Normal Scores Research Articles

Health-Related Quality of Life (HRQoL) in Patients with Genetic Standard and High-Risk Disease at Trial Entry: A Cross-Sectional Analysis of RADAR (UK-MRA Myeloma XV)

Introduction Clinical outcomes in newly diagnosed multiple myeloma (MM) are independently influenced by genetic risk as determined by FISH and molecular profiling. However, little is known about the impact of these characteristics on HRQoL of MM patients at diagnosis, and if this is independent of other diagnostic criteria such as International Staging System (ISS) and CRAB. Similarly, there is little quantitative information on HRQoL of MM patients in contrast to other cancer patients and healthy individuals. We examined patient-reported outcomes from participants enrolling in the RADAR study to understand the HRQoL of MM patients in different subgroups prior to treatment. Methods The RADAR study (Eudract: 2019-001258-25) is a national, multi-centre, risk-adapted, response-guided multi-arm, multi-stage phase II/III trial for newly diagnosed MM eligible for ASCT. RADAR treats patients with induction, consolidation and maintenance options using combinations of lenalidomide, cyclophosphamide, bortezomib, dexamethasone and isatuximab. Genetic risk was defined using centrally reviewed standard-of-care NHS testing and participants enter the standard or high-risk pathway based on the presence of at least two of the markers: t(4;14), t(14;16), t(14:20), del(17p), gain(1q) and del(1p). CRAB diagnostic criteria at baseline were defined as hypercalcaemia (>2.6 mmol/l), renal impairment as indicated by eGFR by MDRD (30-60, >60 mL/min/1.73m 2), anaemia (Hb<100g/L) and the number of lytic lesions at trial entry (0, >=1). HRQoL was measured by EORTC QLQ-C30 and MY20 completed at trial entry. We used one-way ANOVA and two-sample unequal variance t-tests to compare subscales in standard and high-risk groups and CRAB criteria groups. We sought minimally important differences that were at least medium by accepted definitions, and adjusted p-values using the Bonferonni correction for the 19 subscales (adjusted P = 0.05/19 = 0.0026). We undertook similar comparisons with normative scores (NORM) for cancer patients and UK healthy controls. Results Baseline HR-QoL was available for 301 participants enrolled in RADAR. Median age at trial entry was 61 (range, 34-74), 165 (57.5%) were male and 249 (88.3%) ECOG PS0-1. 235 (78.1%) patients were classified as standard risk and 52 (21.9%) as high-risk. 111 (38.7%) patients were ISS1, 116 (40.4%) were ISS1 and 50 (17.4%) were ISS3. 24 (8.6%) patients had hypercalcaemia, 48 (16.7%) patients had eGFR < 60 mL/min/1.73m 2, 67 patients (23.8%) had anaemia and 287 (65.9%) patients had at least one bone lesion. Comparing standard and high-risk genetics patients, there were no significant differences in any C30 or MY20 subscales (Figure A). Increasing ISS was significantly associated with worse Physical and Role Functioning, increased Fatigue and Dyspnoea. Renal impairment (eGFR< 60 mL/min/1.73m 2) was not associated with differences in any C30 or MY20 subscales. Anaemia was significantly associated with worse Global health status/QoL, Physical Functioning and Role Functioning, and Fatigue was significantly increased. The presence of bone lesions was significantly associated with worse Global health status/QoL, Physical Functioning, Role Functioning and Social Functioning, and Fatigue, Pain, Disease Symptoms, Side Effects and Body Image worries were significantly increased (Figure B). Comparing RADAR to the C30 Cancer NORM, 7 of 15 subscales were significantly worse. Small negative differences were observed for Physical and Role Functioning, Fatigue, Insomnia and Constipation and medium negative differences were observed for Social Functioning and Pain. Similarly, in contrast to UK C30 Healthy NORM, 8 of 15 subscales were significantly different. There were small detrimental differences observed for Physical Functioning, Role Functioning, Appetite Loss, Constipation and Financial Problems, medium differences for Fatigue and Pain and large differences for Social Functioning. Conclusion Prior to commencing treatment, patients with genetic high-risk MM did not have significantly different HRQoL to standard risk MM whereas ISS, an established measure of disease burden, did impact HRQoL. Similarly, CRAB criteria of anaemia and bone disease significantly impact several HRQoL domains. Compared to the general Cancer and UK healthy population HRQoL in patients entering RADAR was significantly worse in some subscales, notably Pain and Fatigue.

