NIH toolbox for assessment of neurological and behavioral function

Reconstructing the Neanderthal brain using computational anatomy

The present study attempted to reconstruct 3D brain shape of Neanderthals and early Homo sapiens based on computational neuroanatomy. We found that early Homo sapiens had relatively larger cerebellar hemispheres but a smaller occipital region in the cerebrum than Neanderthals long before the time that Neanderthals disappeared. Further, using behavioural and structural imaging data of living humans, the abilities such as cognitive flexibility, attention, the language processing, episodic and working memory capacity were positively correlated with size-adjusted cerebellar volume. As the cerebellar hemispheres are structured as a large array of uniform neural modules, a larger cerebellum may possess a larger capacity for cognitive information processing. Such a neuroanatomical difference in the cerebellum may have caused important differences in cognitive and social abilities between the two species and might have contributed to the replacement of Neanderthals by early Homo sapiens.

Reconstructing the Neanderthal brain using computational anatomy

The present study attempted to reconstruct 3D brain shape of Neanderthals and early Homo sapiens based on computational neuroanatomy. We found that early Homo sapiens had relatively larger cerebellar hemispheres but a smaller occipital region in the cerebrum than Neanderthals long before the time that Neanderthals disappeared. Further, using behavioural and structural imaging data of living humans, the abilities such as cognitive flexibility, attention, the language processing, episodic and working memory capacity were positively correlated with size-adjusted cerebellar volume. As the cerebellar hemispheres are structured as a large array of uniform neural modules, a larger cerebellum may possess a larger capacity for cognitive information processing. Such a neuroanatomical difference in the cerebellum may have caused important differences in cognitive and social abilities between the two species and might have contributed to the replacement of Neanderthals by early Homo sapiens.

NIH Toolbox® Emotion Batteries for Children: Factor-Based Composites and Norms

The recently released National Institutes of Health Toolbox (NIHTB) batteries for neurological and behavioral function were designed to serve as standardized, common measures in clinical and epidemiological research. The current study aimed to examine constructs assessed by the self-report and parental proxy-report scales in the NIHTB Emotion Battery (NIHTB-EB) for Children by using factor analyses on data from the U.S. national normative sample of 2,916 English-speaking children. This battery contains 31 scales designed to assess both positive and negative aspects of social and emotional functioning that are considered developmentally relevant at each of three age ranges (3-7, 8-12, and 13-17 years). Results revealed four similar self-report factors for ages 8 to 12 years and 13 to 17 years. Proxy reports for ages 3 to 7 years revealed three factors, and for ages 8 to 12 years two factors. Based on the standardization sample data, age- and gender-corrected norms are presented for all NIHTB-EB individual scales and factor-based composites.

Effects of Before-School Physical Activity on Obesity Prevention and Wellness

INTRODUCTION

The effects of Build Our Kids Success-a 12-week, 1-hour before-school physical activity program-on BMI and social-emotional wellness among kindergarten to eighth grade students was examined.

STUDY DESIGN

This was a nonrandomized trial.

SETTING/PARTICIPANTS

Participants were from 24 schools in Massachusetts; there were 707 children from kindergarten to eighth grade.

INTERVENTION

Children registered for Build Our Kids Success in 2015-2016 participated in a 2 days/week or 3 days/week program. Nonparticipating children served as controls.

MAIN OUTCOME MEASURES

At baseline and 12 weeks, study staff measured children's heights/weights; children aged ≥8 years completed surveys. Main outcomes were 12-week change in BMI z-score, odds of a lower BMI category at follow-up, and child report of social-emotional wellness. Analyses were completed in March-June 2017.

RESULTS

Follow-up BMI was obtained from 67% of children and self-reported surveys from 72% of age-eligible children. Children in the 3 days/week group had improvements in BMI z-score (-0.22, 95% CI= -0.31, -0.14) and this mean change was significantly different than the comparison group (-0.17 difference, 95% CI= -0.27, -0.07). Children in the 3 days/week group also had higher odds of being in a lower BMI category at follow-up (OR=1.35, 95% CI=1.12, 1.62); significantly different than the comparison group (p<0.01). Children in the 2 days/week program had no significant changes in BMI outcomes. Children in the 3 days/week group demonstrated improvement in their student engagement scores (0.79 units, p=0.05) and had nonsignificant improvements in reported peer relationships, affect, and life satisfaction versus comparison. The 2 days/week group had significant improvements in positive affect and vitality/energy versus comparison.

CONCLUSIONS

A 3 days/week before-school physical activity program resulted in improved BMI and prevented increases in child obesity. Both Build Our Kids Success groups had improved social-emotional wellness versus controls.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT03190135.

Measurement framework for the Environmental influences on Child Health Outcomes research program

PURPOSE OF REVIEW

Diverse methodological approaches pose significant challenges to assess environmental exposure effects on child health outcomes. Although transdisciplinary research efforts offer unique opportunities for understanding the complex and multidimensional facets of lifespan health and disease trajectories, a shared measurement strategy is necessary for ensuring cohesion and comprehensibility across disciplines and domains.

RECENT FINDINGS

Exposure science often focuses on one life stage, one primary outcome domain and/or one environmental context without regard for understanding the complexity of exposome pathways and outcomes across a developmental continuum. As part of the National Institutes of Health Environmental influences on Child Health Outcomes Program, the Person Reported Outcomes Core developed a unifying measurement framework that takes a lifespan development approach to assess physical, mental and social health outcomes within the complex matrix of environmental exposure pathways.

SUMMARY

The proposed framework offers a shared methodological approach to health outcome assessment, with a particular emphasis on person-reported outcomes. This framework will be instrumental for future large-scale consortia and transdisciplinary team science efforts by providing a common structure, measurement guidance and consistent terminology.

Initial cognitive changes in Parkinson's disease

The focus on cognitive impairment in neurodegenerative diseases, including PD, is shifting from the dementia stage to earlier stages of impairment, including mild cognitive impairment. This shift is driven primarily by the desire to improve long-term outcomes by delivering therapeutic interventions earlier in the clinical course, even presymptomatically in those at highest risk, and at the initial stage in the pathophysiological cascade that underpins common dementia syndromes. This article focuses on key findings and challenges in studying earliest stages of cognitive decline in PD, including a detailed examination of neuropsychological testing, cognitive performance in early and prodromal PD, epidemiological research for PD mild cognitive impairment to date, and expert recommendations for assessment. © 2018 International Parkinson and Movement Disorder Society.

Racial and ethnic disparities in stroke outcomes: a scoping review of post-stroke disability assessment tools

Purpose: To identify how post-stroke disability outcomes are assessed in studies that examine racial/ethnic disparities and to map the identified assessment content to the International Classification of Functioning, Disability, and Health (ICF) across the time course of stroke recovery. Methods: We conducted a scoping review of the literature. Articles published between January 2001 and July 2017 were identified through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion and exclusion criteria. Results: We identified 1791 articles through database and hand-searching strategies. Of the articles, 194 met inclusion criteria for full-text review, and 41 met inclusion criteria for study inclusion. The included studies used a variety of outcome measures encompassing domains within the ICF: body functions, activities, participation, and contextual factors across the time course of stroke recovery. We discovered disproportionate representation among racial/ethnic groups in the post-stroke disability disparities literature. Conclusions: A wide variety of assessments are used to examine disparities in post-stroke disability across the time course of stroke recovery. Several studies have identified disparities through a variety of assessments; however, substantial problems abound from the assessments used including inconsistent use of assessments, lacking evidence on the validity of assessments among racial/ethnic groups, and inadequate representation among all racial/ethnic populations comprising the US. Implications for Rehabilitation An enhanced understanding of racial/ethnic disparities in post-stroke disability outcomes is inherently important among rehabilitation practitioners who frequently engage with racial/ethnic minority populations across the time course of stroke recovery. Clinicians should carefully consider the psychometric properties of assessment tools to counter potential racial bias. Clinicians should be aware that many assessments used in stroke rehabilitation lack cultural sensitivity and could result in inaccurate assessment findings.

