10 results
93 Digitized Trail Making Test in the NKI-Rockland Sample Normative Lifespan Neuroimaging Study
- Anna MacKay-Brandt, Nadine Schwab, Irene Piryatinksy, Maxine Krengel, Malvina Pietrzykowski, Dave Gansler, Andrea Suazo Rivas, Alyssa DiFalco, Stan Colcombe
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 768-769
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Digitized cognitive assessment captures rich behavioral information that remains unmeasured using conventional methods. Data capture tools recently accessible only in specialized laboratories are now feasible at scale using off-the-shelf tablet devices. This study aims to share data from a digitized cognitive assessment embedded in an open-science research program collecting extensive neuroimaging, health, behavioral, neuropsychological, and psychiatric characterizations to advance translational cognitive neuroscience. In this research we present normative performance metrics from a digital version of the Trail Making Test.
Participants and Methods:The NKI-Rockland Sample (NKI-RS) has provided a model for openly-shared lifespan normative neuroimaging resources contributed by a community-ascertained sample (n=1,500, aged 6-85) and generating over 400 publications across diverse research areas. The next generation NKI-RS study (recruitment target= 600, aged 9-75) aims to enrich these resources for brain-behavioral research, normative reference, and biomarker discovery. One focus of innovation is the inclusion of digitized cognitive assessments (DCAs) utilizing an open-resource task development and data collection platform (Mindlogger, Child Mind Institute). We present preliminary data from a digitized version of the Trail Making Tests and report early descriptive metrics. The TMTs was administered via an iPad Pro using an Apple pen as part of a laboratory-based EEG procedure. The TMTs follows standard administration instructions, including a practice sample before each test condition. Error feedback is included in the task implementation such that an incorrect connection is marked with an “x” and the participant is directed to the last correct circle to continue. Feedback is automated within the task. Pixel-level spatial resolution and millisecond timing is captured across all drawing tasks. Task design, implementation, and preliminary performance metrics including speed, accuracy, and variability are reported.
Results:Preliminary data include 12 participants from the NKI-RS2 study ranging in age from 11-75 years (M= 52.83, SD= 19.97); 67% female. Overall participants took longer to complete condition B (Mb = 51.71 secs) compared to condition A (Ma = 23.07 secs), p= 0.0005. Connections were made more slowly (Ma = 37.47 secs vs. Mb = 24.50 secs, p< 0.001) and connection speed was more variable (CVa = 0.90 vs. CVb = 1.22, p< 0.01) on condition B versus A. Connection speed decreased and speed variability increased with age (t[11 ]= -3.25, p= 0.05, t[11]= -3.63, p< 0.01, respectively). Time spent within circles (dwell time) was significantly greater in B versus A (t[11]= 6.81, p< 0.001). Number of errors were limited (MA = .89 and MB = 1.0, range 0-2 in both tests) with no difference between tests or effects of age (both ps >0.05).
Conclusions:These preliminary data from the NKI-RS2 normative neuroimaging study demonstrate that a digitized version of a classic neuropsychological test is feasible across a diverse range of community participants, and replicates known age effects. The advantages of growing access to these DCA tools and the shared data resources they will produce has the potential to revolutionize neuropsychological research and clinical practice.
2 1991 Gulf War Women Veterans: Neurotoxicant Exposures and Cognitive Outcomes
- Maxine H Krengel, Kimberly Sullivan
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 98-99
-
- Article
-
- You have access Access
- Export citation
-
Objective:
The women who served in the 19901991 Persian Gulf War (GW) are unique in that they were the first group to have fewer restrictions in terms of military occupations and exposure to combat. Of the nearly 41,000 US troops who were women deployed to the GW, many were serving in frontline positions and were exposed to the same toxicants as their male counterparts. Toxicant exposures such as pesticide sprays and creams, oil well fires, diesel fuels, chemical and biological warfare (CBW) agents and anti-nerve gas (PB) pills have been found to result in cognitive impairments across a range of neuropsychological tests. Our research team has been following cohorts of women who were deployed to the GW and correlated exposures with neuropsychological outcomes. Overall, in small cohorts of women veterans we found that higher levels of exposures to pesticide sprays and creams and CBW are correlated with short-term memory, mood, and motor deficits. These findings were different from those of their male counterparts. In a recently developed data-repository we have compiled larger groups of women veterans to validate our prior findings.
