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Zhang M, Ho E, Nowinski CJ, Fox RS, Ayturk E, Karpouzian-Rogers T, Novack M, Dodge HH, Weintraub S, Gershon R. The Paradox in Positive and Negative Aspects of Emotional Functioning Among Older Adults with Early Stages of Cognitive Impairment. J Aging Health 2024; 36:471-483. [PMID: 37800686 DOI: 10.1177/08982643231199806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Introduction: Emotional functioning in older adults is influenced by normal aging and cognitive impairment, likely heterogeneous across positive versus negative aspects of emotional functioning. Little is known about positive emotional experiences at the early stages of cognitive impairment. Methods: We assessed different aspects of emotional functioning among 448 participants aged 65+ (Normal Control (NC) = 276, Mild Cognitive Impairment (MCI) = 103, and mild dementia of the Alzheimer type (mild DAT) = 69) and tested moderators. Results: Compared to NC, older adults with MCI and mild DAT have maintained many positive aspects of emotional functioning, despite higher levels of negative affect, sadness, and loneliness. Among the oldest-old, the mild DAT group experienced higher fear and lower self-efficacy. Discussion: Older adults at early stages of cognitive impairment can experience positive aspects of emotional functioning, such as positive affect, purpose, and life satisfaction, all of which are important buildable psychological resources for coping.
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Affiliation(s)
- Manrui Zhang
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Emily Ho
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Cindy J Nowinski
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Rina S Fox
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- College of Nursing, University of Arizona, Tuscon, AZ, USA
| | - Ezgi Ayturk
- College of Social Sciences and Humanities, KOC Universitesi, Istanbul, Turkey
| | - Tatiana Karpouzian-Rogers
- Department of Psychiatry and Behavioral Sciences, Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Miriam Novack
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandra Weintraub
- Department of Psychiatry and Behavioral Sciences, Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Richard Gershon
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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Diachek E, Brown-Schmidt S, Duff M. Attentional Orienting and Disfluency-Related Memory Boost Are Intact in Adults With Moderate-Severe Traumatic Brain Injury. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1803-1818. [PMID: 38749013 PMCID: PMC11196090 DOI: 10.1044/2024_jslhr-23-00385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/31/2023] [Accepted: 02/18/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Traumatic brain injury (TBI) is associated with a range of cognitive-communicative deficits that interfere with everyday communication and social interaction. Considerable effort has been directed at characterizing the nature and scope of cognitive-communication disorders in TBI, yet the underlying mechanisms of impairment are largely unspecified. The present research examines sensitivity to a common communicative cue, disfluency, and its impact on memory for spoken language in TBI. METHOD Fifty-three participants with moderate-severe TBI and 53 noninjured comparison participants listened to a series of sentences, some of which contained disfluencies. A subsequent memory test probed memory for critical words in the sentences. RESULTS Participants with TBI successfully remembered the spoken words (b = 1.57, p < .0001) at a similar level to noninjured comparison participants. Critically, participants with TBI also exhibited better recognition memory for words preceded by disfluency compared to words from fluent sentences (b = 0.57, p = .02). CONCLUSIONS These findings advance mechanistic accounts of cognitive-communication disorder by revealing that, when isolated for experimental study, individuals with moderate-severe TBI are sensitive to attentional orienting cues in speech and exhibit enhanced recognition of individual words preceded by disfluency. These results suggest that some aspects of cognitive-communication disorders may not emerge from an inability to perceive and use individual communication cues, but rather from disruptions in managing (i.e., attending, weighting, integrating) multiple cognitive, communicative, and social cues in complex and dynamic interactions. This hypothesis warrants further investigation.
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Affiliation(s)
- Evgeniia Diachek
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, TN
| | - Sarah Brown-Schmidt
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, TN
| | - Melissa Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Muhammad F, Hameed S, Haynes G, Mohammadi E, Khan AF, Shakir H, Smith ZA. Degenerative cervical myelopathy: establishing severity thresholds for neuromotor dysfunction in the aging spine using the NIH Toolbox Assessment Scale. GeroScience 2024; 46:2197-2206. [PMID: 37880488 PMCID: PMC10828326 DOI: 10.1007/s11357-023-00983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023] Open
Abstract
Degenerative cervical myelopathy (DCM) is a leading cause of age-related non-traumatic spinal cord disorders resulting from chronic degeneration of the cervical spine. While traditional clinical assessments rely on patient-reported measures, this study used the NIH Toolbox Motor Battery (NIHTBm) as an objective, quantitative measure to determine DCM severity. The objective is to define NIHTBm cutoff values that can accurately classify the severity of DCM neuromotor dysfunction. A case-controlled pilot study of patients with DCM and age-matched controls. The focus was an in-depth quantitative motor assessment using the NIHTBm to understand the severity of neuromotor deficits due to degenerative spine disease. Motor assessments, dexterity, grip strength, balance, and gait speed were measured in 45 DCM patients and 37 age-matched healthy subjects (HC). Receiver operating curve (ROC) analysis determined cutoff values for mild and moderate-to-severe myelopathy which were validated by comparing motor assessment scores with disability scores. The ROC curves identified thresholds for mild dexterity impairment (T-score range 38.4 - 33.5, AUC 0.77), moderate-to-severe dexterity impairment (< 33.5, AUC 0.70), mild grip strength impairment (47.4 - 32.0, AUC 0.80), moderate-to-severe grip strength impairment (< 32.0, AUC 0.75), mild balance impairment (36.4 - 33.0, AUC 0.61), and moderate-to-severe balance impairment (< 33.0, AUC 0.78). Mild gait speed impairment was defined as 0.78-0.6 m/sec (AUC 0.65), while moderate-to-severe gait speed impairment was < 0.6 m/sec (AUC 0.65). The NIHTB motor score cutoff points correlated negatively with the DCM neck disability index (NDI) and showed balance and dexterity measures as independent indicators of DCM dysfunction. The use of NIHTB allows for precise delineation of DCM severity by establishing cutoff values corresponding to mild and moderate-to-severe myelopathy. The use of NIHTB in DCM allows enhanced clinical precision, enabling clinicians to better pinpoint specific motor deficits in DCM and other neurological disorders with motor deficits, including stroke and traumatic brain injury (TBI). Furthermore, the utility of objective assessment, NIHTB, allows us to gain a better understanding of the heterogeneity of DCM, which will enhance treatment strategies. This study serves as a foundation for future research to facilitate the discovery of innovative treatment strategies for DCM and other neurological conditions.
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Affiliation(s)
- Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Sanaa Hameed
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Grace Haynes
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ali F Khan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hakeem Shakir
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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4
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Lau SCL, Connor LT, Skidmore ER. Associations of Circadian Rest-Activity Rhythms With Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study. Neurorehabil Neural Repair 2024; 38:197-206. [PMID: 38318642 DOI: 10.1177/15459683241230027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Rest-activity rhythm (RAR) is a modifiable behavioral factor associated with affect and cognition. Identifying RAR characteristics associated with affect and cognition among stroke survivors provides insight into preventing poststroke affective and cognitive impairment. OBJECTIVE To examine the associations of RAR characteristics with affect and cognition among community-dwelling stroke survivors. METHODS Forty participants with mild stroke (mean age = 52.8; 42.5% female; 55% White) reported their affect and cognitive complaints using ecological momentary assessment and wore an accelerometer for 7 consecutive days and completed the National Institutes of Health Toolbox Cognition Battery. RAR characteristics were extracted using parametric and non-parametric approaches. Multivariable linear regressions were used to identify RAR characteristics associated with affect and cognition. RESULTS Later onset of rest (B = 0.45; P = .008) and activity (B = 0.36; P = .041) were positively associated with depressed affect. These associations were reversed for cheerful effect (rest onset: B = -0.42; P = .017; activity onset: B = -0.39; P = .033). Cheerful affect was also positively associated with relative amplitude (ie, distinctions in activity levels between rest and activity; B = .39; P = .030). Intra-daily variability (ie, RAR fragmentation; B = 0.35; P = .042) and later onset of activity (B = .36; P = .048) were positively associated with cognitive complaints. Less erratic RAR was positively associated with fluid cognition (B = 0.29; P = .036); RAR fragmentation was positively associated with crystallized cognition (B = 0.39; P = .015). CONCLUSIONS We identified RAR correlates of affect and cognition among stroke survivors, highlighting the value of managing RAR and sleep in stroke rehabilitation. Future studies should test whether advancing the onset of rest and activity, promoting a regular active lifestyle, and improving rest and sleep in the nighttime protect stroke survivors from affective and cognitive impairment.
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Affiliation(s)
- Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa Tabor Connor
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
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5
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Panigrahy A, Schmithorst V, Ceschin R, Lee V, Beluk N, Wallace J, Wheaton O, Chenevert T, Qiu D, Lee JN, Nencka A, Gagoski B, Berman JI, Yuan W, Macgowan C, Coatsworth J, Fleysher L, Cannistraci C, Sleeper LA, Hoskoppal A, Silversides C, Radhakrishnan R, Markham L, Rhodes JF, Dugan LM, Brown N, Ermis P, Fuller S, Cotts TB, Rodriguez FH, Lindsay I, Beers S, Aizenstein H, Bellinger DC, Newburger JW, Umfleet LG, Cohen S, Zaidi A, Gurvitz M. Design and Harmonization Approach for the Multi-Institutional Neurocognitive Discovery Study (MINDS) of Adult Congenital Heart Disease (ACHD) Neuroimaging Ancillary Study: A Technical Note. J Cardiovasc Dev Dis 2023; 10:381. [PMID: 37754810 PMCID: PMC10532244 DOI: 10.3390/jcdd10090381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Dramatic advances in the management of congenital heart disease (CHD) have improved survival to adulthood from less than 10% in the 1960s to over 90% in the current era, such that adult CHD (ACHD) patients now outnumber their pediatric counterparts. ACHD patients demonstrate domain-specific neurocognitive deficits associated with reduced quality of life that include deficits in educational attainment and social interaction. Our hypothesis is that ACHD patients exhibit vascular brain injury and structural/physiological brain alterations that are predictive of specific neurocognitive deficits modified by behavioral and environmental enrichment proxies of cognitive reserve (e.g., level of education and lifestyle/social habits). This technical note describes an ancillary study to the National Heart, Lung, and Blood Institute (NHLBI)-funded Pediatric Heart Network (PHN) "Multi-Institutional Neurocognitive Discovery Study (MINDS) in Adult Congenital Heart Disease (ACHD)". Leveraging clinical, neuropsychological, and biospecimen data from the parent study, our study will provide structural-physiological correlates of neurocognitive outcomes, representing the first multi-center neuroimaging initiative to be performed in ACHD patients. Limitations of the study include recruitment challenges inherent to an ancillary study, implantable cardiac devices, and harmonization of neuroimaging biomarkers. Results from this research will help shape the care of ACHD patients and further our understanding of the interplay between brain injury and cognitive reserve.
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Affiliation(s)
- Ashok Panigrahy
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
- Department of Pediatric Radiology, Children’s Hospital of Pittsburgh of UPMC, 45th Str., Penn Ave., Pittsburgh, PA 15201, USA
| | - Vanessa Schmithorst
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Rafael Ceschin
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Vince Lee
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Nancy Beluk
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Julia Wallace
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Olivia Wheaton
- HealthCore Inc., 480 Pleasant Str., Watertown, MA 02472, USA;
| | - Thomas Chenevert
- Department of Radiology, Michigan Medicine University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA;
- Congenital Heart Center, C. S. Mott Children’s Hospital, 1540 E Hospital Dr., Ann Arbor, MI 48109, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory School of Medicine, 1364 Clifton Rd., Atlanta, GA 30322, USA;
| | - James N Lee
- Department of Radiology, The University of Utah, 50 2030 E, Salt Lake City, UT 84112, USA;
| | - Andrew Nencka
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA;
| | - Borjan Gagoski
- Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
| | - Jeffrey I. Berman
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
| | - Weihong Yuan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA;
- Department of Radiology, University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH 45267, USA
| | - Christopher Macgowan
- Department of Medical Biophysics, University of Toronto, 101 College Str. Suite 15-701, Toronto, ON M5G 1L7, Canada;
- The Hospital for Sick Children Division of Translational Medicine, 555 University Ave., Toronto, ON M5G 1X8, Canada
| | - James Coatsworth
- Department of Radiology, Medical University of South Carolina, 171 Ashley Ave., Room 372, Charleston, SC 29425, USA;
| | - Lazar Fleysher
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Christopher Cannistraci
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
| | - Arvind Hoskoppal
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave. Floor 2, Pittsburgh, PA 15224, USA; (V.S.); (R.C.); (V.L.); (N.B.); (J.W.); (A.H.)
| | - Candice Silversides
- Department of Cardiology, University of Toronto, C. David Naylor Building, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada;
| | - Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 University Blvd., Indianapolis, IN 46202, USA;
| | - Larry Markham
- Department of Cardiology, University of Indiana School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA;
| | - John F. Rhodes
- Department of Cardiology, Medical University of South Carolina, 96 Jonathan Lucas Str. Ste. 601, MSC 617, Charleston, SC 29425, USA;
| | - Lauryn M. Dugan
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; (L.M.D.); (N.B.)
| | - Nicole Brown
- Department of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA; (L.M.D.); (N.B.)
| | - Peter Ermis
- Department of Radiology, Texas Children’s Hospital, Houston, TX 77030, USA; (P.E.); (S.F.)
| | - Stephanie Fuller
- Department of Radiology, Texas Children’s Hospital, Houston, TX 77030, USA; (P.E.); (S.F.)
| | - Timothy Brett Cotts
- Departments of Internal Medicine and Pediatrics, Michigan Medicine University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA;
| | - Fred Henry Rodriguez
- Department of Cardiology, Emory School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA;
| | - Ian Lindsay
- Department of Cardiology, The University of Utah, 95 S 2000 E, Salt Lake City, UT 84112, USA;
| | - Sue Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Str., Pittsburgh, PA 15213, USA; (S.B.); (H.A.)
