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ObjectivesThe distinction between bipolar I disorder (BD-I) and bipolar II disorder (BD-II) has been a topic of long-lasting debate. This study examined differences between BD-I and BD-II in a large, global sample of OABD, focusing on general functioning, cognition and somatic burden as these domains are often affected in OABD.MethodsCross-sectional analyses were conducted with data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) database. The sample included 963 participants aged ≥50 years (714 BD-I, 249 BD-II). Sociodemographic and clinical factors were compared between BD subtypes including adjustment for study cohort. Multivariable analyses were conducted with generalized linear mixed models (GLMMs) and estimated associations between BD subtype and (1) general functioning (GAF), (2) cognitive performance (g-score) and (3) somatic burden, with study cohort as random intercept.ResultsAfter adjustment for study cohort, BD-II patients more often had a late onset ≥50 years (p=0.008) and more current severe depression (p=0.041). BD-I patients were more likely to have a history of psychiatric hospitalization (p

Delirium and dementia are common causes of cognitive impairment among older adults, which often coexist. Delirium is associated with poor clinical outcomes, and is more frequent and more severe in patients with dementia. Identifying delirium in the presence of dementia, also described as delirium superimposed on dementia (DSD), is particularly challenging, as symptoms of delirium such as inattention, cognitive dysfunction, and altered level of consciousness, are also features of dementia. Because DSD is associated with poorer clinical outcomes than dementia alone, detecting delirium is important for reducing morbidity and mortality in this population. We review a number of delirium screening instruments that have shown promise for use in DSD, including the 4-DSD, combined Six Item Cognitive Impairment Test (6-CIT) and 4 'A's Test (4AT), Confusion Assessment Method (CAM), and the combined UB2 and 3D-CAM (UB-CAM). Each has advantages and disadvantages. We then describe the operationalization of a CAM-based approach in a current ECT in dementia project as an example of modifying an existing instrument for patients with moderate to severe dementia. Ultimately, any instrument modified will need to be validated against a standard clinical reference, in order to fully establish its sensitivity and specificity in the moderate to severe dementia population. Future work is greatly needed to advance the challenging area of accurate identification of delirium in moderate or severe dementia.

Objective: Some individuals with bipolar disorder (BD) experience manic and depressive symptoms concurrently, but data are limited on symptom mixity in older age bipolar disorder (OABD). Using the Global Aging & Geriatric Experiments in Bipolar Disorder Database, we characterized mixity in OABD and associations with everyday function. Methods: The sample (n = 805), from 12 international studies, included cases with both mania and depression severity ratings at a single timepoint. Four mixity groups were created: asymptomatic (A), mixed (Mix), depressed only (Dep), and manic only (Man). Generalized linear mixed models used mixity group as the predictor variable; cohort was included as a random intercept. Everyday function was assessed with the Global Assessment of Functioning score. Results: Group proportions were Mix (69.6%; n = 560), followed by Dep (18.4%; n = 148), then A (7.8%; n = 63), then Man (4.2%; n= 34); levels of depression and mania were similar in Mix compared to Dep and Man, respectively. Everyday function was lowest in Mix, highest in A, and intermediate in Man and Dep. Within Mix, severity of depression was the main driver of worse functioning. Groups differed in years of education, with A higher than all others, but did not differ by age, gender, employment status, BD subtype, or age of onset. Conclusions: Mixed features predominate in a cross-sectional, global OABD sample and are associated with worse everyday function. Among those with mixed symptoms, functional status relates strongly to current depression severity. Future studies should include cognitive and other biological variables as well as longitudinal designs to allow for evaluation of causal effects.

