Normative Mean Research Articles

H - 26 Cognitive Functioning Following Bariatric Surgery in a Bilingual, Spanish, and English - Speaking, Patient: a Case Study.

Overall, 256,000 bariatric surgeries were completed in the United States in 2019 (ASMBS, 2023). Bariatric surgeries are effective in reducing morbidity, prolonging life, and improving cognition, particularly among patients with BMI >40 and those with BMI >35 and obesity-related complications (Handley et al., 2016; Cornejo-Pareja et al., 2021). Nevertheless, up to 16% of patients undergoing bariatric procedures experience neurological sequelae (Thaisetthawatku et al., 2004) that is likely secondary to surgery-related nutritional deficiencies (Gasmi et al., 2022). Although neuropsychological assessments may help to identify postsurgical cognitive changes, cultural and linguistic differences may preclude reliable and valid assessment of non-native English-speaking persons. A Spanish-dominant 38-year-old, right-handed, female reported diminished attention, reduced thinking speed, and memory difficulties that were interfering with her daily functioning. She completed a thorough Clinical Interview (both individually and with collaterals), Record Review, and a comprehensive neuropsychological workup. She demonstrated multi-domain impairment (>1.5S.D. below the normative mean), suggesting a possible dementia or encephalopathy. When her cognitive profile was interpreted in the context of her medical history, further testing was recommended to rule out reversible etiologies. Interdisciplinary collaborations with primary care and gastroenterology revealed nutritional deficiencies that had persisted for over 18months after bariatric surgery and that were not fully resolved with regular oral vitamin consumption. Cultural and linguistic differences were relevant when assessing cognitive changes in non-native English-speaking persons, and in helping to determine whether pharmacological and behavioral interventions are ameliorating these complications. Practical considerations of these high-stakes assessments will be discussed from neuropsychological, psychosocial, and ethical perspectives.

Health-related quality of life in children with congenital vascular malformations

A cross-sectional study was performed to evaluate health-related quality of life (HRQOL) in children with congenital vascular malformations (CVM) and to investigate factors associated with an impaired HRQOL. Children (2–17 years) with CVMs who visited the HECOVAN expertise center between 2016–2018 were included. The PedsQL 4.0 Generic Core Scales were used and a score ≥ 1.0 SD below the normative mean was defined as an impaired HRQOL. Factors associated with impairment were investigated using univariate and multivariate logistic regression analysis. The median overall HRQOL was 84.8/100 (n = 207; 41% boys, 59% girls; self-reported IQR 73.9–92.4 and parent-reported IQR 71.4–92.4). Patients aged 13–17 years reported significantly worse physical functioning than those aged 8–12 years (median 84.4, IQR 71.1–93.8 versus median 90.6, IQR 81.3–96.9; p = 0.02). Parents reported a significantly lower overall HRQOL than their children (median 80.4, IQR 70.7–90.8 versus median 85.9, IQR 76.1–92.4; p = 0.001). HRQOL was impaired in 25% of patients. Impairment occurred significantly more often in lower extremity CVMs (38%, p = 0.01) and multifocal CVMs (47%, p = 0.01) compared to CVMs in the head/neck region (13%). Other associated factors included invasive management (31% versus 14%; p = 0.01), age at first treatment ≤ 5 years (48% versus 25%; p = 0.02) and ongoing treatment (38% versus 18%; p = 0.004). After correction for other factors, significance remained for lower extremity CVMs and ongoing invasive treatment.Conclusions: Overall median HRQOL was reasonable and not significantly different from the norm sample. Parental ratings were significantly lower than their children’s ratings. A quarter of the patients had an impaired HRQOL, which seemed to worsen with age. Independently associated factors included a lower extremity CVM and invasive management.What is Known:• Congenital vascular malformations could affect health-related quality of life (HRQOL).• Studies on pediatric patients are limited and either very small or in combination with adult patient series.What is New:• This study raises awareness of an impaired HRQOL in 25% of pediatric patients with congenital vascular malformations.• Associated factors included a lower extremity CVM and invasive management.