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Str., Pittsburgh, PA 15213, USA; (S.B.); (H.A.)
| | - David C. Bellinger
- Cardiac Neurodevelopmental Program, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
| | - Laura Glass Umfleet
- Department of Neuropsychology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA;
| | - Scott Cohen
- Heart and Vascular Center, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Ali Zaidi
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave., New York, NY 10029, USA; (L.F.); (C.C.); (A.Z.)
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA; (L.A.S.); (J.W.N.); (M.G.)
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Kuzmuk LE, Rebchuk AD, Deptuck HM, Cairncross M, Silverberg ND, Field TS. Three-month Practice Effect of the National Institutes of Health Toolbox Cognition Battery in Young Healthy Adults. Can J Neurol Sci 2023; 50:769-772. [PMID: 35801595 DOI: 10.1017/cjn.2022.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The National Institutes of Health Toolbox-Cognition Battery (NIHTB-CB) is a tablet-based cognitive assessment intended for individuals with neurological diseases of all ages. NIHTB-CB practice effects (PEs), however, need clarification if this measure is used to track longitudinal change. We explored the test-retest PEs on NIHTB-CB performance at 3 months in young healthy adults (n = 22). We examined corrected T-scores normalized for demographic factors and calculated PEs using Cohen's d. There were significant PEs for all NIHTB-CB composite scores and on 4/7 subtests. This work suggests the need to further assess NIHTB-CB PEs as this may affect the interpretation of study results incorporating this battery.
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Affiliation(s)
- Leah E Kuzmuk
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alexander D Rebchuk
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Neurosurgery, University of British Columbia, Vancouver, Canada
| | - Halina M Deptuck
- Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Molly Cairncross
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Thalia S Field
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Neurology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- Vancouver Stroke Program, University of British Columbia, Vancouver, Canada
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Wright B, Guilliod R, Thakur B, Kundig C, Morales J, Tessler J, Berry J, Zhang R, Bell KR, Pinto SM. Hyperbaric Oxygen Therapy versus placebo for post-concussion syndrome (HOT-POCS): A randomized, double-blinded controlled pilot study. Contemp Clin Trials Commun 2023; 34:101176. [PMID: 37416626 PMCID: PMC10320499 DOI: 10.1016/j.conctc.2023.101176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023] Open
Abstract
Post-Concussion Syndrome (PCS) refers to the persistence of physical, cognitive, and emotional symptoms following mild traumatic brain injury (mTBI)/concussion, occurring in roughly 15-30% of individuals. Hyperbaric oxygen therapy (HBOT) has been suggested as a potential treatment for PCS; however, the evidence to date is mixed due to inconsistencies in the treatment protocol and focus on veterans with combat-related injuries, which may not be generalizable to the general population. The goal of Hyperbaric Oxygen Therapy for Post-Concussion Syndrome (HOT-POCS) is to assess the efficacy and safety of HBOT for the treatment of PCS in the civilian population. This randomized, controlled pilot study will be using a standardized HBOT protocol (20 sessions of 100% O2 at 2.0 atm absolute [ATA]) compared with a true placebo gas system that mimics the oxygen composition at room air (20 sessions of 10.5% O2 and 89.5% nitrogen at 2.0 ATA) in a cohort of 100 adults with persistent post-concussive symptoms 3-12 months following injury. Change in symptoms on the Rivermead Post-concussion Questionnaire (RPQ) will be the primary outcome of interest. Secondary outcomes include the rate of adverse events, change in the quality of life, and change in cognitive function. Exploratory outcome measures will include changes in physical function and changes in cerebral brain perfusion and oxygen metabolism on MRI brain imaging. Overall, the HOT-POCS study will compare the efficacy of a standardized HBOT treatment protocol against a true placebo gas for the treatment of PCS within 12 months after injury.
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Affiliation(s)
- Brittany Wright
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Renie Guilliod
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bhaskar Thakur
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Charles Kundig
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jill Morales
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph Tessler
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Berry
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rong Zhang
- Departments of Neurology and Internal Medicine, University of Texas Southwestern Medical Center, Director of Cerebrovascular Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA
| | - Kathleen R. Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shanti M. Pinto
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
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8
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Nolin SA, Cowart H, Merritt S, McInerney K, Bharadwaj PK, Franchetti MK, Raichlen DA, Jessup CJ, Hishaw GA, Van Etten EJ, Trouard TP, Geldmacher DS, Wadley VG, Porges ES, Woods AJ, Cohen RA, Levin BE, Rundek T, Alexander GE, Visscher KM. Validity of the NIH toolbox cognitive battery in a healthy oldest-old 85+ sample. J Int Neuropsychol Soc 2023; 29:605-614. [PMID: 36239453 PMCID: PMC11172394 DOI: 10.1017/s1355617722000443] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the construct validity of the NIH Toolbox Cognitive Battery (NIH TB-CB) in the healthy oldest-old (85+ years old). METHOD Our sample from the McKnight Brain Aging Registry consists of 179 individuals, 85 to 99 years of age, screened for memory, neurological, and psychiatric disorders. Using previous research methods on a sample of 85 + y/o adults, we conducted confirmatory factor analyses on models of NIH TB-CB and same domain standard neuropsychological measures. We hypothesized the five-factor model (Reading, Vocabulary, Memory, Working Memory, and Executive/Speed) would have the best fit, consistent with younger populations. We assessed confirmatory and discriminant validity. We also evaluated demographic and computer use predictors of NIH TB-CB composite scores. RESULTS Findings suggest the six-factor model (Vocabulary, Reading, Memory, Working Memory, Executive, and Speed) had a better fit than alternative models. NIH TB-CB tests had good convergent and discriminant validity, though tests in the executive functioning domain had high inter-correlations with other cognitive domains. Computer use was strongly associated with higher NIH TB-CB overall and fluid cognition composite scores. CONCLUSION The NIH TB-CB is a valid assessment for the oldest-old samples, with relatively weak validity in the domain of executive functioning. Computer use's impact on composite scores could be due to the executive demands of learning to use a tablet. Strong relationships of executive function with other cognitive domains could be due to cognitive dedifferentiation. Overall, the NIH TB-CB could be useful for testing cognition in the oldest-old and the impact of aging on cognition in older populations.
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Affiliation(s)
- Sara A Nolin
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Hannah Cowart
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Stacy Merritt
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Katalina McInerney
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - P K Bharadwaj
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | | | | | - Cortney J Jessup
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - G Alex Hishaw
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - Emily J Van Etten
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - Theodore P Trouard
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - David S Geldmacher
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Virginia G Wadley
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Eric S Porges
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, FL, USA
| | - Adam J Woods
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, FL, USA
| | - Ron A Cohen
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, FL, USA
| | - Bonnie E Levin
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Tatjana Rundek
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Gene E Alexander
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - Kristina M Visscher
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
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9
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Won P, Ding L, McMullen K, Yenikomshian HA. Post-Burn Psychosocial Outcomes in Pediatric Minority Patients in the United States: An Observational Cohort Burn Model System Study. EUROPEAN BURN JOURNAL 2023; 4:173-183. [PMID: 37359277 PMCID: PMC10290777 DOI: 10.3390/ebj4020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Racial and ethnic minority burn patients face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database report adult minority patients experience worse psychosocial outcomes in domains such as body image during burn recovery. No study to date has investigated disparities in psychosocial outcomes by racial or ethnic category in the pediatric population using the BMS database. This observational cohort study addresses this gap and examines seven psychosocial outcomes (levels of anger, sadness, depression, anxiety, fatigue, peer relationships, and pain) in pediatric burn patients. The BMS database is a national collection of burn patient outcomes from four centers in the United States. BMS outcomes collected were analyzed using multi-level, linear mixed effects regression modeling to examine associations between race/ethnicity and outcomes at discharge after index hospitalization, and 6- and 12-months post-injury. A total of 275 pediatric patients were included, of which 199 (72.3%) were Hispanic. After burn injury, of which the total body surface area was significantly associated with racial/ethnicity category (p < 0.01), minority patients more often reported higher levels of sadness, fatigue, and pain interference and lower levels of peer relationships compared to Non-Hispanic, White patients, although no significant differences existed. Black patients reported significantly increased sadness at six months (β = 9.31, p = 0.02) compared to discharge. Following burn injury, adult minority patients report significantly worse psychosocial outcomes than non-minority patients. However, these differences are less profound in pediatric populations. Further investigation is needed to understand why this change happens as individuals become adults.
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Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Li Ding
- Department of Population and Public Health Science, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195-2100, USA
| | - Haig A. Yenikomshian
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA 90033, USA
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10
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Christ SE, Clocksin HE, Zalik M, Goodlett BD, Sacharow SJ, Abbene EE. Neuropsychological assessment of adults with phenylketonuria using the NIH toolbox. Mol Genet Metab 2023; 139:107579. [PMID: 37099821 DOI: 10.1016/j.ymgme.2023.107579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023]
Abstract
Among researchers and clinicians, there is a call for the development and validation of new measures to better assess and characterize neurocognitive difficulties associated with early-treated phenylketonuria (ETPKU) and other metabolic disorders. The NIH Toolbox represents a relatively new computer-administered assessment tool and provides a sampling of performance across multiple cognitive domains, several of which (e.g., executive function, processing speed) are at risk for disruption in ETPKU. The goal of the present study was to provide an initial evaluation of the value and sensitivity of the NIH Toolbox for use with individuals with ETPKU. To this end, a sample of adults with ETPKU and a demographically-matched comparison group without PKU completed the cognitive and motor batteries of the Toolbox. Results indicate that overall performance (as reflected by the Fluid Cognition Composite) was sensitive to both group differences (ETPKU vs non-PKU) as well as blood Phe levels (a marker of metabolic control). The present findings offer preliminary support for the utility of the NIH Toolbox as a measure of neurocognitive functioning in individuals with ETPKU. Future research including a larger sample size and broader age range is needed to fully validate the Toolbox for clinical and research use with individuals with ETPKU.
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Affiliation(s)
- Shawn E Christ
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA.
| | - Hayley E Clocksin
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Maia Zalik
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | | | - Stephanie J Sacharow
- Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Emily E Abbene
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
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11
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Muhammad F, Baha A, Haynes G, Shakir H, Omini M, Martin M, Weber KA, Paliwal M, Van Hal M, Dickson D, Dhaher Y, Zhao YD, Smith ZA. Isolating Neurologic Deficits in Cervical Spondylotic Myelopathy: A Case-Controlled Study, Using the NIH Toolbox Motor Battery. Neurol Clin Pract 2023; 13:e200126. [PMID: 37064579 PMCID: PMC10101713 DOI: 10.1212/cpj.0000000000200126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/08/2022] [Indexed: 03/10/2023]
Abstract
Background and Objectives Patients with cervical spondylotic myelopathy (CSM) have motor impairments, including weakness, imbalance, and loss of dexterity. The reliable assessment of these symptoms is critical for treatment decisions. This study aimed to determine, for the first time, the use of the NIH Toolbox motor battery (NIHTBm) in the objective assessment of motor deficits in patients with CSM. Methods Patients with symptoms and MRI evidence of CSM and age-matched healthy controls (HC), with no evidence of spinal disorder or surgery were included in this case-control study based on our inclusion and exclusion criteria. We performed motor tests, dexterity, gait speed, grip strength, and balance tests, using the NIHTBm in patients with CSM and HCs. Motor impairment rates were determined in patients with CSM based on the NIHTBm scores. We determined the association between NIHTBm scores and patient-reported outcome scores; patient-reported outcome measures (the modified Japanese Orthopedic Association [mJOA] and Nurick grade) to determine the association. One-way analysis of variance was used to analyze group differences and the Spearman rank correlation to determine the relationship between assessment scores. Results We enrolled 24 patients with CSM with a mean age (SD) of 57.96 (10.61) years and 24 age-matched HCs with a mean age (SD) of 53.17 (6.04) years in this study. Overall, we observed a significant decrease in the motor function T-scores mean (SD): dexterity 31.54 (14.82) vs 51.54 (9.72), grip strength 32.00 (17.47) vs 56.79 (8.46), balance 27.58 (16.65) vs 40.21 (6.35), and gait speed 0.64 (0.18) vs 0.99 (0.17) m/s, in patients with CSM compared with that in HCs. The lower extremity dysfunction scores on the NIHTBm, balance (ρ = -0.67) and gait speed (ρ = -0.62), were associated with higher Nurick grades. We observed a similar but weaker association with the Nurick grades and NIHTBm tests: dexterity (ρ = -0.49) and grip strength (ρ = -0.31) scores. The total motor mJOA showed a positive but weak association with NIHTBm scores, gait speed (ρ = 0.38), balance (ρ = 0.49), grip strength (ρ = 0.41), and dexterity (ρ = 0.45). Discussion Patients with CSM had significantly lower NIHTBm scores compared with HCs. The results from the NIHTBm are consistent with the clinical presentation of CSM showing patients have motor impairments in both upper and lower extremities. As a neurologic-specific scale, NIHTBm should be used in the evaluation and clinical management of patients with CSM.
