM and DEP scales but no statistically significant differences in mean scale elevations between Long COVID and PCS groups on SOM (t [92] = 1.33, p = .80) and DEP (t [92] = -2.11, p = .097). However, results demonstrated statistically significant differences on the paranoia subscale (PAR; t [92] = -3.27, p = .009), antisocial features subscale (ANT; t [92] = -2.22, p = .01), stress subscale (STR; t [90] = -3.51, p = .006) and suicidal ideation subscale (SUI; t [92] = -2.73, p = .000) of the PAI. Specifically, the mean scores for the PCS group were higher across the paranoia (M = 57.30), antisocial features (M= 52.24), stress (M = 58.44), and suicidal ideation subscales (M = 57.82) of the PAI than the Long COVID group. While these patterns of reporting differed between groups, mean scores for both groups were in the normal range.

Results support the similarities in emotional/personality functioning across Long COVID and PCS patients and the importance of evaluating psychological functioning in these samples as a standard part of neuropsychological evaluations. Further, the results suggest that psychological treatment strategies utilized with PCS patients may be helpful for Long COVID patients, but more research is needed.

Children who are HIV-exposed uninfected (CHEU) are at risk of neurodevelopmental impairments due to perinatal HIV and antiretroviral therapy exposure as well as additional health and psychosocial burdens. There is limited understanding of the impact of perinatal risk factors on long-term outcomes of CHEU. The present study investigated the association between perinatal risk factors and the intellectual and language abilities in CHEU and children who are HIV-unexposed uninfected (CHUU).

CHEU and CHUU, 6 to 10 years, of age underwent neurodevelopmental assessments through the Kids Imaging and Neurocognitive Development (KIND) study at the Hospital for Sick Children in Toronto, Canada between January 2020 and August 2022. CHUU were recruited from the community with similar sociodemographic backgrounds based on residential area in Toronto and parental income levels. Measures of Full-Scale IQ (FSIQ), Verbal Comprehension (VCI), Visual Spatial skills (VSI), Fluid Reasoning (FRI), Working Memory (WMI), and Processing Speed (PSI) were evaluated with the Wechsler Intelligence Scale for Children - Fifth Edition. Core Language, Receptive Language, and Expressive Language skills were assessed with the Clinical Evaluation of Language Fundamentals - Fifth Edition. Perinatal risk factors included birthweight, birth complications (e.g., premature rupture of membranes, jaundice, etc.), maternal smoking and alcohol use during pregnancy, and NICU admission. Analyses of variance and chi-square tests were performed to investigate group differences and multiple regression analyses tested the relation between neurodevelopmental measures and birth factors. Significance was held at p <0.05.

36 CHEU (21 female, 8.74 ±1.56 years) and 26 CHUU (12 female, 8.53 ±1.50 years) children were included. For both groups, mean standardized scores of the cognitive abilities assessed were in the average range. CHEU had significantly lower birth weight than CHUU, but there were no differences between these groups with respect to maternal smoking and alcohol use, birth complications or NICU admission. There were no between group differences identified for the intellectual and language abilities. In the CHEU group, birthweight was significantly associated with lower VCI, WMI, and expressive language. In the CHUU group, prenatal alcohol and smoking exposure was associated with lower VCI scores. Birth complications were associated with lower WMI, PSI, and FSIQ scores.

In this interim analysis, perinatal risk factors impacted neurodevelopmental outcomes of CHEU and CHUU differently. While the groups did not differ in frequency of birth complications and maternal smoking and alcohol use, these factors negatively impacted aspects of intellectual ability in the CHUU group. CHEU with lower birthweight are at greater risk of working memory and language difficulties, supporting the need for early interventions and close neuropsychological follow-up of this population throughout childhood.

Positive psychological attributes have been associated with better health outcomes and quality of life among people with HIV (PWH). Recently, we identified two latent factors (internal strengths, socioemotional support) among 7 positive psychological attributes through factor analysis (Ham et al., 2022). Depression was inversely associated with both factors. Our current aim was to investigate associations between these latent factors, neurocognition, and daily functioning among PWH.

106 PWH and 90 HIV- participants were included in cross-sectional analyses (Mage = 51.3, 77% men, 60% White). Seven positive psychological questionnaires, a neuropsychological battery covering 7 domains, two daily functioning questionnaires (Patient’s Assessment of Own Functioning (PAOFI); Independent Activities of Daily Living (IADL)), and a depression symptom questionnaire (Center for Epidemiologic Studies Depression Scale) were administered. Internal strengths and socioemotional support composite z-scores were calculated using HIV- participants’ scores as reference. Outcomes included global and domain-specific neurocognitive T-scores (demographically-adjusted), global deficit score (GDS), number of functional impairments (PAOFI), and number of functional declines (IADL). Main effects of HIV status, latent factors, and their interaction were included in linear (neurocognition) and Poisson (daily functioning) regressions. Significant interactions were followed up by simple effects analyses and nonsignificant interactions were removed. Depressive symptoms and demographics associated with daily functioning were included as covariates.

