Automated Neuropsychological Assessment Metrics Research Articles

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.

Long-Term Test-Retest Stability of ANAM in a Large Military Sample.

This paper examines the long-term stability of the Automated Neuropsychological Assessment Metrics (ANAM) over 1-year, 3-year, and 5-year time periods. The sample was drawn from active duty military personnel. All individuals were administered the ANAM and were re-administered the ANAM a second time, either 1year, 3years, or 5years later. All individuals had no reported cognitive problems or concussion or any traumatic brain injury between the first and second assessments and had no intervening contact with the ANAM. All were assessed using the military standard approach with trained proctors. The results for (n=19,997) individuals who were tested 1year apart showed an intra-class correlation (ICC) of .6 for simple reaction time and simple reaction time repeat and .7 and above for all other scales. For the sample with 3years between testings (n=9,166), the ICC was similar to the 1-year sample. When the 5year between testings data was examined (n=2,270), the ICCs for all scales except the simple reaction time and simple reaction time repeat showed ICCs of .7 and.8. The simple reaction time and simple reaction time repeat showed ICCs of .596. These results indicate that the use of the ANAN baseline for comparison can be done even if the baseline is up to 5years old.

Effects of endoscopic sinus surgery on objective and subjective measures of cognitive dysfunction in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a common condition that has been associated with cognitive dysfunction. The purpose of this study was to evaluate the effect of endoscopic sinus surgery (ESS) on the subjective and objective measures of cognitive dysfunction and related quality-of-life measures in CRS. Thirty-five adults with CRS refractory to medical therapy were prospectively enrolled. Preoperatively and postoperatively (≥4 months), subjects completed objective neurocognitive evaluation with the Automated Neuropsychological Assessment Metrics (ANAM) platform and multiple questionnaires, including the Cognitive Failures Questionnaire (CFQ), a modified World Health Organization Health and Work Performance Questionnaire (ctHPQ), 22-item Sino-Nasal Outcomes Test (SNOT-22), Sinus Control Test (SCT), Questionnaire of Olfactory Disorders (QOD), Beck Depression Inventory-second edition (BDI-II), Pittsburgh Sleep Quality Index (PSQI), and Fatigue Severity Scale (FSS). Thirty-three of 35 patients satisfactorily completed the study. Postsurgical improvement in the CFQ was 46.7 ± 18.4 to 31.9 ± 17.8 (p < 0.001). Neurocognitive testing revealed significant improvements in mathematical processing (p = 0.003) and matching to sample (p = 0.023), as well as a significant decline in simple reaction time (p = 0.026). In addition, improvements were noted for SNOT-22 (54.8 ± 21.4 to 24.8 ± 21.1, p < 0.001), SCT (9.3 ± 2.6 to 3.9 ± 3.8, p < 0.001), PSQI (10.7 ± 4.5 to 6.9 ± 4.0, p < 0.001), BDI-II (14.0 ± 9.9 to 8.9 ± 9.0, p < 0.001), QOD (17.6 ± 13.4 to 9.9 ± 12.3, p = 0.001), and FSS (4.6 ± 1.4 to 3.1 ± 1.5, p < 0.001). There was significant improvement in overall presenteeism (7.3 ± 1.4 to 8.4 ± 1.3, p = 0.029). Analysis by polyp status revealed significant improvement in mathematical processing and matching to sample in only CRS patients without polyps. ESS is associated with improvement in subjective and some aspects of objective cognition.

A-72 Cross Validation of the Automated Neuropsychological Assessment Metrics (ANAM) Performance Validity Measure in Active Duty Service Members

