Administration and interpretation of the Trail Making Test

Exploratory randomised trial of tranexamic acid to decrease postoperative delirium in adults undergoing lumbar fusion-a trial stopped early

Background

Postoperative delirium may be mediated by systemic inflammation and neuroinflammation. By inhibiting the proinflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA on blood loss, adding measures of delirium, cognition, systemic inflammation, and astrocyte activation.

Methods

Adults undergoing elective posterior lumbar fusion randomly received intraoperative i.v. TXA (n=43: 10 mg kg-1 loading dose, 2 mg kg-1 h-1 infusion) or placebo (n=40). Blood was collected before surgery and 24 h after surgery (n=32) for biomarkers (cytokines and S100B). Participants had twice daily delirium assessments (n=65). Participants underwent four measures of cognitive function before surgery and during post-discharge follow-up.

Results

Postoperative blood loss was ∼38% less in the TXA group compared with the placebo group with medians of 128 and 207 ml level-1, respectively, P=0.013. Total blood loss in the TXA and placebo groups did not differ with medians of 305 and 333 ml level-1, respectively, P=0.472. Delirium incidence in the TXA group (7/32=22%) was not significantly less than in the placebo group (11/33=33%); P=0.408, effect size =-0.258 (95% confidence interval -0.744 to 0.229).

Conclusions

A potential 33% relative decrease in postoperative delirium incidence justifies an adequately powered clinical trial to determine if intraoperative TXA decreases delirium in adults undergoing lumbar fusion.

Clinical trial registration

NCT04272606.

Enhancing dyadic outcomes of stroke survivors and caregivers: protocol for a randomised controlled trial

INTRODUCTION

Stroke is a leading cause of death and disability worldwide. Stroke survivors and their caregivers often face profound social isolation and various participation restrictions, resulting in frustration and adverse health outcomes. Dyad-focused interventions, which address both survivor and caregiver needs, are essential during the transition process. However, few interventions equally prioritise the outcomes of both survivors and caregivers. This study aims to evaluate the efficacy of a newly developed dyad-focused strategy training intervention in enhancing participation among stroke survivors and their caregivers.

METHODS AND ANALYSIS

This study employs a single-blind, parallel-group randomised controlled trial with allocation concealment and assessor blinding. We aim to enrol 138 stroke survivor-caregiver dyads, randomly assigned in a 1:1 ratio to either the experimental intervention group or the control group. Both groups will receive their usual rehabilitation plus 45-60 min sessions of the intervention twice weekly for a total of 12 sessions. Outcome measures, including the Participation Measure-3 Domains, 4 Dimensions, General Self-Efficacy Scale and Activity Measure for Post-Acute Care, will be collected at baseline, post-intervention and at 3-month, 6-month and 12-month follow-ups. Data will be analysed using multiple linear regression and mixed-effects regression models. Qualitative indepth interviews with participants, caregivers and therapists will be conducted post intervention, transcribed and thematically analysed.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of Taipei Medical University (approval number: N202203083), National Taiwan University Hospital (approval number: 202207096RINA) and Taipei Tzu Chi Hospital (approval number: 11 M-107). Findings will be disseminated through presentations at scientific conferences and publications in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05571150; Preresults.

Microstructural changes in the caudate nucleus and hippocampus and their association with cognitive function in cerebral small vessel disease: A quantitative susceptibility mapping study

BACKGROUND

Cerebral small vessel disease (CSVD) is associated with microstructural changes in subcortical gray matter linked to cognitive function. These changes may vary across different subregions. The aim of our study was to explore microstructural alterations in subcortical gray matter subregions associated with cognition in CSVD patients using magnetic resonance (MR) quantitative susceptibility mapping (QSM).

METHODS

A total of 295 participants were included in the study, consisting of 112 healthy controls (HC), 85 with mild CSVD, and 98 with severe CSVD. All participants underwent MRI scans and cognitive function assessments. QSM images were segmented into 32 subcortical gray matter regions. Differences in susceptibility values across the three groups and their relationships with clinical and cognitive function were analyzed.

RESULTS

After adjusting for potential confounders, the susceptibility values of the posterior part of the right hippocampus (pHIPr) (β = 1.209, P = 0.030) and the posterior part of the right caudate (pCAUr) (β = 4.373, P = 0.005) were positively correlated with CSVD severity. In the CSVD cohort, the mean susceptibility values of pCAUr were significantly associated with various cognitive functions. Furthermore, a simple mediation model demonstrated that the mean susceptibility value of pCAUr mediated the relationship between CSVD burden and SCWT score (indirect effect = 2.309, 95 % CI = 0.450-4.986, Pm = 21.5 %).

CONCLUSION

Our study revealed a relationship between microstructural changes of subcortical gray matter in CSVD patients and cognitive function and highlighted the potential of QSM in detecting brain microstructural alterations associated with cognition.

The Preoperative Level of Pain Predicts Chronic Pain in Patients Operated on for Degenerative Disc Disease-A Prospective Study

Background: Postoperative pain is an unpleasant experience for the patient and impairs postoperative functional outcomes. The current literature on the influence of preoperative predictors on postoperative pain outcomes remains limited. This study aimed to identify sociodemographic, clinical, psychological, and temperamental predictors of postoperative pain in patients undergoing surgery for degenerative disc disease (DDD). Methods: Eighty-one adults with DDD, qualified for neurosurgical intervention, were enrolled. All patients underwent neurological and psychiatric evaluations, as well as preoperative pain assessments using the Visual Analogue Scale (VAS) and the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Psychological assessments included the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Somatic Symptom Scale, temperament, and personality inventories (e.g., FCB-TI, NEO-FFI), and cognitive tests (Trail Making Test, Digit Span Test). Postoperative pain was re-evaluated with the VAS 12 weeks after surgery. Data were analyzed using univariate and multivariate statistical methods. Results: Univariate analyses revealed significant differences between the defined groups regarding lack of improvement of pain 12 weeks after surgery compared to preoperative VAS, systolic blood pressure, and four scales from the WHYMPI. However, stepwise logistic regression identified only preoperative VAS score as an independent predictor of postoperative pain improvement. Receiver Operating Characteristic analysis and Youden's index indicated a preoperative VAS cut-off score of 6 as the most predictive. Conclusions: A VAS score of 6 or more before surgery independently predicts the absence of chronic pain 12 weeks postoperatively for patients without neurological deficits. Moreover, given the complexity of this topic, further prospective, randomized controlled research is essential.

Clinical Outcome Assessment Tools for Evaluating the Management of Gliomas

In recent times, a greater emphasis has been placed on framing patient clinical assessments and QOL as both endpoints and prognostic factors for neuro-oncological care. However, there is currently a lack of consensus on the most effective metrics and instruments for use in patients with primary brain tumors. Due to the heterogeneity in clinical characteristics, histological classification, anatomical location, and available treatment modalities for glioma, quantifying patient clinical condition and QOL within this unique population is particularly challenging. In this paper, we comprehensively review the available literature on the use of clinical assessment tools in glioma patients, highlighting the strengths and limitations of prominent instruments. We demonstrate that clinical outcome assessment (COA) instruments provide valuable and complementary insights into the physical, psychological, and spiritual well-being of glioma patients.

Fostering experiential learning of neurocognitive skills in brain injury tele-rehabilitation: bridging gaps in remote training by integrating scenario-based digital experiences with coaching

Dysregulation of brain state is common following traumatic brain injury (TBI), contributing to long-term difficulties in important life pursuits, spanning school, work, and beyond. Brain state dysregulation makes it difficult to effectively organize and direct cognition and behavior to accomplish any number of goals, resulting instead in difficult-to-understand combinations of neurocognitive and emotional symptoms: distractibility, forgetfulness, poor follow-through, irritability, reduced frustration tolerance, and becoming easily overwhelmed. Given underlying heterogeneity with neurocognitive-emotional symptoms, it may be highly efficient to train use of state regulation skills (SRS) as a generalizable approach to facilitate processing of neurocognitive demands encountered along individual goal pathways. In this report, we present an innovative system of guided experiential skill learning of goal-directed SRS - one that rationally integrates experiential digital technology designed to practice applying and integrating SRS directly into goal-based functional challenges with therapist-led training to maximize skill learning, transfer, and generalization. Moreover, we designed this system specifically to bridge important gaps that interfere with skill learning when individuals are remote from therapists. To advance the integration of technology into rehabilitation neuroscience, we present this communication as a hybrid of intervention design (introducing principles and features), "user experiences" (sharing vignettes informative of the value of technology integration into the learning process), and a controlled, proof-of-principle pilot intervention study for a small cohort of individuals (n = 18) with chronic TBI (assessing the plausibility of strengthening goal-directed functioning, as indexed by performance on neurocognitive assessment tasks and complex functional tasks, as well as ratings of personal life functioning). Data suggest that a technology-augmented remote guided experiential learning approach may bridge important gaps in skill learning to help individuals improve goal-directed functioning. This line of work will inform further advances in remote neuro-cognitive rehabilitation.

Cognitive Correlates of Functional Disruption at Psychosis Onset: Unique Relevance of Visual Cognition

Background: Cognitive impairment is a common feature of schizophrenia spectrum disorders and has been associated with functional disruption preceding the onset of psychosis. Understanding how cognitive deficits interact with clinical symptoms and functioning in early psychosis remains challenging. In this study, we aim to investigate whether a distinct "cognitive signature" characterizes functional disruption at the onset of psychosis. Material and Methods: Clinical, cognitive, and functional data were collected from 101 first episode psychosis patients at their first hospitalization. Stepwise regression models were used to identify predictors of global functioning and symptom severity at the time of onset, as well as diagnostic outcomes at discharge. Path analysis was used to explore the relationship among symptom severity, cognition, and functional outcomes. Results: Deficits in visual memory were selectively predictive of lower functioning and higher global symptom severity at the time of psychosis onset. Reduced visual-spatial abilities were also associated with unemployment at the time preceding hospitalization and predicted a non-affective schizophrenia spectrum diagnosis at discharge. Path analysis found that visual memory fully mediated the relationship between negative symptoms and level of functioning. Conclusions: Impairment in visual cognition seems to be uniquely associated with functional impairment and global symptom severity at the onset of psychosis and to mediate the relationship between negative symptoms and functioning. The results might indicate a primary relevance of visual cognitive aspects in marking functional disruption and symptom exacerbation at psychosis onset. This might have implications for early detection and inform treatment plans.

