Premorbid History Research Articles

Permanent impairment of language in an adolescent case of autoimmune encephalitis

In pediatric and adolescent population, autoimmune encephalitis (AE) may present with a wide variety of symptoms including cognitive regression accompanied with loss of language skills. Despite its high prevalence in AE, linguistic functions have not been investigated in extensive detail. A 12-year-old girl with no significant premorbid history and normal school performance presented with fever, hypersomnia, nocturnal myoclonus and behavioral changes. Although neurological examination was normal, psychiatric evaluation revealed euphoria, mild irritability and visual hallucinations. Cranial MRI was normal, whereas cerebrospinal fluid (CSF) analysis showed elevated protein concentration and lymphocyte count, electroencephalogram (EEG) showed diffuse slow waves. A panel for anti-neuronal antibodies demonstrated glutamic acid decarboxylase (GAD) antibodies in the serum. Following immunotherapy, all neurological and behavioral symptoms vanished. However, the patient suffered from significant worsening of school performance. Psychiatric evaluation revealed severe depression. Assessment of intelligence done on the 10th and 18th month of follow-up yielded significantly low scores at mental retardation level. Linguistic assessment showed significant impairment in all domains but especially in semantics. Our case emphasizes the fact that AE may cause permanent cognitive dysfunction and language impairment even in patients with normal MRI/neurological examination findings and relatively mild treatment-responsive disease course.

Exposure to Head Impacts and Cognitive and Behavioral Outcomes in Youth Tackle Football Players Across 4 Seasons

Repetitive head impacts have been posited to contribute to neurocognitive and behavioral difficulties in contact sport athletes. To identify associations between cognitive and behavioral outcomes and head impacts measured in youth tackle football players over 4 seasons of play. This prospective cohort study was conducted from July 2016 through January 2020, spanning 4 football seasons. The setting was a youth tackle football program and outpatient medical clinic. Players were recruited from 4 football teams composed of fifth and sixth graders, and all interested players who volunteered to participate were enrolled. Data analysis was performed from March 2020 to June 2021. Impacts were measured using helmet-based sensors during practices and games throughout 4 consecutive seasons of play. Impacts were summed to yield cumulative head impact gravitational force equivalents per season. Ten cognitive and behavioral measures were completed before and after each football season. There were 70 male participants aged 9 to 12 years (mean [SD] age, 10.6 [0.64] years), with 18 completing all 4 years of the study. At the post-season 1 time point, higher cumulative impacts were associated with lower self-reported symptom burden (β = -0.6; 95% CI, -1.0 to -0.2; P = .004). After correcting for multiple comparisons, no other associations were found between impacts and outcome measures. At multiple times throughout the study, premorbid attention-deficit/hyperactivity disorder, anxiety, and depression were associated with worse cognitive or behavioral scores, whereas a premorbid headache disorder or history of concussion was less often associated with outcomes. In this cohort of youth tackle football players, premorbid conditions, including attention-deficit/hyperactivity disorder, anxiety, and depression, were associated with cognitive and behavioral outcomes more often than cumulative impact.

Premorbid Primary Headache and Vestibular and Oculomotor Baseline Assessments in Collegiate Athletes.

The purpose of this study was to determine the effects of premorbid headache status on vestibular and oculomotor baseline tests in collegiate club athletes. Retrospective case-control study. Sport Concussion Laboratory. Collegiate club athletes with a self-reported premorbid headache history (n = 32, 19.50 ± 1.98 years, and 31% women) and age-sex-sport-matched controls (n = 32, 19.56 ± 1.47 years, and 31% women) without a self-reported headache history were included. Participants were grouped based on a self-reported headache history at baseline. Controls were randomly matched to self-reported headache participants by age, sex, and sport. Vestibular/ocular motor screen (VOMS) baseline symptoms, symptom provocation, near point of convergence (NPC) distance, and King-Devick (K-D) test time were compared between groups. Athletes with a self-reported headache history at baseline are 3.82 times more likely to have abnormal NPC scores (P = 0.032) and 4.76 times more likely to have abnormal K-D test times (P = 0.014) than those without a headache history. There was no difference in VOMS baseline symptoms or symptom provocation between groups (P > 0.05). Club collegiate athletes with a headache history were more likely to screen as abnormal during a vestibular/ocular motor function assessment than athletes without a history of headaches. Healthcare professionals should screen for pre-existing headache during baseline concussion assessments before test interpretation. A premorbid headache history at preseason baseline assessment may influence vestibular and oculomotor function, and care should be taken when interpreting these individuals' tests.

