Neuropsychological Assessment Metrics Research Articles

Disruptions in Resting State Functional Connectivity and Cerebral Blood Flow in Mild Traumatic Brain Injury Patients.

Mild traumatic brain injury (mTBI) is often occult to conventional imaging techniques. However, there is growing evidence that mTBI patients who lack evidence of structural intracranial injury may develop post-concussive syndrome (PCS). We investigated longitudinal alterations in resting state functional connectivity (rs-FC) in brain networks in a population of 28 patients compared to 28 matched control participants. Rs-FC and cerebral blood flow (CBF) within the nodes of the Default Mode Network (DMN) and Task Positive Network (TPN) were assessed at three time points including acute, sub-acute, and chronic stages following mTBI. Participants received the Automated Neuropsychological Assessment Metrics (ANAM) to assess cognitive performance. Main findings indicate that despite normalized cognitive performance, chronic mTBI patients demonstrate increased rs-FC between the DMN and regions associated with the salience network (SN) and TPN compared to the control populations, as well as reduced strength of rs-FC within the DMN at the acute stage of injury. In addition, chronic mTBI patients demonstrate an imbalance in the ratio of CBF between nodes of the DMN and TPN. Furthermore, preliminary exploratory analysis suggests that compared to those without chronic PCS, patients with chronic PCS reveal an imbalance in the ratio of CBF between the DMN nodes and TPN nodes across multiple stages of recovery. Findings suggest that the altered network perfusion with the associated changes in rs-FC may be a possible predictor of which mTBI patients will develop chronic PCS.

Cognitive Performance Scores for the Pediatric Automated Neuropsychological Assessment Metrics in Childhood-Onset Systemic Lupus Erythematosus.

To develop and initially validate a global cognitive performance score (CPS) for the Pediatric Automated Neuropsychological Assessment Metrics (PedANAM) to serve as a screening tool of cognition in childhood lupus. Patients (n = 166) completed the 9 subtests of the PedANAM battery, each of which provides 3 principal performance parameters (accuracy, mean reaction time for correct responses, and throughput). Cognitive ability was measured by formal neurocognitive testing or estimated by the Pediatric Perceived Cognitive Function Questionnaire-43 to determine the presence or absence of neurocognitive dysfunction (NCD). A subset of the data was used to develop 4 candidate PedANAM-CPS indices with supervised or unsupervised statistical approaches: PedANAM-CPSUWA , i.e., unweighted averages of the accuracy scores of all PedANAM subtests; PedANAM-CPSPCA , i.e., accuracy scores of all PedANAM subtests weighted through principal components analysis; PedANAM-CPSlogit , i.e., algorithm derived from logistic models to estimate NCD status based on the accuracy scores of all of the PedANAM subtests; and PedANAM-CPSmultiscore , i.e., algorithm derived from logistic models to estimate NCD status based on select PedANAM performance parameters. PedANAM-CPS candidates were validated using the remaining data. PedANAM-CPS indices were moderately correlated with each other (|r| > 0.65). All of the PedANAM-CPS indices discriminated children by NCD status across data sets (P < 0.036). The PedANAM-CPSmultiscore had the highest area under the receiver operating characteristic curve (AUC) across all data sets for identifying NCD status (AUC >0.74), followed by the PedANAM-CPSlogit , the PedANAM-CPSPCA , and the PedANAM-CPSUWA , respectively. Based on preliminary validation and considering ease of use, the PedANAM-CPSmultiscore and the PedANAM-CPSPCA appear to be best suited as global measures of PedANAM performance.

Hyper-connectivity of the thalamus during early stages following mild traumatic brain injury.

The thalamo-cortical resting state functional connectivity of seven sub-thalamic regions were examined in a prospectively recruited population of 77 acute mild TBI (mTBI) patients within the first 10days (mean 6 ± 3days) of injury and 35 neurologically intact control subjects using the Oxford thalamic connectivity atlas. Neuropsychological assessments were conducted using the Automated Neuropsychological Assessment Metrics (ANAM). A subset of participants received a magentic resonance spectroscopy (MRS) exam to determine metabolite concentrations in the thalamus and the posterior cingulate cortex. Results show that patients performed worse than the control group on various subtests of ANAM and the weighted throughput score, suggesting reduced cognitive performance at this early stage of injury. Both voxel and region of interest based analysis of the resting state fMRI data demonstrated that acute mTBI patients have increased functional connectivity between the various sub-thalamic regions and cortical regions associated with sensory processing and the default mode network (DMN). In addition, a significant reduction in NAA/Cr was observed in the thalamus in the mTBI patients. Furthermore, an increase in Cho/Cr ratio specific to mTBI patients with self-reported sensory symptoms was observed compared to those without self-reported sensory symptoms. These results provide novel insights into the neural mechanisms of the brain state related to internal rumination and arousal, which have implications for new interventions for mTBI patients with persistent symptoms. Furthermore, an understanding of heightened sensitivity to sensory related inputs during early stages of injury may facilitate enhanced prediction of safe return to work.

