Backward Digit Research Articles

Impact of Hearing Impairment on Missingness of Cognitive Test Scores in the ARIC Study

Despite its high prevalence, the impact of hearing impairment on completion of cognitive tests, many of which rely on auditory input to access test material, has not been described. We investigated if hearing impairment is associated with missing scores in 3602 adults (72-94 years, 23% black, 60% female). Cognition was measured using 10 neurocognitive tests. Pure tone better-ear hearing thresholds (0.5-4 kHz) were averaged and categorized. ≥Moderate hearing impairment (versus none) was associated with greater missingness on two auditory tests: Logical Memory (prevalence ratio [PR]:1.40, 95% confidence interval [CI]:1.01,1.70) and Digits Backwards (PR:1.35, 95% CI:1.00,1.82); and the non-auditory Trail Making Test Part B (PR:1.48, 95% CI:1.24,1.77). Compared to models using complete cognitive data, models that imputed missing scores showed stronger associations of hearing impairment with poor cognitive performance. Older adults with HI are less likely to complete cognitive testing, resulting in biased estimates of the hearing impairment-cognitive performance relationship.

Validation of Padjadjaran Memory Rehearsal Application (PMRA) as A Tool for Measuring Working Memory Using Digit Span and Knox Cube

This study intends to test the validity of PMRA based on relationships with other variables and internal structures. This non-experimental quantitative approach in 61 children aged 5-8 discusses the correlation between PMRA with digit span and knox cube. Pearson product moment indicates that PMRA has a positive significant correlation with digit span and knox cube; i.e. PMRA verbal deret maju with digit forward (r=.557, p=<.001), PMRA verbal deret mundur with digit backward (r=.311, p=.015), and PMRA visual-spatial with knox cube (r=.393, p=.002). The analysis signifies that the working memory ability of children 7-8 (n=31) higher than aged 5-6 (n=30) in three parts of PMRA. Based on the two statistical data processing, PMRA is stated to be a valid working memory function measuring tool of children aged 5-8.

Working memory and mild cognitive impairment: Digital intra‐response latency, subcortical nuclei, and neuropsychological test performance

AbstractBackgroundDigital technology offers the ability to obtain nuanced data previously unobtainable. A digital Backward Digit Span (BDT) using voice recognition was administered to memory clinic patients. Our goal was to assess the validity of this technology by (1) analyzing differences between non‐MCI versus MCI patients; (2) examining correlations with other neuropsychology tests; and, (3) analyzing test performance in relation to MRI subcortical regions of interest known to be related to working memory.MethodJak‐Bondi (2009) criteria classify patients into MCI (n= 67) and non‐MCI (n= 72) groups. Working memory (WM) was assessed with the Backward Digit Span Test (BDT) consisting of 7 trials of 5 digits backwards; all trials were administered; and comprehensive neuropsychological testing was obtained. Only correct test trials were analyzed. BDT variables of interest included latency for each five responses. NeuroquantTM software calculated thalamic, caudate and hippocampal volume (n= 23) controlled for intracranial volume (ICV).ResultBetween‐group difference for total time to completion was not significant (M= 55.64 + 18.91 sec.). An analysis of serial order position latencies clearly suggests two distinct epochs (Figure 1). A latency ratio (LR) for serial order 1 versus serial order 3 was calculated. Using this measure, non‐MCI patients presented with slower latency to initiate their response (serial order 1); but faster latency to sustain their response (serial order 3) compared that MCI patients (F[1,52]= 6.26, p&lt; .016). Simple correlations were significant between the BDT‐LR and Judgement of Line Orientation Oblique test items (r= 0.325, p&lt; .019) and WAIS‐III Digit Symbol test performance (r= 0.316, p&lt; .017). Simple correlations were significant or near significant between the BDT‐LR and left thalamic volume (r= 0.468, p&lt; 0.032); right thalamic volume (0.410, p&lt; .065); total thalamic volume (r= 0.470, p&lt; 0.032); and left caudate volume (r= 0.447, p&lt; .042).ConclusionThese data are remarkable for how patients allocate their time to generate a correct response. Correlations between BDT‐LR, subcortical nuclei, and neuropsychological test performance provide evidence for the validity of using discrete latency measures to assess WM in patients with MCI. Intra‐response BDT latency ratios could be a meaningful neurocognitive biomarker for emergent illness.