Abstract Objective The Automated Neuropsychological Assessment Metrics (ANAM) is the currently mandated Neurocognitive Assessment Tool (NCAT) for the Department of Defense for pre-deployment baseline testing and is the recommended tool for post-concussion evaluation and return to duty decision making. An ANAM performance validity measure has undergone initial validation (Roebuck-Spencer, Vincent, Gilliland, Johnson and Cooper, 2013). However, cross validation in other samples is warranted, particularly in order to establish cut-points for utilization in the evaluation of mTBI/concussion. The current study retrospectively examined the operating characteristics of the ANAM PVI relative to a more established performance validity test (PVT) in a sample of active duty Service Members referred for neurocognitive screening postconcussion in an Army brain injury clinic. Method Retrospective review of 172 US Service Members referred for neurocognitive screen for possible mild traumatic brain injury/concussion on average 3.8 years post injury (range = 8 days to 27 years) and administered the ANAM, Word Memory Test (WMT), and Neuropsychological Assessment Battery Screening Module (NAB-S). Results Utilizing the WMT as the criterion measure, ROC analysis was significant with AUC = 0.894 (p &lt; 0.001). At 90.09% specificity (95% CI = 83.0% - 94.9%), the optimal cut-point was ANAM PVM ≥ 6, and resulted in 67.21% sensitivity (95% CI = 54.0% - 78.7%). Conclusions The standard ANAM PVI clinical report utilizes a cut-point of 14; however, the current data indicate a cut-point of ≥ 6 may be better suited for patients with mTBI/concussion.

Neurocognitive assessment on a tablet device: Test–retest reliability and practice effects of ANAM Mobile

New technology has allowed for the transition of computerized neurocognitive assessments to increasingly user-friendly mobile platforms. While this increased portability facilitates neurocognitive assessment in a wider variety of settings, this transition necessitates further examination of the psychometric properties of tests that have been previously validated on alternate platforms. The present study evaluated the test-retest reliability and practice effects for a new version of the Automated Neuropsychological Assessment Metrics (ANAM), ANAM Mobile, designed to be administered on a tablet computer. A total of 108 undergraduate students completed ANAM Mobile and returned after one week for repeated testing. Observed test–retest reliabilities were consistent with previously established estimates across similar time intervals and ranged from .55 (Simple Response Time) to .87 (Matching to Sample). Modest practice effects were observed. Base rates of reliable decline were low and suggested that declines on two or more tests are uncommon among healthy college students. The present study demonstrates that ANAM Mobile subtests have good-to-excellent reliability across a 7-day retest interval with minimal practice effects. Future research should explore within-subject reliability across repeated ANAM administrations on a tablet device and further examine retest reliabilities over varying time courses and in more diverse samples.

Examining neurocognitive performance and heading in interscholastic female football players over their playing careers

ABSTRACTThe purpose of this study was to examine the effect of purposeful heading in football on measures of cognitive function in a large cohort of female interscholastic football players over the course of their playing career. 217 interscholastic female football players participated in this prospective analysis of football heading over a 4-year timeframe with headers being recorded during sanctioned matches throughout this time. Subjects were categorized into 3 different groups based on their total number of interscholastic career headers: low (< 100), moderate (100−199), and high (200+). Baseline and subsequent post-season neurocognitive performance measures utilizing the Automated Neuropsychological Assessment Metrics (ANAM) software were derived on all players along with a monitoring of concussion-related symptoms. Data were analyzed using a series of two-level growth curves. While there were a few subtle decreases in performance throughout the testing period, no significant differences in test scores occurred during the interscholastic careers of these female football players. While we hypothesized that differences in cognitive performance would degrade over the playing career, especially in the high header group, our results prove otherwise adding to the existing body of evidence recognizing no changes with these variables in other cohorts of football players.

Sensitivity and Specificity of the Ohio State University Traumatic Brain Injury Identification Method to Neuropsychological Impairment

Offenders in justice system settings have high rates of traumatic brain injury (TBI) in comparison with the general population. Consequently, justice systems are using screening tools to identify and manage these individuals. Currently, that includes screening for TBI history and gross cognitive impairment. The present study attempted to determine whether the modified Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) was predictive of ongoing cognitive impairment as measured by the Automated Neuropsychological Assessment Metrics (ANAM) Core Battery. If so, the OSU TBI-ID could be used as a stand-alone measure of TBI history and impairment. This study had 223 participants (male = 160, female = 62). Sensitivity and specificity results revealed poor (.65) to very poor (.36) estimates for all OSU TBI-ID indices across all ANAM subtests. This study suggests that screening for lifetime history of TBI does not identify cognitive impairment. Implications for screening policy and future research are discussed.

What is the prevalence of cognitive impairment in lupus and which instruments are used to measure it? A systematic review and meta-analysis.

