Association of Use of a Mobile Tackling Dummy During College Football Practice With Reduced Sport-Related Concussion: Results of a Pilot Investigation.

Background: Considering the multifaceted consequences of improperly managed sport-related concussions (SRCs) in American football, identifying efficacious prevention measures for enhancing player safety is crucial. Purpose: To investigate the association of primary prevention measures (no-tackle practices and using a mobile tackling dummy in practice) with the frequency of SRCs within college football programs in the United States. Study Design: Descriptive epidemiology study. Methods: In this pilot study, we analyzed the frequency of new SRCs recorded during various settings (total, in preseason, in season, in practice, and game) across 14 seasons (2007-2019 and 2021) for Dartmouth College and across 7 seasons (2013-2019) for the 7 other teams in the Ivy League men's athletic football conference. Trends between seasons and the number of SRCs sustained were examined using correlations and basic descriptive statistics. We also examined SRC frequency in relation to primary prevention measures (no-tackle practices, use of mobile tackling dummies during practice) in the Dartmouth College football program, and we compared SRCs with regard to the no-tackle practice policy in the other Ivy League teams. Results: There was a statistically significant reduction in the number of SRCs over the seasons studied, with the strongest finding observed for Dartmouth College in-game SRCs (r = -0.52; P = .029). Relatedly, the strongest between-season effect was seen for the Dartmouth College practice policy on in-game SRCs (η2 = 0.510; P = .01). The use of mobile tackling dummies was found to be independently associated (adjusting for no-tackle practice) with a lower number total (ß = -0.53; P = .049), in-season (ß = -0.63; P = .023), and in-game (ß = -0.79; P = .003) SRCs. While seasons with the no-tackle practice were not meaningfully associated with SRCs for Dartmouth College, stronger trends were observed in the other Ivy League teams, such that seasons with this policy were associated with lower SRC prevalence. Conclusion: Our data indicate that the use of the mobile tackling dummy in practice was related to the reduced number of SRCs sustained at multiple settings during the football season. To a lesser extent, the no-tackle practice policy was also associated with a reduced number of SRCs.

So how special is special K? A systematic review and meta-analysis of ketamine for PTSD RCTs.

Background: PTSD is a significant mental health problem worldwide. Current evidence-based interventions suffer various limitations. Ketamine is a novel agent that is hoped to be incrementally better than extant interventions.Objective: Several randomized control trials (RCTs) of ketamine interventions for PTSD have now been published. We sought to systematically review and meta-analyse results from these trials to evaluate preliminary evidence for ketamine's incremental benefit above-and-beyond control interventions in PTSD treatment.Results: Omnibus findings from 52 effect sizes extracted across six studies (n = 221) yielded a small advantage for ketamine over control conditions at reducing PTSD symptoms (g = 0.27, 95% CI = 0.03, 0.51). However, bias-correction estimates attenuated this effect (adjusted g = 0.20, 95%, CI = -0.08, 0.48). Bias estimates indicated smaller studies reported larger effect sizes favouring ketamine. The only consistent timepoint assessed across RCTs was 24-hours post-initial infusion. Effects at 24-hours post-initial infusion suggest ketamine has a small relative advantage over controls (g = 0.35, 95% CI = 0.06, 0.64). Post-hoc analyses at 24-hours post-initial infusion indicated that ketamine was significantly better than passive controls (g = 0.44, 95% CI = 0.03, 0.85), but not active controls (g = 0.24, 95% CI = -0.30, 0.78). Comparisons one-week into intervention suggested no meaningful group differences (g = 0.24, 95% CI = 0.00, 0.48). No significant differences were evident for RCTs that examined effects two-weeks post initial infusion (g = 0.17, 95% CI = -0.10, 0.44).Conclusions: Altogether, ketamine-for-PTSD RCTs reveal a nominal initial therapeutic advantage relative to controls. However, bias and heterogeneity appear problematic. While rapid acting effects were observed, all control agents (including saline) also evidenced rapid acting effects. We argue blind penetration to be a serious concern, and that placebo is the likely mechanism behind reported therapeutic effects.