The Dice Trails Test: A modified Trail Making Test for children and adults with Down Syndrome

BACKGROUND

Psychometrically sound instruments to assess cognitive flexibility in people with Down Syndrome (DS) are lacking. The Trail Making Test (TMT) is well-established but requires reading letters and numerals, limiting its applicability for people with DS.

AIMS

To evaluate the psychometric properties and developmental sensitivity of a newly developed TMT adaptation without letters and numerals - the Dice Trails Test (DTT).

METHODS

The DTT was administered to 39 children (8-14 years, 46 % female) and 57 adults (18-57 years, 47 % female) with DS. We evaluated feasibility (proportion of participants completing the task), distributional properties, construct validity, developmental sensitivity, and split-half reliability. Nineteen individuals were reassessed for test-retest reliability. Individuals with DS were compared to typically developing (TD) groups matched on chronological and mental age.

RESULTS

The DTT showed adequate feasibility (≥ 80 %) for individuals with DS and mild intellectual disability (ID), no relevant floor effects, acceptable construct validity, developmental sensitivity, good split-half reliability, and preliminary evidence for good test-retest reliability in DS. DTT performance differed between DS and TD individuals matched on chronological age, but not when matched on mental age.

CONCLUSIONS

Although limited in applicability for individuals with DS and moderate ID, the DTT shows potential as a direct measure of cognitive flexibility in DS across a broad age range.

The impact of pituitary adenomas on cognitive performance: a systematic review

Purpose

Increasing evidence suggests that beyond classical endocrine and visual symptoms, patients with pituitary adenoma (PA) may experience neurocognitive impairment, potentially resulting in reduced productivity and diminished quality of life. Prior studies have used diverse cognitive assessment tools across heterogeneous populations, leading to inconsistent findings. To address the variability, our study systematically analyzes the assessment batteries used in previous research, clarifying their corresponding cognitive domains. We seek to provide a more consistent and comprehensive understanding of the neurocognitive implications associated with PAs.

Methods

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Individual patient-level data, including clinical characteristics, tumor subtype, treatment interventions, hormonal status, and psychological outcomes, were systematically collected. Cognitive assessment tools were categorized according to their corresponding cognitive domains to facilitate domain-specific analyses.

Results

This systematic review included 70 studies encompassing a total of 3,842 patients with PA. Of these, 60 studies employed either objective neuropsychological tests or subjective questionnaires to evaluate cognitive function. The most frequently utilized assessment was the Digit Span test, with 42.9% of studies reporting significant impairments in complex attention and executive functioning among patients with PA. Twelve studies focused on structural brain changes as assessed by magnetic resonance imaging, with half documenting volumetric reductions in gray matter. Across the various PA subtypes, a consistent decline in discrete cognitive domains was observed, most notably in memory and executive function. Treatment-related data were provided in 59 studies. Perioperative changes in cognitive performance were described in 14 studies, of which 11 reported post-surgical improvement in at least one cognitive domain. Twenty studies investigated the potential adverse effects of radiotherapy on cognitive function; among them, 16 found no significant differences following treatment. Eight studies examined the association between tumor size and cognitive impairment; seven reported no statistically significant correlation. In contrast, 24 studies identified a significant relationship between hormonal dysregulation and cognitive decline.

Conclusions

The literature contains heterogeneous findings about the cognitive performance, nature of cognitive impairment, and subsequent effects of treatment. Patients with PA may experience cognitive decline in specific areas and are notably affected by hormone levels, while treatment may lead to cognitive recovery. The proposed tiered cognitive evaluation approach can improve assessment consistency in future practice.

APOE- ε4 Modulates Facial Neuromuscular Activity in Nondemented Adults: Toward Sensitive Speech-Based Diagnostics for Alzheimer's Disease

The APOE-ε4 allele is a genetic risk factor for late-onset Alzheimer's disease (AD). Beyond cognitive decline, APOE-ε4 affects motor function, reducing muscle strength and coordination, potentially through mitochondrial dysfunction and oxidative stress. This study examined the influence of the APOE- ε4 allele on neuromuscular function in oral muscles involved in speech production, using surface electromyography (EMG); and assessed the predictive power of EMG measures in differentiating APOE- ε4 carriers from noncarriers. Forty-two cognitively intact adults (16 APOE- ε4 carriers, 26 noncarriers) completed speech tasks while EMG was recorded from seven craniofacial muscles. Seventy EMG features including amplitude, frequency, complexity, regularity, and functional connectivity were extracted. Statistical analyses assessed genotype effects, sex differences, and correlations with blood metabolic biomarkers. APOE- ε4 carriers exhibited increased motor unit recruitment and synchronization, suggesting accelerated muscle fatigue. EMG-based measures outperformed cognitive tests in distinguishing carriers (AUC = 0.90) and correlated with metabolic biomarkers. Sex differences emerged, with female carriers showing reduced and male carriers showing increased functional connectivity. These findings highlight speech-based neuromuscular changes as potential early biomarkers of Alzheimer's risk before cognition is affected.

Flexibility of action verbs processing in Parkinson's disease

OBJECTIVE

This study aims to investigate action language processing abilities in Parkinson's disease (PD) compared to healthy controls (HCs), specifically examining whether the involvement of motor systems is influenced by task context. By focusing on implicit versus explicit task demands, the study evaluates how semantic processing differs in PD and whether these differences align with a flexible embodied cognition framework.

METHODS

The study analyzed the performance of participants on two tasks: an explicit task (semantic judgment task, SJ) and an implicit task (letter detection task, LD). PD outpatients (n = 31, mean age 64.58 years) referred to the Parkinson and Movement Disorders Unit of ICS Maugeri Hermitage were enrolled, along with a group of healthy controls (n = 31, mean age 64.19 years). Performance was measured through reaction times (RTs) and accuracy scores (Acc) during the processing of action verbs and abstract verbs.

RESULTS

PD patients exhibited slower RTs and lower accuracy when processing action verbs compared to abstract verbs, but only during the SJ task. Slower RTs in the SJ task were predicted by language and executive functioning (semantic fluency) and disease progression (Hoehn and Yahr stages) for both action and abstract verbs. In the LD task, slower RTs were predicted by executive functioning for action verbs and attention (measured by Trail Making Test Part B and Stroop task) for abstract verbs.

CONCLUSIONS

The findings suggest a context-dependent involvement of the motor system in action language processing, supporting a flexible, embodied approach to conceptual semantic processing rather than an automatic one.

Impact of Endovascular Revascularization on Functional Connectivity and Cognition in Symptomatic Chronic Internal Carotid Artery Occlusion Patients: A Preliminary Exploratory Study

BACKGROUND

Symptomatic chronic internal carotid artery occlusion (CICAO) may lead to stroke and cognitive decline. Although endovascular recanalization has been proven to reduce the risk of future strokes, the effect on cognition remains controversial and requires further exploration. We explored alterations in functional connectivity (FC) and their associations with cognition in patients with symptomatic CICAO before and after carotid revascularization.

METHODS

Eighteen patients with unilateral CICAO and fifteen healthy controls (HCs) were enrolled. Resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological assessment were performed on all participants, before and after 6 months post-recanalization in the patient group. FC alterations in multiple brain networks and their correlations with cognitive scores were analyzed.

RESULTS

The FC of the CICAO group were markedly lower relative to the HC group for the following: the dorsal attention network (DAN) with the ipsilateral (occlusion side, right) middle frontal gyrus and frontal pole; the default mode network (DMN) with the ipsilateral angular gyrus; the visual network (VN) with the ipsilateral fusiform gyrus; and the frontoparietal network (FPN) with middle temporal gyrus on the side contralateral to the occlusion. The decreased FC of the DAN exhibited a positive association with the total score of the Mini-Mental State Examination (MMSE, r = 0.499, p = 0.049), Montreal Cognitive Assessment (MoCA, r = 0.515, p = 0.041), and Backward Digit Span Test (BDST, r = 0.594, p = 0.015), and negatively correlated with the score of Trail Making Test (TMT)-A (r = -0.563, p = 0.023) and TMT-B (r = -0.602, p = 0.014). The CICAO group exhibited significantly increased FC of the DMN seed region with the middle occipital gyrus ipsilateral to the occlusion. Additionally, the VN seed region demonstrated increased FC with the fusiform gyrus ipsilateral to the occlusion following endovascular recanalization. The preoperative FC values of the DMN exhibited a strong positive association with the improvement in TMT-A score (r = 0.629, p = 0.021).

CONCLUSION

Our exploratory study found that FC disruption may induce cognitive decline in symptomatic CICAO patients. Endovascular recanalization may improve FC within key brain networks, supporting cognitive improvement. The baseline DMN FC was significantly associated with the postoperative improvement in TMT-A scores, suggesting that preoperative DMN FC could serve as a potential predictor of cognitive recovery.

CLINICAL TRIAL REGISTRATION

NCT05292729. Registered 1 December 2021, https://clinicaltrials.gov/study/NCT05292729?intr=NCT05292729&rank=1.

Alterations of white matter integrity in patients with intracranial tuberculosis: A tract-based spatial statistics study

OBJECTIVE

Intracranial tuberculosis has high mortality and morbidity. Its physiopathologic mechanism, especially neurocognitive mechanism, remains unclear, and there are few studies on white matter in such patients. This study aimed to investigate the white matter abnormalities in patients with intracranial tuberculosis using tract-based spatial statistics (TBSS) method of diffusion tensor imaging (DTI).

METHODS

Fifty patients with intracranial tuberculosis and 49 healthy controls (HCs) were included in this study. Differences in the fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) between patients and HCs were investigated using TBSS analysis. Partial correlation analysis was performed to explore correlations between DTI values and cognitive functions in patients with intracranial tuberculosis, with age and gender as covariates. Subgroup analysis was also conducted using the same method.

RESULTS

Compared to HCs, patients with intracranial tuberculosis showed a widespread reduction of FA and increase of MD, RD and AD (P < 0.05, TFCE and FWE corrected). Notably, abnormalities in all four metrics were observed in 25 white matter tracts according to the Johns Hopkins University ICBM-DTI-81 White Matter Atlas. Patients with mixed intracranial tuberculosis (mixed-ITB) showed increased AD in a limited range compared with patients with tuberculous meningitis (TBM). With age and gender considered, the MD, RD and AD values in some regions significantly correlated with the cognitive assessment scores.

CONCLUSIONS

The results of this study indicated that patients with intracranial tuberculosis might have widespread abnormalities in the white matter of the brain, which might associate with their cognitive impairment.

