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Background: Remote and unsupervised administration of neuropsychological tests may increase opportunities to understand cognition in everyday life compared to in‐clinic assessments. The technological sophistication and widespread use of smartphones now allows this platform to be used for remote neuropsychological testing. However, it is important to ensure that the validity of neuropsychological tests extends to remote and unsupervised administration. As the Cogstate Brief Battery (CBB) has been validated for remote use on computers, the aim of this study was to now examine whether the acceptability and validity holds when administered via smartphone to cognitively unimpaired (CU) middle‐aged and older adults. Method: CU adults (n = 173) aged 41‐75 years (M(SD) = 62.72 (7.18)) enrolled in the Healthy Brain Project completed the smartphone CBB remotely. The mean speed and accuracy of performance on the Detection (DET, psychomotor function), Identification (IDN, attention), One Back (OBK, working memory) and One Card Learning (OCL, visual learning) tests were used to define performance. Acceptability was determined by the percentage of participants completing the full CBB. Relationships between CBB performance with age and test difficulty were described to inform validity. Relationships between objective CBB performance and subjective ratings of how participants felt about their overall performance, obtained via survey, were also explored. Result: 100% of participants completed the smartphone CBB. Increasing age was associated with slower performance on all tests (Figure 1a‐1d), and reduced accuracy on the OBK (Figure 1h). Older adults (66+ years) performed slower than middle‐aged adults (40‐65 years) on all CBB tests, and with less accuracy on OBK (Table 1). Performance speed across all tests slowed with increasing test difficulty (Figure 2). Whilst a ceiling effect was observed for accuracy of simpler tests (DET, IDN, OBK), accuracy was lowest for the most difficult test (OCL) (Figure 2). Subjective ratings of overall CBB performance was significantly, albeit weakly, correlated with OCL accuracy (r = 0.23, p =.003). Conclusion: The results support the acceptability and validity of the remote, unsupervised administration of the smartphone CBB in CU middle‐aged and older adults. These results provide a foundation for gaining further understanding of the performance of the smartphone CBB in diverse and impaired populations. [ABSTRACT FROM AUTHOR]

Psychological stress is a potential modifiable risk factor for cognitive decline. However, the extent to which self-reported psychological stress is differentially associated with decline in specific cognitive domains remains unclear. Differences may be due to heterogeneity in the aspects of psychological stress investigated, for example, neuroticism (which is linked to vulnerability to stress), perceived stress, or exposure to stressful life events. This review aims to establish the associations between these aspects of self-reported psychological stress and cognitive decline. PsychINFO, Embase and MEDLINE were searched from database inception to September 2021. Studies were included if they were observational, prospective, and if they investigated the association between self-reported psychological stress and cognitive decline in adults with a minimum mean age of 40 years at baseline. Thirty studies satisfied the inclusion criteria, with most examining neuroticism (n = 17) as a predictor of cognitive decline. Fewer examined perceived stress (n = 7) or stressful life events (n = 6). There was evidence of an association between neuroticism and cognitive decline, particularly in the domain of memory. Similarly, across studies, perceived stress was also associated with memory decline. Research investigating the relationship between stressful life events and cognitive decline had fewer outcomes to interpret. Overall, the findings highlight that memory may be particularly susceptible to high levels of neuroticism and perceived stress. We identified a lack of research into some cognitive domains, such as executive function, which should be addressed by future studies. [ABSTRACT FROM AUTHOR]

