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Computer-based testing has become a vital tool for the assessment of sport-related concussion (SRC). An increasing number of papers have been published on this topic, focusing on subjects such as the purpose and validity of baseline testing, the performance of special populations on computer-based tests, the psychometric properties of different computerized neurocognitive tools, and considerations for valid and reliable administration of these tools. The current paper describes several considerations regarding computerized test design, input and output devices, and testing environment that should be described explicitly when administering computer-based cognitive testing, regardless of whether the assessment is used for clinical or research purposes. The paper also reviews the conclusions of recent literature (2007–2013) using computer-based testing for the assessment of SRC, with special attention to the methods used in these studies. We also present an appendix checklist for clinicians and researchers that may be helpful in ensuring proper attention to factors that could influence the reliability and validity of computer-based cognitive testing. We believe that explicit attention to these technological factors may lead to the development of standards for the development and implementation of computer-based tests. Such standards have the potential to enhance the accuracy and utility of computer-based tests in SRC.

BACKGROUND Biomarkers and Alzheimer's disease (AD) risk disclosure may help reduce disparities in dementia diagnosis and care in Indigenous communities. METHODS Semi‐structured interviews assessed beliefs about the causes of dementia, and interest in and perceived benefits and risks of obtaining AD risk information, including biomarkers. RESULTS Thirty‐two Indigenous and 26 non‐Hispanic White individuals participated in the study. The Indigenous cohort endorsed divergent beliefs about the causes of dementia relative to the non‐Hispanic White cohort. Eighty‐one percent of the Indigenous cohort and 100% of the non‐Hispanic White cohort endorsed interest in learning their AD risk primarily to improve health behaviors, gain health knowledge, and engage in treatments or clinical trials. Indigenous participants more frequently endorsed concerns about burdening family and limited access to health care. DISCUSSION Incorporating discussions about causes of dementia, caregiver burden, and family involvement into return‐of‐results procedures may support informed, collective decision making. Highlights Indigenous participants reported divergent beliefs about the cause of dementia. Participants across groups reported strong interest in Alzheimer's disease risk. The Indigenous cohort showed concern for family burden and health‐care access. Culturally competent decision making is vital for equitable dementia care.

INTRODUCTION A recently developed mild behavioral impairment (MBI) diagnostic framework standardizes the early characterization of neuropsychiatric symptoms in older adults. However, the joint contributions of Alzheimer's disease (AD) pathology and brain function to MBI remain unclear. METHODS We test a novel model assessing direct relationships between AD biomarker status and MBI symptoms, as well as mediated effects through segregation of the salience and default‐mode networks, using data from 128 participants with diagnosis of amnestic mild cognitive impairment or mild dementia—AD type. RESULTS We identified a mediated effect of tau positivity on MBI through functional segregation of the salience network from the other high‐level, association networks. There were no direct effects of AD biomarkers status on MBI. DISCUSSION Our findings suggest that tau pathology contributes to MBI primarily by disrupting salience network function and emphasize the role of the salience network in mediating relationships between neuropathological changes and behavioral manifestations. Highlights Network segregation mediates Alzheimer's disease (AD) pathology impact on mild behavioral impairment (MBI). The salience network is pivotal in linking tau pathology and MBI. This study used path analysis with AD biomarkers and network integrity. The study evaluated the roles of salience, default mode, and frontoparietal networks. This is the first study to integrate MBI with AD biomarkers and network functionality.