Poor School Performance As an Indicator of Severity of Sickle Cell Disease

Purpose: Patients with sickle cell anemia can have long term neurocognitive deficits throughout their lifespan. The purpose of this study is to conduct neuropsychiatric evaluations and brain imaging to determine if individuals who have higher risk of falling behind in education can be identified, emphasize the importance of addressing educational needs of these patients, and identify patients who are at risk of developing further complications. Methods: IRB approved retrospective study of patients with Hemoglobin SS disease, who underwent Stanford-Binet Intelligence testing and Woodcock Johnson Achievement. All patients who underwent cognitive testing and also received a transcranial doppler ultrasound or magnetic resonance imaging between were included. All patients were referred to neuropsychiatric testing due to poor school performance. Results: 33 patients were included who underwent neuropsychiatric testing. These students were referred due to poor school performance. Of those, 15 patients had additional imaging studies. All patients were identified with hemoglobin SS disease. All patients were African American. The median age was 9 with an age range of 6 to 16 with a median grade was 4. This sample included 12 females and 3 males. 73% (11 of 15 individuals) were identified with below average full scale intelligence quotient. Of these, 46% (6 of 11) had measurable changes in MRI or transcranial doppler results. 5 of them had measurable changes in transcranial doppler and changes in their MRI, while 1 patient had a normal transcranial doppler, but showed changes in their MRI. On average, the maximum mean velocity was 164 cm/s and was higher than the patients with normal intelligence quotient scores at 148cm/s. The remaining 5 individuals also had below average full scale intelligence quotient without any findings on imaging. All 11 individuals also had below average scores in academic application, academic fluency, and academic skills. On average these patients were 3 years behind on reading, 2 years behind on math, and 2 years behind writing. Only one of these patients had an individualized education plan with extra assistance for education. 7 of the 11 patients with below average full scale intelligence quotients were on hydroxyurea and 2 of the 4 patients with average scores used hydroxyurea. The average hemoglobin level in the group that performed below average was 9.5 and 8.9 in the group that performed average. While, all patients who had average scores on the stanford-binet test did not have any abnormal transcranial dopplers and they all had delays in math, reading, and writing. Conclusion: Below average intelligence and delays in academic performance may be an indicator of patients at risk of developing further complications such as stroke.The full extent to this relationship is unclear. Further research is needed to determine the relationship between intelligence, academic performance and changes in imaging. Earlier detection of these patients can prevent further complications, develop individual treatment plans, and target closer monitoring. A multidisciplinary approach to treating patients with sickle cell disease should include neuropsychiatric evaluations, an assessment of academic achievement, and the opportunity for additional support in school to fully address the needs of this population.

Development of Normative Data for the Mini Mental State Examination (MMSE) in the Elderly Population of Chile: A Multi-City Study

The Mini-Mental State Examination (MMSE) is one of the most widely used tests to assess the global cognitive deterioration of older adults. There are many versions of this Test in Spanish. A validation study was previously conducted in Chile, but to date, no standards computed from a large population sample are available. to develop normative scores according to age and educational level for older people living in Chile. Data were collected from a sample of 1199 subjects between 50 and 91 years of age from various research centers. We present the normative scores in percentiles calculated according to age (50-64, 65-74, 75-91 years of age) and educational level (1-12 years and more than 13 years of formal schooling). This article provides normative scores for the MMSE that should be useful in clinical practice as they may help better interpret the performances of Chilean older adults who seek consultation for cognitive impairment.

76 Follow-up of the Therapeutic Effects of Integrative Neuropsychological Training Model for Executive Functions Deficits in School-age Children Born Very Low Birth Weight with Normal Early Development-A Preliminary Report

Objective:The preschool children born very low birth weight(VLBW) still have executive functions(EFs) deficits even with normal early development(Ni, Huang, & Guo, 2011). Consequently, early intervention might be more important than expected. This study aims to investigate the follow-up outcome of the therapeutic effects of integrative neuropsychological training model(INTM) focused on EFs for school-age VLBW children with EFs deficits.Participants and Methods:The VLBW children, recruited from the Regional Cohort Network for premature infants who were admitted to neonatal intensive care units, had normal scores in Bayley and Wechsler Intelligence systems before 6 years old. They also received follow-up neuropsychological assessment for EFs at 6 or 8-year-old. The deficits of EFs were defined from the result of Digit Span Subtest of WISC-IV, Knox's Cube Test(KCT), Tower of London(ToL), Wisconsin Card Sorting Test(WCST), and Comprehensive Nonverbal Attention Test Battery(CNAT). A total of 8 VLBW children with EFs deficits were recruited and received EFs training at 6 or 8-year-old. The INTM combined with Comprehensive Memory Training System(CMTS), Executive FUNction Training(EFT), and multi-ecological materials focused on enhancing the four aspects of EFs, including working memory, planning, cognitive flexibility, and inhibition ability. Then, they received follow-up neuropsychological assessment for EFs at 8 or 10-year-old.Results:The results showed that all children got benefits from 20 hours of INTM and most of the EF aspects remained improved at follow-up. A total of 8 VLBW children with an average of 3.4 aspects EFs deficits had an average of 1.4 aspects of EFs deficits left at the follow-up. More precisely, 5 of them had 1 aspects of EFs deficits and 3 of them had 2 aspects of EFs deficits.Conclusions:This study revealed that such a short-term INTM had long-term effects in enhancing the EFs of those VLBW children who had normal early development but later grew into EFs deficits at school-age. Besides, their EFs are still improving even after two years of intervention. Further study on more subjects with longer follow-up might help VLBW children to achieve better neuropsychological function.

