Automated Neuropsychological Assessment Metrics Research Articles

Increase in Plasma S100B Concentration Is Associated With Decrements in Spatial Processing During Acute High-Altitude Exposure

Vasogenic edema consequent to blood-brain barrier (BBB) permeability may contribute to cognitive performance decrements during acute exposure to high altitude. S100B is a putative marker of BBB permeability, but S100B responses to high altitude are poorly characterized and the relation to cognitive performance is unknown. To test the hypothesis that S100B increases upon ascent to high altitude and that increase is associated with changes in cognitive performance, 41 healthy Soldiers (mean±SD; age=26±5yr) were tested at their baseline residence (SL, 331m), transported to Taos, NM (2845m), then immediately hiked (n=21) or were driven (n=20) to a high-altitude (HA, 3600m) facility. Plasma S100B was measured at 06:00 throughout the study; twice at SL and again after the first night at HA (16h exposure). The automated neuropsychological assessment metric (ANAM) was administered four times at SL and once at HA to assess sustained attention, working memory, spatial processing, computation, executive function, and reaction time. ANAM performance was assessed using throughput scores, a metric considering both response speed and accuracy. The last SL morning assessment and the HA morning assessment (19h exposure) were used to generate ΔANAM scores. Correlations between ΔS100B and ΔANAM scores were significant for 1 of 9 modules, simultaneous spatial processing (SPD; r=-0.401; p=0.009). S100B increased (5.3%, p=0.02) from SL to HA while SPD scores decreased (8.2%, p=0.05). Using the reliable change index (RCI) to dichotomize individuals into those demonstrating a decrease in performance that exceeded measurement error and day-to-day variability (responders; RCI <-1.64; n=7) and those who did not (non-responders; RCI >-1.64; n=34) revealed that responders experienced a greater increase (+12.3%, p=0.01) in S100B from SL to HA relative to non-responders (+3.4%, p=0.14) Findings suggest that acute exposure to 3600m may increase BBB permeability, as indicated from plasma S100B concentrations, and the increased BBB permeability may be mechanistically associated with spatial processing decrements. Funding: USAMRDC, PRMRP. Authors’ views not offcial U.S. Army or DoD policy. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Resistance training's impact on blood biomarkers and cognitive function in older adults with low and high risk of mild cognitive impairment: a randomized controlled trial

BackgroundThe aging brain exhibits a neuroinflammatory state, driven partly by peripheral pro-inflammatory stimuli, that accelerates cognitive deterioration. A growing body of evidence clearly indicates that physical exercise partly alleviates neuroinflammation and positively affects the aging process and cognition. In this randomized controlled trial, we aimed to observe the effect of 12 weeks of resistance training (RT) on peripheral biomarker levels, cognitive function changes and their interrelationship, and explore differences in those exercise-induced changes in older adults with high risk of mild cognitive impairment (MCI) compared to older adults with low risk of MCI.MethodsFifty-two participants (aged 60–85 years old, 28 female) were randomly allocated to a 12 week lower limb RT program consisting of two training sessions per week or waiting list control group. The Montreal Cognitive Assessment (MoCA) was used to stratify participants screened as high (< 26/30) or low risk (≥ 26/30) of MCI. We assessed serum Interleukin 6 (IL-6), Insulin-like Growth Factor-1 (IGF-1), and Kynurenine (KYN) levels. Cognitive measurement consisted of and four subtests of Automated Neuropsychological Assessment Metrics (ANAM), the two-choice reaction time, go/no-go, mathematical processing, and memory search test.ResultsTwelve weeks of RT improved Go/No-go test results in older adults with high MCI risk. RT did not significantly affect blood biomarkers. However, IGF-1 level increases were associated with improvements in response time on the mathematical processing test in the exercise group, and IL-6 level increases were associated with improvements in response time on the memory search test in the total group of participants. Finally, KYN levels significantly differed between older adults with low and high MCI risk but no significant associations with performance were found.ConclusionOur study results suggest a different effect of RT on inhibitory control between older adults with low compared to high MCI risk. IGF-1 may play a role in the mechanism behind the cognitive benefit of RT and KYN may be a surrogate biomarker for neurodegeneration and cognitive decline.

