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The Cambridge Handbook of Emerging Issues at the Intersection of Commercial Law and Technology
- Edited by Stacy-Ann Elvy, Nancy S. Kim
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- December 2024
- Print publication:
- 31 December 2024
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Characteristics of healthcare personnel with SARS-CoV-2 infection: 10 emerging infections program sites in the United States, April 2020–December 2021
- Nora Chea, Taniece Eure, Rebecca Alkis Ramirez, Maria Zlotorzynska, Gregory T. Blazek, Joelle Nadle, Jane Lee, Christopher A. Czaja, Helen Johnston, Devra Barter, Melissa Kellogg, Catherine Emanuel, James Meek, Monica Brackney, Stacy Carswell, Stepy Thomas, Scott K. Fridkin, Lucy E. Wilson, Rebecca Perlmutter, Kaytlynn Marceaux-Galli, Ashley Fell, Sara Lovett, Sarah Lim, Ruth Lynfield, Sarah Shrum Davis, Erin C. Phipps, Marla Sievers, Ghinwa Dumyati, Christopher Myers, Christine Hurley, Erin Licherdell, Rebecca Pierce, Valerie L. S. Ocampo, Eric W. Hall, Christopher Wilson, Cullen Adre, Erika Kirtz, Tiffanie M. Markus, Kathryn Billings, Ian D Plumb, Glen R. Abedi, Jade James-Gist, Shelley S. Magill, Cheri T. Grigg
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- Infection Control & Hospital Epidemiology , First View
- Published online by Cambridge University Press:
- 21 May 2024, pp. 1-9
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Background:
Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021.
Methods:CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively.
Results:Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles.
Conclusions:To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants.
Social determinants of health correlations and resource usefulness at a Milwaukee free clinic for uninsured individuals: A cross-sectional study
- Jessica Miller, Adrianna Doucas, Hamsitha Karra, Suma K. Thareja, Owen Bowie, Xiaowei Dong, Jennifer Terrell, Samuel Hernandez, Ana Mia Corujo-Ramirez, Nicole Xia, Sabrina Qi, Chiang-Ching Huang, Rebecca Lundh, Staci A. Young
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- Journal:
- Journal of Clinical and Translational Science / Volume 8 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 25 March 2024, e71
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Introduction:
Addressing social determinants of health (SDOH) is fundamental to improving health outcomes. At a student-run free clinic, we developed a screening process to understand the SDOH needs and resource utilization of Milwaukee’s uninsured population.
Methods:In this cross-sectional study, we screened adult patients without health insurance (N = 238) for nine traditional SDOH needs as well as their access to dental and mental health care between October 2021 and October 2022. Patients were surveyed at intervals greater than or equal to 30 days. We assessed correlations between SDOH needs and trends in patient-reported resource usefulness.
Results:Access to dental care (64.7%) and health insurance (51.3%) were the most frequently endorsed needs. We found significant correlations (P ≤ 0.05) between various SDOH needs. Notably, mental health access needs significantly correlated with dental (r = 0.41; 95% CI = 0.19, 0.63), medications (r = 0.51; 95% CI = 0.30, 0.72), utilities (r = 0.39; 95% CI = 0.17, 0.61), and food insecurity (r = 0.42; 95% CI = 0.19, 0.64). Food-housing (r = 0.55; 95% CI = 0.32, 0.78), housing-medications (r = 0.58; 95% CI = 0.35, 0.81), and medications-food (r = 0.53; 95% CI = 0.32, 0.74) were significantly correlated with each other. Longitudinal assessment of patient-reported usefulness informed changes in the resources offered.
Conclusions:Understanding prominent SDOH needs can inform resource offerings and interventions, addressing root causes that burden under-resourced patients. In this study, patient-reported data about resource usefulness prompted the curation of new resources and volunteer roles. This proof-of-concept study shows how longitudinally tracking SDOH needs at low-resource clinics can inform psychosocial resources.
Effects of residential acaricide treatments on patterns of pathogen coinfection in blacklegged ticks
- Richard S. Ostfeld, Sahar Adish, Stacy Mowry, William Bremer, Shannon Duerr, Andrew S. Evans, Jr, Ilya R. Fischhoff, Fiona Keating, Jennifer Pendleton, Ashley Pfister, Marissa Teator, Felicia Keesing
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- Parasitology , First View
- Published online by Cambridge University Press:
- 18 March 2024, pp. 1-7
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Medically important ixodid ticks often carry multiple pathogens, with individual ticks frequently coinfected and capable of transmitting multiple infections to hosts, including humans. Acquisition of multiple zoonotic pathogens by immature blacklegged ticks (Ixodes scapularis) is facilitated when they feed on small mammals, which are the most competent reservoir hosts for Anaplasma phagocytophilum (which causes anaplasmosis in humans), Babesia microti (babesiosis) and Borrelia burgdorferi (Lyme disease). Here, we used data from a large-scale, long-term experiment to ask whether patterns of single and multiple infections in questing nymphal I. scapularis ticks from residential neighbourhoods differed from those predicted by independent assortment of pathogens, and whether patterns of coinfection were affected by residential application of commercial acaricidal products. Quantitative polymerase chain reaction was used for pathogen detection in multiplex reactions. In control neighbourhoods and those treated with a fungus-based biopesticide deployed against host-seeking ticks (Met52), ticks having only single infections of either B. microti or B. burgdorferi were significantly less common than expected, whereas coinfections with these 2 pathogens were significantly more common. However, use of tick control system bait boxes, which kill ticks attempting to feed on small mammals, eliminated the bias towards coinfection. Although aimed at reducing the abundance of host-seeking ticks, control methods directed at ticks attached to small mammals may influence human exposure to coinfected ticks and the probability of exposure to multiple tick-borne infections.