We systematically reviewed and meta-analysed all randomized control trials of ketamine intervention for PTSD.While ketamine was associated with a reduction in symptoms, the effect was generally not stronger than control conditions.By two-weeks post-initial infusion, no meaningful differences are evident between ketamine and controls.

Neuropsychological Function in Migraine Headaches: An Expanded Comprehensive Multidomain Meta-Analysis

BACKGROUND AND OBJECTIVES: A sizable literature has studied neuropsychologic function in persons with migraine (PwM), but despite this, few quantitative syntheses exist. These focused on circumscribed areas of the literature. In this study, we conducted an expanded comprehensive meta-analysis comparing performance on clinical measures of neuropsychological function both within and across domains, between samples of PwM and healthy controls (HCs). METHODS: For this Meta-analyses Of Observational Studies in Epidemiology-compliant meta-analysis, a unified search strategy was applied to OneSearch (a comprehensive collection of electronic databases) to identify peer-reviewed original research published across all years up until August 1, 2023. Using random-effects modeling, we examined aggregated effect sizes (Hedges' g), between-study heterogeneity (Cochran Q and I2), moderating variables (meta-regression and subgroup analyses), and publication bias (Egger regression intercept and Duval and Tweedie Trim-and-Fill procedure). Study bias was also coded using the NIH Study Quality Assessment Tools. RESULTS: Omnibus meta-analysis from the 58 studies included (PwM n = 5,452, HC n = 16,647; 612 effect sizes extracted) indicated lower overall cognitive performance in PwM vs HCs (g = -0.37; 95% CI -0.47 to -0.28; p < 0.001), and high between-study heterogeneity (Q = 311.25, I2 = 81.69). Significant domain-specific negative effects were observed in global cognition (g = -0.46, p < 0.001), executive function (g = -0.45, p < 0.001), processing speed (g = -0.42, p < 0.001), visuospatial/construction (g = -0.39, p = 0.006), simple/complex attention (g = -0.38, p < 0.001), learning/memory (g = -0.25, p < 0.001), and language (g = -0.24, p < 0.001). Orientation (p = 0.146), motor (p = 0.102), and intelligence (p = 0.899) were not significant. Moderator analyses indicated that age (particularly younger HCs), samples drawn from health care facility settings (e.g., tertiary headache centers) vs community-based populations, and higher attack duration were associated with larger (negative) effects and accounted for a significant proportion of between-study heterogeneity in effects. Notably, PwM without aura yielded stronger (negative) effects (omnibus g = -0.37) vs those with aura (omnibus g = -0.10), though aura status did not account for heterogeneity observed between studies. DISCUSSION: Relative to HCs, PwM demonstrate worse neurocognition, as detected by neuropsychological tests, especially on cognitive screeners and tests within executive functioning and processing speed domains. Effects were generally small to moderate in magnitude and evident only in clinic (vs community) samples. Aura was not meaningfully associated with neurocognitive impairment.

The absurdity of the latent disease model in mental health: 10,130,814 ways to have a DSM-5-TR psychological disorder.

BACKGROUND: Latent disease classification is currently the accepted approach to mental illness diagnosis. In the United States, this takes the form of the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR). Latent disease classification has been criticized for reliability and validity problems, particularly regarding diagnostic heterogeneity. No authors have calculated the scope of the heterogeneity problem of the entire DSM-5-TR. AIMS: We addressed this issue by calculating the unique diagnostic profiles that exist for every DSM-5-TR diagnosis. METHODS: We did this by applying formulas previously used in smaller heterogeneity analyses to all diagnoses within the DSM-5-TR. RESULTS: We found that there are 10,130,814 ways to be diagnosed with a mental illness using DSM-5-TR criteria. When specifiers are considered, this number balloons to over 161 septillion unique diagnostic presentations (driven mainly by bipolar II disorder). Additionally, there are 1,951,065 ways to present with psychiatric symptoms, yet not meet diagnostic criteria. CONCLUSIONS: Latent disease classification leads to considerable heterogeneity in possible presentations. We provide examples of how latent disease classification harms research and treatment programs. We echo recommendations for the dismissal of latent disease classification as a mental illness diagnostic program.

