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Objective:To determine the reliability of teleneuropsychological (TNP) compared to in-person assessments (IPA) in people with HIV (PWH) and without HIV (HIV−).Methods:Participants included 80 PWH (Mage = 58.7, SDage = 11.0) and 23 HIV− (Mage = 61.9, SDage = 16.7). Participants completed two comprehensive neuropsychological IPA before one TNP during the COVID-19 pandemic (March–December 2020). The neuropsychological tests included: Hopkins Verbal Learning Test-Revised (HVLT-R Total and Delayed Recall), Controlled Oral Word Association Test (COWAT; FAS-English or PMR-Spanish), Animal Fluency, Action (Verb) Fluency, Wechsler Adult Intelligence Scale 3rd Edition (WAIS-III) Symbol Search and Letter Number Sequencing, Stroop Color and Word Test, Paced Auditory Serial Addition Test (Channel 1), and Boston Naming Test. Total raw scores and sub-scores were used in analyses. In the total sample and by HIV status, test-retest reliability and performance-level differences were evaluated between the two consecutive IPA (i.e., IPA1 and IPA2), and mean in-person scores (IPA-M), and TNP.Results:There were statistically significant test-retest correlations between IPA1 and IPA2 (r or ρ = .603–.883, ps < .001), and between IPA-M and TNP (r or ρ = .622–.958, ps < .001). In the total sample, significantly lower test-retest scores were found between IPA-M and TNP on the COWAT (PMR), Stroop Color and Word Test, WAIS-III Letter Number Sequencing, and HVLT-R Total Recall (ps < .05). Results were similar in PWH only.Conclusions:This study demonstrates reliability of TNP in PWH and HIV−. TNP assessments are a promising way to improve access to traditional neuropsychological services and maintain ongoing clinical research studies during the COVID-19 pandemic.

OBJECTIVE: This paper summarizes the findings of the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) Project and offers a roadmap for future research. METHODS: The NP-NUMBRS project represents the largest and most comprehensive co-normed neuropsychological battery to date for native Spanish-speaking healthy adults from the U.S. (California/Arizona)-Mexico borderland region (N = 254; ages 19–60 years). These norms provide demographic adjustments for tests across numerous domains (i.e., verbal fluency, processing speed, attention/working memory, executive function, episodic memory [learning and delayed recall], visuospatial, and fine motor skills). CONCLUSIONS: This project: 1) shows that the NP-NUMBRS norms consistently outperformed previously published norms for English-speaking non-Hispanic (White and African-American) adults in identifying impairment; 2) explores the role of Spanish-English bilingualism in test performance; and 3) provides support for the diagnostic validity of these norms in detecting HIV-associated neurocognitive impairment. Study limitations include the limited assessment of sociocultural variables and generalizability (e.g., other Latina/o populations, age limit [19–60 years]). Future research is needed to: 1) investigate these norms with U.S.-dwelling Spanish-speakers of non-Mexican heritage and other clinical subpopulations; 2) expand coverage of cognitive domains (e.g. language, visuospatial); 3) develop large normative datasets for children and older Latina/o populations; 4) examine how sociocultural factors impact performance (e.g., bilingualism, acculturation); 5) investigate these norms’ diagnostic and ecological validity; and 6) develop norms for neurocognitive change across time. It is hoped that the NP-NUMBRS norms will aid researchers and clinicians working with U.S.-dwelling Spanish-speakers from the U.S.-Mexico borderland to conduct research and evidence-based neuropsychological evaluations in a more culturally responsive and ethical manner.

OBJECTIVE: The present introduction to the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) project aims to provide an overview of the conceptual framework and rationale that guided the development of this project. METHODS: We describe important aspects of our conceptual framework, which was guided by some of the main purposes of neuropsychological testing, including the identification of underlying brain dysfunction, and the characterization of cognitive strengths and weakness relevant to everyday functioning. We also provide our rationale for focusing this norm development project on Spanish-speakers in the United States, and provide an outline of the articles included in this Special Issue focused on the NP-NUMBRS project. CONCLUSIONS: The data presented in this Special Issue represent an important tool for clinicians and researchers working in the neuropsychological assessment of Spanish-speakers in the United States.

