bluuebunny/crossref_metadata_2025 huggingface dataset:
THE STRONG AND SUPER TREE PROPERTIES AT SUCCESSORS OF SINGULAR CARDINALS
Authors: ADKISSON WILLIAM
Published: December 2023

The strong tree property and ITP (also called the super tree property) are generalizations of the tree property that characterize strong compactness and supercompactness up to inaccessibility. That is, an inaccessible cardinal
$\kappa $
is strongly compact if and only if the strong tree property holds at
$\kappa $
, and supercompact if and only if ITP holds at
$\kappa $
. We present several results motivated by the problem of obtaining the strong tree property and ITP at many successive cardinals simultaneously; these results focus on the successors of singular cardinals. We describe a general class of forcings that will obtain the strong tree property and ITP at the successor of a singular cardinal of any cofinality. Generalizing a result of Neeman about the tree property, we show that it is consistent for ITP to hold at
$\aleph _n$
for all
$2 \leq n < \omega $
simultaneously with the strong tree property at
$\aleph _{\omega +1}$
; we also show that it is consistent for ITP to hold at
$\aleph _n$
for all
$3 < n < \omega $
and at
$\aleph _{\omega +1}$
simultaneously. Finally, turning our attention to singular cardinals of uncountable cofinality, we show that it is consistent for the strong and super tree properties to hold at successors of singulars of multiple cofinalities simultaneously.
Mechanism design and dynamic switching modal control of the wheel-legged separation quadruped robot
Authors: Cao Jiandong , Zhang Jinzhu , Wang Tao , Meng Jiahao , Li Senlin , Li Miao
Published: December 2023

Currently, most wheel-legged robots need to complete the switching of the wheel-and-leg modal in a stationary state, and the existing algorithms of statically switching the wheel-leg modal cannot meet the control requirements of multimodal switching dynamically for robots. In this paper, to achieve efficient switching of the wheel-and-leg modal for a quadruped robot, the novel transformable mechanism is designed. Then, a multimodal coordination operation control framework based on multiple algorithms is presented, incorporating the minimum foot force distribution method (algorithm No.1), the minimum joint torque distribution method (algorithm No.2), and the method of combining the single rigid body dynamic model with quadratic programming (algorithm No.3). In the process of switching wheel-leg modal dynamically, the existing algorithm No.3 is prone to produce the wrong optimal force due to the change of the whole-body rotational inertia. Therefore, an improved algorithm No.1 and algorithm No.2 are proposed, which do not consider the change in the body’s inertia. The control effects of the three algorithms are compared and analyzed by simulation. The results show that algorithm No.3 can maintain a small error in attitude angle and speed tracking regardless of whether the robot is under multilegged support or omnidirectional walking compared to the other two algorithms. However, proposed algorithms No.1 and No.2 can more accurately track the target speed when the robot is walking with wheels raising and falling. Finally, a multi-algorithm combination control scheme formulated based on the above control effects has been demonstrated to be effective for the dynamic switching of the wheel-and-leg modal.
CE Workshop 01: Mindfulness Meditation Induced Analgesia Engages Multiple Unique Brain Mechanisms
Authors: Zeidan Fadel
Published: December 2023

Abstract & Learning Objectives:

For millenniums, mindfulness was believed to diminish pain by reducing the influence of self-appraisals of noxious sensations. Today, mindfulness meditation is a highly popular and effective pain therapy that is believed to engage multiple, nonplacebo-related mechanisms to attenuate pain. Recent evidence suggests that mindfulness meditation-induced pain relief is associated with the engagement of unique cortico-thalamo-cortical nociceptive filtering mechanisms. The proposed talk will provide a succinct, yet comprehensive delineation demonstrating that brief mindfulness-based mental training significantly reduces acutely evoked chronic low back pain through non-opioidergic mechanisms. Recent findings indicate that mindfulness-based pain relief, after brief mental training, can significantly uncouple self-referential from nociceptive neural mechanisms, an important finding for the millions of individuals seeking a fast-acting and non-pharmacologic pain treatment. Upon conclusion of this course, learners will be able to:

1.

Recognize if mindfulness reduces pain

2.

Describe brain mechanisms supporting mindfulness-based pain relief

3.

List the physiological systems supporting mindfulness
CE Workshop 02: Bi/Multilingualism and its Impact on Stroke/Neurodegenerative Disease
Authors: Alladi Suvarna
Published: December 2023

Abstract & Learning Objectives:

Modifying risk factors by using effective cognitive strategies across the life-course may prevent or delay up to 40% of dementias through enhancing reserve/resilience. Reserve/Resilience is an emerging concept and refers to the ability of the brain to cope with neuropathology and neurodegeneration. Emerging evidence suggests that bi/multilingualism is associated with cognitive advantages and improves resilience against dementia, stroke and other cognitive disorders. Seven thousand languages are spoken across the world and speaking a second/third or more languages is a natural phenomenon. Further, with globalization, societies are becoming increasingly linguistically diverse and half of the world’s population is bi/multilingual. Exploring beneficial effects of bi/multilingualism will have an impact on dementia risk reduction and recovery from brain injury. Bi/Multilingualism has been demonstrated to delay age at onset of dementia and also improve cognitive and language recovery after stroke. Advantages to executive function are thought to underlie its beneficial effects. Cortical morphometric, white matter connectivity and functional brain changes in bilinguals represent the neural basis for its effect on cognitive reserve/resilience. In this presentation, insights from studies that have explored the role of bi/multilingualism in impacting cognitive resilience against dementia and stroke will be discussed in the context of global research.