Do executive functions differentiate Iranian children with attention-deficit/hyperactivity disorder with and without comorbid obesity?

OBJECTIVE: To compare multiple dimensions of executive function between children with attention-deficit/hyperactivity disorder (ADHD) with and without comorbid obesity. METHOD: Participants were 90 Iranian children (ages 8-13, 50% female) who were equally dispersed across three study groups: typically developing (TD), ADHD with obesity (ADHD+O), and ADHD without obesity (ADHD-O). Study participants were administered a comprehensive battery of Iranian-adapted "cool" executive function tasks including Digit Span from the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V), Victoria Stroop Test (VST), Wisconsin Card Sorting Test (WCST), Tower of London, and dot-probe task (i.e., a task of attentional bias). Parents completed the Children's Scale for Future Thinking Questionnaire, which assesses future-oriented cognition (e.g., saving, planning, episodic foresight, delay of gratification), aligning more with "hot" executive functions. Groups were compared using multivariate and post-hoc univariate general linear models. RESULTS: Significant group effects were observed for all executive function variables, broadly with the gradient pattern of TD > ADHD-O > ADHD+O. ADHD+O had poorer performances than ADHD-O for WISC-V Digit Span (d = -0.84), WCST Categories Completed (d = -0.55) and Perseverative Responses (d = 1.15), VST Interference Errors (d = 0.83) and Interference Time (d = 1.38), and Dot-Probe Task (d = 0.84). Relative to the ADHD-O group, ADHD+O had also poorer parent-reported Prospective Memory (d = -0.62), Episodic Foresight (d = -0.63), and Delay of Gratification (d = -0.54). CONCLUSIONS: Children with ADHD-O have poorer executive functioning than those without obesity. We observed stronger effects for "cool" rather than "hot" domains of executive function, though this could be due to the former being performance-based and the latter parent-reported.

Univariate and Multivariate Base Rates of Score Elevations, Reliable Change, and Inter-Rater Discrepancies in the BRIEF-A Standardization Samples.

The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is a standardized rating scale of subjective executive functioning. We provide univariate and multivariate base rates (BRs) for scale/index scores in the clinical range (T scores ≥65), reliable change, and inter-rater information not included in the Professional Manual. Participants were adults (ages = 18-90 years) from the BRIEF-A self-report (N = 1,050) and informant report (N = 1,200) standardization samples, as well as test-retest (n = 50 for self, n = 44 for informant) and inter-rater (n = 180) samples. Univariate BRs of elevated T scores were low (self-report = 3.3%-15.4%, informant report = 4.5%-16.3%). Multivariate BRs revealed the common occurrence of obtaining at least one elevated T-score across scales (self-report = 26.5%-37.3%, informant report = 22.7%-30.3%), whereas virtually none had elevated scores on all scales. Test-retest scores were highly correlated (self = .82-.94; informant = .91-.96). Inter-rater correlations ranged from .44 to .68. Significant (p < .05) test-retest T-score differences ranged from 7 to 12 for self-report, from 6 to 8 for informant report, and from 16 to 21 points for inter-rater T-score differences. Applications of these findings are discussed.

Sexual and Gender Minority Victimization: Base Rates of Assault in College Students Across Sexual and Gender Identities.

