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Covey TJ, Golan D, Sergott R, Wilken J, Zarif M, Bumstead B, Buhse M, Kaczmarek O, Doniger GM, Penner IK, Hancock LM, Bogaardt H, Barrera MA, Morrow SA, Galetta S, Gudesblatt M. Peering further into the mind's eye: combining visual evoked potential and optical coherence tomography measures enhances insight into the variance in cognitive functioning in multiple sclerosis. J Neurol 2024; 271:658-673. [PMID: 38091086 DOI: 10.1007/s00415-023-12075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Spectral Optical Coherence Tomography (OCT) and Visual Evoked Potentials (VEPs) have both emerged as potentially useful biomarkers of cognitive decline in people with multiple sclerosis (PwMS). Their combined use may provide additional predictive value for identifying disease impact, progression, and remyelination capacity above-and-beyond what is captured using either approach alone. OBJECTIVE We examined the relationship between OCT/VEP measures and cognitive functioning in 205 PwMS. OCT measures included Retinal Nerve Fiber Layer Volume (RNFLV), Papillo-Macular Bundle Volume (PBMV), and Macular Volume (MV). VEP measures included latency of the P100, and inter-ocular latency. Cognitive performance was evaluated across seven separate domains of performance, and for overall cognition, using the NeuroTrax computerized testing battery. RESULTS Both OCT and VEP measures were significantly correlated with cognitive performance across several domains. Linear regression models that controlled for the influence of visual acuity revealed (1) that reduced MV was significantly predictive of poorer visual-spatial functioning, and (2) that delayed VEP latency was significantly predictive of performance in global cognitive functioning and visual-spatial functioning, after controlling for multiple comparisons. Among PwMS with normal visual acuity, PwMS with a combination of both relatively low MV and delayed VEP latency tended to have poorer performance in the domains of global, executive, and visual-spatial functioning compared to PwMS with both high MV and normal VEP latency. CONCLUSION Approaches that combine the use of OCT and VEP measures can enhance insight into underlying factors that contribute to variance in cognitive functioning in PwMS.
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Affiliation(s)
- Thomas J Covey
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Sherman Hall Annex 114, Buffalo, NY, USA.
| | - Daniel Golan
- Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Robert Sergott
- Wills Eye Institute and the William H. Annesley EyeBrain Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA
- Department of Neurology, Georgetown University, Washington, DC, USA
| | - Myassar Zarif
- South Shore Neurologic Associates, New York University, Patchogue, New York, NY, USA
| | - Barbara Bumstead
- South Shore Neurologic Associates, New York University, Patchogue, New York, NY, USA
| | - MariJean Buhse
- South Shore Neurologic Associates, New York University, Patchogue, New York, NY, USA
| | - Olivia Kaczmarek
- South Shore Neurologic Associates, New York University, Patchogue, New York, NY, USA
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laura M Hancock
- Department of Neurology, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | - Marissa A Barrera
- Katz School of Science and Health, Yeshiva University, New York, NY, USA
| | - Sarah A Morrow
- London Health Sciences Centre, University of Western Ontario, Ontario, ON, Canada
| | - Steve Galetta
- Department of Neurology, New York University, New York, NY, USA
| | - Mark Gudesblatt
- South Shore Neurologic Associates, New York University, Patchogue, New York, NY, USA.
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Yamasaki T, Sugi T, Doniger GM. Editorial: New management strategies for older adults with cognitive decline. Front Med (Lausanne) 2023; 10:1282436. [PMID: 38105893 PMCID: PMC10722418 DOI: 10.3389/fmed.2023.1282436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Takao Yamasaki
- Department of Neurology, Minkodo Minohara Hospital, Fukuoka, Japan
- Kumagai Institute of Health Policy, Fukuoka, Japan
- School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Takenao Sugi
- Faculty of Science and Engineering, Saga University, Saga, Japan
| | - Glen M. Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
- School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
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Bergmann C, Becker S, Watts A, Sullivan C, Wilken J, Golan D, Zarif M, Bumstead B, Buhse M, Kaczmarek O, Covey TJ, Doniger GM, Penner IK, Hancock LM, Bogaardt H, Barrera MA, Morrow S, Gudesblatt M. Multiple sclerosis and quality of life: The role of cognitive impairment on quality of life in people with multiple sclerosis. Mult Scler Relat Disord 2023; 79:104966. [PMID: 37690436 DOI: 10.1016/j.msard.2023.104966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/05/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS), a chronic disease of the central nervous system (CNS), affects functional ability and quality of life (QoL). Depression, fatigue, and disability status are among the many factors that have been shown to impact QoL in people with MS, but the extent to which MS-related cognitive impairment is related to QoL is understudied in the literature. OBJECTIVE The purpose of this study was to determine relevant predictors of QoL from a wide list of symptoms including physical disability, and a multi-dimensional computerized cognitive assessment battery (CAB), depression, fatigue, and demographic variables (including employment status). In addition, the unique predictive power of cognitive impairment on QoL was explored in relation to other common factors of disease impact. METHODS 171 people with MS (PwMS) were evaluated with a computerized assessment battery (CAB), EDSS examination, and validated Patient Reported Outcome (PRO) measures (Multiple Sclerosis Impact Scale, MSIS-29; Beck Depression Inventory - Second Edition BDI-2; and the Modified Fatigue Impact Scale, MFIS). RESULTS 171 PwMS were included [Age: 46.02 years ± 9.85, 124 (72.5%) female]. Depression and fatigue scores were highly correlated with MSIS-29. EDSS, unemployment, memory, executive functioning, and motor skills were moderately correlated with MSIS-29. Predictors of QoL were EDSS, depression, fatigue, executive functioning, and attention. Attention and executive functioning were predictive of QoL even after controlling for demographic variables, fatigue, depression, and physical disability status. CONCLUSION Findings indicate the need for comprehensive and quantified evaluation of all factors associated with disease burden, which will ultimately serve to improve the QoL in PwMS through more targeted and patient-centered care.
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Affiliation(s)
| | - Shenira Becker
- Department of Veteran Affairs, Cedar Park, Texas, United States; Senseye, Inc., Austin, Texas, United States
| | - Adreanna Watts
- Washington Neuropsychology Research Group, Fairfax, Virginia
| | - Cynthia Sullivan
- Washington Neuropsychology Research Group, Fairfax, Virginia; Department of Neurology, Georgetown University, Washington, D.C, United States
| | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, Virginia; Department of Neurology, Georgetown University, Washington, D.C, United States
| | - Daniel Golan
- Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Myassar Zarif
- NYU Langone South Shore Neurologic Associates, New York University, Patchogue, New York, USA
| | - Barbara Bumstead
- NYU Langone South Shore Neurologic Associates, New York University, Patchogue, New York, USA
| | - MariJean Buhse
- NYU Langone South Shore Neurologic Associates, New York University, Patchogue, New York, USA; Department of Nursing, State University of Stony Brook, Stony Brook, New York, USA
| | - Olivia Kaczmarek
- NYU Langone South Shore Neurologic Associates, New York University, Patchogue, New York, USA
| | - Thomas J Covey
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Sherman Hall Annex Room 114, Buffalo, NY 14214, USA; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Laura M Hancock
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | - Marissa A Barrera
- Katz School of Science & Health, Yeshiva University, New York, NY, USA
| | - Sara Morrow
- London Health Sciences Centre, University of Western Ontario, Canada
| | - Mark Gudesblatt
- NYU Langone South Shore Neurologic Associates, New York University, Patchogue, New York, USA
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Bogaardt H, Golan D, Barrera MA, Attrill S, Kaczmarek O, Zarif M, Bumstead B, Buhse M, Wilken J, Doniger GM, Hancock LM, Penner IK, Halper J, Morrow SA, Covey TJ, Gudesblatt M. Cognitive impairment, fatigue and depression in multiple sclerosis: Is there a difference between benign and non-benign MS? Mult Scler Relat Disord 2023; 73:104630. [PMID: 36965219 DOI: 10.1016/j.msard.2023.104630] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION Multiple Sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system (CNS). The severity of disability in people with MS (PwMS) is generally measured with the Expanded Disability Status Scale (EDSS). A variant of MS known as 'benign MS' (BMS) has been defined as an EDSS score of 3 or lower, combined with a disease duration of 10 years or longer; however, there is disagreement in the field about whether BMS really exists. Given that the EDSS does not capture cognitive issues, communication dysfunction, fatigue, depression, or anxiety properly, its ability to accurately represent disability in all PwMS, including BMS, remains questionable. METHODS In this study, 141 persons with BMS (PwBMS) were included, consisting of 115 females (82%) and 26 males (18%) with a mean age of 50.8 (±8.68). A computerized test battery (NeuroTrax®) was used to assess cognition, covering seven cognitive domains (memory, executive function, visual-spatial processing, verbal function, attention, information processing, and motor skills). Fatigue was measured using the Fatigue Severity Scale (FSS). The Beck Depression Inventory (BDI) was used to assess symptoms of depression. Cognitive impairment was defined for this study as when someone has a score lower than 85 in at least two subdomains of the cognitive test battery. Rates of impairment were compared to 158 persons with non-benign MS (PwNBMS; with a disease duration of 10 years and longer and an EDSS score higher than 3) and 487 PwMS with a disease duration of fewer than 10 years. RESULTS Cognitive impairment was found in 38% of PwBMS and in 66% of PwNBMS (p<0.001). In PwBMS, the lowest rate of impairment was found in the verbal function domain (18%) and the highest rate of impairment in the domain of information processing (32%). Fatigue and depression were found in 78% and 55% of all PwBMS, with no difference in these rates between PwBMS and PwNBMS (p = 0.787 and p = 0.316 resp.) CONCLUSION: Cognitive impairment, fatigue and depression are common among people with an EDSS-based definition of benign MS. These aspects should be incorporated into a new and better definition of truly benign MS.