Upon conclusion of this course, learners will be able to:

1.

Describe the impact of bilingualism on age at onset and cognitive manifestations of dementia and stroke

2.

Discuss the mechanisms that underlie the potentially protective effects of bilingualism in dementia and stroke

3.

Describe the role of bi/multilingualism on cognitive reserve/resilience in disorders of the brain
CE Workshop 03: Stroke in the Developing Brain: Mechanisms, Outcomes, and Intervention
Authors: Westmacott Robyn
Published: December 2023

Abstract & Learning Objectives:

Over the past 10-15 years, significant progress has been made in the diagnosis and treatment of pediatrics stroke. Accordingly, the focus of much research has turned to understanding factors that determine neurological and neuropsychological outcomes in this population. This Continuing Education (CE) course will start by defining key terms in the field of pediatric stroke and reviewing current understanding of epidemiology, pathophysiology, diagnosis, and medical treatment. Next, we will review recent neuropsychological literature on cognitive outcomes following pediatric stroke, highlighting the vulnerability of the developing brain, the long-term deficits that often result from early disruption of brain function and subsequent brain development, and the significant variability in outcomes seen across individuals. Heterogeneity in outcomes has been linked to a range of clinical and demographic factors, including those related to the brain (e.g., stroke type, lesion location and size, adaptive and maladaptive patterns of reorganization), the child (e.g., age at stroke, age at assessment, comorbid neurological conditions) and the environment (family stress, parent mental health, educational support). Multi-disciplinary approaches to intervention will also be discussed. Finally, directions for future research will also be outlined, as we are just starting to understand how these factors interact to impact neurocognitive outcome and resiliency following pediatric stroke.

Upon conclusion of this course, learners will be able to:

1.

Describe the epidemiology, pathophysiology, and neurological outcomes associated with stroke in infants and children

2.

Illustrate the variability in neuropsychological outcomes after pediatric stroke and highlight important determining factors of these outcomes

3.

Apply current research into outcomes and treatments to neuropsychological practice
CE Workshop 04: Cancer Survivorship Across the Lifespan: Mechanisms and Modifiable Factors
Authors: Krull Kevin
Published: December 2023

Abstract & Learning Objectives:

Long-term survivors of pediatric cancer are at elevated risk for cognitive impairment, which manifests in different ways at different times throughout survivorship. Although some cognitive impairment may result from the cancer itself, as is the case with a brain tumor, impairment has been consistently associated with exposure to CNS-directed therapies like neurosurgery, cranial irradiation, intrathecal chemotherapy or high dose intravenous methotrexate or cytarabine. Additionally, survivors who do not receive CNS-directed therapies are also at elevated risk for cognitive impairment following cancer therapy that disrupts systemic organ function vital to brain health, e.g., cardiac, pulmonary or endocrine function. Risk for cognitive impairment is further exacerbated by adverse events during cancer therapy (e.g., severe infection, recurrent general anesthesia) and health behaviors following cancer therapy (e.g., physical activity, sleep). The type and severity of cognitive impairment in long-term survivors of pediatric cancer may evolve and grow over time, with emerging evidence suggesting some survivors are at risk for accelerated cognitive aging and early onset dementia. Over the course of the survivor’s lifespan, the prevalence and impact of cognitive deficits will be determined by a complex interaction between premorbid development and environment, cancer therapy and clinical care, and post-treatment recovery and physical health. The timing and type of these events will dictate the approach to screening and monitoring for cognitive impairment, and will determine the best course for therapeutic intervention to facilitate future cognitive and emotional health.

Upon conclusion of this course, learners will be able to:

1.

Describe direct and indirect sources of cognitive impairment in long-term survivors of pediatric cancer

2.

Discuss how cognitive impairment may change over the lifespan of survival following treatment for pediatric cancer

3.

Identify modifiable targets for interventions to facilitate cognitive health in long-term survivors of pediatric cancer
2 Musical perception skills in Agenesis of the Corpus Callosum
Authors: Rigg Kameron J , Wallace Matthew , Callaway Kutter D , Paul Lynn K , Brown Warren S
Published: December 2023

Objective:

Agenesis of the corpus callosum(AgCC) is a disorder in which the connection between the two brain hemispheres is congenitally absent. Previous research has suggested that the auditory system can be affected in individuals with AgCC (Demopoulos et al., 2015). However, the nature of AgCC’s effect on musical perception skills is unclear. This study investigated the impact of AgCC on the music perception skills in high-functioining adults using a brief version of the Profile of Music Perception Skills (PROMS; Zentner, M. & Strauß, H. 2017). It was hypothesized that individuals with AgCC would have diminished music perception abilities when compared to a neurotypical control group.

