Validation and Normative Data of the Spanish Version of the Rey Auditory Verbal Learning Test and Associated Long-Term Forgetting Measures in Middle-Aged Adults

Rey Auditory Verbal Learning Test (RAVLT) is an episodic memory helpful measure to detect changes associated with abnormal aging. There is a lack of RAVLT validation and normalization studies in Spain. The aim was to determine its psychometric properties and explore long-term forgetting (LTF) performance through 1-week delayed recall under three different modes of administration. The RAVLT was administered to 602 cognitively healthy volunteers, aged between 41 and 65 years, of whom 251 completed the LTF assessment. Findings reveal a factorial structure of four components, with satisfactory goodness of fit, and adequate convergent and divergent validity. We also demonstrated the differential effect of three methodologies used in LTF assessment, supporting that test expectancy positively influences long-term storage. Finally, normative data were generated according to age, sex, and education. The test, including the LTF measure, is a promising tool to estimate memory in middle-aged adults and develop predictive brain aging models

Cognitive Reserve as a Protective Factor of Mental Health in Middle-Aged Adults Affected by Chronic Pain

Chronic pain is associated with worse mental health and cognitive impairment, which can be a cause or a consequence of brain structure and function alterations, e.g., maladaptive plasticity, antinociceptive system dysregulation. Cognitive reserve reflects the effectiveness of the internal connections of the brain and it has been shown to be a protective factor in brain damage, slowing cognitive aging or reducing the risk of mental health disorders. The current study explored the impact of chronic pain on psychosocial factors, mental health, and cognition. Furthermore, we aimed to examine the role of cognitive reserve in the relationship between mental health and chronic pain clinical characteristics in middle-aged adults. The study group consisted of 477 volunteers from the Barcelona Brain Health Initiative who completed online surveys on pain, mental health, cognitive reserve, and psychosocial factors (sleep and quality of life). We described the differences in sociodemographic data, psychosocial factors, mental health, and self-perceived cognitive impairment, and neuropsychological assessment, between participants reporting pain compared with those without pain, as well as the main characteristics of the chronic pain group. Finally, to study the role of cognitive reserve in the modulation of the relationship between chronic pain and mental health, we compared variables between subgroups of participants with high/low pain intensity and cognitive reserve. The results showed that chronic pain was reported by 45.5% of middle-aged adults. Our results revealed that participants with chronic pain were older and had worse health status than people without pain. The presence of chronic pain affected working memory, mental health, and daily life activities. Moreover, cognitive reserve moderated the influence of pain intensity on mental health, resulting in less mental health affection in people suffering from high pain intensity with high cognitive reserve. In conclusion, the construct of the cognitive reserve could explain differential susceptibility between chronic pain and its mental health association and be a powerful tool in chronic pain assessment and treatment, principally due to its modifiable nature

Long-interval intracortical inhibition in primary motor cortex related to working memory in middle-aged adults

Excitability of the primary motor cortex measured with TMS has been associated with cognitive dysfunctions in patient populations. However, only a few studies have explored this relationship in healthy adults, and even fewer have considered the role of biological sex. Ninety-seven healthy middle-aged adults (53 male) completed a TMS protocol and a neuropsychological assessment. Resting Motor Threshold (RMT) and Long-Interval Intracortical Inhibition (LICI) were assessed in the left motor cortex and related to attention, episodic memory, working memory, reasoning, and global cognition composite scores to evaluate the relationship between cortical excitability and cognitive functioning. In the whole sample, there was a significant association between LICI and cognition; specifically, higher motor inhibition was related to better working memory performance. When the sample was broken down by biological sex, LICI was only associated with working memory, reasoning, and global cognition in men. No associations were found between RMT and cognitive functions. Greater intracortical inhibition, measured by LICI, could be a possible marker of working memory in healthy middle-aged adults, and biological sex plays a critical role in this association

Local Prefrontal Cortex TMS-Induced Reactivity Is Related to Working Memory and Reasoning in Middle-Aged Adults

