Objective: Accurate identification of the earliest cognitive changes associated with Alzheimer's disease (AD) is critically needed. Item-level information within tests of category fluency, such as lexical frequency, harbors valuable information about the integrity of semantic networks affected early in AD.To determine the potential of lexical frequency as a cognitive marker of AD risk, we investigated whether lexical frequency of animal fluency output differentiated APOE ε4 carriers from noncarriers in a cross-sectional design among older African-American adults without dementia. Method: We analyzed animal fluency performance using mean number of items and mean lexical frequency among 230 cognitively normal African Americans with and without the APOE ε4 allele. Results: Lexical frequency was higher in APOE ε4 carriers than noncarriers when analyzed as a mean score and within time bins. In contrast, we found no group difference in the number of items produced. Lexical frequency was particularly sensitive to ε4 status after the first 10 s of the 60-s animal fluency task. Conclusion: Our results suggest that psycholinguistic features may hold value as a cognitive biomarker for identifying people at high risk of AD. General Scientific SummaryDecline in cognition occurs years before the symptoms are distinct enough to establish a clinical diagnosis of Alzheimer's disease (AD) based on traditional neuropsychological test scores. We showed that an alternative, psycholinguistic score of the category fluency task could predict AD genetic risk (having the APOE ε4 allele) in older adults whose overall cognition and function are within normal limits. These results suggest that psycholinguistic features may hold value as a cognitive biomarker for identifying people at high risk of AD.

Background Few studies have applied multiple imaging modalities to examine cognitive correlates of white matter. We examined the utility of T2-weighted MRI-derived white matter hyperintensities (WMH) and diffusion tensor imaging-derived fractional anisotropy (FA) to predict cognitive functioning among older adults. Methods Quantitative MRI and neuropsychological evaluations were performed in 112 older participants from an ongoing study of the genetics of Alzheimer’s disease (AD) in African Americans. Regional WMH volumes and FA were measured in multiple regions of interest. We examined the association of regional WMH and an FA summary score with cognitive test performance. Differences in WMH and FA were compared across diagnostic groups (i.e., normal controls, mild cognitive impairment, and probable AD). Results Increased WMH volume in frontal lobes was associated with poorer delayed memory performance. FA did not emerge as a significant predictor of cognition. White matter hyperintensity volume in the frontal and parietal lobes was increased in MCI participants and more so in AD patients relative to controls. Discussion These results highlight the importance of regionally-distributed small vessel cerebrovascular disease in memory performance and AD among African American older adults. White matter microstructural changes, quantified with DTI, appear to play a lesser role in our sample.

Background Twenty to 40% of infants exposed to in-utero opioids deliver preterm. There is currently no neonatal abstinence syndrome (NAS) scoring tool known to accurately assess preterm opioid-exposed infants. This can lead to difficulties in titrating pharmacotherapy in this population. Purpose To describe NAS symptoms in preterm opioid-exposed infants in comparison with matched full-term controls. Methods This was a retrospective cohort study from a single tertiary care center of methadone-exposed infants born between 2006 - 2010. Using modified Finnegan scores recorded every 3-4 hours beginning at 6 hours of life until 24-48 hours after medication discontinuation, NAS symptomatology was compared between 45 preterm infants and 49 full-term matched controls. Concurrent neonatal medical diagnoses were also compared. Results The median gestational age in the preterm group was 35 weeks (IQR 33-36) vs 39 weeks (IQR 38-40) in the term group. Preterm infants scored less frequently for many items including sleep disturbance (24.4 vs 46.2%), tremors (77.9 vs 89.7%), muscle tone (87.9 vs 97.4%), sweating (2.1 vs 9.4%), nasal stuffiness (11.9 vs 20.5%), and loose stools (7.0 vs 14.3%) when compared with full-term controls. Preterm infants scored more frequently for hyperactive moro reflex (26.4 vs 5.5%), tachypnea (19.3 vs 16.1%), and poor feeding (24.6 vs 11.8%). Implications for Practice Provider awareness of differences in manifestations of preterm and term NAS infants, as well as concurrent prematurity diagnoses that can influence NAS scoring is needed. These findings mandate the development of a modified NAS scoring tool for the preterm NAS population. Implications for Research A preterm NAS scoring tool needs to be developed and validated to more accurately assess and treat preterm opioid-exposed infants.