P076 Comparing Four Different Simulated Shiftwork Schedules on Higher order Cognitive Function

Abstract Introduction Changes in cognitive performance during shiftwork due to fatigue and circadian misalignment are well-documented. However experimental evaluations of shiftwork schedules are often limited to basic tasks such as vigilance and attention. The current study evaluated several higher order cognitive functions such as memory and task switching during four simulated shiftwork schedules. Methods N=27 completed a 10-day laboratory shiftwork simulation. They were randomly assigned to one of four shiftwork conditions: Condition A, 4h-on/4h-off/8h-on/8h-off schedule; Condition B, 6h-on/6h-off schedule; Conditions C and D represented to different sections of a 4h-on/4h-on call/4h-off/4h-on/4h-on call/4h-off schedule. The Automated Neuropsychological Assessment Metrics (ANAM) was used to assess cognitive function. The tasks included in this analysis were Code Substitution (CDS/CDD), Pursuit Tracking (PUR), Matching to Sample (M2S), and Switching Task (SWT). Stability of performance during waking was compared between the conditions using Kruskal-Wallis tests. Results The analysis of cognitive performance tasks yielded mixed findings. Performance on all tasks was ranked from best to worst: Condition D (&amp;gt;Conditions A, B, C; all p &amp;lt; .05), Condition A (&amp;gt;Conditions B, C; p &amp;lt; .05 and p &amp;lt;.001, respectively), Condition B, Condition C. Regarding stability of higher order cognitive function across the waking day, Condition A exhibited the worst stability, and was the only condition whereby performance degraded across the wake period. Discussion These findings highlight the variability in cognitive capacities during different shiftwork schedules. It is important to examine higher order cognitive function, and other cognitive abilities during shiftwork, when evaluating different shiftwork schedules.

Longitudinal assessment of neurocognitive function in people with relapsing multiple sclerosis initiating alemtuzumab in routine clinical practice: LEM-COG study results.

Alemtuzumab is effective in reducing relapse rate and disability, but limited data exist on its effect on cognitive function in relapsing multiple sclerosis (RMS). The present study assessed neurocognitive function and safety associated with alemtuzumab treatment in RMS. This longitudinal, single-arm, prospective study included people with RMS (aged 25-55 years) who were treated with alemtuzumab in clinical practice in the United States of America and Canada. The first participant was enrolled in December 2016. The primary endpoint was the change from baseline to post-baseline (month [M] 12/24) in MS-COGnitive (MS-COG) composite score. Secondary endpoints included Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Selective Reminding Test (SRT), Controlled Oral Word Association Test (COWAT), and Automated Neuropsychological Assessment Metrics (ANAM) scores. Depression and fatigue were assessed using Hamilton Rating Scale-Depression (HAM-D) and Fatigue Severity Scale (FSS)/Modified Fatigue Impact Scale (MFIS), respectively. Magnetic resonance imaging (MRI) parameters were assessed when available. Safety was assessed throughout the study. Descriptive statistics were used for the pre-specified statistical analyses. Since the study was terminated early (November 2019) because of operational and resource difficulties, post hoc analyses for statistical inference were performed among participants who had a baseline value and at least one complete post-baseline assessment for cognitive parameters, fatigue, or depression. Of the 112 participants enrolled, 39 were considered as the primary analysis population at M12. At M12, a mean change of 0.25 (95% confidence interval [CI]: 0.04, 0.45; p=0.0049; effect size [ES]: 0.39) was observed in the MS-COG composite score. Improvements were observed in processing speed (based on PASAT and SDMT; p < 0.0001; ES: 0.62), as well as in individual PASAT, SDMT and COWAT scores. An improvement was also noted in HAM-D (p=0.0054; ES: -0.44), but not in fatigue scores. Among MRI parameters, decreases in burden of disease volume (BDV; ES: -0.12), new gadolinium-enhancing lesions (ES: -0.41) and newly active lesions (ES: -0.07) were observed at M12. About 92% of participants showed stable or improved cognitive status at M12. There were no new safety signals reported in the study. The most common adverse events (≥10% of participants) were headache, fatigue, nausea, insomnia, urinary tract infection, pain in extremity, chest discomfort, anxiety, dizziness, arthralgia, flushing, and rash. Hypothyroidism (3.7%) was the most frequent adverse event of special interest. The findings from this study suggest that alemtuzumab has a positive impact on cognitive function with significant improvements in processing speed and depression in people with RMS over a period of 12 months. The safety profile of alemtuzumab was consistent with previous studies.

