Age Predicts Older Adults' Driving Self-Regulation but Not Dangerous Driving Behaviors after Controlling for Executive Function.

OBJECTIVES: The aim of the study was to examine the unique contributions of age to objectively measure driving frequency and dangerous driving behaviors in healthy older adults after adjusting for executive function (EF). METHOD: A total of 28 community-dwelling older adults (mean age = 82.0 years, standard deviation [SD] = 7.5) without dementia who were in good physical health and enrolled in a longitudinal aging study completed several EF and clinical self-report measures at baseline. Participants subsequently had a sensor installed in their vehicle for a mean of 208 (SD = 38, range = 127-257) days. RESULTS: Participants drove for an average of 54 min per day. Mixed-effects models indicated that after controlling for EF, older age was associated with less time driving per day, decreased number of trips, and less nighttime driving. Age was not associated with hard brakes or hard accelerations. DISCUSSION: After accounting for EF, greater age is associated with higher driving self-regulation but not dangerous driving behaviors in healthy older adults. Future studies should recruit larger samples and collect sensor-measured driving data over a more extended time frame to better determine how and why these self-regulation changes take place.

Family Needs After Traumatic Brain Injury: A VA TBI Model Systems Study.

OBJECTIVE: To describe the self-reported needs of family caregivers of service members and veterans (SMVs) who sustained a traumatic brain injury (TBI) and to identify predictors of the unmet family caregiver needs. SETTING: Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs). PARTICIPANTS: Family caregivers of SMVs enrolled in the VA PRC TBI Model Systems (TBIMS) national database who were within their first 5 years post-TBI ( n = 427). DESIGN: Observational study. MAIN OUTCOME MEASURE: The Family Needs Questionnaire-Revised (FNQ-R) was completed by each SMV's designated caregiver. ANALYSES: Descriptive analyses were conducted on the FNQ-R responses at the item, domain, and total score levels. Unadjusted univariable and adjusted multivariable regression models were fitted to identify predictors of total unmet needs and unmet family need domains. RESULTS: FNQ-R item-level and domain-level descriptive results indicated that health information was the most frequently met need domain. In contrast, emotional and instrumental support domains were the least often met. On average, family caregivers reported that 59.2% of the 37 FNQ-R needs were met at the time of the follow-up assessment. Regression models indicated that both the number of SMV-perceived environmental barriers and whether the SMV received mental health treatment within the past year predicted the number of unmet FNQ-R needs. SMV-reported environmental barriers predicted increased unmet needs in all 6 family caregiver domains, and SMV mental health treatment in the past year predicted more unmet family caregiver emotional support, community support, and professional support needs. CONCLUSIONS: The current findings can be used to inform policy and programming for VA and Department of Defense to proactively address the specific needs of families and caregivers experienced in the first 5 years post-TBI.

Associations between changes in somatic and psychiatric symptoms and disability alterations in recent-era U.S. veterans.

Cross-sectional work suggests that deployment-related posttraumatic sequelae are associated with increased disability in U.S. veterans deployed following the September 11, 2001 (9/11), terrorist attacks. However, few studies have examined the psychiatric and somatic variables associated with changes in functional disability over time. A total of 237 post-9/11 veterans completed comprehensive assessments of psychiatric and cognitive functioning, as well as a disability questionnaire, at baseline and 2-year follow-up. At baseline, higher levels of PTSD, depressive, and pain-related symptoms were associated with baseline global functional disability, semipartial r2 = .036-.044. Changes in symptoms of PTSD, depression, pain, and sleep, but not anxiety or alcohol use, were independently associated with changes in functional disability, semipartial r2 = .017-.068. Baseline symptoms of these conditions were unrelated to changes in disability, and cognitive performance was unrelated to disability at any assessment point. Together, this suggests that changes in psychiatric and somatic symptoms are tightly linked with changes in functional disability and should be frequently monitored, and even subclinical symptoms may be a target of intervention.