The Generalized Thurstonian Unfolding Model (GTUM): Advancing the Modeling of Forced-Choice Data

Forced-choice (FC) measurement has become increasingly popular due to its robustness to various response biases and reduced susceptibility to faking. Although several current Item Response Theory (IRT) models can extract normative person scores from FC responses, each has its limitations. This study proposes the Generalized Thurstonian Unfolding Model (GTUM) as a more flexible IRT model for FC measures to overcome these limitations. The GTUM (1) adheres to the unfolding response process, (2) accommodates FC scales of any block size, and (3) manages both dichotomous and graded responses. Monte Carlo simulation studies consistently demonstrated that the GTUM exhibited good statistical properties under most realistic conditions. Particularly noteworthy findings include (1) the GTUM's ability to handle FC scales with or without intermediate statements, (2) the consistently superior performance of graded responses over dichotomous responses in person score recovery, and (3) the sufficiency of 10 mixed pairs to ensure robust psychometric performance. Two empirical examples, one with 1,033 responses to a static version of the Tailored Adaptive Personality Assessment System and the other with 759 responses to a graded version of the Forced-Choice Five-Factor Markers, demonstrated the feasibility of the GTUM to handle different types of FC scales. To aid in the practical use of the GTUM, we also developed the R package “ fcscoring.”

Abstract 042: Cognitive outcomes in patients with carotid insufficiency after undergoing direct extracranial‐intracranial bypass

Introduction Extracranial‐intracranial (EC‐IC) bypass is a niche procedure that has been selectively used for flow augmentation or flow restoration in patients with intracranial carotid insufficiency.1 The underlying etiology varies but is most commonly related to Moya Moya disease (MMD) or intracranial carotid atherosclerotic disease (ICAD).2 Patients are often managed non‐operatively until they begin to develop symptoms such as transient ischemic attacks (TIAs) or strokes that are recalcitrant to maximal medical management, at which point bypass is pursued.1 This lag period, however, could put patients at risk for long term deficit, not only in the form of focal neurological deficits but also in terms of overall neurocognitive capability.3 Several reports have previously demonstrated some level of association between EC‐IC bypass and neurocognitive outcomes, though in isolated populations of either MMD or ICAD.4,5 We therefore aim to further assess the relationship between EC‐IC bypass and neurocognitive outcomes in patients with intracranial carotid insufficiency. Methods Patients ages 18 years and up undergoing EC‐IC bypass were identified from a single institution database between January 2020 and December 2021. Patient records were reviewed for demographic data including age and sex, as well as preoperative clinical information including comorbidities, operative indication, anticoagulation/antiplatelet therapy usage, prior ischemic stroke, modified Rankin score (mRS), and Montreal Cognitive Assessment (MOCA) score. Radiographic data was also collected including Suzuki grade, collateralization, and perfusion. Post‐operative clinical information including complications, discharge mRS, and discharge MOCA scores were identified. Follow‐up duration, MOCA scores, and mRS were also identified and recorded. Results Of the forty‐four patients that underwent EC‐IC bypass during the specified period, ten had cognitive assessments before and after surgery available for review. The indications for bypass in these cases were ICA steno‐occlusive disease resulting in strokes despite maximal medical management in 9 cases, and MMD in one case. Suzuki grade was IV in the MMD case. Pial collaterals were present in 7 cases, and ECA collaterals were present in 5. Prior ischemic strokes were present in 8 cases, with a preoperative mRS range from 1‐4 (median 1), and average MOCA of 20. Perfusion imaging demonstrated a Tmax mismatch in eight cases, with an average volume of 73.6 cc at risk. All patients underwent direct superficial temporal artery to middle cerebral artery bypass, with additional encephaloduroarteriomyosynangiosis (EDAMS). Follow up MOCA score was improved in 8 cases, unchanged in one case, and worsened in one case (average MOCA increased from 20 to 23). Follow up mRS ranged from 0‐2. Additionally, CT perfusion demonstrated notable improvements in Tmax >4 seconds (decrease from 176 cc to 110 cc), Tmax >6 seconds (decrease from 59 cc to 29 cc), and mismatch (decrease from 59 cc to 17 cc) at 6 month follow up. Conclusion Patients with carotid insufficiency from MMD or ICAD undergoing EC‐IC bypass demonstrate well below normal preoperative MOCA scores. This is suggestive of ongoing neurocognitive decline, which is an often overlooked issue in patients with these pathologies. MOCA and mRS both appear to improve in patients after bypass at longer term follow‐up, suggesting that bypass may be an effective method of addressing the issue of neurocognitive decline in patients with carotid insufficiency.