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Affiliation(s)
- Fauziyya Muhammad
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Alaa Baha
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Grace Haynes
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Hakeem Shakir
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Michael Omini
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Michael Martin
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Kenneth A Weber
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Monica Paliwal
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Michael Van Hal
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Douglas Dickson
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Yasin Dhaher
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Yan Daniel Zhao
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Zachary A Smith
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
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12
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Lopez FV, Schade R, Ratajska A, Kenney L, Rodriguez K, Ray A, Santos L, Scott BM, Trifilio E, Bowers D. Unpacking the NIH Toolbox Emotion Battery in Persons With Parkinson's disease. Arch Clin Neuropsychol 2023; 38:205-212. [PMID: 36446750 PMCID: PMC9940110 DOI: 10.1093/arclin/acac088] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/22/2022] [Accepted: 10/16/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Examine the relationship between the National Institutes of Health Toolbox Emotion Battery (Emotion Toolbox) and traditional measures in Parkinson's disease (PD). METHOD Persons with PD (n = 30) and cognitively healthy older adults (OA; n = 40) completed the Emotion Toolbox consisting of Well-Being, Negative Affect, and Social Satisfaction scores along with traditional measures of depression (Beck Depression Inventory-II [BDI-II]), anxiety (State-Trait Anxiety Inventory [STAI]), and apathy (Apathy Scale [AS]); total raw scores). RESULTS Separate bootstrapped analyses of covariance indicated that the PD group scored higher on BDI-II and STAI-State compared to OA (ps < .01); groups did not differ on Emotion Toolbox. In the PD group, bootstrapped partial correlations indicated that Negative Affect was positively related to BDI-II and STAI (ps ≤ .001). Social Satisfaction was negatively related to BDI-II and STAI-Trait (.05 < ps < .004). Psychological Well-Being was negatively related to BDI-II, AS, and STAI (p < .004). No relationships emerged in OA. In the PD group, separate binary logistic regressions showed that traditional measures (BDI-II, AS, and STAI-Trait) correctly classified 79.6% those with formal psychiatric diagnoses (presence vs. absence; p < .011), whereas Emotion Toolbox measures correctly classified 73.3% (p < .019). CONCLUSIONS The Emotion Toolbox showed moderate-strong correlations with traditional measures in persons with PD. Even so, it did not capture the group differences between PD and OA and had a somewhat lower classification accuracy rate for persons with PD who had a formal psychiatric diagnosis than traditional measures. Together, findings question the utility of the Emotion Toolbox as a stand-alone emotion screener in PD.
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Affiliation(s)
- Francesca V Lopez
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Rachel Schade
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Adrianna Ratajska
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Lauren Kenney
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Katie Rodriguez
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Alyssa Ray
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Lauren Santos
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Bonnie M Scott
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Erin Trifilio
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL 32610, USA
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13
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Lau SCL, Connor LT, Baum CM. Subjective and objective assessments are associated for physical function but not cognitive function in community-dwelling stroke survivors. Disabil Rehabil 2022; 44:8349-8356. [PMID: 34904503 DOI: 10.1080/09638288.2021.2012845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate the relation between subjectively and objectively assessed cognitive and physical functioning among community-dwelling stroke survivors, and to examine the association of stroke severity with subjectively and objectively assessed cognitive and physical impairments. MATERIALS AND METHODS Secondary data analysis was conducted with 127 community-dwelling stroke survivors. For cognitive functioning, objective measures included the NIH Toolbox Cognition Battery and the Executive Function Performance Test; subjective measures included the Quality of Life in Neurological Disorders Applied Cognition. Objective and subjective physical functioning was measured by the NIH Toolbox 2-Minute Walk Test and the Patient-Reported Outcomes Measurement Information System Physical Function, respectively. RESULTS A positive correlation was observed between subjective and objective physical functioning, whereas the correlation between subjective and objective cognitive functioning was nonsignificant. Stroke severity was associated with objective cognitive impairment and objective and subjective physical impairment, but not subjective cognitive impairment. CONCLUSIONS The lack of association between objective and subjective cognitive functioning challenges the conventional assumption that perceived functioning reflects actual performance. We recommend using both objective and subjective measures to accurately identify cognitive and physical impairment following stroke.Implications for RehabilitationSubjective cognitive functioning is not associated with objective cognitive functioning, suggesting that solely relying on stroke patients' reports is inadequate and may inaccurately estimate patients' actual deficits.Both objective and subjective measures should be used to accurately identify cognitive and physical impairment following stroke.Practitioners should be cognizant of stroke patients' behavioral signs associated with underlying cognitive problems that warrant further evaluation.
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Affiliation(s)
- Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa Tabor Connor
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn M Baum
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
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14
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Manglani HR, Fisher ME, Duraney EJ, Nicholas JA, Prakash RS. A promising cognitive screener in multiple sclerosis: The NIH toolbox cognition battery concords with gold standard neuropsychological measures. Mult Scler 2022; 28:1762-1772. [PMID: 35531593 DOI: 10.1177/13524585221088731] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Routine cognitive screening is a priority in MS clinical care. The National Institutes of Health Toolbox (NIHTB) Cognition Battery is a 30-min instrument validated in neurological populations excluding MS. OBJECTIVES To assess construct validity of NIHTB tests and compare classification of cognitive impairment with gold-standard tests. To evaluate relationships between fluid cognition and clinical measures. METHODS Eighty-seven individuals, aged 30-59 years, completed the NIHTB, Minimal Assessment of Cognitive Function in MS (MACFIMS), Wechsler Adult Intelligence Scale-IV subtests, and measures of disease severity, depression, and fatigue. RESULTS The NIHTB showed adequate convergent validity for processing speed, working memory, and episodic memory. Although fluid cognition scores from the NIHTB and MACFIMS classified a similar proportion of participants as cognitively impaired, the two batteries differed in which individuals were classified as impaired versus preserved. NIHTB fluid cognition was inversely correlated with disease severity but not related to depression or fatigue. CONCLUSIONS The NIHTB concords with gold-standard measures, and classifies cognitive impairment at similar rates to the MACFIMS. Adjusted NIHTB fluid cognition was negatively associated with disease severity suggesting clinical utility. Psychometric validation of the NIHTB in clinical practice will elucidate its promise as a cognitive screener in MS.
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Affiliation(s)
- Heena R Manglani
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Megan E Fisher
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | | | | | - Ruchika Shaurya Prakash
- Department of Psychology, The Ohio State University, Columbus, OH, USA/Center for Cognitive and Behavioral Brain Imaging, The Ohio State University, Columbus, OH, USA Analyses for the current study were pre-registered on the Open Science Framework (https://osf.io/fcvga/)
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15
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Validation of the NIH Toolbox-Cognition Battery against legacy neurocognitive measures in adults with cognitive impairments: An exploratory analysis. J Int Neuropsychol Soc 2022; 29:472-479. [PMID: 36062530 PMCID: PMC9985667 DOI: 10.1017/s1355617722000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this exploratory study was to describe associations between NIH Toolbox-Cognition Battery subtests and legacy measures of neurocognitive function in two samples with neurological conditions (stroke and sickle cell disease (SCD)). METHOD This exploratory secondary analysis uses data from two studies that assessed cognition at one time point using the NIH Toolbox-Cognition Battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and subtests from the Delis-Kaplan Executive Functions System (DKEFS). People with stroke (n = 26) and SCD (n = 64) were included. Associations between the NIH Toolbox-Cognition Battery subtests and corresponding legacy measures were examined using linear correlations, Bland-Altman analysis, and Lin's Concordance Correlation Coefficient. RESULTS Linear correlations and Lin's Concordance Correlation Coefficient were poor to strong in both samples on NIH Toolbox-CB subtests: Flanker Inhibitory Control and Attention (r = .35 to .48, Lin CCC = .27 to .37), Pattern Comparison Processing Speed (r = .40 to .65, Lin CCC = .37 to .62), Picture Sequence Memory (r = .19 to .55, Lin CCC = .18 to .48), Dimensional Change Card Sort (r = .39 to .77, Lin CCC = .38 to .63), Fluid Cognition Composite (r = .88 to .90, Lin CCC = .60 to .79), and Total Cognition Composite (r = .64 to .83, Lin CCC = .60 to .78). Bland-Altman analyses demonstrated wide limits of agreement across all subtests (-3.17 to 3.78). CONCLUSIONS The NIH Toolbox-Cognition Battery subtests may behave similarly to legacy measures as an overall assessment of cognition across samples at risk for neurological impairment. Findings should be replicated across additional clinical samples.
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Welbel RZ, Rand CM, Zhou A, Fadl-Alla A, Chen ML, Weese-Mayer DE, Zelko FA. Neurocognitive monitoring in congenital central hypoventilation syndrome with the NIH Toolbox®. Pediatr Pulmonol 2022; 57:2040-2047. [PMID: 35574731 PMCID: PMC9541049 DOI: 10.1002/ppul.25973] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/09/2022]
Abstract
Congenital central hypoventilation syndrome (CCHS) is a rare neurocristopathy, caused by mutations in the paired-like homeobox gene PHOX2B, which alters control of breathing and autonomic nervous system regulation, necessitating artificial ventilation as life-support. A broad range of neurocognitive performance has been reported in CCHS, including an array of cognitive deficits. We administered the NIH Toolbox® Cognition Battery (NTCB), a novel technology comprised of seven tasks presented via an interactive computer tablet application, to a CCHS cohort and studied its convergent and divergent validity relative to traditional clinical neurocognitive measures. The NTCB was administered to 51 CCHS participants, including a subcohort of 24 who also received traditional clinical neurocognitive testing (Wechsler Intelligence Scales). Age-corrected NTCB scores from the overall sample and subcohort were compared to population norms. Associations between NTCB indices and Wechsler Intelligence scores were studied to determine the convergent and divergent validity of the NTCB. NTCB test results indicated reduced Fluid Cognition, which measures new learning and speeded information processing (p < 0.001), but intact Crystallized Cognition, which measures past learning, in CCHS relative to population norms. Moderate to strong associations (r > 0.60) were found between age-corrected NTCB Fluid and Crystallized indices and comparable Wechsler indices, supporting the convergent and discriminant validity of the NTCB. Results reveal deficits of Fluid Cognition in individuals with CCHS and indicate that the NTCB is a valid and sensitive measure of cognitive outcomes in this population. Our findings suggest that the NTCB may play a useful role in tracking neurocognition in CCHS.
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Affiliation(s)
- Remi Z Welbel
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois, USA
| | - Casey M Rand
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois, USA
| | - Amy Zhou
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois, USA
| | - Allaa Fadl-Alla
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois, USA
| | - Maida Lynn Chen
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Debra E Weese-Mayer
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Frank A Zelko
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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17
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Weintraub S, Karpouzian-Rogers T, Peipert JD, Nowinski C, Slotkin J, Wortman K, Ho E, Rogalski E, Carlsson C, Giordani B, Goldstein F, Lucas J, Manly JJ, Rentz D, Salmon D, Snitz B, Dodge HH, Riley M, Eldes F, Ustsinovich V, Gershon R. ARMADA: Assessing reliable measurement in Alzheimer's disease and cognitive aging project methods. Alzheimers Dement 2022; 18:1449-1460. [PMID: 34786833 PMCID: PMC9110564 DOI: 10.1002/alz.12497] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/26/2021] [Accepted: 09/07/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Early detection of cognitive decline in older adults is a public health priority. Advancing Reliable Measurement in Alzheimer's Disease and Cognitive Aging (ARMADA), a multisite study, is validating cognition, emotion, motor, and sensory modules of the National Institutes of Health Toolbox for Assessment of Neurological and Behavioral Function (NIHTB) in the aging spectrum from cognitively normal to dementia of the Alzheimer's type (DAT). METHODS Participants 65 to 85 years old, in demographic groups racially proportional to the general US population, are recruited in one of three groups to validate the NIHTB: cognitively normal, amnestic mild cognitive impairment (aMCI), or mild DAT. Additional special emphasis cohorts include (1) Blacks in the three clinical groups; (2) Spanish-speakers in the three clinical groups; (3) cognitively normal, population-proportional, over age 85. DISCUSSION Longitudinal study will determine whether NIHTB can predict cognitive decline and is associated with Alzheimer's disease biomarkers. Here, we detail the methods for the ARMADA study.
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Affiliation(s)
- Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - Tatiana Karpouzian-Rogers
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Cindy Nowinski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
- Department of Neurology, Northwestern University Feinberg School of Medicine
| | - Jerry Slotkin
- Center for Health Assessment Research and Translation, University of Delaware
| | - Katy Wortman
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Emily Ho
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - Cynthia Carlsson
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health and Wisconsin Alzheimer’s Disease Research Center
| | | | | | - John Lucas
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Jennifer J. Manly
- Department of Neurology, Columbia University, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University
| | - Dorene Rentz
- Departments of Neurology, Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical School
| | - David Salmon
- Department of Neurosciences, University of California San Diego
| | - Beth Snitz
- Department of Neurology, University of Pittsburgh
| | - Hiroko H. Dodge
- Department of Neurology, Layton Aging and Alzheimer’s disease Center, Oregon Health & Science University
| | - Michaela Riley
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine
| | - Fatima Eldes
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine
| | - Vitali Ustsinovich
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Richard Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
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18
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Lau SCL, Connor LT, Heinemann AW, Baum CM. Cognition and Daily Life Activities in Stroke: A Network Analysis. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:260-268. [PMID: 35838366 DOI: 10.1177/15394492221111730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Understanding complex dynamics of cognitive constructs and the interplay between cognition and daily life activities is possible through network analysis. The objectives of this study are to characterize the cognition network and identify central cognitive constructs, and identify the cognitive constructs bridging cognition and daily life activities. In 210 community-dwelling stroke survivors, we employed network analysis to characterize the cognition network, identify the central cognitive constructs, and examine the bridge pathway connecting cognition and daily life activities. Cognitive constructs were positively correlated within the network, forming clusters of fluid (e.g., components of active problem-solving), crystallized (e.g., world knowledge), and functional cognition. Central constructs included inhibition, organization, and cognitive flexibility, whereas bridge constructs included organization, sequencing, and inhibition. Central and bridge constructs identified by this study are potential targets for future research and intervention. The emergence of functional cognition as central and bridge constructs may support its inclusion in occupational therapy practice.