OBJECTIVES: This study explores the association between baseline impaired global cognitive function and changes in global cognitive function and depression among geriatric patients undergoing acute course electroconvulsive therapy (ECT). DESIGN: Retrospective cohort study SETTING: Single freestanding psychiatric hospital PARTICIPANTS: Patients aged 50 and older receiving ECT INTERVENTIONS: 10 ECT treatments MEASUREMENTS: Cognitive assessments with the Montreal Cognitive Assessment (MoCA). Depression assessment with the Quick Inventory of Depressive Symptomatology Self Report 16 item scale (QIDS) RESULTS: Baseline and follow-up data were available for 684 patients. On average, patients with baseline normal cognition (MoCA ≥ 26; N = 371) had a decrease in MoCA of −1.44 ±0.26 points over the course of treatment, while those with baseline impaired global cognitive function (MoCA < 26; N = 313) had an increase in MoCA of 1.72±0.25 points. Baseline cognitive status was not associated with a differential response on the QIDS. CONCLUSIONS: Patients with baseline impaired global cognitive function did not demonstrate a worsening in cognition following ECT, and baseline global cognitive function was not associated with a differential change in depression with ECT. These results suggest that impaired global cognitive function should not be viewed as a contraindication to ECT in geriatric patients.

Agitation is a common neuropsychiatric symptom of Alzheimer’s disease (AD) that greatly impacts quality of life and amplifies caregiver burden. Agitation in AD may be associated with volume loss in the anterior cingulate cortex, posterior cingulate cortex, insula, amygdala, and frontal cortex, as well as with degeneration of monoaminergic neurotransmission, disrupted circadian rhythms, and frailty. Current pharmacological options have troubling safety concerns and only modest efficacy. There is increasing interest in cannabinoids as promising agents due to pre-clinical and early clinical research that suggest cannabinoids can elicit anxiolytic, antidepressant, and/or anti-inflammatory effects. Cannabinoids may relieve agitation by regulating neurotransmitters, improving comorbidities and circadian rhythms, and increasing cerebral circulation. Here we discuss the possible contributory mechanisms for agitation in AD and the therapeutic relevance of cannabinoids, including CBD and THC.

Objective: Harmonizing different depression severity scales often requires creation of categorical variables that may decrease the sensitivity of the measure. Our aim was to compare the associations between categorical and continuous and harmonized measures of depression and global functioning in a large dataset of older age patients with bipolar disorder (OABD). Method: In the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) the 17-item Hamilton Depression scale (HAM-D), Montgomery Asberg Depression Rating Scale (MADRS) or the Center for Epidemiological Studies Depression scales (CES-D) was used to assess current depressive symptoms, while the Global Assessment of Functioning (GAF) assessed functional status. Data were harmonized from 8 OABD studies (n = 582). In each subsample, the relationship of depression severity as a continuous and categorical measure was compared to GAF. In the total sample, harmonized ordinal depression categories were compared to GAF. Results: Effect size and variance explained by the model for the categorical measure in the total sample was higher than both the categorical and continuous measure in the CES-D subsample, higher than the categorical but lower than the continuous measure in the HAM-D subsample, and lower than both the categorical and continuous measures in the MADRS subsample. Limitations: All included studies have different inclusion and exclusion criteria, study designs, and differ in aspects of sociodemographic variables. Conclusions: Associations were only slightly larger for the continuous vs categorical measures of depression scales. Harmonizing different depression scales into ordinal categories for analyses is feasible without losing statistical power.

This review summarizes the extant literature on the epidemiology, neuropsychology, clinical assessment, and treatment/management of older adult bipolar disorder (OABD). The primary aim was to provide a contemporary and accessible reference for clinicians involved in the care of OABD patients. Important research into the unique features of OABD has been carried out in recent years, providing a more robust albeit still limited foundation to help guide clinical decision-making. Some of the more consistent findings have highlighted (1) the importance of assessing for potentially reversible sources of secondary mania (i.e., manic symptoms unrelated to a primary mood disorder but with qualitatively similar presentation) in patients with late-onset mania; (2) the need for closer follow-up and more aggressive treatment to help stabilize illness course in OABD patients with earlier symptom onset; (3) the presence of domain-general cognitive dysfunction (but not accelerated cognitive aging) in OABD; and (4) the strong need for more randomized control trials examining the safety and efficacy of various psychopharmacological interventions in OABD samples. Research continues to support lithium as the gold-standard treatment for OABD, but there are other promising therapies. Asenapine, lurasidone, and divalproex have demonstrated efficacy in reducing symptoms, but future research must also categorize their side effect profile and most effective use in treatment (e.g., monotherapy or adjunctive therapy). ECT may be a useful alternative to pharmacotherapy, but very little research has been conducted in the OABD patient population. Compared with mixed age and younger samples, there is a paucity of clinical research specific to OABD. To date, the treatment literature in OABD is limited by small sample sizes, cohorts of mixed-age populations, and non-randomized and uncontrolled study designs. Consequently, making evidence-based treatment decisions often requires extrapolating data from studies of younger adults with BD. Fortunately, international collaborative efforts have recently been established that will include, for the first time, much larger sample sizes to better characterize the natural history, clinical course, comorbidities, and effective therapies for OABD.

