Continuous Performance Test-II Research Articles

The Effect of Developmental Bottom-up Approach Through Perceptual-motor Interventions on Performance of Children With Mild Intellectual Disability

Background and Aims Intellectual disability manifests through defects in cognitive, motor, and perceptual skills as elements affecting learning and acquiring individual skills. Efforts to improve these skills are essential in these children. This study investigated the durable effects of perceptual-motor process-oriented interventions with the Ramon and Johnston protocol on the motor, cognitive, and perceptual performance of children with mild intellectual disability. Methods In this quasi-experimental research, 21 children with mild intellectual disability aged 7 to 12 years were selected using the available sampling method and according to the inclusion criteria. Then, they were assigned to an experimental group of 10 students (10 weeks of perceptual-motor intervention according to the Johnstone and Ramon protocol, two sessions per week) and a control group of 11 students (no intervention) using a simple random method. The participants were evaluated before and 2 months after the intervention with movement assessment battery for children 2nd Edition, Conners’ continuous performance test-II, the working memory test of Wechsler intelligence scale for children fourth edition, and the test of visual perception skills revised. Univariate covariance test was used for data analysis. Results The findings showed a significant difference between the intervention and control groups in general motor performance, aiming and catching, the correct answer in the attention test, visual sequential memory, and visual figure-ground in the delayed post-test stage (P<0.05). Also, no significant difference was seen in other subtests (P>0.05). Conclusion Bottom-up approach interventions through Ramon and Johnston’s comprehensive perceptual-motor training can significantly help improve general and ball motor skills, sustained attention, visual sequential memory, and visual figure-ground in children with mild intellectual disability.

0812 Inconsistent improvements of neurocognitive function after adenotonsillectomy: a pediatric sleep-disordered breathing cohort study

Abstract Introduction Adenotonsillectomy (AT) is the most common surgical treatment for pediatric obstructive-sleep-apnea (OSA) with fair effectiveness. There are still controversies about the improvement of neurocognitive function after AT. This study investigates the changes of neurocognitive function after AT in preschool and school age children with OSA, including intelligence and attention, and explore the inconsistent improvements by comparing different evaluation tools. Methods 130 children with pediatric OSA were recruited, including 30 preschool and 100 school-age children. 125 participants underwent clinical evaluation, including polysomnography (PSG), before and 1-year after AT. Preschool children received the Wechsler-Preschool-and-Primary-Scale-of-Intelligence (the revised and IV edition, WPPSI-R and WPPSI-IV) and the Conners’-Kiddie-Continuous-Performance-Test (K-CPT) while school-age children received the Wechsler-Intelligence-Scale-for-Children (the 3rd and 4th edition, WISC-III and WISC-IV), and the Conners’-continuous-performance-test-II (CPT-II), before and 1-year after AT. Questionnaires including the Obstructive-Sleep-Apnea-Questionaire-18 (OSA-18) and Child-Behavior-Checklist (CBCL) were also used. The t-test and chi-square test analysis was used to compare data between preschool and school-age children, including PSG, CPT variables, intelligence variables, OSA-18 and CBCL before and after AT, as well as group differences in changes. Correlation analysis of CPT variables were performed by using the Pearson-Correlation to investigate factors related to treatment response. Results No significant group difference was found except age (p=0.000) and less male gender in preschool children (p=0.049). 21.7% of preschool children had language delay, and more than 80% of all children had allergic rhinitis or high narrow palate. After AT, both groups had significant improvement in PSG and OSA-18. No significant change was found by WPPSI-IV in the preschool children and WISC-IV in the school-age children, but significant improvements were found in preschool children and school-age children by WPPSI-R and WISC-III. There were also significant improvements of CPT-II in school-age children, and the Hit-reaction-time-standard-deviation positively correlates with the improvement in PSG. Conclusion Besides the improvement of sleep apnea and subjective improvements of emotion and behavior, AT can be beneficial in the neurocognitive function of preschool and school-age children with OSA, including intelligence and attention. Some tools may not be sensitive enough to detect the improvement in neurocognitive function, and selection of proper evaluation tools can be important in study design. Support (if any)

Resting-State EEG Connectivity at High-Frequency Bands and Attentional Performance Dysfunction in Stabilized Schizophrenia Patients.