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Affiliation(s)
- Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia.
| | - Daniel Golan
- Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel; Department of Neurology, Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Marissa A Barrera
- Katz School of Science and Health, Yeshiva University, New York, United States
| | - Stacie Attrill
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | | | - Myassar Zarif
- South Shore Neurologic Associates, New York, United States
| | | | - Marijean Buhse
- South Shore Neurologic Associates, New York, United States; Department of Nursing, State University of Stony Brook, Stony Brook, NY, United States
| | - Jeffrey Wilken
- Georgetown University Dept of Neurology, Washington D.C. United States; Washington Neuropsychology Research Group, LLC., Fairfax, VA, United States
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | - Laura M Hancock
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - June Halper
- Consortium of Multiple Sclerosis Centers, Hackensack, NJ, United States
| | - Sarah A Morrow
- London Health Sciences Centre, University Hospital, University of Western Ontario (Western), Canada
| | - Thomas J Covey
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Mark Gudesblatt
- Katz School of Science and Health, Yeshiva University, New York, United States
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Jackson DA, Nicholson R, Bergmann C, Wilken J, Kaczmarek O, Bumstead B, Buhse M, Zarif M, Penner IK, Hancock LM, Golan D, Doniger GM, Bogaardt H, Barrera M, Covey TJ, Gudesblatt M. Cognitive impairment in people with multiple sclerosis: Perception vs. performance - factors that drive perception of impairment differ for patients and clinicians. Mult Scler Relat Disord 2023; 69:104410. [PMID: 36399966 DOI: 10.1016/j.msard.2022.104410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurologists' perceptions of the presence of cognitive impairment (CI) in people with multiple sclerosis (PwMS) may not always align with findings of objective cognitive assessment. The accuracy of self-reported CI in PwMS can also be highly variable across individuals, and may not align with objective measurement of cognitive disturbances. Research suggests that additional factors impact perceived cognitive ability, such as depression and fatigue. Objective cognitive screening regardless of patient or neurologist perception has been recommended but still is often limited in routine care. Moreover, comprehensive neuropsychological assessment is even less routinely done. OBJECTIVE To explore how neurologists' perceptions of PwMS' CI compare to the perception of the patient by determining whether PwMS and their clinicians are accurate in detecting the presence and degree of CI as defined by a multi-domain validated computerized test battery in PwMS, as well as investigate what factors influence perception of CI in each group. METHODS PwMS completed a computerized multi-domain cognitive testing battery, and self-reported measures of disease impact (MSIS-29), fatigue (MFIS), and depression (BDI-II). Disability was assessed by the clinician using the Expanded Disability Status Scale (EDSS). Clinicians and patients also provided an estimation of cognitive deficits along a Likert scale. RESULTS In this cohort of PwMS (N=202, age range: 20 to 88, gender: 71% female), their level of accuracy in detecting attention deficits (k = -.028, p = .010) was low but statistically significant. In contrast, clinicians' accuracy in detecting global CI (k = -.037, p < .001) and a number of specific domain deficits was moderate. Fatigue (p < .001) and cognitive performance (p = .012) significantly predicted patient perceived cognitive deficits. Clinician perceived cognitive performance was significantly predicted by multiple factors: cognitive scores (p < .001), physical disability (p = .011), age (p = .021), and depression (p = .038). CONCLUSION The need to objectively screen for CI in PwMS, regardless of perception, can be aided by a better understanding of the agreement and discrepancies between the patient and clinician regarding perceived cognitive disturbances and the presence of CI defined by a multi-dimensional objective screening battery.
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Affiliation(s)
- Daija A Jackson
- The Chicago School of Professional Psychology, Washington, D.C., USA.
| | | | | | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA
| | | | | | | | - Myassar Zarif
- South Shore Neurologic Associates, Patchogue, NY, USA
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Laura M Hancock
- University of Wisconsin School of Medicine, Madison, WI, USA; William S. Middleton VA Medical Center, Madison, WI, USA
| | - Daniel Golan
- Multiple Sclerosis and Neuroimmunology Center, Clalit Health Services, Nazareth, Israel; Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia
| | - Marissa Barrera
- Katz School of Science & Health, Yeshiva University, New York, NY, USA
| | - Thomas J Covey
- Department of Neurology, Division of Cognitive and Behavioral Neurosciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Weisinger B, Pandey DP, Saver JL, Hochberg A, Bitton A, Doniger GM, Lifshitz A, Vardi O, Shohami E, Segal Y, Reznik Balter S, Djemal Kay Y, Alter A, Prasad A, Bornstein NM. Frequency-tuned electromagnetic field therapy improves post-stroke motor function: A pilot randomized controlled trial. Front Neurol 2022; 13:1004677. [PMID: 36452175 PMCID: PMC9702345 DOI: 10.3389/fneur.2022.1004677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/05/2022] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Impaired upper extremity (UE) motor function is a common disability after ischemic stroke. Exposure to extremely low frequency and low intensity electromagnetic fields (ELF-EMF) in a frequency-specific manner (Electromagnetic Network Targeting Field therapy; ENTF therapy) is a non-invasive method available to a wide range of patients that may enhance neuroplasticity, potentially facilitating motor recovery. This study seeks to quantify the benefit of the ENTF therapy on UE motor function in a subacute ischemic stroke population. METHODS In a randomized, sham-controlled, double-blind trial, ischemic stroke patients in the subacute phase with moderately to severely impaired UE function were randomly allocated to active or sham treatment with a novel, non-invasive, brain computer interface-based, extremely low frequency and low intensity ENTF therapy (1-100 Hz, < 1 G). Participants received 40 min of active ENTF or sham treatment 5 days/week for 8 weeks; ~three out of the five treatments were accompanied by 10 min of concurrent physical/occupational therapy. Primary efficacy outcome was improvement on the Fugl-Meyer Assessment - Upper Extremity (FMA-UE) from baseline to end of treatment (8 weeks). RESULTS In the per protocol set (13 ENTF and 8 sham participants), mean age was 54.7 years (±15.0), 19% were female, baseline FMA-UE score was 23.7 (±11.0), and median time from stroke onset to first stimulation was 11 days (interquartile range (IQR) 8-15). Greater improvement on the FMA-UE from baseline to week 4 was seen with ENTF compared to sham stimulation, 23.2 ± 14.1 vs. 9.6 ± 9.0, p = 0.007; baseline to week 8 improvement was 31.5 ± 10.7 vs. 23.1 ± 14.1. Similar favorable effects at week 8 were observed for other UE and global disability assessments, including the Action Research Arm Test (Pinch, 13.4 ± 5.6 vs. 5.3 ± 6.5, p = 0.008), Box and Blocks Test (affected hand, 22.5 ± 12.4 vs. 8.5 ± 8.6, p < 0.0001), and modified Rankin Scale (-2.5 ± 0.7 vs. -1.3 ± 0.7, p = 0.0005). No treatment-related adverse events were reported. CONCLUSIONS ENTF stimulation in subacute ischemic stroke patients was associated with improved UE motor function and reduced overall disability, and results support its safe use in the indicated population. These results should be confirmed in larger multicenter studies. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04039178, identifier: NCT04039178.
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Affiliation(s)
| | - Dharam P. Pandey
- Manipal Hospital Physiotherapy and Rehabilitation, New Delhi, India
| | - Jeffrey L. Saver
- Department of Neurology, UCLA Comprehensive Stroke and Vascular Neurology Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | | | | | | | - Ofir Vardi
- BrainQ Technologies, Ltd., Jerusalem, Israel
| | - Esther Shohami
- BrainQ Technologies, Ltd., Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yaron Segal
- BrainQ Technologies, Ltd., Jerusalem, Israel
| | | | | | | | - Atul Prasad
- Department of Neurology, B. L. Kapur Super Specialty Hospital (BLK), National Capital Territory of Delhi, New Delhi, India
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7
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Gottlieb A, Doniger GM, Kimel-Naor S, Ben-Gal O, Cohen M, Iny H, Beeri MS, Plotnik M. Development and validation of virtual reality-based Rey Auditory Verbal Learning Test. Front Aging Neurosci 2022; 14:980093. [PMID: 36185470 PMCID: PMC9519387 DOI: 10.3389/fnagi.2022.980093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Translations and adaptations of traditional neuropsychological tests to virtual reality (VR) technology bear the potential to increase their ecological validity since the technology enables simulating everyday life conditions in a controlled manner. The current paper describes our translation of a commonly used neuropsychological test to VR, the Rey Auditory Verbal Learning Test (RAVLT). For this aim, we developed a VR adaptation of the RAVLT (VR-RAVLT) Which is based on a conversation with a secretary in a virtual office using a fully immersive VR system. To validate the VR-RAVLT, we tested its construct validity, its age-related discriminant validity and its test-retest validity in reference to the original gold standard RAVLT (GS-RAVLT). Method Seventy-eight participants from different age groups performed the GS-RAVLT and the VR-RAVLT tests in a counterbalanced order in addition to other neuropsychological tests. Construct validity was validated using Pearson’s correlations coefficients and serial position effects; discriminant validity was validated using receiver operating characteristic area under the curve values and test-retest reliability was validated using intraclass correlation coefficients. Results Comparing both RAVLTs’ format results indicates that the VR-RAVLT has comparable construct, discriminant and test–retest validities. Conclusion the novel VR-RAVLT and the GS-RAVLT share similar psychometric properties suggesting that the two tests measure the same cognitive construct. This is an indication of the feasibility of adapting the RAVLT to the VR environment. Future developments will employ this approach for clinical diagnosis and treatment.