Mediation Legal Protection in Handling Minor Crimes

The position of the judiciary as the last place to seek justice has a very important role in the way of solving a case or problem through mediation peace. The first appearance of a mediation process was in 1970 in California where another name is usually Alternative Dispute Resolution (ADR) which was only practiced thoroughly in 1979. The purpose of writing is so that readers will understand the existence of mediation law with protection by means of criminal acts light through mediation, research methods that use the, journal writing with normative legal research methods. Approach to normative juridical means an approach using literature, doctrine, and document studies that have been made by the opinion of experts. In handling criminal acts, mediation can be an effective and useful alternative in cases of minor crimes.

Investigation on the synergy enhancement effect and mechanism of consolidation/thermal conductivity of CNTs-composite cement

Geothermal well is completed generally with a cemented casing across the heat source, while the existing casing cement generally suffered from insufficient performance to meet the demand of actual medium-deep geothermal well construction. In view of this, combining theoretical analysis and experimental research, a new type of carbon nanotubes (CNTs) composite cement for geothermal exploitation was successfully developed by introducing thermal conductivity fillers, heat stabilizing material, nanomaterial and additives to synergistically regulate the comprehensive performance of casing cement. The evaluation of the high-temperature rheology and stability of slurry, and the compressive strength and thermal conductivity of cement stone was carried out based on the normative means. And the results showed that cement slurry had excellent high-temperature performance. The 28d compressive strength (With the curing condition of 150 °C & 20.7 MPa) of cement stone reached 8.15 MPa and the thermal conductivity was stabilized at 2.236 W/(m·K), both of which were at a high level in similar studies. Finally, a combination of hydration process analysis (TGA and XRD), microstructure study (MIP and SEM) and heat transfer mode study (Energy spectrum scanning) was used to summarize the nano-composite cement consolidation/thermal conductivity mechanism. Analysis showed that CNTs could play the effect of "pore filling" and "bridging" hydration products, and the additives could participate in the hydration reaction and regulate the hydration process. In addition, the heat transfer mode of the cement matrix was in accordance with the theory of heat conduction path. The study results provide a new idea to improve the cementing quality of cement and optimize the heat extraction efficiency of geothermal wells from the perspective of material development.

Impact of socioeconomic status and chemotherapy on neurocognitive performance in children with brain tumors.

Although the relationship between radiation and neurocognition has been extensively studied in the pediatric brain tumor population, it is increasingly recognized that neurocognitive impairment is multifactorial. Therefore, we quantified the effect of socioeconomic status (SES) and chemotherapy on neurocognitive impairment and decline post-treatment. Eligible patients included those diagnosed with a brain tumor at < 22 years of age with ≥1 neurocognitive assessment. Neurocognitive impairment was defined as performance 1.5 standard deviations below the normative mean using age-standardized measures of intellectual function. Neurocognitive decline was defined as a negative slope. Neurocognitive outcomes included Wechsler indices of Full-Scale Intelligence Quotient (IQ). Logistic regression identified variables associated with neurocognitive impairment. Longitudinal data was analyzed using linear mixed models. Eligible patients (n = 152, median age at diagnosis = 9.6 years) had a mean neurocognitive follow-up of 50.2 months. After accounting for age and receipt of craniospinal irradiation, patients with public insurance had 8-fold increased odds of impaired IQ compared to private insurance (odds ratio [OR]: 7.59, P < .001). After accounting for age, change in IQ was associated with chemotherapy use (slope: -0.45 points/year with chemotherapy vs. 0.71 points/year without chemotherapy, P = .012). Public insurance, an indicator of low SES, was associated with post-treatment impairment in IQ, highlighting the need to incorporate SES measures into prospective studies. Chemotherapy was associated with change in IQ. Further work is needed to determine whether impairment associated with low SES is secondary to baseline differences in IQ prior to brain tumor diagnosis, brain tumor/therapy itself, or some combination thereof.

Associations Between Executive Functioning, Behavioral Functioning, and Adaptive Functioning Difficulties in Wiedemann-Steiner Syndrome.

