A Novel BrainHealth Index Prototype Improved by Telehealth-Delivered Training During COVID-19

Multimodal Predictive Modeling: Scalable Imaging Informed Approaches to Predict Future Brain Health

Background

Predicting future brain health is a complex endeavor that often requires integrating diverse data sources. The neural patterns and interactions identified through neuroimaging serve as the fundamental basis and early indicators that precede the manifestation of observable behaviors or psychological states.

New Method

In this work, we introduce a multimodal predictive modeling approach that leverages an imaging-informed methodology to gain insights into future behavioral outcomes. We employed three methodologies for evaluation: an assessment-only approach using support vector regression (SVR), a neuroimaging-only approach using random forest (RF), and an image-assisted method integrating the static functional network connectivity (sFNC) matrix from resting-state functional magnetic resonance imaging (rs-fMRI) alongside assessments. The image-assisted approach utilized a partially conditional variational autoencoder (PCVAE) to predict brain health constructs in future visits from the behavioral data alone.

Results

Our performance evaluation indicates that the image-assisted method excels in handling conditional information to predict brain health constructs in subsequent visits and their longitudinal changes. These results suggest that during the training stage, the PCVAE model effectively captures relevant information from neuroimaging data, thereby potentially improving accuracy in making future predictions using only assessment data.

Comparison with Existing Methods

The proposed image-assisted method outperforms traditional assessment-only and neuroimaging-only approaches by effectively integrating neuroimaging data with assessment factors.

Conclusion

This study underscores the potential of neuroimaging-informed predictive modeling to advance our comprehension of the complex relationships between cognitive performance and neural connectivity.

Brain health index as a predictor of possible vascular dementia in the Mexican health and aging study 2012-2015

To determine the burden of disease among subjects at risk of developing stroke or dementia, brain health indexes (BHI) tend to rely on anatomical features. Recent definitions emphasize the need of a broader perspective that encompasses cardiovascular risk factors (CVRFS) and lifestyle components which can be considered partial contributors to optimal brain health. In this study, we aimed to establish the association and risk detected by a Brain Health Index and the risk of possible vascular dementia (PVD) using data from the Mexican Health and Aging Study (MHAS) 2012-2015. The MHAS is a longitudinal study of adults aged ≥ 50 years. We analyzed the data obtained between 2012 and 2015. CVRFS included in the index were diabetes mellitus, hypertension, myocardial infarction, depression, obesity, physical inactivity, and smoking history. A PVD diagnosis was established when scores in the Cross-Cultural Cognitive Examination were below reference norms and limitations in ≥1 instrumental activities of daily living and a history of stroke were present. A multinomial regression model was developed to determine the association between BHI scores and PVD. In 2015, 75 PVD cases were identified. Mean age was 67.1 ±13.2 years, 35.8% were female, and the mean educational level was 5.8 ±5.5 years. In cases with a higher score in the BHI, the model revealed a hazards ratio of 1.63 (95% CI: 1.63-1.64, p< 0.001) for PVD. In this longitudinal study, with the use of a feasible multifactorial BHI in the Mexican population, a greater score was associated with a 1.63-fold risk of developing PVD during the 3-year follow-up, while the risk for stroke was 1.75. This index could potentially be used to predict the risk of PVD in adults with modifiable CVRFS.

Telehealth administration of narrative and procedural discourse: A UK and US comparison of traumatic brain injury and matched controls

BACKGROUND

Impaired discourse production is commonly reported for individuals with traumatic brain injury (TBI). Discourse deficits can negatively impact community integration, return to employment and quality of life. COVID-19 restrictions have reduced in-person assessment services for people with communication impairments. Advances in telehealth may help speech and language therapists (SLTs) to assess monologic discourse more systematically and improve access to services for patients who may find it difficult to attend in-person.

AIMS

To examine the feasibility of telehealth administration of narrative and procedural discourse tasks with individuals with TBI and matched controls.

METHODS & PROCEDURES

A total of 20 individuals with TBI and 20 healthy controls, aged 18-55 years, were directly recruited from the UK and indirectly recruited from the US. For participants with TBI, time post-injury was at least 3 months with no diagnosis of aphasia. Control participants were matched for sex and as closely as possible for age. Feasibility of measures was based upon the time to administer both narrative tasks, the report of any technological problems, and participant feed. Discourse samples were transcribed verbatim and analysed using story grammar analysis (for narrative discourse) and identification of propositions (for procedural discourse). Interrater reliability was calculated using percentage agreement for 50% of the data. Non-parametric analyses were used to analyse the performance of the two groups.