Background and Objectives: Attentional dysfunction has long been viewed as one of the fundamental underlying cognitive deficits in schizophrenia. There is an urgent need to understand its neural underpinning and develop effective treatments. In the process of attention, neural oscillation has a central role in filtering information and allocating resources to either stimulus-driven or goal-relevant objects. Here, we asked if resting-state EEG connectivity correlated with attentional performance in schizophrenia patients. Materials and Methods: Resting-state EEG recordings were obtained from 72 stabilized patients with schizophrenia. Lagged phase synchronization (LPS) was used to measure whole-brain source-based functional connectivity between 84 intra-cortical current sources determined by eLORETA (exact low-resolution brain electromagnetic tomography) for five frequencies. The Conners' Continuous Performance Test-II (CPT-II) was administered for evaluating attentional performance. Linear regression with a non-parametric permutation randomization procedure was used to examine the correlations between the whole-brain functional connectivity and the CPT-II measures. Results: Greater beta-band right hemispheric fusiform gyrus (FG)-lingual gyrus (LG) functional connectivity predicted higher CPT-II variability scores (r = 0.44, p < 0.05, corrected), accounting for 19.5% of variance in the CPT-II VAR score. Greater gamma-band right hemispheric functional connectivity between the cuneus (Cu) and transverse temporal gyrus (TTG) and between Cu and the superior temporal gyrus (STG) predicted higher CPT-II hit reaction time (HRT) scores (both r = 0.50, p < 0.05, corrected), accounting for 24.6% and 25.1% of variance in the CPT-II HRT score, respectively. Greater gamma-band right hemispheric Cu-TTG functional connectivity predicted higher CPT-II HRT standard error (HRTSE) scores (r = 0.54, p < 0.05, corrected), accounting for 28.7% of variance in the CPT-II HRTSE score. Conclusions: Our study indicated that increased right hemispheric resting-state EEG functional connectivity at high frequencies was correlated with poorer focused attention in schizophrenia patients. If replicated, novel approaches to modulate these networks may yield selective, potent interventions for improving attention deficits in schizophrenia.

Beyond BMI: cardiometabolic measures as predictors of impulsivity and white matter changes in adolescents

Obesity is characterized by cardiometabolic and neurocognitive changes. However, how these two factors relate to each other in this population is unknown. We tested the association that cardiometabolic measures may have with impulse behaviors and white matter microstructure in adolescents with and without an excess weight. One hundred and eight adolescents (43 normal-weight and 65 overweight/obesity; 11–19 years old) were medically and psychologically (Temperament Character Inventory Revised, Three-Factor Eating Questionnaire-R18, Conners’ Continuous Performance Test-II, Stroop Color and Word Test, Wisconsin Card Sorting Test, Kirby Delay Discounting Task) evaluated. A subsample of participants (n = 56) underwent a brain magnetic resonance imaging acquisition. In adolescents, higher triglycerides and having a body mass index indicative of overweight/obesity predicted a more impulsive performance in Conners’ Continuous Performance Test-II (higher commission errors). In addition, higher glucose and diastolic blood pressure values predicted increments in the Three-Factor Eating Questionnaire-R18 emotional eating scale. Neuroanatomically, cingulum fractional anisotropy showed a negative relationship with glycated hemoglobin. The evaluation of the neurocognitive differences associated with obesity, usually based on body mass index, should be complemented with cardiometabolic measures.

A-194 Sustained Attention Differences Between Electrical Injury Patients and Combat Exposed Veterans with Post-Traumatic Stress Disorder

Abstract Objective: Electrical injury (EI) patients demonstrate heterogenous neuropsychological performance (NP), yet sustained attention (SA) has not been investigated. This study aimed to characterize differences in SA on the Conners’ Continuous Performance Test II (CPT-II) between patients with past EI and veterans with post-traumatic stress disorder (PTSD). Method: Participants included EI patients and veterans with PTSD receiving neuropsychological evaluations at affiliated academic medical centers. Inclusion criteria for veterans involved meeting criteria for PTSD per the Clinician-Administered PTSD Scale for DSM-IV. EI and PTSD participants were included if they completed the CPT-II and failed &amp;lt; 1 performance validity tests. The 50 EI participants were 80% male, ages 19-64 (M=42, SD=10.67), and 94% White. The 35 PTSD participants were 94% male, ages 25-49 (M=33, SD=5.55), and 31% White, 45% Black, 20% Hispanic, and 3% biracial. Results: Percentage of participants showing at least three atypical scores on the CPT-II was higher for EI (52%) compared with PTSD (20%) participants [χ^2 (1, N = 85) = 8.876, p &amp;lt; .003]. EI participants showed significantly greater SA difficulties on CPT-II overall standard error [F(1,84)=22.18, p&amp;lt; 0.001, ηp2=.21], variability of standard error [F(1,84)=7.70, p=0.028, ηp2=.09], reaction time by inter-stimulus interval (ISI) [F(1,84)=9.19, p=0.018, ηp2=.10], and standard error by ISI [F(1,84)=6.48, p=0.039, ηp2=.07]. All p-values were false discovery rate corrected. Conclusions: EI participants demonstrated overall greater inconsistency in response speed with slower and inconsistent reaction times during different ISIs. EI patients display a unique pattern of SA performance compared to veterans with PTSD, which may relate to the variability in EI NP.