Baseline concussion assessment performance by sex in military service academy rugby players: findings from the CARE Consortium

BackgroundNormative student-athlete concussion assessment data may not be appropriate for service academy members (SAMs), particularly rugby players, because of the uniqueness of their academic/military training environment. Having accurate baseline data...

The Effects of Acute Resistance Exercise on Memory, Processing Speed, and Mood State After a Cognitive Challenge.

Venezia, AC, Barney, P, Spagnoli, D, Greco-Hiranaka, C, Piepmeier, AT, Smith, JC, and Weiss, LR. The effects of acute resistance exercise on memory, processing speed, and mood state after a cognitive challenge. J Strength Cond Res 37(9): 1738-1745, 2023-Acute moderate-to-vigorous-intensity aerobic exercise has been shown to improve learning and memory, but the effectiveness of acute high-intensity resistance exercise for improving memory is not fully understood. Like acute aerobic exercise, acute resistance exercise increases arousal and circulating catecholamines, mechanisms suggested to mediate the memory-enhancing effects of acute exercise. Furthermore, although acute exercise has been shown to benefit mood state, it is unknown if high-intensity resistance exercise positively influences mood state after a cognitive challenge. In this within-subjects design, subjects (18- to 25-year-old men) completed an approximately 40-minute session of resistance exercise or seated rest. Immediately after, the Automated Neuropsychological Assessment Metrics (ANAM) Code Substitution (CS)-Learning, CS-Immediate Recognition, and CS-Delayed Recognition tasks were completed, followed by the ANAM Mood Scale. There were no significant effects of exercise on recognition memory; however, CS-Learning (attention and processing speed) was better after resistance exercise ( p = 0.03). After the cognitive challenge, restlessness ( p < 0.001), vigor ( p = 0.03), and depression ( p = 0.047) scores were higher after resistance exercise compared with rest; however, after false discovery rate correction, only restlessness remained significantly different between sessions ( q = 0.002), whereas vigor ( q = 0.09) and depression ( q = 0.09) did not. These results suggest that an acute bout of resistance exercise improves attention and processing speed, although it does not improve recognition memory and has mixed effects on mood state in college-aged men.

Physician norms for the Automated Neuropsychological Assessment Metrics (ANAM)

Introduction The development of population specific norms for the Automated Neuropsychological Assessment Metrics (ANAM) is to help expand the utility for use with other population groups. Currently, normative data are available for general military, special operations, athletic, and community populations. The current study provides normative reference values for use in assessing physicians. Materials and methods Retrospective data from a sample of 2,288 physicians who completed the ANAM were examined. The data were gathered from practicing civilian physicians serving in the National Guard or Reserves who completed the assessment as part of the mandated Department of Defense clinical testing policy. The effects of age and sex on performance were examined for all subtests. Normative tables were stratified by age (23–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59, 60–64, 65–79) and sex. Base rates of low scores among the physician population were also examined. Results Older age was associated with lower performance on all subtests with small-to-medium effect sizes. A mixed pattern of performance was observed as a factor of sex with females scoring better on one subtest and males scoring better on three subtests. However, effects sizes associated with sex were small and likely of minimal clinical significance. A total of 11.3% of the physician sample scored below average on two or more tests in the battery. Conclusions This study provides normative data for practicing physicians that can be used to help inform clinical decision-making.

Association between Altered Cortisol Profiles and Neurobehavioral Impairment after Mild Traumatic Brain Injury in College Students.

