The effect of physical activity on cognition relative to APOE genotype (PAAD-2): study protocol for a phase II randomized control trial.

BACKGROUND: By 2050, the prevalence of Alzheimer's disease (AD) in the United States is predicted to reach 13.8 million. Despite worldwide research efforts, a cure for AD has not been identified. Thus, it is critical to identify preventive strategies that can reduce the risk of or delay the onset of AD. Physical activity (PA) has potential in this regard. This randomized clinical trial aims to (a) test the causal relationship between PA and AD-associated cognitive function for persons with a family history of AD (FH+), (b) determine the moderating role of apolipoprotein epsilon 4 (APOE4) carrier status on cognition, and (c) assess cerebral structure, cerebral function, and putative biomarkers as mediators of the effects of PA on cognition. METHODS: We are recruiting cognitively normal, middle aged (40-65 years) sedentary adults with FH+. Participants are randomly assigned to a 12-month PA intervention for 3 days/week or to a control group maintaining their normal lifestyle. Saliva samples are taken at pre-test to determine APOE genotype. At pre-, mid-, and post-tests, participants complete a series of cognitive tests to assess information-processing speed, verbal and visual episodic memory, constructional praxis, mnemonic discrimination, and higher-order executive functions. At pre- and post-tests, brain imaging and blood biomarkers are assessed. DISCUSSION: We hypothesize that 1) the PA group will demonstrate improved cognition compared with controls; 2) PA-derived cognitive changes will be moderated by APOE4 status; and 3) PA-induced changes in neural and blood biomarkers will contribute to cognitive changes and differ as a function of APOE4 status. Our results may provide important insights into the potential of PA to preserve neurocognitive function in people with a heightened risk of AD due to FH+ and as moderated by APOE4 status. By using sophisticated analytic techniques to assess APOE as a moderator and neurobiological mechanisms as mediators across trajectories of cognitive change in response to PA, we will advance our understanding of the potential of PA in protecting against AD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03876314. Registered March 15, 2019.

Effects of an aerobic fitness test on short- and long-term memory in elementary-aged children.

Meta-analytic evidence supports that exercise has benefits for short-term memory (STM) and long-term memory (LTM). However, only three studies with children have tested the differential effects of exercise on STM and LTM. The purpose of this study was to examine the effects of an aerobic fitness test on STM and LTM and to consider the moderating effects of grade level. Children (7-13 years of age) were randomly assigned to either perform an aerobic fitness test before (exercise prior) or after (exercise post) performing the Rey Auditory Verbal Learning Test (RAVLT) to assess memory. Memory was tested again after approximately 24 hours. There were significant differences in memory performance as a function of grade with 4th and 6th graders consistently outperforming 2nd graders. For learning, Day 1 Retention, 24-hr recall, and Day 2 Retention, the exercise prior group performed better than the exercise post group. It is concluded that an aerobic fitness test performed prior to a declarative memory test benefits LTM as compared to when the aerobic fitness test is performed after the memory test.

Effects of physical activity interventions on cognitive and academic performance in children and adolescents: a novel combination of a systematic review and recommendations from an expert panel.

OBJECTIVE: To summarise the current evidence on the effects of physical activity (PA) interventions on cognitive and academic performance in children, and formulate research priorities and recommendations. DESIGN: Systematic review (following PRISMA guidelines) with a methodological quality assessment and an international expert panel. We based the evaluation of the consistency of the scientific evidence on the findings reported in studies rated as of high methodological quality. DATA SOURCES: PubMed, PsycINFO, Cochrane Central, Web of Science, ERIC, and SPORTDiscus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: PA-intervention studies in children with at least one cognitive or academic performance assessment. RESULTS: Eleven (19%) of 58 included intervention studies received a high-quality rating for methodological quality: four assessed effects of PA interventions on cognitive performance, six assessed effects on academic performance, and one on both. All high-quality studies contrasted the effects of additional/adapted PA activities with regular curriculum activities. For cognitive performance 10 of 21 (48%) constructs analysed showed statistically significant beneficial intervention effects of PA, while for academic performance, 15 of 25 (60%) analyses found a significant beneficial effect of PA. Across all five studies assessing PA effects on mathematics, beneficial effects were reported in six out of seven (86%) outcomes. Experts put forward 46 research questions. The most pressing research priority cluster concerned the causality of the relationship between PA and cognitive/academic performance. The remaining clusters pertained to PA characteristics, moderators and mechanisms governing the 'PA-performance' relationship and miscellaneous topics. CONCLUSION: There is currently inconclusive evidence for the beneficial effects of PA interventions on cognitive and overall academic performance in children. We conclude that there is strong evidence for beneficial effects of PA on maths performance.The expert panel confirmed that more 'high-quality' research is warranted. By prioritising the most important research questions and formulating recommendations we aim to guide researchers in generating high-quality evidence. Our recommendations focus on adequate control groups and sample size, the use of valid and reliable measurement instruments for physical activity and cognitive performance, measurement of compliance and data analysis. PROSPERO REGISTRATION NUMBER: CRD42017082505.

