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DesRuisseaux LA, Gereau Mora M, Suchy Y. Computerized assessment of executive functioning: Validation of the CNS Vital Signs executive functioning scores in a sample of community-dwelling older adults. Clin Neuropsychol 2024:1-23. [PMID: 38763890 DOI: 10.1080/13854046.2024.2354953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Objective: Computerized assessment of cognitive functioning has gained significant popularity over recent years, yet options for clinical assessment of executive functioning (EF) are lacking. One computerized testing platform, CNS Vital Signs (CNS-VS), offers tests designed to measure EF but requires further validation. The goal of the present study was to validate CNS-VS executive scores against standard clinical measures of EF. We also sought to determine whether a modified CNS-VS composite score that included variables purported to measure inhibition, switching, and working memory would outperform the currently available CNS-VS Executive Function Index. Method: A sample of 73 cognitively healthy older adults completed four tests from the Delis-Kaplan Executive Function System, the Digit Span subtest from the Wechsler Adult Intelligence Scale-fourth edition, and three CNS-VS tasks purported to measure inhibition, switching, and working memory. Results: Performances on the CNS-VS tests were predicted by performances on standard paper-and-pencil measures. Although the currently available CNS-VS Executive Function Index predicted unique variance in a well-validated paper-and-pencil EF composite score, our Modified CNS-VS EF composite accounted for unique variance above and beyond the original CNS-VS Executive Function Index, while the reverse was not true. Conclusions: The present results support the construct validity of CNS-VS EF tests but also suggest that modifications to their current composite scores would improve the prediction of EF performance.
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Affiliation(s)
| | | | - Yana Suchy
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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2
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Ansado J, Eynard B, Mirofle N, Mennetrey C, Banchereau J, Sablon M, Lokietek E, Le Vourc'h F, Tissot J, Wrobel J, Martel C, Granon S, Suarez S. Adult norms for the decision-making MindPulse Digital Test. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-19. [PMID: 38354094 DOI: 10.1080/23279095.2024.2307413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
We present adult normalized data for MindPulse (MP), a new tool evaluating attentional and executive functioning (AEF) in decision-making. We recruited 722 neurotypical participants (18-80 years), with 149 retested. The MP test includes three tasks: Simple Reaction Time (SRT), Go/No-go, and complex Go/No-go, involving perceptual components, motor responses, and measurements of reaction time (RT) and correctness. We compare responses, evaluating 14 cognitive indices (including new composite indices to describe AEF: Executive Speed and Reaction to Difficulty). We adjust for age/sex effects, introduce a difficulty scale, and consider standard deviations, aberrant times, and Spearman Correlation for speed-accuracy balance. Wilcoxon unpaired rank test is used to assess sex effects, and linear regression is employed to assess the age linear dependency model on the normalized database. The study demonstrated age and sex effects on RTs, in all three subtests, and the ability to correct it for individual results. The test showed excellent validity (Cronbach Alpha for the three subtasks is 92, 87, 95%) and high internal consistency (p < 0.001 for each subtask significantly faster than the more complex subtask) of the MP across the wide age range. Results showed correlation within the three RT parts of the test (p < .001 for each) and the independence of SRT, RD, and ES indices. The Retest effect was lower than intersubject variance, showing consistency over time. This study highlights the MP test's strong validity on a homogeneous, large adult sample. It emphasizes assessing AEF and Reaction to Difficulty dynamically with high sensitivity.
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Affiliation(s)
| | - Bertrand Eynard
- It's Brain SAS, Orsay, France
- IPHT/DRF/CEA Institut de Physique Théorique, Gif-sur-Yvette, France
- CRM Montréal, Montreal, Canada
| | - Nastasia Mirofle
- Institut des Neurosciences de Paris-Saclay, CNRS UMR 9197, Université Paris-Saclay, Paris, France
| | | | | | | | - Eline Lokietek
- Centre SSR Marguerite Boucicaut, Chalon sur Saône, France
| | | | | | | | - Claire Martel
- Centre de Santé Universitaire, St Martin d'Hères, France
| | - Sylvie Granon
- Institut des Neurosciences de Paris-Saclay, CNRS UMR 9197, Université Paris-Saclay, Paris, France
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3
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Sandness DJ, McCarter SJ, Dueffert LG, Shepard PW, Enke AM, Fields J, Mielke MM, Boeve BF, Silber MH, St. Louis EK. Cognition and driving ability in isolated and symptomatic REM sleep behavior disorder. Sleep 2022; 45:zsab253. [PMID: 34958375 PMCID: PMC8996024 DOI: 10.1093/sleep/zsab253] [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: 02/12/2021] [Revised: 04/28/2021] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES To analyze cognitive deficits leading to unsafe driving in patients with REM Sleep Behavior Disorder (RBD), strongly associated with cognitive impairment and synucleinopathy-related neurodegeneration. METHODS Twenty isolated RBD (iRBD), 10 symptomatic RBD (sRBD), and 20 age- and education-matched controls participated in a prospective case-control driving simulation study. Group mean differences were compared with correlations between cognitive and driving safety measures. RESULTS iRBD and sRBD patients were more cognitively impaired than controls in global neurocognitive functioning, processing speeds, visuospatial attention, and distractibility (p < .05). sRBD patients drove slower with more collisions than iRBD patients and controls (p < .05), required more warnings, and had greater difficulty following and matching speed of a lead car during simulated car-following tasks (p < .05). Driving safety measures were similar between iRBD patients and controls. Slower psychomotor speed correlated with more off-road accidents (r = 0.65) while processing speed (-0.88), executive function (-0.90), and visuospatial impairment (0.74) correlated with safety warnings in sRBD patients. Slower stimulus recognition was associated with more signal-light (0.64) and stop-sign (0.56) infractions in iRBD patients. CONCLUSIONS iRBD and sRBD patients have greater selective cognitive impairments than controls, particularly visuospatial abilities and processing speed. sRBD patients exhibited unsafe driving behaviors, associated with processing speed, visuospatial awareness, and attentional impairments. Our results suggest that iRBD patients have similar driving-simulator performance as healthy controls but that driving capabilities regress as RBD progresses to symptomatic RBD with overt signs of cognitive, autonomic, and motor impairment. Longitudinal studies with serial driving simulator evaluations and objective on-road driving performance are needed.
