Cognitive "success" in the setting of performance validity test failure.

BACKGROUND: Although studies have shown unique variance contributions from performance invalidity, it is difficult to interpret the meaning of cognitive data in the setting of performance validity test (PVT) failure. The current study aimed to examine cognitive outcomes in this context. METHOD: Two hundred and twenty-two veterans with a history of mild traumatic brain injury referred for clinical evaluation completed cognitive and performance validity measures. Standardized scores were characterized as Within Normal Limits (≥16th normative percentile) and Below Normal Limits (<16th percentile). Cognitive outcomes are examined across four commonly used PVTs. Self-reported employment and student status were used as indicators of "productivity" to assess potential functional differences related to lower cognitive performance. RESULTS: Among participants who performed in the invalid range on Test of Memory Malingering trial 1, Word Memory Test, Wechsler Adult Intelligence Scale-Fourth Edition Digit Span aged corrected scaled score, and the California Verbal Learning Test-Second Edition Forced Choice index, 16-88% earned broadly within normal limits scores across cognitive testing. Depending on which PVT measure was applied, the average number of cognitive performances below the 16th percentile ranged from 5 to 7 of 14 tasks. There were no differences in the total number of below normal limits performances on cognitive measures between "productive" and "non-productive" participants (T = 1.65, p = 1.00). CONCLUSIONS: Results of the current study suggest that the range of within normal limits cognitive performance in the context of failed PVTs varies greatly. Importantly, our findings indicate that neurocognitive data may still provide important practical information regarding cognitive abilities, despite poor PVT outcomes. Further, given that rates of below normal limits cognitive performance did not differ among "productivity" groups, results have important implications for functional abilities and recommendations in a clinical setting.

Does neurocognition contribute to age-related deficits in the online navigation of electronic patient health portals?

OBJECTIVE: The internet serves an increasingly critical role in how older adults manage their personal health. Electronic patient portals, for example, provide a centralized platform for older adults to access lab results, manage prescriptions and appointments, and communicate with providers. This study examined whether neurocognition mediates the effect of older age on electronic patient portal navigation. METHOD: Forty-nine younger (18-35 years) and 35 older adults (50-75 years) completed the Test of Online Health Records Navigation (TOHRN), which is an experimenter-controlled website on which participants were asked to log-in, review laboratory results, read provider messages, and schedule an appointment. Participants also completed a neuropsychological battery, self-report questionnaires, and measures of health literacy and functional capacity. RESULTS: Mediation analyses revealed a significant indirect effect of older age on lower TOHRN accuracy, which was fully mediated by the total cognitive composite. CONCLUSIONS: Findings indicate that neurocognition may help explain some of the variance in age-related difficulties navigating electronic patient health portals. Future studies might examine the possible benefits of both structural (e.g., human factors web design enhancement) and individual (e.g., training and compensation) cognitive supports to improve the navigability of electronic patient health portals for older adults.

Varying failure criteria on performance validity tests influences interpretation of cognitive outcomes.

OBJECTIVE: The present study examined the effects of applying various performance validity tests (PVT) failure criteria on the relationship between cognitive outcomes and posttraumatic stress (PTS) symptomology. METHOD: One hundred and ninety-nine veterans with a history of mild traumatic brain injury referred for clinical evaluation completed cognitive tests, PVTs, and self-report measures of PTS symptoms and symptom exaggeration. Normative T scores of select cognitive tests were averaged into memory, attention/processing speed, and executive functioning composites. Separate one way analyses of variance assessed differences among high PTS (n = 140) versus low PTS (n = 59) groups and were repeated excluding participants based on varying combinations of PVT failure criteria. RESULTS: When no PVTs were considered, the high PTS group demonstrated worse performance across all three cognitive domains. Excluding those who failed two or more stand-alone, or two or more embedded validity measures resulted in group differences across all cognitive composites. When participants were excluded based on failure of any one embedded and any one stand-alone PVT measure combined, the high PTS group performed worse on the executive functioning and attention/processing speed composites. The remaining three proposed methods to control for performance validity resulted in null PTS-cognition relationships. Results remained largely consistent after controlling for symptom exaggeration. CONCLUSIONS: Methods of defining PVT failure can greatly influence differences in cognitive function between groups defined by PTS symptom levels. Findings highlight the importance of considering performance validity when interpreting cognitive data and warrant future investigation of PVT failure criteria in other conditions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Age and neurocognition are associated with credibility evaluations of health websites.