Cognitive function in chronic rhinosinusitis: a controlled clinical study.

Cognitive dysfunction in patients with chronic rhinosinusitis (CRS) has previously received little attention. Cognitive data generally includes only subjective measures and lack appropriate controls when cognition is considered. The purpose of this study was to characterize dimensions of cognitive function that are affected in patients with CRS compared to a control sample using subjective and objective measures of cognitive function. Patients fulfilling diagnostic criteria for CRS and non-CRS controls were recruited from the same clinical reference population. Patient-reported cognitive dysfunction was assessed using the Cognitive Failures Questionnaire (CFQ) and fatigue via the Fatigue Severity Scale (FSS). Objective cognitive function was assessed using a battery of tests from the Automated Neuropsychological Assessment Metrics (ANAM) computerized platform. A total of 100 subjects were enrolled, including 50 patients with active CRS and 50 control subjects. Patients with CRS scored significantly worse in subjective cognition as measured by total CFQ scores (38.3 ± 16.5 vs 30.9 ± 12.5; p = 0.009) and the FSS (4.2 ± 1.6 vs 3.0 ± 1.5; p = 0.001). Patients with CRS were also found to have worse simple reaction time scores compared to controls without CRS (162.4 ± 56.2 vs 193.0 ± 44.6; p = 0.003). These differences persisted regardless of polyp status. Performance differences for FSS and SRT measures remained significant after controlling for age, gender, race/ethnicity, education, allergic rhinitis, asthma, obstructive sleep apnea, depression, and antihistamine usage. Patients with CRS report significantly more cognitive dysfunction and fatigue on validated instruments and had worse reaction times on computerized testing. Further study is necessary to determine whether available treatments impact these measures.

Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan.

To evaluate whether diffusion tensor imaging (DTI) will noninvasively reveal white matter changes not present on conventional MRI in acute blast-related mild traumatic brain injury (mTBI) and to determine correlations with clinical measures and recovery. Prospective observational study of 95 US military service members with mTBI enrolled within 7 days from injury in Afghanistan and 101 healthy controls. Assessments included Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), Post-Traumatic Stress Disorder Checklist Military (PCLM), Beck Depression Inventory (BDI), Balance Error Scoring System (BESS), Automated Neuropsychological Assessment Metrics (ANAM), conventional MRI, and DTI. Significantly greater impairment was observed in participants with mTBI vs controls: RPCSQ (19.7 ± 12.9 vs 3.6 ± 7.1, p < 0.001), PCLM (32 ± 13.2 vs 20.9 ± 7.1, p < 0.001), BDI (7.4 ± 6.8 vs 2.5 ± 4.9, p < 0.001), and BESS (18.2 ± 8.4 vs 15.1 ± 8.3, p = 0.01). The largest effect size in ANAM performance decline was in simple reaction time (mTBI 74.5 ± 148.4 vs control -11 ± 46.6 milliseconds, p < 0.001). Fractional anisotropy was significantly reduced in mTBI compared with controls in the right superior longitudinal fasciculus (0.393 ± 0.022 vs 0.405 ± 0.023, p < 0.001). No abnormalities were detected with conventional MRI. Time to return to duty correlated with RPCSQ (r = 0.53, p < 0.001), ANAM simple reaction time decline (r = 0.49, p < 0.0001), PCLM (r = 0.47, p < 0.0001), and BDI (r = 0.36 p = 0.0005). Somatic, behavioral, and cognitive symptoms and performance deficits are substantially elevated in acute blast-related mTBI. Postconcussive symptoms and performance on measures of posttraumatic stress disorder, depression, and neurocognitive performance at initial presentation correlate with return-to-duty time. Although changes in fractional anisotropy are uncommon and subtle, DTI is more sensitive than conventional MRI in imaging white matter integrity in blast-related mTBI acutely.