Past findings have indicated that sexual and gender minority (SGM) individuals experience disproportionate rates of emotional, physical, and sexual assault compared to their heterosexual/cisgender counterparts. While these findings are robust, many studies report homogenous groupings of SGM participants. This practice likely masks important between-group differences. We sought to address this issue by examining reported base rates of emotional, physical, and sexual assault within 12 months of data collection, split across specific sexual (heterosexual, gay/lesbian, bisexual, questioning, queer, pansexual, asexual, and demisexual) and gender (cisgender men, cisgender women, gender nonconforming female assigned at birth [FAB], and gender nonconforming male assigned at birth) identity groups. Our data came from 2020 to 2021 Healthy Minds Study, a large survey of college students living in the United States (N = 119,181). Results indicated most forms of assault were higher in SGM groups compared to heterosexual and cisgender individuals, both on univariate and multivariate (e.g., one or more type of assault) levels. Demisexual individuals reported the highest base rates for emotional assault (45.7%), whereas pansexual individuals reported highest rates of physical assault (12.5%) and sexual assault (17.3%). Demisexual individuals reported the highest multivariate base rate of experiencing at least one form of assault (49.5%), and pansexual individuals reported the highest multivariate base rate of experiencing all three forms of assault (4.7%) within the past 12 months. Gender nonconforming FAB individuals reported the highest univariate and multivariate base rates across assault types compared to all other gender identity groups. With few exceptions, compared to heterosexual and cisgender men (referents), all other sexual and gender identity groups reported significantly higher adjusted odds of experiencing each assault type. These data suggest SGM individuals experience disproportionate levels of assault.

Another failure of the latent disease model? The case of compulsive sexual behavior disorder •.

Recent debates have evolved regarding the classification/conceptualization of compulsive sexual behavior disorder (CSBD). Conclusions regarding an agreed upon CSBD model are hindered by reliance on the latent disease model. Competing biological-based frameworks are moving forward to replace latent disease classification more broadly but have been met with limited success. We suggest that CSBD researchers move towards developing dimensional, transtheoretical, process-based models. We further suggest additional research, particularly mixed methods and longitudinal studies. Finally, we request that federal funding bodies take a more active role in supporting CSBD research.

Psychometric properties of the Behavior Rating Inventory of Executive Function, second edition (BRIEF2) self-report form in Iranian adolescents.

BACKGROUND: This study investigated the psychometric properties of a Persian translation of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) Self-Report form. METHOD: Participants were 589 typically developing adolescents (336 girls and 253 boys), ages 11-18 years old (M = 15.16; SD = 2.04), in Iran. They completed the Persian version of the BRIEF2 Self-Report form and Teenage Executive Functioning Inventory (TEXI). The Persian translated BRIEF2 psychometric properties were examined via internal consistency, test-retest reliability, convergent validity via associations with TEXI scores, and internal structure using structural equation modeling (SEM) to evaluate fit of the three-factor structure from the original English version BRIEF2. RESULTS: Findings indicated the Persian version of BRIEF2 Self-Report form yielded scores with robust reliability, with internal consistency ranging from .87 to .93 and test-retest correlations ranging from .89 to .96, and adequate convergent validity, with correlations with the TEXI ranging from .48 to .79. SEM revealed that a three-factor solution was the best fitting model for the seven subscales of the Persian BRIEF2. CONCLUSION: These findings support the clinical use of the Persian BRIEF2 in Iranian adolescents, including the interpretation of the BRIEF2 three-factor structure, as well as the multidimensional nature of executive functions.

Leveraging the Power of the Internet for Neurosurgical Education: A Standardized Survey for the Pursuit of Educational Excellence.

OBJECTIVE: Our goal was to investigate the presence of surveys to assess neurosurgical educational content and to propose a novel standardized Neurosurgical Education Outcomes Survey (NEOS) with compatible statistical analyses. METHODS: Google Scholar and PubMed were used to conduct a structured literature review for articles published between January 2000 and July 2021 and containing standardized methodology for assessing neurosurgical educational content. RESULTS: Fifteen studies identified during the search assessed virtual and in-person educational content; however, the literature lacked a standardized assessment. A standardized NEOS was proposed before a comprehensive discussion of compatible statistical analyses. CONCLUSIONS: The NEOS may offer a viable option for comparing in-person and virtual content with respect to learner preferences and subjective and objective feedback. Future studies are needed to explore practical utility in enhancing the quality of neurosurgical educational content.