Objective: Literature on older-age bipolar disorder (OABD) is limited. This first-ever analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated associations among age, BD symptoms, comorbidity, and functioning. Methods: This analysis used harmonized, baseline, cross-sectional data from 19 international studies (N = 1377). Standardized measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), and Global Assessment of Functioning (GAF). Results: Mean sample age was 60.8 years (standard deviation [SD] 12.2 years), 55% female, 72% BD I. Mood symptom severity was low: mean total YMRS score of 4.3 (SD 5.4) and moderate-to-severe depression in only 22%. Controlled for sample effects, both manic and depressive symptom severity appeared lower among older individuals (p's

Highlights • In the midst of the COVID-19 pandemic, how have researchers, clinicians, and participants of geriatric clinical trials been affected, and what are the implications for post-pandemic research of neurocognitive disorders? • Rapidly shifting institutional, sponsor, state and federal guidelines have resulted in halted enrollments, missed visits, interrupted medication delivery and delayed infusions and have challenged the limits of tolerance for continuing key studies on potentially disease-modifying treatments for Alzheimer's. Clinicians, research coordinators, and participants have responded to the chaotic environment by testing new models of care and assessment, pushing for creative adaptations in research methodology and data collection. • Researching treatments for a devastating disease during a global emergency carries unforeseen challenges, limitations, risks, and psychosocial consequences, but may lead to new strategies that improve efficiency, and are more crisis-resistant in the future., Advances in treating and preventing Alzheimer's disease and other neurocognitive disorders of aging arise from rigorous preclinical and clinical research, with randomized controlled treatment trials as the last and definitive test. The COVID-19 pandemic has greatly disrupted ongoing interventional studies and researchers are scrambling to find ways to safely continue this critical work amidst rapidly shifting guidelines from sponsors, institutions, and state and federal guidelines. Here we describe novel approaches and work-flow adaptations to study visits, drug delivery and interim and endpoint safety and outcomes assessments to avoid sacrificing years of preparation and substantial financial investments, to work in the best interest of participants and their caregivers, and to continue on the path towards discovering disease-modifying treatments for the millions of individuals impacted by major neurocognitive disorders.

Introduction Bipolar disorder can impair executive functioning and social cognition which refers to the cognitive processes involved in understanding social cues (this includes theory of mind). However, little is known about the degree to which subclinical manic symptoms can impact social cognition in older adults and the role of executive functioning in this interaction. This cross-sectional study examined if transdiagnostic subclinical manic symptoms in older adults with mood disorders were related to impaired social cognition and if this relationship was mediated by executive functioning. Methods Ninety-five mood disorder patients (43 patients with bipolar disorder, 50 with major depressive disorder, 2 with schizoaffective disorder) ages 55 and above completed a battery of neuropsychological tests, mood and anxiety rating scales, clinical rating scales, functional and medical assessments. Total scores from the Mind in the Eyes task were used to assess social cognition. Executive functioning was assessed using the total correct scores from the Wisconsin Card Sorting Task (WCST). The Young Mania Rating Scale (YMRS), the Generalized Anxiety Disorder 7-item (GAD-7) scale and the Montgomery-Asberg Depression Rating Scale (MADRS) were used to assess mood and anxiety symptoms. Results All participants had subclinical manic symptoms based on the YMRS scores independent of their diagnosis. We used linear regressions to test mediation following the Baron and Kenny (1986) method. We found that greater subclinical manic symptoms (YMRS) were related to reduced executive functioning (path a, p=.043), and lower social cognitive functioning (Mind in the Eyes task), when controlling for depression and anxiety symptoms (path c, p = .002). The association between manic symptoms and social cognition was fully mediated by performance on an executive functioning task (the Wisconsin Card Sorting Task total correct scores, path b, p=.010, path c’ p= .375). Mood diagnosis, depression and anxiety symptoms were not significantly related to performance on social cognitive or executive functioning tasks. Conclusions Executive functioning could explain social cognitive impairment related to subclinical manic symptoms. Our findings shed some light into the neuropsychological features of subclinical manic symptoms in older adults. Funding The Rogers Family Foundation

