In April 2024, over 20 scientists, clinicians, and experts in health equity convened in Denver, Colorado, for an interdisciplinary Summit on Advancing Precision in Health Assessment. The Summit was hosted by the National Academy of Neuropsychology (NAN) with an aim to develop a pathway to identify, assess, and implement alternatives to broad proxies, such as race and sex/gender, in health assessments. Presentations and breakout group discussions focused on re-examining existing clinical algorithms for bias; how big data, artificial intelligence, and machine learning will lead to new algorithms and how to design and use these in ethical ways and how to assess and successfully implement changes in health care assessment aimed at achieving equity. Race received the most discussion. Participants supported calls to replace race-based decision-making tools that erroneously consider race as a biological variable. When possible, underlying social determinants of health should be included in clinical algorithms. Moving forward, research should include clear definitions and justification for all variables used. Future research paths should assess the utility and fairness of algorithms across groups before and after implementation. Changing the narrative to focus on better health for all people, and to achieving health equity, will require collaboration, partnerships, and openness to innovation.

OBJECTIVE:The Houston Conference Policy Statement established an integrated model of training for clinical neuropsychologists and has been widely implemented. However, developments and needs related to professional competencies, cultural/linguistic diversity, and technology prompted the need to update training guidelines. In 2021, an interorganizational Planning Commission (PC), with Commissioners from 17 organizations within clinical neuropsychology, was formed to develop a process by which training guidelines would be comprehensively updated via the Minnesota 2022 Conference to Update Educational and Training Guidelines in Clinical Neuropsychology, held 12-16 September 2022. METHOD:The PC met virtually from June 2021 through August 2022, and responsibilities included conference site selection, fundraising, Delegate selection, and conference goals, schedule, and policies. The PC also defined the roles and responsibilities for the conference and subsequent activities among the Delegates, Steering Committee, and Content Panels. CONCLUSION:The PC set the stage for the participants of the Minnesota Conference to undertake a generational updating of training guidelines. The 25 years since the Houston Conference and the long process of completing the Minnesota guidelines underscore the need to update training guidelines with greater frequency.

OBJECTIVE:Between May 2021 and January 2022, the American Psychological Association (APA) Division 40: Society for Clinical Neuropsychology's (SCN) Strategic Planning Committee conducted multiple methods of data collection to inform the development of an organizational strategic plan. METHODS:Professional consultants conducted semi-structured interviews with members of the SCN Executive Committee (EC) and targeted focus groups in May and June 2021. SCN members and non-member neuropsychology interested parties were surveyed between October 2021 and January 2022 about their perspectives of 1) membership satisfaction, 2) the historical and current strengths and weaknesses of the SCN, 3) equity, diversity, and inclusion (EDI) within the SCN and clinical neuropsychology, 4) current and potential membership benefits, 5) professional challenges and difficulties facing the specialty, and 6) areas that the SCN should prioritize when investing its resources. RESULTS:Seven and five major themes were identified from the EC interviews and focus groups, respectively. These themes overlapped with data from the strategic planning survey, which was completed by nearly 700 people with diverse professional and personal identities. Overall, the data indicated high membership satisfaction and a desire for the SCN to strengthen its professional advocacy, better leverage its relationship with the APA, infuse EDI throughout the organization, and enhance member benefits and professional development opportunities across the career span. CONCLUSIONS:Member satisfaction with the SCN is high. Members and non-members believe that the SCN should expend its resources to bolster its professional advocacy and EDI efforts, thereby increasing its value proposition, long-term viability, and value to society.