The Physical Activity and Alzheimer's Disease (PAAD) Study: Cognitive outcomes.

Background: Alzheimer's disease is a progressive disease that degrades cognitive functioning and ultimately results in death. Currently, there is no cure for Alzheimer's disease and, hence, the identification of preventative strategies is important. Physical activity (PA) is a behavioral intervention that holds promise with respect to delaying the onset of Alzheimer's disease. Purpose: The purpose of this study was to explore the differential cognitive benefits achieved in response to PA as a function of a person's genetic risk for AD. Methods: Older cognitively normal adults (50-65 years) with a family history of AD (FHxAD) participated in an 8-month PA program. Cognitive performance was measured at baseline, pretest, midtest, and posttest and changes over time were assessed as a function of apolipoprotein E (APOE) status (carriers: 1-2 copies of the ɛ4 allele; noncarriers: 0 copies of the ɛ4 allele). Results: Improvements in memory were associated with PA participation irrespective of APOE ɛ4 carrier status. Conclusions: Future experimental studies are needed to confirm that PA causes improvements to cognitive performance in older cognitively normal adults with a FHxAD and that these improvements are equivalent for cognitively normal APOE ɛ4 carriers and noncarriers.

The Effect of Acute Exercise on Encoding and Consolidation of Long-Term Memory.

Evidence supports that acute exercise benefits long-term memory. However, it is unclear whether these effects are due to benefits to encoding or consolidation. The purpose of this study was to more effectively isolate encoding and consolidation to advance our understanding of the specific nature of the effects of exercise on long-term memory. Using a within-subject design, participants completed a control session (no exercise), an encoding and consolidation condition (exercise prior to exposure to the memory task, E + C), and a consolidation condition (exercise following exposure). The exercise was 30 min of moderate-intensity cycling. Memory was assessed using the Rey Auditory Verbal Learning Test with recall assessed at 60 min and recall and recognition assessed at 24 hr. Results showed that the E + C condition had significantly better recall at 60 min and 24 hr than the no-exercise condition. This provides additional evidence that acute exercise benefits encoding more than consolidation.

Motivating Mature Adults to be Physically Active.

As a population, middle-aged and older adults are not meeting national guidelines for exercise. The purpose of this study was to describe factors associated with exercise adherence in an 8-month program offered as part of a research study testing the effects of exercise on cognitive performance for persons with a family history of Alzheimer's disease (AD). After completion of the program, participants provided open-ended responses indicating their reasons for adhering to the exercise program, and they completed the Motives for Physical Activities Measure-Revised. Results indicated that adherence was tied to an interest in contributing to our understanding of AD, the opportunity to join an exercise program, perceived exercise benefits, and social support. In addition, participants reported high levels of extrinsic (fitness-related) and intrinsic (interest/enjoyment) motivation. Other possible motivating factors which emerged from day-to-day observations in the program were identified. Findings suggest directions for exercise professionals with respect to exercise adherence.

The Effects of Acute Exercise on Memory and Brain-Derived Neurotrophic Factor (BDNF).

Acute exercise benefits cognition, and some evidence suggests that brain-derived neurotrophic factor (BDNF) plays a role in this effect. The purpose of this study was to explore the dose-response relationship between exercise intensity, memory, and BDNF. Young adults completed 3 exercise sessions at different intensities relative to ventilator threshold (Vt) (VO2max, Vt - 20%, Vt + 20%). For each session, participants exercised for approximately 30 min. Following exercise, they performed the Rey Auditory Verbal Learning Test (RAVLT) to assess short-term memory, learning, and long-term memory recall. Twenty-four hours later, they completed the RAVLT recognition trial, which provided another measure of long-term memory. Blood was drawn before exercise, immediately postexercise, and after the 30-min recall test. Results indicated that long-term memory as assessed after the 24-hr delay differed as a function of exercise intensity with the largest benefits observed following maximal intensity exercise. BDNF data showed a significant increase in response to exercise; however, there were no differences relative to exercise intensity and there were no significant associations between BDNF and memory. Future research is warranted so that we can better understand how to use exercise to benefit cognitive performance.