The Survey for Memory, Attention, and Reaction Time (SMART): Development and Validation of a Brief Web-Based Measure of Cognition for Older Adults.

INTRODUCTION: Brief, Web-based, and self-administered cognitive assessments hold promise for early detection of cognitive decline in individuals at risk for dementia. The current study describes the design, implementation, and convergent validity of a fWeb-based cognitive assessment tool, the Survey for Memory, Attention, and Reaction Time (SMART), for older adults. METHODS: A community-dwelling sample of older adults (n = 69) was included, classified as cognitively intact (n = 44) or diagnosed with mild cognitive impairment (MCI, n = 25). Participants completed the SMART at home using their computer, tablet, or other Internet-connected device. The SMART consists of 4 face-valid cognitive tasks available in the public domain assessing visual memory, attention/processing speed, and executive functioning. Participants also completed a battery of standardized neuropsychological tests, a cognitive screener, and a daily function questionnaire. Primary SMART outcome measures consisted of subtest completion time (CT); secondary meta-metrics included outcomes indirectly assessed or calculated within the SMART (e.g., click count, total CT, time to complete practice items, and time of day the test was completed). RESULTS: Regarding validity, total SMART CT, which includes time to complete test items, practice items, and directions, had the strongest relationship with global cognition (ß = -0.47, p < 0.01). Test item CT was significantly greater for the MCI group (F = 5.20, p = 0.026). Of the SMART tasks, the executive functioning subtests had the strongest relationship with cognitive status as compared to the attention/processing speed and visual memory subtests. The primary outcome measures demonstrated fair to excellent test-retest reliability (intraclass correlation coefficient = 0.50-0.76). CONCLUSIONS: This study provides preliminary evidence for the use of the SMART protocol as a feasible, reliable, and valid assessment method to monitor cognitive performance in cognitively intact and MCI older adults.

Predictors of Driving Status in Service Members and Veterans at 1 Year Posttraumatic Brain Injury: A VA TBI Model Systems Study.

OBJECTIVE: To identify predictors of driving status in service members and veterans 1 year following a traumatic brain injury (TBI). SETTING: The 5 Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs). PARTICIPANTS: A total of 471 service members and veterans (128 with mild/complicated mild TBI and 343 with moderate/severe TBI) who received TBI-focused inpatient rehabilitation at one of the VA PRCs and who participated in a 1-year postinjury follow-up assessment. DESIGN: Secondary analysis from the Department of Veterans Affairs Polytrauma Rehabilitation Centers Traumatic Brain Injury Model Systems (VA PRC TBIMS) national database. MAIN MEASURES: Primary outcome was a single item that assessed driving status at 1 year postinjury. Predictor variables included demographics; sensory impairment, substance use, and employment status at time of injury; PTSD symptoms reported at study enrollment; and functional impairment rated at rehabilitation discharge. RESULTS: In unadjusted bivariate analyses, among those with a mild/complicated mild TBI, older age and greater functional impairment were associated with lower likelihood of driving. Among those with a moderate/severe TBI, discharge to a nonprivate residence, greater functional impairment, and higher PTSD symptoms were linked to lower likelihood of driving. Adjusted multivariate analyses indicated that functional impairment was uniquely associated with driving status in both TBI severity groups. After controlling for other predictors, self-reported PTSD symptoms, particularly dysphoria symptoms, were associated with lower likelihood of driving in both severity groups. CONCLUSION: Given the significance of clinician-rated functional impairment and self-reported PTSD symptoms to the prediction of driving status 1 year post-TBI among service members and veterans, rehabilitation efforts to improve functioning and reduce negative affect may have a positive impact on driving and community integration.

Examining Relationships between Multiple Self-Reported Sleep Measures and Gait Domains in Cognitively Healthy Older Adults.

