Neuropsychological Assessment Metrics Research Articles

Accuracy of Reaction Time Measurement on Automated Neuropsychological Assessment Metric UltraMobile.

This observational study examined the accuracy of simple reaction time (RT) measurements on various touchscreen tablet devices using the Automated Neuropsychological Assessment Metric (ANAM) UltraMobile test battery. The study investigated the implications of interpreting ANAM UltraMobile with laptop-based normative data by analyzing the magnitude and variability of RT accuracy across devices. RT accuracy on 10 different tablets was assessed using a photodetector and robotic arm to respond to stimuli at predetermined response times. The recorded RT was compared with the true RT obtained from the robotic arm to calculate the RT error. ANAM UltraMobile recorded slower RTs than the laptop version. Additionally, RT error varied considerably among the 10 tablet models, suggesting psychometrically significant implications that could lead to interpretive errors when using laptop-based normative data. Relative to the RT error from the laptop-based version of ANAM, tablet data from ANAM UltraMobile are significantly slower and exhibit large variability between devices. These differences may have clinically significant implications for the comparability of the two versions. The findings suggest that further research with human participants is needed to assess the equivalence of ANAM UltraMobile with its predecessor.

Automated Neuropsychological Assessment Metrics: Normative Reference Values for U. S. Army National Guard Soldiers.

The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized cognitive test system used extensively with military service members. The aim of this study was to develop a nationally representative normative dataset of Army National Guard (ARNG) personnel and to explore potential relationships between ANAM performances and select military service, demographic, and health factors. ANAM performance data were collected using standardized procedures from a representative sample of ARNG service members in six U.S. states. Normative performance values, stratified by age, sex, and military occupational category, were calculated for each ANAM subtest and descriptive measures were computed, along with base rates of below-average performance. The effect of demographic (e.g., age, sex, education, race) and military service and health factors (e.g., deployment, job category, history of head injury) was examined. Data from 1,436 ARNG service members (14.3% female) were analyzed, and normative values calculated. Overall, differences in ANAM performance based on demographic, military service, and health factors were small. A total of 8.9% of the sample had scores on two or more subtests that were ≥ 1.3 SD below the mean; this dropped to 1.9% using a more stringent cut point (≥2 SD below the mean). The ANAM normative data reported herein ensure that healthcare providers and researchers have access to reference data that more accurately reflect the larger population of ARNG service members. These data support the assessment and management of ARNG service members' health, as well as future ANAM research involving ARNG service members.

Cycle-based high-intensity sprint exercise elicits acute cognitive dysfunction in psychomotor and memory task performance

PurposeTo examine the impact of an acute high-intensity sprint exercise protocol (HISEP) for eliciting post-exercise cognitive dysfunction in psychomotor, attentional, executive, and memory tasks.MethodsTwenty-four recreationally active adults (22 ± 4 yrs, 169.39 ± 10.07 cm, 75.80 ± 14.73 kg, 27.03 ± 9.55 BF%) performed a HISEP on a cycle ergometer. Average psychomotor reaction time (avgRT; Dynavision D2 Mode A & Mode B), mood (Profile of Mood States Questionnaire; POMS), and cognition (Automated Neuropsychological Assessment Metrics; ANAM) were assessed pre- (PRE), post- (POST) and 60-min post (60POST) HISEP. One-way repeated measures ANOVAs were used to assess changes across time.ResultsFatigue (main effect: p < 0.001, ηp2 = 0.309) was significantly higher at POST compared to PRE (p = 0.007). Tension (main effect: p = 0.021, ηp2 = 0.154) was significantly lower at 60POST compared to PRE (p = 0.029). Mode A avgRT (main effect: p = 0.022, ηp2 = 0.153) was significantly slower at POST compared to PRE (p = 0.026). Throughput (TP) scores for ANAM code substitution-delayed (CSD) task (main effect: p < 0.001, ηp2 = 0.284) and matching to sample (M2S) tasks (main effect: p = 0.014, ηp2 = 0.169) were significantly lower at POST compared to PRE (p = 0.001 and p = 0.025, respectively), while mathematical processing (main effect: p = 0.002, ηp2 = 0.232) was significantly higher at 60POST compared to both PRE (p = 0.019) and POST (p = 0.005). No other significant changes in cognitive task performance were observed (p's > 0.05).ConclusionsThe HISEP is a feasible and time-effective fatiguing exercise stimulus capable of eliciting acute cognitive dysfunction in psychomotor and memory task performance. NCT05100589.