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Affiliation(s)
- Amihai Gottlieb
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Glen M. Doniger
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Shani Kimel-Naor
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Oran Ben-Gal
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Maya Cohen
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Hila Iny
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Michal Schnaider Beeri
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Department of Physiology and Pharmacology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Meir Plotnik,
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8
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Whitehead JC, Neeman R, Doniger GM. Preliminary Real-World Evidence Supporting the Efficacy of a Remote Neurofeedback System in Improving Mental Health: Retrospective Single-Group Pretest-Posttest Study. JMIR Form Res 2022; 6:e35636. [PMID: 35802411 PMCID: PMC9308076 DOI: 10.2196/35636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Neurofeedback training (NFT) has been shown to be effective in treating several disorders (eg, attention-deficit/hyperactivity disorder [ADHD], anxiety, and depression); however, little is currently known regarding the effectiveness of remote NFT systems.
Objective
This retrospective study provides real-world data (N=593) to assess the efficacy of app-based remote NFT in improving brain health and cognitive performance.
Methods
Improvement was measured from pre- to postintervention of in-app assessments that included validated symptom questionnaires (the 12-item General Health Questionnaire, the ADHD Rating Scale IV, the Adult ADHD Self-Report Scale, the 7-item Generalized Anxiety Disorder scale, and the 9-item Patient Health Questionnaire), a cognitive test of attention and executive functioning (ie, continuous performance task), and resting electroencephalography (EEG) markers. Clinically significant improvement was evaluated using standard approaches.
Results
The greatest improvement was reported for the anxiety questionnaire, for which 69% (68/99) of participants moved from abnormal to healthy score ranges. Overall, adult and child participants who engaged in neurofeedback to improve attention and executive functions demonstrated improved ADHD scores and enhanced performance on a cognitive (ie, response inhibition) task. Adults with ADHD additionally demonstrated elevated delta/alpha and theta/alpha ratios at baseline and a reduction in the delta/alpha ratio indicator following neurofeedback.
Conclusions
Preliminary findings suggest the efficacy of app-based remote neurofeedback in improving mental health, given the reduced symptom severity from pre- to postassessment for general psychological health, ADHD, anxiety, and depression, as well as adjusted resting EEG neural markers for individuals with symptoms of ADHD. Collectively, this supports the utility of the in-app assessment in monitoring behavioral and neural indices of mental health.
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Affiliation(s)
- Jocelyne C Whitehead
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
- Myndlift Ltd, Tel Aviv, Israel
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9
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Covey TJ, Golan D, Doniger GM, Sergott R, Zarif M, Bumstead B, Buhse M, Kaczmarek O, Mebrahtu S, Bergmann C, Wilken J, Gudesblatt M. Longitudinal assessment of the relationship between visual evoked potentials and cognitive performance in multiple sclerosis. Clin Neurophysiol 2022; 137:66-74. [DOI: 10.1016/j.clinph.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/24/2022] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
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Covey TJ, Golan D, Doniger GM, Sergott R, Zarif M, Bumstead B, Buhse M, Kaczmarek O, Mebrahtu S, Bergmann C, Wilken J, Gudesblatt M. The relationship between cognitive impairment, cognitive fatigue, and visual evoked potential latency in people with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103349. [DOI: 10.1016/j.msard.2021.103349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 10/20/2022]
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11
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Gottlieb A, Doniger GM, Hussein Y, Noy S, Plotnik M. The Efficacy of a Virtual Reality Exposure Therapy Treatment for Fear of Flying: A Retrospective Study. Front Psychol 2021; 12:641393. [PMID: 34211419 PMCID: PMC8239461 DOI: 10.3389/fpsyg.2021.641393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Fear of flying (FoF) is a phobia with 10-40% prevalence in the industrialized world. FoF is accompanied by severe economic, social, vocational, and emotional consequences. In recent years, virtual reality (VR)-based exposure therapy (VRET) for FoF has been introduced. Positive long-term efficacy of FoF-VRET has been reported by several studies, which, however, were limited by relatively small, non-representative samples and a lack of comparative pre/post functional efficacy outcome measures. Our objective was to evaluate the efficacy of a VRET treatment utilizing a large-scale VR system, experienced by a representative sample of self-referred individuals. Methods: We conducted a retrospective survey. Of 274 individuals who received the treatment (over a period of 3 years), 209 met inclusion/criteria, and 98 agreed to participate. We mainly collected information regarding flight activity before and after treatment relying on evidence such as boarding passes and flight tickets. The primary outcome measures were (1) number of flights per month (FpM) and (2) number of flight hours per month (FHpM). For each participant, these outcomes were computed for the post-treatment period (≥6 months after FoF-VRET) and the corresponding pre-treatment period. Results: FpM (mean ± SD) increased from 0.04 ± 0.06 to 0.16 ± 14 flights (p < 0.0001). FHpM rose from 0.19 ± 0.35 to 0.79 ± 0.87 h per month (p < 0.0001). Conclusion: These results are indicative of FoF-VRET treatment efficacy. Future studies should evaluate long-term maintenance of the treatment effect and thus identify the optimal frequency for delivery of periodic booster treatments.
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Affiliation(s)
- Amihai Gottlieb
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Glen M Doniger
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Yara Hussein
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Shlomo Noy
- Department of Psychiatry, Sheba Medical Center, Ramat Gan, Israel.,Ono Academic College, Kiryat-Ono, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel.,Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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12
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Covey TJ, Golan D, Doniger GM, Sergott R, Zarif M, Srinivasan J, Bumstead B, Wilken J, Buhse M, Mebrahtu S, Gudesblatt M. Visual evoked potential latency predicts cognitive function in people with multiple sclerosis. J Neurol 2021; 268:4311-4320. [PMID: 33870445 DOI: 10.1007/s00415-021-10561-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Prior studies have reported an association between visual evoked potentials (VEPs) and cognitive performance in people with multiple sclerosis (PwMS), but the specific mechanisms that account for this relationship remain unclear. We examined the relationship between VEP latency and cognitive performance in a large sample of PwMS, hypothesizing that VEP latency indexes not only visual system functioning but also general neural efficiency. Standardized performance index scores were obtained for the domains of memory, executive function, visual-spatial processing, verbal function, attention, information processing speed, and motor skills, as well as global cognitive performance (NeuroTrax battery). VEP P100 component latency was obtained using a standard checkerboard pattern-reversal paradigm. Prolonged VEP latency was significantly associated with poorer performance in multiple cognitive domains, and with the number of cognitive domains in which performance was ≥ 1 SD below the normative mean. Relationships between VEP latency and cognitive performance were significant for information processing speed, executive function, attention, motor skills, and global cognitive performance after controlling for disease duration, visual acuity, and inter-ocular latency differences. This study provides evidence that VEP latency delays index general neural inefficiency that is associated with cognitive disturbances in PwMS.
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Affiliation(s)
- Thomas J Covey
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University At Buffalo, Sherman Hall Annex Room 114, Buffalo, NY, 14214, USA. .,Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, University At Buffalo, Buffalo, NY, USA.
| | - Daniel Golan
- Department of Neurology and Multiple Sclerosis Center, Lady Davis Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | | | - Myassar Zarif
- South Shore Neurologic Associates, 712 Main Street, Islip, Patchogue, NY, USA
| | - Jared Srinivasan
- South Shore Neurologic Associates, 712 Main Street, Islip, Patchogue, NY, USA
| | - Barbara Bumstead
- South Shore Neurologic Associates, 712 Main Street, Islip, Patchogue, NY, USA
| | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA.,Department of Neurology, Georgetown University, Washington, DC, USA
| | - Marijean Buhse
- South Shore Neurologic Associates, 712 Main Street, Islip, Patchogue, NY, USA
| | - Samson Mebrahtu
- South Shore Neurologic Associates, 712 Main Street, Islip, Patchogue, NY, USA
| | - Mark Gudesblatt
- South Shore Neurologic Associates, 712 Main Street, Islip, Patchogue, NY, USA.
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13
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Elkana O, Adelson M, Sason A, Doniger GM, Peles E. Improvement in Cognitive Performance after One Year of Methadone Maintenance Treatment. Psychiatry Res 2020; 294:113526. [PMID: 33126016 DOI: 10.1016/j.psychres.2020.113526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
Individuals with substance use disorders are known to suffer from stress, poor sleep, and cognitive impairment. We investigated whether individuals with opioid use disorder would improve cognitive performance following a year of methadone maintenance treatment (MMT). Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), and a standardized computerized cognitive battery were administered at admission (T0) to 29 patients, and repeatedly following one year of MMT (T1) by 19 patients. Admission measures did not differ between those who studied once or twice. Patients who perceived very high stress levels (PSS ≥24) at T0 (11, 37.9%) had lower computerized global cognitive scores (67.6±16.2 vs. 90.9±12.5 p≤0.0005). At T1, PSS and PSQI scores improved significantly among 11 patients with no substance abuse, but worsened among 8 with substance abuse (PSS p(interaction)=0.009, p(groups)=0.005, PSQI p(interaction)=0.01, p(groups)=0.04). Global cognitive score improved at T1 for the entire sample (81.8±20.1 to 89.2±13.8, p=0.05). Differentiation by high stress at T0 or by substance abuse at T1 subgroups showed that improvement was observed by those with very low cognitive scores at T0. Patients with poor cognition may improve following one year of MMT, due to stress and substance abuse reduction. Interventions for stress reduction are recommended.