PWH exhibited worse neurocognitive performance (global, executive functioning, processing speed, learning, recall, GDS) and reported greater functional difficulties and depressive symptoms compared to HIV-counterparts (ps < 0.05). For neurocognition, there were socioemotional support x HIV status (B = 2.39, p = 0.04) and internal strengths x HIV status (B = 2.70, p < 0.05) interactions on verbal fluency, accounting for depressive symptoms, such that only PWH had a positive association between socioemotional support and verbal fluency (B = 1.97, p = 0.01). Removing nonsignificant interactions, there was a main effect of socioemotional support on global cognition (B = 1.01, p = 0.04) and psychomotor speed (B = 1.83, p = 0.02), independent of HIV status and depressive symptoms. For daily functioning, there was a socioemotional support x HIV status interaction on IADL declines (B = 0.42, p = 0.02), accounting for depressive symptoms and education, such that only HIV- participants had an inverse relationship between socioemotional support and IADL declines (B = -0.64, p < 0.001). Removing non-significant interactions, there were main effects of internal strengths on PAOFI impairments (B = -0.36, p < 0.001) and IADL declines (B = -0.38, p < 0.001), independent of HIV status and depressive symptoms.

Among PWH, both positive psychological factors were associated with better neurocognition, even after adjusting for depressive symptomatology. Though internal strengths were associated with better daily functioning regardless of HIV status, socioemotional support was not related to daily functioning in PWH. While mechanisms underlying these associations cannot be established cross-sectionally, it is possible that among people with medical illnesses complicated by cognitive disturbance, positive psychological factors relate to improved health-related behaviors (e.g., better disease management). Additionally, better neurocognition, including cognitive reserve, may engender greater resilience and improved ability to marshal social support.

hough there is much that is unknown about “post-COVID conditions” the Center for Disease Control (CDC) recognizes that these conditions represent a wide array of new, returning, or ongoing health issues in individuals who have been infected with the novel corona virus, COVID-19. This case series describes the emotional and cognitive screening of three females in their 50's who contracted COVID-19, and were hospitalized during the course of their illness. This case series hopes to provide an initial framework to discuss the recovery trajectory of post-COVID patients who were hospitalized, who have experienced residual post-traumatic stress and cognitive symptoms.

Three middle-aged female patients (ages 52, 53, 55) were screened in an outpatient post-COVID recovery center for initial and post-COVID emotional, cognitive, and physical symptoms. All three women reported being hospitalized during their illness. The Post-Traumatic Stress Disorder - Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) was administered via clinical interview and the patients were asked about subjective cognitive complaints related to concentration, memory, and word finding.

All three women reported persisting cognitive problems, including difficulties with concentration, problems with memory, and word finding difficulties. They also endorsed symptoms of post-traumatic stress, such as avoidance of thoughts and events, as well as recurrent nightmares related to the course of their illness.

The CDC notes that there are no tests that specifically evaluate the multitude of post-COVID conditions. Regardless, this case series suggests that emotional and cognitive screeners may assist in treatment planning and support recovery in this population. Future research should examine the exact nature of the relationship between hospitalization, emotional symptoms, and cognitive functioning in post-COVID patients.

Patients with Post-Acute COVID Syndrome (PACS) are reported to commonly experience a variety of cognitive, physical, and neuropsychiatric symptoms well beyond the acute phase of the illness. Notably, concerns involving mood, fatigue, and physical symptoms (e.g., pain, headaches) following COVID-19 appears to be especially prevalent. It is unclear, however, the extent to which such symptoms are associated with cognitive problems in patients with PACS. In the present study, we examined the prevalence of cognitive impairment in a sample of patients with PACS, as well as the relationship between cognitive functioning and several non-cognitive symptoms.

Participants were 38 patients with PACS [71.1% female; mean age = 48.03 years (SD = 11.60) and years of education = 15.26 years (SD = 2.60)] seen for a neuropsychological evaluation at a large Northeastern medical center at least three months from the time of COVID-19 diagnosis (per PCR test). As part of a larger battery, patients completed the Hopkins Verbal Learning Test- Revised (HVLT, learning and delayed recall), Trail Making Test (TMT; time to complete parts A and B), Controlled Oral Word Association Test (COWAT total correct), and Animals (total correct). They also were administered the Chalder Fatigue Scale-11 (CFS-11), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Patient Health Questionnaire (PHQ-15). The percentage of patients with scores in the impaired range (z < -1.5) on cognitive tests was determined. Correlations between cognitive and non-cognitive measures were also examined.

The most frequent impairment was seen for COWAT (21.2%), followed by TMT-A and TMT-B (both 13.9%), then category fluency (9.1%). No patients were impaired on HVLT-R Learning and only one (4%) for HVLT-R Delayed Recall. Overall, the sample endorsed considerable depression, anxiety, fatigue, as well as physical symptoms. Greater fatigue was associated with worse verbal learning, processing speed, cognitive flexibility, and verbal fluency (letter and category). Worse physical symptom severity was related to poorer verbal delayed recall and cognitive flexibility. Greater anxiety was also associated with worse cognitive flexibility, while more severe depression was related to poorer category fluency.

In our sample of patients with PACS, seen for evaluation several months since contracting COVID-19, phonemic fluency was the most common cognitive impairment, though less than a quarter were impaired on any given cognitive test. Importantly, several associations were observed between cognitive test performance and non-cognitive symptoms commonly endorsed by patients with PACS. These findings highlight the importance of assessing multiple factors potentially contributing to cognitive impairment in these patients. Interventions designed to address such symptoms may be helpful in ameliorating cognitive functioning in those with PACS.