To systematically review the literature on the prevalence of Cognitive Dysfunction (CD) in SLE patients in studies that used a specified neuropsychological instrument. This review was prepared with a protocol following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocols statement. Literature search in Ovid Medline, Embase, and Psyc INFO for articles on CD in adult SLE patients was conducted. Included studies were critically appraised (Newcastle-Ottawa Evaluation Scale) and the Pooled Prevalence (PP) of CD was studied for all instruments. The association between demographics and CD, the risk of CD in SLE compared to healthy subjects and patients with RA, and the course of CD over time were studied narratively whenever sufficient information was available. Of 8054 references, 670 were selected for detailed review and 78 were included in the final analysis. Comprehensive Battery (CB) was utilized in 35 studies in 2463 SLE patients and PP was 38% (95%; CI: 33-43%). The CD prevalence was higher in NPSLE [PP 39% (95% CI: 24-55%]. Automated Neuropsychological Assessment Metric (ANAM) was utilized in 7 studies in 438 patients (PP of CD 26% (95% CI: 12-42%). Other less frequently utilized tools were the Modified Mini-Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), Controlled Oral Word Association Test (COWAT) and The Hopkins Verbal Learning Test-Revised (HVLT-R) and subjective tools and others. The relative risk for CD in SLE was greater when compared to RA and to healthy individuals; RR being 1.80 and 2.80, respectively. Information on demographics and its association with CD was very heterogeneous among studies. Patients with lupus have a high prevalence of CD. The delay in diagnosis of CD is complex; although caregivers and patients express concerns about cognitive function, testing for CD often imposes administrative and cost burdens. There is an unmet need to identify the best screening, diagnostic metrics of CD. The assessment of cognitive function over time, and the association of demographics with CD, will require further research.

Application of virtual environments in a multi-disciplinary day neurorehabilitation program to improve executive functioning using the Stroop task.

Virtual reality (VR) technology has demonstrated usefulness in diagnosis, education, and training. Studies supporting use of VR as a therapeutic treatment in medical rehabilitation settings remain limited. This study examines the use of VR in a treatment capacity, and whether it can be effectively integrated into neurorehabilitation. To determine whether immersive VR treatment interventions improve executive dysfunction in patients with brain injury and whether performance is stronger on a VR version of the Stroop than traditional Stroop formats. 15 patients with brain injury admitted to day neurorehabilitation. reaction time, inhibition, and accuracy indices on VR Stroop; Automated Neuropsychological Assessment Metrics (ANAM) Stroop, Delis-Kaplan Executive Function System Stroop, Golden Stroop, and Woodcock-Johnson, 3rd Edition (WJ-III): Pair Cancellation. Participants demonstrated significantly reduced response time on the word-reading condition of VR Stroop and non-significantly reduced response time on the interference condition. Non-significant improvements in accuracy and inhibition were demonstrated on the color-naming condition of VR Stroop. Significantly improved accuracy under time pressure was found for the ANAM, after VR intervention. Implementation of immersive VR interventions during neurorehabilitation is effective in improving specific executive functions and information processing speed in brain-injured patients during the subacute period.

Advancing the sleep/wake schedule impacts the sleep of African-Americans more than European-Americans.

There are differences in sleep duration between Blacks/African-Americans and Whites/European-Americans. Recently, we found differences between these ancestry groups in the circadian system, such as circadian period and the magnitude of phase shifts. Here we document the role of ancestry on sleep and cognitive performance before and after a 9-h advance in the sleep/wake schedule similar to flying east or having a large advance in sleep times due to shiftwork, both of which produce extreme circadian misalignment. Non-Hispanic African and European-Americans (N = 20 and 17 respectively, aged 21–43 years) were scheduled to four baseline days each with 8 h time in bed based on their habitual sleep schedule. This sleep/wake schedule was then advanced 9 h earlier for three days. Sleep was monitored using actigraphy. During the last two baseline/aligned days and the first two advanced/misaligned days, beginning 2 h after waking, cognitive performance was measured every 3 h using the Automated Neuropsychological Assessment Metrics (ANAM) test battery. Mixed model ANOVAs assessed the effects of ancestry (African-American or European-American) and condition (baseline/aligned or advanced/misaligned) on sleep and cognitive performance. There was decreased sleep and impaired performance in both ancestry groups during the advanced/misaligned days compared to the baseline/aligned days. In addition, African-Americans obtained less sleep than European-Americans, especially on the first two days of circadian misalignment. Cognitive performance did not differ between African-Americans and European-Americans during baseline days. During the two advanced/misaligned days, however, African-Americans tended to perform slightly worse compared to European-Americans, particularly at times corresponding to the end of the baseline sleep episodes. Advancing the sleep/wake schedule, creating extreme circadian misalignment, had a greater impact on the sleep of African-Americans than European-Americans. Ancestry differences in sleep appear to be exacerbated when the sleep/wake schedule is advanced, which may have implications for individuals undertaking shiftwork and transmeridian travel.