Neuropsychological correlates of early grief in bereaved older adults
- Brianna M. Hoffmann, Nutta-on P. Blair, Timothy L. McAuliffe, Gyujoon Hwang, Eric Larson, Stacy A. Claesges, Abigail Webber, Charles F. Reynolds III, Joseph S. Goveas
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- International Psychogeriatrics , First View
- Published online by Cambridge University Press:
- 11 March 2024, pp. 1-6
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Prolonged grief disorder (PGD) is associated with impairments in cognitive functioning, but the neuropsychological correlates of early grief in older adults are poorly understood. This preliminary study cross-sectionally examined neuropsychological functioning in bereaved adults with high and low grief symptoms and a non-bereaved comparison sample and further explored the relationship between multidomain cognitive measures and grief severity. A total of ninety-three nondemented older adults (high grief: n = 44; low grief: n = 49) within 12 months post-bereavement and non-bereaved comparison participants (n = 43) completed neuropsychological battery including global and multiple domain-specific cognitive functioning. Linear regression models were used to analyze differences in multidomain cognitive measures between the groups and specifically examine the associations between cognitive performance and grief severity in the bereaved, after covariate adjustment, including depressive symptoms. Bereaved older adults with higher grief symptoms performed worse than those with lower symptoms and non-bereaved participants on executive functioning and attention and processing speed measures. In the bereaved, poorer executive functioning, attention and processing speed correlated with higher grief severity. Attention/processing speed–grief severity correlation was seen in those with time since loss ≤ 6 months, but not > 6 months. Intense early grief is characterised by poorer executive functioning, attention, and processing speed, resembling findings in PGD. The putative role of poorer cognitive functioning during early grief on the transition to integrated grief or the development of PGD remains to be elucidated.
Towards a Non-Use Regime on Solar Geoengineering: Lessons from International Law and Governance
- Aarti Gupta, Frank Biermann, Ellinore van Driel, Nadia Bernaz, Dhanasree Jayaram, Rakhyun E. Kim, Louis J. Kotzé, Dana Ruddigkeit, Stacy D. VanDeveer, Margaretha Wewerinke-Singh
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- Journal:
- Transnational Environmental Law , First View
- Published online by Cambridge University Press:
- 27 February 2024, pp. 1-32
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In recent years, some scientists have called for research into and potential development of ‘solar geoengineering’ technologies as an option to counter global warming. Solar geoengineering refers to a set of speculative techniques to reflect some incoming sunlight back into space, for example, by continuously spraying reflective sulphur aerosols into the stratosphere over several generations. Because of the significant ecological, social, and political risks posed by such technologies, many scholars and civil society organizations have urged governments to take action to prohibit the development and deployment of solar geoengineering techniques. In this article we take such calls for a prohibitory or a non-use regime on solar geoengineering as a starting point to examine existing international law and governance precedents that could guide the development of such a regime. The precedents we examine include international prohibitory and restrictive regimes that impose bans or restrictions on chemical weapons, biological weapons, weather modification technologies, anti-personnel landmines, substances that deplete the ozone layer, trade in hazardous wastes, deep seabed mining, and mining in Antarctica. We also assess emerging norms and soft law in anticipatory governance of novel technologies, such as human cloning and gene editing. While there is no blueprint for a solar geoengineering non-use regime in international law, our analysis points to numerous specific elements on which governments could draw to constrain or impose an outright prohibition on the development of technologies for solar geoengineering, should they opt to do so.
Pre-COVID respiratory sinus arrhythmia moderates associations between COVID-19 stress and child externalizing behaviors: Testing neurobiological stress theories
- Hilary Skov, Erin B. Glackin, Stacy S. Drury, Jeffrey Lockman, Sarah A. O. Gray
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- Development and Psychopathology , First View
- Published online by Cambridge University Press:
- 26 January 2024, pp. 1-12
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Exposure to stress related to the COVID-19 pandemic contributes to psychopathology risk, yet not all children are negatively impacted. The current study examined a parasympathetic biomarker of stress sensitivity, respiratory sinus arrhythmia (RSA), as a moderator of the effects of exposure to pandemic stress on child internalizing and externalizing behaviors in a sample of children experiencing economic marginalization. Three to five years pre-pandemic, when children were preschool-aged, RSA during baseline and a challenging parent-child interaction were collected. Mid-pandemic, between November 2020 and March 2021, children’s exposure to pandemic stress and internalizing and externalizing behaviors were collected. Results demonstrated that children who, pre-pandemic, demonstrated blunted parasympathetic reactivity (i.e., no change in RSA relative to baseline) during the dyadic challenge exhibited elevated risk for externalizing behaviors mid-pandemic. Further, this risk was greatest for children exposed to high and moderate levels of pandemic stress. Consistent with diathesis stress and polyvagal frameworks, these conditional effects suggest that blunted parasympathetic reactivity in response to stress in early childhood may escalate the development of externalizing behaviors following stress exposure at school age.
35 Preliminary reliability of the Coma Recovery Scale, Revised (CRS-R) in children with a history of disorders of consciousness after acquired brain injury
- Natasha N Ludwig, Stacy Suskauer, Beth Slomine
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 143
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Objective:
The Coma Recovery Scale-Revised (CRS-R) is the gold standard assessment of adults with disorders of consciousness (DoC); however few studies have examined the psychometric properties of the CRS-R in pediatric populations. This study aimed to demonstrate preliminary intra-rater and inter-rater reliability of the CRS-R in children with acquired brain injury (ABI).
Participants and Methods:Participants included 3 individuals (ages 10, 15, and 17 years) previously admitted to an inpatient pediatric neurorehabilitation unit with DoC after ABI who were followed in an outpatient brain injury clinic due to ongoing severe disability. ABI etiology included traumatic brain injury (TBI; n=2) and encephalitis (n=1). Study participation took place on average 4.6 years after injury (range 2-9). The Glasgow Outcome Scale-Extended, Pediatric Version (GOS-E Peds), a measure of outcome after pediatric brain injury, was administered as part of screening. Two participants were placed in the GOS-E Peds “lower severe disability” category (i.e., score of 6) and one was placed in the “upper severe disability” category (i.e., score of 5). The CRS-R includes 6 subscales measuring responsivity including Auditory (range 0-4), Visual (range 05), Motor (range 0-6), Oromotor/Verbal (range 03), Communication (range 0-2), and Arousal (range 0-3) with higher scores indicating higherlevel function. Subscales are totaled for a CRS-R Total score. Behaviors shown during the CRS-R are used to determine state of DoC [Vegetative State (VS), Minimally Conscious State (MCS) or emergence from a minimally conscious state (eMCS)] based on 2002 Aspen Guidelines. Participants were administered the CRS-R three consecutive times on the same day. Administrations were completed by two raters in this order: Rater 1 (1A), Rater 1 (1B) and Rater 2. Intra-rater reliability was deemed by percent agreement across the 6 subscales between Rater 1A and 1B. Inter-rater reliability was deemed by percent agreement across the 6 subscales between 1A and 2.