Cognitive and Emotional Determinants of Automatic Perspective Taking in Healthy Adults.

Previous studies using the dot-perspective task postulated that people automatically take into account others' perspective even when it prevents them from achieving their own goals. This human ability may be of key importance for the ascription of mental states and social interactions. The cognitive and emotional determinants of automatic perspective taking (APT) is still matter of debate. To address this issue, we examined the performance in the Samson et al. APT task in 91 healthy adults who underwent a detailed neuropsychological testing including assessment of their general intelligence (Wechsler Adult Intelligence Scale, WAIS), attention and impulsivity (Conners' Continuous Performance Test-II, CPT-II), alexithymia (Toronto Alexithymia Scale, TAS), and measures of affective empathy and explicit theory of mind (Geneva Social Cognition Scale, GeSoCS, and mini-Social cognition and Emotional Assessment, mini-SEA). Univariate and multiple linear regression models (adjusted for age, gender, and education) were used to explore the association between mean reaction times (respectively, mean number of errors) in the APT task, and the CPT-II parameters, WAIS global score (as well as subscale scores), TAS, and GeSoCS and mini-SEA scores. Only the CPT-II parameters were significantly associated with the mean reaction times. Increased omissions, commissions, and detectability as well as hit reaction time standard error in CPT-II were all related to worse performances both in Self and Other conditions. The mean number of errors was negatively associated with the GeSoCS score. Among the variables studied, only CPT-II parameters had a significant impact on egocentric and altercentric interference. Neither global intelligence nor alexithymia have an effect on dot-perspective task performance. The present findings suggest that people with lower attentional resources and increased impulsivity display worse performances in the APT task and are less responsive to both egocentric and altercentric interference.

Sleep Instability Correlates with Attentional Impairment in Boys with Attention Deficit Hyperactivity Disorder.

Theoretical models of sleep and attention deficit hyperactivity disorder (ADHD) suggest that symptoms of ADHD are associated with daytime sleepiness, but it has received little support. The present study aimed at testing an alternative model involving the association of attentional instability with sleep instability, i.e., sleep stage transitions and arousals. Twelve ADHD and 15 healthy control (HC) boys aged between 8 and 12 years old underwent polysomnography recording and attentional testing. The microarousal index, the number of awakenings, and the number of stage shifts between stages 1, 2, 3, 4 and REM sleep throughout the night were computed as sleep stability parameters. Attentional functioning was assessed using the Continuous Performance Test-II. We found significantly higher sleep instability in ADHD compared to HC. Sleep arousals and stage transitions (micro arousal index, stage 4/3 and 2/4 transitions) in ADHD significantly correlated with lower attentional scores. No association whatsoever was found between sleep instability and attentional functioning in HC. The results show that sleep instability is associated with lower attentional performance in boys with ADHD, but not in HC. This could be compatible with a model according to which attention and sleep stability share a common neural substrate in ADHD.

Impulsivity in Compulsive Sexual Behavior Disorder and Pedophilic Disorder.

Background and aimsImpulsivity is regarded as a risk factor for sexual crime reoffending, and a suggested core feature in Compulsive Sexual Behavior Disorder. The aim of this study was to explore clinical (e.g. neurodevelopmental disorders), behavioral and neurocognitive dimensions of impulsivity in disorders of problematic sexuality, and the possible correlation between sexual compulsivity and impulsivity.MethodsMen with Compulsive Sexual Behavior Disorder (n = 20), and Pedophilic Disorder (n = 55), enrolled in two separate drug trials in a specialized Swedish sexual medicine outpatient clinic, as well as healthy male controls (n = 57) were assessed with the Hypersexual Behavior Inventory (HBI) for sexual compulsivity, and with the Barratt Impulsiveness Scale (BIS) and Connors’ Continuous Performance Test-II (CPT-II) for impulsivity. Psychiatric comorbidity information was extracted from interviews and patient case files.ResultsApproximately a quarter of the clinical groups had Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder. Both clinical groups reported more compulsive sexuality (r = 0.73−0.75) and attentional impulsivity (r = 0.36−0.38) than controls (P < 0.05). Based on results on univariate correlation analysis, BIS attentional score, ADHD, and Commissions T-score from CPT-II were entered in a multiple linear regression model, which accounted for 15% of the variance in HBI score (P < 0.0001). BIS attentional score was the only independent positive predictor of HBI (P = 0.001).DiscussionSelf-rated attentional impulsivity is an important associated factor of compulsive sexuality, even after controlling for ADHD. Psychiatric comorbidity and compulsive sexuality are common in Pedophilic Disorder.ConclusionNeurodevelopmental disorders and attentional impulsivity – including suitable interventions – should be further investigated in both disorders.