The internet has become a common means by which many older adults seek out health information. The prevalence of misinformation on the internet makes the search for accurate online health information a more complex and evaluative process. This study examined the role of age and neurocognition in credibility evaluations of credible and non-credible health websites. Forty-one older adults and fifty younger adults completed a structured credibility rating task in which they evaluated a series of webpages displaying health information about migraine treatments. Participants also completed measures of neurocognition, internet use, and health literacy. Results suggested that older adults rated non-credible health websites as more credible than younger adults, but the age groups did not differ in their ratings of credible sites. Within the full sample, neurocognition was associated with credibility ratings for non-credible health websites, whereas health literacy was related to the ratings of credible sites. Findings indicate that older adults may be more likely to trust non-credible health websites than younger adults, which may be related to differences in higher-order neurocognitive functions. Future work might examine whether cognitive-based supports for credibility training in older adults can be used to improve the accuracy with which they evaluate online health information.

Promoting gender-informed mentorship in neuropsychology: Reflections and suggestions from early career women.

INTRODUCTION: While women now represent a majority of neuropsychology trainees, men remain prominent in senior positions. As such, female mentees are often paired with senior male mentors, a practice referred to as "cross-gender mentorship." Although cross-gender mentoring dynamics have inherent potential for missteps due to implicit power differentials, when approached through a gender-informed lens, they can be optimized and lead to personal and professional growth for women neuropsychologists. The present article provides a framework for promoting gender-informed mentorship by cataloging first-hand accounts of early career women and discussing resultant lessons and concrete suggestions for mentorship. METHOD: The authors provide first-hand accounts of experiences related to cross-gender mentorship across a variety of settings and professional contexts. From these accounts, the following steps offer a framework to encourage effective mentorship: 1) Set appropriate expectations and boundaries, 2) Address challenging clinical interactions through a gender-informed lens, 3) Foster personal and professional development, 4) Understand the intersection between gender and multicultural traits, 5) Advocate for advancement of women in the field, and 6) Maintain knowledge of women's issues. CONCLUSIONS: Providing effective mentorship for women in neuropsychology is crucial to promote ascension of women to leadership positions and close long-established disparities in the field. The authors hope that our shared experiences can serve as useful tools for both women trainees and their mentors as they embark on mentoring relationships. Practically, we envision that mentoring dyads may discuss this article at the outset of their relationship to understand potential challenges and collaboratively establish a groundwork for optimal mentoring.

Neuropsychological aspects of internet-based transit navigation skills in older adults.

Older adults commonly experience difficulties efficiently searching the Internet, which can adversely affect daily functioning. This study specifically examined the neuropsychological aspects of online transit planning in 50 younger (M = 22 years) and 40 older (M = 64 years) community-dwelling adults. All participants completed a neuropsychological battery, questionnaires, and measures of Internet use and skills. Participants used a live transit planning website to complete three inter-related tasks (e.g., map a route from an airport to a specific hotel at a particular time). On a fourth Internet transit task, participants were randomized into either a support condition in which they received brief goal management training or into a control condition. Results showed that older adults were both slower and less accurate than their younger counterparts in completing the first three Internet transit tasks. Within the older adults, Internet transit accuracy showed a medium association with verbal memory, executive functions, and auditory attention, but not visuomotor speed, which was the only domain associated with Internet transit task speed in both groups. The goal management training was beneficial for plan development in younger, but not older adults. The planning supports did not impact actual Internet transit task performance in either group. Findings indicate that older adults experience difficulties quickly and accurately using a transit website to plan transportation routes, which is associated with poorer higher-order neurocognitive functions (e.g., memory). Future work might examine the benefits of established memory strategies (e.g., spaced retrieval practice) for online transit planning.

Gender disparities in the author bylines of articles published in clinical neuropsychology journals from 1985 to 2019.

