Use of the QuickSort with older adults whose lifestyle decision-making capacity is being questioned.

OBJECTIVES: Cognitive impairment affects older adults' capacity to live independently and make lifestyle decisions (lifestyle decision-making capacity; LS-DMC). Cognitive screens and clinical interviews are often used to assess people's need for living-supports prior to conducting comprehensive LS-DMC assessments in busy clinical settings. This study investigated whether the QuickSort - a brief new cognitive screen - provides efficient and accurate information regarding patients' LS-DMC when initially interviewed. METHODS: This is an observational and diagnostic accuracy study of older inpatients (≥60 years) consecutively referred for neuropsychological assessment of LS-DMC (n = 124). The resources required by inpatients with questionable LS-DMC were quantified (length of hospital stay, living-supports). QuickSort scores, patient background information, and two common cognitive screens were used to differentiate between older inpatients (n = 124) who lacked (64%)/did not-lack (36%) LS-DMC. RESULTS: Hospitalizations averaged 49 days, with 62% of inpatients being readmitted within one year. The QuickSort differentiated between those lacking/not-lacking LS-DMC better than two common cognitive screens and patient information. The likelihood that inpatients lacked LS-DMC increased by a factor of 65.26 for QuickSort scores <2 and reduced by a factor of 0.32 for scores ≥13. Modeling revealed that the post-test likelihood of lacking LS-DMC increased to 99% (scores <2) and reduced to 30% (scores ≥ 13) in settings where many inpatients lack LS-DMC. CONCLUSIONS: Older adult inpatients with questionable LS-DMC have a high risk of extended hospitalization and readmission. The QuickSort provides time-efficient and sensitive information regarding patients' LS-DMC, making it a viable alternative to longer cognitive screens that are used at the initial interview stage.

Service and support needs following pediatric brain injury: perspectives of children with mild traumatic brain injury and their parents.

OBJECTIVE: To provide a qualitative examination of the service and support needs of children who have had a mild traumatic brain injury (mTBI), and their parents, in order to improve clinical services. METHODS: Semi-structured interviews were conducted with 9 children (8-12 years; M = 10.6 years, SD = 0.8) and their parents (n = 9) 29-55 days (M = 34 days; SD = 9.3) after presenting to an Australian Paediatric Emergency Department (PED) for mTBI. Children's post-concussive symptoms (PCS) were additionally measured using the Post-Concussive Symptom Inventory (PCSI). Audio recordings were transcribed, and a thematic analysis was conducted. RESULTS: Post-injury needs were reflected in four main themes: Communication; Family Burden; Continuity of Care; and Social and Community Support. These themes reflected children's and parents' needs for information, emotional/social/community support, and follow-up care. Both the children's and parents' needs, and the extent to which they were met, appeared to be related to the severity and duration of the child's PCS. CONCLUSIONS: Dedicated pediatric mTBI follow-up services that build on family's resources and meet their individual needs for information, emotional support, and referral may assist in optimizing post-injury outcomes.

Prevalence of Depression, Anxiety and PTSD in People with Dementia: a Systematic Review and Meta-Analysis.

There appears to be a link between depression/anxiety/PTSD and dementia, although the evidence is incomplete and the reason is unclear. Mental illness may cause dementia or may be prodromal or comorbid with dementia, or dementia may trigger a relapse of symptoms in individuals with a history of mental illness. This study examined the link between depression/anxiety/PTSD and dementia by evaluating the prevalence of these disorders in people with dementia, relative to their healthy peers. Existing meta-analyses have examined the prevalence of clinically-significant depression and anxiety in Alzheimer's disease (AD), and depression in frontotemporal dementia (FTD), but have not considered vascular dementia (VaD), dementia with Lewy bodies (DLB), PTSD, or anxiety in FTD. The current meta-analysis compared the prevalence of clinically-significant depression, anxiety and PTSD in the four most common types of dementia (AD, VaD, DLB, FTD) and in unspecified dementia to that of healthy controls (PROSPERO number: CRD42017082086). PubMed, EMBASE, PsycINFO and CINAHL database searches identified 120 eligible studies. Prevalence rates were calculated for depression and anxiety in AD, VaD, DLB, FTD, unspecified dementia, and controls. PTSD data were only available for unspecified dementia. Subgroup analyses indicated that depression, but not anxiety, was more prevalent in people with dementia compared to controls; however, the anxiety analyses were probably under-powered. The results support a link between depression and dementia; however, the link between anxiety or PTSD and dementia remains unclear due to insufficient data. Longitudinal data is now needed to clarify whether depression/anxiety/PTSD may be risk factors for dementia.