Transcranial Photobiomodulation to Improve Cognition in Gulf War Illness.

Introduction: Approximately 25–30% of veterans deployed to Kuwait, 1990-91, report persistent multi-symptom Gulf War Illness (GWI) likely from neurotoxicant exposures. Photobiomodulation (PBM) in red/near-infrared (NIR) wavelengths is a safe, non-invasive modality shown to help repair hypoxic/stressed cells. Red/NIR wavelengths are absorbed by cytochrome C oxidase in mitochondria, releasing nitric oxide (increasing local vasodilation), and increasing adenosine tri-phosphate production. We investigated whether PBM applied transcranially could improve cognition, and health symptoms in GWI.Materials and Methods: Forty-eight (40 M) participants completed this blinded, randomized, sham-controlled trial using Sham or Real, red/NIR light-emitting diodes (LED) applied transcranially. Fifteen, half-hour transcranial LED (tLED) treatments were twice a week (7.5 weeks, in-office). Goggles worn by participant and assistant maintained blinding for visible red. Pre-/Post- testing was at Entry, 1 week and 1 month post- 15th treatment. Primary outcome measures were neuropsychological (NP) tests; secondary outcomes, Psychosocial Questionnaires, including PTSD.Results: Primary Analyses (all participants), showed improvement for Real vs. Sham, for Digit Span Forwards (p < 0.01); and a trend for Trails 4, Number/Letter Sequencing (p < 0.10). For secondary outcomes, Real group reported more improvement on the SF-36V Plus, Physical Component Score (p < 0.08). Secondary Analyses included only subjects scoring below norm (50%ile) at Entry, on specific NP test/s. Real and Sham improved at 1 week after 15th treatment; however, at 1 month, only those receiving Real improved further: Digit Span Total, Forwards and Backwards; Trails 4, Number/Letter Sequencing; California Verbal Learning Test-II, long delay free recall; Continuous Performance Test-II, False Alarm Rate; and Color-Word Interference, Stroop, Trial 3, Inhibition; Sham group worsened, toward Entry values. Only those with more post-traumatic stress disorder (PTSD) symptomatology at Entry, receiving Real, continued to have additional PTSD reduction at 1 month; Sham regressed.Conclusion: This study was underpowered (n = 48), with large heterogeneity at Entry. This likely contributed to significance or trend to significance, for only two of the NP tests (Digit Span Forwards; Trails 4, Number/Letter Sequencing) and only one general health measure, the SF-36V Plus, Physical Component Score. More subjects receiving Real, self-reported increased concentration, relaxation and sleep. Controlled studies with newer, transcranial LED home treatment devices are warranted; this is expected to increase enrollment.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01782378.

A-157 How Important Is Sustained Attention in Reversal Learning and Visual Task Shifting Abilities: A Canonical Correlation Analysis in Adults

Abstract Objective We used canonical correlation analysis (CCA) to examine the relationship between performance on cognitive neuroscience measures of sustained attention, deterministic reversal learning (DRLT), and visual task-shifting (VTS). We evaluated whether DRLT and VTS predicted performance on the Continuous Performance Test-II (CPT-II). Method Participants were 1011 adults from the Consortium for Neuropsychiatric Phenomics. The first CCA was conducted between four VST variables (set 1) and three CPT-II variables (set 2). The second CCA was conducted using eight Reversal Learning variables (set 1) and three CPT-II variables (set 2). Results Our first CCA suggests that accuracy of performance in VTS predicts CPT-II measures, Rc = 0.33, Wilks’s λ = 0.86, F(12, 2646) = 1.92, p &amp;lt; .001. The analysis revealed a positive relationship with Hits (=0.87) and a negative relationship with FA (= − 0.76), consistent with sustained attention. The second CCA revealed that acquisition trials and RT on reversal trials significantly predicted less FA and more hits on the CPT-II, Rc = 0.23, Wilks’s λ = 0.90, F(24, 1273) = 1.92, p = .005. Conclusion Our multivariate findings confirm that attention is significantly involved in executive and mnemonic processes. To our knowledge, we are the first neuroscientific group to report multivariate evidence from a large data set that confirms sustained attention plays a significant role in reversal learning and task-shifting. Our results show that the CPT-II FA and mean RT variables specifically are important predictors of reversal learning and task-shifting, strengthening the concurrent validity of our experimental measures.

