Impaired Thresholds Research Articles

Neighborhood resources are associated with neuropsychological outcomes among pediatric brain tumor survivors

Background: Cancer-related cognitive impairment in survivors of pediatric brain tumors is a public health concern, yet studies seldom explore the role of social determinants of health beyond treatment effects. We investigated the influence of neighborhood resources using the Child Opportunity Index (COI) on neuropsychological functioning in survivors. Methods: Intelligence (IQ) and untimed reading and math proficiency were assessed retrospectively in 190 survivors. Multiple regression analyses explored associations among the COI composite and indices (Education, Health-Environment, Social-Economic) and neuropsychological outcomes, controlling for cumulative neurological risk and treatment exposures (Neurological Predictor Scale; NPS) and parental education. Results: Performance was on average within normal limits: IQ (M = 94.08, SD = 15.85, d=.37) with 13.4% of scores below impairment thresholds; reading (M = 95.08, SD = 17.36, d=.28) and math calculation (M = 91.84, SD = 18.82, d=.43) with 16.92% and 20.63% of scores below impairment thresholds, respectively. Each COI domain predicted reading and IQ after controlling for NPS, parental education, and age at diagnosis; however, the Education domain was the only significant predictor of math outcomes. Conclusion: The COI domains significantly predicted IQ and untimed academic skills in survivors, revealing the critical role of neighborhood resources on cognition above and beyond parental education and treatment factors. This is among the first studies to illuminate the influence of neighborhood resources on cognition in survivors. Future research should examine neighborhood context, an understudied construct, with importance in the move toward precision medicine.

Cognitive Impairment in Atrial Fibrillation Patients: A Literature Review

Introduction: Atrial fibrillation (AF) has become one of the most significant health problems worldwide, warranting urgent answers to currently pending questions on the effects of AF on brain function. Recent evidence has emerged to show an association between AF and an increased risk of developing dementia and worsening of stroke outcomes. In the last two decades several reports have shown an association between AF and cognitive function, ranging from impairment to dementia. Purpose: To present data on cognitive impairment in atrial fibrillation patients. Materials and methods: The study material consisted of reviewed articles on the topic found on the globally accepted electronic databases, PubMed, Medline, Google Scholar, regarding cognitive decline in atrial fibrillation patients. The study material consisted of scientific books, reviews and research papers published online. Results: In the absence of clinical stroke, people with incident atrial fibrillation are likely to reach thresholds of cognitive impairment or dementia at earlier ages than people with no history of atrial fibrillation. Results in a large sample of patients show that AF may be associated with higher risk for both cognitive impairment and dementia in patients with preexisting stroke, even if there was significant heterogeneity in the analysis for cognitive impairment. Adequate oral anticoagulation and improved management of the overall cardiovascular risk profile in individuals with AF offer the promise of reducing the impact of AF on cognitive decline and dementia. Conclusion: AF is associated with higher risk of developing AD and dementia. Future studies should examine whether specific treatments, including optimal anticoagulation, can decrease this risk.

Intracranial Pressure Thresholds for Cerebral Autoregulation Impairment: Age-Stratified Analysis of Ultra-Low-Frequency Pressure Reactivity Index (UL-PRx) in Traumatic Brain Injury.

The study investigated the effectiveness of low-frequency sampling in detecting alterations in cerebrovascular reactivity (CVR) associated with changes in intracranial pressure (ICP) in patients with traumatic brain injury (TBI) across different age groups. The primary objective was to investigate an ICP threshold that indicates a decrease in CVR as evidenced by a significant increase in the ultra-low-frequency pressure reactivity index (UL-PRx). Additionally, the study aimed to develop an age-based categorization method for patients with TBI to investigate the differences between these ICP thresholds in different age groups. In this retrospective analysis, data from 263 patients with TBI were prospectively collected. ICP and mean arterial pressure were extracted from the hospital database at 5-min intervals. Demographic details, clinical presentation, computed tomography scans, neurosurgical interventions, and 12-months outcome were recorded. ICP versus UL-PRx values were categorized into ICP bins and graphically represented with boxplots for each age group, illustrating how as ICP values rise, there is a bin (age-tailored ICP [AT-ICP]) beyond which UL-PRx shows a sudden increase, indicating CVR loss. Homogeneous age groups were established to obtain a consistent AT-ICP threshold. The discriminatory ability of the AT-ICP thresholds was compared with the guideline-recommended thresholds by calculating the area under the Receiver Operating Characteristic curve of the ICP-derived indices (dose above threshold, and the hourly dosage above threshold). Age groups 0-5, 6-20, 21-60, 61-70, and 71-85years were the best age subdivisions, corresponding to AT-ICP thresholds of 20, 30, 35, 25, and 30mmHg, respectively. The AT-ICP thresholds exhibited better discriminative ability compared with the guideline-recommended thresholds. The AT-ICP thresholds offer a novel approach for estimating CVR impairment and the developed method represents an alternative solution to address the age stratification issue in patients with TBI.