A double-blind randomised controlled trial on the effect of Tocovid, a tocotrienol-rich capsule on postoperative atrial fibrillation at the National Heart Institute, Kuala Lumpur: an interim blinded analysis

IntroductionPost-operative atrial fibrillation (POAF) is associated with poorer outcomes, increased resource utilisation, morbidity and mortality. Its pathogenesis is initiated by systemic inflammation and oxidative stress. It is hypothesised that a potent antioxidant and anti-inflammatory agent such as tocotrienol, an isomer of Vitamin E, could reduce or prevent POAF.AimsThe aim of this study is to determine whether a potent antioxidative and anti-inflammatory agent, Tocovid, a tocotrienol-rich capsule, could reduce the incidence of POAF and affect the mortality and morbidity as well as the duration of ICU, HDU and hospital stay.MethodsThis study was planned as a prospective, randomised, controlled trial with parallel groups. The control group received placebo containing palm superolein while the treatment group received Tocovid capsules. We investigated the incidence of POAF, the length of hospital stay after surgery and the health-related quality of life.ResultsRecruitment commenced in January 2019 but the preliminary results were unblinded as the study is still ongoing. Two-hundred and two patients have been recruited out of a target sample size of 250 as of January 2021. About 75% have completed the study and 6.4% were either lost during follow-up or withdrew; 4% of participants died. The mean age group was 61.44 ± 7.30 years with no statistical difference between the groups, with males having a preponderance for AF. The incidence of POAF was 24.36% and the mean time for developing POAF was 55.38 ± 29.9 h post-CABG. Obesity was not a predictive factor. No statistically significant difference was observed when comparing left atrial size, NYHA class, ejection fraction and the premorbid history. The mean cross-clamp time was 71 ± 34 min and the mean bypass time was 95 ± 46 min, with no difference between groups. There was a threefold increase in death among patients with POAF (p = 0.008) and an increase in the duration of ICU stay (p = 0.01), the total duration of hospital stay (p = 0.04) and reintubation (p = 0.045).ConclusionA relatively low incidence rate of POAF was noted although the study is still ongoing. It remains to be seen if our prophylactic intervention using Tocovid would effectively reduce the incidence of POAF.Clinical Registration Number: US National Library of Medicine. Clinical Trials - NCT03807037. Registered on 16th January 2019. Link: https://clinicaltrials.gov/ct2/show/NCT03807037

Stress-protective effects of micronized progesterone in treatment of anxiety disorders in pregnant women after in vitro fertilisation

Aim. To study a stress-protective efficacy of micronized progesterone (MP) in pregnant women with anxiety disorders after in vitro fertilisation (IVF).
 Materials and methods. We conducted a prospective, comparative open-label randomized trial in two IVF-clinics. A total of 98 pregnant women after IVF with anxiety disorders were recruited at the 9th week of pregnancy. Progesterone supplementation after IVF for luteal phase support was administered out until 9 weeks gestation. Then, after randomization, group 1 (n=35) received 400 mg per day of MP vaginally, group 2 (n=33) received 400 mg of MP orally, group 3 (n=30) was comparative for the other groups. The duration of progesterone treatment was 12 weeks. The Spielberger State Trait Anxiety Inventory (STAI), the Montgomerysberg depression rating scale (MADRS), Hospital Anxiety and Depression Scale (HADS), and the Epworth Sleepiness Questionnaires (ESQ) were used to compare maternal mood at 9 weeks (day of randomization) after delivery and at 283, 565, 847 days after randomization.
 Results. The mean STAI sumscore in MP-groups was significantly lower than in group 3 starting from day 565 and continued until the end of the study. There were no significant differences between vaginal and oral administration of progesterone. There were no significant differences between the mean sumscores when questioning on the HADS, MADRS and ESQ.
 Conclusion. Prolonged use of MP in pregnant women with anxiety disorders led to the prevention of manifestations of an increase in anxiety and depression. The stress-protective and neuromodulating properties of MP can determine additional indications for its prolonged administration in women with anxiety disorders and/or premorbid history.