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Affiliation(s)
- David J Sandness
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
| | - Stuart J McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Lucas G Dueffert
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Park Nicollet Rehabilitation, Maple Grove, MN, USA
| | - Paul W Shepard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
| | - Ashley M Enke
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
| | - Julie Fields
- Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michael H Silber
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
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4
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Abstract
OBJECTIVE The long-term effects of pediatric concussion on white matter microstructure are poorly understood. This study investigated long-term changes in white matter diffusion properties of the corpus callosum in youth several years after concussion. METHODS Participants were 8-19 years old with a history of concussion (n = 36) or orthopedic injury (OI) (n = 21). Mean time since injury for the sample was 2.6 years (SD = 1.6). Participants underwent diffusion magnetic resonance imaging, completed cognitive testing, and rated their post-concussion symptoms. Measures of diffusivity (fractional anisotropy, mean, axial, and radial diffusivity) were extracted from white matter tracts in the genu, body, and splenium regions of the corpus callosum. The genu and splenium tracts were further subdivided into 21 equally spaced regions along the tract and diffusion values were extracted from each of these smaller regions. RESULTS White matter tracts in the genu, body, and splenium did not differ in diffusivity properties between youth with a history of concussion and those with a history of OI. No significant group differences were found in subdivisions of the genu and splenium after correcting for multiple comparisons. Diffusion metrics did not significantly correlate with symptom reports or cognitive performance. CONCLUSIONS These findings suggest that at approximately 2.5 years post-injury, youth with prior concussion do not have differences in their corpus callosum microstructure compared to youth with OI. Although these results are promising from the perspective of long-term recovery, further research utilizing longitudinal study designs is needed to confirm the long-term effects of pediatric concussion on white matter microstructure.
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5
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Brooks BL, Virani S, Khetani A, Carlson H, Jadavji Z, Mauthner M, Low TA, Plourde V, MacMaster FP, Bray S, Harris AD, Lebel C, Lebel RM, Esser MJ, Yeates KO, Barlow KM. Functional magnetic resonance imaging study of working memory several years after pediatric concussion. Brain Inj 2020; 34:895-904. [PMID: 32396403 DOI: 10.1080/02699052.2020.1753240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PRIMARY OBJECTIVE The neurophysiological effects of pediatric concussion several years after injury remain inadequately characterized. The objective of this study was to determine if a history of concussion was associated with BOLD response differences during an n-back working memory task in youth. RESEARCH DESIGN Observational, cross-sectional. METHODS AND PROCEDURES Participants include 52 children and adolescents (M = 15.1 years, 95%CI = 14.4-15.8, range = 9-19) with past concussion (n = 33) or orthopedic injury (OI; n = 19). Mean time since injury was 2.5 years (95%CI = 2.0-3.0). Measures included postconcussion symptom ratings, neuropsychological testing, and blood-oxygen-dependent-level (BOLD) functional magnetic resonance imaging (fMRI) during an n-back working memory task. MAIN OUTCOMES AND RESULTS Groups did not differ on accuracy or speed during the three n-back conditions. They also did not differ in BOLD signal change for the 1- vs. 0-back or 2- vs. 0-back contrasts (controlling for task performance). CONCLUSIONS This study does not support group differences in BOLD response during an n-back working memory task in youth who are on average 2.5 years post-concussion. The findings are encouraging from the perspective of understanding recovery after pediatric concussion.