BACKGROUND Research suggests that physical activity (PA) has both acute and chronic beneficial effects on cognitive function in laboratory settings and under supervised conditions. Mobile health technologies make it possible to reliably measure PA and cognition in free-living environments, thus increasing generalizability and reach. Research is needed to determine whether the benefits of PA on cognitive function extend from the laboratory to real-world contexts. OBJECTIVE This observational study aims to examine the association between daily fluctuations in PA and cognitive performance using mobile health technologies in free-living environments. METHODS A total of 90 adults (mean age 59, SD 6.3 years; 65/90, 72% men) with various comorbidities (eg, cardiovascular risk and HIV) and different levels of baseline cognition (ranging from cognitively normal to impaired) completed ecological momentary cognitive tests (EMCTs) on a smartphone twice daily while wearing an accelerometer to capture PA levels for 14 days. Linear mixed-effects models examined the daily associations of PA with executive function and verbal learning EMCTs. Moderation analyses investigated whether the relationship between daily PA and daily performance on EMCTs changed as a function of baseline cognition, cardiovascular risk, and functional status (independent vs dependent). RESULTS Days with greater PA were associated with better (faster) performance on an executive function EMCT after covariate adjustment (estimate −0.013; β=−.16; P=.04). Moderation analyses (estimate 0.048; β=.58; P=.001) indicated that days with greater PA were associated with better (faster) executive function performance in individuals who were functionally dependent (effect size −0.53; PP=.91). CONCLUSIONS EMCTs may be a sensitive tool for capturing daily-level PA-related fluctuations in cognitive performance in real-world contexts and could be a promising candidate for tracking cognitive performance in digital health interventions aimed at increasing PA. Further research is needed to determine individual characteristics that may moderate the association between daily PA and EMCT performance in free-living environments.

Author(s): Paolillo, Emily W; Inkelis, Sarah M; Heaton, Anne; Saloner, Rowan; Moore, Raeanne C; Moore, David J | Abstract: AimsOlder persons living with HIV (PLWH) and past alcohol use disorder (AUD) are at higher risk for neurocognitive deficits compared to those with either condition alone; however, factors underlying this relationship are unknown. Given that aging potentiates multi-system damage from alcohol misuse, the current study examined whether neurocognitive functioning among older adults relates to the age at which they last met criteria for AUD (i.e. 'age of last AUD'), and whether this relationship differed by HIV serostatus.MethodsAll participants (aged between 50 and 75 years) were grouped by HIV/AUD status: 345 HIV+/AUD+, 148 HIV-/AUD+, 273 HIV+/AUD-, and 206 HIV-/AUD-. Neurocognitive functioning was assessed globally and within seven domains. Among only the two AUD+ groups, multivariable linear regressions examined the interaction between age of last AUD and HIV status on neurocognitive functioning, controlling for demographics and clinical characteristics.ResultsOlder age of last AUD related to worse processing speed among PLWH (b = -0.03; P = 0.006); however, this relationship was not significant among persons without HIV (b = 0.01; P = 0.455). The interaction between age of last AUD and HIV status did not predict neurocognitive functioning in other domains. Processing speed appeared clinically important, as slower speed related to worse everyday functioning, including more reported cognitive difficulties (r = -0.26, P l 0.001) and higher rates of functional dependence (OR = 0.87, 95%CI = 0.80-0.95, P = 0.002).ConclusionsOur novel findings, demonstrating slower processing speed when a past AUD occurred at an older age in PLWH, highlight the value in assessing older PLWH for processing speed deficits, even if other cognitive domains appear to be intact.