Participants and Methods:The current study is an analysis of data from a national bio/data-repository (Boston Biorepository Recruitment and Integrative Network for Gulf War Illness; BBRAIN) which includes key data samples from prior GW studies that have been merged and combined into retrospective datasets. Data include general health and chronic symptom questionnaires, demographics, deployment and self-reported exposure histories (separated into no exposure, fewer than 7 days exposure and greater than or equal to 7 days exposure), as well as key neuropsychological test variables. Three separate datasets were combined to include 62 women. Exposures to chemical alarms, oil well fires, pesticide cream or spray, pesticide fogging, and PB pills were self-reported. Linear regression models were produced for each continuous cognitive outcome, modeled on a given exposure, and controlling for age, education level, PTSD, and other exposures.
Results:Of the 62 women, the majority were White (77%). 74% of women surveyed were employed and 55% were married. 63% of women had at least a high school education. Deployed women who had > 7 days of exposure to pesticide sprays, CBW, smoke from oil well fires, and PB pills were more likely to show deficits in the areas of verbal learning and short-term memory (p < .03) and those with exposure to CBW, smoke from oil well fires, pesticides creams and PB pills had more errors on a test of executive functioning (p < .01). These data differ from the findings from cohorts of men.
Conclusions:These data validate the findings of our prior studies and add credence to the need for separate analyses for men and women. The unique outcomes may lead to individualized treatments for women veterans that may also help women with similar exposures from other deployments in addition to women with occupational exposures.
51 Optimizing the Mapping out of Neurocognitive Functioning in Glioblastomas in the Era of Intraoperative Mapping in Surgical Resection
- Nora Grace Z Turok, Maxine Krengel, Stephen Correia, Irene Piryatinksy
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 460-461
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Glioblastomas, Grade 4 astrocytomas, comprise about 60% of all astrocytomas and have a median survival rate between 14 and 16 months. The extent of resection impacts the prognosis, with an eloquent balance of preserving the patient's functional status. As preoperative imaging and intraoperative techniques improve to maximize safe operative resection, thorough neuropsychological evaluation can aid in assessing cognitive decline and quality of life pre- and post-treatment. In light of the tumors' progressive nature and potential presence in precarious brain locations, it is imperative that the functional burden of the various presentations of glioblastomas be understood. Given the limited data on cognitive presentations of glioblastomas, we present a case study describing a neuropsychological and neuroradiologic profile of a Grade 4 astrocytoma in a patient with a left temporal glioblastoma.
Participants and Methods:The patient signed consent for clinical evaluation and research. At the time of evaluation, he was 68 years old with a master's degree and was working at multiple start-up companies. He began noticing subtle cognitive functioning changes approximately two months prior with difficulty understanding information. His challenges progressed to difficulty composing emails, word-finding issues, and some slurring and mispronunciations. He was diagnosed with a brain tumor after an emergency MRI was performed. He participated in a neuropsychological evaluation just prior to surgery. The evaluation included a battery of neuropsychological tests examining attention, processing speed, executive functioning, learning and memory, language functioning, visuospatial functioning, motor functioning, and mood.
Results:The imaging results revealed a non-enhancing intra-axial mass in the left superior temporal lobe with surrounding edema. Also noted were rare scattered nonspecific T2 hyperintensities. The scores showed variable motor functioning and deficits within attention for complex information, executive functioning abilities (i.e., motor planning and sequencing, phonemic fluency), language functioning, visuospatial functioning, and learning and memory of information relative to his premorbid level of functioning, indicating total brain involvement consistent with imaging findings of edema.