Automatic Assessment of Cognitive Tests for Differentiating Mild Cognitive Impairment: A Proof of Concept Study of the Digit Span Task.

Current conventional cognitive assessments are limited in their efficiency and sensitivity, often relying on a single score such as the total correct items. Typically, multiple features of response go uncaptured. We aim to explore a new set of automatically derived features from the Digit Span (DS) task that address some of the drawbacks in the conventional scoring and are also useful for distinguishing subjects with Mild Cognitive Impairment (MCI) from those with intact cognition. Audio-recordings of the DS tests administered to 85 subjects (22 MCI and 63 healthy controls, mean age 90.2 years) were transcribed using an Automatic Speech Recognition (ASR) system. Next, five correctness measures were generated from Levenshtein distance analysis of responses: number correct, incorrect, deleted, inserted, and substituted words compared to the test item. These per-item features were aggregated across all test items for both Forward Digit Span (FDS) and Backward Digit Span (BDS) tasks using summary statistical functions, constructing a global feature vector representing the detailed assessment of each subject's response. A support vector machine classifier distinguished MCI from cognitively intact participants. Conventional DS scores did not differentiate MCI participants from controls. The automated multi-feature DS-derived metric achieved 73% on AUC-ROC of the SVM classifier, independent of additional clinical features (77% when combined with demographic features of subjects); well above chance, 50%. Our analysis verifies the effectiveness of introduced measures, solely derived from the DS task, in the context of differentiating subjects with MCI from those with intact cognition.

348 - Increased White Matter Hyperintensity and Brain Resting-state fMRI Topology Changes in Suicide Attempters of Late-life Depression

Supported by (1) medical research grants CMRPG3C0041/42 from Chang Gung Memorial Hospital and NRRPG2H0031 from Ministry of Science and Technology, Taiwan to Chemin Lin (2) NMRPG3G6031/32 from Ministry of Science and Technology, Taiwan to Shwu-Hua, Lee (3) the KKHo International Charitable Foundation to Tatia Lee.Introduction:Suicide rate tends to peak in old age, and major depression is the most salient risk factor for late-life suicide. However, few studies have focused on the neuroscientific facet of suicide in the context of late-life depression (LLD).Methods:We recruited 114 participants of LLD (28 with history of suicide attempt and 86 without) and 47 elderly controls. They received MRI scanning and behavioral assessment. White matter hyperintensity (WMH) was quantified by an automated segmentation algorithm and graph theoretical analysis was applied to resting-state fMRI. We used ANCOVA to compare group difference in WMH loading and multivariate generalized linear model to compare global and local topological parameters in fMRI signals, controlling for demographics. Partial correlation was conducted between imaging parameters and behavioral data in group of suicide attempters.Results:We found significant higher WMH in suicide attempters than those of LLD without suicide attempts and elderly controls (F =7.091; p = 0.001). Suicide attempters also had increased betweenness centrality (BC) in right superior occipital gyrus (SOG) (Bonferroni corrected), right precuneus (False positive corrected) and right superior temporal gyrus (uncorrected) and decreased BC in left hippocampus (uncorrected). In suicide attempters, higher BC in right SOG correlated with higher WMH, higher depression severity, higher illness awareness and insight, and lower cognitive function (digit backward), while higher BC in right precuneus correlated with higher decrease awareness and insight and higher cognitive function (digit backward).Conclusion:Resonating with the vascular hypothesis in LLD, higher WMH was found in those having history of suicide attempts. However, the re-organized brain topology changes are related with divergent cognitive function and convergent heightened disease insight.