People with HIV (PWH) are at an increased risk for cognitive impairment as they age compared to their HIV-negative counterparts. Lifestyle factors can have protective effects on cognitive outcomes among PWH. However, little work has examined diet quality and cognitive function in PWH. Examining the association between diet quality and cognitive function among PWH is particularly important given this population’s increased risk for both poor diet quality and cognitive impairment. The purpose of this study was to examine the relationship between diet and cognitive function in aging PWH.

This cross-sectional study was conducted in Birmingham, Alabama and Cleveland, Ohio. Eighty-six PWH (mean age 56 years) completed standard triple-pass 24-hour diet recalls and a neurocognitive assessment. Partial Pearson’s correlations were conducted between diet variables and global neurocognitive function T scores, adjusting for total calories, sex, and education level.

Overall diet quality of the sample was poor. The overall sample presented with low Healthy Eating Index (HEI)-2015 scores, high glycemic index, twice the goal amount for saturated fatty acids (SFAs), and inadequate consumption of several nutrients typically associated with cognitive health including omega-3 fatty acids, dietary protein, fiber, Vitamin D, Zinc, and several B-vitamins. Greater total calories per day (r=0.28, p<0.05), greater percentage of total calories of SFAs (r=0.26, p<0.01), and lower glycemic index (r=-0.24, p<0.05) were associated with better cognition. Higher intake of several individual fatty acids, particularly SFAs, were associated with better cognition (correlations ranging from 0.23 to 0.31). Higher intakes of phosphorus (r=0.29, p<0.01), magnesium (r=0.25, p<0.05), and potassium (r=0.22, p<0.05) were associated with better cognition. Higher grams/day of several amino acids were associated with better cognition (correlations ranging from 0.22 to 0.27).

In a sample with overall poor diet quality not meeting recommended guidelines, findings suggest that being nourished in itself is associated with better cognitive function. Associations with several individual nutrients may inform potential intervention targets to protect brain health in PWH. Further, targeting food insecurity in interventions may have downstream effects on cognition in PWH.

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.

Approximately half of people living with HIV (PWH) experience HIV-associated neurocognitive disorders (HAND), yet HAND often goes undiagnosed. There is an ongoing need to find efficient, cost-effective ways to screen for HAND and monitor its progression in order to intervene earlier in its course and more effectively treat it. Prior studies that analyzed brief HAND screening tools have demonstrated that certain cognitive test pairs are sensitive to HAND cross-sectionally and outperform other screening tools such as the HIV Dementia Scale (HDS). However, few studies have examined optimal tests for longitudinal screening. This study aims to identify the best cognitive test pairs for detecting cognitive decline longitudinally.

Participants were HIV+ adults (N=132; ages 25-68; 59% men; 92% Black) from the Temple/Drexel Comprehensive NeuroHIV Center cohort. Participants were currently well treated (98% on cART, 92% with undetectable viral load, and mean current CD4 count=686). They completed comprehensive neurocognitive assessments longitudinally (328 total visits, average follow-up time=4.9 years). Eighteen participants (14% of the cohort) demonstrated significant cognitive decline, defined as a decline in global cognitive z-score of 0.5 (SD) or more. In receiver operating characteristic (ROC) analyses, tests with an area under the curve (AUC) of greater than .7 were included in subsequent test pair analyses. Further ROC analyses examined the sensitivity and specificity of each test pair in detecting significant cognitive decline. Results were compared with the predictive ability of the Modified HIV Dementia Scale (MHDS).

The following test pairs demonstrated the best balance between sensitivity and specificity in detecting global cognitive decline: Grooved Pegboard dominant hand (GPD) and category fluency (sensitivity=.89, specificity=.60, AUC=.75, p<.001), GPD and Coding (sensitivity=.76, specificity=.70, AUC=.73, p<.001), letter fluency and Trail Making Test (TMT) B (sensitivity=.82, specificity=.63, AUC=.73, p<.001), and GPD and TMT B (sensitivity=.81, specificity=.64, AUC=.73, p<.001). Change in MHDS predicted significant decline no better than chance (sensitivity=.61, specificity=.47, AUC=.53, p=.65).

Several cognitive test pairs, particularly those that include GPD, are sensitive to HIV-associated cognitive change, and far more sensitive and specific than the MHDS. Cognitive test pairs can serve as valid, rapid, cost-effective screening tools for detecting cognitive change in PWH, thereby better enabling early detection and intervention. Future research should validate the present findings in other cohorts and examine the implementation of test pair screenings in HIV care settings. Most of the optimal tests identified are consistent with the well-established impact of HAND on frontal-subcortical motor and executive networks. The utility of category fluency is somewhat unexpected as it places more demands on temporal semantic networks; future research should explore the factors driving this finding, such as the potential interaction of HIV with aging and neurodegenerative disease.