Wiedemann-Steiner syndrome (WSS) is a neurogenetic disorder caused by heterozygous variants in KMT2A. Recent investigations suggest increased anxiety and behavior regulation challenges among those with WSS although the neurobehavioral phenotype remains largely unknown. This study aims to examine the pattern of and associations between executive functioning (EF) and behavior functioning among those with WSS. This study involved utilizing caregiver-report inventories (Behavior Rating Inventory of Executive Function 2nd Edition, BRIEF-2; Adaptive Behavior Assessment 3rd Edition, ABAS-3; Strengths and Difficulties Questionnaire, SDQ) to assess day-to-day behavior functioning among those with WSS (N = 24; mean age = 10.68years, SD = 3.19). Frequency of clinical elevations in daily difficulties in EF, adaptive behaviors, and behavior regulation were reported. Correlations and hierarchical linear regressions were used to determine the relationships between EF with behavior and adaptive functioning. Out of our sample, 63% met clinical levels of executive functioning difficulties on the BRIEF-2, and 75% with Hyperactivity and 54% with Emotional Problems on the SDQ. In addition, 33% were rated >2 SD below the normative mean in overall adaptive functioning on the ABAS-3. Elevated ratings in BRIEF-2 Shift, reflective of challenges with mental flexibility, predicted more Emotional Problems and accounted for 33.5% of its variance. More difficulties in Emotional Control were related to greater adaptive deficits, accounting for 33.3% of its variance. Those with WSS are at risk for EF deficits, hyperactivity, and emotional dysregulation. EF correlates with adaptive and affective behaviors, highlighting the promise of behavioral interventions to target cognitive flexibility, emotional awareness, and reactivity in this population.

Assessing the Sensitivity of OCT-A Retinal Vasculature Metrics.

The purpose of this study was to examine the sensitivity of quantitative metrics of the retinal vasculature derived from optical coherence tomography angiography (OCT-A) images. Full retinal vascular slab OCT-A images were obtained from 94 healthy participants. Capillary loss, at 1% increments up to 50%, was simulated by randomly removing capillary segments (1000 iterations of randomized loss for each participant at each percent loss). Thirteen quantitative metrics were calculated for each image: foveal avascular zone (FAZ) area, vessel density, vessel complexity index (VCI), vessel perimeter index (VPI), fractal dimension (FD), and parafoveal intercapillary area (PICA) measurements with and without the FAZ (mean PICA, summed PICA, PICA regularity, and PICA standard deviation [PICA SD]). The sensitivity of each metric was calculated as the percent loss at which 80% of the iterations for a participant fell outside of two standard deviations from the sample's normative mean. The most used OCT-A metrics, FAZ area and vessel density, were not significantly different from normative values until 27.69% and 16.00% capillary loss, respectively. Across the remaining metrics, metric sensitivity ranged from 6.37% (PICA SD without FAZ) to 39.78% (Summed PICA without FAZ). The sensitivity of vasculature metrics for detecting random capillary loss varies substantially. Further efforts simulating different patterns of capillary loss are needed for comparison. Additionally, mapping the repeatability of metrics over time in a normal population is needed to further define metric sensitivity. Quantitative metrics vary in their ability to detect vascular abnormalities in OCT-A images. Metric choice in screening studies will need to balance expected capillary abnormalities and the quality of the OCT-A images being used.

Individual Assessment of Perioperative Brain Growth Trajectories in Infants With Congenital Heart Disease: Correlation With Clinical and Surgical Risk Factors.

Background Infants with congenital heart disease (CHD) are at risk of neurodevelopmental impairments, which may be associated with impaired brain growth. We characterized how perioperative brain growth in infants with CHD deviates from typical trajectories and assessed the relationship between individualized perioperative brain growth and clinical risk factors. Methods and Results A total of 36 infants with CHD underwent preoperative and postoperative brain magnetic resonance imaging. Regional brain volumes were extracted. Normative volumetric development curves were generated using data from 219 healthy infants. Z-scores, representing the degree of positive or negative deviation from the normative mean for age and sex, were calculated for regional brain volumes from each infant with CHD before and after surgery. The degree of Z-score change was correlated with clinical risk factors. Perioperative growth was impaired across the brain, and it was associated with longer postoperative intensive care stay (false discovery rate P<0.05). Higher preoperative creatinine levels were associated with impaired brainstem, caudate nuclei, and right thalamus growth (all false discovery rate P=0.033). Older postnatal age at surgery was associated with impaired brainstem and right lentiform growth (both false discovery rate P=0.042). Longer cardiopulmonary bypass duration was associated with impaired brainstem and right caudate growth (false discovery rate P<0.027). Conclusions Infants with CHD can have impaired brain growth in the immediate postoperative period, the degree of which associates with postoperative intensive care duration. Brainstem growth appears particularly vulnerable to perioperative clinical course, whereas impaired deep gray matter growth was associated with multiple clinical risk factors, possibly reflecting vulnerability of these regions to short- and long-term hypoxic injury.