Delays in blood collection and drug toxicology results among crash-involved drivers arrested for impaired driving

Objective The concentration of drugs in a driver’s system can change between an impaired driving arrest or crash and the collection of a biological specimen for drug testing. Accordingly, delays in specimen collection can result in the loss of critical information that has the potential to affect impaired driving prosecution. The objectives of the study were: (1) to identify factors that influence the time between impaired-driving violations and specimen collections (time-to-collection) among crash-involved drivers, and (2) to consider how such delays affect measured concentrations of drugs, particularly with respect to common drug per se limits. Method Study data included blood toxicology results and crash-related information from 8,923 drivers who were involved in crashes and arrested for impaired driving in Wisconsin between 2019 and 2021. Analyses examined how crash timing and severity influenced time-to-collection and the effects of delays in specimen collection on blood alcohol concentrations (BACs) and blood delta-9-tetrahydrocannabinol (THC) concentrations. Results The mean time-to-collection for the entire sample was 1.80 h. Crash severity had a significant effect on time-to-collection with crashes involving a fatality having the longest duration ( M = 2.35 h) followed by injury crashes ( M = 2.06 h) and noninjury crashes ( M = 1.69 h). Time of day also affected time-to-collection; late night and early morning hours were associated with shorter durations. Both BAC (r = −0.11) and blood THC concentrations (r = −0.16) were significantly negatively correlated with time-to-collection. Conclusions Crash severity and the time of day at which a crash occurs can result in delays in the collection of blood specimens after impaired driving arrests. Because drugs often continue to be metabolized and eliminated between arrest and biological specimen collection, measured concentrations may not represent the concentrations of drugs that were present at the time of driving. This has the potential to affect drug-impaired driving prosecution, particularly in jurisdictions whose laws specify per se impairment thresholds.

Longitudinal Associations Between Optimism and Objective Measures of Physical Functioning in Women.

Identifying factors contributing to sustained physical functioning is critical for the health and well-being of the aging population, especially as physical functioning may precede and predict subsequent health outcomes. Prior work suggests optimism may protect health, but less is known about the association between optimism and objective physical functioning measures as individuals age. To evaluate the longitudinal association between optimism and 3 physical functioning measures. This was a prospective cohort study using data from the Women's Health Initiative (WHI) with participants recruited from 1993 to 1998 and followed up over 6 years. Data analysis was conducted from January 2022 to July 2022. Participants included postmenopausal women older than 65 years recruited from 40 clinical centers in the US. Optimism was assessed at baseline using the Life Orientation Test-Revised. Physical functioning was measured at 4 time points across 6 years by study staff evaluating performance in grip strength, timed walk, and chair stands. The final analytic sample included 5930 women (mean [SD] age, 70 [4] years). Linear mixed-effects models controlling for demographics, depression, health status, and health behaviors showed that higher optimism was associated with higher grip strength (β = 0.36; 95% CI, 0.21-0.50) and number of chair stands (β = 0.05; 95% CI, 0.01-0.10) but not timed walk at baseline. Higher optimism was also associated with slower rates of decline in timed walk (β = -0.09; 95% CI, -0.13 to -0.04) and number of chair stands (β = 0.01; 95% CI, 0-0.03) but not grip strength over time. Cox proportional hazards models showed that higher optimism was associated with lower hazards of reaching clinically defined thresholds of impairment for all 3 outcomes over 6 years of follow-up. For example, in fully adjusted models, for a 1-SD increase in optimism, hazard ratios for reaching impairment thresholds were 0.86 (95% CI, 0.80-0.92) for grip strength, 0.94 (95% CI, 0.88-1.01) for timed walk, and 0.91 (95% CI, 0.85-0.98) for chair stands. In this cohort study of postmenopausal women, at baseline, higher optimism was associated with higher grip strength and number of chair stands but not with the time it took to walk 6 m. Higher optimism at baseline was also associated with maintaining healthier functioning on 2 of the 3 performance measures over time, including less decline in walking speed and in number of chair stands women could perform over 6 years of follow-up. Given experimental studies suggesting that optimism is modifiable, it may be a promising target for interventions to slow age-related declines in physical functioning. Future work should explore associations of optimism with maintenance of physical functioning in diverse populations.

