Frontal Systems Behavior Scale Research Articles

Cognitive Intra-individual Variability in the Laboratory Is Associated With Greater Executive Dysfunction in the Daily Lives of Older Adults With HIV.

Executive dysfunction, which is common among persons with HIV (PWH), can have an adverse impact on health behaviors and quality of life. Intra-individual variability (IIV) is a measure of within-person variability across cognitive tests that is higher in PWH and is thought to reflect cognitive dyscontrol. To assess whether cognitive IIV in the laboratory is associated with self-reported executive dysfunction in daily life among older PWH. Participants included 71 PWH aged ≥50 years who completed six subtests from the Cogstate battery and two subscales from the Frontal Systems Behavior Scale (FrSBe; self-report version). Cognitive IIV was calculated from the Cogstate as the coefficient of variation derived from age-adjusted normative T scores. Cognitive IIV as measured by the Cogstate showed a significant, positive, medium-sized association with current FrSBe ratings of executive dysfunction but not disinhibition. Higher cognitive IIV in the laboratory as measured by the Cogstate may be related to the expression of HIV-associated symptoms of executive dysfunction in daily life for older PWH.

Genetic Risk for Alzheimer's Disease Alters Perceived Executive Dysfunction in Cognitively Healthy Middle-Aged and Older Adults.

Subjective cognitive complaints (SCC) may be an early indicator of future cognitive decline. However, findings comparing SCC and objective cognitive performance have varied, particularly in the memory domain. Even less well established is the relationship between subjective and objective complaints in non-amnestic domains, such as in executive functioning, despite evidence indicating very early changes in these domains. Moreover, particularly early changes in both amnestic and non-amnestic domains are apparent in those carrying the Apolipoprotein-E ɛ4 allele, a primary genetic risk for Alzheimer's disease (AD). This study investigated the role of the ɛ4 allele in the consistency between subjective and objective executive functioning in 54 healthy, cognitively intact, middle-aged and older adults. Participants (Mage = 64.07, SD = 9.27, range = 48-84; ɛ4+ = 18) completed the Frontal Systems Behavior Scale (FrSBe) Executive Dysfunction Scale (EXECDYS) to measure subjective executive functioning (SEF) and multiple executive functioning tasks, which were condensed into a single factor. After accounting for age, depression, and anxiety, objective executive functioning performance significantly predicted SEF. Importantly, ɛ4 moderated this effect. Specifically, those carrying the ɛ4 allele had significantly less accurate self-awareness of their executive functioning compared to ɛ4 non-carriers. Utilizing an approach that integrates self-evaluation of executive functioning with objective neurocognitive assessment may help identify the earliest signs of impending cognitive decline, particularly in those with genetic risk for AD. Such an approach could sensitively determine those most prone to future cognitive decline prior to symptom onset, when interventions could be most effective.

Sleep quality and executive function in a diverse sample of healthy young adults

Few studies examine the relationship between sleep and executive function in diverse samples of young adults. Our research aims to fill this gap by analyzing how self-reported sleep quality is related to informant-rated executive function as a whole and its working memory component in a diverse sample of 29 healthy college students. Using the self-report measure, the Pittsburgh Sleep Quality Index (PSQI), we divided our sample into two groups based on cutoff criteria (score ≥5: poor sleep): good sleep quality (n = 11) and poor sleep quality (n = 18). Participants were on average 20.86 years old. Informants rated participants’ executive functioning and working memory using the Frontal Systems Behavior Scale (FrSBe) and Behavior Rating Inventory of Executive Function (BRIEF). Individuals in the poor sleep quality group were reported as having significantly worse executive function and working memory scores. Young adult college students who report less than 7 hours of sleep per night have lower scores on informant measures of working memory and executive function. This study raises awareness about how self-reported sleep experiences are related to other’s observation of cognitive abilities in everyday life in a diverse young adult sample.

Behavioral disinhibition in stroke.

Post-stroke behavioral disinhibition (PSBD) is common in stroke survivors and often presents as impulsive, tactless or vulgar behavior. However, it often remains undiagnosed and thus untreated, even though it can lead to a longer length of stay in a rehabilitation facility. The proposed study will aim to evaluate the clinical, neuropsychological and magnetic resonance imaging (MRI) correlates of PSBD in a cohort of stroke survivors and describe its 12-month course. This prospective cohort study will recruit 237 patients and will be conducted at the Neurology Unit of the Prince of Wales Hospital. The project duration will be 24 months. The patients will be examined by multiple MRI methods, including diffusion-weighted imaging, within 1 week after stroke onset. The patients and their caregivers will receive a detailed assessment at a research clinic at 3, 9 and 15 months after stroke onset (T1, T2 and T3, respectively). The disinhibition subscale of the Frontal Systems Behavior Scale (FrSBe) will be completed by each subject and caregiver, and scores ≥65 will be considered to indicate PSBD.A stepwise logistic regression will be performed to assess the importance of lesions in the regions of interest (ROIs), together with other significant variables identified in the univariate analyses. For patients with PSBD at T1, the FrSBe disinhibition scores will be compared between the groups of patients with and without ROI infarcts, using covariance analysis. The demographic, clinical and MRI variables of remitters and non-remitters will be examined again at T2 and T3 by logistic regression. This project will be the first MRI study on PSBD in stroke survivors. The results will shed light on the associations of lesions in the orbitofrontal cortex, anterior temporal lobe and subcortical brain structures with the risk of PSBD. The obtained data will advance our understanding of the pathogenesis and clinical course of PSBD in stroke, as well as other neurological conditions. The findings are thus likely to be applicable to the large population of patients with neurological disorders at risk of PSBD and are expected to stimulate further research in this field.