Resistance training's impact on blood biomarkers and cognitive function in older adults with low and high risk of mild cognitive impairment: a randomized controlled trial

BackgroundThe aging brain exhibits a neuroinflammatory state, driven partly by peripheral pro-inflammatory stimuli, that accelerates cognitive deterioration. A growing body of evidence clearly indicates that physical exercise partly alleviates neuroinflammation and positively affects the aging process and cognition. In this randomized controlled trial, we aimed to observe the effect of 12 weeks of resistance training (RT) on peripheral biomarker levels, cognitive function changes and their interrelationship, and explore differences in those exercise-induced changes in older adults with high risk of mild cognitive impairment (MCI) compared to older adults with low risk of MCI.MethodsFifty-two participants (aged 60–85 years old, 28 female) were randomly allocated to a 12 week lower limb RT program consisting of two training sessions per week or waiting list control group. The Montreal Cognitive Assessment (MoCA) was used to stratify participants screened as high (< 26/30) or low risk (≥ 26/30) of MCI. We assessed serum Interleukin 6 (IL-6), Insulin-like Growth Factor-1 (IGF-1), and Kynurenine (KYN) levels. Cognitive measurement consisted of and four subtests of Automated Neuropsychological Assessment Metrics (ANAM), the two-choice reaction time, go/no-go, mathematical processing, and memory search test.ResultsTwelve weeks of RT improved Go/No-go test results in older adults with high MCI risk. RT did not significantly affect blood biomarkers. However, IGF-1 level increases were associated with improvements in response time on the mathematical processing test in the exercise group, and IL-6 level increases were associated with improvements in response time on the memory search test in the total group of participants. Finally, KYN levels significantly differed between older adults with low and high MCI risk but no significant associations with performance were found.ConclusionOur study results suggest a different effect of RT on inhibitory control between older adults with low compared to high MCI risk. IGF-1 may play a role in the mechanism behind the cognitive benefit of RT and KYN may be a surrogate biomarker for neurodegeneration and cognitive decline.

Remote digital cognitive assessment reveals cognitive deficits related to hippocampal atrophy in autoimmune limbic encephalitis: a cross-sectional validation study

Autoimmune limbic encephalitis (ALE) is a neurological disease characterised by inflammation of the limbic regions of the brain, mediated by pathogenic autoantibodies. Because cognitive deficits persist following acute treatment of ALE, the accurate assessment of long-term cognitive outcomes is important for clinical assessments and trials. However, evaluating cognition is costly and an unmet need exists for validated digital methods. In this cross-sectional validation study, we investigated whether a remote digital platform could identify previously characterised cognitive impairments in patients with chronic ALE and whether digital metrics would correlate with standard neuropsychological assessment and hippocampal volume. Patients with ALE who had a chronic and stable presentation and received a clinical diagnosis of ALE were recruited for this study. The cognitive performance of 21 patients with ALE and 54 age-matched healthy controls - enrolled via the University of Oxford (UK) Cognitive Neurology Lab testing programme - was assessed with a battery of 12 cognitive tasks from the Cognitron online platform. The platform was optimised with National Institute for Health and Care Research (NIHR) support to be deliverable remotely to elderly and patient groups. The primary outcome measure was behavioural performance and corresponding neuroimaging and neuropsychological assessment metrics. Between February 15, 2021, and April 21, 2022, 21 patients with ALE (mean age 63.01 years, 14 males) and 54 healthy controls (mean age 65.56 years, 23 males) completed the digital cognitive assessment. Patients with ALE performed significantly worse in memory, visuospatial abilities, executive function, and language. No impairments in digit & spatial span, target detection (attention) and emotion discrimination were observed. The global score on the online cognitive tasks correlated significantly with the established Addenbrooke's Cognitive Examination III (ACE) pen-and-paper test. Deficits in visuospatial processing and language were identified in ALE compared to controls using remote digital testing but not using the ACE, highlighting higher sensitivity of computerised testing to residual cognitive impairment. Finally, the hippocampal volumes of patients with ALE and healthy controls correlated with online cognitive scores. These findings demonstrate that subtle cognitive deficits in patients with chronic ALE, who often show full recovery in measures of disability and dependence on daily activities, are detectable using a remote online platform, which also relates to hippocampal atrophy. Such methods may facilitate the characterisation of cognitive profiles in complex neurological diseases. Future longitudinal studies designed to assess the utility of such digital methods for further clinical characterisation are needed. The Wellcome Trust, Medical Research Council, National Institute for Health Research, Rhodes Scholarship, and the Berrow Foundation Scholarship.