BACKGROUND: Gait-related changes in older adulthood may be related to changes in cognition (e.g., executive functioning), and recent work suggests that different self-reported measures of sleep may be tied to contrasting aspects of executive functioning. However, the relationship between these self-reported sleep measures and gait domains has not been explored. Such an investigation would be useful in helping to determine which older adults might exhibit changes in gait as well as experience other gait-associated changes (e.g., increased fall risk). OBJECTIVE: To examine associations between different aspects of self-reported sleep and gait domains in a sample of cognitively healthy older adults. METHOD: A total of 423 older adults (mean age 69.9 years, range 50-92) completed self-report measures of sleep quality, daytime sleepiness, and sleep-related distress. The participants also completed an objective, electronic measure of both single-task and dual-task gait (i.e., GAITRite). Principal component analyses were used to elucidate the solution for each gait condition, and multiple linear regression was used to examine the contributions of sleep measures to variability in gait performance. RESULTS: A 5-component solution of the single-task condition and a 4-component solution of the dual-task condition were identified. Multiple linear regressions revealed that a poorer sleep quality was associated with greater single-task and dual-task asymmetry. Greater daytime sleepiness was associated with increased dual-task gait variability and postural control. After controlling for the effects of other facets of sleep, sleep-related distress was not associated with any gait domain. CONCLUSIONS: Among cognitively healthy older adults,sleep quality and daytime sleepiness, but not sleep-related distress, are associated with aspects of gait. Patients who report these symptoms should be assessed and monitored for possible changes in gait.

Assessment of anxiety in older adults: psychometric properties and relationships with self-reported functional impairment.

OBJECTIVE: The current study aimed to examine the psychometric properties of two geriatric anxiety measures: the Geriatric Anxiety Inventory (GAI) and the Geriatric Anxiety Scale (GAS). This study also aimed to determine the relationships of these measures with two measures of functional ability and impairment: the Barkley Functional Impairment Scale (BFIS) and the Everyday Cognition Scale (E-Cog). DESIGN: Confirmatory factor analyses (CFA) were used to analyze the factor structures of the GAI and GAS in older adults. Tests for dependent correlations were used to examine the relationship between anxiety scales and functioning. SETTING: Amazon's Mechanical Turk. PARTICIPANTS: 348 participants (aged 55-85, M= 62.75 (4.8), 66.5% female) with no history of psychosis or traumatic brain injury. RESULTS: CFAs supported the previously demonstrated bifactor solution for the GAI. For the GAS, the previously demonstrated three-factor model demonstrated a good-to-excellent fit. Given the high correlation between the cognitive and affective factors (r =.89), a bifactor solution was also tested. The bifactor model of the GAS was found to be primarily unidimensional. Tests for dependent correlations revealed that the GAS demonstrated stronger relationships with measures of self-reported functional impairment than the GAI. CONCLUSIONS: The current study provides further psychometric validation of the factor structure of two geriatric anxiety measures in an older adult sample. The results support previous work completed on the GAI and the GAS. The GAS was more strongly correlated with self-reported functional impairment than the GAI, which may reflect differences in content in the two measures.

Predictors of Collegiate Student-Athletes' Concussion-Related Knowledge and Behaviors.

OBJECTIVE: This study aimed to explore student-athletes' concussion-related knowledge and attitudes toward reporting symptoms, demographic predictors of knowledge and attitudes, and determine whether responses to the survey changed following an online educational intervention. METHODS: A total of 108 Division I student-athletes enrolled at a large southern university completed a survey evaluating knowledge regarding concussion-related terminology, symptoms and recovery trajectories, as well as attitudes toward reporting symptoms following a possible concussion. Student-athletes completed the questionnaire both 24-48 h before and one week after reviewing the educational presentation. RESULTS: At baseline, participants correctly identified 72% of concussion symptoms included in the questionnaire, as well as correctly identified 75% of items related to the typical recovery trajectory post-concussion. A total of 54% of baseline attitudes toward reporting symptoms matched clinical best practices. Multiple analysis of variance (MANOVA) revealed that male sex and non-Caucasian race were associated with worse baseline knowledge of concussion symptoms. Concussion knowledge was not associated with attitudes toward reporting symptoms. Paired samples t-tests indicated that knowledge of concussion-related terminology improved modestly following the educational presentation. CONCLUSIONS: Some subsets of collegiate student-athletes show relatively lower knowledge about symptoms of concussion than others. As a result, these groups may benefit from increased educational efforts to ensure they recognize when a concussion may have occurred. Additionally, as knowledge and attitudes were unrelated and the intervention had a modest effect on knowledge but not attitudes, future work should explore interventions that are designed to directly alter attitudes.