Results:Mean CRS-R Total score for Rater 1A was 22 (SD=1.73, range 20-23), Rater 1B was 22 (SD=1.73, range 20-23), and Rater 2 was 21.33 (SD=2.08, range 19-23). Intra-rater reliability was 100% and inter-rater reliability was 94% across all subscales. All participants were deemed eMCS at all 3 ratings.
Conclusions:Data from this very small sample of children suggests that the CRS-R demonstrates both intra-rater and inter-rater reliability in patients with a history of DoC after ABI. Given that all children were at the high end of the scale (eMCS), further research is needed with a larger sample of children with a range of states of DoC.
61 Network Segregation Predicts Processing Speed in the Cognitively Healthy Oldest-old
- Sara A Nolin, Mary E Faulkner, Paul Stewart, Leland Fleming, Stacy Merritt, Roxanne F Rezaei, Pradyumna K Bharadwaj, Mary Kathryn Franchetti, Daniel A Raichlen, Courtney J Jessup, Lloyd Edwards, G Alex Hishaw, Emily J Van Etten, Theodore P Trouard, David S Geldmacher, Virginia G Wadley, Noam Alperin, Eric C Porges, Adam J Woods, Ronald A Cohen, Bonnie E Levin, Tatjana Rundek, Gene E Alexander, Kristina M Visscher
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 367-368
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Objective:
Understanding the factors contributing to optimal cognitive function throughout the aging process is essential to better understand successful cognitive aging. Processing speed is an age sensitive cognitive domain that usually declines early in the aging process; however, this cognitive skill is essential for other cognitive tasks and everyday functioning. Evaluating brain network interactions in cognitively healthy older adults can help us understand how brain characteristics variations affect cognitive functioning. Functional connections among groups of brain areas give insight into the brain’s organization, and the cognitive effects of aging may relate to this large-scale organization. To follow-up on our prior work, we sought to replicate our findings regarding network segregation’s relationship with processing speed. In order to address possible influences of node location or network membership we replicated the analysis across 4 different node sets.
Participants and Methods:Data were acquired as part of a multi-center study of 85+ cognitively normal individuals, the McKnight Brain Aging Registry (MBAR). For this analysis, we included 146 community-dwelling, cognitively unimpaired older adults, ages 85-99, who had undergone structural and BOLD resting state MRI scans and a battery of neuropsychological tests. Exploratory factor analysis identified the processing speed factor of interest. We preprocessed BOLD scans using fmriprep, Ciftify, and XCPEngine algorithms. We used 4 different sets of connectivity-based parcellation: 1)MBAR data used to define nodes and Power (2011) atlas used to determine node network membership, 2) Younger adults data used to define nodes (Chan 2014) and Power (2011) atlas used to determine node network membership, 3) Older adults data from a different study (Han 2018) used to define nodes and Power (2011) atlas used to determine node network membership, and 4) MBAR data used to define nodes and MBAR data based community detection used to determine node network membership.
Segregation (balance of within-network and between-network connections) was measured within the association system and three wellcharacterized networks: Default Mode Network (DMN), Cingulo-Opercular Network (CON), and Fronto-Parietal Network (FPN). Correlation between processing speed and association system and networks was performed for all 4 node sets.
Results:We replicated prior work and found the segregation of both the cortical association system, the segregation of FPN and DMN had a consistent relationship with processing speed across all node sets (association system range of correlations: r=.294 to .342, FPN: r=.254 to .272, DMN: r=.263 to .273). Additionally, compared to parcellations created with older adults, the parcellation created based on younger individuals showed attenuated and less robust findings as those with older adults (association system r=.263, FPN r=.255, DMN r=.263).
Conclusions:This study shows that network segregation of the oldest-old brain is closely linked with processing speed and this relationship is replicable across different node sets created with varied datasets. This work adds to the growing body of knowledge about age-related dedifferentiation by demonstrating replicability and consistency of the finding that as essential cognitive skill, processing speed, is associated with differentiated functional networks even in very old individuals experiencing successful cognitive aging.
64 Comparison of Post-Concussion Symptom Network Structure at Baseline and Post-Concussion
- Christine Salva, Grace J Goodwin, Hana Kuwabara, Jessica Woodyatt, Julia E Maietta, Thomas Kinsora, Staci Ross, Daniel N Allen
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 169-170
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Objective:
Recent conceptualizations of concussion symptoms have begun to shift from a latent perspective (which suggests a common cause; i.e., head injury), to a network perspective (where symptoms influence and interact with each other throughout injury and recovery). Recent research has examined the network structure of the Post-Concussion Symptom Scale (PCSS) cross-sectionally at pre-and post-concussion, with the most important symptoms including dizziness, sadness, and feeling more emotional. However, within-subject comparisons between network structures at pre-and post-concussion have yet to be made. These analyses can provide invaluable information on whether concussion alters symptom interactions. This study examined within-athlete changes in PCSS network connectivity and centrality (the importance of different symptoms within the networks) from baseline to post-concussion.
Participants and Methods:Participants were selected from a larger longitudinal database of high school athletes who completed the PCSS in English as part of their standard athletic training protocol (N=1,561). The PCSS is a 22-item self-report measure of common concussion symptoms (i.e., headache, vomiting, dizziness, etc.) in which individuals rate symptom severity on a 7-point Likert scale. Participants were excluded if they endorsed history of brain surgery, neurodevelopmental disorder, or treatment history for epilepsy, migraines, psychiatric disorders, or alcohol/substance use. Network analysis was conducted on PCSS ratings from a baseline and acute post-concussion (within 72-hours post-injury) assessment. In each network, the nodes represented individual symptoms, and the edges connecting them their partial correlations. Estimations of the regularized partial correlation networks were completed using the Gaussian graphical model, and the GLASSO algorithm was used for regularization. Each symptom’s expected influence (the sum of its partial correlations with other symptoms) was calculated to identify the most central symptoms in each network. Recommended techniques from Epskamp et al. (2018) were completed for assessing the accuracy of the estimated symptom importance and relationships. Network Comparison Tests were conducted to observe changes in network connectivity, structure, and node influence.