Introduction: The prefrontal cortex (PFC) plays a crucial role in cognition, particularly in executive functions. Cortical reactivity measured with Transcranial Magnetic Stimulation combined with Electroencephalography (TMS-EEG) is altered in pathological conditions, and it may also be a marker of cognitive status in middle-aged adults. In this study, we investigated the associations between cognitive measures and TMS evoked EEG reactivity and explored whether the effects of this relationship were related to neurofilament light chain levels (NfL), a marker of neuroaxonal damage. Methods: Fifty two healthy middle-aged adults (41–65 years) from the Barcelona Brain Health Initiative cohort underwent TMS-EEG, a comprehensive neuropsychological assessment, and a blood test for NfL levels. Global and Local Mean-Field Power (GMFP/LMFP), two measures of cortical reactivity, were quantified after left prefrontal cortex (L-PFC) stimulation, and cognition was set as the outcome of the regression analysis. The left inferior parietal lobe (L-IPL) was used as a control stimulation condition. Results: Local reactivity was significantly associated with working memory and reasoning only after L-PFC stimulation. No associations were found between NfL and cognition. These specific associations were independent of the status of neuroaxonal damage indexed by the NfL biomarker and remained after adjusting for age, biological sex, and education. Conclusion: Our results demonstrate that TMS evoked EEG reactivity at the L-PFC, but not the L-IPL, is related to the cognitive status of middle-aged individuals and independent of NfL levels, and may become a valuable biomarker of frontal lobe-associated cognitive function

Local Prefrontal Cortex TMS-Induced Reactivity Is Related to Working Memory and Reasoning in Middle-Aged Adults

Introduction: The prefrontal cortex (PFC) plays a crucial role in cognition, particularly in executive functions. Cortical reactivity measured with Transcranial Magnetic Stimulation combined with Electroencephalography (TMS-EEG) is altered in pathological conditions, and it may also be a marker of cognitive status in middle-aged adults. In this study, we investigated the associations between cognitive measures and TMS evoked EEG reactivity and explored whether the effects of this relationship were related to neurofilament light chain levels (NfL), a marker of neuroaxonal damage. Methods: Fifty two healthy middle-aged adults (41-65 years) from the Barcelona Brain Health Initiative cohort underwent TMS-EEG, a comprehensive neuropsychological assessment, and a blood test for NfL levels. Global and Local Mean-Field Power (GMFP/LMFP), two measures of cortical reactivity, were quantified after left prefrontal cortex (L-PFC) stimulation, and cognition was set as the outcome of the regression analysis. The left inferior parietal lobe (L-IPL) was used as a control stimulation condition. Results: Local reactivity was significantly associated with working memory and reasoning only after L-PFC stimulation. No associations were found between NfL and cognition. These specific associations were independent of the status of neuroaxonal damage indexed by the NfL biomarker and remained after adjusting for age, biological sex, and education. Conclusion: Our results demonstrate that TMS evoked EEG reactivity at the L-PFC, but not the L-IPL, is related to the cognitive status of middle-aged individuals and independent of NfL levels, and may become a valuable biomarker of frontal lobe-associated cognitive function. Keywords: Electroencephalography; TMS-EEG; cognition; cortical reactivity; prefrontal cortex (PFC); transcranial magnetic stimulation (TMS)

Sense of Coherence Mediates the Relationship Between Cognitive Reserve and Cognition in Middle-Aged Adults

In recent years, supported by new scientific evidence, the conceptualization of cognitive reserve (CR) has been progressively enriched and now encompasses not only cognitive stimulating activities or educational level, but also lifestyle activities, such as leisure physical activity and socialization. In this context, there is increasing interest in understanding the role of psychological factors in brain health and cognitive functioning. In a previous study, we have found that these factors mediated the relationship between CR and self-reported cognitive functioning. In this study, we have confirmed an association between two important constructs included in the psychological wellbeing and salutogenic models, 'purpose in life' and 'sense of coherence,' CR, as assessed using a questionnaire, and cognitive functioning, as evaluated using a comprehensive neuropsychological battery. Results from 888 middle-aged healthy participants from the Barcelona Brain Health Initiative indicate that both sense of coherence (SoC) and CR were positively associated with verbal memory, reasoning and attention, working memory, and global cognition. Moreover, the relation between CR and cognitive functioning in the different domains is partially mediated by SoC. When we controlled for brain integrity, introducing into the model neurofilament light chain measures, the mediator role of SoC was confirmed for reasoning and attention and global cognition. However, purpose in life was not associated with cognitive functioning. These results reveal the central role of the SoC construct, which mediates the association between classic CR estimates and cognitive functions, potentially representing a modifiable target for interventions that aim to promote brain health