The COMbined Physical and somatoSEnsory (COMPoSE) training intervention to improve upper limb recovery after stroke: a single-case experimental study

PURPOSE

The COMbined Physical and somatoSEnsory (COMPoSE) program is a novel intervention combining training of somatosensory and motor variables synchronously to improve upper limb recovery after stroke. The aim of this study was to evaluate the impact of COMPoSE on the upper limbs after stroke, using a single-case experimental study design.

METHODS

Five people with chronic stroke (62-89 years) completed the COMPoSE intervention trial (15 h, 10 sessions). Effects on participants were assessed using laboratory measures (maximal tactile pressures) and clinical motor and somatosensory measures.

RESULTS

Notable improvements were observed in measures of maximal tactile pressures in four out of five participants between baseline and post-intervention (range of change index: 12.0-62.5%; change in level: 2.3-10.6 KPa). Also, improvements were observed in the Wolf motor function test (score and time), box and block test, motor activity log, grip strength, wrist position sense test, tactile discrimination test, stroke impact scale at post-intervention (range of change index: 3.0-50.3%) compared to baseline.

CONCLUSION

Our findings suggest that COMPoSE could be beneficial to people with mild to severe somatosensory and motor deficits after stroke. The delivery of the COMPoSE intervention could be tailored to individual needs to maximize somatosensory and motor improvements in the upper limb after stroke.

CLINICAL TRIALS REGISTRY

This study was registered with the Australian New Zealand Clinical Trials Registry ACTRN12615001222538.

Validation of reading as a predictor of mild cognitive impairment

Mild cognitive impairment (MCI) is a neurocognitive disorder that precedes Alzheimer's disease, but also other types of dementia. The use of reading tasks, when paired with eye-tracking technology, has been suggested as an effective biomarker for identifying MCI and distinguishing it from healthy individuals. The objective of this study was twofold: (1) to explore the disparities in eye movements during reading between individuals with MCI and healthy controls and train a predictive model to detect MCI, and (2) to validate these findings on a large independent dataset. We developed features for a model designed to automatically detect cognitive impairment based on the data of 115 subjects; 62 cognitively impaired and 53 healthy controls. Each subject was subjected to a neurological evaluation, a thorough psychological analysis, and completed a brief reading exercise while their eye movements were monitored using an eye-tracker. Their eye movements were characterised by patterns of saccades and fixations and were analysed across both groups. Several characteristics showed very high statistical significance, indicating differences in gaze behaviour between the groups. These characteristics were then employed to develop a machine learning model that differentiates cognitively impaired individuals from healthy controls. For the validation purposes, we ran a separate study with 99 new subjects using the same experimental design. The model reached about 75% AUROC. These results confirm that reading tasks can serve as a basis for early detection of MCI; however, complementary eye-tracking tasks are needed to further increase the detection accuracy.

Effectiveness and cost-effectiveness of a home-based functional exercise programme for community-dwelling frail older adults, ACTIVE-AGE@home, provided by professionals and volunteers: protocol of a pragmatic randomised controlled trial

Between 2020 and 2050, the world's population aged 80 years and over will triple, drastically increasing the prevalence of frailty and associated healthcare costs. Multimodal exercise programmes have proven to be an ideal countermeasure for frailty, but the current Flemish standard of care does not include them. The purpose of this study is to investigate the effect of the home-based exercise programme for frail community-dwelling older adults (>70 years), ACTIVE-AGE@home, on frailty-associated outcomes, when delivered by professionals or volunteers, as well as its cost-effectiveness. A pragmatic randomised controlled trial will be conducted. Participants will be randomised into three parallel groups using permuted block randomisation. There will be two intervention groups: in one group, the intervention is delivered by professionals with a bachelor or masters' degree in physiotherapy, occupational therapy and/or physical education, and in the other by trained volunteers. Both groups will be compared with a control group receiving usual care. Participants (n=195) are community-dwelling physically frail older adults (>70 years), as defined by Fried et al. (2001). The intervention is a 24 week programme that consists of three 1 hour visits per week and contains aerobic, strength, balance, flexibility, coordination and dual tasking exercises, accompanied by goal-setting and motivational interviewing. The Timed Chair Stand (TCS) test is the primary outcome. Functional ability, cognition, loneliness, self-management, health-related quality of life, healthcare utilisation and meaningful activities will be measured in all groups at 0, 24 and 48 weeks. Time and expenses invested by professionals or volunteers will be kept in diaries for trial and model-based cost-effectiveness analyses, expressed in incremental cost per QALY (quality-adjusted life year). The model will be designed to associate the frailty at the end of follow-up with further expected healthcare expenses beyond the duration of the trial. Statistical analysis will be blinded to group allocation, and outcome assessors will be blinded to the maximal extent possible. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Medical Ethics Committee of UZ Brussel (O.G. 016), Peer reflection group Biomedical Ethics, Laarbeeklaan 101, 1090 Brussels. Results will be disseminated in publications and other relevant platforms. This study was registered at Clinicaltrials.gov on 6 July 2023 and posted on 14 July 2023 after National Library of Medicine quality control review. Registration details: NCT05946109 TRIAL REGISTRATION NUMBER: NCT05946109.

Higher blood-brain barrier leakage in schizophrenia-spectrum disorders: A comparative dynamic contrast-enhanced magnetic resonance imaging study with healthy controls

BACKGROUND

Blood-brain barrier (BBB) disruptions are presumed to be implicated in schizophrenia-spectrum disorders (SSDs). Previous studies focused on cerebrospinal fluid (CSF) markers, which are imprecise for detecting subtle BBB disruption. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) enables sensitive investigation of subtle BBB leakage in vivo, yet remains unexplored in SSD research. We hypothesized higher leakage in SSDs compared to healthy controls (HCs), indicating a clinical sub-phenotype.

METHODS

Forty-one people with SSDs and forty age- and sex-matched HCs were included in this cross-sectional study employing DCE-MRI, clinical characterization, cognitive assessment, blood and CSF analyses. The volume transfer constant Ktrans, calculated using the Patlak method to estimate the contrast agent transfer between blood and extravascular space, was compared between groups to detect differences in BBB leakage.

RESULTS

Individuals with SSDs showed higher BBB leakage compared to HCs in a widespread pattern, in brain regions typically affected in SSDs. No significant association was detected between leakage and measures of cognition, symptom severity, peripheral inflammation markers and albumin CSF/serum ratio.

CONCLUSIONS

This is the first study to date reporting BBB leakage in SSDs compared to HCs in multiple brain regions implicated in the disorder. These findings provide insights into disease mechanisms, highlighting the need for further investigation into the role of the BBB in SSDs.

Clinical Improvement after Shunt Surgery in Patients with Idiopathic Normal Pressure Hydrocephalus Can Be Quantified by Diffusion Tensor Imaging

BACKGROUND AND PURPOSE

White matter changes assessed by DTI typically reflect tract functionality. This study aimed to investigate DTI parameter alterations in important regions pre- and postshunt implantation in patients with idiopathic normal pressure hydrocephalus (iNPH), alongside assessing the relationship between DTI parameters and clinical improvement.

MATERIALS AND METHODS

Patients with probable iNPH underwent prospective preoperative MRI and comprehensive clinical work-up between 2017-2022. Patients with clinical symptoms of iNPH, positive result on a lumbar infusion test, and/or gait improvement after 120-hour lumbar drainage were diagnosed with iNPH and underwent shunt-placement surgery. Fractional anisotropy and mean diffusivity values for individual regions of interest were extracted from preoperative and postoperative MRI. These values were correlated with the clinical picture of individual patients.

RESULTS

A total of 32 patients (73.59 ± 4.59 years) with definite iNPH were analyzed. Preoperative DTI characteristics of internal capsule and corona radiata correlated with the 1-year improvement in the Dutch Gait Scale postoperatively (all P < .036). Cognitive domain improvement after surgery in memory and psychomotor speed correlated with preoperative DTI values of cingulate gyrus (P = .050), uncinate fasciculus (P = .029), superior longitudinal fasciculus (P = .020), or corpus callosum (P < .045).

CONCLUSIONS

DTI characteristics of white matter regions reflect clinical improvement after shunt surgery in patients with iNPH. They tend to improve toward physiologic DTI values, thus further accentuating the benefit of shunt surgery in both clinical and radiologic pictures.

Exploring Factors Influencing Driving Simulator Performance in Patients With Acquired Brain Injury Using Hierarchical Clustering Analysis of Principal Components

Background Driving simulator training is widely recognized as an effective tool for driving rehabilitation. However, the key factors influencing simulator performance and the extent of training-related improvements remain insufficiently explored. This study aimed to identify the demographic, motor, and cognitive factors associated with driving simulator performance and post-training improvements in patients with acquired brain injury (ABI) using clustering analysis. Methods A total of 64 patients with ABI (59% cerebral hemorrhage, 34% cerebral infarction, 7% traumatic brain injury; mean age 64±13 years; 81% male) underwent comprehensive neuropsychological assessments and driving simulator evaluations before and after training. Multiple factor analysis was applied to integrate pre- and post-training variables and reduce dimensionality. Hierarchical Clustering on Principal Components was then performed to classify patients based on training effect patterns. The Kruskal-Wallis test and post hoc multiple comparisons were used to assess differences in background factors among the clusters. Results Three distinct clusters were identified: Cluster 1 (n=32) exhibited consistently high performance in reaction and city-driving tasks, Cluster 2 (n=19) demonstrated prolonged reaction times but showed significant improvements in city-driving tasks after training, and Cluster 3 (n=13) demonstrated severe city-driving errors and limited post-training improvement. Neuropsychological assessments revealed significant differences among the clusters (p < 0.05), with Cluster 1 consistently outperforming Clusters 2 and 3 across multiple cognitive domains, including attention, cognitive flexibility, visuospatial abilities, memory, and executive function. Conclusion Neuropsychological assessments may serve as predictors of both baseline driving performance and post-training improvements. Tailoring interventions to individual cognitive profiles, particularly focusing on attention, visuospatial abilities, and executive function, may enhance the efficacy of simulator-based rehabilitation and support the safe resumption of driving. Future longitudinal studies should examine how targeted cognitive training might improve driving performance in patients with different cognitive profiles.