This observational cross-sectional study of 152 people with HIV (PWH) examined the effects of age and estimated duration of HIV infection (EDI) on depressive and anxiety symptoms. All participants were cisgender men and completed the Profile of Moods State (POMS), a self-report inventory of current (i.e., past week) mood states. Overall, study results confirmed higher levels of anxiety and depression in PWH compared to individuals without HIV. Age group (

International audience; Objective: We developed a mobile cognitive test of verbal learning and memory, the mobile verbal learning test (mVLT), to allow for brief, repeated and portable delivery of a 12-item list learning test through a smartphone. This study examined the psychometric properties of the mVLT among older persons with and without human immunodeficiency virus (HIV). Methods: Sixty-eight persons with HIV and 36 HIV-negative individuals (aged 50-74) completed three trials of the mVLT on a smartphone once daily for 14 days. A different word list was administered each day. Results: Participants completed 80% of the 14 mVLT administrations, equating to 1166 valid and complete mVLTs. Neither adherence nor mean mVLT total score (number correct in 3 recall trials) differed by HIV status. No practice effects from repeated mVLT administration were observed, and there were moderately strong correlations of mVLT performance with performance on the in-lab version of the task and with traditional cognitive assessments of cognitive processes contributing to memory. We found evidence of within-person learning across mVLT trials, with persons with HIV demonstrating less learning from trials 1 to 3 compared to HIV-negative participants. Conclusions: The mVLT is a valid method to assess learning in the real world in older adults with and without HIV.

Background Daily activities have been associated with neurocognitive performance. However, much of this research has used in-person neuropsychological testing that requires participants to travel to a laboratory or clinic, which may not always be feasible and does not allow for the examination of real-time relationships between cognition and behavior. Thus, there is a need to understand the real-time relationship between activities in the real world and neurocognitive functioning to improve tracking of symptoms or disease states and aid in the early identification of neurocognitive deficits among at-risk individuals. Objective We used a smartphone-based ecological momentary cognitive assessment (EMCA) platform to examine real-time relationships between daily activities and neurocognitive performance (executive functioning and verbal learning) in the everyday environment of middle-aged and older adults with and without HIV. Methods A total of 103 adults aged 50-74 years (67 persons with HIV; mean age 59 years, SD 6.4) were recruited from the University of California, San Diego HIV Neurobehavioral Research Program and the San Diego community. Participants completed our EMCA protocol for 14 days. Participants reported their current daily activities 4 times per day; following 2 of the 4 daily ecological momentary assessment (EMA) surveys, participants were administered the mobile Color-Word Interference Test (mCWIT) and mobile Verbal Learning Test (mVLT), each once per day. Activities were categorized into cognitively stimulating activities, passive leisure activities, and instrumental activities of daily living (IADLs). We used multilevel modeling to examine the same-survey and lagged within-person and between-person effects of each activity type on mobile cognitive performance. Results On average, participants completed 91% of the EMA surveys, 85% of the mCWIT trials, and 80% of the mVLT trials, and they reported engaging in cognitively stimulating activities on 17% of surveys, passive leisure activities on 33% of surveys, and IADLs on 20% of surveys. Adherence and activity percentages did not differ by HIV status. Within-persons, engagement in cognitively stimulating activities was associated with better mCWIT performance (β=−1.12; P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance (β=.94; P=.005). There were no lagged associations. At the aggregate between-person level, a greater percentage of time spent in cognitively stimulating activities was associated with better mean mVLT performance (β=.07; P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance (β=−.07; P=.01). IADLs were not associated with mCWIT or mVLT performance. Conclusions Smartphones present unique opportunities for assessing neurocognitive performance and behavior in middle-aged and older adults’ own environment. Measurement of cognition and daily functioning outside of clinical settings may generate novel insights on the dynamic association of daily behaviors and neurocognitive performance and may add new dimensions to understanding the complexity of human behavior.

Most previous studies investigating sleep’s association with health outcomes have relied on averaged sleep quality and laboratory-based health measures. This study examines the dynamic within-person relationships between subjective (Ecological Momentary Assessment) and objective sleep (actigraphy) on next-day cognition (subjective and objective), mood, and engagement in daily activities using linear mixed-effects regression modeling. Participants included 94 individuals (59 people with HIV, 35 HIV-) aged 50–74, assessed daily for 14 consecutive days/nights. Subjective and objective sleep were well correlated and were both associated with subjective ratings of cognition, but not objective cognition. Worse subjective sleep was associated with next-day lower happiness and higher depressed mood, and more pain, but was not related to next-day daily activities. Objective sleep was associated with next-day depressed mood and feelings of worry, and was positively associated with next-day television watching. Results provide evidence to support the utility of real-time assessment for sleep and functional outcomes that may lead to potential personalized interventions for individuals with and without HIV.