Prédicteurs des connaissances et des comportements d'athlètes-étudiants post-secondaires en ce qui regarde les commotions cérébrales. Objectif: Cette étude vise à explorer les connaissances et les attitudes d'athlètes-étudiants en ce qui regarde le signalement des symptômes liés aux commotions cérébrales mais aussi les prédicteurs démographiques de ces connaissances et de ces attitudes. Elle vise également à déterminer dans quelle mesure des réponses à un sondage ont changé à la suite d'une intervention éducative en ligne. Méthodes: Un total de 108 athlètes-étudiants de première division inscrits dans une université importante du sud des États-Unis ont ainsi répondu à un sondage visant à évaluer, outre leurs attitudes à l'égard du fait de signaler des symptômes consécutifs à une possible commotion cérébrale, leurs connaissances en ce qui regarde la terminologie des commotions cérébrales, les symptômes qui y sont liés ainsi que les trajectoires de rétablissement. Fait à souligner, ces jeunes ont complété le sondage 24 à 48 heures avant leur présentation éducative en ligne et une semaine après l'avoir visionnée. Résultats: Au départ, nos répondants ont correctement identifié 72 % des symptômes de commotion cérébrale inclus dans le sondage. Ils ont aussi identifié correctement 75 % des aspects liés à une trajectoire de rétablissement typique suivant une commotion cérébrale. Un total de 54 % d'attitudes au départ à l'égard du fait de signaler des symptômes a correspondu aux meilleures pratiques sur le plan clinique. Une analyse de variance multivariée (ou « MANOVA ¼ en anglais) a par ailleurs révélé que les athlètes masculins non-caucasiens étaient associés à de plus faibles connaissances de départ au sujet des symptômes des commotions cérébrales. Le fait de posséder de telles connaissances n'a pas été associée à des attitudes spécifiques en ce qui a trait au signalement de symptômes. Des tests de Student d'échantillons appariés ont indiqué que les connaissances portant sur la terminologie des commotions cérébrales se sont améliorées légèrement à la suite des présentations éducatives. Conclusions: Quelques sous-groupes d'athlètes-étudiants du collège ont montré des connaissances relativement plus faibles au sujet des symptômes liés aux commotions cérébrales si on les compare à d'autres. En cela, il se pourrait qu'ils puissent bénéficier d'efforts éducatifs accrus nous permettant de nous assurer qu'ils sont en mesure de reconnaître lorsqu'une commotion éventuelle s'est produite. De plus, considérant que connaissances et attitudes ne sont pas reliées et que l'intervention en ligne a eu un faible impact sur les connaissances mais non sur les attitudes, les efforts à venir devraient envisager des interventions destinées directement à modifier ces mêmes attitudes.

Examining differences in neuropsychiatric symptom factor trajectories in empirically derived mild cognitive impairment subtypes.

