Neurocognitive Tests Research Articles

The effects of adrenal insufficiency and its treatment on cognition in an athlete with post-concussion syndrome

ABSTRACT Post-concussion Syndrome (PCS) describes persistent nonspecific neurological, cognitive and emotional symptoms following concussion. A young male presented to a sports concussion clinic with persistent symptoms post-injury. Neurocognitive testing found unexpected severe memory impairment. Blood tests for pituitary function returned low cortisol levels secondary to adrenal insufficiency (AI), which was immediately treated. Post-treatment and improvement of cortisol levels, repeat neuropsychology testing demonstrated reliable improvement in memory and processing speed test scores, commensurate with premorbid expectations. This case highlights the importance of a broad diagnostic approach to formulating unexpected persistent PCS symptoms, screening for AI in PCS cases, and completing neurocognitive testing.

Sports Medicine Physician Confidence in Concussion Assessments for Postconcussion Return-to-Play Decisions.

To identify sport-related concussion (SRC) assessments sports medicine physicians perform and in which they place confidence when making return-to-play (RTP) decisions. Cross-sectional study. Online survey. Active members of the American Medical Society for Sports Medicine (AMSSM) at the fellowship level or higher making RTP decisions following concussion within the last year. An electronic REDCap survey gathering demographic and practice information and responses to clinical scenarios was sent to AMSSM members. The primary outcome was the SRC assessment(s) in which physicians expressed the most confidence for RTP decisions. Four hundred thirty AMSSM members responded to the survey, 392 of which met inclusion criteria. The graded symptom checklist was rated the most useful test for making return-to-play decisions, and respondents felt most confident starting the RTP process if the graded symptom checklist was normal. An assessment was considered most useful if it closely reflected resolution of SRC's pathological processes. Computerized neurocognitive testing was most likely to be ignored if abnormal. An abnormal neurological examination made physicians feel least confident SRC had resolved. Sports medicine physicians view the graded symptom checklist as a useful tool for making RTP decisions. Physicians expressed less confidence in computerized neurocognitive testing to determine RTP readiness. This study uncovered reliance on symptom reporting by sports medicine physicians and an opportunity for the creation of concussion clinical decision tools.

Multifaceted concussion assessment battery: sensitivity at the expense of specificity?

ABSTRACT Objectives A multifaceted assessment battery is recommended for testing suspected concussed athletes; however, the individual tests have limitations and potentially may lead to false positive outcomes. Therefore, the purpose of this study was to psychometrically evaluate concussion assessment tools used for intercollegiate student-athletes, with a focus on the time interval between baseline and subsequent assessments. Methods 92 collegiate student-athletes matched between concussion (N = 46. F32/M14) and non-concussion (N = 46, 32F/14 M) completed the standard assessment of concussion, balance error scoring system, symptom questionnaire, and computerized neurocognitive tests at baseline and acutely (<48 hours) following a concussion. Test outcomes were compared between time points with three approaches, 1) vs baseline, 2) reliable change scores (RCI), and 3) vs American College of Rehabilitation Medicine (ACRM). Concussion assessment sensitivity, specificity, likelihood ratios, predictive values, and diagnostic odds ratio were calculated. A receiver operator characteristic compared area under the curve (AUC) for the overall battery as well as between academic years. Results The sensitivity of the battery was high (78.3 – 95.7%), but specificity was low to moderate (6.5 – 52.2%) with comparison to the RCI typically performing best. The three approaches yielded AUC values between 0.51 – 0.63 which is below the discriminatory threshold (0.70) with comparison to RCI performing best. By academic year, Juniors was the only year in which the ROC exceeded the threshold (0.75). The number of tests failed did not improve any AUC values (0.51 – 0.69) to exceed the threshold. Conclusions The outcomes of this study support the premise that concussion must be evaluated using a comprehensive clinical examination including a variety of assessments to evaluate each clinical domain. Clinicians need to recognize that the multifaceted assessment battery has high sensitivity, but the overall psychometrics do not exceed the threshold for group discrimination and caution must be used in their interpretation.

Functional Vision Questionnaire Detects Near Triad Impairments in Adolescent Athletes With Concussion History.