Elevated Plasma S100B, Psychotic Symptoms, and Cognition in Schizophrenia

S100B is a calcium binding protein mainly produced by glial cells. Previous studies have shown elevated levels of S100B in patients with schizophrenia. We measured S100B levels in fasting plasma of 39 patients with schizophrenia and 19 adult healthy controls. We used linear regression to compare S100B between patients and controls. In patients only, we also investigated the relationship between S100B levels and psychotic symptoms (assessed by the Positive and Negative Syndrome Scale), and cognitive function (assessed by the NIH Toolbox Cognition Battery), respectively by calculating Pearson's correlation coefficients. Mean plasma S100B was significantly higher in the patient group than in the control group. There were no significant correlations between plasma S100B and psychotic symptoms or cognition.

Preliminary Safety and Tolerability of a Novel Subcutaneous Intrathecal Catheter System for Repeated Outpatient Dosing of Nusinersen to Children and Adults With Spinal Muscular Atrophy

BACKGROUND

Many patients with spinal muscular atrophy (SMA) who might benefit from intrathecal antisense oligonucleotide (nusinersen) therapy have scoliosis or spinal fusion that precludes safe drug delivery. To circumvent spinal pathology, we designed a novel subcutaneous intrathecal catheter (SIC) system by connecting an intrathecal catheter to an implantable infusion port.

METHODS

Device safety and tolerability were tested in 10 SMA patients (age, 5.4 to 30.5 y; 80% with 3 copies of SMN2); each received 3 sequential doses of nusinersen (n=30 doses). Pretreatment disease burden was evaluated using the Revised Hammersmith Scale, dynamometry, National Institutes of Health pegboard, pulmonary function testing, electromyography, and 2 health-related quality of life tools.

RESULTS

Device implantation took ≤2 hours and was well tolerated. All outpatient nusinersen doses were successfully administered via SIC within 20 minutes on the first attempt, and required no regional or systemic analgesia, cognitive distraction, ultrasound guidance, respiratory precautions, or sedation. Cerebrospinal fluid withdrawn from the SIC had normal levels of glucose and protein; cerebrospinal fluid white blood cells were slightly elevated in 2 (22%) of 9 specimens (median, 1 cell/µL; range, 0 to 12 cells/µL) and red blood cells were detected in 7 (78%) specimens (median, 4; range, 0 to 2930 cells/µL).

DISCUSSION

Preliminary observations reveal the SIC to be relatively safe and well tolerated in SMA patients with advanced disease and spinal fusion. The SIC warrants further study and, if proven effective in larger trials of longer duration, could double the number of patients able to receive nusinersen worldwide while reducing administration costs 5- to 10-fold.

An open resource for transdiagnostic research in pediatric mental health and learning disorders

Technological and methodological innovations are equipping researchers with unprecedented capabilities for detecting and characterizing pathologic processes in the developing human brain. As a result, ambitions to achieve clinically useful tools to assist in the diagnosis and management of mental health and learning disorders are gaining momentum. To this end, it is critical to accrue large-scale multimodal datasets that capture a broad range of commonly encountered clinical psychopathology. The Child Mind Institute has launched the Healthy Brain Network (HBN), an ongoing initiative focused on creating and sharing a biobank of data from 10,000 New York area participants (ages 5–21). The HBN Biobank houses data about psychiatric, behavioral, cognitive, and lifestyle phenotypes, as well as multimodal brain imaging (resting and naturalistic viewing fMRI, diffusion MRI, morphometric MRI), electroencephalography, eye-tracking, voice and video recordings, genetics and actigraphy. Here, we present the rationale, design and implementation of HBN protocols. We describe the first data release (n=664) and the potential of the biobank to advance related areas (e.g., biophysical modeling, voice analysis).

Assessing cognitive functioning in individuals with cocaine use disorder

INTRODUCTION

There have been mixed findings assessing the impact of regular cocaine use on cognitive functioning. This study employed a comprehensive cognitive battery to compare the performance of individuals diagnosed with a cocaine use disorder (N = 3 abusers, N = 17 dependent) against the performance of two control groups: (a) non-drug-users, and (b) marijuana users who report no cocaine use (N = 7 marijuana abusers, N = 0 dependent, N = 13 marijuana users with no Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, DSM-IV, diagnosis).

METHOD

This one-session, between-participants, outpatient study was conducted at the New York State Psychiatric Institute. Sixty research volunteers completed the study. Drug users in both groups had no signs of current intoxication, but had a positive urine toxicology-which indicated use within 72 hours in the cocaine use disorder group and within the past 30 days (depending on frequency of use) for the marijuana-using control group. The National Institutes of Health (NIH) Toolbox Cognition Battery was used to assess cognitive functioning across six domains: executive function, attention, episodic memory, working memory, processing speed, and language. Each participant's score was also compared against a normative database adjusted for age.

RESULTS

Although the mean cognitive scores for all groups fell within the normal range for all tests, marijuana-using control participants outperformed those with a cocaine use disorder on a cognitive flexibility and language measure.

CONCLUSIONS

Cognitive functioning of individuals diagnosed with cocaine use disorder was observed to be similar to that of control group participants on the majority of tasks and fell within the normal range when compared against normative data.

Demographic, physical and mental health assessments in the adolescent brain and cognitive development study: Rationale and description

The Adolescent Brain and Cognitive Development (ABCD) Study incorporates a comprehensive range of measures assessing predictors and outcomes related to both mental and physical health across childhood and adolescence. The workgroup developed a battery that would assess a comprehensive range of domains that address study aims while minimizing participant and family burden. We review the major considerations that went into deciding what constructs to cover in the demographics, physical health and mental health domains, as well as the process of selecting measures, piloting and refining the originally proposed battery. We present a description of the baseline battery, as well as the six-month interim assessments and the one-year follow-up assessments. This battery includes assessments from the perspectives of both the parent and the target youth, as well as teacher reports. This battery will provide a foundational baseline assessment of the youth's current function so as to permit characterization of stability and change in key domains over time. The findings from this battery will also be utilized to identify both resilience markers that predict healthy development and risk factors for later adverse outcomes in physical health, mental health, and substance use and abuse.

A framework for identifying the adaptations responsible for differences in pegboard times between middle-aged and older adults

Time to complete two tests of manual dexterity, the 9-hole Peg Test and Grooved Pegboard Test, increases with advancing age. However, the adaptations responsible for the differences in pegboard times between middle-aged and older adults are largely unknown. Potential mechanisms include neuromuscular characteristics, cognitive function, and cutaneous sensation. To provide a tractable framework to address these gaps in knowledge, the purpose of the current study was to identify the latent variables underlying age-associated differences in time to complete the 9-hole and grooved pegboard tests. The approach involved an independent component analysis that identified associations between the two pegboard times for the two groups of participants with two to six secondary outcomes. The common association across three of the four conditions (two groups and two pegboard tests) was features derived from force-matching tasks requiring submaximal isometric contraction. In addition, there were significant associations for older adults between age, measures of cognitive function, and pegboard times. Nonetheless, the significant associations were unique for each age group and pegboard test. The results provide a framework for subsequent mechanistic studies to identify the adaptations underlying age-associated declines in manual dexterity.

Effect of transcranial direct current stimulation combined with cognitive training on cognitive functioning in older adults with HIV: A pilot study

The objective of this study was to examine combination speed of processing (SOP) cognitive remediation therapy (CRT) and transcranial direct stimulation (tDCS) as neurorehabilitation in older HIV+ adults. Thirty-three HIV+ adults aged 50+ completed neurocognitive testing and were randomized to either active (n = 17) or sham (n = 16) tDCS. Both conditions received 10 1-hour sessions of SOP CRT, with either active or sham tDCS for the first 20 minutes. Participants then completed a posttest assessment. Repeated measures analysis of variance examining Time X Condition showed small-to-medium effects in the expected direction for an executive (d = 0.36), and SOP measure (d = 0.49), while medium-to-large effects were observed for an executive/attention (d = 0.60) and oral reading measure (d = 0.75). The only statistically significant interaction was the oral reading measure. Small-to-medium and medium-to-large effects (ds = 0.32, 0.58) were found for two SOP measures in the opposite direction (sham group showing greater improvements). Further trials of CRT and tDCS in this population are needed, including larger samples and a nonactive control and tDCS only condition, as is determination of which parameters of each technique (e.g., tDCS montage, timing of tDCS, domain targeted in CRT, number of sessions) are most effective in improving cognitive outcomes, durability of training gains, and translation to everyday functioning.

