Neurocognitive Conditions Research Articles

Neurocognitive demands reducejump distance and coordination variability of the injured leg in athletes after anterior cruciate ligament reconstruction.

The study aimed to evaluate the impact of neurocognitive reliance on jump distance and lower extremity kinematics in individuals who had undergone anterior cruciate ligament reconstruction (ACLR). This was achieved by comparing hop performance under standard and neurocognitive conditions. Thirty-two patients after ACLR and 32 healthy controls (CTRL) participated. Both groups performed a single-leg hop for distance (SLHD) and two neurocognitive hop tests, each designed to evaluate distinct aspects of neurocognition. The neurocognitive tests included the reaction SLHD (R-SLHD), measuring reaction to a central stimulusand working memory SLHD (WM-SLHD) assessing response to a memorized stimulus amidst distractor stimuli. Distances were assessed for the three-hop tests. In addition, joint kinematics were collected to calculate lower extremity coordination of the lower extremity. SLHD performance was defined as the mean hop distance per condition per leg for each participant and was analyzed using a mixed ANOVA with condition and leg as the within-subjects factors and the group (ACLR or CTRL) as the between-subjects factor. Differences in joint coordination variability were analyzed using two-sample t-test statistical parametric mapping (SPM) with linear regression. The WM-SLHD resulted in a significantly decreased jump distance compared with the standard hop test both for ACLR and CTRL. Furthermore, the leg difference within the ACLR group increased under higher cognitive load as tested with the WM-SLHD, indicating leg-specific adaptations in lower extremity coordination. Neurocognitive single-leg hop tests resulted in reduced jump distance in CTRL and ACLR. The neurocognitive hop test revealed changes in coordination variability for the CTRL and the uninjured leg of ACLR individuals, whereas the injured leg's coordination variability remained unaltered, suggesting persistent cognitive control of movements post-ACLR. Level III.

Severe Neurologic Issues in Children Hospitalized With COVID Tied to New Neurocognitive Conditions at Discharge

Severe Neurologic Issues in Children Hospitalized With COVID Tied to New Neurocognitive Conditions at Discharge

Mapping Quality Indicators to Assess Older Adult Health and Care in Community-, Continuing-, and Acute-Care Settings: A Systematic Review of Reviews and Guidelines.

Quality indicators (QIs) play a vital role in enhancing the care of older adults. This study aimed to identify existing QIs relevant to the health and care of older adults in community-care, continuing-care, and acute-care settings, along with available information such as definitions and calculation methods. A systematic review of published review studies, grey literature, and guidelines was undertaken, utilizing six electronic databases searched for materials dated from 2010 to 2 June 2023. To be included in this study, the literature had to provide data on QIs in a setting involving older adults. This study included 27 reviews and 44 grey literature sources, identifying a total of 6391 QIs. The highest number of indicators (37%) were relevant to continuing care; 32% and 28% were pertinent to community- and acute-care settings, respectively. The process domain had the highest number of QIs (3932), while the structure domain had the fewest indicators (521). A total of 39 focus areas were identified, with the five most common areas being, in descending order, orthopedics/hip fractures, end-of-life/palliative care, appropriate prescribing, neurocognitive conditions, and cardiovascular conditions; these areas ranged between 10% and 6%. When mapped against the Quadruple Aim framework, most QIs (85%) were linked to improving health outcomes. This inclusive compilation of QIs serves as a resource for addressing various focus areas pertinent to the Quadruple Aims. However, few quality indicators have been designed to provide a comprehensive and thorough evaluation of a specific aspect, taking into account all three key domains: structure, process, and outcomes. Addressing the description and psychometric properties of QIs is foundational for ensuring their trustworthiness and effective application.

