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73 Processing Speed in Migraine With and Without Aura: A Meta-Analysis
- Jasmin H Pizer, Stephen L Aita, Melissa A Myers, Nanako A Hawley, Vasilios C Ikonomou, Kyle M Brasil, Katherine A Hernandez, Erika C Pettway, Benjamin D Hill
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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. 67
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Objective:
Migraine refers to recurrent, unilateral headache attacks, lasting 4-72 hours, that have a pulsating quality and can occur with or without aura. Aura is a symptom, usually preceding the onset of a migraine, where there is an experience of gradually spreading focal neurological symptoms which typically last less than one hour. A meta-analysis was conducted which quantitatively synthesized literature documenting performance on clinical measures of processing speed (PS) in individuals with migraine with (MwA) and without aura (MwoA).
Participants and Methods:Data for this study came from a larger study that compared overall neuropsychological functioning in primary headache disorders (PHD) and healthy controls (HC). We searched OneSearch and PubMed using a uniform search-strategy to locate original research comparing cognition between PHD and HC. Analyses were modeled under random effects. Hedge’s g was used as a bias-corrected estimate of effect size. We assessed between-study heterogeneity using Cochran’s Q and I2. Egger’s regression test was used to assess publication bias (i.e., the association between standard error and effect size). High heterogeneity in effects was analyzed for possible moderating variables using metaregression and sub-group analyses.
Results:The initial search interval spanned inception-May 2021 and yielded 6692 results. Twelve studies met inclusion criteria, included clinical measures of PS, and included PHD subgroups with MwA and/or MwoA (MwA n = 279, MwoA n = 655, HC n = 2159). MwA demonstrated moderately worse performance in PS overall when compared to HC (k = 7, g = -0.41, p = 0.028). MwoA also demonstrated worse performance in PS overall when compared to HC but the effect size was small (k = 12, g = -0.21, p = 0.006). Heterogeneity of MwoA studies was low (Q = 15.12, I2 = 21.19) while heterogeneity of MwA studies was high (Q = 21.91, I2 = 72.61). Meta-regressions of MwA studies indicated clinical age and disease duration to be related to effect sizes such that studies with older clinical participants and longer disease durations yielded greater (negative) differences. Egger’s regression intercept noted a possible association effect size and standard error for MwA articles (t = 3.60, p = 0.02) and MwoA articles (t = 5.21, p < 0.005). Trim-and-fill procedure estimated 0 MwA studies to be missing due to publication bias (adjusted g = -0.41, p = 0.028) while 7 MwoA studies were estimated to be missing due to publication bias (adjusted g = -0.03, Q = 34.79).
Conclusions:Individuals with migraine demonstrated worse performances on tests of PS compared to controls. Effect sizes were generally moderate in strength for MwA while effect sizes were generally small in strength for MwoA. This quantitative summary confirmed that individuals with migraine experience slowed processing speed in general and this effect is magnified when aura is a presenting symptom.
35 The Effect of Diagnostic Method on Racial Disparities in Mild Cognitive Impairment and Dementia Diagnosis Using the NACC Database.
- Jennifer L Nosker, Stephen L Aita, Nicholas C Borgogna, Tina Jimenez, Keenan A Walker, Tasha Rhoads, Janelle M Eloi, Zachary J Resch, Victor A Del Bene
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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. 909-910
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Objective:
Population studies have shown that Black individuals are at higher risk for MCI and dementia than White individuals but are more likely to be underdiagnosed or misdiagnosed. Although multiple contributory factors have been identified in relation to neurocognitive diagnostic disparities among persons of color, few studies have investigated race-associated differences in MCI and dementia classification across diagnostic methods. The current study examined the agreement of cognitive classification made via semi-structured interview and neuropsychological assessment.