Objective:There are many potential benefits of early identification of those with Alzheimer’s disease (AD), including more opportunity for early intervention to slow AD progression (e.g., treatment, lifestyle changes, etc.) and to plan for the future. Positron emission tomography (PET) scans for abnormal amyloid and tau are commonly conducted in research settings. Despite strong interest in learning AD biomarker results, participants rarely receive their research data, in part due to concern about the possibility of undue distress based on results. We aimed to explore both positive and negative emotional reactions following PET biomarker disclosure as a function of result received.Participants and Methods:Forty-three older adults (age = 72.0±6.21 years, education = 16.5±2.62 years, 49% Female, 88% White Non-Hispanic) completed PET amyloid and tau testing and disclosure. Sixty-three percent were diagnosed with mild cognitive impairment (MCI) while the remainder of participants were diagnosed with Dementia Alzheimer’s type (DAT). Participants completed pre-disclosure biomarker education and a decisional capacity assessment followed by baseline measures. Participants then completed a disclosure session where they received personal PET amyloid and tau results on an elevated vs. not elevated scale for each ligand. Results were discussed in relation to presence/absence of Alzheimer’s disease, how the result relates to their cognitive difficulties, and risk of developing Dementia-Alzheimer’s Type. At baseline (pre-disclosure), immediately post-disclosure, and 1-week post-disclosure, participants completed the Beck Anxiety Inventory (BAI), The Geriatric Depression Scale - 15 Item (GDS-15), Impact of Neuroimaging in AD (INI-AD) Scale, and the Positive and Negative Affective Scale - Short Form (PANAS-SF). All questionnaires were modified to apply to Alzheimer’s disease and related experiences.Results:Of the 43 participants who participated in disclosure, 74% received biomarker positive results (either A+T- or A+T+); all others were biomarker negative. We conducted a series of mixed analysis of variance (ANOVA) tests to determine the effect of disclosure and biomarker status for each of the outcomes of interest. Neither the effect of time nor the time by biomarker status interaction was significant for any of the outcomes (all p>.05). The main effect of biomarker status was significant for BAI (F(1)=5.12, p=.031, n,p2=.146) and INI-AD Distress (F(1)=12.70, p=.001, np2=.241) and Positive (F(1)=34.57, p<.001, np2=.464) subscale scores with A+T-/A+T+ participants reporting higher negative affect than those who were A-/T-; however, even among biomarker positive individuals, scores did not exceed clinical thresholds. GDS-15, PANAS-Negative and Positive Subscale scores did not differ significantly by biomarker status (all p>.05) and no significant adverse events occurred following disclosure. Additionally, no participants cited regret about receiving their results.Conclusions:While disclosure of biomarker positivity may result in mild increases in acute anxiety or distress, or fewer positive emotions, it does not result in clinically significant emotional reactions and was not associated with regret. Overall, findings are consistent with literature indicating safety of biomarker disclosure procedures for symptomatic individuals. Future research should follow participants over longer periods to evaluate the impacts of biomarker disclosure.

INTRODUCTION The Consortium for Clarity in Alzheimer's Disease and Related Dementias Through Imaging (CLARiTI) Return of Results Core aims to develop tools and a framework for disclosing individual results at Alzheimer's Disease Research Centers (ADRCs). An understanding of current disclosure practices is necessary to generate this protocol. METHODS All 37 ADRCs received a survey between January and April 2024; 36 provided valid responses. RESULTS Most ADRCs disclose diagnosis and cognitive results to participants with impairment, and disclosure of biomarker data (e.g., amyloid and tau positron emission tomography) has accelerated since 2019. Though less common, disclosure to unimpaired participants has increased since 2019. Motivators for disclosure include to thank participants, for recruitment/retention, and to help inform health‐care decisions. Barriers include limited expertise and infrastructure, concerns about clinical actionability, and risks to participants. DISCUSSION The ADRC network is invested in sharing research results. While some concerns remain, CLARiTI will critically evaluate a standardized approach to sharing these results. Highlights Individual research results disclosure has increased significantly since 2019. Results are shared more frequently with cognitively unimpaired participants. Disclosure requires interdisciplinary teams including physicians and psychologists. Disclosure motivations include enhancing retention and supporting clinical care. Barriers include limited resources/expertise and potential participant risks.

