TMT-B Scores Research Articles

Chronic subdural hematoma in patients over 65 years old: Results of using a postoperative cognitive evaluation to determine whether to permit return to driving.

Background: Chronic subdural hematoma (CSDH) is usually associated with good recovery with burr hole irrigation and postoperative drainage under local anesthesia. In Japan, traffic accidents by the elderly drivers over 65 years old are severely increasing, and there is no consensus on whether or not to return to driving after CSDH treatment. We perform a postoperative cognitive assessment. We retrospectively investigated the return-to-driving rate and associated factors.Methods: Of the 45 patients over 65 y.o. and who had usually driven, 30 patients wished to drive again. We performed tests composed of Mini-Mental State Examination (MMSE), line cancellation and line bisection task, Kohs block design test, trail making test (TMT)-A and B, Kana-hiroi test, Rey-Osterrieth complex figure test, and behavioral assessment of the dysexecutive syndrome, in order. When all tests’ scores were better than the cutoff values, we let patients drive again. When some of the scores were worse than the cutoff values, we reevaluated the patients at the outpatient every month. If the patients’ scores could not improve at the outpatient, we recommended them to stop driving.Results: Nineteen of 30 patients could return to driving. Worse MMSE, Kohs block design test, TMT-A, TMT-B scores, higher age, dementia, or consciousness disturbance as chief complaints were associated with driving disability.Conclusion: CSDH is known as treatable dementia. However, we should perform an objective cognitive assessment before discharge because only 63% of the patients over 65 y.o. who wished to drive could return to driving.

Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes.

The purpose of this study was to describe objective sleep-wake characteristics and glycemia over 7-14 days in young adults with type 1 diabetes. In addition, person-level associations among objective sleep-wake characteristics (total sleep time, sleep variability, and sleep fragmentation index), daytime sleepiness, and glycemia (glycemic control and glucose variability) were examined. In this cross-sectional study, objective sleep-wake characteristics were measured via actigraphy and glucose variability via continuous glucose monitoring over 6-14 days. At baseline, participants completed the Psychomotor Vigilance Test, the Trail Making Test, and questionnaires on daytime sleepiness, sleep quality, and sleep disturbance including sleep diaries. Forty-six participants (mean age, 22.3 ± 3.2 years) wore a wrist actigraph and underwent continuous glucose monitoring concurrently for 6-14 days. Greater sleep variability was directly associated with greater glucose variability (mean of daily differences; r = .33, P = .036). Higher daytime sleepiness was directly associated with greater glucose variability (mean of daily differences; r = .50, P = .001). The association between sleep variability and glucose variability (mean of daily differences) was no longer significant when accounting for daytime sleepiness and controlling for type 1 diabetes duration (P > .05). A higher sleep fragmentation index was associated with greater glucose variability (B = 1.27, P = .010, pr2 = 0.40) after controlling for type 1 diabetes duration and accounting for higher daytime sleepiness. Sleep-wake variability, sleep fragmentation, daytime sleepiness, and the associations with glycemia are new dimensions to consider in young adults with type 1 diabetes. Sleep habits in this population may explain higher glucose variability, and optimizing sleep may improve overall diabetes management. Griggs S, Hickman RL Jr, Strohl KP, Redeker NS, Crawford SL, Grey M. Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes. J Clin Sleep Med. 2021;17(9):1865-1874.

The relationship between attention and static balance disturbance in patients with Parkinson’s disease