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Affiliation(s)
- Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv, Yaffo, Israel
| | - Miriam Adelson
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Israel
| | - Anat Sason
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Israel
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | - Einat Peles
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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14
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Ben-Gal O, Benady A, Zadik S, Doniger GM, Schnaider Beeri M, Plotnik M. Using the loading response peak for defining gait cycle timing: A novel solution for the double-belt problem. J Biomech 2020; 110:109963. [PMID: 32889150 DOI: 10.1016/j.jbiomech.2020.109963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
Split-belt treadmills (SBTM) contain force plates under each belt that measure ground reaction force (GRF). Initial contact (IC) detection for each gait cycle obtained from the GRF is used for calculating temporal gait parameters (e.g., gait variability, step time, stride time). Occasionally, the participant steps with one leg on the contralateral belt (i.e., crossing) making the IC undetectable and the calculation of temporal gait parameters are compromised. We term this the double-belt problem (DBP). OBJECTIVE here we developed a complementary detection method using the loading response peak (LRP), anchor point for calculating gait parameters. METHODS we used GRF gait data from twenty adults (age 56.45 ± 4.81 y; 6 males) who walked on an SBTM. First, we used no-crossing gait periods free of the DBP to calculate stride time, step time, and stride time to stride time coefficient of variation and evaluated the true error and the normalized true error of the LRP detection method. Then, we used multiple comparisons between no-crossing data and crossing data. RESULTS we found that normalized errors (in comparison to the IC method) are ≤5.1%. Strong correlations were found between gait parameters computed based on the two detection methods (Intraclass correlation coefficient ≥0.97; p ≤ 0.001). CONCLUSION detecting gait cycle timing based on the LRP detection method is reliable for estimating temporal gait parameters, demonstrating high correspondence with the gold standard IC detection method.
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Affiliation(s)
- Oran Ben-Gal
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Amit Benady
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; St George's University of London Medical School, Sheba Medical Center, Ramat Gan, Israel
| | - Sean Zadik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; St George's University of London Medical School, Sheba Medical Center, Ramat Gan, Israel
| | - Glen M Doniger
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Michal Schnaider Beeri
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel; Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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15
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Golan D, Doniger GM, Srinivasan J, Sima DM, Zarif M, Bumstead B, Buhse M, Van Hecke W, Wilken J, Gudesblatt M. The association between MRI brain volumes and computerized cognitive scores of people with multiple sclerosis. Brain Cogn 2020; 145:105614. [PMID: 32927305 DOI: 10.1016/j.bandc.2020.105614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Computerized cognitive assessment facilitates the incorporation of multi-domain cognitive monitoring into routine clinical care. The predictive validity of computerized cognitive assessment among people with multiple sclerosis (PwMS) has scarcely been investigated. OBJECTIVE To explore the associations between brain volumes and cognitive scores from a computerized cognitive assessment battery (CAB, NeuroTrax) among PwMS. METHODS PwMS were evaluated with the CAB and underwent brain MRI within 40 days. Cognitive assessment yielded age- and education-adjusted scores in 9 cognitive domains: memory, executive function, attention, information processing speed, visual spatial, verbal function, motor skills, problem solving, and working memory. The global cognitive score (GCS) is the average of all domain scores. MRI brain and lesion volumes were assessed with icobrain ms, a fully automated tissue and lesion segmentation and quantification software. RESULTS 91 PwMS were included [Age: 52.1 ± 11.7 years, 64 (70%) female, EDSS: 3.4 ± 2.0, 79 (87%) with a relapsing remitting course]. Significant correlations were found between the GCS and whole brain, white matter, grey matter, thalamic, lateral ventricles, hippocampal and lesion volumes (Correlation coefficients: 0.46, 0.40, 0.25, 0.42, -0.36, 0.21, -0.3, respectively). Regression analysis revealed that lateral ventricles and thalamic volumes were the most consistent predictors of all cognitive domain scores. CONCLUSION Computerized cognitive scores were significantly associated with quantified MRI. These findings support the predictive validity of multi-domain computerized cognitive assessment for people with multiple sclerosis.
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Affiliation(s)
- Daniel Golan
- Department of Neurology & Multiple Sclerosis Center, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | | | - Diana M Sima
- Research and Development Department, icometrix, Leuven, Belgium
| | - Myassar Zarif
- South Shore Neurologic Associates, Patchogue, NY, USA
| | | | | | - Wim Van Hecke
- Research and Development Department, icometrix, Leuven, Belgium
| | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA; Department of Neurology, Georgetown University, Washington DC, USA
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16
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Cano Porras D, Zeilig G, Doniger GM, Bahat Y, Inzelberg R, Plotnik M. Seeing Gravity: Gait Adaptations to Visual and Physical Inclines - A Virtual Reality Study. Front Neurosci 2020; 13:1308. [PMID: 32038123 PMCID: PMC6992711 DOI: 10.3389/fnins.2019.01308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 11/22/2019] [Indexed: 11/13/2022] Open
Abstract
Using advanced virtual reality technology, we demonstrate that exposure to virtual inclinations visually simulating inclined walking induces gait modulations in a manner consistent with expected gravitational forces (i.e., acting upon a free body), suggesting vision-based perception of gravity. The force of gravity critically impacts the regulation of our movements. However, how humans perceive and incorporate gravity into locomotion is not well understood. In this study, we introduce a novel paradigm for exposing humans to incongruent sensory information under conditions constrained by distinct gravitational effects, facilitating analysis of the consistency of human locomotion with expected gravitational forces. Young healthy adults walked under conditions of actual physical inclinations as well as virtual inclinations. We identify and describe ‘braking’ and ‘exertion’ effects – locomotor adaptations accommodating gravito-inertial forces associated with physical inclines. We show that purely visual cues (from virtual inclinations) induce consistent locomotor adaptations to counter expected gravity-based changes, consistent with indirect prediction mechanisms. Specifically, downhill visual cues activate the braking effect in anticipation of a gravitational boost, whereas uphill visual cues promote an exertion effect in anticipation of gravitational deceleration. Although participants initially rely upon vision to accommodate environmental changes, a sensory reweighting mechanism gradually reprioritizes body-based cues over visual ones. A high-level neural model outlines a putative pathway subserving the observed effects. Our findings may be pivotal in designing virtual reality-based paradigms for understanding perception and action in complex environments with potential translational benefits.
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Affiliation(s)
- Desiderio Cano Porras
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Perception and Action in Complex Environments, Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium
| | - Gabriel Zeilig
- Department of Neurological Rehabilitation, Sheba Medical Center, Ramat Gan, Israel.,Department of Physical and Rehabilitation Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Glen M Doniger
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel.,Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel.,The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Yotam Bahat
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Rivka Inzelberg
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Golan D, Wilken J, Doniger GM, Fratto T, Kane R, Srinivasan J, Zarif M, Bumstead B, Buhse M, Fafard L, Topalli I, Gudesblatt M. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord 2019; 30:154-162. [DOI: 10.1016/j.msard.2019.01.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/04/2019] [Accepted: 01/29/2019] [Indexed: 11/25/2022]
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18
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Cohen-Manheim I, Sinnreich R, Doniger GM, Simon ES, Pinchas-Mizrachi R, Kark JD. Fasting plasma glucose in young adults free of diabetes is associated with cognitive function in midlife. Eur J Public Health 2019; 28:496-503. [PMID: 29140417 DOI: 10.1093/eurpub/ckx194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Evidence for an association of fasting plasma glucose (FPG) with cognitive function in adults free of diabetes is scarce and based on middle-aged and older adults. We examined the association of FPG, measured at age 30, and of change in FPG from age 30 to 43, with cognitive function at age 50. Methods 505 nondiabetic participants of the population-based Jerusalem Lipid Research Clinic (LRC) cohort study had baseline FPG, 2-h post-oral challenge plasma glucose (OGTT) and insulin determined at ages 28-32, and FPG and OGTT again at ages 41-46. Subsequently at ages 48-52, global cognitive function and its five specific component domains were assessed with a NeuroTrax computerized test battery, using multiple linear regression and multivariable logistic models. Results Hyperglycemia (FPG ≥ 5.6 mmol/l vs. <5.6 mmol/l) at baseline was associated with poorer global cognitive function in midlife (predominantly in the visual spatial and attention domains), independent of socio-demographic characteristics, life style variables, body mass index (BMI), and inflammatory and biochemical variables (standardized Beta = -0.121, P = 0.002, plinear trend(FPG continuous) =0.016). Similarly, increased odds for low-ranked (lowest fifth) global cognition was evident (ORper mmol/l FPG=2.31, 95% CI = 1.30-4.13, P = 0.005). Baseline OGTT, insulin resistance (HOMA-IR) and change in FPG and OGTT over 13 years were not associated with cognition. Conclusion A higher FPG in young adults was associated with lower cognitive performance in midlife. Although we cannot dismiss the possibility of reverse causation, hyperglycemia at a young age may be a modifiable risk factor for low-ranked cognitive function in midlife.
