bluuebunny/crossref_metadata_2025 huggingface dataset:
A - 148 Pre-Injury Personality and Engagement in Inpatient Rehabilitation Following TBI
Authors: Krasucki Lauren , Wingfield Roberto , Rabinowitz Amanda
Published: October 2023

Objective

We sought to evaluate the relationship between pre-injury motivational systems and engagement in inpatient rehabilitation (IR) following moderate-to-severe traumatic brain injury (msTBI).

Methods

We recruited 20 individuals, aged 18–80 years, from IR with msTBI as evidenced by a GCS score < 13, loss of consciousness ≥60 minutes, post-traumatic amnesia (PTA) of at least 24 hours, and/or positive findings on neuroimaging. After emergence from PTA, participants reported on their general behavior and personality prior to their injury in a verbal interview, which included the 24-item BIS/BAS Scale. This scale measures the behavioral inhibition system (BIS), which motivates avoidance of aversive outcomes, and the behavioral activation system (BAS), which motivates approach to goal-oriented outcomes. Rehabilitation therapists rated participants’ engagement in each physical (PT), occupational (OT), and speech therapy (ST) session using the Rehabilitation Intensity of Therapy Scale. We assessed the relationship between BIS/BAS scores and average level of engagement in each rehabilitation discipline using Pearson’s correlation.

Results

The sample was 65% male and 65% white with a mean age of 38.95 years (SD = 19.57) and a mean education of 13.45 years (SD = 2.61). Engagement in PT was significantly correlated with BAS Drive, r(18) = −0.55, p = 0.012; BAS Fun-Seeking, r(18) = −0.55, p = 0.013; and BAS Reward Responsiveness, r(18) = −0.56, p = 0.010. There were no significant correlations between the BIS/BAS subscales and engagement in OT or ST.

Conclusion

Pre-injury motivation to approach goal-oriented outcomes predicts engagement in inpatient PT following msTBI, which may impact treatment benefit and subsequent functioning.
A - 151 Assessing the Role of Executive Function in the Memory Performances of Retired National Football League Players
Authors: Lopez Hernandez Daniel W , Cantu Robert , Guskiewicz Kevin M , Kelly Daniel F , Swerdloff Ronald , Woo Ellen , Wright Matthew J
Published: October 2023

Objective

We evaluated the relationship between retired National Football League players executive functioning (EF) abilities on verbal memory performance and subprocesses.

Method

Fifty-eight participants were divided into two groups: intact executive functioning (IEF) and deficit executive functioning (DEF). Participants completed the California Verbal Learning Test, Second Edition (CVLT-II) to evaluate verbal memory performance. Additionally, the Item Specific Deficit Approach (ISDA) was applied to the CVLT-II to quantify verbal memory subprocesses (i.e., encoding, consolidation, & retrieval). Next, we determined which ISDA indices predicted long-delayed free recall (LDFR) for both groups. We then computed hierarchal regressions to determine which ISDA indices were predictive of LDFR for each group. Next, we retained significant predictors from the ISDA and correlated them with measures of executive function in both groups with and without partialling out cognitive reserve (CR).

Results

We found the IEF group outperformed the DEF group on the CVLT-II learning trials and LDFR, and demonstrated better encoding abilities. Hierarchical regression revealed that the ISDA was predictive of LDFR in both groups. The DEF group LDFR issues were only predicted by encoding problems. In contrast, LDFR deficits in the IEF were primarily driven by consolidation problems. The ISDA encoding index correlated with Trail Making Test part B and Phonemic Fluency Test. However, after partialling out the variance accounted for by CR, the associations between the encoding index and executive function were nonsignificant.

Conclusions

Our results suggest that greater executive function results in better memory performances in retired football players. Lastly, improved executive function is related to greater CR.
A - 155 Southern African Parents’ Concussion Knowledge and Intention to Report Youth Athletes
Authors: Lonsdale Louise C , Ernst William , Fetterman Joshua , Kneavel Meredith
Published: October 2023

Objective

To determine Southern African parents’ concussion knowledge and intention to report in youth athletes.

Method

A diverse sample of 48 Southern African parents of youth athletes ages 5–18 completed an online survey. Recruitment included: 1) contacting school administrations to forward the survey to parents and 2) a social media post. The Concussion Knowledge Checklist (CKC) consists of 27 items, 19 true and eight false symptoms, with a score range of 0–54. The Intention to Report Scale consists of seven questions on a Likert scale, with a score range of 7–49. Higher scores indicate greater knowledge and intention to report, respectively.

Results

CKC score (M = 37.24; SD = 7.1) indicates a moderate degree of concussion knowledge. Certain symptoms (i.e., blurred vision) were accurately endorsed at a high rate (83%). Conversely, affective symptoms, such as more emotional, were accurately endorsed at a low rate (25%). The Intention to Report Scale score (M = 40.98; SD = 5.97) suggests a moderate to strong degree of participants’ intention to report.