Prospective and Retrospective Metacognitive Abilities and Their Association with Impaired Self-awareness in Patients with Traumatic Brain Injury.

Metacognitive impairment often occurs in patients with traumatic brain injury (TBI) and is associated with clinical problems. The aim of this study was to clarify the pathology of metacognitive impairment in TBI patients using a behavioral task, clinical assessment of self-awareness, and lesion-symptom mapping. Metacognitive abilities of TBI patients and healthy controls were assessed using a modified perceptual decision-making task. Self-awareness was assessed using the Patient Competency Rating Scale and the Frontal Systems Behavior Scale. The associations between estimated metacognitive abilities, self-awareness, and neuropsychological test results were examined. The correspondence between metacognitive disabilities and brain lesions was explored by ROI-based lesion-symptom mapping using structural magnetic resonance images. Overall, 25 TBI patients and 95 healthy controls were included in the analyses. Compared with that in healthy controls, the prospective metacognitive ability of TBI patients was lower, with metacognitive evaluations revealing a bias toward overestimating their abilities. Retrospective metacognitive ability showed a negative correlation with self-awareness but not with neuropsychological test results. In the lesion-symptom mapping analysis, the left pFC was associated with lower retrospective metacognitive ability. This study contributes to a better understanding of the pathology of metacognitive and self-awareness deficits in TBI patients and may explain the cause of impaired realistic goal setting and adaptive behavior in these patients.

43 Chronic Neurobehavioral and Cognitive Symptoms in Combat Deployed Military Service Personnel With and Without History of Blast-Related Mild Traumatic Brain Injury

Objective:Investigate the relationship of chronic neurobehavioral and cognitive symptoms in military personnel with history of blast-related mild TBI and compare to a well-matched group of combat-deployed controls.Participants and Methods:274 participants (mean age=34 years; mean education=14.75 years; 91.2% male) enrolled in the EVOLVE longitudinal study of combat-deployed military personnel were subdivided into those with history of blast TBI (n=165) and controls without history of blast exposure and TBI (n=109). As part of a larger study, we conducted a sub-analysis of 5-year follow up data. We focused on group differences (Mann-Whitney U) and correlational relationships between self-report neurobehavioral symptoms via the Frontal Systems Behavior Scale (FrSBE) and cognitive performances on measures of attention, working memory, processing speed, and executive functioning including D-KEFS Color Word Interference (CWI), Trailmaking A and B, and the Conners Continuous Performance Test (CPT).Results:The Blast TBI group reported higher levels of neurobehavioral symptoms on the FrSBE (p<.001), including domains of apathy (p<.001), disinhibition (p<.001), and executive dysfunction (p<.001), compared to Controls. On cognitive measures, group differences were observed on CWI Inhibition/Switching (p=.008), Trails B time (p=.010), and CPT commission errors (p=.014), such that the Blast TBI group performed worse than Controls. No significant group differences were observed for CPT omission errors or CPT hit rate (p’s>.05). After adjustment for multiple comparisons, greater FrSBE apathy correlated with slower performance on Trails A for Blast TBI (r=0.22, p=.014) but not Controls. Apathy endorsement was not significantly related to CPT omission errors for either group (p’s>.05). Higher endorsement of disinhibition symptoms was associated with worse performance on CWI Inhibition (Blast TBI: r=-0.19, p=.036; Controls: r=-0.28, p=.012) and Inhibition/Switching (Blast TBI: r=-0.23, p=.010; Controls: r=-0.29, p=.010) conditions for both groups, whereas only the Blast TBI group showed significant relationships between disinhibition symptoms and Trails B-A time (r=0.20, p=.025) and CPT commission errors (r=.18, p=.038). Higher endorsement of executive dysfunction correlated with poorer performance for Trails B-A for both groups (Blast TBI: r=.24, p=.009; Controls: r=.24, p=.030).Conclusions:Our findings reveal that at 5-year follow up, military personnel with history of blast-related mild TBI reported significantly greater neurobehavioral symptoms and performed lower on standardized measures of executive functioning, relative to combat-deployed controls without TBI or blast exposure. Significant relationships between neurobehavioral symptoms and cognitive performance were present in both groups. However, these relationships were more pronounced in the Blast TBI group, including greater apathy associated with slower visual tracking as well as greater endorsement of disinhibition associated with set-switching. Objective measures of response inhibition were related to disinhibition endorsement for both groups, though impulsive errors were more pronounced for the Blast TBI group. Our results suggest chronic cognitive and neurobehavioral symptoms are present in military personnel with history of blast TBI exposure, and also discrepant from a well-matched control group of combat deployed military personnel. Future studies of this population should explore models to predict cognitive performance from neurobehavioral symptoms in military personnel, as this could inform treatment approaches for those at greatest risk of cognitive change.