Concussions are mild traumatic brain injuries that often cause vision problems. They have significant impacts on everyday life, cognitive capacity, and sports performance, and may affect injury prevalence in fast contact sports such as ice hockey. A functional vision questionnaire specifically designed for sports was used here to study the correlation between vision problems and concussion history. In this national cross-sectional concussion study, 860 Finnish elite-level male adolescent ice hockey players (aged 13-21 years) answered a functional vision questionnaire and performed a computerized neurocognitive test, ImPACT. Totally 265 athletes reported a history of at least 1 concussion. All data were statistically compared with age-matched athletes with no concussion history (n = 595). For further analysis, athletes were divided into subgroups by age and number of previous concussions. Previously concussed athletes reported more general and eye-specific symptoms than their healthy controls. Increases in eye fatigue, frontal headaches, and blinking were statistically significant. Also statistically more problems with depth perception and evaluating distances, concentration problems, blurred vision, and losing the object in sight were observed among athletes with concussion history. Concussion history reflects an increase in the prevalence of vision deficits, as determined by multiple disturbances in the near triad. The significant number of vision problems in the concussion history groups strongly suggests that functional vision should routinely be evaluated in athletes. The vision problems observed in the athletes with concussion history may indicate an increased injury risk that should be addressed.

Effect of Sleep Duration and Concussion History on Neurocognitive Testing Symptoms for Post-injury States.

Evaluate the influence of sleep duration and concussion history on postconcussion symptoms in adolescent athletes. Observational retrospective study using the Immediate Post-Concussion Assessment and Cognitive Testing and Post-Concussion Symptom Scale (PCSS). Multivariable linear regression assessed sleep hours against 22 PCSS symptoms, controlling for demographic and health variables. Urban concussion centers in Colorado and Florida, 2009 to 2019. 11 564 student-athletes aged 12 to 22, categorized by concussion history. Analysis of sleep duration and concussion history in relation to neurocognitive and psychiatric symptom severity. Primary outcomes included neurocognitive, psychiatric, and total symptom scores. Secondary outcomes were specific PCSS symptoms. Among 5349 student-athletes, 2671 (49.9%) had no prior concussions and 2678 (50.1%) had 1 or more. For those without prior concussions, sleep was negatively associated with age (β = -0.18, 95% confidence interval [CI], -0.22 to -0.13, P < 0.0001), vomiting (β = -0.22, 95% CI, -0.38 to -0.05, P = 0.012), and difficulty concentrating (β = -0.11, 95% CI, -0.19 to -0.35, P = 0.005). In athletes with a history of concussion, less sleep correlated with decreased age (β = -0.11, 95% CI, -0.14 to -0.07, P < 0.0001), headache (β = -0.065, 95% CI, -0.12 to -0.01, P = 0.031), irritability (β = -0.08, 95% CI, -0.15 to -0.01, P = 0.021), and difficulty concentrating (β = -0.08, 95% CI, -0.15 to -0.01, P = 0.031) but increased sensitivity to light (β = 0.10, 95% CI, 0.001-0.137, P = 0.048), numbness/tingling (β = 0.15, 95% CI, 0.04-0.26, P = 0.008), and feeling slowed down (β = 0.13, 95% CI, 0.05-0.21, P = 0.001). Sleep duration and concussion history are associated with variations in postconcussion symptom severity among adolescent athletes. This data underscore the need for individualized management strategies based on sleep patterns and concussion history.

Efficacy of biomarkers and imaging techniques for the diagnosis of traumatic brain injury: challenges and opportunities.

Concussion is a pervasive health issue in the present day. Increased prevalence in recent years has indicated a need to improve the current understanding of minor traumatic brain injury (mTBI). Effort has been devoted to understanding the underlying pathophysiology of TBIs, but some mechanisms remain unknown. Potentially lethal secondary effects of concussion include second impact syndrome and chronic traumatic encephalopathy (CTE), introducing long-term considerations for the management of mTBI. Post-concussion syndrome is another long-term consequence of concussion and may be influenced by both neuroinflammation and hormonal imbalances resulting from head trauma. Genetically mutated apolipoprotein E may also contribute to the severity and persistence of concussion symptoms, perhaps even acting as a risk factor for CTE. As it stands, the diagnosis of concussion is nuanced, depending primarily on subjective diagnostic tools that incorporate patient-reported symptoms and neurocognitive tests. Diagnostic tools provide some assistance in concussion diagnosis, but still lack accuracy and inherently leave room for uncertainty. To mitigate some of this uncertainty, considerable research has been devoted to the development of methods to diagnose concussions objectively. Biomarkers such as S100 calcium binding protein B (S100B), glial fibrillary acidic protein (GFAP), neurofilament light protein (Nf-L), interleukin-6 (IL-6) and microRNAs (miRNAs) as well as imaging techniques including diffusion tensor imaging (DTI) and blood-oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) show great promise in this regard. This review aims to compile the relevant literature in these areas in the hopes of being used as a reference point for future research regarding concussions.