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Affiliation(s)
- Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital , Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada
| | - Shane Virani
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary , Calgary, Alberta, Canada.,Vi Riddell Pain and Rehabilitation Program, Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada
| | - Aneesh Khetani
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Helen Carlson
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Zeanna Jadavji
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Micaela Mauthner
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Trevor A Low
- Department of Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Vickie Plourde
- École de Psychologie, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Monton, New Brunswick, Canada; Faculty Saint-Jean, University of Alberta , Edmonton, AB, Canada
| | - Frank P MacMaster
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Psychiatry and Paediatrics, University of Calgary , Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute , Calgary, Alberta, Canada.,Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services , Edmonton, Alberta, Canada
| | - Signe Bray
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Ashley D Harris
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Radiology, University of Calgary , Calgary, Alberta, Canada
| | - Catherine Lebel
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Radiology, University of Calgary , Calgary, Alberta, Canada
| | - R Marc Lebel
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Radiology and Biomedical Engineering, University of Calgary , Calgary, Alberta, Canada.,MR Applications and Workflow, GE Healthcare , Calgary, Alberta, Canada
| | - Michael J Esser
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Alberta, Canada.,Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary , Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary , Calgary, Alberta, Canada
| | - Karen M Barlow
- Departments of Paediatrics and Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada.,Faculty of Medicine, University of Queensland , Brisbane, Australia
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6
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N-Acetyl-Aspartate in the Dorsolateral Prefrontal Cortex Long After Concussion in Youth. J Head Trauma Rehabil 2020; 35:E127-E135. [DOI: 10.1097/htr.0000000000000535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Brooks BL, Sayers PQ, Virani S, Rajaram AA, Tomfohr-Madsen L. Insomnia in Adolescents with Slow Recovery from Concussion. J Neurotrauma 2019; 36:2391-2399. [DOI: 10.1089/neu.2018.6257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Brian L. Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, and University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, and University of Calgary, Calgary, Alberta, Canada
| | - Payton Q. Sayers
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shane Virani
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Alysha A. Rajaram
- Neurosciences Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lianne Tomfohr-Madsen
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, and University of Calgary, Calgary, Alberta, Canada
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8
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Brooks BL, Plourde V, Fay-McClymont TB, MacAllister WS, Sherman EMS. Factor structure of the CNS Vital Signs computerized cognitive battery in youth with neurological diagnoses. Child Neuropsychol 2019; 25:980-991. [DOI: 10.1080/09297049.2019.1569609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Brian L. Brooks
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Departments of Paediatrics, Clinical Neurosciences, and Psychology, University of Calgary, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Vickie Plourde
- Faculty St-Jean, University of Alberta, Edmonton, Canada
| | - Taryn B. Fay-McClymont
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Paediatrics, University of Calgary, Calgary, Canada
| | - William S. MacAllister
- Neuropsychology Service, Alberta Children’s Hospital, Calgary, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Paediatrics, University of Calgary, Calgary, Canada
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9
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Plourde V, Hrabok M, Sherman EMS, Brooks BL. Validity of a Computerized Cognitive Battery in Children and Adolescents with Neurological Diagnoses. Arch Clin Neuropsychol 2018; 33:247-253. [PMID: 28981565 DOI: 10.1093/arclin/acx067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/12/2017] [Indexed: 12/26/2022] Open
Abstract
Objective Little is known about the validity of computerized cognitive batteries, such as CNS Vital Signs (CNSVS), in pediatric patients. The purpose of this study was to examine convergent and divergent validity of the CNSVS in a clinical pediatric sample with neurological diagnoses. Method Participants included 123 pediatric patients assessed in a tertiary care setting as part of clinical care. CNSVS (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility domains, and a Neurocognition Index) and paper-and-pencil neuropsychological measures assessing learning, memory, processing speed, reaction time, attention, and executive functioning were administered. Results Most correlations between CNSVS domain scores and neuropsychological measures assessing similar constructs were medium in strength. With the exception of stronger correlations between psychomotor speed tests, correlations between tests of similar constructs were not significantly higher than those between dissimilar constructs. Conclusions These results provide support for validity of the CNSVS battery, but also caution that many abilities are inter-correlated.