Distinct age-related alterations in alpha-beta neural oscillatory activity during verbal working memory encoding in children and adolescents

Emerging imaging studies of working memory (WM) have identified significant WM-related oscillatory events that are unique to each phase of working memory (e.g. encoding, maintenance). Although many previous imaging studies have shown age-related changes within the frontoparietal network when performing a WM task, understanding of the age-related changes in the oscillatory dynamics underlying each phase of WM during development and their relationships to other cognitive function is still in its infancy. To this end, we enrolled a group of 74 typically-developing youths aged 7-15 years to perform a letter-based Sternberg WM task during magnetoencephalography. Trial-wise data were transformed into the time-frequency domain, and significant oscillatory responses during the encoding and maintenance phases of the task were independently imaged using beamforming. Our results revealed widespread age-related power differences in alpha-beta oscillatory activity during encoding throughout left frontal, parietal, temporal, occipital and cerebellar regions. By contrast, age-related differences in maintenance-related activity were limited to a small area in the superior temporal gyrus and parieto-occipital regions. Follow-up exploratory factor analysis of age-related encoding alpha-beta activity revealed two distinct factors, and these factors were each found to significantly mediate age-related improvements in both verbal and non-verbal cognitive ability. Additionally, late maintenance alpha activity was related to reaction time on the task. Taken together, our results indicate that the neural dynamics in the alpha and beta bands are uniquely sensitive to age-related changes throughout this developmental period and are related to both task performance and other aspects of cognitive development. KEY POINTS: Understanding of the age-related changes in neural oscillatory dynamics serving verbal working memory function is in its infancy. This study identified the age-related neural alterations during each phase of working memory processing in youths. Developmental differences during working memory processing were primarily isolated to alpha-beta activity during the encoding phase. Alpha-beta activity during encoding significantly mediated age-related improvements in both verbal and non-verbal ability. This study establishes new brain-behaviour relationships linking working memory function to other aspects of cognitive development.

Bottom-up versus Top-down designed rehabilitation sessions in chronic stroke survivors: a pilot randomized controlled trial

PURPOSE

The present study aimed to compare the effectiveness of Top-down and Bottom-up approaches on levels of the International Classification of Functioning, Disability and Health Framework (ICF), including impairments, activities, and participation.

MATERIALS AND METHODS

Thirty-nine chronic stroke survivors were recruited for this single-blinded randomized clinical trial. Participants were assigned to Top-down, Bottom-up interventions, or control group, and received a 6-week intervention. They were assessed before/after treatments and at follow-up (6 weeks later). Impairments were measured through kinematic analysis, Trail Making Tests (TMT), and Fugl-Meyer Assessment (FMA). Activity and participation were evaluated via Box and Block Test, Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM), respectively.

RESULTS

We found significant improvements in impairment (FMA) and participation (COPM) in all groups, however, COPM scores improved beyond the MCID only in the Top-down, and FMA scores exceeded the MCID in Top-down and Bottom-up groups. Use of the upper limb in daily activities (MAL) enhanced in the Top-down group, although was not clinically significant.

CONCLUSION

In most of the outcome measures, no significant difference was observed between groups. It seems that Top-down, Bottom-up, and traditional interventions have relatively comparable effectiveness in chronic stroke survivors.

TRIAL REGISTRATION

IRCT20150721023277N2.

Disturbed Dynamic Brain Activity and Neurovascular Coupling in End-Stage Renal Disease Assessed With MRI

BACKGROUND

Pathophysiological mechanisms underlying cognitive impairment in end-stage renal disease (ESRD) remain unclear, with limited studies on the temporal variability of neural activity and its coupling with regional perfusion.

PURPOSE

To assess neural activity and neurovascular coupling (NVC) in ESRD patients, evaluate the classification performance of these abnormalities, and explore their relationships with cognitive function.

STUDY TYPE

Prospective.

POPULATION

Exactly 33 ESRD patients and 35 age, sex, and education matched healthy controls (HCs).

FIELD STRENGTH/SEQUENCE

The 3.0T/3D pseudo-continuous arterial spin labeling, resting-state functional MRI, and 3D-T1 weighted structural imaging.

ASSESSMENT

Dynamic (dfALFF) and static (sfALFF) fractional amplitude of low-frequency fluctuations and cerebral blood flow (CBF) were assessed. CBF-fALFF correlation coefficients and CBF/fALFF ratio were determined for ESRD patients and HCs. Their ability to distinguish ESRD patients from HCs was evaluated, alongside assessment of cerebral small vessel disease (CSVD) MRI features. All participants underwent blood biochemical and neuropsychological tests to evaluate cognitive decline.

STATISTICAL TESTS

Chi-squared test, two-sample t-test, Mann-Whitney U tests, covariance analysis, partial correlation analysis, family-wise error, false discovery rate, Bonferroni correction, area under the receiver operating characteristic curve (AUC) and multivariate pattern analysis. P < 0.05 denoted statistical significance.

RESULTS

ESRD patients exhibited higher dfALFF in triangular part of left inferior frontal gyrus (IFGtriang) and left middle temporal gyrus, lower CBF/dfALFF ratio in multiple brain regions, and decreased CBF/sfALFF ratio in bilateral superior temporal gyrus (STG). Compared with CBF/sfALFF ratio, dfALFF, and sfALFF, CBF/dfALFF ratio (AUC = 0.916) achieved the most powerful classification performance in distinguishing ESRD patients from HCs. In ESRD patients, decreased CBF/fALFF ratio correlated with more severe renal impairment, increased CSVD burden, and cognitive decline (0.4 < |r| < 0.6).

DATA CONCLUSION

ESRD patients exhibited abnormal dynamic brain activity and impaired NVC, with dynamic features demonstrating superior discriminative capacity and CBF/dfALFF ratio showing powerful classification performance.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY: Stage 1.

Cog-First: standardization of a tablet-based self-administered cognitive screening

BACKGROUND

Acquired brain injury can lead to subtle cognitive disorders that can be challenging to detect albeit impacting patients' long-term functional prognosis. Cog-First has been developed as a tablet-based self-administered cognitive screening tool to assess executive function, memory and attention in approximately 20 minutes, in the acute phase following brain injury.

AIM

The aim of this study was to establish reliable normative data for Cog-First to enable meaningful comparisons between patients and a reference population.

DESIGN

Cross-sectional study.

SETTING

This study was conducted at the PRISME platform of Paris Brain Institute.

POPULATION

Four hundred and six healthy French-speaking healthy volunteers were randomly selected from the Paris Brain Institute's database.

METHODS

Each participant underwent the Cog-First assessment, which comprises seven subtests, in standardized conditions. Ninety-five participants performed the alternative version one month later to assess the test-retest effect. The effects of gender, age, years of education and test version, as well as their two-way interactions, were evaluated by generalized linear models (GLMs). Formulas from the GLMS were extracted to calculate a corrected score that removes the effects of age, sex, version and years of education. This enables us to derive percentiles in a population of healthy volunteers, allowing the development of the standardization process.

RESULTS

The results revealed a significant influence of gender, age, level of education and version on several sub-scores. Based on these results, the standardization process was implemented by calculating the percentiles on the corrected scores in the population of healthy volunteers. Test-retest analyses indicated a learning effect on four out of seven subtests.

CONCLUSIONS

The standardization of Cog-First resulted in the development of score formulas adjusted for gender, age, education and version, integrated within the software for automated scoring.

CLINICAL REHABILITATION IMPACT

This study establishes reliable norms for Cog-First, enabling meaningful score interpretation and clinical use, thereby facilitating early detection of cognitive impairments and potentially improving patient outcomes. Further research is necessary to determine the tool's applicability and sensitivity in brain-injured patients.

Cardiovascular risk factors and cognitive performance among people living with HIV: cross-sectional study in the country of Georgia

OBJECTIVES

Older people living with HIV (PLWH) globally are experiencing a combination of both communicable and non-communicable disease (NCD) morbidities. Vascular contributions to cognitive impairment and dementia (VCID) can contribute to adverse ageing brain health. This study aimed to measure VCID and HIV-related factors and evaluate their association with cognitive performance.

DESIGN

A cross-sectional study.

SETTING

Five cities in the country of Georgia.

PARTICIPANTS

We enrolled PLWH age ≥40 years. Recruitment and data collection were carried out between February and September 2023. We conducted face-to-face interviews and collected data on sociodemographic characteristics, medical history, HIV history, cardiovascular health, mental health, clinical measurements and cognitive performance.

PRIMARY OUTCOME MEASURES

We calculated the estimated 10-year cardiovascular risk using the Framingham risk score (FRS). Descriptive analyses were conducted using the frequency distributions of relevant categorical variables and median and IQR for continuous variables. Multivariable linear regression analyses were conducted separately for each cognitive assessment score.

RESULTS

A total of 125 PLWH aged ≥40 years were enrolled in the study. The median FRS was 9% (IQR: 4, 15), with 37 (30%) participants having intermediate risk and 17 (14%) with high risk of cardiovascular event. In univariate correlation analysis, FRS was associated with worse cognitive performance. The FRS remained associated with worse performance on the Trails Making Test B and Grooved Pegboard Test using multivariable models. On average, every 1 per cent increase in FRS corresponded to an increase of 1.65 s (95% CI: 0.11, 3.19, p=0.04) for completing the Trails Making Test B and an increase of 1.02 s (95% CI: 0.43, 1.60, p=0.001) for completing the Grooved Pegboard Test.

CONCLUSIONS

We found a high prevalence of cardiovascular risk and an association between this risk and cognitive performance in our sample. Our findings provide a baseline that can be further investigated in larger-scale studies with longitudinal assessment of cardiovascular risk factors and cognitive performance. Furthermore, it can inform the development of policies and programmes to mitigate adverse effects of VCID on the health of PLWH in Georgia and the Eastern Europe and Central Asia region.

PEMOCS: effects of a concept-guided, PErsonalized, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-a randomized, controlled trial

Purpose

Motor-cognitive exergames may be beneficial for addressing both motor and cognitive residual impairments in chronic stroke, however, effective training schedules are yet to be determined. Therefore, this study investigates the effects of a concept-guided, personalized, motor-cognitive exergame training on cognitive functions and gait in chronic stroke survivors.

Methods

In this single-blind, randomized, controlled trial, stroke survivors (at least six-months post-stroke and able to perform step-based exergaming) were allocated either to the intervention (usual care + concept-guided, personalized, motor-cognitive exergame training) or the control group (usual care only). Global cognitive functioning was primarily targeted, while health-related quality of life (HRQoL), cognitive functions, mobility, and gait were evaluated secondarily. Analyses were performed with linear-mixed effect models.

Results

Effects on global cognitive functioning were non-significant, with no differences between responders (participants exhibiting a clinically relevant change) and non-responders (participants exhibiting no clinically relevant change). Among secondary outcomes, the mobility domain of the HRQoL questionnaire, intrinsic visual alertness, cognitive flexibility, working memory, and outdoor walking speed as well as swing width (unaffected side) showed significant interaction effects in favour of the exergame group.