Examining embedded validity indicators in Conners continuous performance test-3 (CPT-3)

Objective Prior research has identified a variety of embedded performance validity indicators on the Conners’ Continuous Performance Test-II (CPT-II). The purpose of this study was to examine embedded validity indicators within the updated third edition of the Conners Continuous Performance Test (CPT-3). Method This study used a retrospective chart review from an ADHD evaluation clinic at a Mid-Atlantic VA hospital. Participants were 197 military veterans who completed a clinical assessment for ADHD. All participants were consecutive referrals to the ADHD clinic who completed the CPT-3 and the Test of Memory Malingering, Trial 1 (TOMM1). Results Logistic regression analyses indicated that the following five variables were able to significantly predict validity status on the TOMM1: detectability (d’), omissions (OMI), commissions (COM), hit reaction time (HRT) standard deviation (SD), and HRT inter-stimulus interval (ISI) change. Among these measures, HRT SD and HRT ISI change were identified as the scores with the highest AUC values. Optimal cutoffs for all significant predictors were identified. A number of composite EVIs were created using various combinations of CPT-3 scores. All composite EVIs significantly differentiated between pass and fail status on the TOMM1. Conclusions Several CPT-3 variables have clinical utility as embedded validity indicators; however, due to low sensitivity, they should not be used in isolation. These scores may be used as indicators of invalid performance but should not be used to rule out invalid performance. Identified CPT-3 scores may be useful as one component in a multivariate, multi-point continuous approach to performance validity sampling.

Facial emotion recognition in children with attention-deficit/hyperactivity disorder

There are difficulties in relationships that are attributed to a commitment in facial emotions recognition skills in subjects with attention-deficit/hyperactivity disorder (ADHD). The studies carried out did not always take into account the nature of the stimulus selected in pediatrics, which is important because the familiarity in faces, in terms of their physiognomic characteristics, makes it easier the recognition of the expressions. To identify the profile of recognition of emotions in pediatric subjects with ADHD, using as a stimulus photos of boys and girls. Analytical cross-sectional study of cases and controls. We analyzed the results obtained from 54 participants between 7 and 13 years divided into two groups: 26 in control group and 28 in ADHD group. They conducted an assessment with the Wechsler Intelligence Scale for Children (WISC-V), Conners' Continuous Performance Test II (CPT-II), and Child Affective Facial Expression set (CAFE). The ADHD group showed a lower performance in recognition of emotions in general, with greater difficulty in the recognition of anger, surprise and neutral expression in particular. No relationship was found between the recognition of emotions and age, sex, total intelligence quotient or CPT-II care variables. The subjects with ADHD present deficits in the recognition of emotions, especially in the recognition of anger, surprise and neutral expression, which could explain the difficulties in the interaction and that should be treated within the therapeutic framework.

Reduced Attention in Former Smokers with and without COPD.

Attention difficulties are often reported by patients with chronic obstructive pulmonary disease (COPD); however, limited research exists using objective tests designed specifically to measure attention in this population. This study aimed to (1) identify specific attention deficits in COPD and (2) determine which demographic/clinical characteristics are associated with reduced attention. Eighty-four former smokers (53 COPD, 31 no COPD) completed questionnaires, pulmonary function testing, and the Conner's Continuous Performance Test II (CPT-II). Participants with and without COPD were compared on CPT-II measures of inattention, impulsivity, and vigilance. CPT-II measures that differed significantly between the two groups were further examined using hierarchical regression modeling. Demographic/clinical characteristics were entered into models with attention as the dependent variable. Participants with COPD performed worse than those without COPD on CPT measures of inattention and impulsivity (i.e., detectability [discrimination of target from non-target stimuli], perseverations [reaction time under 100ms], omissions [target stimuli response failures], and commissions [responses to non-target stimuli]). More severe COPD (measured by greater airflow limitation) was associated with poorer ability to detect targets vs. foils and perseverative responding after adjusting for age and other covariates in the model. Former smokers with COPD experience problems with attention that go beyond slowed processing speed, including aspects of inattention and impulsivity. Clinicians should be aware that greater airflow limitation and older age are associated with attention difficulties, as this may impact functioning.