Effectiveness of a Serious Game for Cognitive Training in Chronic Stroke Survivors with Mild-to-Moderate Cognitive Impairment: A Pilot Randomized Controlled Trial

Previous cognitive training games for stroke survivors required the close supervision of therapists. We aim to demonstrate the preliminary therapeutic effectiveness of Neuro-World, serious mobile games for cognitive training, in chronic stroke survivors with mild-to-moderate cognitive impairment without therapist supervision. For that, we conducted a randomized, controlled clinical trial at a single long-term care rehabilitation center with 50 stroke survivors in the chronic stage with mild-to-moderate cognitive impairment. Participants were randomized to standard medical care (n = 25) or standard medical care plus administration of Neuro-World (n = 25) over 12 weeks. A two-way mixed model ANOVA and Tukey’s post hoc tests identified significant differences in outcomes between the experimental and the control groups at post-intervention but not at baseline. Within the experimental group, there were statistically significant improvements in all the outcomes except for the language category of the Mini-Mental State Examination and Digit Forward Span. The improvements were clinically significant for the total Mini-Mental State Examination, Digit Forward Span, and Digit Backward Span. Within the control group, there were no improvements in any of the outcomes. The practice of Neuro-World led to significant improvements in cognitive function and marginal mitigation of depressive symptoms in chronic stroke survivors with mild-to-moderate cognitive impairment.

A-112 Validity of In-Person Assessment of Traumatic Brain Injury Inpatients Using the Brief Test of Adult Cognition by Telephone

Abstract Objective Examine the correlation of the Brief Test of Adult Cognition by Telephone (BTACT) with established neuropsychological tests in an inpatient traumatic brain injury (TBI) population. Method Participants were 55 patients aged 18–76 years (M age = 37 years; 69% male) receiving inpatient rehabilitation for new-onset TBI at a level I trauma center, acute inpatient rehabilitation hospital. The BTACT is a brief cognitive test battery consisting of the following subtests: Word List Immediate and Delayed Recall (episodic verbal memory), Digits Backward (working memory), Number Series (inductive reasoning), Animal Fluency (verbal fluency), and Backward Counting (processing speed). With the intention of mirroring cognitive functions measured by the BTACT, the neuropsychological battery was comprised of the California Verbal Learning Test-2 (CVLT-2), Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span, Trail Making Test (TMT), semantic fluency, phonemic fluency, Symbol Digit Modalities Test, and Wisconsin Card Sorting Test. Results The BTACT was related to established neuropsychological tests across composite scores of overall cognition (r = .64, p &amp;lt; .001), episodic verbal memory (r = .66, p &amp;lt; .001), and executive function (r = .56, p &amp;lt; .001). For BTACT subtests, Word List Immediate Recall and Word List Delayed Recall were correlated with CVLT-2 learning trials total (r = .57, p &amp;lt; .01) and long delay free recall (r = .60, p &amp;lt; .001), respectively. BTACT Digits Backward correlated with WAIS-IV Digit Span (r = .51, p &amp;lt; .01). BTACT Animal Fluency was related to semantic fluency (r = .65, p &amp;lt; .01), phonemic fluency (r = .60, p &amp;lt; .01), and TMT-B (r = .39, p &amp;lt; .01). Conclusion BTACT composite scores of overall cognition, verbal memory, and executive function are valid measures in a TBI inpatient population.

A-064 Executive Functioning in an Acute Pediatric Neurocritical Care Population Recently Discharged from the PICU: Exploring the Associations among Parent Report and Individual Performance Measures

Abstract Objective An emerging literature has identified that PICU survivors face a host of long-term physical, cognitive, emotional, and psychosocial difficulties that stem from the underlying concern and side effects of critical care intervention. Research shows that executive functioning (EF) is particularly vulnerable to sequelae. This study sought to understand associations between parent-report of daily life EF and performance-based measures following neurocritical care. Method Twenty-three children ages 8–16 (M = 12.66 years; 39% male) were screened as part of an integrated (neuropsychology and pediatric critical care) acute phase (3–6-week post-discharge) follow-up clinic. Injuries included children with traumatic brain injury (n = 19), or acquired brain injury (i.e., anoxic brain injury, AVM, acute cerebellitis, hemorrhagic stroke; n = 4). EF outcomes were assessed using the Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2), Delis-Kaplan Executive Function System (D-KEFS) Trail Making Test and Verbal Fluency Test, Children’s Memory Scale Digits Backwards, and Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) Coding and Symbol Search subtests. Bivariate correlations were used to examine associations among parent-report of EF and performance-based measures of EF in our neurocritical care population. Results Analyses demonstrated significant (□ = .05) correlations between the WISC-V Coding subtest and the BRIEF-2 Shift scale (r = −.44) and Global Executive Composite (GEC; r = −.59). Correlations between D-KEFS Category Fluency and BRIEF-2 Initiate (r = −.51), Working Memory (r = −.44), and GEC (r = −.55) were significant. Inverse correlations demonstrate agreement. Conclusion In the acute recovery phase following neurocritical care, parent-report and specific performance-based measures are only moderately associated, demonstrating the importance of multi-method assessment to detect potential acquired deficits to inform rehabilitation.

