bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
81 Developing and Validating for Cognitive Screening Tools for Identifying and Intervening Dementia among Older Persons in Rural Uganda.
Authors: Batange Haruna , Ddumba Isaac , olal Christine Jane 
Published: December 2023

Objective:The study aimed to develop, validate and field test the cognitive screening tool for use in outpatient departments within health facilities in Uganda.Participants and Methods:In the rural eastern region of Uganda, twenty-three (23) purposively selected health facilities and administered a scientifically derived cognitive screening tools to all eligible older persons. We conducted an inter-rater reliability in all the health facilities using three raters. Diagnosis of dementia (DSM IV) was classified as a major cognitive impairment and was quality checked by physiatrist who were blinded to results of the screening assessment.Results:The area under the receiver operating characterizes (AUROC) curve in health facilities was 0.912. The inter-rater reliability was good (Intra-class correlation coefficient of 0.692 to 0.734). the predictive accuracy of the tool to discriminate between dementia and other cognitive impairment was 0.892. In regression modal, the cognitive screening tool, didn’t appear to be biased by age.Conclusions:The cognitive screening tool if performed well among the older persons, can be proved useful for screening dementia in other developing countries.
86 Subjective Executive Dysfunction Mediates Relationship Between Perceived Sleep Quality and Societal Participation in Veterans with TBI
Authors: Ramirez Nathan R. , Walker Nicole C. , Madore Michelle R. 
Published: December 2023

Objective:Perceived poor sleep quality is the most commonly reported issue among veterans with a history of mild traumatic brain injury (mTBI). Poor sleep can impact aspects of objective and subjective executive functioning abilities (e.g., planning, organization, decision-making) and lead to decreased societal participation. However, less is known about how perceived executive dysfunction impacts the relationship between perceived poor sleep and societal participation in veterans with a prior history of mTBI. We hypothesized that executive dysfunction mediates the relationship between subjective sleep quality and societal participation.Participants and Methods:Participants included sixty-two U.S. veterans [Age: M=41.73 (SD=13.19); Education: M=15.16 (SD=2.20); 14.5% female]. The participants completed the Mayo-Portland Adaptability Inventory - 4 (MPAI-4; total scores), the Behavior Rating Inventory of Executive Function - Adult (BRIEF-A; subscale planning/organizing), and the Pittsburg Sleep Quality Index (PSQI; total scores). 21 participants met diagnostic criteria for Post-traumatic stress disorder (PTSD) [as determined by a cutoff score of 45 on the PTSD Checklist for DSM-5 (PCL-5)]. A mediation analysis was utilized to examine the impact of executive functions on the relationship between perceived sleep quality and societal participation. Mediation analyses were conducted via linear regression modeling using SPSS Version 27. Post hoc analyses were conducted to control for PTSD, which is common in veteran populations.Results:The total PSQI scores significantly predicted MPAI-4 total scores F(1, 53) = 16.740, p < .001 (R2= .55) when controlling for PTSD diagnoses. A mediation analysis showed that BRIEF-A Planning/Organizing T-scores partially mediate the relationship between PSQI scores and MPAI-4 scores when controlling for PTSD diagnoses F(2, 54) = 12.055, p < .001 (R2 = .61).Conclusions:Results suggest that per000eived sleep quality impacts societal participation. However, how patients perceive their executive functioning abilities partially mediates the relationship between perceived sleep quality and societal participation, such that perceived poor sleep quality leads to reduced societal participation when there is subjective executive dysfunction. Therefore, clinical interventions should focus on the cognitive rehabilitation of executive functioning among veterans with a history of mTBI to improve their subjective experience. Ultimately, these efforts may improve veterans’ participation and utilization of healthcare services.
92 To know or not to know: A case of CADASIL highlighting the ethical dilemmas of genetic testing among families carrying a highly heritable neurological condition
Authors: Coady Alanna , Piercy Jamie , Miller Harry 
Published: December 2023

Objective:Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary form of cerebral small vessel disease leading to early cerebrovascular changes. These changes result from mutations in the NOTCH3 gene that cause progressive accumulations of granular osmiophilic material (GOM) deposits, thickening arterial walls and reducing or restricting blood flow in the brain. The clinical presentation of CADASIL is characterized by migraines with aura, early and recurrent strokes, progressive cognitive impairment, and psychiatric disturbances. CADASIL is rare but frequently underrecognized or misdiagnosed. A genetic condition with a 50% risk of inheritance from an affected parent, the gold standard for diagnosis is genetic testing to determine the presence of mutations in the NOTCH3 gene. This presentation aims to familiarize neuropsychologists with the condition of CADASIL through a unique case study highlighting important psychological, social, and ethical considerations raised by genetic testing.Participants and Methods:This case study presents a 67-year-old, right-handed, married female diagnosed with CADASIL who was referred for neuropsychological evaluation of cognitive function and low mood concerns following multiple ischemic events.Results:Results revealed severe cognitive deficits in domains of attention, learning, and memory. Her superior verbal abilities and executive function remained largely intact. Assessment of mood revealed elevations in symptoms of depression and anxiety. The patient was aware of CADASIL in her father, paternal aunt, and younger brother, but elected to forego any genetic testing to confirm whether she had the condition until she experienced a stroke at age 61. She has two adult children who have also elected to forego testing and currently remain asymptomatic. Cognitive profile, mood disturbances, and patient perspectives on refraining from pre-symptomatic genetic testing for CADASIL diagnosis will be discussed.Conclusions:Aspects of this case are consistent with a small body of literature evidencing distinct psychological, emotional, and social challenges among families carrying genetic risk of CADASIL. While providing an example of an often underrecognized neurological disorder with which neuropsychologists should be familiar, this case uniquely raises ethical questions relevant to care providers and current treatment guidelines regarding genetic testing among families carrying highly heritable neurological conditions. In particular, personal ethical challenges around deciding to pursue or forego pre-symptomatic testing, and implications for family planning, highlight the importance of genetic counseling for affected families.