Validación y normalización de instrumentos neurocognitivos para la medición de memoria episódica en una muestra española de mediana edad

La memòria episòdica, referida a la capacitat de l'ésser humà per emmagatzemar experiències personals del passat abastant aspectes temporals i contextuals, juga un rol protagonista en la predicció del deteriorament neurocognitiu. L'S-FNAME és una prova de memòria associativa que ha demostrat ser potencialment útil per discriminar entre canvis normals en els processos mnèsics associats a l'edat i el declivi associat a indicadors preclínics d'EA. La validació prèvia de la versió espanyola del test es va dur a terme únicament per a adults més grans de 49 anys, amb limitacions rellevants a nivell mostral. El TAAVR és una de les proves més utilitzades a nivell internacional que ha demostrat capacitat per detectar canvis relatius a malalties neurodegeneratives. Tot i les diverses versions desenvolupades del test, a Espanya no es troben estudis de validació ni barems normatius en les darreres dècades emprant mostres representatives de subjectes sans. Per tant, es va plantejar com a objectiu principal d'aquest projecte estudiar les propietats psicomètriques de l'S-FNAME i el TAAVR, i desenvolupar els barems normatius per a una mostra espanyola de subjectes sans de mitjana edat. El primer estudi relatiu a les propietats psicomètriques de l'S-FNAME es va dur a terme amb una mostra de 511 subjectes cognitivament sans amb edats compreses entre 41 i 65 anys. Es va obtenir evidència de validesa de constructe a través d'una anàlisi factorial confirmatòria, que va donar dos components a la seva estructura interna, amb indicadors de bona bondat d'ajust. Així mateix, se'n va comprovar la validesa convergent i divergent a partir de correlacions amb altres mesures neurocognitives. Després de determinar la influència del gènere, l'edat i el nivell educatiu sobre el resultat al test, usant anàlisis de regressió múltiple, es van obtenir els barems normatius. El segon estudi relatiu a la validació del TAAVR va fer servir una mostra de 602 participants cognitivament sans amb un rang d'edat entre 41 i 65 anys. Es va obtenir evidència de la validesa convergent i divergent i es va dur a terme una anàlisi factorial confirmatòria per determinar la validesa de constructe, obtenint-se una estructura de quatre components amb un ajustament satisfactori. Els barems normatius es van desenvolupar segons gènere, edat i nivell educatiu, tenint en compte que a partir d'anàlisi de regressió múltiple es va determinar l'efecte de les variables sociodemogràfiques esmentades sobre les puntuacions del test. Finalment, es va valorar el desenvolupament de 251 subjectes en una nova mesura d'oblit a llarg termini, comparant-se l'efecte de diferents modalitats d'aplicació i es va mesurar la influència de les variables sociodemogràfiques. Es va confirmar que el procés de consolidació de la memòria depèn de la modalitat d'aplicació en la mesura a llarg termini, i els subjectes a qui explícitament se li ha advertit respecte a la valoració posterior van tenir un resultat superior. En conclusió, es va determinar que ambdues proves tenen bones propietats psicomètriques, obtenint barems específics per a la població espanyola cognitivament sana de mitjana edat que permetran, als professionals de l'àrea clínica i del camp de la investigació, examinar la trajectòria de la memòria episòdica en etapes primerenques de l'envelliment. Així mateix, es va demostrar que el procediment d'administració escollit en la mesura proposada d'oblit a llarg termini usant el TAAVR influeix en l'evocació després d'una setmana, suggerint l'emmagatzematge a llarg termini és afectat per les expectatives de ser avaluat. Aquest projecte ressalta la importància de comptar amb instruments psicomètrics validats a la nostra població per detectar canvis primerencs associats a les malalties neurodegeneratives, permetrà examinar, detectar i intervenir precoçment el declivi cognitiu.La memoria episódica, referida a la capacidad del ser humano para almacenar experiencias personales del pasado abarcando aspectos temporales y contextuales, juega un rol protagónico en la predicción del deterioro neurocognitivo. El S-FNAME es una prueba de memoria asociativa que ha demostrado ser potencialmente útil para discriminar entre cambios normales en los procesos mnésicos asociados a la edad y el declive asociado a indicadores preclínicos de EA. La validación previa de la versión española del test se llevó a cabo únicamente para adultos mayores de 49 años, con limitaciones relevantes a nivel muestral. El TAAVR es una de las pruebas más usadas a nivel internacional que ha demostrado capacidad para detectar cambios relativos a enfermedades neurodegenerativas. A pesar de las diversas versiones desarrolladas del test, en España no se encuentran estudios de validación ni baremos normativos en las últimas décadas empleando muestras representativas de sujetos sanos. Por lo tanto, se planteó como objetivo principal de este proyecto estudiar las propiedades psicométricas del S-FNAME y TAAVR, y desarrollar sus baremos normativos para una muestra española de sujetos sanos de mediana edad. El primer estudio relativo a las propiedades psicométricas del S-FNAME se llevó a cabo con una muestra de 511 sujetos cognitivamente sanos con edades comprendidas entre 41 y 65 años. Se obtuvo evidencia de validez de constructo a través de un análisis factorial confirmatorio, que arrojó dos componentes en su estructura interna, con indicadores de buena bondad de ajuste. Asimismo, se comprobó su validez convergente y divergente a partir de correlaciones con otras medidas neurocognitivas. Tras determinar la influencia del género, la edad y el nivel educativo sobre el desempeño en el test, usando