Rates and Predictors of Invalid Baseline Test Performance in High School and Collegiate Athletes for 3 Computerized Neurocognitive Tests

Background: Preseason baseline testing using computerized neurocognitive tests (CNTs) is increasingly performed on athletes. Adequate effort is critical to establish valid estimates of ability, but many users do not evaluate performance validity, and the conditions that affect validity are not well understood across the available CNTs. Purpose: To examine the rates and predictors of invalid baseline performance for 3 popular CNTs: Automated Neuropsychological Assessment Metrics (ANAM), Axon Sports, and Immediate Post-Concussion and Cognitive Testing (ImPACT). Study Design: Controlled laboratory study. Methods: High school and collegiate athletes (N = 2063) completed 2 of 3 CNTs each during preseason evaluations. All possible pairings were present across the sample, and the order of administration was randomized. Examiners provided 1-on-1, scripted pretest instructions, emphasizing the importance of good effort. Profile validity was determined by the manufacturers’ standard criteria. Results: The overall percentage of tests flagged as of questionable validity was lowest for ImPACT (2.7%) and higher for ANAM and Axon (10.7% and 11.3%, respectively). The majority of invalid baseline profiles were flagged as such because of failure on only 1 validity criterion. Several athlete and testing factors (eg, attention deficit hyperactivity disorder [ADHD], estimated general intellectual ability, administration order) predicted validity status for 1 or more CNTs. Considering only first CNT administrations and participants without ADHD and/or a learning disability (n = 1835) brought the rates of invalid baseline performances to 2.1%, 8.8%, and 7.0% for ImPACT, ANAM, and Axon, respectively. Invalid profiles on the Medical Symptom Validity Test (MSVT) were rare (1.8% of participants) and demonstrated poor correspondence to CNT validity outcomes. Conclusion: The validity criteria for these CNTs may not identify the same causes of invalidity or be equally sensitive to effort. The validity indicators may not be equally appropriate for some athletes (eg, those with neurodevelopmental disorders). Clinical Relevance: The data suggest that athletes do not put forth widespread low effort or that some validity criteria are more sensitive to invalid performance than others. It is important for examiners to be aware of the conditions that maximize the quality of baseline assessments and to understand what sources of invalid performance are captured by the validity criteria that they obtain.

Neurocognitive Performance and Prior Injury Among U.S. Department of Defense Military Personnel

This study examined the neurocognitive performance of U.S. military personnel completing the Automated Neuropsychological Assessment Metrics (version 4) TBI Military (ANAM4 TBI-MIL) battery as part of the Department of Defense Neurocognitive Functional Assessment Program. Descriptive analyses utilizing the ANAM4TBI Military Performance Database were performed. We examined ANAM Composite Score (ACS) differences between five injury subgroups (no injury, brain injury with current symptoms, brain injury without current symptoms, nonbrain injury with current symptoms, and nonbrain injury without current symptoms) using general linear mixed modeling. Almost 11% (70,472/641,285) reported brain injury in the 4 years before assessment. The ACS differed significantly by injury group (p < 0.0001). In comparison to the no injury group, those reporting brain injury with current symptoms (d = -0.44) and nonbrain injury with current symptoms (d = -0.24) demonstrated significantly reduced ACS scores (p < 0.0001) indicative of reduced neurocognitive proficiency. In this population-based study of U.S. military personnel, neurocognitive performance was significantly associated with reported injury within the past 4 years among those experiencing current symptoms. Occupational programs focusing on prospective brain health of injured population groups are warranted.

Remote cognitive assessments for patients with multiple sclerosis: a feasibility study

Background: measuring cognitive function in patients with multiple sclerosis (MS) can be challenging given the obstacles faced when traveling to testing centers. Objective: the purpose of this study was to evaluate the feasibility of remote cognitive assessment in patients with MS using the automated neuropsychological assessment metrics (ANAM–MS) and the symbol digit modalities test (SDMT). Methods: patients meeting the McDonald criteria for MS (n = 24) were randomized to complete the live-in-office condition or a remote-in-office condition first, with all patients completing both sessions. Patients (n = 20) then completed a final remote-in-home testing session. Both remote sessions were proctored by a psychologist using a secure telehealth connection. Results: scores on the live SDMT differed from scores in the two remote settings F(2, 38) = 4.46, p = 0.018. However, summary scores on the ANAM–MS were similar across the three settings, F(2, 36) = 2.21, p = 0.124. Satisfaction with telehealth testing was high on the part of the examiner and patients. Each telehealth testing session saved more than $144.00 in travel costs and lost wages. Conclusion: this study demonstrated that valid results can be obtained when evaluating patients remotely using ANAM–MS. Some differences were noted for the SDMT that suggest that either specific norms or a different implementation approach may be needed for telehealth.