Objective: Women are becoming more prevalent in clinical neuropsychology, but gender bias and disparities persist across multiple professional domains. This study examined potential gender disparities in historical authorship trends across commonly read journals in clinical neuropsychology. Method: Analyses were conducted on 10,531 articles published in six clinical neuropsychology journals from 1985 to 2019. Each author was coded as either a man or a woman using the OpenGenderTracking Project database. Results: On average, women comprised 43.3% (±30.6) of the authors listed in clinical neuropsychology article bylines and were lead and/or corresponding author on 50.3% of these papers. Findings varied by journal, with Child Neuropsychology having the best representation of women across several study metrics. Women comprised an increasing proportion of authors over time and the gender gap in clinical neuropsychology is smaller than was recently reported for the broader field of psychology; nevertheless, the recent rates of women as authors lag behind the prevalence of women in clinical neuropsychology. Encouragingly, gender was not associated with the number of times an article was cited. Articles that included women in leadership roles had significantly more authors overall and specifically more women authors. Conclusions: Women are under-represented as authors in clinical neuropsychology journals, but they are becoming more common and their papers are cited just as frequently as men. Efforts to increase women as research mentors and sponsors may help to further close the publishing gender gap in clinical neuropsychology.

Older age and online health information search behaviors: The mediating influence of executive functions.

INTRODUCTION: Searching the internet for health-related information is a complex and dynamic goal-oriented process that ostensibly places demands on executive functions, which are higher-order cognitive abilities that can deteriorate with older age. This study examined the effects of older age on electronic health (eHealth) search behavior and the potential mediating influence of executive functions. METHOD: Fifty younger adults (≤ 35 years) and 41 older adults (≥50 years) completed naturalistic eHealth search tasks involving fact-finding (Fact Search) and symptom determination (Symptom Search), a neurocognitive battery, and a series of self-report questionnaires. RESULTS: Multiple regression models controlling for potentially confounding psychiatric symptoms, health conditions, literacy, and demographic variables revealed that older adults were slower and less accurate than younger adults on the eHealth Fact Search task, but not on the eHealth Symptom Search task. Executive functions mediated the relationship between age and Fact and Symptom Search accuracy, independent of basic processing speed and attention. Parallel mediation models showed that episodic memory was not an independent mediator of age and search accuracy for either eHealth task once speed/attention and executive functions were included. CONCLUSIONS: Older adults can experience difficulty searching the internet for some health-related information, which is at least partly attributable to executive dysfunction. Future studies are needed to determine the benefits of training in the organizational and strategic aspects of internet search for older adults and whether these findings are applicable to clinical populations with executive dysfunction.

Internet navigation skills for financial management: Associations with age, neurocognitive performance, and functional capacity.

Objective: Online banking is becoming increasingly common among middle-aged and older adults, who may experience difficulties effectively navigating this sometimes complicated technology. This study examined age effects on a performance-based internet banking task and its association with neurocognitive, functional, and numerical abilities. Method: Thirty-five older adults (age 51-75) and 50 younger adults (age 18-32) completed an experimenter-controlled online banking measure in which they independently performed a series of naturalistic financial tasks (e.g., account transfers, bill paying). Participants also completed standardized tests of cognition, numeracy, and functional capacity. Results: Older adults were markedly slower and less accurate in completing the internet-based banking task, which was not confounded by other demographic, mood, or computer use factors. Higher scores on measures of neurocognition, numeracy, and financial functional capacity were both strongly associated with higher internet-based banking among older, but not younger adults. Conclusions: Findings suggest that older adults experience difficultly quickly and accurately navigating online banking platforms, which may be partly related to age-related declines in neurocognitive functions and basic financial capacity. Future studies might examine whether neurocognitive approaches to remediation and compensation can be used to improve online banking capacity in older adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Conceptualizing and Assessing Everyday Functioning in the Context of HIV-Associated Neurocognitive Disorders.

Combination antiretroviral therapy has reduced the rates of severe HIV-associated neurocognitive disorders (HAND), but the prevalence of milder forms of HAND that can affect everyday functioning remains high. As HIV-infected adults approach near-normal life expectancies, they may become increasingly susceptible to declines in everyday functioning secondary to a variety of physical and mental factors, including HAND. Although impairments in everyday functioning are a hallmark of HAND diagnoses and can adversely influence quality of life, there are no gold standard measures of this fundamentally important and complex construct. This chapter provides a brief review of the various self-report, clinician-rated, and performance-based methods by which everyday functioning is measured in the setting of HIV disease, including global activities of daily living and specific domains of medication adherence, financial management, automobile driving, and vocational functioning.

Identification of Subtle Verbal Memory Deficits in Premanifest Huntington Disease Using the California Verbal Learning Test.