Commitment-based negotiation semantics for accountability in multi-agent systems

Negotiation is a key form of interaction in multi-agent systems. Negotiation enables agents to come to a mutual agreement about a goal or plan of action. Current negotiation approaches use traditional interaction protocols which do not capture the normative meaning of interactions and often restrict agent autonomy. These traditional negotiation approaches also have difficulty specifying accountability. This paper seeks to address this gap in maintaining autonomy and capturing accountability during negotiation through the use of normative commitments. We propose Nala, a commitment-based negotiation semantics. Nala uses commitments to provide normative meaning to agent interactions. The nature of commitments support in capturing accountability through the violation of created commitments. We illustrate Nala’s usage via a case study using a game scenario where agents participate in negotiation to bring about their goals in a research constrained environment.

Assessing learning and memory among patients with pediatric brain tumor (PBT): a comparison of measures

ABSTRACT Patients with pediatric brain tumor (PBT) can have memory deficits due to tumor location, medical complications, and treatment. The main objective of this study was to investigate whether the California Verbal Learning Test-Children’s Version (CVLT-C; 1994) and briefer Child and Adolescent Memory Profile (ChAMP; 2015) similarly identify such deficits. Seventy-five patients with PBT ages 8–16 ( = 13.1 years, SD = 2.1) were administered the ChAMP or CVLT-C. Rote verbal learning, long-term retrieval, and recognition were analyzed using standardized z-scores. Analyses of differences between measures did not reach statistical significance. Both measures indicated significant downward shifts across free retrieval trials from normative means, with scores approximately 1/3 (ChAMP) to 1/2 (CVLT-C) SD below means across learning and long-term retrieval trials. Scores on recognition trials did not differ significantly from the normative mean. Post-hoc analyses using a subset of the sample who received cranial irradiation (n = 45) similarly found no significant differences between memory measures. Additional post-hoc examination of proportion of participants falling within or below the “below average” range (≤8th percentile) revealed comparable performance between the two measures, whereas the proportion of participants falling at or below 1.5 SDs below the mean on retrieval trials was lower using ChAMP Lists as compared to the CVLT-C. Given the ChAMP is less demanding in terms of time and effort and utilizes more updated and representative normative data, this study supports the ChAMP as a useful tool to evaluate learning and memory within this population.

위헌심사기준으로서 헌법 제22조 제2항의 의미와 내용

Article 22, Paragraph 2 of the Constitution stipulates that “the rights of authors, inventors, scientists, and artists are protected by law”. Despite being a provision that has continued since the Constitution's establishment, there has not been enough discussion in the constitutional academic community regarding its normative meaning and function, relationship with other fundamental rights, especially property rights, and concrete criteria for constitutionality review. Recently, in a case in which the Court reviewed the constitutionality of Article 9 of the Copyright Act, Article 22, Paragraph 2 of the Constitution was applied. As a result of this decision, discussions on the normative meaning of Article 22, Paragraph 2 of the Constitution and its standard for constitutionality review were triggered in the constitutional law academia. These discussions are mostly related to whether Article 22, Paragraph 2 of the Constitution has a unique meaning and performs an independent function, its normative meaning, and the concrete standard for constitutionality review. However, many ambiguous aspects remain. Therefore, this article examines the normative contents of Article 22, Paragraph 2 of the Constitution. The composition of this article is as follows. First, as a starting point, the meaning and limitations of the decision of the Court are examined. Second, by examining the US Supreme Court's doctrine about the copyrights clause and related discussions, this article seeks applicability of it to the interpretation of the Korean Constitution. Third, based on this, it critically reviews the recent discussions in constitutional law academia and offers the contents of Article 22, Paragraph 2 of the Constitution as a standard for constitutionality review.