[Formula: see text]Multivariate base rates of score elevations on the BRIEF2 in children with ADHD, autism spectrum disorder, or specific learning disorder with impairment in reading.

There is a paucity of research examining multivariate base rates (MBRs) of elevated scores in pediatric rating scales of cognition. We present novel MBR information on the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) for several clinical groups: Attention-Deficit/Hyperactivity Disorder Combined Presentation (ADHD-C); ADHD Inattentive Presentation (ADHD-I); Autism Spectrum Disorder (ASD); and Specific Learning Disorder with impairment in Reading (SLD-R). Participants included children diagnosed as having ADHD-C (n = 350), ADHD-I (n = 343), ASD (n = 390), or SLD-R (n = 240). Cumulative MBRs (e.g., the % of a sample having one or more elevated scores) were examined for each BRIEF2 form (Parent, Teacher, and Self-Report) and at three T-score cutoffs (T ≥ 60, T ≥ 65, and T ≥ 70). The MBR of obtaining at least one elevated score was common across clinical groups and forms at T ≥ 60 (ADHD-C = 90.5-98.1%; ADHD-I = 83.9-98.7%; ASD = 90.3-96.9%, SLD-R = 60.0-78.4%), T ≥ 65 (ADHD-C = 66.7-97.2%; ADHD-I = 77.5-94.9%; ASD = 77.3-92.7%; SLD-R = 38.5-64.0%), and T ≥ 70 (ADHD-C = 52.4-89.4%; ADHD-I = 64.8-84.2%; ASD = 54.5-83.2%; SLD-R = 26.9-44.1%). MBRs appeared to differ as a function of group (ADHD-C > ADHD-I > ASD > SLD-R) and form (Parent > Teacher > Self-Report) though future research with well-defined samples is needed to investigate this. We provide novel MBR information to enhance clinical interpretation of BRIEF2 data.

Neuropsychological Functioning in Primary Dystonia: Updated and Expanded Multidomain Meta-Analysis.

BACKGROUND: Primary dystonia is conventionally considered as a motor disorder, though an emerging literature reports associated cognitive dysfunction. OBJECTIVES: Here, we conducted meta-analyses on studies comparing clinical measures of cognition in persons with primary dystonia and healthy controls (HCs). METHODS: We searched PubMed, Embase, Cochrane Library, Scopus, and PsycINFO (January 2000-October 2020). Analyses were modeled under random effects. We used Hedge's g as a bias-corrected estimate of effect size, where negative values indicate lower performance in dystonia versus controls. Between-study heterogeneity and bias were primarily assessed with Cochran's Q, I2 , and Egger's regression. RESULTS: From 866 initial results, 20 studies met criteria for analysis (dystonia n = 739, controls n = 643; 254 effect sizes extracted). Meta-analysis showed a significant combined effect size of primary dystonia across all studies (g = -0.56, P < 0.001), with low heterogeneity (Q = 25.26, P = 0.15, I2  = 24.78). Within-domain effects of primary dystonia were motor speed = -0.84, nonmotor speed = -0.83, global cognition = -0.65, language = -0.54, executive functioning = -0.53, learning/memory = -0.46, visuospatial/construction = -0.44, and simple/complex attention = -0.37 (P-values <0.01). High heterogeneity was observed in the motor/nonmotor speed and learning/memory domains. There was no evidence of publication bias. Moderator analyses were mostly negative but possibly underpowered. Blepharospasm samples showed worse performance than other focal/cervical dystonias. Those with inherited (ie, genetic) disease etiology demonstrated worse performance than acquired. CONCLUSIONS: Dystonia patients consistently demonstrated lower performances on neuropsychological tests versus HCs. Effect sizes were generally moderate in strength, clustering around -0.50 SD units. Within the speed domain, results suggested cognitive slowing beyond effects from motor symptoms. Overall, findings indicate dystonia patients experience multidomain cognitive difficulties, as detected by neuropsychological tests. © 2022 International Parkinson and Movement Disorder Society.