The impact of increased daily peanut consumption on indices of peripheral and cerebral vascular function in non-Hispanic Black individuals

Cardiovascular disease, neurocognitive conditions, and cerebral vascular diseases including cognitive impairment, stroke, and Alzheimer’s disease and related dementias disproportionately impact the Non-Hispanic Black (BL) population. The mechanisms are multifactorial but is related to reduced vascular function/health. Our lab, and others, have demonstrated that reduced nitric oxide (NO) bioavailability secondary to oxidative stress, systemic inflammation, and reduced L-arginine bioavailability contributes to reduced vascular function/health in this population. Increased dietary peanut consumption improves various physiological outcomes including blood pressure, cholesterol, type II diabetes, cognitive health, NO bioavailability, and vascular function/health. This improvement is related to increased bioavailability of L-arginine, reduced systemic inflammation, and antioxidant capacity. This study hypothesized that increased daily peanut consumption would improve indices of peripheral and cerebral vascular function/health in a cohort of BL individuals. Methods: Seventeen people participated (11 non-Hispanic White (WH) and 6 BL (age: WH 25±8, BL 21±2; BMI: WH 23±3, BL 22 ± 4; p>0.05 for both). Measures were made before (pre) and after (post) 56 days of daily lightly salted peanut consumption (2 oz/day for females and 3 oz/day for males). Peripheral macro and microvascular function/health was assessed as brachial artery vasodilation (flow mediated dilation, %FMD) and forearm reactive hyperemia (peak mean forearm blood velocity (FBVmean) respectively following 5-min of suprasystolic cuff inflation. Cerebral vascular function/health was assessed as the cerebral vasodilator response during a hypercapnic challenge, i.e., the slope of % cerebral vascular conductance index (CVCi) relative to the change in end-tidal carbon dioxide concentration (ΔPETCO2). Results: There was no effect of race on peripheral macrovascular function assessed as %FMD (WH: 5.3 ±0.89, BL: 6.3 ±1.9 %, p=0.31) or peripheral microvascular function assessed as FBVmean (WH: 82.90 ± 4.5, BL: 72 ± 6.7 cm·s−1, p=0.13). Likewise, there no effect of treatment on %FMD (Pre: 5.4 ± 0.7, Post: 6.2 ± 2.1 %, p=0.46) or FBVmean (Pre: 81.4 ± 6.7, Post: 73.4 ± 8.8 cm·s−1, p=0.27). Lastly, there were no effect of race (WH: 4.0 ± 0.36, BL: 3.9 ± 0.6 %, p=0.85) or treatment (Pre: 3.9 ± 0.56, Post: 4.0 ± 0.39 %, p=0.79) on cerebral vascular function assessed as %CVCi during hypercapnia. Conclusion: The preliminary data suggest that 56 days of increased daily peanut consumption does not induce measurable improvements in indices of vascular function in a cohort of relatively young BL individuals. Future work will continue to assess this effect in a larger cohort of individuals as well as in individuals with existing conditions or diseases (i.e., hypertension, type II diabetes, etc.). Funding: Peanut Institute (982307). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Indices of cerebral vascular function & health in young healthy adults: impact of sex and race

