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Background: Efficacy and validity of the MoCA for cognitive screening in ethnoculturally and linguistically diverse settings is unclear. We sought to examine the utility and discriminative validity of the Spanish and English MoCA versions to identify cognitive impairment among diverse community‐dwelling older adults. Methods: Participants aged ≥65 with cognitive concerns attending outpatient primary care in Bronx, NY, were recruited. MoCA and neuropsychological measures were administered in Spanish or English, and a neuropsychologist determined cognitive status (normal with subjective cognitive concerns [SCC], mild cognitive impairment [MCI], and dementia). One‐way ANOVA compared cognitive statuses. ROC analyses identified optimal MoCA cutpoints for discriminating possible cognitive impairment. Results: There were 231 participants, with mean age 73, 72% women, 43% Hispanic; 39% Black/African American; 113 (49%) completed testing in English and 118 (51%) in Spanish. Overall MoCA mean was 17.7 (SD = 4.3). Neuropsychological assessment identified 90 as cognitively normal/SCC, average MoCA 19.9 (SD = 4.1), 133 with MCI, average MoCA 16.6 (SD = 3.7), and 8 with dementia, average MoCA 10.6 (SD = 3.1). Mean English MoCA average was 18.6 (SD = 4.1) versus Spanish 16.7 (SD = 4.3). The published cutpoint ≤23 for MCI yielded a high false‐positive rate (79%). ROC analyses identified ≤18.5 as the score to identify MCI or dementia using the English MoCA (65% sensitivity; 77% specificity) and ≤16.5 for the Spanish MoCA (64% sensitivity;73% specificity) in this sample of older adults with cognitive concerns. Conclusions: Current MoCA cutpoints were inappropriately high in a culturally/linguistically diverse urban setting, leading to a high false‐positive rate. Lower Spanish and English MoCA cutpoints may improve diagnostic accuracy for identifying cognitive impairment in this group, highlighting the need for the creation and validation of accurate cognitive screeners for ethnoculturally and linguistically diverse older adults. [ABSTRACT FROM AUTHOR]

Introduction: Language acculturation is the process by which a bilingual individual obtains proficiency and comfort in speaking a new language while maintaining fluency in their native language. Considering the degree of language acculturation in bilingual patients is essential to choosing appropriate tests and interpreting neuropsychological assessment. The Language Acculturation Meter™ (LAM) was created for native Spanish speakers who are bilingual in English to aid in selecting and interpreting verbally-administered assessments. While the LAM was created to be completed as an interview, a Spanish version of the form exists and can be given to patients to complete independently. We sought to evaluate the feasibility and utility of self-administered LAM in a clinical older adult population in NY State. Methods: The LAM was given to Spanish-speaking older adults and their caregivers as part of their clinical neuropsychological evaluation at Montefiore's Memory Disorders Centers. 16 patient and caregiver dyads completed the LAM in either English or Spanish. Results: Patient ages ranged from 67 to 83; 75% of the patients were female, and 56% self-identified as bilingual. 18% of patients completed the LAM without caregiver assistance. Dyads did not comment on the form, but early qualitative feedback suggests that some had difficulty understanding how to complete aspects of the LAM, and others found that some items on the LAM did not apply to them. Conclusions: The LAM is a previously validated interview tool that requires further research to determine if it can be used as a self-report questionnaire in clinical populations, including older adults with cognitive complaints. [ABSTRACT FROM AUTHOR]

Objective: Anti-leucine-rich glioma-inactivated 1 limbic encephalitis (LGI1-LE) is a rare diagnosis but the second most common autoimmune encephalitis. While it has a growing body of neuropsychological literature, there is limited awareness by the lay public about this condition. As with all complex neurological conditions, caregiver/family understanding of the disorder and engagement in treatment is important for optimal recovery and dyad wellbeing. We present the case of a caregiver and patient dyad with confirmed LGI1-LE/ Voltage-Gated Potassium Channel antibodies seen for repeat neuropsychological evaluations to demonstrate the importance of education, advocacy, and multidisciplinary involvement as part of the neuropsychological assessment process. Method: Repeat neuropsychological evaluations of a 72-year-old Spanish-speaking woman with limited formal education and complex medical history, including past strokes and recent autoimmune encephalitis. Results: Initial evaluation revealed marked behavioral and cognitive fluctuations/variability with familial frustration secondary to poor understanding by caregiver until neuropsychological feedback session. Repeat evaluation was delayed four weeks due to caregiver factors but demonstrated improvement in global cognition and overall functioning. Follow up, six months later, demonstrated significant cognitive decline and new motoric symptoms with further difficulty coordinating appointments by the caregiver. In addition to assistance with medical management, neuropsychological involvement led to connection to case management, home evaluation, concrete solutions for food insecurity, and cognitive evaluation for the caregiver. Conclusions: This case adds to LG1-LE literature and demonstrates the importance of neuropsychology not only for disease tracking/ management but also as an important tool for advocacy and patient/caregiver education, specifically in culturally and educationally diverse populations with complex medical conditions. [ABSTRACT FROM AUTHOR]