The presence of multiple pathologies is the largest predictor of dementia. A major gap in the field is the in vivo detection of mixed pathologies and their antecedents. The Alzheimer's Disease Research Centers (ADRCs) are uniquely positioned to address this gap. The ADRCs longitudinally follow ≈ 17,000 participants, ranging from cognitively unimpaired to dementia, arising from Alzheimer's disease (AD) and related dementias (ADRD; e.g., AD, Lewy body disorders, vascular). Motivated by the Alzheimer's Disease Neuroimaging Initiative's (ADNI) impact, the ADRC Consortium for Clarity in ADRD Research Through Imaging (CLARiTI) was formed. Leveraging existing ADRC infrastructure, CLARiTI will integrate standardized imaging and plasma collection to characterize mixed pathologies and use community‐engaged research methods to ensure that ≥ 25% of the sample is from underrepresented populations (e.g., ethnoculturally minoritized, low education). The resulting ADRD profiles, within a more diverse sample, will provide key resources for ADRCs and an unprecedented, more generalizable publicly available imaging‐plasma dataset. Highlights In vivo detection of mixed pathologies is critical for Alzheimer's disease and related dementias research. The Alzheimer's Disease Research Centers (ADRCs) are uniquely positioned to address gaps related to mixed pathologies. The ADRC Consortium for Clarity in ADRD Research Through Imaging (CLARiTI) will enhance this national program by adding standardized imaging and plasma collection to existing ADRC infrastructure. This effort will provide key resources for ADRCs and an unprecedented publicly available imaging–plasma–neuropath dataset.

Introduction This study assessed the construct validity and clinical utility of the National Alzheimer's Coordinating Center Lewy Body Dementia (LBD) Module, consisting of the Speeded Attention and Noise Pareidolia Tasks. Methods Participants included 459 older adults diagnosed as cognitively normal (n = 202), or with non‐amnestic mild cognitive impairment (n = 61), amnestic mild cognitive impairment (n = 96), Alzheimer's disease dementia (n = 44), or LBD (n = 56). Results Speeded Attention demonstrated strong convergent validity and moderate discriminant validity when compared to established neuropsychological tests. Noise Pareidolia demonstrated strong discriminant validity, but limited convergent validity. Noise Pareidolia scores were significantly lower in those with reported hallucinations, delusions, or REM sleep behavior disorder symptoms. LBD Module tests discriminated well between cognitively normal adults and those with LBD. Discussion The LBD Module demonstrates promising construct validity and clinical utility, which support its use across research and clinical settings.

Background The 2024 Clinical Guidelines and Staging Framework (Jack et al., 2024) further advances the integration of biomarker testing for clinical use. However, legal and ethical challenges persist regarding the implementation of biomarker testing, including the potential risk of discrimination following such testing. In December 2024, the Alzheimer’s Association science and public policy teams convened with a selection of experts (including a pre‐established workgroup) to discuss the rapidly evolving landscape of biomarkers for clinical use, with a focus on blood‐based biomarkers (BBM). The Association charged meeting participants with evaluating disclosure of clinical biomarkers to patients and to consider potential consequences, including discrimination (e.g., insurance, employment, housing, healthcare). The Workgroup identified a need to collect evidence that will support future policy development and positions that aim to mitigate potential discrimination risks. Two foundation research needs were identified: (1) a better understanding of what evidence currently exists, including the status of perceived, observed, and possible legal risks and (2) prioritization of the legal protections needed for patients in Stages 1 (asymptomatic, biomarker evidence) & 2 (transitional decline) within updated staging framework. To meet these identified needs, panelists will discuss ongoing work to identify and describe the perceived, observed, and possible threat of discrimination based on disclosure of one’s biomarker status for AD patients. Panelists will first report on prior work that informs a need to understand discrimination and other legal/ethical risks. We will then report on our approach to bridge gaps between the existing evidence on these issues and to mitigate discrimination risks due to biomarker testing within a clinical setting. During the panel discussion, panelists will summarize the current state of knowledge regarding the perceived, observed, and possible risk of discrimination based on AD biomarker disclosure in clinical settings, propose an approach to develop a legal framework, and share plans for synthesizing our findings. We will seek engaged feedback from attendees to help prioritize findings and develop approaches for next steps, including a future research agenda and educational products. Method N/A Result N/A Conclusion N/A