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Affiliation(s)
- Vickie Plourde
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marianne Hrabok
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Brian L Brooks
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Neurosciences (Brain Injury and Rehabilitation Program), Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
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10
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Incorporating a Computerized Cognitive Battery Into the Emergency Department Care of Pediatric Mild Traumatic Brain Injuries-Is It Feasible? Pediatr Emerg Care 2018; 34:501-506. [PMID: 28030519 DOI: 10.1097/pec.0000000000000959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The use of computers to test cognitive function acutely after a concussion is becoming increasingly popular, especially after sport-related concussion. Although commonly performed in the community, it is not yet performed routinely in the emergency department (ED), where most injured children present. The challenges of performing computerized cognitive testing (CCT) in a busy ED are considerable. The aim of this study was to evaluate the feasibility of CCT in the pediatric ED after concussion. METHODS Children, aged 8 to 18 years with mild traumatic brain injury, presenting to the ED were eligible for this prospective study. Exclusion criteria included the use of drugs, alcohol, and/or physical injury, which could affect CCT performance. A 30- or 15-minute CCT battery was performed. Feasibility measures included environmental factors (space, noise, waiting time), testing factors (time, equipment reliability, personnel), and patient factors (age, injury characteristics). RESULTS Forty-nine children (28 boys; mean age, 12.6; SD, ± 2.5) participated in the study. All children completed CCT. Mean testing times for the 30- and 15-minute battery were 29.7 and 15.2 minutes, respectively. Noise-cancelling headphones were well tolerated. A shorter CCT was more acceptable to families and was associated with fewer noise disturbances. There was sufficient time to perform testing after triage and before physician assessment in over 90% of children. CONCLUSIONS Computerized cognitive testing is feasible in the ED. We highlight the unique challenges that should be considered before its implementation, including environmental and testing considerations, as well as personnel training.
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Is Computerized Cognitive Testing Useful in Children and Adolescents with Moderate-to-Severe Traumatic Brain Injury? J Int Neuropsychol Soc 2017; 23:304-313. [PMID: 28215191 DOI: 10.1017/s1355617717000066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Children and adolescents with moderate-to-severe traumatic brain injury (TBI) present with short and long-term neuropsychological deficits following their injury. The aim of this study was to investigate the utility of a brief computerized test battery for evaluating cognitive functioning sub-acutely following a TBI. METHODS Participants (n=33) sustained a moderate-to-severe TBI, were between 8 and 18 years old, and were assessed using CNS Vital Signs (CNSVS) within 6 months post-injury (median=0.6 month). Participants with TBI were matched to 33 healthy controls based on age, sex, and handedness to compare their cognitive functioning on the CNSVS battery. RESULTS Children and adolescents with moderate-to-severe TBI had significantly lower scores and large effect sizes on Reaction Time, Complex Attention, and Cognitive Flexibility domains, as well as medium effect sizes on two Visual Memory test scores and one Psychomotor Speed test score. A significantly higher percentage of participants with TBI had cognitive impairment on Reaction Time domain score compared to the control group. Finally, CNSVS domain scores correctly categorized 76% of participants as either group with TBI or control group. CONCLUSIONS CNSVS may be a useful tool for screening cognitive abilities in children and adolescents who are early in their recovery from a moderate-to-severe TBI, particularly when a rapid screening evaluation can help guide management, interventions, and track recovery. (JINS, 2017, 23, 304-313).
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12
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Barlow KM, Marcil LD, Dewey D, Carlson HL, MacMaster FP, Brooks BL, Lebel RM. Cerebral Perfusion Changes in Post-Concussion Syndrome: A Prospective Controlled Cohort Study. J Neurotrauma 2017; 34:996-1004. [PMID: 27554429 PMCID: PMC5333570 DOI: 10.1089/neu.2016.4634] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The biology of post-concussive symptoms is unclear. Symptoms are often increased during activities, and have been linked to decreased cerebrovascular reactivity and perfusion. The aim of this study was to examine cerebral blood flow (CBF) in children with different clinical recovery patterns following mild traumatic brain injury (mTBI). This was a prospective controlled cohort study of children with mTBI (ages 8 to 18 years) who were symptomatic with post-concussive symptoms at one month post-injury (symptomatic, n = 27) and children who had recovered quickly (asymptomatic, n = 24). Pseudo continuous arterial spin labeling magnetic resonance imaging (MRI) was used to quantify CBF. The mTBI groups were imaged at 40 days post-injury. Global and regional CBF were compared with healthy controls of similar age and sex but without a history of mTBI (n = 21). Seventy-two participants (mean age: 14.1 years) underwent neuroimaging. Significant differences in CBF were found: global CBF was higher in the symptomatic group and lower in the asymptomatic group compared with controls, (F(2,69) 9.734; p < 0.001). Post-injury symptom score could be predicted by pre-injury symptoms and CBF in presence of mTBI (adjusted R2 = 0.424; p < 0.001). Altered patterns of cerebral perfusion are seen following mTBI and are associated with the recovery trajectory. Symptomatic children have higher CBF. Children who "recovered" quickly, have decreased CBF suggesting that clinical recovery precedes the cerebral recovery. Further longitudinal studies are required to determine if these perfusion patterns continue to change over time.