Cortical Tracking of Speech in Delta Band Relates to Individual Differences in Speech in Noise Comprehension in Older Adults.

Understanding speech in adverse listening environments is challenging for older adults. Individual differences in pure tone averages and working memory are known to be critical indicators of speech in noise comprehension. Recent studies have suggested that tracking of the speech envelope in cortical oscillations <8 Hz may be an important mechanism related to speech comprehension by segmenting speech into words and phrases (delta, 1 to 4 Hz) or phonemes and syllables (theta, 4 to 8 Hz). The purpose of this study was to investigate the extent to which individual differences in pure tone averages, working memory, and cortical tracking of the speech envelope relate to speech in noise comprehension in older adults. Cortical tracking of continuous speech was assessed using electroencephalography in older adults (60 to 80 years). Participants listened to speech in quiet and in the presence of noise (time-reversed speech) and answered comprehension questions. Participants completed Forward Digit Span and Backward Digit Span as measures of working memory, and pure tone averages were collected. An index of reduction in noise (RIN) was calculated by normalizing the difference between raw cortical tracking in quiet and in noise. Comprehension question performance was greater for speech in quiet than for speech in noise. The relationship between RIN and speech in noise comprehension was assessed while controlling for the effects of individual differences in pure tone averages and working memory. Delta band RIN correlated with speech in noise comprehension, while theta band RIN did not. Cortical tracking by delta oscillations is robust to the effects of noise. These findings demonstrate that the magnitude of delta band RIN relates to individual differences in speech in noise comprehension in older adults. Delta band RIN may serve as a neural metric of speech in noise comprehension beyond the effects of pure tone averages and working memory.

Effect of a concussion on subsequent baseline SCAT performance in professional rugby players: a retrospective cohort study in global elite Rugby Union

ObjectivesThis study assessed whether concussion affects subsequent baseline performance in professional rugby players. Annual baseline screening tests are used to guide return-to-play decisions and concussion diagnosis during subsequent screens. It...

The effect of nocturnal epileptic seizures on cognitive functions in children with idiopathic epilepsy

BackgroundCognitive impairment is a common finding epileptic children. Studies have linked nocturnal epileptic discharges to delayed cognitive abilities in children.ObjectiveThe study aims to evaluate the effect of nocturnal epileptic seizures on cognitive functions in children with idiopathic epilepsy.Patients and methodsThe study was conducted on 70 children with idiopathic generalized or benign focal epilepsy. Based on seizures semiology, they were classified into cases either with nocturnal epileptic seizures (NES) (n = 40) or with diurnal epileptic seizures (DES) (n = 30). Patients receiving antiepileptic drugs (AEDs) that affect cognitive function, patients with intelligence quotient (IQ) below 70, and those having other neurological or psychiatric disorders' were excluded. All patients were subjected to neurological examination, brain magnetic resonance imaging (MRI), and electroencephalography. Cognition was assessed using Wechsler Intelligence scale for children (WISC) to measure IQ, Wisconsin card sorting test (WCST) (computerized version), Trail Making Test, and Digit spans test.ResultsThere was no significant difference between both groups regarding age, sex, age of epilepsy onset, or seizure frequency. There was a significant difference in almost all cognitive variables including digit forward, digit backward, processing speed, verbal IQ, WCST perseverative responses, WCST failure to maintain set, Trail Making Test A (error), Trail Making Test B (Time), and Trail Making Test B (error). There was no significant difference regarding the associated sleep disturbances between the studied groups.ConclusionChildren with idiopathic epilepsy suffering from predominant nocturnal seizure have overt and subtle cognitive functions impairments compared to children with predominant diurnal seizure.