A COMPARISON OF THE IMPACT OF ADVERSE CHILDHOOD EXPERIENCES ON BRAIN HEALTH IN LATINA AND NON-LATINA WOMEN

Abstract Early-life experiences and social determinants of health influence late-life cognitive performance, cognitive aging trajectories, and risk of Alzheimer’s disease and related dementias (ADRD). Research shows adversity during childhood plays a central role in health outcomes later in life, such that more adverse childhood experiences (ACEs) predict higher likelihood of negative physical and mental health outcomes. As ACEs may also predict neurocognitive performance and historically marginalized groups are disproportionately exposed to ACEs, this study aims to enhance diversity in research on ACEs and cognitive aging by clarifying the role of ethnicity. Latinos are 51% more likely to experience ACEs and 1.5x more likely to experience ADRD than their non-Latino counterparts. Data were collected in two studies assessing cognitive functioning in women aged 65-85 who reported no ACEs or 3+ ACEs (54 non-Latinas, Oklahoma; 50 Latinas, Rhode Island). ACEs were measured with the Adverse Childhood Experiences Questionnaire. Cognition was measured using NIH Toolbox Cognition-Battery and Automated Neuropsychological Assessment Metrics. In the non-Latina white sample (Mage=73.2), those with 3+ ACEs exhibited inferior scores on Stroop Interference, p=.050, d=-.44. The ACEs group demonstrated higher scores on List Sorting, p=.003, d=-.78. Small effects were found in Stroop Color, Stroop Color-Word, Cognition Fluid Composite, Flanker, and Cart Sort (d=-.25, -.39, -.29, .24, -.25, respectively). These findings are compared to those within the Latina sample, demonstrating the need to extend research on life course risk factors for ADRD to this underrepresented group, which is at elevated risk of both ACEs and ADRD.

Mild Traumatic Brain Injury in the Maturing Brain: An Investigation of Symptoms and Cognitive Performance in Soldiers Returning From Afghanistan and Iraq.

The majority of traumatic brain injuries (TBIs) are classified as mild and occur in young individuals. The course of recovery varies but can result in chronic or troubling outcomes. The impact of age on TBI outcomes in young adults before complete brain maturation is not well studied. In this study, we compared the effects of mild TBI on cognitive performance and self-reported TBI symptoms and posttraumatic stress disorder (PTSD) in 903 soldiers in 3 different age groups: 24 years or younger, 25 to 27 years, and 28 to 40 years. The soldiers had returned from war zones in Iraq and were screened for TBI within a few days of return. Cognitive performance was measured with the Automated Neuropsychological Assessment Metrics of Military TBI Version 4 (ANAM4). Symptoms associated with mild TBI were self-reported on the Neurobehavioral Symptom Inventory, and the PTSD Checklist-Civilian Version (PCL-C). Soldiers with TBI in every age group had significantly higher prevalence of most symptoms than those with no TBI. Soldiers with TBI also reported more chronic pain sites, regardless of age. Soldiers aged 28 to 40 years with TBI had the lowest cognitive performance scores (ANAM) across several subtests, both unadjusted and adjusted. The Global Deficit Score was significantly higher for soldiers aged 28 to 40 years and 25 to 27 years with TBI than for soldiers younger than 24 years with no TBI. After adjusting for PTSD symptoms, education, and number of lifetime TBIs, the overall test battery mean for soldiers aged 28 to 40 years with TBI was significantly lower than for soldiers younger than 24 years with no TBI. Soldiers with mild TBI in the younger age group show more symptoms associated to frontal lobe function while soldiers in the older group suffer more cognitive impairment. This may warrant further study as it may indicate a propensity to later cognitive decline among soldiers who were older at the time of injury.