A-60 Case of Moyamoya Syndrome in Haitian Female without Known Risk Factors

Abstract Objective Moyamoya is a rare, progressive cerebrovascular disorder characterized by carotid artery stenosis or occlusion. Tiny “moyamoya” blood vessels open at the brain base to compensate, often resulting in large vessel ischemic strokes or from hemorrhage of moyamoya vessels. Peak incidence in adults is 30 to 50 years old and 30% progress bilaterally. 54 year-old right-handed Black Haitian female with 13 years of education presented with new stroke, now diagnosed with bilateral moyamoya syndrome. Premorbid history includes hypertension, Type II Diabetes Mellitus, patent foramen ovale, and malignant phyllodes breast tumor treated by resection and local radiation. Presents with no traditional risk factors for moyamoya (e.g., brain radiation, sickle cell disease, neurofibromatosis). Method Five years previously patient experienced multi-focal embolic MCA strokes from left internal carotid occlusion attributed to hypercoagulability of malignancy, returning to previous activities except driving. Present perfusion CT showed complete occlusion of bilateral cavernous carotid arteries. Diagnostic angiogram showed collateral system via PCA-MCA pial-pial collaterals in parieto-occipital-temporal regions, and leptomeningeal collaterals to ACA territory. She underwent bilateral STA-MCA direct bypass. Results Acute neuropsychological testing conducted in Haitian Creole by native-speaking trainee showed expressive aphasia, orientation to person and situation, ability to follow 1-step commands, moderately impaired naming of familiar objects, reduced sustained attention. Also left hemiparesis, right gaze preference, and left homonymous hemianopsia. Conclusions The present case study delineates development of secondary moyamoya in a Black Haitian woman without known risk factors, resulting in significant cognitive-linguistic deficits consistent with brain findings. Limitations include lack of validated measures in Haitian Creole.

Parkinson Disease-Related Brain Metabolic Patterns and Neurodegeneration in Isolated REM Sleep Behavior Disorder.

To elucidate the role of Parkinson disease (PD)-related brain metabolic patterns as a biomarker in isolated REM sleep behavior disorder (iRBD) for future disease conversion. This is a prospective cohort study consisting of 30 patients with iRBD, 25 patients with de novo PD with a premorbid history of RBD, 21 patients with longstanding PD on stable treatment, and 24 healthy controls. The iRBD group was longitudinally followed up. All participants underwent 18F-fluorodeoxyglucose (FDG) PET and were evaluated with olfaction, cognition, and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) at baseline. From FDG-PET scans, we derived metabolic patterns from the longstanding PD group (PD-RP) and de novo PD group with RBD (dnPDRBD-RP). Subsequently, we calculated the PD-RP and dnPDRBD-RP scores in patients with iRBD. We validated the metabolic patterns in each PD group and separate iRBD cohort (n = 14). The 2 patterns significantly correlated with each other and were spatially overlapping yet distinct. The MDS-UPDRS motor scores significantly correlated with PD-RP (p = 0.013) but not with dnPDRBD-RP (p = 0.076). In contrast, dnPDRBD-RP correlated with olfaction in butanol threshold test (p = 0.018) in patients with iRBD, but PD-RP did not (p = 0.21). High dnPDRBD-RP in patients with iRBD predicted future phenoconversion with all cutoff ranges from 1.5 to 3 SD of the control value, whereas predictability of PD-RP was only significant in a partial range of cutoff. The dnPDRBD-RP is an efficient neuroimaging biomarker that reflects prodromal features of PD and predicts phenoconversion in iRBD that can be applied individually. This study provides Class IV evidence that a de novo PD pattern on FDG-PET predicts future conversion to neurodegenerative disease in patients with iRBD.

Is severe head injury associated with functional (psychogenic) seizures?