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Affiliation(s)
- Stephen C L Lau
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carolyn M Baum
- Washington University School of Medicine, St. Louis, MO, USA.,Washington University in St. Louis, MO, USA
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19
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Taylor BK, Frenzel MR, Eastman JA, Wiesman AI, Wang YP, Calhoun VD, Stephen JM, Wilson TW. Reliability of the NIH toolbox cognitive battery in children and adolescents: a 3-year longitudinal examination. Psychol Med 2022; 52:1718-1727. [PMID: 33032665 PMCID: PMC8589010 DOI: 10.1017/s0033291720003487] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/15/2020] [Accepted: 09/07/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Cognitive Battery of the National Institutes of Health Toolbox (NIH-TB) is a collection of assessments that have been adapted and normed for administration across the lifespan and is increasingly used in large-scale population-level research. However, despite increasing adoption in longitudinal investigations of neurocognitive development, and growing recommendations that the Toolbox be used in clinical applications, little is known about the long-term temporal stability of the NIH-TB, particularly in youth. METHODS The present study examined the long-term temporal reliability of the NIH-TB in a large cohort of youth (9-15 years-old) recruited across two data collection sites. Participants were invited to complete testing annually for 3 years. RESULTS Reliability was generally low-to-moderate, with intraclass correlation coefficients ranging between 0.31 and 0.76 for the full sample. There were multiple significant differences between sites, with one site generally exhibiting stronger temporal stability than the other. CONCLUSIONS Reliability of the NIH-TB Cognitive Battery was lower than expected given early work examining shorter test-retest intervals. Moreover, there were very few instances of tests meeting stability requirements for use in research; none of the tests exhibited adequate reliability for use in clinical applications. Reliability is paramount to establishing the validity of the tool, thus the constructs assessed by the NIH-TB may vary over time in youth. We recommend further refinement of the NIH-TB Cognitive Battery and its norming procedures for children before further adoption as a neuropsychological assessment. We also urge researchers who have already employed the NIH-TB in their studies to interpret their results with caution.
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Affiliation(s)
- Brittany K. Taylor
- Department of Neurological Sciences, Cognitive Neuroscience of Development & Aging (CoNDA) Center, and the Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michaela R. Frenzel
- Department of Neurological Sciences, Cognitive Neuroscience of Development & Aging (CoNDA) Center, and the Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jacob A. Eastman
- Department of Neurological Sciences, Cognitive Neuroscience of Development & Aging (CoNDA) Center, and the Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alex I. Wiesman
- Department of Neurological Sciences, Cognitive Neuroscience of Development & Aging (CoNDA) Center, and the Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yu-Ping Wang
- Department of Biomedical Engineering, Tulane University, New Orleans, LA, USA
| | | | | | - Tony W. Wilson
- Department of Neurological Sciences, Cognitive Neuroscience of Development & Aging (CoNDA) Center, and the Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
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20
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Improving outcomes for care partners of persons with traumatic brain injury: Protocol for a randomized control trial of a just-in-time-adaptive self-management intervention. PLoS One 2022; 17:e0268726. [PMID: 35679283 PMCID: PMC9182304 DOI: 10.1371/journal.pone.0268726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Informal family care partners of persons with traumatic brain injury (TBI) often experience intense stress resulting from their caregiver role. As such, there is a need for low burden, and easy to engage in interventions to improve health-related quality of life (HRQOL) for these care partners. This study is designed to evaluate the effectiveness of a personalized just-in-time adaptive intervention (JITAI) aimed at improving the HRQOL of care partners. Participants are randomized either to a control group, where they wear the Fitbit® and provide daily reports of HRQOL over a six-month (180 day) period (without the personalized feedback), or the JITAI group, where they wear the Fitbit®, provide daily reports of HRQOL and receive personalized self-management pushes for 6 months. 240 participants will be enrolled (n = 120 control group; n = 120 JITAI group). Outcomes are collected at baseline, 1-, 2-, 3-, 4-, 5- & 6-months, as well as 3- and 6-months post intervention. We hypothesize that the care partners who receive the intervention (JITAI group) will show improvements in caregiver strain (primary outcome) and mental health (depression and anxiety) after the 6-month (180 day) home monitoring period. Participant recruitment for this study started in November 2020. Data collection efforts should be completed by spring 2025; results are expected by winter 2025. At the conclusion of this randomized control trial, we will be able to identify care partners at greatest risk for negative physical and mental health outcomes, and will have demonstrated the efficacy of this JITAI intervention to improve HRQOL for these care partners. Trial registration: ClinicalTrial.gov NCT04570930; https://clinicaltrials.gov/ct2/show/NCT04570930.
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21
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Boyne P, Doren S, Scholl V, Staggs E, Whitesel D, Carl D, Shatz R, Sawyer R, Awosika OO, Reisman DS, Billinger SA, Kissela B, Vannest J, Dunning K. Preliminary Outcomes of Combined Treadmill and Overground High-Intensity Interval Training in Ambulatory Chronic Stroke. Front Neurol 2022; 13:812875. [PMID: 35185766 PMCID: PMC8854218 DOI: 10.3389/fneur.2022.812875] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Locomotor high-intensity interval training (HIIT) is a promising intervention for stroke rehabilitation. However, overground translation of treadmill speed gains has been somewhat limited, some important outcomes have not been tested and baseline response predictors are poorly understood. This pilot study aimed to guide future research by assessing preliminary outcomes of combined overground and treadmill HIIT. MATERIALS AND METHODS Ten participants >6 months post-stroke were assessed before and after a 4-week no-intervention control phase and a 4-week treatment phase involving 12 sessions of overground and treadmill HIIT. RESULTS Overground and treadmill gait function both improved during the treatment phase relative to the control phase, with overground speed changes averaging 61% of treadmill speed changes (95% CI: 33-89%). Moderate or larger effect sizes were observed for measures of gait performance, balance, fitness, cognition, fatigue, perceived change and brain volume. Participants with baseline comfortable gait speed <0.4 m/s had less absolute improvement in walking capacity but similar proportional and perceived changes. CONCLUSIONS These findings reinforce the potential of locomotor HIIT research for stroke rehabilitation and provide guidance for more definitive studies. Based on the current results, future locomotor HIIT studies should consider including: (1) both overground and treadmill training; (2) measures of cognition, fatigue and brain volume, to complement typical motor and fitness assessment; and (3) baseline gait speed as a covariate.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Victoria Scholl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Emily Staggs
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Russell Sawyer
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Darcy S. Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
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22
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French MA, Cohen ML, Pohlig RT, Reisman DS. Fluid Cognition Relates to Locomotor Switching in Neurotypical Adults, Not Individuals After Stroke. J Neurol Phys Ther 2022; 46:3-10. [PMID: 34507340 PMCID: PMC8692381 DOI: 10.1097/npt.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The ability to switch between walking patterns (ie, locomotor switching) is vital for successful community navigation and may be impacted by poststroke impairments. Thus, the purpose of this work was to examine locomotor switching and the relationship between locomotor switching and fluid cognition in individuals after stroke compared with neurotypical adults. METHODS Twenty-nine individuals more than 6 months after stroke and 18 neurotypical adults participated in a 2-day study. On day 1, participants were taught a new walking pattern on the treadmill and then locomotor switching was assessed by instructing participants to switch between the new walking pattern and their usual walking pattern. The change between these 2 patterns was calculated as the switching index. On day 2, the NIH Toolbox Cognition Battery was administered to obtain the Fluid Cognition Composite Score (FCCS), which reflected fluid cognition. The switching index was compared between groups using an analysis of covariance, and the relationship between locomotor switching and fluid cognition was assessed with regression. RESULTS Individuals after stroke had significantly lower switching indexes compared with neurotypical adults (P = 0.03). The regression showed a significant interaction between group and FCCS (P = 0.002), with the FCCS predicting the switching index in neurotypical adults but not in individuals after stroke. DISCUSSION AND CONCLUSIONS Individuals after stroke appear to have deficits in locomotor switching compared with neurotypical adults. The relationship between fluid cognition and locomotor switching was significant in neurotypical adults but not in individuals after stroke. Future work to understand the relationship between specific cognitive domains and locomotor switching is needed (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A361).
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Affiliation(s)
- Margaret A French
- Departments of Physical Therapy (M.A.F., D.S.R.) and Communication Sciences and Disorders (M.L.C.), University of Delaware, Newark; Biomechanics and Movement Science Program, University of Delaware, Newark (M.A.F., D.S.R.); and College of Health Sciences Biostatistics Core Facility, University of Delaware, Newark (R.T.P.)
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23
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Dudley-Javoroski S, Lee J, Shields RK. Cognitive function, quality of life, and aging: relationships in individuals with and without spinal cord injury. Physiother Theory Pract 2022; 38:36-45. [PMID: 31914347 PMCID: PMC7702216 DOI: 10.1080/09593985.2020.1712755] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Correlations between aging, cognitive impairment and poor quality of life (QOL) have been observed for many patient populations.Objective: The purpose of this study was to examine these correlations in individuals with and without spinal cord injury (SCI).Methods: 23 individuals with complete SCI and 20 individuals without SCI ("NON") underwent assessment of cognitive function via the NIH Toolbox for Neurological and Behavioral Function. Participants self-rated QOL via global and symptom/domain-specific measures.Results: SCI rated global QOL to be lower than NON for the EQ-5D QALY (p < .001), but not the EQ-5D VAS, which imposes no penalty for wheeled mobility. Low QOL clustered mainly in domains pertaining to physical function/symptoms. Participants with SCI reported high QOL for positive affect/well-being and resilience. Cognitive function in SCI did not differ from NON. However, strong correlations between age and cognition observed in NON (all R2 > 0.532) were absent in SCI. Significant correlations between cognition and QOL were prevalent for NON but not for SCI.Conclusions: Dissociation of age, cognition and QOL occurred with SCI. Divergence between EQ-5D QALY and VAS suggests that individuals with SCI may recalibrate personal assessments of QOL in ways that minimize the importance of mobility impairment.
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24
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Carlozzi NE, Choi SW, Wu Z, Miner JA, Lyden AK, Graves C, Wang J, Sen S. An App-Based Just-in-Time Adaptive Self-management Intervention for Care Partners (CareQOL): Protocol for a Pilot Trial. JMIR Res Protoc 2021; 10:e32842. [PMID: 34889775 PMCID: PMC8704108 DOI: 10.2196/32842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Care partners (ie, informal family caregivers) of individuals with health problems face considerable physical and emotional stress, often with a substantial negative impact on the health-related quality of life (HRQOL) of both care partners and care recipients. Given that these individuals are often overwhelmed by their caregiving responsibilities, low-burden self-management interventions are needed to support care partners to ensure better patient outcomes. OBJECTIVE The primary objective of this study is to describe an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention that incorporates passive mobile sensor data feedback (sleep and activity data from a Fitbit [Fitbit LLC]) and real time self-reporting of HRQOL via a study-specific app called CareQOL (University of Michigan) to provide personalized feedback via app alerts. METHODS Participants from 3 diverse care partner groups will be enrolled (care partners of persons with spinal cord injury, care partners of persons with Huntington disease, and care partners of persons with hematopoietic cell transplantation). Participants will be randomized to either a control group, where they will wear the Fitbit and provide daily reports of HRQOL over a 3-month (ie, 90 days) period (without personalized feedback), or the just-in-time adaptive intervention group, where they will wear the Fitbit, provide daily reports of HRQOL, and receive personalized push notifications for 3 months. At the end of the study, participants will complete a feasibility and acceptability questionnaire, and metrics regarding adherence and attrition will be calculated. RESULTS This trial opened for recruitment in November 2020. Data collection was completed in June 2021, and the primary results are expected to be published in 2022. CONCLUSIONS This trial will determine the feasibility and acceptability of an intensive app-based intervention in 3 distinct care partner groups: care partners for persons with a chronic condition that was caused by a traumatic event (ie, spinal cord injury); care partners for persons with a progressive, fatal neurodegenerative disease (ie, Huntington disease); and care partners for persons with episodic cancer conditions that require intense, prolonged inpatient and outpatient treatment (persons with hematopoietic cell transplantation). TRIAL REGISTRATION ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32842.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Angela K Lyden
- Clinical Trials Support Office, University of Michigan, Ann Arbor, MI, United States
| | - Christopher Graves
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Jitao Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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25
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Tartar JL, Antonio J, Kalman DS, Hewlings SJ, Baisley J, Marang M, Flynn S, Peacock CA. An Evaluation of the Effects of a Non-caffeinated Energy Dietary Supplement on Cognitive and Physical Performance: A Randomized Double-Blind Placebo-Controlled Study. Cureus 2021; 13:e16178. [PMID: 34367785 PMCID: PMC8336296 DOI: 10.7759/cureus.16178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/08/2022] Open
Abstract
A large and growing body of research shows that non-caffeinated plant-based nutritional supplements can increase cognitive and physical performance. This study aimed to build on this work by investigating the possibility that a specific botanical blend (consisting of Bacopa monnieri bacosides, Kaempferia parviflora methoxy flavones, pomegranate peel polyphenols, and Moringa oleifera leaf saponins) could improve cognitive and physical performance. To this end, we carried out a randomized, double-blind, placebo-controlled 21-day parallel study on 36 healthy adults. We compared the effects of the botanical blend at baseline to a caffeine and a placebo condition on 1) self-reported alertness, anxiety, and headaches; 2) multiple measures of attention and cognition; 3) physical performance; and 4) stress biomarkers. We found that relative to baseline and compared to the Caffeine and Placebo groups, the botanical blend increased alertness and improved cognitive performance. The cognitive effects were most robust for attention measures. The botanical blend did not improve physical performance on a time to exhaustion (TTE) test. Of note, there was not the expected increase in catecholamine response after the TTE on Day 21, suggesting that long-term botanical blend use decreases the catecholamine stress response of a physical endurance task. In conclusion, we show that, within the confines of this study, a combination of the botanical blend could serve as a safe and effective nutritional supplement to improve cognitive performance.