Conclusions

Participants indicated a moderate degree of concussion knowledge. However, variability was evidenced by some symptoms (e.g., blurred vision) endorsed at a high rate and others, for example, more emotional, at a low rate. These findings have possible implications for concussion education. The Intention to Report Scale indicated a moderate to strong degree of parents’ intention to report their children with a suspected concussion.
A - 156 History of Mild Traumatic Brain Injury Is Not Associated with worse Neuropsychological Functioning in Amnestic Mild Cognitive Impairment
Authors: Neaves Stephanie , Helphrey Jessica , Cabrera Hannah , Lacritz Laura , Schaffert Jeff , Smernoff Eric , Logan Rebecca , Nguyen Trung , Khera Alka , Hart John , Cullum C Munro , LoBue Christian
Published: October 2023

Objective

The mechanisms for traumatic brain injury (TBI) being a risk factor for Alzheimer’s disease is unclear, and whether mild TBI (mTBI) may relate to decreased neural circuit functioning in the prodromal phase is unknown. This study examined whether a history of mTBI was associated with lower functioning of neural circuits, measured with neuropsychological tasks, in amnestic Mild Cognitive Impairment (aMCI).

Method

Twenty older adults (MAge = 71 years; 70% Male; 90% White) with aMCI were recruited to complete a detailed TBI interview and were classified based on the presence (mTBI+ n = 13) or absence (mTBI- n = 7) of past mTBI. Most mTBI+ participants (n = 11) had multiple mTBIs, and on average were 32 years from last injury. A comprehensive neuropsychological assessment was administered, and composite T-scores were calculated for the domains of attention, executive functioning, memory, and language. One-tailed T-tests were conducted to compare the means between groups.

Results

No statistically significant differences (p’s = 0.06–0.09) were found between the groups in memory (mTBI+ M = 38.11; mTBI- M = 33.19), executive function (mTBI+ M = 48.79; mTBI- M = 43.09), language (mTBI+ M = 48.12; mTBI- M = 43.09), or attention (mTBI+ M = 40.54; mTBI- M = 35.57). Nonetheless, medium effect sizes were seen for the mTBI+ group performing better than the mTBI- group on all composite scores (Cohen’s d = 0.45–0.66).

Conclusions

A history of mTBI was not associated with poorer neuropsychological performance in aMCI, often a prodromal stage of Alzheimer’s disease. While concerns about later-in-life effects from multiple mTBIs is prevalent, repetitive mTBI may not be related to lower neural circuit functioning in aMCI, though further evaluation with larger samples is needed.
A - 157 Neurobehavioral Symptoms in Veterans with Deployment-Related TBI: Examining the Additional Impact of Pre- and Post-Deployment Tbis
Authors: Ozturk Erin , Yim Jaelynn , Chanfreau-Coffinier Catherine , Merritt Victoria
Published: October 2023

Objective

We utilized a large sample of Veterans who had sustained a traumatic brain injury (TBI) during deployment to evaluate the additional impact of pre- and post-deployment TBI’s on neurobehavioral symptoms.

Method

Participants included 9934 Veterans (90.9% male; age: M = 34.5) diagnosed with TBI during the Veterans Health Administration’s Comprehensive Traumatic Brain Injury Evaluation (CTBIE), a clinician-administered interview that includes an assessment of pre-, during-, and post-deployment TBI. The Neurobehavioral Symptom Inventory (NSI) is administered as part of the CTBIE, from which five subscale scores were evaluated: vestibular, somatic/sensory, cognitive, affective symptoms, and symptom interference. Chi-square tests evaluated the relationship between TBI group (“TBI during deployment only” [n = 6886]; “pre-deployment TBI” [n = 1835]; “post-deployment TBI” [n = 775]; “both pre/post-deployment TBI” [n = 438]) and NSI subscale scores (dichotomized into high vs. low symptoms).

Results

There was a significant association between TBI status and all five symptom scores (p’s ≤ 0.001; V = 0.04–0.06). The “post-deployment TBI” group endorsed the highest rates of symptoms across all NSI scores except vestibular. Pairwise comparisons showed that the “post-deployment TBI” and “both pre/post-deployment TBI” groups endorsed comparable rates of symptoms, while both groups generally endorsed higher rates of symptoms compared to the “pre-deployment TBI” and “TBI during deployment only” groups. Finally, rates of symptoms among these latter groups (pre-deployment and during deployment) did not differ from each other.

Conclusions

Results suggest that post-deployment TBI’s have a greater impact on symptom endorsement than pre-deployment TBI’s. Findings highlight the importance of evaluating both number and timing of TBI’s and the value of providing psychoeducation around brain health to this population.
A - 158 The Effects of Migraine and Traumatic Brain Injury on Subjective Cognitive Functioning in Veterans in the Million Veteran Program
Authors: Ozturk Erin , Merritt Victoria , Afari Niloofar , Gasperi Marianna
Published: October 2023

Objective

The relationship between migraine and cognitive symptoms in Veterans is a complex issue, made more challenging by the high prevalence of traumatic brain injury (TBI) in this population. This study examined the relationship between migraine, TBI, and subjective cognitive function.

Method

Participants included 338,217 Veterans enrolled in the Million Veteran Program who completed the Medical Outcomes Study Cognitive Functioning Scale Revised (MOS-Cog-R), a self-report measure of cognitive functioning. Veterans were categorized into the following groups: (1) both migraine and TBI history (n = 7828), (2) migraine-only (n = 22,252), (3) TBI-only (n = 24,078), and (4) no history of migraine or TBI (n = 284,059). MOS-Cog-R scales were compared across groups using the Kruskal-Wallis Test for omnibus differences and Dunn’s test and Cliff’s Delta for effect size calculations of differences between groups.

Results

The migraine/TBI group reported the highest prevalence of cognitive symptoms across all domains (range: 76.1% for confusion to 90.5% for forgetfulness). In contrast, the no migraine/TBI group had the lowest prevalence of cognitive problems (range: 32.0% for confusion to 63.7% for forgetfulness). All omnibus group differences were statistically significant (p < 0.001), and nearly all pairwise comparisons were significant, except for some of the migraine-only vs. TBI-only group comparisons.