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Affiliation(s)
- Karen M. Barlow
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | | | - Deborah Dewey
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Helen L. Carlson
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Frank P. MacMaster
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Brian L. Brooks
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - R. Marc Lebel
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Biomedical Engineering, University of Calgary, Calgary, Alberta, Canada
- GE Healthcare, Calgary, Alberta, Canada
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13
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Mangone A, Yates KF, Sweat V, Joseph A, Convit A. Cognitive functions among predominantly minority urban adolescents with metabolic syndrome. APPLIED NEUROPSYCHOLOGY-CHILD 2017. [PMID: 28631969 DOI: 10.1080/21622965.2017.1284662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The rise in the rate of adolescent obesity has led to a concurrent rise in the rate of metabolic syndrome (MetS) among young people. In addition to diabetes and cardiovascular disease, MetS has also been linked to cognitive dysfunction. The goal of this study was to assess whether cognitive differences exist between minority urban adolescents carrying excess weight who meet criteria for MetS as compared to their peers without MetS. Two hundred and ninety-six urban adolescents, predominantly Hispanic and carrying excess weight as defined by a BMI above 25 kg/m2, were screened for MetS and divided into MetS and no MetS groups. All participants completed the CNS Vital Signs (CNS-VS) computerized neurocognitive battery that assesses cognitive domains of Memory, Processing Speed, Reaction Time, Executive Function, Complex Attention, and Cognitive Flexibility. The MetS group (29.2%, n = 84) performed significantly lower on 2 of the 7 cognitive domains: Executive Function (EF) and Cognitive Flexibility. Additionally, waist circumference was determined to be a significant predictor of both these domains. These findings suggest EF is negatively impacted in adolescents with MetS, despite there being no statistical differences between MetS groups on most other measured cognitive domains. Due to the interrelated nature of obesity, waist circumference, and MetS, these findings have larger implications for the obesity epidemic as well.
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Affiliation(s)
- Alexander Mangone
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
| | - Kathy F Yates
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA.,d Nathan Kline Institute for Psychiatric Research, Orangeburg , New York , NY , USA
| | - Victoria Sweat
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
| | - Adriana Joseph
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
| | - Antonio Convit
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA.,b Department of Medicine , New York University School of Medicine , New York , NY , USA.,c Department of Radiology , New York University School of Medicine , New York , NY , USA.,d Nathan Kline Institute for Psychiatric Research, Orangeburg , New York , NY , USA
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14
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Brooks BL, Low TA, Daya H, Khan S, Mikrogianakis A, Barlow KM. Test or Rest? Computerized Cognitive Testing in the Emergency Department after Pediatric Mild Traumatic Brain Injury Does Not Delay Symptom Recovery. J Neurotrauma 2016; 33:2091-2096. [DOI: 10.1089/neu.2015.4301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brian L. Brooks
- Department of Neurosciences (Brain Injury and Vi Riddell Rehabilitation Programs), Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Trevor A. Low
- Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Hussain Daya
- Department of Psychology, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Samna Khan
- Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada
| | - Angelo Mikrogianakis
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Section of Emergency Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Karen M. Barlow
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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15
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Nickels KC, Zaccariello MJ, Hamiwka LD, Wirrell EC. Cognitive and neurodevelopmental comorbidities in paediatric epilepsy. Nat Rev Neurol 2016; 12:465-76. [PMID: 27448186 DOI: 10.1038/nrneurol.2016.98] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cognitive and behavioural comorbidities are often seen in children with epilepsy, and are more common and severe in refractory epilepsy. These comorbidities are associated with worse quality of life, increased behavioural and language problems and worse social skills, all of which adversely affect long-term psychosocial functioning. To enable early intervention and therapy, children and teens with epilepsy should be periodically screened for cognitive comorbidities. The location of the epileptic focus can, to a certain degree, predict the type(s) of comorbidity; however, the spectrum of disability is often broad, presumably because focal perturbations can cause network dysfunction. Comorbidities often result from underlying structural or functional pathology that has led to seizures. In selected cases, therapy targeting the underlying cause, such as the ketogenic diet for GLUT1 deficiency syndromes, may be remarkably effective in ameliorating both seizures and cognitive concerns. In many cases, however, cognitive impairment persists despite seizure control. In epileptic encephalopathies, frequent seizures and/or interictal epileptiform abnormalities exacerbate neurocognitive dysfunction, owing to synaptic reorganization or impaired neurogenesis, or to other effects on developing neural circuits, and prompt initiation of effective antiepileptic therapy is essential to limit cognitive comorbidities.
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Affiliation(s)
- Katherine C Nickels
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Michael J Zaccariello
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Lorie D Hamiwka
- Seattle Children's Hospital, MB.7.420 - Neurology, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
| | - Elaine C Wirrell
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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16
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Bozkurt H, Özer S, Yılmaz R, Sönmezgöz E, Kazancı Ö, Erbaş O, Demir O. Assessment of Neurocognitive Functions in Children and Adolescents with Obesity. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:262-268. [PMID: 27183151 DOI: 10.1080/21622965.2016.1150184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Obesity is linked to adverse neurocognitive outcomes including reduced cognitive functioning. We aimed to investigate the differences in neuropsychological test performance of Turkish children and adolescents with obesity and healthy peers. Study includes 147 children and adolescents ranging in age from 8 to 16 years: 92 with obesity and 55 with healthy controls. After the participants were administered the Children's Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders (SCARED), they completed the battery tests of the Central Nervous System Vital Signs (CNSVS), a neurocognitive test battery, via computer. The battery calculates seven domain scores (Memory, Psychomotor speed, Processing speed, Reaction time, Complex attention, Executive Function, Cognitive flexibility), and a summary score (Neurocognition Index [NCI]). There was a statistically significant difference between the obesity and control groups on all cognitive domains. The mean NCI score of the obesity group was 81.3 ± 10.24 compared to 97.29 ± 4.97 for the control group. The mean NCI score in the obesity group was significantly lower than that of the control group (p < 0.001). The mean scores of other domains of obese patients were also found to be significantly lower than those of the control participants (p < 0.001). The mean SCARED scores of the participants with obesity were found to be significantly higher than those of the control participants (p < 0.05). However, no statistically significant relationship was found between the SCARED and the CNSVS scores. Cognitive dysfunction in children and adolescents with obesity should be taken into consideration when assessing and managing this population.