BACKGROUND Daily activities have been associated with neurocognitive performance. However, much of this research has used in-person neuropsychological testing that requires participants to travel to a laboratory or clinic, which may not always be feasible and does not allow for the examination of real-time relationships between cognition and behavior. Thus, there is a need to understand the real-time relationship between activities in the real world and neurocognitive functioning to improve tracking of symptoms or disease states and aid in the early identification of neurocognitive deficits among at-risk individuals. OBJECTIVE We used a smartphone-based ecological momentary cognitive assessment (EMCA) platform to examine real-time relationships between daily activities and neurocognitive performance (executive functioning and verbal learning) in the everyday environment of middle-aged and older adults with and without HIV. METHODS A total of 103 adults aged 50-74 years (67 persons with HIV; mean age 59 years, SD 6.4) were recruited from the University of California, San Diego HIV Neurobehavioral Research Program and the San Diego community. Participants completed our EMCA protocol for 14 days. Participants reported their current daily activities 4 times per day; following 2 of the 4 daily ecological momentary assessment (EMA) surveys, participants were administered the mobile Color-Word Interference Test (mCWIT) and mobile Verbal Learning Test (mVLT), each once per day. Activities were categorized into cognitively stimulating activities, passive leisure activities, and instrumental activities of daily living (IADLs). We used multilevel modeling to examine the same-survey and lagged within-person and between-person effects of each activity type on mobile cognitive performance. RESULTS On average, participants completed 91% of the EMA surveys, 85% of the mCWIT trials, and 80% of the mVLT trials, and they reported engaging in cognitively stimulating activities on 17% of surveys, passive leisure activities on 33% of surveys, and IADLs on 20% of surveys. Adherence and activity percentages did not differ by HIV status. Within-persons, engagement in cognitively stimulating activities was associated with better mCWIT performance (β=−1.12; P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance (β=.94; P=.005). There were no lagged associations. At the aggregate between-person level, a greater percentage of time spent in cognitively stimulating activities was associated with better mean mVLT performance (β=.07; P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance (β=−.07; P=.01). IADLs were not associated with mCWIT or mVLT performance. CONCLUSIONS Smartphones present unique opportunities for assessing neurocognitive performance and behavior in middle-aged and older adults’ own environment. Measurement of cognition and daily functioning outside of clinical settings may generate novel insights on the dynamic association of daily behaviors and neurocognitive performance and may add new dimensions to understanding the complexity of human behavior.

OBJECTIVE: The Wechsler Adult Intelligence Scale (WAIS) processing speed subtests are among the most ubiquitous indices of processing speed in the field. The aim of this study was to develop and examine demographically-adjusted normative data for Spanish language versions of the WAIS-III Digit Symbol Coding (DSC) and Symbol Search (SS) subtests for US-dwelling Spanish-speakers living in the US/Mexico border region. METHODS: The sample included 203 healthy participants who were part of the larger Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) project (DSC: n = 201; SS: n = 200). RESULTS: Older age and higher education were both related to lower scores on the DSC and SS subtests (all ps .05). Raw-to-scaled score conversions were calculated for both subtests, and fractional polynomial equations were derived to compute demographically-adjusted T-scores accounting for age, education, and gender for each subtest and the Processing Speed Index. Published norms for English-speaking non-Hispanic white adults slightly overestimated impairment rates (T-scores