Results:Both baseline and acute post-concussion networks contained negative and positive relationships. The expected influence of symptoms was stable in both networks, with difficulty concentrating having the greatest expected influence in both. The strongest edges in the networks were between symptoms within similar domains of functioning (e.g., sleeping less was associated with trouble falling asleep). Network connectivity was not significantly different between networks (S=0.43), suggesting the overall degree to which symptoms are related was not different at acute post-concussion. Network structure significantly differed at acute post-concussion (M=0.305), suggesting specific relationships in the acute post-concussion network were different than they were at baseline. In the acute post concussion network, vomiting was less central and sensitivity to noise and mentally foggy more central.
Conclusions:PCSS network structure at acute post-concussion is altered, suggesting concussion may disrupt symptom networks and certain symptoms’ associations with the experience of others after sustaining a concussive injury. Future research should compare PCSS networks later in recovery to examine if similar structural changes remain or return to baseline structure, with the potential that observing PCSS network structure changes post-concussion could inform symptom resolution trajectories.
74 Timed Motor Performance in Children Medically Cleared for Return to Activities Post Mild Traumatic Brain Injury
- Tyler A Busch, Adrian M Svingos, Hsuan-Wei Chen, Kayla Huntington, Nishta Amin, Beth S Slomine, Stacy J Suskauer
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 177-178
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Objective:
Children who sustain a mild traumatic brain injury (mTBI) are at increased odds of additive injury and continue to show altered motor performance relative to never-injured peers after being medically cleared (MC) to return to normal activities. There is a critical need to determine when children can return to activities without risk of short and long-term adverse effects, with research showing high reinjury rates for 3-12 months after RTP. The Physical and Neurological Examination for Subtle Signs (PANESS) measures subtle signs of motor impairment during gait, balance, and timed motor functions. Recent literature has demonstrated that PANESS timed motor function can distinguish between children medically cleared post-mTBI compared to never-injured controls. The present study examined performance on timed motor tasks in youth medically cleared from mTBI following medical clearance and 3-months later, compared to never-injured peers.
Participants and Methods:25 children (Mage=14.16, SD=2.46; Male=68%) were enrolled within 6 weeks of medical clearance from mTBI (Mdays post MC=33, SD=13.4, Range=2-59) along with 66 typically developing, never-injured controls (Mage=13.9, SD=2.22; Male=50%). Group differences were evaluated for the Timed Motor section of the PANESS at enrollment and at a 3-month follow-up (Mdays from enrollment to follow-up=95.90, SD=12.69, Range=62-129). This 3-month follow-up occurred on average 4 months after medical clearance (Mdays from MC to follow-up=130.08, SD=17.58, Range=92 - 164). The Timed Motor section includes Repetitive (foot tapping, hand patting, and finger tapping) and Sequential (heel-toe rocking, hand pronate/supinate, finger sequencing) raw time scores, measured in seconds. The Total Timed Motor Speed score is the combination of Repetitive and Sequential Movement and the side-to-side tongue item.
Results:At 3-month follow-up, mTBI participants (M=67.55, SD=8.26, Range=53.66-83.88) performed worse than controls (M=63.09, SD=10.23, Range=39.86-100.51) on Total Timed Motor Speed, t(89)= 1.95, p<0.05), including when controlling for age and sex, F(1, 87)=4.67, p<0.05. At the same time point, mTBI participants (M=36.54, SD=5.47, Range=28.74-49.17) performed worse on Sequential Speed than controls (M=32.93, SD=6.1, Range=21.49-56.76), t(89)=2.59, p<0.01, including when controlling for age and sex, F(1, 87)=7.687, p<0.01). Although groups performed similarly on Sequential Speed at the initial time point, mTBI participants exhibited a trend of less improvement from initial to follow-up (MmTBI=-1.69, Mcontrol=-3.68, t(90)=1.445, p=0.076).
Conclusions:Although groups did not significantly differ on Timed Motor Speed items at the initial time point, the mTBI group showed consistently lower scores than controls at both time points and less improvement over time. Results indicate that Total Timed Motor Speed, specifically Sequential Speed, may be a sensitive marker of persisting differences in high-level motor and cognitive learning/control in children who have been medically cleared after mTBI. More data are needed to evaluate these findings over a longer time period, and future studies should examine behavioral markers concurrently with physiologic brain recovery over time.
4 Initial Application of Constraint-Induced Cognitive Therapy to Long COVID Brain Fog
- Gitendra Uswatte, Edward Taub, Karlene Ball, Kristine Lokken, Shruti P Agnihotri, Victor W Mark, Amy Knight, Brandon Mitchell, Jason Blake, Staci McKay, Terika Miller, Elizabeth Pollard, Piper Hempfling, Morgan Smith, Rebekah Chatfield, Erin Stanley, Cliff Lynam, Kyli Blagburn, Brooke Carroll, Gary Cutter
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 598-599
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Objective:
Persistent brain fog is common in adults with Post-Acute Sequelae of SARS-CoV-2 infection (PASC), in whom it causes distress and in many cases interferes with performance of instrumental activities of daily living (IADL) and return-to-work. There are no interventions with rigorous evidence of efficacy for this new, often disabling condition. The purpose of this pilot is to evaluate the efficacy, on a preliminary basis, of a new intervention for this condition termed Constraint-Induced Cognitive therapy (CICT). CICT combines features of two established therapeutic approaches: cognitive speed of processing training (SOPT) developed by the laboratory of K. Ball and the Transfer Package and task-oriented training components of Constraint-Induced Movement therapy developed by the laboratory of E. Taub and G. Uswatte.
Participants and Methods:Participants were > 3 months after recovery from acute COVID symptoms and had substantial brain fog and impairment in IADL. Participants were randomized to CICT immediately or after a 3-month delay. CICT involved 36 hours of outpatient therapy distributed over 4-6 weeks. Sessions had three components: (a) videogamelike training designed to improve how quickly participants process sensory input (SOPT), (b) training on IADLs following shaping principles, and (c) a set of behavioral techniques designed to transfer gains from the treatment setting to daily life, i.e., the Transfer Package. The Transfer Package included (a) negotiating a behavioral contract with participants and one or more family members about the responsibilities of the participants, family members, and treatment team; (b) assigning homework during and after the treatment period; (c) monitoring participants’ out-of-session behavior; (d) supporting problem-solving by participants and family members about barriers to performance of IADL; and (e) making follow-up phone calls. IADL performance, brain fog severity, and cognitive impairment were assessed using validated, trans-diagnostic measures before and after treatment and three months afterwards in the immediate-CICT group and on parallel occasions in the delayed-CICT group (aka waitlist controls).