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Affiliation(s)
- Hasan Bozkurt
- a Department of Child and Adolescent Psychiatry , Gaziosmanpasa University Hospital , Tokat , Turkey
| | - Samet Özer
- b Department of Pediatrics , Gaziosmanpasa University Hospital , Tokat , Turkey
| | - Resul Yılmaz
- b Department of Pediatrics , Gaziosmanpasa University Hospital , Tokat , Turkey
| | - Ergün Sönmezgöz
- b Department of Pediatrics , Gaziosmanpasa University Hospital , Tokat , Turkey
| | - Özlem Kazancı
- b Department of Pediatrics , Gaziosmanpasa University Hospital , Tokat , Turkey
| | - Oytun Erbaş
- c Department of Physiology , Gaziosmanpasa University Hospital , Tokat , Turkey
| | - Osman Demir
- d Department of Biostatistics , Gaziosmanpasa University Hospital , Tokat , Turkey
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17
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Cognition in the Emergency Department as a Predictor of Recovery after Pediatric Mild Traumatic Brain Injury. J Int Neuropsychol Soc 2016; 22:379-87. [PMID: 26786357 DOI: 10.1017/s1355617715001368] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cognitive abilities can be acutely disrupted in children and adolescents who sustain a mild traumatic brain injury (mTBI), with the potential that these disruptions may be predictive of recovery. The objective of this study was to determine if cognitive abilities in the emergency department (ED) can differentiate and predict poor symptom recovery following a pediatric mTBI. Participants included 77 male and female youth with a mTBI (mean age=13.6; SD=2.6). All participants completed computerized cognitive testing (four subtests from the CNS Vital Signs) when they presented to the ED. Symptom measurement occurred in the ED (for pre-injury), at 7-10 days, 1 month, 2 months, and 3 months post-mTBI using the post-concussion symptom inventory (PCSI). Recovery was determined using reliable change scores for symptom ratings from 28 orthopedic injury controls (mean age=13.9 years; SD=2.1). Significantly worse Reaction Time scores (i.e., rapid information processing) in the ED were found in those who remained symptomatic at 1 month. Performances on the Reaction Time and Cognitive Flexibility domain scores were predictive of symptom outcome at 1 month for youth (above and beyond sex and baseline symptom burden). Youth with low scores on Reaction Time and/or Cognitive Flexibility were nearly 15 times (95% CI=1.8-323.5) more likely to remain symptomatic at 1 month post-mTBI. No significant group differences were found at 7-10 days, 2 months, or 3 months post-injury. Rapid computerized cognitive testing in the ED following a mTBI may help clinicians predict which youth may or may not remain symptomatic at follow-up.
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18
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Rubinstein TB, Putterman C, Goilav B. Biomarkers for CNS involvement in pediatric lupus. Biomark Med 2016; 9:545-58. [PMID: 26079959 DOI: 10.2217/bmm.15.26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
CNS disease, or central neuropsychiatric lupus erythematosus (cNPSLE), occurs frequently in pediatric lupus, leading to significant morbidity and poor long-term outcomes. Diagnosing cNPSLE is especially difficult in pediatrics; many current diagnostic tools are invasive and/or costly, and there are no current accepted screening mechanisms. The most complicated aspect of diagnosis is differentiating primary disease from other etiologies; research to discover new biomarkers is attempting to address this dilemma. With many mechanisms involved in the pathogenesis of cNPSLE, biomarker profiles across several modalities (molecular, psychometric and neuroimaging) will need to be used. For the care of children with lupus, the challenge will be to develop biomarkers that are accessible by noninvasive measures and reliable in a pediatric population.