Tipsy, trashed, or totalled? Lay understanding of dose-specific alcohol intoxication and the criminal justice system

ABSTRACT This online survey study explored how Australian laypeople (N = 147) define alcohol intoxication using language, standard drinks, blood alcohol concentration (BAC), and symptoms. Participants used an extensive vocabulary to describe intoxication and better understood intoxication in terms of standard drinks and symptoms compared to BAC. Lay intoxication definitions and perceived alcohol-induced impairment thresholds (memory and capacity for consent) were influenced by personal characteristics (e.g. age, personal alcohol consumption). Participants rated symptom-based evidence as most useful when evaluating a person’s intoxication status in a legal setting and welcomed expert evidence. Findings can inform litigation and educational strategies that facilitate accurate engagement with alcohol intoxication in the courtroom.

Tryptophan metabolism and small fibre neuropathy: a correlation study.

Small nerve fibres located in the epidermis sense pain. Dysfunction of these fibres decreases the pain threshold known as small fibre neuropathy. Diabetes mellitus is accompanied by metabolic changes other than glucose, synergistically eliciting small fibre neuropathy. These findings suggest that various metabolic changes may be involved in small fibre neuropathy. Herein, we explored the correlation between pain sensation and changes in plasma metabolites in healthy Japanese subjects. The pain threshold evaluated from the intraepidermal electrical stimulation was used to quantify pain sensation in a total of 1021 individuals in the 2017 Iwaki Health Promotion Project. Participants with a pain threshold evaluated from the intraepidermal electrical stimulation index <0.20 mA were categorized into the pain threshold evaluated from the intraepidermal electrical stimulation index-low group (n = 751); otherwise, they were categorized into the pain threshold evaluated from the intraepidermal electrical stimulation index-high group (n = 270). Metabolome analysis of plasma was conducted using capillary electrophoresis time-of-flight mass spectrometry. The metabolite set enrichment analysis revealed that the metabolism of tryptophan was significantly correlated with the pain threshold evaluated from the intraepidermal electrical stimulation index in all participants (P < 0.05). The normalized level of tryptophan was significantly decreased in participants with a high pain threshold evaluated from the intraepidermal electrical stimulation index. In addition to univariate linear regression analyses, the correlation between tryptophan concentration and the pain threshold evaluated from the intraepidermal electrical stimulation index remained significant after adjustment for multiple factors (β = -0.07615, P < 0.05). These findings indicate that specific metabolic changes are involved in the deterioration of pain thresholds. Here, we show that abnormal tryptophan metabolism is significantly correlated with an elevated pain threshold evaluated from the intraepidermal electrical stimulation index in the Japanese population. This correlation provides insight into the pathology and clinical application of small fibre neuropathy.

Investigation of a novel TBC1D24 variation causing autosomal dominant non-syndromic hearing loss.