Relation Between Cognitive Assessment and Clinical Physical Performance Measures After Mild Traumatic Brain Injury

ObjectivesTo investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DesignMulti-center, cross-sectional study. SettingThree institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). ParticipantsData were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. InterventionsNot applicable. Outcome MeasuresCognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. ResultsIndividuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. ConclusionsCombining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.

P076 Comparing Four Different Simulated Shiftwork Schedules on Higher order Cognitive Function

Abstract Introduction Changes in cognitive performance during shiftwork due to fatigue and circadian misalignment are well-documented. However experimental evaluations of shiftwork schedules are often limited to basic tasks such as vigilance and attention. The current study evaluated several higher order cognitive functions such as memory and task switching during four simulated shiftwork schedules. Methods N=27 completed a 10-day laboratory shiftwork simulation. They were randomly assigned to one of four shiftwork conditions: Condition A, 4h-on/4h-off/8h-on/8h-off schedule; Condition B, 6h-on/6h-off schedule; Conditions C and D represented to different sections of a 4h-on/4h-on call/4h-off/4h-on/4h-on call/4h-off schedule. The Automated Neuropsychological Assessment Metrics (ANAM) was used to assess cognitive function. The tasks included in this analysis were Code Substitution (CDS/CDD), Pursuit Tracking (PUR), Matching to Sample (M2S), and Switching Task (SWT). Stability of performance during waking was compared between the conditions using Kruskal-Wallis tests. Results The analysis of cognitive performance tasks yielded mixed findings. Performance on all tasks was ranked from best to worst: Condition D (&amp;gt;Conditions A, B, C; all p &amp;lt; .05), Condition A (&amp;gt;Conditions B, C; p &amp;lt; .05 and p &amp;lt;.001, respectively), Condition B, Condition C. Regarding stability of higher order cognitive function across the waking day, Condition A exhibited the worst stability, and was the only condition whereby performance degraded across the wake period. Discussion These findings highlight the variability in cognitive capacities during different shiftwork schedules. It is important to examine higher order cognitive function, and other cognitive abilities during shiftwork, when evaluating different shiftwork schedules.

Carbohydrate ingestion attenuates the reduction in complex cognitive function and cerebral blood flow during prolonged passive heat stress in humans

PurposeTo determine whether carbohydrate ingestion would reduce cognitive dysfunction in humans following long duration passive heat stress (PHS) versus consuming electrolytes alone. MethodsFifteen young (27 ± 4 y) healthy adults were exposed to 120 min of PHS through the use of a liquid perfused suit (50 °C) on two randomized visits. Subjects consumed fluids supplemented with electrolytes (E) or electrolytes + carbohydrates (E + C). Pre- and post-heat stress, body mass (BM) and plasma osmolality (pOsm) were measured. Heart rate (HR), blood pressure (BP), Physiological Strain Index (PSI), core temperature (Tc), plasma glucose, respiration rate (RR), end-tidal CO2 (PetCO2) and internal carotid artery (ICA) blood flow were recorded at baseline and every 15 min of heat stress. Cognitive function was assessed via the Automated Neuropsychological Assessment Metric at baseline and at 30- and 120 min during heat stress. ResultsThere were no significant differences between fluid conditions for BM, pOsm, PSI, Tc, RR or PetCO2. Plasma glucose was ∼75% greater in the E + C condition compared to the E condition after 90 min of PHS (P < 0.05). Cognitive function (120 min) was impaired following PHS only in E condition (P < 0.05) and performance on complex cognitive tasks were better by ∼22–340% in the E + C vs. E (P < 0.05). Compared to the E condition, HR and BP were lower and ICA blood flow, vascular conductance, and glucose delivery was ∼90% greater in the E + C after 90 min of PHS (P < 0.05). ConclusionsThese data are the first to demonstrate that carbohydrate ingestion may have a protective effect on cognitive function during long duration PHS. Furthermore, this protection was associated with preserved ICA blood flow and glucose delivery to the brain.