Normal multiple sleep latency test values in adults: A systematic review and meta-analysis

Sleep latency is a measure of time it takes to enter sleep. Very short sleep latencies are indicative of excessive daytime sleepiness and pathological sleep conditions such as narcolepsy. The normal range of mean sleep latency calculated from the multiple sleep latency test in healthy adults is not well-established. We provide a review of normative mean sleep latency values on the multiple sleep latency test by synthesizing data from 110 healthy adult cohorts. We also examine the impact of demographic variables such as age, sex, body mass index, sleep architecture and sleep-disordered breathing as well as methodological variables such as sleep onset definitions and multiple sleep latency test protocols. The average mean sleep latency was 11.7 min (95% CI: 10.8–12.6; 95% PI: 5.2–18.2) for cohorts evaluated using the earlier definition of sleep onset and 11.8 min (95% CI: 10.7–12.8; 95% PI: 7.2–16.3) for those evaluated using the later definition. There were no significant associations between mean sleep latency and demographic or methodological variables. A negative association of −0.29 per one unit increase (95% CI: −0.55 to −0.04) was found between mean sleep latency and apnea-hypopnea index on prior night polysomnography. Establishing updated ranges for mean sleep latency among healthy adults may guide clinical decision-making surrounding sleep pathologies and inform future research into the associations between patient variables, daytime sleepiness, and sleep pathologies.

Transiting From the East to the ‘Core’ West of Europe: Slovakia’s Ontological Liminality After the Outbreak of 2022 Russia’s War on Ukraine

This article examines the effects of the outbreak of Russia’s full-scale war against Ukraine in February 2022 on the reconstruction of the notion of ‘Eastern Europe’ in Slovak political discourse and the subsequent re-definition of Slovakia’s political subjectivity vis-à-vis the contested notion of the ‘East’. It aims to advance the application of ontological liminality concept in international relations integrating it with post-structuralist and post-colonial insights on identity formation. I seek to shed light on how Slovakia negotiates its liminal position of being ‘the East of the Western Europe’ under the new geopolitical and discursive realities. Drawing on the concept of ontological liminality and post-colonial notion of master, my principal argument suggests that Slovakia aspired to demonstrate its capability to define the normative meaning of EUrope as one of its ‘core’ members positioning itself as a superior European state, a ‘master’ in relation to Ukraine. Although, on Slovakia’s mental map, the notion of ‘East’ assumes a far-away position it escaped long time ago, at the same time ‘East’ with the tinge of orientalism has been constructed as an indispensable subject position that the future newcomers to EUrope carry when they are pursuing their transition to the West. Based on hierarchically underpinned discursive self-positioning of Slovakia, ‘East’ is thus made a pre-liminal attribute which post-communist countries let go when beginning their transition to/through the Central Europe that ultimately emerges as an intermediary post-colonial spatial and discursive setting where liminals undergo the ritual of becoming genuinely EUropean.

OUTC-03. IMPACT OF TREATMENT EXPOSURES AND SOCIOECONOMIC STATUS ON NEUROCOGNITIVE PERFORMANCE IN CHILDREN WITH BRAIN TUMORS

Abstract PURPOSE To investigate the impact of treatment exposures and socioeconomic status on neurocognitive performance in children with brain tumors. METHODS Eligible patients included those diagnosed with a brain tumor at &amp;lt;22 years of age with ≥ 1 neurocognitive assessment. Neurocognitive impairment was defined as performance 1.5 standard deviations below the normative mean using age standardized measures of intellectual function. Neurocognitive outcomes included Wechsler indices of full-scale intelligent quotient (IQ), working memory (WM), and processing speed (PS). Neurocognitive decline was defined as a negative slope. Logistic regression identified variables associated with neurocognitive impairment. Longitudinal data was analyzed using linear mixed models. RESULTS Eligible patients (n=152) had a mean neurocognitive follow-up of 50.2 months and median age at diagnosis of 9.6 years. PS was most frequently impaired in patients (37.5%) followed by IQ (20.6%) and WM (16.5%). Patients with public insurance had eight-fold increased odds of impaired IQ compared to those with private insurance (Odds Ratio [OR]: 7.59, p&amp;lt;0.001). Patients treated with CSI had eight-fold increased odds of impaired IQ (OR: 7.86, p=0.003) and almost six-fold increased odds of impaired WM (OR: 5.66, p=0.028) compared to those treated without RT. After accounting for age, change in IQ was associated with chemotherapy use (slope: -0.45 points/year with chemotherapy vs. 0.71 points/year without chemotherapy, p=0.012). Patients treated with both chemotherapy and RT demonstrated the greatest decline whereas those treated without either demonstrated no decline in any of the neurocognitive measures. CONCLUSION After treatment for pediatric brain tumors, public insurance, an indicator of low socioeconomic status, was associated with impairment in IQ with a large effect size similar to that of CSI. Chemotherapy was associated with decline in IQ with a small effect size. Combined chemotherapy and RT had additive effects on neurocognitive decline in IQ, WM, and PS.