Hearing loss is considered one of the most common sensory neurological defects, with approximately 60% of cases attributed to genetic factors. Human pathogenic variants in the TBC1D24 gene are associated with various clinical phenotypes, including dominant nonsyndromic hearing loss DFNA65, characterized by progressive hearing loss after the development of language. This study provides an in-depth analysis of the causative gene and mutations in a family with hereditary deafness. We recruited a three-generation family with autosomal dominant nonsyndromic hearing loss (ADNSHL) and conducted detailed medical histories and relevant examinations. Next-generation sequencing (NGS) was used to identify genetic variants in the proband, which were then validated using Sanger sequencing. Multiple computational software tools were employed to predict the impact of the variant on the function and structure of the TBC1D24 protein. A series of bioinformatics tools were applied to determine the conservation characteristics of the sequence, establish a three-dimensional structural model, and investigate changes in molecular dynamics. A detailed genotype and phenotype analysis were carried out. The family exhibited autosomal dominant, progressive, postlingual, and nonsyndromic sensorineural hearing loss. A novel heterozygous variant, c.1459C>T (p.His487Tyr), in the TBC1D24 gene was identified and confirmed to be associated with the hearing loss phenotype in this family. Conservation analysis revealed high conservation of the amino acid affected by this variant across different species. The mutant protein showed alterations in thermodynamic stability, elasticity, and conformational dynamics. Molecular dynamics simulations indicated changes in RMSD, RMSF, Rg, and SASA of the mutant structure. We computed the onset age of non-syndromic hearing loss associated with mutations in the TBC1D24 gene and identified variations in the hearing progression time and annual threshold deterioration across different frequencies. The identification of a new variant associated with rare autosomal dominant nonsyndromic hereditary hearing loss in this family broadens the range of mutations in the TBC1D24 gene. This variant has the potential to influence the interaction between the TLDc domain and TBC domain, thereby affecting the protein's biological function.

Состояние слухового анализатора на фоне акустической травмы. Экспериментальное исследование

Sensorineural hearing loss is a pressing medical and social problem of modern society. A large proportion of the population is at risk of acoustic injury every day. The high incidence of acoustic trauma, coupled with insufficient diagnosis and treatment, necessitates experimental studies to identify the mechanisms of injury and to develop effective prevention and treatment. The similarities in the anatomy and physiology of the auditory analyzer of mice and humans, the relatively inexpensive keeping, and the available set of genetic tools make the mouse model extremely useful in hearing organ research. The purpose of the study was to assess changes in the auditory function of mice caused by acute acoustic trauma. The simulation of the acoustic trauma was carried out using narrow-band noise with a basic frequency of 4,000–6,000 Hz of high intensity for 4 hours. As a result, a significant increase (deterioration) in hearing thresholds was recorded in all voiced mice. On the 5th, 14th, and 28th days, there was a change in hearing in most mice. Hearing changes were uneven over time. The greatest improvement occurred from the 1st to the 5th day. With further observation, the rate of hearing recovery decreased. On the 28th day, no hearing restoration occurred in any mouse. Experimental model of acute acoustic trauma with damage parameters in this work combined with the recording of short-latency auditory induced potentials (SAEPs) can be used in further study of different types of hearing loss and development of methods of their treatment.

Determinants of Cognitive Trajectories in Lower Educated Older Adults: Evidence from Brazil.

AbstractBackgroundPatterns of cognitive change and modifiable factors for declining versus stable cognitive trajectories have rarely been described in a lower‐educated older population. Our goal was to identify heterogeneous long‐term trajectories of cognitive functioning and explore possible factors associated with cognitive decline beyond education, among older Brazilian adults.MethodWe used data on n = 1,042 adults aged ≥ 60 from the Health, Welfare and Aging (SABE) without cognitive impairment at baseline over four waves (2000‐2015) in São Paulo, Brazil. We applied group‐based trajectory modelling to identify cognitive trajectories. Cognition was measured using the abbreviated version of the Mini‐Mental State Examination (MMSE).ResultWe identified three cognitive groups: stable (n = 754), mild declining (n = 183), and strongly declining (n = 105). The probability of being in the strongly declining group membership was 10.7%. According to the MMSE classification, the mild declining group reached the average threshold for cognitive impairment on the last follow‐up, while the strongly declining group was on the second follow‐up. Furthermore, respondents in the stable trajectory were more likely to report more than primary education, to be white and married, to earn more than four times the minimum wage/month, to live in urban areas during childhood, and to practice vigorous physical activity at least three times a week. On the other hand, those in the strongly declining trajectory were more likely to identify as black or mixed, to self‐report subjective emptiness, and to have lower BMI, diabetes, and stroke. Moreover, both mild and strongly declining participants presented higher average age and lower MMSE scores at baseline compared to the stable trajectory. The multinomial logistic regression analysis revealed that respondents who self‐reported being mixed, had higher age, had primary education, had a stroke, and smoked at baseline were more likely to be in the strongly declining group.ConclusionOur findings suggest that besides education, interventions to reduce cognitive decline might include health and social policies addressing inequalities and modifiable risk factor burdens to improve later‐life cognitive functioning of at‐risk individuals. Sample attrition suggests estimates of the magnitude of the risk factors for cognitive decline to be conservative.