Neuropsychological Assessment: Past and Future

Neuropsychological assessment tools are the staple of our field. The development of standardized metrics sensitive to brain-behavior relationships has shaped the neuropsychological questions we can ask, our understanding of discrete brain functions, and has informed the detection and treatment of neurological disorders. We identify key turning points and innovations in neuropsychological assessment over the past 40-50 years that highlight how the tools used in common practice today came to be. Also selected for emphasis are several exciting lines of research and novel approaches that are underway to further probe and characterize brain functions to enhance diagnostic and treatment outcomes. We provide a brief historical review of different clinical neuropsychological assessment approaches (Lurian, Flexible and Fixed Batteries, Boston Process Approach) and critical developments that have influenced their interpretation (normative standards, cultural considerations, longitudinal change, common metric batteries, and translational assessment constructs). Lastly, we discuss growing trends in assessment including technological advances, efforts to integrate neuropsychology across disciplines (e.g., primary care), and changes in neuropsychological assessment infrastructure. Neuropsychological assessment has undergone massive growth in the past several decades. Nonetheless, there remain many unanswered questions and future challenges to better support measurement tools and translate assessment findings into meaningful recommendations and treatments. As technology and our understanding of brain function advance, efforts to support infrastructure for both traditional and novel assessment approaches and integration of complementary brain assessment tools from other disciplines will be integral to inform brain health treatments and promote the growth of our field. (JINS, 2017, 23, 778-790).

Breathing above the brain stem: volitional control and attentional modulation in humans

Whereas the neurophysiology of respiration has traditionally focused on automatic brain stem processes, higher brain mechanisms underlying the cognitive aspects of breathing are gaining increasing interest. Therapeutic techniques have used conscious control and awareness of breathing for millennia with little understanding of the mechanisms underlying their efficacy. Using direct intracranial recordings in humans, we correlated cortical and limbic neuronal activity as measured by the intracranial electroencephalogram (iEEG) with the breathing cycle. We show this to be the direct result of neuronal activity, as demonstrated by both the specificity of the finding to the cortical gray matter and the tracking of breath by the gamma-band (40-150 Hz) envelope in these structures. We extend prior observations by showing the iEEG signal to track the breathing cycle across a widespread network of cortical and limbic structures. We further demonstrate a sensitivity of this tracking to cognitive factors by using tasks adapted from cognitive behavioral therapy and meditative practice. Specifically, volitional control and awareness of breathing engage distinct but overlapping brain circuits. During volitionally paced breathing, iEEG-breath coherence increases in a frontotemporal-insular network, and during attention to breathing, we demonstrate increased coherence in the anterior cingulate, premotor, insular, and hippocampal cortices. Our findings suggest that breathing can act as an organizing hierarchical principle for neuronal oscillations throughout the brain and detail mechanisms of how cognitive factors impact otherwise automatic neuronal processes during interoceptive attention. NEW & NOTEWORTHY Whereas the link between breathing and brain activity has a long history of application to therapy, its neurophysiology remains unexplored. Using intracranial recordings in humans, we show neuronal activity to track the breathing cycle throughout widespread cortical/limbic sites. Volitional pacing of the breath engages frontotemporal-insular cortices, whereas attention to automatic breathing modulates the cingulate cortex. Our findings imply a fundamental role of breathing-related oscillations in driving neuronal activity and provide insight into the neuronal mechanisms of interoceptive attention.

Recruitment and baseline characteristics of the Community of Voices choir study to promote the health and well-being of diverse older adults

Objective

To describe the recruitment and baseline results of the Community of Voices study that aims to examine the effect of a community choir intervention on the health and well-being of older adults from diverse racial/ethnic and socioeconomic backgrounds.

Method

Using community-based participatory research methods, we recruited adults age 60 and over from 12 Administration on Aging-supported senior centers in San Francisco into a 2-arm cluster-randomized controlled trial of the community choir intervention. Multiple outreach methods were used. We tracked outreach, screening, and recruitment metrics and collected demographics and baseline outcomes via community-based, interviewer-administered surveys and performance measures of cognition, physical function, and psychosocial variables.

Results

The study contacted 819 individuals, screened 636, and enrolled 390 diverse older adults over a 42-month, phased recruitment period. The mean age was 71.2 (SD = 7.3), and the majority were women. Two-thirds of the sample are non-white, and 20% of participants reported having financial hardship.

Discussion

Outreach and recruitment methods used in the Community of Voices trial facilitated enrollment of a large proportion of minority and lower-SES older adults in the final sample. Similar recruitment approaches could serve as a model for recruiting diverse racial/ethnic and socioeconomic older adults into research.

Working memory predicts children's analogical reasoning

Analogical reasoning is the cognitive skill of drawing relationships between representations, often between prior knowledge and new representations, that allows for bootstrapping cognitive and language development. Analogical reasoning proficiency develops substantially during childhood, although the mechanisms underlying this development have been debated, with developing cognitive resources as one proposed mechanism. We explored the role of executive function (EF) in supporting children's analogical reasoning development, with the goal of determining whether predicted aspects of EF were related to analogical development at the level of individual differences. We assessed 5- to 11-year-old children's working memory, inhibitory control, and cognitive flexibility using measures from the National Institutes of Health Toolbox Cognition battery. Individual differences in children's working memory best predicted performance on an analogical mapping task, even when controlling for age, suggesting a fundamental interrelationship between analogical reasoning and working memory development. These findings underscore the need to consider cognitive capacities in comprehensive theories of children's reasoning development.

Is the Newest Vital Sign a Useful Measure of Health Literacy in HIV Disease?

BACKGROUND

Limited health literacy is common among persons infected with HIV and has been linked to poor mental and physical health outcomes, but there are no well-validated screening measures of health literacy in this vulnerable clinical population. The present study evaluates the usefulness of the Newest Vital Sign (NVS) as a brief measure of health literacy in HIV disease.

METHODS

Seventy-eight HIV+ adults were administered the NVS, Rapid Estimate of Adult Literacy in Medicine (REALM), and Single Item Literacy Screener (SILS). Main criterion variables included plasma HIV viral load, medication management capacity, self-efficacy for medication management, and perceived relationships with healthcare providers.

RESULTS

The NVS showed good internal consistency and moderate correlations with the REALM and SILS. Rates of limited health literacy were highest on the NVS (30.3%) as compared to SILS (6.6%) and REALM (9.2%). A series of regressions controlling for education showed that the NVS was incrementally predictive of viral load, medication management capacity and self-efficacy, and relationships with healthcare providers, above and beyond the REALM and SILS.

CONCLUSION

The NVS shows evidence of reliability, convergent validity, and incremental criterion-related validity and thus may serve as useful screening tool for assessing health literacy in HIV disease.

