bluuebunny/crossref_metadata_2025 huggingface dataset:
A - 96 Advocacy for Neuropsychological Services in pre-Surgical fMRI Procedures for the Treatment of Patients with Brain Tumors
Authors: Kdeiss Bianca , McCuddy William Travis
Published: October 2023

Objective

Functional magnetic resonance imaging (fMRI) has become an essential tool in presurgical language and motor mapping for patients with brain tumors. Despite being theoretically well suited for delivering all aspects of a clinical fMRI service, a recent large survey found neuropsychologists were less likely to be involved than radiologists and MR technologists (Benjamin et al., 2018). This review aimed to explore the involvement of neuropsychologists in clinical fMRI.

Data Selection

A systematic review of articles published within the last decade was conducted using PubMed, ScienceDirect, and Google Scholar to identify literature addressing the role of neuropsychology in clinical fMRI with brain tumor populations. Boolean logic was employed to search key words: clinical fMRI, awake craniotomy or direct cortical stimulation, neuropsychology, presurgical, evaluation, and brain tumor. The search returned 1917 articles: We subsequently removed duplicates, gray literature, book chapters, and conference proceedings then searched abstracts and full text accordingly for mention of neuropsychology and fMRI. The final analysis included 33 articles.

Data Synthesis

The majority of articles did not mention involvement of neuropsychologists in the administration of neurofunctional tasks during fMRI (n = 22) while others mentioned alternate disciplines conducting the assessment (n = 2). Comparatively, traditional pre- (n = 14) and post-surgical (n = 11) neuropsychological testing services appear more commonly utilized. No specific barriers limiting the use of neuropsychologists were identified.

Conclusions

Neuropsychologists are underused in pre-surgical fMRI language and motor mapping despite possessing specialized knowledge and skills to conduct such procedures. Potential explanations, including availability of neuropsychologists and a lack of specific training in clinical fMRI, are discussed.
A - 101 A Neuropsychological Case Study of Progressive Bulbar Palsy
Authors: Kysor-Itri Sarah E , Sekunda Victoria-Maria
Published: October 2023

Objective

There has been limited literature regarding cognitive dysfunction associated with progressive bulbar palsy. This case study presents the neuropsychological profile of a 66-year-old White male diagnosed with progressive bulbar palsy (evolving primary lateral sclerosis) with speech production difficulties.

Method

The patient was referred by his neurologist for a neuropsychological evaluation of progressively worsening cognitive changes over the past two years, including difficulties with reading directions, spelling, structuring sentences, thinking of words to write down, and counting. He also described progressively worsening speech production difficulties. During the evaluation, the patient communicated solely through written means. Available MRI results demonstrated subtle evidence of anterior temporal atrophy bilaterally. Additional relevant history includes chronic obstructive pulmonary disease and a remote history of recreational opioid use.

Results

Given the patient’s speech production difficulties, measures were selected to include those that did not require verbal responses. For the few measures that did require verbal responses, administration was adjusted to allow him to provide written responses. On evaluation, he demonstrated intact orientation, processing speed, receptive language, and visuospatial functioning. In contrast, he demonstrated relative weaknesses on measures of attention, executive functioning (i.e., problem solving and cognitive flexibility), and free recall of information (with intact recognition). Behavioral features were also noted during the evaluation, including impulsivity and disorganization.

Conclusions

The case provides preliminary data regarding possible cognitive profiles associated with progressive bulbar palsy, including possible areas of cognitive strengths and weaknesses. This case also highlights the need for further investigation of cognitive profiles of the condition which may assist with treatment planning.
A - 102 Neuropsychological Findings in a Patient Diagnosed with Wernicke’s Encephalopathy Due to Chemoradiation and Malnutrition: a Case Presentation
Authors: Laique Aamir , Breting Leslie Guidotti
Published: October 2023

Objective

Wernicke’s Encephalopathy (WE) is a rare neuropsychiatric syndrome caused by thiamine deficiency. WE is characterized by inattention, incoherence, confusion, eye-movement disorders, and ataxia. However, scarce information exists on neurocognitive outcomes, particularly stemming from oncology-related etiologies, (e.g., malnutrition caused by chemoradiation). In hopes of elucidating consequential deficits, a case presenting the neurocognitive profile of WE in a 71-year-old female cancer survivor is reported.

Method

Patient underwent standard chemoradiation for squamous cell carcinoma of the oropharynx in 2021 followed by frequent nutritional deficiency resulting from decreased appetite, mouth sores, and nausea/vomiting. She developed increased weakness, confusion, difficulty walking, nystagmus, and altered mental state. Completion of chemoradiation and onset of WE saw her experience altered mental status, confusion, gait instability, dysarthric speech, and memory difficulties. Imaging indicated a linear chronic infarct in the left cerebellar hemisphere and frontal predominant brain volume loss.

Results

Patient was referred for neuropsychological evaluation after beginning treatment for WE and psychotherapy to assess barriers to improving nutrition. Primary deficits were observed on verbal learning and memory, verbal fluency, executive functioning, attention, and visuomotor functioning. Comprehension and visual memory skills were intact. Both basic and higher order cognitive processes were impacted resulting in declining quality of life and activities of daily living.

