The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial.

Prior research has found that cognitive benefits of physical exercise and brain health in older adults may be enhanced when mental exercise is interactive simultaneously, as in exergaming. It is unclear whether the cognitive benefit can be maximized by increasing the degree of mental challenge during exercise. This randomized clinical trial (RCT), the Aerobic and Cognitive Exercise Study (ACES) sought to replicate and extend prior findings of added cognitive benefit from exergaming to those with or at risk for mild cognitive impairment (MCI). ACES compares the effects of 6 months of an exer-tour (virtual reality bike rides) with the effects of a more effortful exer-score (pedaling through a videogame to score points). Fourteen community-dwelling older adults meeting screening criteria for MCI (sMCI) were adherent to their assigned exercise for 6 months. The primary outcome was executive function, while secondary outcomes included memory and everyday cognitive function. Exer-tour and exer-score yielded significant moderate effects on executive function (Stroop A/C; d's = 0.51 and 0.47); there was no significant interaction effect. However, after 3 months the exer-tour revealed a significant and moderate effect, while exer-score showed little impact, as did a game-only condition. Both exer-tour and exer-score conditions also resulted in significant improvements in verbal memory. Effects appear to generalize to self-reported everyday cognitive function. Pilot data, including salivary biomarkers and structural MRI, were gathered at baseline and 6 months; exercise dose was associated with increased BDNF as well as increased gray matter volume in the PFC and ACC. Improvement in memory was associated with an increase in the DLPFC. Improved executive function was associated with increased expression of exosomal miRNA-9. Interactive physical and cognitive exercise (both high and low mental challenge) yielded similarly significant cognitive benefit for adherent sMCI exercisers over 6 months. A larger RCT is needed to confirm these findings. Further innovation and clinical trial data are needed to develop accessible, yet engaging and effective interventions to combat cognitive decline for the growing MCI population. ClinicalTrials.gov ID: NCT02237560.

The relationships among premilitary vocational aptitude assessment, traumatic brain injury, and postdeployment cognitive functioning in combat veterans.

Traumatic brain injury (TBI) in Iraq and Afghanistan war veterans is frequently associated with a variety of complaints, including cognitive problems and posttraumatic stress disorder. In this study, the authors explored the predictive impact of premilitary cognitive abilities on postdeployment cognitive functioning, as mitigated by posttraumatic stress symptoms in a sample of veterans with and without history of TBI. Measures included clinical interview, neuropsychological tests, the PTSD Checklist-Military Version, and the Armed Services Vocational Aptitude Battery. In contrast to history of TBI, premilitary abilities and posttraumatic stress symptoms emerged as significant predictors of postdeployment cognitive deficits.

Dimensionality, reliability, and validity of the combat experiences scale.

Few studies have measured combat exposure during deployment to a war zone. Valid, reliable, and specific measurement is needed to broaden existing knowledge of combat experiences to accurately answer clinically important questions regarding postcombat treatment and recovery, particularly with the recognition of new kinds of combat and resulting psychological sequelae. The Combat Experiences Scale (CES) is a 33-item measure that assesses deployment-related experiences. The psychometrics of this measure, however, were undefined before this study. The purpose of this study was to examine aspects of internal and external validity of the CES. Data were collected as part of a study of 500 veterans of the conflicts in Iraq and Afghanistan across five Veterans Affairs medical centers in Upstate New York. An exploratory factor analysis suggested that three factors represented the scale well: Exposure to Combat Environment, Physical Engagement, and Proximity to Serious Injury and Death. The CES scores showed adequate internal consistency, and evidence for convergent validity and discriminant validity was also found. This study underscores the importance of casting a wide net with regard to the assessment of deployment-related experiences and provides evidence that probable post-traumatic stress disorder, depression, and anxiety are highly correlated with all forms of deployment-related experiences.

The fuld object-memory evaluation: development and validation of an alternate form.