49 Subjective and Objective Psychophysical Olfactory Dysfunction in Men Living with HIV

Objective:Olfactory dysfunction can influence nutritional intake, the detection of environmental hazards, and quality of life. Prior research has found discordance between subjective and objective measures of olfaction. In people living with HIV (PLWH), olfactory dysfunction is widely reported; however, few studies have examined concordance between subjective olfactory self-ratings and performance on an objective psychophysical measure of olfaction and associated factors in men living with HIV (MLWH).Participants and Methods:MLWH (n=51, mean age=54 years, 66.7% Black) completed two subjective olfaction ratings (two 5-point Likert scales), the Smell Identification Test (SIT), cognitive measures (HVLT-R, TMT), and self-report questionnaires assessing smell habits, mood, cognitive failures, and quality of life. Participants were categorized into one of four groups: true positives (TP; impaired subjective olfaction and objective olfaction dysfunction), false negatives (FN; intact subjective olfaction and objective olfaction dysfunction), false positives (FP; impaired subjective olfaction and objective normosmia), and true negatives (TN; intact subjective olfaction and normosmia). Established formulas were used to calculate the sensitivity and specificity of subjective olfaction, and t-tests and ANOVA were used to examine potential demographic, clinical, and cognitive factors contributing to discordance between subjective and objective olfaction dysfunction.Results:Across both subjective self-report items, 35.3% reported olfactory dysfunction, whereas 60.8% had objective olfaction dysfunction on the SIT (score < 33). Black MLWH had significantly higher rates of subjective (Black 41.2% vs. White 35.3%) and objective (Black 73.5% vs. White 35.3%) olfactory dysfunction (X2(1)=9.22, p=.002). We found discordance between subjective and objective olfaction measures, with 29.4% of the sample having objective olfaction dysfunction and not recognizing it (FN). In comparison, 3.9% with self-rated olfaction impairment had normal objective olfaction scores (FP). Additionally, there was concordance in subjective self-reports compared with objective olfaction, with 35.3% correctly identifying normal olfaction (TN) and 31.4% correctly identifying olfactory dysfunction (TP). Those unaware of olfaction dysfunction (FN) reported using less scented products in daily life on the Smell Habits Questionnaire. Although the FN group had faster TMT scores, these findings were no longer significant after the removal of three outliers in the TP group (e.g., time to complete greater than 350 seconds).Conclusions:Our findings cohere with work in healthy older adults, traumatic brain injury, and Parkinson’s disease, documenting that subjective olfaction may inadequately capture the full range of a person’s olfactory status. We extend these findings to a sample of MLWH, in which discordance rates ranged from 35-61% for subjective and objective olfactory dysfunction. Unawareness of olfactory dysfunction in MLWH was associated with less daily smell habits and paradoxically faster TMT performance. A higher number of smell habits in the TP group indicate that more frequent odor exposure may increase sensitivity to olfactory declines. Future studies with larger samples will be helpful in understanding the full nature of these relationships. Lastly, given that one-third of the sample had discordance between subjective and objective olfaction, objective olfaction measures may be useful to consider in the neuropsychological assessment and standard clinical care for PLWH.

Pre-eclampsia among Pregnant Women Admitted to the Department of Obstetrics and Gynaecology of a Tertiary Care Centre.

Pre-eclampsia is a pregnancy-related hypertensive disorder with maternal and neonatal complications. Many studies are done regarding the prevalence of pre-eclampsia in Nepal but ascertaining the maternal risk factors and fetal outcomes are important. The aim of this study was to find out the prevalence of pre-eclampsia among pregnant women admitted to the Department of Obstetrics and Gynaecology of a tertiary care centre. A descriptive cross-sectional study was conducted among pregnant women admitted to the Department of Obstetrics and Gynaecology of a tertiary care hospital from 13 July 2023 to 29 September 2023 after obtaining ethical approval from the Institutional Review Committee. Convenience sampling method was used. Point estimate was calculated at a 95% Confidence Interval. Among 5065 patient, pre-eclampsia was seen in 44 (0.87%) (0.61-1.13, 95% Confidence Interval). A total of 16 (36.36%) cases of pre-eclampsia were in the age group 25-29 years and 30 (68.18%) of them were nulliparous. A total of 38 (86.36%) of the newborns of the pre-eclamptic cases had low birth weight. The APGAR score of newborns at the 1 minute after birth was 26 (59.09%) followed by the newborns who needed re-evaluation 16 (36.36%). The APGAR score recorded at 5 minutes showed maximum newborns with normal APGAR score 40 (90.90%). The prevalence of pre-eclampsia among pregnant women was found to be lower than other studies done in similar settings. maternity; Nepal; pre-eclampsia; prevalence.

A specialized HE testing clinic improves rational decision-making for therapy in cirrhosis.

Cognitive complaints in cirrhosis are often attributed to HE with reflexive therapy if specialized tests are not performed. The aim was to determine the utility of a specialized HE clinic for management decisions. Cirrhosis patients with cognitive complaints were referred through a dedicated consult pathway to a specialized clinic and followed for 6 months. This clinic included detailed history, medication review, standardized tests [Mini-Mental Status Exam (MMSE), Psychometric HE Score, and others], and obstructive sleep apnea screening. Results were communicated with patients and referring providers. A subset was offered repeat testing. A total of 286 patients were tested between 2012 and 2022. Of the 286 patients, 4 patients who showed a Mini-Mental State Exam <25 were referred to neurology. Thirty-nine percent had normal Psychometric HE Score (higher in younger patients, without prior HE, depression, and lower Model for End-Stage Liver Disease-Sodium), while 172 (61%) patients had cognitive impairment. Of the 172 patients, 51 did not want management change, 84 were started on HE therapy, and 37 were considered impaired due to other causes. In 51 without management change, 32 refused lactulose, while the remaining were counseled regarding lactulose titration. Of the 84 patients with HE-therapy initiation, lactulose was initiated in 56 and rifaximin in 28; most therapies continued over 6 months. The ones who were retested improved their Psychometric HE Score. The 37 with other causes (obstructive sleep apnea, mood disorders, substance use, and mild cognitive impairment) led to specialized referrals. No overt HE was found over 6 months in those without HE-related impairment. The clinic was billed for. A specialized HE clinic for patients with cirrhosis and cognitive complaints established through a dedicated consult pathway showed that 39% of referred patients had normal cognitive performance, while the results guided management changes, including for HE and other causes in the remaining patients.