Traumatic Brain Injury and Depression in a Community-Based Sample: A Cohort Study Across the Adult Life Span.

OBJECTIVES: To determine whether self-reported traumatic brain injuries (TBIs) are associated with "cases" of clinically significant depression in the general community. To examine interactions between variables previously linked to depression after a TBI. SETTING: Population-based community study (Canberra and Queanbeyan, Australia). PARTICIPANTS AND DESIGN: Three age cohorts: young, middle-aged, and older adults (aged 20-24, 40-44, and 60-64 years at baseline) randomly selected from the electoral roll and followed across 3 waves (4 years apart). A total of 7397, 6621, and 6042 people provided their TBI history in waves 1 to 3. MEASURES: Lifetime (TBIlifetime: sustained at any time since birth), recent (TBIrecent: in the preceding 4 years), and multiple (TBImultiple: more than 1) TBIs, current depression, and known risk factors for depression (age, sex, marital/employment status, prior history of depression, medical conditions, recent life events, alcohol consumption, social support, physical activity). RESULTS: Generalized estimating equations demonstrated a significant association between sustaining a TBI and experiencing clinically significant depression (cases), even after controlling for multiple demographic and health/lifestyle factors. CONCLUSION: There is an enduring association between depression and TBI, suggesting that, following a TBI, individuals should be monitored and supported to optimize their long-term psychological health.

Impact of day-of-injury alcohol consumption on outcomes after traumatic brain injury: A meta-analysis.

Although a known risk factor for traumatic brain injury (TBI), alcohol has been found to both promote and protect against secondary brain damage. However, it is presently unclear whether the cognitive, psychological and medical/functional outcomes of adults who have consumed alcohol prior to sustaining a TBI differ from those who have not. This meta-analysis examined the outcomes of groups that differed in terms of their day-of-injury (DOI) blood alcohol levels (BALs) by comparing positive with zero BAL (BAL+/BAL-) and high with low BAL (BALhigh/BALlow) samples. The PubMed, PsycINFO, EMBASE, and Scopus databases were searched from inception until the end of March 2015. Hedge's g effects (continuous data) and odds ratios (categorical data) were calculated for 27 studies that compared either the outcomes of BAL+ and BAL- groups or BALhigh and BALlow groups. BAL+ was associated with significantly poorer cognitive outcomes (overall and on general tests) and higher levels of disability, and BALhigh was associated with shorter stays in intensive care. More generally, however, most effect sizes were small to low-moderate in size, non-significant and inconsistent in their direction. Although DOI alcohol consumption increases the risk of sustaining a TBI, it is not consistently associated with better or worse outcomes, other than subtle cognitive deficits; the source of which remains to be determined.

Depression and anxiety after total joint replacement among older adults: a meta-analysis.