Early Cognitive Screening is recommended for the Population with Higher Blood Pressure Variation: A Cross‐sectional Study from a Blood Pressure Management Cohort in Hong Kong

AbstractBackgroundCognitive impairment was shown to be associated with blood pressure (BP) and blood pressure variability (BPV), but the association with BPV is still uncertain in Chinese. This study explored whether BPV is associated with cognitive impairment among the elderly in Hong Kong.MethodParticipants in a community‐based cohort for regular BP measurements with health surveys were randomly invited to have a cognitive assessment with a shortened validated version of MoCA. Different thresholds of mild cognitive impairment (MCI) were used with reference to the age group and educational background. BPV was defined as standard deviation. K‐means clustering methods were applied to group the standard deviation of BPV into high, medium, and low variations. Logistic and quantile regression models were conducted to explore the association of MCI with systolic or diastolic BPV and a combined BPV classification. Odds ratios (OR) were adjusted for age, gender, educational background social economic status, and other medical histories, including hypertension, hyperlipidemia, diabetes, and stroke.ResultA total of 573 participants with a mean age of 72 years were included. Most participants were females (86%). The median follow‐up times were eight months with a median number of nineteen BP records. Systolic BPV was shown to be associated with a higher risk of MCI (adjusted OR: 1.16; 95% CI: 1.03 to 1.31); whereas diastolic BPV was not significantly associated with MCI (adjusted OR: 1.05; 95% CI: 0.85 to 1.24) (Table 1). In the combined groupings for BPV classifications, participants with high BPV were shown to have around 5 times higher risk of MCI than those with low BPV.ConclusionEarly stage of cognitive impairment was shown to be associated with systolic blood pressure variability in the Hong Kong population. Early cognitive screening for those with high blood pressure variability levels is recommended.

Impact of the COVID‐19 Pandemic on Dementia Research Participants

AbstractBackgroundThe impact of COVID‐19 on Alzheimer’s disease and related dementias (ADRD) research participation is not fully known. Individual differences in stress and coping may impact research findings (Goldfarb, 2020). It is possible that participants with questionable cognitive impairment (QCI) may be more vulnerable to stress and loss to follow up. The objective of this study is to examine the differential impact of the COVID‐19 pandemic on dementia research participants among individuals with varying degrees of cognitive impairment.MethodThe COVID‐19 impact survey was mailed to participants of the UC Davis Alzheimer’s Disease Research Center (ADRC) in August 2020. The survey asked questions related to feelings about the pandemic and how it impacted willingness to participate in research. Fisher’s exact test was used to compare responses across diagnostic groups. All analyses were conducted using SAS software, version 9.4.ResultOf 115 participants (69.6% female, 52.2% non‐White), 38 had normal cognition, 38 had questionable cognitive impairment (QCI; defined as having one or more neuropsychological tests that was slightly low but did not rise to the threshold of impairment), 16 had mild cognitive impairment (MCI), and 22 had dementia (Table 1). Overall, 9% of the participants were very or extremely worried about getting COVID‐19, 19% felt very or extremely isolated, 36% felt the pandemic had been very or extremely disruptive. The pandemic changed willingness to participate in research at least a little for 50% and very much or extremely for 13%. Impaired participants (either MCI or dementia) were less concerned about getting COVID‐19 and felt less isolated than those with normal cognition or QCI (Table 2). A higher percentage of those with QCI (vs. normal cognition or impaired groups) felt that the pandemic was very or extremely disruptive. Although not statistically significant, a higher percentage of those with QCI also reported that the pandemic changed their willingness to participate in in‐person research very much or extremely.ConclusionThe COVID‐19 pandemic was more disruptive to participants with QCI than participants with normal or impaired cognition. More research is needed to evaluate the impact of the pandemic on dementia research participants.