OBJECTIVES:To examine differences between demographic and cultural identity group responses on the Society for Clinical Neuropsychology's (SCN) Strategic Planning Survey. METHODS:Respondents were grouped into self-identified demographic and cultural identity groups. Descriptive statistics were used to summarize responses to demographic and survey data. We used Chi-square and Fisher's Exact tests to compare group differences. Adjusted residuals were calculated for post-hoc testing, when appropriate. RESULTS:Membership satisfaction was high across groups. Respondents who identified as persons of color, women, with a disability, or students/trainees were more likely to indicate that the SCN could better represent them by increasing diversity and inclusion efforts. Persons of color and other historically marginalized/minoritized groups viewed the SCN's equity, diversity, and inclusion (EDI) efforts as less successful than comparative groups, but they expressed more optimism that initiatives could increase the engagement of persons of color in the SCN. Respondents earlier in their career and from marginalized/minoritized groups more frequently viewed the lack of diversity in clinical neuropsychology as an important issue facing the specialty and the desire for the SCN to prioritize improving EDI within clinical neuropsychology. Women and earlier career respondents were more likely to indicate that the SCN should focus efforts on increasing clinical neuropsychology's value to society. CONCLUSIONS:Respondents earlier in their careers and from marginalized/minoritized groups were more likely to identify EDI related issues as significant to the SCN and specialty, and a desire for the SCN to prioritize efforts to improve EDI.

Introduction:White matter hyperintensities (WMHs) are strongly linked to cardiovascular risk factors and other health conditions such as Alzheimer's disease. However, there is a dearth of research on this topic in low-income countries and underserved populations, especially in the Democratic Republic of Congo (DRC) where the population is aging rapidly with increasing cardiovascular risk factors and dementia-related diseases. This study evaluates health factors associated with WMH in the elderly Sub-Saharan Africa (SSA), specifically Congolese adults. Methods:In a cross-sectional study of 77 people from the DRC, participants underwent neuroimaging to analyze WMHs volume and completed clinical evaluation, laboratory-based blood exams, self-reported questionnaires, and interviews. A simple linear regression model was conducted to test the association between WMHs and potential predictors (dementia, age, sex, hypertension, diabetes, tobacco abuse, stroke, high cholesterol, cardiovascular medication, and alcohol abuse). Stepwise selection and backward elimination analyses were performed to obtain the final model. Finally, a multiple linear regression model was conducted to assess the association between WMHs and variables retained in the final model (dementia, sex, and age). Results:Of the 77 individuals, 47 (61%) had dementia, 40 (52.6%) were males, and the mean age was 73 years (± 8.0 years standard deviation). In simple linear regression models, WMHs was significantly associated with dementia (expβ1 = 1.75, 95% CI = 1.14-2.71, p-value = 0.01) though it had a weak association with age (expβ1 = 1.03, 95% CI = 1.00-1.05, p-value = 0.05) and sex (male) (expβ1 = 0.66, 95% CI = 0.43-1.01, p-value = 0.05). In multiple linear regression models, WMHs was statistically significantly associated with dementia (expβ1 = 1.97, 95% CI = 1.31-2.95, p-value =0.001), male sex (expβ2 = 0.54, 95% CI = 0.36-0.80, p-value = 0.003), and age (expβ3 = 1.03, 95% CI = 1.00-1.06, p-value = 0.03). However, WMHs was not significantly associated with common cardiovascular risk factors, such as high blood pressure, diabetes, tobacco use, obesity, and high cholesterol levels. Discussion:WMHs is significantly associated with dementia, sex, and age in the Congolese population. Understanding these predictors may improve our ability to diagnose, assess, and develop preventative treatments for white matter disease in SSA/DRC populations, where neuroimaging is difficult to obtain.

ObjectivesThis single-blind, parallel groups, randomized controlled trial examined whether (1) mnemonic strategy training (MST) improved memory for face-name associations relative to vanishing cue training (VCT) and (2) the interventions modulated blood oxygen level dependent (BOLD) signal in a training-specific manner.MethodsWe randomized 30 cognitively intact older adults to either MST or VCT (1:1 basis). Memory for face-name associations (primary outcome) was evaluated at baseline and post-training using functional magnetic resonance imaging (fMRI) and again at 1-month follow-up (memory test only). During training sessions, MST participants applied a 3-step strategy while those receiving VCT recalled the targeted name across trials with letters subtracted (correct trials) or added (incorrect trials) as appropriate.ResultsThere were no adverse events and excellent retention. The magnitude of memory test improvement was significantly greater after MST at both post-training and 1-month relative to VCT. The MST group also showed significantly greater BOLD signal changes in multiple brain regions as well as increased functional connectivity between networks relative to the VCT group.ConclusionsMST is superior to VCT for enhancing long-term retention of face-name associations in cognitively intact older adults and appears to enhance use of lateral frontoparietal regions and networks involved in top-down processing.

