Brief Test Of Adult Cognition By Telephone Research Articles

Cognitive Performance is Associated With 1-Year Participation and Life Satisfaction Outcomes: A Traumatic Brain Injury Model Systems Study.

To determine, in persons with traumatic brain injury (TBI), the association between cognitive change after inpatient rehabilitation discharge and 1-year participation and life satisfaction outcomes. Secondary analysis of prospectively collected TBI Model Systems (TBIMS) data. Inpatient rehabilitation and community. 499 individuals with TBI requiring inpatient rehabilitation who completed the Brief Test of Adult Cognition by Telephone (BTACT) at inpatient rehabilitation discharge (ie, baseline) and 1-year postinjury. Participation Assessment with Recombined Tools-Objective (PART-O) and Satisfaction with Life Scale (SWLS). Of 2,840 TBIMS participants with baseline BTACT, 499met inclusion criteria (mean [standard deviation] age=45 [19] years; 72% male). Change in BTACT executive function (EF) was not associated with 1-year participation (PART-O; β=0.087, 95% CI [-0.004, 0.178], P =.061) when it was the sole model predictor. Change in BTACT episodic memory (EM) was associated with 1-year participation (β=0.096, [0.007, 0.184], P =.035), but not after adjusting for demographic, clinical, and functional status covariates (β=0.067, 95% CI [-0.010, 0.145], P =.089). Change in BTACT EF was not associated with life satisfaction total scores (SWLS) when it was the sole model predictor (β=0.091, 95% CI [-0.001, 0.182], P =.0503). Change in BTACT EM was associated with 1-year life satisfaction before (β=0.114, 95% CI [0.025, 0.202], P =.012) and after adjusting for covariates (β=0.103, [0.014, 0.191], P =.023). In secondary analyses, change in BTACT EF was associated with PART-O Social Relations and Out and About subdomains before (Social Relations: β=0.127, 95% CI [0.036, 0.217], P =.006; Out and About: β=0.141, 95% CI [0.051, 0.232], P =.002) and after (Social Relations: β=0.168, 95% CI [0.072, 0.265], P <.002; Out and About: β=0.156, 95% CI [0.061, 0.252], P <.002) adjusting for functional status and further adjusting for covariates (Social Relations: β=0.127, 95% CI [0.040, 0.214], P =.004; Out and About: β=0.136, 95% CI [0.043, 0.229], P =.004). However, only the models adjusting for functional status remained significant after multiple comparison correction (ie, Bonferroni-adjusted alpha level=0.002). EF gains during the first year after TBI were related to 1-year social and community participation. Gains in EM were associated with 1-year life satisfaction. These results highlight the potential benefit of cognitive rehabilitation after inpatient rehabilitation discharge and the need for interventions targeting specific cognitive functions that may contribute to participation and life satisfaction after TBI.

Longitudinal associations of effort and reward at work with changes in cognitive function: evidence from a national study of U.S. workers.

This study aimed to examine longitudinal associations of workplace effort and reward with changes in cognitive function among United States workers. Data from the national, population-based Midlife in the United States (MIDUS) study with a 9-year follow-up were used. Validated workplace effort and reward scales were measured at baseline, and cognitive outcomes (including composite cognition, episodic memory, and executive functioning) were measured with the Brief Test of Adult Cognition by Telephone (BTACT) at baseline and follow-up. Multivariable linear regression analyses based on generalized estimating equations (GEE) examined the longitudinal associations under study. Among this worker sample of 1,399, after accounting for demographics, socioeconomics, lifestyle behaviors, health conditions, and job control, high reward at baseline was associated with increased composite cognition (regression coefficient: 0.118 [95% CI: 0.049, 0.187]), episodic memory (0.106 [0.024, 0.188]), and executive functioning (0.123 [0.055, 0.191]) during follow-up. The joint exposure of 'high effort and high reward' was also associated with increased composite cognition (0.130 [0.030, 0.231]), episodic memory (0.131 [0.012, 0.250]), and executive functioning (0.117 [0.017, 0.216]), while the combination of 'low effort and high reward' was associated with increased composite cognition (0.106 [0.009, 0.204]) and executive functioning (0.139 [0.042, 0.235]). Findings suggest that workplace high reward is related to improved cognitive scores among United States workers. Future research should investigate larger cohorts over longer timespans and expand into disease outcomes such as dementia. If these findings emerge as causal, relevant workplace rewards to promote worker cognitive health should be considered.

Detecting and Predicting Cognitive Decline in Individuals with Traumatic Brain Injury: A Longitudinal Telephone-Based Study.