Effects of radiotherapy for tumors of the larynx and hypopharynx in hearing levels

The head and neck oncological patients are susceptible, either because of tumor location or the treatments performed, to changes of their ear structures. Due to close proximity of radiation field to the ear, radiotherapy induces short and long-term toxicities to the external, middle and internal ear. The aim of this study was to evaluate the impact of radiotherapy on the inner ear. We conducted a cross-sectional retrospective study of patients with cancer of the larynx and hypopharynx undergoing radiotherapy alone or adjuvant to surgery. The follow-up period was 1 year. Relevant clinical and audiological variables were analyzed. We included 15 patients, mostly males, with a median age of 66 years. Average hearing threshold (AHT) deterioration was found in 13 ears, with a median of 8.1dB. Mean bone conduction threshold at 4000 Hz, air conduction threshold at 8000 Hz at 12 months and the median of the final air conduction threshold at 10,000 Hz was significantly higher than the pre-treatment. A correlation was observed between final AHT and dosage of radiation per fraction. Thus, for each increase of 1 Gy per fraction there was an increase of 22.13 dB in the final AHT. About half of the patients had deterioration of the final AHT, proving, on the one hand, the sensorineural hearing loss associated with radiotherapy, while emphasizing the need to perform long-term follow-up protocols for early auditory rehabilitation of these patients.

Raised Hematocrit at High Altitude: Its Relation to Sensorineural Hearing Loss

Abstract Background: Military troops deployed in high altitude areas (HAAs) may suffer from illnesses peculiar to the terrain which are usually due to hypoxia. The physiological dynamics at high altitude (HA) are different from those in the plains and hence environmental factors play an important role at HA. The effect, if any, of hemodynamic changes in terms of raised hemoglobin (Hb) levels in HA on otological disorders is not very well researched and needs to be explored further. This study was undertaken to study the clinical manifestations, if any, of the hemodynamic alterations in the inner ear and their correlation with the Hb levels after 1 year deployment at HA. Methods: A longitudinal descriptive study was conducted over 1 year duration at a Military Hospital located at HAA on 99 soldiers who were &lt;40 years of age with no history of prior ear complaints/ear surgery and with normal pure tone audiometry (PTA) thresholds and Hb levels at initial evaluation. Each soldier underwent PTA and Hb estimation twice: initially, at the time of induction, and later after completion of 1 year deployment at HAA. Statistical analysis was done using simple paired t-test. Results: On data analysis, no hearing loss was found in any participant of the study cohort at frequencies 500 Hz and 1 kHz in either ear on second evaluation. At 2 kHz, for left ear, the mean Hb level for the group with hearing thresholds greater than 25 dB was 17.07 g% with a standard deviation of 0.66, and for right ear, it was 16.95 g% with standard deviation of 0.64. At 4 kHz, the mean Hb level was 16.50 g% and 16.49 g% for hearing thresholds below and up to 25 dB for left and right ear, respectively. It was 16.99 g% and 16.96 g% for hearing thresholds above 25 dB. The results were statistically significant for both right and left ear at 4 kHz. Conclusion: A statistically significant deterioration of hearing thresholds for 4 kHz frequency with corresponding increase in Hb levels was observed in our study. Hb levels can therefore be used as a marker to ensure no further exposure to other risk factors like loud noise exposure, further deployment at higher altitudes to prevent deterioration, and progression of hearing loss.

Impaired Neurological Activity in the Mental Rotation Ability of Tibetan Indigenous Residents After Chronic Exposure to High Altitude.

Mental rotation is a core indicator of spatial ability, and a threshold for cognitive impairment may exist at approximately 4,000m above sea level, but the specific thresholds for the severity of hypoxia in Tibetan indigenous populations in mental rotation ability remain largely unknown. To determine whether a threshold for mental rotation impairment exists in indigenous residents, we related a mental rotation task to inter-individual differences in a range of behavioral performance and neuropsychological characteristics across 51 indigenous Tibetan highlanders and 34 matched controls at three different altitudes (sea level, 2,900m, and 4,200m). Analyses of reaction time showed delayed behavioral responses in the 4,200m altitude group. Further analyses of rotation-related negativity (RRN) revealed that the RRN was significantly more negative and the differences disappeared gradually for different angles among individuals exposed to an altitude of 4,200m. Moreover, a time-frequency analysis showed significantly enhanced alpha- and beta-band power values for the 4,200m altitude participants after stimulus presentation. The impairment in mental rotation ability is related to hypoxia and can be attributed to the absence of sufficient cognitive resources, which demonstrates the existence of a threshold for the effects of high altitude on the brain's mental rotation ability. Taken together, our findings have important implications for exploring the altitude threshold for the influence of high-altitude exposure on brain function, as well as for guiding the development of innovative strategies to optimize the response of the organism against chronic hypoxia-induced under extreme environments.