OBJECTIVE: Patients usually experience good physical recovery after total joint replacement (TJR); however, it is unclear whether mood also improves. The current meta-analysis examined changes in depression and anxiety following TJR in older (≥50 years) patients in order to address this gap in the literature. METHODS: Data from 26 studies (4045 TJR, 55 controls) that assessed depression and/or anxiety pre- and post-surgery in TJR patients, with or without a control group, were analyzed. Prevalence rates and Cohen's d effect sizes were used to evaluate changes in the prevalence and severity of depression/anxiety, respectively. RESULTS: Approximately 23% of TJR patients had clinically significant levels of depression prior to surgery, which decreased to 13% one year later. The prevalence of anxiety could not be evaluated due to the limited available data. TJR patients did not show any clinically meaningful reductions in symptoms of depression or anxiety, following surgery. Compared to controls, there was no difference in symptom progression over time; although only one study examined this. CONCLUSIONS: TJR patients appear to have higher rates of clinically significant symptoms of depression before and after surgery, compared to the general population, however more research with adequate control groups is needed to confirm this. Only a modest improvement in the severity of depression and anxiety symptoms was noted post-surgery. However, existing research is limited; preventing definite conclusions regarding the impact of TJR on mood.

Community versus orthopaedic controls in traumatic brain injury research: how comparable are they?

BACKGROUND: Community (CC) or orthopaedic/injury (OC) control groups are typically used to evaluate the consequences of traumatic brain injuries (TBIs). Whereas CCs match for demographic variables and are readily available, OCs may additionally control for other pre- and post-injury variables but are more costly to recruit. Together, they enable an evaluation of brain- vs general-injury effects. However, the comparability of these two groups and the increase in control over confounding variables when OCs are used has rarely been examined. METHOD: The current study compared samples of CCs (n = 71) and OCs (n = 69), aged between 18-80, on a range of demographic (age, gender, education, socio-economic status), background (medical history, handedness), psychosocial (alcohol use, fatigue, pain, depression, social support, community integration, 'post-concussion' symptoms) and cognitive (motor and processing speed, memory, intellectual ability) variables. RESULTS: The two groups were comparable on all variables, except alcohol use, with the OC group having higher levels of alcohol consumption. However, alcohol use did not correlate with any other variable, including commonly used measures of outcome following TBI. CONCLUSION: The current findings suggest that an orthopaedic injury control group does not have any clear advantages over a carefully recruited community control group.

Predictors of mental health in adults with congenital craniofacial conditions attending the Australian craniofacial unit.

Objective : Adults with craniofacial conditions experience more psychosocial problems than adults in the general population, but little is known about the factors that render a person more or less susceptible to these problems. Guided by research on adults with other conditions that affect appearance, this study examined predictors of psychosocial outcome in adults with craniofacial conditions. Design : Single-sample cross-sectional design. Setting : The Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, one of the main craniofacial treatment centers in Australia. Participants : Adults (N  =  93; 36.9% of the potential sample) with congenital craniofacial conditions (excluding cleft lip and/or cleft palate) who were treated in the Australian Craniofacial Unit. Main Outcome Measures : All participants completed measures assessing anxiety, depression, and quality of life (Hospital Anxiety and Depression Scale, Short-Form Health Survey) and variables predicted to affect these outcomes (SF-36 Health Survey - Multidimensional Scale of Perceived Social Support, Rosenberg Self-Esteem Scale, Cleft Satisfaction Profile, Brief Fear of Negative Evaluation Scale, Derriford Appearance Scale). Results : Multiple regression analyses revealed that anxiety was predicted by social support, self-esteem, and fear of negative evaluation, while depression was predicted by self-esteem and social support. Physical quality of life was not predicted by any of the measures. Satisfaction with appearance, gender, age, and education were not related to outcome. Conclusions : Interventions designed to increase perceived social support and self-esteem and reduce fear of negative evaluation appear to be indicated and may assist in establishing a causal relationship between these variables.

Inflammatory markers in persons with clinically-significant depression, anxiety or PTSD: A systematic review and meta-analysis.

