Neuropsychological Assessment Metrics Research Articles

0239 THE INFLUENCE OF ANCESTRY ON SLEEP AND PERFORMANCE

Racial differences exist in sleep duration and circadian timing, however it is unknown whether these differences extend to cognitive performance. The current study investigated the role of ancestry on sleep and performance before and after a 9h advance of the sleep/wake episode. Twenty African-Americans (9F; 32.1 ± 7.5yr) and 17 European-Americans (8F; 29.7 ± 5.7yr) completed the study. Participants were scheduled to four baseline days each with 8h time in bed based on their habitual sleep schedule such that sleep and circadian rhythms were aligned. The sleep-wake schedule was then advanced 9h earlier (misaligned) for three days. Total sleep time (TST) was assessed with actigraphy. The Automated Neuropsychological Assessment Metrics (ANAM) test battery was administered every 3h each day starting 2h after waking. Tests included a simple reaction time task (SRT) and Stanford sleepiness scale (SSS). Mixed model ANOVAs assessed the effects of ancestry (African-American or European-American) and condition (aligned or misaligned) on sleep and performance. TST was reduced on misaligned days compared to baseline (F=18.67, p<0.001) and African-Americans slept less compared to European-Americans (F=8.58, p<0.01), especially on the first two misaligned days when the difference was 47 and 59 minutes respectively (F=6.67, p<0.01). Compared to baseline, misalignment increased SSS ratings (F=72.69, p<0.001), but did not affect the number of lapses (F=0.02, p=0.90) or median reaction time (RT)(F=0.02, p=0.88) on the SRT. While there was no effect of ancestry on SSS (F=0.22, p=0.64), there was a trend for lapses (F=3.55, p=0.07) and median RT (F=2.80, p=0.10) to be higher for African-Americans. On misaligned days, African-Americans performed worse than European-Americans at times corresponding to the end of baseline sleep (lapses, F=7.16, p<0.05; median RT, F=5.16, p<0.05). Racial disparities in sleep may be more prominent when the sleep episode is shifted, and there may be racial differences in the circadian regulation of performance. Results have implications for the sleep and performance of individuals undertaking shiftwork or transmeridan travel. R01NR007677(CIE).

Validation of ANAM for cognitive screening in a mixed clinical sample

ABSTRACTThe Automated Neuropsychological Assessment Metrics (ANAM) is a library of computer based tests designed to measure cognitive function at a single time-point or longitudinally for detection of cognitive change. This study sought to validate ANAM as a cognitive screening tool for presence of confirmed neuropsychological diagnosis in an outpatient setting. Retrospective data analysis was conducted for 139 patients referred for outpatient neuropsychological assessment. Clinical diagnosis was made independent of ANAM test results and resulted in a diagnostic mix of both neurologic and psychologic etiologies. ANAM scores predictive of presence of confirmed diagnosis were identified using multiple logistic regression and the predictive ability of the resulting model was quantified using receiver operator characteristic analysis. Sensitivity and specificity for the ANAM when combined with anger and depressive symptom scores were 71% and 91%, respectively, with a positive predictive value of 97.5 and negative predictive value of 40.4. This combined approach provided the greatest accuracy for individual tests as well as the composite score of the ANAM in identifying those who received a subsequent clinical diagnosis. Although data should be replicated in larger samples, these results suggest that ANAM may have predictive value and may be a useful screening tool for identifying those who would likely benefit from neuropsychological services.

Structural and Functional Integrity of the Intraparietal Sulcus in Moderate and Severe Traumatic Brain Injury.