ObjectivesThe aim of the current study was to compare the frequency of significant head injuries in three groups of people with seizures [idiopathic generalized epilepsies (IGE) vs. temporal lobe epilepsy (TLE) vs. functional seizures (FS)]. MethodsThis was a retrospective study. All patients with a diagnosis of IGE, TLE, or FS were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. ResultsOne thousand and four hundred ninety-two patients were studied (559 patients with IGE, 646 people with TLE, and 287 persons with FS). Overall, 77 (5.2%) individuals of the studied people reported experiencing severe head injuries before the onset of their seizures [9 patients (1.6%) with IGE, 56 people (8.7%) with TLE, and 12 persons (4.2%) with FS; p = 0.0001]. Compared to people with IGE, the odds ratio of having a premorbid history of severe head injury in the FS group was 2.67 [95% Confidence Interval (CI): 1.11–6.40; p = 0.0280]. Compared to people with TLE, the odds ratio of having a premorbid history of severe head injury in the FS group was 0.46 (95% CI: 0.24–0.87; p = 0.0170). ConclusionSevere head injury is significantly associated with FS. However, since head injury is also a significant risk factor for focal epilepsies, it may be necessary to ascertain the diagnosis of post-traumatic seizures by obtaing a detailed clinical history and also by performing video-EEG monitoring in order to adopt an appropriate treatment strategy in these patients.

Using the Newcastle Model to Understand and Manage Behaviors That Challenge in Dementia: A Case Study

Behaviors that challenge (BC) are common in dementia and can have a significant impact on the wellbeing of the person with dementia, their family and staff in care homes. The Newcastle model is a biopsychosocial, person-centerd, approach that aims to support care staff and family members in order to manage BC within care homes by identifying and fulfilling unmet needs of the person with dementia. After outlining its theoretical basis and practical utility, we describe a case study where the Newcastle model has been implemented to manage sexualised behaviors and verbal aggression. The patient described is a lady with dementia residing in a care home where the staff felt unable to manage increasing incidence of these BC. Information from multiple sources was collated to conceptualise the behaviors and understand them in terms of unmet needs, which was followed by a process to develop corresponding practical strategies together with care staff and family. Following successful implementation of the Newcastle model, the care staff reported a reduction in BC on standardised instruments (Cohen-Mansfield Agitation Inventory, and the Neuropsychiatric Inventory). The staff group also described increasing confidence in managing sexualised vocalisations as they had a better understanding with regards to premorbid history and personality, and an increased awareness of the impact of dementia on behavior. Complicating factors relating to staff stress and physical health conditions in older adults are discussed, and adaptations to the model are suggested in order to maintain treatment gains in the long-term.

A case of new coronavirus infection course in a child with severe secondary immunodeficiency associated with hematopoietic stem cell transplantation

Numerous articles have been published on COVID-19 cases in the child population now. Children become infected and get sick with a new infection much less often and more easily than adults. The supposed relative resistance of children to SARS-CoV-2 can be explained by a number of reasons, one of which is the immaturity of the ACE2 receptor, or by the fact that children have certain features of innate immunity that disappear in ontogenesis. On the contrary, the maturity of the immune system may explain the unfavorable type of triggered immune response associated with the development of acute respiratory distress syndrome in adult patients.
 The article describes a case of a new coronavirus infection in a 5-year-old child with a severe secondary immunodeficiency condition associated with hematopoietic stem cell transplantation. By describing this clinical case, we wanted to draw attention to a mild course of COVID-19 infection in a child with a burdened premorbid history in the form of severe secondary immunodeficiency associated with hematopoietic stem cell transplantation in the treatment of acute promyelocytic leukemia.

Exploring the clinical relevance of a dichotomy between affective and non-affective psychosis: Results from a first-episode psychosis cohort study.