Magnitude of extended high frequency hearing loss associated with auditory related tinnitus distress, when controlling for magnitude of hearing loss at standard frequenciesa).

Impaired thresholds at extended high frequencies (EHF) are tightly linked to the prevalence of tinnitus, but little is known about how EHF status relates to tinnitus characteristics. In the present study, 93 individuals with tinnitus underwent standard (from 0.125 to 8 kHz) and EHF (from 10 to 16 kHz) audiometry and indicated their degree of tinnitus distress by completing the tinnitus functional index and their perceived tinnitus loudness by using a numeric rating scale. Partial correlation analyses indicated that the magnitude of EHF loss was significantly associated with degree of auditory related tinnitus distress (r = 0.343, p < 0.001) when controlling for pure tone average at standard frequencies and compensating for multiple testing. It is concluded that EHF status is related specifically to auditory related tinnitus distress, but not to intrusive-, sense of control-, cognitive-, sleep-, relaxation-, quality of life-, emotional-related tinnitus distress, total tinnitus distress, or perceived tinnitus loudness.

Degenerative cervical myelopathy: establishing severity thresholds for neuromotor dysfunction in the aging spine using the NIH Toolbox Assessment Scale.

Degenerative cervical myelopathy (DCM) is a leading cause of age-related non-traumatic spinal cord disorders resulting from chronic degeneration of the cervical spine. While traditional clinical assessments rely on patient-reported measures, this study used the NIH Toolbox Motor Battery (NIHTBm) as an objective, quantitative measure to determine DCM severity. The objective is to define NIHTBm cutoff values that can accurately classify the severity of DCM neuromotor dysfunction. A case-controlled pilot study of patients with DCM and age-matched controls. The focus was an in-depth quantitative motor assessment using the NIHTBm to understand the severity of neuromotor deficits due to degenerative spine disease. Motor assessments, dexterity, grip strength, balance, and gait speed were measured in 45 DCM patients and 37 age-matched healthy subjects (HC). Receiver operating curve (ROC) analysis determined cutoff values for mild and moderate-to-severe myelopathy which were validated by comparing motor assessment scores with disability scores. The ROC curves identified thresholds for mild dexterity impairment (T-score range 38.4 - 33.5, AUC 0.77), moderate-to-severe dexterity impairment (< 33.5, AUC 0.70), mild grip strength impairment (47.4 - 32.0, AUC 0.80), moderate-to-severe grip strength impairment (< 32.0, AUC 0.75), mild balance impairment (36.4 - 33.0, AUC 0.61), and moderate-to-severe balance impairment (< 33.0, AUC 0.78). Mild gait speed impairment was defined as 0.78-0.6m/sec (AUC 0.65), while moderate-to-severe gait speed impairment was < 0.6m/sec (AUC 0.65). The NIHTB motor score cutoff points correlated negatively with the DCM neck disability index (NDI) and showed balance and dexterity measures as independent indicators of DCM dysfunction. The use of NIHTB allows for precise delineation of DCM severity by establishing cutoff values corresponding to mild and moderate-to-severe myelopathy. The use of NIHTB in DCM allows enhanced clinical precision, enabling clinicians to better pinpoint specific motor deficits in DCM and other neurological disorders with motor deficits, including stroke and traumatic brain injury (TBI). Furthermore, the utility of objective assessment, NIHTB, allows us to gain a better understanding of the heterogeneity of DCM, which will enhance treatment strategies. This study serves as a foundation for future research to facilitate the discovery of innovative treatment strategies for DCM and other neurological conditions.