análisis de regresión múltiple, se obtuvieron los baremos normativos. El segundo estudio relativo a la validación del TAAVR empleó una muestra de 602 participantes cognitivamente sanos con un rango de edad entre 41 y 65 años. Se obtuvo evidencia de la validez convergente y divergente y se llevó a cabo un análisis factorial confirmatorio para determinar la validez de constructo, obteniéndose una estructura de cuatro componentes con un ajuste satisfactorio. Los baremos normativos se desarrollaron según género, edad y nivel educativo, tomando en cuenta que a partir de análisis de regresión múltiple se determinó el efecto de dichas variables sociodemográficas sobre las puntuaciones del test. Finalmente, se valoró el desenvolvimiento de 251 sujetos en una medida novedosa de olvido a largo plazo, comparándose el efecto de distintas modalidades de aplicación y se midió la influencia de las variables sociodemográficas. Se confirmó que el proceso de consolidación de la memoria depende de la modalidad de aplicación en la medida a largo plazo, encontrándose que los sujetos a quienes explícitamente se le ha advertido respecto a la valoración posterior tuvieron un desempeño superior. En conclusión, se determinó que ambas pruebas tienen buenas propiedades psicométricas, obteniéndose baremos específicos para la población española cognitivamente sana de mediana edad que permitirán, a los profesionales del área clínica y del campo de la investigación, examinar la trayectoria de la memoria episódica en etapas tempranas del envejecimiento. Asimismo, se demostró que el procedimiento de administración escogido en la medida propuesta de olvido a largo plazo usando el TAAVR influye en la evocación tras una semana, sugiriendo el almacenamiento a largo plazo es afectado por las expectativas de ser evaluado. Este proyecto resalta la importancia de contar con instrumentos psicométricos adaptados y validados en nuestra población para detectar cambios tempranos asociados a las enfermedades neurodegenerativas, permitirá examinar, detectar e intervenir precozmente el declive cognitivo.Episodic memory, referring to the human being's ability to store past personal experiences encompassing temporal and contextual aspects, is a cognitive function that plays a leading role in predicting neurocognitive impairment associated with pathological aging. The S-FNAME is an associative memory test that has been shown to be potentially useful for discriminating normal changes in medical processes associated with age and decline associated with preclinical indicators of AD. The previous validation of the Spanish test version was carried out only for adults over 49 years of age, with relevant limitations at the sample level. The TAAVR is one of the most widely used verbal EM tests internationally, which, in turn, has demonstrated the ability to detect changes related to neurodegenerative diseases. Despite the various test's versions developed, no validation studies or regulatory scales have been found in Spain in recent decades using representative samples of healthy subjects. Therefore, the main objective of this project was to study the psychometric properties of the S-FNAME Exam and TAAVR and to develop their normative scales for a Spanish sample of healthy middle-aged subjects. The first study on the psychometric properties of the S-FNAME Exam was carried out with a sample of 511 cognitively healthy subjects aged between 41 and 65 years. Construct validity was obtained through a confirmatory factor analysis, which yielded two components in its internal structure, with indicators of good goodness of fit. Likewise, its convergent and divergent validity was verified based on correlations with other neurocognitive measures. After determining the influence of gender, age and educational level on performance in the test, using multiple regression analysis, the norms were obtained. The TAAVR validation study used a sample of 602 cognitively healthy participants ranging in age from 41 to 65 years. Convergent and divergent validity was proved, and a confirmatory factor analysis was carried out to determine construct validity, obtaining a four-component structure with a satisfactory fit. The normative scales were developed according to gender, age and educational level. The effect of these sociodemographic variables on the test scores was determined from multiple regression analysis. Finally, the performance of 251 subjects in a novel measure of long-term forgetfulness was assessed, comparing the effect of different application modalities and measuring the influence of sociodemographic variables. We confirmed that memory consolidation depends on the modality of application in the long-term measure, finding that subjects who have been explicitly warned regarding the long-term forgetting measure had superior performance. In conclusion, both tests of episodic memory have good psychometric properties, obtaining specific scales for the middle-aged cognitively healthy Spanish population that will allow professionals in the clinical area and in the field of research to examine the trajectory of episodic memory in early stages of aging. Likewise, it was shown that the administration procedure chosen in the proposed measure of long-term forgetfulness using the TAAVR influences the recall after one week, suggesting that long-term storage is affected by the expectations of being evaluated. This research project highlights the importance of having adapted and validated psychometric instruments in our population. Normative data for two episodic memory tests that have been considered in the literature as promising to detect early changes associated with neurodegenerative diseases, will make it possible to examine, detect and intervene early on deficits in episodic memory