BACKGROUND: Depression, anxiety and PTSD appear to be risk factors for dementia, but it is unclear whether they are causal or prodromal. The inflammatory-mediated neurodegeneration hypothesis suggests a causal link, proposing that mental illness is associated with an inflammatory response which, in turn, triggers neurodegenerative changes that lead to dementia. Existing meta-analyses have yet to examine inflammatory markers in depression, anxiety or PTSD with the view to exploring the inflammatory-mediated neurodegeneration hypothesis. The current meta-analysis therefore examined whether: a) depression, anxiety and PTSD are individually associated with inflammation, independently of comorbid mental illnesses and physical health problems with known inflammatory responses, and b) there are any similarities in the inflammatory profiles of these disorders in order to provide a basis for exploring inflammation in people with dementia who have a history of clinically-significant anxiety, depression or PTSD. METHODS: PubMed, EMBASE, PsycINFO and CINAHL searches identified 64 eligible studies. RESULTS: Depression is associated with an inflammatory response, with tentative evidence to suggest anxiety and PTSD are also associated with inflammation. However, the specific response may differ across these disorders. LIMITATIONS: The data for anxiety, PTSD and multiple inflammatory markers were limited. CONCLUSIONS: Depression, anxiety, and PTSD each appear to be associated with an inflammatory response in persons who do not have comorbid mental or physical health problems that are known to be associated with inflammation. Whether this inflammatory response underlies the increased risk of dementia in persons with a history of depression and anxiety, and possibly PTSD, remains to be determined.

Psychosocial functioning in adults with congenital craniofacial conditions.

OBJECTIVE: To examine the psychosocial functioning of adults with congenital craniofacial conditions relative to normative data. DESIGN: Single sample cross-sectional design. SETTING: The Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, which is one of the main craniofacial treatment centers in Australia. PARTICIPANTS: Adults (N  =  93) with congenital craniofacial conditions (excluding cleft lip/palate) who were treated in the Australian Craniofacial Unit. MAIN OUTCOME MEASURES: All participants completed self-report scales assessing health-related quality of life (SF-36); life satisfaction, anxiety, and depression (HADS); self-esteem (Rosenberg); appearance-related concerns; perceived social support; and social anxiety. RESULTS: Overall, participants were very similar in psychosocial function to the general population. However, adults with craniofacial conditions were less likely to be married and have children (females), were more likely to be receiving a disability pension, and reported more appearance-related concerns and less social support from friends. They also reported more limitations in both their social activities, due to physical or emotional problems, and usual role activities, because of emotional problems, as well as poorer mental health. CONCLUSIONS: These results give cause to be very positive about the long-term outcomes of children who are undergoing treatment for craniofacial conditions, while also identifying specific areas that interventions could target.

Validity of the montreal cognitive assessment (MoCA) as a screening test for mild cognitive impairment (MCI) in a cardiovascular population.

While rates of mild cognitive impairment (MCI) are relatively high in populations with cardiovascular diseases and risk factors, screening tests for MCI have not been evaluated in this patient group. This study investigated the sensitivity and specificity of the Montreal Cognitive Assessment (MoCA) tool for detecting MCI in 110 patients (mean age 67.9 + 11.7 years; 60% female) recruited from hospital cardiovascular outpatient clinics. Mean MoCA performance was relatively low (22.8 + 3.8) in this group, with 72.1% of participants scoring below the recommended cutoff for cognitive impairment (<26). The presence of MCI was determined using the Neuropsychological Assessment Battery Screening Module (NAB-SM). Both amnestic MCI and multiple-domain MCI were identified. The optimum MoCA cutoff for detecting MCI in this group was <24. At this cutoff, the MoCA's sensitivity for detecting amnestic MCI was 100% and for multiple-domain MCI it was 83.3%. Specificity rates for amnestic MCI and multiple-domain MCI were 50.0% and 52% respectively. The poor specificity of the MoCA suggests that it will have limited value as a screening test for MCI in settings where the overall prevalence of MCI is low.

Effectiveness of sorting tests for detecting cognitive decline in older adults with dementia and other common neurodegenerative disorders: A meta-analysis.