Defining diagnosis is complex in early psychosis, which may delay the introduction of an appropriate treatment. The dichotomy of affective and non-affective psychosis is used in clinical setting but remains questioned on a scientific basis. In this study, we explore the clinical relevance of this dichotomy on the basis of clinical variables in a sample of first-episode psychosis patients. We conducted a prospective study in a sample of 330 first-episode psychosis treated at an early intervention program. Affective and non-affective psychosis patients were compared on premorbid history, baseline data, outcomes and course of symptoms over the 3 years of treatment. Affective psychosis patients (22.42%) were more likely to be female, and had a shorter duration of untreated psychosis. The longitudinal analyses revealed that positive symptoms remained higher over the entire follow-up in the non-affective sub-group. A higher degree of variability of manic symptoms and a significantly better insight after 6months were observed in the affective sub-group. No difference was observed regarding depressive and negative symptoms. At discharge, only the environmental quality of life and insight recovery were better in affective psychosis. Our study suggests that despite marginal differences at baseline presentation, these sub-groups differ regarding outcome, which may require differentiation of treatment and supports the utility of this dichotomy.

Delirium, Depression and Long-Term cognitive Impairment

<h3>Introduction</h3> Over the last decade, we are seeing increased survival rates from critical care stays. However, critical care survivors are at increased risk for long-term physical, psychological, and cognitive impairments. While there is substantial work examining how premorbid medical and demographic factors influence adverse long-term outcomes, less is known about how pre-existing psychiatric illnesses such as depression may influence ICU course and post-ICU outcomes. Delirium is a key negative prognostic indicator of poor post-ICU course. and a risk factor for cognitive impairment. Along with changes in cognitive performance, the most frequent psychological sequela found in intensive care unit (ICU) survivors is depression. Depression affects approximately one third of adults in the ICU and increases the risk of mortality in the 2 years after discharge. It is unclear how depression and cognitive performance deficits may interact. In adult and geriatric populations depression is itself a risk factor for cognitive impairment. Cognitive deficits in attention, memory and executive function are seen in depressed patients and ICU survivors who suffered delirium. The purpose of the study is to examine whether premorbid history of depression influences acute and long-term critical care outcomes. We hypothesized that a premorbid history of depression would be associated with a more complicated ICU course, quantified as days of delirium. We also hypothesized that a premorbid depression would be associated with greater levels of cognitive impairment and greater depression severity in the year following ICU stay. <h3>Methods</h3> Patients admitted to the medical/surgical ICU services were eligible for enrollment in the Brain ICU longitudinal cohort study. We determined a pre-admission history of depression from the health proxy. Patients were assessed for delirium using the Confusion Assessment Method for the ICU (CAM-ICU) and level of consciousness using the Richmond Agitation-Sedation Scale (RASS). Patients were assessed after hospital discharge at 3 and 12 months (+/- 1 month) for depression using the Beck Depression Inventory-II (BDI-II). In all long-term models, we included patients who had any assessment data available at a given time point to have the same number of patients in cognitive outcomes and depressive symptom severity models at a given time point. Missing outcome and covariate data was handled using five imputations (with three burn-in imputations) and predictive mean matching. All continuous covariates were allowed to have a nonlinear relationship with DCFDs using restricted cubic splines with three knots, except for IQCODE which has too little variability to allow splines. Primary models examined the effect of pre-admission history of depression on: a) ICU course, measured as delirium/coma free days; b) post-discharge cognitive performance, measured by the RBANS total score; and c) post-discharge depression symptom severity, measured by the BDI. To examine the effect of depression history on delirium/coma free days we used a proportional odds logistic regression model adjusting for age, gender, Charlson Score, Framingham Stroke Risk Profile, IQCODE, years of education, AHRQ socioeconomic status index, CSHA frailty and APACHE APS at enrollment. To examine the association of a reported pre-admission history of depression with long-term cognition and depression, we used multivariable regression with history of depression as our primary exposure of interest and either RBANS global cognition scores or Beck Depression Inventory II (BDI-II) depression scores as outcomes. We created separate models to examine these outcome measures at 3 and 12 months after hospital discharge. <h3>Results</h3> A total of 821 were included in the analysis. The median age at enrollment was 61 years and 261 (33%) had a history of depression prior to their critical illness. After adjusting for demographic and other relevant covariates, a pre-admission history of depression, was not associated with days of delirium or coma in the ICU (OR 0.78, 95% CI, 0.59 - 1.03 p=0.077). We did not observe an effect of pre-admission history of depression on RBANS scores at either 3 months or 12 months compared to those with no prior history of depression (3 months -0.04, 95% CI, -2.70 - 2.62 p=0.97; 12 months 1.5, 95% CI, -1.26 – 4.26 p=0.28). Patients with a prior history of depression were more likely to have higher BDI scores at 3 months and 12 months (3 months OR 2.15, 95% CI, 1.42 – 3.24 p=0.001; 12 months OR 1.89, 95% CI, 1.24- 2.87 p=0.003). <h3>Conclusions</h3> Patients with a history of depression prior to ICU stay exhibit a greater severity of depressive symptoms in the following year.