Validación y normalización de instrumentos neurocognitivos para la medición de memoria episódica en una muestra española de mediana edad

La memòria episòdica, referida a la capacitat de l’ésser humà per emmagatzemar experiències personals del passat abastant aspectes temporals i contextuals, juga un rol protagonista en la predicció del deteriorament neurocognitiu. L’S-FNAME és una prova de memòria associativa que ha demostrat ser potencialment útil per discriminar entre canvis normals en els processos mnèsics associats a l’edat i el declivi associat a indicadors preclínics d’EA. La validació prèvia de la versió espanyola del test es va dur a terme únicament per a adults més grans de 49 anys, amb limitacions rellevants a nivell mostral. El TAAVR és una de les proves més utilitzades a nivell internacional que ha demostrat capacitat per detectar canvis relatius a malalties neurodegeneratives. Tot i les diverses versions desenvolupades del test, a Espanya no es troben estudis de validació ni barems normatius en les darreres dècades emprant mostres representatives de subjectes sans. Per tant, es va plantejar com a objectiu principal d’aquest projecte estudiar les propietats psicomètriques de l’S-FNAME i el TAAVR, i desenvolupar els barems normatius per a una mostra espanyola de subjectes sans de mitjana edat. El primer estudi relatiu a les propietats psicomètriques de l’S-FNAME es va dur a terme amb una mostra de 511 subjectes cognitivament sans amb edats compreses entre 41 i 65 anys. Es va obtenir evidència de validesa de constructe a través d’una anàlisi factorial confirmatòria, que va donar dos components a la seva estructura interna, amb indicadors de bona bondat d’ajust. Així mateix, se’n va comprovar la validesa convergent i divergent a partir de correlacions amb altres mesures neurocognitives. Després de determinar la influència del gènere, l’edat i el nivell educatiu sobre el resultat al test, usant anàlisis de regressió múltiple, es van obtenir els barems normatius. El segon estudi relatiu a la validació del TAAVR va fer servir una mostra de 602 participants cognitivament sans amb un rang d’edat entre 41 i 65 anys. Es va obtenir evidència de la validesa convergent i divergent i es va dur a terme una anàlisi factorial confirmatòria per determinar la validesa de constructe, obtenint-se una estructura de quatre components amb un ajustament satisfactori. Els barems normatius es van desenvolupar segons gènere, edat i nivell educatiu, tenint en compte que a partir d’anàlisi de regressió múltiple es va determinar l’efecte de les variables sociodemogràfiques esmentades sobre les puntuacions del test. Finalment, es va valorar el desenvolupament de 251 subjectes en una nova mesura d’oblit a llarg termini, comparant-se l’efecte de diferents modalitats d’aplicació i es va mesurar la influència de les variables sociodemogràfiques. Es va confirmar que el procés de consolidació de la memòria depèn de la modalitat d’aplicació en la mesura a llarg termini, i els subjectes a qui explícitament se li ha advertit respecte a la valoració posterior van tenir un resultat superior. En conclusió, es va determinar que ambdues proves tenen bones propietats psicomètriques, obtenint barems específics per a la població espanyola cognitivament sana de mitjana edat que permetran, als professionals de l’àrea clínica i del camp de la investigació, examinar la trajectòria de la memòria episòdica en etapes primerenques de l’envelliment. Així mateix, es va demostrar que el procediment d’administració escollit en la mesura proposada d’oblit a llarg termini usant el TAAVR influeix en l’evocació després d’una setmana, suggerint l’emmagatzematge a llarg termini és afectat per les expectatives de ser avaluat. Aquest projecte ressalta la importància de comptar amb instruments psicomètrics validats a la nostra població per detectar canvis primerencs associats a