Results:To date, five were enrolled in the immediate-CICT group; four were enrolled in the wait-list group. All had mild cognitive impairment, except for one with moderate impairment in the immediate-CICT group. Immediate-CICT participants, on average, had large reductions in brain fog severity on the Mental Clutter Scale (MCS, range = 0 to 10 points, mean change = -3.7, SD = 2.0); wait-list participants had small increases (mean change = 1.0, SD = 1.4). Notably, all five in the immediate-CICT group had clinically meaningful improvements (i.e., changes > 2 points) in performance of IADL outside the treatment setting as measured by the Canadian Occupational Performance Measure (COPM) Performance scale; only one did in the wait-list group. The advantage for the immediate-CICT group was very large on both the MCS and COPM (d’s = 1.7, p’s < .05). In follow-up, immediate-CICT group gains were retained or built-upon.
Conclusions:These preliminary findings warrant confirmation by a large-scale randomized controlled trial. To date, CICT shows high promise as an efficacious therapy for brain fog due to PASC. CICT participants had large, meaningful improvements in IADL performance outside the treatment setting, in addition to large reductions in brain fog severity.
69 Verbal Comprehension and PTSD: A Glimpse into Trauma and Resilience
- Analisa Bublitz, Joshua Mastan, Isabella Grivois, Anne Nolty, Stacy Amano
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 273
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Objective:
Many of those who experience the trauma and abuse of sex trafficking also struggle with a variety of physical and mental health issues, a major one of those issues being posttraumatic stress disorder (PTSD). In this study, we explored the relationship between verbal comprehension and a PTSD diagnosis to see if this aspect of intelligence might be stronger for individuals without a diagnosis of PTSD.
Participants and Methods:Participants included 22 adolescent girls between the ages of 14 and 18 who had experienced sex trafficking. Participants were referred to Fuller Psychological and Family Services for learning difficulties, where they were given comprehensive clinical neuropsychological evaluations, including a Wechsler Intelligence Scale (WISC or WAIS) and a screening for PTSD. WISC or WAIS Full Scale IQ ranged from 75 to 115 (M = 85.1, SD = 11.2).
Results:Contrary to the hypothesis that those without PTSD would have higher verbal comprehension scores than those with PTSD, the results indicated no difference between the two groups, t(23) = -.86 , p = .40. However, verbal comprehension scores across both groups were significantly below the normal range, suggesting a relationship between trauma and verbal comprehension.
Conclusions:The diagnosis of PTSD may impact intelligence in ways not anticipated for this population, or perhaps our method of diagnosing PTSD did not adequately nuance the varying responses to trauma. By further exploring the relationships between Verbal Comprehension Indexes and markers of resilience, we may be able to better understand the characteristics of resilience demonstrated by those who become involved in prostitution.
57 Association Between Adverse Childhood Experiences on Depression and Anxiety in Adulthood: Examining the Role of Cognitive Flexibility
- Rosario Pintos Lobo, Alexandria G. Nuccio, Zachary T. Goodman, Stacy S. Merritt, Xiaoyan Sun, Katalina F. McInerney, Bonnie E. Levin
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 842-843
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Objective:
The association between adverse childhood experiences (ACEs) and adult depression and anxiety has been well described (Aafjes-van Doorn et al., 2020; Dolbier et al., 2021; Herzog & Schmahl, 2018). However, cognitive flexibility, as a potential moderating factor of this relationship, has been underreported (Kalia et al., 2021). We hypothesize that increased ACEs will be associated with increased symptoms of depression and anxiety, and cognitive flexibility will exhert a moderating role in this relationship.
Participants and Methods:Participants from the Evelyn F. McKnight University of Miami Frailty Registry were included in the study. 224 adults (Mage= 66.30, SD = 11.63; 59.4% female; 62.1% Hispanic/Latinx) without primary neurological disorders were recruited from University of Miami clinics and community centers. Participants completed a demographic questionnaire and neuropsychological evaluation including the Adverse Childhood Experiences inventory, Beck Depression Inventory, Beck Anxiety Inventory, and the Wisconsin Card Sorting Test (WCST). Current data were initially analyzed using descriptive statistics and correlations among variables. A series of hierarchical multiple linear regressions (HLR) were conducted to examine the effect that age has on cognitive flexibility (measured by number of perseverative errors on the WCST), as well as the association between number of ACEs endorsed on symptoms of depression and anxiety in late life.
Results:Correlation analyses revealed a negative correlation between total ACE score and cognitive flexibility (r=-.16, p=0.03); a positive correlation between age and cognitive flexibility (r=0.19, p=0.01); and positive relationships between ACE score and both BDI (r=0.35, p<0.001) and BAI (r=0.28, p<0.001) scores. Correlations further revealed a negative correlation between cognitive flexibility and both BDI (r=-0.18, p=0.014) and BAI (r=-0.14, p=0.048) scores. A series of hierarchical multiple linear regressions revealed that total number of ACEs had a statistically significant effect on both depression (f=7.24, p<.001, ΔR2=0.072) and anxiety (f=4.57, p<.001, ΔR2=0.044) symptoms, in models adjusted for demographic correlates (i.e., age, sex, race, ethnicity). While the overall moderation model examining the effect of cognitive flexibility on the relationship between ACEs and psychopathology was significant (f=6.04, p<.001, ΔR2=0.191), the interaction was not significant (p=.4199). However, HLRs further revealed a statistically significant effect of age on cognitive flexibility (f=6.77, p=0.01, ΔR2=0.034).
Conclusions:Current findings support past research showing higher number of ACEs are associated with more symptoms of depression and anxiety in later life. However, cognitive flexibility did not moderate the relationship between ACEs and symptoms of depression and anxiery. This suggests cognitive flexibility might not play a significant role in the association between childhood trauma and symptoms of depression and anxiety in later life. Alternatively present results could be attributed to a small sample size, or the specific measure of cognitive flexibility used. This study expands on prior research highlighting the role of cognitive flexibility on age, with age serving as a prominent feature in the association between ACEs and adult depression and anxiety. Further research examining the role of cognitive flexibility in younger and middle years and its association with ACEs and psychopathology may provide unique insights on how to intervene earlier in the life course before cognitive flexibility begins to decline.