Clinical utility of the GAD-7 in identifying anxiety disorders after traumatic brain injury

ABSTRACT To determine if the GAD-7 provides incremental value, predicting a final diagnosis of an anxiety disorder after traumatic brain injury (TBI). Retrospective analysis of archival data of 100 patients with TBI, who underwent neuropsychological evaluation 1–12 months after injury. Receiver Operating Characteristic analysis determined the optimal cutoff point for clinically significant symptoms on the GAD−7. Hierarchical logistic regression analyses determined the relative contributions of premorbid psychiatric history, injury severity, and GAD−7 results in predicting a final diagnosis of anxiety disorder. GAD−7 cutoff point of ≥7 yielded the best combination of sensitivity and specificity regarding a final diagnosis of anxiety disorder. Within hierarchical logistic regression models, injury severity did not statistically significantly add to prior psychiatric history in predicting a final diagnosis of anxiety disorder. When GAD-7 was added, it made a statistically significant contribution in accounting for such a diagnosis and increased sensitivity from 71% to 91%. The GAD−7 holds diagnostic utility as a screening measure for anxiety disorders in patients with TBI. It should not be used in isolation but as part of a more comprehensive interview and history. The GAD−7 can benefit clinicians in assisting with timelier identification and treatment of symptoms of anxiety.

Subtyping based on premorbid profile: A strategy to personalize treatment in first‐episode affective psychosis

Premorbid history may have a major influence on the way patients cope with the onset of psychosis. This issue has been widely studied in the context of early intervention in schizophrenia but considerably less is known regarding affective psychosis. Our first goal was to investigate if subgroups could be identified among affective psychosis patients based on premorbid factors. Our second goal was to compare these subtypes according to the evolution of mood symptoms and outcomes at the end of the program. We conducted a 3-year prospective study on a sample of 74 adults aged 18-35 with a first episode of affective psychosis. Latent class analysis (LCA) was used to reveal distinct exploratory subgroups within affective psychosis patients. Three distinct subgroups could be distinguished. One with later onset of psychosis mainly including women with more severe depressive symptoms in the first 6 months contrasting with two other subgroups with more severe manic symptoms all along the follow-up and earlier onset of psychosis, with or without many serious antecedents. The subgroup with many serious antecedents was more likely to require several hospitalizations, less likely to achieve recovery, especially regarding professional integration and return to premorbid general functioning. This study provides further evidence of poor functional recovery in the early phase of affective psychosis and shows that premorbid characteristics allow the identification of subgroups with distinct outcome which may require specification of treatment.

Cigarette Smoking, Alcohol Consumption, and the Risk of Prostate Cancer-A Retrospective Analysis of Prostate Cancer Patients in Southern Nigeria.

Tobacco contains harmful carcinogens that have been associated with cancers. Some studies have associated tobacco smoking with prostate cancer (PCa). The relationship between alcohol consumption as a risk factor for prostate cancer has been debated. Some studies associated alcohol consumption with increased risk of PCa, associating alcohol consumption with higher-grade cancers and poorer prognosis. Other studies have found a minimal relationship with PCa, with some even suggesting that alcohol consumption may even be protective. This study evaluates the association between smoking and alcohol consumption in prostate cancer patients. This is a retrospective study on one hundred and fifty-two patients diagnosed with prostate cancer with a known history of both smoking and or alcohol consumption managed over a 9year period from January 2012 to December 2020 from three Urology referrals hospitals. Patients with incomplete history were excluded. Their data such as age, a history of cigarette smoking, prostate-specific antigen level, prostate biopsy histopathology reports, and Gleason's grade were extracted. This was coded into Microsoft Excel and analyzed with SPSS version 20. The results were analyzed and presented in tables and charts. One hundred and thirty-five patients had a premorbid history of smoking and alcohol consumption with a mean age of 69 years and a modal age in the 70-79-year age group. Fifty-three (39.3%) of the patients had a history of cigarette smoking, ninety-four (69.6%) had a history of alcohol consumption. In comparison, fifty-one (37.8%) had a history of cigarette smoking and alcohol consumption. The high-risk Gleason's 8-10 prostate cancer was commoner among smokers than nonsmokers. There was no statistically significant association between cigarette smoking and alcohol consumption alone and combined with PCa. The high-risk Gleason's 8-10 prostate cancer was commoner among smokers than nonsmokers. There was no statistically significant association between cigarette smoking and alcohol consumption and the risk of prostate cancer.