Cognitive difficulties are amongst the most frequently reported sequelae following COVID-19 infection, even in those experiencing mild to moderate illness (Matos et al., 2021). Recent research has identified patterns of diminished cognitive performance on tests of memory and executive functioning in COVID-19 cases; however, the etiology of neurocognitive difficulties remains unclear (Delgado-Alonso et al., 2022). Emerging evidence has identified moderate associations between decreased performance on neuropsychological tests of memory and elevated anxiety and depression symptom reporting in COVID-19 patients. Similar associations are well-established in the literature in persons with anxiety and depression disorders, warranting further investigation as to whether mental health variables such as internalizing symptom severity may moderate the association between COVID-19 illness and cognitive difficulties. This study examined how internalizing symptoms as indexed by depression and anxiety symptom scales may differentially influence performance on neuropsychological tests of memory between persons who have and have not had COVID-19.

In this cross-sectional study, 104 adults aged 19-80, were recruited in Ontario and British Columbia, Canada; 84 adults met inclusion criteria and participated in neuropsychological testing. There were 40 participants who tested positive for COVID-19 infection (N=44 with no suspected exposures or confirmed diagnosis of COVID-19). Participants had no history of dementia, mild cognitive impairment, or other known neurological disorder. Anxiety and depression symptoms were measured using the Generalized Anxiety Disorder-7 (GAD-7) and Center for Epidemiologic Studies Depression Scale (CES-D) via self-report on Qualtrics. Memory encoding and delayed recognition performance were assessed using the Hopkins Verbal Learning Test Revised (HVLT-R) and the Neuropsychological Assessment Battery Shape Learning subtest (NAB-SL). To test for potential moderating effects of anxiety and depression symptoms on the association between COVID-19 infection status and memory performance, a series of multiple linear regressions were conducted. Age and sex were included as covariates in all analyses.

Moderation analyses revealed that the interaction between COVID-19 infection and anxiety symptoms accounted for a significant portion of variance in both HVLT-R recognition (B= -0.78, SE= 0.34, p<0.05) and NAB-SL delayed recognition scores (B= -0.83, SE= 0.35, p<0.05). Simple slopes analyses revealed that among participants who tested positive for COVID-19 infection, higher GAD-7 scores were associated with lower verbal and visual recognition scores. A similar interaction was observed between COVID-19 and depressive symptoms in accounting for variance in NAB-SL delayed recognition scores, however, for that model the threshold of p=0.05 was not met in our small sample (p=0.07).

Findings demonstrate that anxiety symptom severity had a moderating effect on the impact of COVID-19 on delayed retrieval of verbal and visual information from memory. Future work in a larger sample is needed to further elucidate the potential moderating role of depression on memory in COVID-19 positive persons, as the current work suggests that depression symptoms could have a similar impact as anxiety. Further identifying the relationships between key modifiable psychological factors such as anxiety and memory following COVID-19 infection will provide insight into potential interventions to minimize the negative effects of internalizing symptoms on long-term cognitive outcomes.

Over 80% of hospitalized COVID-19 patients have neurological symptoms, including memory loss, attention difficulties, and trouble thinking clearly that can last for months. The long-term neurological impact of the SARS-CoV-2 virus is unknown and it remains to be seen whether it would create a surge in cases of dementia and cognitive decline years later, which is already a global public health challenge. Examining the cognitive effects of the virus will help with understanding its impact on the brain and inform treatment options. The goal of the present study was to examine cognitive performance among those who have had COVID-19 via mobile-based assessments using smartphone-based cognitive tests. Participants with a previous COVID-19 diagnosis (COVID+) were expected to have worse cognitive performance at baseline than those without COVID-19 (COVID-).

Participants (n=23) with self-reported positive or negative COVID-19 statuses based on polymerase chain reaction or antigen testing were recruited from the Boston area. Inclusion criteria included access to a smartphone with an Android or iOS operation

system and to internet connectivity, along with proficiency in English. Cognitive performance was measured using Defense Automated Neurobehavioral Assessment (DANA) from AnthroTronix. Welch’s 2-sample t-test was used to compare cognitive performance among those with and without COVID-19.

The sample was comprised primarily of COVID+ (59%), female (59%), and Caucasian (50%) participants that were generally well educated (77% with a bachelor’s degree), and had >1 COVID vaccination (95%). About 50% of the sample reported symptoms of depression and mild anxiety. Results were not indicative of significant differences between COVID+ and COVID- groups at baseline: Simple Reaction Time (Immediate; M = 5.62; p = 0.81), Code Substitution (M = 1.25; p = 0.77), Procedural Reaction Time (M = -7.26; p = 0.49), Spatial Processing (M = -3.14; p = 0.50), Go No Go (M = -1.37; p = 0.89), Match to Sample (M = 2.00; p = 0.57), Memory Search (M = -2.62; p = 0.75), and Simple Reaction Time (Delayed; M = 2.99; p = 0.81).

Results indicate that cognitive performance at baseline does not differ based on COVID status, emphasizing the need for examination of longitudinal cognitive performance. Future directions include examining the impact of COVID disease severity and reinfection on cognition.