4～6세 일반아동 및 언어발달지연 아동의 음운인식 및 음운처리 능력이 언어 능력에 미치는 영향*

Phonological awareness is a metalinguistic awareness ability of phonology and is known to predict language skills, such as reading and vocabulary skills. The purpose of this study was to investigate the relationship between phonological awareness, phonological processing, and language skills in 4- to 6-years-old typically developing (TD) children and children with language delay (LD). A total of 32 children (TD=18, LD=15) participated in this study. They performed a phonological awareness task consisting of counting, deletion, and discrimination at syllable level. Nonword Repetition, Digit Backward, Receptive &amp; Expressive Vocabulary Test, and Grammaticality Judgment Task were performed to analyze the correlation between phonological awareness, phonological processing, and language ability. A multiple stepwise regression analysis was performed to examine the phonological awareness subtasks that predict language ability. In the TD group, the syllable categorization task significantly predicted the receptive vocabulary and the performance of the Grammaticality Judgment Task. The LD group showed that the syllable counting task significantly predicted the receptive vocabulary, the expressive vocabulary, and the performance of the Grammaticality Judgment Task. The results showed that the phonological awareness performance was significantly different between the two groups. Further, correlation analysis and regression analysis showed different results for each group. The result of the phonological awareness performance predicted the language ability of each group significantly, suggesting the importance of the meta-linguistic awareness ability of phonology.

Assessment of auditory working memory in children with abacus training.

Abacus involves remembering multiple numbers and calculations, and thus auditory working memory is getting trained. Hence, auditory working memory could be enhanced in children who practice working memory. In the present study, it is attempted to examine the difference in the auditory working memory of the children with abacus training and children without abacus training. The study was carried out to compare the score and reaction time for digit forward test, digit backward, ascending digit span and descending digit span test in individuals with and without abacus training and to correlate the level of abacus training with the scores and reaction time for all the tests in individuals with abacus training. The participants were divided based on those with and without abacus training between the age of 9-13years. The children with the abacus training group were taking intensive abacus training in the range of 2-4years. The results of the study revealed that children with abacus training had significantly better reaction time and scores than children without abacus training with effect size between 0.73 and 0.91 which suggests a strong difference. The results also showed moderate to strong correlation (r = 0.53-0.84) between the abacus levels and scores and reaction time for the auditory working memory tests. The results agree with previous studies, which also report superior auditory performance and enhanced auditory working memory in children with abacus training.

Cognitive impairment profile differences in patients with psychogenic non-epileptic seizures and epilepsy patients with generalized seizures

ABSTRACTObjective: This study aimed to compare cognitive skills in epilepsy patients and psychogenic non-epileptic seizures (PNES) patients who have no history of frequent seizures to those of a healthy control group.Methods: This prospective cross-sectional study was conducted between January 2017 and June 2019 and included 103 epilepsy patients, 100 PNES patients, and 101 healthy controls, aged 18 to 60 years. Patients with fewer than 12 annual seizure episodes and no history of seizures during the last 30 days were added to the study. A sociodemographic data form, the Beck Anxiety and Depression Scales, Montreal Cognitive Assessment, Digit Span test, and Stroop Color-Word Interference Test were used.Results: Compared to the control group, sub-component scores were significantly lower in naming, attention, abstract thinking, and delayed recall for the epilepsy and PNES groups. Sub-component scores in orientation, executive functioning, and delayed recall were significantly lower in the epilepsy group compared to the PNES group. Digits Backward subtest scores and total Digit Span test scores were significantly lower in the epilepsy and PNES groups. Patients in the epilepsy and PNES groups took longer to complete the Stroop test and made more errors and corrections compared to the healthy controls. There was a negative correlation between the duration of the disease and the total Digit Span score in the epilepsy group.Conclusion: These findings suggest that the epilepsy group showed reduced cognitive scores even though they did not suffer from frequent seizures and were not drug-resistant.

Evolution of cognitive impairment after a traumatic brain injury: is there any improvement after controlling the practice effect?