Discussion

Additional exergaming helped maintaining global cognitive functioning and showed encouraging effects in mobility and cognitive outcomes. Responders and non-responders did not differ in adherence, baseline values or age. Enhancing the frequency and intensity of sessions could unlock more substantial benefits. Adopting a blended therapy approach may be key to maximizing positive effects.

Clinical trial registration

clinicaltrials.gov, identifier NCT05524727.

Cognitive Complaints in Patients with Suspected Obstructive Sleep Apnea Are Associated with Sleepiness, Fatigue, and Anxiety, Not with Final Diagnosis or Objective Cognitive Impairment

This study examined the nature, severity, and predictors of cognitive complaints in patients referred for suspected obstructive sleep apnea (OSA). The sample included 127 patients classified as no OSA (AHI, apnea/hypopnea index < 5, N = 32), mild OSA (AHI 5-15, N = 46), moderate OSA (AHI 15-30, N = 25), or severe OSA (AHI > 30, N = 24), and 53 healthy controls (HCs), matched for age, sex, education, and IQ. Cognitive complaints were assessed using the Cognitive Failure Questionnaire (CFQ) and the Behavioral Rating Inventory of Executive Functioning Adult Version (BRIEF-A). Regression analyses examined predictors of cognitive complaints including AHI, sleepiness, anxiety, depression, fatigue, and neuropsychological performance. Compared to HCs, those with mild OSA reported more forgetfulness, distractibility, and working memory issues, while those with severe OSA reported more difficulties with initiative, both with large effect sizes. Cognitive complaints were linked to sleepiness, anxiety, and fatigue (ß's 0.29-0.37), but not AHI or cognitive performance. Cognitive complaints were not specific to subjects with OSA but were also common among individuals with sleep complaints suspected for OSA. In conclusion, cognitive complaints were associated with anxiety, fatigue, and sleepiness rather than objective cognitive performance or impairment.

Contribution of cognitive status on admission to mobility and balance at discharge from acute rehabilitation for stroke

Acute inpatient rehabilitation is crucial for improving mobility and balance for individuals with stroke. A potentially important factor in the recovery of mobility and balance is cognition. The purpose of this study was to determine the effect of cognition on mobility and balance in acute stroke rehabilitation. This was a longitudinal cohort study based on an inpatient rehabilitation unit at a large academic medical center. Participants were individuals with stroke admitted to acute rehabilitation after an acute care hospital stay ( N  = 281). Demographic data and predictor variables were collected on admission to the unit. Outcomes were collected at discharge from the unit. Multiple regression analyses were used to determine the associations between cognition (Montreal Cognitive Assessment) on mobility (Functional Independence Measure mobility subscale) and balance (Berg Balance Scale). Subtests from the Montreal Cognitive Assessment were also examined to determine if specific dimensions of cognition could predict balance after controlling for covariates. Dominance analysis was used to determine the relative importance of baseline predictors. In separate models, cognition was a significant predictor of mobility ( B  = 0.19) and balance ( B  = 0.28) at discharge after adjusting for admission mobility and balance, as well as age, sex, and length of stay. The most important predictors in both models were baseline mobility and balance, but cognition contributed to the models independently of baseline scores. Cognition was generally more important than age and sex while about equally important as length of stay. In separate models, the visuospatial/executive ( B  = 0.42) and the delayed recall ( B  = 0.37) subtests were also significant predictors of mobility. The models' most important predictors were baseline mobility and balance scores. Cognition is a clinically relevant predictor of mobility and balance in acute stroke rehabilitation. Specific dimensions of cognition, such as executive function, visuospatial function, and delayed recall, may be especially important. Cognitive challenges and meta-cognitive strategies should be included in mobility and balance tasks when possible. Studies that evaluate the efficacy of dual-task training and meta-cognitive approaches are needed.

Associations Between Vestibular Perception and Cognitive Performance in Healthy Adults

OBJECTIVES

A growing body of evidence has linked vestibular function to the higher-order cognitive ability in aging individuals. Past evidence has suggested unique links between vestibular function and cognition on the basis of end-organ involvement (i.e., otoliths versus canals). However, past studies have only assessed vestibular reflexes despite the diversity of vestibular pathways. Thus, this exploratory study aimed to assess associations between vestibular perception and cognition in aging adults to determine potential relationships.

DESIGN

Fifty adults (21 to 84 years; mean = 52.9, SD = 19.8) were included in this cross-sectional study. All participants completed a vestibular perceptual threshold test battery designed to target perception predominantly mediated by each end-organ pair and intra-vestibular integration: 1 Hz y -translation (utricle), 1 Hz z -translation (saccule), 2 Hz yaw rotation (horizontal canals), 2 Hz right anterior, left posterior (RALP), and left anterior, right posterior (LARP) tilts (vertical canals), and 0.5 Hz roll tilt (canal-otolith integration). Participants also completed standard assessments of cognition and path integration: Digit Symbol Substitution Test (DSST), Trail Making Test (TMT), and the Gait Disorientation Test (GDT). Associations were assessed using Spearman rank correlation, and multivariable regression analyses.

RESULTS

For correlation analyses, DSST correlated to RALP/LARP tilt, roll tilt, and z -translation. TMT-A only correlated to z -translation, and TMT-B correlated to roll tilt and z -translation after correcting for multiple comparisons. GDT correlated to RALP/LARP tilt and y -translation. In age-adjusted regression analyses, DSST and TMT-B were associated with z -translation thresholds and GDT was associated with y -translation thresholds.

CONCLUSIONS

In this cross-sectional study, we identified associations between vestibular perceptual thresholds with otolith contributions and standard measures of cognition. These results are in line with past results suggesting unique associations between otolith function and cognitive performance.

The Role of Neuropsychology in the Management of Spinal Cord Injury: A Comprehensive Literature Review

Spinal cord injury (SCI) poses a complex set of physiological, psychological, and cognitive challenges that significantly affect an individual's quality of life. Analysis of longitudinal studies reveals that cognitive changes following SCI are often underestimated yet significantly impact patient's ability to adapt to their new circumstances. However, the role of neuropsychology in SCI management and rehabilitation is yet to be elucidated. This article offers an in-depth review of the role of neuropsychology in understanding and addressing the cognitive, emotional, and behavioral outcomes of SCI. Additionally, we delve into the emotional and psychological consequences of SCI, which can include increased stress, depression, anxiety, and potential changes in personality and social functioning. Neuropsychological assessment tools are highlighted as essential for diagnosing and monitoring these psychological shifts, aiding in the creation of personalized rehabilitation interventions. We also explore the role of neuroplasticity in cognitive rehabilitation post-SCI, emphasizing the potential of targeted cognitive training to alleviate cognitive deficits and improve adaptive functioning. The article further investigates the interplay between physical and cognitive recovery, underscoring the reciprocal relationship between motor function and cognitive improvement. In conclusion, this review emphasizes the crucial role of neuropsychology in understanding the multifaceted impact of SCI. By enhancing our comprehension of the intricate connections among neural integrity, cognitive function, and psychological well-being, neuropsychology provides valuable insights for developing holistic rehabilitation strategies that address both the cognitive and emotional challenges faced by individuals with SCI. As neurorehabilitation continues to advance, integrating neuropsychological principles offers promise for improving the overall recovery and quality of life for those affected by spinal cord injury.

Return-to-Play With R2Play: Protocol for Evaluating Cross-Site Feasibility, Face Validity, and Content Validity of a Multidomain Concussion Assessment Tool for Youth

CONTEXT

Clinical concussion assessments do not typically simulate the speed or complexity of sport. Performance changes arising from combined physical, cognitive, and sensory demands of sport may thus remain undetected during rehabilitation. We developed R2Play, a multidomain return-to-play assessment tool for youth with concussions. R2Play involves levels and conditions that vary in physical, cognitive, and sensory load to simulate the multidomain demands of sport.

OBJECTIVES

To explore cross-site feasibility, face validity, and content validity of R2Play by integrating quantitative and qualitative data.

METHODS

Convergent mixed-methods feasibility study. Five sites will each recruit 5 clinicians (total nc = 25) and 10 youth sport participants (ages 10-25 y) with a history of concussion in the previous year (total ny = 50). Feasibility will be evaluated using quantitative criteria for acceptability, demand, implementation, practicality, and integration, and qualitative investigated data from content analysis of postassessment interviews with youth and clinician participants. Face validity will be investigated in postassessment interviews. Content validity will be established through (1) changes in performance metrics (time to completion, errors, and heart rate) across R2Play levels, (2) youth-perceived physical and cognitive exertion for each level, and (3) overall clinician perceptions determined through postassessment interviews. Qualitative and quantitative data will be merged through joint display to identify areas of convergence, divergence, and complementarity, and to establish meta-inferences about feasibility, face validity, and content validity.

DISCUSSION

This study aims to demonstrate the face and content validity of R2Play, and its feasibility for cross-site implementation. Findings will guide further iteration of R2Play and establish the foundation for a larger multicenter validation study to establish the psychometric properties of R2Play. This work represents an important first step toward the implementation of an ecologically valid multidomain assessment tool designed to support a safe and efficient return-to-play after concussion, ultimately reducing the risk of recurrent concussion and subsequent injury.

Longitudinal Cognitive Changes in Cerebral Small Vessel Disease: The Effect of White Matter Hyperintensity Regression and Progression

BACKGROUND AND OBJECTIVES

White matter hyperintensities (WMHs) are the commonest imaging marker of cerebral small vessel disease (SVD) and a major cause of cognitive decline and vascular dementia. WMHs typically accumulate over time, but recent studies show they can also regress, but potential clinical benefits have received little attention. We examined progressing, stable, and regressing WMH in people with stroke-related SVD and the effect on cognitive outcomes.

METHODS

We recruited patients with minor nondisabling ischemic stroke (modified Rankin score ≤2) from stroke services into our prospective longitudinal observational study. Participants underwent cognitive assessment and brain MRI within 3-month poststroke and 1 year later. We gathered information on vascular risk factors, stroke severity, global cognition (Montreal Cognitive Assessment [MoCA]), processing speed and executive functioning (Trail Making Test [TMT] A and B, and the B/A ratio with ratio ≥3 reflecting executive dysfunction), and the Letter Digit Substitution Test. We measured WMH volumes at baseline and 1 year and categorized net WMH volume change into quintiles: Q1 (most regression), Q3 (stable), and Q5 (most progression). We applied repeated-measures linear mixed models to analyze longitudinal WMH and cognitive changes, adjusting for age, sex, premorbid intelligence, stroke severity, disability, white matter structural integrity, and baseline WMH volume.