Conclusion

Results showed a “dose–response” relationship between diagnostic group and subjective cognitive symptoms, such that the migraine/TBI group fared the worst, followed by the TBI-only and migraine-only groups, and finally the no migraine/TBI group. Findings set the stage for follow-up work to be conducted within MVP that will address the neurobiological underpinnings of cognitive distress in this population.
A - 159 The Influence of Sleep Duration on Reported Post-Concussion Symptoms Following Cognitive Exertion
Authors: Peart Zachary , Brett Jonathan , Arias Brittny , Bennett Ryan
Published: October 2023

Objective

To investigate the influence of self-reported sleep disturbance on post-concussion symptom clusters after completing the ImPACT concussion screening tool in collegiate athletes.

Method

Participants (Nf215) were selected from a deidentified sports medicine ImPACT database. Participants were stratified into groups based on self-reported sleep disturbance: intact sleep duration (n = 150, Mage = 19.2, Medu = 11.8,64.7% female) and hyposomnia (n = 65, Mage = 22.5, Medu = 13.8,72.3% female). Data were included from the first post-injury follow-up session. Groups did not differ in gender, age, or years of education. ANCOVAs were used to test for differences in cognitive, physical, and neuropsychiatric symptom clusters post-ImPACT while controlling for pre-ImPACT symptoms and previous concussions.

Results

ANCOVA indicated a significant effect of sleep duration on cognitive (F(1,192) = 13.01,p < 0.001,ηp2 = 0.063), physical (F(1,154) = 7.29,p = 0.008,ηp2 = 0.045), and neuropsychiatric (F(1,192) = 6.24,p = 0.013,ηp2 = 0.031) symptoms reported after completing the ImPACT screening assessment. Mean comparisons revealed that the hyposomnia group reported symptom scores 1.5 points greater on cognitive (SE = 0.42), 1.4 points greater on physical (SE = 0.52), and 0.78 points greater on neuropsychiatric (SE = 0.31) symptom clusters.

Conclusion

Results indicated that athletes who endorsed sleeping less during concussion recovery reported greater symptom scores after completing cognitive screening when controlling for pre-screening symptoms. These findings align with previous research suggesting that sleep dysfunction may negatively impact the recovery process. Our findings suggest that reduced sleep duration may lead to worsened symptoms following cognitive exertion, thereby exacerbating deficits and potentially lengthening the recovery trajectory. As a result, these athletes may benefit from interventions targeting sleep and a gradual return to sport.
A - 160 Cognition over Time in Chronic sTBI with Non-Neurologic Comorbidities in Residential NeuroRehab
Authors: Pigman Matthew C , West Sarah
Published: October 2023

Objective

Traumatic brain injury has been associated with increased risk of many comorbid neurologic and non-neurologic disorders (Masel & DeWitt, 2010). There is scant literature, however, to describe serial assessment of cognitive changes associated with comorbid non-neurologic disorders and sequelae in patients with chronic, severe traumatic brain injury (sTBI).

Method

A 60-year-old, right-handed, White male sustained an sTBI at age 15 secondary to a motor vehicle collision and subsequently developed behavioral and substance use problems, before being placed in a long-term residential neurorehabilitation program. He later developed kidney disease, believed to be the result of long-term use of anti-epileptic drugs (AEDs) that were prescribed to control seizures that developed following his brain injury. He continued to experience seizures, despite taking AEDs. Staff at his residential program reported concerns of declines in cognition and daily functioning over the past three years.

Results

Compared to results from two previous evaluations performed approximately four and six years prior, he demonstrated reductions in attention and working memory, processing speed, executive functioning, auditory and reading comprehension, and functional living skills. Expressive language, memory, and visuospatial skills were generally consistent with previous evaluations.

Conclusions

Due to significant reductions across multiple cognitive domains, and multiple potential contributing factors, including ongoing seizures, late-stage kidney disease, and a possible superimposed neurodegenerative disorder, it was recommended that the patient continue to undergo serial neurocognitive testing to monitor for further decline and provide etiological clarification. The results were used by his therapists, residential program staff, and neurology providers to inform his treatment planning and care.
A - 161 Acute Injury Characteristics and Cognitive Post-Concussion Symptom Reporting in Collegiate Athletes with Sports-Related Concussion
Authors: Sakamoto McKenna S , Thomas Garrett A , Bradson Megan L , Merritt Victoria C , Arnett Peter A
Published: October 2023

Objective

Surprisingly little is known about how acute injury characteristics (i.e., loss of consciousness [LOC], retrograde amnesia [RA], and anterograde amnesia [AA]) predict cognitive symptom reporting after sports-related concussion (SRC). This study examined this relationship in collegiate athletes who sustained an SRC. We predicted that athletes who endorsed LOC, RA, and AA would report more cognitive symptoms.

Method

141 collegiate athletes who recently sustained an SRC were grouped based on whether they experienced LOC, RA, or AA. Cognitive symptoms were assessed by the cognitive cluster of the Post Concussion Symptoms Scale (PCSS-Cog) both categorically (i.e., presence of symptoms) and continuously (i.e., total score). Chi-square tests investigated group differences on the presence of cognitive symptoms, and independent samples t-tests examined group differences on PCSS-Cog scores.