OBJECTIVE: The aim of this study was to examine neuropsychiatric symptom (NPS) factor severity progression over time in empirically derived (ED) mild cognitive impairment (MCI) subtypes. METHODS: Participants in the Alzheimer's Disease Neuroimaging Initiative study diagnosed with MCI by Alzheimer's Disease Neuroimaging Initiative protocol using conventional clinical (CC) criteria (n = 788) were reclassified using cluster analysis as amnestic, dysnomic, dysexecutive MCI, or cluster-derived normal (CC-Normal) using empirical criteria. Cognitively normal (CN) participants (n = 207) were also identified. The Neuropsychiatric Inventory-Questionnaire (NPI-Q) was administered from baseline through 48-month follow-up. Exploratory factor analysis was completed to determine the NPI-Q factor structure at 6-month follow-up. Multilevel modeling was used to determine NPI-Q symptom severity factor and apathy symptom progression over time by cognitive subtype. RESULTS: The exploratory factor analysis revealed that the NPI-Q consisted of 2 factors: hyperactivity/agitation and mood symptoms. Using clinical and empirical criteria, all MCI groups were identified as having more severe hyperactivity/agitation symptoms than CN participants. However, only the amnestic MCI group identified using empirical criteria showed an increase in symptom severity over time relative to CN participants. Mood factor and apathy symptoms were found to be more severe in dysexecutive and amnestic groups in both models. Similarly, both models identified a significant worsening of mood and apathy symptoms over time for dysexecutive and amnestic groups relative to CN participants. CONCLUSIONS: This study provides further support that empirical criteria aid in examining the progression of clinical characteristics associated with MCI. Further, it helps to identify which MCI subtypes may be at higher risk for NPS progression.

Executive functioning predicts discrepancies between objective and self-reported physical activity in older adults: a pilot study.

Physical activity (PA) has been linked to cognitive functioning and mental health in older adulthood. Multiple subjective (i.e., self-report) and objective measures (e.g., pedometer) have been used to assess PA, however their agreement varies across studies. This pilot study examined cognitive predictors of the agreement between subjective and objectively measured PA. A total of 30 community-dwelling older adults completed a neuropsychological battery, as well as a measure of subjective PA and wore a wristwatch-based pedometer for 30 days to assess objective PA. Greater discrepancy between subjective and objective PA was correlated with poorer executive functioning (r = -.44, p = .02), and this remained true in regression models after controlling for age and education (b = .-54, p = .01). Older adults with lower executive functioning may be more likely to inaccurately report time spent engaging in PA. Future studies should explore whether this relationship holds in larger samples.

The Survey for Memory, Attention, and Reaction Time (SMART): Preliminary normative online panel data and user attitudes for a brief web-based cognitive performance measure.

ObjectiveThe Survey for Memory, Attention, and Reaction Time (SMART) was recently introduced as a brief (<5 min), self-administered, web-based measure of cognitive performance in older adults. The purpose of this study was threefold: (1) to develop preliminary norms on the SMART; (2) to examine the relationship between demographic variables (i.e. age, sex, education), device type used, and SMART performance; and (3) to assess user attitudes of the SMART. Method A sample of 1,050 community-dwelling adults (M age =59.5 (15.2), M education = 16.5 (2.1), 67.1% female, 96% white) was recruited from an ongoing web-based research cohort. Participants completed the SMART, which consists of four face-valid cognitive tasks assessing visual memory, attention/processing speed, and executive functioning. SMART performance outcome metrics were subtest completion time (CT), click count, and total CT. Participants provided demographic information and completed a survey of user attitudes toward the SMART (i.e. usability, acceptability). Results Older age was the only demographic variable associated with slower SMART total CT (r = .60, p <.001). Education was not associated with SMART CT or click counts overall (p > .05). Male sex was generally associated with longer SMART CT (p < .001, partial eta squared = .14) on all sub-tests. Regarding acceptability, 97.3% indicated willingness to take the SMART again, with more than half willing to complete it on a weekly basis. Conclusion The preliminary normative data on the SMART indicates that it is a feasible and well-accepted web-based cognitive assessment tool that can be administered on multiple device platforms.

Poorer Inhibitory Control Uniquely Contributes to Greater Functional Disability in Post-9/11 Veterans.