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Affiliation(s)
- Irit Cohen-Manheim
- Epidemiology Unit, Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Ronit Sinnreich
- Epidemiology Unit, Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel.,Center for Medical Decision Making, Ono Academic College, Kiryat Ono, Israel
| | - Ely S Simon
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel.,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ronit Pinchas-Mizrachi
- Epidemiology Unit, Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Jeremy D Kark
- Epidemiology Unit, Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
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Abstract
OBJECTIVES To confirm our previous findings of less cognitive impairments (based on cognitive screening tools) among methadone maintenance treatment (MMT) patients who achieved take-home dose (THD) privileges. METHODS a random sample of 65 Israeli MMT patients were studied using computerised, age and education standardised, cognitive domains (attention, executive function, memory, motor skills), and non-computerised phonetic and semantic verbal fluency. RESULTS Cognitive scores were within ±1 standard deviation (SD) of average for most domains, including non-verbal IQ, attention and motor skills. Verbal fluency and memory were >1 SD below average (mean = 84; z = -1.1 for both). Females were younger than the males and had poorer motor skills (P = 0.005) but better verbal memory (P < 0.0005). Opiate usage duration correlated with reaction time (P = 0.05) and inversely with verbal memory (P = 0.01). Overall cognitive function was poorest among 25 (38.5%) current drug users, and 6 (9.2%) lifetime schizophrenia patients. Cognitive domains were comparable between THD privileges subgroups. CONCLUSIONS Despite heterogeneity in MMT duration, abuse duration, substance use and psychiatric comorbidity, all performed within ±1 SD of average for age and education in most cognitive domains. Our findings challenge the notion of MMT as being synonymous with compromised cognition and may lead to reduced bias regarding cognitive function of MMT patients.
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Affiliation(s)
- Odelia Elkana
- a Behavioral Sciences , Academic College of Tel Aviv-Yaffo , Tel Aviv , Israel
| | - Miriam Adelson
- b Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Glen M Doniger
- c Department of Clinical Research , NeuroTrax Corporation , Modiin , Israel.,d Sagol Neuroscience Center & Center of Advanced Technologies in Rehabilitation , Sheba Medical Center , Ramat-Gan , Israel
| | - Anat Sason
- b Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Einat Peles
- b Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.,e Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,f Sagol School of Neuroscience , Tel Aviv University , Tel Aviv , Israel
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20
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Doniger GM, Beeri MS, Bahar-Fuchs A, Gottlieb A, Tkachov A, Kenan H, Livny A, Bahat Y, Sharon H, Ben-Gal O, Cohen M, Zeilig G, Plotnik M. Virtual reality-based cognitive-motor training for middle-aged adults at high Alzheimer's disease risk: A randomized controlled trial. Alzheimers Dement (N Y) 2018; 4:118-129. [PMID: 29955655 PMCID: PMC6021455 DOI: 10.1016/j.trci.2018.02.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction Ubiquity of Alzheimer's disease (AD) coupled with relatively ineffectual pharmacologic treatments has spurred interest in nonpharmacologic lifestyle interventions for prevention or risk reduction. However, evidence of neuroplasticity notwithstanding, there are few scientifically rigorous, ecologically relevant brain training studies focused on building cognitive reserve in middle age to protect against cognitive decline. This pilot study will examine the ability of virtual reality (VR) cognitive training to improve cognition and cerebral blood flow (CBF) in middle-aged individuals at high AD risk due to parental history. Methods The design is an assessor-blind, parallel group, randomized controlled trial of VR cognitive-motor training in middle-aged adults with AD family history. The experimental group will be trained with adaptive “real-world” VR tasks targeting sustained and selective attention, working memory, covert rule deduction, and planning, while walking on a treadmill. One active control group will perform the VR tasks without treadmill walking; another will walk on a treadmill while watching scientific documentaries (nonspecific cognitive stimulation). A passive (waitlist) control group will not receive training. Training sessions will be 45 minutes, twice/week for 12 weeks. Primary outcomes are global cognition and CBF (from arterial spin labeling [ASL]) at baseline, immediately after training (training gain), and 3 months post-training (maintenance gain). We aim to recruit 125 participants, including 20 passive controls and 35 in the other groups. Discussion Current pharmacologic therapies are for symptomatic AD patients, whereas nonpharmacologic training is administrable before symptom onset. Emerging evidence suggests that cognitive training improves cognitive function. However, a more ecologically valid cognitive-motor VR setting that better mimics complex daily activities may augment transfer of trained skills. VR training has benefited clinical cohorts, but benefit in asymptomatic high-risk individuals is unknown. If effective, this trial may help define a prophylactic regimen for AD, adaptable for home-based application in high-risk individuals.
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Affiliation(s)
- Glen M. Doniger
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
- Corresponding author. Tel.: +97235304874; Fax: +97235307572.
| | - Michal Schnaider Beeri
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Bahar-Fuchs
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Center for Research on Aging, Health, and Wellbeing, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
- The Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Amihai Gottlieb
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Anastasia Tkachov
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Hagar Kenan
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Abigail Livny
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Yotam Bahat
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Hadar Sharon
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Oran Ben-Gal
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Maya Cohen
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Gabi Zeilig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurological Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Cohen-Manheim I, Doniger GM, Sinnreich R, Simon ES, Murad H, Pinchas-Mizrachi R, Kark JD. Body Mass Index, Height and Socioeconomic Position in Adolescence, Their Trajectories into Adulthood, and Cognitive Function in Midlife. J Alzheimers Dis 2018; 55:1207-1221. [PMID: 27814299 DOI: 10.3233/jad-160843] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Whether life course anthropometric indices relate to cognitive function in midlife remains insufficiently explored. Rarely was socioeconomic position (SEP) adequately accounted for. OBJECTIVE To examine the association of the cumulative life course burden of high-ranked body mass index (BMI), its trajectory, and stature with cognitive function in midlife. METHODS Weight and height were measured from age 17 across a 33-year follow-up. 507 individuals completed a NeuroTrax computerized cognitive assessment at ages 48-52. Life course SEP was assessed by multiple methods. Using mixed models we calculated the area under the curve (AUC), representing both the life-course burden of BMI (total AUC) and trends in BMI (incremental AUC) from age 17 to midlife. The associations of BMI and height with global cognition and its five component domains were assessed by multiple regression. RESULTS Higher BMI in late adolescence and total AUC over the life course were associated with poorer global cognition (Standardized beta (Beta) = -0.111, p = 0.005 and Beta = -0.105, p = 0.018, respectively), adjusted for childhood and adulthood SEP, and demographic characteristics. The associations with higher adolescent and midlife BMI were both restricted to those with low childhood SEP (p < 0.05 for interaction). Short adolescent stature was related to poorer cognition (Beta = 0.115, p = 0.040), whereas late final growth in women was associated with better cognition (Beta = 0.213, p = 0.007). CONCLUSION An adverse association of higher BMI with cognitive function began in adolescence and was restricted to low childhood SEP. Taller stature in both sexes and late growth in women were associated with better midlife cognitive performance.
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Affiliation(s)
- Irit Cohen-Manheim
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel.,Centre for Medical Decision Making, Ono Academic College, Kiryat Ono, Israel
| | - Ronit Sinnreich
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Ely S Simon
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel.,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Havi Murad
- Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Israel
| | - Ronit Pinchas-Mizrachi
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Jeremy D Kark
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
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22
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Doniger GM, Plotnik M, Bahar‐Fuchs A, Gottlieb A, Tkachov A, Bahat Y, Sharon H, Ben‐Gal O, Zeilig G, Beeri MS. [P2–040]: VIRTUAL REALITY‐BASED COGNITIVE‐MOTOR TRAINING FOR MIDDLE‐AGED ADULTS AT HIGH AD RISK: STUDY DESIGN AND BASELINE CHARACTERISTICS FROM A RANDOMIZED CONTROLLED TRIAL. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Meir Plotnik
- Sheba Medical CenterRamat GanIsrael
- Tel Aviv UniversityTel AvivIsrael
| | - Alex Bahar‐Fuchs
- Sheba Medical CenterRamat GanIsrael
- The Australian National UniversityCanberraAustralia
- The University of MelbourneMelbourneAustralia
| | - Amihai Gottlieb
- Sheba Medical CenterRamat GanIsrael
- Tel Aviv UniversityTel AvivIsrael
| | | | | | | | | | - Gabi Zeilig
- Sheba Medical CenterRamat GanIsrael
- Tel Aviv UniversityTel AvivIsrael
| | - Michal Schnaider Beeri
- Mount Sinai School of MedicineNew YorkNYUSA
- The Joseph Sagol Neuroscience Center, Sheba Medical CenterRamat GanIsrael
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Miron-Shatz T, Rapaport SR, Srebnik N, Hanoch Y, Rabinowitz J, Doniger GM, Levi L, Rolison JJ, Tsafrir A. Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability. J Genet Couns 2017; 27:59-68. [DOI: 10.1007/s10897-017-0120-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
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24
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Golan D, Doniger GM, Wissemann K, Zarif M, Bumstead B, Buhse M, Fafard L, Lavi I, Wilken J, Gudesblatt M. The impact of subjective cognitive fatigue and depression on cognitive function in patients with multiple sclerosis. Mult Scler 2017; 24:196-204. [PMID: 28273778 DOI: 10.1177/1352458517695470] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The association between subjective cognitive fatigue and objective cognitive dysfunction in patients with multiple sclerosis (PwMS) has been studied, with conflicting results. OBJECTIVE To explore the impact of fatigue on cognitive function, while controlling for the influence of depression, disability, comorbidities, and psychotropic medications. METHODS PwMS completed a computerized cognitive testing battery with age- and education-adjusted cognitive domain scores. Disability (Expanded Disability Status Scale (EDSS)), cognitive fatigue, and depression were concurrently evaluated. RESULTS In all, 699 PwMS were included. Both cognitive fatigue and depression were significantly and negatively correlated with the same cognitive domains: information processing speed, executive function, attention, motor function, and memory (-0.15 ⩽ r ⩽ -0.14 for cognitive fatigue; -0.24 ⩽ r ⩽ -0.19 for depression). Multivariate analysis revealed significant but small independent correlations only between depression and neuropsychological test results, while cognitive fatigue had no independent correlation with objective cognitive function except for a trend toward impaired motor function in highly fatigued PwMS. Depression and cognitive fatigue accounted for no more than 6% of the variance in objective cognitive domain scores. CONCLUSION Cognitive fatigue is not independently related to objective cognitive impairment. Depression may influence cognitive function of PwMS primarily when it is severe. Cognitive impairment in PwMS should not be ascribed to fatigue or mild depression.