Balance disturbance is one of the main complications of the Parkinson's disease (PD). As studies have shown that impairments in some cognitive processescan lead to balance problems, we investigated the relationship between focused and divided attention and static balance in patients with PD and a healthycontrol group. We included 111 patients with PD (M age = 49.41, SD = 6.33 years) and 142 healthy individuals (M age = 50.62, SD = 6.07 years). All participants wereevaluated with the Trails Making Test A and B (TMT), and all participants' balance was evaluated with a Wii Balance Board, from which we measured theantero-posterior (AP), medio-lateral (ML), and total center of pressure (COP) velocity. We compared the two groups in terms of TMT-A, TMT-B, and COPvelocity tests in both eyes-open and eyes-closed conditions with independent t-tests, and we calculated Pearson's correlation coefficients between thebalance board-derived outcomes and the TMT scores. The two groups differed significantly on TMT-A and TMT-B scores, in total and ML COP velocity in both eyes-closed and eyes-open conditions, and in APCOP velocity only in eyes-open condition. Among patients with PD, TMT-A and TMT-B scores were positively correlated with total, ML, and AP COPvelocity, in both eyes-open and eyes-closed conditions. Associated attention deficits may be among the causes of balance disturbances in patients with PD, though both attention and balance may have a commonroot in brain circuitry.

ASSOCIATIONS BETWEEN THE UPPER EXTREMITY FUNCTION AND COGNITION IN POST-STROKE PATIENTS

The aim: Was to determine the relations between the the upper extremity function and cognition in post-stroke patients. Materials and methods: Totally there were 86 patients examined in the 1-year period after first-ever anterior circulation ischemic stroke. Examination of the upper extremity function was performed with the Fugl-Meyer assessment (FMA). Cognitive function was assessed with the Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Trail-making Test A and B (TMT) and the Clock Drawing Test (CDT). Results: Motor dysfunction mostly manifested in low “Wrist” and “Hand” subtests scores (5 and 7 , respectively) and therefore resulted in decreased “Total motor function” score of 40 . The most significant relations were found out between the FMA “Hand”, “Total motor function” subtests and CI indices. MoCA score correlated with FMA “Wrist” (r=0.34; p=0.021), “Hand” (r=0.52; p=0.001) and “Total motor function” (r=0.48; p=0.003) scores. “Hand” score also correlated with the FAB (r=0.43; p=0.012), CDT (r=0.22; p=0.016), TMT-A (r=-0.31; p=0.023) and TMT-B (-0.48; p=0.009) scores. There was no significant correlation between the sensory FMA subtests. Conclusion: Our findings suggest that upper extremity motor impairment, especially hand and wrist dysfunction, are associated with cognitive impairment and executive functions disorder in particular.

Efecto del entrenamiento en ábaco mental sobre la flexibilidad cognitiva: un estudio exploratorio

Mental Abacus (MA) training teaches students to solve math problems by visualizing a physical abacus structure to perform arithmetic operations. Research shows that MA practice relates with enhanced working memory in children, but other cognitive processes that could mediate the benefits registered remain unknown. The aim of the study was to analyze the effect of MA training in a cognitive flexibility task in twelve-year-old children, and compare it with a control group. 121 children from the sixth course of primary education were recruited. 54 students received MA training added during the academic year, while the control group received normative arithmetic instruction. MA training was provided by UCMAS Mental Arithmetic Spain S.L. To assess cognitive flexibility, we used the Trail Making Test (TMT). Data analysis entailed parametric assumptions check and a one-way ANOVA between MA and control group. There were no differences between groups in age. There were statistical differences in TMT-A (Z=-5,78, p<,001, d=,67) and TMT-B scores (Z=-2,24, p=,021, d=,08). Our data suggest that MA enhances cognitive flexibility in children. MA is a promising tool teaching math which benefits go beyond arithmetic calculation.

Schizophrenia with and without obsessive-compulsive symptoms: a comparative analysis of performance on trail making test and disability on WHODAS

BackgroundPresence of obsessive-compulsive symptoms (OCS) affects performance on tests of some cognitive functions, such as the trail making test (TMT), and may affect the level of disability in schizophrenia (SZ).AimsThe...