OBJECTIVE: Post-9/11 Veterans endorse greater self-reported functional disability than 80% of the adult population. Previous studies of trauma-exposed populations have shown that increased post-traumatic stress disorder (PTSD) and depressive symptoms are consistently associated with greater disability. Additionally, poorer cognitive performance in the domain of executive functions, particularly inhibitory control, has been associated with disability, though it is unclear if this effect is independent of and/or interacts with PTSD and depression. METHOD: Three overlapping samples of n = 582, 297, and 183 combat-deployed post-9/11 Veterans completed comprehensive assessments of executive functions, PTSD and depressive symptoms, and self-reported World Health Organization Disability Assessment Schedule-II (WHODAS II). RESULTS: Poorer performance on measures of inhibitory control (Delis-Kaplan Executive Functioning System Color-Word Interference-CWI Test and gradual-onset Continuous Performance Test-gradCPT), but not other executive functions, were significantly associated with greater disability on the WHODAS II (ρ's = -.13 and -.13, p = .002 and .026, respectively). CWI inhibitory control measures accounted for unique variance in disability after controlling for PTSD and depressive symptoms (R2 change = 0.02, p < .001). Further, CWI significantly moderated the effect of depressive symptoms on disability, such that better inhibitory control weakened the relationship between depression and disability. CONCLUSIONS: Inhibitory control deficits are uniquely associated with increased disability in combat-deployed post-9/11 Veterans, and better inhibitory control abilities may serve as a protective factor for depressive symptoms leading to increased disability.

Contributory Etiologies to Cognitive Performance in Multimorbid Post-9/11 Veterans: The Deployment Trauma Phenotype.

OBJECTIVE: This study examined cognitive functioning in post-9/11 Veterans with the deployment trauma phenotype (DTP), comprised of co-occurring diagnoses of depressive disorder (major depressive disorder and or persistent depressive disorder/dysthymia), posttraumatic stress disorder (PTSD), and mild traumatic brain injury (mTBI), using objective neuropsychological measures. METHOD: Participants included a cross-sectional sample of 399 post-9/11 Veterans who completed clinical interviews and neuropsychological tests as part of a larger study at VA Boston Healthcare System. Confirmatory factor analysis identified four cognitive domains: attention, cognitive control/processing speed, episodic memory, and cognitive flexibility. Veterans with DTP and its constituent diagnoses in isolation, two-way diagnostic combinations, and no constituent diagnoses were compared. RESULTS: Veterans with DTP had a twofold increased prevalence for below average performance in cognitive control/processing speed compared with those with no constituent diagnoses (prevalence ratios [PRs] = 2.04; 95% confidence interval [CI]: 1.03-4.05). The PTSD + depressive disorder group also had a twofold increased prevalence for below average performance in episodic memory (PR = 2.16; 95% CI: 1.05-4.43). CONCLUSIONS: The deployment trauma phenotype is associated with clinically significant decrease in cognitive control/processing speed in post-9/11 Veterans. Comorbid PTSD and depressive disorder negatively impacted performances in episodic memory. Mild TBI alone showed no cognitive deficits. Clinical interventions should target psychiatric symptoms with a transdiagnostic approach to address this multimorbid population.

Associations between Post-Traumatic stress disorder symptoms and automobile driving behaviors: A review of the literature.

Human factors are responsible for most motor vehicle accidents that occur on the road. Recent work suggests that symptoms of posttraumatic stress disorder (PTSD) are linked to reduced driving safety, yet none have provided a comprehensive review of this small, emerging literature. The present review identified twenty-two studies reporting associations between PTSD and driving behaviors. Among these, longitudinal designs (k = 3) and studies using objective driving performance measures (e.g., simulators) (k = 2) were rare. Most studies (k = 18) relied on brief screener measures of PTSD status/symptoms or a prior chart diagnosis, while few used a standardized structured interview measure to determine PTSD status (k = 4), and only a small number of studies assessed PTSD symptom clusters (k = 7). PTSD was most frequently associated with increased rates of hostile driving behaviors (e.g., cutting off others), unintentional driving errors (e.g., lapses in attention) and negative thoughts and emotions experienced behind the wheel. Findings regarding risk of motor vehicle accident and driving-related legal issues were variable, however relatively few studies (k = 5) explored these constructs. Future directions are discussed, including the need for work focused on concurrent PTSD symptom/driving-related changes, more comprehensive PTSD and driving assessment, and consideration of the contributions of comorbid traumatic brain injury history and other neurological and psychiatric conditions on driving outcomes.