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Affiliation(s)
- Daniel Golan
- Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel/The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel/The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel/Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | | | - Myassar Zarif
- South Shore Neurologic Associates, Patchogue, NY, USA
| | | | - Marijean Buhse
- South Shore Neurologic Associates, Patchogue, NY, USA/Stony Brook University, Stony Brook, New York USA
| | - Lori Fafard
- South Shore Neurologic Associates, Patchogue, NY, USA
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA/Department of Neurology, Georgetown University, Washington, DC, USA
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25
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Cohen-Manheim I, Pinchas-Mizrachi R, Doniger GM, Simon ES, Sinnreich R, Kark JD. Measures of carotid atherosclerosis and cognitive function in midlife: The Jerusalem LRC longitudinal study. Intelligence 2016. [DOI: 10.1016/j.intell.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Currall SC, Hammer TH, Baggett LS, Doniger GM. Combining Qualitative and Quantitative Methodologies to Study Group Processes:An Illustrative Study of Acorporate Board of Directors. Organizational Research Methods 2016. [DOI: 10.1177/109442819921002] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In this demonstration article, the authors explain procedures for combining the richness of detail that is characteristic of qualitative data collection with the hypothesis testing advantage of statistical inference techniques. Qualitative data came from a 5-year participant observation study of a corporate board of directors. Quantification of the participant observer’s qualitative field notes was achieved by using content analysis to code directors’ verbal behaviors. Based on counts of directors’ verbal behaviors, the authors tested illustrative hypotheses concerning group process within the board. Univariate (Cox-Stuart’s test of trend), bivariate (Kendall’s nonparametric correlation), and multivariate (log Poisson regression with post hoc contrasts) analyses were conducted. The study’s use of qualitative and quantitative information promoted both “discovery” (i.e., theory development) and “justification” (i.e., theory evaluation) and facilitated a “discovery-justification-discovery cycle” that was particularly useful for understanding group processes with the corporate board.
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Cohen-Manheim I, Doniger GM, Sinnreich R, Simon ES, Pinchas-Mizrachi R, Otvos JD, Kark JD. Increase in the Inflammatory Marker GlycA over 13 Years in Young Adults Is Associated with Poorer Cognitive Function in Midlife. PLoS One 2015; 10:e0138036. [PMID: 26406330 PMCID: PMC4583455 DOI: 10.1371/journal.pone.0138036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/24/2015] [Indexed: 01/08/2023] Open
Abstract
Background Inflammatory markers are elevated in patients with dementia. Evidence for an association between inflammation and cognitive function in dementia-free individuals is sparse, inconsistent, and predominantly restricted to the elderly. Assessment of inflammatory markers in young adults as predictors of cognitive function in midlife, well before the onset of overt dementia, is lacking. Furthermore, rarely has the relation with longitudinal change in inflammatory markers been examined. Objective To examine the association of the inflammatory markers C-reactive protein (CRP), fibrinogen, white blood cell count (WBC) and GlycA, a novel NMR-determined biomarker of systemic inflammation, measured in young adulthood and of GlycA change over 13 years follow-up with cognitive function in midlife. Methods 507 participants of the Jerusalem Lipid Research Clinic (LRC) study were assessed at 3 time points over 18–22 years. First, the inflammatory variables GlycA, CRP, fibrinogen, and WBC were measured in blood samples drawn at ages 28–32. Then, in blood samples drawn a mean 13 years later (range, 12–16 years) at ages 41–46, GlycA was again measured (in 484 individuals). Subsequently at ages 48–52, on average 7 years later, global cognitive function and its five specific component domains were assessed with a NeuroTrax computerized test battery. Multiple regression and multivariable logistic models were applied. Results Inverse unadjusted associations were shown for baseline levels and longitudinal change in inflammatory markers and measures of cognition. Multiple regression models were adjusted for age at cognitive assessment, sex, socio-demographic characteristics, baseline measures of leisure-time vigorous activity, smoking status and body mass index (BMI) at ages 28–32, change in smoking status and BMI between ages 28–32 and 41–46, and depression assessed at the time of cognitive testing. The highest quintile of GlycA change, but not the baseline inflammation measures, was inversely related to global cognition (standardized β = -.109, p = .011) as well as to the information processing speed and memory domains (standardized β = -.124, p = .008 and-.117, p = .014, respectively). The multivariable-adjusted odds ratio for low ranked global cognitive function (lowest fifth) comparing the extreme quintiles of GlycA change was 4.8 (95%CI, 1.7–13.5, p = .003; p for trend = .031). Conclusions In this longitudinal study of a novel systemic inflammatory marker in a population-based cohort of young adults, GlycA increase over 13 years, but not baseline measures of inflammation, was associated with poorer cognitive function in midlife.
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Affiliation(s)
- Irit Cohen-Manheim
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, 91120, Israel
| | - Glen M. Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, 71711, Israel
- Center for Medical Decision Making, Ono Academic College, Kiryat Ono, 55000, Israel
| | - Ronit Sinnreich
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, 91120, Israel
| | - Ely S. Simon
- Department of Clinical Research, NeuroTrax Corporation, Modiin, 71711, Israel
- Department of Neurology, Albert Einstein College of Medicine, the Bronx, New York City, New York, 10461, United States of America
| | - Ronit Pinchas-Mizrachi
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, 91120, Israel
| | - James D. Otvos
- LabCorp, Raleigh, North Carolina, 27616, United States of America
| | - Jeremy D. Kark
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, 91120, Israel
- * E-mail:
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Bar-Hen M, Doniger GM, Golzad M, Geva N, Schweiger A. Empirically derived algorithm for performance validity assessment embedded in a widely used neuropsychological battery: Validation among TBI patients in litigation. J Clin Exp Neuropsychol 2015; 37:1086-97. [DOI: 10.1080/13803395.2015.1078294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Miron-Shatz T, Bhargave R, Doniger GM. Milestone Age Affects the Role of Health and Emotions in Life Satisfaction: A Preliminary Inquiry. PLoS One 2015; 10:e0133254. [PMID: 26244348 PMCID: PMC4526679 DOI: 10.1371/journal.pone.0133254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 06/24/2015] [Indexed: 11/25/2022] Open
Abstract
Jill turns 40. Should this change how she evaluates her life, and would a similar change occur when she turns 41? Milestone age (e.g., 30, 40, 50)—a naturally occurring feature in personal timelines—has received much attention is popular culture, but little attention in academic inquiry. This study examines whether milestone birthdays change the way people evaluate their life. We show that life outlook is impacted by this temporal landmark, which appears to punctuate people’s mental maps of their life cycle. At these milestone junctures, people take stock of where they stand and have a more evaluative perspective towards their lives when making life satisfaction judgments. Correspondingly, they place less emphasis on daily emotional experiences. We find that milestone agers (vs. other individuals) place greater weight on health satisfaction and BMI and lesser weight on daily positive emotions in their overall life satisfaction judgments, whereas negative emotions remain influential.
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Affiliation(s)
- Talya Miron-Shatz
- Center for Medical Decision Making, Ono Academic College, Kiryat Ono, Israel
- * E-mail:
| | - Rajesh Bhargave
- Department of Marketing, University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Glen M. Doniger
- Center for Medical Decision Making, Ono Academic College, Kiryat Ono, Israel
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Achiron A, Chapman J, Magalashvili D, Dolev M, Lavie M, Bercovich E, Polliack M, Doniger GM, Stern Y, Khilkevich O, Menascu S, Hararai G, Gurevich M, Barak Y. Modeling of cognitive impairment by disease duration in multiple sclerosis: a cross-sectional study. PLoS One 2013; 8:e71058. [PMID: 23936485 PMCID: PMC3731335 DOI: 10.1371/journal.pone.0071058] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/26/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/AIMS Large-scale population studies measuring rates and dynamics of cognitive decline in multiple sclerosis (MS) are lacking. In the current cross-sectional study we evaluated the patterns of cognitive impairment in MS patients with disease duration of up to 30 years. METHODS 1,500 patients with MS were assessed by a computerized cognitive battery measuring verbal and non-verbal memory, executive function, visual spatial perception, verbal function, attention, information processing speed and motor skills. Cognitive impairment was defined as below one standard deviation (SD) and severe cognitive impairment as below 2SD for age and education matched healthy population norms. RESULTS Cognitive performance in our cohort was poorer than healthy population norms. The most frequently impaired domains were information processing speed and executive function. MS patients with secondary-progressive disease course performed poorly compared with clinically isolated syndrome, relapsing-remitting and primary progressive MS patients. By the fifth year from disease onset, 20.9% of patients performed below the 1SD cutoff for impairment, p=0.005, and 6.0% performed below the 2SD cutoff for severe cognitive impairment, p=0.002. By 10 years from onset 29.3% and 9.0% of patients performed below the 1SD and 2SD cutoffs, respectively, p=0.0001. Regression modeling suggested that cognitive impairment may precede MS onset by 1.2 years. CONCLUSIONS The rates of cognitive impairment in this large sample of MS patients were lower than previously reported and severe cognitive impairment was evident only in a relatively small group of patients. Cognitive impairment differed significantly from expected normal distribution only at five years from onset, suggesting the existence of a therapeutic window during which patients may benefit from interventions to maintain cognitive health.