Background: The International Shopping List Test (ISLT) is a rater‐administered verbal list learning test, sensitive to memory dysfunction in early Alzheimer's disease (AD). This study examined the acceptability of a self‐administered ISLT (called LILA) in cognitively unimpaired (CU) middle‐aged and older adults. The validity of LILA was determined by the nature of ISLT learning curves and from examination of the effects of age. Method: CU adults (n = 113) completed LILA on their own smartphone device in a remote, unsupervised setting (n = 113). The LILA app administered a novel ISLT, where a list of 12 shopping list items was read aurally through the speaker to the participant. Participants were required to recall, into the smartphone, as many words as they could remember. This immediate recall trial was repeated three times (T1‐3). After a 10‐minute delay, participants recalled as many of the 12 words as they could. LILA performance measures included, number of words recalled on each trial, and on the delayed recall trial. Result: 10% of participants (n = 11) failed to provide a response on at least one learning trial (T1 = 3, T2 = 2, T3 = 4, DR = 2), with this data excluded from subsequent analyses. All participants reported feeling highly (74%) or moderately (26%) confident about using a smartphone, and reported using their phone daily. Improvement in immediate recall, known to occur for the ISLT was observed for LILA (Fig 1). Lower LILA immediate recall scores were associated with older age and higher depressive symptomatology (Table 1), but not sex, education or anxiety symptoms. Lower scores on delayed recall was associated with male sex and lower years of education (Table 1), but not age or mood symptoms. Conclusion: The very low rate of data loss indicates high acceptability of LILA in CU middle‐ and older‐aged adults. Validity of performance was indicated by the learning curves, which were qualitatively similar to those of the rater‐administered ISLT, and the effect of age on the immediate recall outcome. These data provide a strong foundation for future studies of the sensitivity of LILA to memory impairment in AD. [ABSTRACT FROM AUTHOR]

Background: The apolipoprotein E (APOE) ɛ4 allele is associated with dose-response effects on cognitive dysfunction and dementia risk in older adults. However, its effects on cognition in middle-aged adults remains unclear.Objective: We examined effects of ɛ4 heterozygosity and homozygosity on objective and subjective cognition in middle-aged adults enrolled in the Healthy Brain Project (HBP) and in older adults from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study.Methods: HBP participants (1,000 non-carriers; 450 ɛ4 heterozygotes; 50 ɛ4 homozygotes) completed unsupervised assessments of the Cogstate Brief Battery (CBB), ratings of subjective cognitive function and provided a saliva sample. AIBL cognitively normal participants (650 non-carriers; 204 ɛ4 heterozygotes; 31 ɛ4 homozygotes) completed in-person assessments of the CBB, ratings of subjective cognitive function and provided a blood sample.Results: Greater memory impairment was observed in middle-aged ɛ4 homozygotes compared with ɛ4 heterozygotes and non-carriers. When data from middle-aged (HBP) and older (AIBL) adults were pooled, the effect of ɛ4 homozygosity and memory impairment increased with age. In both middle-aged and older adults, ɛ4 heterozygotes did not differ from non-carriers on any measure of objective or subjective cognition.Conclusion: Memory impairment in ɛ4 homozygotes is evident in adults aged 50-60 years, and this can be detected through unsupervised cognitive assessments. The effect of ɛ4 homozygosity increases with older age. APOEɛ4 homozygosity has a negative impact on memory as early as midlife, but due to the subtle magnitude of effect, our findings support the necessity of online platforms in large cohorts to assess these complex relationships. [ABSTRACT FROM AUTHOR]

Background: A range of lifestyle factors in midlife can increase risk for developing dementia in late‐life.1 However, it remains unclear whether the presence of such risk factors (RFs) is associated with individuals' insight into their risk of developing dementia. In a group of middle‐aged adults with a family history of dementia enrolled in a lifestyle prevention trial, we measured associations between modifiable RF prevalence, subjective cognitive concerns, and perceived susceptibility to dementia. Method: Participants (n = 456) enrolled in BetterBrains (betterbrains.org.au)2 completed a comprehensive self‐report RF assessment at baseline. Modifiable dementia risk was determined across four domains (vascular health, social/cognitive engagement, mood, sleep) and trial eligibility required risk in at least one domain. Participants were grouped according to the number of domains in which they reported high‐risk (ranging from 1‐4). Participants completed the Cognitive Function Instrument, and a brief questionnaire to assess perceived susceptibility to dementia (Motivation to Change Lifestyle/Health Behaviours for Dementia Risk Reduction scale). Linear regressions examined associations between modifiable RF prevalence, subjective cognition, and perceived susceptibility to dementia, adjusting for age, sex, education, negative beliefs about ageing, and beliefs about protective health behaviours on dementia risk. Result: Participants were mostly female (80%), with an average age of 59.4 years and 15.2 years of education. Of the sample, 29.6% reported risk in all domains (29.6%) and 16.9% in three domains. Risk in a higher number of RF domains was significantly associated with greater subjective cognitive concerns (β(SE) = 0.18(0.06), p = <.001), but not with greater perceived susceptibility to developing dementia (β(SE) = 0.62(0.35), p =.08). Increasingly negative beliefs about ageing and weaker beliefs in the protective effect of health behaviours were the only significant predictors of perceived susceptibility to dementia (both p's <.05). Conclusion: In middle‐aged adults, dementia RFs are associated with greater subjective cognitive concerns, but not with an increased perception of susceptibility to dementia. Incongruence between participants' self‐report of subjective cognitive concerns and susceptibility to dementia may be due in part to poor knowledge on modifiable dementia RFs.3 Perceptions of personal susceptibility to dementia may also be tied more closely to negative ageing stereotypes typically associated with older age and family history of disease. [ABSTRACT FROM AUTHOR]