Effect of oral health intervention on cognitive decline in community-dwelling older adults: A randomized controlled trial

PurposeThe incidence of dementia is rapidly increasing worldwide, especially in developed countries. Little is known regarding the effectiveness of dental intervention to prevent dementia or a decline in cognitive functions among community-dwelling older adults, but a few studies have reported a correlation between the lack of regular dental checkups and dementia. For that reason, this study aimed to investigate the effects of oral health intervention on cognitive functions in community-dwelling subjects with a mild cognitive decline via a randomized controlled trial. Patients and methodsFifty-five community-dwelling older adults with a Mini-Mental State Examination score of ≥21 to ≤26 who had not visited a dental clinic in the previous year were randomized to an intervention group (n = 28) or a control group (n = 29). The intervention group received monthly oral health intervention by dental hygienists for 8 months while the control group did not. Data on demographics, cognitive function and oral parameters were collected before and after the intervention. ResultsTwenty-five subjects in the intervention group (mean age 77.0 years) and 25 in the control group (mean age 72.8 years) completed the study. Significant improvements were observed in the Trail Making Test (TMT)-A, TMT-B, bleeding on probing rate, oral diadochokinesis, tongue pressure and chewing ability in the intervention group (P < 0.05). There were also significant interactions between the TMT-A and TMT-B scores, oral diadochokinesis, tongue pressure and chewing ability (P < 0.05). ConclusionOral health intervention by dental hygienists may be effective for improving the oral health and executive function of cognitive function assessed via TMT.

Gender and gambling disorder: Differences in compulsivity-related neurocognitive domains

Background and aims: It has been suggested that compulsivity has an essential role in gambling disorder (GD), yet there is a lack of literature exploring the link between GD, compulsivity and gender. Our main aim was to explore gender differences between two of the neurocognitive domains of compulsivity (attentional set-shifting and attentional bias and disengagement) in patients with GD and compare them with healthy controls (HCs). Methods: The sample included 57 treatment-seeking adults with GD and 60 HCs recruited from the general population. Results: The pairwise comparisons showed a worse attentional set-shifting performance in women with GD than in men (total trials (p = 0.042, |d| = 0.56), perseverative responses (p = 0.001, |d| = 0.89), trails to complete the first category (p = 0.001, |d| = 0.78) and categories completed (p = 0.001, |d| = 0.98. Also, men with GD presented higher difficulties than HC men in the two assessed compulsivity domains (attentional bias and disengagement and attentional set-shifting; Stroop interference (p = 0.015, |d| = 0.11), TMT-B (p = 0.041, |d| = 1.96) and lower scores for the WCST perseverative responses (p = 0.007, |d| = 0.78), whereas the differences observed in women with GD and HCs were most significantly in attentional set-shifting. Conclusions: This study provides the first evidence of gender compulsivity differences in GD. The results are relevant for improving current treatments by targeting specific compulsivity domains that can lead to more successful treatment options.

Virtual Reality-Based Cognitive–Motor Rehabilitation in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Study on Motivation and Cognitive Function

The purpose of this study was to investigate the effects of virtual reality-based cognitive–motor rehabilitation (VRCMR) on the rehabilitation motivation and cognitive function in older adults. This study enrolled 40 older adults with mild cognitive impairment (MCI), living in the community. The subjects were randomly assigned to a VRCMR group (n = 20) or a conventional cognitive rehabilitation (CCR) group (n = 20). The VRCMR group underwent VRCMR using MOTOcog, a computer recognition program, whereas the CCR group underwent conventional cognitive rehabilitation, which included puzzles, wood blocks, card play, stick construction activity, and maze activity. Both interventions were performed 30 min per day, 5 days/week, for 6 weeks. This study performed a cognitive assessment using the Montreal Cognitive Assessment (MoCA) scale, Trail Making Test A and B (TMT-A/B), and Digit Span Test forward and backward (DST-forward/backward). In addition, a 0-to-10 numeric rating self-report scale was used to assess interest and motivation during the rehabilitation training. After the intervention, the VRCMR group showed a significantly greater improvement in the MoCA (p = 0.045), TMT-A (p = 0.039), TMT-B (p = 0.040), and DST-forward (p = 0.011) scores compared to the CCR group, but not in the DST-backward score (p = 0.424). In addition, subjects in the experimental group had significantly higher interest (p = 0.03) and motivation (p = 0.03) than those in the control group. Cohen’s d effect size was 0.4, 0.3, 0.35, 0.4, and 0.5 for the MoCA, TMT-A, TMT-B, DST-forward, and DST-backward tests, respectively. This study demonstrates that VRCMR enhances motivation for rehabilitation and cognitive function in older adults with MCI better than CCR.