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Affiliation(s)
- Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel.
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Sasson E, Doniger GM, Pasternak O, Tarrasch R, Assaf Y. White matter correlates of cognitive domains in normal aging with diffusion tensor imaging. Front Neurosci 2013; 7:32. [PMID: 23493587 PMCID: PMC3595518 DOI: 10.3389/fnins.2013.00032] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/26/2013] [Indexed: 11/17/2022] Open
Abstract
The ability to perform complex as well as simple cognitive tasks engages a network of brain regions that is mediated by the white matter fiber bundles connecting them. Different cognitive tasks employ distinctive white matter fiber bundles. The temporal lobe and its projections subserve a variety of key functions known to deteriorate during aging. In a cohort of 52 healthy subjects (ages 25–82 years), we performed voxel-wise regression analysis correlating performance in higher-order cognitive domains (executive function, information processing speed, and memory) with white matter integrity, as measured by diffusion tensor imaging (DTI) fiber tracking in the temporal lobe projections [uncinate fasciculus (UF), fornix, cingulum, inferior longitudinal fasciculus (ILF), and superior longitudinal fasciculus (SLF)]. The fiber tracts were spatially registered and statistical parametric maps were produced to spatially localize the significant correlations. Results showed that performance in the executive function domain is correlated with DTI parameters in the left SLF and right UF; performance in the information processing speed domain is correlated with fractional anisotropy (FA) in the left cingulum, left fornix, right and left ILF and SLF; and the memory domain shows significant correlations with DTI parameters in the right fornix, right cingulum, left ILF, left SLF and right UF. These findings suggest that DTI tractography enables anatomical definition of region of interest (ROI) for correlation of behavioral parameters with diffusion indices, and functionality can be correlated with white matter integrity.
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Affiliation(s)
- Efrat Sasson
- Department of Neurobiology, Faculty of Life Sciences, Tel Aviv University Tel Aviv, Israel
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Oyama G, Rodriguez RL, Jones JD, Swartz C, Merritt S, Unger R, Hubmann M, Delgado A, Simon E, Doniger GM, Bowers D, Foote KD, Fernandez HH, Okun MS. Selection of Deep Brain Stimulation Candidates in Private Neurology Practices: Referral May Be Simpler than a Computerized Triage System. Neuromodulation 2012; 15:246-50; discussion 250. [DOI: 10.1111/j.1525-1403.2012.00437.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Miron-Shatz T, Golan O, Brezis M, Siegal G, Doniger GM. Shared decision-making in Israel: status, barriers, and recommendations. Isr J Health Policy Res 2012; 1:5. [PMID: 22913605 PMCID: PMC3415133 DOI: 10.1186/2045-4015-1-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 01/30/2012] [Indexed: 11/27/2022] Open
Abstract
Shared decision making (SDM) - involving patients in decisions relevant to their health - has been increasingly influential in medical thought and practice around the world. This paper reviews the current status of SDM in Israel, including efforts to promote SDM in the legislation and healthcare system, its influence in medical training and the national health plans, and funding for SDM-related research. Published studies of SDM in Israel are also reviewed. Although informed consent and patients' right to information are regulated by Israeli law, little provision is made for SDM. Further, there are few organized programs to promote SDM among medical professionals or the public, and governmental support of SDM-related research is minimal. Nonetheless, patients have begun to influence litigation in both formal and informal capacities, medical schools have begun to incorporate courses for improving physician-patient communication into their curricula, and the largest national health plan has initiated a plan to increase public awareness. A review of the limited research literature suggests that although patients and physicians express a desire for greater patient involvement, they often have reservations about its implementation. Research also suggests that despite the positive effects of SDM, such an approach may only infrequently be applied in actual clinical practice. In conclusion, though not actively promoting SDM at present, Israel's universal coverage and small number of health plans make rapid, widespread advances in SDM feasible. Israeli policymakers should thus be encouraged to nurture burgeoning initiatives and set plausible milestones. Comparing the status of SDM in Israel with that in other countries may stimulate further advancement.
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Affiliation(s)
- Talya Miron-Shatz
- Center for Medical Decision Making, Ono Academic Collage, Kiryat Ono, Israel
- Wharton School of Business, University of Pennsylvania, Philadelphia, PA, USA
| | - Ofra Golan
- The Unit for Genetic Policy and Bioethics, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Mayer Brezis
- Center for Clinical Quality and Safety, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Gil Siegal
- The Unit for Genetic Policy and Bioethics, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
- Center for Health Law, Bioethics and Health Policy, Ono Academic College, Kiryat Ono, Israel
| | - Glen M Doniger
- Center for Medical Decision Making, Ono Academic Collage, Kiryat Ono, Israel
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Sasson E, Doniger GM, Pasternak O, Assaf Y. Structural correlates of memory performance with diffusion tensor imaging. Neuroimage 2010; 50:1231-42. [DOI: 10.1016/j.neuroimage.2009.12.079] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 11/08/2009] [Accepted: 12/18/2009] [Indexed: 10/20/2022] Open
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Abstract
Few objective cognitive assessment tools have been validated for mild cognitive impairment (MCI) in African Americans despite higher prevalence of disease. This preliminary study evaluated discriminant validity of a computerized cognitive assessment battery for MCI in an urban African American cohort. Twenty-seven participants with MCI and 22 cognitively healthy individuals completed a multidomain battery (Mindstreams, NeuroTrax Corp, New Jersey). Mild cognitive impairment participants performed more poorly than cognitively healthy participants in all domains, with significant differences in memory (P = .003; d = 0.96), executive function (P = .046; d = 0.64), and overall battery performance (P = .041; d = 0.63). Adjustment for intelligence quotient (IQ) yielded significant differences in memory (P < .001; d = 1.34), executive function (P = .007; d = 0.86), attention (P = .014; d = .80), and overall performance (P = .001; d = 1.09). Such a validated battery may help to address an important clinical need in this population.
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Affiliation(s)
- Glen M Doniger
- Department of Clinical Science, NeuroTrax Corporation, Newark, New Jersey 07103, USA.
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Affiliation(s)
- Glen M. Doniger
- Department of Clinical ScienceNeuroTrax CorporationNewarkNew Jersey
| | - Ely S. Simon
- Department of Clinical ScienceNeuroTrax CorporationNewarkNew Jersey
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37
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Sasson E, Doniger GM, Pasternak O, Assaf Y. Structural correlates of memory performance with diffusion tensor imaging. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Simon ES, Simon DR, Dwolatzky T, Tanne D, Goldstein FC, Doniger GM. P3‐045: Relevance of computerized cognitive assessment to functional disability in a mildly impaired elderly cohort. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.04.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | - David Tanne
- Chaim Sheba Medical CenterTel HaShomerIsrael
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Doniger GM, Simon ES, Schweiger A. Adjustment of cognitive scores with a co-normed estimate of premorbid intelligence: implementation using mindstreams computerized testing. ACTA ACUST UNITED AC 2009; 15:250-63. [PMID: 19023742 DOI: 10.1080/09084280802325074] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neuropsychological assessment is critically dependent upon comparison to a standard normative database. While generally appropriate for individuals of near-average intelligence, high-intelligence individuals may be erroneously scored as unimpaired and low-intelligence individuals as impaired on cognitive measures. The current paper describes an approach for minimizing such misclassifications that is standardized and practical for clinical use. A computerized test of nonverbal reasoning co-normed with cognitive measures is used for automatic adjustment of normalized cognitive scores. This premorbid estimate showed good construct validity, and adjustment raised cognitive scores for low-intelligence individuals, and lowered cognitive scores for high-intelligence individuals similarly across demographic (age, education, computer experience) and clinical (cognitively healthy, mild cognitive impairment, dementia) subgroups. Adjustment was typically up to three normalized units for scores on the premorbid estimate of +/-1 SD and 6 normalized units for scores of +/-2 SD. The present approach shows promise as a practical solution for assessment of high- and low-intelligence individuals.
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Elstein D, Doniger GM, Simon E, Korn-Lubetzki I, Navon R, Zimran A. Neurocognitive testing in late-onset Tay-Sachs disease: a pilot study. J Inherit Metab Dis 2008; 31:518-23. [PMID: 18618288 DOI: 10.1007/s10545-008-0884-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 03/31/2008] [Accepted: 04/01/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To test neurocognitive function in patients with late-onset Tay-Sachs disease (LOTS) using a computerized system to assess whether cognition is a clinically relevant outcome measure of possible therapeutic intervention in LOTS. METHODS Ten adults with Tay-Sachs disease were administered at least one battery of the Mindstreams Neurotrax system for evaluation of cognitive function. Six sub-scores and a Global Cognitive Score (GCS) were tabulated. A disease specific severity score was also devised with six domains. RESULTS Despite identical genotypes, all patients but the two oldest had > or = 3/6 sub-scores one standard deviation below normal mean (100); verbal and executive functions were most affected. The severity score measured other functions. CONCLUSIONS Because of provocative findings on re-testing in patients exposed to miglustat, and despite the very small cohort, cognitive function may be an appropriate and clinically relevant outcome measure for future therapeutic interventions in LOTS.