The demand for simple, accurate and time-efficient screens to detect cognitive decline at point-of-care is increasing. Sorting tests are often used to detect the 'executive' deficits that are commonly associated with behavioural-variant frontotemporal dementia (bvFTD), but their potential for use as a cognitive screen with older adults is unclear. A comprehensive search of four databases identified 142 studies that compared the sorting test performance (e.g. WCST, DKEFS-ST) of adults with a common neurodegenerative disorder (e.g. Alzheimer's disease, vascular dementia, bvFTD, Parkinson's disease) and cognitively-healthy controls. Hedges' g effect sizes were used to compare the groups on five common test scores (Category, Total, Perseveration, Error, Description). The neurodegenerative disorders (combined) showed large deficits on all scores (g -1.0 to -1.3), with dementia (combined subtypes) performing more poorly (g -1.2 to -2.1), although bvFTD was not disproportionately worse than the other dementias. Overall, sorting tests detected the cognitive impairments caused by common neurodegenerative disorders, especially dementia, highlighting their potential suitability as a cognitive screen for older adults.

Cognitive, behavioral and psychological functioning of children and adults with conservatively managed metopic synostosis.

Children diagnosed with metopic synostosis (MS) commonly experience poor neuropsychological outcomes, with research suggesting that children whose MS is managed conservatively (without surgery) potentially having worse outcomes than their operated peers. However, studies of children whose MS was managed conservatively are scarce. This study therefore examined the cognitive, behavioral, and psychological functioning of children/adults with conservatively managed MS (N = 38) and compares their outcomes to individually matched healthy controls (N = 38) of the same age and sex (matched-pairs design) from the general community. Age-appropriate, validated assessments measuring general cognition, verbal and visuospatial ability, attention and working memory, executive functioning, behavior, depression, anxiety, and satisfaction with appearance were utilized. Group differences were estimated using linear regression for (a) the overall sample and (b) by broad developmental stages: 2&3 yrs; ≥6-≤17. Moderate to large negative effects (g = -0.38 to -1.30) were evident before controlling for socio-economic status (SES), with the MS group performing significantly worse on 8 out of the 10 cognitive domains (general cognition, visuospatial ability, working memory, information processing, executive functioning: semantic & initial letter verbal fluency, switching, inhibition+switching). However, only initial letter verbal fluency (g = -0.99) and switching (g = -1.19) remained significant after adjusting for SES. The MS group displayed more behavioral problems, although this was not significant. Depression, anxiety, and satisfaction with appearance did not differ between the groups. Regular monitoring of cognitive functioning, particularly executive functioning, should be undertaken for those with conservatively managed MS.

Cognitive functioning in chronic fatigue syndrome: a meta-analysis.

BACKGROUND: Cognitive problems are commonly reported in persons with chronic fatigue syndrome (CFS) and are one of the most disabling symptoms of this condition. A number of cognitive deficits have been identified, although the findings are inconsistent and hindered by methodological differences. The current study therefore conducted a meta-analysis of research examining cognitive functioning in persons with CFS in order to identify the pattern and magnitude of any deficits that are associated with this condition. METHOD: A comprehensive search of the PubMed and PsycINFO databases for studies that examined cognitive functioning in CFS between 1988 and 2008 identified 50 eligible studies. Weighted Cohen's d effect sizes, 95% confidence intervals and fail-safe Ns were calculated for each cognitive score. RESULTS: Evidence of cognitive deficits in persons with CFS was found primarily in the domains of attention, memory and reaction time. Deficits were not apparent on tests of fine motor speed, vocabulary, reasoning and global functioning. CONCLUSIONS: Persons with CFS demonstrate moderate to large impairments in simple and complex information processing speed and in tasks requiring working memory over a sustained period of time.

Psychological intervention during spinal rehabilitation: a preliminary study.