Innovative Research Design Exploring the Effects of Physical Activity and Genetics on Cognitive Performance in Community-Based Older Adults.

Physical activity is predictive of better cognitive performance and lower risk of Alzheimer's disease (AD). The apolipoprotein E gene (APOE) is a susceptibility gene for AD with the e4 allele being associated with a greater risk of AD. Cross-sectional and prospective research shows that physical activity is predictive of better cognitive performance for those at greater genetic risk for AD. However, the moderating role of APOE on the effects of a physical activity intervention on cognitive performance has not been examined. The purpose of this manuscript is to justify the need for such research and to describe the design, methods, and recruitment tactics used in the conductance of a study designed to provide insight as to the extent to which cognitive benefits resulting from an 8-month physical activity program are differentiated by APOE e4 status. The effectiveness of the recruitment strategies and the feasibility of recruiting APOE e4 carriers are discussed.

Exercise and Acute Cognitive Enhancement.

Substantial research has explored the effects of a single session of exercise on cognitive performance. Meta-analytic reviews provide summary statistics relative to these effects when the cognitive task is performed while exercising and when performed after exercise. When performed concomitantly the effects of exercise are typically small or negative with the exception of moderate effects for speed of cognitive performance during moderate intensity exercise. When cognitive performance is assessed following the cessation of exercise, the effects are typically positive. When considering the effects following exercise, most studies have focused on executive function and episodic memory as the cognitive outcomes of interest with meta-analyses supporting small-to-moderate benefits. When potential moderators related to exercise parameters or participants characteristics are examined, results suggest that 20 minutes of moderate to vigorous intensity exercise consistently benefits performance with larger effects evident for executive function tasks with higher cognitive demands, for long-term memory tasks when exercise is performed prior to information encoding, and when considering individuals with lower initial cognitive performance levels. These observed benefits are likely due to the impacts acute exercise can have on physiological arousal, brain function, and brain neurotrophic factors. Advancements in our understanding of the potential of a single session of exercise to benefit cognitive performance are important for exercise prescription and to inform chronic exercise programs designed to benefit cognition.

Dietary Adherence and Cognitive Performance in Older Adults by Nativity Status: Results from the National Health and Nutrition Examination Survey (NHANES), 2011-2014.

Although adherence to dietary guidelines is associated with better cognitive performance, there may be differences by nativity status. This study aimed to investigate the association between adherence to the healthy eating index (HEI) and cognitive performance (CP) among United States (US)-born and foreign-born older adults (60+ years). Data were obtained from the 2011-2014 NHANES (n = 3065). Dietary adherence was assessed with HEI quintiles. CP (adequate vs. low) was examined using word listing (CERAD), animal naming (AFT), and the digit symbol substitution test (DSST). Weighted multivariable logistic regressions were used to examine associations. The US-born participants in higher dietary quintiles had adequate CP when compared to foreign-born participants. In adjusted models, the US-born participants in the highest HEI quintile had increased odds of adequate DSST scores (odds ratio: 1.95, 95% confidence interval: 1.15-3.28) compared with those in the lowest quintile. Patterns of association were generally reversed for foreign-born participants and were non-statistically significant. Future research should consider the influence of diets in delaying or preventing decline in cognition and evaluate nutritional factors that contribute to cognitive outcomes for the foreign-born population.

Take a Break for Memory Sake! Effects of Short Physical Activity Breaks on Inhibitory Control, Episodic Memory, and Event-Related Potentials in Children.