The test-retest reliability of three computerized neurocognitive tests used in the assessment of sport concussion.

Computerized neurocognitive tests (CNTs) are widely used at all competitive levels of sport to assess sport concussion (SC). Whereas there are multiple CNTs available, little is known about how some of the most popular platforms compare. The purpose of this study was to investigate the test-retest reliability of the Automated Neuropsychological Assessment Metrics (ANAM), Concussion Vital Signs (CVS) and the Immediate Postconcussion and Cognitive Testing battery (ImPACT) using clinically relevant time points in healthy college-age participants. Participants were healthy college-age students (N=128) randomly assigned into one of three groups which were administered ANAM, CVS, or ImPACT at Days 1, 45 and 50. Intraclass correlation coefficients (ICCs) and Pearson correlations were used to assess reliability of the various CNT scores and subtest scores between time points. Participants were tested approximately 47.1±2.75days after time point 1 and approximately 7.0±2.45days after time point 2. ICC values ranged from 0.18 (Procedural Reaction Time) to 0.53 (Mathematical Processing and Simple Reaction Time 1) for ANAM, 0.14 (Continuous Performance Test) to 0.85 (Reaction Time) for CVS, and 0.19 (Verbal Memory) to 0.89 (Visual Motor Speed) for ImPACT. Significant improvements (p<0.05) across time were observed for (7/10) CNS Vital Signs composite scores, but no additional significant changes in performance were observed for the remaining CNTs. Overall, weak to strong reliability coefficients for ANAM, CVS, and ImPACT were observed when using clinically relevant time points of repeated administration.

0239 THE INFLUENCE OF ANCESTRY ON SLEEP AND PERFORMANCE

Racial differences exist in sleep duration and circadian timing, however it is unknown whether these differences extend to cognitive performance. The current study investigated the role of ancestry on sleep and performance before and after a 9h advance of the sleep/wake episode. Twenty African-Americans (9F; 32.1 ± 7.5yr) and 17 European-Americans (8F; 29.7 ± 5.7yr) completed the study. Participants were scheduled to four baseline days each with 8h time in bed based on their habitual sleep schedule such that sleep and circadian rhythms were aligned. The sleep-wake schedule was then advanced 9h earlier (misaligned) for three days. Total sleep time (TST) was assessed with actigraphy. The Automated Neuropsychological Assessment Metrics (ANAM) test battery was administered every 3h each day starting 2h after waking. Tests included a simple reaction time task (SRT) and Stanford sleepiness scale (SSS). Mixed model ANOVAs assessed the effects of ancestry (African-American or European-American) and condition (aligned or misaligned) on sleep and performance. TST was reduced on misaligned days compared to baseline (F=18.67, p<0.001) and African-Americans slept less compared to European-Americans (F=8.58, p<0.01), especially on the first two misaligned days when the difference was 47 and 59 minutes respectively (F=6.67, p<0.01). Compared to baseline, misalignment increased SSS ratings (F=72.69, p<0.001), but did not affect the number of lapses (F=0.02, p=0.90) or median reaction time (RT)(F=0.02, p=0.88) on the SRT. While there was no effect of ancestry on SSS (F=0.22, p=0.64), there was a trend for lapses (F=3.55, p=0.07) and median RT (F=2.80, p=0.10) to be higher for African-Americans. On misaligned days, African-Americans performed worse than European-Americans at times corresponding to the end of baseline sleep (lapses, F=7.16, p<0.05; median RT, F=5.16, p<0.05). Racial disparities in sleep may be more prominent when the sleep episode is shifted, and there may be racial differences in the circadian regulation of performance. Results have implications for the sleep and performance of individuals undertaking shiftwork or transmeridan travel. R01NR007677(CIE).