Severe and moderate traumatic brain injury (sTBI) often results in long-term cognitive deficits such as reduced processing speed and attention. The intraparietal sulcus (IPS) is a neocortical structure that plays a crucial role in the deeply interrelated processes of multi-sensory processing and top down attention. Therefore, we hypothesized that disruptions in the functional and structural connections of the IPS may play a role in the development of such deficits. To examine these connections, we used resting state magnetic resonance imaging (rsfMRI and diffusion kurtosis imaging (DKI) in a cohort of 27 patients with sTBI (29.3 ± 8.9 years) and 27 control participants (29.8 ± 10.3 years). Participants were prospectively recruited and received rsfMRI and neuropsychological assessments including the Automated Neuropsychological Assessment Metrics (ANAM) at greater than 6 months post-injury. A subset of participants received a DKI scan. Results suggest that patients with sTBI performed worse than control participants on multiple subtests of the ANAM suggesting reduced cognitive performance. Reduced resting state functional connectivity between the IPS and cortical regions associated with multi-sensory processing and the dorsal attention network was observed in the patients with sTBI. The patients also showed reduced structural integrity of the superior longitudinal fasciculus (SLF), a key white matter tract connecting the IPS to anterior frontal areas, as measured by reduced mean kurtosis (MK) and fractional anisotropy (FA) and increased mean diffusivity (MD). Further, this reduced structural integrity of the SLF was associated with a reduction in overall cognitive performance. These findings suggest that disruptions in the structural and functional connectivity of the IPS may contribute to chronic cognitive deficits experienced by these patients.

A review of the validity of computerized neurocognitive assessment tools in mild traumatic brain injury assessment

Computerized neurocognitive assessment tools (NCATs) offer potential advantages over traditional neuropsychological tests in postconcussion assessments. However, their psychometric properties and clinical utility are still questionable. The body of research regarding the validity and clinical utility of NCATs suggests some support for aspects of validity (e.g., convergent validity) and some ability to distinguish between concussed individuals and controls, though there are still questions regarding the validity of these tests and their clinical utility, especially outside of the acute injury timeframe. In this paper, we provide a comprehensive summary of the existing validity literature for four commonly used and studied NCATs (automated neuropsychological assessment metrics, CNS vital signs, cogstate and immediate post-concussion and cognitive testing) and lay the groundwork for future investigations.

Neurocognitive Function and Suicide in U.S. Army Soldiers.

This prospective cohort study used administrative data from the Army Study to Assess Risk and Resilience in Servicemembers to examine associations between neurocognitive functioning and subsequent suicidal events among Regular Army enlisted soldiers during the years 2004-2009. Cases were all soldiers who completed the Army's Automated Neuropsychological Assessment Metrics (ANAM) computerized testing battery prior to documented suicide attempt (n=607), ideation (n=955), or death (n=57). Controls were an equal-probability sample of 9,893 person-months from other soldiers. Exploratory factor analysis of five ANAM tests identified a general neurocognitive factor that excluded the mathematic processing test (MTH). When examined separately in logistic regression analyses that controlled for sociodemographics and prior mental health diagnosis, both the general neurocognitive factor (logit [β]=-.197 to -.521; p<.01) and MTH (β=-.024 to -.064; p<.05) were associated with all outcomes. When both predictors were examined simultaneously, the general neurocognitive factor continued to be associated with all outcomes (β=-.164 to -.417; p<.05) and MTH continued to be associated with suicide attempt (β=-.015; p=.046) and ideation (β=-.014; p=.018). These small but robust associations suggest that future research must continue to examine the extent to which objective neurocognitive tests may enhance understanding and prediction of suicide risk.

Mild traumatic brain injury and suicide risk among a clinical sample of deployed military personnel: Evidence for a serial mediation model of anger and depression

Research has demonstrated a robust link between traumatic brain injuries (TBIs) and suicide risk. Yet, few studies have investigated factors that account for this link. Utilizing a clinical sample of deployed military personnel, this study aimed to examine a serial meditation model of anger and depression in the association of mild TBI and suicide risk. A total of 149 military service members referred for evaluation/treatment of a suspected head injury at a military hospital participated in the present study (92.6% male; Mage = 27.9y). Self-report measures included the Suicidal Behaviors Questionnaire—Revised (SBQ-R), Automated Neuropsychological Assessment Metrics (ANAM) anger and depression subscales, and Behavioral Health Measure-20 depression subscale. A current mild TBI diagnosis was confirmed by a licensed clinical psychologist/physician. Overall, 84.6% (126/149) of participants met diagnostic criteria for a current mild TBI. Bootstrapped serial mediation analyses indicated that the association of mild TBI and suicide risk is serially mediated by anger and depression symptoms (bias-corrected 95% confidence interval [CI] for the indirect effect = 0.044, 0.576). An alternate serial mediation model in which depression symptoms precede anger was not statistically significant (bias-corrected 95% CI for the indirect effect = −0.405, 0.050). Among a clinical sample of military personnel, increased anger and depression statistically mediated the association of mild TBI and suicide risk, and anger appears to precede depression in this pathway. Findings suggest that therapeutically targeting anger may serve to thwart the trajectory to suicide risk among military personnel who experience a mild TBI. Future research should investigate this conjecture within a prospective design to establish temporality.