OUTCOMES & RESULTS

Narrative and procedural discourse samples were collected via telehealth in approximately 10 min with no reported technical difficulties or complaints from any participants. For narrative discourse performance, there were significant differences for the TBI and control groups for measures of complete episodes (p < 0.001) and missing episodes (p = 0.005). No significant group differences were noted for any of the procedural discourse measures.

CONCLUSIONS & IMPLICATIONS

Results support the feasibility of collecting discourse samples via telehealth. Although the participants' discourse performance distinguished the TBI and control groups on the narrative task, no differences between the groups were noted for the procedural task. The narrative discourse task may have been more difficult than the procedural task, or video cue support reduced the cognitive load of the procedural task. This finding suggests the use of more complex procedural tasks without video cue support may be needed.

WHAT THIS PAPER ADDS

What is already known on this subject Although little research has explored the feasibility of administering discourse assessments for individuals with TBI via telehealth, some studies have found that discourse interventions can be feasibly administered via telehealth. It is also well established that individuals with TBI struggle with the supra-structural and macro-linguistic elements of discourse production. Both procedural and narrative discourse tasks have been found to differentiate individuals with TBI from healthy controls. What this paper adds to existing knowledge Few studies have investigated the feasibility of, and procedures for, administering discourse tasks via telehealth. Additionally, the inclusion of multiple types of discourse tasks to parse cognitive-communication abilities is lacking in the current literature. Findings from this study support that narrative and procedural discourse can be feasibly sampled via telehealth and that international collaboration for research on this topic can facilitate such studies. Individuals with TBI performed more poorly on three measures of narrative discourse. No differences between groups were identified for the procedural task. What are the potential or actual clinical implications of this work? Telehealth assessment for discourse provides flexibility for both the individual with TBI and the speech-language therapist and does not compromise the quality of data collected. The administration of discourse tasks and collection of data was not time-consuming and was well accepted by the study participants. Additionally, international research collaboration not only expands potential participation in research but increases the opportunity to recruit and study more diverse groups.

Toward precision brain health: accurate prediction of a cognitive index trajectory using neuroimaging metrics

The goal of precision brain health is to accurately predict individuals' longitudinal patterns of brain change. We trained a machine learning model to predict changes in a cognitive index of brain health from neurophysiologic metrics. A total of 48 participants (ages 21-65) completed a sensorimotor task during 2 functional magnetic resonance imaging sessions 6 mo apart. Hemodynamic response functions (HRFs) were parameterized using traditional (amplitude, dispersion, latency) and novel (curvature, canonicality) metrics, serving as inputs to a neural network model that predicted gain on indices of brain health (cognitive factor scores) for each participant. The optimal neural network model successfully predicted substantial gain on the cognitive index of brain health with 90% accuracy (determined by 5-fold cross-validation) from 3 HRF parameters: amplitude change, dispersion change, and similarity to a canonical HRF shape at baseline. For individuals with canonical baseline HRFs, substantial gain in the index is overwhelmingly predicted by decreases in HRF amplitude. For individuals with non-canonical baseline HRFs, substantial gain in the index is predicted by congruent changes in both HRF amplitude and dispersion. Our results illustrate that neuroimaging measures can track cognitive indices in healthy states, and that machine learning approaches using novel metrics take important steps toward precision brain health.

Exploring how brain health strategy training informs the future of work

Introduction

The workplace typically affords one of the longest periods for continued brain health growth. Brain health is defined by the World Health Organization (WHO) as the promotion of optimal brain development, cognitive health, and well-being across the life course, which we expanded to also include connectedness to people and purpose. This work was motivated by prior work showing individuals, outside of an aggregate setting, benefitted from training as measured by significant performance gains on a holistic BrainHealth Index and its factors (i.e., clarity, connectedness, emotional balance). The current research was conducted during the changing remote work practices emerging post-pandemic to test whether a capacity-building training would be associated with significant gains on measures of brain health and components of burnout. The study also tested the influence of utilization of training modules and days in office for individuals to inform workplace practices.