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Affiliation(s)
- D Elstein
- Gaucher Clinic, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem, 91031, Israel.
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Simon ES, Dwolatzky T, Goldstein F, Doniger GM, Levey AI, Lah J, Friger M. P1‐170: Non‐verbal memory performance is associated with conversion to dementia within one year: A prospective study of mild cognitive impairment using computerized cognitive assessment. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simon ES, Sasson E, Doniger GM, Pasternak O, Assaf Y. P2‐081: Brain localization of cognitive domains with diffusion MRI. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | | | - Yaniv Assaf
- Tel Aviv University/Tel Aviv Sourasky Medical CenterTel AvivIsrael
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Fillit HM, Simon ES, Doniger GM, Cummings JL. Practicality of a computerized system for cognitive assessment in the elderly. Alzheimers Dement 2008; 4:14-21. [DOI: 10.1016/j.jalz.2007.09.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 07/25/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
Affiliation(s)
| | - Ely S. Simon
- Department of Clinical ScienceNeuroTrax CorporationNewarkNJUSA
- Center for Neurosciences, The Feinstein Institute for Medical ResearchNorth Shore-Long Island Jewish Health SystemManhassetNYUSA
| | - Glen M. Doniger
- Department of Clinical ScienceNeuroTrax CorporationNewarkNJUSA
| | - Jeffrey L. Cummings
- Department of NeurologyAlzheimer's Disease Research CenterDavid Geffen School of Medicine at UCLALos AngelesCAUSA
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Abstract
Cognitive impairment is amongst the main symptoms affecting multiple sclerosis (MS) and should be comprehensively and accurately assessed. To study the added value of a computerized neuropsychological battery enabling the measurement of response times in the cognitive domains, 58 randomly selected MS patients and 71 age-, gender- and education-matched healthy subjects were evaluated. Construct and discriminant validity were assessed for the standard Neuropsychological Screening Battery for Multiple Sclerosis (NSBMS) and the Mindstreams Computerized Cognitive Battery (MCCB). The MCCB demonstrated good construct validity in comparison with the NSBMS in memory (P < 0.001), executive function (P < 0.001), attention (P < 0.05) and information processing (P < 0.05) domains. In addition, it showed high discriminant validity most prominently for executive function, attention and motor skills (P < 0.001). Response times measured by the computerized battery were longer in all cognitive domains and varied with cognitive load, demonstrating that response time deficits in MS are associated with particular task demands. We conclude that in MS prolonged response times on a range of cognitive tasks signify abnormal conduction within demyelinative tracts.
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Affiliation(s)
- A Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel.
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Abstract
BACKGROUND Despite interest in causes of dementia in older persons, particularly in post-menopausal women, it is unclear whether hormone replacement therapy (HRT) is a risk factor. AIM To assess cognitive function in post-menopausal women with high educational status receiving HRT, compared to non-users. DESIGN Cognitive functioning was assessed with in women aged 55-60 years with at least university-level education, using the Mindstreams system, a computerized cognitive battery with multiple domains. RESULTS Of 165 women meeting the inclusion/exclusion criteria, 82 women (49.7%) declined participation. Of the remaining 83, 40 (48.2%) had never received HRT; the remainder was divided into women receiving 5-9 years HRT (n = 29)versus those with >or=10 years HRT (n = 11). There were no statistically significant differences between HRT users and non-users in global scores or sub-domains of cognitive functioning, and no difference between those women receiving HRT for 5-9 years vs. >or=10 years. DISCUSSIONS Long-term HRT does not appear to impair cognitive functioning in highly-educated women. Recommendations regarding post-menopausal HRT should be made on an individual basis.
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Affiliation(s)
- R Lavi
- Gaucher Clinic, Shaare Zedek Medical Center, One Bazak Road, Jerusalem 91031, Israel
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Sasson E, Doniger GM, Simon ES, Assaf Y. P‐120: Age‐related cognitive decline measured by computerized assessment correlates with regional brain changes measured by Q‐space MRI. Alzheimers Dement 2007. [DOI: 10.1016/j.jalz.2007.04.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schweiger A, Abramovitch A, Doniger GM, Simon ES. A clinical construct validity study of a novel computerized battery for the diagnosis of ADHD in young adults. J Clin Exp Neuropsychol 2007; 29:100-11. [PMID: 17162726 DOI: 10.1080/13803390500519738] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The cognitive profile of adult attention deficit hyperactivity disorder (ADHD) remains understudied despite difficulty in diagnosis. Further, no battery of neuropsychological tests has been shown valid in adult ADHD. Continuous performance tests are widely used for ADHD but provide limited information on cognitive functioning in general. The present study evaluated the construct and discriminant validity of Mindstreams (NeuroTrax Corp., NY), a computerized battery assessing multiple cognitive domains. Twenty-nine young male adults with ADHD diagnosis completed a Mindstreams battery, including a multi-stage continuous performance ('Expanded Go-NoGo') test, and the Conners' CPT-II (Multi-Health Systems Inc., NY). Discriminant validity was assessed by comparisons with cognitively healthy controls of comparable age and education. Expanded Go-NoGo and corresponding CPT-II outcomes were significantly correlated in ADHD participants, and the Expanded Go-NoGo test exhibited excellent discriminant validity, with ADHD participants performing more poorly than controls. ADHD participants also performed more poorly on Stroop and Staged Information Processing Speed tests.
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Affiliation(s)
- Avraham Schweiger
- Department of Behavioral Sciences, Academic College of Tel Aviv, Tel Aviv, Israel
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Leitner Y, Doniger GM, Barak R, Simon ES, Hausdorff JM. A novel multidomain computerized cognitive assessment for attention-deficit hyperactivity disorder: evidence for widespread and circumscribed cognitive deficits. J Child Neurol 2007; 22:264-76. [PMID: 17621495 DOI: 10.1177/0883073807299859] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multidomain assessment may enhance the diagnosis of cognitive impairment in children with attention-deficit hyperactivity disorder (ADHD). A set of novel Web-enabled computerized tests has recently been shown to be valid for identifying mild cognitive impairment and characterizing the cognitive profile associated with various disorders. It was anticipated that these tests would be well suited for use in children with ADHD. The authors tested this idea in a pilot study of 15 children (12 males, 3 females; mean age, 11 years 10 months; range, 9-15 years) with ADHD and 15 age-, education-, and gender-matched controls. The profile of cognitive impairment in ADHD children off methylphenidate across 6 cognitive domains (memory, executive function, visual-spatial skills, verbal function, attention, and motor skills) was described relative to controls. The effect of treatment with methylphenidate was examined by comparing the ADHD children on methylphenidate and on placebo (administered in a double-blind randomized fashion) relative to controls and by comparing the ADHD children on methylphenidate relative to placebo. Significant impairment in ADHD was evident in memory, visual-spatial, verbal, and attention domains, and near-significant impairment was observed in executive function and motor skills. On methylphenidate but not placebo, performance was comparable to controls in immediate verbal memory, psychomotor accuracy, visual-spatial, verbal rhyming, and overall battery performance. Significant improvement with administration of methylphenidate relative to placebo was evident for psychomotor accuracy, verbal rhyming, and overall battery performance. Hence, on the limited basis of this pilot study, the set of computerized tests studied appears to be useful for measuring cognitive function in ADHD; however, additional studies are needed to confirm this.
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Affiliation(s)
- Yael Leitner
- Paediatric Neurology Unit and Child Development Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Hausdorff JM, Doniger GM, Springer S, Yogev G, Simon ES, Giladi N. A common cognitive profile in elderly fallers and in patients with Parkinson's disease: the prominence of impaired executive function and attention. Exp Aging Res 2006; 32:411-29. [PMID: 16982571 PMCID: PMC1868891 DOI: 10.1080/03610730600875817] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study examined the cognitive profile of elderly fallers relative to healthy elderly controls and patients with Parkinson's disease (PD), a positive-control group, using a computerized battery. Fallers performed more poorly than controls on executive function, attention, and motor skills, but performed comparably on memory, information processing and the Mini-Mental State Examination. A similar profile was evident for PD patients. However, unlike PD patients, fallers were abnormally inconsistent in their reaction times. These findings indicate that elderly fallers may have a unique cognitive processing deficit (i.e., variability of response timing) and underscore the importance of executive function and attention as potential targets for fall risk screening and interventions.
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Abstract
Food deprivation has been shown to deleteriously affect human cognition, but findings are equivocal, and few studies have examined several cognitive domains. In this study, the authors used computerized testing to describe the profile of shifts in cognition attributable to short-term religious fasting. Multiple cognitive domains were evaluated at midday and late afternoon following complete abstention from eating and drinking beginning at midnight. Cross-domain, fasting-related deficits were found for tasks requiring perception of spatial relations. Fasting-related information processing deficits were found for response time but not accuracy for test levels of intermediate difficulty. Time-of-day effects often reflected poorer afternoon performance. These findings provide a detailed profile of cognitive consequences of food deprivation, affected by time of day, task demands, and type of outcome.
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Affiliation(s)
- Glen M Doniger
- Department of Clinical Science, NeuroTrax Corporation, New York, NY, USA
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