The Interaction of Age at Diagnosis and Neurological Risk Predicts Adaptive Functioning Changes in Pediatric Brain Tumor Survivors

ABSTRACT T-tests from 42 brain tumor patients showed adaptive functioning below normative means at both time points (test interval M=2.60y, SD=1.32). Neurological risk, time since diagnosis,age at diagnosis, age at evaluation, and time since evaluation were correlated with specific adaptive skills. There was a main effect of age at diagnosis, age at assessment, time since diagnosis, and neurological risk as well as an interaction of age at diagnosis × neurological risk for specific adaptive skills. Results highlight the importance of considering the relationship between developmental and medical variables on changes in adaptive functioning in survivors of pediatric brain tumors.

Physical and emotional quality of life in children with B-acute lymphoblastic leukemia randomized to every 4- vs. 12-week vincristine/dexamethasone during maintenance: Children’s Oncology Group AALL0932.

10025 Background: Children with B-acute lymphoblastic leukemia (B-ALL) undergo 2-3 years of treatment that impacts their quality of life. AALL0932 randomized reduction in vincristine and dexamethasone pulses (VCR/DEX every 4 weeks vs. every 12 weeks) during maintenance in the average-risk (AR) subset of NCI standard risk (SR) B-ALL. We longitudinally measured physical and emotional function overall and by treatment. Methods: SR AR B-ALL patients enrolled on AALL0932, aged ≥4 years, with English-speaking parents were evaluated at 5 timepoints (T1-T5: end consolidation, maintenance month 1, maintenance month 10, maintenance month 18 for boys/end of therapy for girls, end of therapy for boys). Parents completed the Pediatric Quality of Life Inventory Generic Core Scales 4.0 and a survey of supportive services received. Age- and sex-matched z scores and proportion impaired ( &gt; 2 SD below normative mean; 2.5% expected in normative population) on the emotional and physical function subscales were measured longitudinally and compared by treatment with the Fisher’s exact test and repeated measures logistic regression. Results: Consent and data were obtained from 555 participants (mean/sd age = 6.0±1.6 years, 46.8% female). Among randomized participants with completed evaluations, 31.3% had impaired physical function at T1 decreasing to 12.5% at T4. Emotional function was impaired in 24.5% of patients at T1 decreasing to 9.8% at T4. Overall 34.9-43.8% received special education/accommodations at T1-T5; there was low use of other services (Table). In adjusted analysis, treatment group was not associated with physical or emotional function. T2 impairment predicted increased risk of impairment at T4 for physical (OR = 4.7, 95% CI 2.3-9.7, p &lt; 0.0001) and emotional (OR = 4.7, CI 2.3-9.5, p &lt; 0.0001) function. Conclusions: Impaired physical and emotional function were prevalent early in SR AR B-ALL therapy, improved by the end of therapy, but remained higher than norms. Outcomes did not vary with VCR/DEX frequency. Patients with early emotional and physical impairment are at elevated risk of later impairment. Clinical trial information: NCT01190930 . [Table: see text]

Applicability of an actuarial neuropsychological method to diagnose mild cognitive impairment in a diverse sample