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Affiliation(s)
- Jaime L Tartar
- Psychology and Neuroscience, Nova Southeastern University, Davie, USA
| | - Jose Antonio
- College of Health Care Sciences, Nova Southeastern University, Davie, USA
| | - Douglas S Kalman
- College of Health Care Sciences, Nova Southeastern University, Davie, USA
| | - Susan J Hewlings
- The Herbert H & Grace A. Dow College of Health Professions, Central Michigan University, Mt. Pleasant, USA
| | - Joshua Baisley
- Clinical Design and Delivery, Nutrasource Pharmaceutical and Nutraceutical Services, Guelph, CAN
| | - Mykola Marang
- Psychology and Neuroscience, Nova Southeastern University, Davie, USA
| | - Sarah Flynn
- Glanbia Research and Development Center, Glanbia Nutritionals, Twin Falls, USA
| | - Corey A Peacock
- College of Health Care Sciences, Nova Southeastern University, Davie, USA
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26
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Evaluating High-Functioning Young Stroke Survivors with Cognitive Complaints. Can J Neurol Sci 2021; 49:368-372. [PMID: 34134793 DOI: 10.1017/cjn.2021.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is a commonly used cognitive outcome in stroke trials. However, it may be insufficiently sensitive to detect impairment in high-functioning stroke survivors. The National Institutes of Health (NIH) Toolbox Cognition Battery (NIHTB-CB), a 30-min comprehensive tablet-based cognitive assessment, may be a better choice to characterize cognitive issues in this cohort. METHODS We compared MoCA and NIHTB-CB performance in young stroke survivors (18-55 years) with excellent functional outcomes (modified Rankin Scale 0-1) reporting subjective cognitive complaints to that of age-matched healthy controls. We recruited 53 stroke survivors and 53 controls. We performed a sensitivity analysis in those participants with normal MoCA scores (≥26). RESULTS Median MoCA scores were not significantly different between stroke survivors (27.0 vs. 28.0) and healthy controls. Mean T scores for NIHTB-CB fluid (44.9 vs. 54.2), crystallized (53.8 vs. 60.0), and total cognition (49.1 vs. 58.4) components were significantly lower in stroke survivors compared to healthy controls (p < 0.001 for all). In participants scoring within normal range (≥26) on the MoCA, NIHTB-CB scores for all components remained significantly lower in stroke survivors. CONCLUSIONS In young stroke survivors with excellent functional outcomes and subjective cognitive complaints, the NIHTB-CB, but not the MoCA, was able to detect differences in cognitive performance between stroke survivors and healthy controls. The NIHTB-CB may be a suitable outcome measure for cognition in clinical trials examining higher-functioning young stroke survivors.
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27
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Ma Y, Carlsson CM, Wahoske ML, Blazel HM, Chappell RJ, Johnson SC, Asthana S, Gleason CE. Latent Factor Structure and Measurement Invariance of the NIH Toolbox Cognition Battery in an Alzheimer's Disease Research Sample. J Int Neuropsychol Soc 2021; 27:412-425. [PMID: 33012297 PMCID: PMC8108547 DOI: 10.1017/s1355617720000922] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study investigated the latent factor structure of the NIH Toolbox Cognition Battery (NIHTB-CB) and its measurement invariance across clinical diagnosis and key demographic variables including sex, race/ethnicity, age, and education for a typical Alzheimer's disease (AD) research sample. METHOD The NIHTB-CB iPad English version, consisting of 7 tests, was administered to 411 participants aged 45-94 with clinical diagnosis of cognitively unimpaired, dementia, mild cognitive impairment (MCI), or impaired not MCI. The factor structure of the whole sample was first examined with exploratory factor analysis (EFA) and further refined using confirmatory factor analysis (CFA). Two groups were classified for each variable (diagnosis or demographic factors). The confirmed factor model was next tested for each group with CFA. If the factor structure was the same between the groups, measurement invariance was then tested using a hierarchical series of nested two-group CFA models. RESULTS A two-factor model capturing fluid cognition (executive function, processing speed, and memory) versus crystalized cognition (language) fit well for the whole sample and each group except for those with age < 65. This model generally had measurement invariance across sex, race/ethnicity, and education, and partial invariance across diagnosis. For individuals with age < 65, the language factor remained intact while the fluid cognition was separated into two factors: (1) executive function/processing speed and (2) memory. CONCLUSIONS The findings mostly supported the utility of the battery in AD research, yet revealed challenges in measuring memory for AD participants and longitudinal change in fluid cognition.
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Affiliation(s)
- Yue Ma
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Cynthia M. Carlsson
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Michelle L. Wahoske
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Hanna M. Blazel
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Richard J. Chappell
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Biostatistics and Medical Informatics,
University of Wisconsin, Madison, WI, USA
- Department of Statistics, University of Wisconsin, Madison,
WI, USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Carey E. Gleason
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
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French MA, Cohen ML, Pohlig RT, Reisman DS. Fluid Cognitive Abilities Are Important for Learning and Retention of a New, Explicitly Learned Walking Pattern in Individuals After Stroke. Neurorehabil Neural Repair 2021; 35:419-430. [PMID: 33754890 DOI: 10.1177/15459683211001025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is significant variability in poststroke locomotor learning that is poorly understood and affects individual responses to rehabilitation interventions. Cognitive abilities relate to upper extremity motor learning in neurologically intact adults, but have not been studied in poststroke locomotor learning. OBJECTIVE To understand the relationship between locomotor learning and retention and cognition after stroke. METHODS Participants with chronic (>6 months) stroke participated in 3 testing sessions. During the first session, participants walked on a treadmill and learned a new walking pattern through visual feedback about their step length. During the second session, participants walked on a treadmill and 24-hour retention was assessed. Physical and cognitive tests, including the Fugl-Meyer-Lower Extremity (FM-LE), Fluid Cognition Composite Score (FCCS) from the NIH Toolbox -Cognition Battery, and Spatial Addition from the Wechsler Memory Scale-IV, were completed in the third session. Two sequential regression models were completed: one with learning and one with retention as the dependent variables. Age, physical impairment (ie, FM-LE), and cognitive measures (ie, FCCS and Spatial Addition) were the independent variables. RESULTS Forty-nine and 34 participants were included in the learning and retention models, respectively. After accounting for age and FM-LE, cognitive measures explained a significant portion of variability in learning (R2 = 0.17, P = .008; overall model R2 = 0.31, P = .002) and retention (ΔR2 = 0.17, P = .023; overall model R2 = 0.44, P = .002). CONCLUSIONS Cognitive abilities appear to be an important factor for understanding locomotor learning and retention after stroke. This has significant implications for incorporating locomotor learning principles into the development of personalized rehabilitation interventions after stroke.
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Lee J, Dudley-Javoroski S, Shields RK. Motor demands of cognitive testing may artificially reduce executive function scores in individuals with spinal cord injury. J Spinal Cord Med 2021; 44:253-261. [PMID: 30943119 PMCID: PMC7952072 DOI: 10.1080/10790268.2019.1597482] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To determine whether the motor demands of cognitive tests contribute to differences in cognitive function scores in participants with and without spinal cord injury (SCI).Design: Cohort study.Setting: Rehabilitation research laboratory.Participants: 68 individuals without SCI ("NON") and 22 individuals with motor complete SCI ("SCI").Interventions: None.Outcome Measures: NIH Toolbox cognitive assessments, including two with motor demands and reaction-time based scoring (Dimensional Change Card Sort (DCCS), Flanker Inhibitory Control and Attention (Flanker) and two without timed scoring (List Sorting Working Memory (List Sorting), Picture Sequence Memory Test (Picture Sequence). Tests were administered with and without the assistance of a proctor on two randomly-determined days (>24 hr interval). For DCCS and Flanker, the motor-task score offset was estimated as the difference between the proctored and non-proctored scores.Results: For demographically-corrected data, proctoring reduced DCCS and Flanker scores (P < 0.001) but mitigated apparent differences between SCI and NON (all P > 0.403). SCI and NON did not differ for List Sorting (P > 0.072) but did differ significantly for Picture Sequence (P < 0.001). Significant practice effects existed for memory-based tests (List Sorting and Picture Sequence); all P < 0.015, effect size>0.645.Conclusions: DCCS and Flanker scores for individuals with SCI may be artificially reduced consequent to secondary motor demands of the tests. Proctoring and computation of a motor-response score offset enables comparisons to be made between individuals with SCI and a Non-SCI control cohort; however, further work is needed to determine whether offset-adjusted scores can be compared to standardized normative values.
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Affiliation(s)
- Jinhyun Lee
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Shauna Dudley-Javoroski
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Richard K. Shields
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA,Correspondence to: Richard K. Shields, Department of Physical Therapy and Rehabilitation Science, University of Iowa, 1-252 Medical Education Building, Iowa City, IA52242, USA.
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30
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Sebold AJ, Day AM, Ewen J, Adamek J, Byars A, Cohen B, Kossoff EH, Mizuno T, Ryan M, Sievers J, Smegal L, Suskauer SJ, Thomas C, Vinks A, Zabel TA, Hammill AM, Comi AM. Sirolimus Treatment in Sturge-Weber Syndrome. Pediatr Neurol 2021; 115:29-40. [PMID: 33316689 PMCID: PMC8209677 DOI: 10.1016/j.pediatrneurol.2020.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sturge-Weber syndrome is a rare neurovascular disorder associated with capillary malformation, seizures, cognitive impairments, and stroke-like episodes (SLEs), arising from a somatic activating mutation in GNAQ. Studies suggest this mutation may cause hyperactivation of the mammalian target of rapamycin pathway. Sirolimus is an mammalian target of rapamycin inhibitor studied in other vascular anomalies and a potentially promising therapy in Sturge-Weber syndrome. METHODS Ten patients with Sturge-Weber syndrome brain involvement and cognitive impairments were enrolled. Oral sirolimus was taken for six months (maximum dose: 2 mg/day, target trough level: 4-6 ng/mL). Neuropsychological testing, electroencephalography, and port-wine score were performed at baseline and after six months on sirolimus. Neuroquality of life, adverse events, and Sturge-Weber Syndrome Neurological Score (neuroscore) were recorded at each visit. RESULTS Sirolimus was generally well tolerated; one subject withdrew early. Adverse events considered related to sirolimus were mostly (15/16) grade 1. A significant increase in processing speed was seen in the overall group (P = 0.031); five of nine patients with available data demonstrated statistically rare improvement in processing speed. Improvements were seen in the neuroquality of life subscales measuring anger (P = 0.011), cognitive function (P = 0.015), and depression (P = 0.046). Three subjects experiencing SLEs before and during the study reported shortened recovery times while on sirolimus. CONCLUSIONS Sirolimus was well tolerated in individuals with Sturge-Weber syndrome and may be beneficial for cognitive impairments, especially in patients with impaired processing speed or a history of SLE. A future, randomized, placebo-controlled trial of sirolimus in patients with Sturge-Weber syndrome is needed to further understand these potentially beneficial effects.
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Affiliation(s)
- Alison J. Sebold
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland, USA
| | - Alyssa M. Day
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland, USA
| | - Joshua Ewen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jack Adamek
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Anna Byars
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bernard Cohen
- Division of Pediatric Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Eric H. Kossoff
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins Hospital, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Tomoyuki Mizuno
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Matthew Ryan
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jacqueline Sievers
- Clinical Trials Compliance and Quality Assurance, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Lindsay Smegal
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland, USA
| | - Stacy J. Suskauer
- Johns Hopkins Hospital, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Department of Pediatric Rehabilitation Medicine, Krieger Institute, Baltimore, Maryland, USA,Johns Hopkins University School of Medicine, Departments of Physical Medicine and Rehabilitation, Baltimore, Maryland, USA
| | - Cameron Thomas
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexander Vinks
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - T. Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adrienne M. Hammill
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Anne M. Comi
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins Hospital, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Communications should be addressed to: Dr. Anne M. Comi; Department of Neurology, Hugo Moser Kennedy Krieger Research Institute,801 N. Broadway; Baltimore, MD, 21205. (A.M. Comi)
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Evans EA, Cook NE, Iverson GL, Townsend EL, Duhaime AC. Assessing Physical Function and Mobility following Pediatric Traumatic Brain Injury with the NIH Toolbox Motor Battery: A Feasibility Study. Phys Occup Ther Pediatr 2021; 41:56-73. [PMID: 32396483 PMCID: PMC7657981 DOI: 10.1080/01942638.2020.1758985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS Traumatic brain injury (TBI) can impair physical function in children. The NIH Toolbox Motor Battery (NIHTB-M) was designed to be a brief assessment of physical function, but no studies have examined its use in children with TBI. This study aims to describe the feasibility of using the NIHTB-M to assess children with TBI. METHODS The NIHTB-M was administered to children with TBI 2 weeks (n = 22) and/or 6 months (n = 23) following injury. This descriptive study summarizes participant performance, administration challenges, and the association between NIHTB-M scores, participant characteristics, and subjective report of physical function. RESULTS Of the NIHTB-M domains, deficits in endurance and balance were most prevalent. Children aged 5 to 16 years could complete the assessment per administration guidelines, except for a few cases (n = 3) where orthopedic injuries limited participation. Younger children (aged 3 to 4) had difficulty following the NIHTB-M directions. Technological issues impacted balance assessment in several cases (n = 6). CONCLUSION The NIHTB-M is brief to administer, generally well tolerated by school-aged children and, despite occasional technological challenges, is a feasible performance-based battery for assessment of children with TBI for clinical and research purposes. Additional investigation of psychometric properties and ceiling and floor effects is needed.
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Affiliation(s)
- Emily A Evans
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Gerontology and Healthcare Research, Brown University, Rhode Island, USA
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,MassGeneral Hospital for Children™ Sports Concussion Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,MassGeneral Hospital for Children™ Sports Concussion Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, USA
| | - Elise L Townsend
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | -
- San Francisco General Hospital and Trauma Center, University of California, San Francisco, California, USA
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32
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VanGilder JL, Hooyman A, Peterson DS, Schaefer SY. Post-stroke cognitive impairments and responsiveness to motor rehabilitation: A review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:461-468. [PMID: 33767922 PMCID: PMC7987128 DOI: 10.1007/s40141-020-00283-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW a)This review discusses the prevalence of cognitive deficits following stroke and their impact on responsiveness to therapeutic intervention within a motor learning context. RECENT FINDINGS b)Clinical and experimental studies have established that post-stroke cognitive and motor deficits may impede ambulation, augment fall risk, and influence the efficacy of interventions. Recent research suggests the presence of cognitive deficits may play a larger role in motor recovery than previously understood. SUMMARY c)Considering that cognitive impairments affect motor relearning, post-stroke motor rehabilitation therapies may benefit from formal neuropsychological testing. For example, early work suggests that in neurotypical adults, cognitive function may be predictive of responsiveness to motor rehabilitation and cognitive training may improve mobility. This sets the stage for investigations probing these topics in people post-stroke. Moreover, the neural basis for and extent to which these cognitive impairments influence functional outcome remains largely unexplored and require additional investigation.