BACKGROUND: Verbal memory impairment in individuals with Huntington disease (HD) is well-documented; however, the nature and extent of verbal memory impairment in individuals with premanifest HD (pre-HD) are less understood. OBJECTIVE: To evaluate verbal memory function in individuals with pre-HD by comparing their performance on the California Verbal Learning Test to that of individuals with a clinical diagnosis of HD and that of a demographically similar group of adults with no family history of, or genetic risk for, HD, thereby reducing possible complications of psychiatric difficulties commonly experienced by individuals who are at risk for HD but are gene negative. METHODS: Participant groups included 77 adults with a diagnosis of HD, 23 premanifest gene carriers for HD (pre-HD), and 54 demographically similar, healthy adults. The California Verbal Learning Test-Second Edition (CVLT-II) was used to evaluate the participants' immediate and delayed recall, recognition, learning characteristics, errors, and memory retention. RESULTS: The pre-HD group performed significantly worse than the healthy group, yet significantly better than the HD group, on Short and Long Delay Recall (Free and Cued) and Recognition Discriminability. On Total Immediate Recall, Learning Slope, Semantic Clustering, and Intrusions, the pre-HD group performed similarly to the healthy group and significantly better than the HD group. None of the groups differed in their performance on Repetitions and a measure of retention. CONCLUSIONS: Subtle memory deficits can be observed during the premanifest stage of HD with use of a subset of indices from the CVLT-II.

One-year stability of prospective memory symptoms and performance in aging and HIV disease.

Introduction: HIV disease and aging can both affect prospective memory (PM), which describes the complex process of executing delayed intentions and plays an essential role in everyday functioning. The current study investigated the course of PM symptoms and performance over approximately one year in younger and older persons with and without HIV disease. Method: Participants included 77 older (>50 years) and 35 younger (<40 years) HIV+ individuals and 44 older and 27 younger seronegative adults. Participants completed the Memory for Intentions Test to measure PM in the laboratory, the Prospective and Retrospective Memory Questionnaire to measure PM symptoms in daily life, and several clinical measures of executive functions and retrospective memory as a part of a comprehensive neurocognitive evaluation at baseline and at 14-month follow-up. Results: Findings showed additive, independent main effects of HIV and aging on time- and event-based PM performance in the laboratory, but no change in PM over time. There were no interactions between time and HIV or age groups. Parallel findings were observed for clinical measures of retrospective memory and executive functions. Older HIV+ adults endorsed the greatest frequency of PM symptoms, but there was no change in PM symptom severity over time and no interactions between time and HIV or age groups. There were no effects of HIV or aging on naturalistic PM performance longitudinally. Conclusion: Overall these findings suggest that PM symptoms and performance in the laboratory are stably impaired over the course of a year in the setting of aging and HIV disease.

The neuropsychological aspects of performance-based Internet navigation skills: A brief review of an emerging literature.

OBJECTIVE: Over the last 20 years, the Internet has become a fundamental means by which many people with neurocognitive disorders manage their activities of daily living (e.g. shopping) and engage in health behaviors (e.g. appointment scheduling). The aim of this review is to summarize the emerging literature on the neuropsychology of performance-based tasks of Internet navigation skills (INS) as measures of everyday functioning. METHOD: We performed a structured, qualitative review of the extant literature on INS using PRISMA guidelines. RESULTS: Seventeen peer-reviewed studies met inclusion criteria and their results suggest that performance-based tests of INS: (1) discriminate healthy adults from some neuropsychological populations [e.g. human immunodeficiency virus (HIV), multiple sclerosis (MS), traumatic brain injury (TBI)]; (2) are associated with performance-based tests of everyday functioning capacity, domain-specific declines in manifest everyday functioning, and self-reported Internet behavior, but not global manifest functional status; (3) correlate with standard clinical neuropsychological tests, particularly executive functions and episodic memory; (4) may relate to demographic factors, most notably age; and (5) have largely unknown psychometric properties (e.g. reliability). CONCLUSION: This review provided early support for the construct validity of performance-based tasks of INS as modern measures of everyday functioning in neuropsychological populations. Future work is needed to refine these tasks, establish their psychometrics, and evaluate their construct validity in diverse populations, as well as to develop effective remediation and compensatory strategies to improve Internet functionality among persons with neurocognitive disorders.

Extrapyramidal motor signs in older adults with HIV disease: frequency, 1-year course, and associations with activities of daily living and quality of life.