Conclusions:Taken together, the results of the evaluation and imaging were suggestive of a level of cognitive decline that is more than expected with normal aging. Moreover, there was a lack of evidence representative of a lateralized profile. Notably, the evaluation was conducted before resection surgery, and therefore, the patient continued to experience significant brain edema due to the tumor. Although medication may have contributed to dysfunction, particularly with motor and cognitive slowing, it is not likely that it explained his presentation entirely. As such, the evaluation results were suggestive of neurocognitive dysfunction, which was partially attributable to the tumor and edema displacing neuronal tissue. Given the potential for improvement following tumor resection and secondary decline resulting from recurrence or treatment, it is crucial to have a baseline and the ability to map out higher order functioning, including frontal and temporal lobe functioning. Ultimately, as the field continues to look toward long-term survival for patients with currently lethal brain tumors, the goal is to achieve maximum resection with minimal neurocognitive loss.
22 Neuropsychological Outcomes Vary by Sex in Neurotoxicant Exposed Veterans with Gulf War Illness
- Dylan Keating, Jenna Groh, Maxine Krengel, Rosemary Toomey, Linda Chao, Emily Quinn, Julianne Dugas, Kimberly Sullivan
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 812-813
-
- Article
-
- You have access Access
- Export citation
-
Objective:
More than 30 years after the 199091 Gulf War (GW), approximately 200,000 veterans are still suffering from Gulf War Illness (GWI). Veterans who have this multi-symptom disorder experience impaired cognition, chronic pain, sustained fatigue, and gastrointestinal issues. GWI is believed to be associated with neurotoxicant exposures during the war. Prior research has shown cognitive deficits in combined samples of male and female GW veterans with GWI. These studies have shown that veterans with GWI have cognitive decrements in memory, learning and sustained attention. Studies have yet to compare neuropsychological outcomes by sex. This is mainly due to the lack of collected data on women GW veterans in the past. This study aims to analyze neuropsychological differences in males compared with female veterans with GWI and in those with neurotoxicant exposures from the Boston, Biorepository and Integrative Network (BBRAIN) for GWI repository dataset.
Participants and Methods:The total sample included 297 veterans with GWI (women n=50, men n=247) who were deployed to the 1990-91 Gulf War with an average age of 52 years. GWI case status was defined by the Kansas GWI criteria. Neuropsychological data including the Conners Continuous Performance Test Third Edition (CPT3), Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Test, and the California Verbal Learning Test (CVLT-II) were combined from the BBRAIN repository datasets. War-related exposures, including chemical weapons, anti-nerve gas pills and pesticides were measured by a self-reported survey. Multiple linear regression was used to analyze the association between sex, war-related exposures, and neuropsychological test score outcomes.
Results:After adjusting for age, education level and PTSD, men had a significantly lower number of words correct in the CVLT-II learning Trials 1-5, short delay recall and long delay recall compared with women veterans (p<0.05). The two groups also differed significantly in CPT3 commission scores, and total time on the D-KEFs Color-Word Inference total times in Trials 1 and 2 with men performing worse (p<0.05). Reported exposure to chemical weapons, pesticides, pyridostigmine bromide (PB) anti-nerve gas pills or smoke from oil well fires were all significantly associated with fewer words correctly recalled on all learning trials of the CVLT-II, long delay, and short delay to a greater degree in men as compared to women (p<0.05). Reported exposure to chemical weapons or smoke from oil well fires were significantly associated with more commission errors on CPT3 in men with GWI (p<0.05). Chemical alarms, smoke from oil well fires and PB were associated with slower response time on the Color-Word Interference test Trial 1 in men compared with women veterans.
Conclusions:In this study, men with GWI demonstrated significantly poorer performance in verbal memory, learning, response speed and attention. Male veterans reporting neurotoxicant exposures during the war also showed worse learning and verbal memory, impulsivity and response speed decrements compared to exposed women veterans. Future research should consider men and women separately when examining outcomes from war-related exposures.