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Affiliation(s)
| | - Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University
| | - Daniel S. Peterson
- College of Health Solutions, Arizona State University
- U.S. Department of Veterans Affairs, Phoenix, AZ, USA
- Department of Physical Therapy and Athletic Training, University of Utah
| | - Sydney Y. Schaefer
- School of Biological and Health Systems Engineering, Arizona State University
- Department of Physical Therapy and Athletic Training, University of Utah
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33
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Assessment of Prorated Scoring of an Abbreviated Protocol for the National Institutes of Health Toolbox Cognition Battery. J Int Neuropsychol Soc 2020; 26:1045-1050. [PMID: 33081872 DOI: 10.1017/s1355617720001010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate an abbreviated NIH Toolbox Cognition Battery (NIHTB-CB) protocol that can be administered remotely without any in-person assessments, and explore the agreement between prorated scores from the abbreviated protocol and standard scores from the full protocol. METHODS Participant-level age-corrected NIHTB-CB data were extracted from six studies in individuals with a history of stroke, mild traumatic brain injury (mTBI), treatment-resistant psychosis, and healthy controls, with testing administered under standard conditions. Prorated fluid and total cognition scores were estimated using regression equations that excluded the three fluid cognition NIHTB-CB instruments which cannot be administered remotely. Paired t tests and intraclass correlations (ICCs) were used to compare the standard and prorated scores. RESULTS Data were available for 245 participants. For fluid cognition, overall prorated scores were higher than standard scores (mean difference = +4.5, SD = 14.3; p < 0.001; ICC = 0.86). For total cognition, overall prorated scores were higher than standard scores (mean difference = +2.7, SD = 8.3; p < 0.001; ICC = 0.88). These differences were significant in the stroke and mTBI groups, but not in the healthy control or psychosis groups. CONCLUSIONS Prorated scores from an abbreviated NIHTB-CB protocol are not a valid replacement for the scores from the standard protocol. Alternative approaches to administering the full protocol, or corrections to scoring of the abbreviated protocol, require further study and validation.
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Wang X, Li B, Wang Z, Wang F, Liang J, Chen C, Zhao L, Zhou B, Guo X, Ren L, Yuan X, Chen X, Wang T. miR-30b Promotes spinal cord sensory function recovery via the Sema3A/NRP-1/PlexinA1/RhoA/ROCK Pathway. J Cell Mol Med 2020; 24:12285-12297. [PMID: 32977360 PMCID: PMC7686968 DOI: 10.1111/jcmm.15591] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022] Open
Abstract
Spinal cord injury (SCI) induces both motor and sensory dysfunctions. We wondered whether miR-30b could promote primary sensory neuron (PSN) axon growth in inhibitory microenvironment. The neurite growth was promoted by miR-30b agomir and inhibited by antagomir. MiR-30b targeted and degraded sema3A mRNA. MiR-30b regulated the formation of sema3A-NRP-1-PlexinA1 complex via targeting sema3A. The neurite length was induced by the miR-30b agomir, and the application of sema3A protein could reverse the effect of agomir. GTP-RhoA and ROCK expression were down-regulated by miR-30b. Neurite outgrowth that inhibited by sema3A and the miR-30b antagomir was increased by Y-27632. Agomir promoted neurite growth in NogoA inhibitory conditions, which indicated miR-30b could both enhance neuronal intrinsic regenerative ability and promote neurite growth against inhibitory microenvironment via Sema3A/NRP-1/PlexinA1/RhoA/ROCK axis. The agomir could also regulate Sema3A/NRP-1/PlexinA1/RhoA/ROCK axis in vivo and restore spinal cord sensory conductive function. In conclusion, miR-30b could be a novel target for sensation recovery after SCI.
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Affiliation(s)
- Xin Wang
- Chengde Medical University, Chengde, China
| | - Bo Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhijie Wang
- Department of Pediatric Internal Medicine, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Fengyan Wang
- Department of Orthopedics, 981st Hospital of the Chinese People's Liberation Army Joint Logistics Support Force, Chengde, China
| | - Jing Liang
- Department of Nursing, 981st Hospital of the Chinese People's Liberation Army Joint Logistics Support Force, Chengde, China
| | - Chuanjie Chen
- Department of Orthopedics, Chengde Central Hospital, Chengde, China
| | - Lei Zhao
- Department of Education, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Bo Zhou
- Chengde Medical University, Chengde, China.,Department of Neurology, 981st Hospital of the Chinese People's Liberation Army Joint Logistics Support Force, Chengde, China
| | - Xiaoling Guo
- Department of Neurology, 981st Hospital of the Chinese People's Liberation Army Joint Logistics Support Force, Chengde, China
| | - Liqun Ren
- Laboratory of Spinal Cord Injury and Rehabilitation, Chengde Medical University, Chengde, China
| | - Xin Yuan
- Department of Spine Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xueming Chen
- Department of Spine Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Tianyi Wang
- Department of Orthopedics, 981st Hospital of the Chinese People's Liberation Army Joint Logistics Support Force, Chengde, China
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Nguyen AL, Sundermann E, Rubtsova AA, Sabbag S, Umlauf A, Heaton R, Letendre S, Jeste DV, Marquine MJ. Emotional health outcomes are influenced by sexual minority identity and HIV serostatus. AIDS Care 2020; 33:1127-1132. [PMID: 32590909 DOI: 10.1080/09540121.2020.1785998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
For people living with HIV (PLWH) and sexual minorities (SM), the intersection of identities can compound experiences like stigma and discrimination resulting in poor emotional health. We investigated the separate and interactive associations of HIV serostatus and sexual identity with emotional health. Our dataset included 371 participants. Emotional health was assessed by the NIH Toolbox emotion battery which yields negative affect, social satisfaction, and psychological well-being. Regressions were conducted for each composite, with HIV serostatus, sexual identity, and their interaction as independent variables along with covariates. The HIV serostatus x SM identity interaction was statistically significant in the regression of Negative Affect (p = .01): heterosexuals living with HIV had worse Negative Affect compared to heterosexual HIV-persons (p = .01). The interaction terms were for social satisfaction and psychological well-being were not significant. However, among PLWH, sexual minorities reported better Social Satisfaction (p = .03) and marginally better psychological well-being (p = .07) compared to heterosexuals.
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Affiliation(s)
- Annie L Nguyen
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Anna A Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Samir Sabbag
- Department of Psychiatry, University of Miami, Miami, FL, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Robert Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Scott Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Neuroscience, University of California San Diego, San Diego, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Snitz BE, Tudorascu DL, Yu Z, Campbell E, Lopresti BJ, Laymon CM, Minhas DS, Nadkarni NK, Aizenstein HJ, Klunk WE, Weintraub S, Gershon RC, Cohen AD. Associations between NIH Toolbox Cognition Battery and in vivo brain amyloid and tau pathology in non-demented older adults. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12018. [PMID: 32426450 PMCID: PMC7228102 DOI: 10.1002/dad2.12018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/13/2020] [Accepted: 01/23/2020] [Indexed: 12/04/2022]
Abstract
INTRODUCTION The National Institutes of Health (NIH) Toolbox Cognition Battery (NIHTB-CB) was developed to be a common assessment metric across a broad array of research studies. We investigated associations between NIHTB-CB and brain amyloid and tau deposition in cognitively unimpaired older adults. METHODS One hundred eighteen community-based volunteers completed magnetic resonance imaging (MRI), Pittsburgh compound B (PiB)-PET (positron emission tomography) and AV-1451-PET neuroimaging, a neuropsychological evaluation, NIHTB-CB, and the Clinical Dementia Rating (CDR) scale. Demographically adjusted regression models evaluated cognition-biomarker associations; standardized effect sizes allowed comparison of association strength across measures. RESULTS No NIHTB-CB measures were associated with amyloid deposition. NIHTB-CB measures of fluid cognition, including Pattern Comparison Processing Speed, Dimensional Change Card Sort, and Fluid Cognition Composite, were associated with tau deposition in higher Braak regions. Pattern Comparison Processing Speed was the most robust association with sensitivity analyses. DISCUSSION NIHTB-CB tasks of processing speed and executive functions may be sensitive to pathologic tau deposition on imaging in normal aging.
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Affiliation(s)
- Beth E. Snitz
- Department of NeurologyUniversity of PittsburghSchool of MedicinePittsburghPennsylvania
| | - Dana L. Tudorascu
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
| | - Zheming Yu
- Department of RadiologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
| | - Elizabeth Campbell
- Department of RadiologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
| | - Brian J. Lopresti
- Department of RadiologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
| | - Charles M. Laymon
- Department of RadiologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
- Department of BioengineeringUniversity of Pittsburgh School of EngineeringPittsburghPennsylvania
| | - Davneet S. Minhas
- Department of RadiologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
| | - Neelesh K. Nadkarni
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
| | - Howard J. Aizenstein
- Department of BioengineeringUniversity of Pittsburgh School of EngineeringPittsburghPennsylvania
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
| | - William E. Klunk
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
| | - Sandra Weintraub
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Richard C. Gershon
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Ann D. Cohen
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
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Beier M, Alschuler K, Amtmann D, Hughes A, Madathil R, Ehde D. iCAMS: Assessing the Reliability of a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) Tablet Application. Int J MS Care 2020; 22:67-74. [PMID: 32410901 DOI: 10.7224/1537-2073.2018-108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background This study aimed to develop a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) tablet application, "iCAMS," and examine equivalency between the original paper-based and the tablet-based assessments. Methods This study enrolled 100 participants with physician-confirmed multiple sclerosis (MS). Interrater reliability, parallel forms reliability, and concurrent validity were evaluated by incorporating two test administrators in each session: one scoring participant responses with the original paper assessments and the other with iCAMS. Although the participant was exposed to the material only once, responses were recorded on both administration methods. In addition to the standard test procedures, each research assistant used a stopwatch to measure the amount of time required to administer and score each version of BICAMS. Results Pearson correlation coefficients (r) revealed strong and significant correlations for all three tests. Excellent agreement was observed between iCAMS and paper versions of the BICAMS tests, with all intraclass correlation coefficients exceeding 0.93. The scores from all the cognitive tests were not statistically significantly different, indicating no proportional bias. Including scoring, administration of the iCAMS application saved approximately 10 minutes over the paper version. Conclusions Preliminary findings suggest that the tablet application iCAMS is a reliable and fast method for administering BICAMS.
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Cassetta BD, Menon M, Carrion PB, Pearce H, DeGraaf A, Leonova O, White RF, Stowe RM, Honer WG, Woodward TS, Torres IJ. Preliminary examination of the validity of the NIH toolbox cognition battery in treatment-resistant psychosis. Clin Neuropsychol 2019; 34:981-1003. [PMID: 31782350 DOI: 10.1080/13854046.2019.1694072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Prior research has suggested that treatment-resistant psychosis (TRP) may be a categorically distinct subtype from treatment-responsive psychotic disorders. However, relatively few studies have investigated the cognitive profile of individuals with TRP. Moreover, no prior studies have investigated the effectiveness of using the NIH Toolbox Cognition Battery (NTCB) for assessing cognition among psychiatric inpatients despite its promising efficiency and practicality in such settings. The current study aimed to investigate the validity of the NTCB and the associated cognitive profile of inpatients with TRP.Methods: Participants (N = 38) were administered the NTCB and a neuropsychological test battery. The Positive and Negative Syndrome Scale and the Routine Assessment of Patient Progress measured psychosis symptomatology and daily functioning, respectively.Results: Results showed deficits relative to normative values in fluid cognitive abilities using the NTCB, as predicted. There was strong convergent validity and adequate divergent validity between the NTCB subtests and corresponding neuropsychological measures, though no NTCB subtest correlated with performance on the Wisconsin Card Sorting Task. NTCB performance correlated with positive and disorganized symptoms of psychosis as well as daily functioning.Conclusions: Taken together, the NTCB appears to be a relatively strong tool for cognitive screening among psychiatric inpatients and may be used to identify which patients might benefit from further neuropsychological evaluation.
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Affiliation(s)
- Briana D Cassetta
- Department of Psychology, University of Calgary, Calgary, AB, Canada.,Vancouver Coastal Health, Vancouver, BC, Canada
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Psychosis Program, Vancouver, BC, Canada
| | - Prescilla B Carrion
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Hadley Pearce
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ashley DeGraaf
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Randall F White
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Psychosis Program, Vancouver, BC, Canada
| | - Robert M Stowe
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Psychosis Program, Vancouver, BC, Canada
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
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Li B, Wang Z, Yu M, Wang X, Wang X, Chen C, Zhang Z, Zhang M, Sun C, Zhao C, Li Q, Wang W, Wang T, Zhang L, Ning G, Feng S. miR-22-3p enhances the intrinsic regenerative abilities of primary sensory neurons via the CBL/p-EGFR/p-STAT3/GAP43/p-GAP43 axis. J Cell Physiol 2019; 235:4605-4617. [PMID: 31663116 DOI: 10.1002/jcp.29338] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023]
Abstract
Spinal cord injury (SCI) is a devastating disease. Strategies that enhance the intrinsic regenerative ability are very important for the recovery of SCI to radically prevent the occurrence of sensory disorders. Epidermal growth factor (EGF) showed a limited effect on the growth of primary sensory neuron neurites due to the degradation of phosphorylated-epidermal growth factor receptor (p-EGFR) in a manner dependent on Casitas B-lineage lymphoma (CBL) (an E3 ubiquitin-protein ligase). MiR-22-3p predicted from four databases could target CBL to inhibit the expression of CBL, increase p-EGFR levels and neurites length via STAT3/GAP43 pathway rather than Erk1/2 axis. EGF, EGFR, and miR-22-3p were downregulated sharply after injury. In vivo miR-22-3p Agomir application could regulate CBL/p-EGFR/p-STAT3/GAP43/p-GAP43 axis, and restore spinal cord sensory conductive function. This study clarified the mechanism of the limited promotion effect of EGF on adult primary sensory neuron neurite and targeting miR-22-3p could be a novel strategy to treat sensory dysfunction after SCI.