Validation of ANAM for cognitive screening in a mixed clinical sample

ABSTRACTThe Automated Neuropsychological Assessment Metrics (ANAM) is a library of computer based tests designed to measure cognitive function at a single time-point or longitudinally for detection of cognitive change. This study sought to validate ANAM as a cognitive screening tool for presence of confirmed neuropsychological diagnosis in an outpatient setting. Retrospective data analysis was conducted for 139 patients referred for outpatient neuropsychological assessment. Clinical diagnosis was made independent of ANAM test results and resulted in a diagnostic mix of both neurologic and psychologic etiologies. ANAM scores predictive of presence of confirmed diagnosis were identified using multiple logistic regression and the predictive ability of the resulting model was quantified using receiver operator characteristic analysis. Sensitivity and specificity for the ANAM when combined with anger and depressive symptom scores were 71% and 91%, respectively, with a positive predictive value of 97.5 and negative predictive value of 40.4. This combined approach provided the greatest accuracy for individual tests as well as the composite score of the ANAM in identifying those who received a subsequent clinical diagnosis. Although data should be replicated in larger samples, these results suggest that ANAM may have predictive value and may be a useful screening tool for identifying those who would likely benefit from neuropsychological services.

Structural and Functional Integrity of the Intraparietal Sulcus in Moderate and Severe Traumatic Brain Injury.

Severe and moderate traumatic brain injury (sTBI) often results in long-term cognitive deficits such as reduced processing speed and attention. The intraparietal sulcus (IPS) is a neocortical structure that plays a crucial role in the deeply interrelated processes of multi-sensory processing and top down attention. Therefore, we hypothesized that disruptions in the functional and structural connections of the IPS may play a role in the development of such deficits. To examine these connections, we used resting state magnetic resonance imaging (rsfMRI and diffusion kurtosis imaging (DKI) in a cohort of 27 patients with sTBI (29.3 ± 8.9 years) and 27 control participants (29.8 ± 10.3 years). Participants were prospectively recruited and received rsfMRI and neuropsychological assessments including the Automated Neuropsychological Assessment Metrics (ANAM) at greater than 6 months post-injury. A subset of participants received a DKI scan. Results suggest that patients with sTBI performed worse than control participants on multiple subtests of the ANAM suggesting reduced cognitive performance. Reduced resting state functional connectivity between the IPS and cortical regions associated with multi-sensory processing and the dorsal attention network was observed in the patients with sTBI. The patients also showed reduced structural integrity of the superior longitudinal fasciculus (SLF), a key white matter tract connecting the IPS to anterior frontal areas, as measured by reduced mean kurtosis (MK) and fractional anisotropy (FA) and increased mean diffusivity (MD). Further, this reduced structural integrity of the SLF was associated with a reduction in overall cognitive performance. These findings suggest that disruptions in the structural and functional connectivity of the IPS may contribute to chronic cognitive deficits experienced by these patients.

Neurocognitive Function and Suicide in U.S. Army Soldiers.

This prospective cohort study used administrative data from the Army Study to Assess Risk and Resilience in Servicemembers to examine associations between neurocognitive functioning and subsequent suicidal events among Regular Army enlisted soldiers during the years 2004-2009. Cases were all soldiers who completed the Army's Automated Neuropsychological Assessment Metrics (ANAM) computerized testing battery prior to documented suicide attempt (n=607), ideation (n=955), or death (n=57). Controls were an equal-probability sample of 9,893 person-months from other soldiers. Exploratory factor analysis of five ANAM tests identified a general neurocognitive factor that excluded the mathematic processing test (MTH). When examined separately in logistic regression analyses that controlled for sociodemographics and prior mental health diagnosis, both the general neurocognitive factor (logit [β]=-.197 to -.521; p<.01) and MTH (β=-.024 to -.064; p<.05) were associated with all outcomes. When both predictors were examined simultaneously, the general neurocognitive factor continued to be associated with all outcomes (β=-.164 to -.417; p<.05) and MTH continued to be associated with suicide attempt (β=-.015; p=.046) and ideation (β=-.014; p=.018). These small but robust associations suggest that future research must continue to examine the extent to which objective neurocognitive tests may enhance understanding and prediction of suicide risk.