Objective: This paper is the first in a series of three that describe the context, rationale, and results of the American Psychological Association's Division 40: Society for Clinical Neuropsychology's (SCN) strategic planning initiative. Methods: In this paper, we provide a review of the SCN's history, including previous organizational changes and strategic planning efforts, and discuss the rationale for undertaking the current strategic planning process. We discuss the development and work of the SCN Strategic Planning Committees (SPCs) and their multi-method approach to assessing the SCN's strengths and weaknesses, the needs and preferred organizational priorities of membership, and opportunities for improving organizational inclusivity and member benefits. We discuss how the results of extensive qualitative and quantitative data collection methods were used to develop the SCN 2023 Strategic Plan and guide organizational changes. Results: The SCN 2023 Strategic Plan was approved by the SCN Executive Committee in 2023. It includes six guiding principles, three operating principles, five strategic priorities, and specific organizational objectives. Based on the data collected, the plan includes a focus on strengthening professional advocacy and equity, justice, and inclusion within the SCN, increasing organizational effectiveness, and improving the SCN's membership value proposition. To align the SCN with the strategic plan, subsequent implementation efforts include changes to the SCN Bylaws, policies and procedures, and organizational structure. Conclusions: The SCN 2023 Strategic Plan operationalizes the values, strategies priorities, and objectives of the organization, and in doing so, enhances the SCN's capacity to optimize its value to members and societal impact.

BackgroundWestern countries have provided reference values (RV) for Alzheimer’s disease (AD) plasma biomarkers, but there are not available in Sub-Saharan African populations.ObjectiveWe provide preliminary RV for AD and other plasma biomarkers including amyloid-β (Aβ42/40), phosphorylated tau-181 and 217 (p-tau181, p-tau217), neurofilament light (Nfl), glial fibrillary acidic protein (GFAP), interleukin 1b and 10 (IL-1b and IL-10) and tumor necrosis factor α (TNFα) in Congolese adults with and without dementia.Methods85 adults (40 healthy and 45 dementia) over 50 years old were included. Blood samples were provided for plasma AD biomarkers Aβ42/40 and p-tau181, p-tau217; Nfl and GFAP; IL-1b and IL-10 and TNFα analyzed using SIMOA. Linear and logistic regressions were conducted to evaluate differences in biomarkers by age and gender and neurological status, and for the prediction of dementia status by each individual biomarker. RV were those that optimized sensitivity and specificity based on Youden’s index.ResultsIn this sample of 85 adults, 45 (53%) had dementia, 38 (45%) were male, overall mean age was 73.2 (SD 7.6) years with 8.3 (5.4) years of education. There were no significant differences in age, gender, and education based on neurological status. Biomarker concentrations did not significantly differ by age except for p-tau181 and GFAP and did not differ by sex. Preliminary normal value cutoffs of various plasma in pg./mL were 0.061 for Aβ42/40, 4.50 for p-tau 181, 0.008 for p-tau 217, 36.5 for Nfl, 176 for GFAP, 1.16 for TNFa, 0.011 for IL-1b, and 0.38 for IL-10. All AUCs ranged between 0.64–0.74. P-tau 217 [0.72 (95% CI: 0.59, 0.84)] followed by GFAP [0.72 (95% CI: 0.61, 0.83)], and Nfl [0.73 (95% CI: 0.62, 0.84)] had the highest AUC compared to other plasma biomarkers.ConclusionThis study provides RV which could be of preliminary utility to facilitate the screening, clinical diagnostic adjudication, and classification, of dementia in Congolese adults.