Traumatic brain injuries (TBIs) can lead to long-lasting cognitive impairments, and some survivors experience cognitive decline post-recovery. Early detection of decline is important for care planning, and understanding risk factors for decline can elucidate targets for prevention. While neuropsychological testing is the gold standard approach to characterizing cognitive function, there is a need for brief, scalable tools that are capable of detecting clinically significant changes in post-TBI cognition. This study examines whether a clinically significant change can be detected using the Brief Test of Adult Cognition by Telephone (BTACT) in a sample of individuals with chronic TBI and investigates whether potentially modifiable factors are associated with cognitive decline. Ninety participants aged 40 or older with complicated mild-to-severe TBI participated in two telephone-based study visits ∼1 year apart. Demographic, head trauma exposure, comorbid medical conditions, physical, and psychosocial functioning data were collected via self-report. The BTACT, a brief measure of global cognitive function, was used to assess cognitive performance across six domains. A reliable change index for quantifying clinically significant changes in BTACT performance was calculated. Results revealed cognitive decline in 10-27% of participants across various cognitive domains. More specifically, only depressive symptoms, including depressed affect and anhedonia, were significantly associated with cognitive decline after correcting for multiple comparisons using false discovery rate (FDR). Other factors such as the number of blows to the head, male gender, dyspnea, increased anxiety symptoms, seizures, illicit drug use, and fewer cardiovascular comorbidities should be considered hypothesis generating. Importantly, age was not a significant predictor of cognitive decline, which challenges the assumption that cognitive decline is solely related to the natural aging process. It suggests that there are unique factors associated with TBI that impact cognitive function, and these factors can affect individuals across the lifespan. The BTACT is a brief and sensitive tool for identifying clinically meaningful changes in cognitive function over a relatively brief period (i.e., 1 year) in a sample of individuals in the chronic stages of TBI (i.e., x̄ = 6.7 years post-TBI). Thus, the BTACT may be useful in surveillance efforts aimed at understanding and detecting decline, particularly in situations where in-person cognitive screening is impractical or unfeasible. We also identified potentially modifiable targets for the prevention of post-TBI cognitive decline. These findings can offer insights into treatment goals and preventive strategies for individuals at risk for cognitive decline, as well as help to facilitate early identification efforts.

A pilot longitudinal study of decrease in cognitive functions during the most painful day of the period among women with primary dysmenorrhea.

Painful menstruation is a common problem associated with many limitations in day-to-day functioning. There is limited research on the temporary effects of menstrual pain on cognitive functioning. A longitudinal pilot study was conducted. A group of 32 women was tested with the Brief Test of Adult Cognition by Telephone (BTACT), which consists of 7 tests measuring various cognitive functions. Participants were tested both on a regular, pain-free day and the most painful day of their period. The subjects displayed significantly lower results in several domains of cognitive functions during measurement on the most painful day of the period. We observed a decline in inhibitory and cognitive control, attention functioning and processing speed. The results provide tentative evidence for experiencing cognitive difficulties under the influence of menstrual pain and may contribute to raising awareness about related difficulties.

Longitudinal changes in sodium concentration and in clinical outcome in mild traumatic brain injury.

Ionic imbalances and sodium channel dysfunction, well-known sequelae of traumatic brain injury (TBI), promote functional impairment in affected subjects. Therefore, non-invasive measurement of sodium concentrations using 23Na MRI has the potential to detect clinically relevant injury and predict persistent symptoms. Recently, we reported diffusely lower apparent total sodium concentrations (aTSC) in mild TBI patients compared to controls, as well as correlations between lower aTSC and worse clinical outcomes. The main goal of this study was to determine whether these aTSC findings, and their changes over time, predict outcomes at 3- and 12-month from injury. Twenty-seven patients previously studied with 23Na MRI and outcome measures at 22 ± 10 days (average ± standard deviation) after injury (visit-1, v1) were contacted at 3- (visit-2, v2) and 12-month after injury (visit-3, v3) to complete the Rivermead post-concussion symptoms questionnaire (RPQ), the extended Glasgow outcome scale (GOSE), and the brief test of adult cognition by telephone (BTACT). Follow-up 1H and 23Na MRI were additionally scheduled at v2. Linear regression was used to calculate aTSC in global grey and white matters. Six hypotheses were tested in relation to the serial changes in outcome measures and in aTSC, and in relation to the cross-sectional and serial relationships between aTSC and outcome. Twenty patients contributed data at v2 and fifteen at v3. Total RPQ and composite BTACT z-scores differed significantly for v2 and v3 in comparison to v1 (each P < 0.01), reflecting longitudinally reduced symptomatology and improved performance on cognitive testing. No associations between aTSC and outcome were observed at v2. Previously lower grey and white matter aTSC normalized at v2 in comparison to controls, in line with a statistically detectable longitudinal increase in grey matter aTSC between v1 and v2 (P = 0.0004). aTSC values at v1 predicted a subset of future BTACT subtest scores, but not future RPQ scores nor GOSE-defined recovery status. Similarly, aTSC rates of change correlated with BTACT rates of change, but not with those of RPQ. Tissue aTSC, previously shown to be diffusely decreased compared to controls at v1, was no longer reduced by v2, suggesting normalization of the sodium ionic equilibrium. These changes were accompanied by marked improvement in outcome. The results support the notion that early aTSC from 23Na MRI predicts future BTACT, but not RPQ scores, nor future GOSE status.