Rôle de l’impulsivité dans la relation entre surpoids et TDAH chez l’enfant : étude exploratoire des caractéristiques cliniques, neuropsychologiques et neurobiochimiques

ObjectivesRelationship between Attention Deficit Hyperactivity Disorder (ADHD) and obesity in adults and children had previously been established in research studies. Brain imaging studies pointed out the important role of the prefrontal region in both ADHD and obesity. However, the underlying link between ADHD and obesity is not well understood. The hypothesis that impulsivity could play a role has been explored in clinical studies of ADHD and Binge Eating Disorders or Loss of Control Eating, with contradictory results. Our study aims to compare children with ADHD and obesity to children with ADHD and normal weight. We propose to compare these two populations with clinical, neuropsychological and brain spectroscopy investigation, focusing specifically on impulsivity items. MethodTen children presenting overweight or obesity were selected from a larger population of children with ADHD (5–12y) and paired with regard to gender and age with ten children with ADHD and normal weight from the same population. Conners Rating scales version parents (CPRS) and teachers (CTRS), Conners’ Continuous Performance Test II (CPT-II), and Magnetic Resonance Spectroscopy (MRS) metabolites in five regions of interest (left and right prefrontal, left and right striatal and left cerebellum regions) were measured for all the children. For MRS, ratio to creatinine levels of following metabolites were measured: glycerophosphocholine+phosphocholine/creatinine (GPC+PCh/Cr), glutamate+glutamine (Glu+Gln/Cr), myoinositol (mI/Cr) et N-acétylaspartate+N-acétylaspartylglutamate (NAA+NAAG/Cr). ResultsHyperactivity/Impusivity and Conners Global Index (CGI) subscales of Conners rating scales showed a higher rate of impulsivity in children with ADHD and obesity as compared to children with ADHD and normal weight. Neuropsychological results were comparable in the two groups. Finally, MRS showed a higher GPC+PCh/Cr ratio in right prefrontal cortex in children with ADHD and obesity as compared to children with ADHD and normal weight. ConclusionsOur results are concordant with the hypothesis that impulsivity could be the link between obesity and ADHD in a population of children with ADHD. The right prefrontal regions seem to be areas of interests that need more research in the study of the link between obesity and ADHD.

The changing burden of long-term health outcomes in survivors of childhood acute lymphoblastic leukaemia: a retrospective analysis of the St Jude Lifetime Cohort Study

Treatment for childhood acute lymphoblastic leukemia has evolved over the past five decades, with moderation of traditional chemotherapy and radiotherapy and the introduction of targeted immune-based and cellular-based therapies. The affect of these changes on late health outcomes has not been assessed. Using data from the The St Jude Lifetime (SJLIFE) Cohort, we aimed to characterise the magnitude of morbidity and patterns of late health outcomes among survivors of childhood acute lymphoblastic leukaemia treated over time. The St Jude Lifetime (SJLIFE) Cohort is a retrospective cohort study with prospective follow-up and ongoing data accrual designed to facilitate longitudinal, clinically-based assessment of health outcomes among survivors of paediatric malignancies. 980 survivors included in this analysis were diagnosed with paediatric acute lymphoblastic leukaemia at St Jude Children's Research Hospital (SJCRH) between Aug 28, 1963, and July 19, 2003, were aged 18 years old and older at enrolment, had a minimum follow-up of 10 years after diagnosis, and completed an initial on-campus SJLIFE assessment as of data cutoff (June 30, 2015). 272 community control participants, matched to survivors on 5-year age blocks in each sex, were recruited for comparison. Cumulative chemotherapy and radiation dose exposures and major medical events during and after therapy were retrieved from the medical records of the survivors. History or physical examination, laboratory analysis, physical fitness, and neurocognitive testing were done. Health conditions were graded according to a modified version of the Common Terminology Criteria for Adverse Events. Neurocognitive domains of attention (Trial Making Test Part A and Conner's Continuous Performance Test-II) and executive function (Trail Making Test Part B, Controlled Oral Word Association Test, and Wechsler Adult Intelligence Scale-III Digit Span Test Backward) were measured and age-adjusted Z scores were calculated. Mean cumulative count was used to calculate the age-standardised cumulative burden of health conditions over time. This cohort study is registered at ClinicalTrials.gov, number NCT00760656. 980 survivors of acute lymphoblastic leukaemia (50% women, median age at diagnosis 5 years [IQR 3·1-9·1 years], and median time from diagnosis of 30·0 years [22·7-36·3]) had a median age of 35·8 years (29·4-42·9) at assessment compared with 35·1 years (28·7-42·6) for 272 controls. Survivors had significantly more growth hormone deficiency, hypogonadism, and neuropathy than controls. By age 30 years, survivors of acute lymphoblastic leukaemia had, on average, 5·4 (95% CI 5·1-5·8) grade 1-4 health conditions, including 3·2 (2·9-3·4) grade 2-4 health conditions, compared with 2·0 (CI 1·7-2·2) grade 1-4 and 1·2 (1·03-1·4) grade 2-4 health conditions among controls. The cumulative burden of grade 2-4 health conditions involved multiple organ systems for survivors treated on protocols between 1962-91, but after elimination of cranial radiotherapy for children with acute lymphoblastic leukaemia, conditions now predominately include musculoskeletal and endocrine disorders for survivors on protocols between 1991-2007. Although changes in paediatric acute lymphoblastic leukaemia treatment protocols have improved overall survival, the burden of late morbidity remains high for these patients. We show that the pattern of late toxic effects has markedly changed over time, with survivors having a reduction in health conditions that are immediately life-threatening, however, maintaining health status and quality of life for survivors of paediatric acute lymphoblastic leukaemia requires continued medical surveillance, counselling, and lifestyle modifications. US National Cancer Institute and the American Lebanese Syrian Associated Charities.