Objective: The present review paper aimed to identify published neuropsychological test norms developed for Spanish-speakers living in the United States (U.S.). Methods: We conducted a systematic review of the literature via an electronic search on PubMed using keywords "Normative data," "Neuropsychological test," "norms", "Hispanic/Latinos," "Spanish Speakers," and "United States." We added other studies and published manuals as identified by citations in papers from the original search. Results Eighteen sources of normative data for Spanish-speakers in the U.S. were identified. Of the 18 citations identified, only four provide normative data on comprehensive batteries of tests for Spanish-Speakers. Two of these are based on persons living in the southwest of the U.S., who tend to be of Mexican origin. Overall, a number of the studies are focused on older persons and although the majority include participants with wide ranges of education, participants in the ends of the education distribution tend to be underrepresented. Conclusion: Here we provide a detailed description of the neuropsychological normative data currently available for Spanish-speakers living in the U.S. While there has been increased attention towards developing norms for neuropsychological batteries in Spanish-speaking countries (e.g., Latin America and Spain), there is still an urgent need to standardize neuropsychological tests among diverse groups of Spanish-speaking adults living in the U.S. The present review presents a list of norms for U.S.-dwelling Spanish-speakers, thus providing an important tool for clinicians and researchers.

OBJECTIVE: We developed demographically-corrected norms for Spanish-speakers from the U.S.-Mexico border regions of California and Arizona on two tests of motor skills - the Grooved Pegboard Test (Pegboard) and Finger Tapping Test (Tapping) - as part of a larger normative effort. METHOD: Participants were native Spanish-speakers from the Neuropsychological Norms for the U.S.-Mexico Border Region in Spanish (NP-NUMBRS) Project (Pegboard: N=254; Tapping: N=183; age: 19–60 years; education: 0–20 years; 59% women). We examined the association of demographics (age, education and gender) with raw scores. Raw test scores were then converted to demographically-corrected T-scores via fractional polynomial equations. We also examined rates of impairment (T-score

The original version of this article unfortunately contained an error, and it has been corrected with this erratum. The original version of this article unfortunately contained and error. “In this article affiliations were incorrect: the affiliation for María J. Marquine should have been “Division of Geriatrics, Gerontology and Palliative Care, University of California, USA”; Sara Gianella, Genevieve Curtin, Susan J. Little, Scott L. Letendre “Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0679, La Jolla, CA 92093-0679, USA”. The original article has been corrected.

Objectives: Human immunodeficiency virus (HIV) disproportionately affects Hispanics/Latinos in the United States, yet little is known about neurocognitive impairment (NCI) in this group. We compared the rates of NCI in large well-characterized samples of HIV-infected (HIV+) Latinos and (non-Latino) Whites, and examined HIV-associated NCI among subgroups of Latinos. Methods: Participants included English-speaking HIV+ adults assessed at six U.S. medical centers (194 Latinos, 600 Whites). For overall group, age: M=42.65 years, SD=8.93; 86% male; education: M=13.17, SD=2.73; 54% had acquired immunodeficiency syndrome. NCI was assessed with a comprehensive test battery with normative corrections for age, education and gender. Covariates examined included HIV-disease characteristics, comorbidities, and genetic ancestry. Results: Compared with Whites, Latinos had higher rates of global NCI (42% vs. 54%), and domain NCI in executive function, learning, recall, working memory, and processing speed. Latinos also fared worse than Whites on current and historical HIV-disease characteristics, and nadir CD4 partially mediated ethnic differences in NCI. Yet, Latinos continued to have more global NCI [odds ratio (OR)=1.59; 95% confidence interval (CI)=1.13–2.23; pn=60; 71%) versus Mexican (n=79, 44%) origin/descent; this disparity persisted in models adjusting for significant covariates (OR=2.40; CI=1.11–5.29; p=.03). Conclusions: HIV+ Latinos, especially of Puerto Rican (vs. Mexican) origin/descent had increased rates of NCI compared with Whites. Differences in rates of NCI were not completely explained by worse HIV-disease characteristics, neurocognitive comorbidities, or genetic ancestry. Future studies should explore culturally relevant psychosocial, biomedical, and genetic factors that might explain these disparities and inform the development of targeted interventions. (JINS, 2018, 24, 163–175)