Cardio-ankle vascular index of increased arterial wall stiffness is associated with neurocognitive impairment in well-controlled HIV.

OBJECTIVES: HIV-associated neurocognitive disorders (HAND) remain prevalent in people living with HIV (PLWH) despite widespread use of combined antiretroviral therapy (ART). Vascular disease contributes to the pathogenesis of HAND, but traditional vascular risk factors do not fully explain the relation between vascular disease and HAND. A more direct measure of vascular dysfunction is needed. This cross-sectional study tested whether the cardio-ankle vascular index (CAVI), a novel method to assess arterial stiffness, is associated with HAND among PLWH. METHODS: Participants included 75 non-diabetic adults with well-controlled HIV from an outpatient HIV clinic. We assessed the relation between CAVI and neurocognitive impairment (NCI). The latter was primarily characterized by the Frascati criteria and secondarily (post hoc) using the Global Deficit Score (GDS). Logistic regression models tested whether high CAVI (≥ 8) was independently associated with NCI when controlling for potential confounders. RESULTS: Participants (Mage  = 45.6 ± 8.3 years; 30.1% male) had few traditional cardiovascular disease (CVD) risk factors (hypertension, n = 7; dyslipidaemia, n = 34; body mass index ≥ 25 kg/m2 , n = 12; smoking history, n = 13; 2.2% mean 10-year risk of CVD or stroke). Twelve (16%) participants had high CAVI, which was independently associated with meeting Frascati criteria for NCI [n = 39, odds ratio (OR) = 7.6, p = 0.04], accounting for age, education, gender, income, CD4 nadir, recent CD4 and traditional CVD risk factors. High CAVI was also associated with NCI as reflected by higher GDS (OR = 17.4, p = 0.02). CONCLUSIONS: Cardio-ankle vascular index is a promising measure of vascular dysfunction that may be independently associated with NCI in relatively healthy PLWH. Larger studies should test the utility of CAVI in predicting NCI/decline in PLWH.

Black and White individuals differ in dementia prevalence, risk factors, and symptomatic presentation.

INTRODUCTION: Although dementia prevalence differs by race, it remains unclear whether cognition and neuropsychiatric symptom severity differ between Black and White individuals with dementia. METHODS: Using National Alzheimer's Coordinating Center (NACC) data, we evaluated dementia prevalence in non-Hispanic Black and White participants and compared their clinicodemographic characteristics. We examined race differences in cognition, neuropsychiatric symptoms, and functional abilities in participants with dementia using multivariable linear and logistic regression models. RESULTS: We included 5,700 Black and 31,225 White participants across 39 Alzheimer's Disease Research Centers. Of these, 1,528 (27%) Black and 11,267 (36%) White participants had dementia diagnoses. Despite having lower dementia prevalence, risk factors were more prevalent among Black participants. Black participants with dementia showed greater cognitive deficits, neuropsychiatric symptoms/severity, and functional dependence. DISCUSSION: Despite lower dementia prevalence, Black participants with dementia had more dementia risk factors, as well as greater cognitive impairment and neuropsychiatric symptom severity than White participants.

Normative and Maladaptive Personality Traits and Self-Reported Executive Functioning.

