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Symposia

Obsessive Compulsive and Related Disorders

Characterizing Hoarding Disorder Across the Lifespan: Recent Research from Pediatrics to Geriatrics

2 - (SYM 26) Cognitive Profiles in Rural-dwelling Older Adults with Hoarding Disorder: Insights from the NIH Toolbox Cognition Battery

Friday, November 21, 2025
5:18 PM - 5:32 PM CST
Location: Bolden 4, Level 2
Keywords: Hoarding, Early Intervention, Social Skills Training
Recommended Readings: Cath, D. C., Nizar, K., Boomsma, D., & Mathews, C. A. (2017). Age-specific prevalence of hoarding and obsessive compulsive disorder: a population-based study. The American Journal of Geriatric Psychiatry, 25(3), 245-255.,   Dozier, M. E., Porter, B., & Ayers, C. R. (2016). Age of onset and progression of hoarding symptoms in older adults with hoarding disorder. Aging and Mental Health, 20(7), 736-742. https://doi.org/10.1080/13607863.2015.1033684,   Nix, C. A., Dozier, M. E., Porter, B., & Ayers, C. R. (2024). Clinician Sentiments Related to Implementation of Evidence-Based Treatment for Hoarding in Older Adults. Journal of Psychopathology and Behavioral Assessment, 46, 683–694. https://doi.org/10.1007/s10862-024-10140-5,   Prosser, R. M., Salkovskis, P. M., & Dennis, J. P. (2024). Understanding stigma in hoarding disorder: A systematic review. Journal of Obsessive-Compulsive and Related Disorders, 100872.,   Stumpf, B. P., De Souza, L. C., Mourão, M. S., Rocha, F. L., Fontenelle, L. F., & Barbosa, I. G. (2023). Cognitive impairment in hoarding disorder: a systematic review. CNS spectrums, 28(3), 300-312.
Abstract Body

Hoarding disorder in older adults has been linked to cognitive deficits, particularly in executive function and processing speed. However, research findings remain inconsistent, with some studies suggesting no clear neurocognitive impairment beyond subjective reports of cognitive difficulty. Given the heterogeneity in prior results, this study sought to provide a detailed cognitive profile of rural-dwelling older adults with hoarding disorder using the NIH Toolbox Cognition Battery (NIHTB-CB) and explore associations between cognition, hoarding severity, and attrition.

Participants (N = 26) aged 50 and older completed in-home assessments that included the NIHTB-CB, the Saving Inventory-Revised (SI-R), and the Clutter Image Rating (CIR). Fully corrected T-scores from the NIHTB-CB were analyzed to assess executive function, processing speed, working memory, episodic memory, and language. Logistic regression evaluated predictors of attrition (dropping out before the one-month assessment).

Findings revealed that while 69% performed at a high level (defined as ≥ 50 while low was set at ≤ 40) in crystallized cognition (M = 51.52, SD = 6.10), processing speed was notably lower (M = 42.78, SD = 11.10), with 39% scoring in the low range. Additionally, 39% of participants showed low performance on the Flanker task (executive function), suggesting difficulties with attention and inhibitory control. General cognitive performance was negatively associated with both clutter severity (r = -0.49, p = ,017) and total hoarding severity (r = -0.19, p = .209). However, these correlations were not significantly different, suggesting cognitive impairments may be broadly linked to hoarding symptoms rather than any single aspect of the disorder. Despite these cognitive differences, no cognitive or hoarding-related measures significantly predicted early attrition (p > .05).

Findings contribute to a growing body of evidence surrounding cognition and hoarding suggesting considerable deficits in processing speed and executive function. Future work should further investigate how neurocognitive deficits impact decision-making, daily functioning, and treatment outcomes in late life.