les malalties neurodegeneratives, permetrà examinar, detectar i intervenir precoçment el declivi cognitiu.La memoria episódica, referida a la capacidad del ser humano para almacenar experiencias personales del pasado abarcando aspectos temporales y contextuales, juega un rol protagónico en la predicción del deterioro neurocognitivo. El S-FNAME es una prueba de memoria asociativa que ha demostrado ser potencialmente útil para discriminar entre cambios normales en los procesos mnésicos asociados a la edad y el declive asociado a indicadores preclínicos de EA. La validación previa de la versión española del test se llevó a cabo únicamente para adultos mayores de 49 años, con limitaciones relevantes a nivel muestral. El TAAVR es una de las pruebas más usadas a nivel internacional que ha demostrado capacidad para detectar cambios relativos a enfermedades neurodegenerativas. A pesar de las diversas versiones desarrolladas del test, en España no se encuentran estudios de validación ni baremos normativos en las últimas décadas empleando muestras representativas de sujetos sanos. Por lo tanto, se planteó como objetivo principal de este proyecto estudiar las propiedades psicométricas del S-FNAME y TAAVR, y desarrollar sus baremos normativos para una muestra española de sujetos sanos de mediana edad. El primer estudio relativo a las propiedades psicométricas del S-FNAME se llevó a cabo con una muestra de 511 sujetos cognitivamente sanos con edades comprendidas entre 41 y 65 años. Se obtuvo evidencia de validez de constructo a través de un análisis factorial confirmatorio, que arrojó dos componentes en su estructura interna, con indicadores de buena bondad de ajuste. Asimismo, se comprobó su validez convergente y divergente a partir de correlaciones con otras medidas neurocognitivas. Tras determinar la influencia del género, la edad y el nivel educativo sobre el desempeño en el test, usando análisis de regresión múltiple, se obtuvieron los baremos normativos. El segundo estudio relativo a la validación del TAAVR empleó una muestra de 602 participantes cognitivamente sanos con un rango de edad entre 41 y 65 años. Se obtuvo evidencia de la validez convergente y divergente y se llevó a cabo un análisis factorial confirmatorio para determinar la validez de constructo, obteniéndose una estructura de cuatro componentes con un ajuste satisfactorio. Los baremos normativos se desarrollaron según género, edad y nivel educativo, tomando en cuenta que a partir de análisis de regresión múltiple se determinó el efecto de dichas variables sociodemográficas sobre las puntuaciones del test. Finalmente, se valoró el desenvolvimiento de 251 sujetos en una medida novedosa de olvido a largo plazo, comparándose el efecto de distintas modalidades de aplicación y se midió la influencia de las variables sociodemográficas. Se confirmó que el proceso de consolidación de la memoria depende de la modalidad de aplicación en la medida a largo plazo, encontrándose que los sujetos a quienes explícitamente se le ha advertido respecto a la valoración posterior tuvieron un desempeño superior. En conclusión, se determinó que ambas pruebas tienen buenas propiedades psicométricas, obteniéndose baremos específicos para la población española cognitivamente sana de mediana edad que permitirán, a los profesionales del área clínica y del campo de la investigación, examinar la trayectoria de la memoria episódica en etapas tempranas del envejecimiento. Asimismo, se demostró que el procedimiento de administración escogido en la medida propuesta de olvido a largo plazo usando el TAAVR influye en la evocación tras una semana, sugiriendo el almacenamiento a largo plazo es afectado por las expectativas de ser evaluado. Este proyecto resalta la importancia de contar con instrumentos psicométricos adaptados y validados en nuestra población para detectar cambios tempranos asociados a las