Neurocognitive deficits in severe COVID-19 infection: Case series and proposed model

Objective: To date, very few studies investigating neurocognitive deficits in COVID-19 have been published. This case series addresses cognition in post-COVID-19 patient by describing three patients in acute rehabilitation to inform a model of cognitive sequelae of COVID-19. Methods: Three English-speaking inpatients with severe symptoms and long-term intensive care unit (ICU) treatment are described. All patients had a premorbid history of hypertension and hyperlipidemia and experienced delirium and hypoxemia when hospitalized. Patient 1 is a 62-year-old male with 15 years of education with additional history of obstructive sleep apnea and type 2 diabetes. Patient 2 is a 73-year-old female with 12 years of education with a premorbid medical history of alcohol use disorder and Guillain-Barre syndrome. Patient 3 is a 75-year-old male with 14 years of education. No patients had premorbid psychiatric histories. Results: The three patients demonstrated deficits on formal neuropsychological testing, particularly with encoding and verbal fluency. Memory measures improved with a more structured story memory task compared to a less-structured verbal list-learning task, suggesting executive dysfunction impacted learning. None of the patients demonstrated rapid forgetting of information. Two patients endorsed new depressive and/or anxiety symptoms. Conclusions: The results suggest evidence for neurocognitive deficits after severe COVID-19 infection, particularly in encoding and verbal fluency. These results were interpreted with caution given the limited number of patients and the telephone-based battery. The specific mechanism that caused these cognitive deficits in these individuals remains unclear. A proposed three-stage model of cognitive dysfunction is described to help guide future research.

A-147 Post-Concussive Symptoms in Adolescent Athletes with Premorbid Psychiatric History: A Matched Case–Control Study

Abstract Objective To examine sport-related concussion (SRC) symptoms in adolescent athletes with premorbid psychiatric history (PPH+) compared to a matched control sample without such history (PPH-). It was hypothesized that adolescents with PPH+ would report higher symptom severity both initially and at 3-month follow-up. Method Participants aged 13–18 (M age = 14.9) who reported a psychiatric history (N = 29) presented to clinic within 7 days of sustaining a SRC. Subjects were matched to those without premorbid psychiatric history (N = 29) by age, sex, race, sport, and time to clinic ( 1 day). All participants (N = 58) completed the Post-Concussion Symptom Scale (PCSS) at initial visit and 3-month follow-up as part of the North Texas Concussion Registry (ConTex). Independent sample T tests compared PCSS total and cognitive/fatigue, vestibular, ocular, posttraumatic migraine, and anxiety/mood domain scores between groups across time points. Results Consistent with our hypothesis, the PPH+ group reported significantly higher PCSS total (M = 41.0/132 vs. M = 27.7/132; p = .02), posttraumatic migraine domain (M = 3.5/6 vs. M = 2.5/6; p = .03), and anxiety domain (M = 1.1/6 vs. M = 0.4/6; p = .002) severity at the initial evaluation. However, there were no significant differences in PCSS total (PPH+ M = 4.1/132 vs. PPH- M = 3.3/132) or domain scores at 3-month follow-up. Conclusion(s) After matching by age, sex, race, sport, and time to clinic, adolescents with self-endorsed PPH+ reported higher total symptom, posttraumatic migraine, and anxiety domain symptom severity immediately following SRC but not at 3-month follow-up. Findings suggest that adolescents with PPH+ may experience higher subjective levels of distress following SRC, although further research is needed to understand the role of recovery in this population.