Exploring the Predictive Ability of the Motor-Free Visual Perception Test (MVPT) and Trail Making Test (TMT) for On-Road Driving Performance.

Resuming driving after a change in functional ability is challenging for patients with a neurological condition. Although a combination of assessment tools has been suggested for use in driving evaluation, resources and availability of tools have been a problem. To examine the predictive ability of two commonly used tools, the Motor-Free Visual Perception Test (MVPT) and the Trail Making Test, Parts A and B (TMTA and TMTB), on on-road driving performance. Retrospective chart review of 82 patient charts between 2015 and 2016. Local rehabilitation hospital. Eighty-two patients with a primary neurological diagnosis (general neurological condition, n = 13; spinal cord injury, n = 11; stroke, n = 58). MVPT, TMTA, and TMTB. Among the patients, 36 passed and 46 failed the on-road evaluation. The TMTA and TMTB scores were significantly different between those who passed or failed the on-road evaluation. Logistic regression analyses revealed that the TMTB completion time was the only significant predictor of on-road driving performance (for the all-patient model, 66% prediction accuracy, -2 log-likelihood [LL] = 93.47, exp β = 0.98; for the stroke-only model, 76% prediction accuracy, -2LL = 59.61, exp β = 0.97). Our findings suggest that the TMTB is a better predictor of on-road driving performance for patients with a neurological condition than the MVPT. The findings shed light on the importance of selecting proper tools when assessing driving performance. Future prospective studies with a wider array of predictive variables are recommended to support the present findings. Occupational therapists should revisit the use of the MVPT in driving assessment and consider multiple assessment tools when evaluating and predicting driving performance.

The CC Genotype of Insulin-Induced Gene 2 rs7566605 Is a Protective Factor of Hypercholesteremia Susceptible to Mild Cognitive Impairment, Especially to the Executive Function of Patients with Type 2 Diabetes Mellitus.

Methods 233 T2DM patients with MCI or without MCI were recruited. Baseline data and genotype frequency were compared between MCI and non-MCI groups. Demographic parameters and neuropsychological tests results were analyzed among patients with different genotypes. Further correlation and regression analysis were conducted to find the association between cognition and cholesterol. Results Despite no significant statistical difference was detected, we observed higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL) in patients with MCI than those without MCI. In addition, we observed higher TC and LDL levels in patients with GG or GC genotypes than those with CC genotype (P < 0.001, P = 0.004, or P < 0.001, P = 0.002). Interestingly, increased MoCA and decreased TMTB scores were found in patients with CC genotype, compared to those with GG or CG genotype (P = 0.009, P = 0.024, or P = 0.005, P = 0.109). Moreover, partial correlation (P = 0.030 and P = 0.004, respectively) and multiple linear regression (P = 0.030 and P = 0.005, respectively) showed that TC and LDL levels are associated with the TMTB score, indicating the executive function. Conclusions CC genotype of INSIG-2 rs7566605 may be a protective factor of hypercholesteremia susceptible to MCI, especially to the executive function of T2DM. This trial is registered with ChiCTROCC15006060.