The Fuld Object-Memory Evaluation (FOME) uses multisensory (tactile, visual, and verbal) encoding of objects for assessing memory, with particular clinical and research application in older adults. This preliminary study reports the first known psychometric data on the development of an alternate form of the FOME. Data were drawn from 102 independent-living older adults participating in a larger clinical trial. Seventy participants completed three versions of the shortened administration of the FOME, and comparability of forms was established by significant, moderate intraclass correlation coefficients for immediate and delayed recall scores. Reliable change indexes indicate the new alternate form performs well, with minimal practice or learning effects. Evidence of convergent and discriminant validity was documented using the Rey Auditory Verbal Learning Test, category fluency task, and North American Adult Reading Test. Normative data are provided stratified by age for participants completing at least one of three time points (n = 96). Results of this preliminary study provide evidence for the comparability and construct validity of a new alternate form of the FOME with prior forms. An additional well-validated form of the FOME has practical implications for serial testing often required in clinical practice and research design.

Psychometric study of the Neurobehavioral Symptom Inventory.

The Department of Veterans Affairs (VA) uses the Neurobehavioral Symptom Inventory (NSI) to measure postconcussive symptoms in its comprehensive traumatic brain injury (TBI) evaluation. This study examined the NSI's item properties, internal consistency, and external validity. Data were obtained from a federally funded study of the experiences of combat veterans. Participants included 500 Operations Iraqi and Enduring Freedom veterans, 219 of whom sustained at least one TBI. Data were collected at five VA medical centers and one VA outpatient clinic across upstate New York. Measures included neuropsychological interview, NSI, Beck Anxiety Inventory, Beck Depression Inventory-II, and Posttraumatic Stress Disorder Checklist-Military Version. The NSI demonstrated high internal consistency (total alpha = 0.95; subscale alpha = 0.88 to 0.92). Subscale totals based on Caplan et al.'s factor analysis correlated highly with the NSI total score (r = 0.88 to 0.93). NSI scores differentiated veterans with TBI history from those without but were strongly influenced by variance associated with probable posttraumatic stress disorder, depression, and generalized anxiety. Results suggest that the NSI is a reliable and valid measure of postconcussive symptoms. Scale validity is evident in the differentiation of TBI and non-TBI classifications. The scale domain is not limited to TBI, however, and extends to detection of probable effects of additional affective disorders prevalent in the veteran population.

Neuropsychological and neurophysiological effects of strengthening exercise for early dementia: a pilot study.

Research demonstrates a positive effect of aerobic exercise on cognitive functioning in older adults. Unfortunately, aerobic exercise is often contraindicated for older adults due to cardiovascular and functional limitations. Low-intensity strengthening exercise may offer a practical alternative, but the neuropsychological benefits and potential neurophysiological mechanisms are less well understood. The current study evaluated the effects of a 10-week strengthening exercise intervention on cognitive functioning and EEG in a sample of 13 older adults with early dementia, and 9 normative controls. Results revealed beneficial effects of strengthening exercise on verbal memory coupled with frontal beta and delta power asymmetries and N200 amplitude asymmetry. Results point to increased cognitive efficiency following 10 weeks of strengthening exercise. The findings suggest it is feasible to conduct a strengthening intervention with early dementia patients, and to gather neuropsychological and neurophysiological data to evaluate outcomes. Strengthening exercise may serve as a useful alternative to aerobic exercise.

Reliability, sensitivity, and specificity of the VA traumatic brain injury screening tool.

OBJECTIVE: To provide item analyses, estimates of temporal reliability and internal consistency, and examination of the sensitivity and specificity of a traumatic brain injury-screening tool. PARTICIPANTS: Five hundred veterans of the wars in Iraq and Afghanistan enrolled in the study, approximately half of whom (248) volunteered. The remaining 252 participants were referred to Veteran Affairs (VA) neuropsychology or polytrauma clinics. DESIGN: This psychometric study constitutes part of a larger 4-year, multisite prospective cohort study of veterans returning from Iraq and Afghanistan. SETTING: Five VA medical centers and one VA outpatient clinic. MAIN MEASURES: Veteran traumatic brain injury screening tool (VATBIST), a structured diagnostic interview for traumatic brain injury; a military-oriented posttraumatic stress disorder checklist. RESULTS: The VATBIST appeared to have high-internal consistency (0.77) and test-retest reliability (0.80), high sensitivity (0.94) and moderate specificity (0.59). Diagnostic odds ratios for the screening tool ranged from 12.6 for the total sample to 24, when veterans with probable posttraumatic stress disorder were excluded from analysis. CONCLUSIONS: The VATBIST appears to be a reliable and valid instrument. The presence of significant posttraumatic stress disorder symptoms, however, reduces the accuracy of the measure and highlights the need for careful clinical follow-up of persons who screen positive.