Age and HIV disease have additive effects on neural systems that support motor functioning. The current study examined the combined impact of aging and HIV on extrapyramidal motor functions, which were hypothesized to influence on activities of daily living (ADLs) and quality of life (QoL). Participants included 336 adults classified by HIV serostatus and age. A research nurse administered the Unified Parkinson's Disease Rating Scale (UPDRS) and participants completed the modified Lawton & Brody ADL and the Short Form Survey Instrument (SF-36) questionnaires as part of a larger neuropsychological research battery. A convenience subset of 172 participants completed a 14-month follow-up evaluation. At baseline, only older age was associated with mild extrapyramidal signs; however, at 14-month follow-up, independent adverse effects of both HIV status and age group were observed on a 3-level UPDRS change variable. Among older HIV+ adults, the presence of mild UPDRS motor signs was independently associated with basic and instrumental ADL dependence, as well as lower physical (ps < .05), but not mental QoL. In the modern treatment era, older HIV+ adults show higher frequency of mild extrapyramidal signs as compared to younger individuals (but not older HIV- persons) and are at higher risk of incident extrapyramidal signs relative to HIV- persons (but not younger HIV+ persons). When present in older HIV+ adults, extrapyramidal signs are of mild severity but nevertheless increase the risk of daily functioning problems and lower health-related physical QoL.

Real-world implications of apathy among older adults: Independent associations with activities of daily living and quality of life.

OBJECTIVES: Apathy is common in older adults and has been linked to adverse health outcomes. The current study examined whether apathy contributes to problems managing activities of daily living (ADLs) and lower quality of life (QoL) in older adults. METHOD: Participants included 83 community-dwelling older adults. Apathy was assessed using a composite of the self and family-rating scales from the Frontal Systems Behavioral Scale (FrSBe). A knowledgeable informant completed the Activities of Daily Living Questionnaire (ADLQ), and participants completed the World Health Organization Quality of Life (WHOQol) scale. RESULTS: Nominal logistic regressions controlling for age, anxiety and depression symptoms, chronic medical conditions, and global cognition revealed that higher levels of apathy were significantly associated with a wide range of mild ADL problems. In parallel, a multiple linear regression indicated that greater apathy was significantly associated with lower QoL independent of ADL problems, anxious and depressive symptomology, chronic medical conditions, global cognition and age. DISCUSSION: Findings suggest that apathy confers an increased risk of problems in the independent management of daily activities and poorer well-being among community-dwelling older adults. Neurobehavioral and pharmacological interventions to improve apathy may have beneficial effects on the daily lives of older adults.

A systematic review of prospective memory in HIV disease: from the laboratory to daily life.

OBJECTIVE: Prospective memory (PM) is described as the capacity to form and maintain an intention that is executed in response to a specific cue. Neural injury and associated neurocognitive disorders are common among persons living with HIV disease, who might therefore be susceptible to impairment in PM. METHOD: This literature review utilized a structured qualitative approach to summarize and evaluate our current understanding of PM functioning in people living with HIV disease. 33 studies of PM in HIV+ persons met criteria for inclusion. RESULTS: Findings showed that HIV is associated with moderate deficits in PM, which appear to be largely independent of commonly observed comorbid factors. The pattern of PM deficits reveals dysregulation of strategic processes that is consistent with the frontal systems pathology and associated executive dysfunction that characterizes HIV-associated neural injury. The literature also suggests that HIV-associated PM deficits present a strong risk of concurrent problems in a wide range of health behaviors (e.g. medication non-adherence) and activities of daily living (e.g. employment). Early attempts to improve PM in HIV disease have revealed that supporting strategic processes might be effective for some individuals. CONCLUSIONS: HIV-associated PM deficits are common and exert a significant adverse effect on the daily lives and health of infected persons. Much work remains to be done to understand the cognitive architecture of HIV-associated PM deficits and the most efficient means to enhance PM functioning and improve health outcomes in persons living with HIV.

A comparison of the sensitivity, stability, and reliability of three diagnostic schemes for HIV-associated neurocognitive disorders.