A-113 A Case Study: Utilization of C3 Logix in Serial Evaluation of Concussion in a Multidisciplinary Medical Setting

Abstract Objective C3 Logix is a concussion assessment and management system addressing patient care, return to play standards, and rehabilitation or understanding of concussion. This case study demonstrates the utility of the C3 Logix screening measure with a concussion patient in a multidisciplinary medical setting. Repeat C3 Logix screening data was compared to reported symptoms on the Post-Concussion Symptom Scale (PCSS) and interpreted by a physician in medical setting. This case highlights the comparison of C3 Logix findings and a neuropsychological profile in a young adult with history of traumatic closed head injury. Method 25-year old, right-handed, Caucasian man with no significant medical history prior to sustaining a parenchymal hemorrhage along the left anterior inferior frontal lobe and left temporal lobe, as well as a left anterior frontal subdural hematoma in 2019. The patient reported a premorbid history of generalized anxiety with panic, and elevated emotionality post-injury. Results Estimated premorbid verbal functioning was average, consistent with his score as predicted by demographic variables. The patient exhibited decreased concussion symptom severity and improved cognitive performance across repeat C3 Logix administrations. On comprehensive neuropsychological evaluation, he demonstrated intact performance across cognitive domains, with relative weakness consistent with localization of injury, sustained eye injury, and expected recovery duration. Conclusions Repeat cognitive screenings were generally consistent with comprehensive neuropsychological evaluation results. This case study highlights that the C3 Logix tool should be further considered as a brief cognitive screening measure to inform treatment of traumatic head injuries within a multidisciplinary medical setting.

Precision diagnosis and therapy of a case of brain abscesses associated with asymptomatic pulmonary arteriovenous fistulas

BackgroundBrain abscesses, a severe infectious disease of the CNS, are usually caused by a variety of different pathogens, which include Streptococcus intermedius (S. intermedius). Pulmonary arteriovenous fistulas (PAVFs), characterized by abnormal direct communication between pulmonary artery and vein, are a rare underlying cause of brain abscesses.Case presentationThe patient was a previous healthy 55-year-old man who presented with 5 days of headache and fever. Cerebral magnetic resonance imaging (MRI) suggested a brain abscess. Thoracic CT scan and angiography demonstrated PAVFs. Aiding by metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid (CSF) sample which identified S. intermedius as the causative pathogen, the patient was switched to the single therapy of large dose of penicillin G and was cured precisely and economically.ConclusionsIt is an alternative way to perform mNGS to identify causative pathogens in patients with brain abscesses especially when the results of traditional bacterial culture were negative. Further thoracic CT or pulmonary angiography should also be undertaken to rule out PAVFs as the potential cause of brain abscess if the patient without any known premorbid history.

Symptom profiles and postural control after concussion in female artistic athletes

ABSTRACT Objectives The purpose of our investigation was to compare post-concussion symptom profiles and postural control measures among female youth artistic athletes (gymnasts and cheerleaders) relative to female ball sport athletes (volleyball or basketball). Methods/Findings We compared 27 artistic athletes (median age = 15.0 years; evaluated median = 13 days post-injury) and 49 ball sport athletes (median age = 15.3 years; evaluated median = 10 days post-injury) within 21 days of sustaining a concussion on measures of symptom profiles and postural control (Balance Error Scoring System [BESS]), tandem gait, and Romberg tests. After adjusting for the independent effect of time from injury-evaluation, concussion history, and pre-morbid migraine history, we observed that artistic athletes performed the BESS tandem stance foam condition with fewer errors than ball sport athletes (β = −2.4; 95% CI = −4.7, −0.2; p = .03). Artistic athletes demonstrated a higher, yet not statistically significant, headache severity than ball sport athletes (median = 4.5 vs 4.0, p = .07). Conclusions Overall, artistic athletes had similar symptom profiles to ball sport athletes. Postural control measures, other than the BESS tandem stance foam condition, were not significantly different from ball sport athletes. This suggests that although their sports may require higher levels of balance, artistic athletes’ performance on post-concussion balance tests may be similar to athletes of other disciplines.