16 Relative Contributions of Motor and Non-Motor Symptoms to Caregiver Burden in Parkinson’s Disease Patients Being Evaluated for Deep Brain Stimulation

Objective:Parkinson’s disease (PD) is a neurodegenerative disorder affecting over 10 million people worldwide. PD is characterized by both motor (e.g., tremor, rigidity, and bradykinesia) and non-motor (including cognitive impairment and neuropsychiatric symptoms such as apathy, disinhibition, executive dysfunction) symptoms. Caregiver burden is prevalent in those providing care for patients with PD and can result in negative health complications. Past work shows associations between motor symptoms, cognitive impairment, neuropsychiatric symptoms, and caregiver burden in PD. However, their relative contributions are poorly understood. This study examined these relationships, hypothesizing that while motor symptoms, cognitive impairment, and neuropsychiatric symptoms would all affect caregiver burden, neuropsychiatric symptoms would predict burden above and beyond the contribution of the other factorsParticipants and Methods:Participants were 42 people living with PD who were assessed at a hospital-based tertiary movement disorders specialty clinic for deep brain stimulation (DBS) candidacy evaluation with their caregiver. Motor exam was assessed by a PD specialist using the Unified Parkinson’s Disease Rating Scale (UPDRS). The Mini Mental State Examination (MMSE) assessed global cognition. Frontal Systems Behavior Scale (FrSBe) Family Form captured caregiver ratings of neuropsychiatric symptoms under 3 subscales: apathy, disinhibition, and executive dysfunction. The Multidimensional Caregiver Strain Index (MCSI) captured caregiver burden. Linear regression analyses examined relationships between caregiver burden (MCSI) and motor symptoms (UPDRS), cognitive impairment (MMSE), and neuropsychiatric symptoms (FrSBe).Results:Using linear regression analyses, cognitive impairment (R2=0.08, F(1,41)=4.42, p=0.04) and neuropsychiatric symptoms (R2=0.35, F(1, 41)=21.0, p<0.01) predicted caregiver burden but motor symptoms did not (R2=0.03, F(1,41)=1.30, p=0.26). Hierarchical linear regression revealed that neuropsychiatric symptoms predicted caregiver burden above and beyond the contribution of cognitive impairment (AR2=0.28, AF(1)=12.7, p=0.001), accounting for an additional 28% of the variance in caregiver burden. Follow-up linear regression to examine the relationships between caregiver burden and the FrSBe subscales indicated that apathy (p<0.001), versus disinhibition (p=0.16) and dysexecutive behaviors (p=0.80), was the driver of the significant relationship.Conclusions:Consistent with our hypothesis, results revealed that cognitive impairment and neuropsychiatric symptoms (specifically apathy) were independent predictors of caregiver burden, with neuropsychiatric symptoms predicting caregiver burden above and beyond the contribution of cognitive impairment. Somewhat surprisingly, motor symptoms were not a predictor of caregiver burden contrary to some previous research, though findings are mixed. Results highlight the importance of assessing for neuropsychiatric symptoms in PD, which may be overlooked by care providers relative to motor or cognitive symptoms, but which appear stressful to caregivers. Future directions include reexamining results in a larger more heterogenous sample including people living with PD at different disease stages (i.e., everyone in the present sample had severe enough symptoms to be considering DBS). Cognitive measures of executive functioning (which are more specific to PD than measures of global cognition) should also be included in future works. Development of supportive caregiver interventions specifically targeting apathy in PD may be useful. Longitudinal designs would be helpful to reexamine relationships following DBS surgery, as there are some reports of increased neuropsychiatric symptoms following the procedure.

Inhibitory control impairment in social disinhibition following severe traumatic brain injury: An experimental study using social and nonsocial go/no-go task.

Inhibitory control impairment is highly prevalent following traumatic brain injury (TBI). There have not been any empirical investigations into whether this could explain social disinhibition following severe TBI. Further, social context may be important in studying social disinhibition. Therefore, the objectives of this research study were to investigate the role of inhibitory control impairment in social disinhibition following severe TBI, using a social and a nonsocial task. This was a between-group comparative study. Twenty-six adult participants with severe TBI and 27 sex, age, and education-matched controls participated. Social disinhibition was assessed using the Frontal Systems Behavior Scale and the Social Disinhibition Interview. Inhibitory control was assessed using a social and a nonsocial go/no-go task. Two-way mixed analyses of covariance were used to test study hypotheses. Overall, participants were slower, F(1, 43) = 9.841, p = .003, ηp² = .245, and made more errors of commission on no-go trials, F(1, 44) = 11.560, p = .001, ηp² = .208, on the social go/no-go task. When categorized based on disinhibition level (high vs. low), the high disinhibition group made more errors on the social task, F(1, 41) = 4.095, p = .050, ηp² = .091, than the low disinhibition group, and more errors on the social, compared to nonsocial task, task-group interaction, F(1, 41) = 7.233, p = .010, ηp² = .150. Social disinhibition appears to be associated with inhibitory control impairment, although this is only evident when a social task is used. No relationship between social disinhibition and response speed was found. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