RESULTS

One hundred ninety-eight of 229 participants had WMH volumes available at both time-points. At baseline, the mean age was 67.5 years (SD = 10.9), with 33% female. Mean net WMH volume change per quintile was Q1 -1.79 mL (SD = 1.54), Q2 -0.27 mL (0.20), Q3 0.35 mL (0.18), Q4 1.43 mL (0.48), and Q5 5.31 mL (3.07). MoCA deteriorated the most in participants with most WMH progression (Q5) (estimated β -0.428 [95% CI -0.750 to -0.106]), compared with stable WMH (Q3), with no clear deterioration in those with most WMH regression (Q1). TMT B/A ratio improved in participants with most WMH regression (Q1; -0.385 [-0.758 to -0.012]).

DISCUSSION

WMH regression was associated with preserved global cognition and improved executive function, compared with stable WMH, while WMH progression was associated with global cognitive decline. Cognitive benefits of WMH regression suggest that WMH-affected tissue can recover, may explain variance in cognitive outcomes, offer an important intervention target, and should be assessed in other populations and longer follow-up times.

Cognitive Training for Emotion-Related Impulsivity and Rumination: Protocol for a Pilot Randomized Waitlist-Controlled Trial

BACKGROUND

Inhibitory deficits are common in psychopathology. Emotion-related impulsivity (ERI) and rumination are general risk factors for psychiatric distress that are similarly associated with dysfunctional inhibition-particularly in affective contexts. A number of cognitive remediation procedures have been developed to improve inhibitory control; however, most remediation programs focus on "cold" cognition independent of affective processing. This pilot trial will gather preliminary evidence for a new cognitive training intervention targeting "hot" affective control (ie, inhibitory functions during elevated emotional arousal) in a transdiagnostic sample of adults who report heightened emotion dysregulation.

OBJECTIVE

This manuscript describes a protocol for a pilot randomized waitlist-controlled trial to assess changes in ERI and rumination after neurobehavioral affective control training (N-ACT), an 8-week cognitive training intervention designed to improve emotional response inhibition and emotional working memory. Our primary aim is to evaluate the efficacy, feasibility, and acceptability of N-ACT in reducing rumination and ERI, which we respectively conceptualize as complementary cognitive and behavioral consequences of emotion dysregulation. Secondarily, we will examine whether N-ACT leads to improvements in inhibitory control and, more distally, psychopathology symptoms.

METHODS

The final sample will comprise 80 adults who report high ERI or rumination. Participants will be randomized to (1) begin the N-ACT program without delay or (2) join a waitlist condition and then complete N-ACT. Exclusion criteria include active alcohol or substance use disorders, psychosis, and suicide risk. At the baseline and postintervention time points, participants will complete measures of emotion dysregulation and psychiatric symptoms, as well as a neuropsychological assessment of inhibitory control. Individuals assigned to the control group will undergo an identical assessment before joining the waitlist, followed by parallel assessments before and after N-ACT.

RESULTS

This trial is funded by support from the University of California Board of Regents and the Peder Sather Foundation (funding period: October 2022-September 2025). Recruitment is scheduled to begin in spring 2025. We will begin data analysis once data collection is complete, which is planned to occur in fall 2025.

CONCLUSIONS

This pilot randomized waitlist-controlled trial is designed to assess the initial efficacy, feasibility, and acceptability of N-ACT, a novel cognitive remediation approach developed to address 2 key contributors to psychopathology: ERI and rumination. The N-ACT program uses computerized adaptive behavioral tasks to strengthen the affective control processes theoretically and empirically linked to ERI and rumination. We hope this work will help inform future studies with sufficient statistical power to ascertain whether enhancing affective control through cognitive training (N-ACT) produces downstream reductions in psychiatric symptoms via improved emotion regulation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06226467; https://www.clinicaltrials.gov/study/NCT06226467; Open Science Framework Registry rak5z; https://osf.io/rak5z.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/54221.

Cognitive profile in burning mouth syndrome versus mild cognitive impairment: A comparative study

OBJECTIVES

This study aims to assess and contrast cognitive and psychological aspects of patients with burning mouth syndrome (BMS-MCI) and geriatric patients (G-MCI) with mild cognitive impairment, focusing on potential predictors like pain, mood disorders, blood biomarkers, and age-related white matter changes (ARWMCs).

METHODS

The study enrolled 40 BMS-MCI and 40 geriatric G-MCI, matching them by age, gender, and educational background. Participants underwent psychological, sleepiness, and cognitive assessment including the Mini-Mental State Exam (MMSE), Trail Making Test (TMT), Corsi Block-Tapping Task, Rey Auditory Verbal Learning Test, Copying Geometric Drawings Test, Frontal Assessment Battery, and Digit Cancellation Test.

RESULTS

G-MCI patients exhibited higher ARWMCs scores in right (p = 0.005**) and left (p < 0.001**) temporal regions, which may relate to specific neurodegenerative processes. Conversely, BMS-MCI patients showed higher levels of depression and anxiety and lower MMSE scores(p < 0.001**), also struggling more with tasks requiring processing speed and executive function, as evidenced by their higher TMT-A scores (p < 0.001**).

CONCLUSIONS

The study highlights particular deficits in global cognition and processing speed for BMS-MCI. The influence of educational background, pain levels, cholesterol, sleep disturbances, and anxiety on these cognitive assessments underscores the need for personalized therapeutic strategies addressing both cognitive and emotional aspects of MCI.

Contribution of physiological dynamics in predicting major depressive disorder severity

This study aimed to explore the physiological dynamics of cognitive stress in patients with Major Depressive Disorder (MDD) and design a multiparametric model for objectively measuring severity of depression. Physiological signal recordings from 40 MDD patients and 40 healthy controls were collected in a baseline stage, in a stress-inducing stage using two cognitive tests, and in the recovery period. Several features were extracted from electrocardiography, photoplethysmography, electrodermal activity, respiration, and temperature. Differences between values of these features under different conditions were used as indexes of autonomic reactivity and recovery. Finally, a linear model was designed to assess MDD severity, using the Beck Depression Inventory scores as the outcome variable. The performance of this model was assessed using the MDD condition as the response variable. General physiological hyporeactivity and poor recovery from stress predict depression severity across all physiological signals except for respiration. The model to predict depression severity included gender, body mass index, cognitive scores, and mean heart rate recovery, and achieved an accuracy of 78%, a sensitivity of 97% and a specificity of 59%. There is an observed correlation between the behavior of the autonomic nervous system, assessed through physiological signals analysis, and depression severity. Our findings demonstrated that decreased autonomic reactivity and recovery are linked with an increased level of depression. Quantifying the stress response together with a cognitive evaluation and personalization variables may facilitate a more precise diagnosis and monitoring of depression, enabling the tailoring of therapeutic interventions to individual patient needs.

Medial orbitofrontal cortex structure, function, and cognition associates with weight loss for laparoscopic sleeve gastrectomy

OBJECTIVE

The objective of this study was to investigate underlying mechanisms of long-term effective weight loss after laparoscopic sleeve gastrectomy (LSG) and effects on the medial orbitofrontal cortex (mOFC) and cognition.

METHODS

A total of 18 individuals with obesity (BMI ≥ 30 kg/m2) underwent LSG. Clinical data, cognitive scores, and brain magnetic resonance imaging scans were evaluated before LSG and 12 months after LSG. We employed voxel-based morphometry analysis and seed-based resting-state functional connectivity (RSFC) analysis to assess LSG-induced structural and functional changes in mOFC. Partial correlation analysis and univariate and multivariate linear regression models were used to explore associations among biochemical indexes, neuroimaging, cognition, and weight loss.

RESULTS

No significant improvement in general cognition was found after LSG. Decreases in gray matter volume of the bilateral mOFC and increases in RSFC of the right mOFC were observed 12 months after LSG. Weight loss was associated with RSFC, general cognitive scores, and triglyceride changes. Multivariate linear regression model revealed gray matter volume of the left mOFC and working memory scores at baseline explained 55.2% of the variation in weight loss.

CONCLUSIONS

These findings suggest that mOFC imaging and cognitive scores could serve as biomarkers for predicting persistent weight loss after LSG, which provides a solid foundation for a potential target for neuromodulation research.

Effect of transcranial direct current stimulation with cognitive training on executive functions in healthy older adults: a secondary analysis from the ACT trial

Cognitive aging has become a public health concern as the mean age of the population is ever-increasing. It is a naturalistic and common process of degenerative and compensatory changes that may result in neurocognitive disorders. While heterogeneous, cognitive aging mostly affects executive functions that may be associated with functional losses during activities of daily living. Cognition-oriented treatments like cognitive training and transcranial direct current stimulation (tDCS) have garnered considerable attention in the past few decades while the exact picture regarding their efficacy in healthy older adults has not been determined yet. The present paper aimed to evaluate the effects of a 3-month intervention of tDCS over the dorsolateral prefrontal cortex (DLPFC) with multimodal cognitive training on the Stroop test and Trail Making Tests A and B performance. One hundred and ninety-three healthy older adults from 2 sites were administered repeated sessions of active/sham tDCS with cognitive training. Baseline, post-intervention, and 1-year performance results between groups were compared using multiple linear regressions. Active tDCS resulted in better Stroop test performance at post-intervention (p = 0.033) but not at 1-year follow-up while no differences between groups were observed in Trail Making Tests A & B performance. The present results may correspond to a modest improvement in conflict monitoring, potentially due to modulation of prefrontal regions, without changing shifting performance. Further investigation is warranted to draw an interference regarding the subdomain-specific impact of repeated tDCS with multimodal cognitive training on executive functions.

Germain D, Dorsey SG. The National Cancer Institute clinical trials planning meeting to address gaps in observational and intervention trials for cancer-related cognitive impairment

Cancer-related cognitive impairment is a broad term encompassing subtle cognitive problems to more severe impairment. The severity of this impairment is influenced by host, disease, and treatment factors, and the impairment affects patients before, during, and following cancer treatment. The National Cancer Institute (NCI) Symptom Management and Health-Related Quality of Life Steering Committee (SxQoL SC) convened a clinical trial planning meeting to review the state of the science on cancer-related cognitive impairment and develop phase II/III intervention trials aimed at improving cognitive function in cancer survivors with non-central nervous system disease and longitudinal studies to understand the trajectory of cognitive impairment and contributing factors. Participants included experts in the field of cancer-related cognitive impairment, members of the SxQoL SC, patient advocates, representatives from all 7 NCI Community Oncology Research Program research bases, and the NCI. Presentations focused on the following topics: measurement, lessons learned from pediatric and geriatric oncology, biomarker and mechanism endpoints, longitudinal study designs, and pharmacological and behavioral intervention trials. Panel discussions provided guidance on priority cognitive assessments, considerations for remote assessments, inclusion of relevant biomarkers, and strategies for ensuring broad inclusion criteria. Three clinical trial planning meeting working groups (longitudinal studies as well as pharmacological and behavioral intervention trials) convened for 1 year to discuss and report on top priorities and to design studies. The meeting experts concluded that sufficient data exist to advance phase II/III trials using selected pharmacological and behavioral interventions for the treatment of cancer-related cognitive impairment in the non-central nervous system setting, with recommendations included herein.