94 Equivalence of In-person and Virtual Administration of the Delis-Kaplan Executive Function System’s Color-Word Interference Subtest in Youth Recovered from Concussion and Controls
- Nishta R Amin, Tyler A Busch, Kayla B Huntington, Isaac H Chen, Beth S Slomine, Stacy J Suskauer, Adrian M Svingos
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 496-497
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Objective:
Virtual testing can reduce cost and burdens, as well as increase access to clinical care. Few studies have examined the equivalency of virtual and in-person administration of standardized measures of executive functioning in children. During the COVID-19 pandemic, we utilized virtual administration of the Delis-Kaplan Executive Function System, Color-Word Interference Test (DKEFS-CW) in our ongoing longitudinal research study exploring outcomes in children clinically recovered from concussion compared to never-concussed peers. In the current study, we explore the equivalence of scores obtained via in-person and virtual administration of the DKEFS-CW in youth recovered from concussion and never-concussed controls.
Participants and Methods:Participants included 112 youth ages 10-18 (Mage=14.05 years, SD=2.296; 53.5 % Male) who completed the DKEFS-CW in-person (n=63) or virtually (n=49) as part of their involvement in the parent study. Of these, 38 were recovered from concussion (Mdays since injury— 91.21, SD=88.91), and 74 were never-injured controls. Virtual administration was done via Zoom by presenting digital scans of the DKEFS stimulus book using the screen-sharing function. Participants set up and joined the Zoom call from a secondary device (cell phone) that was set in a stable position to provide a view of their screen, mouse and keyboard setup. Group (in-person vs remote) differences in DKEFS-CW scores were examined using independent-samples t-tests for all subtest conditions (color naming, word reading, inhibition, and inhibition/switching). T-tests/chi-square tests were used to examine between-group differences in demographic variables (i.e., age, sex maternal education, IQ, concussion history). Demographic variables that were significantly different by group were then included as covariates in ANCOVA models examining the effect of administration context on performance.
Results:There were no significant differences in DKEFS-CW scaled scores between those who were administered the measure in-person or virtually (Color Naming: Min-person=10.78, Mvirtual=10.08, t(110)=1.634, p=.105; Word Reading: Min-person=11.25, Mvirtual=10.92, t(110)=.877, p=.382; Inhibition: M in-person= 11.70, Mvirtual=11.24, t(110)=1.182, p=.240; Inhibition/Switching: Mi n-person= 11.29, Mvirtual=10.82, t(110)=1.114, p=.268). There were no significant between-group differences in concussion history, sex, maternal education or IQ. However, those who were administered the DKEFS-CW in-person (Mage=13.55) were significantly younger than those who were administered the measure virtually (Mage=14.69), t(110)=-2.777, p=.006. After controlling for age, there remained no significant relationship between administration context (in-person vs. virtual) and DKEFS-CW performance for any subtest condition (Color Naming: F(1,30)=.016, p=.889; Word Reading: F(1,76)=.655, p=.421; Inhibition: F(1,30)=.038, p=.847; Inhibition/Switching: F(1,30)=.015, p=.902).
Conclusions:The recommended practice for remote administration of DKEFS-CW is to have test stimuli presented flat on a table by a trained facilitator present with the examinees. Here, we provide preliminary evidence of equivalence between DKEFS-CW scores from tests completed in-person and those completed virtually with stimuli presented on a computer screen. Future studies are needed to replicate these findings in clinical populations with greater variability in executive function. Some clinical populations may also require more in-person support. Likewise, future studies may examine the role of trained facilitators or caregivers in the virtual testing process.
18 Measurement Invariance of ImPACT in Bilingual and Monolingual High School Athletes
- Hana Kuwabara, Grace Goodwin, Christine Salva, Jessica Woodyatt, Julia Maietta, Staci Ross, Thomas Kinsora, Daniel Allen
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 432-433
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Previous studies have found differences between monolingual and bilingual athletes on ImPACT, the most widely used sport-related concussion (SRC) assessment measure. Most recently, results suggest that monolingual English-Speaking athletes outperformed bilingual English- and Spanish-speaking athletes on Visual Motor Speed and Reaction Time composites. Before further investigation of these differences can occur, measurement invariance of ImPACT must be established to ensure that differences are not attributable to measurement error. The current study aimed to 1) replicate a recently identified four-factor model using cognitive subtest scores of ImPACT on baseline assessments in monolingual English-Speaking athletes and bilingual English- and Spanish-speaking athletes and 2) to establish measurement invariance across groups.
Participants and Methods:Participants included high school athletes who were administered the ImPACT as part of their standard pre-season athletic training protocol in English. Participants were excluded if they had a self-reported history of concussion, Autism, ADHD, learning disability or treatment history of epilepsy/seizures, brain surgery, meningitis, psychiatric disorders, or substance/alcohol use. The final sample included 7,948 monolingual English-speaking athletes and 7,938 bilingual English- and Spanish-speaking athletes with valid baseline assessments. Language variables were based on self-report. As the number of monolingual athletes was substantially larger than the number of bilingual athletes, monolingual athletes were randomly selected from a larger sample to match the bilingual athletes on age, sex, and sport. Confirmatory factor analysis (CFA) was used to test competing models, including one-factor, two-factor, and three-factor models to determine if a recently identified four-factor model (Visual Memory, Visual Reaction Time, Verbal Memory, Working Memory) provided the best fit of the data. Eighteen subtest scores from ImPACT were used in the CFAs. Through increasingly restrictive multigroup CFAs (MGCFA), configural, metric, scalar, and residual levels of invariance were assessed by language group.
Results:CFA indicated that the four-factor model provided the best fit in the monolingual and bilingual samples compared to competing models. However, some goodness-of-fit-statistics were below recommended cutoffs, and thus, post-hoc model modifications were made on a theoretical basis and by examination of modification indices. The modified four-factor model had adequate to superior fit and met criteria for all goodness-of-fit indices and was retained as the configural model to test measurement invariance across language groups. MGCFA revealed that residual invariance, the strictest level of invariance, was achieved across groups.