Evaluating the effects of PeakATP® supplementation on visuomotor reaction time and cognitive function following high-intensity sprint exercise.

The purpose of this study was to examine the effects of 14-days adenosine 5'-triphosphate (ATP) supplementation (PeakATP®) on reaction time (RT), multiple object tracking speed (MOT), mood and cognition. Twenty adults (22.3 ± 4.4 yrs., 169.9 ± 9.5 cm, 78.7 ± 14.6 kg) completed two experimental trials in a double-blind, counter-balanced, crossover design. Subjects were randomized to either PeakATP® (400 mg) or placebo (PLA) and supplemented for 14-days prior to each trial. During each trial, subjects completed a three-minute all-out test on a cycle ergometer (3MT), with measures of visuomotor RT [Dynavision D2 Proactive (Mode A) and Reactive (Mode B) tasks], MOT (Neurotracker), mood (Profile of Mood States Questionnaire; POMS) and cognition (Automated Neuropsychological Assessment Metrics; ANAM) occurring before (PRE), immediately post (IP) and 60 min post-3MT (60P). Subjects ingested an acute dose of the assigned supplement 30 min prior to completing PRE assessments for each trial. Trials were separated by a 14-day washout period. PeakATP® significantly attenuated declines in hits (p = 0.006, ηp2 = 0.235) and average RT (AvgRT, p = 0.006, ηp2 = 0.236) in Mode A, significantly improved AvgRT (p = 0.039, ηp2 = 0.174) in Mode B, and significantly reduced the total number of misses (p = 0.005, ηp2 = 0.343) in Mode B. No differences between treatments were noted for MOT, POMS or ANAM variables. In conclusion, these results indicate that PeakATP® maintains proactive RT and improves reactive RT following high-intensity sprint exercise suggesting that supplemental ATP may mitigate exercise induced cognitive dysfunction.

0161 Structural Changes in Mood Domains During Sleep Deprivation and Recovery

Abstract Introduction Mood is known to vary as a function of sleep debt. Mood batteries often measure multiple, non-orthogonal domains. In the present study, the latent structure of the Automated Neuropsychological Assessment Metrics Mood (ANAM-mood) battery was assessed during five different states of alertness. We present a novel scheme to evaluate changes in the structure of such batteries across conditions. It was hypothesized that the structure would change, with the greatest changes manifest during sleep deprivation. Methods The present analyses were conducted on data from a prior sleep deprivation study (n = 25 healthy young adults). We used the identity property of MANOVA. Given correlation matrices Σi and Σj, structural invariance was defined as Σi Σj-1 ≈ I (Identity). MANOVA statistic m was the largest eigenvalue of Σi Σj-1. Resampling was used to generate m-distributions within and between the five different alertness conditions - Rested, Sleep Deprived (SD) days 1 and 2, and Recovery days 1 and 2. In addition, the relative number of mood dimensions was estimated by the odds (via resampling) of two dimensions explaining 80% of the variance of Σi compared to Σj. Results The pairwise MANOVA-statistic revealed significant structural variations across conditions (p&amp;lt; 0.001 for all comparisons). Significant differences included Rested vs SD1 and SD2. Recovery 1 showed the most pronounced differences to all conditions. Recovery 2 was like Recovery 1, but more like Rested than the prior day. The odds ratio of two-dimensions for Recovery 1 was much higher compared to all other conditions (OR: 2.4-245, p&amp;lt; 0.001). Conclusion Individuals respond differently to a mood survey across specific alertness conditions resulting in structural changes to the data. Wakefulness during recovery from severe sleep loss differs most significantly from all states, contrary to our hypothesis. This is important to consider when interpreting mood changes as measured by such batteries (including related Spielberger's State Anxiety Inventory and Beck Depression Inventory-II) during sleep studies. Follow up studies are needed to fully assess such effects and devise methods to account for them. Support (if any) This effort was fully supported by the Department of Defense Military Operational Medicine Research Program (MOMRP).

Combining multimodal magnetic resonance brain imaging and machine learning to unravel neurocognitive function in non-neuropsychiatric systemic lupus erythematosus.