Introduction BACKGROUND: Obstructive sleep apnea (OSA) is a treatable respiratory condition that becomes more prevalent with age. The extant literature suggests OSA is associated with domain-general cognitive dysfunction, though attention/executive skills may be disproportionately affected (Stranks & Crowe, 2016). Meta-analytic data further suggest that treatment with continuous positive airway pressure (CPAP) can result in small to medium improvements in executive function (Olaithe & Bucks, 2013). However, the relationship between CPAP adherence and executive dysfunction in older adults is less clear – an important target of investigation given mounting evidence demonstrating a link between OSA and age-related cognitive decline, including Alzheimer's disease (Mullins et al., 2020). Accordingly, the current study examined the relationship between self-reported CPAP adherence and attention/executive function, namely basic attention span and executive control, in a mixed clinical sample of older adults with OSA. Methods METHODS: Data were obtained from the McLean Hospital Neuropsychology Data Repository, which is a comprehensive, archival dataset comprised of patients who completed a neuropsychological evaluation as part of routine clinical care. The current study examined a transdiagnostic subset of older adults aged 50+ years with OSA. Data were analyzed using univariate general linear models, with self-reported CPAP adherence (i.e., no CPAP vs full/partial adherence) as a fixed factor, performance on each condition of the WAIS-IV Digit Span task as outcome variables, and age as a covariate. Results RESULTS: Of the sample used (N=52), 52% were either fully or partially CPAP compliant (n=27), whereas 48% were entirely non-compliant (n=25). Significant performance differences (p Conclusions DISCUSSION: These results suggest that at least some degree of CPAP treatment adherence amongst OSA-diagnosed older adults may improve working memory cognitive processes, compared to non-compliancy. Limitations Further research should consider methods for accurately quantifying OSA severity and CPAP treatment (i.e., partial versus full compliancy), distinguishing OSA diagnosis/treatment between different age demographics (i.e., middle adults versus older adults), determining possible relationships between time of diagnosis and initiating treatment/non-treatment, and controlling for co-occurring variables that impact sleep and cognitive functioning (i.e., medication side effects, comorbid vascular and respiratory conditions, psychiatric comorbidities). Future studies should also consider examining larger, age-specific OSA populations, with a more extensive examination of neurocognitive functioning across domains that have been suggested to be strongly influenced by working memory processes (e.g., attention, learning/memory, executive functioning). Funding N/A

Introduction The World Health Organization estimates that annual deaths due to suicide have reached nearly 800,000 globally. Data suggests that per attempt, older adults are far more likely to complete suicide compared to younger adults. Risk factors for suicide such as prior suicide attempts, physical and psychiatric illness, stressful or traumatic life events, and social isolation have been identified in older adults. However, there is sparse research which examines the unique biopsychosocial challenges faced by older adults and how these might interact with established risk factors to lead to higher lethality of suicidal behavior. Several prior studies of community-dwelling older adults have identified the Interpersonal Theory of Suicide (IPTS) as a plausible framework for this phenomenon. The IPTS posits that the pathway which bridges the gap between suicidal ideation (SI) and lethal suicidal behavior originates from two constructs which precipitate a desire for suicide - thwarted belongingness (TB) and perceived burdensomeness (PB) - combined with the capability for suicide. For older adults who are also diagnosed with personality disorders (PDs) or PD traits, which are well-known to negatively impact psychosocial functioning, this further adds to a “perfect storm” of risk factors likely to lead to completed suicide. This study aims to explore the relationship between these factors and severity of suicidality in an older adult sample on an inpatient psychiatric unit. Methods This cross-sectional study recruited all participants from the inpatient Older Adult Unit at McLean Hospital. For all participants, a chart review was conducted to obtain information regarding medical comorbidities, cognitive status, trauma history, and responses to a suicide risk assessment upon admission. Subjects also completed the Interpersonal Needs Questionnaire (INQ), Personality Inventory-DSM 5 (PID-5), PROMIS Social Isolation, World Health Organization Disability Assessment Schedule-12 Item, and Personality Assessment Inventory-Sterssors and Nonsupport Subscale at one timepoint. Primary endpoints were suicidality severity and INQ total score. Results Data collection is ongoing for this study. Data analysis will occur prior to poster presentation and results will be presented. Conclusions Data collection is ongoing. Results from this study may help identify unique risk factors contributing to suicidality in older adults and pertinent targets for intervention. This research was funded by: No funding.