The impact of administration order in studies of computerized neurocognitive assessment tools (NCATs)

ABSTRACTComputerized neurocognitive assessment tools (NCATs) have become a common way to assess postconcussion symptoms. As there is increasing research directly comparing multiple NCATs to each other, it is important to consider the impact that order of test administration may have on the integrity of the results. This study investigates the impact of administration order in a study of four different NCATs; Automated Neuropsychological Assessment Metrics (ANAM4), CNS Vital Signs (CNS-VS), CogState, and Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). A total of 272 healthy active duty Service Members were enrolled into this study. All participants were randomly assigned to take two of the four NCATs with order of administration counterbalanced. Analyses attempted to investigate the effect of administration order alone (e.g., Time 1 versus Time 2), the effect of administration order combined with the impact of the specific NCAT received at Time 1, and only the impact of the Time 1 NCAT on Time 2 score variability. Specifically, independent samples t tests were used to compare Time 1 and Time 2 scores within each NCAT. Additional t tests compared Time 1 to Time 2 scores with Time 2 scores grouped by the NCAT received at Time 1. One-way analysis of variance (ANOVA) was used to compare only an NCAT’s Time 2 scores grouped by the NCAT received at Time 1. Cohen’s d effect sizes were calculated for all comparisons. The results from this study revealed statistically significant order effects for CogState and CNS-VS, though with effect sizes generally indicating minimum practical value, and marginal or absent order effects for ANAM4 and ImPACT with no clinically meaningful implications. Despite finding minimal order effects, clinicians should be mindful of the impact of administering multiple NCATs in a single session. Future studies should continue to be designed to minimize the potential effect of test administration order.

Reliable Change Estimates for Assessing Recovery From Concussion Using the ANAM4 TBI-MIL.

To establish the reliable change parameters for the Automated Neuropsychological Assessment Metrics (ANAM) using a healthy normative sample of active duty service members (SMs) and apply the parameters to sample of recently deployed SMs. Postdeployment neurocognitive performance was compared in 1893 US Marines with high rates of combat exposure during deployment. Of the sample, 289 SMs had data for 2 predeployment assessments and were used as a normative subsample and 502 SMs had data for predeployment and postdeployment assessments and were used as a deployed subsample. On the basis of self-report, the deployed subsample were further classified as concussed (n = 238) or as nonconcussed controls (n = 264). Reliable change parameters were estimated from the normative sample and applied data for both deployed groups. Postdeployment performance was quantified using a general linear model (2 group × 2 time) multivariate analysis of variance with repeated measures. Both deployed groups demonstrated a pattern of meaningful decreases in performance over time. Information from this effort, specifically the reliable change parameters and the base rates of reliable decline, can be used to assist with the identification of postdeployment cognitive issues.

Combat Effectiveness and Sleep Patterns in US Marines

The Habitability Assessment Test (HAT) was designed to evaluate whether Marines exposed to waterborne motion in an amphibious vehicle experience reductions in combat effectiveness. A total of 61 active duty Unites States Marines participated in a within-subjects, repeated measures, quasi-experimental design with counterbalancing to control for order of exposure to waterborne motion of one, two, or three hours. Dependent variables included wrist-worn actigraphy, Stanford Sleepiness Scale scores, marksmanship scores, obstacle course performance, and the switching task from the Automated Neuropsychological Assessment Metric (ANAM) battery. Results showed no statistically significant associations between sleep metrics and the mean radius of impact in the marksmanship test. In contrast, short sleep duration and elevated sleepiness were associated with worse (higher) completion times in the obstacle course. Elevated sleepiness was also associated with lower cognitive throughput, i.e., the number of correct responses per minute, as measured by the ANAM Switching Task. Increased sleep duration was associated with increased throughput, however the trend was not statistically significant. These results suggest that sleep-deprived Marines experienced poorer executive decision making as measured using the ANAM. In addition to showing decrements in combat effectiveness that are associated with their sleep patterns, the current study may provide an early indication of circadian scarring in these young Marines.