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Affiliation(s)
- Bo Li
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Zhijie Wang
- Department of Pediatric Internal Medicine, Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China
| | - Mei Yu
- Department of Leukemia Center, Chinese Academy of Medical Sciences & Peking Union of Medical College, Institute of Hematology & Hospital of Blood Diseases, Tianjin, 30020, China
| | - Xu Wang
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Xin Wang
- Department of Graduate School, Chengde Medical University, Chengde, Hebei, 067000, China
| | - Chuanjie Chen
- Department of Orthopedics, Chengde Central Hospital, Chengde, 067000, Hebei, China
| | - Zheng Zhang
- Department of Orthopedics, The 981st Hospital of the Chinese People's Liberation Army Joint Logistics Support Force, Chengde, 067000, Hebei, China
| | - Meiling Zhang
- Department of Graduate School, Chengde Medical University, Chengde, Hebei, 067000, China
| | - Chao Sun
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Chenxi Zhao
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Qiang Li
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.,Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, Shanxi, China
| | - Wei Wang
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Tianyi Wang
- Department of Orthopedics, The 981st Hospital of the Chinese People's Liberation Army Joint Logistics Support Force, Chengde, 067000, Hebei, China
| | - Liang Zhang
- Department of Orthopedics, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Guangzhi Ning
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.,Department of Translational Medicine, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.,Department of Translational Medicine, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, 154 Anshan Road, Heping District, Tianjin, 300052, China
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Saa JP, Tse T, Baum C, Cumming T, Josman N, Rose M, Carey L. Longitudinal evaluation of cognition after stroke - A systematic scoping review. PLoS One 2019; 14:e0221735. [PMID: 31465492 PMCID: PMC6715188 DOI: 10.1371/journal.pone.0221735] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cognitive impairment affects up to 80 percent of the stroke population, however, both the available evidence about post-stroke cognition and the measures used to evaluate it longitudinally have not been well described. The aims of this systematic scoping review were: to identify and characterize studies evaluating cognition longitudinally after stroke; to summarize the cognitive instruments used and the domains they target; and to organize cognitive domains assessed using the International Classification of Functioning, Disability and Health (ICF). METHODS We used a systematic scoping approach to search for peer-reviewed articles involving adults with stroke that evaluated cognition longitudinally. Screening of titles, abstracts, and full reports was completed independently by two reviewers, across six electronic databases (PubMed, PsycInfo, Medline, Cinahl Plus, Embase, and Web of Science). Cognitive domains were mapped to an ICF function independently by the same two reviewers, using a previously tested, standardized approach. RESULTS A total of 5,540 records were found; 257 were included, representing a total pooled sample of 120,860 stroke survivors. Of these studies, 200 (78%) provided specific cognitive outcomes from the longitudinal evaluations, 57 (22%) reported model predictions, and 77 (30%) included interventions. Cognition was evaluated with 356 unique instruments, targeting 95 distinct cognitive domains, and 17 mental functions from the ICF. The Mini-Mental State Examination was the most frequently used instrument (117 reports, 46%). Other tools used longitudinally were the Trail Making Test (17% of reports), tests of verbal fluency (14%), the Functional Independence Measure (14%), the Montreal Cognitive Assessment (13%), the Digit Span (11%), and the Stroop test (10%). Global cognition was evaluated in 170 reports (66%), followed by higher-level cognitive functioning (29%), memory (28%), language (21%), attention (21%), and perceptual skills (14%). Studies using functional (or performance-based) cognitive assessments over time were scarce (< 1%). CONCLUSION Our findings indicate that whilst there is a substantial number of studies available that report longitudinal evaluations of cognition after stroke, there is large variability in the measures used and the cognitive domains they target. Nonetheless, the available data for evaluation of cognition over time after stroke can be organized and described systematically.
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Affiliation(s)
- Juan Pablo Saa
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Tamara Tse
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
| | - Carolyn Baum
- Occupational Therapy, Washington University School of Medicine, Saint Louis, Missouri, United States of America
- George Warren Brown School of Social Work, Washington University in Saint Louis, Saint Louis, Missouri, United States of America
| | - Toby Cumming
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Naomi Josman
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Miranda Rose
- Speech Pathology, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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Willingham TB, Melbourn J, Moldavskiy M, McCully KK, Backus D. Effects of Treadmill Training on Muscle Oxidative Capacity and Endurance in People with Multiple Sclerosis with Significant Walking Limitations. Int J MS Care 2019; 21:166-172. [PMID: 31474809 DOI: 10.7224/1537-2073.2018-021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Exercise can improve muscle function and mobility in people with multiple sclerosis (MS). However, the effects of exercise training on skeletal muscle oxidative capacity and endurance in people with MS remain unclear, and few studies have evaluated muscle plasticity in people with MS who have moderate-to-severe disability. The present study evaluated the effects of treadmill training on muscle oxidative capacity and muscle endurance and examined the relationship to walking function in people with MS who have moderate-to-severe disability. Methods Six adults (mean ± SD age, 50 ± 4.9 years) with MS (Expanded Disability Status Scale score, 6.0-6.5) performed treadmill training for 24 minutes approximately twice per week for approximately 8 weeks (16 sessions total) using an antigravity treadmill system. The following measures were taken before and after the intervention phase: muscle oxidative capacity in the medial gastrocnemius using near-infrared spectroscopy after 15 to 20 seconds of electrical stimulation; muscle endurance in the medial gastrocnemius using accelerometer-based mechanomyography during 9 minutes of twitch electrical stimulation in three stages (3 minutes per stage) of increasing frequency (2, 4, and 6 Hz); and walking function using the 2-Minute Walk Test. Results Mean ± SD muscle oxidative capacity increased from 0.64 ± 0.19 min-1 to 1.08 ± 0.52 min-1 (68.2%). Mean ± SD muscle endurance increased from 80.9% ± 15.2% to 91.5% ± 4.8% at 2 Hz, from 56.3% ± 20.1% to 76.6% ± 15.8% at 4 Hz, and from 29.2% ± 13.1% to 53.9% ± 19.4% at 6 Hz of stimulation in the gastrocnemius. There were no significant improvements in walking function. Conclusions Treadmill training can improve muscle oxidative capacity and endurance in people with MS who have moderate-to-severe levels of disability.
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Wong AWK, Chen C, Baum MC, Heaton RK, Goodman B, Heinemann AW. Cognitive, Emotional, and Physical Functioning as Predictors of Paid Employment in People With Stroke, Traumatic Brain Injury, and Spinal Cord Injury. Am J Occup Ther 2019; 73:7302205010p1-7302205010p15. [PMID: 30915962 DOI: 10.5014/ajot.2019.031203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Our objective was to examine demographic, cognitive, emotional, and physical factors that predict return to paid employment for people after neurological injury. METHOD Four hundred eighty adults with stroke (n = 149), traumatic brain injury (n = 155), and spinal cord injury (n = 176) completed an occupational outcome questionnaire and physical, emotional, and cognitive assessments at three rehabilitation facilities. RESULTS Odds of employment were predicted by being married or partnered, having more education, requiring fewer prompts for task sequencing, and having higher inhibitory control (but were not predicted by specific type of injury). Participants who returned to work within 3 mo were more likely to work with the same employer and to take a full-time position than those who returned later. CONCLUSION Executive functioning, in particular sequencing and inhibitory control, strongly predicts employment and highlights the importance of cognitive strategy training during occupational therapy with people who have sustained neurological injuries.
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Affiliation(s)
- Alex W K Wong
- Alex W. K. Wong, PhD, DPhil, is Assistant Professor, Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO;
| | - Cynthia Chen
- Cynthia Chen, PhD, is Assistant Professor, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - M Carolyn Baum
- M. Carolyn Baum, PhD, OTR/L, FAOTA, is Professor and Elias Michael Executive Director, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Robert K Heaton
- Robert K. Heaton, PhD, is Professor, Department of Psychiatry, University of California, San Diego
| | - Berrit Goodman
- Berrit Goodman, BA, is Master of Science in Occupational Therapy Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Allen W Heinemann
- Allen W. Heinemann, PhD, ABPP-RP, FACRM, is Professor, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, and Director, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago
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Brearly TW, Rowland JA, Martindale SL, Shura RD, Curry D, Taber KH. Comparability of iPad and Web-Based NIH Toolbox Cognitive Battery Administration in Veterans. Arch Clin Neuropsychol 2019; 34:524-530. [PMID: 30260372 PMCID: PMC9586718 DOI: 10.1093/arclin/acy070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the comparability of National Institutes of Health Toolbox Cognitive Battery test scores across iPad application and web-based personal computer administration platforms. Original test norms were developed using a personal computer-based administration and no previous studies assessing platform comparability have been published. METHOD Participants (N = 62; final analyzed sample n = 49) were combat-exposed post-deployment veterans without neurologic disorder, severe mental illness, current substance use disorder, or a history of moderate or severe traumatic brain injury. All participants completed both iPad and web-based versions of tests on the same day in an experimental within-subjects crossover design. Standalone validity measures were incorporated to exclude invalid performance. Outcome measures included the Dimensional Change Card Sort Test, Flanker Inhibitory Control and Attention Test, List Sorting Working Memory Test, and Pattern Comparison Processing Speed Test. RESULTS Score differences between platforms were found on the Flanker Inhibitory Control and Attention Test. Scores were moderately correlated across tests, with the exception of low correlations for the Pattern Comparison Processing Speed Test. Most participants preferred iPad to web administration, regardless of administration order. CONCLUSIONS Results suggest caution when interpreting iPad-acquired scores, particularly for the Flanker Inhibitory Control and Attention Test. iPad-based testing offers valuable improvements; however, the development of iPad-specific norms may be necessary to ensure valid interpretation of acquired data.
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Affiliation(s)
- Timothy W. Brearly
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
- Neuropsychology Assessment Service, Directorate of Behavioral Health (Consultation & Education), Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jared A. Rowland
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Mental Health & Behavioral Sciences Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
| | - Sarah L. Martindale
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Mental Health & Behavioral Sciences Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
| | - Robert D. Shura
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Mental Health & Behavioral Sciences Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
- Via College of Osteopathic Medicine, Blacksburg, VA, USA
| | - David Curry
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
| | - Kathy H. Taber
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
- Via College of Osteopathic Medicine, Blacksburg, VA, USA
- Baylor College of Medicine, Houston, TX, USA
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Babakhanyan I, Carlozzi NE, McKenna BS, Casaletto KB, Heinemann AW, Heaton RK. National Institutes of Health Toolbox Emotion Battery: Application of Summary Scores to Adults With Spinal Cord Injury, Traumatic Brain Injury, and Stroke. Arch Phys Med Rehabil 2019; 100:1863-1871. [PMID: 31153854 DOI: 10.1016/j.apmr.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/23/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the validity of factor analytically based summary scores that were developed using the National Institutes of Health Toolbox Emotion Battery (NIHTB-EB); (ie, psychological well-being, social satisfaction, negative affect) normative sample in individuals with neurologic conditions. DESIGN Cross-sectional, observational cohort. SETTING Community. PARTICIPANTS A total of 1036 English-speaking adults from the National Institutes of Health Toolbox (NIHTB) normative project and 604 community-dwelling adults with neurologic conditions including spinal cord injury (SCI n=209), traumatic brain injury (TBI n=184), and stroke (cerebrovascular accident [CVA] n=211) (N=1640). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The NIHTB-EB. RESULTS A series of univariate analyses comparing summary scores across the 4 groups (SCI, TBI, CVA, normative group) were conducted to identify group differences. Base rates (defined as >1 SD toward the problematic direction) were also identified. The normative group demonstrated better emotional functioning characterized by greater social satisfaction and psychological well-being (normative group > SCI, TBI, CVA; P's <.0001), and less negative affect (normative group < SCI, P=.016; normative group < TBI, P<.001; normative group < CVA; P=.034) compared with each neurologic group. Using base rates to identify problematic emotions for the 3 summary scores, there were higher rates of problematic emotions on all 3 summary scores for the neurologic groups compared with the normative group. CONCLUSIONS The NIHTB-EB summary scores demonstrate an increased prevalence of problematic emotions among individuals with 3 neurologic conditions, and might be useful for identifying individuals with similar conditions and potentially in need of psychological support.
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Affiliation(s)
- Ida Babakhanyan
- Department of Psychiatry, University of California San Diego, San Diego, CA.