Emerging evidence suggests that individuals recovering from COVID-19 perceive changes to their cognitive function and psychological health that persist for weeks to months following acute infection. Although there is a strong relationship between initial COVID-19 infection severity and development of prolonged symptoms, there is only a modest relationship between initial COVID-19 severity and self-reported severity of prolonged symptoms. While much of the research has focused on more severe COVID-19 cases, over 90% of COVID-19 infections are classified as mild or moderate. Previous work has found evidence that non-severe COVID-19 infection is associated with cognitive deficits with small-to-medium effect sizes, though patients who were not hospitalized generally performed better on cognitive measures than did those who were hospitalized for COVID-19 infection. As such, it is important to also quantify subjective cognitive functioning in non-severe (mild or moderate) COVID-19 cases. Our meta-analysis examines self-reported cognition in samples that also measured objective neuropsychological performance in individuals with non-severe COVID-19 infections in the post-acute (>28 days) period.

This study’s design was preregistered with PROSPERO (CRD42021293124) and used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist for reporting guidelines. Inclusion criteria were established prior to article searching and required peer-reviewed studies to have (1) used adult participants with a probable or documented diagnosis of non-severe (asymptomatic, mild, or moderate) COVID-19 who were in the post-acute stage (>28 days after initial infection); (2) used objective neuropsychological testing to document cognitive functioning; and (3) include a self-report measure of subjective cognition. At least two independent reviewers conducted all aspects of the screening, reviews, and extraction process. Twelve studies with three types of study design met full criteria and were included (total n=2,744).

Healthy comparison group comparison: Compared with healthy comparison participants, the post-COVID-19 group reported moderately worse subjective cognition (d=0.546 [95% CI (0.054, 1.038)], p=0.030). Severity comparison: When comparing hospitalized and not hospitalized groups, patients who were hospitalized reported modestly worse subjective cognition (d=-0.241, [95% CI (-0.703, 0.221)], p=0.30), though the difference was not statistically significant. Normative data comparison: When all non-severe groups (mild and moderate; k=12) were compared to the normative comparison groups, there was a large, statistically significant effect (d=-1.06, [95% CI (-1.58, -0.53)], p=0.001) for self-report of worse subjective cognitive functioning.

There was evidence of subjective report of worse cognitive functioning following non-severe COVID-19 infection. Future work should explore relationships between objective neuropsychological functioning and subjective cognitive difficulties following COVID-19.

Human immunodeficiency virus (HIV) type 1 (HIV-1), cardiovascular disease, and HIV-associated neurocognitive disorders (HAND) disproportionately affect Black/African American individuals compared to other racial and ethnic groups. Understanding the mechanisms of cognitive health disparities is essential for developing policy and health interventions to combat such disparities. Cardiovascular risk factors/diseases are common comorbidities that likely contribute to cognitive health disparities among Black/African American people living with HIV (PWH), but their impacts on cognition longitudinally in this population are unclear. The current study examines the relationship between cardiovascular risk and cognitive functioning over time in Black/African American adults living with HIV.

A sample of 122 Black/African American adults with HIV (ages 25-68, M=51.8, SD=7.7; 98% on antiretroviral therapy; 91% with undetectable viral load) were selected from the Drexel/Temple Comprehensive NeuroHIV Center, Clinical and Translational Research Support Core (CTRSC; based at Drexel University College of Medicine) Cohort. They completed longitudinal visits (300 total visits, average follow-up time=4.9 years) that included clinical interviews, medical record review, biometric measurements, and comprehensive neuropsychological assessments. Cardiovascular risk factors of interest were body mass index (BMI), waist-to-height ratio (WHtR), and a total vascular risk burden score (VBS) representing five risk factors: obesity, central obesity, diabetes, hyperlipidemia, and hypertension. Based on a prior principal component analysis, three cognitive domains were examined: (1) verbal fluency, (2) visual memory/visuoconstruction, and (3) motor speed/executive functions. Mixed models were used to examine domain-specific cognitive trajectories in relation to baseline cardiovascular risk factors and changes in cardiovascular risk factors.

Overall, cognitive test performance improved over time (p<.003). Baseline VBS was marginally associated with longitudinal change in verbal fluency (p=.06). Participants with low baseline VBS (0-1 risk factors) demonstrated improvement in verbal fluency (p=.002), while those with higher VBS (2-5 risk factors) demonstrated stability in verbal fluency. In contrast, greater increases in BMI and in WHtR predicted more favorable trajectories in motor speed/executive function (both p<.001). Patients with increasing BMI over time improved in this domain (p=.02), while patients with stable or decreasing BMI did not. A similar pattern was observed for WHtR change. No vascular risk factors were associated with trajectories of visual memory/visuoconstruction.

Higher total vascular risk burden was associated with less favorable verbal fluency trajectories, reflecting the negative cognitive consequences of disorders such as diabetes, hyperlipidemia, and hypertension. Unexpectedly, greater increases in BMI and WHtR were associated with more favorable trajectories in motor speed and executive functioning. In this population, weight gain may be a proxy for other positive health factors, such as immune reconstitution, which will be examined in future analyses. Taken together, cardiovascular risk factors have heterogeneous associations with cognitive trajectories, emphasizing the importance of examining the mechanisms of these varying relationships. Future research will examine how social determinants of health, such as racial/ethnic discrimination, contribute to disparities in cardiovascular risk factors and cognitive outcomes.