Participants and Methods:

Participants included 10 high-functioning adults with AgCC that had an intelligence quotation within the normal range (FSIQ>80) and 63 neurotypical controls who were recruited via Cloud Research. During the PROMS the participants were asked to listen to two different sound excerpts after which they were asked whether the second sound was the same or different from the first (correct answers= 2 points, uncertain answers= 1 point, and remaining answers not coded). The participants answered questions in four different areas of musical perception: Melody, Tuning, Accent, and Tempo.

Results:

Results indicated that there was not a significant difference between the control group and the AgCC participants on music perception skills on the overall PROMS scores F(1,72)= .365, P-value= .548. Tested individually, none of the 4 individual domains showed a significant difference: Melody F(1,72)=2.67, P-value= .107; Tuning F(1,72)= .271, P-value= .606; Accent F(1,72)= .017, P-value= .897; or Tempo F(1,72)=.106, P-value= .746.

Conclusions:

Contrary to the hypothesis of this study, the results showed that the participants with AgCC did not perform significantly differently in the PROMS total score when compared to neurotypical controls, nor were there significant differences in any of the four of the subtests (Melody, Tuning, Accent, and Tempo). Thus these high-functioning individuals with AgCC did not have deficient music perception abilities. These findings demonstrate that although the auditory system may be affected in some individuals with AgCC, we do not see differences in musical perception skills in high-functioning individuals with AgCC.
28 Challenges to Lateralizing Visual Memory Dysfunction in TLE Patients
Authors: Muller-Cohn Chantal , McDonald Carrie , Gooding Amanda , Norman Marc
Published: December 2023

Objective:

Neuropsychological assessment is an essential part of presurgical evaluation for epilepsy patients with refractory temporal lobe epilepsy. Evaluations assist in localizing and lateralizing epileptogenic focal points and identifying possible risks for cognitive decline following surgery. Researchers and clinicians consistently find that verbal memory dysfunction is an accurate indicator of left temporal lobe epilepsy (TLE) through verbal measures such as the CVLT-II. Although visual memory structures are assumed to be in the right (nondominant) hemisphere, visual memory assessments have not been reliable in identifying right TLE. It is hypothesized that assessments to test visual memory are confounded by verbal cueing to assist in visual learning. To account for this, researchers have identified that comparing verbal and visual score asymmetries does accurately differentiate left and right TLE patients. This study aimed to determine if verbalvisual asymmetry using the CVLT-II and BVMT-R accurately identifies left and right TLE relative weaknesses potentially associated with epileptogenic regions.

Participants and Methods:

As part of a pre-surgical neuropsychological evaluation, 37 well-characterized medically refractory TLE patients (18 right TLE; 19 left TLE) were administered the Brief Visuospatial Memory Test-Revised to evaluate visuospatial memory and the CVLT-II to evaluate verbal memory. A multivariate analysis of variance was used to compare RTLE and LTLE group performances on BVMT-R delay recall subscales, using T-scores. Then memory asymmetry scores were calculated by converting CVLT-II verbal delay memory scores to T-scores and subtracting BVMT-R delayed recall T-score from the verbal memory T-score. An independent samples t-test was used to compare asymmetry scores between the groups.

Results:

There were no significant differences between patients with RTLE and LTLE for BVMT-R Delay [F(2,34) = 0.11, p = .895]. There was not a significant difference when accounting for verbal-visual asymmetry (t (35) = 0.422, p = 0.675, d = 12.566) between left (M = -2.42, SD = 13.82) and right side (M = -4.17, SD = 11.09).

Conclusions:

The BVMT-R did not identify nondominant hemisphere dysfunction in this sample of 18 right TLE patients. Because visual memory performance did not inform lateralization, we investigated the usefulness of memory asymmetry. Inconsistent with our hypothesis, verbal-visual memory asymmetry scores did not differentiate RTLE from LTLE in this sample. These findings add to existing findings that the BVMT-R may not be able to identify visuospatial memory dysfunction in epilepsy. Additionally, these data indicate the inability to assess for visuospatial memory even when accounting for verbal abilities in epilepsy patients. Future research should consider alternate visuospatial measures for the evaluation of epilepsy patients.
35 MoCA performance as an indicator of NSAb positivity in focal epilepsy: A preliminary analysis
Authors: Pleshkevich Maria , John Emily St. , Steriade Claude
Published: December 2023

Objective:

Researchers are increasingly finding that the presence of neuronal surface antibodies (NSAb) may account for a larger percentage of outpatient epilepsy cases than previously thought (Elisak et al., 2018; Brenner et al., 2013). However, systematic NSAb screening is not included in standard epilepsy care (Kambadja et al., 2022). The Montreal Cognitive Assessment (MoCA; Nasreddine, 2005) is one of the most commonly used screening tools among physicians (Judge et al., 2019) across various neurological conditions, and has previously been validated in populations with autoimmune encephalitis (Hebert et al., 2018). Because patients with NSAb associated epilepsy often present with cognitive dysfunction (Greco et al., 2006), a MoCA is often administered as part of standard clinical care. The present analysis compared MoCA performance profiles in epilepsy patients with and without the presence of serum NSAbs. We explored what specific cognitive profile, as defined by the MoCA, may predict NSAb positivity.