Perceived stress is associated with increased rostral middle frontal gyrus cortical thickness: a family-based and discordant-sibling investigation

Elevated stress perception and depression commonly co-occur, suggesting that they share a common neurobiology. Cortical thickness of the rostral middle frontal gyrus (RMFG), a region critical for executive function, has been associated with depression- and stress-related phenotypes. Here, we examined whether RMFG cortical thickness is associated with these phenotypes in a large family-based community sample. RMFG cortical thickness was estimated using FreeSurfer among participants (n = 879) who completed the ongoing Human Connectome Project. Depression-related phenotypes (i.e. sadness, positive affect) and perceived stress were assessed via self-report. After accounting for sex, age, ethnicity, average whole-brain cortical thickness, twin status and familial structure, RMFG thickness was positively associated with perceived stress and sadness and negatively associated with positive affect at small effect sizes (accounting for 0.2-2.4% of variance; p-fdr: 0.0051-0.1900). Perceived stress was uniquely associated with RMFG thickness after accounting for depression-related phenotypes. Further, among siblings discordant for perceived stress, those reporting higher perceived stress had increased RMFG thickness (P = 4 × 10^-7 ). Lastly, RMFG thickness, perceived stress, depressive symptoms, and positive affect were all significantly heritable, with evidence of shared genetic and environmental contributions between self-report measures. Stress perception and depression share common genetic, environmental, and neural correlates. Variability in RMFG cortical thickness may play a role in stress-related depression, although effects may be small in magnitude. Prospective studies are required to examine whether variability in RMFG thickness may function as a risk factor for stress exposure and/or perception, and/or arises as a consequence of these phenotypes.

Interdisciplinary Approach to the Development of Accessible Computer-Administered Measurement Instruments

Principles of fairness in testing require that all test takers, including people with disabilities, have an equal opportunity to demonstrate their capacity on the construct being measured. Measurement design features and assessment protocols can pose barriers for people with disabilities. Fairness in testing is a fundamental validity issue at all phases in the design, administration, and interpretation of measurement instruments in clinical practice and research. There is limited guidance for instrument developers on how to develop and evaluate the accessibility and usability of measurement instruments. This article describes a 6-stage iterative process for developing accessible computer-administered measurement instruments grounded in the procedures implemented across several major measurement initiatives. A key component of this process is interdisciplinary teams of accessibility experts, content and measurement experts, information technology experts, and people with disabilities working together to ensure that measurement instruments are accessible and usable by a wide range of users. The development of accessible measurement instruments is not only an ethical requirement, it also ensures better science by minimizing measurement bias, missing data, and attrition due to mismatches between the target population and test administration platform and protocols.

Multimodal neural correlates of cognitive control in the Human Connectome Project

Cognitive control is a construct that refers to the set of functions that enable decision-making and task performance through the representation of task states, goals, and rules. The neural correlates of cognitive control have been studied in humans using a wide variety of neuroimaging modalities, including structural MRI, resting-state fMRI, and task-based fMRI. The results from each of these modalities independently have implicated the involvement of a number of brain regions in cognitive control, including dorsal prefrontal cortex, and frontal parietal and cingulo-opercular brain networks. However, it is not clear how the results from a single modality relate to results in other modalities. Recent developments in multimodal image analysis methods provide an avenue for answering such questions and could yield more integrated models of the neural correlates of cognitive control. In this study, we used multiset canonical correlation analysis with joint independent component analysis (mCCA + jICA) to identify multimodal patterns of variation related to cognitive control. We used two independent cohorts of participants from the Human Connectome Project, each of which had data from four imaging modalities. We replicated the findings from the first cohort in the second cohort using both independent and predictive analyses. The independent analyses identified a component in each cohort that was highly similar to the other and significantly correlated with cognitive control performance. The replication by prediction analyses identified two independent components that were significantly correlated with cognitive control performance in the first cohort and significantly predictive of performance in the second cohort. These components identified positive relationships across the modalities in neural regions related to both dynamic and stable aspects of task control, including regions in both the frontal-parietal and cingulo-opercular networks, as well as regions hypothesized to be modulated by cognitive control signaling, such as visual cortex. Taken together, these results illustrate the potential utility of multi-modal analyses in identifying the neural correlates of cognitive control across different indicators of brain structure and function.

Evaluating the sources and functions of gradiency in phoneme categorization: An individual differences approach

During spoken language comprehension listeners transform continuous acoustic cues into categories (e.g., /b/ and /p/). While long-standing research suggests that phonetic categories are activated in a gradient way, there are also clear individual differences in that more gradient categorization has been linked to various communication impairments such as dyslexia and specific language impairments (Joanisse, Manis, Keating, & Seidenberg, 2000; López-Zamora, Luque, Álvarez, & Cobos, 2012; Serniclaes, Van Heghe, Mousty, Carré, & Sprenger-Charolles, 2004; Werker & Tees, 1987). Crucially, most studies have used 2-alternative forced choice (2AFC) tasks to measure the sharpness of between-category boundaries. Here we propose an alternative paradigm that allows us to measure categorization gradiency in a more direct way. Furthermore, we follow an individual differences approach to (a) link this measure of gradiency to multiple cue integration, (b) explore its relationship to a set of other cognitive processes, and (c) evaluate its role in individuals' ability to perceive speech in noise. Our results provide validation for this new method of assessing phoneme categorization gradiency and offer preliminary insights into how different aspects of speech perception may be linked to each other and to more general cognitive processes. (PsycINFO Database Record

Neuroimaging biomarkers to associate obesity and negative emotions

Obesity is a serious medical condition highly associated with health problems such as diabetes, hypertension, and stroke. Obesity is highly associated with negative emotional states, but the relationship between obesity and emotional states in terms of neuroimaging has not been fully explored. We obtained 196 emotion task functional magnetic resonance imaging (t-fMRI) from the Human Connectome Project database using a sampling scheme similar to a bootstrapping approach. Brain regions were specified by automated anatomical labeling atlas and the brain activity (z-statistics) of each brain region was correlated with body mass index (BMI) values. Regions with significant correlation were identified and the brain activity of the identified regions was correlated with emotion-related clinical scores. Hippocampus, amygdala, and inferior temporal gyrus consistently showed significant correlation between brain activity and BMI and only the brain activity in amygdala consistently showed significant negative correlation with fear-affect score. The brain activity in amygdala derived from t-fMRI might be good neuroimaging biomarker for explaining the relationship between obesity and a negative emotional state.

Interpreting Patterns of Low Scores on the NIH Toolbox Cognition Battery

INTRODUCTION

The National Institutes of Health Toolbox for Assessment of Neurological and Behavioral Function Cognition Battery is comprised of seven cognitive tests, including two tests measuring crystallized cognitive ability (i.e., vocabulary and reading) and five tests measuring fluid cognitive functioning (i.e., working memory, memory, speed of processing, and executive functioning). This study presents comprehensive base rate tables for the frequency of low scores in adults and older adults from the normative sample.

METHODS

Participants were 843 adults, ages 20-85, from the NIH Toolbox standardization sample who completed all seven cognition tests. Rates of low scores were derived for standard age-adjusted and fully-demographically-adjusted scores at multiple cut-scores. Base rates were stratified by education, crystallized intellectual ability, and cognitive domain.

RESULTS

Using the five demographically-adjusted fluid cognitive test scores, 45.9% of adults obtained one or more scores at or below the 16th percentile, and 16.8% obtained one or more score at or below the 5th percentile, which is consistent with findings from other neurocognitive test batteries.

DISCUSSION

Based on the study findings, nearly 50% of adults in the general population would meet psychometric criteria for a diagnosis of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) Mild Neurocognitive Disorder (MND). We developed new psychometric criteria for identifying MND using the NIH Toolbox Cognition Battery that reduce the false positive rate. Knowing these multivariate normative base rates will help researchers and clinicians interpret NIH Toolbox scores in people with neurodevelopmental, psychiatric, medical, neurological, and neurodegenerative disorders that affect cognitive functioning.

Implementing guidelines: Proposed definitions of neuropsychology services in pediatric oncology

Several organizations have published guidelines for the neuropsychological care of survivors of childhood cancer. However, there is limited consensus in how these guidelines are applied. The model of neuropsychology service delivery is further complicated by the variable terminology used to describe recommended services. In an important first step to translate published guidelines into clinical practice, this paper proposes definitions for specific neuropsychological processes and services, with the goal of facilitating consistency across sites to foster future clinical program development and to clarify clinical practice guidelines.