Neurocognitive Performance and Military Occupation Among Enlisted United States Army Soldiers

Background: Prior studies have demonstrated that occupational risk factors (such as exposure to chemical hazards and threats, traumatic experiences, physical or cognitive stressors) may place military personnel at increased risk of reduced neurocognitive performance and readiness. We conducted a population-based cohort study to evaluate whether military occupational category was associated with neurocognitive performance as measured by the Automated Neuropsychological Assessment Metrics (version 4) TBI Military battery (ANAM4 TBI-MIL). We hypothesized that of the 10 broad military occupational categories, those categories with higher risk of exposure to hazardous environments- Infantry, Craftsmen, and Technical Specialists- would show a reduced proficiency in neurocognitive performance compared to those in Administrative Support roles (reference group). Methods: Between 2007 to 2010, 360,765 enlisted Army members completed the ANAM4 TBI-MIL prior to deployment. The association between occupational category and cognitive performance was analyzed using linear regression models adjusting for sex, education, race, ethnicity, age, handedness, and Armed Services Vocational Aptitude Battery scores. We used inverse probability weighting within our models to account for differences in years served in the Army and paygrade between the occupational categories. Results: Across the majority of the seven ANAM4 TBI-MIL tasks, the Infantry, Craftsmen, Healthcare Specialists, and Technical Specialists categories demonstrated significantly reduced neurocognitive proficiencies (p&lt;0.005) compared to the reference group. Conclusions: Our findings suggest occupational category is associated with neurocognitive performance after adjustment for relevant covariates. Future research will examine specific job titles with higher exposure to chemical hazards within the occupational categories identified, and address those risk factors associated with reduced neurocognitive performance.

Anti-NR2 antibodies, blood-brain barrier, and cognitive dysfunction.

Cognitive dysfunction (CD) is one of the most common neuropsychiatric manifestations of systemic lupus erythematosus (SLE). In animal models, antibodies to NR2 subunit of N-methyl D-aspartate receptor (anti-NR2) cause memory impairment, but only with blood-brain barrier (BBB) disruption or intrathecal administration. Several studies have failed to find association of aNR2 with CD, but none have assessed BBB integrity. S100B, an astrocyte-specific protein, has been used as biomarker of BBB disruption in traumatic brain injury and some neurodegenerative disorders. Antibodies to this immunologically privileged protein (anti-S100B) might indicate preceding BBB disruption. We hypothesized that aNR2 antibody is pathogenic in SLE patients only with BBB disruption. Demographic, clinical, and laboratory data was collected from patients with SLE. Total throughput score (TTS) of the Automated Neuropsychological Assessment Metrics (ANAM) was used as primary outcome measure. CD was defined as TTS < 1.5 SD below an age-, sex-, and race-matched RA population mean. Serum was analyzed by established ELISA techniques. Fifty-seven patients were evaluated and 12 had CD. Age, ethnicity, and family income were significantly different between the two groups (p < 0.05). In a multiple regression model adjusting for other variables, no significant effects of anti-NR2, S100B, or anti-S100B on TTS were found. Even at high levels of S100B and anti-S100B, no significant influence of anti-NR2 on TTS was found. The anti-NR2 was not associated with CD in SLE even in context of potential BBB disruption. This suggests that, if pathogenic, these antibodies may be produced intrathecally.

A Randomized Exploratory Study to Evaluate Two Acupuncture Methods for the Treatment of Headaches Associated with Traumatic Brain Injury.