Dynamics of Changes in the Level of Cognitive Functioning Among Patients After SARS-CoV-2 Infection ‒ A Proposal for Remote Neuropsychological Assessment in a Longitudinal Study

Study purpose: The aim of this longitudinal study was to assess the cognitive functioning of people who had COVID-19, to determine the dynamics of changes observed in this area over a period of 3‒4 months, to compare the patients' results with those of a control group, and to verify the usefulness of a new method of remote neuropsychological assessment. Method: A longitudinal study was conducted using the Brief Test of Adult Cognition by Telephone (BTACT) neuropsychological assessment tool, which was translated into Polish for the purpose of the study. The study included subjects following SARS-CoV-2 infection (COVID(+) group) and control subjects (COVID(‒) group). Cognitive functions in both groups were assessed twice, 3‒4 months apart. The study was conducted from July 2020 to January 2022. Results: Data comparisons were performed using mixed ANOVA with repeated measures. Compared to the COVID(‒) group, the COVID(+) group scored significantly lower on the first and second measurements of the Backward Digit Span Test and on the first measurement of the Number Series Test. Additionally, an improvement was observed in COVID(+) group scores in the second measurement compared to the first measurement in: Rey Auditory-Verbal Learning Test (RAVLT) in both the immediate and delayed recall condition; the Backward Digit Span Test, the Number Series Test and 30 Seconds and Counting Task (30-SACT). Conclusions: The obtained results show an impairment in working memory functions and inductive reasoning in COVID(+) subjects compared to COVID(‒) subjects. In addition, the study indicates the usefulness of BTACT in tracking the changes in cognitive functioning over time in individuals following SARS-CoV-2 infection. Tests to assess working memory (Rey Auditory-Verbal Learning Test (RAVLT), Backward Digit Span Test) and a test of inductive reasoning (Number Series Test) appear to be particularly useful in monitoring the mentioned changes.

GREATER ADHERENCE TO DAILY HEALTH BEHAVIORS RELATE TO BETTER COGNITIVE FUNCTION

Abstract Healthy life habits cannot be formed overnight; therefore, adherence to optimal sleep, physical activity, and healthy eating behaviors is vital. This paper examined the relationship between the adherence rate of the three key health behaviors (i.e., sleep, physical activity, and healthy diet) and cognitive function in adulthood. Data were retrieved from Midlife in the United States third wave (MIDUS 3) Project 2, National Study of Daily Experiences (n=1,061). For eight consecutive days, participants reported nightly sleep duration, daily amount of physical activity, and daily consumption of fast food. Adherence rates of health behaviors were calculated by the sum of having optimal sleep (6 &amp;lt; sleep hours ≤ 9), any intensity of physical activity (60 min.≤), and not eating fast food (yes/no) across the study period. Participants also completed a Brief Test of Adult Cognition by Telephone (BTACT). A series of general linear models examined the associations of the three adherence variables with the overall BTACT cognition score adjusting for sociodemographic and health covariates. Greater adherence rates of optimal sleep (𝛽=0.02; SE=0.01; p=0.01), physical activity (𝛽=0.03; SE=0.01; p&amp;lt;0.01 ), and not eating fast food (𝛽=0.02; SE=0.01; p=0.02) were each and associated with higher BTACT score. Among the three adherence variables, adherence to physical activity was the most important for cognition independent of other health behaviors. Consistent associations were found for executive function, but not episodic memory. These findings suggest that adults with greater adherence to a healthy lifestyle have better cognitive function, and consistency of healthy behaviors is vital for cognitive health.

Associations between insulin‐like growth factor‐1 and executive function in normoglycemia, prediabetes, and type 2 diabetes mellitus

AbstractBackgroundThe relationship between insulin‐like growth factor‐1 (IGF‐1) and cognition has been studied in healthy individuals, yet the results have been inconclusive. The aim of this study was to determine whether the association between IGF‐1 and executive function differs in individuals with normoglycemia, prediabetes, and type 2 diabetes mellitus (T2DM).MethodThe Midlife in the United States (MIDUS) study used the Brief Test of Adult Cognition by Telephone (BTACT) to assess cognitive function. A composite z‐score for executive function was created from the following tests: Digits backward span, category fluency, number series, backward counting, and Stop and Go Switch Task (SGST). IGF‐1 levels were measured from fasting blood samples using an immunochemiluminescent assay. Normoglycemia was defined as individuals without a physician diagnosis of diabetes and glycated hemoglobin (HbA1c) &lt; 5.6%. Prediabetes was defined as those without a physician diagnosis of diabetes and HbA1c between 5.7%‐6.4%. T2DM was defined as anyone with a physician diagnosis of diabetes, or HbA1c ≥6.5%, or use of oral hypoglycemic medication. Multiple imputation was used to handle missing covariate data. A linear regression model controlling for demographic factors, homeostatic model of insulin resistance (HOMA‐IR), C‐reactive protein (CRP) levels, exercise, smoking, sleep disturbance, alcohol intake and medication use, was used to determine the cross‐sectional association between IGF‐1 and executive function across subgroups.ResultThe MIDUS dataset included 447 normoglycemia (47.0% female, mean age 53.4±9.6), 467 prediabetes (57.4% female, mean age 56.8±10.6), and 271 T2DM participants (53.1% female, mean age 57.5±9.8). In participants with prediabetes, IGF‐1 levels were associated with better executive function (β = 0.126, p = 0.007), particularly in males (β = 0.258, p&lt;0.001). This association was absent in individuals with normoglycemia or T2DM. Compared to males with prediabetes, the opposite trend was observed in males with T2DM (β = ‐0.181, p = 0.062).ConclusionThe findings of this study suggest that the association between IGF‐1 and executive function may be influenced by insulin resistance or T2DM. Gaining a better understanding of why the associations differ in T2DM compared to prediabetes may explain the inconsistency observed in the literature and help elucidate the mechanism behind cognitive decline in T2DM.