Mild traumatic brain injury (mTBI) is the most common form of TBI, with more than 2.5 million TBI cases in the United States annually. Identification of easily obtainable biomarkers that track strongly with mTBI symptoms may improve our understanding of biological factors that contribute to mTBI symptom profiles and long-term outcomes. Notably, some individuals with mTBI exhibit circadian disruptions and elevated stress sensitivity, which in other clinical groups often correlate with disrupted secretion of cortisol, a glucocorticoid hormone that coordinates circadian and stress physiology. Here, we examined whether cortisol profiles could serve as a biomarker to complement the assessment of neurobehavioral sequelae after mTBI. We partnered with our on-campus health clinic to recruit college students seeking medical care after mTBI (n = 46) and compared this population to a well-matched non-injured student control group (n = 44). We collected data at an initial visit (shortly after injury in mTBI subjects) and one week later. At each visit, we evaluated neurobehavioral function using the Automated Neuropsychological Assessment Metric (ANAM). The subjects also provided cortisol samples through at-home saliva collection. We observed strong coherence between ANAM subjective and objective measures, indicating significant multi-dimensional impairment in subjects with mTBI. Further, female mTBI subjects exhibited diminished neurobehavioral function compared with males. Regardless of sex, decreased amplitude of diurnal cortisol and a blunted cortisol awakening response were associated with mTBI symptom severity and neurobehavioral impairment. Taken together, these findings suggest that salivary cortisol profiles may be a sensitive biomarker for studying underlying biological factors that impact mTBI symptoms and outcomes.

Validation of the automated neuropsychological assessment metrics for assessing cognitive impairment in systemic lupus erythematosus.

ObjectiveWe previously demonstrated the utility of the Automated Neuropsychological Assessment Metrics (ANAM) for screening cognitive impairment (CI) in patients with systemic lupus erythematosus (SLE) and developed composite indices for interpreting ANAM results. Our objectives here were to provide further support for the ANAM’s concurrent criterion validity against the American College of Rheumatology neuropsychological battery (ACR-NB), identify the most discriminatory subtests and scores of the ANAM for predicting CI, and provide a new approach to interpret ANAM results using Classification and Regression Tree (CART) analysis.Methods300 adult SLE patients completed an adapted ACR-NB and ANAM on the same day. As per objectives, six models were built using combinations of ANAM subtests and scores and submitted to CART analysis. Area under the curve (AUC) was calculated to evaluate the ANAM’s criterion validity compared to the adapted ACR-NB; the most discriminatory ANAM subtests and scores in each model were selected, and performance of models with the highest AUCs were compared to our previous composite indices; decision trees were generated for models with the highest AUCs.ResultsTwo models had excellent AUCs of 86 and 89%. Eight most discriminatory ANAM subtests and scores were identified. Both models demonstrated higher AUCs against our previous composite indices. An adapted decision tree was created to simplify the interpretation of ANAM results.ConclusionWe provide further validity evidence for the ANAM as a valid CI screening tool in SLE. The decision tree improves interpretation of ANAM results, enhancing clinical utility.

Acute Effects of Local Ischemic Hypoxia and Systemic Hypoxemia on Neuromuscular and Cognitive Function

Rivera, Paola M., Chris E. Proppe, Esther Beltran, and Ethan C. Hill. Acute effects of local ischemic hypoxia and systemic hypoxemia on neuromuscular and cognitive function. High Alt Med Biol. 23:18-25, 2022. Background: The application of blood flow restriction (BFR) induces local ischemic hypoxia within the muscle(s) distal to the restriction device. Systemic hypoxemia via oxygen or barometric pressure manipulation achieves whole-body hypoxia and thus may be a more potent exercise adjunct than BFR. Therefore, the purpose of this study was to examine the acute effects of local ischemic hypoxia versus systemic hypoxemia on maximal voluntary isometric contraction (MVIC) torque, electromyographic amplitude (EMG AMP), EMG mean power frequency (MPF), and cognition. Materials and Methods: Twelve recreationally trained women (mean age ± standard deviation = 21 ± 1.6 years) performed 75 submaximal (1 × 30, 3 × 15) unilateral leg extension muscle actions under normoxia, local ischemic hypoxia, and systemic hypoxemia. Before and immediately after the 75 repetitions, MVIC muscle actions were performed, and surface EMG was simultaneously assessed from the vastus lateralis. Cognitive function was assessed immediately after each exercise using the Automated Neuropsychological Assessment Metrics (ANAM). Separate repeated-measures analyses of variance (ANOVAs) were performed to examine changes in MVIC, reaction time, EMG AMP, and EMG MPF responses during the MVIC muscle actions. Results: There were no significant (p = 0.21-0.953) Condition × Time interactions for MVIC, EMG AMP, or EMG MPF but a significant (p < 0.001-0.005) main effect for the Time collapsed across Condition for MVIC torque (pretest 238.8 ± 19.5, posttest 212.7 ± 20.1 Nm) and EMG MPF (88.5% ± 1.4% of pretest). There were no significant (p = 0.503) differences in reaction time among Conditions. Conclusions: The findings of the present study suggest that all three conditions elicited comparable acute changes in performance as assessed by MVIC torque that were associated with no changes in muscle activation but decrease in action potential conduction velocity. Therefore, the application of local ischemic hypoxia or systemic hypoxemia during low-load resistance exercise can be used to elicit similar acute physiological responses and not adversely affect cognitive function relative to nonhypoxic conditions.