Cognitive control impairment in suicide behaviors: what do we know? A systematic review and meta-analysis of Stroop in suicide behaviors.

Suicidal behavior results from a complex interplay between stressful events and vulnerability factors, including cognitive deficits. Poorer performance on the Stroop task, a measure of cognitive control, has been associated with suicidal behavior in numerous studies. The objective was to conduct an updated systematic review of the literature on the Stroop task as a neuropsychological test of vulnerability to suicidal acts in patients with mood and other psychiatric disorders, while also looking at how the type (classic versus emotional) or the version (paper or computerized) of the Stroop task, as well as the characteristics of the patient (clinical population, age, sex) moderated the Stroop effect. A search on Medline, Embase, PsycInfo databases, and article references was performed. 53 studies (6781 participants) met the selection criteria. Interference time and errors of the Stroop Test were assessed in at least 3 studies to be analyzed. Moderators, such as the type (classic versus emotional) of the Stroop task and the characteristics of the patient (clinical population, age, sex) were also assessed. Interference time on Stroop performance was lower in suicide attempters than in patient controls (g = 0.20; 95%CI [0.10-0.30]) and healthy controls (g = 0.79; 95 % CI [0.29-1.29]), with patient controls scoring lower than healthy controls (g = -0.63; 95%CI [-1.01-0.25]). This was moderated by age and having a mood disorder. In terms of interference errors, suicide attempters performed worse than healthy controls (g = 0.57; 95%CI [0.01-1.15]) but did not perform differently from patient controls (g = 0.20; 95 % CI [-0.06-0.45]). Patient controls also did not score differently than healthy controls (g = -0.18; 95 % CI [-0.54-0.18]). There was a significant moderation effect for the type (i.e., original Stroop task) and version (i.e., paper format) of the Stroop task, and for some characteristics of the patient (i.e., older patients and having a mood disorder). Cognitive control impairment was associated with a history of suicidal behavior in patients, especially in older populations and those with mood disorders, however this result was moderated by outcome measure (interference time vs. errors), the type (i.e., original Stroop task) and the version (i.e., paper format) of the Stroop task. Cognitive control processes may be an important factor of suicidal vulnerability. Choosing the right neurocognitive test in the right population to detect suicide vulnerability is important direction for future research.

Corticosteroid-responsive narcolepsy type II after COVID-19: A relevant differential diagnosis of post-COVID syndrome (a case report).

Excessive daytime sleepiness is a possible symptom of post-COVID syndrome and is also the cardinal symptom of narcolepsy, a rare life-long sleep disorder with a possible autoimmune background. Recent reports indicate that COVID-19 infection may trigger narcolepsy. However, it remains unclear how best to identify and treat such cases. A 25-year-old male developed daytime sleepiness after COVID-19 infection. A diagnosis of narcolepsy type II was made based on pathologically shortened sleep latencies in polysomnography and multiple sleep latency tests (MSLT) together with several sleep-onset REM-sleep periods (SOREMs). Pupillography and neuropsychological testing revealed reduced alertness levels. Hypocretin levels in the cerebrospinal fluid were borderline. Based on the postulated autoimmune background of narcolepsy, we performed an intravenous high-dose corticosteroid pulse therapy with methylprednisolone. Narcoleptic symptoms immediately and consistently remitted after the corticosteroid pulse. Follow-up after 4 months revealed normalisation of sleep latencies, no further SOREMs in the MSLT, and increased alertness in pupillography and neurocognitive testing. No further wakefulness promoting drug therapy was required. Narcolepsy should be considered in the differential diagnosis of post-COVID syndrome with leading symptoms of daytime sleepiness. Furthermore, immunosuppressive therapy may offer a treatment option in managing an otherwise lifelong disorder in select cases.