Conclusion

This study highlights the need to consider chemoradiation as an etiological risk factor for the development of WE and associated neurocognitive sequelae. Neuropsychological dysfunction is an important consideration given the acute nature of this life-threatening disease. The key elements in treatment involve thiamine replacement, nutrition, appropriate rehabilitation, and medical follow-up.
A - 106 Predicting Depression in Individuals with Parkinson’s Disease Using the Repeatable Battery for the Assessment of Neuropsychological Status
Authors: Richardson Spring
Published: October 2023

Objective

This study investigates whether deficits in specific cognitive domains predict depression in individuals with Parkinson’s disease.

Method

Neurocognitive domains are measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Affective symptoms are measured by the Personality Assessment Inventory (PAI). A simultaneous hierarchical multiple regression with three univariately predicting RBANS indices was used to predict the PAI Depression Scale. Participants were individuals diagnosed with Parkinson’s disease who underwent neuropsychological evaluation as candidates for deep brain stimulation procedures. The sample included 31 participants, between ages 41 to 75, with a mean age of 61.29. Twenty-seven were male and four were female. Twenty-six were white, one was African-American, one was Hispanic, one was Asian, two were not racially identified.

Results

The model was significant with a large effect size, R2 = 0.444, F(3,27) = 7.177, p < 0.001, indicating Attention, Visuospatial/constructional, and Immediate Memory RBANS indices accounted for 44% of the variation found in depression as measured by the PAI. Attention had 15% of unique variance accounting for one third of the 44% predicted by the regression model. Visuospatial/constructional had 9% unique variance, indicating that approximately 20% of the model variance is in common between the predictors and depression.

Conclusions

The analysis found a significant negative correlation between depression and cognitive deficits, supporting the hypothesis that cognitive deficits in one or more of the RBANS domains predicts depression in individuals with Parkinson’s disease.
A - 110 Cognitive Phenotypes in Children with a History of Brain Tumors
Authors: Robinson Mary L , Bean Akanksha M , Schneider Bruna M , Krapf Erica M , Hassara Kathleen E
Published: October 2023

Objective

Research indicates children with a history of pediatric brain tumors (PBTs) are at increased risk for cognitive impairment. Cognitive phenotyping could reveal latent cognitive profiles and ascertain the impact of clinical and sociodemographic variables in this population. There is only one such study to date. We hypothesized patients with more treatment modalities, additional medical diagnoses, and diagnosis age/time since treatment completion would impact performance.

Method

K-means clustering was used to explore 17 test scores across 9 cognitive domains in 67 children with brain tumors aged 8–17 years (median age = 12; 41 male; 85.1% Caucasian) in a pediatric hospital. Exclusion criteria included failed performance validity testing, IQs < 50, and active treatment. Parametric and non-parametric tests were utilized, and effect sizes were calculated.

Results

Two clusters were identified. Cluster 2 (n = 37) had lower scores than Cluster 1 (n = 30) on all neuropsychological domains assessed except for memory and mental flexibility with large effect sizes (p’s < 0.005, n2 = 0.151–0.57). Clusters differed by tumor location (p = 0.021, V = 0.340), hydrocephalus (p = 0.041, V = 0.250), and treatment type (p = 0.037, V = 0.447).

Conclusion(s)

Results suggest multi-domain cognitive impairment in a large subgroup of children with PBTs associated with infratentorial tumors, history of hydrocephalus, and exposure to multiple treatment modalities (i.e., surgery, radiation, and chemotherapy). Other demographic, treatment (i.e., diagnosis age, time since diagnosis/treatment completion), and medical (i.e., tumor grade, seizures, genetic diagnoses) factors did not account for clusters. Future studies should include larger samples, increased age range, and additional clinical, sociodemographic, and psychosocial variables to form more generalizable models of cognitive phenotypes in youth with PBTs.
A - 111 Neuropsychological Performance in CDK-13 Related Disorder: a Multi-Year Case Study
Authors: Robinson Mary L , Bean Akanksha M , Krapf Erica M
Published: October 2023

Objective

CDK13-related disorder (CDK13-RD) is a rare genetic condition first described in 2016 as involving congenital heart defects, dysmorphic facial features, and intellectual developmental disorder (CHDFIDD). Few studies have reported clinical presentations. There is very minimal information about cognitive and neuropsychological outcomes; however, developmental delays and intellectual disability are common. This study presents longitudinal neuropsychological outcomes of one adolescent with CKD13-RD.

Method

A female patient underwent five neuropsychological evaluations over eight years due to learning concerns. Pregnancy complications included recurrent maternal infections/treatment and fetal heart deceleration. The patient was born at full-term with average birthweight. Patient’s history includes developmental delays, cerebral palsy, learning disabilities, anxiety, atrial septal defect, abnormal MRI and EEG, submucous cleft palate, velopharyngeal insufficiency, and craniofacial dysmorphisms. Genetic tests confirmed a likely pathogenetic variant in the CDK13-gene at 9-years-old.

Results

Patient’s intellectual functioning varied during the five evaluations, with heterogeneous performance across indices. Verbal comprehension was often a strength in the low average to average ranges. Visual perception, nonverbal reasoning, fine motor coordination/planning, attention, and aspects of executive functioning were consistently impaired. Memory across evaluations was variable but broadly average. Caregiver reports revealed increasing executive and adaptive functioning concerns and fluctuating mood/behavioral concerns across evaluations.