5 Anticholinergic Medications, Cognition, and Parkinson’s Disease. Do Medications matter?

Objective:While Parkinson’s disease (PD) is traditionally known as a movement disorder, cognitive decline is one of the most debilitating and common non-motor symptoms. Cognitive profiles of individuals with PD are notably heterogeneous (Goldman et al., 2018). While this variability may arise from the disease itself, other factors might play a role. Greater anticholinergic medication use has been linked to worse cognition in those with PD (Fox et al., 2011, Shah et al., 2013). However, past studies on this topic had small sample sizes, limited ranges of disease duration, and only used cognitive screeners. Thus, this study aimed to examine this question within a large, clinical sample, using a more comprehensive neuropsychological battery. We hypothesized that higher anticholinergic medication usage would relate to worse cognitive performance, particularly memory.Participants and Methods:Participants included 491 nondemented individuals with PD (m=64.7, SD=9.04 years old; education m=15.01, SD=2.79; 71.9% male; 94.3% non-Hispanics white) who underwent a comprehensive neuropsychological assessment at the UF Fixel Institute’s movement disorders program. Medications at the time of the neuropsychological evaluation were identified from chart review and scored based on anticholinergic properties using the Magellan Anticholinergic Risk Scale (Rudolph J.L., et al, 2008); each medication was scored from 0 (no load) to 3 (high load). The neuropsychological battery included measures across 5 cognitive domains: (1) executive function (Trails B, Stroop Interference, Letter Fluency), (2) verbal delayed memory (WMS-III Logical Memory and Hopkin’s Verbal Learning Test-Revised delayed recalls), (3) language (Boston Naming Test-II, Animal Fluency), (4) visuospatial skills (Judgment of Line Orientation, Face Recognition Test), and (5) attention/working memory (WAIS-III Digit Span Forward and Backward). The published normative scores for each task were converted into z-scores and averaged into a domain composite. Due to non-normality of Magellan scores, Spearman correlations examined the relationship between each cognitive domain composite score and Magellan scores.Results:As predicted, higher Magellan scores were significantly associated with worse memory (r=-0.11, p=0.016), with a small effect size. There were no significant relationships between Magellan scores and the remaining cognitive domains (EF, language, visuospatial, attention).Conclusions:We found that greater anticholinergic burden was associated with worse performance on memory, but not other neuropsychological domains, in a large cohort of nondemented individuals with PD who underwent comprehensive assessment. This finding corresponds to previous literature in smaller PD cohorts. Though the effect size was low, this finding highlights the importance of monitoring anticholinergic burden in PD patients in order to minimize detrimental effects of medications on memory function. Future work should examine whether greater anticholinergic burden predicts future progression of memory decline.Acknowledgement: Supported in part by the NIH, T32-NS082168

BODY-Q Normative Scores: Psychometric Validation of the BODY-Q in the General Population in Europe and North America.

BODY-Q is a rigorously developed patient-reported outcome measure designed to measure outcomes of weight loss and body contouring patients. To allow interpretation and comparison of BODY-Q scores across studies, normative BODY-Q values were generated from the general population. The aim of this study was to examine the psychometric properties of BODY-Q in the normative population. Data were collected using two crowdsourcing platforms (Prolific and Amazon Mechanical Turk) in 12 European and North American countries. Rasch measurement theory (RMT) was used to examine reliability and validity of BODY-Q scales. RMT analysis supported the psychometric properties of BODY-Q in the normative sample with ordered thresholds in all items and nonsignificant chi-square values for 167 of 176 items. Reliability was high with person separation index of greater than or equal to 0.70 in 20 of 22 scales and Cronbach alpha values of greater than or equal to 0.90 in 17 of 22 scales. Mean scale scores measuring appearance, health-related quality of life, and eating-related concerns scales varied as predicted across subgroups with higher scores reported by participants who were more satisfied with their weight. Analysis to explore differential item functioning by sample (normative versus field-test) flagged some potential issues, but subsequent comparison of adjusted and unadjusted person estimates provided evidence that the scoring algorithm worked equivalently for the normative sample as in the field-test samples. The BODY-Q scales showed acceptable reliability and validity in the normative sample. The normative values can be used as reference in research and clinical practice in combination with local estimates for parallel analysis and comparison.

17 The Chinese Version of Craft Story Recall: A Preliminary Study on the Diagnostic Values of Mild Cognitive Impairment and Dementia.