The 2024 Clinical Guidelines and Staging Framework (Jack et al., 2024) further advances the integration of biomarker testing for clinical use. However, legal and ethical challenges persist regarding the implementation of biomarker testing, including the potential risk of discrimination following such testing. In December 2024, the Alzheimer's Association science and public policy teams convened with a selection of experts (including a pre-established workgroup) to discuss the rapidly evolving landscape of biomarkers for clinical use, with a focus on blood-based biomarkers (BBM). The Association charged meeting participants with evaluating disclosure of clinical biomarkers to patients and to consider potential consequences, including discrimination (e.g., insurance, employment, housing, healthcare). The Workgroup identified a need to collect evidence that will support future policy development and positions that aim to mitigate potential discrimination risks. Two foundation research needs were identified: (1) a better understanding of what evidence currently exists, including the status of perceived, observed, and possible legal risks and (2) prioritization of the legal protections needed for patients in Stages 1 (asymptomatic, biomarker evidence) & 2 (transitional decline) within updated staging framework. To meet these identified needs, panelists will discuss ongoing work to identify and describe the perceived, observed, and possible threat of discrimination based on disclosure of one's biomarker status for AD patients. Panelists will first report on prior work that informs a need to understand discrimination and other legal/ethical risks. We will then report on our approach to bridge gaps between the existing evidence on these issues and to mitigate discrimination risks due to biomarker testing within a clinical setting. During the panel discussion, panelists will summarize the current state of knowledge regarding the perceived, observed, and possible risk of discrimination based on AD biomarker disclosure in clinical settings, propose an approach to develop a legal framework, and share plans for synthesizing our findings. We will seek engaged feedback from attendees to help prioritize findings and develop approaches for next steps, including a future research agenda and educational products. N/A RESULT: N/A CONCLUSION: N/A.

Objective:High-definition transcranial direct current stimulation (HD-tDCS) is a non-invasive form of brain stimulation used to modulate neuronal activity in a brain region of interest. Growing research has shown that HD-tDCS is a promising treatment for cognitive decline in neurodegenerative disease. Most HD-tDCS studies have used amplitudes of 2mA or less, with little investigation into tolerability at greater intensities since anecdotal lore generally suggests them to be poorly tolerated. Therefore, we examined the tolerability of HD-tDCS and common side effect profile in older adults who received total amplitudes of 3mA to 10mA (delivered using multiple electrodes delivering 2-4mA). We developed a series of methods (e.g., participant instructions, task engagement, techniques to lower impedance) and hypothesized they would equate the experience between active and sham HD-tDCS. We also compared symptom endorsement between those receiving active stimulation at 3mA+ total versus those receiving 2mA or lower; again, hypothesizing no difference in reported symptoms.Participants and Methods:295 older adults (Mage = 71.12±9.42) (Normal Cognition = 75, Amnestic MCI [aMCI] = 172, Dementia of the Alzheimer's Type [DAT] = 27, Other = 21) were enrolled across six HD-tDCS studies. All participants received one to thirty 20- to 30-minute sessions of active or sham stimulation at total amplitudes between 2mA and 10mA. All participants completed a standardized side effect questionnaire after each session asking whether they experienced burning, tingling, itching, scalp pain, trouble concentrating, sleepiness, headache, mood changes, neck pain, skin redness, or any other symptoms. When symptoms were endorsed, participants rated the severity of the symptom (mild, moderate, severe).Results:We used Fisher's Exact tests to compare the frequency and severity of side effects in active (3mA or higher) vs. sham stimulation. Those receiving sham were significantly more likely to report tingling than those receiving active HD-tDCS. Conversely, those receiving active stimulation more frequently endorsed mood changes and skin redness relative to the sham group, though moderate-severe ratings were endorsed in only 2.9% and 0.4% of the sessions, respectively. Relative to those receiving 2mA, participants receiving higher intensities of active stimulation experienced skin redness more frequently, whereas the 2mA reported higher frequencies of itching and scalp pain. A burning sensation was endorsed at equal rates between these groups; however, the higher intensity active group reported it as moderate or severe more frequently than the 2mA active group. Despite these minor differences, most side effects following 3mA+ were reported at low frequencies and were typically mild when endorsed.Conclusions:Our findings demonstrate that HD-tDCS is well-tolerated for total amplitudes up to 10mA in older adults with little tangible difference in the reported experience relative to sham. Findings support the use of higher HD-tDCS amplitudes, at least when key methodological procedures are followed.