Background: Cerebral vascular diseases and neurocognitive conditions including stroke, cognitive impairment, & Alzheimer’s disease and related dementias are the fastest growing causes of morbidity and mortality. Studies have demonstrated sex differences in indices of physiological function associated with cardiovascular and metabolic disease risk/prevalence. Further, the incidence of these conditions is elevated in Black (BL) individuals; however, BL females have a reduced age adjusted stroke mortality compared to BL males. Reduced cerebral vascular function/health contributes to the risk for these conditions. Limited studies have examined the influence of sex and race on indices of cerebral vascular function/health. This study examined the potential interaction between race and sex in cerebral pulsatility index (PI: index of cerebral vascular stiffness) and cerebral vasomotor reactivity (CVMR) to a hypercapnic challenge (index of cerebral vasodilatory responsiveness). Hypothesis: We hypothesized: 1) females would have reduced PI and elevated CVMR relative to males. 2) BL individuals would exhibit augmented PI and reduced CVMR. 3) BL females would have reduced PI relative to BL males. 4) Lastly, we posit that CVMR will be negatively correlated with PI. Methods: Data is presented from 136 young healthy individuals. 40 BL males (age: 22±3 yr, BMI: 25±4 kg/m²), 37 BL females (age: 21±3 yr, BMI: 24±4 kg/m²), 39 White (WH) males (age: 24±3 yr, BMI: 25±3 kg/m²), and 20 WH females (age: 25±6 yr, BMI: 23±3 kg/m²). Heart rate, beat-to-beat blood pressure, end-tidal carbon dioxide concentration (PETCO2), and middle cerebral artery blood velocity (MCAv) were continuously recorded (minimum of 6 min). Cerebral vascular function/health was indexed as (a) PI ((MCAVv systolic − MCAv diastolic)/MCAv mean). (b) CVMR assessed as % increase in cerebral vascular conductance (CVCi) slope during a hypercapnic challenge (%CVCi/ΔPETCO2). Results: PI was elevated in males (male: 0.86±0.18, female: 0.77±0.11, P=0.03). There was no difference between races (WH: 0.83±0.19, BL: 0.79±0.13, P=0.27) nor was there a sex x race interaction ( P=0.54). CVMR assessed as %CVCi slope was not different between sexes (male: 2.4±1.7 %/mmHg, female: 2.7±1.2 %/mmHg, P=0.16) or BL & WH (WH: 2.7±1.3 %/mmHg, BL: 2.4±1.1 %/mmHg, P=0.16). CVMR was lower in the BL males relative to the BL females (BL male: 2.0±0.9 %/mmHg, BL female: 2.8±1.2 %/mmHg, P=0.002). There was no difference between WH males and females ( P=0.88). Lastly, there was not a significant correlation between PI and CVMR to hypercapnia ( P=0.16). Conclusion: These preliminary data suggest that relatively young and otherwise health White and Black females have augmented indices of cerebral vascular function/health relative to males. Furthermore, BL males have reduced cerebral vasodilatory responsiveness to a hypercapnic stimuli. The University of Texas at Arlington College of Nursing and Health Innovation and Institutional Start up Funds to Dr. Brothers. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Estimating the dosage and feasibility of intranasal administration of creatine.

Creatine dysregulation is present in many psychiatric and neurocognitive conditions, supporting the notion that oral creatine supplementation could constitute a viable treatment for conditions such as dementia, depression, and concussion. We recently proposed an intranasal route of administration (ROA) of creatine as a means of efficiently dosing creatine to achieve absorption across the blood brain barrier while targeting preferential delivery to the brain. Indeed, a subsequent murine study supports that creatine can be absorbed via the nasal ROA. The objective of this project is to refine this ROA and estimate appropriate dosage for research trials. The amount of creatine needed to directly supply the brain is but a small portion of the dose that is administered orally for whole-body saturation. A single dose of creatine is typically 5 g, which results in a calculated blood concentration of 80 mg/dL based upon average adult blood volume. Evidence suggests this is sufficient to raise brain creatine levels. Given the adult brain blood volume of 100‒130 mL, we estimate that a minimum of 80 mg of nasally-administered creatine would need to pass from the nasal cavity across the blood-brain barrier. Even if the nasal columnar epithelium or mucus were to pose a barrier, doubling or tripling the dose would still represent a relatively modest amount of nasally-delivered creatine (e.g., 160‒240 mg) in solution. We predict that the amount of nasally-administered creatine to theoretically raise brain blood concentration to a therapeutic level would be modest and practical.

Dementia and Depression Among Older Adults Following Traumatic Brain Injury.

Traumatic brain injuries are increasingly common in older adults and represent a substantial source of morbidity and mortality for this population. In addition to the impact from the primary insult, TBI can lead to a variety of chronic neurocognitive conditions including dementia, depression, and sleep disturbances. When caused by TBI, these conditions differ importantly from their non-TBI-related counterparts. Much about how TBI relates to the development of these conditions is unknown, and more research is needed to further elucidate optimal treatment strategies.

Sleep-Wake Disorders Among Older Adults Following Traumatic Brain Injury.