Background: Headaches are prevalent among Service members with traumatic brain injury (TBI); 80% report chronic or recurrent headache. Evidence for nonpharmacologic treatments, such as acupuncture, are needed.Objective: The aim of this research was to determine if two types of acupuncture (auricular acupuncture [AA] and traditional Chinese acupuncture [TCA]) were feasible and more effective than usual care (UC) alone for TBI–related headache.Materials and Methods: Design: This was a three-armed, parallel, randomized exploratory study. Setting: The research took place at three military treatment facilities in the Washington, DC, metropolitan area. Patients: The subjects were previously deployed Service members (18–69 years old) with mild-to-moderate TBI and headaches. Intervention: The interventions explored were UC alone or with the addition of AA or TCA. Outcome Measures: The primary outcome was the Headache Impact Test (HIT). Secondary outcomes were the Numerical Rating Scale (NRS), Pittsburgh Sleep Quality Index, Post-Traumatic Stress Checklist, Symptom Checklist-90-R, Medical Outcome Study Quality of Life (QoL), Beck Depression Inventory, State-Trait Anxiety Inventory, the Automated Neuropsychological Assessment Metrics, and expectancy of outcome and acupuncture efficacy.Results: Mean HIT scores decreased in the AA and TCA groups but increased slightly in the UC-only group from baseline to week 6 [AA, −10.2% (−6.4 points); TCA, −4.6% (−2.9 points); UC, +0.8% (+0.6 points)]. Both acupuncture groups had sizable decreases in NRS (Pain Best), compared to UC (TCA versus UC: P = 0.0008, d = 1.70; AA versus UC: P = 0.0127, d = 1.6). No statistically significant results were found for any other secondary outcome measures.Conclusions: Both AA and TCA improved headache-related QoL more than UC did in Service members with TBI.

Simple and Procedural Reaction Time for Mild Traumatic Brain Injury in a Hyperbaric Oxygen Clinical Trial.

Simple reaction time (SRT) and procedural reaction time (PRT) are speed-of-processing tasks in the Automated Neuropsychological Assessment Metrics (ANAM) that may be sensitive to mild traumatic brain injury (mTBI). The investigators measured SRT and PRT throughput (correct responses per minute) at baseline, 6 weeks, and 13 weeks in military personnel with mTBI randomized to local care or 40 chamber sessions (sham-1.2 atmospheres absolute [ATA] air, hyperbaric oxygen-1.5 ATA O2). Scores were assessed at baseline using univariate analysis of variance and across time with repeated measures methods. Data reported as throughput standard scores (mean = 100, SD = 15). Seventy-two participants with ongoing symptoms after mTBI enrolled in the study (three female, median age 31 years, mean three lifetime concussion events, most recent mTBI 23 months prior). Sixty-four had Automated Neuropsychological Assessment Metrics data at 13 weeks. SRT and PRT throughput standard scores were comparable across groups at baseline. Over time, SRT scores did not change in the hyperbaric oxygen or sham groups and decreased in the local care group. PRT throughput standard scores increased from baseline to mid-intervention and decreased from mid-intervention to postintervention in all groups. Repeated measures change over time in SRT (p = 0.23), and PRT (p = 0.17) scores were not different among groups. This study may be underpowered to detect statistically significant change.

Examining Computerized Neuropsychological Test Performance Scores Pre to Post Season Following a Season of Competitive Interscholastic Girls’ Soccer

Purposeful heading of a soccer ball is an inherent and strategic part of the sport. Recent neuroimaging evidence suggests that there may be detrimental effects of repetitive soccer heading on neurophysiology. With neuropsychological testing (NP) part of most sport-related concussion management programs, the ability to access this data and make reasonable conclusions even in the absence of concussion is advantageous. PURPOSE: To determine if differences in NP test performance exist pre to post season in a large cohort of female interscholastic soccer players. METHODS: A total of 707 interscholastic female soccer players from 19 different schools consented to participate in this study. Subjects were administered the computerized Automated Neuropsychological Assessment Metrics (ANAM) test battery prior to and at the conclusion of their playing season. Throughput scores (T-PUT) (measures of performance speed and accuracy) were taken from the ANAM test battery for the Simple Reaction Time (SRT), Math Processing Test (MTH), Continuous Performance Test (CPT), Matching to Sample (MSP), Sternberg Memory Test (ST6), Repeat Simple Reaction Time (RSRT), and Repeat Continuous Performance Test (RCPT); whereas higher scores are interpreted as better. Data were analyzed using a series of paired-samples t-tests. RESULTS: Significant (all p-values P < .000) improvements in T-PUT scores occurred in 6 of 7 of the NP variables [SRT 209.1 vs. 212.5, MTH 21.9 vs. 25.0, CPT 92.1 vs.103.4, MSP 31.0 vs. 33.6, ST6 75.4 vs. 82.7, RCPT 100.1 vs. 109.9]. The only pair that was not significant was RSRT (208.3 vs. 209.3). Calculated effect sizes ranged from small to medium. CONCLUSION: The SRT, RSRT, and MSP values reported here are lower than those previously reported in collegiate athletes. Practice effect improvements of +9 for SRT, +2 for MTH, +5 for MSP, and +10 for ST6 have been previously shown and compare favorably to what is demonstrated in our subject pool. Having hypothesized that we would find deficits in NP test performance, we unexpectedly report that in all NP variables this cohort actually improved performance. Our large scale research effort involving female interscholastic soccer players is important in providing evidence surrounding issues related to the subconcussive head impacts that take place during soccer competition.