Eight-Day Temporal Stability of the Automated Neuropsychological Assessment Metric (ANAM) in a Deployment Environment

Automated neurocognitive tests are commonly used by military providers for making clinical decisions about the recovery of postconcussive cognitive sequelae. This practice often utilizes baseline assessments that precede the concussive injury. As such, investigating and establishing the psychometrics of an instrument is necessary to minimize confounds for interpreting assessment scores. Test–retest reliability (TRR) values for an 8.3 ± 2-day retest window for the Automated Neuropsychological Assessment Metrics-Version 4 (ANAM) were calculated in 86 healthy U.S. Army soldiers deployed to Iraq. After removal of outliers, all but 1 subtest, Simple Reaction Time, had adequate or greater TRR values (intraclass correlation coefficient = 0.72–0.86). The findings suggest that overall, the ANAM has good temporal stability when the retesting intertrial interval is less than 11 days while in a deployed environment.

Examining Neurocognitive Function in Previously Concussed Interscholastic Female Soccer Players

Awareness of sport-related concussions in soccer has gained recent attention in the medical community. Interestingly, purposeful heading—a unique yet strategic and inherent part of soccer—involves repeated subconcussive blows to the head. We divided 210 female interscholastic soccer players into control (CON [never concussed]) and experimental (EXP [previously concussed]) groups. We assessed neurocognitive performance using the Automated Neuropsychological Assessment Metrics computer program before and after the players' competitive season. Headers were recorded at all sanctioned matches. Data were analyzed using a series of one-way analyses of covariance and t tests. Both groups essentially played in the same number of games (EXP = 16.1 vs. CON = 16.1) and had an equal number of total headers (EXP = 24.9 vs. CON = 24.3). Additionally, headers per game were surprisingly low in both groups (1.4 in EXP vs. 1.3 in CON). Unexpectedly, there were no significant differences between the EXP and CON groups across all dependent variables measured (p > .05). This study suggests that although previously concussed players involve themselves in purposeful heading (i.e., subconcussive insults) throughout a competitive season, there appear to be no negative consequences on neuropsychological test performance or concussion-related symptoms. Additional research is needed to determine what may result during the course of a playing career.

Blood-based candidate biomarkers of the presence of neuropsychiatric systemic lupus erythematosus in children

ObjectiveTo examine select brain-reactive proteins for their usefulness to serve as blood-based biomarkers in the screening for neurocognitive deficits in childhood-onset systemic lupus erythematosus (cSLE-NCD).MethodsPatients withcSLE (n=40) were studied longitudinally...

B-83 * An Exploratory Factor Analysis of the Repeatable Battery for the Assessment of Neuropsychological Status and the Automated Neuropsychological Assessment Metrics

B-83 * An Exploratory Factor Analysis of the Repeatable Battery for the Assessment of Neuropsychological Status and the Automated Neuropsychological Assessment Metrics

Erratum to: Associations between interhemispheric functional connectivity and the Automated Neuropsychological Assessment Metrics (ANAM) in civilian mild TBI

This study investigates cognitive deficits and alterations in resting state functional connectivity in civilian mild traumatic brain injury (mTBI) participants with high and low symptoms. Forty-one mTBI participants completed a resting state fMRI scan and the Automated Neuropsychological Assessment Metrics (ANAM) during initial testing (<10 days of injury) and a 1 month follow up. Data were compared to 30 healthy control subjects. Results from the ANAM demonstrate that mTBI participants performed significantly worse than controls on the code substitution delayed subtest (p = 0.032) and weighted throughput score (p = 0.001). Among the mTBI patients, high symptom mTBI participants performed worse than those with low symptoms on the code substitution delayed (p = 0.017), code substitution (p = 0.012), repeated simple reaction time (p = 0.031), and weighted throughput score (p = 0.009). Imaging results reveal that during the initial visit, low symptom mTBI participants had reduced interhemispheric functional connectivity (IH-FC) within the lateral parietal lobe (p = 0.020); however, during follow up, high symptom mTBI participants showed reduced IH-FC compared to the control group within the dorsolateral prefrontal cortex (DLPFC) (p = 0.013). Reduced IH-FC within the DLPFC during the follow-up was associated with reduced cognitive performance. Together, these findings suggest that reduced rs-FC may contribute to the subtle cognitive deficits noted in high symptom mTBI participants compared to control subjects and low symptom mTBI participants.