Application of the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) to frontal lobe epilepsy using multicenter data

RationaleThe International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) was recently introduced as a consensus-based, empirically-driven taxonomy of cognitive disorders in epilepsy and has been effectively applied to patients with temporal lobe epilepsy (TLE). The purpose of this study was to apply the IC-CoDE to patients with frontal lobe epilepsy (FLE) using national multicenter data. MethodsNeuropsychological data of 455 patients with FLE aged 16 years or older were available across four US-based sites. First, we examined test-specific impairment rates across sites using two impairment thresholds (1.0 and 1.5 standard deviations below the normative mean). Following the proposed IC-CoDE guidelines, patterns of domain impairment were determined based on commonly used tests within five cognitive domains (language, memory, executive functioning, attention/processing speed, and visuospatial ability) to construct phenotypes. Impairment rates and distributions across phenotypes were then compared with those found in patients with TLE for which the IC-CoDE classification was initially validated. ResultsThe highest rates of impairment were found among tests of naming, verbal fluency, speeded sequencing and set-shifting, and complex figure copy. The following IC-CoDE phenotype distributions were observed using the two different threshold cutoffs: 23–40% cognitively intact, 24–29% single domain impairment, 13–20% bi-domain impairment, and 18–33% generalized impairment. Language was the most common single domain impairment (68% for both thresholds) followed by attention and processing speed (15–18%). Overall, patients with FLE reported higher rates of cognitive impairment compared with patients with TLE. ConclusionsThese results demonstrate the applicability of the IC-CoDE to epilepsy syndromes outside of TLE. Findings indicated generally stable and reproducible phenotypes across multiple epilepsy centers in the U.S. with diverse sample characteristics and varied neuropsychological test batteries. Findings also highlight opportunities for further refinement of the IC-CoDE guidelines as the application expands.

The Prevalence of Cognitive Impairment and Dementia in Incarcerated Older Adults.

In view of the growing number of older incarcerated persons in the United States, cognitive impairment represents one of the most challenging and costly health care issues facing the U.S. correctional system. This study examined the prevalence and correlates of this growing public health issue in the nation's largest prison system. In this study of a random sample of 143 older (≥55 years) adults incarcerated in the Texas prison system, we assessed-using the Montreal Cognitive Assessment (MoCA)-the percentage of inmates who met the MoCA thresholds for mild cognitive impairment (MCI; <23) and dementia (<18). Due to sample size limitations, our multivariable analysis assessed the binary outcome, MoCA <23. Overall, 35.0% of our random sample of incarcerated older adults in Texas met the threshold for MCI and 9.1% met the threshold for dementia. After adjusting for covariates, study participants who were Black (odds ratio [OR] = 4.12, 95% confidence interval [CI] = 1.57-10.82), Hispanic (OR = 4.34, 95% CI = 1.46-12.93), and those with a diagnosis of major depressive disorder (8.56, 95% CI = 1.21-60.72) all had higher prevalence of a positive screen for MCI or dementia. Dementia was underdiagnosed in our study sample of incarcerated adults, with 15.4% of MoCA-diagnosed dementia patients having a dementia diagnosis documented in their medical records. Future studies of cognitive impairment in prisons and jails can inform health care planning and resource allocation, such as expansion of access to palliative care, advance care planning, and targeted cognitive screening in older age groups.

Revision cochlear implant surgery in adults and children is a safe and effective technique: a retrospective single faculty study in Okayama University Hospital, Japan

Background Cochlear implant (CI) surgery is a safe surgical technique, although some patients require revision CI surgery. Aims/Objectives This study investigated the cause and underlying reason of revision CI surgery as well as hearing outcomes in a single institution. Patients and Methods This retrospective study evaluated patients who underwent CI surgery between April 2006 to March 2022 (n = 351). Sex, aetiology of hearing loss (HL), age and period from initial CI surgery to reimplantation, cause of revision, and related factors were examined. Results Twelve patients (8 males, 4 females) received CI reimplantation. The revision surgery rate was 2.59% (3.15% children, 1.69% adults); the period from initial surgery to reoperation was 8.60 ± 6.56 years for 9 children with congenital HL and 15.27 ± 5.72 years for 3 adults with progressive HL. Device failure was the most common cause (n = 8), followed by infections (n = 2), advanced facial irritation symptoms (n = 1), and electrode slip-out (n = 1). Mean preoperative and postoperative CI thresholds were 44.0 ± 9.46 dBnHL and 39.19 ± 8.89 dBnHL (p < .068), respectively. Conclusion and Significance Caregiver education, surgical technique advances, flap design, and extensive antibiotic use may decrease the revision surgery rate. The lack of post-revision deterioration of the hearing threshold contributed to well-being in patients with CI.