NCOG-38. PREDICTORS OF COGNITIVE PERFORMANCE IN PATIENTS WITH PRIMARY BRAIN TUMORS: AN ANALYSIS OF BRAIN FITNESS CENTER (BFC) AT WALTER REED NATIONAL MILITARY MEDICAL CENTER

Abstract INTRODUCTION Although developed initially for patients with traumatic brain injury (TBI), cognitive rehabilitation training (CRT) has expanded its use to include patients suffering from a variety of neurocognitive disorders including neurologic malignancies. The Brain Fitness Center (BFC) at Walter Reed National Military Medical Center (WRNMMC) is a cognitive rehabilitation clinic that offers computer-based cognitive training programs as an adjunctive rehabilitation resource for a diverse patient population with cognitive complaints. METHODS Using a retrospective analysis of data from the BFC at WRNMMC, our study analyzed forty patients with primary brain tumors who had completed both symptom self-report questionnaires and cognitive assessments at the BFC. Self-report questionnaires included the neurobehavioral symptom inventory (NSI) and headache symptom inventory (HIT-6) while cognitive assessments were done using the Automated Neuropsychological Assessment Metrics (ANAM). Our study examined the relationship between subjective cognitive complaints, headache severity, neuropsychiatric symptoms and objective cognitive performance before and after initial CRT. The influence of high vs low grade tumors was also evaluated. RESULTS Our analysis demonstrated that increased number of affective symptoms, particularly self-reported irritability, were the strongest predictors of baseline, objective cognitive performance (r= -.377, p=0.008). Patient self-reported forgetfulness, but not overall subjective cognitive complaints, was also negatively correlated with objective cognitive performance (r= - 0.353, p= 0.020). A mean difference in objective cognitive performance between high grade and low grade tumors was also found (p=0.003). CONCLUSIONS Our results point to potential patient-level factors which could predict benefit from CRT including self-reported irritability, self-reported forgetfulness, and tumor grade. Further prospective studies will help to examine the true benefit of sustained CRT, and the subset of patients with CNS neoplasms most likely to benefit from this training.

Quinolinic acid, a kynurenine/tryptophan pathway metabolite, associates with impaired cognitive test performance in systemic lupus erythematosus

ObjectivesInterferon-alpha, an important contributor to SLE pathogenesis, induces the enzyme indoleamine 2,3-dioxygenase in the kynurenine/tryptophan (KYN/TRP) pathway. This leads to a potentially neurotoxic imbalance in the KYN/TRP pathway metabolites, quinolinic...

Effect of Transcranial Near-Infrared Light 1068 nm Upon Memory Performance in Aging Healthy Individuals: A Pilot Study.

Background: We present a pilot study of near-infrared (NIR) 1068 nm transcranial photobiomodulation therapy (PBM-T). Impact upon motor function, memory, and processing speed in healthy individuals, older than 45 years of age, was evaluated. Methods: PBM-T was performed at home using a transcranial phototherapy device, a helmet that comprised 14 air cooled light emitting diode panel arrays, with a peak wavelength of 1068 nm, full width at half maximum bandwidth of 60 nm and total average optical output power of 3.8 W. The device was used for 6 min twice daily on age-matched middle-aged subjects with normal intellectual function. The US Food and Drug Administration (FDA)-approved computerized assessment tool Automated Neuropsychological Assessment Metrics (ANAM) was adopted to quantify a series of cognitive and motor activities in the participating groups. Results: A significant improvement in motor function, memory performance, and processing speed was observed in healthy individuals with PBM-T compared to the placebo group. No adverse effects were reported. Conclusions: PBM-T may be a promising new approach to improve memory in healthy middle-aged individuals. ClinicalTrials.gov ID: NCT04568057.