Participants and Methods:

Forty-eight epilepsy patients were enrolled through an outpatient epilepsy clinic or during non-intensive or elective hospital stays. Participants were eligible if they met one of three diagnostic categories: focal epilepsy of unknown cause (n = 33), lesional focal epilepsy (n = 5), or generalized epilepsy (n = 4). All participants signed consent, underwent a comprehensive interview, which included MoCA testing, and serum NSAb testing paralleling standard clinical practice. Mann-U Whitney tests were run to compare overall MoCA and subgroup domain performance between groups.

Results:

Six patients (13%), all with focal epilepsy of unknown cause, had positive NSAb panels (LGI1: n = 3; GAD65: n = 2; CASPR2: n = 1). There was no significant difference in overall MoCA scores between participants with focal epilepsy of unknown cause who were antibody positive versus negative, and antibody positive versus antibody negative lesional or generalized epilepsy. However, when analyzing by MoCA subgroup, we found that antibody positive patients performed significantly worse on delayed recall than antibody negative patients with focal epilepsy of unknown cause (Mdn = 1.5 vs 3), U(Nantibodynegative=27, Nantibodypositive=6) = 69.00, p = .02. There was no significant difference in other MoCA cognitive domain tests, and delayed recall scores did not significantly differ between antibody positive patients and those with lesional focal and generalized epilepsy.

Conclusions:

These preliminary findings suggest that episodic memory impairment, as measured by delayed recall on the MoCA, may predict NSAb antibody positivity among patients with focal epilepsy of unknown cause. This may relate to specific predilection of the hippocampal regions in antibody-mediated epileptogenesis and pathology.
42 Social Problems in Childhood Epilepsy as it Relates to Overall Intellectual and Adaptive Functioning and Social Skills
Authors: Mitra Tarini , Kalscheur Emily
Published: December 2023

Objective:

Previous studies have demonstrated a high prevalence of social and emotional problems in young adults with a history of childhood epilepsy, with social skill impairment hypothesized to play a significant role in these outcomes. Few studies have examined social skills within children with epilepsy and very few have examined this within the context of other neuropsychological and neurological variables. This study aims to examine the association between social problems and other relevant neuropsychological variables (IQ, adaptive functioning, social skills) within the pediatric epilepsy population.

Participants and Methods:

Participants were 86 epilepsy patients between the ages 5 and 18 years of age who were referred for neuropsychological assessment as a part of their surgical candidacy work-up. Pearson correlation analysis was conducted to examine the correlations between performance on objective measures of full-scale IQ, and parent ratings on questionnaires assessing parent perception of the patients’ overall adaptive functioning, social skills, and social problems.

Results:

As expected, earlier age of onset was associated with lower IQ, which itself was associated with weaker overall daily living skills and social skills. Later age of seizure onset was associated greater social problems. Social skills were not correlated with social problems.

Conclusions:

The results of this study suggest that children with later age of onset of seizures, are at increased risk of social problems and that these problems may not related to social skill impairment. Implications for clinical practice and future directions are discussed.
57 CSF Markers of AD-Related Pathology Relate to aMCI among People with HIV
Authors: Lobo Judith D. , Sundermann Erin E. , Campbell Laura M. , Gouaux Ben , Letendre Scott , Bondi Mark W. , Moore David J.
Published: December 2023

Objective:

Older people with HIV (PWH) are at-risk for Alzheimer’s disease (AD) and its precursor, amnestic mild cognitive impairment (aMCI). Identifying aMCI among PWH is challenging because memory impairment is also common in HIV-associated neurocognitive disorders (HAND). The neuropathological hallmarks of aMCI/AD are amyloid-ß42 (Aß42) plaque and phosphorylated tau (p-tau) accumulation. Neurofilament light chain protein (NfL) is a marker of neuronal injury in AD and other neurodegenerative diseases. In this study, we assessed the prognostic value of the CSF AD pathology markers of lower Aß42, and higher p-tau, p-tau/Aß42 ratio, and NfL levels to identify an aMCI-like profile among older PWH and differentiating it from HAND. We assessed the relationship between aMCI and HAND diagnosis and AD biomarker levels

Participants and Methods:

Participants included 74 PWH (Mean age=48 [SD=8.5]; 87.4% male, 56.5% White) from the National NeuroAIDS Tissue Consortium (NNTC). CSF Aß42, Aß40, p-tau and NfL were measured by commercial immunoassay. Participants completed a neurocognitive evaluation assessing the domains of learning, recall, executive function, speed of information processing, working memory, verbal fluency, and motor. Memory domains were assessed with the Hopkins Verbal Learning Test-Revised and the Brief Visuospatial Memory Test-Revised, and aMCI was defined as impairment (<1.0 SD below normative mean) on two or more memory outcomes among HVLT-R and BVMT-R learning, delayed recall and recognition with at-least one recognition impairment required. HAND was defined as impairment (<1.0 SD below normative mean) in 2 or more cognitive domains. A series of separate linear regression models were used to examine how the levels of CSF p-tau, Aß42, p-tau/Aß42 ratio, and NfL relate to aMCI and HAND status while controlling for demographic variables (age, gender, race and education). Covariates were excluded from the model if they did not reach statistical significance.