Updated report on tools to measure outcomes of clinical trials in fragile X syndrome

OBJECTIVE

Fragile X syndrome (FXS) has been the neurodevelopmental disorder with the most active translation of preclinical breakthroughs into clinical trials. This process has led to a critical assessment of outcome measures, which resulted in a comprehensive review published in 2013. Nevertheless, the disappointing outcome of several recent phase III drug trials in FXS, and parallel efforts at evaluating behavioral endpoints for trials in autism spectrum disorder (ASD), has emphasized the need for re-assessing outcome measures and revising recommendations for FXS.

METHODS

After performing an extensive database search (PubMed, Food and Drug Administration (FDA)/National Institutes of Health (NIH)'s www.ClinicalTrials.gov, etc.) to determine progress since 2013, members of the Working Groups who published the 2013 Report evaluated the available outcome measures for FXS and related neurodevelopmental disorders using the COSMIN grading system of levels of evidence. The latter has also been applied to a British survey of endpoints for ASD. In addition, we also generated an informal classification of outcome measures for use in FXS intervention studies as instruments appropriate to detect shorter- or longer-term changes.

RESULTS

To date, a total of 22 double-blind controlled clinical trials in FXS have been identified through www.ClinicalTrials.gov and an extensive literature search. The vast majority of these FDA/NIH-registered clinical trials has been completed between 2008 and 2015 and has targeted the core excitatory/inhibitory imbalance present in FXS and other neurodevelopmental disorders. Limited data exist on reliability and validity for most tools used to measure cognitive, behavioral, and other problems in FXS in these trials and other studies. Overall, evidence for most tools supports a moderate tool quality grading. Data on sensitivity to treatment, currently under evaluation, could improve ratings for some cognitive and behavioral tools. Some progress has also been made at identifying promising biomarkers, mainly on blood-based and neurophysiological measures.

CONCLUSION

Despite the tangible progress in implementing clinical trials in FXS, the increasing data on measurement properties of endpoints, and the ongoing process of new tool development, the vast majority of outcome measures are at the moderate quality level with limited information on reliability, validity, and sensitivity to treatment. This situation is not unique to FXS, since reviews of endpoints for ASD have arrived at similar conclusions. These findings, in conjunction with the predominance of parent-based measures particularly in the behavioral domain, indicate that endpoint development in FXS needs to continue with an emphasis on more objective measures (observational, direct testing, biomarkers) that reflect meaningful improvements in quality of life. A major continuous challenge is the development of measurement tools concurrently with testing drug safety and efficacy in clinical trials.

Functional Connectivity in Frontoparietal Network: Indicator of Preoperative Cognitive Function and Cognitive Outcome Following Surgery in Patients with Glioma

BACKGROUND

Patients with diffuse glioma are known to have impaired cognitive functions preoperatively. However, the mechanism of these cognitive deficits remains unclear. Resting-state functional connectivity in the frontoparietal network (FPN) is associated with cognitive performance in healthy subjects. For this reason, it was hypothesized that functional connectivity of the FPN would be related to cognitive functioning in patients with glioma. To assess this relationship, preoperative cognitive status was correlated to patient-specific connectivity within the FPN. Further, we assessed whether connectivity could predict neuropsychologic outcome following surgery.

METHODS

Sixteen patients with diffuse glioma underwent neuropsychologic assessment and preoperative functional magnetic resonance imaging using task (n-back) and resting-state scans. Thirteen patients had postoperative cognitive assessment. An index of patient-specific functional connectivity in the FPN was derived by averaging connectivity values between 2 prefrontal and 2 parietal cortex regions defined by activation during the n-back task. The relationship of these indices with cognitive performance was assessed.

RESULTS

Higher average connectivity within the FPN is associated with lower composite cognitive scores. Higher connectivity of the parietal region of the tumor-affected hemisphere is associated specifically with lower fluid cognition. Lower connectivity of the parietal region of the nontumor hemisphere is associated with worse neuropsychologic outcome 1 month after surgery.

CONCLUSION

Resting-state functional connectivity between key regions of the FPN is associated with cognitive performance in patients with glioma and is related to cognitive outcome following surgery.

Fluid and flexible minds: Intelligence reflects synchrony in the brain's intrinsic network architecture

Human intelligence has been conceptualized as a complex system of dissociable cognitive processes, yet studies investigating the neural basis of intelligence have typically emphasized the contributions of discrete brain regions or, more recently, of specific networks of functionally connected regions. Here we take a broader, systems perspective in order to investigate whether intelligence is an emergent property of synchrony within the brain’s intrinsic network architecture. Using a large sample of resting-state fMRI and cognitive data (n = 830), we report that the synchrony of functional interactions within and across distributed brain networks reliably predicts fluid and flexible intellectual functioning. By adopting a whole-brain, systems-level approach, we were able to reliably predict individual differences in human intelligence by characterizing features of the brain’s intrinsic network architecture. These findings hold promise for the eventual development of neural markers to predict changes in intellectual function that are associated with neurodevelopment, normal aging, and brain disease.

In our study, we aimed to understand how individual differences in intellectual functioning are reflected in the intrinsic network architecture of the human brain. We applied statistical methods, known as spectral decompositions, in order to identify individual differences in the synchronous patterns of spontaneous brain activity that reliably predict core aspects of human intelligence. The synchrony of brain activity at rest across multiple discrete neural networks demonstrated positive relationships with fluid intelligence. In contrast, global synchrony within the brain’s network architecture reliably, and inversely, predicted mental flexibility, a core facet of intellectual functioning. The multinetwork systems approach described here represents a methodological and conceptual extension of earlier efforts that related differences in intellectual ability to variations in specific brain regions, networks, or their interactions. Our findings suggest that the neural basis of complex, integrative cognitive functions can be most completely understood from the perspective of network neuroscience.

Peripheral Inflammatory Biomarkers and Cognitive Decline in Older Adults With and Without Alzheimer's Disease: A Systematic Review

Peripheral inflammatory biomarkers may play an important role in the cognitive decline of aging and incidence of Alzheimer's disease (AD); however, data from epidemiological studies present conflicting findings. The purpose of the current review was to systematically determine the current state of the science on the association between peripheral inflammatory biomarkers and cognitive decline. Articles published from January 1, 2006 to October 28, 2016 were searched using the Medline and Embase databases. Nine studies met inclusion criteria (two examined participants with AD dementia and seven examined participants without dementia). Although a wide range of peripheral inflammatory biomarkers was examined, C-reactive protein and interleukin 6 were the most studied. Findings show conflicting results for the association between peripheral inflammatory biomarkers and cognitive decline. Peripheral inflammation may harm and help the brain, and therefore, the challenge of modulating immunity will be to find ways of fine tuning inflammation to delay, prevent, or treat AD. [Journal of Gerontological Nursing, 43(12), 53-60.].

Have Standard Tests of Cognitive Function Been Misappropriated in the Study of Cognitive Enhancement?

In the past decade, there has emerged a vast research literature dealing with attempts to harness brain plasticity in older adults, with a view to improving cognitive function. Since cognitive training (CT) has shown restricted utility in this regard, attention has increasingly turned to interventions that use adjunct procedures such as motor training or physical activity (PA). As evidence builds that these have some efficacy, it becomes necessary to ensure that the outcome measures being used to infer causal influence upon cognitive function are subjected to appropriate critical appraisal. It has been highlighted previously that the choice of specific tasks used to demonstrate transfer to the cognitive domain is of critical importance. In the context of most intervention studies, standardized tests and batteries of cognitive function are de rigueur. The argument presented here is that the latent constructs to which these tests relate are not usually subject to a sufficient level of analytic scrutiny. We present the historical origins of some exemplar tests, and give particular consideration to the limits on explanatory scope that are implied by their composition and the nature of their deployment. In addition to surveying the validity of these tests when used to appraise intervention-related changes in cognitive function, we also consider their neurophysiological correlates. In particular, we argue that the broadly distributed brain activity associated with the performance of many tests of cognitive function, extending to the classical motor networks, permits the impact of interventions based on motor training or PA to be better understood.

Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds

OBJECTIVE

This study examined the influence of Hispanic ethnicity and language/cultural background on performance on the NIH Toolbox Cognition Battery (NIHTB-CB).

METHOD

Participants included healthy, primarily English-speaking Hispanic (n = 93; Hispanic-English), primarily Spanish-speaking Hispanic (n = 93; Hispanic-Spanish), and English speaking Non-Hispanic white (n = 93; NH white) adults matched on age, sex, and education levels. All participants were in the NIH Toolbox national norming project and completed the Fluid and Crystallized components of the NIHTB-CB. T-scores (demographically-unadjusted) were developed based on the current sample and were used in analyses.

RESULTS

Spanish-speaking Hispanics performed worse than English-speaking Hispanics and NH whites on demographically unadjusted NIHTB-CB Fluid Composite scores (ps < .01). Results on individual measures comprising the Fluid Composite showed significant group differences on tests of executive inhibitory control (p = .001), processing speed (p = .003), and working memory (p < .001), but not on tests of cognitive flexibility or episodic memory. Test performances were associated with language/cultural backgrounds in the Hispanic-Spanish group: better vocabularies and reading were predicted by being born outside the U.S., having Spanish as a first language, attending school outside the U.S., and speaking more Spanish at home. However, many of these same background factors were associated with worse Fluid Composites within the Hispanic-Spanish group.

CONCLUSIONS

On tests of Fluid cognition, the Hispanic-Spanish group performed the poorest of all groups. Socio-demographic and linguistic factors were associated with those differences. These findings highlight the importance of considering language/cultural backgrounds when interpreting neuropsychological test performances. Importantly, after applying previously published NIHTB-CB norms with demographic corrections, these language/ethnic group differences are eliminated.

Adaptation to novel foreign-accented speech and retention of benefit following training: Influence of aging and hearing loss

Adaptation to speech with a foreign accent is possible through prior exposure to talkers with that same accent. For young listeners with normal hearing, short term, accent-independent adaptation to a novel foreign accent is also facilitated through exposure training with multiple foreign accents. In the present study, accent-independent adaptation is examined in younger and older listeners with normal hearing and older listeners with hearing loss. Retention of training benefit is additionally explored. Stimuli for testing and training were HINT sentences recorded by talkers with nine distinctly different accents. Following two training sessions, all listener groups showed a similar increase in speech perception for a novel foreign accent. While no group retained this benefit at one week post-training, results of a secondary reaction time task revealed a decrease in reaction time following training, suggesting reduced listening effort. Examination of listeners' cognitive skills reveals a positive relationship between working memory and speech recognition ability. The present findings indicate that, while this no-feedback training paradigm for foreign-accented English is successful in promoting short term adaptation for listeners, this paradigm is not sufficient in facilitation of perceptual learning with lasting benefits for younger or older listeners.

Neural Mechanism Underling Comprehension of Narrative Speech and Its Heritability: Study in a Large Population

Comprehension of narratives constitutes a fundamental part of our everyday life experience. Although the neural mechanism of auditory narrative comprehension has been investigated in some studies, the neural correlates underlying this mechanism and its heritability remain poorly understood. We investigated comprehension of naturalistic speech in a large, healthy adult population (n = 429; 176/253 M/F; 22-36 years of age) consisting of 192 twin pairs (49 monozygotic and 47 dizygotic pairs) and 237 of their siblings. We used high quality functional MRI datasets from the Human Connectome Project (HCP) in which a story-based paradigm was utilized for the auditory narrative comprehension. Our results revealed that narrative comprehension was associated with activations of the classical language regions including superior temporal gyrus (STG), middle temporal gyrus (MTG), and inferior frontal gyrus (IFG) in both hemispheres, though STG and MTG were activated symmetrically and activation in IFG were left-lateralized. Our results further showed that the narrative comprehension was associated with activations in areas beyond the classical language regions, e.g. medial superior frontal gyrus (SFGmed), middle frontal gyrus (MFG), and supplementary motor area (SMA). Of subcortical structures, only the hippocampus was involved. The results of heritability analysis revealed that the oral reading recognition and picture vocabulary comprehension were significantly heritable (h ²  > 0.56, p < 10^- 13). In addition, the extent of activation of five areas in the left hemisphere, i.e. STG, IFG pars opercularis, SFGmed, SMA, and precuneus, and one area in the right hemisphere, i.e. MFG, were significantly heritable (h ²  > 0.33, p < 0.0004). The current study, to the best of our knowledge, is the first to investigate auditory narrative comprehension and its heritability in a large healthy population. Referring to the excellent quality of the HCP data, our results can clarify the functional contributions of linguistic and extra-linguistic cortices during narrative comprehension.

Behavioral and Neurologic Assessment: Using the National Institutes of Health Toolbox

Cognition, psychological well-being, stress, functional status, and pain are all priority outcomes of interest to oncology nurses. However, it can be challenging to choose an instrument for clinical assessment or for use in research projects that assess these constructs. The National Institutes of Health Toolbox for Assessment of Neurological and Behavioral Function was created for measuring emotional health and cognitive, motor, and sensory function. The toolbox can be a potentially useful resource for clinicians and nurse researchers.

Computerized Cognitive Testing for Use in Clinical Trials: A Comparison of the NIH Toolbox and Cogstate C3 Batteries

BACKGROUND

As prevention trials for Alzheimer's disease move into asymptomatic populations, identifying older individuals who manifest the earliest cognitive signs of Alzheimer's disease is critical. Computerized cognitive testing has the potential to replace current gold standard paper and pencil measures and may be a more efficient means of assessing cognition. However, more empirical evidence about the comparability of novel computerized batteries to paper and pencil measures is required.

OBJECTIVES

To determine whether two computerized IPad batteries, the NIH Toolbox Cognition Battery and Cogstate-C3, similarly predict subtle cognitive impairment identified using the Preclinical Alzheimer Cognitive Composite (PACC).

DESIGN, SETTING, PARTICIPANTS

A pilot sample of 50 clinically normal older adults (Mage=68.5 years±7.6, 45% non-Caucasian) completed the PACC assessment, and the NIH Toolbox and Cogstate-C3 at research centers of Massachusetts General and Brigham and Women's Hospitals. Participants made 3-4 in-clinic visits, receiving the PACC first, then the NIH Toolbox, and finally the Cogstate-C3.>= 0.5SD), versus subtle cognitive impairment (<0.5SD). Composites for each computerized battery were created using principle components analysis, and compared with the PACC using non-parametric Spearman correlations. Logistic regression analyses were used to determine which composite was best able to classify subtle cognitive impairment from typical performance.

RESULTS

The NIH Toolbox formed one composite and exhibited the strongest within-battery alignment, while the Cogstate-C3 formed two distinct composites (Learning-Memory and Processing Speed-Attention). The NIH Toolbox and C3 Learning-Memory composites exhibited positive correlations with the PACC (ρ=0.49, p<0.001; ρ=0.58, p<0.001, respectively), but not the C3 Processing Speed-Attention composite, ρ=-0.18, p=0.22. The C3 Learning-Memory was the only composite that classified subtle cognitive impairment, and demonstrated the greatest sensitivity (62%) and specificity (81%) for that subtle cognitive impairment.

CONCLUSIONS

Preliminary findings suggest that the NIH Toolbox has the advantage of showing the strongest overall clustering and alignment with standardized paper-and-pencil tasks. By contrast, Learning-Memory tasks within the Cogstate-C3 battery have the greatest potential to identify cross-sectional, subtle cognitive impairment as defined by the PACC.