Background Recent research has shown that patients with schizophrenia (SCZ) exhibit reduced directed forgetting (DF) for negative words, suggesting impaired ability to instantiate goal-directed inhibition in order to suppress a competing, emotion-driven responses (i.e., emotional memory enhancement). However, disrupted inhibition is not the only possible mechanism by which patients could manifest reduced emotional DF. Therefore, the primary objective of the current study was to use event-related brain potential (ERP) recordings to investigate alternative hypotheses. Methods ERPs were recorded while patients and controls completed an item-method DF paradigm using negative and neutral words. The N2 indexed goal-directed inhibition of to-be-forgotten items. The late positive potential (LPP) indexed emotional memory enhancement for negative study items. The P300 indexed selective rehearsal of to-be-remembered items. Results The SCZ group exhibited a reduced DF effect overall, but this was not modulated by emotion. N2 amplitude at anterior sites was larger for forget versus remember cues in the control group only, but this effect was not modulated by emotion. LPP amplitude was greater for negative versus neutral words in both groups, independent of region. P300 amplitude at posterior sites was greater for remember versus forget cues in the control group only. Discussion These data suggest that reduced DF in SCZ may be due, in part, to both diminished goal-directed inhibition of to-be-forgotten items and reduced selective rehearsal of to-be-remembered items. However, these data do not support the hypothesis that goal-directed, inhibitory processes are disrupted by competing, emotion-driven processes in SCZ. Patients' ERP data also suggested that they did not exhibit disproportionately heightened encoding of emotional stimuli, nor did they have deficient selective rehearsal of to-be-remembered emotional items.

Recent models of schizophrenia suggest deficient use of contextual response cues when confronted with countermanding emotional cues. It is important to clinically validate these models by testing patients diagnosed with schizophrenia on tasks with competing emotional and contextual response determinants. Control and schizophrenia groups completed a novel task that elicited motor responses consistent with, or in opposition to, pre-potent emotional actions (i.e., approach vs. avoidance). An analogous non-emotional task was also used to examine cue-conflict impairment more generally. The groups demonstrated statistically equivalent performance decrements on incongruent versus congruent trials on both tasks. However, within the schizophrenia group, the incongruency effect was significantly greater in the emotional versus non-emotional task. These data suggest that, while patients with schizophrenia were able to employ contextual response cues to override competing emotional responses, they were slower to resolve emotional versus non-emotional response conflict. When patients were subdivided according to the presence or absence of disorganized symptoms, this effect was confined to patients with disorganized symptoms.

BackgroundSeveral psychological and neurobiological models imply that patients with schizophrenia (SCZ) are more inclined to utilize emotional cues as response determinants to the detriment of more task-appropriate cognitive or contextual cues. However, there is a lack of behavioural data from human clinical studies to support this assertion. Therefore, it is important to evaluate the performance of persons with SCZ using tasks designed to index the resolution between competing emotional and cognitive determinants of goal-directed behaviour.MethodThe current study employed a list-method, emotional directed-forgetting (DF) paradigm designed to invoke inhibitory mechanisms necessary to override emotional memory enhancement for successful task completion. Four psycholinguistically matched lists were constructed that were comprised of five negative, five positive, and five neutral words.ResultsCompared with healthy controls, individuals with SCZ showed a reduced DF effect overall. When broken down according to valence, this effect was only observed for negative words, which, in turn, resulted from reduced forgetting of list 1 words following the forget cue.ConclusionsThese results indicate that individuals with SCZ were less able to engage strategic inhibitory mechanisms for the purpose of overriding recall of negative stimuli when tasks demand call for such action. Thus, our data support the theoretical assertion that SCZ patients have difficulty utilizing cognitive or contextual cues as determinants of goal-directed behaviour in the face of countermanding emotional cues.