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Affiliation(s)
- Tamar B Rubinstein
- Department of Pediatrics, Division of Rheumatology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA
| | - Chaim Putterman
- Department of Medicine, Division of Rheumatology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Beatrice Goilav
- Department of Pediatrics, Division of Nephrology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA
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19
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Özer S, Bozkurt H, Yılmaz R, Sönmezgöz E, Bütün I. Evaluation of executive functions in children and adolescents with familial Mediterranean fever. Child Neuropsychol 2015; 23:332-342. [DOI: 10.1080/09297049.2015.1108397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Dede E, Zalonis I, Gatzonis S, Sakas D. Integration of computers in cognitive assessment and level of comprehensiveness of frequently used computerized batteries. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.npbr.2015.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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21
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Triplett RL, Asato MR. Brief cognitive and behavioral screening in children with new-onset epilepsy: a pilot feasibility trial. Pediatr Neurol 2015; 52:49-55. [PMID: 25433909 PMCID: PMC4276487 DOI: 10.1016/j.pediatrneurol.2014.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Minimal work has used psychometrically robust measures in a systematic fashion to identify and monitor children at risk for cognitive and behavioral comorbidities in current epilepsy care. We piloted a computerized cognitive battery and behavioral questionnaire for children with newly diagnosed epilepsy to determine clinical feasibility and acceptability to parents and patients. METHODS We recruited medication-naïve children (ages 8-17 years) with recent-onset seizures and typical developmental history from an outpatient child neurology clinic. Children completed the CNS Vital Signs computerized battery, whereas parents completed the Strengths and Difficulties Questionnaire. Post-test interviews with parents and patients were completed regarding the acceptability of the assessment procedures. RESULTS Forty-four families were eligible, and 39 agreed to participate (89%). All assessments were completed in less than 45 minutes. Parents rated testing in clinic as convenient and important, expressing strong interest in the cognitive and behavioral impact of epilepsy and medication. Children also rated the testing procedure as acceptable and agreed that they would recommend it to peers. CONCLUSIONS Our brief battery was tolerated and well received by children and their parents. Computerized testing of children along with a parent questionnaire is a psychometrically viable approach that is acceptable to families. Our protocol is time efficient for clinical use with the potential to detect early cognitive and behavioral difficulties related to epilepsy. Ongoing longitudinal study will provide further information regarding the success of our screening methods in monitoring for disease- or treatment-related changes.
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Affiliation(s)
| | - Miya R. Asato
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh PA,Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh PA
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22
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Brooks BL, Khan S, Daya H, Mikrogianakis A, Barlow KM. Neurocognition in the Emergency Department after a Mild Traumatic Brain Injury in Youth. J Neurotrauma 2014; 31:1744-9. [DOI: 10.1089/neu.2014.3356] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brian L. Brooks
- Neurosciences (Brain Injury and Rehabilitation), Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, Alberta, Canada
| | - Samna Khan
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Hussain Daya
- Department of Psychology, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Angelo Mikrogianakis
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Emergency Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Karen M. Barlow
- Neurosciences (Brain Injury and Rehabilitation), Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, Alberta, Canada
- Pediatric Neurology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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23
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Brooks BL, Sherman EMS, Iverson GL. Embedded Validity Indicators on CNS Vital Signs in Youth with Neurological Diagnoses. Arch Clin Neuropsychol 2014; 29:422-31. [DOI: 10.1093/arclin/acu029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Barlow KM, Brooks BL, MacMaster FP, Kirton A, Seeger T, Esser M, Crawford S, Nettel-Aguirre A, Zemek R, Angelo M, Kirk V, Emery CA, Johnson D, Hill MD, Buchhalter J, Turley B, Richer L, Platt R, Hutchison J, Dewey D. A double-blind, placebo-controlled intervention trial of 3 and 10 mg sublingual melatonin for post-concussion syndrome in youths (PLAYGAME): study protocol for a randomized controlled trial. Trials 2014; 15:271. [PMID: 25001947 PMCID: PMC4227124 DOI: 10.1186/1745-6215-15-271] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/17/2014] [Indexed: 12/14/2022] Open
Abstract
Background By the age of sixteen, one in five children will sustain a mild traumatic brain injury also known as concussion. Our research found that one in seven school children with mild traumatic brain injury suffer post-concussion syndrome symptoms for three months or longer. Post-concussion syndrome is associated with significant disability in the child and his/her family and yet there are no evidence-based medical treatments available. Melatonin has several potential mechanisms of action that could be useful following mild traumatic brain injury, including neuroprotective effects. The aim of this study is to determine if treatment with melatonin improves post-concussion syndrome in youths following mild traumatic brain injury. Our hypothesis is that treatment of post-concussion syndrome following mild traumatic brain injury with 3 or 10 mg of sublingual melatonin for 28 days will result in a decrease in post-concussion syndrome symptoms compared with placebo. Methods/Design Ninety-nine youths with mild traumatic brain injury, aged between 13 and 18 years, who are symptomatic at 30 days post-injury will be recruited. This study will be conducted as a randomized, double blind, placebo-controlled superiority trial of melatonin. Three parallel treatment groups will be examined with a 1:1:1 allocation: sublingual melatonin 3 mg, sublingual melatonin 10 mg, and sublingual placebo. Participants will receive treatment for 28 days. The primary outcome is a change on the Post-Concussion Symptom Inventory (Parent and Youth). The secondary outcomes will include neurobehavioral function, health-related quality of life and sleep. Neurophysiological and structural markers of change, using magnetic resonance imaging techniques and transcranial magnetic stimulation, will also be investigated. Discussion Melatonin is a safe and well-tolerated agent that has many biological properties that may be useful following a traumatic brain injury. This study will determine whether it is a useful treatment for children with post-concussion syndrome. Recruitment commenced on 4 December 2014. Trial registration This trial was registered on 6 June 2013 at ClinicalTrials.gov. Registration number: NCT01874847.