28 Cognitive, Emotional, and Interactional Determinants in Loneliness, in a Heterogeneous Sample of Puerto Ricans with ABI in the Chronic Phase

Objective:An acquired brain injury (ABI) is a neurological pathology that generates a physical injury in the brain. These include cerebrovascular accidents (CVA) and traumatic brain injuries (TBI). Brain injuries can cause cognitive, emotional, and social problems, which have the potential to severely alter a person’s independence and quality of life. Loneliness, thesubjective experience of social isolation, has been shown to be the best predictor of mental health problems and poorquality of life in patients with ABI. This study aimed to explore the relationship between cognitive, emotional, and social determinants and loneliness in Puerto Ricans with ABI in the chronic phase.Participants and Methods:Cross-sectional, exploratory, and correlational methods were implemented. Assessments included the Frontal Systems Behavioral Scale - Spanish version (FrSBe-SP), Perth Emotional Reactivity Scale -Spanish version (PERS), Anticipated Stigma and Concealment (ASC), and the University of California Los Angeles - Loneliness Scale (UCLA-LS).Results:A total of seventeen participated (n=17). Twenty-nine percent of participants were female. Forty-seven percent had history of previous CVA and fifty-two percent had history of TBI. Correlational analyses suggest a positive and significant relationship between executive dysfunction (FrSBe-SP) and feelings of loneliness (UCLA-LS) (p=.601), as well as a positive and significant relationship between neuroticism-negative emotional reactivity (PERS) and feelings of loneliness (UCLA-LS) (p=.736). Correlational analysis suggests there is no significant relationship between anticipated stigma (ASC) and feelings of loneliness (UCLA-LS) (p=.282).Conclusions:Our findings suggest that there is a significant relationship between cognitive determinants (executive functions) and emotional determinants (neuroticism) with feelings of loneliness in people with a history of ABI. These results support the connection between executive dysfunction, the tendency to experience negative emotions, and the subjective experience of loneliness, consistent with previous studies. However, our study did not find any significant relationship between interactional determinants, such as stigma and concealment, and loneliness. Understanding the role of cognition, emotions, and social variables in reported feelings of loneliness is important for clinical neuropsychological assessment and rehabilitation interventions.

61 Increased Apathy Post-Laser Ablation for Refractory Obsessive-Compulsive Disorder

Objective:Severe OCD is often nonresponsive to pharmacological and behavioral therapies and thus surgical interventions are emerging. Surgical interventions have proven to be efficacious for treating refractory OCD, however limited publications suggest 22–40% of patients experience transient apathy and disinhibition post-surgery (McLaughlin et al., 2021). Apathy is highly associated with the same brain regions, the prefrontal cortex, striatum, and thalamus, which have also been implicated in OCD symptoms (Le Heron et al., 2018). Prior research noting post-surgical changes in apathy in OCD either used physician observations or less precise surgical methods (i.e., gamma knife or radiofrequency ablation). Apathy has also been highly associated with depression and executive dysfunction (Raffard et al, 2020) and often not co-assessed in prior studies. The newest intervention, cutting-edge MR-guided laser interstitial thermal therapy (LITT), limits damage outside the region of interest by precise control of thermal application in real-time. Thus, the current case series aims to investigate objective patient-reported change in apathy, disinhibition, depression, and executive dysfunction following anterior capsulotomy via this newest surgical approach for OCD.Participants and Methods:In this retrospective study, the responses of ten consecutive patients pre- and post-LITT on the following measures were examined: Frontal Systems Behavior Scale (FrSBe), Beck Depression Inventory-II (BDI-II), and Yale Brown Obsessive-Compulsive Scale (Y-BOCS). Reliable Change Index (RCI) was used to evaluate meaningful change in pre- and post-LITT self-reported levels of apathy, disinhibition, executive dysfunction, along with depressive symptoms. Per prior published guidelines, patient-reported Y-BOCS (range 0–40) scores were used to measure OCD symptoms with 24–34 % score reduction representing partial and 35% or greater score reduction representing full response (Pepper et al., 2019).Results:Seven patients (70%) were male, with a sample mean age of 38.4 (SD=13.6) and a mean of 14.6 (SD =2.27) years of education. Mean Y-BOCS score decreased from 32 (SD=5.3) before surgery to 18.8 (SD=11.1) after. Over 65% had partial or full response in OCD symptoms post-surgery. Six patients endorsed increased apathy, with others endorsing no change. Half of the non-responders reported this increase in apathy. The cohort remained relatively stable in disinhibition and executive dysfunction. Over half the cohort demonstrated a significant decrease in depressive symptoms. Interestingly, two of the non-responders and one responder endorsed increased apathy despite stable or improving depressive symptoms, disinhibition, and executive dysfunction.Conclusions:Surgical interventions for psychiatric disorders are emerging quickly and being refined daily. In this cohort, anterior capsulotomy via LITT provided full or partial OCD recovery for most patients. However, most patients reported significant increases in apathy, despite experiencing a decrease in depressive symptoms, with stable disinhibition and executive dysfunction. Despite these promising improvements in OCD symptomatology via LITT, impact of surgery on apathy levels is clearly warranted using objective, quantifiable methods. As apathy has consistently been related to functional impairment and poorer quality of life, understanding this outcome is imperative in larger trials. Better understanding of this finding and underlying circuity will allow patients to be fully informed regarding this promising surgical intervention.