Objective:Craft story recall test in the National Alzheimer’s Coordinating Center Uniformed Data Set 3 (NACC UDS3) neuropsychological battery has been employed to assess verbal memory and assist clinical diagnosis of mild cognitive impairment (MCI) and dementia. While a Chinese version of the test was adapted, no existing literature has examined the diagnostic validity of the test in Chinese Americans. This study aimed to evaluate the predictive validity of both immediate and delayed recall.Participants and Methods:The Chinese version of Craft Story was administered in to 78 Chinese participants per their language preference of Mandarin or Cantonese. Outcome measures were verbatim and paraphrase recall of the story immediately and after a 20-minute delay. A multiple linear regression was performed to investigate the association of each outcome measure with age, education, gender, age when moved to the U.S., years in the U.S., and testing language. To assess its diagnostic value, cutoff standard deviation scores of -1.5 and -2.0 from the mean of the clinically cognitive normal participants were generated for MCI and dementia diagnoses, respectively. Due to the small sample size, a normative group fitting the mean age (73 years), years of education (12 years), and the majority gender (female) of the current sample were used to identify standard cut points. A receiver-operating characteristic analysis was used to compare predicted diagnosis with actual clinical diagnosis obtained through patients’ overall performance and a consensus meeting by licensed clinicians.Results:Younger age (p &lt; 0.05) and being tested in Mandarin (p &lt; .01) were positively associated with immediate and delayed recall. Strong positive correlations between each measure were observed (all p &lt; .001), indicating a significant relationship between information encoded and retained. Among all the participants, 15 (19.2%) were diagnosed with MCI and 22 (28.2%) with dementia. For MCI diagnosis, the standard cutoff scores demonstrated adequate sensitivity (verbatim=82%, paraphrase=91%) but low specificity (verbatim=44%, paraphrase=67%) in all outcome measures. For dementia diagnosis, delayed recall showed strong sensitivity (100%) and adequate specificity (75%) in both verbatim and paraphrasing scores. Immediate recall paraphrase (sensitivity = 95%, specificity = 50%) showed a better sensitivity but lower specificity than verbatim scoring (sensitivity = 86%, specificity = 58%). The accuracy was higher in delayed recall for both MCI and dementia diagnosis. A preliminary analysis on the optimal cut points indicated higher cutoff scores to distinguish MCI and dementia from clinically cognitive normal population, and from each other (e.g., the optimal cut point for delayed verbatim in distinguishing MCI from normal is 8.0 (sensitivity=89%, specificity=73%, AUC=84.3%)).Conclusions:Consistent with previous literature, Craft Story delayed recall served as a more accurate diagnostic tool for both MCI and dementia compared to immediate recall in older Chinese Americans. However, poor specificity might increase the chance of following false positive subjects in clinical trials. In addition, testing language appeared to impact performance on verbal memory recall of constructed information. Thus, future studies should focus on developing normative scores that address both the overall cultural differences of Chinese Americans and the heterogeneity within this population.

52 Open Access, Normative Morphometric Software Indicate Neurodegeneration Associated with Episodic Memory Dysfunction in Amnestic MCI

Objective:Neurodegeneration in Alzheimer’s disease (AD) is typically assessed through brain MRI, and proprietary software can provide normative quantification of regional atrophy. However, proprietary software can be cost-prohibitive for research settings. Thus, we used the freely available software NOrmative Morphometry Image Statistics (NOMIS) which generates normative z-scores of segmented T1-weighted images from FreeSurfer to determine if these scores replicate established patterns of neurodegeneration in the context of amnestic mild cognitive impairment (aMCI), and whether these measures correlate with episodic memory test performance.Participants and Methods:Patients with aMCI (n = 25) and cognitively normal controls (CN; n = 74) completed brain MRI and two neuropsychological tests of episodic memory (the Rey Auditory Verbal Learning Test and the Wechsler Logical Memory Tests I &amp; II), from which a single composite of normed scores was computed. A subset returned for follow-up (aMCI n = 11, CN n = 52) after ∼15 months and completed the same procedures. T1-weighted images were segmented using FreeSurfer v6.0 and the outputs were submitted to NOMIS to generate normative morphometric estimates for AD-relevant regions (i.e., hippocampus, parahippocampus, entorhinal cortex, amygdala) and control regions (i.e., cuneus, lingual gyrus, pericalcarine gyrus), controlling for age, sex, head size, scanner manufacturer, and field strength. Baseline data were used to test for differences in ROI volumes and memory between groups and to assess the within-group associations between ROI volumes and memory performance. We also evaluated changes in ROI volumes and memory over the follow-up interval by testing the main effects of time, group, and the group X time interactions. Lastly, we tested whether change in volume was associated with declines in memory.Results:At baseline, the aMCI group performed 2 SD below the CN group on episodic memory and exhibited smaller volumes in all AD-relevant regions (volumes 0.4 - 1.2 SD below CN group, ps &lt; .041). There were no group differences in control region volumes. Memory performance was associated with volumes of the AD-relevant regions in the aMCI group (average rho = .51) but not with control regions. ROI volumes were not associated with memory in the CN group. At follow-up, the aMCI group continued to perform 2 SD below the CN group on episodic memory tests; however, change of performance over time did not differ between groups. The aMCI group continued to exhibit smaller volumes in all AD-relevant regions than the CN group, with greater declines in hippocampal volume (17% annual decline vs. 8% annual decline) and entorhinal volume (54% annual decline vs. 5% annual decline). There was a trending Group X Time interaction such that decrease in hippocampal volume was marginally associated with decline in memory for the aMCI group but not the CN group.Conclusions:Normative morphometric values generated from freely available software demonstrated expected patterns of group differences in AD-related volumes and associations with memory. Significant effects were localized to AD-relevant brain regions and only occurred in the aMCI group. These findings support the validity of these free tools as reliable and cost-effective alternatives to proprietary software.

The Nightmare of Calcaneus: Gustilo-Anderson Type IIIB Fractures.