1 Quantity or quality? Comparing objective and subjective participation measures to predict quality of life in aging msTBI.

Objective:Community reintegration and participation have been shown to be significantly correlated to improved Quality of Life (QoL) following moderate to severe traumatic brain injury (msTBI), yet these models often come with significant levels of unaccounted variability (Pierce and Hanks, 2006). Measures for community participation frequently employ objective measures of participation, such as number of outings in a week or current employment status (Migliorini et al., 2016), which may not adequately account for lifestyle differences, especially in aging populations. Less often integrated are subjective measures of an individual’s own belongingness and autonomy within the community (Heineman et al., 2011), also referred to as their participation enfranchisement (PE). The present study examines three questions pertinent to the potential clinical value of PE. First, do measures of objective participation significantly predict an individual’s PE ratings? Second, are both types of measures equally successful predictors of QoL for aging individuals with chronic-stage msTBI. Finally, would controlling for either objective or subjective integration ratings enable neurocognitive assessments to better predict QoL post injury?Participants and Methods:41 older-adults (M= 65.32; SD= 7.51) with a history of msTBI were included (M= 12.59 years post-injury;SD= 8.29) for analysis. Subjective community integration was measured through the Participation Enfranchisement Survey. The Participation Assessment with Recombined Tools-Objective (PART-O) provided the objective measurement of participation. Quality of life was assessed through the Quality of Life after Brain Injury (QOLIBRI). An estimate of neurocognitive performance was created through the Brief Test of Adult Cognition by Telephone (BTACT), which includes six domains including: verbal-learning and memory (immediate and delayed recall), working memory (digit-span backwards), reasoning (number sequencing), semantic fluency (category fluency), and processing speed (backwards counting). Performance on the BTACT, PE ratings, and PART-O scores were included as the dependent variables in stepwise, linear regression models predicting QoL ratings to assess the differential contribution of the dependent variables and potential interaction effects.Results:While both the PART-O (f(1,39)=5.52;p=.024,n2=.124) and the PE survey (f(1,39)=14.31 ;p&lt;.001,n2=.268) significantly predicted QoL, the addition of PE in the PART-O model resulted in significant (20.9%) reduction in unaccounted variance. Further in the model controlling for PE, PART-O no longer provides a significant (p=.15) contribution to the model estimating QoL (f(2,38)=8.41; p=.001). Performance on the BTACT correlated with PART-O (p&lt;.0001), but not PE (p=.13) ratings. Finally, across two models controlling for BTACT performance, PE (p=.002,partial n2=.23), but not PART-O (p=.28,partial n2=.031) contributed significantly to QoL predictions. No significant interactions between PART-O, PE, and/or BTACT were observed when added to any model.Conclusions:MsTBI impacts nearly every facet of an individual’s life, and as such, improving QoL post-injury requires a broad, yet well-considered approach. The objective ratings of participation, subjective PE, BTACT performance, all independently predicted quality of life in this sample. However, after controlling for neurocognitive assessment performance, PE was shown to independently contribute to quality of life, while the PART-O ratings no longer provided significant contribution. While community integration is a vital factor to consider for long-term rehabilitation, tailoring what “integration” means to the patient may hold significant potential to improve long-term quality of life.