To study whether multimodal brain MRI comprising permeability and perfusion measures coupled with machine learning can predict neurocognitive function in young patients with SLE without neuropsychiatric manifestations. SLE patients and healthy controls (HCs) (≤40 years of age) underwent multimodal structural brain MRI that comprised voxel-based morphometry (VBM), magnetization transfer ratio (MTR) and dynamic contrast-enhanced (DCE) MRI in this cross-sectional study. Neurocognitive function assessed by Automated Neuropsychological Assessment Metrics was reported as the total throughput score (TTS). Olfactory function was assessed. A machine learning-based model (i.e. glmnet) was constructed to predict TTS. Thirty SLE patients and 10 HCs were studied. Both groups had comparable VBM, MTR, olfactory bulb volume (OBV), olfactory function and TTS. While after correction for multiple comparisons the uncorrected increase in the blood-brain barrier (BBB) permeability parameters compared with HCs did not remain evident in SLE patients, DCE-MRI perfusion parameters, notably an increase in right amygdala perfusion, was positively correlated with TTS in SLE patients (r = 0.636, false discovery rate P < 0.05). A machine learning-trained multimodal MRI model comprising alterations of VBM, MTR, OBV and DCE-MRI parameters mainly in the limbic system regions predicted TTS in SLE patients (r = 0.644, P < 0.0005). Multimodal brain MRI demonstrated increased right amygdala perfusion that was associated with better neurocognitive performance in young SLE patients without statistically significant BBB leakage and microstructural abnormalities. A machine learning-constructed multimodal model comprising microstructural, perfusion and permeability parameters accurately predicted neurocognitive performance in SLE patients.

Longitudinal assessment of neurocognitive function in people with relapsing multiple sclerosis initiating alemtuzumab in routine clinical practice: LEM-COG study results.

Alemtuzumab is effective in reducing relapse rate and disability, but limited data exist on its effect on cognitive function in relapsing multiple sclerosis (RMS). The present study assessed neurocognitive function and safety associated with alemtuzumab treatment in RMS. This longitudinal, single-arm, prospective study included people with RMS (aged 25-55 years) who were treated with alemtuzumab in clinical practice in the United States of America and Canada. The first participant was enrolled in December 2016. The primary endpoint was the change from baseline to post-baseline (month [M] 12/24) in MS-COGnitive (MS-COG) composite score. Secondary endpoints included Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Selective Reminding Test (SRT), Controlled Oral Word Association Test (COWAT), and Automated Neuropsychological Assessment Metrics (ANAM) scores. Depression and fatigue were assessed using Hamilton Rating Scale-Depression (HAM-D) and Fatigue Severity Scale (FSS)/Modified Fatigue Impact Scale (MFIS), respectively. Magnetic resonance imaging (MRI) parameters were assessed when available. Safety was assessed throughout the study. Descriptive statistics were used for the pre-specified statistical analyses. Since the study was terminated early (November 2019) because of operational and resource difficulties, post hoc analyses for statistical inference were performed among participants who had a baseline value and at least one complete post-baseline assessment for cognitive parameters, fatigue, or depression. Of the 112 participants enrolled, 39 were considered as the primary analysis population at M12. At M12, a mean change of 0.25 (95% confidence interval [CI]: 0.04, 0.45; p=0.0049; effect size [ES]: 0.39) was observed in the MS-COG composite score. Improvements were observed in processing speed (based on PASAT and SDMT; p < 0.0001; ES: 0.62), as well as in individual PASAT, SDMT and COWAT scores. An improvement was also noted in HAM-D (p=0.0054; ES: -0.44), but not in fatigue scores. Among MRI parameters, decreases in burden of disease volume (BDV; ES: -0.12), new gadolinium-enhancing lesions (ES: -0.41) and newly active lesions (ES: -0.07) were observed at M12. About 92% of participants showed stable or improved cognitive status at M12. There were no new safety signals reported in the study. The most common adverse events (≥10% of participants) were headache, fatigue, nausea, insomnia, urinary tract infection, pain in extremity, chest discomfort, anxiety, dizziness, arthralgia, flushing, and rash. Hypothyroidism (3.7%) was the most frequent adverse event of special interest. The findings from this study suggest that alemtuzumab has a positive impact on cognitive function with significant improvements in processing speed and depression in people with RMS over a period of 12 months. The safety profile of alemtuzumab was consistent with previous studies.