Traumatic brain injuries (TBI) are increasingly common in older adults and represent a substantial source of morbidity and mortality for this population. In addition to the impact from the primary insult, TBI can lead to a variety of chronic neurocognitive conditions including dementia, depression, and sleep disturbances. When caused by TBI, these conditions differ importantly from their non-TBI-related counterparts. Much about how TBI relates to the development of these conditions is unknown, and more research is needed to further elucidate optimal treatment strategies.

Amplification Effects on the Acoustic Change Complex in Older Adults With Sensorineural Hearing Loss

Purpose: This pilot study evaluated the effect of stimulus level and amplification on the acoustic change complex (ACC) in adults with sensorineural hearing loss. Method: Ten adults with a M age of 74 years and bilaterally symmetrical mild-to-severe sensorineural hearing loss listened to contrasting vowel pairs, while cortical evoked potentials were recorded. The vowel contrasts (/a/−/i/ and /u/−/o/) were presented in the sound field at 30 and 60 dBA. Participants were tested with and without amplification fit to their audiogram configurations. ACC component P1–N1–P2 latencies and P1–N1, N1–P2, and P2–N2 peak-to-trough amplitudes were measured for eight test conditions ([two vowel contrasts] × [two levels] × [aided vs. unaided]). Paired-sample t tests were used to determine the effects of test conditions on ACC component latencies and amplitudes. Results: At 60 dBA, nine of 10 listeners had ACCs in the unaided condition, and the ACC amplitudes were significantly increased in the aided condition for the /a/−/i/ contrast. Amplification did not affect ACC amplitudes for the /u/−/o/ contrast at 60 dBA. At 30 dBA, only three of 10 participants had ACCs present in the aided condition, and none had ACCs in the unaided condition. ACC latencies at 60 dBA were unaffected as a function of amplification, but differences were noted as a function of vowel contrast type. Conclusions: ACCs were obtained for adults with hearing loss, demonstrating the feasibility of measuring a listener's neural capacity to discriminate vowel contrasts. The data indicate promising efficacy for using the ACC to evaluate those who cannot provide reliable perceptual responses, such as in immaturity (infants) or neurocognitive conditions (dementia). The ACC provides evidence of the sensory and neural capacity to detect and discriminate vowel sound contrasts, a neuro-biological validation that can be coupled with electroacoustic verification.

TikTok as algorithmically mediated biographical illumination: Autism, self-discovery, and platformed diagnosis on #autisktok

Scholarship in the sociology of medicine has tended to characterize diagnosis as disruptive to one’s self-concept. This categorization, though, requires reconsideration in light of public conversations about mental health and community building around neurocognitive conditions, particularly among youth online. Drawing upon Tan’s notion of “biographical illumination” (BI), which describes how medical frameworks can enrich personal biographies, we explored the shifting nature of BI through the case of TikTok. Combining quantitative and qualitative methods, we argue that TikTok serves as a space to discuss diagnosis and refine one’s sense of self as a result of diagnosis. However, such personal transformation is inseparable from the app’s affordances, or what we term “algorithmically mediated biographical illumination.” BI shapes TikTok as a platform, and TikTok informs BI as a psychosocial process, leading to what we call “platformed diagnosis.” These findings have broader critical applications for the study of algorithms, disability, and digital platforms.

Promoting older adult mental health through integrated care

The prevalence of behavioral health conditions among older adults continues to rise while the number of specialty providers remains low. Nurses caring for aging populations across care settings have opportunities to integrate behavioral healthcare into their practice with adults to promote wellness and avoid negative outcomes. Priority issues for integrated behavioral health among older adults include depression, substance use disorders, and neurocognitive conditions. Connections to professional organizations, timely continuing education, and integration of evidenced-based clinical protocols are vital for nurses to provide effective integrated care.