Conclusions

Patient’s overall intellectual functioning is generally stronger than expected compared to the few available studies. This case adds to the scarce literature on neuropsychological outcomes in children with CKD13-RD and helps elucidate developmental trends given these serial results. Additional research is needed to better understand neuropsychological presentations and long-term outcomes in children with CKD13-RD.
A - 117 Neuropsychological Profile of CSF1R-Related Adult-Onset Leukoencephalopathy with Axonal Spheroids and Pigmented Glia
Authors: Taylor Sarah E , Naini Savana M , Eskridge Courtney , Holker Erin , Logemann Allison M , Porter James , Whiteside Douglas M , Waldron Eric J
Published: October 2023

Objective

Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is a rapidly progressive neurodegenerative disorder caused by mutations in the CSF1R gene and is characterized by white matter disease, seizures, motor and cognitive impairment, and personality change. However, the existing neuropsychological literature on ALSP is limited. This exploratory study describes the cognitive profile of patients diagnosed with CSF1R-related ALSP.

Methods

7 patients with genetically confirmed CSF1R-related ALSP (Mage = 43.71, SD = 1.6; Meducation = 15.71, SD = 1.89; 71% female; 100% white) underwent neuropsychological examination as part of a pre-bone-marrow transplant work-up. Patients completed tests assessing all standard cognitive domains. Given variability in tests between evaluations, domain means were calculated for each patient and used to calculate frequencies of poor (below average and exceptionally low range) cognitive performance by domain.

Results

Two patients were asymptomatic at the time of the evaluation and performed in the low average to exceptionally high range across domains. Of the remaining patients, the average time between symptom onset and the neuropsychological evaluation was 1.6 years (SD = 0.55). Below average to exceptionally low range performances were most often observed in executive functioning (80%) and processing speed (80%) domains. 60% of symptomatic patients showed poor performances in attention, verbal skills, visual skills, and fine motor functioning domains.

Conclusions

Consistent with prior research, results suggest primarily frontal and subcortical system dysfunction. Neuropsychologists may be uniquely qualified to aid in detecting subtle cognitive changes in ALSP patients that may be critical for early detection of symptoms and treatment planning. Future studies should evaluate these findings in large and more diverse samples.
A - 118 Disenfranchised Grief as a Part of Acquired Brain Injury Recovery: Role of the Feedback Session
Authors: Tozser Timea , Williams Julie
Published: October 2023

Objective

Disenfranchised grief is a response to events or a loss that society does not acknowledge, such as a loss of sense of self, opportunity, or one’s functioning. During the neuropsychological assessment process, this societal construct can often overlook the bereavement of one’s “old self,” which diminishes the opportunity for processing loss. This poster highlights the societal creation and further perpetuation of disenfranchised grief among individuals with ABI and neuropsychologists’ duty to name it in feedback sessions, igniting holistic recovery.

Data Selection

A literature review of peer-reviewed articles from 2011 to 2022 from PubMed and Google Scholar was conducted. Keywords include disenfranchised grief, acquired brain injury, neuropsychological feedback, brain injury, neuropsychological testing, stroke, and TBI.

Data Synthesis

The societal taboo surrounding non-death grief prevents individuals from processing this grief. Implications of unaddressed disenfranchised grief can include changes in one’s sense of self, withdrawal, feeling powerless, depression, and anxiety. Disenfranchised grief commonly emerges following acute rehabilitation. This can impact optimal cognitive performance during the assessment and daily functioning.

Conclusions

The social construction of the onset of disability perpetuates the inability to acknowledge grief following brain injury. Neuropsychologists can use the feedback session to initiate the healing process surrounding disenfranchised grief. Normalizing this aspect of recovery can allow individuals and their families to holistically understand changes after brain injury and acknowledge adapting to a new way of life. Future studies should explore how the cultural implications of disenfranchised grief impact conceptualization.
A - 119 A Case Study: the Cognitive Functioning of an Adult Patient with Recurrent Craniopharyngiomas
Authors: Tse Phoebe Ka Yin , Basurto Karen S , VanLandingham Hannah , Oh Alison , Alfonso Demy , Jennette Kyle
Published: October 2023

Objective

Craniopharyngiomas are extremely rare (incidence rate of 1.34 per million). Due to its proximity to the sellar/suprasellar prefrontal regions region, cognitive impairment, behavioral changes, and adverse endocrinological outcomes are common. Further, surgery and radiotherapy can further impact functioning. Currently, there is no parsimonious cognitive profile of adult patients following interventions. This case highlights the role of neuropsychological evaluations in monitoring global psychological functioning and frontal behavioral syndrome in an adult with recurrent craniopharyngioma.

Method

The patient is a 39-year-old Black female first evaluated as an inpatient prior to resection surgery. She was evaluated on four additional times post-surgically. At the most recent evaluation, she and her family reported memory problems, apathy, and gait instability. Complicating factors included hypothyroidism, chronic kidney disease, diabetes, obstructive sleep apnea, pulmonary embolism, hypotension, COVID-19, and recurrent tachycardia, with inconsistent adherence to treatment recommendations.

Results

She displayed global cognitive deficits two years post-surgery, particularly in language and memory. Neurobehaviorally, she exhibited pervasive signs of severe frontal lobe syndrome, including, abulia, hypophonic and dysarthric speech, psychomotor retardation, bradyphrenia, and anosognosia.