Participants and Methods:Only participants assigned normal cognitive status or cognitive impairment with presumed Alzheimer’s etiology were included in the study. Baseline visit data in the National Alzheimer’s Coordinating Center (NACC) dataset was collected to compare correspondence of cognitive classification (normal cognition, MCI, dementia) via semi-structured interview (Clinical Dementia Rating; CDR) with formal NACC diagnostic determination. NACC diagnostic determination was further separated by single clinician and consensus diagnostic methods. Inter-rater agreement was evaluated using chi-squared tests, and respective analyses were stratified for race (Black vs White), ethnicity (Hispanic vs Non-Hispanic), and education (<12 years vs. >12 years).
Results:The sample size included 4,739 Black and 26,393 White participants across 43 Alzheimer’s Disease Research Centers (ADRCs). Inter-rater analyses between CDR (semi-structured interview) versus single-clinician and formal consensus NACC diagnostic methods showed strong (all (pc>.70) consistency in cognitive diagnoses overall, irrespective of race, ethnicity, and education. The percentage of agreement between diagnostic methods was nearly 100% for those categorized as cognitively normal or with dementia. However, the agreement for MCI was considerably lower (ranging from 28-74%) and revealed a disparity in diagnostic method between Black and White individuals. White individuals diagnosed with MCI via CDR (CDR total =0.5) were more likely to be labeled as having dementia regardless of NACC diagnostic method. However, Black individuals diagnosed with MCI via CDR were equally likely to be diagnosed as cognitively normal or with dementia via the formal consensus method.
Conclusions:Irrespective of race and other demographic variables, diagnostic methods had high agreement for groups labeled with normal cognition and dementia. Agreement was consistently lower for the group labeled with MCI, with Black individuals having greater variability in diagnostic differentials when diagnosed via formal consensus method. The results of the study suggest that neuropsychological assessment continues to be an integral component of diagnosing individuals with MCI, reducing possible sources of bias.
32 Prediction of Seizure Outcome with Presurgical IAT, MRI, and PET in Patients with Temporal Lobe Epilepsy Undergoing Surgery
- Grant G Moncrief, Stephen L Aita, Jennifer Lee, Bryce Jacobson, George P Thomas, Robert M Roth, Angeline S Andrew, Krzysztof A Bujarski, Vijay M Thadani, Erik J Kobylarz, Stephen J Guerin, David W Roberts, Barbara C Jobst
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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. 31-32
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Objective:
Anterior temporal lobectomy is a common surgical approach for medication-resistant temporal lobe epilepsy (TLE). Prior studies have shown inconsistent findings regarding the utility of presurgical intracarotid sodium amobarbital testing (IAT; also known as Wada test) and neuroimaging in predicting postoperative seizure control. In the present study, we evaluated the predictive utility of IAT, as well as structural magnetic resonance imaging (MRI) and positron emission tomography (PET), on long-term (3-years) seizure outcome following surgery for TLE.
Participants and Methods:Patients consisted of 107 adults (mean age=38.6, SD=12.2; mean education=13.3 years, SD=2.0; female=47.7%; White=100%) with TLE (mean epilepsy duration =23.0 years, SD=15.7; left TLE surgery=50.5%). We examined whether demographic, clinical (side of resection, resection type [selective vs. non-selective], hemisphere of language dominance, epilepsy duration), and presurgical studies (normal vs. abnormal MRI, normal vs. abnormal PET, correctly lateralizing vs. incorrectly lateralizing IAT) were associated with absolute (cross-sectional) seizure outcome (i.e., freedom vs. recurrence) with a series of chi-squared and t-tests. Additionally, we determined whether presurgical evaluations predicted time to seizure recurrence (longitudinal outcome) over a three-year period with univariate Cox regression models, and we compared survival curves with Mantel-Cox (log rank) tests.