25 Longitudinal Decline in Memory in 1991 Gulf War Veterans: Where you Start Matters.
- Leah A Orlinsky, Kathryn A Price, Clara G Zundel, Kimberly Sullivan, Maxine H Krengel
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 815-816
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Memory complaints have been a concern of Gulf War (GW) veterans since their return from the war in 1991, and over time it has been reported that exposures to neurotoxicants during the war have been associated with memory decline from premorbid levels. However, many of the studies that have shown slight or no memory decrements only looked at one time point and have not followed participants to document trajectory of symptoms over time. Longitudinal design is an optimal way to document change in cognitive function over time and the Fort Devens cohort (FDC), the longest running cohort of GW veterans, is ideal for assessing such change. This prospectively designed non-treatment seeking cohort were assessed at multiple timepoints with neuropsychological assessments and surveys. Initial neuropsychological assessments from 1997 showed above average scores on tests of verbal memory (California Verbal Learning Test) and average nonverbal memory (Wechsler Memory Scale-R) performances. A follow-up study of neuropsychological testing was completed between 2019-2022. This study was designed to document change in cognitive status between the two time points.
Participants and Methods:Participants (N=50) from the original 1991 cohort were again tested from 2019-2022. Neuropsychological tests included California Verbal Learning Test-Second edition (CVLT2) for verbal learning, and the visual reproduction subtest from the Wechsler Memory Scale-Revised (WMS-R) for nonverbal learning and memory. For both time points, the average scores of the participants were compared with age scaled scores for each neuropsychological test.
Results:The mean age of our current participants was 58 years. 72% were men. Relative to standardized test norms at the first time point, the scores for total learning from trials 1 through 5 from the CVLT2 were in the above average range relative to age and gender-based norms. During the second time point, the participants average scores on the same scale had dropped to the average range, one full standard deviation below their prior performances. In addition, at the first time point, total learning from visual reproductions was in the average range and dropped to the low average range for the second time point. This value dropped by one-half a standard deviation.
Conclusions:Results showed significant diminishment in verbal and visual memory relative to prior test performances. Whenever possible, documenting the trajectory of symptoms relative to where each participant started on neuropsychological functional outcomes is key to understanding the longitudinal impact of neurotoxicant and other war-related exposures in military veterans. Given this decline, further assessment of GW veterans’ cognitive trajectories is warranted.
92 Teleneuropsychological Evaluation of Bariatric Surgery Candidates: Cognitive Profiles and Recommendations for Future Practice
- Madeline Uretsky, Hayden Ferguson, Serena Mainiero, Irene Piryatinsky, Maxine Krengel
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 494-495
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Vascular complications, including elevated body mass index (BMI), are known risk factors for cognitive impairment. Obtaining a cognitive baseline is commonplace in pre-surgical protocols, including for Parkinson’s disease and epilepsy. Currently, routine evaluations for bariatric surgery candidates do not include neuropsychological assessment. This setting provides a unique opportunity to identify cognitive profiles of younger individuals at risk for cognitive impairment. Here, we argue for the standard implementation of a brief, online cognitive battery via telemedicine, to enhance existing protocols of bariatric pre-surgical evaluations.
Participants and Methods:Nineteen bariatric surgery candidates were referred to a private neuropsychological assessment practice for pre-surgical cognitive/psychological evaluation. Assessments were conducted by a neuropsychologist and a psychology graduate student, via remote video conferencing, between April 2020 and June 2022. Candidates completed a clinical interview, intake form, and the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A), and were administered a battery of cognitive measures: Wechsler Test of Adult Reading (WTAR), Hopkins Verbal Learning Test-Revised (HVLT-R); and select subtests from the TestMyBrain Digital Neuropsychology Toolkit: Trail Making Tests A and B (TMT-A/B), Matrix Reasoning (MR), Digit Span Forward and Backward (DSF, DSB), Gradual Onset Continuous Performance Test (CPT), and Simple and Choice Reaction Time (SRT, CRT). Descriptive statistics were conducted to analyze sample demographics. Raw scores on cognitive measures were converted to z-scores and averaged across the sample.