Longitudinal and Prognostic Evaluation of Mild Traumatic Brain Injury: A 1H-Magnetic Resonance Spectroscopy Study

In the majority of patients with mild traumatic brain injury (mTBI), brain tissue impairment is undetectable by computed tomography and/or structural magnetic resonance imaging. Even in confirmed cases of head injury, conventional neuroimaging methods lack sensitivity in predicting neuropsychological outcomes of patients. The objectives of this study were to (1) cross-sectionally determine deviations in the neurometabolic profile of patients with mTBI from healthy controls at different stages of mTBI using tightly controlled examination windows, and (2) determine associations between acute neurometabolic markers of mTBI and chronic neurocognitive performance. Patients were examined at the early subacute (n=43; 5.44 ± 3.15 days post-injury (DPI)), late subacute (n=33; 37.00 ± 12.26 DPI) and chronic (n=27; 195.30 ± 19.60 DPI) stages of mTBI. Twenty-one neurologically intact subjects were used as controls. Proton magnetic resonance spectroscopy imaging ((1)H-MRSI) was used to obtain metabolic measurements from different brain regions. The Automated Neuropsychological Assessment Metrics (ANAM) was used for cognitive evaluation of patients at the chronic stage of mTBI. Measurements in the thalamus and centrum semiovale (CSV) emerged as the most indicative of injury and were used to predict neurocognitive outcome. The major findings of this study are (1) decreases in Cho/Cre (choline-to-creatine ratio) measured in the thalamus (p=0.042) and CSV (p=0.017) at the late subacute stage of mTBI; (2) positive associations of early subacute Cre measurements in the CSV with chronic ANAM scores measuring performance in delayed (r=0.497, p=0.019) and immediate (r=0.391, p=0.072) code substitution. These findings show that metabolic measurements in the thalamus and CSV can potentially serve as diagnostic and prognostic markers of mTBI.

Relationships of posttraumatic stress symptoms and sleep measures to cognitive performance in young-adult African Americans.

Disturbed sleep is a prominent feature of posttraumatic stress disorder (PTSD). PTSD and disrupted sleep have been independently linked to cognitive deficits; however, synergistic effects of PTSD and poor sleep on cognition have not been investigated. The purpose of this study was to examine the effects of PTSD symptoms and objectively measured disruptions to sleep on cognitive function. Forty-four young-adult African American urban residents comprised the study sample. The Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995) was utilized to determine the severity of PTSD symptoms. Participants underwent 2 consecutive nights of polysomnography. The Automated Neuropsychological Assessment Metrics (Reeves, Winter, Bleiberg, & Kang, ) was utilized to assess sustained attention and the Rey Auditory Verbal Learning Test (Schmidt, ) was used to evaluate verbal memory. PTSD symptom severity, r(42) = .40, p = .007, was significantly associated with omission errors on the sustained attention task, and sleep duration, r(42) = .41, p = .006, and rapid eye movement sleep, r(42) = .43, p = .003, were positively correlated with verbal memory. There was an interaction of PTSD symptom severity and sleep duration on omission errors such that more than 7 hours 12 minutes of sleep mitigated attentional lapses that were associated with PTSD.

Blast-related mild traumatic brain injury in the acute phase: Acute stress reactions partially mediate the relationship between loss of consciousness and symptoms