Results

Athletes who experienced RA were significantly more likely to report cognitive symptoms than those without RA (RA+/PCSS-Cog+ = 62.50%; RA-/PCSS-Cog+ = 40.17%), X2 (1, N = 141) = 4.03, p = 0.045. Similar results were observed for athletes who endorsed AA (AA+/PCSS-Cog+ = 58.82%; AA-/PCSS-Cog+ = 35.56%), X2 (1, N = 141) = 7.15, p = 0.007. There was not a significant relationship between cognitive symptom endorsement and LOC. Athletes who experienced AA had significantly higher PCSS-Cog scores (M = 3.27, SD = 4.60) than those without AA (M = 1.39, SD = 3.04), t(75.22) = 2.62, p = 0.011, 95% CI[0.45, 3.32]. However, there was not a significant relationship between PCSS-Cog scores and LOC or RA.

Conclusions

Results suggest that athletes who experience amnesia during SRC are more likely to report cognitive symptoms post-concussion. Moreover, amnesia may be a risk factor for increased self-reported cognitive dysfunction, and athletes who experience RA and especially AA may require more careful SRC management.
A - 162 Comparing Bilingual and Monolingual Baseline Post-Concussion Symptom Scale Network Structures
Authors: Salva Christine E , Kuwabara Hana C , Goodwin Grace J , Goto Amber , Ross Staci , Kinsora Thomas , Allen Daniel N
Published: October 2023

Objective

Studies comparing Post-Concussion Symptom Scale (PCSS) ratings between bilingual Spanish/English- and monolingual English-speaking athletes have found increased symptom endorsements for bilingual individuals. Conducting network analysis on PCSS scores and comparing network structures between bilingual and monolingual individuals can help characterize possible differences in symptom interactions between these two groups. We conducted baseline PCSS network comparisons between bilingual and monolingual high school athletes to examine differences in symptom interactions.

Method

Bilingual (n = 5201) and monolingual (n = 5201) athletes completed the PCSS in English (matched by age, gender, and sport type). Network analysis was conducted on valid baseline PCSS scores, with nodes representing symptoms and edges representing partial correlations among symptoms. Each symptom’s importance was determined by calculating their expected influence. Network connectivity, structure, and symptoms’ expected influences were compared using Network Comparison Tests.

Results

Both networks had positive and negative edges. The strongest edges connected symptoms within similar domains (i.e., “feeling more emotional” and “sadness”). Node expected influence was stable in both networks. “Feeling more emotional”, “difficulty concentrating”, and “dizziness” were most influential in both networks. The networks did not differ in connectivity, structure, and expected influence.

Conclusions

PCSS network connectivity, structure, and symptom influence do not differ between bilingual and monolingual athletes, suggesting differences do not exist in symptom interactions between groups and likely do not underly observed differences in symptom ratings. Future work should examine whether administration language influences symptom networks.
A - 165 A Pilot Study of an Online Screening Assessment of Lifetime Exposure to Traumatic Brain Injury (TBI)
Authors: Sullivan Karen , Caltabiano Elysia
Published: October 2023

Objective

To conduct a pilot test of the feasibility and validity of administering an online screening measure of lifetime TBI exposure (LTE) and determine associations between LTE and health status.

Method

156 adults were recruited from the general community (Age = 18–65 years; 73% women) most of whom (~70%) were at-risk for TBI, primarily from playing contact-sport (62.2%). TBI exposure was assessed using the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) short form. Health status was assessed using the Rivermead Post-concussion Symptoms Questionnaire, the Depression, Anxiety and Stress Scales, and items from the 2014 Ohio Behavioral Risk Factor Surveillance Study. All measures were administered via cross-sectional survey.

Results

Online OSU TBI-ID feasibility was high (e.g., minimal missing data/attrition). With covariates controlled (e.g., TBI risk), there were positive associations between LTE [Worst TBI, Multiple TBIs] and health status (post-concussion symptoms; p’s < 0.05.

Conclusion

Initial support was found for the feasibility and validity of the online OSU TBI-ID. The patterns of associations between online LTE measures and health status were consistent with those reported for non-online methods (e.g., interview). While validation of the online LTE record against clinical records would be ideal, this study suggests that a structured method of assessing LTE can be validly administered online.
A - 167 Neuropsychological Correlates of Challenging Behavior in Moderate to Severe ABI
Authors: West Sarah , McGrath Claire , Buckley Caitlin Ogram
Published: October 2023

Objective

Cognitive and behavioral changes, common after severe acquired brain injury (ABI), are important predictors of functional recovery, independence, and quality of life. The Overt Behavior Scale (OBS) is a standardized measure of challenging behaviors following ABI, and has been associated with pre-injury risk factors and psychosocial stressors. Information about the neuropsychological underpinnings of OBS scores is unknown, however. The current study is a preliminary analysis of relationships among OBS scores and neuropsychological data associated with behavioral dysregulation in adults with chronic moderate to severe ABI in a residential neurorehabilitation setting.

Method

Participants were 81 adults, ages 27–71 (SD = 10.46), 55 males, with average education of 12.6 years, and average time since injury of 26.34 (SD = 13.35). Participants were administered neuropsychological tests (including NAB Screening Module Memory, Executive Functioning, and Attention Index and subtests, NAB Judgment, and Trails B). The OBS was administered by the psychology provider with input from the treatment team.

Results

Exploratory correlations examined the relationship between neuropsychological tests and OBS scores. Results found a significant relationship between the number of challenging behaviors on the OBS and NAB delayed story recall (p < 0.040, r = −0.266). Other correlations between OBS and the NAB and Trails B were not significant.