Ordinal pattern transition networks in eye tracking reading signals

Eye tracking is an emerging technology with a wide spectrum of applications, including non-invasive neurocognitive diagnosis. An advantage of the use of eye trackers is in the improved assessment of indirect latent information about several aspects of the subjects' neurophysiology. The path to uncover and take advantage of the meaning and implications of this information, however, is still in its very early stages. In this work, we apply ordinal patterns transition networks as a means to identify subjects with dyslexia in simple text reading experiments. We registered the tracking signal of the eye movements of several subjects (either normal or with diagnosed dyslexia). The evolution of the left-to-right movement over time was analyzed using ordinal patterns, and the transitions between patterns were analyzed and characterized. The relative frequencies of these transitions were used as feature descriptors, with which a classifier was trained. The classifier is able to distinguish typically developed vs dyslexic subjects with almost 100% accuracy only analyzing the relative frequency of the eye movement transition from one particular permutation pattern (plain left to right) to four other patterns including itself. This characterization helps understand differences in the underlying cognitive behavior of these two groups of subjects and also paves the way to several other potentially fruitful analyses applied to other neurocognitive conditions and tests.

Mental health and neurocognitive disorder–related hospitalization rates in immigrants and Canadian-born population: a linkage study

ObjectivesMental health and neurocognitive conditions are important causes of hospitalization among immigrants, though patterns may vary by immigrant category, world region of origin, and time since arrival in Canada. This study uses linked administrative data to explore differences in mental health hospitalization rates between immigrants and individuals born in Canada.MethodsHospital records from the Discharge Database and the Ontario Mental Health Reporting System for 2011 to 2017 were linked to the 2016 Longitudinal Immigrant Database and to Statistics Canada’s 2011 Canadian Census Health and Environment Cohort. Age-standardized hospitalization rates for mental health–related conditions (ASHR-MHs) were derived for immigrants and the Canadian-born population. ASHR-MHs overall and for leading mental health conditions were compared between immigrants and the Canadian-born population, stratified by sex and selected immigration characteristics. Quebec hospitalization data were not available.ResultsOverall, immigrants had lower ASHR-MHs compared to the Canadian-born population. Mood disorders were leading causes of mental health hospitalization for both cohorts. Psychotic, substance-related, and neurocognitive disorders were also leading causes of mental health hospitalization, although there was variation in their relative importance between subgroups. Among immigrants, ASHR-MHs were higher among refugees and lower among economic immigrants, those from East Asia, and those who arrived in Canada most recently.ConclusionDifferences in hospitalization rates among immigrants from various immigration streams and world regions, particularly for specific types of mental health conditions, highlight the importance of future research that incorporates both inpatient and outpatient mental health services to further understand these relationships.

Antibiotic-Therapy-Induced Gut Dysbiosis Affecting Gut Microbiota-Brain Axis and Cognition: Restoration by Intake of Probiotics and Synbiotics.

Antibiotic therapy through short-term or repeated long-term prescriptions can have several damaging effects on the normal microbiota of the gastrointestinal tract. Changes in microbiota could be multiple including decreased diversity of species in gut microbiota, changed metabolic activity, and the occurrence of antibiotic-resistant strains. Antibiotic-induced gut dysbiosis in turn can induce antibiotic-associated diarrhoea and recurrent infections caused by Clostridioides difficile. There is also evidence that the use of different chemical classes of antibiotics for the treatment of a variety of ailments can lead to several health issues including gastrointestinal, immunologic, and neurocognitive conditions. This review discusses gut dysbiosis, its symptoms and one important cause, which is antibiotic therapy for the induction of gut dysbiosis. Since the maintenance of good gut health is important for the well-being and functioning of physiological and cognitive activities through the normal gut-microbiota-brain relationship, the condition of dysbiosis is not desirable. Specific therapies are prescribed by medical practitioners for the cure of a variety of ailments, and, if the prescription of antibiotics becomes unavoidable, there is a possibility of the onset of gut dysbiosis as the side or after effects. Therefore, the restoration of imbalanced gut microbiota to its balanced condition becomes necessary. A healthy relationship between gut microbiota and the brain can be achieved with the introduction of probiotic strains into the gut in a practical and consumer-friendly way, such as consumption of food and beverages prepared with the use of characterised probiotic species, fermented foods as the potential biotics, or synbiotic supplements.