HIV-associated neurocognitive disorders (HAND) occur in approximately 50% of HIV-infected individuals, yet available diagnostic criteria yield varying prevalence rates. This study examined the frequency, reliability, and sensitivity to everyday functioning problems of three HAND diagnostic criteria (DSM-5, Frascati, Gisslén). Participants included 361 adults with HIV disease and 199 seronegative adults. Neurocognitive status as defined by each of the three diagnostic systems was determined via a comprehensive neuropsychological battery. Everyday functioning was evaluated through self-report and clinician ratings. Results of logistic regressions revealed an association of HIV serostatus with Frascati-defined neurocognitive impairment (p = .027, OR = 1.7[1.1, 2.7]), but not DSM-5 or Gisslén-defined criteria (ps > .05). Frascati and DSM-5 criteria demonstrated agreement on 71% of observations, Frascati and Gisslén showed agreement on 80%, and DSM-5 and Gisslén criteria showed agreement on 46%, though reliability across the three criteria was poor. Only Frascati-defined neurocognitive impairment significantly predicted everyday functioning problems (p = .002, OR = 2.3[1.4, 3.8]). However, when both neurocognitive and complaint criteria were considered, the DSM-5 guidelines demonstrated significant relationships to everyday functioning, serostatus, and also increased reliability overtime compared to neurocognitive criteria alone (all ps < .05). A subset (n = 118) of the HIV+ group was assessed again after 14.0 (2.2) months. DSM-5 criteria evidenced significantly higher rates of incident neurocognitive disorder compared to both Frascati (p = .003) and Gisslén (p = .021) guidelines, while there were fewer remitting neurocognitive disorder diagnoses when Gisslén criteria were applied to the study sample compared to Frascati (p = .04). Future studies should aim to identify gold standard biological markers (e.g., neuropathology) and clinical outcomes associated with specific diagnostic criteria.

Retrieval cue and delay interval influence the relationship between prospective memory and activities of daily living in older adults.

OBJECTIVE: Older adults commonly experience mild declines in everyday functioning and the strategic aspects of prospective memory (PM). This study used multiprocess theory to examine whether the strategic demands of retrieval cue type (event vs. time based) and delay interval length (2 vs. 15 min) influence the relationship between PM and activities of daily living (ADLs) in older adults. METHOD: Participants included 97 community-dwelling older adults recruited from the Western Australia Participant Pool. Participants were administered the Memory for Intentions Screening Test (MIST) and Prospective and Retrospective Memory Questionnaire (PRMQ) as part of a larger neurocognitive assessment. A knowledgeable informant completed the Activities of Daily Living Questionnaire (ADLQ), from which a cutpoint of ≥ 1 was used to classify participants into "ADL normal" (n = 37) or "mild ADL problems" (n = 60) groups. Repeated measures multivariate analysis of variance (MANOVA) controlling for age was conducted with ADL group as the between-subjects factor and either MIST or PRMQ cue and delay scores as the within-subjects factors. RESULTS: We observed a significant ADL group by PM interaction on the MIST, with pair-wise analyses showing that the mild ADL problems group performed worse than ADL normal participants on the 15-min time-based scale (p < .001, Cohen's d = 0.71). No other MIST or PRMQ cue-delay variable differed between the two ADL groups (ps > .10). CONCLUSION: Findings indicate that decrements in strategically demanding cue monitoring and detection over longer PM delays may partly explain older adults' mild problems in everyday functioning. Findings may inform neuropsychological interventions aimed at maintaining ADL independence and enhancing quality of life in older adults.

The effect of interference on temporal order memory in premanifest and manifest Huntington's disease.

BACKGROUND: Frontal-striatal dysfunction has been linked to cognitive impairment in Huntington's disease (HD). The frontal lobes play a role in memory for the temporal order in which items occur in a sequence. However, little is known about temporal order memory in HD or how it may be affected by interference. OBJECTIVE: The study assessed temporal order memory in patients with manifest HD (n = 20), premanifest gene carriers for HD (Pre-HD; n = 18), and controls (n = 25) using a computerized radial 8-arm maze. METHODS: On the sample phase of each trial, participants viewed a random sequence of circles appearing one at a time at the end of each arm. On the choice phase, participants viewed two sample phase circles and chose the circle occurring earliest in the sequence. Manipulations of the temporal lag (defined as the number of circles occurring in the sample phase sequence between the two choice phase circles) were conducted to systematically vary interference. Temporally proximal lags were hypothesized to generate more interference relative to temporally distal lags. RESULTS: The Pre-HD group was significantly impaired (p < 0.05) compared to controls on proximal temporal lags (high interference) but matched controls on distal lags (low interference). HD patients improved as a function of increased lag but demonstrated significant impairments (p < 0.05) across lags relative to controls. CONCLUSIONS: Temporal order memory is differentially affected by interference during the premanifest and manifest stages of HD. The study identifies a fundamental, yet relatively unexamined, deficit associated with HD.