The clock drawing test (CDT) in the digital era: Underperformance of generation Z adults

Background and objectivesThe clock drawing test (CDT) is a widely recognized neurocognitive test for executive and visuospatial functions. However, no normative data exist for Generation Z young adults (born on or after 1997). The widespread use of digital displays among this generation may impair performance on the analog CDT. MethodsYoung Generation Z adults with at least 12 years of education, who were evaluated at the Israel Defense Forces (IDF) outpatient neurology clinic between 2021 and 2022, completed a CDT using the Manos-Wu method and drew a digital clock. Patients with possible cognitive impairment were excluded. ResultsThree hundred Generation Z patients were recruited, with a mean age of 19.7 ± 1.2 years. 171 (57.0 %) were female. Mean CDT score was 8.1 ± 2.5 out of 10 (Manos & Wu). A lower CDT score was associated with younger age (p = 0.031). No association was found with chief complaint, presence of ADHD diagnosis, gender, or postsecondary education. Digital clock drawing (4/4 digits) was successful in 100 % of patients. DiscussionGeneration Z adults demonstrate lower CDT scores than previously reported for older generations. The CDT may require revision to maintain its specificity for this population. Developing an alternative, digital-based tool for cognitive screening in young generations could be advisable.

Child Outcomes after Prenatal Exposure to Platinum and Taxane-based Chemotherapy: An Unplanned Interim Analysis of the International Network on Cancer, Infertility, and Pregnancy Study

Platina and taxanes are frequently used chemotherapeutic agents to treat cancer, also when diagnosed during pregnancy. This report presents an interim analysis of the largest series of children prenatally exposed to platinum and/or taxane agents and aims to determine their physical health and neurocognitive outcomes. As part of a multicentre, prospective cohort study (ClinicalTrials.gov: NCT00330447), children born between 2000 and 2022 were assessed between 2005 and 2024at ages 1.5-18 years (interim analysis; median length of follow-up, 3.2 years (IQR 3.0-6.4)) by a comprehensive neurocognitive test battery, parent-reported questionnaires, and a physical assessment. Mixed-effects regression and Type III Analysis of Variance models were used to investigate associations between these outcomes and platinum/taxane cumulative dose and agent type, with best-fit models corrected for age and covariates (gestational age at birth, chemotherapy timing, other chemotherapy, sex, parental education level, maternal death). In total, 144 children were included (13% exposed to platinum, 62% to taxanes, 25% to both). Of these, 101 were assessed at age 1.5 years, 96at age 3, 63at age 6, 32at age 9, 18at age 12, 7at age 15, and 2at age 18 years. Neurocognitive outcomes were within normal ranges across all ages, compared with test-specific normative data. Eight children (6%) reported ototoxicity, seven (5%) reported chronic medical conditions, three (2%) had congenital malformations, and two (1%) were diagnosed with Attention-Deficit Hyperactivity Disorder. Thirty-three children (23%) needed extra neurocognitive support, of which 64% were born preterm. Children prenatally exposed to paclitaxel scored lower on visuospatial (β=0.64± 0.21, p=0.0052) and verbal memory (β=0.68± 0.27, p=0.015) than those exposed to docetaxel. In this interim analysis, we found normal neurocognitive outcomes and no increase in congenital malformations nor medical conditions after prenatal exposure to platinum/taxane-based chemotherapy. However, owed to the limited number of older children, further investigation regarding their potential neurotoxicity and its long term effects is necessary in follow-up studies with larger samples. Kom Op Tegen Kanker, KWF Kankerbestrijding, Stichting Tegen Kanker, Cooperatio program, Research Foundation Flanders.

The role of predominant polarity on cognitive dysfunctions in patients with bipolar disorder

BackgroundCognitive impairment is frequently observed in bipolar disorder (BD). Previous findings indicated that predominant polarity could have an effect on cognitive deficits. This study aimed to examine the association between predominant polarity and cognitive impairments in BD.Materials and methodsEuthymic BD patients with manic (MPP, n = 31), depressive (DPP, n = 25), undetermined predominant polarity (UPP, n = 28), and healthy controls (HC, n = 27) participated in the study. A battery of neurocognitive and social cognitive tests was implemented. Neurocognitive domains were identified via principal component analysis.ResultsThe MPP group performed worse in the Controlled Oral Word Association Test (COWAT), Reading the Mind in the Eyes Test (RMET), and Hinting Test (HT) compared to the DPP group and reasoning/problem-solving skills compared to the UPP group. Both MPP and UPP groups showed impairments in processing speed compared to HC. Among patient groups, there was no significant difference in working memory, attention, processing speed, verbal, and visual domain scores. The MPP group had poorer scores compared to controls in most of the social cognitive and neurocognitive domains in the study, while the overall cognitive impairment in the DPP group was relatively milder.ConclusionsAlthough our sample size was relatively small, the MPP group yielded more severe cognitive impairment in verbal fluency and social cognition tests compared to DPP. Patients with MPP are particularly vulnerable to cognitive impairment, making them a priority for cognitive enhancement interventions. Future studies should focus on the outcomes of cognitive and pharmacological interventions in these polarity subgroups.