Amplified Intraindividual Variability in Motor Performance in Stroke Survivors: Links to Cognitive and Clinical Outcomes

BACKGROUND

Intraindividual variability (IIV) in motor performance reflects unintentional fluctuations in the motor output across repeated attempts. Behavioral variability in older adults has been linked to impaired neuronal integrity and cognitive decline. Despite this, the traditional motor assessments in stroke have neglected to characterize IIV in motor performance also known as "motor inconsistency." Therefore, the aim of this study was to investigate the impact of stroke on motor inconsistency and its relationship with cognitive and clinical outcomes.

METHODS

Sixty-six stroke survivors and 32 healthy older adults performed 30 trials of a goal-directed task to match a force-time target of 10 N in 180 ms. To measure motor inconsistency, we applied a well-established approach to measuring IIV from the cognitive aging literature that accounts for the inherent, systematic effects of practice and mean-level performance on IIV. In addition, participants completed domain-specific cognitive evaluations and global clinical assessments. Domain-specific cognitive evaluations assessed episodic memory, visuospatial processing, processing speed, and executive function. Global clinical assessments included years of education as a proxy of cognitive reserve, the Dementia Rating Scale-2 (DRS-2), ankle strength, and the Modified Rankin Score (mRS).

RESULTS

Stroke survivors exhibited greater motor inconsistency compared with healthy older adults. Declines in domain-specific cognitive function, particularly executive dysfunction, predicted motor inconsistency in stroke survivors. Cognitive reserve and mRS emerged as significant predictors of motor inconsistency.

CONCLUSIONS

Stroke significantly impairs the ability to perform a motor task with consistency. Compromised executive function following stroke is associated with increased motor inconsistency. Interestingly, reduced cognitive reserve and greater functional disability are linked to increased motor inconsistency in stroke survivors. These findings highlight that inconsistency is an important indicator of motor dysfunction following stroke that is linked to cognitive and clinical outcomes and may serve as an important target for stroke rehabilitation.

Association between post-COVID-19 sleep disturbance and neurocognitive function: a comparative study based on propensity score matching

Despite that sleep disturbance and poor neurocognitive performance are common complaints among coronavirus disease 2019 (COVID-19) survivors, few studies have focused on the effect of post-COVID-19 sleep disturbance (PCSD) on cognitive function. This study aimed to identify the impact of PCSD on neurocognitive function and explore the associated risk factors for the worsening of this condition. This cross-sectional study was conducted via the web-based assessment in Chinese mainland. Neurocognitive function was evaluated by the modified online Integrated Cognitive Assessment (ICA) and the Number Ordering Test (NOT). Propensity score matching (PSM) was utilized to match the confounding factors between individuals with and without PCSD. Univariate analyses were performed to evaluate the effect of PCSD on neurocognitive function. The risk factors associated with worsened neurocognitive performance in PCSD individuals were explored using binary logistic regression. A total of 8692 individuals with COVID-19 diagnosis were selected for this study. Nearly half (48.80%) of the COVID-19 survivors reported sleep disturbance. After matching by PSM, a total of 3977 pairs (7954 individuals in total) were obtained. Univariate analyses revealed that PCSD was related to worse ICA and NOT performance (P<0.05). Underlying disease, upper respiratory infection, loss of smell or taste, severe pneumonia, and self-reported cognitive complaints were associated with worsened neurocognitive performance among PCSD individuals (P<0.05). Furthermore, aging, ethnicity (minority), and lower education level were found to be independent risk factors for worsened neurocognitive performance in PCSD individuals (P<0.05). PCSD was related to impaired neurocognitive performance. Therefore, appropriate prevention and intervention measures should be taken to minimize or prevent PCSD and eliminate its potential adverse effect on neurocognitive function.

Measuring working memory span with WAIS-IV: Digit sequence is the superior span test

The Digit Span test has been part of the Wechsler tests from the first version. In the WAIS-IV the Digit Span Sequencing subtest (DSS) was introduced and in the forthcoming WAIS-5 working memory span will also be measured in the visual modality. The present study analyzes WAIS-IV Digit Span, Letter- Number Span (LNS) and WMS-III Spatial Span (SS) performance in a mixed clinical sample, expecting to find that Digit Span Forwards (DSF) lacks sensitivity to the Working Memory impairment evident in D-KEFS Trail Making Test-4 (TMT-4) scores ≤1 SD below normative means in the sample. The results showed DSF score above normative means, Digit Span Backwards (DSB) around mean, while SS and LNS was slightly impaired and DSS impaired at the same level as TMT- 4. A double dissociation was observed in DSF and SS performance between subjects with Language- and Non-verbal learning disorders. Most subjects scored in the average range on the LNS-span and high kurtosis reduced sensitivity. Taking LNS and TMT-4 as criterion measures of WM, regression analyses showed no unique contribution of DSF to the variance in these tests. The study supports prior critiques regarding the composite Digit Span measure and demonstrates that the DSS are more effective than the current version of LNS in identifying reduced Working Memory capacity.

Age-specific effects of a sustained cognitive activity on perceived cognitive fatigue as well as single- and dual-task treadmill walking performance

During their daily lives humans are often confronted with sustained cognitive activities (SCA) leading to state fatigue, a psychobiological state characterized by a decrease in cognitive and/or motor performance and/or an increase in perception of fatigue. It was recently shown that performing SCA can impair overground dual-task gait performance in older adults, but it is currently unknown whether there is a task- and/or age-specific modulation in gait performance during treadmill walking. Therefore, the effect of a SCA on single- and dual-task treadmill walking performance was investigated in young and old adults. Using a crossover design, spatio-temporal gait parameters of 24 young and 23 older healthy participants were measured using motion capturing during single- and dual-task (including three cognitive interference tasks: word list generation, arithmetic, and Stroop-task) treadmill walking before and after SCA (30 min Stroop-task) and a control task (reading). Moreover, cognitive fatigue, wakefulness, mood, and arousal were assessed. Although the SCA induced age-specific perceptual responses, no difference was found for cognitive performance during the Stroop-task. The cognitive interference task performance (word list generation, arithmetic, and Stroop-task) during walking on the treadmill did not decrease after the SCA. Single- and dual-task gait performance (e. g., step width and step length) specifically changed after the SCA and after the reading control task in both groups. Data indicate that perceived cognitive fatigue has an impact on single- and dual-task treadmill walking performance, with task- and age-specific differences. Although no general age-specific changes in single- and dual task gait performance following SCA were identified, perceived cognitive fatigue should be considered as an intrinsic risk factor for falls.

Determining Clinical Disease Progression in Symptomatic Patients With CADASIL

BACKGROUND AND OBJECTIVES

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most frequent small artery brain disease caused by pathogenic variants of the NOTCH3 gene. During the disease, we still do not know how the various deficits progress and develop with each other at different stages of the disease. We aim to model disease progression and identify possible progressive subgroups and the effects of different covariates on clinical worsening.

METHODS

Data were obtained from patients followed in the French CADASIL referral center, who were aged 25-80 years and had completed at least 2 visits and one of 14 clinical scores. Progression and variability were assessed using a disease course model (Leaspy). A Gaussian mixture model was used to identify different progression subgroups. Logistic regressions were used to compare the characteristics between groups.

RESULTS

In 395 patients along 2,007 visits, the follow-up ranged from 6 months to 19 years, with a mean of 7.5 years. They were 45% men with a mean age of 52.2 years. The evolution curves of the different scores showed that clinical manifestations develop heterogeneously and can vary considerably depending on the disease stage. We identified an early-onset, rapidly progressing subgroup of patients with earlier motor symptoms and focal neurologic deficits (median time shift 59 [Q1-Q3 48.9-66.3], median acceleration rate 0.84 [0.07-1.31]) and a late-onset slowly progressing group with earlier cognitive symptoms (median time shift 69.2 [63.4-75.1], median acceleration rate -0.18 [-0.48 to 0.14]). Male sex, lower education level, hypertension, and NOTCH3 pathogenic variant location within epidermal growth factor-like repeat (EGFr) 1-6 were found to be associated with this group difference.

DISCUSSION

Our results suggest a gradual and heterogeneous decline in different clinical and cognitive performances over the lifetime of patients with CADASIL. Two progression profiles-one rapid and early and the other, more delayed and slower-are possible after the onset of symptoms. A major limitation of our study is that the clusters were assessed post hoc, which may induce some bias. Overall, male sex, low level of education, pathogenic variant location in EGFr 1 to 6 domains, smoking, and/or arterial hypertension may affect the clinical progression of the disease.

The added value of metadata on test completion time for the quantification of cognitive functioning in survey research

OBJECTIVE

Information on the time spent completing cognitive testing is often collected, but such data are not typically considered when quantifying cognition in large-scale community-based surveys. We sought to evaluate the added value of timing data over and above traditional cognitive scores for the measurement of cognition in older adults.

METHOD

We used data from the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) study (N = 4,091), to assess the added value of timing data over and above traditional cognitive scores, using item-specific regression models for 36 cognitive test items. Models were adjusted for age, gender, interviewer, and item score.

RESULTS

Compared to Quintile 3 (median time), taking longer to complete specific items was associated (p < 0.05) with lower cognitive performance for 67% (Quintile 5) and 28% (Quintile 4) of items. Responding quickly (Quintile 1) was associated with higher cognitive performance for 25% of simpler items (e.g., orientation for year), but with lower cognitive functioning for 63% of items requiring higher-order processing (e.g., digit span test). Results were consistent in a range of different analyses adjusting for factors including education, hearing impairment, and language of administration and in models using splines rather than quintiles.

CONCLUSIONS

Response times from cognitive testing may contain important information on cognition not captured in traditional scoring. Incorporation of this information has the potential to improve existing estimates of cognitive functioning.