Results:

58% percent of participants were diagnosed with HAND, 50.5% were diagnosed with aMCI. PWH with aMCI had higher levels of CSF p-tau/Aß42 ratio compared to PWH without aMCI (ß=.222, SE=.001, p=.043) while controlling for age (ß=.363, p=.001). No other AD biomarker significantly differed by aMCI or HAND status.

Conclusions:

Our results indicate that the CSF p-tau/Aß42 ratio relates specifically to an aMCI-like profile among PWH with high rates of cognitive impairment across multiple domains in this advanced HIV disease cohort. Thus, the p-tau/Aß42 ratio may have utility in disentangling aMCI from HAND and informing the need for further diagnostic procedures and intervention. Further research is needed to fully identify, among a broader group of PWH, who is at greatest risk for aMCI/AD and whether there is increased risk for aMCI/AD among PWH as compared to those without HIV.
90 Association Between Sedentary-To-Light Physical Activity Time Ratio and Cognitive Function in Bariatric Surgery Candidates
Authors: Bhatia Urja , Bond Dale , Gunstad John , Carroll Ian , Crosby Ross , Mitchell James , Peat Christine , Steffen Kristine , Heinberg Leslie
Published: December 2023

Objective:

Class III obesity is associated with increased risk for cognitive impairment. Though hypothesized to be partially attributable to sedentary time (ST), past research examining the association between ST and cognitive function has produced mixed findings. One possible explanation is that studies do not typically account for the highly correlated and almost inverse relationship between ST and light intensity physical activity (LPA), such that ST displaces time engaging in LPA. Therefore, we aimed to evaluate whether: (1) higher ST-to-LPA time ratio associates with poorer performance across multiple cognitive domains in patients with Class III obesity seeking bariatric surgery; and (2) the associations differ by sex.

Participants and Methods:

Participants (N = 121, 21-65 years of age, BMI > 40 kg/m2) scheduled for either Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) completed the NIH Toolbox, a computerized neuropsychological assessment battery and wore a waist-mounted ActiGraph monitor during waking hours for 7 days to measure minutes/day spent in ST, LPA, and moderate-to-vigorous physical activity (MVPA). A ratio of time spent in ST-to-LPA was calculated by dividing the percentage of daily wear time spent in sedentary behavior (SB) by the percentage of daily wear time spent in LPA.

Results:

On average, participants (mean age = 43.22 years old and BMI = 45.83 kg/m2) wore the accelerometer for 909±176 minutes/day and spent 642±174 minutes/day in ST, 254±79 minutes/day in LPA, and 14±13 minutes/day in MVPA. Mean daily ST-to-LPA time ratio was 2.81 ± 1.3 (0.73-7.11). Overall, bivariate Pearson correlations found no significant relationships between LPA and cognitive performance on any of the NIH Toolbox subtests (r values = -.002 to -.158, all p values >.05). Additionally, bivariate Pearson correlations also found no significant relationships between daily ST-to-LPA time ratio and cognitive performance on any of the subtests (r values = .003 to .108, all p values >.05). However, higher ST-to-LPA was associated with lower scores on the Dimensional Change Card Sort Test in women (r = -.26, p = .01).

Conclusions:

Results showed that participants’ mean daily time spent in ST was 2.5 times higher than that spent in LPA and a higher ratio of ST-to-LPA was associated with poorer set-shifting in women with Class III obesity. Future studies should look to clarify underlying mechanisms, particularly studies examining possible sex differences in the cognitive benefits of PA. Similarly, intervention studies are also needed to determine if increasing LPA levels for individuals with Class III obesity would lead to improved cognitive performance by means of reducing ST.
CE Workshop 07: Cognitive Effects of Cancer and Treatment: “Chemobrain” and Beyond
Authors: McDonald Brenna C.
Published: December 2023

Abstract & Learning Objectives:

Improvements in treatment for non-CNS cancer have greatly improved survivorship, allowing increased attention to cancer- and treatment-related sequelae. Cognitive symptoms (cancer-related cognitive impairment, or CRCI) are reported by a large percentage of cancer survivors, and can have a clinically meaningful impact on educational, vocational, and social functioning, and thus overall quality of life. Better understanding of these concerns is therefore of critical importance, and is needed to guide treatment and potential prevention strategies. Neuropsychological studies over the past 40 years have demonstrated cognitive domains commonly affected in cancer patients treated with chemotherapy, but have also shown cognitive differences in patients not treated with systemic therapy and those receiving other types of treatment (e.g., hormonal therapies) relative to non-cancer control groups. More recently, structural and functional neuroimaging research has added to our understanding of the neural substrate of these cognitive symptoms. This course will describe various neuroimaging modalities used to investigate CRCI, including examination of grey and white matter volume and structural integrity, blood flow, brain activation during cognitive processing and at rest, and structural and functional connectivity. The presentation will also review how neuroimaging findings relate to objective and self-reported cognition and clinical and treatment factors, and discuss potential approaches currently being investigated to treat CRCI. Upon conclusion of this course, learners will be able to:

1.

Explain commonly affected cognitive domains after non-CNS cancer and treatment

2.

Discuss structural and functional brain changes related to cancer, chemotherapy, and other treatments

3.