Research on self-reported executive functioning (EF) and personality has largely focused on normative personality traits. While previous research has demonstrated that maladaptive personality traits are associated with performance-based EF, the literature examining the relationship between these traits and self-reported EF is limited. The current study examined the relationship between multiple domains of self-reported EF (Barkley Deficits in Executive Functioning Scale) and both normative (The International Personality Item Pool-NEO-120 Item [IPIP-120]) and maladaptive (Personality Inventory for DSM-5-Short Form [PID-5-SF]) personality traits in an undergraduate student sample (n = 354). Similar to past research, relationships were largest across EF domains for both measures related to neuroticism (i.e., IPIP-120 neuroticism and PID-5-SF negative affectivity) and conscientiousness (i.e., IPIP-120 conscientiousness and PID-5-SF disinhibition). Normative personality traits generally accounted for greater variance in EF when examined alone and were also generally associated with greater incremental validity when compared with maladaptive personality traits. However, multiple regression analyses indicated that maladaptive personality traits added unique predictive variance above and beyond normative personality traits in their association with multiple domains of EF. These results highlight the utility of assessing both normative and maladaptive personality traits as well as multiple domains of EF to more fully understand the relationship between personality and EF.

[Formula: see text]Enhanced interpretation of the BRIEF2: multivariate base rates of elevated scores in the standardization samples.

The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) is a standardized rating (self, parent, and teacher) scale of executive functioning in children and adolescents. Here, we provide multivariate base rate (MBR) information (for the Self, Parent, and Teacher forms), which is not included in the BRIEF2 Professional Manual. Participants were children and adolescents for the BRIEF2 Self-Report (ages = 11-18; N = 803), Parent-Report (ages = 5-18; N = 1,400), and Teacher-Report (ages = 5-18; N = 1,400) standardization samples. We focused on cumulative (e.g., % of sample with oneor more elevated scores) MBRs across scales, which were examined at three elevation levels on each form: T≥ 60, ≥65, and ≥70. Across forms, MBRs predictably decreased with increasing number of elevated scores and at higher cutoffs. The cumulative MBR of having at least one score at T≥ 60 was common (37.5-42.2%), but less frequent at T≥ 70 (15.4-17.4%). The probability of having elevated scores on all scales was very low, irrespective of form, age, or elevation threshold (T≥ 60 = 2.4-4.4%; T≥ 65 = 1.0-1.4%; T≥ 70 = 0.0-0.7%). There was no clinically meaningful relation between demographic factors (age, gender, race, and parental education) and MBRs. These data provide clinicians and researchers with an enhanced way of concurrently interpreting multiple BRIEF2 scales.

Correlates of deep brain stimulation consensus conference decision to treat primary dystonia.

BACKGROUND: Deep brain stimulation (DBS) is an effective treatment for motor disturbance in people with primary dystonia (PWD). Numerous factors are considered by an interdisciplinary consensus conference before deciding candidacy for DBS surgery (e.g., demographic, medical, cognitive, and behavioral factors). However, little is known about which of these factors are associated with PWD DBS surgery consensus conference decisions. OBJECTIVE: Our goal was to examine whether pre-operative demographic, medical, and cognitive/behavioral variables are associated DBS consensus conference decisions in patients with dystonia. METHODS: Thirty-two PWD completed comprehensive presurgery workup included neurological and neuropsychological exams, and neuroimaging in consideration for DBS surgery. An interdisciplinary conference committee either recommended or did not recommend DBS surgery based upon these data. Demographic and medical data (e.g., dystonia disease characteristics, medical comorbidities, medications) were also collected. We also examined impact from cardiovascular disease factors, using a Revised Cardiac Risk Index. PWD were grouped based on DBS conference decision (eligible: n = 21, ineligible: n = 11) and compared across demographic, medical, and cognitive/behavioral variables. RESULTS: Across clinical variables, PWD who were deemed ineligible for DBS surgery had a higher Revised Cardiac Risk Index. PWD who were classified as ineligible displayed lower global cognitive functioning, working memory, phonemic fluency, memory retrieval, and cognitive flexibility. CONCLUSIONS: Consensus decision making regarding DBS surgery eligibility involves a multifactorial process. We found that deficits in executive functioning were associated with the DBS consensus committee decision. We also observed elevated cardiac risk among these individuals, likely reflecting the relation between vascular health and cognition. Implications, and clinical and scientific applications of these findings are discussed.