Global Neurocognitive and Frontal Functions Analysis and Precision Intrathecal Pressure Measurement to Settle the Diagnostic Dilemma of the Normal Pressure Hydrocephalus: A Preliminary Experience

Normal-pressure hydrocephalus (NPH) is a common condition associated with a cognitive deterioration and possibly involving up to 9%-14% of all nursing home residents older than 65 years old. The purpose of the present paper is to introduce an inclusive study protocol aimed at increasing the diagnostic precision and follow-up accuracy. A total of 28 patients were operated on for NPH in our institution in the period ranging between January 2015 and December 2019. All the patients underwent magnetic resonance imaging of the brain with standard sequences, calculation of the Evans index and corpus callosum angle, and evaluations by means of Montreal Cognitive Assessment (MOCA), Mini-Mental State Examination, and Frontal Assessment Battery (FAB) neuropsychological tests preoperatively and at 1 and 6 months. A preoperative lumbar test infusion (LIT) with fine measurement of the intrathecal pressures at the beginning and at the end of the procedures was performed. MOCA and FAB proved an overall improvement of the neurocognitive conditions at 1 month postoperatively. The mean pressure at the beginning of the LIT, was negatively associated with the neuropsychological outcome variables (Mini-Mental State Examination, FAB, and MOCA) in the 3 different evaluations, with FAB and MOCA at 6 months. We found a strong positive correlation between the Evans index as measured on the first magnetic resonance imaging scan both with the diastolic and systolic pressure at the beginning of the test. Neuropsychological assessment, combined with LIT with intrathecal pressure managements aids the diagnostic process in patients affected by NPH. It allows standardizing in a rigorous fashion the follow-up evaluation of patients undergoing surgery for a ventriculoperitoneal shunt.

Chocolate and Cocoa-Derived Biomolecules for Brain Cognition during Ageing.

Cognitive decline is a common problem in older individuals, often exacerbated by neurocognitive conditions, such as vascular dementia and Alzheimer’s disease, which heavily affect people’s lives and exert a substantial toll on healthcare systems. Currently, no cure is available, and commonly used treatments are aimed at limiting the progressive loss of cognitive functions. The absence of effective pharmacological treatments for the cognitive decline has led to the search for lifestyle interventions, such as diet and the use of nutraceuticals that can prevent and limit the loss of cognition. Cocoa and chocolate are foods derived from cocoa beans, commonly used in the population and with good acceptability. The purpose of this review was to collect current experimental evidence regarding the neuroprotective effect of chocolate and cocoa (or derived molecules) in the elderly. From a systematic review of the literature, 9 observational studies and 10 interventional studies were selected, suggesting that the biomolecules contained in cocoa may offer promising tools for managing cognitive decline, if provided in adequate dosages and duration of treatment. However, the molecular mechanisms of cocoa action on the central nervous system are not completely understood.

The Hidden Disease: Delayed Diagnosis in Duchenne Muscular Dystrophy and Co-Occurring Conditions.

Early diagnosis of Duchenne muscular dystrophy (DMD) is important for timely intervention to prolong function and preserve quality of life. The prevalence of various neurocognitive disorders is known to be higher in patients with DMD than the general population. In this study, we highlight cases of delayed DMD diagnosis that resulted from misattribution of early motor symptoms to co-occurring neurocognitive conditions. We also investigate the difference in age at DMD diagnosis in the setting of specific co-occurring neurocognitive conditions. In this study, we reviewed 40 consecutive patients seen at a Certified Duchenne Care Center, excluding siblings of already-diagnosed patients. We highlight cases of significant delay in DMD diagnosis in the setting of co-occurring neurocognitive diagnoses. We also investigate the association of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), intellectual disability, and speech/language delay on age of DMD diagnosis. The prevalence of co-occurring neurocognitive diagnoses was 73.1% in patients diagnosed at or after age 5 years vs. 35.7% in those diagnosed before age 5 years. The average age of DMD diagnosis was 6.6 years in patients with any co-occurring neurocognitive diagnoses and 4.9 years in patients without ( p = 0.09). Individual analysis of ASD and ADHD showed significant differences. A greater number of co-occurring conditions were associated with an increased age at DMD diagnosis ( R2 = 0.87, p < 0.001). The data suggest an association between the presence of co-occurring neurocognitive conditions and a later age of DMD diagnosis. One cost-effective diagnostic step that can be implemented by all pediatric practitioners is testing serum creatinine kinase (CK) in any child with motor delays or hypotonia, even in the context of other behavioral or cognitive disabilities.