Neurocognitive functioning in adults with neurofibromatosis type 1- a nationwide population-based study

BackgroundNeurofibromatosis type 1 (NF1) is a genetic condition characterized by various somatic manifestations and cognitive impairments, but the latter are sparsely described in adults. This study aimed at characterizing potential impairments of neurocognitive functions using neuropsychological tests as well as a self-report questionnaire.MethodsIn a nationwide, population-based study including 103 adults with NF1 and 38 age- and gender-matched NF1-free comparisons, we used a comprehensive neurocognitive test battery to assess intelligence and visual short-term memory, immediate visuospatial recall, reaction time, sustained attention, motor speed, planning, planning time, working memory as well as multitasking and a questionnaire to assess executive functions. Descriptive statistics, multivariate analysis of variance (MANOVA), and general linear models with repeated measure analysis of variance (ANOVA) were used.ResultsWe observed a statistically significant difference in overall performance-based cognitive functioning. Adults with NF1 showed significant, moderate-to-severe impairments in intelligence, visual short-term memory, immediate visuospatial recall, sustained attention (p < 0.0001–0.002), and some executive functions (p = 0.008 − 0.001), whereas other cognitive functions (multitasking, reaction time, motor speed, spatial working memory, planning time, and planning efficacy as well as some self-reported executive functions) were unimpaired.ConclusionsThis is the first study with a population-based sample of persons with NF1 and the results show impairments of intelligence and other cognitive functions. The pattern of both significant cognitive impairments and non-significantly different cognitive functions suggests a cognitive profile of selective rather than generalized cognitive deficits in NF1.

Hydroxyurea therapy for neurological and cognitive protection in pediatric sickle cell anemia in Uganda (BRAIN SAFE II): Protocol for a single-arm open label trial

BackgroundChildren with sickle cell anemia (SCA) in Sub-Saharan Africa are at high risk of sickle cerebrovascular injury (SCVI). Hydroxyurea, a commonly used disease-modifying therapy, may reduce SCVI resulting in potential impact on reducing stroke and cognitive dysfunction. We aim to test the impact of daily hydroxyurea therapy on these outcomes in Ugandan children with SCA. We hypothesized that hydroxyurea therapy over 36 months will prevent, stabilize or improve these complications of SCA. MethodsThe BRAIN SAFE II study is an open label, single arm trial of daily hydroxyurea in 270 children with SCA (HbSS) in Uganda, ages 3–9 years. Following baseline assessments, participants began hydroxyurea therapy and are followed according to local guidelines. Standard hydroxyurea dose is escalated to maximum tolerated dose (MTD). SCVI is assessed by cerebral arterial velocity using Doppler ultrasound, with cognitive function determined by formal neurocognitive testing (primary outcomes). Structural SCVI is assessed by magnetic resonance imaging (MRI) and angiography (MRA) in a sub-sample of 90 participants ages >5 years. At trial midpoint (18 months) and completion (36 months), outcomes of age-specific assessments will be compared to baseline, as well as biomarkers of anemia, inflammation and malnutrition (secondary outcomes) to determine their relationships to primary outcomes. ConclusionThis trial will examine the impact of hydroxyurea on preventing or ameliorating SCA SCVI in children, assessed by reducing incident stroke, stroke risk and neurocognitive dysfunction. Trial results will provide critical insight into the role of hydroxyurea therapy on critical manifestations of SCVI in children with SCA. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04750707 (registered 11 February 2021). Protocol versionBRAIN SAFE II Protocol Version 3.0, Mar 02, 2022.