Baseline concussion assessment performance by sex in military service academy rugby players: findings from the CARE Consortium

BackgroundNormative student-athlete concussion assessment data may not be appropriate for service academy members (SAMs), particularly rugby players, because of the uniqueness of their academic/military training environment. Having accurate baseline data...

Added Inspiratory Resistance Does Not Impair Cognitive Function and Mood State.

This study evaluated cognitive function and mood state with inspiratory resistance before and after maximal exercise in hypoxia. Nine healthy men (age = 25 ± 2 years) performed the Automated Neuropsychological Assessment Metrics-4th Edition (ANAM4) of the Stroop color-word test (SCWT) and total mood disturbance (TMD) before and after an incremental cycling exercise until volitional fatigue with four different inspiratory resistances (0, 1.5, 4.5, 7.5 cm H2O·L-1·s-1). There was no significant difference in the interference score of SCWT and TMD at normobaric, hypoxic conditions at four different inspiratory resistances. However, the interference score of SCWT was improved following maximal cycling exercise, whereas TMD was not improved. Inspiratory resistance did not have a deleterious effect on cognitive function and mood state in normobaric hypoxia after maximal cycling exercise. However, following maximal cycling exercise, cognitive function was improved.

The Effects of Acute Resistance Exercise on Memory, Processing Speed, and Mood State After a Cognitive Challenge.

Venezia, AC, Barney, P, Spagnoli, D, Greco-Hiranaka, C, Piepmeier, AT, Smith, JC, and Weiss, LR. The effects of acute resistance exercise on memory, processing speed, and mood state after a cognitive challenge. J Strength Cond Res 37(9): 1738-1745, 2023-Acute moderate-to-vigorous-intensity aerobic exercise has been shown to improve learning and memory, but the effectiveness of acute high-intensity resistance exercise for improving memory is not fully understood. Like acute aerobic exercise, acute resistance exercise increases arousal and circulating catecholamines, mechanisms suggested to mediate the memory-enhancing effects of acute exercise. Furthermore, although acute exercise has been shown to benefit mood state, it is unknown if high-intensity resistance exercise positively influences mood state after a cognitive challenge. In this within-subjects design, subjects (18- to 25-year-old men) completed an approximately 40-minute session of resistance exercise or seated rest. Immediately after, the Automated Neuropsychological Assessment Metrics (ANAM) Code Substitution (CS)-Learning, CS-Immediate Recognition, and CS-Delayed Recognition tasks were completed, followed by the ANAM Mood Scale. There were no significant effects of exercise on recognition memory; however, CS-Learning (attention and processing speed) was better after resistance exercise ( p = 0.03). After the cognitive challenge, restlessness ( p < 0.001), vigor ( p = 0.03), and depression ( p = 0.047) scores were higher after resistance exercise compared with rest; however, after false discovery rate correction, only restlessness remained significantly different between sessions ( q = 0.002), whereas vigor ( q = 0.09) and depression ( q = 0.09) did not. These results suggest that an acute bout of resistance exercise improves attention and processing speed, although it does not improve recognition memory and has mixed effects on mood state in college-aged men.

Physician norms for the Automated Neuropsychological Assessment Metrics (ANAM)

Introduction The development of population specific norms for the Automated Neuropsychological Assessment Metrics (ANAM) is to help expand the utility for use with other population groups. Currently, normative data are available for general military, special operations, athletic, and community populations. The current study provides normative reference values for use in assessing physicians. Materials and methods Retrospective data from a sample of 2,288 physicians who completed the ANAM were examined. The data were gathered from practicing civilian physicians serving in the National Guard or Reserves who completed the assessment as part of the mandated Department of Defense clinical testing policy. The effects of age and sex on performance were examined for all subtests. Normative tables were stratified by age (23–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59, 60–64, 65–79) and sex. Base rates of low scores among the physician population were also examined. Results Older age was associated with lower performance on all subtests with small-to-medium effect sizes. A mixed pattern of performance was observed as a factor of sex with females scoring better on one subtest and males scoring better on three subtests. However, effects sizes associated with sex were small and likely of minimal clinical significance. A total of 11.3% of the physician sample scored below average on two or more tests in the battery. Conclusions This study provides normative data for practicing physicians that can be used to help inform clinical decision-making.