Objective: Numerous nonpharmacological treatments (NPTs) have been developed for older adults with mild cognitive impairment (MCI). Two forms of cognition-focused NPTs, cognitive rehabilitation (CR) and cognitive training (CT), demonstrate cognitive benefit, but limitations remain regarding the contribution of cultural and demographic factors to study outcome heterogeneity, generalizability to diverse populations, and feasibility. This article aimed to review demographic and culturally informed NPTs and provides recommendations for culturally informed clinical practice and research. Method: We conducted a PubMed review to identify CR and CT interventions that incorporated cultural adaptations. Results from the review, combined with the authors' clinical expertise, were used to identify methodological, demographic, social, cultural, and systemic variables relevant to NPTs. Results: Existing CR and CT studies that included cultural adaptations adopted modifications to language, measures (cognition, function), and lifestyle factors (diet, physical activity) among others. In addition, provider, patient, and group-level factors were then raised to promote inclusivity and increase NPT generalizability. Nevertheless, there is a paucity of research considering cultural and demographic factors when delivering cognition-focused NPTs. Recommendations were generated that incorporated current literature as well as the authors' clinical and research experiences. Conclusions: Culturally informed NPTs are understudied. Social, demographic, and cultural factors may contribute to the heterogeneity of outcomes, lack of generalizability of findings to diverse groups, and application of intervention to said groups. Several tools are available and can focus on broadening collection of information regarding patients' identities, social network, adapting to literacy level and linguistic diversity needs, and responding to social and structural determinants of health.

Objective:The hippocampus is one of the first brain structures affected by Alzheimer's disease (AD), and its atrophy is a strong indicator of the disease. This study investigates the ability of plasma biomarkers of AD and AD-related dementias-amyloid-β (Aβ42/40), phosphorylated tau-181 (p-tau181), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP)-to predict hippocampal atrophy in adult individuals in Kinshasa, Democratic Republic of Congo (DRC). Methods:Eighty-five adult individuals (40 healthy and 45 suspected AD) over 65 years old were evaluated using the Community Screening Instrument for Dementia and Alzheimer's Questionnaire (AQ). Core AD biomarkers (Aβ42/40 and p-tau181) and non-specific neurodegeneration biomarkers (NfL, GFAP) were measured in blood samples collected at the study visit. Hippocampal volumes were measured using magnetic resonance imaging (MRI). General linear regression was used to evaluate differences in biomarker concentrations by neurological status. Logistic regression models were used to create receiver operating characteristic curves and calculate areas under the curve (AUCs) with and without clinical covariates to determine the ability of biomarker concentrations to predict hippocampal atrophy. Plasma biomarkers were used either individually or in combination in the models. Results:Elevated p-tau181 was associated with left hippocampal (LH) atrophy p= 0.020). Only higher p-tau181 concentrations were significantly associated with 4.2-fold increased odds [OR=4.2 (1.5-18.4)] of hippocampal atrophy per standard deviation. The AUC of plasma biomarkers without clinical covariates to discriminate LH, RH, and total hippocampal (TH) or both hippocampi atrophy ranged between 90% to 94%, 76% to 82%, and 85% to 87%, respectively. The AUC of models including clinical covariates and AD biomarkers used in combination to discriminate LH, RH, and TH ranged between 94%-96%, 81%-84%, and 88%-90%, respectively. Conclusion:These results indicate that, consistent with studies in other settings, core AD plasma biomarkers can predict hippocampal atrophy in a population in Sub-Saharan Africa.

Objective: To introduce New2Neuropsychology (N2N), an organization that seeks to increase recruitment of historically underrepresented minoritized (URM) students, and to examine preliminary data on N2N's impact and effectiveness in increasing knowledge about neuropsychology for URM students. Method: This paper reviews relevant literature on factors informing the development of N2N. We also present descriptive data on N2N's impact to date, and results of pre- and post- surveys for presentations about neuropsychology delivered to 90 college students (mean age = 24.23, 64.4% juniors or seniors) between November 2021 - March 2023. Results: N2N has reached >500 students in events across 27 schools and, with the American Academy of Clinical Neuropsychology, disseminated $84,000 in scholarships to URM students. N2N presentation attendees reported increased understanding of neuropsychology and the training pathway (ps < .001, Cohen's ds = 0.94 - 1.73) and increased confidence in their ability to become neuropsychologists (p < .001, d = 0.41). There were no overall pre-post differences for interest in pursuing a career in neuropsychology (p > .05); however, a subset of students who reported low interest at baseline (n = 57) reported a statistically significant increase in their interest post-presentation (p < .01, d = 0.36). Conclusions: To date, N2N has progressed toward its goal, showing preliminary success increasing knowledge about neuropsychology for URM students. With continued development and support, N2N seeks to transform the pathway to neuropsychology for URM students, expanding accessibility of N2N resources across diverse groups and connecting URM students to neuropsychology research and clinical experiences.