1 Post-stroke Apathy, Pseudobulbar Affect and Memory Loss Hinder Return-to-Work After CVA

Objective:Post-stroke depression (PSD) and anxiety disorders are the most common psychiatric issues that occur after cerebrovascular accident (CVA), with prevalence rates of up to 50%. Less studied, post-stroke apathy and pseudobulbar affect (PBA) also occur in a subset of individuals after CVA leading to reduced quality of life. Cognitive impairments also persist, especially memory, language, and executive difficulties. Residual cognitive and emotional sequelae after CVA limit return-to-work with between 20-60% becoming disabled or retiring early. This study examined the frequency and relative contribution of cognitive, behavioral and emotional factors for not returning-to-work after CVA.Participants and Methods:Participants included 242 stroke survivors (54% women, average age of 59.2 years) who underwent an outpatient neuropsychological evaluation approximately 13 months after unilateral focal CVA. Exclusion criteria were a diagnosis of dementia, comprehension issues identified during assessment, multifocal or bilateral CVA, and inpatients. Predictors of return-to-work included in logistic regression analyses were psychological (depressive and anxiety disorders, apathy, PBA, history of psychiatric treatment before stroke) and neuropsychological (memory, executive functioning) variables. Depression and anxiety were diagnosed using DSM-IV-TR or -5 criteria. Apathy was operationalized as diminished goal-directed behavior, reduced initiation and decreased interest that impacted daily life more than expected from physical issues after stroke (including self- and family-report using the Frontal Systems Behavior Scale [FrSBe]). PBA was defined by the Center for Neurologic Study-Lability Scale and clinical judgment based on chart review.Results:Post-stroke apathy persisted in 27.3% of patients 13 months after stroke, PBA persisted in 28.2% of patients (i.e., uncontrollable crying spellings not simply attributable to depression alone, uncontrollable laughing spells), anxiety disorders persisted in 18.6% of patients (mainly panic attacks), and PSD persisted in 29.8% of patients. Memory loss persisted in 67.4% of patients and executive difficulties persisted in 74.4% of patients. Thirteen months after stroke, 34.7% of individuals had returned-to-work and 47.1% had not returned-to-work. The other 18.2% were not working either at the time of their stroke or after the stroke. Logistic regression indicated that post-stroke apathy, PBA, and memory loss were significant predictors of not returning-to-work (odds ratio p < 0.001). Patients who experienced post-stroke apathy were 7.1 times more likely to not return-to-work after stroke (p=0.008), those who suffered from PBA were 4.8 times more likely to not return-to-work (p=0.028), and those with memory loss were 6.6 times more likely to not return-to-work (p=0.005). PSD, history of treatment for psychiatric issues before the stroke, presence of an anxiety disorder after stroke, and executive difficulties were not significant predictors (p’s>0.05).Conclusions:Results replicate the finding that return-to-work is hindered by residual cognitive deficits after stroke and extends previous research by clarifying the multifactorial emotional and behavioral barriers to not returning-to-work. Results highlight the importance of quantifying post-stroke apathy and pseudobulbar affect in a standard neuropsychological work-up after stroke to identify candidates for services to facilitate efforts in returning to work (e.g., vocational rehabilitation services, psychotherapy, interventions for decreased initiation).