Objective: Neuropsychiatric System Lupus Erythematosus (NP-SLE) is a subtype of SLE characterized by chronic or episodic neurologic and/or psychiatric central nervous system features. The neuropsychological profile of NP-SLE is not well-established. Here we present serial evaluations of a woman with confirmed NP-SLE who underwent subsequent medical intervention. This case study adds to the growing body of literature demonstrating the role neuropsychology plays in the care of patients with NP-SLE. Method: This was an evaluation of a 25-year-old woman with NP-SLE. Initial testing took place inpatient prior to treatment with immunotherapy treatment subsequent evaluations were outpatient at 1 month, 4 months and 8 months post-treatment. Results: Inpatient evaluation revealed a woman of at least average premorbid abilities with suboptimal performances across cognitive domains including reduced speed of processing and notable difficulty with planning and organization. Evaluation 1 month later evidenced worsening cognitive and motoric performances across tasks which led to adjustment of medical management. Evaluation at 4 months demonstrated a positive trend and some improved cognitive functioning; 8-month evaluation confirmed improvement in global cognition and functioning with suspected return to premorbid abilities. Conclusions: This case provides an example of NP-SLE neuropsychological profile over time and demonstrates the beneficial impact of correct diagnosis and medical regimen. It also highlights the role of serial neuropsychological assessment in the management of complex neurological disease. [ABSTRACT FROM AUTHOR]

Objective: Wernicke-Korsakoff syndrome (WKS) is a neurological disorder caused by the lack of thiamine (vitamin B1) and includes Wernicke encephalopathy and the later stage of Korsakoff amnesic syndrome. WKS could be secondary to malnutrition, including Hyperemesis Gravidarum (HEG), which is characterized by severe vomiting during pregnancy. We present a case of HEG resulting in suspected WKS where neuropsychological evaluation clarified cognitive status with complex cultural, language, and educational factors. Method: Repeat evaluations of a 29-year-old West-African* woman with mental status change, decreased verbal output, agitation, and inability to walk in the context of HEG. Initially referred for inpatient neuropsychological evaluation at 21 weeks gestation. MRI demonstrated mild diffuse cerebral atrophy and symmetric foci of T2 FLAIR hyperintensities in periaqueductal gray matter, hypothalamus, bilateral thalami, perirolandic cortex, and bilateral mammillary bodies. Results: Initial inpatient testing with a face-to-face language congruent interpreter demonstrated notable multidomain impairment. Possible Intellectual Disability was considered by the referring team and test performances. Attempts at re-evaluation were limited by medical complications and prolonged hospitalization. Repeat inpatient evaluation 5 months later following birth of healthy child and initiation of stimulant medication, demonstrated profound memory impairment but otherwise improved cognitive capacity and engagement. Results aided in discharge planning including cognitive remediation with goal of improving functional independence. Conclusions: Wernicke-Korsakoff syndrome due to Hyperemesis Gravidarum is an uncommon but known complication that can have profound acute and long-term consequences. This case demonstrates that repeat neuropsychological evaluations can clarify cognitive status in complex medical/cultural/language situations. *(country of origin and primary language not provided for patient privacy). [ABSTRACT FROM AUTHOR]