BackgroundThe current study examined the sensitivity of two memory subtests and their corresponding learning slope metrics derived from the African Neuropsychology Battery (ANB) to detect amyloid pathology and APOEε4 status in adults from Kinshasa, the Democratic Republic of the Congo.Methods85 participants were classified for the presence of β-amyloid pathology and based on allelic presence of APOEε4 using Simoa. All participants were screened using CSID and AQ, underwent verbal and visuospatial memory testing from ANB, and provided blood samples for plasma Aβ42, Aβ40, and APOE proteotype. Pearson correlation, linear and logistic regression were conducted to compare amyloid pathology and APOEε4 status with derived learning scores, including initial learning, raw learning score, learning over trials, and learning ratio.ResultsOur sample included 35 amyloid positive and 44 amyloid negative individuals as well as 42 without and 39 with APOEε4. All ROC AUC ranges for the prediction of amyloid pathology based on learning scores were low, ranging between 0.56–0.70 (95% CI ranging from 0.44–0.82). The sensitivity of all the scores ranged between 54.3–88.6, with some learning metrics demonstrating good sensitivity. Regarding APOEε4 prediction, all AUC values ranged between 0.60–0.69, with all sensitivity measures ranging between 53.8–89.7. There were minimal differences in the AUC values across learning slope metrics, largely due to the lack of ceiling effects in this sample.DiscussionThis study demonstrates that some ANB memory subtests and learning slope metrics can discriminate those that are normal from those with amyloid pathology and those with and without APOEε4, consistent with findings reported in Western populations.

Background:Alzheimer's Disease (AD), the most common cause of dementia, poses a significant global burden. Diagnosis typically involves invasive and costly methods like neuroimaging or cerebrospinal fluid (CSF) biomarker testing of phosphorylated tau (p-tau) and amyloid-β42/40 (Aβ42/40). Such procedures are especially impractical in resource-constrained regions, such as the Democratic Republic of Congo (DRC). Blood-based biomarker testing may provide a more accessible screening opportunity. Objective:This study aims to examine if AD-related blood-based biomarkers are associated with cognitive test performance in the Congolese population, where limited research has been conducted. Methods:In this cross-sectional study of 81 Congolese individuals, cognitive assessments (Alzheimer's Questionnaire (AQ) and Community Screening Interview for Dementia (CSID)) distinguished dementia cases from controls. Blood draws were taken to assess p-tau 181 and Aβ42/40 biomarkers. Relationships between the biomarkers and cognitive performance were analyzed using multiple linear regression models. Results:Lower plasma Aβ42/40 was significantly associated with lower CSID scores and higher AQ scores, indicative of AD (p<0.001). These relationships were observed in healthy controls (CSID p=0.01, AQ p=0.03), but not in dementia cases. However, p-tau 181 did not exhibit significant associations with either measure. Factors such as age, sex, education, presence of APOE e4 allele, did not alter these relationships. Conclusion:Understanding relationships between AD-related screening tests and blood-biomarkers is a step towards utilization of blood-based biomarker tests as a screening tool for AD, especially in resource-limited regions. Further research should be conducted to evaluate blood biomarker test efficacy in larger samples and other populations.

The term cognitive training includes a range of techniques that hold potential for treating cognitive impairment caused by neurologic injury and disease. Our central premise is that these techniques differ in their mechanisms of action and therefore engage distinct brain regions (or neural networks). We support this premise using data from a single-blind randomized-controlled trial in which patients with mild cognitive impairment were randomized to either mnemonic strategy training (MST) or spaced retrieval training (SRT) as they learned ecologically relevant object-location associations. Both training approaches were highly effective in the short term, but MST demonstrated a clear advantage after days to weeks. MST also increased activation in and functional connectivity between frontal, temporal, and parietal regions as well as the hippocampus. In contrast, patterns of reduced activation and functional connectivity were evident following SRT. These findings support the rational development of cognitive training techniques.