The aim of this study was to share the clinical results of open calcaneus fractures, which are extremely rare and have become the fearful nightmare of orthopedic surgeons. Between June of 2014 and June of 2020, of 196 patients with the diagnosis of calcaneus fracture, Gustilo-Anderson type IIIB, 17 patients (11 men and six women; mean age, 36.2 ± 4.6 years; range, 22-56 years) under prospective follow-up were retrospectively screened and included in the study. Patients were recorded in terms of classification of fracture, mechanism of injury, comorbidities, surgical progress, complications, and associated orthopedic and nonorthopedic injuries. Functional clinical results and quality of life of the patients were evaluated at the 6-month follow-up with the American Orthopedic Foot and Ankle Society score and the 36-Item Short Form Health Survey questionnaire. The most common etiologic factor was work-related injuries, with 29.4%. Although triple arthrodesis surgery was performed in three cases because of pseudoarthrosis, amputation was performed in one case because of deep infection. The most common soft-tissue defect was located at the medial aspect of the foot, which was commonly reconstructed with the used of reverse flow island sural flap. The average total American Orthopedic Foot and Ankle Society hindfoot score was 51.6 (range, 48-74) and similarly, physical component, pain, and social parameters on the 36-Item Short Form Health Survey were statistically significant compared to Turkish population normal scores. A long and laborious process is required for both the patient and the surgeon in the treatment of open calcaneal fractures. However, it is possible to obtain good results with soft-tissue reconstructions.

OTHER-11 DEMENTIA AND EPILEPSY REVERSED SUCCESSFULLY THROUGH STAGED EMBOLISATION OF A SYMPTOMATIC HYPERVASCULAR PARAGANGLIOMA : A CASE REPORT

Abstract INTRODUCTION Paragangliomas (PGs) are rare neuroendocrine tumours that can arise from parasympathetic glossopharyngeal and vagus nerves. Atypical presentations involving seizures and dementia can occur due to excessive catecholamine release. Physiological intracranial arteriovenous fistulae (AVF) can occur concurrently due to increased vascularity, especially in the cavernous and sigmoid sinuses. METHODS We present a case of a patient who developed a highly vascular AVF from an ipsilateral glomus jugulare PG, presenting with rapidly progressive but reversible dementia and epilepsy. CASE: A 64-year-old lady presented on several occasions with new-onset stereotyped episodes of confusional dysphasia suggestive of seizures, confirmed on electroencephalography. Further history revealed two years of progressive deafness and imbalance, and one year of increasing forgetfulness and executive dysfunction, which had deteriorated rapidly in the period of the patient's current presentations. Montreal cognitive assessment (MoCA) score was 21/30 at baseline (normal score &amp;gt;25/30), and she had no lateralising signs. Serial brain magnetic resonance imaging (MRI) revealed progressively worsening vasculopathic white matter hyper-intensities (WMHs). Eventual MR angiography showed a 14x22×23mm right glomus jugulotympanicum PG with numerous feeding arteries, and associated multiple AVFs (Cognard grade III). She was initially managed with anti-seizure medications and then discussed in our multidisciplinary neurosciences meeting. The patient underwent staged right glomus jugulare embolization over several weeks. Her cognitive function gradually improved, and at three months she had fully returned to normal functioning with a MoCA of 30/30 and no residual neurological deficit. The WMHs disappeared on follow-up MRI scans. CONCLUSION Our case highlights a rare clinical presentation of dementia and seizures from a right glomus jugulare PG with associated AVF. Multidisciplinary involvement was key in excluding other causes, and definitive treatment of the PG led to complete reversal of the patient’s dementia.

Linear Factor Analytic Thurstonian Forced-Choice Models: Current Status and Issues.

Thurstonian forced-choice modeling is considered to be a powerful new tool to estimate item and person parameters while simultaneously testing the model fit. This assessment approach is associated with the aim of reducing faking and other response tendencies that plague traditional self-report trait assessments. As a result of major recent methodological developments, the estimation of normative trait scores has become possible in addition to the computation of only ipsative scores. This opened up the important possibility of comparisons between individuals with forced-choice assessment procedures. With item response theory (IRT) methods, a multidimensional forced-choice (MFC) format has also been proposed to estimate individual scores. Customarily, items to assess different traits are presented in blocks, often triplets, in applications of the MFC, which is an efficient form of item presentation but also a simplification of the original models. The present study provides a comprehensive review of the present status of Thurstonian forced-choice models and their variants. Critical features of the current models, especially the block models, are identified and discussed. It is concluded that MFC modeling with item blocks is highly problematic and yields biased results. In particular, the often-recommended presentation of blocks with items that are keyed in different directions of a trait proves to be counterproductive considering the goal to reduce response tendencies. The consequences and implications of the highlighted issues are further discussed.

Cognitive, behavioral, neuroimaging and inflammatory biomarkers after hospitalization for COVID-19 in Brazil