P: 72 Hyponatremia Correction in Cirrhosis May Increase the Speed of Complex Information Processing

BACKGROUND: Hyponatremia is frequent in patients with advanced cirrhosis and ascites. A decrease in plasma osmolality exacerbates astrocyte swelling and through this mechanism may worsen cognitive function. Our objective was to determine whether, in patients with cirrhosis and ascites, an increase in plasma sodium (spontaneous or induced by an aquaretic) leads to an improvement in cognitive function. METHODS: 250 patients with liver cirrhosis and ascites were included in two double-blind, randomised, multicentre clinical studies of satavaptan (a vasopressin V2 antagonist). Patients were included after a "wash-out period" (one week on controlled sodium intake and spironolactone 100 mg/d) and received either placebo (n = 61) or satavaptan (n = 189) at three different doses (5, 12.5, 25 mg/d). Patients completed the trail-making test (TMT) at baseline and at 5–7 and 14–28 days of follow-up. The TMT (scored in seconds) assesses speed of information processing and is considered a test of simple (part A) and complex attention (part B). Improvement of hyponatraemia was defined as an increase in plasma sodium &gt;5 mmol/l or to a value &gt;135 mmol/l. RESULTS: At inclusion into the studies, patients with normonatremia exhibited better results on the TMT-A and TMT-B that could not be explained by differences on age. This group also exhibited better parameters of liver function (Table 1). Improvement of hyponatremia was associated with shortening on the time needed to complete TMT-B: −20 s vs −6.5 s (P = 0.02), but not TMT-A: −10 s vs −5 s (P = 0.16). Increase in serum osmolality was also associated with better TMT-B scores (P &lt; 0.001 at Day 5-7 and P = 0.033 at Day 14–28), but this was not shown for TMT-A. Liver function parameters remained stable in both groups of patients. Improvement of hyponatremia at Day 5 was most commonly seen in patients that received satavaptan (59.7%, n = 82) than in those treated with placebo (18.5%, n = 28). Median changes in TMT scores with satavaptan (all doses pooled) compared to placebo were: TMT-A −10 s vs 0 s (P = 0.08) and TMT-B −20 s vs −7.5 s (P = 0.12). CONCLUSIONS: Improvement of hyponatremia in cirrhosis was associated with an increase in the speed of complex information processing. Improvement of hyponatremia was achieved more frequently with satavaptan treatment, which showed a trend towards better results on cognitive function.

Autonomic, Tactile, Symptom, and Cognitive Improvements in a Male Quadriplegic Spinal Cord Injury after Near-Drowning Incident

Autonomic, Tactile, Symptom, and Cognitive Improvements in a Male Quadriplegic Spinal Cord Injury after Near-Drowning Incident

Cognition and renal function: findings from a Brazilian population.

ABSTRACTIntroduction:The prevalence of chronic kidney disease (CKD) is increasing, with a potential impact in the risk of acceleration of dementia. The potential association between glomerular filtration rate (eGFR) and cognitive performance was scarcely studied. The aim of this study was to evaluate cognitive performance levels across different degrees of kidney function.Methods:We analyzed 240 outpatients in a nephrology service, classified according to eGFR: Advanced (≤ 30ml/min/1.73m2), Moderate (30,1ml/min/1.73m2 to ≤ 60ml/min/1.73m2), and Mild CKD (> 60ml/min/1.73m2). Word list memory, Semantic fluency, Mental State Mini Exam and Trail Making Test (TMT) were applied to evaluate cognitive performance. In the TMT, lower scores are associated with better cognition. In linear regression, cognitive function was considered as dependent variables while groups based on eGFR were considered explanatory variables. The group with eGFR > 60ml/min was the reference and models were adjusted for confounding factors.Results:In our population (n = 240) 64 patients (26.7%) were classified as having advanced, 98(40,8%) moderate, and 78(32,5%) mild. There was no statistical difference among them in MMSE or in the verbal fluency test. However, comparing to mild, patients with advanced CKD presented significantly worse cognitive performance measured by TMTA [50,8s ± 31.1s versus 66,6s ± 35,7s (p = 0.016)] and TMTB [92,7s ± 46,2s versus 162,4s ± 35,7s (p < 0.001)]. Significantly lower TMTB scores (CI95%) 33,0s (4,5-61,6s) were observed in patients with mild compared to advanced CKD in the multivariate analysis adjusting for age, education, sex, diabetes, and alcohol use.Conclusion:Advanced CKD is independently associated with poorer cognitive performance measured by an executive performance test compared to mild CKD.