4 The Role of Cognition and Self-Awareness on Driving Patterns After Moderate-to-Severe Traumatic Brain Injury

Objective:Return to driving after moderate-to-severe traumatic brain injury (TBI) is often a key step in recovery to regain independence. Survivors are often eager to resume driving and may do so despite having residual cognitive limitations from their injury. A better understanding is needed of how cognition and self-awareness impact survivors’ driving after injury. This study examined the influence of cognition and self-awareness on driving patterns following moderate-to-severe TBI.Participants and Methods:Participants were 350 adults aged 19-87 years (mean age = 46 years; 70% male) with history of moderate-to-severe TBI, who resumed driving and were enrolled in the TBI Model System. Cross-sectional data were obtained ranging 1-30 years post injury, including questions on driving practices, the Brief Test of Adult Cognition by Telephone (BTACT), and the Functional Independence Measure (FIM). Self-awareness of cognitive function was measured via the discrepancy between dichotomized ratings (intact versus impaired) of objective cognitive testing (BTACT) and self-reported cognitive function (FIM Cognition subscale). Driving patterns included frequency (driving 'more than once a week’ versus 'once a week or less') and restricted driving behavior (total number of driving situations the survivor described as restricted, ranging 0-15). Regression analyses were conducted to examine the relationships between cognition, self-awareness, and each driving outcome (frequency and restriction), followed by causal mediation analyses to examine the mediating effect of self-awareness. Demographics (age, sex, education), injury characteristics (time since injury, injury severity, history of seizures in past year), and medical/social factors (family income, motor function, urban-rural classification) were included in the models as covariates.Results:Thirty-nine percent of survivors had impaired self-awareness, 88% of survivors drove numerous times per week, and the average survivor reported limited driving in 6 situations (out of 15 total situations). Cognition was inversely related to impaired self-awareness (OR = 0.03, p &lt; 0.001) and inversely related to restricted driving behavior (b = -0.79, p &lt; 0.001). Motor function was positively related to impaired self-awareness (OR = 1.28, p &lt; 0.01). Cognition was not related to driving frequency, and self-awareness did not mediate the relationships between cognition and driving patterns (all p &gt; 0.05).Conclusions:Most survivors who drive after their injury are driving frequently, but the situations they drive in differ based on their cognitive ability. Impaired self-awareness of cognitive deficits is common after TBI, and self-awareness of cognitive function does not affect driving patterns. Future research needs to focus on how cognition affects nuanced aspects of driving behavior after injury (i.e., types of situations survivors drive in).

5 LIfestyle for BRAin Health (LIBRA) Modifiable Factors Risk Score and Concussion History Associations with Cognition in Older Former National Football League Players.

Objective:Traumatic brain injury is one of several recognized risk factors for cognitive decline and neurodegenerative disease. Currently, risk scores involving modifiable risk/protective factors for dementia have not incorporated head injury history as part of their overall weighted risk calculation. We investigated the association between the LIfestyle for BRAin Health (LIBRA) risk score with odds of mild cognitive impairment (MCI) diagnosis and cognitive function in older former National Football League (NFL) players, both with and without the influence of concussion history.Participants and Methods:Former NFL players, ages ≥ 50 (N=1050; mean age=61.1±5.4-years), completed a general health survey including self-reported medical history and ratings of function across several domains. LIBRA factors (weighted value) included cardiovascular disease (+1.0), hypertension (+1.6), hyperlipidemia (+1.4), diabetes (+1.3), kidney disease (+1.1), cigarette use history (+1.5), obesity (+1.6), depression (+2.1), social/cognitive activity (-3.2), physical inactivity (+1.1), low/moderate alcohol use (-1.0), healthy diet (-1.7). Within Group 1 (n=761), logistic regression models assessed the association of LIBRA scores and independent contribution of concussion history with the odds of MCI diagnosis. A modified-LIBRA score incorporated concussion history at the level planned contrasts showed significant associations across concussion history groups (0, 1-2, 3-5, 6-9, 10+). The weighted value for concussion history (+1.9) within the modified-LIBRA score was based on its proportional contribution to dementia relative to other LIBRA risk factors, as proposed by the 2020 Lancet Commission Report on Dementia Prevention. Associations of the modified-LIBRA score with odds of MCI and cognitive function were assessed via logistic and linear regression, respectively, in a subset of the sample (Group 2; n=289) who also completed the Brief Test of Adult Cognition by Telephone (BTACT). Race was included as a covariate in all models.Results:The median LIBRA score in the Group 1 was 1.6(IQR= -1, 3.6). Standard and modified-LIBRA median scores were 1.1(IQR= -1.3, 3.3) and 2(IQR= -0.4, 4.6), respectively, within Group 2. In Group 1, LIBRA score was significantly associated with odds of MCI diagnosis (odds ratio[95% confidence interval]=1.27[1.19, 1.28], p &lt;.001). Concussion history provided additional information beyond LIBRA scores and was independently associated with odds of MCI; specifically, odds of MCI were higher among those with 6-9 (Odds Ratio[95% confidence interval]; OR=2.54[1.21, 5.32], p&lt;.001), and 10+ (OR=4.55;[2.21, 9.36], p&lt;.001) concussions, compared with those with no prior concussions. Within Group 2, the modified-LIBRA score was associated with higher odds of MCI (OR=1.61[1.15, 2.25]), and incrementally improved model information (0.04 increase in Nagelkerke R2) above standard LIBRA scores in the same model. Modified-LIBRA scores were inversely associated with BTACT Executive Function (B=-0.53[0.08], p=.002) and Episodic Memory scores (B=-0.53[0.08], p=.002).Conclusions:Numerous modifiable risk/protective factors for dementia are reported in former professional football players, but incorporating concussion history may aid the multifactorial appraisal of cognitive decline risk and identification of areas for prevention and intervention. Integration of multi-modal biomarkers will advance this person-centered, holistic approach toward dementia reduction, detection, and intervention.

2 Contributions of Cardiovascular Disease Burden and Concussion History on Cognitive Function in Older Former National Football League Players.