Conclusion

Neuropsychological evaluations remain critical in monitoring the patient’s neurocognitive status and provide valuable insights into treatment planning and need for additional support and care to optimize patients’ quality of life in the context of significant cognitive disability.
A - 121 Psychosocial and Neurocognitive Correlates of Suicidal Thoughts and Behaviours Amongst Siblings of Persons with and without Neurodevelopmental Conditions
Authors: Wolff Brittany , Magiati Iliana , Pestell Carmela , Glasson Emma
Published: October 2023

Objective

Siblings of individuals with neurodevelopmental conditions (NDCs) have greater incidence of psychiatric diagnoses and neurocognitive difficulties compared to siblings of persons without NDCs. Despite suicidality being labelled a global health crisis, and NDC siblings experiencing risk factors implicated in suicidality, no previous studies examined suicidality amongst adolescent and young adult siblings of persons with NDCs. Our study aimed to bridge this gap.

Method

The present study used Bayesian analyses and risk classification models to examine individual and environmental risk factors associated with suicidal thoughts and behaviour amongst siblings of persons with and without NDCs (n = 267; 132 NDC, 135 control group, mean age 20.61, range 14–27, 76.40% female, 76.78% White Caucasian), as measured using self-report survey data and remote self-administered cognitive tests.

Results

NDC siblings had higher rates of current nonsuicidal self-injury (NSSI; 18.94% versus 14.07%, δ = −0.32), suicidal ideation (25.76% versus 8.89%, δ = −0.40) and history of suicide attempts (18.18% versus 4.44%, δ = −0.43) compared to controls. Classification models using boosting and random forest demonstrated adequate performance: positive predictive value 0.86–0.91, negative predictive value 0.81–0.90, false negative rates 0.11–0.24. Cognitive inflexibility, alexithymia, inattention, bullying, depression, NSSI, and eating or psychotic disorder history had the highest relative importance in predicting lifetime suicidality. Poorer executive functioning (measured by the Wisconsin Card Sorting Task, Sustained Attention to Response Task, Stop Signal Task, and N-Back 2-back task) was strongly correlated with suicidality.

Conclusions

Screening for proximal and modifiable risk factors is critical to inform suicidal behaviour intervention and prevention programs for at-risk siblings.
A - 123 Depression and Negative Symptoms Predicting Memory and Verbal Fluency in Psychotic Major Depression
Authors: Jariwala Namasvi , Sotelo Lizeth , Wu Ying Hua , Ghuman Sabrin , Kiefer Jamie P , Gomez Rowena
Published: October 2023

Objective

Although substantial research exists regarding negative symptoms and depression impacting cognitive functioning in schizophrenia, research in major depression with psychotic features (psychotic major depression; PMD) is limited (Calderon-Mediavilla et al., 2021). This study investigates if negative symptoms can predict delayed verbal memory and verbal fluency in individuals with PMD, after controlling for depression severity.

Method

As part of a larger study, 49 adults with PMD (57% female; Mage = 37.7 years) were administered the following measures. The Hamilton Depression Rating Scale measured depression severity. A negative symptoms composite score was made with items from the Brief Psychiatric Rating Scale. The California Verbal Learning Test-II measured verbal memory. The Controlled Oral Word Association Test measured verbal fluency.

Results

Depression and negative symptoms were not significantly correlated (r = 0.08, p > 0.05). After controlling for depression severity, negative symptoms explained an additional 8.5% of the variance in long-delay free recall (Adjusted R2 = 12%, p < 0.05). Depression and negative symptoms were significant unique predictors (β = 0.302, β = −0.29, respectively; ps < 0.05). After controlling for depression severity (which was not a significant predictor), negative symptoms explained 14.9% of the variance in verbal fluency (p < 0.05).

Conclusions

Negative psychotic symptoms are just as important or more important than depression severity in predicting verbal fluency and memory for individuals with depression who experience psychotic symptoms during a depressive episode. These findings improve the understanding of cognitive functioning in individuals with PMD, which can impact treatment planning.
A - 128 Sex Differences in CBF in a Pediatric Sample of Depression: a SPECT Analysis
Authors: Stafford Claire , Amen Daniel , Golden Charles , Willeumier Kristen
Published: October 2023

Objective

The present study aims to determine whether there are differences in cerebral blood flow (CBF) levels in females versus males with depression.

Method

The data for this study was derived from an archival SPECT database. Participants in the female group (n = 140, Mage = 14.48) were like those in the male group (n = 241, Mage = 13.77). Multiple independent t-tests were performed between the female and male groups on the CBF levels in the left and right sides of the cerebellum, cingulum, frontal, occipital, parietal, and temporal lobes, and subcortical areas.

Results

CBF levels in males were higher than those of females in the following areas: the left and right sides of the cerebellum, and occipital lobe, the right side of the parietal lobe, and the temporal lobe. CBF levels in females were higher than those of males in the following areas: the left and right sides of the cingulum, the vermis, and the subcortical areas.

Conclusions

While females had higher CBF in subcortical areas, the findings regarding higher CBF levels in males raise questions regarding prior literature which suggested that females have higher CBF than males in studies of depression subjects. These differences may be due to the differences in how males and females cope with depressive symptoms. Sex differences in CBF may suggest a contributing factor in the relationship between sex and responsiveness to antidepressant medication, ketamine treatment, and transcranial magnetic stimulation.
A - 129 An Examination of the Relationship between Posttraumatic Stress Disorder Symptom Severity and Cognitive Test Performance in a Veteran Sample
Authors: Valencia Julianna P , Marceaux Janice C , Andrews Anthony P
Published: October 2023

Objective

This study examined the relationship between Posttraumatic Stress Disorder (PTSD) symptom severity and cognitive test performance in veterans, hypothesizing that PTSD Checklist for DSM-5 (PCL-5) scores would be correlated with test performance on commonly used neuropsychological measures.