Results:The average age at evaluation was 38.2 (9.6) years and average pre-surgical BMI was 46.6k/m2 (9.3), indicating morbid obesity (BMI>40k/ m2). Ten (52.6%) candidates identified as female, 10 (52.6%) identified as White, 8 (42.1%) had 12 years of education or less, 4 (21.1%) were unemployed, and 9 (47.4%) had comorbid psychiatric diagnoses. BRIEF-A sub-scales were within the average range (T’s= 47.9 - 52.9, SD’s [10.1 - 12.8]). Estimated premorbid IQ was average at 102.7 (11.4). Neuropsychological data revealed group performance within the average range on DSF and DSB (z’s= 0.00), TMT-A (z= -0.16), MR (z= -0.53), CPT (z= -0.39), and HVLT-R False Positives (z= 0.05) and Recognition Discriminability (z= -0.44). SRT (z= -0.70), CRT Accuracy (z= -1.37), TMT-B (z= -0.79), HVLT-R Total Recall and Percent Retained (z’s= -0.88), and Delayed Recall and True Positives (z’s= -1.27) were low average.
Conclusions:In this sample of pre-surgical bariatric candidates with average intelligence, baseline evaluations revealed mild deficits in reaction time accuracy, visual motoric set-shifting, and verbal learning/memory. These deficits may be the result of microvascular changes in the brain secondary to physical compromise. Results provide additional insight into potential early-onset executive dysfunction, psychomotor slowing, and verbal learning/memory difficulties. In addition to these relative areas of neuropsychological weakness, candidates demonstrated relative strengths in attention, working memory, and visuospatial functioning. These insights provide pre-surgical evaluators with additional information to tailor recommendations and treatment approaches that foster surgical success. With a remote, concise, easy-to-administer battery of tests, routine neuropsychological assessment for bariatric surgery candidates is both a feasible and a useful tool for identifying areas of cognitive strengths and weaknesses. Documenting a patients’ cognitive baseline can assist with monitoring long-term vascular risk-factors and potential cognitive impairment.
24 Longitudinal Neuropsychological Functioning in Gulf War Veterans Exposed to Neurotoxicants and War-Related Trauma
- Kathryn A Price, Leah A Orlinsky, Clara G Zundel, Kimberly Sullivan, Maxine H Krengel
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 814-815
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Gulf War (GW) veterans were exposed to many neurotoxicants during the 1990-1991 Gulf War. Neurotoxicants included: chemical warfare such as sarin nerve gas, combustion byproducts from oil well fires and diesel fuels from tent heaters, pesticides, and prophylactic anti- nerve gas pyridostigmine bromide pills (PB); all of which have been associated with both cognitive and mood concerns. There are few longitudinal studies that have examined cognitive functioning regarding these toxicant exposures. In our longitudinal Fort Devens cohort, we found decrements over time in the area of verbal learning and memory but no differences in measures of nonverbal memory and executive function. To describe changes more accurately over time in this GW veteran cohort, we examined cognitive functioning in those with probable Post-Traumatic Stress Disorder (PTSD) versus those without.
Participants and Methods:The FDC is the longest running cohort of GW veterans with initial baseline cognitive, mood, exposure and trauma assessments in 1997-1998 and follow-up evaluations in 2019-2022. FDC veterans (N=48) who completed both time points were the participants for this study. Veterans were categorized into dichotomous (yes/no) groups of PTSD classification. The PTSD checklist (PCL) was used to determine PTSD case status. Symptom ratings on the PCL were summed (range:17-85) and a cutoff score of 36 or higher was utilized to indicate probable PTSD. Neuropsychological measures of mood (POMS) and memory (Visual Reproductions from the Weschler Memory Scale-R; California Verbal Learning Test Second Edition; CVLT2) and executive function and language; (Delis-Kaplan Executive Function System- Color Word and Verbal fluency- Animals) were compared overtime using Paired T-tests.
Results:The study sample (N=48) was 92% male and 96% reported active-duty status at the time of the GW. Mean current age was 58 years. All veterans reported exposure to at least one war-related toxicant. 48% met criteria for probable PTSD (N = 23) while 52% did not (n=25). No differences between groups were found in any of the POMS subscales, nor were differences seen in verbal memory, executive function, or language tasks. There were, however, significant differences in nonverbal memory in those with probable PTSD showing fewer details recalled during delay on the WMS-R Visual Reproductions (p<0.05).