Objective:Traumatic brain injury and cardiovascular disease (CVD) are modifiable risk factors for cognitive decline and dementia. Greater concussion history can potentially increase risk for cerebrovascular changes associated with cognitive decline and may compound effects of CVD. We investigated the independent and dynamic effects of CVD/risk factor burden and concussion history on cognitive function and odds of mild cognitive impairment (MCI) diagnoses in older former National Football League (NFL) players.Participants and Methods:Former NFL players, ages 50-70 (N=289; mean age=61.02±5.33 years), reported medical history and completed the Brief Test of Adult Cognition by Telephone (BTACT). CVD/risk factor burden was characterized as ordinal (0-3+) based on the sum of the following conditions: coronary artery disease/myocardial infarction, chronic obstructive pulmonary disease, hypertension, hyperlipidemia, sleep apnea, type-I and II diabetes. Cognitive outcomes included BTACT Executive Function and Episodic Memory Composite Z-scores (standardized on age- and education-based normative data), and the presence of physician diagnosed (self-reported) MCI. Concussion history was discretized into five groups: 0, 1-2, 3-5, 6-9, 10+. Linear and logistic regression models were fit to test independent and joint effects of concussion history and CVD burden on cognitive outcomes and odds of MCI. Race (dichotomized as White and Non-white due to sample distribution) was included in models as a covariate.Results:Greater CVD burden (unstandardized beta [standard error]; B=-0.10[0.42], p=.013, and race (B=0.622[0.09], p&lt;.001), were associated with lower executive functioning. Compared to those with 0 prior concussions, no significant differences were observed for those with 1-2, 3-5, 6-9, or 10+ prior concussions (ps &gt;.05). Race (B=0.61[.13], p&lt;.001), but not concussion history or CVD burden, was associated with episodic memory. There was a trend for lower episodic memory scores among those with 10+ prior concussion compared to those with no prior concussions (B=-0.49[.25], p=.052). There were no significant differences in episodic memory among those with 1-2, 3-5, or 6-9 prior concussions compared to those with 0 prior concussions (ps&gt;.05). CVD burden (B=0.35[.13], p=.008), race (greater odds in Non-white group; B=0.82[.29], p=.005), and greater concussion history (higher odds of diagnosis in 10+ group compared to those with 0 prior concussions; B=2.19[0.78], p&lt;.005) were associated with higher odds of MCI diagnosis. Significant interaction effects between concussion history and CVD burden were not observed for any outcome (ps &gt;.05).Conclusions:Lower executive functioning and higher odds of MCI diagnosis were associated with higher CVD burden and race. Very high concussion history (10+) was selectively associated with higher odds of MCI diagnosis. Reduction of these modifiable factors may mitigate adverse outcomes in older contact sport athletes. In former athletes, consideration of CVD burden is particularly pertinent when assessing executive dysfunction, considered to be a common cognitive feature of traumatic encephalopathy syndrome, as designated by the recent diagnostic criteria. Further research should investigate the social and structural determinants contributing to racial disparities in long-term health outcomes within former NFL players.

Emotional, Behavioral, and Cognitive Symptom Associations With Community Participation in Chronic Traumatic Brain Injury.

To determine the association between self-reported emotional and cognitive symptoms and participation outcomes in chronic traumatic brain injury (TBI) and to explore the relative contribution of self-reported versus performance-based cognition to participation outcomes. Community. Community-dwelling adults ( n = 135) with a lifetime history of mild to severe TBI. Secondary analysis of a cross-sectional study on neurobehavioral symptoms in chronic TBI. Behavioral Assessment Screening Tool (BAST) (Negative Affect, Fatigue, Executive Dysfunction, Impulsivity, Substance Abuse subscales) measured self-reported neurobehavioral symptoms; Participation Assessment with Recombined Tools (Productivity, Social Relations, and Out and About) measured self-reported participation outcomes; and Brief Test of Adult Cognition by Telephone (BTACT) measured performance-based cognition (Episodic Memory and Executive Function summary scores) in a subsample ( n = 40). The BAST Executive Dysfunction was significantly associated with less frequent participation and had the strongest effect on participation in all participation domains. No other BAST subscales were associated with participation, after adjusting for all subscale scores and age, with the exception of BAST Impulsivity, which was associated with more frequent Social Relationships. Exploratory analysis in the sample including the BTACT revealed that, after accounting for subjective Executive Dysfunction using the BAST, performance-based Executive Function was associated with Productivity and Working Memory was associated with Social Relations, but neither was associated with being Out and About; the BAST Executive Dysfunction remained significant in all models even after including BTACT scores. Self-reported Executive Dysfunction contributed to participation outcomes after mild to severe TBI in community-dwelling adults, whereas self-reported emotional and fatigue symptoms did not. Performance-based cognition measures may capture different variability in participation after injury.