The VESPA Project: Virtual Reality Interventions for Neurocognitive and Developmental Disorders

VESPA is a financed project supported by the Sicilian Regional Research and Development funds, and it is structured by the development, research and validation of Virtual Reality (VR) based application for the diagnosis and treatment of neurocognitive conditions. In particular, this article presents its characteristics, referred to as the first (2013-2015) and second (2021-ongoing) generations of VESPA, with particular reference to literature regarding the VR technology application and development, the VR treatment of neurocognitive conditions and prior versions of this intervention. Through a comprehensive review of the research conducted over the last 5 years, evidence has emerged supporting VESPA’s aim and scopes, highlighting how the application of VR can be considered to add value to typical rehabilitation/therapeutic paths. VESPA project generations are then presented in detail, including specific session/task battery characteristics, 2.5D, 3D and 5D typologies, system usability and architecture and pathological domain-based dynamics and features. The discussion about VESPA will highlight the current advantages along with limitations and future directions.

Understanding how Canadian healthcare providers have learned to identify co-occurring PTSD symptoms and dementia in Veterans.

WHAT IS KNOWN ON THE SUBJECT?: Little is known about how PTSD and dementia in Veterans is identified by health care providers. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Healthcare providers identify those behavioural symptoms experienced by older people living with dementia that represent an unmet need associated with PTSD secondary to military service. Once healthcare providers recognize the presence of symptoms relevant to PTSD, they modify their care approach to include focused/tailored non-pharmacological care interventions that address environmental and situational variables that reflect military action. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Specialized education and training is needed to improve the identification of PTSD when existent with other co-occurring neurocognitive conditions such as delirium, dementia and depression. ABSTRACT: Introduction Co-occurring PTSD and dementia in Veterans can be difficult to distinguish from dementia-related responsive behaviours, which may result in inappropriate care management. Improved identification of PTSD and dementia is necessary to inform more appropriate and effective care for Veterans. Aim/Question The purpose of this study was to understand how Canadian healthcare providers have learned to identify the co-occurrence of PTSD symptoms in Veterans with dementia. Methods Eight semi-structured interviews employing the Critical Incident Technique were conducted with key informant healthcare providers who treat Veterans from across Canada. Framework analysis was used to code, sort and develop themes. Results Observed differences in Veterans with PTSD and dementia cued healthcare providers to seek our more information, leading to a new understanding of past trauma underlying the symptoms they observed. Healthcare providers then altered their usual care approaches to utilize trust-based and validation-oriented strategies resulting in more effective care management. Discussion Improvement in the identification of co-occurring PTSD and dementia in Veterans requires specialized education and training for healthcare providers. Implications for Practice Recognizing the complex needs of older Veterans with co-occurring PTSD and dementia is necessary for healthcare providers to implement more effective care for this population. Relevance Statement This paper provides mental health nurses with new understanding of co-occurring PTSD and dementia in Veterans. With an ageing Veteran population in Canada, mental health nurses need to be knowledgeable about the care for Veteran specific mental health needs.

National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players.

To provide evidence-based recommendations for reducing the prevalence of head-first contact behavior in American football players with the aim of reducing the risk of head and neck injuries. In American football, using the head as the point of contact is a persistent, well-documented, and direct cause of catastrophic head and cervical spine injury. Equally concerning is that repeated head-impact exposures are likely to result from head-first contact behavior and may be associated with long-term neurocognitive conditions such as dementia, depression, and chronic traumatic encephalopathy. The National Athletic Trainers' Association proposes 14 recommendations to help the certified athletic trainer, allied health care provider, coach, player, parent, and broader community implement strategies for reducing the prevalence of head-first contact in American football.