Dual-task performance as it relates to driving, such as tuning a radio or manipulating a cellular phone, forces drivers to divide their attention between the traffic demands and the in-car task. The present study investigated how concurrent spatial or non-spatial cognitive distractions mediated proximity judgments using vehicular stimuli. Utilizing a modified version of the task employed by [Elias, L.J., Robinson, B. in press. Drive on the right side of the road: perceptual asymmetries for judgments of automobile proximity. International Journal of Neuroscience.] the current study examined how mental navigation (spatial distraction) affected accuracy and response time for depth judgments on vehicular stimuli in each visual field. These were compared to a control condition in which no distraction was present, as well as when a semantic (non-spatial) distraction was present. We found that conversation of a navigational nature (i.e., spatial distraction) most negatively impacted accuracy and response time when processing dynamically changing vehicle proximity. Further, these deleterious effects appeared to be uniform throughout the visual field. Findings are related to driving while being distracted, with particular emphasis on the role of cerebral lateralization in dual-task performance.

The current study sought to characterize the psychological architecture of individuals who put forth inadequate effort. The Minnesota Multiphasic Personality Inventory, 2nd Edition-Restructured Form was used to identify dimensions of psychological functioning in a mixed outpatient sample of U.S. Veterans referred for neuropsychological evaluation as part of their clinical care. After accounting for external financial incentive and symptom overreporting, results showed that the inadequate effort group (n = 23, mean age = 42.48) scored higher than the adequate effort group (n = 29, mean age = 44.31) on neurologic complaints (NUC) and lower on behavioral/externalizing dysfunction (BXD), antisocial behaviors (RC4), and disconstraint (DISC-r). Lower scores on BXD, RC4, and DISC-r could indicate higher behavioral constraint-a psychological characteristic that has been linked to the pursuit of high-value future rewards. Alternatively, lower scores on these scales could have reflected a self-presentation strategy aimed at minimizing externalizing and RC4 in order to appear more psychological healthy. Implications of each of these interpretations are discussed.

People tend to display the left cheek when posing for a portrait; however, this effect does not appear to generalise to advertising. The amount of body visible in the image and the sex of the poser might also contribute to the posing bias. Portraits also exhibit lateral lighting biases, with most images being lit from the left. This effect might also be present in advertisements. A total of 2801 full-page advertisements were sampled and coded for posing direction, lighting direction, sex of model, and amount of body showing. Images of females showed an overall leftward posing bias, but the biases in males depended on the amount of body visible. Males demonstrated rightward posing biases for head-only images. Overall, images tended to be lit from the top left corner. The two factors of posing and lighting biases appear to influence one another. Leftward-lit images had more leftward poses than rightward, while the opposite occurred for rightward-lit images. Collectively, these results demonstrate that the posing biases in advertisements are dependent on the amount of body showing in the image, and that biases in lighting direction interact with these posing biases.

preference and performance abilities, a cross-sectional sample of 548 children (ages 3–18) and adults (over 19) completed the Waterloo Handedness Questionnaire, the WatHand Cabinet Test (an observational test of hand preference), and the Annett pegboard. Findings revealed that while the direction of hand preference does not change significantly with age, the degree of hand preference does, such that younger children exhibit weaker hand preference than older children and adults. This pattern of hand preference was much more evident for lefthanded individuals, where consistent hand preference was not seen until 8 years of age. Similarly, performance differences between the hands did not emerge for left-handers until later childhood, while in comparison large performance differences were seen for right-handers at all ages. The implications for the development of handedness will be discussed.