Repeated Low-Level Blast Exposure: A Descriptive Human Subjects Study.

The relationship between repeated exposure to blast overpressure and neurological function was examined in the context of breacher training at the U.S. Marine Corps Weapons Training Battalion Dynamic Entry School. During this training, Students are taught to apply explosive charges to achieve rapid ingress into secured buildings. For this study, both Students and Instructors participated in neurobehavioral testing, blood toxin screening, vestibular/auditory testing, and neuroimaging. Volunteers wore instrumentation during training to allow correlation of human response measurements and blast overpressure exposure. The key findings of this study were from high-memory demand tasks and were limited to the Instructors. Specific tests showing blast-related mean differences were California Verbal Learning Test II, Automated Neuropsychological Assessment Metrics subtests (Match-to-Sample, Code Substitution Delayed), and Delayed Matching-to-Sample 10-second delay condition. Importantly, apparent deficits were paralleled with functional magnetic resonance imaging using the n-back task. The findings of this study are suggestive, but not conclusive, owing to small sample size and effect. The observed changes yield descriptive evidence for potential neurological alterations in the subset of individuals with occupational history of repetitive blast exposure. This is the first study to integrate subject instrumentation for measurement of individual blast pressure exposure, neurocognitive testing, and neuroimaging.

Comparison of baseline-referenced versus norm-referenced analytical approaches for in-theatre assessment of mild traumatic brain injury neurocognitive impairment

Primary objective: To examine differences between the baseline-referenced and norm-referenced approaches for determining decrements in Automated Neuropsychological Assessment Metrics Version 4 TBI-MIL (ANAM) performance following mild traumatic brain injury (mTBI).Research design: ANAM data were reviewed for 616 US Service members, with 528 of this sample having experienced an mTBI and 88 were controls.Methods and procedures: Post-injury change scores were calculated for each sub-test: (1) normative change score = in-theater score – normative mean and (2) baseline change score = in-theater score – pre-deployment baseline. Reliable change cut-scores were applied to the change and the resulting frequency distributions were compared using McNemar tests. Receiver operator curves (ROC) using both samples (i.e. mTBI and control) were calculated for the change scores for each approach to determine the discriminate ability of the ANAM.Main outcomes and results: There were no statistical differences, p < 0.05 (Bonferonni-Holm corrected), between the approaches. When the area under the curve for the ROCs were averaged across sub-tests, there were no significant differences between either the norm-referenced (0.65) or baseline-referenced (0.66) approaches, p > 0.05.Conclusions: Overall, the findings suggest there is no clear advantage of using the baseline-referenced approach over norm-referenced approach.

25-Hydroxyvitamin D3 Deficiency Independently Predicts Cognitive Impairment in Patients with Systemic Lupus Erythematosus.

ObjectivesCognitive dysfunction has been reported in 20–80% of SLE patients. Converging evidence has indicated the importance of vitamin D as a neuroimmunomodulator for cognitive function. In this study, we evaluated the relationship between vitamin D and cognitive dysfunction.MethodsConsecutive age- and gender-matched SLE patients and healthy controls (HCs) were administered Automated Neuropsychological Assessment Metrics in this cross-sectional study. The primary outcome was the total throughput score (TTS). Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Levels of 25-hydroxyvitamin D [25(OH)D3 and total 25(OH)D] were measured using Liquid Chromatography-Tandem Mass Spectrometry.ResultsIn total, 61 SLE patients and 61 HCs were studied. SLE patients scored significantly lower than HCs in the TTS (p = 0.004). There were no statistically significant differences in 25(OH)D3 levels, total 25(OH)D levels and total 25(OH)D deficiency between SLE patients and HCs. However, more SLE patients had 25(OH)D3 deficiency compared to HCs [12 (19.7%) versus 2 (3.3%), p = 0.003]. Deficiency of 25(OH)D3 (β = -63.667, SE = 27.456, p = 0.025), but not other vitamin D variables, independently predicted worse TTS after adjusting for age, education, gender, ethnicity, HADS-Total, duration of SLE, SELENA-SLEDAI, SLICC/ACR Damage Index and cumulative steroid dose in SLE patients. Age (β = -4.261, SE = 0.866, p < 0.001) was the only predictor of TTS after adjusting for education, gender, ethnicity, HADS-Total, vitamin D levels or status in HCs.ConclusionsDeficiency of 25(OH)D3, a potentially modifiable risk factor, independently predicted cognitive impairment in SLE patients.