Objective:Hippocampal and medial temporal lobe structure atrophy is commonly observed in patients with mild neurocognitive disorders and dementias of various neurodegenerative conditions, with the degree of atrophy in these regions correlating with cognitive performance on memory tasks. This research has been conducted largely in western and educated countries. As cognitive aging, risk factors, clinical course, and neuropathology can differ between individuals of different races and ethnicities, our goal is to determine whether these findings also generalize to patients with suspected dementias living in the Democratic Republic of the Congo (DRC).Participants and Methods:Neuroimaging and cognitive data have been collected on 40 subjects with probable dementia from the DRC and 40 age-, education-, and gender-matched controls. Patients were classified into groups based on scores on the Community Screening Instrument and the Alzheimer's Questionnaire. All participants completed the African Neuropsychological Battery. T1 MPRAGE images were acquired on Siemens 1.5T scanner. Freesurfer was used to derive volumes and cortical thickness of medial temporal lobe regions. Volumes of structures were divided by intracranial vault volumes to adjust for head size. T-tests were used to compare hippocampal volumes, entorhinal cortex thickness, and perirhinal cortex thickness between subjects with probable dementia compared to healthy age-, gender-, and education-matched controls. Bivariate correlations were conducted to determine whether the volumes of these structures correlate significantly with learning and memory measures on the ANB.Results:Results will be determined by the methods described previously.Conclusions:Results from this study will demonstrate whether structural brain changes commonly seen in individuals with dementia living in western and educated countries also are observed in the DRC. Results will also demonstrate whether these brain changes coincide with the degree of impairments on tasks of memory, and whether these structures can be used to aid in clinical diagnosis of patients with dementia and support the use of the ANB and neuroimaging in clinical detection of dementias in the DRC.

BACKGROUND:Western studies indicate potential associations between hippocampal volume and memory in the trajectory of Alzheimer's disease (AD). However, limited availability of neuroimaging technology and neuropsychological tests appropriate for sub-Saharan African (SSA) countries makes it difficult to establish neuroanatomical associations of hippocampus and memory in this locale. OBJECTIVE:This study examined hippocampal volumes and memory in healthy control (HC) and probable AD groups in the Democratic Republic of Congo (DRC). METHODS:Forty-six subjects with probable AD and 29 HC subjects were screened using the Community Instrument for Dementia and the Alzheimer Questionnaire. Participants underwent neuroimaging in Kinshasa, DRC, and memory was evaluated using the African Neuropsychology Battery (ANB). Multiple linear regression was used to determine associations between hippocampal volumes and memory. RESULTS:Patients with probable AD performed significantly worse than HCs on ANB memory measures, and exhibited greater cerebral atrophy, which was significantly pronounced in the medial temporal lobe region (hippocampus, entorhinal cortex). Both AD and HC subjects exhibited high rates of white matter hyperintensities compared to international base rate prevalence, which was significantly worse for probable AD. Both also exhibited elevated rates of microhemorrhages. Regression analysis demonstrated a significant association between hippocampal volume and ANB memory tests. Hippocampal atrophy discriminated probable AD from the HC group. CONCLUSIONS:This study establishes the feasibility of conducting neuroimaging research in the SSA, demonstrates many known neuroimaging findings in probable AD patients hold up using culturally appropriate memory tasks, and suggest cardiovascular problems are a greater issue in SSA than in Western countries.