Describe treatment interventions being investigated to treat cancer- and treatment-related cognitive symptoms.
CE Workshop 08: Theory and Practice in the Design and Evaluation of Cognition-Oriented Treatments in Aging and Dementia
Authors: Bahar-Fuchs Alex
Published: December 2023

Abstract & Learning Objectives:

Cognition-Oriented Treatments (COTs) such as cognitive training and rehabilitation are increasingly recognized for their potential benefits for older people at risk of or with dementia, as well as for people with other conditions. An effective and well-informed use of such approaches depends on researchers and clinicians developing a careful understanding of key theoretical assumptions and of practical considerations. The workshop will provide participants with background theory and practical knowledge related to the application of COTs in research and practice, including review of the evidence, and demonstration of key principles in designing and delivering person-centered interventions likely to result in clinically meaningful outcomes. After attending this workshop, participants will be able to summarize the basic assumptions and techniques associated with different COTs, recognize important person and intervention-related factors likely to moderate treatment response, and able to apply those in designing COTs in research and clinical practice. Upon conclusion of this course, learners will be able to:

1.

Summarize basic theoretical assumptions and key techniques underpinning cognition-oriented treatments

2.

Recognize key person-related and intervention-related factors moderating response to cognition-oriented treatments

3.

Design appropriate clinical trials to evaluate cognition-oriented treatments
2 1991 Gulf War Women Veterans: Neurotoxicant Exposures and Cognitive Outcomes
Authors: Krengel Maxine H , Sullivan Kimberly
Published: December 2023

Objective:

The women who served in the 19901991 Persian Gulf War (GW) are unique in that they were the first group to have fewer restrictions in terms of military occupations and exposure to combat. Of the nearly 41,000 US troops who were women deployed to the GW, many were serving in frontline positions and were exposed to the same toxicants as their male counterparts. Toxicant exposures such as pesticide sprays and creams, oil well fires, diesel fuels, chemical and biological warfare (CBW) agents and anti-nerve gas (PB) pills have been found to result in cognitive impairments across a range of neuropsychological tests. Our research team has been following cohorts of women who were deployed to the GW and correlated exposures with neuropsychological outcomes. Overall, in small cohorts of women veterans we found that higher levels of exposures to pesticide sprays and creams and CBW are correlated with short-term memory, mood, and motor deficits. These findings were different from those of their male counterparts. In a recently developed data-repository we have compiled larger groups of women veterans to validate our prior findings.

Participants and Methods:

The current study is an analysis of data from a national bio/data-repository (Boston Biorepository Recruitment and Integrative Network for Gulf War Illness; BBRAIN) which includes key data samples from prior GW studies that have been merged and combined into retrospective datasets. Data include general health and chronic symptom questionnaires, demographics, deployment and self-reported exposure histories (separated into no exposure, fewer than 7 days exposure and greater than or equal to 7 days exposure), as well as key neuropsychological test variables. Three separate datasets were combined to include 62 women. Exposures to chemical alarms, oil well fires, pesticide cream or spray, pesticide fogging, and PB pills were self-reported. Linear regression models were produced for each continuous cognitive outcome, modeled on a given exposure, and controlling for age, education level, PTSD, and other exposures.

Results:

Of the 62 women, the majority were White (77%). 74% of women surveyed were employed and 55% were married. 63% of women had at least a high school education. Deployed women who had > 7 days of exposure to pesticide sprays, CBW, smoke from oil well fires, and PB pills were more likely to show deficits in the areas of verbal learning and short-term memory (p < .03) and those with exposure to CBW, smoke from oil well fires, pesticides creams and PB pills had more errors on a test of executive functioning (p < .01). These data differ from the findings from cohorts of men.

Conclusions:

These data validate the findings of our prior studies and add credence to the need for separate analyses for men and women. The unique outcomes may lead to individualized treatments for women veterans that may also help women with similar exposures from other deployments in addition to women with occupational exposures.
9 Serum Neurofilament is Associated with Diffusion Kurtosis Imaging in Chronic Mild-Moderate Traumatic Brain Injury
Authors: Trifilio Erin R , Claar Robert D , Venkatesh Aditi , Bottari Sarah , Barton David , Robertson Claudia S , Rubenstein Richard , Wagner Amy K , Wang Kevin K W , Lamb Damon G , Williamson John B
Published: December 2023

Objective:

To determine the association between blood markers of white matter injury (e.g., serum neurofilament light and phosphorylated neurofilament heavy) and a novel neuroimaging technique measuring microstructural white matter changes (e.g., diffusion kurtosis imaging) in regions (e.g., anterior thalamic radiation and uncinate fasciculus) known to be impacted in traumatic brain injury (TBI) and associated with symptoms common in those with chronic TBI (e.g., sleep disruption, cognitive and emotional disinhibition) in a heterogeneous sample of Veterans and non-Veterans with a history of remote TBI (i.e., >6 months).