Results:Demographic and clinical variables (including type [selective vs. whole lobectomy] and side of resection) were not associated with seizure outcome. No associations were found among the presurgical variables. Presurgical MRI was not associated with cross-sectional (OR=1.5, p=.557, 95% CI=0.4-5.7) or longitudinal (HR=1.2, p=.641, 95% CI=0.4-3.9) seizure outcome. Normal PET scan (OR= 4.8, p=.045, 95% CI=1.0-24.3) and IAT incorrectly lateralizing to seizure focus (OR=3.9, p=.018, 95% CI=1.2-12.9) were associated with higher odds of seizure recurrence. Furthermore, normal PET scan (HR=3.6, p=.028, 95% CI =1.0-13.5) and incorrectly lateralized IAT (HR= 2.8, p=.012, 95% CI=1.2-7.0) were presurgical predictors of earlier seizure recurrence within three years of TLE surgery. Log rank tests indicated that survival functions were significantly different between patients with normal vs. abnormal PET and incorrectly vs. correctly lateralizing IAT such that these had seizure relapse five and seven months earlier on average (respectively).
Conclusions:Presurgical normal PET scan and incorrectly lateralizing IAT were associated with increased risk of post-surgical seizure recurrence and shorter time-to-seizure relapse.
75 Neuropsychological performance in vestibular migraine: Preliminary findings from a meta-analysis
- Nanako A Hawley, Jasmin H Pizer, Stephen L Aita, Melissa A Myers, Vasilios C Ikonomou, Kyle B Brasil, Katherine A Hernandez, Erika C Pettway, Benjamin D Hill
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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. 68-69
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Objective:
Primary headache disorder is characterized by recurrent headaches which lack underlying causative pathology or trauma. Primary headache disorder is common and encompasses several subtypes including migraine. Vestibular migraine (VM) is a subtype of migraine that causes vestibular symptoms such as vertigo, difficulties with balance, nausea, and vomiting. Literature indicates subjective and performance-based cognitive problems (executive dysfunction) among migraineurs. This study compared the magnitude of the total effect size across neuropsychological domains to determine if there is a reliable difference in effect sizes between individuals with VM and healthy controls (HC). An additional aim was to meta-analyze neuropsychological outcomes in migraine subtypes (other than VM) in reference to healthy controls.
Participants and Methods:This study was a part of a larger study examining neuropsychological functioning and impairment in individuals with primary headache disorder and HCs. Standardized search terms were applied in OneSearch and PubMed. The search interval covered articles published from 1986 to May 2021. Analyses were random-effects models. Hedge’s g was used as a bias-corrected estimate of effect size. Between-study heterogeneity was assessed using Cochran’s Q and I2. Publication bias was assessed with Duval and Tweedie’s Trim-and-Fill method to identify evidence of missing studies.
Results:The initial omnibus literature search yielded 6692 studies. Three studies (n=151 VM and 150 HC) met our inclusion criteria of having a VM group and reported neuropsychological performance. VM demonstrated significantly worse performance overall when compared to HCs (k=3, g=-0.99, p<0.001; Q=4.41, I2=54.66) with a large effect size. Within-domain effects of VM were: Executive Functioning=-0.99 (Q=0.62, I2=0), Screener=-1.15 (Q=3.29, I2=69.59), and Visuospatial/Construction=-1.47 (Q=0.001, I2=0.00). Compared to chronic migraine (k=3, g=-0.59, p<0.001; Q=0.68, I2=0.00) and migraine without aura (k=23, g=-0.39, p<0.001; Q=109.70, I2=79.95), VM was the only migraine subgroup to display a large effect size. Trim-and-fill procedure estimated zero VM studies to be missing due to publication bias (adjusted g=-0.99, Q=4.41).
Conclusions:This initial attempt at a meta-analysis of cognitive deficits in VM was hampered by a lack of studies in this area. Based on our initial findings, individuals with VM demonstrated overall worse performances on neuropsychological tests compared to HCs with the greatest level of impairment seen in visuospatial/construction. Additionally, VM resulted in a large effect size while other migraine subtypes yielded small to moderate effect sizes. Despite the small sample of studies, the overall effect across neuropsychological performance was generally stable (i.e., low between-study heterogeneity). Given than VM accounts for 7% of patients seen in vertigo clinics and 9% of all migraine patients, our results suggest that neuropsychological impairment in VM deserves significantly more study.