Objective: The KCNQ2 gene mutations (KCNQ2), a known cause of neuronal potassium channel dysfunction in brain cells, causes susceptibility to seizures beginning within the first days of life. Seizure semiology, severity and cognitive sequela can vary depending on the type of KCNQ2 mutation. Cognitive impact ranges from moderate to severe; no known consistent presentation. KCNQ2 affects approximately 2.8 in 100,000 births: over 3,000 annual cases worldwide. We describe the neuropsychological findings of an 11-year-old female with a monoallelic mutation of the KCNQ2 gene, and history of seizures. EEG indicated generalized epilepsy syndrome with a right occipital focal area of dysfunction. We highlight the importance of neuropsychological evaluation in medical and psychological management of children with KCNQ2. Methods: Medical history includes multifocal seizures beginning at 2 days old and significant anxiety, both managed with medication, language delay, and a diagnosis of KCNQ2 at age 9. A comprehensive neuropsychological evaluation was conducted to assess slower processing speed, behavioral concerns, and anxiety. Results: Evaluation revealed low average overall cognition and average academic performances, with strengths in verbal comprehension, fluid reasoning, and written expression. Cognitive processing speed was atypical, with slow processing speed affecting her performance across multiple domains. Behavior assessment supports Generalized Anxiety Disorder. Conclusion: This case of a girl with KCNQ2 demonstrated an atypical cognitive and behavioral profile, contributing to our limited knowledge of how KCNQ2 presents. The patterns of her performances add to the literature of the KCNQ2 gene mutation and raise important questions regarding the role of KCNQ2 in manifestations of cognitive and behavioral symptoms. [ABSTRACT FROM AUTHOR]

Objective Spinocerebellar ataxia 29 (SCA29) is a rare autosomal dominant disorder resulting in infantile-onset hypertonia, gross motor delay and cognitive impairment. SCA29 causes cerebellar dysfunction and atrophy manifested by poor hand coordination, instability of gait, impaired articulation, poor hand-eye coordination, language delay, and a wide legged, unsteady walk. Slow improvement across childhood is common, but the limited available research suggests significant clinical heterogeneity among individuals diagnosed with SCA29. We report the case of a six-year-old first grade girl to highlight the cognitive profile of SCA29 and determine its consistency with the literature. Methods Full neuropsychological evaluation was conducted, including examination of overall cognitive ability, academic achievement, and behavior. Results The patient demonstrated delayed cognitive and motor skills, slow processing, reduced reading fluency, and weak reading comprehension. Impaired verbal comprehension and limited fund of knowledge was seen. Working memory and visual spatial ability were relative individual strengths, though normatively weak. Untimed and non-motor academic skills were well below peers. Performances met criteria for ADHD and Language Disorder. Conclusion Six-year-old girl with SCA29 with expected motor difficulties including gross motor delay, hypotonia, ataxia, poor ocular fixation evidenced global impairments with expected weakness with verbal comprehension and receptive language skills. This is consistent with the findings in the SCA29 literature. Comorbid diagnoses of ADHD and Language Disorder were present. Given clinical heterogeneity, this case serves to expand existing knowledge on case variability, and adds the consideration of wider comorbidities in this rare condition. [ABSTRACT FROM AUTHOR]

Objective Developmental Discoordination Disorder (DCD) is an often overlooked and seldom diagnosed neurodevelopmental condition marked by impairments in motor skills. Lacking identifiable medical or neurological etiology, children with DCD often have preserved intellectual abilities. Comorbidity is common, including ADHD and specific learning disability. Despite extensive evidence of significant impact on daily activities and academics due to differences in motor behaviors, DCD difficulties are regularly treated as behavioral problems. Method Neuropsychological evaluation of an 8-year-old boy with a possible reading delay and inability to perform some age-appropriate academic and self-care tasks. Results Average overall ability with very strong verbal performances; intact visual perceptual processing, memory, and non-written language. Academics are within expected range, although graphomotor weakness impacted academic performances on tasks with written demands. Patient appeared clumsy and awkward with low muscle tone, poor balance, and difficulty learning new motor skills. Impaired fine motor control, handwriting, gait, gross motor skills, motor planning, coordination, and oromotor weakness as well as inferior verbal language abilities were evident. Impulsivity, inattention, poor planning, and poor self-monitoring were also evident. Conclusions DCD is evidenced by impairment in fine and gross motor skills, oromotor skills, motor planning, energy, and coordination with clear discrepancy between motor abilities and abilities in other areas, specifically language. In our case, DCD features were overlooked despite wide ranging impact. ADHD and SLD with impairment in written expression were concurrent. This case highlights the need for greater appreciation of DCD so that children can benefit from early detection and intervention considering the life-long implications of the disorder. [ABSTRACT FROM AUTHOR]