6 The Relationship Between Inhibitory Control Impairment in Social Disinhibition Following Severe Traumatic Brain Injury

Objective:Inhibitory control impairment is highly prevalent following traumatic brain injury (TBI). There have not been any empirical investigations into whether this could explain social disinhibition following severe TBI, i.e. socially inappropriate behaviour of verbal, physical or sexual nature. Further, social context has proven to be important in studying social disinhibition and using a social version of an established task for the assessment of inhibitory control may provide a new perspective. Therefore, the objectives of this research study were to investigate the role of inhibitory control impairment in social disinhibition following severe TBI, using a social and a non-social task. We hypothesized that people with TBI and clinical levels of social disinhibition would perform worse on both task versions, when compared to those with low disinhibition levels. Further, we hypothesized that participants high on social disinhibition would perform worse on the social, when compared to the non-social version.Participants and Methods:We conducted a between-group comparative study. Twenty-six adult participants with severe TBI were matched with 27 adult, healthy controls based on gender, age and education. Frontal Systems Behavior Scale and Social Disinhibition Interview were used to assess social disinhibition. A computerized task based on the cued go/no-go paradigm was used to assess inhibitory control. We included two versions of this task – a coloured (non-social) Go/No-Go with different colored rectangles, and an emotional (social) Go/No-Go with emotional faces serving as ‘go‘ and ‘no-go‘ cues. Two-way mixed ANCOVAs were used to test between-group differences in errors of commission and response speed.Results:Unexpectedly, the TBI and the control group did not significantly differ on their levels of depression, anxiety, stress, or their level of social disinhibition. Overall, participants were slower (F(1,47) = 15.212, p<.001, ηp2 = .245) and made more errors of commission on no-go trials (F(1,44) = 11.560, p = .001, ηp2 = .208) on the social Go/No-Go task. There was no main effect of participants‘ brain injury status on errors of commission on no-go trials or mean reaction times. When categorized based on disinhibition level (high vs low), participants in the highdisinhibition group made more errors on the social task (F(1,41) = 4.095, p = .050, ηp2 = .091) than those in the low-disinhibition group, and more errors on the social, compared to the non-social task (task-group interaction (F(1,41) = 7.233, p = .010, ηp2 = .150)).Conclusions:Based on these initial results, social disinhibition is associated with inhibitory control impairment, although this is only evident when a social inhibitory control task is used for assessment. We did not find any relationship between social disinhibition and the speed with which people react to stimuli. The results of this study add to the conceptualization of social disinhibition that is commonly present after severe TBI.

A regulatory pathway model of neuropsychological disruption in Havana syndrome.

In 2016 diplomatic personnel serving in Havana, Cuba, began reporting audible sensory phenomena paired with onset of complex and persistent neurological symptoms consistent with brain injury. The etiology of these Anomalous Health Incidents (AHI) and subsequent symptoms remains unknown. This report investigates putative exposure-symptom pathology by assembling a network model of published bio-behavioral pathways and assessing how dysregulation of such pathways might explain loss of function in these subjects using data available in the published literature. Given similarities in presentation with mild traumatic brain injury (mTBI), we used the latter as a clinically relevant means of evaluating if the neuropsychological profiles observed in Havana Syndrome Havana Syndrome might be explained at least in part by a dysregulation of neurotransmission, neuro-inflammation, or both. Automated text-mining of >9,000 publications produced a network consisting of 273 documented regulatory interactions linking 29 neuro-chemical markers with 9 neuropsychological constructs from the Brief Mood Survey, PTSD Checklist, and the Frontal Systems Behavior Scale. Analysis of information flow through this network produced a set of regulatory rules reconciling to within a 6% departure known mechanistic pathways with neuropsychological profiles in N = 6 subjects. Predicted expression of neuro-chemical markers that jointly satisfy documented pathways and observed symptom profiles display characteristically elevated IL-1B, IL-10, NGF, and norepinephrine levels in the context of depressed BDNF, GDNF, IGF1, and glutamate expression (FDR < 5%). Elevations in CRH and IL-6 were also predicted unanimously across all subjects. Furthermore, simulations of neurological regulatory dynamics reveal subjects do not appear to be "locked in" persistent illness but rather appear to be engaged in a slow recovery trajectory. This computational analysis of measured neuropsychological symptoms in Havana-based diplomats proposes that these AHI symptoms may be supported in part by disruption of known neuroimmune and neurotransmission regulatory mechanisms also associated with mTBI.

Action control and selection in social disinhibition following severe TBI: a pavlovian-to-instrumental transfer and outcome devaluation study

ABSTRACT Introduction Social disinhibition is a significant sequela of severe traumatic brain injury (TBI). Some research suggests that it could reflect a deficiency in goal-directed behavior. The current study aimed to test whether these inappropriate behaviors tend to be deficient in goal-directed control, that is, triggered more by environmental stimuli than by the known consequences of their actions. Method We used a between-group design with 25 adult participants with severe TBI, and 27 control participants. Social disinhibition was measured using Frontal Systems Behavior Scale and Social Disinhibition Interview. Changes in reward-related goal-directed behavior were evaluated using a computer-based task in which we assessed the influence of cues predicting reward and of reward devaluation on choice performance. Results We found no difference in the levels of social disinhibition between the TBI and control groups and, using mixed two-way ANCOVAs, no overall effect of the stimuli or outcome devaluation. However, after combing these groups and splitting them based on their disinhibition levels, a significant interaction between group (High vs Low disinhibition) and reward type (Valued vs Devalued) in sensitivity to outcome devaluation test (F = 5.99, p = .01, ηp2 = .13) appeared. Comparing with the baseline rate of responding, the Low disinhibition group decreased their responding to devalued and increased their responding to still-valued outcomes. In contrast, the High disinhibition group showed the opposite pattern of choice performance. Conclusions It appears that people with clinical levels of social disinhibition are both prone to outcome-response priming effects and insensitive to changes in the value of the consequences of their actions, that is, despite evidence they were aware of the reduction in the value of their actions’s outcomes, people with high-level disinhibition kept performing those actions. This pattern has the hallmarks of a habit suggesting their disinhibition reflects a loss of executive control.