The importance of knowing the pattern of evolution of cognitive deficits in the first months after a traumatic brain injury (TBI) has encouraged the development of numerous longitudinal studies. However, the results of most of them should be taken with caution due to the lack of adequate control of practice effects that can lead to overestimating the genuine recovery of cognitive processes. To describe the cognitive changes between the acute and subacute phases of the TBI controlling the effect of the practice. Twenty-two patients were assessed in two different time points after TBI (immediately and after six months) using the following tests: Trail Making Test (A, B, B/A, B-A), Stroop Test (W, C, CW, interference), Digit Symbol-Coding, Symbol Search, Digits Forward and Backward, Verbal Fluency and Short-term Memory. To control for the practice effects, a transformation of the scores was performed applying the procedure proposed by Calamia et al. RESULTS. Before controlling the practice effects, the scores of all tests improved (p > 0.001). However, afterward, the improvement remained only in the Trail Making Test-B, B/A and B-A, Digit Symbol-Coding, Symbol Search, Stroop CW and Digits Backward. The lack of control of practice effects in longitudinal studies can generate misleading interpretations about the evolution of cognitive deficits. The pattern of recovery after a TBI varies depending on the cognitive process.

Neurocognitive Assessment in Stage 5 Chronic Kidney Disease Patients on Various Treatment Modalities

Background and Aim: The prevalence of Chronic Kidney Disease (CKD) is expected to rise among the various non-communicable diseases in India. CKD is associated with cognitive impairment. It requires one among the various treatments such as renal transplantation, Hemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD). So cognitive deficit is known but the magnitude of improvement on different methods of treatment is not well established. Therefore, the present study is undertaken to determine the cognitive functions using MMSE score and paper and pencil neurocognitive test battery in stage 5 chronic kidney disease patients on various methods of treatment such as HD, CAPD and conservative management and compare it with controls. Methods: 54 medically stable stage 5 CKD patients (18 in each treatment group) and 18 healthy controls were recruited for the study. Mini Mental State Examination (MMSE) and Paper and pencil neurocognitive battery such as Trail making test A (TMT A), Trail Making Test B (TMT B), Letter Cancellation Test (LCT), Forward Digit Span (FDS) and Backward Digit Span (BDS) along with Body Mass Index (BMI) and biochemical parameters such as Urea, Creatinine, Glucose, Hemoglobin were noted from case sheets and eGFR calculated using CKD-EPI. Results: The mean MMSE scores, TMT A, TMT B, LCT, FDS and BDS were prolonged in all three treatment groups but found to be more prolonged in CKD patients on conservative management (p<0.001, p=0.008, p=0.039, p=0.059, p=0.135 and p=0.038) respectively. Conclusion: Cognitive functions are more affected in stage 5 CKD patients on conservative management compared to patients on dialysis.

Reading deficits correlate with cortical and subcortical volume changes in a genetic migration disorder.

Periventricular nodular heterotopia (PNH) is the most common type of epileptogenic neuronal migration disorder, and often presents with epilepsy and reading disability. The functional role of ectopic nodules has been widely studied. However, the associated structural cortical and subcortical volumetric alterations have not been well characterized. Moreover, it is unknown whether a correlation between volumetric changes and behavioral problems exists.40 subjects with bilateral PNH and 40 matched healthy controls were enrolled in this study. The total cerebral, gray matter, white matter, and cerebrospinal fluid (CSF) volumes were compared between the two groups. Furthermore, structural and functional correlations were evaluated between volumetric changes and reading disability.There were no significant differences detected in total cerebral, gray matter or CSF volumes between the two groups, but there was a significant trend of larger gray-matter volume in PNH. Specifically, smaller white matter volumes were found in the PNH patients. Moreover, the volume of white matter was negatively related to time in the digit rapid naming task and a similar but insignificant trend was seen between the volume of gray matter and backward digit span.These findings suggest that reading disability exists in our sample of bilateral PNH. Periventricular nodules would have normally migrated to the overlying cortex. However, the total cerebral, gray matter, and CSF volumes were unaffected. Alterations in neuronal migration may have an impact in the white matter associated reading dysfluency, that is, visually normal.

“Cerebellar lesions after low-grade tumor resection can induce memory impairment in children, similar to that observed in patients with frontal lesions”