Participants and Methods:

Participants with complete imaging and blood data (N=24) were sampled from a larger multisite study of chronic mild-moderate TBI. Participants ranged in age from young to middle-aged (mean age = 34.17, SD age = 10.96, range = 19-58) and primarily male (66.7%). The number of distinct TBIs ranged from 1-5 and the time since most recent TBI ranged from 0-30 years. Scores on a cognitive screener (MoCA) ranged from 22-30 (mean = 26.75). We performed bivariate correlations with mean kurtosis (MK) in the anterior thalamic radiation (ATR; left, right) uncinate fasciculus (UF; left, right), and serum neurofilament light (NFL), and phosphorylated neurofilament heavy (pNFH). Both were log transformed for non-normality. Significance threshold was set at p<0.05.

Results:

pNFH was significantly and negatively correlated to MK in the right (r=-0.446) and left (r=-0.599) UF and right (r=-0.531) and left (r=-0.469) ATR. NFL showed moderate associations with MK in the right (r=-0.345) and left (r=-0.361) UF and little to small association in the right (r=-0.063) and left (r=-0.215) ATR. In post-hoc analyses, MK in both the left (r=0.434) and right (r=0.514) UF was positively associated with performance on a frontally-mediated list-learning task (California Verbal Learning Test, 2nd Edition; Trials 1-5 total).

Conclusions:

Results suggest that serum pNFH may be a more sensitive blood marker of microstructural complexity in white matter regions frequently impacted by TBI in a chronic mild-moderate TBI sample. Further, it suggests that even years after a mild-moderate TBI, levels of pNFH may be informative regarding white matter integrity in regions related to executive functioning and emotional disinhibition, both of which are common presenting problems when these patients are seen in a clinical setting.
12 AppReminders - A pilot feasibility randomised controlled trial of a memory aid app for people with acquired brain injury
Authors: Jamieson Matthew , McClelland Heather , Cullen Breda , Lennon Marilyn , Brewster Stephen , Goudie Nicola , McFarlane Jean , Evans Jonathan
Published: December 2023

Objective:

Mobile phone reminding apps can be used by people with acquired brain injury (ABI) to compensate for their memory impairments. However off-the-shelf apps may be difficult to use. ApplTree has been developed to be accessible to this group, compared to off-the-shelf reminding apps such as Google Calendar. This pilot feasibility trial aimed to establish the feasibility of running (and issues that should be addressed to complete) a randomised controlled trial comparing ApplTree to Google Calendar in an ABI community treatment setting.

Participants and Methods:

Adults with self or other reported memory difficulty after an ABI were enrolled (n=39). Those who completed the baseline phase were randomised (n=29) and randomly allocated to the Google Calendar or ApplTree intervention. They were shown a 30 minute video tutorial of the app and an assessment on their ability to use it. Timely completion of everyday memory tasks were measured for a 3 week pre-intervention baseline and 3 week post-intervention follow-up phase. Participants also completed neuropsychological tests assessing memory, attention and executive function and gave qualitative feedback on the app and their experience in the trial.

Results:

Recruitment rate was 58% of the target (29 were randomised, n=50 was the target in 2 years). Retention rate was 65.5% and adherence rate was 57.9%. While the feasibility trial was not powered to calculate efficacy, there was a 13% increase in everyday memory tasks completed on time for those in the ApplTree group (n=10) compared to baseline and no change for the Google Calendar group (n=9). Feasibility results indicate 72 participants would need to fully complete a trial to detect the minimum clinically important difference (12.5% increase in successful performance of everyday memory tasks) in the efficacy of ApplTree compared to Google Calendar, should such a difference exist.

Conclusions:

The challenges with recruitment of people receiving community care for ABI are highlighted in this trial and discussed along with the impact of the Covid-19 pandemic. Methodological considerations for researchers or clinicians looking to measure everyday memory ability are discussed. The majority (19 of 21) of participants who were given an app were capable of learning to use it during an hour-long session. This indicates it is a feasible intervention that community ABI services could offer. Participant feedback highlighted the merits of design features implemented in ApplTree that can improve the uptake and utility of reminding apps.
15 Examining Unmet Needs in a Brain Injury Sample, Consisting of Various Races/Ethnicities, Referred to Resource Facilitation
Authors: Parker Kiriana P , Garcia Patricia , Parrott Devan , Crockett Stephanie , Conner Cori , Thomas Kira
Published: December 2023

Objective:

To investigate differences of the perceived unmet needs in a post-acute brain injury sample when referred to Resource Facilitation (RF) among various race/ethnic groups.

Participants and Methods:

The methodology utilizied within this study consisted of a retrospective chart review, which was sourced from a clinical database serving chronic outpatients in the Midwest region. The main outcome measure was the Service of Unmet Needs & Service Use (SUNSU). The sample consisted of N = 455 subjects, which included a small sample size of Hispanics (N=7). Therefore, African American and Hispanic groups were combined for a total minority sample (N=84). Clinical disorders included within the study was an ABI from either stroke, anoxic injury, ruptured aneurysm, or tumor resection surgery. Eligibility criteria included participants’ admission into a RF program, a vocational goal, and a diagnosis of a moderate to severe TBI or other ABI. Lastly, key sociodemographic features included age, race, ethnicity, education, and sex.