Social cognition refers to processing, analyzing and understanding information about emotions and social situations. Many studies indicate a frequent deficit of these functions in people with tumors of the cerebellum. Visual search is an important attention process prior to information processing. It also mediates the relationship between cognitive function (attention) and social cognition. There are numerous data showing that disorders of various aspects of attention are fairly common in patients with tumors of the cerebellum. The question arises whether there is any relationship between these functions. The purpose of this study was to find out if there is a relationship between visual search performance and the ability to recognize emotions.

The study included 19 patients with the cerebello-pontine angle (CPA) tumors (mean age = 38.84, SD = 14.27; 10 women and 9 men) and 19 healthy controls (mean age 38.26, SD = 10.40; 10 women and 9 men). The research group consisted of patients from the Department of Neurosurgery, UCK Medical University of Warsaw, the control group was healthy. The groups did not differ demographically. At the beginning, the respondents completed a questionnaire in which they were asked about demographic data and health status. Then, a series of 40 boards presenting the letters T in two colors, blue and orange, scattered in different planes was presented. The letters were right or upside down. The test person’s task was to find and click the correctly positioned orange T letter as quickly as possible. Then, a series of 56 photos of faces representing seven different emotions was presented (happiness, anger, sadness, surprise, disgust, fear and a neutral face). The test person’s task was to decide which of the emotions mentioned under the photo were presented by the presented face.

The results indicated that patients with tumors in the CPA area had a longer mean reaction time and lower accuracy when performing visual searches than subjects from the control group. Likewise, there were longer times and lower accuracy in the emotional recognition task. Moreover, in the group of patients with CPA tumor, the response time during visual search was negatively associated with the correctness of the response in visual search (p = -0.57, p <0.05). There were also negative correlations between the reaction time and the correctness of recognizing particular emotional states: anger (p = -0.48, p <0.05), disgust (p = -0.62, p <0.01) and neutral (p = -0.64, p <0.01). The correctness of answers in visual search correlated positively with the accuracy of emotion recognition (p = 0.72, p <0.01). None of the above-mentioned relationships were found in the control group.

The obtained results indicate a relationship between the quality of visual attention and the ability to recognize emotions in people with cerebellar lesions. In order to better understand this phenomenon, it is necessary to continue research in this field.

Arachnoid cysts are fluid-filled sacs thought to be a developmental abnormality which form as a result of splitting or duplication of the arachnoid membrane. In most cases, arachnoid cysts are congenital and asymptomatic throughout an individual’s life. Rarely, arachnoid cysts develop because of head injury, intraventricular hemorrhage of prematurity, presence of a tumor, infection or surgery on the brain. Intracranial cysts are typically incidental brain imaging findings and most commonly located in the middle fossa, the suprasellar region, and the posterior fossa. In cases where the cyst enlarges significantly individuals may experience symptoms of increased intracranial pressure, mass effects, seizures, nausea and vomiting, focal neurological deficits, or hydrocephalus. This presentation compares the differing symptom presentation of two individuals with medically confirmed arachnoid cysts -- one in the middle cranial fossa region (Patient A) and the other in the posterior cranial fossa region (Patient B).

The 2 patients were referred to a private practice neuropsychological clinic for neuropsychological assessment. Patient A was a 39-year-old, right-handed, married Syrian male with 12 years if education, unemployed at the time of testing. Changes in cognition, behavior and personality were reported for Patient A approximately two years after a known cerebrovascular accident. Patient B was a 48-year-old, left-handed married Caucasian male with 16 years of education, on disability due to his medical condition. Patient B reported severe memory impairment, speech and language deficits, variable attention, executive dysfunction, impaired gait with falls, emotional dysregulation, and sleep difficulties. He was diagnosed with bipolar disorder and alcohol use disorder in remission for 9 years.

Neuropsychological testing results for Patient A were not valid, due to initiation difficulties, paranoia about the testing and consequent limited engagement in the process. Predominant symptoms were consistent with negative symptoms of schizophrenia, (i.e., avolition, abulia, and diminished emotional expression); no positive symptoms were observed or reported. His speech was limited -he lacked spontaneous speech and only responded to direct questions. His informant completed a measure assessing pre/post changes in frontal systems and there were significant increases in apathy and executive dysfunction reported. Neuropsychological results collected from Patient B revealed mild to severe impairment of aspects of executive functioning, memory, processing speed, visual attention, expressive language, and manual dexterity bilaterally and manual motor strength - more consistent with subcortical neurological disease. Self-report and informant data revealed significant difficulties with functional abilities, pre/post changes in frontal systems (apathy, disinhibition, and executive dysfunction), sleep efficiency and daytime fatigue, and psychological distress (anxiety and depressive symptoms).

The presenting case analysis illustrates the importance of neuropsychology in identifying and tracking the nature of symptoms associated with neuroimaging confirmed arachnoid cysts. This case analysis is unique as it highlights the complexities of differing symptom phenotypes of the same condition due to location of the cyst. Surgical intervention usually through draining the cyst directly or implantation of a shunt is typically recommended for symptomatic patients and that course of treatment was suggested to both patients. Treatment recommendations geared to target psychosocial and functional difficulties should also be considered.