AbstractBackgroundThe Jak/Bondi actuarial neuropsychological method for detection of mild cognitive impairment (MCI) has been shown to identify subjects less likely to revert to normal and more likely to have Alzheimer’s Disease (AD) biomarkers compared to conventional clinical methods. Various iterations of this method have been applied to datasets of predominately White, highly‐educated participants, limiting generalizability to more diverse cohorts. This project investigated the applicability of the actuarial MCI diagnostic method to the Texas Alzheimer’s Research and Care Consortium (TARCC) cohort.MethodAll subjects from the TARCC cohort with expert consensus diagnoses of normal control (NC) and MCI at baseline (n = 1911; 65.72% female; 47.11% Hispanic; Mage = 67.49; Medu = 12.80) were re‐classified as NC or MCI using actuarial criteria of 2 impaired (&gt;1 SD below normative mean) tests in any of 4 cognitive domains OR 1 impaired test in at least 3 cognitive domains. The clinically‐diagnosed MCI (MCIc) sample (n = 655; 58.47% female; 42.44% Hispanic; Mage = 71.34; Medu = 13.01) and the actuarially‐diagnosed MCI (MCIa) sample (n = 837; 71.21% female; 68.82% Hispanic; Mage = 66.30; Medu = 10.87) were separately submitted to cluster analysis. McNemar’s test was used to investigate frequency of APOE4 allele by diagnostic group.ResultCluster analysis of the MCIa group yielded 3 distinct clusters: a purely amnestic cluster (n = 332), a primary language‐impaired cluster (n = 381), and a multidomain/mixed cluster (n = 124). The MCIc group yielded 2 clusters: a multidomain/mixed cluster (n = 538), and a cognitively normal cluster (n = 117). The MCIc cases were significantly more likely to have APOE4 alleles (33% vs. 28% of MCIa group).ConclusionSimilar to previous research, the MCIa group fell into 3 distinct cognitively‐impaired groups. Despite 18% of MCIc participants falling in a “cognitively‐normal” cluster, MCIc subjects were more likely to have the AD biomarker APOE4. These findings warrant further investigation, particularly in relation to ethnicity, as individuals of Hispanic origin are less likely to carry APOE4 alleles, and APOE4 confers less AD risk in Hispanics compared to non‐Hispanic Whites. Future research will investigate the prognostic utility of the actuarial method for racial/ethnic minorities using cognitive and functional longitudinal data.

Comprehensive volumetric phenotyping of the neonatal brain in Down syndrome.

Down syndrome (DS) is the most common genetic cause of intellectual disability with a wide range of neurodevelopmental outcomes. To date, there have been very few in vivo neuroimaging studies of the neonatal brain in DS. In this study we used a cross-sectional sample of 493 preterm- to term-born control neonates from the developing Human Connectome Project to perform normative modeling of regional brain tissue volumes from 32 to 46weeks postmenstrual age, accounting for sex and age variables. Deviation from the normative mean was quantified in 25 neonates with DS with postnatally confirmed karyotypes from the Early Brain Imaging in DS study. Here, we provide the first comprehensive volumetric phenotyping of the neonatal brain in DS, which is characterized by significantly reduced whole brain, cerebral white matter, and cerebellar volumes; reduced relative frontal and occipital lobar volumes, in contrast with enlarged relative temporal and parietal lobar volumes; enlarged relative deep gray matter volume (particularly the lentiform nuclei); and enlargement of the lateral ventricles, amongst other features. In future, the ability to assess phenotypic severity at the neonatal stage may help guide early interventions and, ultimately, help improve neurodevelopmental outcomes in children with DS.

Tracking Motor Impairment in People with Neurosarcoidosis (P9-5.009)