A-107 Quantifying the Effect of Sleepiness and Mood on Gross Neuropsychological Functioning in a Forensic Population with a History of Traumatic Brain Injury

Abstract Objective Traumatic brain injury (TBI) is a serious public health concern. Furthermore, inmates and probationers are at a higher risk for TBI, as well as mental health issues and sleepiness. Both sleep and mood disturbance have been linked to poor cognitive performance. These state-dependent cognitive changes can undermine the evaluation of true cognitive ability and contaminate validity. This study examined the effects of sleep and mood on neurocognitive functioning and its impact on the validity of assessment results. Methods This study looked at retrospective Automated Neuropsychological Assessment Metrics (ANAM) core battery data. The sample included inmates and probationers (n = 419) with a history of TBI. A multiple linear regression was used to examine the relationship between self-reported sleepiness, mood state, and cognitive performance. Results All regression models were statistically significant, with negative mood being the most significant predictor of ANAM throughput scores (p = 0.000). Higher endorsement of negative mood states was related to lower cognitive performance overall (p = 0.003). Sleepiness predicted worse performance on at the end of the battery (p &amp;lt; 0.05), whereas positive mood predicted better performance at the beginning of the battery (p &amp;lt; 0.01). Conslusion The present study confirms that negative mood adversely affects global neurocognitive test performance in a forensic population. Examiners should be aware that sleepiness and mood states have an effect on test performance during even brief cognitive batteries. The current findings suggest that it is imperative to screen and identify sleepiness and negative mood symptoms as they may depress test results and threaten the validity or test interpretations and recommendations.

Automated neuropsychological assessment metrics (v4) military expanded battery: Normative data for special operations forces

Objective: The Automated Neuropsychological Assessment Metrics (ANAM) has long been used to assess cognition in military samples before deployment and following injury. The purpose of this study was to explore the effects of various demographic factors on the ANAM4 Military Expanded (ANAM4 ME) performance of Special Operations Forces (SOF) and to provide regression-based normative data for clinicians working with SOF personnel. Method: The sample was a large active duty military sample of SOF and support personnel (n = 24,072) who were tested under a new baseline policy. Results: Performance differences based on demographic variables were generally small. In general, increasing age was associated with significantly worse performance, except on mathematical processing. Higher education level was associated with better performance on most subtests, as expected, but was associated with worse performance on spatial processing. Conclusion: This paper provides regression formulas for calculating adjusted scores based on the most relevant demographic variables, as well as base rates of obtaining one or more clearly above or below average scores across the entire ANAM4 ME battery.

Acute Effects of High-intensity Resistance Exercise on Cognitive Function.

The purpose of the present study was to examine the influence of an acute bout of high-intensity resistance exercise on measures of cognitive function. Ten men (Mean ± SD: age = 24.4 ± 3.2 yrs; body mass = 85.7 ± 11.8 kg; height = 1.78 ± 0.08 m; 1 repetition maximum (1RM) = 139.0 ± 24.1 kg) gave informed consent and performed a high-intensity 6 sets of 10 repetitions of barbell back squat exercise at 80% 1RM with 2 minutes rest between sets. The Automated Neuropsychological Assessment Metrics (ANAM) was completed to assess various cognitive domains during the familiarization period, immediately before, and immediately after the high-intensity resistance exercise bout. The repeated measures ANOVAs for throughput scores (r·m-1) demonstrated significant mean differences for the Mathematical Processing task (MTH; p < 0.001, η2p = 0.625) where post hoc pairwise comparisons demonstrated that the post-fatigue throughput (32.0 ± 8.8 r·m-1) was significantly greater than the pre-fatigue (23.8 ± 7.4 r·m-1, p = 0.003, d = 1.01) and the familiarization throughput (26.4 ± 5.3 r·m-1, p = 0.024, d = 0.77). The Coded Substitution-Delay task also demonstrated significant mean differences (CDD; p = 0.027, η2p = 0.394) with post hoc pairwise comparisons demonstrating that the post-fatigue throughput (49.3 ± 14.4 r·m-1) was significantly less than the pre-fatigue throughput (63.2 ± 9.6 r·m-1, p = 0.011, d = 1.14). The repeated measures ANOVAs for reaction time (ms) demonstrated significant mean differences for MTH (p < 0.001, η2p = 0.624) where post hoc pairwise comparisons demonstrated that the post-fatigue reaction time (1885.2 ± 582.8 ms) was significantly less than the pre-fatigue (2518.2 ± 884.8 ms, p = 0.005, d = 0.85) and familiarization (2253.7 ± 567.6 ms, p = 0.009, d = 0.64) reaction times. The Go/No-Go task demonstrated significant mean differences (GNG; p = 0.031, η2p = 0.320) with post hoc pairwise comparisons demonstrating that the post-fatigue (285.9 ± 16.3 ms) was significantly less than the pre-fatigue (298.5 ± 12.1 ms, p = 0.006, d = 0.88) reaction times. High-intensity resistance exercise may elicit domain-specific influences on cognitive function, characterized by the facilitation of simple cognitive tasks and impairments of complex cognitive tasks.