Test-Retest Reliability of a Serious Game for Delirium Screening in the Emergency Department

Introduction: Cognitive screening in settings such as emergency departments (ED) is frequently carried out using paper-and-pencil tests that require administration by trained staff. These assessments often compete with other clinical duties and thus may not be routinely administered in these busy settings. Literature has shown that the presence of cognitive impairments such as dementia and delirium are often missed in older ED patients. Failure to recognize delirium can have devastating consequences including increased mortality (Kakuma et al., 2003). Given the demands on emergency staff, an automated cognitive test to screen for delirium onset could be a valuable tool to support delirium prevention and management. In earlier research we examined the concurrent validity of a serious game, and carried out an initial assessment of its potential as a delirium screening tool (Tong et al., 2016). In this paper, we examine the test-retest reliability of the game, as it is an important criterion in a cognitive test for detecting risk of delirium onset. Objective: To demonstrate the test-retest reliability of the screening tool over time in a clinical sample of older emergency patients. A secondary objective is to assess whether there are practice effects that might make game performance unstable over repeated presentations. Materials and Methods: Adults over the age of 70 were recruited from a hospital ED. Each patient played our serious game in an initial session soon after they arrived in the ED, and in follow up sessions conducted at 8-h intervals (for each participant there were up to five follow up sessions, depending on how long the person stayed in the ED). Results: A total of 114 adults (61 females, 53 males) between the ages of 70 and 104 years (M = 81 years, SD = 7) participated in our study after screening out delirious patients. We observed a test-retest reliability of the serious game (as assessed by correlation r-values) between 0.5 and 0.8 across adjacent sessions. Conclusion: The game-based assessment for cognitive screening has relatively strong test-retest reliability and little evidence of practice effects among elderly emergency patients, and may be a useful supplement to existing cognitive assessment methods.

Intermittent Hypoxia and Locomotor Training Enhances Dynamic but Not Standing Balance in Patients With Incomplete Spinal Cord Injury

OBJECTIVE

To test the effect of combined intermittent hypoxia (IH) and body weight-supported treadmill training (BWSTT) on standing and dynamic balance in persons with incomplete spinal cord injury (iSCI).

DESIGN

Randomized, triple-blind, placebo-controlled study.

SETTING

Rehabilitation medical centers.

PARTICIPANTS

Study participants (N=35) with chronic iSCI with American Spinal Injury Association grades C and D (>1y postinjury) were randomly assigned to either IH plus BWSTT (n=18) or continued normoxia (placebo) plus BWSTT protocol (n=17).

INTERVENTIONS

Participants received either IH (alternating 1.5min 9% inspired O₂ with 1.5min 21% inspired O₂, 15 cycles per day) or continued normoxia (21% O₂) combined with 45 minutes of BWSTT for 5 consecutive days, followed by 3 times per week IH or normoxia plus BWSTT, for 3 additional weeks.

MAIN OUTCOME MEASURES

Standing balance (normalized jerk and root-mean-square [RMS]) and dynamic balance (turning duration, cadence in a turn, and turn-to-sit duration) were assessed before and after IH and normoxia protocol by means of instrumented sway and instrumented timed Up and Go test.

RESULTS

There was no significant difference in standing balance between interventions for both normalized jerk and RMS instrumented sway components (both P>.05). There was a significantly faster cadence (P<.001), turning duration (P<.001), and turn-to-sit duration (P=.001) in subjects receiving IH plus BWSTT, compared with placebo.

CONCLUSIONS

A 4-week protocol of IH combined with locomotor training improves dynamic, but not standing, balance in persons with iSCI.

Research needs for assessing iodine intake, iodine status, and the effects of maternal iodine supplementation

The Office of Dietary Supplements of the NIH convened 3 workshops on iodine nutrition in Rockville, Maryland, in 2014. The purpose of the current article is to summarize and briefly discuss a list of research and resource needs developed with the input of workshop participants. This list is composed of the basic, clinical, translational, and population studies required for characterizing the benefits and risks of iodine supplementation, along with related data, analyses, evaluations, methods development, and supporting activities. Ancillary studies designed to use the participant, biological sample, and data resources of ongoing and completed studies (including those not originally concerned with iodine) may provide an efficient, cost-effective means to address some of these research and resource needs. In the United States, the foremost question is whether neurobehavioral development in the offspring of mildly to moderately iodine-deficient women is improved by maternal iodine supplementation during pregnancy. It is important to identify the benefits and risks of iodine supplementation in all population subgroups so that supplementation can be targeted, if necessary, to avoid increasing the risk of thyroid dysfunction and related adverse health effects in those with high iodine intakes. Ultimately, there will be a need for well-designed trials and other studies to assess the impact of maternal supplementation on neurodevelopmental outcomes in the offspring. However, 2 basic information gaps loom ahead of such a study: the development of robust, valid, and convenient biomarkers of individual iodine status and the identification of infant and toddler neurobehavioral development endpoints that are sensitive to mild maternal iodine deficiency during pregnancy and its reversal by supplementation.

Evaluating Health Span in Preclinical Models of Aging and Disease: Guidelines, Challenges, and Opportunities for Geroscience

Life extension is no longer considered sufficient evidence of delayed aging in research animals. It must also be demonstrated that a broad swathe of health indicators have been extended. During a retreat of the Geroscience Network, a consortium of basic and clinical aging researchers, potential measures of mouse health were considered for their potential as easily standardized, highly informative metrics. Major health domains considered were neuromuscular, cognitive, cardiovascular, metabolic, and inflammatory functions as well as body composition and energetics and a multitude of assays interrogating these domains. A particularly sensitive metric of health is the ability to respond to, and recover, from stress. Therefore, the Network also considered stresses of human relevance that could be implemented in mouse models to assess frailty and resilience. Mouse models already exist for responses to forced immobility, cancer chemotherapy, infectious diseases, dietary challenges, and surgical stress, and it was felt that these could be employed to determine whether putative senescence-retarding interventions increased and extended organismal robustness. The Network discussed challenges in modeling age-related human chronic diseases and concluded that more attention needs to be paid to developing disease models with later age of onset, models of co- and multimorbidity, diversifying the strains and sexes commonly used in aging research, and considering additional species.

Frameworks for Proof-of-Concept Clinical Trials of Interventions That Target Fundamental Aging Processes

Therapies targeted at fundamental processes of aging may hold great promise for enhancing the health of a wide population by delaying or preventing a range of age-related diseases and conditions—a concept dubbed the “geroscience hypothesis.” Early, proof-of-concept clinical trials will be a key step in the translation of therapies emerging from model organism and preclinical studies into clinical practice. This article summarizes the outcomes of an international meeting partly funded through the NIH R24 Geroscience Network, whose purpose was to generate concepts and frameworks for early, proof-of-concept clinical trials for therapeutic interventions that target fundamental processes of aging. The goals of proof-of-concept trials include generating preliminary signals of efficacy in an aging-related disease or outcome that will reduce the risk of conducting larger trials, contributing data and biological samples to support larger-scale research by strategic networks, and furthering a dialogue with regulatory agencies on appropriate registration indications. We describe three frameworks for proof-of-concept trials that target age-related chronic diseases, geriatric syndromes, or resilience to stressors. We propose strategic infrastructure and shared resources that could accelerate development of therapies that target fundamental aging processes.

Moving to Capture Children's Attention: Developing a Methodology for Measuring Visuomotor Attention

Attention underpins many activities integral to a child's development. However, methodological limitations currently make large-scale assessment of children's attentional skill impractical, costly and lacking in ecological validity. Consequently we developed a measure of 'Visual Motor Attention' (VMA)-a construct defined as the ability to sustain and adapt visuomotor behaviour in response to task-relevant visual information. In a series of experiments, we evaluated the capability of our method to measure attentional processes and their contributions in guiding visuomotor behaviour. Experiment 1 established the method's core features (ability to track stimuli moving on a tablet-computer screen with a hand-held stylus) and demonstrated its sensitivity to principled manipulations in adults' attentional load. Experiment 2 standardised a format suitable for use with children and showed construct validity by capturing developmental changes in executive attention processes. Experiment 3 tested the hypothesis that children with and without coordination difficulties would show qualitatively different response patterns, finding an interaction between the cognitive and motor factors underpinning responses. Experiment 4 identified associations between VMA performance and existing standardised attention assessments and thereby confirmed convergent validity. These results establish a novel approach to measuring childhood attention that can produce meaningful functional assessments that capture how attention operates in an ecologically valid context (i.e. attention's specific contribution to visuomanual action).