enfermedades neurodegenerativas, permitirá examinar, detectar e intervenir precozmente el declive cognitivo.Episodic memory, referring to the human being’s ability to store past personal experiences encompassing temporal and contextual aspects, is a cognitive function that plays a leading role in predicting neurocognitive impairment associated with pathological aging. The S-FNAME is an associative memory test that has been shown to be potentially useful for discriminating normal changes in medical processes associated with age and decline associated with preclinical indicators of AD. The previous validation of the Spanish test version was carried out only for adults over 49 years of age, with relevant limitations at the sample level. The TAAVR is one of the most widely used verbal EM tests internationally, which, in turn, has demonstrated the ability to detect changes related to neurodegenerative diseases. Despite the various test’s versions developed, no validation studies or regulatory scales have been found in Spain in recent decades using representative samples of healthy subjects. Therefore, the main objective of this project was to study the psychometric properties of the S-FNAME Exam and TAAVR and to develop their normative scales for a Spanish sample of healthy middle-aged subjects. The first study on the psychometric properties of the S-FNAME Exam was carried out with a sample of 511 cognitively healthy subjects aged between 41 and 65 years. Construct validity was obtained through a confirmatory factor analysis, which yielded two components in its internal structure, with indicators of good goodness of fit. Likewise, its convergent and divergent validity was verified based on correlations with other neurocognitive measures. After determining the influence of gender, age and educational level on performance in the test, using multiple regression analysis, the norms were obtained. The TAAVR validation study used a sample of 602 cognitively healthy participants ranging in age from 41 to 65 years. Convergent and divergent validity was proved, and a confirmatory factor analysis was carried out to determine construct validity, obtaining a four-component structure with a satisfactory fit. The normative scales were developed according to gender, age and educational level. The effect of these sociodemographic variables on the test scores was determined from multiple regression analysis. Finally, the performance of 251 subjects in a novel measure of long-term forgetfulness was assessed, comparing the effect of different application modalities and measuring the influence of sociodemographic variables. We confirmed that memory consolidation depends on the modality of application in the long-term measure, finding that subjects who have been explicitly warned regarding the long-term forgetting measure had superior performance. In conclusion, both tests of episodic memory have good psychometric properties, obtaining specific scales for the middle-aged cognitively healthy Spanish population that will allow professionals in the clinical area and in the field of research to examine the trajectory of episodic memory in early stages of aging. Likewise, it was shown that the administration procedure chosen in the proposed measure of long-term forgetfulness using the TAAVR influences the recall after one week, suggesting that long-term storage is affected by the expectations of being evaluated. This research project highlights the importance of having adapted and validated psychometric instruments in our population. Normative data for two episodic memory tests that have been considered in the literature as promising to detect early changes associated with neurodegenerative diseases, will make it possible to examine, detect and intervene early on deficits in episodic memory.Universitat Autònoma de Barcelona. Programa de Doctorat en Medicin