Two sides of the same coin? What neural processing of emotion and rewards can tell us about complex post-traumatic stress disorder and borderline personality disorder

BACKGROUND

Borderline personality disorder (BPD) and complex posttraumatic stress disorder (cPTSD) share clinical similarities, complicating diagnosis and treatment. Research on the neurobiology of BPD and monotraumatic PTSD has shown that a prefrontal-limbic imbalance in emotional and reward processing is a hallmark of both disorders, but studies examining this network in cPTSD are lacking. Therefore, this study aimed to directly compare neural processing of emotion and reward during decision making in cPTSD and BPD.

METHODS

Using functional magnetic resonance imaging, we measured neural activity in female patients (27 patients with cPTSD, 21 patients with BPD and 37 healthy controls) during a Desire-Reason Dilemma task featuring distracting fearful facial expressions.

RESULTS

We found no differences in neural activation when comparing cPTSD and BPD. However, when grouping patients based on symptom severity instead on diagnosis, we found that increased symptoms of cPTSD were associated with increased activation of dorsolateral prefrontal cortex during reward rejection, whereas increased symptoms of BPD were associated with decreased activation in prefrontal and limbic regions during reward rejection with distracting negative emotional stimuli.

CONCLUSION

This is the first study to investigate and compare emotional processing and reward-based decision making in cPTSD and BPD. Although we found no neural differences between disorders, we identified symptom-related neural patterns. Specifically, we found that elevated cPTSD symptoms were related to greater sensitivity to reward stimuli, whereas heightened BPD symptoms were related to increased susceptibility to emotional stimuli during goal-directed decision making. These findings enhance our understanding of neural pathomechanisms in trauma-related disorders.

Which motor-cognitive abilities underlie the digital Trail-Making Test? Decomposing various test scores to detect cognitive impairment in Parkinson's disease-Pilot study

Since Parkinson's disease (PD) is a heterogeneous disorder with symptoms, such as tremors, gait and speech disturbances, or memory loss, individualized diagnostics are needed to optimize treatment. In their current form, the typical paper-pencil methods traditionally used to track disease progression are too coarse to capture the subtleties of clinical phenomena. For this reason, digital biomarkers that capture, for example, motor function, cognition, and behavior using apps, wearables, and tracking systems are becoming increasingly established. However, given the high prevalence of cognitive impairment in PD, digital cognitive biomarkers to predict mental progression are important in clinical practice. This pilot study aimed to identify those components of our digital version of the TMT (dTMT) that allow discrimination between PD patients with and without cognitive deficits. A total of 30 healthy control (age 66.3 ± 8.61) and 30 participants with PD (age 68.3 ± 9.66) performed the dTMT using a touch-sensitive tablet to capture enhanced performance metrics, such as the speed between and inside circles. The decomposition of cognitive abilities based on integrating additional variables in the dTMT revealed that the Parkinson's disease group was significantly more sensitive to parameters of inhibitory control. In contrast, the mild cognitive impairment group was sensitive to parameters of cognitive flexibility and working memory. The dTMT allows objective, ecologically valid, and long-term cognitive and fine-motor performance tracking, suggesting its potential as a digital biomarker in neurodegenerative disorders.

Intermittent hypoxia training improves cerebral blood flow without cognitive impairment

OBJECTIVE

Brief exposure to intermittent hypoxia has been shown to potentially induce protective effects in the body. Animal studies suggest that intermittent hypoxia could increase cerebral blood flow and confer resistance to subsequent hypoxic-ischemic injury, yet clinical investigations are limited. This study aimed to evaluate the impact of a moderate short-term intermittent hypoxia protocol on cerebral blood flow and cognitive performance.

METHODS

Subjects who met the inclusion criteria were recruited to this study and randomized into the intermittent hypoxia group or the control group, which receives intermittent hypoxia training and sham-intermittent hypoxia training, respectively. Cerebral hemodynamics, cognitive performance, cerebral perfusion pressure, and oxygen saturation were assessed before and after the intervention.

RESULTS

A total of 100 healthy participants were included in this study. Compared to the control group, the intermittent hypoxia group exhibited higher peak systolic blood flow velocity (108.64 ± 22.53 vs. 100.21 ± 19.06, p = 0.049) and cerebrovascular conduction index (0.74 ± 0.17 vs. 0.66 ± 0.21, p = 0.027), and lower cerebrovascular resistance index (1.41 ± 0.29 vs. 1.54 ± 0.36, p = 0.044) following intermittent hypoxia training. Additionally, within-group comparisons revealed that intermittent hypoxia training led to increased cerebral blood flow velocity, elevated cerebrovascular conductance index, and decreased cerebrovascular resistance index (p < 0.05). Other indicators including cognitive function, cerebral perfusion pressure, and oxygen saturation did not exhibit significant differences between groups.

INTERPRETATION

These findings revealed that intermittent hypoxia may represent a safe and effective strategy for improving cerebral blood flow.

Individual and Combined Effects of Sport-Related Concussion and Anterior Cruciate Ligament Injury on Neurocognitive and Neuromechanical Reaction Time

CONTEXT

Recent epidemiological data have indicated a potential connection between sport-related concussion (SRC) and elevated anterior cruciate ligament (ACL) injury risk. Limited research exists in which authors have quantified cognitive and motor outcome measures between SRC and ACL injury history.

OBJECTIVE

To examine the individual and combined effects of a history of SRC and ACL injury and reconstruction (ACLR) on neurocognitive and neuromechanical function.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Forty-seven recreationally active college individuals with either an injury history of SRC (n = 12), ACLR (n = 12), combination of SRC + ACLR (n = 11), or uninjured controls (n = 12).

MAIN OUTCOME MEASURE(S)

Participants completed a neurological battery using the C3 Logix application and TRAZER system for neuromechanical reaction time (RT). C3 Logix subtests consisted of the Trail Making Test (TMT) A, B, and B - A; simple and choice RT; and processing speed. TRAZER subtests consisted of simple, Flanker-task, and Stroop-task RT. Participants were categorized into 3 group comparisons of either (i) SRC, ACLR, SRC + ACLR, and controls, (ii) any or no SRC overall, or (iii) any or no ACLR overall.

RESULTS

No differences were demonstrated between SRC, ACLR, SRC + ACLR, and controls on TMT (P = .07-.14), neurocognitive (P = .14-.93), or neuromechanical (P = .64-.99) performance. Those with any SRC had slower TMT B - A times (P = .03), while those with any ACLR had slower TMT A (P = .02) times than those with no ACLR. No differences were noted for the TRAZER simple, Flanker, or Stroop RT for any or no SRC and ACLR groups.

CONCLUSIONS

College students with a combined effect of SRC and ACLR did not differ from other groups on neurocognition and neuromechanical RT. Individuals with a history of SRC or ACLR had a worse TMT, leading to inquiry about potential long-term neurological deficits, despite no differences in those with a combined history.

Personality, functional performance, and travel patterns related to older drivers' risky driving behavior: A naturalistic driving study

Older drivers are among the most vulnerable demographics within the road traffic system. The rising number of elderly motorists has raised public concern regarding their driving safety. It is crucial to understand the factors influencing risky driving behaviors among older drivers to enhance their safety. This study aimed to analyze the personality, functional performance, and travel patterns related to older drivers' risky driving behavior. The analysis utilized a sample of 58 older drivers, aged 65 years and above (mean age = 72.41 years; 40 males and 18 females) from the Nagoya metropolitan area. Risky driving behaviors and travel patterns were assessed using naturalistic driving data. Bivariate correlation analysis revealed that impulsivity and diminished contrast sensitivity were significantly correlated with more frequent risky driving behaviors. Additionally, both low driving exposure and high-risk driving routes (i.e., more frequent left and right turns, driving more on minor roads) were significantly correlated with an increased risk of harsh events. Moreover, a strong association was observed between driving exposure and driving route, indicating that the driving route of lower mileage drivers tend to be riskier. When the relationship between driving exposure and risky driving behaviors was adjusted for driving route, the strength of the correlation diminished from 0.35 to 0.16, rendering it insignificant. This partial correlation analysis suggests that the increased driving risk among low-mileage drivers can be partially attributed to their high-risk driving routes. The findings of this study provide further evidence regarding the role of personality in explaining older drivers' risky driving behavior and the explanation of older drivers' low-mileage bias.

Music-Evoked Autobiographical Memories are Associated with Negative Affect in Younger and Older Adults

BACKGROUND

Music evokes strong and persistent emotional responses. However, the mechanisms underlying the emotional effects of music, particularly in older adults, are largely unknown. One purported mechanism by which music evokes emotions is through memory - that is, music evokes personal, autobiographical memories that then lead to emotional responses.

METHOD

Here, we investigated whether memory-evoking music induces stronger and longer-lasting emotional responses than non-memory-evoking music, and whether these emotional responses differ between younger and older adults. Older (N = 30) and younger adults (N =30) listened to two blocks of self-selected music (one block of memory-evoking music and one block of familiar but non-memory-evoking music). Participants reported their emotions prior to and at three timepoints post-listening.

RESULTS

Older adults reported higher levels of positive affect than younger adults. For both groups, positive affect increased after listening to both memory-evoking and non-memory-evoking music. However, negative affect only increased after listening to memory-evoking music.

CONCLUSIONS

These results suggest that both memory-evoking and non-memory-evoking music generate strong emotions in younger and older adults, but music that conjures personal memories is more likely to elicit mixed emotions. Our results have important clinical implications when designing music-based interventions for mood and affect, particularly in older adult populations.

Impaired network organization in mild age-related hearing loss

Age-related hearing loss (ARHL) is considered one of the most common neurodegenerative disorders in the elderly; however, how it contributes to cognitive decline is poorly understood. With resting-state functional magnetic resonance imaging from 66 individuals with ARHL and 54 healthy controls, group spatial independent component analyses, sliding window analyses, graph-theory methods, multilayer networks, and correlation analyses were used to identify ARHL-induced disturbances in static and dynamic functional network connectivity (sFNC/dFNC), alterations in global network switching and their links to cognitive performances. ARHL was associated with decreased sFNC/dFNC within the default mode network (DMN) and increased sFNC/dFNC between the DMN and central executive, salience (SN), and visual networks. The variability in dFNC between the DMN and auditory network (AUN) and between the SN and AUN was decreased in ARHL. The individuals with ARHL had lower network switching rates than controls among global network nodes, especially in the DMN. Some disturbances within DMN were associated with disrupted executive and memory performance. The prolonged loss of sensory information associated with ARHL-induced compensatory within-network segregations and between-network integrations in the DMN might reduce network information processing and accelerate brain aging and cognitive decline.