STUDY DESIGN: A repeated measures, non-randomised controlled trial. OBJECTIVE: To examine the effectiveness of individualised cognitive behaviour therapy (CBT) on the psychological adjustment of patients undergoing rehabilitation for newly acquired spinal cord injury. SETTING: South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, South Australia, Australia. METHODS: Eleven participants received individual CBT as part of their spinal rehabilitation. Self-reported levels of depression, anxiety and stress were assessed before the intervention, at week 12 of rehabilitation and at 3 months post-discharge, using the depression, anxiety and stress scales (DASS-21). Functional independence was also assessed, using the Functional Independence Measure (FIM). Responses were compared with 13 participants, closely matched on demographic and injury variables, who received standard psychological care (that is, assessment and monitoring only). RESULTS: Depression scores for treatment participants showed a significant time effect, with worsening symptoms reported at three-month follow-up, after CBT was discontinued. In contrast, the DASS-21 scores of standard care participants remained at subclinical levels throughout the study. Clinical improvements in symptoms of anxiety and stress were also reported by the treatment group as inpatient therapy progressed. CONCLUSION: Targeted, individualised psychological treatment contributed to short-term, meaningful improvements in emotional outcomes for individuals reporting psychological morbidity after recent spinal injury. The results also highlight the need for ongoing access to specialised, psychological services post-discharge. Replication of these results with a larger sample is required before definitive conclusions can be drawn.

Risk of Dementia in persons who have previously experienced clinically-significant Depression, Anxiety, or PTSD: A Systematic Review and Meta-Analysis.

BACKGROUND: Depression, anxiety and PTSD appear to be linked to dementia, but it is unclear whether they are risk factors (causal or prodromal) for, comorbid with, or sequelae to (secondary effect of) dementia. Existing meta-analyses have examined depression or anxiety in all-cause dementia, Alzheimer's disease (AD) and vascular dementia (VaD), but have not considered post-traumatic stress disorder (PTSD), dementia with Lewy bodies (DLB), or frontotemporal dementia (FTD). The current meta-analysis examined the risk of developing dementia (AD, VaD, DLB, FTD, all-cause) in people with and without a history of clinically-significant depression, anxiety or PTSD in order to better understand the link between mental illness and dementia (PROSPERO number: CRD42018099872). METHODS: PubMed, EMBASE, PsycINFO and CINAHL searches identified 36 eligible studies. RESULTS: There is a higher risk of developing all-cause dementia and AD in people with previous depression, and a higher risk of all-cause dementia in people with prior anxiety, than in persons without this history. Prior PTSD was not associated with a higher risk of later being diagnosed with dementia. LIMITATIONS: The data for anxiety, PTSD, DLB and FTD were limited. CONCLUSIONS: Depression and anxiety appear to be risk factors for dementia, but longitudinal studies across adulthood (young adult/mid-life/older adult) are needed to evaluate the likely causal or prodromal nature of this risk. The link between PTSD and dementia remains unclear. Regular screening for new onset mental illness and for cognitive changes in older adults with a history of mental illness may assist with earlier identification of dementia.

Are patient educational resources effective at deterring stroke survivors from considering experimental stem cell treatments? A randomized controlled trial.

OBJECTIVE: To evaluate whether online resources developed to educate people about the risks associated with experimental stem cell (SC) treatments influence stroke survivors' attitudes about the safety and effectiveness of these treatments. METHODS: Adult stroke survivors who had not previously received SC treatments (N = 112) were recruited from international stroke advocacy/support groups for a prospective, parallel-group randomized controlled trial. Participants indicated whether they were considering SC treatments (yes/no) prior to, immediately following, and 30-days after reading/viewing the International Society for Stem Cell Research booklet or Stem Cell Network video. Participant attitudes regarding the safety, effectiveness, accessibility and affordability of SC treatments were examined on each occasion, and compared to those of a waitlist control group. RESULTS: Significantly fewer participants were considering SC treatments immediately after reading the SC research booklet (p =.031), although neither intervention had any impact after 30-days (p >.05). Waitlist and intervention groups reported positive attitudes toward SC treatments at each assessment. CONCLUSIONS: Stroke survivor attitudes toward SC treatments were initially influenced by the patient booklet, however these changes were not maintained. PRACTICAL IMPLICATIONS: Clinicians are encouraged to initiate discussions about experimental SC treatments during inpatient rehabilitation and to reinforce the risks throughout subsequent care.