Alterations of the default mode network and cognitive impairment in patients with unilateral chronic tinnitus.

Previous studies have demonstrated that cognitive impairment is linked with neurophysiological alterations in chronic tinnitus. This study aimed to investigate the intrinsic functional connectivity (FC) pattern within the default mode network (DMN) and its associations with cognitive impairment in tinnitus patients using a resting-state functional magnetic resonance imaging (rs-fMRI). Thirty-five chronic unilateral tinnitus patients, and 50 healthy controls were recruited for rsfMRI scanning. Both groups were age, gender and education level well-matched. The posterior cingulate cortex (PCC) was chosen as the region of interest (ROI) for detecting the FC changes, and determining if these abnormalities were related to a specific cognitive performance and tinnitus characteristic. Relative to the healthy controls, tinnitus patients showed increased FC between the PCC and the right medial prefrontal cortex (mPFC). Moreover, the enhanced FC between the PCC and right mPFC was correlated with the poorer TMT-B scores (r=0.474, P=0.008). These correlations were adjusted by age, gender, education level, GM volume, and mean hearing thresholds. The enhanced FC was not correlated with other tinnitus characteristics or cognitive performances. The enhanced FC pattern of the PCC that is correlated with cognitive impairment in chronic tinnitus patients, especially the executive dysfunction. Enhanced connectivity pattern within the DMN may play a crucial role in neurophysiological mechanism in tinnitus patients with cognitive dysfunction.

Convergent and divergent altered patterns of default mode network in deficit and non-deficit schizophrenia

ObjectivePrevious studies suggested likely mechanisms underlying the dysfunction of the default mode network (DMN) in schizophrenia. However, altered patterns of the intrinsic activity of the DMN in both deficit schizophrenia (DS) and non-deficit schizophrenia (NDS) patients, as well as the neurocognitive relationships among them, remain unknown. This study explores the resting-state characteristics of the DMN activity in both DS and NDS patients, and further investigates correlations with neurocognitive features. MethodsDemographic, resting-state functional MRI, and neurocognitive data were collected in 37 DS and 38 NDS patients, as well as in 38 matched healthy control subjects (HCs). Independent component analysis was conducted to investigate the characteristics of DMN activity and to further distinguish between common and specific altered regions. In addition, partial correlation analysis was conducted to examine associations between the activity of altered regions and neurocognitive assessments. ResultsOverlapping altered brain activity was observed in both DS and NDS patients in the left middle frontal gyrus (MFG), the left angular gyrus (ANG), and the calcarine sulcus (CAL) region. Furthermore, compared to HCs, DS patients showed less activity in the right inferior temporal gyrus, the right para-hippocampal gyrus / hippocampus (PHP / HIP), and the left precuneus (PCUN), while they showed increased activity in the posterior cingulate cortex (PCC). Notably, NDS patients showed less activity in the bilateral middle occipital gyrus. Correlation analysis indicated that, in the DS group, both Trail Making Test (TMT)-B and spatial processing scores were positively associated with the activities of the left PCUN and the right PHP / HIP, while the Stroop color scores were negatively associated with PCC activity. In the NDS group, the TMT-B scores were associated with activities of the left MFG and CAL regions, while the scores of the Wechsler adult intelligence scale (Chinese revision) were negatively associated with CAL region activity. ConclusionThe present study demonstrates convergent and divergent altered patterns of the DMN in both DS and NDS patients. Importantly, the specific altered regions of the DMN in DS patients may be associated with extensive deficient neurocognition, indicating novel insights into the pathogenesis of cognitive impairment in schizophrenia.