Migraine refers to recurrent, unilateral headache attacks, lasting 4-72 hours, that have a pulsating quality and can occur with or without aura. Aura is a symptom, usually preceding the onset of a migraine, where there is an experience of gradually spreading focal neurological symptoms which typically last less than one hour. A meta-analysis was conducted which quantitatively synthesized literature documenting performance on clinical measures of processing speed (PS) in individuals with migraine with (MwA) and without aura (MwoA).

Data for this study came from a larger study that compared overall neuropsychological functioning in primary headache disorders (PHD) and healthy controls (HC). We searched OneSearch and PubMed using a uniform search-strategy to locate original research comparing cognition between PHD and HC. Analyses were modeled under random effects. Hedge’s g was used as a bias-corrected estimate of effect size. We assessed between-study heterogeneity using Cochran’s Q and I2. Egger’s regression test was used to assess publication bias (i.e., the association between standard error and effect size). High heterogeneity in effects was analyzed for possible moderating variables using metaregression and sub-group analyses.

The initial search interval spanned inception-May 2021 and yielded 6692 results. Twelve studies met inclusion criteria, included clinical measures of PS, and included PHD subgroups with MwA and/or MwoA (MwA n = 279, MwoA n = 655, HC n = 2159). MwA demonstrated moderately worse performance in PS overall when compared to HC (k = 7, g = -0.41, p = 0.028). MwoA also demonstrated worse performance in PS overall when compared to HC but the effect size was small (k = 12, g = -0.21, p = 0.006). Heterogeneity of MwoA studies was low (Q = 15.12, I2 = 21.19) while heterogeneity of MwA studies was high (Q = 21.91, I2 = 72.61). Meta-regressions of MwA studies indicated clinical age and disease duration to be related to effect sizes such that studies with older clinical participants and longer disease durations yielded greater (negative) differences. Egger’s regression intercept noted a possible association effect size and standard error for MwA articles (t = 3.60, p = 0.02) and MwoA articles (t = 5.21, p < 0.005). Trim-and-fill procedure estimated 0 MwA studies to be missing due to publication bias (adjusted g = -0.41, p = 0.028) while 7 MwoA studies were estimated to be missing due to publication bias (adjusted g = -0.03, Q = 34.79).

Individuals with migraine demonstrated worse performances on tests of PS compared to controls. Effect sizes were generally moderate in strength for MwA while effect sizes were generally small in strength for MwoA. This quantitative summary confirmed that individuals with migraine experience slowed processing speed in general and this effect is magnified when aura is a presenting symptom.

Victims of electrical injury (EI) often experience injuries to the peripheral nervous system and neuromuscular damage that may diminish motor function, such as flexibility/dexterity. These difficulties may continue after rehabilitation due to the reorganization of muscle afferent projections during peripheral nerve regeneration. Therefore, understanding how patients with a history of thermal burn injuries perform on motoric measures is necessary to explain the impact neuromuscular damage has on both motor and non-motor tests of cognition. However, no studies have examined the impact of motor functioning on cognition in patients who experienced thermal and electrical injuries compared to an electrical shock injury. This study explored the impact of motor dysfunction and psychiatric distress measured by depression severity on psychomotor speed and executive test performances among EI patients with and without thermal burn injuries.

This cross-sectional study consisted of EI patients undergoing an outpatient neuropsychological evaluation, including tests of motor dexterity (Grooved Pegboard [GP]), psychomotor speed (Wechsler Adult Intelligence Scale-IV Coding, Trail Making Test [TMT] Part A), and executive functioning (Stroop Color and Word Test [SCWT] Color-Word trial, TMT Part B). The sample was 83% male and 17% female, 88% White, 3% Black, 5% Hispanic, and 2% other race/ethnicity, with a mean age of 43.9 years (SD=11.36), mean education of 12.9 years (SD=2.05), and mean depression severity of 20.05 (SD=12.59) on the Beck Depression Inventory-II (BDI-II). Exclusion criteria were: 1) injury history of moderate-to-severe head trauma, 2) >2 performance validity test failures, and 3) any amputation of the upper extremity. Regression analyses included GP T-Scores for dominant hand and BDI-II total score as independent variables and neuropsychological normative test data as dependent variables.

Among validly performing patients with EI (n=86), regression analyses revealed GP performance accounted for significant variance (R2 =.153-.169) on all neuropsychological measures. Among EI patients with burn injuries (n=50), regression analyses revealed GP performance accounted for significant variance (R2 =.197-.266) on all neuropsychological measures. Among EI patients without burn injuries (n=36), analyses revealed that neither GP performance nor BDI-II severity accounted for significant variance across the neurocognitive tests (R2=.056-.142). Furthermore, among EI patients with burn injuries and the total sample, regression analyses revealed depression severity negatively predicted GP performance (R2 =.099-.13), however, in patients without burn injuries, depression did not predict GP performance (R2 =.052).

Overall, results showed that GP performance is a significant predictor of neurocognitive performance on both motor and non-motor measures in EI patients with burn injuries. Therefore, among EI patients with burn injuries, GP performance may have potential utility as an early indicator of injury severity, considering that it predicts neuropsychological test performance on measures of psychomotor speed and executive functioning. Lastly, depression predicted GP performance within the burn injury sample illustrating that psychological distress may negatively impact motor functionality.