Post-COVID-19 Condition (PCC) refers to a multisystemic syndrome that persists for months after SARS-CoV-2 infection. Cognitive deficits, fatigue, depression, and anxiety are common manifestations of the condition, but the underlying mechanisms driving these long-lasting neuropsychiatric features are still unclear. We conducted a prospective multi-method investigation of post-hospitalization COVID-19 patients in Rio de Janeiro, Brazil. Months after hospital admission (mean = 168.45 ± 90.31 days; range = 75.00–365.00 days), COVID-19 survivors (n = 72) presented significant difficulties in tests tapping global cognition, episodic memory, working memory and inhibitory control relative to controls and to validated normative scores. A considerable proportion of participants suffered from fatigue (36.1 %), anxiety (27.8 %), and depressive symptoms (43.1 %). Elevated blood levels of TNF-α, during hospitalization, and TNF-α and IL-1β, at follow-up, correlated with changes in brain microstructural diffusion indices (β = 0.144, p = 0.005). These neuroimaging markers were associated with decreased episodic memory (β = -0.221, p = 0.027), working memory (β = -0.209, p = 0.034) and inhibitory control (β = -0.183, p = 0.010) at follow-up. Severity of depressive symptoms correlated with deficits in global cognition in post-COVID-19 cases (β = -0.366, p = 0.038). Our study provides preliminary evidence that long-term cognitive dysfunction following COVID-19 may be mediated by brain microstructural damage, triggered by persistent neuroinflammation. In addition, depressive symptoms may contribute to prolongated global cognitive impairments in those cases.

Normative Data for the 12-Item Sniffin' Sticks Odor Identification Test in Older Adults.

Quantitative olfactory assessment has demonstrated clinical utility for the evaluation of a range of neurologic, psychiatric, and sinonasal conditions. Here, we provide age, sex, race, and education-specific normative data for the 12-item Sniffin Sticks Odor Identification Test (SSOIT-12) in older Black and White U.S. adults without preclinical or clinical dementia or sinonasal disease. A sample of 2,224 Atherosclerosis Risk in Communities study participants aged 66-89years were included. A normative regression equation was developed using a linear model for the association of age, sex, race, and education with odor identification score. Regression-based normative mean scores and percentiles were generated by age, sex, race, and education groups. Participants (mean age = 74years, 59% women, 20% Black, 48% > high school education) had a mean SSOIT-12 score of 9.8. Age, sex, race, and education were all associated with odor identification performance (all ps < .05). A linear regression model for the predicted SSOIT-12 score was developed for use with an individual's actual SSOIT-12 score in order to calculate the Z-score and corresponding percentile for a specific age, sex, race, and education group. Data are also reported in tabular format. Our study provides SSOIT-12 normative data obtained from a large population of White and Black older adults without preclinical or clinical dementia or sinonasal disease living in the USA. These findings can aid clinicians in assessing the degree of olfactory loss, establishing concordance with a person's perception of olfactory difficulties and quantitatively monitoring changes in olfactory performance over time.

Evening type negatively affects semen quality by deteriorating sperm morphology: Results from an infertility clinic

ObjectiveThe effect of sleep-related variables on the reproductive system has garnered attention in recent years. One of the mediators that reportedly plays an important role in the relationship between sleep disorders and the reproductive system is a disruption of the circadian rhythm. The aim of curent study is to investigate the effect of chronotype on morning semen quality. Study DesignThree-hundred and fourteen patients who applied to the infertility clinic were included in the study. The patients filled a socio-demographic data form. The “Pittsburg Sleep Quality Index (PSQI) was used to evaluate the sleep quality while the chronotypes of the patients were evaluated with the “Morningness –Eveningness-Questionnaire (MEQ)”. Semen analyses and biochemical analysis for testosterone serum plasma level of all patients were performed. ResultsTwenty-one patients were assigned as evening, 187 patients were assigned as intermediate, and 106 were assigned as morning chronotype. No statistically significant difference was identified in the comparison of the mean MEQ scores between patients with low and normal sperm concentrations(p = 0.884). A correlation analysis indicated the presence of a significant positive correlation between normal morphology and MEQ scores (r = 0.13, p < 0.05) and a negative corelation between the hours spent in bed and sperm concentration (r = -0.13, p < 0.05). A general linear model created with independent variables suggested that the presence of varicocele and MEQ scores had a significant effect on normal morphology. ConclusionThe results of present study support that evening type could negatively affect sperm morphology; additionally, the time spent in bed also negatively affected sperm concentration.

Hepatic mesenchymal hamartoma masquerading as neonatal unconjugated hyperbilirubinemia: a case report

BackgroundHepatic mesenchymal hamartoma (HMH) is the second most common benign hepatic tumor in the pediatric age group. The etiology of HMH is unclear. Theories include abnormal hepatic mesenchyme, a reactive change or a proliferative lesion. The condition can present prenatally in USG as a mass, high output cardiac failure, pulmonary hypertension, respiratory distress, and abdominal distension or mass in older children. We present this case to discuss an extremely rare presentation of a comparatively rare disease and to emphasise the need for a high index of suspicion even if the patient presents with symptoms common for that age.Case presentationA 7-day-old male baby with an uneventful antenatal period, born by vaginal delivery, with a birth weight of 3.1 kg and normal APGAR scores, presented with jaundice, poor feeding, and labored breathing noticed on the same day itself. Examination revealed a grossly distended abdomen with a mass of size 8 × 7 cm occupying the right side down to the right iliac fossa, crossing midline and dullness continuous with liver dullness. On investigation an abnormal liver function test with unconjugated hyperbilirubinemia was seen. USG and CECT abdomen were suggestive of HMH with close proximity to hepatic vessels. Exploratory laparotomy and near total excision with marsupialisation was done. Histopathology report was suggestive of HMH. A 2-year follow-up was normal.ConclusionThis case of HMH presented as neonatal jaundice with unconjugated hyperbilirubinemia which is a rarity. We had to limit our surgery to near total excision and marsupialisation due to its proximity to vascular structures.