The Relationship Of Cognitive Scores With Muscle Power, Strength, And 6-minute Walk In Breast Cancer Survivors

The relationship between cognition and aerobic fitness is well studied in breast cancer survivors (BCS); however, there is a lack of research evaluating the relationships between cognition and anaerobic fitness. PURPOSE: This study examined the relationship between cognition, muscle power, strength, and the 6-min walk (6MW) in BCS. METHODS: Forty-four BCS (60±8 yrs; BMI: 29.9±6.5 kg/m2) completed Trail-Making Test A and B [TMTA (processing speed), TMTB (executive function)], Digit Span Forward (attention) and Backward (working memory), and Controlled Oral Word Association Test [COWAT (executive function)] to assess cognitive domains. Lower body isokinetic (ISK) power and strength were assessed by the Biodex™. Endurance was assessed by the 6MW. Pearson product-moment correlations were used to evaluate relationships between cognition and anaerobic fitness. Significance was accepted at p≤0.05. RESULTS: Faster TMTA and TMTB scores were correlated with greater ISK average power for extension at 60 degrees/sec (TMTA: r=-0.40; TMTB: r=-0.31) and 180 degrees/sec (TMTA: r=-0.45; TMTB: r=-0.30) while TMTA was correlated with greater ISK average power for extension at 120 degrees/sec (r=-0.34). A subcategory of the COWAT was correlated with greater 6MW distance (r=0.31) and greater ISK average power for extension at 180 degrees/sec (r=0.30). CONCLUSION: Higher cognitive functioning, specifically processing speed and executive function domains, may be correlated to greater average power. These findings warrant more research on the benefits of power and strength training on cognition in BCS.

Trail Making Test: Normative data for the Latin American Spanish-speaking pediatric population.

To generate normative data for the Trail Making Test (TMT) in Spanish-speaking pediatric populations. The sample consisted of 3,337 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the TMT as part of a larger neuropsychological battery. The TMT-A and TMT-B scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. The final multiple linear regression models showed main effects for age on both scores, such that as children needed less time to complete the test while they become older. TMT-A scores were affected by age2 for all countries except, Cuba, Guatemala, and Puerto. TMT-B scores were affected by age2 for all countries except, Guatemala and Puerto Rico. Models indicated that children whose parent(s) had a MLPE >12 years of education needed less time to complete the test compared to children whose parent(s) had a MLPE ≤12 years for Mexico and Paraguay in TMT-A scores; and Ecuador, Mexico, Paraguay, and Spain for TMT-B scores. Sex affected TMT-A scores for Chile, Cuba, Mexico, and Peru, in that boys needed less time to complete the test than girls. Sex did not affect TMT-B scores. This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate approach to interpret the TMT in pediatric populations.

THE SURVEY FOR MEMORY, ATTENTION, AND REACTION TIME (SMART): A BRIEF ONLINE PERSONAL COMPUTING-BASED COGNITIVE ASSESSMENT FOR HEALTHY AGING AND MILD COGNITIVE IMPAIRMENT

The SMART was developed to allow for frequent (daily to monthly) in-home assessment of everyday cognition in older adults. SMART contains three face-valid cognitive items in the domains of episodic memory, visual attention, and information processing speed, while also capturing passive aspects of cognitive task engagement such as mouse cursor movement efficiency, typing speed, time to complete the task, time of day started, and task adherence. Participants were 85 cognitively intact older adults (mean age = 83.8 years; 80% female) and 7 with MCI (mean age=81.4 years; 71% female) who were part of a longitudinal cohort study. All participants had rudimentary computer use experience (able to regularly receive and send email). SMART was emailed to all participants on the same day and time. Data were collected using commercially available software on participants’ home computers. Each participant's baseline SMART data were used to compare cognitively intact and MCI older adults and correlate with conventional cognitive tests (e.g., MMSE, CERAD word-list recall, TMT-B). Sixty-five percent of the cognitively intact group completed their baseline SMART in one session (8 ± 5 minutes on average). Of the MCI participants, only 29% completed the task in one session (within a time frame similar to the intact group), while 71% had delays, took multiple sessions or didn't finish at all. MCI participants started their first SMART later in the day than cognitively intact participants, 4:30 PM vs. 1:24 PM on average, p=0.06. Faster SMART completion time was associated with higher MMSE and CERAD word list recall scores, and faster TMT-B scores, p<.05. Answering the SMART memory recall item incorrectly was associated with lower CERAD word-list recall score, p=0.02. SMART trails times were positively correlated with TMT-B (r=0.26, p=0.02). Only 14% of older adults with MCI answered the SMART word search item correctly compared to 67% of cognitively intact participants, p<0.01. The SMART is a brief personal computing experienced-based online assessment that can be easily integrated into longitudinal protocols for frequent cognitive evaluations to identify and quantify subtle changes associated with developing MCI in community dwelling older adults.