Internal (Factorial) Validity of the ANAM using a Cohort of Woman High-School Soccer Players.

Computerized neuropsychological testing is a cornerstone of sport-related concussion assessment. Female soccer players are at an increased risk for concussion as well as exposures to repetitive head impacts from heading a soccer ball. Our primary aim was to examine factorial validity of the Automated Neuropsychological Assessment Metrics (ANAM) neuropsychological test battery in computing the multiple neurocognitive constructs it purports to measure in a large cohort of interscholastic female soccer players. Study participants included 218 interscholastic female soccer players (age = 17.0±0.7year; mass = 55.5±6.8kg; height = 164.7±6.6cm) drawn from a large (850+) prospective database examining purposeful heading from four area high schools over a 10-year period. The ANAM-2001 measured neurocognitive performance. Three methods were used to identify integral constructs underlying the ANAM: (a) exploratory factor analysis (EFA), (b) first-order confirmatory factor analysis (CFA), and (c) hierarchical CFA. Neuropsychological phenomena measured by the ANAM-2001 were best reproduced by a hierarchical CFA organization, composed of two lower level factors (Simple Reaction Time, Mental Efficiency) and a single, general composite. Although the ANAM was multidimensional, only the composite was found to possess sufficient construct dimensionality and reliability for clinical score interpretation. Findings failed to uphold suppositions that the ANAM measures seven distinct constructs, or that any of its seven tests provide unique information independent of other constructs, or the composite, to support individual interpretation. Outcomes infer the ANAM possesses factorial-validity evidence, but only scores from the composite appear to sufficiently internally valid, and reliable, to support applied use by practitioners.

Changes In Cognition During A 24-h Simulated Military Operation. Role Of Classical Monocytes And Beta-alanine.

Cognitive dysfunction during sustained military operations (SUSOP’s) may be related to the recruitment and infiltration of classical monocytes into the brain. Beta-alanine (BA) supplementation may attenuate cognitive dysfunction and improve resilience to stress exposure, which may be relevant during a SUSOP. PURPOSE: To examine the effect of BA on serum monocyte chemoattractant protein-1 (MCP1), C-C chemokine receptor 2 (CCR2), macrophage-1-antigen (CD11b) and cognition (COG), and to examine the relationships between these variables during a SUSOP. METHODS: Nineteen recreationally active men ingested 12g·day-1 BA (n = 10) or placebo (PL; n = 9) for 14-days prior to completing a simulated 24-h SUSOP. MCP1 was assessed via multiplex assay. Classical monocyte CCR2 and CD11b expression were assessed via flow cytometry. Throughput (TP) scores were extracted from seven cognitive subtests administered via Automated Neuropsychological Assessment Metric (ANAM) software. The relative weight of each ANAM subtest was determined by dividing its outer weight by the standard deviation of all TP scores for that subtest. TP scores were multiplied by their relative weights, and the values summed to provide a value for COG. Assessments occurred at baseline (0H), 12-hours (12H), 18-hours (18H) and 24-hours (24H). A two-way mixed ANOVA was used to assess differences between BA and PL. The statistical significance of pathway (β) coefficients derived from partial least squares structural equation modeling were used to evaluate relationships between MCP1, CCR2, CD11b and COG. RESULTS: MCP1 was significantly greater at 12H, 18H and 24H relative to 0H (p’s < 0.001). CCR2 expression was significantly lower at 12H (p = 0.031), 18H and 24H (p’s < 0.001), while CD11b expression was significantly greater at 12H (p = 0.039) and 24H (p = 0.003) relative to 0H. COG was significantly lower at 18H and 24H compared to 0H and 12H (p’s ≤ 0.001). No significant differences were noted between BA and PL for any variable (p’s > 0.05). MCP1 had a direct negative relationship with cognition (β = -0.395, p = 0.002). CCR2 and CD11b were not directly related to cognition (p’s > 0.50). CONCLUSIONS: Greater serum MCP1 concentrations were associated with increased cognitive dysfunction during the SUSOP. BA did not affect MCP1, CCR2, CD11b or COG compared to placebo.