ABSTRACTThe aim of the present study was to specify if cerebellar lesions cause memory impairment in children. The study sample consisted of 44 children with low-grade cerebellar astrocytoma, who underwent surgical treatment and 30 healthy controls, matched with regard to age and sex. Memory was tested using the Rey Auditory Verbal Learning Test AVLT, Corsi Block-Tapping Test, Digit Span, Digit Backwards and Information Subtests from the Wechsler Intelligence Scale for Children-Revised WISC-R (PL). Patients with cerebellar lesions demonstrated memory impairments, similar to those typical for patients with frontal lesions, with auditory and visuospatial working memory deficits, a disorganized learning process without mnemonic strategy (executive dysfunctions) and problems with recalling new material from long-term memory storage, while maintaining good recognition of previously learned material, preserved semantic knowledge and short-term auditory-verbal memory (digit span). Obtained results showed that memory deficits would vary according to the side of the cerebellar lesion, with more pronounced impairment of visuospatial memory tasks accompanying the left-sided cerebellar lesions and worse performance of verbal memory task, observed in the group of patients with right-sided cerebellar lesions. Although the presence of hydrocephalus significantly worsens the memory performance of the children studied, patients with cerebellar lesions without hydrocephalus still present significantly lower memory indicators in the profile described, compared to the control group of healthy children. It confirms the hypothesis that cerebellar lesion alone could result in memory dysfunctions in children.

Children with Attention-Deficit/Hyperactivity Disorder Perform Differently on Pediatric Concussion Assessment

Abstract Purpose In the absence of recent concussion, youth with ADHD endorse many concussion-like symptoms, perform worse on cognitive tests, and are more likely to have balance difficulty, thus complicating the interpretation of concussion assessment results. This study compared uninjured middle school students with ADHD to precisely matched controls without ADHD on the Child Sport Concussion Assessment Tool Fifth Edition (Child SCAT5). Methods A cohort of 1,045 middle school athletes (ages 11-14) completed preseason testing. Students with self-reported ADHD were individually matched to students without ADHD based on age, gender, language spoken at home, number of prior concussions, sport, and school they attended. The final sample included 136 students (68 with ADHD and 68 matched controls), 104 (76.5%) boys and 32 (23.5%) girls. They were 12.7 years old on average (SD=0.9). Mann-Whitney U tests were conducted to compare students with and without ADHD on the Child SCAT5. Results Children with ADHD reported more symptoms (M=11.18, SD=5.94) and greater symptom severity (M=18.01, SD=11.66) compared to children without ADHD (total symptoms: M=6.54, SD=5.15; symptom severity: M=8.84, SD=7.79). Children with ADHD (M=2.88, SD=1.04) performed worse than children without ADHD (M=3.21, SD=0.94) on Digits Backwards (Cohen’s d=-.33). Children with ADHD committed more errors on the tandem stance than children without ADHD (median for both groups=1; d=.45) and children with ADHD (median=4) committed twice as many errors than children without ADHD (median=2) on single leg stance (d=.76). Conclusion Children with ADHD endorsed more concussion-like symptoms and performed worse on certain cognitive tasks and balance tests during baseline, preseason Child SCAT5 assessment compared to matched controls without ADHD.

Computerized Cognitive Rehabilitation verses Clinician Directed Therapy in mTBI

Abstract Background Cognitive problems following mTBI are common and typically managed with one-on-one clinician directed treatment (CDT); however, this is time and labor intensive. Computerized cognitive rehabilitation (CCR) programs overcome these limitation but the comparable efficacy is not well understood in mTBI. Method A randomized controlled trial included 13 active duty service members with a history of mTBI and persistent cognitive complaints. Participants received either CCR (N = 6) or CDT (N = 7) during the initial phase of this study. Treatments were one hour, 3 times a week for 4 weeks. Average age was 32.77 (SD = 7.96). Average intelligence estimated by word reading was average (WTAR M = 107.46, SD = 9.32). Specific measures for attention included Symbol Digit Modality Test (SDMT), Paced Auditory Serial Addition Test (PASAT), Conners Continuous Performance Test (CPT-3), as well as Digit Forward (DF), Digit Backward, and Driving from the Neuropsychological Assessment Battery (NAB). Standard scores corrected for age were analyzed. Change scores were computed between pre and post intervention. Results There was a significant difference for SDMT (p = 0.034, d = 1.342) and DF (p = 0.0015, d = 2.33), where those who received CDT showed greater improvement. The groups did not differ on Driving, PASAT, CPT-3, and DB (p’s &gt; 0.62). Conclusions Preliminary analysis of data suggests that clinician directed treatment was superior to a computerized intervention matched for time and intensity in treating patients with persistent cognitive complaints following mTBI. Large effects were observed on measures of processing speed and focused attention. This may suggest computerized treatment alone is less effective though further data is needed.