Cognitive performance, psychiatric comorbidities, and quality of life in pediatric patients with juvenile idiopathic arthritis: a comparative analysis with healthy controls

ABSTRACT This study aimed to assess the extent of cognitive impairment in children and adolescents with Juvenile Idiopathic Arthritis (JIA). While cognitive deficits are recognized in other systemic rheumatic diseases, exploration within the pediatric JIA population remains limited. The investigation utilized a comprehensive approach to examine neuropsychological test performance. A cohort of 160 participants (79 JIA, 81 healthy controls aged 8–17) underwent evaluations using the Pediatric Quality of Life Inventory (PedsQL), Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and the computerized neurocognitive test battery Central Nervous System Vital Signs (CNSVS). Children with JIA exhibited statistically significant cognitive deficits across various parameters (p < .05). This was associated with an increased prevalence of lifelong psychiatric illnesses and diminished overall quality of life compared to healthy counterparts (p < .05). Analysis highlighted that specific JIA subtypes, excluding Oligoarthritis, significantly elevated the risk of neurocognitive impairments, emphasizing the impact on various cognitive outcomes (OR range: 3.1–5.1, 95% CI: 1.163–19.980). Additionally, the active disease stage was identified as a specific risk factor, amplifying the likelihood of low executive functions by 4.3 times (OR: 4.363, 95% CI: 1.095–17.378). This study underscores the critical importance of recognizing and addressing neurocognitive impairments in children with JIA. Specific attention to disease subtypes and activity levels is crucial, with the potential for targeted interventions to enhance overall cognitive well-being and quality of life in this vulnerable population.

Associations between Physical Performance Tests with Cognitive Changes: The Moderating Effect of Cognitive Status.

Age-related cognitive decline has been linked with risk factors, including physical performance. Prior studies investigating such associations were typically conducted in clinical settings within Western populations with a frequent focus on late neurocognitive diagnostic stages (i.e., Alzheimer's disease), reducing their generalizability to the Asian population and early neurocognitive stages. To address these knowledge gaps, our study investigated longitudinal associations between physical performance measures at baseline and cognitive change in global cognition, executive functioning (EF) based and non-executive functioning (non- EF) based cognitive domains within the Singaporean population. The moderating role of early neurocognitive status, namely mild cognitive impairment (MCI) and cognitively normal (CN), was also examined. This paper examined data from 347 participants (CN = 284; MCI = 63) who participated in the Community Health and Intergenerational (CHI) study at baseline and follow-up. Data from a neurocognitive battery and three physical performance tests, namely the timed-up and go (TUG), fast gait speed (FGS) and 30-second chair-stand test (30s-CST), were analysed using multivariate linear regression models. Only one significant association between FGS scores and cognitive change in Semantic Fluency was observed; other associations were not significant. Cognitive status also significantly moderated associations between TUG/30s-CST tasks with several neurocognitive tests. The lack of significant longitudinal associations between baseline physical performance measures and cognitive change differed from findings in the literature. Nevertheless, the moderating role of cognitive status further highlighted the need to account for cognitive status when exploring such associations within a heterogeneous group of older adults without dementia.

Cognitive Function in Individuals with Chronic Hypoparathyroidism - A Prospective Observational Study.

"Brain fog" is a frequently reported, distressing experience among individuals with chronic hypoparathyroidism, characterized by reduced concentration and reduced ability to perform day-to-day tasks. However, evidence linking chronic hypoparathyroidism to cognitive impairment is limited and inconsistent. This study aimed to explore cognitive function in these patients using a validated neurocognitive test battery, compare results with a matched healthy control group, and analyze the frequency of cognitive impairment based on normative data. The participants' cognitive performance was tested using a cognitive test battery, including the Trail Making Test A/B, the Color-Word Interference Test, and the California Verbal Learning Test. These tests were used to evaluate the cognitive domains of "attention and processing speed," "verbal learning and memory, " and "executive function." In total, 30 individuals with hypoparathyroidism and 30 healthy controls were included. 24 patients were women (80.0%), with a median age of 44.5±13.1 and a median disease duration of 8.7 years (±5.3). Individuals with chronic hypoparathyroidism showed poorer cognitive performance in "attention and processing speed" (F(1,57) = 8.65, p = 0.005*, η² = 0.13) compared to healthy controls. A significantly higher percentage of patients had cognitive deficits in both "attention and processing speed" (56.7% vs. 3.3%) and "executive function" (60.0% vs. 16.7%). This study provides evidence that cognitive dysfunction, particularly in "attention and processing speed" is common in chronic hypoparathyroidism. Recognizing cognitive impairment in these patients is crucial, especially when discussing workability. Neuropsychological training as an adjunct therapy strategy may be beneficial in managing these cognitive deficits.