Mild traumatic brain injury and suicide risk among a clinical sample of deployed military personnel: Evidence for a serial mediation model of anger and depression

Research has demonstrated a robust link between traumatic brain injuries (TBIs) and suicide risk. Yet, few studies have investigated factors that account for this link. Utilizing a clinical sample of deployed military personnel, this study aimed to examine a serial meditation model of anger and depression in the association of mild TBI and suicide risk. A total of 149 military service members referred for evaluation/treatment of a suspected head injury at a military hospital participated in the present study (92.6% male; Mage = 27.9y). Self-report measures included the Suicidal Behaviors Questionnaire—Revised (SBQ-R), Automated Neuropsychological Assessment Metrics (ANAM) anger and depression subscales, and Behavioral Health Measure-20 depression subscale. A current mild TBI diagnosis was confirmed by a licensed clinical psychologist/physician. Overall, 84.6% (126/149) of participants met diagnostic criteria for a current mild TBI. Bootstrapped serial mediation analyses indicated that the association of mild TBI and suicide risk is serially mediated by anger and depression symptoms (bias-corrected 95% confidence interval [CI] for the indirect effect = 0.044, 0.576). An alternate serial mediation model in which depression symptoms precede anger was not statistically significant (bias-corrected 95% CI for the indirect effect = −0.405, 0.050). Among a clinical sample of military personnel, increased anger and depression statistically mediated the association of mild TBI and suicide risk, and anger appears to precede depression in this pathway. Findings suggest that therapeutically targeting anger may serve to thwart the trajectory to suicide risk among military personnel who experience a mild TBI. Future research should investigate this conjecture within a prospective design to establish temporality.

Combat Effectiveness and Sleep Patterns in US Marines

The Habitability Assessment Test (HAT) was designed to evaluate whether Marines exposed to waterborne motion in an amphibious vehicle experience reductions in combat effectiveness. A total of 61 active duty Unites States Marines participated in a within-subjects, repeated measures, quasi-experimental design with counterbalancing to control for order of exposure to waterborne motion of one, two, or three hours. Dependent variables included wrist-worn actigraphy, Stanford Sleepiness Scale scores, marksmanship scores, obstacle course performance, and the switching task from the Automated Neuropsychological Assessment Metric (ANAM) battery. Results showed no statistically significant associations between sleep metrics and the mean radius of impact in the marksmanship test. In contrast, short sleep duration and elevated sleepiness were associated with worse (higher) completion times in the obstacle course. Elevated sleepiness was also associated with lower cognitive throughput, i.e., the number of correct responses per minute, as measured by the ANAM Switching Task. Increased sleep duration was associated with increased throughput, however the trend was not statistically significant. These results suggest that sleep-deprived Marines experienced poorer executive decision making as measured using the ANAM. In addition to showing decrements in combat effectiveness that are associated with their sleep patterns, the current study may provide an early indication of circadian scarring in these young Marines.

Reliable Change Estimates for Assessing Recovery From Concussion Using the ANAM4 TBI-MIL.

To establish the reliable change parameters for the Automated Neuropsychological Assessment Metrics (ANAM) using a healthy normative sample of active duty service members (SMs) and apply the parameters to sample of recently deployed SMs. Postdeployment neurocognitive performance was compared in 1893 US Marines with high rates of combat exposure during deployment. Of the sample, 289 SMs had data for 2 predeployment assessments and were used as a normative subsample and 502 SMs had data for predeployment and postdeployment assessments and were used as a deployed subsample. On the basis of self-report, the deployed subsample were further classified as concussed (n = 238) or as nonconcussed controls (n = 264). Reliable change parameters were estimated from the normative sample and applied data for both deployed groups. Postdeployment performance was quantified using a general linear model (2 group × 2 time) multivariate analysis of variance with repeated measures. Both deployed groups demonstrated a pattern of meaningful decreases in performance over time. Information from this effort, specifically the reliable change parameters and the base rates of reliable decline, can be used to assist with the identification of postdeployment cognitive issues.