Traumatic hemorrhagic brain injury: impact of location and resorption on cognitive outcome.

OBJECTIVE Hemorrhagic contusions are often the most visible lesions following traumatic brain injury. However, the incidence, location, and natural history of traumatic parenchymal hemorrhage and its impact on neurological outcome have been understudied. The authors sought to examine the location and longitudinal evolution of traumatic parenchymal hemorrhage and its association with cognitive outcome. METHODS Sixteen patients with hemorrhagic contusions due to acceleration-deceleration injuries underwent MRI in the acute (mean 6.3 days postinjury) and chronic (mean 192.9 days postinjury) phases. ImageJ was used to generate GRE and FLAIR volumes. To account for the effect of head-size variability across individuals, the authors calculated each patient's total brain tissue volume using SIENAX. GRE and FLAIR volumes were normalized to the total brain tissue volume, and values for absolute and percent lesion volume and total brain volume change were generated. Spearman's rank correlations were computed to determine associations between neuroimaging and 6-month postinjury neuropsychological testing of attention (Symbol Digit Modalities Test [SDMT], oral [O] and written [W] versions), memory (Selective Reminding Test, total learning and delayed recall), and executive function (Trail Making Test Part B [TMT-B]). RESULTS The patients' mean age was 31.4 ± 14.0 years and their mean Glasgow Coma Scale score at admission was 7.9 ± 2.8. Lesions were predominantly localized to the frontal (11 lesions) and temporal (9 lesions) lobes. The average percent reductions in GRE and FLAIR volumes were 44.2% ± 46.1% and 80.5% ± 26.3%, respectively. While total brain and frontal lesion volumes did not correlate with brain atrophy, larger temporal lobe GRE and FLAIR volumes were associated with larger volumes of atrophy (GRE: acute, -0.87, p < 0.01, chronic, -0.78, p < 0.01; FLAIR: acute, -0.81, p < 0.01, chronic, -0.88, p < 0.01). Total percent volume change of GRE lesions correlated with TMT-B (0.53, p < 0.05) and SDMT-O (0.62, p < 0.05) scores. Frontal lobe lesion volume did not correlate with neuropsychological outcome. However, robust relationships were seen in the temporal lobe, with larger acute temporal lobe GRE volumes were associated with worse scores on both oral and written versions of the SDMT (SDMT-W, -0.85, p < 0.01; SDMT-O, -0.73, p < 0.05). Larger absolute change in temporal GRE volume was strongly associated with worse SDMT scores (SDMT-W, 0.88, p < 0.01; SDMT-O, 0.75, p < 0.05). The same relationships were also seen between temporal FLAIR lesion volumes and neuropsychological outcome. CONCLUSIONS Traumatic parenchymal hemorrhages are largely clustered in the frontal and temporal lobes, and significant residual blood products are present at 6 months postinjury, a potential source of ongoing secondary brain injury. Neuropsychological outcome is closely tied to lesion volume size, particularly in the temporal lobe, where larger GRE and FLAIR volumes are associated with more brain atrophy and worse SDMT scores. Interestingly, larger volumes of hemorrhage resorption were associated with worse SDMT and TMT-B scores, suggesting that the initial tissue damage had a lasting impact on attention and executive function.