Cerebral Blood Flow Alterations in Acute Sport-Related Concussion.

Sport-related concussion (SRC) is a major health problem, affecting millions of athletes each year. While the clinical effects of SRC (e.g., symptoms and functional impairments) typically resolve within several days, increasing evidence suggests persistent neurophysiological abnormalities beyond the point of clinical recovery after injury. This study aimed to evaluate cerebral blood flow (CBF) changes in acute SRC, as measured using advanced arterial spin labeling (ASL) magnetic resonance imaging (MRI). We compared CBF maps assessed in 18 concussed football players (age, 17.8 ± 1.5 years) obtained within 24 h and at 8 days after injury with a control group of 19 matched non-concussed football players. While the control group did not show any changes in CBF between the two time-points, concussed athletes demonstrated a significant decrease in CBF at 8 days relative to within 24 h. Scores on the clinical symptom (Sport Concussion Assessment Tool 3, SCAT3) and cognitive measures (Standardized Assessment of Concussion [SAC]) demonstrated significant impairment (vs. pre-season baseline levels) at 24 h (SCAT, p < 0.0001; SAC, p < 0.01) but returned to baseline levels at 8 days. Two additional computerized neurocognitive tests, the Automated Neuropsychological Assessment Metrics and Immediate Post-Concussion and Cognitive Testing, showed a similar pattern of changes. These data support the hypothesis that physiological changes persist beyond the point of clinical recovery after SRC. Our results also indicate that advanced ASL MRI methods might be useful for detecting and tracking the longitudinal course of underlying neurophysiological recovery from concussion.

Performance of the Automated Neuropsychological Assessment Metrics (ANAM) in detecting cognitive impairment in heart failure patients

ObjectiveEvaluate capacity of the Automated Neuropsychological Assessment Metrics (ANAM) to detect cognitive impairment (CI) in heart failure (HF) patients. BackgroundCI is a key prognostic marker in HF. Though the most widely used cognitive screen in HF, the Mini-Mental State Examination (MMSE) is insufficiently sensitive. The ANAM has demonstrated sensitivity to cognitive domains affected by HF, but has not been assessed in this population. MethodsInvestigators administered the ANAM and MMSE to 57 HF patients, compared against a composite model of cognitive function. ResultsANAM efficiency (p < .05) and accuracy scores (p < .001) successfully differentiated CI and non-CI. ANAM efficiency and accuracy scores classified 97.7% and 93.0% of non-CI patients, and 14.3% and 21.4% with CI, respectively. ConclusionsThe ANAM is more effective than the MMSE for detecting CI, but further research is needed to develop a more optimal cognitive screen for routine use in HF patients.

The Effect of Age and Mood State on Sustained Attention

Maintaining attention during tasks that require sustained, focused attention can be difficult and is influenced by motivation, feedback, sleep, and stress. The purpose of this research was to investigate the impact of age and mood state on two sustained performance tasks. Active duty military and veterans (n=211) completed a demographic survey, the Running Memory Continuous Performance Test and the Standard Continuous Performance Test using the Automated Neuropsychological Assessment Metric software program. Results revealed that younger age and greater happiness yield faster reaction times, older age and greater depression and fatigue yield slower reaction times on various sustained performance measures (p &lt; .05). The discussion includes both theoretical, as well as practical implications. While one cannot change their age, it is suggested that one can be aware of how their age influences reaction times. In addition, an individual can influence their own mood state or choose to avoid sustained attention tasks that depend on quick reactions when fatigued or depressed.