Primary objective: The objective was to compare symptoms in service members diagnosed with a blast-related mTBI (mild traumatic brain injury) with a loss of consciousness (LOC) to those without LOC.Research design: Clinicians saw US military personnel within 72 hours of sustaining a blast-related mTBI and at a follow-up visit 48–72 hours later (n = 210).Methods and procedures: Demographics, post-concussive symptoms, diagnosis of acute stress reaction (ASR) and simple reaction time data from the Automated Neuropsychological Assessment Metric (ANAM) were collected.Main outcomes and results: ASRs were significantly more likely in patients reporting LOC versus patients reporting no LOC. At the first post-injury visit, LOC was associated with difficulty sleeping, hearing loss, memory problems and reporting more symptoms. A follow-up analysis explored if symptomatic differences were influenced by ASR. Adjusting for ASR, the statistical relationships between LOC and symptoms were weaker (i.e. reduced Odds Ratios). At the follow-up visit, difficulty sleeping was associated with LOC before and after adjusting for ASR. Patients with both ASR and LOC had the slowest simple reaction times.Conclusions: Results suggest ASR may partially mediate symptom presentation and cognitive dysfunction in the acute phase following blast-related mTBI. Future research is warranted.

Evaluation of the Zurich Guidelines and Exercise Testing for Return to Play in Adolescents Following Concussion

To evaluate return to play (RTP) and return to classroom outcomes when the Zurich guidelines are combined with a standardized exercise treadmill test [Buffalo Concussion Treadmill Test (BCTT)] and computerized neuropsychological (cNP) testing in adolescent athletes after concussion. Retrospective chart review and follow-up. University Sports Medicine Concussion Clinic. One hundred seventeen athletes (75% male) with sport concussion ages 13 to 19 years and telephone follow-up of 91 (77.8%) athletes and their parents. Concussed athletes who were asymptomatic at rest completed Automated Neuropsychological Assessment Metrics or Immediate Post-concussion Assessment and Cognitive Test cNP testing followed by the BCTT on the same day. Athletes then followed the Zurich consensus guidelines for RTP. The primary outcome measure was the degree of success in RTP, that is, RTP with or without return of concussive symptoms. Secondary outcome measure was return to school with or without symptoms. All athletes returned to sport without exacerbation of symptoms. Telephone follow-up revealed that 38.5% experienced new issues upon return to the classroom. Forty-eight percent of athletes had 1 or more cNP subtests below average (<ninth percentile) when asymptomatic. Ultimately, performance on cNP was not predictive of return to school issues. The BCTT in combination with the Zurich consensus guidelines seems to be safe and successful for RTP. There is evidence to suggest that cNP testing performed in athletes who do not have a preinjury baseline test was not related to RTP or problems upon return to school.

A33: Cognitive Performance Scores for the Pediatric Automated Neuropsychological Assessment Metrics in Childhood‐Onset Systemic Lupus Erythematosus

Background/Purpose:Children with SLE (cSLE) can experience neuropsychiatric SLE (NPSLE), commonly manifesting as neurocognitive dysfunction which can interfere with normal development.Formal neurocognitive testing (FNCT) is the most accepted test for diagnosing neurocognitive deficits (NCD). Access to it is limited and costly, and it is time‐consuming. The Pediatric Automated Neurophysiological Assessments Metrics (PedANAM) is a computerized battery of 10 subtests measuring various aspects of cognitive ability. Concurrent validity of PedANAM test scores with FNCT has been demonstrated. However, the PedANAM generates several measures of accuracy (% of correct responses), processing speed and efficiency, and it is unclear how they can be used in a clinical setting. The usefulness of the PedANAM as a screen for NCD would be enhanced by the development of a PedANAM Cognitive Performance Score (PedANAM‐CPS) to represent aspects of PedANAM task performance that are sensitive to NCD in cSLE.The purpose of this study was to develop a PedANAM‐CPS for use in cSLE, using statistical methods.Methods:cSLE patients (pts) and age plus sex‐matched healthy controls enrolled in a study of cognitive functioning and neuroimaging were studied. At the time of enrollment (visit 1—V1) and 18 months later (visit 2—V2), subjects completed the PedANAM and FNCT. Three candidate PedANAM‐CPS measurement approaches were explored via 3 statistical methods: 1) Simple mean—of all subtest accuracy scores; 2) Logit score—via a logistic regression model; 3) PCA score—using a Principal Component Analysis (PCA) method. The latter 2 methods assigned in a different way a statistical weight to each subtest accuracy score. Fixed effect models were used to compare performance scores between groups. Receiver operating characteristic (ROC) curves were used to assess the accuracy of the CPS as predictors of NCD as determined by FNCT.Results:77 children (female = 68%) were evaluated at V1; Nine cSLE pts with NCD, 31 with cSLE and no NCD, and 37 control with no NCD as per FNCT. At V1, age (values are mean ± standard deviation) of children was 13.6 ± 2.4 years. For cSLE pts, disease activity (SLEDAI) was 4.9 ± 4.4, and 77.5% were on oral prednisone (19.8 ± 17.4 mg). Table summarizes the PedANAM‐CPS for all methods at V1. The Logit score best discriminated the groups, especially contrasting the NCD group against the other groups. The Logit and PCA scores showed g 82% area under the ROC curve during the validation stage using V2 data. Summary of PedANAM Cognitive Performance Score (PedANAMCPS) Visit Score Mean ± SD p‐value (1) Control (2) cSLE No NCD (3) cSLE w. NCD (1) vs. 2) (1) vs. (3) (1) vs. (3) 1 Simple mean 88.79 ± 0.97 88.91 ± 1.06 85.18 ± 1.96 0.931 0.103 0.098 Logit score −0.04 ± 0.13 −0.04 ± 0.15 0.84 ± 0.27 0.992 0.005 0.006 PCA score 438.80 ± 4.22 441.30 ± 4.61 421.69 ± 8.55 0.690 0.077 0.057Conclusion:Candidate PedANAM‐CPS derived from the Logit and PCA scores seem to perform better than an index based on the simple means at discriminating cSLE pts with NCD from cSLE and control children with normal cognition. Further analysis in a larger sample is needed to better determine accuracy performance scores with clinical relevance.