0412 Multimethod Remote Assessment of Cognition Among Older Adults with Insomnia

Abstract Introduction Cognitive complaints are common among older adults with insomnia. However, previous research is inconsistent regarding the association between insomnia and objective cognitive function. The purpose of this study was to compare subjective and objective cognitive function between older adults with insomnia and healthy sleepers. We hypothesized that relative to healthy sleepers, older adults with insomnia would display diminished subjective and objective cognitive function as measured via multiple remote assessment methods. Methods Participants were recruited from an academic medical center through multiple pathways. Cognitive assessments were administered via several approaches. First, subjective cognitive function was assessed via the 5-item Alert Cognition subscale of the psychometrically derived Daytime Insomnia Symptoms Scale (DISS), completed via smartphone 4x/day throughout a two-week study period (i.e., 56 administrations over 14 days). Second, objective cognitive function was assessed via telephone using the Brief Test of Adult Cognition by Telephone (BTACT), which assesses memory, reasoning, verbal fluency, and executive function. Finally, the psychomotor vigilance task [PVT], Stroop test, and a task-switching exercise were administered remotely via participant’s home desktop computer. Results Participants included 31 older adults who met DSM-V diagnostic criteria for insomnia disorder (67.5 [sd 6.6] years) and 33 older adults without sleep disorders (70.5 [sd 5.7] years). Large between-group differences were observed in the Alert Cognition subscale of the DISS (p-values &amp;lt; 0.0001); compared to healthy sleeper controls, participants with insomnia reported worsened forgetfulness, concentration, alertness, clear-headedness, and cognitive effort. No between-groups differences were observed in any domain of the BTACT or PVT. A numeric but not statistically significant between-groups difference was observed in overall response speed (e.g., Incongruent Response Time) on the Stroop test (p-values &amp;gt; 0.125). Conclusion Remote assessment of cognition is feasible among older adults with insomnia. Significant differences in subjective but not objective cognitive function, likely due to low statistical power, as cognitive deficits in insomnia tend to have small effect sizes. Overall, findings highlight the importance of multimethod assessments of cognition in older adults with insomnia and need for large sample sizes when evaluating objective cognitive function. Support (if any) Research was supported by an investigator-initiated research award from Merck Investigator Studies Program (PI: EMW).

Incorporation of concussion history as part of the LIfestyle for BRAin Health (LIBRA) modifiable factors risk score and associations with cognition in older former National Football League players.

Investigate associations between the LIfestyle for BRAin Health (LIBRA) risk score with odds of mild cognitive impairment (MCI) diagnosis and cognitive function, incorporating concussion history. Former National Football League (NFL) players (N=1050; mean age=64.8±9.0-years) completed initial testing for integration of concussion history into LIBRA scores (i.e., modified-LIBRA) and completed the Brief Test of Adult Cognition by Telephone (BTACT). Modified-LIBRA score (including concussion history) associations with odds of MCI and cognitive dysfunction were assessed via logistic and linear regression. The highest quartile LIBRA scores were six times more likely to have a diagnosis of MCI compared to the lowest quartile (OR=6.27[3.61, 10.91], p<0.001). Modified-LIBRA scores significantly improved model fit for odds of MCI above original LIBRA scores (χ2 (1)=7.76, p=0.005) and accounted for a greater fraction of variance in executive function (ΔR2 =0.02, p=0.003) and episodic memory (ΔR2 =0.02, p=0.002). Modified-LIBRA score, incorporating concussion history, may help monitoring risk status in former contact sport athletes, by targeting modifiable, lifestyle-related risk factors.

CON/DISCORDANCE BETWEEN SUBJECTIVE AND OBJECTIVE SLEEP PARAMETERS AND THEIR ASSOCIATION WITH COGNITIVE FUNCTION

Abstract Studies report that subjective and objective sleep parameters often do not agree with each other. This study examined if discordance between subjective and objective sleep measures are associated with cognition. Participants from the Midlife in the United States study (n=627) provided subjective (self-report) and objective (actigraphy) sleep duration and sleep quality. Discordance was assessed by absolute difference between subjective and objective z-scores in each sleep variable. Cognitive function was measured by the Brief Test of Adult Cognition by Telephone (BTACT). The correlations between subjective and objective sleep measures were weak-to-moderate (r=.43, .18 for duration and quality, respectively). Discordance scores in sleep duration and quality were each significantly associated with BTACT, such that greater discrepancy was associated with poorer cognitive function. These associations remained persistent after adjusting for sociodemographic differences. Results suggest that discordance between subjective and objective sleep parameters may relate to cognitive abilities needed to accurately monitor sleep characteristics.

Obstructive sleep apnea is associated with worse cognitive outcomes in acute moderate-to-severe traumatic brain injury: A TBI Model Systems study

ObjectiveTo examine the relationship between polysomnography-classified obstructive sleep apnea (OSA) severity and cognitive performance in acute moderate-to-severe traumatic brain injury (TBI). MethodThis was a cross-sectional, secondary analysis leveraging data from a clinical trial (NCT03033901) and TBI Model Systems. Sixty participants (mean age = 50 ± 18y, 72% male, 67% white) with moderate-to-severe TBI from five civilian rehabilitation hospitals were assessed at one-month post-injury. Participants underwent Level 1 polysomnography. OSA severity was classified as mild, moderate, and severe using the Apnea-Hypopnea Index (AHI). Associations between OSA metrics of hypoxemia (nadir and total time spent below 90%) and AHI with cognition were examined. Cognition was assessed with the Brief Test of Adult Cognition by Telephone (BTACT), which is comprised of six subtests assessing verbal memory, attention/working memory, processing speed, language, and executive function. ResultsOver three-quarters of this acute TBI sample (76.7%) were diagnosed with OSA (no OSA n = 14; mild OSA n = 19; moderate/severe OSA n = 27). After adjustment for age, gender, and education, those with OSA had worse processing speed, working memory, and executive functioning compared to those without OSA. Compared to those with moderate/severe OSA, those with mild OSA had worse working memory and executive function. ConclusionsOSA is highly prevalent during acute stages of TBI recovery, and even in mild cases is related to poorer cognitive performance, particularly in the domains of attention/working memory and executive functioning. Our results support the incorporation of OSA diagnostic tools and interventions into routine clinical care in rehabilitation settings.