Pre-treatment frontal beta events are associated with executive dysfunction improvement after repetitive transcranial magnetic stimulation for depression: A preliminary report

Repetitive transcranial magnetic stimulation (rTMS) is an established clinical treatment for major depressive disorder (MDD) that has also been found to improve aspects of executive functioning. The objective of this study was to examine whether oscillatory burst-like events within the beta band (15–29 Hz) prior to treatment could predict subsequent change in self-reported executive dysfunction (EDF) across a clinical course of rTMS for MDD. Twenty-eight adults (64% female) with MDD completed the self-report Frontal Systems Behavior Scale (FrSBe) and provided eyes-closed resting-state electroencephalography (EEG) before and after a clinical course of rTMS therapy for primary MDD. The rate, power, duration, and frequency span of transient EEG measured oscillatory beta events were calculated. Events within delta/theta and alpha bands were examined to assess for beta specificity. After controlling for improvement in primary depressive symptoms, a lower rate of beta events at F3, Fz, F4, and Cz prior to rTMS treatment was associated with a larger improvement in EDF after rTMS treatment. In addition, a decrease in beta event rate at Fz pre-to-post treatment was associated with a larger improvement in EDF after treatment. Results were largely specific to the beta band. In this study, the rate of frontrocentral beta events prior to treatment significantly predicted the likelihood of subsequent improvement in EDF symptoms following a clinical course of rTMS for MDD. These preliminary findings suggest the potential utility of EEG measured beta events and rTMS for targeting EDF across an array of neuropsychiatric disorders.

A - 172 STEP-Home Intervention Improves Inhibitory and Anger Control, Reintegration, and Neurobehavioral Symptoms in Post-9/11 Veterans with TBI and Other Common Comorbidities.

Post-9/11U.S. Veterans are clinically complex with multiple co-occurring health conditions contributing to morbidity/mortality and decreased quality of life. TBI diagnosis can worsen these outcomes. STEP-Home is a cognitive-behavioral transdiagnostic intervention for TBI and common comorbidities. This study determines if STEP-Home improves anger control, frontal system function, civilian readjustment, neurobehavioral symptoms, and work/life functioning in post-9/11 Veterans. TBI may influence Veterans' ability to learn core skills and, thus, impact response to treatment. Treatment outcomes for Veterans with and without TBI will be explored. 56 (39M/17F; mean age = 39.9) post-9/11 Veterans with high rates of psychiatric comorbidity, with and without TBI received 12weeks of the STEP-Home cognitive-behavioral intervention. Assessments at baseline, posttreatment (12weeks), and follow-up (12weeks posttreatment) included: State-Trait Anger Expression Inventory 2 (STAXI-2); Military to Civilian Questionnaire (M2CQ); Post-Deployment Readjustment Inventory (PDRI); Frontal Systems Behavioral Scale (FrSBe); Neurobehavioral Symptom Inventory (NSI); World Health Disability Scale (WHODAS); PTSD Checklist (PCL-5); Depression Anxiety and Stress Scale (DASS-21). STEP-Home significantly improved anger expression (STAXI-2 p = 0.0320), inhibitory control (FrSBe p = 0.0001), and reintegration status (MC2Q p = 0.0001; PDRI p = 0.0097) posttreatment. Similar improvements were seen in neurobehavioral symptoms, work/life functioning, PTSD, depression, and stress (p's < 0.01). Treatment gains were maintained at follow-up (p's < 0.001). Treatment response did not differ by TBI status. STEP-Home teaches Veterans cognitive-behavioral skills to improve anger and impulse control, executive functioning, reintegration, and work/life functioning. Treatment gains were comparable for Veterans with and without TBI. This is critical given TBI prevalence among post-9/11 Veterans and the need for additional palatable treatment options.

인지재활에서 고기능 인지 평가도구 사용에 관한 문헌고찰 : 집행기능을 중심으로

Objective: This study aims to conduct an analysis according to the frequency of use, implementation method, and evaluation area of high-functional cognitive assessment tool. Methods: A systematic review of literature published from January 2017 to December 2022 was conducted, and the frequency, subjects, evaluation methods, and evaluation areas of 9 evaluation tools extracted from 45 papers suitable for the selection criteria were analyzed. Results: The most commonly used frontal lobe evaluation tool was identified as BRIEF. As a result of analyzing the subjects using the evaluation tool, Cerebral Palsy was the most common subject diagnosis. Most of the evaluation types were task performance assessments. The frontal systems behavior scale (FrSBe), dysexecutive questionnaire (DEX), and computerized neurocognitive battery (CNB) included areas for evaluating emotional and psychosocial cognitive components along with executive functions, and the executive function praxis test (EFPT) was the only ADL-based task performance assessment Most of the assessments were reliable and valid. Conclusion: The number of evaluation tools measuring both 'Hot executive function (EF)' and 'Cold EF' was small, and the number of evaluation tools based on the practice of daily tasks was also limited. Both development and research on a comprehensive frontal lobe function evaluation tool that complements this point are needed to evaluate a wider frontal lobe area and enable independent functions in daily life, which are important for rehabilitation treatment.

Apathy Among Persons Living With HIV Is Associated With Lower Self-efficacy for Health Care Provider Interactions.