Multimethod assessment of driving in older adults using a novel driving simulator.

Driving simulators may be an effective means of assessing driving performance, however many are cost-prohibitive. The present pilot study examined whether a novel, cost-effective driving simulator (Assetto Corsa (AC)) may be useful in the evaluation of older adults' driving performance, and explore associations among various driving safety indicators. A community sample of older adults completed a battery of cognitive measures, several self-reported driving measures, and a novel driving simulator task (AC). Simple attention, executive functioning, and processing speed were associated with simulator performance variables. Lower self-rated driving safety was associated with slower simulated driving. Additionally, several cognitive domains were associated with perceptions about driving-related safety and driving-related legal repercussions (e.g., traffic tickets). Findings suggested that associations between cognitive tests with AC were less robust than those found in other simulator studies. Novel associations between cognitive performance and self-reported driving were identified; however, given the small sample size of this study, such associations should be explored further.

Representation of U.S. Black Americans in neuropsychology research: How well do our reporting practices show that Black lives matter?

OBJECTIVE: Black American individuals comprise about 13% of the population in the United States (U.S.). It is estimated by 2045, approximately 50% of U.S. residents will belong to an ethnic minority group underscoring the importance of the provision of culturally competent services. The present study provides a critical/systematic review of the literature to examine the representation of Black Americans in recent neuropsychological research in U.S. neuropsychology journals. We examined the representation of U.S. Black American individuals across journals, year of study, and by study sample. METHOD: We evaluated 1,151 journal articles published in 4 neuropsychology journals published in 2011, 2014, 2017 and 2019. Articles were coded for reporting of age, sex/gender, years of education, ethnicity/race, and if race was a focus of the study. We also recorded sample size and type of sample. RESULTS: Out of the 397 articles meeting inclusion criteria, 37.5% did not report ethnic or racial demographic information. Additionally, 96% of the articles were not racially/ethnically focused. Black participants comprised 10.7% of participants in articles that reported race/ethnicity. The proportion of Black participants increased by 3.7% between 2011 and 2019. CONCLUSION: Our results demonstrate the underrepresentation of U.S. Black Americans in neuropsychological research over the targeted years. This highlights our shortcomings as a field in demonstrating the importance of including Black Americans in research.

Cognitive and psychological improvements following CogSMART in veterans with mental health diagnoses.

INTRODUCTION: The present study examined the efficacy of a CogSMART-based program in improving cognitive and emotional functioning in a clinic-based sample of Veterans presenting with cognitive concerns and history of mental health diagnoses. METHOD: Forty Veterans (Mage = 61.2 years, 85% male) completed a weekly CogSMART-based group program as well as a battery of neuropsychological and psychological measures at both pre- and post-group evaluations. Participants met DSM-5 criteria for at least one mental health diagnosis. RESULTS: Significant improvements on global cognition as well as measures of learning/memory and attention were observed from pre- to post-group (p < .05, cohen's d range = .48-1.01). As many as 33.3% of participants showed significant improvement, depending on the cognitive domain. Significant overall improvements were observed in depression symptoms and life satisfaction (p < .01, cohen's d = .67 and .59, respectively). Over one-third of the sample demonstrated a reliable improvement in depressive symptoms, 25% in anxiety symptoms, and 18% in life satisfaction. CONCLUSIONS: Among individuals with mental health diagnosis but without major neurocognitive disorders, CogSMART-based interventions may be an effective treatment for improving aspects of cognition, depression, and life satisfaction.

Post-traumatic stress disorder and depression are uniquely associated with disability and life dissatisfaction in post-9/11 veterans.