Conclusions

The results raise the possibility that the OBS captures unique aspects of behavioral change that are not measured by traditional neuropsychological tests. Other possible explanations of the data include that the severity of cognitive impairment and physical limitations may be moderating factors, which will be examined in future studies.
A - 168 Self-Awareness in Survivors of Acquired Brain Injury and the Impact on Family Burden
Authors: Barcenas Caleb , Murthy Joseph , Schaffer Samuel , Klonoff Pamela
Published: October 2023

Objective

Caregiver burden is commonly experienced by family members of survivors of acquired brain injury (ABI). Research has demonstrated that self-awareness of survivors of ABI impacts family member burden (Rubin et al. 2020). This study utilized the discrepancy model of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) to measure self-awareness by calculating a discrepancy score from self and family member-rated MPAI-4 total score. We examined the relationship between family member burden, time since injury, and level of self-awareness of survivors of ABI at discharge following holistic neurorehabilitation.

Method

This retrospective study analyzed data on 28 individuals with heterogeneous ABI’s who participated in a holistic milieu-oriented outpatient neurorehabilitation program from 2020–2023. Demographic information (age, education, race/ethnicity), injury history (injury type, age at injury, chronicity), program variables (length of program participation), functionality (MPAI-4), and family burden (Zarit Burden Interview) at discharge were collected.

Results

A multiple linear regression analysis was run to predict family burden from self-awareness of survivors of ABI and time since injury. The multiple regression model statistically significantly predicted family burden, F(2, 24) = 6.698, p < 0.005, adj. R2 = 0.305. Only self-awareness added statistically significantly to the prediction, p < 0.002. Self-awareness accounted for 33.4% of the variance in family burden.

Conclusion

Among family members of survivors of ABI, self-awareness of the survivor is an important predictor of burden experienced by family. Self-awareness, as measured by utilizing the MPAI-4 discrepancy model, explained a significant proportion of the variance in family burden regardless of time since injury.
A - 169 Efficacy, Retention and Predictors of Response to Treatment of Group Based Remotely Delivered Goal Management Training for Acquired Brain Injury
Authors: Colella Brenda , Meusel Liesel-Ann , Jeffay Eliyas , Sharma Bhanu , Curran Orla , Green Robin
Published: October 2023

Objective

Given the gap in group-based, remotely delivered executive interventions, and the ubiquitousness of executive impairment in acquired brain injury (ABI), we examined: (1) pre-to-post-to-follow-up efficacy of remotely-delivered, group-based Goal Management Training (GMT; a metacognitive, executive intervention) in individuals with neurological disorders in the chronic stages of illness (2) predictors of response to treatment.

Methods

Participants and Protocol. N = 160 adults with ABI >6 months post-diagnosis, participated in this single-group study at the Telerehab Centre for ABI @KITE, University Health Network, Toronto, Canada. GMT – which enhances self-awareness, task engagement and task follow-through - was delivered remotely and in group format to allow scalability, peer-to-peer support, cost-effectiveness, and geographical reach. Primary outcomes. Cognitive Failures Questionnaire (CFQ); Dysexecutive Questionnaire (DEX). Predictors of response to treatment. Demographics (age, education); time since injury; and symptom burden (i.e., cognitive, somatic, and emotional). Linear mixed effects models measured efficacy and predictors of change.

Results

Significant pre/post and pre/follow-up improvements on the CFQ total and “forget”, “false”, and “distract” subscales (95% CI; p = 0.000 all comparisons). Significant pre/post improvements observed for the DEX (95% CI; p = 0.000), but not significant retention. No effects of age, education or time since injury found, indicating generalizability. High symptom burden negatively associated with pre/post and pre/ follow-up improvements on CFQ.

Conclusions

Encouragingly, this group-based, remotely delivered GMT offers promise of efficacy and retention regardless of age, time since injury or educational attainment of patients, and can reach patients regardless of geographic location. Lower response with heavy symptom burden suggests collateral treatment of symptoms may improve treatment response.
A - 170 Neuropsychological Findings after Treatment for Recurrent Left Fronto-Temporal Gemistocytic Astrocytoma
Authors: Harness James Edward , Reis Jacqueline , Ismail Hajar , Rossing John , Bylsma Frederick W
Published: October 2023

Objective

Astrocytoma tumors originate from astrocytes and are the most common brain tumors represented in adults. Gemistocytic astrocytoma is classified as a low-grade astrocytoma and data reflects that it has poorer prognosis than other matched WHO grade II astrocytic tumors. The goal of this study is to investigate the neurocognitive deficits following astrocytoma treatment.

Participants and Methods

A 60-year-old male was referred for neuropsychological assessment (2017) after resection of a left fronto-temporal gemistocytic astrocytoma (2011) and after chemotherapy and photon radiation treatments for tumor reemergence (2021). Seizure was the initial symptom in 2011; increased seizure frequency (3–5/week) signaled the tumor’s regrowth in 2021. Seizure frequency has reduced after treatment (1/10 days), but cognitive deficits persist.

Results

Neuropsychological testing in 2017 revealed superior general intellect, average motor abilities, attention (auditory and visual), and visual perception/discrimination – but a discrete verbal memory deficit consistent with lesion location. Reassessment in 2022 revealed declines in intellect (superior to average) with decreased visual perceptual reasoning and processing speed abilities (superior to average), confrontational naming (average to moderate), verbal fluency (average to moderate), simple auditory attention (average to mild), and both verbal and visual memory abilities (mild to severe impairment). Reliable change findings will be analyzed and discussed.