Methods

We investigated whether 193 individuals across a firm's sites would improve on measures of brain health and burnout from micro-delivery of online tactical brain health strategies, combined with two individualized coaching sessions, and practical exercises related to work and personal life, over a six-month period. Brain health was measured using an evidenced-based measure (BrainHealth™ Index) with its components (clarity, connectedness, emotional balance) consistent with the WHO definition. Burnout was measured using the Maslach Burnout Inventory Human Services Survey. Days in office were determined by access to digital workplace applications from the firm's network. Regression analyses were used to assess relationships between change in BrainHealth factors and change in components of the Maslach Burnout Inventory.

Results

Results at posttest indicated that 75% of the individuals showed gains on a composite BrainHealth Index and across all three composite factors contributing to brain health. Benefits were directly tied to training utilization such that those who completed the core modules showed the greatest gains. The current results also found an association between gains on both the connectedness and emotional balance brain health factors and reduced on burnout components of occupational exhaustion and depersonalization towards one's workplace. We found that fewer days in the office were associated with greater gains in the clarity factor, but not for connectedness and emotional balance.

Discussion

These results support the value of a proactive, capacity-building training to benefit all employees to complement the more widespread limited offerings that address a smaller segment who need mental illness assistance programs. The future of work may be informed by corporate investment in focused efforts to boost collective brain capital through a human-centered, capacity-building approach. Efforts are underway to uncover the value of better brain health, i.e., Brainomics© - which includes economic, societal, and individual benefits.

The impact of loneliness and social adaptation on depressive symptoms: Behavioral and brain measures evidence from a brain health perspective

Introduction

Early detection of depression is a cost-effective way to prevent adverse outcomes on brain physiology, cognition, and health. Here we propose that loneliness and social adaptation are key factors that can anticipate depressive symptoms.

Methods

We analyzed data from two separate samples to evaluate the associations between loneliness, social adaptation, depressive symptoms, and their neural correlates.

Results

For both samples, hierarchical regression models on self-reported data showed that loneliness and social adaptation have negative and positive effects on depressive symptoms. Moreover, social adaptation reduces the impact of loneliness on depressive symptoms. Structural connectivity analysis showed that depressive symptoms, loneliness, and social adaptation share a common neural substrate. Furthermore, functional connectivity analysis demonstrated that only social adaptation was associated with connectivity in parietal areas.

Discussion

Altogether, our results suggest that loneliness is a strong risk factor for depressive symptoms while social adaptation acts as a buffer against the ill effects of loneliness. At the neuroanatomical level, loneliness and depression may affect the integrity of white matter structures known to be associated to emotion dysregulation and cognitive impairment. On the other hand, socio-adaptive processes may protect against the harmful effects of loneliness and depression. Structural and functional correlates of social adaptation could indicate a protective role through long and short-term effects, respectively. These findings may aid approaches to preserve brain health via social participation and adaptive social behavior.

Effects of online brain training on self-reported mental health symptoms for generally healthy adults during the Covid-19 pandemic

BACKGROUND

The cognitive training Strategic Memory Advanced Reasoning Training (SMART) has been shown to improve symptoms of depression, anxiety, and stress when completed using in-person delivery, but mental health outcomes have not yet been studied for online delivery of SMART.

METHODS

Data was analyzed from 145 generally healthy adults participating in the BrainHealth Project pilot study who had access to 12 weeks of online self-paced SMART and self-reported mental health symptoms on the Depression Anxiety Stress Scale (DASS-21) pre- and post-training. We utilized linear models to examine the change in self-reported symptoms of depression, anxiety, and stress following the 12-week training period and to explore the influence of age, gender, and education on changes in symptomatology. Data from 44 participants who completed a follow-up DASS-21 6 months after completing SMART was used to explore the lasting impact of the training.

RESULTS

Improvements in depression, anxiety, and stress symptoms were observed following online SMART, evidenced by a significant decrease in self-reported symptoms on the DASS-21. Improvement in self-reported mental health symptomatology was maintained or continued to improve 6-month post-training. No significant effect of gender was observed, but findings motivate additional exploration of the effects of education and age.

CONCLUSION

Online SMART should be considered a low-cost, high-impact approach for supporting public mental health for generally healthy adults.