"Guttmann Cognitest" ®, preliminary validation of a digital solution to test cognitive performance

Thanks to technological advances, the administration of cognitive assessments via digital solutions continues to increase, both in research and clinical practice. "Guttmann Cognitest" °ledR is a digital solution for cognitive assessment which includes seven computerized tasks designed to assess main cognitive functions requiring approximately 20 min to be completed. The purpose of the present study was to validate it against standard and more extensive in-person neuropsychological assessments in the context of the Barcelona Brain Health Initiative (BBHI) cohort study. We studied 274 participants of the BBHI (126 women, mean age = 56.14, age range 44-69), who underwent an extensive in-person assessment, including a classical paper-and-pencil neuropsychological assessment and a cognitive assessment via the "Guttmann Cognitest" °ledR. Principal component analysis indicated that "Guttmann Cognitest" °ledR measures four main cognitive domains and convergent validity analysis demonstrated that cognitive performance was associated with gold standard paper and pencil tests. Results also showed an expected negative correlation with age, a relation with educational level as well as a gender effect. Regression-based norming equations for the sample tested are also reported. Performing a cognitive assessment with this digital solution is feasible and potentially useful to gather information about cognitive functioning in large samples and experimental settings

Modifiable factors, cardiorespiratory fitness and cardiovascular risk are associated with cognitive and structural brain health in midlife: Results from the BBHI

Background Neurodegenerative brain changes that lead to cognitive decline generally begin decades prior to the onset of symptoms. On the other hand, brain health relates to overall, and specifically cardio‐vascular health, and vice‐versa. The objective of this investigation was to assess the relationships between two important domains of cardiovascular health (cardiorespiratory fitness, CRF, and cardiovascular risk, CVR) and two important markers of brain health (cognitive performance and volumetric measures of brain structure) in late middle age. Method In a relatively large sample (n=327) of middle‐aged adults in the Barcelona Brain Health Initiative (Cattaneo et al., 2018), we assessed the associations between CRF (measured by VO2 max), CVR (measured by Framingham risk score), domain‐specific cognitive performance (measured by performance in a neuropsychological test battery) and brain volumes (measured by high‐resolution brain MRI). All regression models were corrected for age and education. Result We found differential associations between CRF and CVR and cognitive performance. CRF was significantly associated with visuo‐spatial abilities and frontal loading problem solving (p=.003), whereas CVR was associated with visuo‐spatial abilities (p=.023), flexibility (p=.005), processing speed (p<.001) and memory (p<.001). Moreover we found that CRF was associated with frontal (p=.042), temporal (p=.016) and sensorimotor (p=.013) cortical volume, whereas CVR was significantly associated with all cortical volume measures (frontal, temporal, parietal, occipital and sensorimotor; ps<0.05). Conclusion We found that two modifiable factors in mid‐life (CRF and CVR) are significantly associated with a number of metrics of brain health in a cross‐sectional analysis. Future longitudinal analyses of this cohort will show whether these associations have predictive value for the maintenance of brain health across the lifespan. Finally, our findings suggest that lifestyle habits that promote CRF and reduce CVR, e.g. sufficient physical activity and appropriate nutrition, might help sustain brain health across the lifespan and prevent cognitive decline