Conclusions

Though tumor regrowth was limited to the left fronto-temporal region and radiation treatments were “targeted” to that area, more generalized cognitive deficits are apparent after those treatments. This case highlights the importance of neuropsychological assessment for delineating deficits related to chemotherapy and radiation treatments for recurrent tumors.
A - 174 The Clinical Utility of RBANS Coding Compared to WAIS-IV PSI in Community Dwelling Older Adults
Authors: Kent George , Kern Jen , Wenzel Ben , Ramirez Amanda , Fawcett Maddie , Pyykkonen Benjamin
Published: October 2023

Objective

Fatigue and cognitive performance are important considerations in assessment with older adults. Utilization of a shorter cognitive battery may provide similar results to lengthier batteries in older adults diagnosed with various degenerative diseases (Mooney et al., 2007). Studies have identified implications for both normative and abnormal cognitive decline with regard to task-related fatigue (Campbell et al., 2022; Hess & Knight, 2021). When examining processing speed and mental fatigue, research has identified strong associations in clinical populations (Andreasen et al., 2010; Hess & Knight, 2021; Banerjee et al., 2020). The current study compares longer and shorter measures of cognitive processing speed in a community dwelling older adult sample.

Methods

bThe current sample consists of 60 community dwelling participants (female n = 54; Caucasian n = 52); mean education 13.83 years; mean age = 76 years. Measures: Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Coding; Wechsler Adult Intelligence Scale Fourth Edition (WAIS-IV) Symbol Search (SS) and Coding (CD) subtests.

Results

Linear regression identified that 82.7% of the variance in RBANS Coding was accounted for by WAIS-IV SS and CD (Adjusted R Squared = 0.827). The specific correlations for RBANS Coding were strong for SS (r = 0.794, p < 0.001) and CD (r = 0.907, p < 0.001).

Conclusions

RBANS Coding appears to map on strongly to the WAIS PSI in community dwelling older adult populations. RBANS Coding may be considered as an alternative to longer measures of processing speed due to the strong correlation to better established PSI measures on the WAIS.
A - 177 The Self-Concept Scale of Conners Adult Rating Scale in the Diagnosis of Autism Spectrum Disorder in Adults
Authors: Ramirez Amanda M , Kent G Whitman , Kern Jennie , Pyykkonen Ben , Shepardson Kati , Wenzel Ben
Published: October 2023

Objective

Self-report scales are beneficial in identifying symptoms of Autism Spectrum Disorder (ASD) in adults (Hayashi et al., 2021; Hull et al., 2019). Symptoms of ASD and attention-deficit/hyperactivity disorder (ADHD) overlap significantly even without dual-diagnosis (Nakagawa et al., 2021). The Conners Adult ADHD Rating Scale (CAARS) is a reliable and valid screening tool when identifying ADHD in adults, 78% sensitivity and 56% specificity (Abbass et al., 2021). Distinguishing features of ASD include restricted repetitive behaviors (RRB) and social interaction and communication deficits (SIC) (American Psychiatric Association, 2022). In adults, CAARS has shown a moderate correlation of RRB with the inattention (IA) and hyperactivity/impulsivity (HI) of ADHD; SIC moderately correlates with IA and mildly with HI. This study explores group differences when comparing Self-Concept (SC) Scale of CAARS in those diagnosed with ASD from clinical comparisons.

Data Selection

Data composed of 93 adult participants, 7 diagnosed with ASD, were extracted from a midwest neuropsychological outpatient clinic and analyzed to determine the sensitivity of CAARS-SC in diagnosing ASD.

Data Synthesis

Independent t-Test identified no significant effect for diagnosis, t(91) = −0.301, p = 0.764, despite those in the ASD group (M = 62.00, SD = 12.432) endorsing more concerns than those without the diagnosis (M = 60.47, SD = 12.996).

Conclusion

This study did not identify significant group differences on the CAARS-SC when comparing those diagnosed with ASD to the clinical comparisons. Further implications and limitations will be explored to distinguish ASD from overlapping diagnoses to employ appropriate treatment and future psychometric research directions.
A - 179 AI-Driven Diagnostics for Child Neuropsychology: Promising but Insufficient
Authors: Stuart Elizabeth M , Torres Samantha , Gutierrez Brian
Published: October 2023

Objective

This research tested the capacity of a current generative AI model (i.e., ChatGPT-4) to accurately diagnose neuropsychological issues in children. The secondary aim was to explore the AI’s potential in assisting in cognitive functioning evaluation, with the goal of improving the accessibility, efficiency, and accuracy of diagnosis.

Method

The study had three phases. First, the diagnostic information of 15 children (including the results of a standard neuropsychological battery and basic demographic information) was provided to the generative AI model to suggest a diagnosis. These results were then compared with the child’s confirmed diagnoses. Next, a logistic regression was conducted using a large dataset on the most commonly missed diagnosis by the AI model, which identified the common factors not initially included, but necessary for a more accurate diagnosis by ChatGPT-4. The third phase involved re-analyzing the initial datasets in the same manner as the first, but with the addition of salient information determined by the logistic regression.

Results

The results of this study suggest that current generative AI models perform well interpreting scores under sanitized conditions. However, AI also struggles to interpret the effect of context. Although the model performed marginally better with the use of additional scores and information, it still struggled to capture the nuances of context-sensitive conditions.