Objective We developed demographically-corrected norms for US-dwelling, Spanish-speaking Hispanics on two widely used tests of motor skills - the Grooved Pegboard Test (Pegs) and Finger Tapping Test (Tapping). We then examined the effects of applying established norms for non-Hispanic Caucasians (NH Whites) and non-Hispanic African Americans (NH Blacks) on motor test results from our Hispanic population. Participants and Method 254 participants living in the US-Mexico border region of San Diego, CA and Tucson, AZ completed Pegs, and a subset (n = 183) completed Tapping. Age ranged from 19-60 and education from 0-20 years, with 59% women. Raw test scores were converted to demographically-corrected T-scores with a fractional polynomial procedure and compared to a fitted curve for the original data. Results Findings included significant main effects of education on both tests (p < .001), and of age for Pegs (p < .001). There was a significant interaction of sex and age on Tapping, such that older age was associated with lower scores in men only (p = .02). The resulting normative T-scores were confirmed to be free from demographic influences. Using a T < 40 cut point, rates of impairment in the Spanish speaking normative sample for dominant (D) and nondominant (ND) hands, respectively, were 17% and 14% for Pegs, and 12% and 10% for Tapping. Applying existing norms for NH Whites and NH Blacks to the raw scores of Spanish speakers generally yielded lower impairment rates on all measures, with one exception, Pegs ND, for which NH White norms overestimated impairment (23%). Conclusions Normative standards from other groups are not a good fit for interpreting motor test performance in this Hispanic population, which in the current instance would have generally underdiagnosed fine motor impairment. These findings underscore the importance of appropriate, population-specific normative data- even for tests of motor ability.

Author(s): Moore, Raeanne C; Paolillo, Emily W; Heaton, Anne; Fazeli, Pariya L; Jeste, Dilip V; Moore, David J | Abstract: ObjectiveRequiring only 10-15 minutes to complete, the UCSD Performance-Based Skills Assessment (UPSA-B) has high clinical utility as a brief measure of functional capacity. This study aimed to validate the UPSA-B in adults living with HIV/AIDS (HIV+), and identify whether the UPSA-B can be used as an indicator of functional dependence in this population.MethodOne hundred and three HIV+ adults and 91 HIV- adults completed a comprehensive neuropsychological and neuromedical battery, including a self-report measure of functional status (IADL Dependence vs. IADL Independence), an objective measure of functional capacity (UPSA-B), and a self-report measure of mood states including a subscale related to cognitive difficulties (Profile of Mood States [POMS]-Confusion/Bewilderment subscale).ResultsHIV+ participants had significantly lower UPSA-B scores than their HIV- counterparts (p = 0.02), although this fell to a trend (p = 0.08) when including covariates. Among the HIV+ group, higher UPSA-B scores were related to better neuropsychological ability, but unrelated to self-reported functional independence. Conversely, UPSA-B scores were unrelated to participant-reported cognitive difficulties on the POMS Confusion/Bewilderment subscale. An ROC curve was generated to determine the optimal UPSA-B value for discriminating between normal neuropsychological functioning versus neuropsychological impairment, with results indicating an optimal cutoff of 79. The UPSA-B identified HIV+ persons with cognitive impairment with 70.9% accuracy.ConclusionsThe UPSA-B was able to differentiate neuropsychological impairment from no impairment among HIV+ participants and holds promise as a clinical screening tool in this population. However, indicators of functional disability among adults living with HIV is still not well understood and is likely multifactorial in nature. These data highlight the complex interplay between objective functional capacity, neurocognitive ability, subjective cognitive symptoms, and functional dependence.

Chinese hamster ovary cells spontaneously resistant to the cytotoxic action of methylglyoxal-bis(guanylhydrazone) have been isolated in a multistep selection scheme. A low-level resistant isolate has been shown to be defective in the ability to accumulate the drug intracellularly. This was reflected in a 10-fold lower Vmax than wild-type cells for drug uptake as well as a slight enhancement of drug efflux. More highly resistant isolates selected from this low-level resistant isolate were totally deficient in the ability to take up the drug. A partial revertant, selected from this low-level resistant isolate, retained some change in the Vmax for uptake but lost the accelerated rate of efflux characteristic of the low-level resistant line. Genetic analysis by somatic cell hybridization indicated that the low-level resistant phenotype was recessive to the wild-type phenotype. In addition, the low-level resistant phenotype could be complemented by a previously isolated highly resistant cell also defective in drug uptake (Mandel and Flintoff (1978) J. Cell. Physiol., 97: 335-344). Taken together, these data suggest that more than one locus controls drug uptake in Chinese hamster ovary cells.