<h3>Objective:</h3> Evaluate NIH Toolbox motor battery (NIHTB-M), a multidimensional set of measures used to track motor impairment, for use in people with neurosarcoidosis (PwNS). <h3>Background:</h3> Despite its profound impact on quality of life, there are no validated measures of neurologic impairment in NS to track disability progression or treatment response. <h3>Design/Methods:</h3> Cross-sectional study of adults with NS recruited from a tertiary referral center for sarcoidosis. All participants were adults meeting NS Consortium diagnostic criteria for NS. NIHTB-M measures were compared to age-, education-, sex-, and race/ethnicity-matched peers using neurologically healthy individuals from the NIHTB norming project. NIHTB-M measures were compared to patient-reported assessments of mobility and fine motor control using Quality of Life in Neurological Disorders (Neuro-QoL) and clinician-assessed functional impairment using Barthel Index (BI). <h3>Results:</h3> 41 PwNS were enrolled, 62% female, 29% African American, 71% Caucasian, 86% with biopsy-proven sarcoidosis. 7% had severe, 27% moderate, 7% slight, and 56% no functional dependence by BI. Compared to propensity-matched healthy controls, impairment (≥ 1 standard deviation worse than normative mean) was more common in PwNS on 9-Hole Peg Test (9-HPT) (81% vs. 14%, OR: 19.53, 95%CI [6.51, 67.56]) and 4-Meter Walk Test (4-MWT) (77% vs. 15%, OR: 18.89, 95% CI [6.41, 64.41]). There were moderate correlations between 9-HPT and Neuro-QoL fine motor scores (r = 0.39, 95% CI [0.03, 0.66]) and strong correlations between 4-MWT and 2-Minute Walk Test (2-MWT) and Neuro-QoL mobility scores (r = −0.69, 95% CI [−0.84, −0.44]; 0.66, 95% CI [0.44, 0.78], respectively). Scores on 9-HPT (<i>P</i>=0.008), 4-MWT (<i>P</i>=0.007), 2-MWT (<i>P</i>=0.032), and select measures of Standing Balance Test (SBT) (<i>P</i> &lt; 0.001) were significantly different between subjects who were functionally dependent versus independent by BI. <h3>Conclusions:</h3> We provide preliminary evidence for validity of 9-HPT as a measure of fine motor control and 4-MWT, 2-MWT, and SBT as measures of mobility in PwNS. <b>Disclosure:</b> Dr. Moss has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. An immediate family member of Dr. Moss has stock in Pfizer. The institution of Dr. Moss has received research support from Novartis. The institution of Dr. Moss has received research support from Genentech. Nicholas Thompson has nothing to disclose. Daniel Culver has nothing to disclose.

Parent Psychological Distress Is Associated with Symptom Burden and Health-Related Quality of Life in Children and Adolescents Undergoing Stem Cell Transplantation or Chimeric Antigen Receptor T Cell Therapy

Hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor T cell therapy (CAR-T) are potentially curative treatment options for children with life-threatening conditions but can result in a high symptom burden, poor health-related quality of life (HRQoL), and parent psychological distress. In this study we investigated the associations over time between parent psychological distress and symptom burden and HRQoL in children undergoing HSCT or CAR-T. This multisite study used a longitudinal, repeated-measures design. English- and Spanish-speaking parents and their children age 2 to 18 years with planned HSCT or CAR-T therapy were eligible. Parents completed self-report measures of psychological distress (Beck Anxiety and Depression Inventories and Perceived Stress Scale) at 4 time points: before cell infusion and days +30, +60, and +90 after cell infusion. The Memorial Symptom Assessment Scale and PedsQL Cancer Module were administered to children (parent proxy for younger children) at corresponding time points. A symptom cluster called parent distress was created from each parent outcome using exploratory factor analysis. Longitudinal parallel process modeling was used to study the relationship between parent distress and child symptoms and HRQoL over time. A total of 140 child-parent dyads (280 participants) were enrolled across 4 sites. The mean age of the children was 8.4 ± 5 years, 56.4% were male, and most had an underlying diagnosis of malignancy (72.9%). The parents had a mean age of 39 ± 8.1 years, and the majority were mothers (80.7%),. Parent distress was consistently higher than normative means generated from nonclinical samples of adults. A high frequency of suicidal ideation was reported by parents (38.5% at baseline, 37% at day +30, 27.4% at day +60, and 33.6% at day +90). A significant relationship between parent distress and child HRQoL and symptoms was observed at baseline and through day +90. Our findings suggest that parents experience clinically relevant psychological distress throughout their child's HSCT or CAR-T therapy, and that this parent distress is associated with child HRQoL and symptom scores. Increased psychoeducational support tailored to address parental psychological distress is needed and has the potential to positively impact the child's HRQoL and symptoms.