Primary headache disorder is characterized by recurrent headaches which lack underlying causative pathology or trauma. Primary headache disorder is common and encompasses several subtypes including migraine. Vestibular migraine (VM) is a subtype of migraine that causes vestibular symptoms such as vertigo, difficulties with balance, nausea, and vomiting. Literature indicates subjective and performance-based cognitive problems (executive dysfunction) among migraineurs. This study compared the magnitude of the total effect size across neuropsychological domains to determine if there is a reliable difference in effect sizes between individuals with VM and healthy controls (HC). An additional aim was to meta-analyze neuropsychological outcomes in migraine subtypes (other than VM) in reference to healthy controls.

This study was a part of a larger study examining neuropsychological functioning and impairment in individuals with primary headache disorder and HCs. Standardized search terms were applied in OneSearch and PubMed. The search interval covered articles published from 1986 to May 2021. Analyses were random-effects models. Hedge’s g was used as a bias-corrected estimate of effect size. Between-study heterogeneity was assessed using Cochran’s Q and I2. Publication bias was assessed with Duval and Tweedie’s Trim-and-Fill method to identify evidence of missing studies.

The initial omnibus literature search yielded 6692 studies. Three studies (n=151 VM and 150 HC) met our inclusion criteria of having a VM group and reported neuropsychological performance. VM demonstrated significantly worse performance overall when compared to HCs (k=3, g=-0.99, p<0.001; Q=4.41, I2=54.66) with a large effect size. Within-domain effects of VM were: Executive Functioning=-0.99 (Q=0.62, I2=0), Screener=-1.15 (Q=3.29, I2=69.59), and Visuospatial/Construction=-1.47 (Q=0.001, I2=0.00). Compared to chronic migraine (k=3, g=-0.59, p<0.001; Q=0.68, I2=0.00) and migraine without aura (k=23, g=-0.39, p<0.001; Q=109.70, I2=79.95), VM was the only migraine subgroup to display a large effect size. Trim-and-fill procedure estimated zero VM studies to be missing due to publication bias (adjusted g=-0.99, Q=4.41).

This initial attempt at a meta-analysis of cognitive deficits in VM was hampered by a lack of studies in this area. Based on our initial findings, individuals with VM demonstrated overall worse performances on neuropsychological tests compared to HCs with the greatest level of impairment seen in visuospatial/construction. Additionally, VM resulted in a large effect size while other migraine subtypes yielded small to moderate effect sizes. Despite the small sample of studies, the overall effect across neuropsychological performance was generally stable (i.e., low between-study heterogeneity). Given than VM accounts for 7% of patients seen in vertigo clinics and 9% of all migraine patients, our results suggest that neuropsychological impairment in VM deserves significantly more study.

Individuals with chronic pain frequently report diminished cognitive functioning. Prior cross-sectional studies have demonstrated strong associations between chronic pain and neurocognitive impairment, most notably in memory, attention, processing speed, and executive functioning. However, there is a paucity of research evaluating visual learning and memory abilities in this population. Further, while current practice standards advocate for the use of performance validity tests (PVTs) to assess the credibility of neuropsychological test performance, they have infrequently been incorporated into studies examining chronic pain samples, despite a higher observed rate of noncredible performance in the literature. This study aimed to compare visual learning and memory performance between a mixed neuropsychiatric (MNP) group and a chronic pain group in a validity-controlled sample.

The study consisted of 371 adults referred for outpatient neuropsychological evaluation. Between groups, various PVTs were administered, which included, at minimum, one freestanding and four embedded PVTs. All patients were administered the Brief Visuospatial Memory Test-Revised (BVMT-R) as part of a comprehensive neuropsychological evaluation. Only patients classified as valid performers (<1 PVT fails; n=295) were included in the analyses (Pain: n=109; MNP: n=186). The overall sample was 69% female and racially diverse (22% non-Hispanic Black, 43% non-Hispanic White, 30% Hispanic, 3% Asian/Pacific Islander, and 2% other race/ethnicities), with a mean age of 46.8 (SD=14.8) and mean education of 13.7 years (SD=2.7). Independent samples t-tests were performed to investigate the differences in visual learning and memory abilities between the chronic pain and MNP groups.

Chi-square analyses revealed significant differences between the pain and MNP groups on race, with more non-Hispanic White and Hispanic patients represented in the MNP group. There were also modest group differences in age and education. For the chronic pain group, patients scored lower on both BVMT-R Total T-Score (mean difference = 9.65T, p<.001) and BVMT Delayed Recall T-Score (mean difference = 8.97T, p<.001). The effect size was robust for both for Total T-Score (d = 0.682) and Delayed Recall T-Score (d = 0.632). In contrast, the difference in BVMT Recognition Discriminability was not statistically significant.

This study demonstrated significant differences in performance between mixed neuropsychiatric and chronic pain patients. Preliminary evidence indicated that chronic pain patients displayed lower visual mediated encoding and retrieval performance, although their recognition is comparable. Although the nature of this study was targeted toward visual learning and retrieval, it is likely that the known impact of chronic pain on attention, working memory, and processing speed accounts for this relationship. Future studies will benefit from further elucidating these potential mechanisms and better inform clinical decision-making and neuropsychological testing performance in patients with chronic pain.