Apathy is common in persons with HIV (PWH) and has been associated with a variety of health outcomes. We examined the association between apathy and self-efficacy for health care provider interactions in 142 PWH. A composite score comprised of the apathy subscale of the Frontal Systems Behavioral Scale and the vigor-activation scale of the Profile of Mood States was used to measure apathy. Self-efficacy for health care provider interactions was measured using the Beliefs Related to Medication Adherence - Dealing with Health Professional subscale. Higher levels of apathy were associated with lower self-efficacy for health care provider interactions at a medium effect size, independent of mood disorders, health literacy, and neurocognition. Findings suggest that apathy plays a unique role in self-efficacy for health care provider interactions and support the importance of assessment and management of apathy to maximize health outcomes among PWH.

Concordance of informant and self-reported ratings on the Frontal Systems Behavior Scale in adult survivors of pediatric brain tumor

Objective: It has been theorized that pediatric brain tumor survivors may have reduced insight into their executive functioning. Agreement between informants and survivors has been used to probe this theory, but findings have been inconsistent. This study sought to expand on prior work by examining the relationship between participant role and ratings on the Frontal Systems Behavior Scale (FrSBe) among 73 adult survivors and their informants. This study also sought to test whether agreement on scores varied as a function of tumor treatment. Method: Dyadic mixed effects models examined the relationship between participant ratings on FrSBe subscales and the role of a participant (survivor or informant). Intraclass correlations (ICC) were used to calculate reliable change indices to evaluate significant divergence in self and informant agreement. Results: Dyadic mixed effects models showed an insignificant relationship between participant role and ratings on the FrSBe apathy and executive dysfunction subscales. Participant role was related to ratings on the disinhibition subscale of the FrSBe. The ICC for apathy was ICC = .583, for disinhibition ICC = .420, and for executive dysfunction ICC = .373. Significant divergence in scores did not vary by history of chemoradiation. Conclusions: Results demonstrate an effect of role on one FrSBe subscale and weak to moderate agreement between survivor and informant scores, which suggests that agreement between informants and survivors varies by FrSBe domain. The strongest relationship between survivors and informants was seen on apathy, which suggests that apathy is a shared concern for survivors and their families.

Exploring neuropsychological underpinnings of poor communication after traumatic brain injury: The role of apathy, disinhibition and social cognition.

Dysarthria, aphasia and executive processes have been examined for their role in producing impaired communicative competence post traumatic brain injury (TBI). Less understood is the role of emotional dysregulation, that is, apathy and disinhibition, and social cognition, that is, reading and interpreting social cues. In this study, we examined 49 adults with moderate to severe TBI and 18 neurologically healthy adults. We hypothesised that apathy and disinhibition would predict communication outcomes as would social cognition. We also predicted that apathy and disinhibition would influence social cognition. Communication outcomes were measured by the La Trobe Communication Questionnaire (LCQ) and the Social Skills Questionnaire-TBI (SSQ-TBI). Apathy and disinhibition were measured by the Frontal Systems Behavior Scale (FrSBe). We measured four aspects of social cognition: emotion perception and theory of mind using The Awareness of Social Inference Test (TASIT) and the Complex Audio-Visual Evaluation of Affect Test (CAVEAT), empathy using the Questionnaire of Cognitive and Affective Empathy (QCAE) and the Balanced Emotional Empathy Scale (BEES), and alexithymia using the Toronto Alexithymia Scale (TAS-20) and the Bermond-Vorst Alexithymia Questionnaire. Consistent with predictions, the LCQ and SSQ-TBI were associated with disinhibition and the LCQ was also associated with apathy. The LCQ was associated with the full range of social cognition constructs although the SSQ-TBI was not. Finally, apathy and disinhibition predicted a number of social cognition measures. These results are discussed in relation to understanding the nature of communication disorders following TBI and how they are measured, as well as the interrelation between emotion dysregulation and social cognition. What is already known on this subject The role of emotional dysregulation and social cognition in producing impaired communicative competence post traumatic brain injury (TBI) is not well understood. Although most adults with severe TBI have minimal or possibly no language impairment, they often struggle with functional communication in everyday situations. Many have been reported to be overtalkative, insensitive, childish and self-centred, displaying an inappropriate level of self-disclosure and making tangential and irrelevant comments. Conversely, some speakers with TBI have been noted to have impoverished communication, producing little language either spontaneously or in response to the speaker's questions and prompts. What this paper adds to existing knowledge We found that both apathy and disinhibition were strongly associated with the Latrobe Communication Questionnaire both empirically and conceptually, despite the LCQ being developed from a different, pragmatic orientation. Disinhibition was also associated with the Social Skills Questionnaire for TBI. We also found that poor social cognition scores predicted communication difficulties. Finally, we found that behavioural dysregulation itself, i.e., both apathy and disinhibition, predicted poor social cognition. What are the potential or actual clinical implications of this work? Our findings highlight the central role that apathy and disinhibition play in both communication and social cognition. These insights point to the importance of remediation to target behavioural and autonomic dysregulation as a means to improve everyday social function.