Results:

Significant differences were found between ethnic groups (white non-Hispanics and minority group) in terms of years of education (p=<.01). White non-Hispanics had higher education (M=13.39, SD=2.23), reported significantly more rural addresses (40.2%, p=<.01), and had private insurance coverage more frequently than the minority group (33.7%, p=<.01). The full model was statistically significant, R2=.077 = F(4,450) = 9.387, p<.0001; adjusted R2 = .069. The addition of ethnicity led to a statistically significant increase in R2 of .019, F(1,450) =9.025, p<.0005.

Conclusions:

Ethnicity was found to be a predictive factor for greater unmet needs even after controlling for insurance, employment status, and urbanicity. It is currently unknown RF’s success rate in providing culturally competent services to different racial/ethnic groups, which consider factors such as primary language spoken, immigration status, and additional ethnocultural factors that could deter accurate reporting of unmet needs by minoritized groups. Future studies should investigate barriers in referring and meeting eligibility for this program and analyze post-treatment data to determine if the impact of racial, geographic, and insurance disparities is mitigated with RF treatment.
44 The Link Between Loss of Consciousness, Working Memory, and Depressive Symptoms in Adult Concussion Patients.
Authors: Hewatt Catherine N , Bennett Lauren
Published: December 2023

Objective:

Individuals who have experienced a mild traumatic brain injury, or concussion, often experience a variety of cognitive and emotional sequelae. Specifically, concussions can place individuals at increased risk for experiencing symptoms of depression. It is important to understand if loss of consciousness (LOC) is related to higher rates of depression in order to improve care and cognitive functioning by appropriately monitoring for mood-related symptoms post-concussion. The current study sought to examine the relationship between depressive symptoms (measured using the PHQ-9), working memory (WM; measured using RBANS Digit Span subtest), and presence of LOC in individuals who have sustained a head injury. The relationships between presence of LOC, depressive symptoms, and WM performance were examined, as it was expected LOC would result in greater depressive symptoms and negatively impact WM performance. Finally, the relationship between depressive symptoms and WM performance, while controlling for LOC, was also assessed.

Participants and Methods:

Data was drawn from archival medical records of 40 patients who underwent brief neuropsychological screening in an outpatient, community clinic after being referred following a head injury. Patients ranged in ages from14 to 75, with a mean age of 39.1. The average years of education amongst patients was 14.62. Twenty-five (62%) of the patients were women. Ten individuals endorsed LOC secondary to their head injury.

Results:

The average PHQ-9 score was 9.68 (SD=7.69). LOC did not impact reported depressive symptoms (p >.05). The correlation between LOC and WM performance was also nonsignificant (p >.05). While it was predicted there would be an inverse relationship between PHQ-9 scores and WM performance, there was no statistical significance (p >.05). Similarly, there was no significant relationship between PHQ-9 and WM performance when controlling for LOC (p >.05).

Conclusions:

While the relationships between LOC, depressive symptoms, and WM performance were found to be nonsignificant, understanding the course and best supports of cognitive and emotional sequelae of head injuries is of paramount importance. Future research exploring these relationships with larger, diverse populations would likely prove beneficial.
45 Providing a Definition of Head Injuries Increases Reported Trauma in Women Between 30 and 50
Authors: Fifty Chris , Ehret Ben , Haeffner Katie , Seichepine Daniel
Published: December 2023

Objective:

Utilization of an objective measure to evaluate history of head trauma has been demonstrated to have a significant effect on the amount of sustained trauma reported by the individual, in athletic male populations. The ability to generalize this definition across a more diverse population remains an opportunity; a report from the World Health Organization recognized that 93% of current research on mild traumatic brain injuries omitted gender specific data. Further, relative to reports in young adults, research on the effects of concussions in midlife remain sparse. Researchers hypothesized that women between the ages of 30 and 50 from a general population would report additional head injuries when provided with an objective definition similar to those previously used in male athletes.

Participants and Methods:

Highly educated (M=16.7 years, SD=2.1 years) women between the ages of 30 and 50 (M=40.3, SD= 5.1) completed an online web-based survey. The survey probed for demographic information tied to participation in sports & related activities, individual history of head trauma, as well as a series of objective measures. Participants were first asked to provide a history of head trauma, in absence of an objective definition; they were then provided with an objective definition similar to what was previously documented to be effective in the literature, and then asked to provide a reassessment of sustained trauma.

Results:

A Wilcoxen Signed Rank test indicated a significant change in number of reported head injuries, pre and post definition (z= 4.06, p<.0001). The number of head injuries reported increased for 42% of the population, for this portion of the sample the median increased fourfold. To better understand the differences between those who reported an increase, and those who didn’t, researchers performed an examination of commonalities between those groups. A Chi-Square Test of Independence indicated a significant relationship (chi=7.03, p<.01) between participation in sports (recreational, organized) and change in reported head injuries: 21% of individuals without a sport history increased the number of reported head injuries, in contrast 58% of individuals with a sport history increased the number of head injuries reported.

Conclusions:

Consistent with the literature in male athletes, providing a definition of a head injury significantly increased the number of reported head injuries in women, between 30 and 50 years of age. This finding indicates that providing a definition can improve reported concussion history within a more diverse population. This fourfold increase for 42% of our population could bear significant implications for those receiving clinical care. Further, given that the definition utilized was especially effective at correcting history of reported head injury in those who participated in sports, it’s adoption within clinical communities evaluating athletic populations seems especially promising.