The pervasive sedentary lifestyle exacerbated by the COVID-19 pandemic has significantly reduced physical activity (PA) among school-age children, necessitating innovative strategies to evaluate short PA breaks that are feasible in a classroom setting. This study explored the cognitive and neurophysiological (electroencephalography; EEG) impacts of short bouts of different PA modalities on inhibitory control (flanker task) and episodic memory (word recognition task) in children. Utilizing a within-participants cross-over design, thirty-six children (n = 36; 9-12 years old) attended the lab on three separate days with each visit including either a 9 min bout of sustained moderate-intensity cycling, high-intensity interval exercise (HIIE), or seated rest. Event-related potentials (ERPs) were assessed during the flanker task (P3 component) and the word recognition task (LPC and FN400 components) to elucidate the neural mechanisms underpinning behavioral outcomes. Findings indicated no differences in flanker performance but greater episodic memory recall for HIIE compared to seated rest. Neurophysiological results revealed no differences for P3, but notably larger amplitude for LPC and FN400 postcycling, particularly over parietal electrode sites. These results underscore the potential of short PA breaks to improve cognitive and neurocognitive function in children, offering a feasible integration strategy into daily school routines without extensive time commitment.

Acute Exercise Effect on Neurocognitive Function Among Cognitively Normal Late-Middle-Aged Adults With/Without Genetic Risk of AD: The Moderating Role of Exercise Volume and APOE Genotype.

BACKGROUND: Acute exercise is a behavior that benefits cognitive function; however, its effect on populations with different risks for Alzheimer's disease (AD) and the role of exercise variance and Apolipoprotein E (APOE) genotype on this effect remains unknown. This study explores the acute exercise effect on behavioral and neurocognitive function, and its potential moderation by exercise intensity and duration and APOE genetic risk. METHODS: Fifty-one cognitively normal adults (~36% APOE ε4 carriers) performed the Stroop task under a rest condition and 3 exercise conditions while electroencephalographic activity was assessed. RESULTS: Acute exercise improved cognitive performance assessed through both behavioral and neuroelectrical indices. These benefits were observed regardless of adjustments of intensity and duration at a predetermined exercise volume as well as being evident irrespective of APOE ɛ4 carrier status. CONCLUSIONS: Acute exercise could be proposed as a lifestyle intervention to benefit neurocognitive function in populations with and without genetic risk of AD. Future exploration should further the precise exercise prescription and also the mechanisms underlying the beneficial effects of acute exercise for neurocognitive function. CLINICAL TRIALS REGISTRATION NUMBER: NCT05591313.

Cardiorespiratory fitness, independent of APOE genotype, is associated with better neurocognitive function in older adults: An ERP study.

This study assessed the association between cardiorespiratory fitness and carriage of the apolipoprotein-E ε4 (APOE ε4) alleles and cognitive function using behavioral and neuroelectric measures obtained from cognitively normal older adults. A total of 159 adults aged 50-70 years were categorized into four groups based on cardiorespiratory fitness (i.e., higher vs. lower fitness) and the APOE genotype status (i.e., APOE ε4 carrier vs. non-carrier). Neurocognitive functions were indexed using response time and accuracy measures from the Stroop task and averaged mean P3 amplitudes of event-related potentials obtained during task performance. A significant main effect of cardiorespiratory fitness (p = .01) and the Stroop congruency (p < .001), but not the APOE genotype status, with shorter response times for the higher fitness group than for the lower fitness group and for the congruent condition relative to the incongruent condition, were observed. Similar findings were also revealed, with larger averaged mean P3 amplitudes for the higher fitness group than those in the lower fitness group, and in the congruent condition than in the incongruent condition. These findings suggest that higher cardiorespiratory fitness is linked to better neurocognitive function, and the positive association is evident regardless of the APOE ε4 status and the cognitive domain assessed in cognitively normal older adults.

Exploring the use of music to promote physical activity: From the viewpoint of psychological hedonism.

Despite the global efforts to encourage people to regularly participate in physical activity (PA) at moderate-to-vigorous intensity, an inadequate number of adults and adolescents worldwide meet the recommended dose of PA. A major challenge to promoting PA is that sedentary or low-active people experience negative shifts in affective valence (feeling bad versus good) in response to moderate-to-vigorous intensity PA. Interestingly, empirical data indicate that listening to music during acute bouts of PA positively alters affective valence (feeling good versus bad), reduces perceived exertion, and improves physical performance and oxygen utilization efficiency. From the viewpoint of the ancient principle of psychological hedonism - humans have ultimate desires to obtain pleasure and avoid displeasure - we elaborate on three putative mechanisms underlying the affective and ergogenic effects of music on acute bouts of PA: (1) musical pleasure and reward, (2) rhythmic entrainment, and (3) sensory distraction from physical exertion. Given that a positive shift in affective valence during an acute bout of PA is associated with more PA in the future, an important question arises as to whether the affective effect of music on acute PA can be carried over to promote long-term PA. Although this research question seems intuitive, to our knowledge, it has been scarcely investigated. We propose a theoretical model of Music as an Affective Stimulant to Physical Activity (MASPA) to further explain the putative mechanisms underlying the use of music to promote long-term PA. We believe there have been important gaps in music-based interventions in terms of the rationale supporting various components of the intervention and the efficacy of these interventions to promote long-term PA. Our specification of relevant mechanisms and proposal of a new theoretical model may advance our understanding of the optimal use of music as an affective, ergogenic, and sensory stimulant for PA promotion. Future directions are suggested to address the gaps in the literature.