Abstract 4126628: Worse Cardiac Structure and Function is Associated with Decline in Multiple Domains of Cognitive Function: the Atherosclerosis Risk in Communities (ARIC) Study

Background: Cognitive impairment is cross-sectionally associated with worse cardiac structure/function. However, limited data exist regarding cardiac structure/function and longitudinal changes in cognitive function. Objective: Determine the association of cardiac structure and function with longitudinal changes in cognitive performance in late life. Methods: Among HF- and dementia-free participants in the community-based ARIC study who attended the 5th study visit (V5; 2011-2013), underwent protocol echocardiography, and completed a neurocognitive test battery at both V5 and study Visit 6 (V6; 2015-17), we assessed associations of cardiac structure and function measures with changes in both domain-specific and global cognitive scores between V5 and V6 using multivariable linear regression. Models were initially adjusted for demographics and education level, with additional models further adjusting for cardiovascular risk factors and disease at both V5 and V6. The neuropsychological test battery consisted of 10 neuropsychological tests that covered 3 domains of cognitive function: memory, executive functioning, and language. Factor scores were constructed for each cognitive domain, and their average represented a global composite score. Results: Among 2,988 included participants, mean age was 74±5 years, 60% were female, 20% reported Black race, and mean LVEF was 66±6%. Over a mean of 4.9±0.6 years (the V5 to V6 interval), raw scores declined for all neuropsychological tests. In fully adjusted models, worse diastolic function (larger LAVi) and LV remodeling (greater LV mass index) were associated with decline in executive function. Lower LVEF was associated with decline in language function, while worse LV longitudinal strain – a more sensitive measure of systolic dysfunction – was associated with decline in executive function, language function, and global cognition performance (all p&lt;0.05; Table). Conclusion: Subclinical LV remodeling and dysfunction is associated with greater declines in cognitive function over 5 years in late life. Differential associations were observed by cognitive domains, with executive function decline most uniformly associated with impairments in cardiac structure/function.

Neurodevelopmental Outcomes After Multiple General Anaesthetic Exposure Before Five Years Of Age - A Cohort Study.

The GAS trial demonstrated evidence that most neurodevelopmental outcomes at 2 years and 5 years of age in infants who received a single general anaesthetic (GA) for elective inguinal herniorrhaphy were clinically equivalent when compared to infants who did not receive GA. More than 20% of the children in the trial had at least one subsequent anaesthetic exposure after their initial surgery. Using the GAS database, this study aimed to address whether multiple (2 or more) GA exposures compared to one or no GA exposure in early childhood were associated with worse neurodevelopmental outcomes at 5 years. Children with multiple GA exposures and children with one or no GA exposure were identified from the GAS database. The primary outcome was the full-scale intelligence quotient (FSIQ) on the Wechsler Preschool and Primary Scale of Intelligence third edition (WPPSI-III) at 5 years of age. Secondary outcomes included neurocognitive tests addressing all major developmental domains and caregiver-reported questionnaires assessing emotional and behavioural problems. Complete assessment was available from a total of 90 children in the multiple GA group and 141 children in the 0 or 1 GA group. Compared with children with a single or no GA exposure, multiply exposed children scored on average almost 6 points lower (mean: -5.8, 95% CI: -10.2 to -1.4, p= 0.011) in WPPSI-III FSIQ. They also demonstrated lower verbal and performance IQ scores and more emotional, behavioural, and executive function difficulties. However, significant residual confounding cannot be excluded from the results due to the observational nature of this study. Multiple GA exposure before 5 years of age was associated with reduced performance in general intelligence score and some domains of neurodevelopmental assessments. The clinical significance of our results must be cautiously interpreted in light of several sources of limitations including small sample size and unadjusted residual confounding. This study illustrates the limitations of trial data sets that may not be fit for the purpose for the secondary analysis.