Remotely supervised home-based online chair yoga intervention for older adults with dementia: Feasibility study

BACKGROUND

and Purpose: Social isolation and caregiver burden call for an innovative way to deliver a chair yoga (CY) intervention to older adults with dementia who cannot travel to a community center. During a remotely supervised CY session, the yoga instructor can monitor each participant's pose and correct poses to optimize efficacy of CY and reduce chances of injury. This study assessed the feasibility of a remotely supervised online CY intervention for older adults with dementia and explored the relationship between CY and clinical outcomes: pain interference, mobility, risk of falling, sleep disturbance, autonomic reactivity, and loneliness.

METHODS

Using a one-group pretest/posttest design, a home-based CY intervention was delivered remotely to 10 older adults with dementia twice weekly in 60-minute sessions for 8 weeks. Psychosocial and physiological (i.e., cardiac) data were collected remotely at baseline, mid-intervention, and post-intervention.

RESULTS

The results indicated that remotely supervised online CY is a feasible approach for managing physical and psychological symptoms in socially isolated older adults with dementia, based on retention (70%) and adherence (87.5%), with no injury or other adverse events. While there were no significant findings for pain interference, mobility, sleep, or social loneliness longitudinally, emotional loneliness showed a significant increase, F(1.838, 11.029) = 6.293, p = .016, η² = 0.512, from baseline to post-intervention. Although participants were socially connected to other participants via a videoconferencing platform, emotional loneliness increased during the pandemic period.

CONCLUSION

A home-based remotely supervised online CY is a feasible approach for socially isolated older adults with dementia who are unable to travel to a facility.

Parenting With a Kind Mind: Exploring Kindness as a Potentiator for Enhanced Brain Health

A growing body of research has suggested that high levels of family functioning—often measured as positive parent–child communication and low levels of parental stress—are associated with stronger cognitive development, higher levels of school engagement, and more successful peer relations as youth age. The COVID-19 pandemic has brought tremendous disruption to various aspects of daily life, especially for parents of young children, ages 3–5, who face isolation, disconnection, and unprecedented changes to how they engage and socialize. Fortunately, both youth and parent brains are plastic and receptive to change. Resilience research shows that factors such as engaging in acts of kindness, developing trusting relationships, and responding compassionately to the feelings of others can help lay new neural pathways and improve quality of life. Yet, little research has investigated the effects of brain healthy parental practices of kindness with pre-school aged children. The current study examines whether an interactive, parent–child kindness curriculum can serve as a potentiator for brain health as measured by resilience and child empathy levels. During a peak of the pandemic, mother participants between the ages of 26–46 (n = 38, completion rate 75%) completed questionnaires on parental resilience levels and parent-reported child empathic pro-social behaviors before and after engaging in a 4 weeks online, self-paced, kindness curriculum. Half of the group received additional brain health education explaining the principles of neuroplasticity, empathy, perspective taking, and resiliency. Mothers in both groups showed increased resilience ( p < 0.001) and reported higher levels of empathic behavior in their child ( p < 0.001) after completing the curriculum. There was no significant difference between groups. Comparison of mean resilience levels during COVID-19 to pre-pandemic general means indicated that mothers are reporting significantly lower levels of resilience as well as decreased empathetic behaviors in their children. These results support the notion that kindness is a powerful brain health booster that can increase resilience and empathy. This research study was timely and relevant for parents in light of the myriad of stresses brought about by the ongoing COVID-19 pandemic. There are broader public health implications for equipping individuals with tools to take a proactive and preventative approach to their brain health.

A new definition of brain reserve

Brain reserve definitions foster debate and disagreements. A consensus definition of brain reserve would fill gaps in converging ongoing research and action plans to promote brain health. Different terms are used for the capacity to adapt to life hardships and cognitive and social compliance and to neutralize or compensate for age-related neurological degeneration to prevent impaired cognition. Brain reserve, resilience, cognitive reserve, and brain maintenance have been used usually in isolation, but at times interchangeably. However, the need remains for a simplified overarching definition of brain reserve. Brain health is a continuous development and exercise of the brain, and thus the brain reserve requires a definition encompassing this continuum. We propose for discussion a new definition of brain reserve that incorporates available definitions and emphasizes the dynamic and interactive nature of a healthy brain. Brain reserve is the lifelong, dynamic, interactive, accumulating capacity to resist physical, emotional, and/or social harms.