Conclusions:In this longitudinal analysis, GW veterans with PTSD showed declines in nonverbal memory and consistent levels of function in all other tasks. Basic mood scales did not show decline; therefore, these results are not due to generalized changes in mood. All participants reported at least one neurotoxicant exposure and we did not have the power to examine the impact of the individual exposures, thus we cannot rule any contributing factors other than PTSD. This study highlights the importance of longitudinal follow up and continual documentation of GW veterans’ memory performance and their endorsement of mood symptoms overtime. Specifically, these findings reveal that future studies should examine the prolonged course of memory and mood symptomatology in GW veterans who have endorsed a traumatic experience.
21 Toxic Wounds are Associated with Cognitive Decrements in Women Veterans of the 1991 Gulf War
- Dylan Keating, Jenna Groh, Maxine Krengel, Rosemary Toomey, Linda Chao, Emily Quinn, Julianne Dugas, Kimberly Sullivan
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 811-812
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Gulf War Illness (GWI) is a debilitating multi-symptom condition that affects nearly a third of 1990-91 Gulf War (GW) veterans. Symptoms include chronic pain, debilitating fatigue, gastrointestinal issues, and cognitive decrements. Prior studies have documented reduced cognitive functioning in this affected population, particularly in the areas of memory, attention and response inhibition. To date, research has focused on cognitive functioning in male and female veterans together. Very limited research has reported on GW women's cognitive functioning separately mostly due to scarcity of data on women veterans. In this study, we had the unique opportunity to utilize a newly combined neuropsychological test dataset from women GW veterans in the Boston, Biorepository and Integrative Network (BBRAIN) for GWI. The aim was to compare neuropsychological outcomes with toxicant exposures in women veterans with and without GWI.
Participants and Methods:Cognitive data from the BBRAIN biorepository was used for this study. The sample consisted of 62 women veterans who were deployed to the Persian Gulf War from 1990-91. Neuropsychological test scores included the Conners Continuous Performance Test Third Edition (CPT3), Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference, and the California Verbal Learning Test Second Edition (CVLT-II). War-related exposure to chemical weapons, anti-nerve gas pills and pesticides were measured by a self-reported survey. For analysis, war-related exposure was classified into three groups: controls with 0-6 days of exposure; cases with 0-6 days of exposure and cases with 7 or more days of exposure. Multiple linear regression modeling was used to measure differences in neuropsychological scores across the three groups by each war-related exposure.
Results:After adjusting for age, education and other exposures, an increase in duration of exposure to pesticides was significantly associated with worse CPT3 commission errors, fewer words correct in the CVLT-II trials 1-5, and an increase in self-corrected errors on DKEFS Color-Word Interference Test Trials 1, 2 and 4 (p<0.05). More days reported hearing chemical alarms and seeing smoke from oil well fires was significantly associated with fewer words correct on all CVLT-II trials, and more self-corrected errors on Color-Word Interference Trials 2 and 4 (p<0.05). An increase in exposure duration to pyridostigmine bromide anti-nerve gas pills was associated with fewer words correct on the CVLT-II learning Trials 1-5 and short delay recall and an increase in self-corrected errors on Color-Word Interference Trials 2, 3, and 4 (p<0.05). When associations were adjusted for PTSD, all significant associations stayed constant (p<0.05).
Conclusions:In this study, women veterans with GWI who had higher levels of exposure to pesticides, oil well fires and who took more antinerve gas pills during the war are showing increased learning difficulties and more deficits in attention and response inhibition. Future research should examine if similar patterns of neuropsychological symptoms are also present in male GW veterans with higher war-time related toxicant exposures.