Cognitive functioning in Alzheimer's and vascular dementia: a meta-analysis.

Differentiating between Alzheimer's disease (AD) and vascular dementia (VaD) remains difficult but important if existing pharmacological treatments are to provide symptomatic relief in the case of AD or to alter disease progression in the case of VaD. Cognitive assessments play an important role in aiding diagnosis, despite a lack of clear evidence defining the cognitive abilities and tests that best distinguish between the two types of dementia. The current study therefore completed a meta-analysis of research comparing the cognitive abilities of persons diagnosed with AD and VaD. A comprehensive search was undertaken of the PubMed and PsychInfo databases, with 81 studies being eligible for inclusion. Weighted Cohen's d effect sizes, percentage overlap statistics, fail-safe Ns, and confidence intervals were calculated for all cognitive tests. Of the tests that were examined by more than one study, there was one test of perception and one test of verbal memory that showed large and significant group differences. There were an additional 12 tests that may prove useful. However, all cognitive tests were limited in their ability to discriminate between AD and VaD, suggesting that they should be used cautiously and only in conjunction with other information (imaging, medical history) when diagnosing patients.

Relationship between intelligence and the size and composition of the corpus callosum.

We investigated the relationship between the morphology of the corpus callosum (CC) and IQ in a healthy sample of individuals in their late teens and early twenties. The relationship between the area of the CC, measured at the midline, and IQ showed regional differences. We observed that a higher estimated performance IQ was associated with smaller area in the posterior regions of the CC, a finding that differs from a positive association previously observed in a somewhat older adult sample. In contrast, higher estimated verbal IQ was associated with decreased fractional anisotropy of the genu, an anterior portion of the CC. Age effects were also observed such that older age was associated with larger CC area. Our results suggest that CC morphology is related to cognitive performance, which may have implications for clinical populations in whom CC morphology is atypical.

Cognitive, behavioral and psychological functioning in children with metopic synostosis: a meta-analysis examining the impact of surgical status.

Neurodevelopmental delays are known to occur in children with metopic synostosis, but it is presently unclear whether the cognitive, behavioral and psychological outcomes of children with metopic synostosis differ to those of their healthy peers. This meta-analysis consolidated data from 17 studies (published prior to August 2017) that examined the cognitive, behavioral and psychological outcomes of children (n = 666; aged ≤19 yrs) with metopic synostosis. Hedges'g (gw) effect sizes compared the outcomes of samples with metopic synostosis (unoperated, operated) to healthy controls or normative data and, where available, the prevalence of problems/disorders was calculated. Children with unoperated metopic synostosis performed significantly worse than their healthy peers on measures of: general cognition (gw = -.38), motor functioning, (gw = -.81), and verbal (gw = -.82) and visuospatial (gw = -.92) abilities. Children with operated metopic synostosis performed significantly worse on measures of motor functioning (gw = -.45), visuospatial skills (gw = -.32), attention (gw = -.50), executive functioning (gw = -.36), arithmetic ability (gw = -.37), and behavior (gw = -.34). Cognitive, behavioral, and psychological problems were prevalent, but variable. Overall, the cognitive, behavioral, and psychological outcomes of children with metopic synostosis are generally worse than their healthy peers, regardless of surgical status. However, research is sparse, samples small, controls are rarely recruited, and the severity of metopic synostosis often not stated. Nevertheless, the findings suggest that children with metopic synostosis are likely to experience a variety of negative outcomes and should therefore receive ongoing monitoring and support.