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Benjamin S McKenna
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Kaitlin B Casaletto
- Memory and Aging Center, University of California San Francisco, Department of Neurology, San Francisco, CA
| | - Allen W Heinemann
- Shirley Ryan AbilityLab and Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA
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Balsamo LM, Mitchell HR, Ross W, Metayer C, Hardy KK, Kadan-Lottick NS. Monitoring neurocognitive functioning in childhood cancer survivors: evaluation of CogState computerized assessment and the Behavior Rating Inventory of Executive Function (BRIEF). BMC Psychol 2019; 7:26. [PMID: 31046815 PMCID: PMC6498488 DOI: 10.1186/s40359-019-0302-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/15/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many childhood cancer survivors develop neurocognitive impairment, negatively affecting education and psychosocial functioning. Recommended comprehensive neuropsychological testing can be time- and cost- intensive for both institutions and patients and their families. It is important to find quick and easily administered surveillance measures to identify those in need of evaluation. METHODS We evaluated, individually and in combination, the sensitivity and specificity of the 1) Behavior Rating Inventory of Executive Functioning-Metacognition Index (BRIEF-MCI), and 2) CogState Composite Index (computerized assessment of cognition) in identifying below grade-level performance on state-administered tests of reading and mathematics among childhood cancer survivors. RESULTS The 45 participants (39% female) were a mean age of 7.1 ± 4.4 years at diagnosis, 14.0 ± 3.0 at evaluation, with a history of leukemia (58%), lymphoma (9%), central nervous system tumors (20%), and other tumors (13%). Impairment on the BRIEF-MCI was associated with low sensitivity (26% reading, 41% mathematics) but stronger specificity (88% reading, 96% mathematics). We found similar associations for the CogState Composite Index with sensitivity of 26% for reading and 29% for mathematics and specificity of 92% for both reading and mathematics. Combining the two measures did not improve sensitivity appreciably (47% reading, 59% mathematics) while reducing specificity (84% reading, 88% mathematics). CONCLUSIONS While individuals identified from the BRIEF-MCI or CogState Composite would likely benefit from a full neuropsychological evaluation given the strong specificity, use of these measures as screening tools is limited. With poor sensitivity, they do not identify many patients with academic difficulties and in need of a full neuropsychological evaluation. Continued effort is required to find screening measures that have both strong sensitivity and specificity.
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Affiliation(s)
- Lyn M Balsamo
- Yale University School of Medicine, 15 PO Box 208064, 16 333 Cedar Street, LMP-2073 (for courier mail), 17, New Haven, CT, 06520-8064, USA.
| | | | - Wilhelmenia Ross
- Yale University School of Medicine, 15 PO Box 208064, 16 333 Cedar Street, LMP-2073 (for courier mail), 17, New Haven, CT, 06520-8064, USA
| | - Catherine Metayer
- School of Public Health, University of California, Berkeley, California, USA
| | - Kristina K Hardy
- Center for Neuroscience and Behavioral Medicine, Neuropsychology Division, Children's National Medical Center, Washington, DC, USA
- Department of Psychiatry and Behavioral Science, George Washington University School of Medicine, Washington, DC, USA
| | - Nina S Kadan-Lottick
- Yale University School of Medicine, 15 PO Box 208064, 16 333 Cedar Street, LMP-2073 (for courier mail), 17, New Haven, CT, 06520-8064, USA
- Yale Cancer Center, New Haven, CT, USA
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Bockbrader M, Annetta N, Friedenberg D, Schwemmer M, Skomrock N, Colachis S, Zhang M, Bouton C, Rezai A, Sharma G, Mysiw WJ. Clinically Significant Gains in Skillful Grasp Coordination by an Individual With Tetraplegia Using an Implanted Brain-Computer Interface With Forearm Transcutaneous Muscle Stimulation. Arch Phys Med Rehabil 2019; 100:1201-1217. [PMID: 30902630 DOI: 10.1016/j.apmr.2018.07.445] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/28/2018] [Accepted: 07/26/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To demonstrate naturalistic motor control speed, coordinated grasp, and carryover from trained to novel objects by an individual with tetraplegia using a brain-computer interface (BCI)-controlled neuroprosthetic. DESIGN Phase I trial for an intracortical BCI integrated with forearm functional electrical stimulation (FES). Data reported span postimplant days 137 to 1478. SETTING Tertiary care outpatient rehabilitation center. PARTICIPANT A 27-year-old man with C5 class A (on the American Spinal Injury Association Impairment Scale) traumatic spinal cord injury INTERVENTIONS: After array implantation in his left (dominant) motor cortex, the participant trained with BCI-FES to control dynamic, coordinated forearm, wrist, and hand movements. MAIN OUTCOME MEASURES Performance on standardized tests of arm motor ability (Graded Redefined Assessment of Strength, Sensibility, and Prehension [GRASSP], Action Research Arm Test [ARAT], Grasp and Release Test [GRT], Box and Block Test), grip myometry, and functional activity measures (Capabilities of Upper Extremity Test [CUE-T], Quadriplegia Index of Function-Short Form [QIF-SF], Spinal Cord Independence Measure-Self-Report [SCIM-SR]) with and without the BCI-FES. RESULTS With BCI-FES, scores improved from baseline on the following: Grip force (2.9 kg); ARAT cup, cylinders, ball, bar, and blocks; GRT can, fork, peg, weight, and tape; GRASSP strength and prehension (unscrewing lids, pouring from a bottle, transferring pegs); and CUE-T wrist and hand skills. QIF-SF and SCIM-SR eating, grooming, and toileting activities were expected to improve with home use of BCI-FES. Pincer grips and mobility were unaffected. BCI-FES grip skills enabled the participant to play an adapted "Battleship" game and manipulate household objects. CONCLUSIONS Using BCI-FES, the participant performed skillful and coordinated grasps and made clinically significant gains in tests of upper limb function. Practice generalized from training objects to household items and leisure activities. Motor ability improved for palmar, lateral, and tip-to-tip grips. The expects eventual home use to confer greater independence for activities of daily living, consistent with observed neurologic level gains from C5-6 to C7-T1. This marks a critical translational step toward clinical viability for BCI neuroprosthetics.
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Affiliation(s)
- Marcie Bockbrader
- Department of Physical Medicine & Rehabilitation, Ohio State University, Columbus, Ohio; Neurological Institute, Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Biomedical Engineering, Ohio State University, Columbus, Ohio.
| | | | | | | | | | - Samuel Colachis
- Department of Physical Medicine & Rehabilitation, Ohio State University, Columbus, Ohio; Department of Biomedical Engineering, Ohio State University, Columbus, Ohio; Battelle Memorial Institute, Columbus, Ohio
| | | | | | - Ali Rezai
- Neurological Institute, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Walter J Mysiw
- Department of Physical Medicine & Rehabilitation, Ohio State University, Columbus, Ohio; Neurological Institute, Ohio State University Wexner Medical Center, Columbus, Ohio
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Rebchuk AD, Deptuck HM, O'Neill ZR, Fawcett DS, Silverberg ND, Field TS. Validation of a Novel Telehealth Administration Protocol for the NIH Toolbox-Cognition Battery. Telemed J E Health 2019; 25:237-242. [DOI: 10.1089/tmj.2018.0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - Noah D. Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Thalia S. Field
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Vancouver Stroke Program, Vancouver, Canada
- Division of Neurology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
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Chiaravalloti ND, Weber E, Wylie G, Dyson-Hudson T, Wecht JM. Patterns of cognitive deficits in persons with spinal cord injury as compared with both age-matched and older individuals without spinal cord injury. J Spinal Cord Med 2018; 43:88-97. [PMID: 30508409 PMCID: PMC7006756 DOI: 10.1080/10790268.2018.1543103] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Context/Objective: Cognitive deficits can impact as many as 60% of individuals with spinal cord injury (SCI). In an effort to identify the nature of cognitive deficits in SCI, we examined neuropsychological test performance in individuals with SCI, age matched healthy controls and older healthy controls.Design: Participants completed a motor-free neuropsychological test battery assessing attention, working memory, information processing speed, new learning /memory and executive control.Setting: Outpatient rehabilitation research facility.Participants: Participants included 60 individuals with chronic spinal cord injury [SCI; 32 with paraplegia (T2-T12) and 28 with tetraplegia (C3-T1)], 30 age-matched healthy controls (AMHC; 30-40 years old) and 20 older healthy controls (OHC; 50-60 years old).Outcome Measures: Wechsler Intelligence Scale - 3rd edition (WAIS-III) Digit Span and Letter-Number Sequencing; Symbol Digit Modalities Test (SDMT) - oral version; California Verbal Learning Test-II; Paced Auditory Serial Addition Test (PASAT); Wechsler Abbreviated Scale of Intelligence (WASI); Delis-Kaplan Executive Function System; Verbal Fluency subtest.Results: Significant differences were noted between the SCI and AMHC groups on measures of information processing speed, new learning and memory, and verbal fluency. No significant differences were noted between the groups on tests of attention or working memory.Conclusion: The current study documented differences in specific realms of cognitive functioning between a chronic SCI sample and AMHC. Implications for cognitive rehabilitation and overall quality of life are discussed. Additional research is needed utilizing a more comprehensive battery of motor-free neuropsychological tests that avoid the confound of upper limb motor limitations on cognitive performance.
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Affiliation(s)
- Nancy D. Chiaravalloti
- Kessler Foundation, Traumatic Brain Injury Research, West Orange, New Jersey, USA,Kessler Foundation, Neuropsychology & Neuroscience Research, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation Medical School, Rutgers-NJ, Newark, New Jersey, USA,Correspondence to: Nancy D. Chiaravalloti, PhD, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ 07936, (973) 324–8440.
| | - Erica Weber
- Kessler Foundation, Traumatic Brain Injury Research, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation Medical School, Rutgers-NJ, Newark, New Jersey, USA
| | - Glenn Wylie
- Kessler Foundation, Neuropsychology & Neuroscience Research, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation Medical School, Rutgers-NJ, Newark, New Jersey, USA,VA War Related Illness and Injury Study Center, East Orange, New Jersey, USA
| | - Trevor Dyson-Hudson
- Department of Physical Medicine and Rehabilitation Medical School, Rutgers-NJ, Newark, New Jersey, USA,Kessler Foundation, Spinal Cord Injury Research, West Orange, New Jersey, USA
| | - Jill M. Wecht
- VA RR&D National Center for the Medical Consequences of SCI, James J. Peters VAMC, Bronx, New York, USA,Department of Medicine and Rehabilitation Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
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Carlozzi NE, Tulsky DS, Wolf TJ, Goodnight S, Heaton RK, Casaletto KB, Wong AWK, Baum CM, Gershon RC, Heinemann AW. Construct validity of the NIH Toolbox Cognition Battery in individuals with stroke. Rehabil Psychol 2018; 62:443-454. [PMID: 29265865 DOI: 10.1037/rep0000195] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The National Institutes of Health (NIH) Toolbox (NIHTB) for the Assessment of Behavior and Neurological Function Cognition Battery (NIHTB-CB) provides a brief assessment (approximately 30 min) of key components of cognition. This article examines construct validity to support the clinical utility of the NIHTB-CB in individuals with stroke. RESEARCH METHOD A total of 131 individuals with stroke (n = 71 mild stroke; n = 60 moderate/severe stroke) completed the NIHTB-CB. Univariate analyses were conducted to examine the cognitive profiles of the two different stroke groups (mild vs. moderate/severe stroke) on NIHTB-CB measures and composite scores. Pearson correlations were conducted between NIHTB-CB and established measures to examine convergent and discriminant validity. Effect sizes and clinical impairment rates for the different NIHTB-CB measures and composite scores were also examined. RESULTS Participants experiencing moderate to severe stroke had poorer performance than did individuals with mild stroke on several of the NIHTB cognition measures. Evidence of convergent validity was provided by moderate to strong correlations between the NIHTB measures and the corresponding standard neuropsychological test (Pearson rs ranged from 0.31 to 0.88; median = .60). Evidence of discriminant validity was provided by smaller correlations between different cognitive domains than correlations of measures within the same domain. Effect sizes for composite and subtest scores regarding stroke severity were generally moderate-to-large. In addition, 42% of the sample were exhibiting mild cognitive impairment (i.e., ≥2 low scores on fluid tests). CONCLUSIONS Findings provide support for the construct validity of the NIHTB-CB in individuals with stroke. (PsycINFO Database Record
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware
| | - Timothy J Wolf
- Occupational Therapy and Department of Neurology, Washington University
| | - Siera Goodnight
- Department of Physical Medicine and Rehabilitation, University of Michigan
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego
| | | | - Alex W K Wong
- Occupational Therapy and Department of Neurology, Washington University
| | - Carolyn M Baum
- Occupational Therapy and Department of Neurology, Washington University
| | | | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab
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50
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Carlozzi NE, Goodnight S, Umlauf A, Heaton RK, Heinemann AW, Schalet BD, Gershon RC, Tulsky DS. Motor-free composites from the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) for people with disabilities. Rehabil Psychol 2018; 62:464-473. [PMID: 29265867 DOI: 10.1037/rep0000185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE The National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) includes a group of brief measures (i.e., 30 min) designed to assess language, processing speed, working memory, episodic memory, and executive functioning. These subtests can be combined to create composite scores that reflect fluid and crystallized cognition, as well as overall cognition. The battery is of limited utility with individuals who have impaired upper extremity motor functioning. This manuscript examines the accuracy of the Oral Symbol Digit Modalities Test as a substitute for the Pattern Comparison Processing Speed Test for computing motor-free composite scores. Research Method/Design: Individuals with spinal cord injury (SCI; n = 188), traumatic brain injury (TBI; n = 159), or stroke (n = 180) completed the NIHTB-CB. We used the Oral Symbol Digit Modalities Test to create a Motor-Free Pattern Comparison score; this was used to create revised, Motor-Free Composite scores for Fluid Cognition and Overall Cognition. RESULTS Although there were statistically significant overall differences between the two Fluid and Overall Cognition composite scores for some of the clinical groups (scores based on the motor-free approach were significantly higher than the original score), these differences were small and partly because of overclassification of impaired processing speed in participants with motor impairment. There was good to substantial agreement with regard to "impairment" classification between the two sets of Original and Motor-Free composite scores. CONCLUSIONS/IMPLICATIONS Although the Motor-Free scores are not a perfect match for the Original Composite scores, they provide a reliable and valid way to examine overall and fluid cognition in individuals with upper extremity motor impairments. (PsycINFO Database Record
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan
| | - Siera Goodnight
- Department of Physical Medicine and Rehabilitation, University of Michigan
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego
| | | | - Benjamin D Schalet
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Richard C Gershon
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware
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