QOL-26. GLIOMA PATIENTS’ COGNITION AND THEIR CAREGIVERS: THE GOOD, THE BAD, AND THE BURDEN

Abstract BACKGROUND Cognitive decline, common in patients with gliomas, can contribute to reduced independence in daily functioning. Patients with gliomas often rely on informal caregivers for functional support, evidenced to cause distress in other caregiver populations (e.g., Alzheimer’s, terminal cancer, dementia). Few studies have investigated this relationship in neuro-oncology; thus, we explored whether patients’ neurocognitive function was associated with aspects of caregiver burden. METHODS Patients with glioma underwent neurocognitive testing including Auditory Verbal Learning Test-Delayed Recall (AVLT), Trail Making Test-Part B (TMT-B), Stroop Color-Word Interference (CWI), Controlled Oral Word Association Test (COWA), and the Grooved Pegboard (GPB). Caregiver burden was assessed using the schedule burden and self-esteem subscales of the Caregiver Reaction Assessment (CRA). Hierarchical regressions and independent samples t-tests evaluated whether neurocognitive performance predicted caregiver burden and differences in caregiver burden between patients with intact versus impaired (AVLT; ≥ -1.5 SD) memory. RESULTS Seventy-eight dyads were included for analyses (Patient: Mage=53.4, 65.4% male, 97.4% Non-Hispanic/White; Caregiver: Mage =52.5, 71.8% female, 96.2% Non-Hispanic/White). AVLT performance was significantly related to both caregiver schedule burden (β = -.63, p =.003) and self-esteem (β =.26, p =.046). Performance on TMT-B, COWA, GPB, and CWI and patient age were not related to caregiver burden in any model (ps&amp;gt;.05). There was a significant difference in caregiver schedule burden between those with (M=15.17, SD=5.84) and without memory impairment (M=18.50, SD=5.60) [t(72)=-2.44, p=.017] but not for self-esteem (p&amp;gt;.05). CONCLUSIONS Patient performance on verbal memory was sensitive to the changes that may contribute to increased caregiver burden. An amnestic profile may be the most salient cognitive predictor of strain on neuro-oncology caregivers. Our findings speak to the interdependence of patient outcomes and caregiver quality of life. Supporting patients’ neurocognitive capabilities, such as implementing individualized cognitive rehabilitation programs, may improve caregiver burden.

Dural Arteriovenous Fistulas: Baseline Cognitive Changes and Changes following Treatment: A Prospective Longitudinal Study.

Dural arteriovenous fistulas (DAVFs) exhibit varied clinical manifestations, and high-grade cases are associated with both a risk of hemorrhage and (in certain cases) dementia. Less known, however, is the association between DAVF and more subtle cognitive changes, which might not be clinically apparent without formal neurocognitive testing. This study prospectively assesses baseline cognitive changes in patients with unruptured DAVFs and looks at the effects of treatment on any such changes. A longitudinal prospective study was conducted to formally evaluate the neurocognitive status of patients with unruptured DAVFs undergoing embolization. Pre- and posttreatment assessments included neurologic examinations and cognitive tests (Repeatable Battery for the Assessment of Neuropsychological Status and Trail-Making Test [TMT]). A total of 23 patients were treated, with 78% demonstrating cortical venous reflux at baseline. At baseline, 50% of patients demonstrated cognitive impairment in at least 1 cognitive domain, and this was significantly associated with cortical venous reflux (P < .05). Following treatment, significant improvements were observed in several cognitive domains. The mean change in Immediate Memory was an increase of 10.5 points (95% CI, 6.2-14.8, P < .001). Visuospatial/Constructional abilities showed a mean increase of 3.8 points (95% CI, 1.1-6.5, P = .008), while Language improved by a mean of 4.2 points (95% CI, 0.9-7.5, P = .015). Attention scores increased by a mean of 6.1 points (95% CI, 2.7-9.5, P < .001). Delayed Memory demonstrated a mean improvement of 7.4 points (95% CI, 3.5-11.3, P < .001), and the Total Repeatable Battery for the Assessment of Neuropsychological Status Score increased by a mean of 8.6 points (95% CI, 5.0-12.2, P < .001). For the TMT, the mean change in TMT-A was a decrease of 9.2 seconds (95% CI, 5.6-12.8, P < .001), indicating faster completion times. TMT-B scores decreased by a mean of 12.7 seconds (95% CI, 8.4-17.0, P < .001). The TMT B-A difference decreased by a mean of 3.5 seconds (95% CI, 0.5-6.5, P = .023), and the TMT B/A ratio showed a mean decrease of 0.18 (95% CI, 0.10-0.26, P = .002). Overall, among the patients with baseline cognitive impairment, 70% showed significant cognitive improvement following endovascular treatment, particularly in memory domains. In our study, 50% of patients with DAVFs had cognitive impairment when assessed with formal neurocognitive testing, with a significant link to cortical venous reflux. This cognitive impairment improved in 70% of those patients following treatment. These findings expand our understanding of how DAVF affects the brain, highlighting cognitive impairment as a critical factor. Consequently, the treatment of DAVFs should perhaps not only focus on hemorrhagic risk but also consider cognitive outcomes as a potential indicator for intervention.