Item response theory and the measurement of psychiatric constructs: some empirical and conceptual issues and challenges

Item response theory (IRT) measurement models are now commonly used in educational, psychological, and health-outcomes measurement, but their impact in the evaluation of measures of psychiatric constructs remains limited. Herein we present two, somewhat contradictory, theses. The first is that, when skillfully applied, IRT has much to offer psychiatric measurement in terms of scale development, psychometric analysis, and scoring. The second argument, however, is that psychiatric measurement presents some unique challenges to the application of IRT - challenges that may not be easily addressed by application of conventional IRT models and methods. These challenges include, but are not limited to, the modeling of conceptually narrow constructs and their associated limited item pools, and unipolar constructs where the expected latent trait distribution is highly skewed.

Developing a Cognition Endpoint for Traumatic Brain Injury Clinical Trials

Cognitive impairment is a core clinical feature of traumatic brain injury (TBI). After TBI, cognition is a key determinant of post-injury productivity, outcome, and quality of life. As a final common pathway of diverse molecular and microstructural TBI mechanisms, cognition is an ideal endpoint in clinical trials involving many candidate drugs and nonpharmacological interventions. Cognition can be reliably measured with performance-based neuropsychological tests that have greater granularity than crude rating scales, such as the Glasgow Outcome Scale-Extended, which remain the standard for clinical trials. Remarkably, however, there is no well-defined, widely accepted, and validated cognition endpoint for TBI clinical trials. A single cognition endpoint that has excellent measurement precision across a wide functional range and is sensitive to the detection of small improvements (and declines) in cognitive functioning would enhance the power and precision of TBI clinical trials and accelerate drug development research. We outline methodologies for deriving a cognition composite score and a research program for validation. Finally, we discuss regulatory issues and the limitations of a cognition endpoint.

Following young people with perinatal HIV infection from adolescence into adulthood: the protocol for PHACS AMP Up, a prospective cohort study

INTRODUCTION

The first generation of adolescents born with HIV infection has reached young adulthood due to advances in treatment. It is important to continue follow-up of these individuals to assess their long-term medical, behavioural and mental health and ability to successfully transition to adulthood while coping with a chronic, potentially stigmatising condition. To accomplish this, and to maintain their interest in long-term research participation, we need to accommodate the changing lifestyles and interests of young adult study participants while ensuring valid data collection. We report the protocol for Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) Up, a prospective cohort study enrolling young adult participants for long-term follow-up.

METHODS AND ANALYSIS

AMP Up is recruiting 850 young men and women 18 years of age and older-600 perinatally HIV-infected and a comparison group of 250 perinatally HIV-exposed, uninfected-at 14 clinical research sites in the USA and Puerto Rico. Recruitment began in April 2014 and is ongoing, with 305 participants currently enrolled. Planned follow-up is ≥6 years. Data are collected with a flexible hybrid of online and in-person methods. Outcomes include: transition to adult clinical care and retention in care; end-organ diseases; malignancies; metabolic complications; sexually transmitted infections; reproductive health; mental health and neurocognitive functioning; adherence to antiretroviral treatment; sexual behaviour and substance use; hearing and language impairments; and employment and educational achievement.

ETHICS AND DISSEMINATION

The study received ethical approval from the Harvard T.H. Chan School of Public Health's institutional review board (IRB), and from the IRBs of each clinical research site. All participants provide written informed consent; for cognitively impaired individuals with legally authorised representatives, legal guardian permission and participant assent is obtained. Findings will be disseminated through peer-reviewed journals, conference presentations and participant summaries.

Distinct Global Brain Dynamics and Spatiotemporal Organization of the Salience Network

One of the most fundamental features of the human brain is its ability to detect and attend to salient goal-relevant events in a flexible manner. The salience network (SN), anchored in the anterior insula and the dorsal anterior cingulate cortex, plays a crucial role in this process through rapid detection of goal-relevant events and facilitation of access to appropriate cognitive resources. Here, we leverage the subsecond resolution of large multisession fMRI datasets from the Human Connectome Project and apply novel graph-theoretical techniques to investigate the dynamic spatiotemporal organization of the SN. We show that the large-scale brain dynamics of the SN are characterized by several distinctive and robust properties. First, the SN demonstrated the highest levels of flexibility in time-varying connectivity with other brain networks, including the frontoparietal network (FPN), the cingulate–opercular network (CON), and the ventral and dorsal attention networks (VAN and DAN). Second, dynamic functional interactions of the SN were among the most spatially varied in the brain. Third, SN nodes maintained a consistently high level of network centrality over time, indicating that this network is a hub for facilitating flexible cross-network interactions. Fourth, time-varying connectivity profiles of the SN were distinct from all other prefrontal control systems. Fifth, temporal flexibility of the SN uniquely predicted individual differences in cognitive flexibility. Importantly, each of these results was also observed in a second retest dataset, demonstrating the robustness of our findings. Our study provides fundamental new insights into the distinct dynamic functional architecture of the SN and demonstrates how this network is uniquely positioned to facilitate interactions with multiple functional systems and thereby support a wide range of cognitive processes in the human brain.

Human cognitive versatility is supported by a distinct, highly flexible, yet stable, dynamic brain organization of the salience network and its interactions with multiple other functional systems.

One of the most distinguishing features of the human brain is its ability to detect and attend to salient events in the environment. The salience network—a core large-scale brain network anchored in the anterior insula and the dorsal anterior cingulate cortex—is thought to play a crucial role in this process. To gain insights into the mechanisms that support this complex set of functions carried out by the salience network, we analyzed state-of-the-art fMRI data collected during multiple sessions with subsecond resolution and mapped dynamic time-varying functional interactions among the key neural components within the salience network and between the salience network and other core brain networks. We show that the large-scale brain dynamics of the salience network is characterized by several distinctive, behaviorally relevant, and robust properties, highlighting its highly flexible yet stable organization. Our findings provide fundamental new insights into the dynamic functional architecture of the salience network and demonstrate how it is uniquely positioned to facilitate interactions with multiple functional systems and thereby support cognitive flexibility.

Multivariate Analyses and Classification of Inertial Sensor Data to Identify Aging Effects on the Timed-Up-and-Go Test

Many tests can crudely quantify age-related mobility decrease but instrumented versions of mobility tests could increase their specificity and sensitivity. The Timed-up-and-Go (TUG) test includes several elements that people use in daily life. The test has different transition phases: rise from a chair, walk, 180° turn, walk back, turn, and sit-down on a chair. For this reason the TUG is an often used test to evaluate in a standardized way possible decline in balance and walking ability due to age and or pathology. Using inertial sensors, qualitative information about the performance of the sub-phases can provide more specific information about a decline in balance and walking ability. The first aim of our study was to identify variables extracted from the instrumented timed-up-and-go (iTUG) that most effectively distinguished performance differences across age (age 18-75). Second, we determined the discriminative ability of those identified variables to classify a younger (age 18-45) and older age group (age 46-75). From healthy adults (n = 59), trunk accelerations and angular velocities were recorded during iTUG performance. iTUG phases were detected with wavelet-analysis. Using a Partial Least Square (PLS) model, from the 72-iTUG variables calculated across phases, those that explained most of the covariance between variables and age were extracted. Subsequently, a PLS-discriminant analysis (DA) assessed classification power of the identified iTUG variables to discriminate the age groups. 27 variables, related to turning, walking and the stand-to-sit movement explained 71% of the variation in age. The PLS-DA with these 27 variables showed a sensitivity and specificity of 90% and 85%. Based on this model, the iTUG can accurately distinguish young and older adults. Such data can serve as a reference for pathological aging with respect to a widely used mobility test. Mobility tests like the TUG supplemented with smart technology could be used in clinical practice.

Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

PURPOSE

The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke.

METHODS

Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee.

RESULTS

Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential.

CONCLUSIONS

As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).