Associations between interhemispheric functional connectivity and the Automated Neuropsychological Assessment Metrics (ANAM) in civilian mild TBI

This study investigates cognitive deficits and alterations in resting state functional connectivity in civilian mild traumatic brain injury (mTBI) participants with high and low symptoms. Forty-one mTBI participants completed a resting state fMRI scan and the Automated Neuropsychological Assessment Metrics (ANAM) during initial testing (<10 days of injury) and a 1 month follow up. Data were compared to 30 healthy control subjects. Results from the ANAM demonstrate that mTBI participants performed significantly worse than controls on the code substitution delayed subtest (p = 0.032). [corrected]. Among the mTBI patients, high symptom mTBI participants performed worse than those with low symptoms on the code substitution delayed (p = 0.017), code substitution (p = 0.012), repeated simple reaction time (p = 0.031), and weighted throughput score (p = 0.019). [corrected]. Imaging results reveal that during the initial visit, low symptom mTBI participants had reduced interhemispheric functional connectivity (IH-FC) within the lateral parietal lobe (p = 0.020); however, during follow up, high symptom mTBI participants showed reduced IH-FC compared to the control group within the dorsolateral prefrontal cortex (DLPFC) (p = 0.013). Reduced IH-FC within the DLPFC during the follow-up was associated with reduced cognitive performance. Together, these findings suggest that reduced rs-FC may contribute to the subtle cognitive deficits noted in high symptom mTBI participants compared to control subjects and low symptom mTBI participants.

Changes in Fatigue and Cognition in Patients with Relapsing Forms of Multiple Sclerosis Treated with Natalizumab

Fatigue and cognitive impairment are debilitating features of multiple sclerosis (MS). ENER-G was a 12-month, open-label, multicenter, single-arm observational study designed to evaluate changes in fatigue and cognition in MS patients treated with natalizumab. Adults with relapsing MS and initiating natalizumab were enrolled. The primary endpoint was change in Visual Analog Scale for Fatigue (VAS-F) score over 12 weeks. Changes in Modified Fatigue Impact Scale (MFIS) score, Fatigue Severity Scale (FSS) score, and cognitive performance, using Automated Neuropsychological Assessment Metrics (ANAM), were also assessed. Patients (N = 89) had a mean age of 41 years and a median Expanded Disability Status Scale score of 3.0, and 83% had used at least two prior MS therapies. Significant improvements were observed and maintained at 12 weeks in VAS-F (mean ± SD baseline score, 77.7 ± 10.2; mean ± SD change, -14.9 ± 17.1; P < .0001), MFIS (mean baseline score, 59.1 ± 12.2; mean change, -7.4 ± 11.8; P < .0001), and FSS (median baseline score, 6.3 [range, 3.9-7.0]; median change, -0.4 [range, -2.9-1.4]; P < .0001). Cognitive performance remained stable or improved (depending on the ANAM measure). Thus significant improvements in fatigue were maintained over time, and cognitive performance improved or remained stable up to 48 weeks after initiation of natalizumab in MS patients with some degree of fatigue.