Effects of methylphenidate on cognition and behaviour in children with neurofibromatosis type 1: a study protocol for a randomised placebo-controlled crossover trial

IntroductionDopamine dysregulation has been identified as a key modulator of behavioural impairment in neurofibromatosis type 1 (NF1) and a potential therapeutic target. Preclinical research demonstrates reduced dopamine in the brains...

Prenatal and childhood exposure to perfluoroalkyl substances (PFAS) and measures of attention, impulse control, and visual spatial abilities

BackgroundDespite evidence from toxicological studies describing the potential neurotoxicity of perfluoroalkyl substances (PFAS), their role in neurodevelopment remains uncertain amid inconsistent findings from epidemiological studies. MethodsUsing data from 218 mother-child dyads from the Health Outcomes and Measures of the Environment Study, we examined prenatal and childhood (3 and 8 years) serum concentrations of four PFAS and inattention, impulsivity, and visual spatial abilities. At 8 years, we used the Conners' Continuous Performance Test-II to assess attention and impulse control and the Virtual Morris Water Maze (VMWM) to measure visual spatial abilities. ResultsIn multiple informant models, there was no evidence to indicate that prenatal or childhood PFAS are associated with attention. However, there was an inverse association between prenatal ln-perfluorooctanoate (PFOA) and errors of commission (β = −2.0, 95% Confidence Interval [CI] −3.8, −0.3). Ln-perfluorononanoate (PFNA) at 3 years was associated with longer (poorer) VMWM completion times of 3.6 seconds (CI 1.6, 5.6). However, higher concurrent concentrations of ln-perfluorohexane sulfonate (PFHxS) (β = −2.4 s, 95% CI −4.4, −0.3) were associated with shorter (better) times. Higher prenatal PFHxS was positively associated with percentage of traveling distance in the correct quadrant (β = 4.2%, 95% CI 0.8, 7.7), indicating better performance. ConclusionFindings were mixed for prenatal and childhood PFAS concentrations and visual spatial abilities. There is not enough evidence to support that PFAS are associated with visual spatial abilities as assessed by the VMWM or CPT-II measures of inattention or impulsivity in children at age 8 years.

Altered cortical thickness and attentional deficits in adolescent girls and women with bulimia nervosa.

Frontostriatal and frontoparietal abnormalities likely contribute to deficits in control and attentional processes in individuals with bulimia nervosa and to the persistence of dysregulated eating across development. This study assessed these processes and cortical thickness in a large sample of adolescent girls and women with bulimia nervosa compared with healthy controls. We collected anatomical MRI data from adolescent girls and women (ages 12-38 yr) with full or subthreshold bulimia nervosa and age-matched healthy controls who also completed the Conners Continuous Performance Test-II (CPT-II). Groups were compared on task performance and cortical thickness. Mediation analyses explored associations among cortical thickness, CPT-II variables, bulimia nervosa symptoms and age. We included 60 girls and women with bulimia nervosa and 54 controls in the analyses. Compared with healthy participants, those with bulimia nervosa showed increased impulsivity and inattention on the CPT-II, along with reduced thickness of the right pars triangularis, right superior parietal and left dorsal posterior cingulate cortices. In the bulimia nervosa group, exploratory analyses revealed that binge eating frequency correlated inversely with cortical thickness of frontoparietal and insular regions and that reduced frontoparietal thickness mediated the association between age and increased symptom severity and inattention. Binge eating frequency also mediated the association between age and lower prefrontal cortical thickness. These findings are applicable to only girls and women with bulimia nervosa, and our cross-sectional design precludes understanding of whether cortical thickness alterations precede or result from bulimia nervosa symptoms. Structural abnormalities in the frontoparietal and posterior cingulate regions comprising circuits that support control and attentional processes should be investigated as potential contributors to the maintenance of bulimia nervosa and useful targets for novel interventions.