Background: Characterization of the contribution of modifiable risk factors (MRF) to dementia generally consider MRFs individually, despite strong evidence that MRFs co‐occur. In a large group of middle‐aged adults, the prevalence and co‐occurrence of MRFs for dementia was determined, spanning five broad domains (mood, lifestyle behaviours (e.g., physical inactivity), cardiovascular health, cognitive/social engagement, and sleep). We then investigated relationships between MRFs, both individually and combined, to cognitive performance and subjective cognition. Method: Middle‐aged adults (n = 1610), most (70%) with a family history of dementia, enrolled in the Healthy Brain Project, completed an extensive set of questionnaires about their physical and psychological health and lifestyle. Participants also completed the Cogstate Brief Battery (CBB), and the Cognitive Function Instrument (CFI), a measure of subjective cognition. Participants were classified according to the number of domains (mood, lifestyle behaviours, cardiovascular health, cognitive/social engagement, and sleep, ranging from 0‐5) in which they reported at least one MRF. Age, sex, education and ethnicity were adjusted for in analyses. Result: Most participants (65%) reported at least one MRF in two or more domains (Fig 1A). Compared to participants reporting no MRFs, participants who reported at least one MRF in 3‐5 domains showed worse memory performance and reported greater subjective cognitive concerns, with magnitudes of differences moderate to large (d = 0.30‐0.93; Fig 1B). Participants who reported at least one MRF in five domains also showed worse attention than those reporting no MRFs (d = 0.58). When individual MRFs were considered simultaneously, MRFs in the mood (e.g., anxiety symptomatology) and cognitive/social engagement domains (e.g., leisure activities) were associated with worse attention and memory performance. Individual MRFs reflecting mood and sleep symptomatology were associated with greater subjective cognitive concerns. Conclusion: In middle‐aged community dwelling adults, multidomain MRFs for dementia are highly prevalent and co‐occur, and are associated with poorer cognitive outcomes. This suggests that the presence of multiple MRFs as early as midlife may have negative neurological outcomes, however, this will need to be explored in future neuroimaging studies. These findings indicate that multidomain lifestyle prevention trials in middle‐aged adults may be useful to delay or prevent future cognitive impairment or dementia. [ABSTRACT FROM AUTHOR]

Introduction: Engagement in cognitively stimulating work and activities may slow cognitive decline and dementia. We examined the individual and combined associations of four cognitive engagement indices (educational attainment, occupational complexity, social engagement, and cognitively stimulating leisure activities) with objective and subjective cognition., Methods: Middle-aged adults (n = 1864) enrolled in the Healthy Brain Project completed the Cogstate Brief Battery, the Cognitive Function Instrument, and self-report questionnaires of cognitive engagement., Results: Educational attainment and leisure activity engagement were individually associated with memory performance. Participants were classified based on whether they rated highly in zero to four cognitive engagement indices. Compared to participants with no indices, participants with two or more indices performed moderately better on memory., Discussion: Results suggest that greater variety of cognitive engagement across different areas of life is related to better memory in midlife. Possible explanation for this relationship may be increased opportunity for enhancing cognitive reserve, but further investigations are required., Competing Interests: P. Maruff is a full‐time employee of Cogstate Ltd., the company that provides the Cogstate Brief Battery. All other investigators have no relevant disclosures to report., (© 2021 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, LLC on behalf of Alzheimer's Association.)