Exploring the Mediating Role of Executive Function in the Relationship between Aerobic Fitness and Academic Achievement in Adolescents.

(1) Background: The performance of physical activity at a sufficient volume can result in improvements in fitness. Aerobic fitness is a particular aspect of fitness that has consistently been shown to be related to both cognitive performance and academic achievement. Cognitive performance, particularly executive function, is itself predictive of academic achievement. It has been hypothesized that the benefits of aerobic fitness for academic achievement are due to improvements in executive function. This study explores the mediating role of cognitive performance on the relationship between physical fitness and academic achievement in high-school-aged adolescents. (2) Methods: High school students (N = 283, 127 male, 156 females, mean age = 16.05 years, SD = 0.41) performed a shuttle run test to assess aerobic fitness and completed the Stroop Color, Stroop Word, and Stroop Color-Word tests to measure information processing and inhibition. They also completed the National Union Academic Achievement Assessment (NUAAA) as part of their high school requirements. (3) Results: Mediation analyses showed that inhibition (performance in the Stroop Color-Word test) fully mediated the relationship between aerobic fitness and both mathematics and Korean performance. (4) Conclusions: This cross-sectional investigation suggests an important mediating role of cognitive performance related to executive function in understanding the relationship between aerobic fitness and the academic achievement of high-school-aged adolescents. This suggests that enhancements in performance related to executive function, which are attributed to increases in aerobic fitness, could explain the observed benefits for academic attainment.

Music-based multicomponent exercise training for community-dwelling older adults with mild-to-moderate cognitive decline: a feasibility study.

Introduction: This study explored the feasibility and preliminary efficacy of a music-based, multicomponent exercise intervention among community-dwelling older adults with mild-to-moderate cognitive impairment. Methods: 16 older adults aged 85±9 years with mild-to-moderate cognitive impairment received music-based multicomponent exercise training for 20 weeks at an independent living facility. Participants received aerobic, resistance, and balance training paired with beat-accentuated music stimulation. Participants' adherence to the training was tracked down and their cognitive and physical functioning and health-related quality of life were assessed at pre- and post-test. Results: 3 participants withdrew due to unexpected issues unrelated to the intervention and thus 13 participants (7 females) attended an average of 4.6 days/week over 20 weeks and reported high satisfaction with the intervention (90.6%). Participants showed significant improvement in global cognition, cognitive processing speed, and walking endurance/aerobic fitness at post-test. Discussion: These findings support the feasibility of music-based, multicomponent exercise training for older adults in an independent living facility and set the stage for future studies to test the efficacy of music on physical activity and ensuing health outcomes. We conclude that music-based, multicomponent exercise training can be beneficial for community-dwelling older adults with mild-to-moderate cognitive decline. As a form of rhythmic auditory stimulation, beat-accentuated music can be combined with exercise training to manipulate exercise tempo and may provide a source of motivation to help older adults adhere to exercise.

Culture in Physical Activity: The Contribution of Basic Psychological Needs and Goal Orientation.