Attention in individuals with aphasia: Performance on the Conners’ Continuous Performance Test – 2nd edition

ABSTRACTStudies suggest that individuals with aphasia present with impairments in attention. However, most research has been conducted with small sample sizes using experimental protocols that lack established psychometric properties. We examined the attention performance of 114 individuals with chronic post-stroke aphasia using a standardised, norm-referenced assessment of attention, the Conners’ Continuous Performance Test-II (CPT-II; Conners, C. K. (2000). Conners’ Continuous Performance Test II. Toronto: Multi-Health Systems Inc). Participants completed the CPT-II and the Western Aphasia Battery-Revised (WAB-R; Kertesz, A. (2007). Western Aphasia Battery-Revised. San Antonio, TX: PsychCorp). As a group, variable performance on selected CPT-II measures was observed. Participants demonstrated impairments on omissions (48.2%) and hit reaction time (67.5%), with 11.4% demonstrating atypically slow performance and over half of the sample (56.1%) performing atypically fast. The Confidence Index, a summary score, was also within the impaired range for the majority of participants. However, there were also measures in which a greater percentage of participants demonstrated performance within normal limits. Using the WAB-R Aphasia Quotient (AQ) as a measure of severity, there was significantly worse performance in participants with more severe (AQ < 50) compared to less severe (AQ ≥ 50) aphasia. No significant differences in attention were identified between participants with fluent versus non-fluent aphasia. The CPT-II is a feasible measure for persons with aphasia, which may assist in identifying attention performance deficits that potentially affect language.

Neurocognitive Outcomes and Dosimetric Correlates in Central Nervous System Germ Cell Tumors

To evaluate clinical outcomes of patients with central nervous system germ cell tumor (CNS GCT) who received radiation therapy (RT) as a component of definitive treatment, with a focus on longitudinal neurocognitive outcomes in relation to radiation dose-volume parameters and clinical and pathologic variables. Sixty consecutively treated pediatric and young adult patients with CNS GCT who received definitive RT at our institution from 1995 to 2015 were reviewed. Forty-three patients underwent age appropriate neuropsychologic assessment with at least three measures of interest after diagnosis. Variance of neuropsychometric evaluations from normative means was evaluated by t-test. Differential dose-volume histograms for 14 brain volumes were obtained in 35 patients. Dose-volume parameters were modelled with time and clinical variables using neurocognitive test scores as the response variable. Median age at diagnosis of the overall cohort was 12 years (range, 2 – 28 years). Pure germinoma was diagnosed in 65% patients and nongerminomatous germ cell tumor (NGGCT) in 35%. Eighty six percent of patients were treated with craniospinal irradiation (CSI), 12% with whole ventricle irradiation, and 2% with focal RT. With a median follow-up of all patients of 6.2 years (range, 0.36 – 18.4 years), 5 patients developed recurrent disease, with all but one failing outside the high dose region. The 5 year event-free survival (EFS) and overall survival (OS) estimates for patients with pure germinoma were 91% and 100%, respectively, while 5 year EFS and OS estimates for patients with NGGCT were and 79.6% and 90.0%, respectively. The median time from start of RT to neurocognitive assessment was 4.1 years (range, 0.41 – 11.1 years). Domains significantly worse than normative expectations included intelligence, attention, memory, executive function, adaptive, psychosocial, visuomotor, and academic measures. Using the Conners’ Continuous Performance Test-II (CPT-II), there was an association between time after irradiation and mean dose to the mammillary bodies and Response Style Indicator (β) Scores were lower (less concern about mistakes) at a rate of -0.00167 points/Gy/day (p=0.007). Statistically significant (p≤0.05) associations were found between time and mean dose to several supratentorial brain regions (hippocampi, bilateral subventricular zones, left temporal lobe) and CPT Detectability (d') Scores were higher (lower discriminating power) at a rate ranging from 0.000345 to 0.00433 points/Gy/day. This study confirms excellent disease control rates achieved with RT as a component of CNS GCT management. However, patients do experience cognitive late effects of disease and treatment with deficits in attentional regulation associated with extent and location of irradiation. Ultimately, we aim to use identified dosimetric factors to inform proton-based treatment planning to limit these long term complications.