Conclusions

AI technology can assist diagnosis, but due to failures of understanding in-situ symptomatology, the use must remain limited. Further advancements can enhance neuropsychological assessment for more accuracy and accessibility. Clinical implications and future directions are discussed.
A - 183 Novel Performance Validity Indicators for Frequently Used Memory Tests Using Infrequent Patterns of Memory Performance
Authors: Parks Adam , Reinhart Clare , Ecklund-Johnson Eric , Brunette Amanda , Spresser Carrie , Stroescu Ioan
Published: October 2023

Objective

Determining performance validity is an imperative part of neuropsychological assessment in concussion management. Several existing embedded performance validity tests (PVTs) have been developed for popular measures of memory, Hopkins Verbal Learning Test Revised (HVLT-R) and Brief Visuospatial Memory Test Revised (BVMT-R). However, many PVTs utilize cognitive performance measures to classify performance invalidity, which increases the likelihood of false positives, especially in clinical populations. To reduce this possibility, a novel embedded PVT was developed utilizing infrequent patterns of performance in a primarily amnestic, dementia population.

Method

Neuropsychological data for 50 adult outpatients (Mean Age = 73, Range = 50–97) who met criteria for Major Neurocognitive Disorder (MND) were reviewed. Infrequent patterns of performance (IPOP) were identified on the HVLT-R and BVMT-R, including inconsistency between recall and recognition, unusually high intrusions, exceedingly poor learning, and lack of primary effect. Scaled scores were developed from the IPOP scores (0 = 0–74%, 1 = 75–94%, 2 = 95–99%). Total IPOP scaled scores were compared to existing embedded PVTs, which utilized recognition discrimination and percent retention scores, to examine classification rates.

Results

Failure rates on the embedded PVTs for the HVLT-R were 16–42% and BVMT-R 38–58% whereas elevated IPOP scaled scores were identified in less than 15% of the sample.

Conclusions

High frequencies of embedded PVT failures were found in a clinical sample of patients with MND, which is concerning for false positive misclassification. Infrequent patterns of memory performances identified in a dementia population were less frequent and could potentially be utilized to examine performance validity in persons suspected of producing invalid memory performances.
A - 185 Validating 10 Critical Items of the Word Choice Test (WCT-CI-10)
Authors: Collier Marissa N , Beach Jameson , Bain Kathleen M , Valencia Julianna M , Marceaux Janice C , Soble Jason
Published: October 2023

Objective

The purpose of the study was to identify ten critical items of the Word Choice Test (WCT) and validate the items as an abbreviated PVT (WCT-CI-10).

Method

The study included a diverse sample of veterans (M age = 55.87, SD = 14.10; M education = 13.89, SD = 2.55; 85.4% Male; 49.4% White, 33.7% Hispanic, 12.4% African American, 2.2% Multiracial, 1.1% American Indian, 1.1% Other). Chi-square analyses were used to determine the 10 critical items (WCT-CI-10) from the full WCT. A receiver operating characteristic curve (ROC) analysis was then conducted to determine the sensitivity and specificity of the WCT-CI-10 as well as identify an optimal cut score. The relationship between the WCT-CI-10 and other established PVTs was conducted by using bivariate correlations.

Results

WCT-CI-10 total scores were found to be significantly correlated with widely used and validated PVTs at the p < 0.001 level ranging from.48 to 0.70. ROC curve analysis for the WCT-CI-10 indicated optimal cutoff of ≥2 errors, with 68% sensitivity and 97% specificity (AUC = 0.907, p < 0.001) which is comparable to standard 50-item WCT which indicated an optimal cutoff of ≥8 errors with 70% sensitivity and 91% specificity (AUC = 0.890, p < 0.001).

Conclusions

In this study we have identified 10 critical items of the WCT with adequate sensitivity and specificity for the detection of invalid performance. These results provide preliminary evidence for future research including these ten critical items as a theoretical basis for validating them as an abbreviated PVT measure.
A - 187 A Comparison of Reliable Digit Span and Reliable Digit Span - Revised Failure Rates among a Highly Educated Sample of Bilingual Hispanics
Authors: Ramirez Nathan , Boone Lutavious , Parma David R
Published: October 2023

Objective

Patient’s bilingual status has significant implications for neuropsychological assessment, namely, performance validity. However, linguistic diversity has made the evaluation of non-credible performance difficult for clinicians and researchers alike. The goal of this research is to supplement the current understanding of Hispanic bilingual individuals’ performance on a commonly administered working memory task.

Method

Participants included 82 Hispanic, Spanish-English bilingual adults. (Age: Education: M = 15.68, SD = 2.26; Gender: Female (n = 44; 53.7%). Measures included the Wechsler Adult Intelligence Scale –Fourth Edition (WAIS-IV) Digit Span subtest and Language and Social Background Questionnaire (LSBQ). Participants were collected via snowball sampling method within the general community and social media, i.e., Twitter, LinkedIn. Participants were administered Digit Span in English.

Results

Statistical analyses indicate 2.4% of participants met failure rate criteria for Reliable Digit Span (RDS; ≤ 7) and 1.2% of participants for Reliable Digit Span - Revised (RDS-R; ≤ 11).