Numerous variables affect motivation in physical activity (PA) with culture being an understudied variable. Self-determination theory's basic psychological needs (BPN) includes a combination of autonomy, competence, and relatedness in PA; however, cultural definitions pit autonomy and relatedness against each other. Thus, this study aims to investigate the moderating role of culture on relationships between BPN, goal orientations (ego, task) for PA, and PA behavior. A survey was implemented to 168 participants (109 females, 59 males; 92 Turks, 76 Americans) investigating students' self-construal type, their basic psychological needs in exercise (BPNES), PA levels (Godin Leisure-Time Exercise Questionnaire/GLTEQ), and goal orientation types (Task and Ego Orientation in Sport Questionnaire/TEOSQ). Turks (n = 92) and Americans (n = 76) demonstrated distinct cultural differences in terms of the study variables. American students were more autonomous, task-oriented, and physically active than Turkish students. Results from the multi-group path analysis showed that there was a moderating role of culture between predictors (i.e., BPN Autonomy, BPN Relatedness, BPN Competence, Ego Orientation, and Task Orientation) and Physical Activity. Such that, the paths from predictors (i.e., BPNT Autonomy, BPNT Relatedness, BPNT Competence, Ego Orientation, and Task Orientation) to PA was not significant in Turkish cultural context. Results suggest that culturally tailored approaches to PA interventions are critical in supporting motivation for physical activity and further research is needed to explore different culturally relevant motivational drivers for PA among adults.

The effects of physical activity on attention deficit hyperactivity disorder symptoms: the evidence.

UNLABELLED: Evidence supports the beneficial effects of physical activity (PA) on cognitive performance and suggests that effects might be particularly large for children. However, limited research has explored PA as a means of managing behavioral symptoms and improving cognitive performance of children with attention deficit hyperactivity disorder (ADHD). The etiology of ADHD and the putative mechanisms for the effects of PA on cognitive performance suggest that PA might be especially important for this population. OBJECTIVE: The purpose of this paper is to review the literature regarding the potential of PA for ADHD symptom management, particularly in regard to behavioral and cognitive symptoms. METHODS: Literature was reviewed for published and unpublished research specifically examining the effects of PA on cognitive and/or behavioral symptoms of ADHD. Additionally, potential mechanisms were addressed. RESULTS: Albeit limited, current research generally supports the potential for acute and chronic PA to mitigate ADHD symptoms. CONCLUSION: Given the generally supportive extant literature and the challenges that face children with ADHD, future research exploring the potential of PA with this population is advocated.

Effects of acute exercise on executive function: a study with a Tower of London Task.

The purpose of this study is to extend the literature by examining the effects of an acute bout of moderate to vigorous intensity aerobic exercise on the executive functions of planning and problem solving assessed using a Tower of London Task (TOL Task). Forty-two participants were randomly assigned into either exercise or control group, and performed the TOL Task, before and immediately following exercise or a control treatment. The exercise group performed 30 min of exercise on a stationary cycle at moderate to vigorous intensity while the control group read for the same length of time. Results indicated that the exercise group achieved improvements in TOL Task scores reflecting the quality of planning and problem solving, but not in those reflecting rule adherence and performance speed. These findings indicate that an acute bout of aerobic exercise has facilitative effects on the executive functions of planning and problem solving.

An innovative protocol for the artificial speech-directed, contactless administration of laboratory-based comprehensive cognitive assessments: PAAD-2 trial management during the COVID-19 pandemic.

The COVID-19 pandemic resulted in suspending in-person human subject research across most institutions in the US. Our extensive cognitive assessment for a phase-2 clinical trial, Physical Activity and Alzheimer's Disease-2 (PAAD-2), was also paused in March 2020. It was important to identify strategies to mitigate the risk of COVID-19 transmission during our testing, which initially required substantial human speech and close person-to-person contact for test directions and instant feedback on paper/pencil tests. Given current understanding of the COVID-19 transmission, we dramatically adjusted the testing protocol to minimize the production of speech droplets and allow social distancing while maintaining the integrity of testing. We adopted state-of-the-art speech synthesis and computerization techniques to create an avatar to speak on behalf of the experimenter for all verbal instructions/feedback, used a document camera to observe the paper/pencil tests from the required distances, and automated the testing sequence and timing. This paper aims 1) to describe an innovative laboratory-based cognitive testing protocol for a completely contact-free, computer-speaking, and semi-automated administration; and 2) to evaluate the integrity of the modified protocol (n = 37) compared with the original protocol (n = 32). We have successfully operated the modified protocol since July 2020 with no evidence of COVID-19 transmission during testing, and data support that the modified protocol is robust and captures data identical to the original protocol. This transition of data collection methods has been critical during the pandemic and will be useful in future studies to mitigate the risk of contagious disease transmission and standardize laboratory-based psychological tests. Trial registration: ClinicalTrials.gov NCT03876314. Registered March 15, 2019.