Abstract Introduction This study investigates whether plasma biomarkers (Aβ42/40 and p‐tau 181), APS, as well as apolipoprotein E (APOE) proteotype predict cognitive deficits in elderly adults from the Democratic Republic of Congo. Methods Forty‐four with possible AD (pAD) and 41 healthy control (HC) subjects were screened using CSID and AQ, underwent cognitive assessment with the African Neuropsychology Battery (ANB), and provided blood samples for plasma Aβ42, Aβ40, Aβ42/40, and APOE proteotype. Linear and logistic regression were used to evaluate the associations of plasma biomarkers with ANB tests and the ability of biomarkers to predict cognitive status. Results Patients with pAD had significantly lower plasma Aβ42/40 levels, higher APS, and higher prevalence of APOE E4 allele compared to HC. Groups did not differ in levels of Aβ40, Aβ42, or P‐tau 181. Results showed that Aβ42/40 ratio and APS were significantly associated with African Naming Test (ANT), African List Memory Test (ALMT), and African Visuospatial Memory Test (AVMT) scores, while the presence of APOE E4 allele was associated with ANT, ALMT, AVMT, and APT scores. P‐tau 181 did not show any significant associations while adjusting for age, education, and gender. APS showed the highest area under the curve (AUC) value (AUC = 0.78, 95% confidence interval [CI]: 0.68–0.88) followed by Aβ42/40 (AUC = 0.75, 95% CI: 0.66–0.86) and APOE E4 (AUC = 0.69 (CI 0.57–0.81) in discriminating pAD from HC. Discussion These results demonstrate associations between select plasma biomarker of AD pathology (Aβ42/40), APS, and APOE E4 allele) and ANB test scores and the ability of these biomarkers to differentiate pAD from cognitively normal SSA individuals, consistent with findings reported in other settings.

Cross-sectional and longitudinal measurements of plasma biomarkers of Alzheimer’s disease (AD) in Western countries are being applied in clinical practice, whereas their associations with culturally validated cognitive tests in other settings remain unknown. We aim to examine cross-sectional association of plasma protein biomarker concentrations and APOE proteotype with cognitive function and explore the discriminative role of these AD biomarkers in such an association. This is a cross-sectional retrospective study completed from 2018 to 2022 in the Democratic Republic of Congo (DRC). Subjects were recruited from clinics, hospitals, churches, and across DRC. The study started in January 2018 until December 2022. Data were analyzed from May 2022 to December 2022. The DRC Memory clinic team recruited 1430 individuals 65 years and over. Based on Community Screening Instruments for Dementia (CSID), and Alzheimer’s Questionnaire (AQ), and DSM-5 diagnostic criteria, participants included 44 individuals classified as major neurocognitive disorder (dementia) and 41 as healthy controls (HC). Subjects underwent cognitive assessment with a validated, culturally-tailored cognitive battery. AD plasma biomarkers (Aβ42, Aβ40, Aβ42/40, p-tau 181), APS (derived from Aβ42/40, APOE status, and age), and APOE proteotype were utilized to assess for genetic risk. Individuals with dementia had significantly lower Aβ42/40 levels, higher APS, and higher APOE ε4 prevalence compared to HC. Linear regressions showed significantly associations between Aβ42/40 and APS with ANT, ALMT, and AVMT scores, while APOE ε4 presence was associated with ANT, ALMT, AVMT, and APT scores. APS showed the highest AUC value (AUC = 0.78, 95% CI: 0.68-0.88) followed by Aβ42/40 (AUC = 0.75, 95% CI: 0.66-0.86) and APOE ε4 (AUC = 0.69 (CI 0.57-0.81) in discriminating dementia from HC. Select AD biomarkers were associated with cognition and differentiated dementia from HC, consistent with extant research. These findings may have implications for the assessment of AD biomarkers in DRC.

OBJECTIVE:Using the African Neuropsychology Battery (ANB), we seek to develop normative data by examining the demographic effects for two learning process scores: initial learning (Trial One) and learning ratio (LR, the percentage of items learned relative of to-be-learned material following Trial 1).METHODS:Healthy participants from the Democratic Republic of Congo completed the four memory tests of the ANB: the African Story Memory Test (ASMT), African List Memory Test (ALMT), African Visuospatial Memory Test (AVMT), and African Contextual Visuospatial Memory Test (ACVMT). We developed indices of learning for each subtest, as well as aggregate learning indices for Trial 1 and LR, and composite indices examining verbal, visual, contextual, and noncontextual learning, and grand indices comprising all four subtests.RESULTS:Trial 1 and LR scores each demonstrated acceptable intercorrelations across memory tests. We present normative data for Trial 1 and LR by age and education.CONCLUSION:These data provide normative standards for evaluating learning in Sub-Saharan Africa.