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Affiliation(s)
- Karen M Barlow
- Alberta Children's Hospital Research Institute, University of Calgary, Room 293, Heritage Medical Research Building 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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Lisdexamfetamine dimesylate augmentation in adults with persistent executive dysfunction after partial or full remission of major depressive disorder. Neuropsychopharmacology 2014; 39:1388-98. [PMID: 24309905 PMCID: PMC3988542 DOI: 10.1038/npp.2013.334] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 10/28/2013] [Accepted: 10/30/2013] [Indexed: 12/28/2022]
Abstract
Evaluate lisdexamfetamine dimesylate (LDX) augmentation of antidepressant monotherapy for executive dysfunction in partially or fully remitted major depressive disorder (MDD). This randomized, placebo-controlled study (NCT00985725) enrolled 143 adults (18-55 years) with mild MDD (Montgomery-Åsberg Depression Rating Scale (MADRS) score ≤ 18) and executive dysfunction (Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) Self-Report Global Executive Composite (GEC) T score ≥ 60) on stable antidepressant monotherapy for ≥ 8 weeks. After 2 weeks of screening, participants were randomized to 9 weeks of double-blind LDX (20-70 mg/day) or placebo augmentation, followed by 2 weeks of single-blind placebo. The primary end point was change from baseline to week 9/end of study (EOS) in BRIEF-A Self-Report GEC T score; secondary assessments included the BRIEF-A Informant Report, MADRS, and treatment-emergent adverse events (TEAEs). Of 143 randomized participants, 119 completed double-blind treatment (placebo, n=59; LDX, n=60). Mean ± standard deviation (SD) BRIEF-A GEC T scores decreased from baseline (placebo, 74.2 ± 8.88; LDX, 76.8 ± 9.66) to week 9/EOS (placebo, 61.4 ± 14.61; LDX, 55.2 ± 16.15); the LS mean (95% CI) treatment difference significantly favored LDX (-8.0 (-12.7, -3.3); P=0.0009). The LS mean (95% CI) treatment difference for MADRS total score also significantly favored LDX (-1.9 (-3.7, 0.0); P=0.0465). TEAE rates were 73.6% with placebo and 78.9% with LDX; serious TEAE rates were 4.2 and 2.8%. In this trial, LDX augmentation significantly improved executive dysfunction and depressive symptoms in participants with mild MDD. The safety profile of LDX was consistent with prior studies in adults with attention-deficit/hyperactivity disorder.
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Iverson GL, Brooks BL, Ashton Rennison VL. Minimal gender differences on the CNS vital signs computerized neurocognitive battery. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:36-42. [PMID: 24826494 DOI: 10.1080/09084282.2012.721149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Normative test scores often are corrected for demographic variables that can have an impact on neurocognitive abilities (e.g., gender, age, education, and ethnicity). The purpose of this study is to determine whether there are gender differences on the CNS Vital Signs computerized neurocognitive test battery. Participants, selected from a large normative database, were 100 healthy adults aged 18 to 68 years old (M(age) = 35.8 years, SD = 13.6) with 15.5 years of education (SD = 2.2). Men (n = 50) and women (n = 50) were individually and precisely matched on age, education, ethnicity, computer use, occupation, and handedness. This battery of seven tests yields 23 test scores, 5 domain scores (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility), and a total score. Men had significantly better scores than did women on the Finger-Tapping Test for the right hand (p = .006, Cohen's d = 0.57). No other scores were significantly different, although there were small-medium effect sizes in favor of women on Symbol-Digit Coding (d = .39) and Verbal Memory (d = .37). The trends toward gender differences in word-list recognition memory and processing speed are consistent with the literature, but because they were nonsignificant and the effect sizes were modest, the clinician likely does not need to factor this into test interpretation.
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Affiliation(s)
- Grant L. Iverson
- a Department of Psychiatry , University of British Columbia and Research Department, Copeman Healthcare Centre , Vancouver , British Columbia , Canada
| | - Brian L. Brooks
- b Neurosciences Program, Alberta Children's Hospital and Departments of Pediatrics and Clinical Neurosciences and Alberta Children's Hospital Research Institute, University of Calgary , Calgary , Alberta , Canada
| | - V. Lynn Ashton Rennison
- c Mental Health & Substance Use, Department of Psychology , Fraser Health Authority–Royal Columbian Hospital, New Westminster and Division of Psychiatry, Department of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
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