Veterans who served in post-9/11 conflicts and experience deployment trauma sequelae frequently endorse disability and dissatisfaction with life. Although correlated, disability and life dissatisfaction represent distinct constructs with separate implications for quality of life. We examined associations between deployment trauma sequelae, disability and life dissatisfaction in 288 post-9/11 Veterans. Participants completed assessments of psychiatric, somatic and social functioning. Self-reports evaluating disability and life dissatisfaction were used to group participants based on established criteria (i.e., Disability and Dissatisfaction, Disability Only, Dissatisfaction Only, or No Disability or Dissatisfaction). Multinomial logistic regressions revealed that greater post-traumatic stress disorder (PTSD) and depressive symptom severity were independently associated with increased odds of being in the Disability and Dissatisfaction group, the Disability Only group and the Dissatisfaction Only group, relative to the No Disability or Dissatisfaction group. Number of prior mild traumatic brain injuries (mTBI) was not associated with disability or dissatisfaction after accounting for other trauma sequelae. Social support attenuated the relationship between depression and membership in the Disability and Dissatisfaction group. Participants who reported greater dissatisfaction than disability endorsed greater depression and mTBI frequency. Overall, PTSD and depression convey a heightened risk of both disability and life dissatisfaction, while social support may be protective.

An executive function subtype of PTSD with unique neural markers and clinical trajectories.

Previous work identified a cognitive subtype of PTSD with impaired executive function (i.e., impaired EF-PTSD subtype) and aberrant resting-state functional connectivity between frontal parietal control (FPCN) and limbic (LN) networks. To better characterize this cognitive subtype of PTSD, this study investigated (1) alterations in specific FPCN and LN subnetworks and (2) chronicity of PTSD symptoms. In a post-9/11 veteran sample (N = 368, 89% male), we identified EF subgroups using a standardized neuropsychological battery and a priori cutoffs for impaired, average, and above-average EF performance. Functional connectivity between two subnetworks of the FPCN and three subnetworks of the LN was assessed using resting-state fMRI (n = 314). PTSD chronicity over a 1-2-year period was assessed using a reliable change index (n = 175). The impaired EF-PTSD subtype had significantly reduced negative functional connectivity between the FPCN subnetwork involved in top-down control of emotion and two LN subnetworks involved in learning/memory and social/emotional processing. This impaired EF-PTSD subtype had relatively chronic PTSD, while those with above-average EF and PTSD displayed greater symptom reduction. Lastly, FPCN-LN subnetworks partially mediated the relationship between EF and PTSD chronicity (n = 121). This study reveals (1) that an impaired EF-PTSD subtype has a specific pattern of FPCN-LN subnetwork connectivity, (2) a novel above-average EF-PTSD subtype displays reduced PTSD chronicity, and (3) both cognitive and neural functioning predict PTSD chronicity. The results indicate a need to investigate how individuals with this impaired EF-PTSD subtype respond to treatment, and how they might benefit from personalized and novel approaches that target these neurocognitive systems.

Unobtrusive, in-home assessment of older adults' everyday activities and health events: associations with cognitive performance over a brief observation period.

In-home assessment of everyday activities over many months to years may be useful in predicting cognitive decline in older adulthood. This study examined whether a comparatively brief data collection period (3 months) may yield similar diagnostic information. A total of 91 community-dwelling older adults without dementia underwent baseline neuropsychological testing and completed weekly computer-based surveys assessing health-related events/activities. A subset of participants wore fitness tracker watches assessing daily sleep and physical activity patterns, used a sensor-instrumented pillbox, and had their computer use frequency recorded on a daily basis. Similar patterns in computer use, sleep and medication use were noted in comparison to prior literature with more extensive data collection periods. Greater computer use and sleep, as well as self-reported pain and independence, were also linked to better cognition. These activities and symptoms may be useful correlates of cognitive function even when assessed over a relatively brief monitoring period.