Criterion validity of the brief test of adult cognition by telephone (BTACT) for mild traumatic brain injury

ABSTRACT Objectives There is a growing demand for remote assessment options for measuring cognition after mild traumatic brain injury (mTBI). The current study evaluated the criterion validity of the Brief Test of Adult Cognition by Telephone (BTACT) in distinguishing between adults with mTBI and trauma controls (TC) who sustained injuries not involving the head or neck. Methods The BTACT was administered to the mTBI (n = 46) and TC (n = 35) groups at 1–2 weeks post-injury. Participants also completed the Rivermead Post Concussion Symptoms Questionnaire. Results The BTACT global composite score did not significantly differ between the groups (t(79) = −1.04, p = 0.30); the effect size was small (d = 0.23). In receiver operating characteristic curve analyses, the BTACT demonstrated poor accuracy in differentiating between the groups (AUC = 0.567, SE = 0.065, 95% CI [0.44, 0.69]). The BTACT’s ability to discriminate between mTBI and TCs did not improve after excluding mTBI participants (n = 15) who denied ongoing cognitive symptoms (AUC = 0.567, SE = 0.072, 95% CI [0.43, 0.71]). Conclusions The BTACT may lack sensitivity to subacute cognitive impairment attributable to mTBI (i.e., not explained by bodily pain, post-traumatic stress, and other nonspecific effects of injury).

Complexity of work with people: Associations with cognitive functioning and change after retirement.

Retirement has been associated with cognitive decline. However, the influence of specific job characteristics like occupational complexity on post-retirement cognitive outcomes is not well understood. Data from the Midlife in the United States (MIDUS) study were used to examine occupational complexity in relation to cognitive performance and cognitive change after retirement. Initial sample included 471 workers between 45 and 75 years of age. At 9-year follow-up (T2), 149 were retired and 322 were still working. All six tasks from the Brief Test of Adult Cognition by Telephone (BTACT) were used. Hierarchical regression with workers at T1 indicated that, controlling for sociodemographic variables, complexity of work with people significantly contributed to explaining variance in overall cognitive performance (1.7%) and executive function (2%). In Latent Change Score (LCS) models, complexity of work with people was the only significant predictor of cognitive change in retirees, with those retiring from high-complexity jobs showing less decline. In conclusion, high complexity of work with people is related to better executive functioning and overall cognition during working life and slower decline after retirement. The finding that more intellectually stimulating work carries cognitive advantage into retirement fits the cognitive reserve concept, where earlier intellectual stimulation brings about lower risks of cognitive problems later. Study results also go along with the unengaged lifestyle hypothesis, whereby people may slip into so-called "mental retirement," leading to post-retirement cognitive loss, which may be most apparent among those retiring from jobs with low complexity of work with people. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Convergent Validity of In-Person Assessment of Inpatients With Traumatic Brain Injury Using the Brief Test of Adult Cognition by Telephone (BTACT).

To examine convergent validity of the Brief Test of Adult Cognition by Telephone (BTACT) by determining correlation with established neuropsychological tests, administered an average of 4.4 days apart, in an inpatient traumatic brain injury (TBI) population. Acute inpatient rehabilitation hospital. Fifty-five patients receiving inpatient rehabilitation for new-onset TBI (69.1% male; mean age = 37 years, SD = 14 years). Cross-sectional, secondary data analysis. BTACT; California Verbal Learning Test-second edition (CVLT-2); Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span; Trail Making Test; semantic fluency; phonemic fluency; Symbol Digit Modalities Test; Wisconsin Card Sorting Test. The BTACT was significantly associated with established neuropsychological tests across composite scores of overall cognition (r = 0.64, P < .001), episodic verbal memory (r = 0.66, P < .001), and executive function (r = 0.56, P < .001). For BTACT subtests, Word List Immediate Recall and Word List Delayed Recall were correlated with CVLT-2 learning trials total score (r = 0.57, P < .01) and long delay free recall (r = 0.60, P < .001), respectively. BTACT Digits Backward correlated with WAIS-IV Digit Span (r = 0.51, P < .01). BTACT Animal Fluency was associated with semantic fluency (r = 0.65, P < .01), phonemic fluency (r = 0.60, P < .01), and Trail Making Test Part B (r = 0.39, P < .01). BTACT composite scores of overall cognition, verbal memory, and executive function demonstrate initial convergent validity in a TBI inpatient population. Future research should examine validity in a larger sample of individuals with TBI.