Conclusions:This study provides support for a modified four-factor model as estimating the latent structure of ImPACT cognitive scores in monolingual English-speaking and bilingual English- and Spanish-speaking high school athletes at baseline assessment. Results further suggest that differences between monolingual English-speaking and bilingual English- and Spanish-speaking athletes reported in prior ImPACT studies are not caused by measurement error. The reason for these differences remains unclear but are consistent with other studies suggesting monolingual advantages. Given the increase in bilingual individuals in the United States, and among high school athletics, future research should investigate other sources of error such as item bias and predictive validity to further understand if group differences reflect real differences between these athletes.
71 Feasibility of Virtual Useful Field of View Assessment and Equivalence with In-Person Administration Among Youth Clinically Recovered from Concussion and Uninjured Controls
- Kayla B Huntington, Tyler A Busch, Nishta Amin, Hsuan-Wei Chen, Beth Slomine, Stacy Suskauer, Adrian Svingos
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 174-175
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Youth athletes with concussion are at an increased risk of sustaining new concussions and orthopedic injuries after clearance for return-to-play. There are training programs, extensively studied in other patient populations, which can improve performance in cognitive domains that have been implicated in sport-related injury and re-injury after concussion (i.e., visual attention/processing speed). The Useful Field of View (UFOV) is one such training program, accompanied by a computerized adaptive assessment for evaluating response to training and maintenance in clinical trials. Remote UFOV assessment administration may help improve adherence, particularly in assessing long-term training effects. The current study explores the feasibility of virtual UFOV assessment and equivalence with in-person administration in youth clinically recovered from concussion and healthy controls.
Participants and Methods:Participants included youth ages 10-18 enrolled in a longitudinal study examining neural recovery following medical clearance from concussion. UFOV was attempted in 61 participants (Mage=15.06; SD=2.00; n=19 in-person; n=42). Of these, 7 virtual administrations were discontinued due to computer limitations, and 1 in-person administration was excluded due to overall performance validity concerns. This resulted in a total sample of 53 participants (Mage=15.02, SD=2.00, 58.5% male; n=14 concussion, Mdays_since_injury=272.64, SD=185.35; n=39 controls). UFOV was administered either in-person (n=18) using manual guidelines or virtually (n=35) on the participant’s computer using video-conference screen-share and a secondary device for an additional view of the participant and their keyboard/mouse. For virtual visits, the examiner recorded concerns about the remote testing environment (e.g., screen glare, viewing distance not measured appropriately), and analyses were conducted with and without cases with concerns. Between-group (in-person vs virtual administration) demographic differences were examined using chi-square tests/t-tests. Mann-Whitney U tests were used to examine for differences in UFOV scores (ms; higher scores are worse) by administration context (in-person vs. virtual) given threats to normality.
Results:For virtual administrations, the most commonly reported concerns about the remote testing environment were related to lighting (n=12) and viewing distance (n=3). There were no significant differences in age, sex, concussion history, sport participation history, or IQ by administration context (in-person vs. virtual). UFOV performance did not vary significantly by administration context for processing speed or divided attention subtests, but performance on the selective attention subtest was significantly better in the virtual administration group (Median in-person =93.33; Medianvirtual=63.33; U=203.00, p=0.035). This trend persisted after removing an outlier (>2SD; p=0.065) and after removing cases where lighting (p=0.060) and screen-viewing distance (p=0.085) were not adequately controlled.
Conclusions:Though preliminary, results suggest that UFOV can be administered virtually, in youth with and without a history of concussion, but that those assessed virtually using their home computer may have an advantage, particularly for the selective attention subtest. This may be due to comfort level within the home environment or subtle differences in viewing distance that were not appreciated by the examiner remotely. Importantly, not all participants were able to complete the assessment virtually due to computer limitations. Future work with larger samples size should examine the extent to which completers vary from non-completers in terms of sociodemographic variables.
4 The Effect of Age on the Relationship Between Adverse Childhood Experiences and Frailty in Late Life: A Moderation Model
- Alexandria G. Nuccio, Rosario PInts Lobo, Zachary Goodman, Stacy S Merritt, Xiaoyan Sun, Katalina F. McInerney, Bonnie E. Levin
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 320-321
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Although relationships between Fried frailty criteria (i.e., weakness, slowness, weight loss, exhaustion and low physical activity), cognitive decline, and adverse childhood experiences (ACEs) have been examined (Brigalo et al., 2015, Brown et al., 2022, Fabricio et al., 2020, & Tani et al., 2021), the moderating effect of age on the relationship between ACEs and frailty has yet to be explored. The present study examined whether age moderates the relationship between total number of ACEs and number of frailty criteria in older age.
Participants and Methods:137 older adults were recruited from University of Miami clinics and surrounding community care centers. Collected data included demographic information, number of frailty criteria met, and number of ACEs endorsed. Participants were primarily Hispanic-White (64.2%) and female (56.9%), with a mean age of 73.62 years (SD=6.252). Data were initially analyzed using descriptive statistics. A hierarchical linear regression was run to test the effect of ACE score on number of frailty criteria met. A simple moderation analysis using the PROCESS macro was then performed with total number of medical conditions included as a covariate to address any potentially confounding effects. To avoid multicollinearity issues, number of ACEs endorsed and age were mean centered and an interaction term between the two was produced.
Results:Scores on the ACE did substantially effect the total number of frailty criteria met by participants in this study (f=2.37, p=0.028, ΔR2=0.023), independent of number of medical conditions. The overall moderation model was significant (f=2.99, p=0.022, R2=0.103), and the addition of the interaction effect resulted in a statistically significant change to the model (f=4.08, p=0.045, ΔR2=0.035). Taken together, support for a moderating effect was found, specifically within the lower age group (65 - 71years), but not older (greater than 72 years) with ACE score positively predicting the number of frailty criteria met (b =0.230, t=2.62, p=0.010).
Conclusions:Results largely support the positive effect of ACE endorsement on the number of frailty criteria met in later life. Age acted as a moderating effect, for the younger old population, such that as number of ACEs endorsed increased, so too did the number of frailty criteria met. This finding highlights the importance of early intervention among those in younger late life who have experienced trauma. Given the positive relationship between frailty and cognitive decline in late life (Brigalo et al., 2015 & Fabricio et al., 2020), these findings also support the need for a better understanding of how childhood adversity impacts physical well-being over the life course.