Method

Clinically-referred veterans without a neurocognitive disorder who passed the Test of Memory Malingering (TOMM), completed the PCL-5, and completed Weschler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Digit Span or Coding, Weschler Memory Scale-Fourth Edition (WMS-IV) Logical Memory (LMI/LMII), letter fluency (FAS), or Trail Making Test (Parts A and B) were included. The sample included 38 veterans (81.6% male); mean age = 58.79 (SD = 14.71; range 22–80) and mean education level = 13.97 years (SD = 2.42, range 6–20). Primary diagnoses included PTSD (47.4%), depression (21.1%), and no diagnosis (23.7%). Pearson, Spearman, and partial correlations were calculated.

Results

Moderate negative correlations were found between PCL-5 and FAS raw scores (r = −0.41, p = 0.014; 95%CI [−0.654,-0.089]) and LMI raw scores (r = −0.453, p = 0.02; 95%CI [−0.715,-0.080]). After controlling for age and education, moderate negative correlations remained for FAS (r = −0.46, p = 0.004) and LMI (r = −0.43, p = 0.018) and a weak, non-significant correlation with LMII (r = −0.297, p = 0.079).

Conclusions

In veterans with valid cognitive test performance and no neurocognitive disorder, PTSD symptom severity negatively correlated with FAS and WMS-IV LM performance. This suggests PTSD symptoms may influence performance on phonemic fluency and story recall task. Assessing and addressing PTSD symptoms may result in more accurate diagnoses and improved cognitive functioning. Understanding the PTSD-cognition relationship can inform interventions and support strategies to enhance veterans’ quality of life.
A - 130 Differences in Emotion Identification in Schizophrenia, Bipolar with or without Psychosis, and Healthy Controls
Authors: Gates-Woodyatt Jessica , Ringdahl Erik N , Salva Christine , Rairata Yuan , Jarvis Sierra , Allen Daniel N
Published: October 2023

Objective

Research suggests individuals with schizophrenia and bipolar with psychotic features have difficulty accurately identifying emotions expressed by others. Such findings raise questions to whether impairments in emotion identification are better explained by the presence of psychosis, regardless of diagnosis.

Method

The Emotion Evaluation Test (EET) of The Awareness of Social Inference Test (TASIT) was administered to individuals with schizophrenia (SZ; N = 22), bipolar disorder with psychotic features (BP+; N = 20), bipolar disorder without psychotic features (BP-; N = 21), and healthy controls (HC; N = 22). The EET comprises 24 video vignettes portraying happiness, surprise, sadness, anger, fear, disgust, and neutral emotions. Participants were prompted to identify the emotion in each vignette. Emotion identification of positive, negative, and neutral emotions was compared between groups.

Results

Group comparisons showed that the SZ group performed significantly worse than the other groups when identifying positive and negative emotions. The BP+ group performed significantly worse than BP- and HC when identifying negative emotions. No significant differences were found in neutral emotion identification between groups.

Conclusions

The BP+ group was less accurate in identifying negative emotions but not positive emotions compared to the BP- and HC groups. Further investigation is required to determine factors that contribute to this differential performance.
A - 133 Self-Reported Loss of Consciousness Predicts Executive Functions in Veterans with a History of Traumatic Brain Injury
Authors: Adhikari Ashna , Brooks Jared , Watson Kelsey , Morris Elizabeth E , LoBue Christian , Motes Michael , Cullum C Munro , Hart John , Chiang Hsueh-Sheng
Published: October 2023

Objective

The long-term cognitive effects of traumatic brain injury (TBI) in military personnel remain unclear and need to be better understood. We assessed how cognitive performance was related to the remote history of TBI involving loss of consciousness (LOC) and blast injury (regardless of LOC) in veterans.

Method

Veterans (N = 101; age 42.8 ± 10.5 years; 10 Females) with a self-reported history of TBI and persistent cognitive symptoms were recruited. Effects of (1) the presence of LOC, (2) total number of TBIs with LOC (0, 1–2, >2), and (3) the presence of blast injury were examined on composite scores from tests of executive function (Trail-Making Test B, Color Word Interference), word retrieval (Boston Naming, Letter and Category Fluency), processing speed (Trail Making-A, Color Word Naming/Reading), and episodic memory (Rey-Auditory Verbal Learning Test-total learning and delayed recall), while controlling for age, sex, years of education, and total number of TBIs.

Results

TBI with LOC was a significant predictor of executive function (p = 0.014) and processing speed (p = 0.014), with more episodes of LOC predicting lower functioning, but not of word retrieval or episodic memory (p > 0.1). Additionally, presence of a blast injury, regardless of LOC, did not predict differences in function on any of the composite measures.

Conclusions

Self-reported TBI history with LOC was associated with poorer executive function and processing speed. The findings further characterize the relationship between TBI history and long-term cognitive sequelae in veterans, particularly suggesting LOC can affect neural systems underlying executive function and processing speed.
A - 135 The Relationship between Executive Functioning and Psychological Outcomes Post Mild Traumatic Brain Injury
Authors: Balloun Bailey A , Kent Whitman , Fawcett Maddie , Martin Ethan , Pyykkonen Ben , Han Dan
Published: October 2023

Objective

Cognitive outcomes post mTBI are well-researched, but the relationship between executive functioning and psychiatric outcomes have received much less attention. This study explored emotional outcomes of individuals who sustained a mTBI and the potential relationship to executive functioning. A research study by Zainal & Newman (2021) found that older adults with severe depression and anxiety experienced increased inflammation, which potentially resulted in reduced executive functioning. mTBI is also associated with inflammation – potentially providing a compound effect or interaction. Additional research is needed to clarify the potential compound impact of mTBI and depression and anxiety might have upon cognition.