Exploratory study of a screening measure for polycystic ovarian syndrome, quality of life assessment, and neuropsychological evaluation

BackgroundThe universally adopted 2018 PCOS medical diagnostic and treatment guidelines for Polycystic Ovarian Syndrome (PCOS) cites the need for a brief screening measure that can be easily administered in the clinical care setting. We evaluate a 12-item questionnaire emphasizing the medical symptoms of PCOS with a group of women with PCOS as well as comparison samples of college women not diagnosed with PCOS.MethodOf 120 undergraduate psychology women 18 to 41 years of age, 86 screened negative on a 12-item PCOS symptoms inventory. They were compared to a group of PCOS patients diagnosed medically in a manner consistent with the Teede et al. (2018) evidence-based diagnostic guidelines. The screen-positive, screen-negative, and PCOS-confirmed groups were compared on the PCOS Quality-of-Life (QoL) questionnaire, Zung Self-Rating Depression Scale (ZDS), Spielberg State-Trait Anxiety Inventory (STAI), Fatigue Symptom Inventory (FSI), Spiritual well-being and Spiritual Beliefs Inventories, the computerized Automated Neuropsychological Assessment Metric (ANAM) battery, and an experimental tachistoscopic Bilateral Perceptual Asymmetries Letter and Dots Matching Bilateral Field Advantage (BFA) test (to evaluate the effects of early brain androgenization possible from PCOS). For each questionnaire and neuropsychological performance principal outcome, the Linear Mixed Effects (LME) model was employed to evaluate the predictive significance of demographic characteristics and group membership (confirmed cases, screen negative and screen positive cases) for these outcomes.ResultsThe PCOS-confirmed women scored more poorly than the screen-negative (reference) and screen-positive groups on all the measures of physical, emotional, social, and spiritual well-being measures. On the ANAM neuropsychological battery, PCOS-confirmed women did more poorly on Sternberg Memory and Stimulus Response throughput measures. They also had slower correct response speed for both the unilateral and bilateral dot- and letter-matching tachistoscopic stimulus presentations. However, the bilateral field advantage throughput performance ratio did not differ among groups, which is a global measure of bilateral versus unilateral brain/behavior asymmetries.ConclusionPCOS screening can be a feasible and important part of women’s healthcare. PCOS-confirmed women should receive not only the medical standard of care from the 2018 guidelines, but also comprehensive psychosocial and neurocognitive support to enhance their quality of life.

Chronic decompression illness cognitive dysfunction improved with hyperbaric oxygen: a case report

Altitude chamber exposures are used for training to allow aircrew to experience their hypoxia and pressure effect symptoms. Decompression illness (DCI) can occur subsequent to altitude chamber training or in operational aircraft when the cabin altitude is at least 18,000 feet. Definitive emergent treatment is hyperbaric oxygen (HBO2) to decrease bubble size, dissipate excess nitrogen, hyperoxygenate tissue and reduce inflammation. A 27-year-old female underwent altitude chamber training to 25,000 feet. She developed tingling in both legs and left arm, headache, dizziness, malaise, then difficulty talking. She underwent two HBO2 treatments. Over the next 12 months, she had paresthesia, decreased memory and cognitive function similar to symptoms seen following traumatic brain injury. She was referred 14 months after the event for evaluation. Using pre-deployment Automated Neuropsychological Assessment Metrics (ANAM) and serial tests over 58 HBO2 treatments, the patient demonstrated near-return to her pre-deployment test scores.. The reason for HBO2 treatment was based on previous experience with chronic traumatic brain injury subjects where HBO2 improved outcome. The patient's chronic neurological symptoms mimicked chronic TBI. The patient was unique in that baseline cognitive tests existed that could be used to monitor her changes during the treatment series.