Conclusion(s)

Results suggest highly educated Hispanic Spanish-English bilingual individuals perform within the expected range when using traditional cut-off scores of embedded performance validity measures for the Digit Span subtest.
A - 189 Subjective Response to a Social Stressor in Individuals with Mild Cognitive Impairment
Authors: Shoemaker Katherine , Bienko Nicholas , Krafft Lilly Adair , Kirby Mackenzie , Clark Phoebe A , Pierre Mersania Jn , Horn Samantha , Munro Cynthia A
Published: October 2023

Objective

Because stress is a risk factor for Alzheimer’s disease (ad), characterizing individual differences in the stress response could help identify those who might be targeted in risk-prevention efforts. Studies measuring the stress response in individuals with mild cognitive impairment (MCI), however, are lacking, in part due to concerns that doing so would be too distressing to these individuals. In this study, we aimed to characterize the subjective response to an acute stressor in individuals with mild cognitive impairment (MCI).

Method

This study consisted of 20 community-dwelling individuals (9 with MCI and 11 cognitively normal individuals; 11 women) 60 years and older (Mean = 70.1, SD = 5.6) who underwent the Trier Social Stress Test (TSST). Subjects rated their subjective distress using a standardized visual analog scale at prespecified intervals 3 points prior to, and 6 points following, the TSST. Data were subjected to repeated measures analysis with sex as a covariate.

Results

Subjects with MCI rated the TSST as less stressful than their cognitively normal peers (p = 0.04), due to group differences in both post-TSST ratings of subjective distress (p = 0.013) and an increase from pre-TSST to post-TSST ratings of subjective distress (p = 0.04). No individuals withdrew from the study while participating in the TSST.

Conclusion(s)

Our finding that individuals with MCI reported experiencing lower distress than their cognitively normal peers in response to a laboratory-based stressor may help alleviate concerns regarding the risks of studying stress in this population. Future research with larger samples will be valuable in studying other determinants of the stress response in these individuals.
A - 190 Neuropsychological Profile of an Adolescent with Primary Mitochondrial Disorder
Authors: Meier Lauren M , Holder Christen M
Published: October 2023

Objective

This case describes a 16-year-old Hispanic male presenting with progressive brain atropy and upper motor neuron symptoms. He was diagnosed with a primary mitochondrial disorder (MT-TL1; variant m.3255 G > A). Language and history produced difficulties in establishing onset. There is no literature describing the neuropsychological outcomes of this rare disorder.

Method

The patient spoke Spanish exclusively until 4. At 12, the patient had a CT after a fall noting ventriculomegaly without transependymal migration of fluid. MRIs, neurological examinations, and whole exome sequencing were ordered. An unknown neurodegenerative process was suspected. Parents felt cognitive changes started with the fall, but care team suspected onset as early as kindergarten due to reports of difficulty learning to read.

Results

Neuropsychological evaluation found IQ scores in the exceptionally low range, with relatively preserved adaptive skills. Significant fine motor and language deficits were noted, with low average to below average verbal memory, reading, and spelling, and exceptionally low visual memory and calculation. Executive functioning skills were variable. Extensive history-taking revealed that while the patient had struggled to learn to read English in kindergarten, he had taught himself to read in Spanish at home without difficulty concurrently.

Conclusions

Although m.3255G > A mutation is the most frequent of MT-TL1 mutations, literature has only described its mutation associated with myopathy, maternal inherited diabetes and deafness, focal segmental glomerulosclerosis, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). No literature has defined neuropsychological outcomes of this rare disorder. Further, this case highlights the importance of understanding how language and education intersect in English Language Learner children.
B - 02 The Impact of Cardiovascular Surgeries on Attention and Executive Functioning Outcomes in Children with Congenital Heart Defects with and without Attention-Deficit/Hyperactivity Disorder (ADHD) Diagnoses
Authors: Bean Akanksha M , Robinson Mary L , Krapf Erica M , Hassara Kathleen E , Schneider Bruna M
Published: October 2023

Objective

Children with congenital heart defects (CHDs) exhibit attention and executive functioning (EF) difficulties resulting in increased risk for attention-deficit/hyperactivity disorder (ADHD). Anesthesia events are also associated with worsened cognitive outcomes. This study aims to elucidate how ADHD and cardiovascular surgeries (CVS) in children with CHDs impact attention and EF performance.

Method

Attention and EF measures (Continuous Performance Test, 3rd edition [CPT-3], Delis Kaplan Executive Function System [DKEFS], Test of Everyday Attention in Children [TEA-Ch], A Developmental Neuropsychological Assessment, 2nd edition [NEPSY-II]) were used in 58 children ages 8–17 years (mean = 11.44 years; 48.3% male; 70.7% Caucasian) with CHDs. MANOVAs were utilized to assess if children with ADHD diagnoses demonstrated poorer cognitive outcomes. Correlations were performed within subgroups to assess the relationship between number of CVS and measures.

Results

ADHD subgroups did not statistically differ on attention and EF outcomes. Number of CVS approached significance with DKEFS Verbal Fluency Category Accuracy for children without ADHD diagnoses but was significantly negatively correlated with NEPSY Auditory Attention (r = −0.628, p < 0.05) and Response Set (r = −0.601, p < 0.05) for those with ADHD.

Conclusions

Results suggest clinical ADHD diagnoses are not related to worse attention and EF outcomes in a pediatric CHD population. The number of cardiovascular surgeries impacted performance on different measures irrespective of diagnosis. Discrepancies may reflect use of multiple data points in deciding on a diagnosis, the behavioral nature of ADHD, poor construct validity of measures, patient medical comorbidities, and/or differences in clinical judgment. Future studies should explore weightage of objective measures in clinical decision-making in medically complex populations.