Method

185 individuals were extracted from an archival clinical database of neuropsychological evaluations of individuals noting deficits following mTBI. Executive functioning was measured using Trail Making Test B (TMT-B). Emotional distress was assessed using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). A Multiple Linear Regression was used to assess the impact of emotional distress (BAI and BDI) upon executive functioning performance (TMT-B) in this population.

Results

Regression analysis identified a relationship between emotional distress upon executive functioning that approached significance (p = 0.057; r^2 = 0.031).

Conclusions

These findings are consistent with previous literature suggesting a modest relationship between emotional distress and executive functioning – this time in a sample with mTBI population. Specific injury, resilience, and other confounding factors to clarify the actual risk and relationship is warranted.
A - 136 Association of Pre-Injury Anxiety and Oculomotor Symptoms Following Concussion among Adolescents
Authors: Burley Chris , Patel Shan , Kegel Nathan , Collins Michael , Kontos Anthony
Published: October 2023

Objective

To investigate the utility of demographic risk factors and post-concussion oculomotor symptoms to identify adolescents with anxiety panic disorder symptoms.

Method

Participants included 124 patients (63 male) aged 10 to 18 (M = 14.4, SD = 2.3) within 2–30 days of injury (M = 9.3, SD = 6.3) who presented to a concussion specialty clinic between 2017–2018. All participants completed the Screening for Child Anxiety Related Disorders (SCARED-C) to evaluate pre-injury anxiety as well as the Vestibular/Ocular Motor Screening (VOMS) as part of standard clinical care. A backward logistic regression (LR) was employed to determine the utility of symptom provocation on oculomotor components of the VOMS (i.e., smooth pursuits, horizontal saccades, vertical saccades, and near point of convergence) and demographic risk factors (i.e., history of anxiety or depression and gender) to identify adolescents with panic disorder symptoms on the SCARED-C.

Results

The LR model was statistically significant (χ2 (6) = 26.8, p < 0.001) and explained 32.0% of the variance. The model correctly classified 84.7% of cases with high specificity = 0.97 but low sensitivity = 0.27. Variables retained in the model included provocation of dizziness during vertical saccades (OR = 1.85, p = 0.016), self-reported history of depression (OR = 7.34, p = 0.032), and sex (i.e., female; OR = 5.45, p = 0.009).

Conclusion

The results indicate that symptom provocation on oculomotor components of the VOMS (i.e., dizziness during vertical saccades), sex, and self-reported history of depression diagnosis are modest predictors of panic disorder symptoms in adolescents. Clinicians should consider these symptoms when interpreting symptoms post-injury.
A - 139 Neurobehavioral Symptoms Are Not Associated with Objective Neuropsychological Test Performance in a Group of Veterans and First Responders Seeking Care for Post-Concussive Symptoms
Authors: Cernasov Paul M , Cole Wesley R , Kane Shawn F , Kanser Robert J , Mihalik Jason P , Sirhal Stephanie R
Published: October 2023

Objective

Subjective post-concussive neurobehavioral symptoms do not often relate to objective cognitive assessment. This archival analysis aimed to characterize the relationship of subjective neurobehavioral symptoms to neuropsychological tests among military veterans and retired first responders with previous mild TBI (mTBI) presenting to an outpatient multidisciplinary program.

Methods

51 patients (88% male; 82% White; 94% veteran), ages 25–68 (M = 43.9, SD = 10.1) underwent neuropsychological evaluation with a flexible battery (M subtests = 29.6; SD = 5.2), through the Transforming Health and Resilience in Veterans (THRIVE) Program at UNC-Chapel Hill. The proportion of below average neuropsychological scores (i.e., ≤ 8th percentile on published norms) was modeled as a function of three subscales (Affective, Cognitive, Somatosensory) on the Neurobehavioral Symptom Inventory (NSI) and estimated premorbid IQ (PIQ) using fractional logit regression with quasi-maximum likelihood estimation and heteroskedasticity consistent “HC1” standard errors. Model diagnostics and sensitivity analyses for overly influential cases (|DFBETAS| ≥ 2/√n) were conducted.

Results

Thirty-eight individuals were included in analyses after removing those with invalid test performance (n = 4) and missing data (n = 9). The mean (median) observed below average scores was 10.9% (5.7%), with the predicted proportion at 8%. No NSI subscale was related to neuropsychological performance. However, upon removal of two overly influential cases, PIQ was inversely associated with rate of low scores - OR: 0.61 (95% CI: 0.36–0.97), SE: 0.14, p = 0.035.

Conclusion

Subjective neurobehavioral symptoms were unrelated to objective neuropsychological tests in veterans and first responders seeking care for TBI-related symptoms.
A - 141 Effects of Posttraumatic Growth on Current and Predicted Future Satisfaction with Recovery in Patients with Moderate/Severe Traumatic Brain Injury and their Families
Authors: Fedio Alison A , Nastea Katerina , Sexton James , Dekarchuk Marina , Dinklocker Brandy , Jackson KaShawn , Rafel Hannah , Okeke Chioma , Jowi Esther , Swartz Allison , Lebedun Alec
Published: October 2023

Objective

This study was designed to assess effects of posttraumatic growth (PTG) on ratings of current and predicted future functioning in adults with moderate–severe traumatic brain injury (mod-sev TBI) and their family members.