Cognitive Performance in Patients with Systemic Lupus Erythematosus Using the Ped-ANAM

Computerized batteries have been widely used to investigate cognitive impairment (CI) in patients with SLE. The aim of this study was to evaluate the cognitive performance of patients with SLE in relation to healthy controls using the Pediatric Automated Neuropsychological Assessment Metrics (Ped-ANAM) battery. In addition, we aimed to examine differences in Ped-ANAM scores according to age of disease onset, presence of disease activity, and disease damage. We included 201 consecutive adult-onset (aSLE) and childhood-onset SLE (cSLE) patients who were being followed at the hospital's rheumatology outpatient clinic and 177 healthy controls. We applied the percentage of correct answers on the Ped-ANAM subtests and the Performance Validity Index (PVI) metric and correlated them with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus Erythematosus Damage Index (SDI). Then, we established their relationships with neuropsychiatric systemic lupus erythematosus (NPSLE). We observed CI in a total of 38 (18.9%) SLE patients and 8 (4.5%) healthy controls (p < 0.001). CI was observed in eight (19.5%) cSLE patients and 32 (20%) aSLE patients (p = 0.8175). Individual analysis of the aSLE subtests showed a significant difference in all subtests compared to healthy controls; the greatest differences were in matching to sample (p < 0.001) and memory search ( p < 0.001). In the cSLE group, we observed a difference in the code substitution subtests (p = 0.0065) compared to the healthy controls. In the evaluation of clinical outcomes, disease activity was significantly correlated with CI in cSLE (r = 0.33; p = 0.042) and aSLE (r = 0.40; p = 0.001). We also observed an association between disease activity and neuropsychiatric manifestations (p = 0.0012) in aSLE. In conclusion, we determined that cognitive dysfunction, mainly in memory and attention, was more prevalent in patients with SLE. In both the cSLE and aSLE groups, disease activity was associated with worse cognitive function. This is the first study to use the Ped-ANAM in Brazil. Longitudinal studies are necessary to determine how the Ped-ANAM will perform over time.

The effects of a 6-week controlled, hypocaloric ketogenic diet, with and without exogenous ketone salts, on cognitive performance and mood states in overweight and obese adults

BackgroundKetogenic diets are a commonly used weight loss method, but little is known how variations in sodium content and ketones influence cognition and mood during the early keto-adaptation period.ObjectivesTo investigate the effects of an exogenous ketone salt (KS) as part of a hypocaloric KD on mood and cognitive outcomes in overweight and obese adults. A secondary objective was to evaluate changes in biochemical markers associated with inflammatory and cognitive responses.Materials and methodsAdults who were overweight or obese participated in a 6-week controlled-feeding intervention comparing hypocaloric diets (∼75% of energy expenditure). KD groups received twice daily ketone salt (KD + KS; n = 12) or a flavor-matched placebo, free of minerals (KD + PL; n = 13). A separate group of age and BMI matched adults were later assigned to an isoenergetic low-fat diet (LFD; n = 12) as comparison to KD. Mood was assessed by shortened Profile of Mood States and Visual Analog Mood Scale surveys. Cognitive function was determined by the Automated Neuropsychological Assessment Metrics mental test battery.ResultsBoth KD groups achieved nutritional ketosis. Fasting serum glucose decreased in both KD groups, whereas glucose was unaffected in the LFD. Insulin decreased at week 2 and remained lower in all groups. At week 2, depression scores in the KD + PL group were higher compared to KD + KS. Performance in the math processing and go/no-go cognitive tests were lower for KD + PL and LFD participants, respectively, compared to KD + KS. Serum leptin levels decreased for all groups throughout the study but were higher for KD + KS group at week 6. Serum TNF-α steadily increased for LFD participants, reaching significance at week 6.ConclusionDuring a short-term hypocaloric diet, no indication of a consistent decline in mood or cognitive function were seen in participants following either KD, despite KD + PL being relatively low in sodium. WK2 scores of “anger” and “depression” were higher in the LFD and KD + PL groups, suggesting that KS may attenuate negative mood parameters during the early intervention stages.