Psychometric utility of the international HIV dementia scale and Montreal Cognitive Assessment in HIV-associated asymptomatic neurocognitive impairment.

There is a growing need for brief screening measures for HIV Associated Neurocognitive Disorders (HAND). We compared two commonly used measures (the Montreal Cognitive Assessment [MoCA] and the International HIV Dementia Scale [IHDS]) in their ability to identify asymptomatic HAND (i.e., asymptomatic neurocognitive impairment [ANI]). Participants included 74 Thai PLWH: 38 met Frascati criteria for ANI and 36 were cognitively normal (CN). Participants completed Thai language versions of the MoCA (MoCA-T) and IHDS, and a validated neurocognitive battery. We examined between-group differences for MoCA-T and IHDS total scores, and scale subcomponents. We also conducted receiver operating characteristic (ROC) analyses to determine the ability of the MoCA-T and IHDS to discriminate between CN and ANI groups, and compared their area under the curve (AUC) values. Results revealed lower MoCA-T total score, as well as the Visuospatial/Executive and Delayed Recall subtask scores, in the ANI relative to CN group. Groups did not differ on the IHDS. For ROC analyses, the MoCA-T, but not the IHDS, significantly differentiated the ANI from CN group, and there was a significant difference in AUC values between the MoCA-T (AUC = .71) and IHDS (AUC = .56). Sensitivity and specificity statistics were poor for both screening measures. These data indicate while the MoCA-T functions better than the IHDS in detecting Thai PLWH with ANI, the mildest form of HAND, neither cognitive screener, showed strong utility. Our findings reflect the limited efficacy of common screening measures in detecting subtler cognitive deficits among Thai PLWH, and highlight the need for better screening tools.

Self-rated executive dysfunction in adults with epilepsy and effects of a cognitive-behavioral intervention (HOBSCOTCH).

RATIONALE: Cognitive problems are common in adults with epilepsy and significantly affect their quality of life. HOBSCOTCH (HOme Based Self-management and COgnitive Training CHanges lives) was developed to teach problem-solving and compensatory memory strategies to these individuals. This study examined whether HOBSCOTCH is associated with improvement in specific aspects of subjective executive functions. METHODS: Fifty-one adults, age 18-65, with epilepsy and subjective cognitive concerns were randomized to receive HOBSCOTCH (n = 31) or a care-as-usual control sample (n = 20). Participants completed the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), as well as the Patient Health Questionnaire-9 (PHQ-9) to assess depression. Rates of elevated (i.e., T ≥ 65, impaired) BRIEF-A scores at baseline, as well as pre-post score changes for the BRIEF-A clinical scales were evaluated. Significance was set at α = 0.05, one-tailed, given our directional hypothesis. RESULTS: At baseline, a considerable percentage of patients in the overall sample endorsed executive dysfunction on BRIEF-A scales: Inhibit = 28%, Shift = 51%, Emotional Control = 45%, Self-Monitor = 33%, Initiate = 35%, Working Memory = 88%, Plan/Organize = 45%, Task Monitor = 47%, Organization of Materials = 28%. Significant improvement was seen in mean T-scores for Inhibit, Shift, Initiate, and Working Memory in the treatment group, but only Working Memory improved in the control group. The control group endorsed worse task monitoring and organization of materials at baseline and follow-up. Change in depression was not observed for either group, and there was no association between changes in depression and BRIEF-A scores. CONCLUSIONS: A sizeable subset of adults with epilepsy reported experiencing executive dysfunction in their everyday lives, especially for working memory. HOBSCOTCH resulted in amelioration of subjective executive functioning independent of changes in mood.