Method

Fifteen adults with mod-sev TBI (age 34.5; 4.1 yrs post), and a family member for each, rated current, and predicted 2–3-year future, satisfaction with physical, cognitive, and emotional recovery. All participants also completed the Neurobehavioral Functioning Inventory, and patients completed the Motivation for TBI Rehabilitation Questionnaire. PTG was assessed by raters independently judging the content of brief narratives written by the patients. Results of repeated measures within-subjects contrasts and independent samples t-tests are reported at the p < 0.05 level.

Results

Findings for individuals with (vs without) PTG revealed greater agreement of current and future satisfaction by self and family member, including greater satisfaction with depression and aggression. Families rated less concern across areas of functioning, especially regarding aggression, for individuals with (vs without) PTG. Patients with (vs without) PTG rated poor current satisfaction with memory. Overall, patients with (vs without) PTG were less interested in rehabilitative treatment.

Conclusions

Results align with published findings regarding PTG reflecting acceptance of personal challenges. Benefits to negative emotions are notable. Reasons for patients’ current dissatisfaction with their memory, juxtaposed with satisfaction with their future memory, merits further study but may relate to patients’ noticing memory difficulties while being evaluated. Less interest in rehab may relate to patients with PTG believing they were functioning well overall and therefore being less in need of treatment.
A - 142 The Somatic Factor Drives Elevations on the Beck Depression Inventory-2 in Mild Traumatic Brain Injury
Authors: Glisky Martha L , Caughie Cali , Chu Zoey , Hayden Abigail
Published: October 2023

Objective

The Beck Depression Inventory-2 (BDI-2) is used to identify depression, which is common following a mild traumatic brain injury (mTBI). This study explored the specific type of symptom cluster (Affective, Cognitive and Somatic) most commonly endorsed in mTBI.

Method

A sample of 138 individuals diagnosed with an mTBI completed the BDI-2 during a clinical neuropsychological evaluation. A one-way repeated measures Analysis of Variance (ANOVA) was conducted to examine whether the type of symptoms reported on the BDI-2 differed in our mTBI sample.

Results

The sample included 63% females, with mean age of 46.93 (SD = 13.28) and a mean education level of 15.08 (SD = 2.65).

There was a significant main effect of BDI-2 factors, F (1.74, 238.5) = 199.211, p < 0.001, partial η2 = 0.25. Post-hoc pairwise comparisons (with Bonferroni correction) revealed differences between all three clusters, with significantly more somatic symptoms endorsed (M = 11.07, SD = 4.77, p < 0.001) compared to cognitive symptoms (M = 6.51, SD = 5.44, p < 0.001) and affective symptoms (M = 5.01, SD = 2.81, p < 0.001).

Conclusion

High scores on the BDI-2 were driven primarily by somatic symptoms, followed by cognitive symptoms, and lastly affective symptoms in our mTBI sample. The overlap between the BDI-2 somatic symptoms and post-concussive symptoms raises the question as to whether mTBI patients have higher rates of depression or just higher physical mTBI symptoms elevating the BDI-2. The implications for rates of depression in mTBI, and appropriate treatments will be discussed.
A - 144 Prior Concussions and Symptom Elevation Rates in Collegiate Student-Athletes at Preseason Baseline
Authors: Ingram Eric O , Karr Justin E
Published: October 2023

Objective

Assess how prior concussions are related to baseline symptom endorsement using a four-factor model of post-concussion symptoms (i.e., cognitive, sleep-arousal, physical, and affective).

Method

Athletes from the Concussion Assessment, Research, and Education consortium (Nf7,370; 64% Male; 62% White; 36% Freshmen; 15% Football players) with at least one prior concussion were administered the Sport Concussion Assessment Tool-3 Symptom Evaluation at baseline. Subscale and total scores ≥84th percentile were considered elevated based on normative reference data from uninjured participants matched on gender and number of preexisting conditions.

Results

The symptoms of Headache, Pressure in head, Sensitivity to light, and Difficulty remembering were endorsed at a significantly higher rate (ps < 0.001, OR range = 1.35 to 1.40) by those with two or more prior concussions compared to those with one prior concussion. Approximately 22% of athletes had an elevated subscale score without an elevated total score. In contrast, no athletes were elevated on the total score without also being elevated on a subscale score, and 18% of athletes were elevated on both a subscale and the total score. The physical subscale was consistently the most frequent exclusively elevated subscale in the full sample (cognitive = 4%; physical = 10%, sleep-arousal = 6%, affective = 7%).

Conclusion(s)

Prior concussion status is related to item-level symptom endorsement among collegiate athletes at preseason baseline. A multidimensional approach to symptom interpretation identified a sizeable number of athletes (i.e., 22%) with significant symptoms that were not captured by a total score elevation. Most athletes with an elevated subscale score (i.e., 55%) were experiencing physical symptoms.
A - 145 Using a Multidimensional Symptom Model to Identify Persistent Post-Concussion Symptoms in Collegiate Athletes
Authors: Ingram Eric O , Karr Justin E
Published: October 2023

Objective

Determine if a multidimensional (i.e., four-factor model) approach to post-concussion symptoms identifies more participants with persistent post-concussion symptoms after a sport-related concussion than a standard total score approach.