16 Longitudinal Cognitive Functioning in Gulf War veterans with and without Gulf War Illness: Data Mining from the BBRAIN Repository
- Jenna R Groh, Dylan Keating, Rabindra Kadel, Julianne N Douglas, Emily Quinn, Maxine Krengel, Kimberly Sullivan
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 807-808
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Veterans from the 1991 Gulf War (GW) experienced several neurotoxicant exposures, including chemical weapons, pesticide sprays and creams, oil well fires and pyridostigmine bromide anti-nerve gas pills during the war. Research has shown these exposures to affect cognition and mood. Moreover, MR diffusion imaging has shown microstructural changes in the white matter that may be related to psychomotor slowing. Over a third of all GW veterans suffer from a chronic multi-symptom disorder called Gulf War Illness (GWI). The Kansas Criteria for GWI consists of six distinct criteria including symptoms of fatigue/sleep problems, pain symptoms, neurologic/cognitive/mood symptoms, gastrointestinal symptoms, respiratory symptoms, and skin symptoms. The Boston Gulf War Illness Consortium (GWIC) was a multi-site study designed to assess symptoms of GWI. After the conclusion of the GWIC study, the Boston Biorepository Recruitment and Integrative Network for Gulf War Illness (BBRAIN) was developed to harmonize retrospectively collected GW Veteran data while simultaneously collecting Time 2 data and samples from GW veterans who participated in the original study. This analysis includes the first 58 participants who have completed the GWIC study and the BBRAIN study.
Participants and Methods:We conducted a longitudinal analysis of cognitive outcomes from the BBRAIN data repository. Verbal learning, memory, attention, and executive functioning were assessed using neuropsychological tests including the Continuous Performance Test (CPT3), Trail Making Test A, Delis-Kaplan Executive Function System (DKEFS), California Verbal Learning Test (CVLT-II). A total of 58 participants were re-evaluated from the original GWIC cohort with a total of 47 cases and 11 controls. Paired t-tests for the cognitive measures were completed separately for GWI cases and healthy GW veteran controls for each of the neuropsychological test measures. Average time between assessments was four years.
Results:The overall sample was on average 56 years old, 84% male and 75% White. The average level of education was 15 years. GWI cases showed significantly more commission errors and slower reaction times on the CPT3 at Time 2 compared to Time 1 (p < 0.05). Cases also showed a slowing in time to completion on Trails A at the second time point (p<0.05). On the other hand, controls only showed significantly slower reaction times on the CPT3 at Time 2 (p<0.05).
Conclusions:These results showed that veterans with GWI are showing more decline over time in cognitive functioning particularly on psychomotor slowing and impulsivity than control veterans. It is important to document illness trajectories for veterans with GWI in order to devise strategies for interventions and treatments. The importance of studying longitudinal cohorts is to document changes in the same individuals over time. The next steps are to assess if this accelerated aging develops into neurodegenerative conditions by using brain imaging and other biomarkers in addition to cognitive evaluations. This could identify individuals who should be the focus of targeted treatment strategies while there is still time to intervene.
Interrater reliability of neuropsychological diagnoses: A Department of Veterans Affairs cooperative study
- ROBERTA F. WHITE, KENNETH E. JAMES, JENNIFER J. VASTERLING, KAREN MARANS, RICHARD DELANEY, MAXINE KRENGEL, FREDRIC ROSE
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 8 / Issue 4 / May 2002
- Published online by Cambridge University Press:
- 18 May 2002, pp. 555-565
-
- Article
- Export citation
-
This study examined the interrater reliability of neuropsychological diagnoses produced by clinical neuropsychologists across 4 medical centers. These diagnoses were based on evaluations using a comprehensive battery of commonly used neuropsychological test instruments, interview, history and medical chart review. The diagnoses of individual neuropsychologists were compared to those made by members of an external review panel for each patient evaluated. Patients were first diagnosed as showing cognitive impairment versus no cognitive impairment. If a patient was diagnosed as impaired, a specific neuropsychological diagnosis was assigned. The diagnostic classification for cognitive impairment was moderately reliable [κ = .48 ± s.e.(κ) = .062]. The interrater reliability for specific diagnoses was in the fair to good range [κ = .44 ± s.e.(κ) = .029]. These levels of reliability are comparable to those found for other psychiatric and neurologic specialties and for medical diagnoses made by other health care disciplines. (JINS, 2002, 8, 555–565.)