3 CI Cognitive Therapy: Initial Application in a Pilot Study to Improve Cognitive Impairment in Chronic Stroke Survivors
- Edward Taub, Gitendra Uswatte, Karlene Ball, Victor W Mark, Staci McKay, Brandon Mitchell, Jason Blake, Amy Knight, Chen Lin, Gary Cutter
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 597-598
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CI Cognitive Therapy (CICT) is a combination of behavioral techniques derived from CI Movement Therapy (CIMT) modified to apply to the cognitive domain, and Speed of (Cognitive) Processing Training (SOPT). SOPT is effective in improving cognitive function in the treatment setting and driving ability in everyday situations. The data concerning the effect of SOPT on other cognition-based instrumental activities of daily living (IADL) in everyday situations is incomplete. The strengths of CIMT, based on its Transfer Package (TP), are to facilitate 1) transfer of improved function from the treatment setting to IADL in everyday settings, and 2) long-term retention of the improved performance of IADL. This study sought to determine in a preliminary case series whether the TP of CI Movement Therapy combined with SOPT would have the same effect on a wide range of impaired cognition-based ADL.
Participants and Methods:Participants were 6 adults with chronic stroke: mean chronicity = 36.2 months, (range, 16-56 months); mean age = 59.7 years, (range, 47-55); 1 female; 3 African American and 3 European American. Five had mild cognitive impairment, while one had moderate impairment. Participants received 35 hours of outpatient treatment in 10-15 sessions distributed over 2-6 weeks, depending on the participants’ availability. Sessions began with 1 hour of SOPT training followed by training of cognition-based ADL by the process of shaping, a common method in the behavior analysis field. Other behavior analysis methods employed in the TP of CI Movement Therapy were used, including: 1) behavior contracting, daily assignment of homework, participation of a family member in the training and monitoring process, daily administration of a structured interview assessing amount and quality of performance of 30 IADL, problem solving to overcome perceived (or real) barriers to performance of IADL. Participants were given daily homework assignments in follow-up and were contacted in periodic, pre-arranged phone calls to determine status, compliance and problem-solve.
Results:All six participants showed marked improvement on the SOPT test similar to that in the Ball et al studies. However, here transfer to IADL outside the treatment setting was substantial. On the main real-world outcome, the Canadian Occupational Performance Measure (COPM), there were increases of 2.7±1.3 and 2.1±1.6 on the two scales (d’s = 1.9 & 1.3, respectively). (Changes on the COPM > 2 points are considered clinically meaningful and changes in d’ >.8 are considered large). On two other real-word measures, the Cognitive Task Activity Log (CTAL) and inventory of Improved and New Cognitive Activities (INCA), there was a marked increase during the acquisition phase of training. There was no loss in retention over the 6-16 months (mean = 12.2) of follow-up to date. Instead, the INCA showed strong further improvement after the end of treatment-setting training, especially in the New Activities Not Performed Since Before Stroke Onset category, going from a mean of 8.2 after training to 14.6 at the end of follow-up.
Conclusions:These very preliminary results suggest that CICT may be an efficacious therapy for mild to moderate cognitive impairment in chronic stroke and possibly other disorders.
95 Delving Beyond the Test Score: Linguistic Markers of Cognitive Impairment on Paragraph Recall
- Stacy L Andersen, Seho Park, Nicole Roth, Paola Sebastiani, Megan Barker, Zhiwei Zheng, Sanford Auerbach Auerbach, Stephanie Cosentino, Rhoda Au, David J Libon
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 766-767
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Cognitive tests requiring spoken responses, such as paragraph recall, are rich in cognitive-related information that is not captured using traditional scoring methods. This study aimed to determine if linguistic features embedded in spoken responses may differentiate between individuals who are and are not cognitively impaired.
Participants and Methods:Participants in the Long Life Family Study completed a neuropsychological assessment which included the WMS-R Logical Memory I paragraph recall. For a subset of participants (N=709), test responses were digitally recorded and manually transcribed. We used Linguistic Inquiry Word Count, a text analysis program, to quantify word counts, grammatical features (e.g, prepositions, verb tenses), and the use of content words related to specific semantic categories (e.g., work-related, numbers) for immediate (IR) and delayed recall (DR). We used regression models with Generalized Estimating Equations adjusted by age, sex, education, and within-family correlation to select features associated with cognitive status (normal cognition [NC] versus cognitive impairment [CI]; Bonferroni-corrected threshold p<0.001). Next, we developed a “polyfeature score” (PFS) for both immediate and delayed recall, each calculated as a weighted sum of the selected linguistic features. We then built a logistic regression model to evaluate the predictive value of each PFS for identifying cognitively impaired individuals. In secondary analyses, we used regression models as above to identify features associated with mild cognitive impairment subtype (amnestic [aMCI] versus nonamnestic [naMCI]; threshold p< .05).
Results:The sample included 599 participants with NC and 110 with CI (mean age = 72.3 ± 11.0 years, 54% female). The regression identified 8 linguistic features for IR and 7 for DR that significantly predicted cognitive status. Decreased use of content words related to work (e.g., employed, school, police) and biological processes (e.g., cook, cafeteria, eat) and the use of negations (e.g., no, not, can’t) were predictive of cognitive impairment in both recall conditions. In contrast, the use of other content word categories were predictive of cognitive status in only one recall condition (IR: leisure, cognitive processes, space; DR: drives, number). The use of fewer prepositions in IR, more first-person pronouns in DR, and fewer words in the past tense in DR were each associated with cognitive impairment. Word count was not predictive of cognitive status. Both PFSs were highly associated with cognitive status (PFS_IR ß= 0.74, p< 0.001; PFS_DR ß= 0.86, p= 0.001) with high discriminative value (PFS_IR AUC= 0.93, sensitivity = 0.81, specificity= 0.91; PFS_DR AUC= 0.95, sensitivity= 0.77, specificity= 0.88). In the CI subset, linguistic features differed between those classified as aMCI (n= 24) and naMCI (n= 40). Two function word categories predicted aMCI in IR whereas decreased word count, two function word categories, and two content word categories predicted aMCI in DR (all p< .05)
Conclusions:Linguistic features from paragraph recall provide high predictive value for classifying cognitive status increasing its potential as a cognitive screener in clinical settings. Additionally, each recall condition identified unique linguistic features associated with cognitive impairment which may aid differentiation of cognitive impairment subtypes and elucidate processes underlying deficits in learning and recall.