Method

Student-athletes (N = 1097; 61% Male; 59% White; 35% Freshmen; 14% Football athletes) from the Concussion Assessment, Research, and Education consortium completed the Sport Concussion Assessment Tool-3 Symptom Evaluation six months after a concussion. Scores ≥84th percentile compared to normative data were considered elevated. Elevation rates for total and subscale scores were compared to examine the utility of a multidimensional interpretation in identifying persistent symptoms.

Results

Six months after injury, 9.9% of athletes had symptom elevations on the total or subscale score. Overall, 8.1% of athletes were elevated on a subscale (i.e., physical = 3.9%, cognitive = 1.9%, affective = 2.3%, sleep-arousal = 1.7%) but not the total score, whereas just 1.8% were elevated on both a subscale and the total score. No athletes were elevated on the total score without being concurrently elevated on a subscale.

Conclusion(s)

Multidimensional symptom interpretations may aid in identifying cases of persistent post-concussion symptoms, detecting up to 8.1% of athletes with elevated symptoms that would not be detected by focusing on a total score alone. This study did not assess for daily symptoms, which is one of the consensus criteria for persistent post-concussion symptoms. Future research should evaluate whether specific subscale elevations correspond to functional deficits or adverse health outcomes in these athletes.
A - 146 Subjective and Objective Cognitive Functioning in Women Survivors of Intimate Partner Violence with Repetitive Mild Traumatic Brain Injuries
Authors: Karr Justin E , White Agnes E , Leong Sharon E , Logan T K
Published: October 2023

Objective

This study examined subjective and objective cognitive functioning among women survivors of intimate partner violence (IPV) with a history of repetitive mild traumatic brain injury (mTBI), hypothesizing they would have elevated subjective cognitive complaints and lower objective cognitive test performances compared to national norms.

Method

Women were recruited from a domestic violence shelter (N = 16; M = 39.8 ± 7.9 years-old) and completed the Neurological Quality-of-Life Cognitive Function questionnaire (Neuro-QoL-CF), Rey Auditory Verbal Learning Test (RAVLT), NIH Toolbox Cognition Battery (NIHTB-CB), and Delis-Kaplan Executive Function System (D-KEFS) Trail Making and Verbal Fluency tests. One-sample t-tests compared mean scores against national norms for the Neuro-QoL-CF, RAVLT trials 1–5 and delayed recall, NIHTB-CB Crystallized-Fluid difference score, and D-KEFS composite index score.

Results

Nearly all women (81.3%) reported elevated subjective cognitive concerns on the Neuro-QoL-CF, significantly greater than the national average, t = 10.50, p < 0.001, d = 2.62. RAVLT learning, t = 5.41, p < 0.001, d = −1.35, and delayed recall, t = 4.54, p < 0.001, d = −1.28, were significantly lower than the national average. NIHTB-CB difference scores were significantly higher than the national average, t = 5.23, p < 0.001, d = 1.14, indicating worse fluid cognition than anticipated compared to estimated premorbid functioning. Mean D-KEFS composite scores were comparable to national norms, t = 0.73, p = 0.474, d = 0.18.

Conclusions

Women survivors of IPV with repetitive mTBI history had greater subjective cognitive concerns and lower cognitive test performances compared to national norms, indicating cognitive health needs in this population. These findings may be attributable to repetitive mTBI or other neurobehavioral variables that may affect this population, including concurrent physical conditions (e.g., headache), mental illness, chronic pain, substance use, or a combination thereof.
A - 147 Activity Scheduling of Rewarding Activities Is Associated with Decreased Negative Affect and Increased Sense of Accomplishment in a Sample with Anxiety and/or Depression and Traumatic Brain Injury
Authors: Kerr Alissa L , Rabinowitz Amanda R
Published: October 2023

Objective

To determine the effect of activity scheduling as part of a Behavioral Activation (BA) trial on ecological momentary assessment (EMA) of affect and reward in persons with anxiety and/or depression and chronic moderate to severe traumatic brain injury (TBI).

Method

A sample of adults (N = 32) with moderate to severe TBI sustained ≥6 months prior to enrollment, and at least mild depression and/or anxiety were selected from a larger treatment study (N = 60) based on their BA treatment group assignment and EMA response rate. Participants responded to a smartphone app five times daily for approximately 2 weeks prior to and 6 weeks after initiation of activity scheduling (8-week total), while participating in a BA treatment program as part of a randomized controlled trial. The EMA included 0–6 Likert ratings of perceived enjoyment/accomplishment, and the Positive and Negative Affect Scale (PANAS). Average daily scores for positive affect (PA), negative affect (NA), enjoyment, and accomplishment were calculated, and repeated measures general linear modeling was employed to examine the effect of activity scheduling on each outcome.

Results

We found that activity scheduling had a significant impact on reducing NA (F[1,31] = 11.0, p = 0.002) and increasing sense of accomplishment (F[1,31] = 10.46, p = 0.003). We did not detect a significant difference with regards to PA (F[1,31] = 1.41, p = 0.245) or enjoyment (F[1,31] = 2.39, p = 0.132).

Conclusions

Our findings suggest that activity scheduling as part of BA may be helpful for reducing negative affect and increasing a sense of accomplishment in participants with mental health concerns following moderate to severe TBI.