Public Chronic Traumatic Encephalopathy Knowledge: Sources, Accuracy and Confidence.

ABSTRACT: The goal of this study was to examine the general public's level of accuracy and confidence in knowledge of chronic traumatic encephalopathy (CTE), as well as information sources. This study also explored how these factors affected comfort in allowing children to play a high-contact sport. This study utilized online surveys and included 529 participants. Overall, CTE knowledge accuracy was 48.02% (standard deviation = 0.23). Inaccuracies regarding the etiology and diagnosis of CTE were most common, whereas the symptoms and lack of treatments for CTE were more widely known. Despite overall low CTE knowledge accuracy, CTE knowledge confidence was positively correlated with comfort in allowing children to play a high-contact sport (r = 0.199, P ≤ 0.001). Participants identified television/movies followed by web sites and social media as the most utilized CTE information sources. These results further support the need for clinicians and researchers to address misconceptions about CTE.

Minimizing Post-Intensive Care Syndrome to Improve Outcomes for Intensive Care Unit Survivors.

TOPIC: Post-intensive care syndrome is a collection of symptoms that more than half of patients who survive a critical illness, and their family caregivers, experience after the illness. Those symptoms include weakness/ fatigue, sleep disturbances/insomnia, cognitive dysfunction, posttraumatic stress disorder, other mental health conditions, and a lack of effective coping strategies. CLINICAL RELEVANCE: To minimize the risk of a patient developing post-intensive care syndrome, intensive care unit nurses must adopt practices that reduce the severity of disability and optimize patient outcomes. They must also advocate for patients who need additional expert care. PURPOSE: To describe interventions that critical care nurses can implement to minimize a patient's risk for post-intensive care syndrome. CONTENT COVERED: This article describes patients who have a high risk of developing post-intensive care syndrome and interventions that are within nurses' purview.

Rapid Handheld Continuous Electroencephalogram (EEG) Has the Potential to Detect Delirium in Older Adults.

BACKGROUND: Delirium-related biochemical derangements lead to electrical changes that can be detected in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. Studies using limited lead EEG show a large difference between patients with and without delirium while discriminating delirium from other causes. Handheld rapid EEG devices may be capable of detecting delirium before symptom onset, thus providing an objective physiological method to detect delirium when it is most amenable to interventions. OBJECTIVE: The aim of this study was to explore the potential for rapid EEG to detect waveform pattern changes consistent with delirium status. METHODS: This prospective exploratory pilot study used a correlational design and mixed models to explore the relationships between handheld portable EEG data and delirium status. RESULTS: While being under powered minimized opportunities to detect statistical differences in EEG-derived ratios using spectral density analysis, sleep-to-wake ratios tended to be higher in patients with delirium. CONCLUSIONS: Limited lead EEG may be useful in predicting adverse outcomes and risk for delirium in older critically ill patients. Although this population is at the highest risk for mortality, delirium is not easily identified by current clinical assessments. Therefore, further investigation of limited lead EEG for delirium detection is warranted.

Utilizing the BAT-LQ to assess TBI incidence in a college student population.

OBJECTIVE: Although the annual number of traumatic brain injuries (TBIs) reported in the US exceeds two million, data suggests that this is an underestimate. The goal of this study was to understand lifetime TBI incidence among a sample of college students. Additionally, this study examined whether a single yes/no question regarding TBI history was sufficient to gather accurate information about TBI incidence in college students. DESIGN: Participants were asked a single TBI question and administered the BAT-LQ. MAIN MEASURES: The BAT-LQ is a screening tool designed to assess for probable lifetime TBIs. RESULTS: Data from 121 participants were analyzed for this study. On the single-question, 24.8% of participants reported experiencing a TBI. However, upon further prompting, 76.8% of all participants reported experiencing a blow to the head accompanied by at least one diagnostic symptom of a TBI, suggesting a probable TBI based on best-practice diagnosis guidelines. CONCLUSION: The results of this study suggest that increased education about TBI is warranted to ensure that individuals receive care for probable TBIs, as many individuals likely lack knowledge about what constitutes a TBI diagnosis. Additionally, the results suggest that a single question may not be sufficient to capture true lifetime TBI incidence.

Behavioral and exercise interventions for sleep dysfunction in the elderly: a brief review and future directions.

PURPOSE: The impact of sleep-related changes and disorders in the geriatric populations are of utmost concern due to health consequences and increased risk of injury as well as injuring others as a result of poor sleep. The purpose of this paper is to provide a brief review of the current state of the literature with regard to sleep, aging, common non-pharmacological interventions, and the potential use of exercise in combination with behavioral interventions. METHODS: Initially, this manuscript focuses on a brief (nonsystematic) review of sleep parameters and physiology that are associated with the aging process. Subsequently, information regarding sleep disorders in the elderly in general, and insomnia in particular are discussed. Last, a brief review of current recommended interventions is provided. RESULTS: The current major nonpharmacological interventions are described including Cognitive Behavioral Therapy for Insomnia (CBT-I). The potential use of exercise as a safe intervention for poor sleep is discussed. Finally, a call is made for increased research that examines the combination of traditional behavioral interventions with exercise.

A Review of Neuronal Pathways Associated With Consciousness.

ABSTRACT: INTRODUCTION: Accurate communication of information regarding fluctuations in level of consciousness is critical. It is, important for nurses to understand terms related to consciousness to appropriately assess and implement plans of care. CONTENT: Although the neurobiology of consciousness is complex and multifaceted, consciousness can be conceptualized as having 2 distinct but interrelated dimensions: arousal and awareness. The different levels of consciousness are thought to fall on a continuum ranging from being fully awake to coma. CONCLUSION: This article focuses on the terms of consciousness, awareness, and arousal along with nursing implications where appropriate.

Validating the Adolescent Sleep Wake Scale for use with young adults.

OBJECTIVE: There is a need for examination of sleep across the entire adolescence to young adulthood developmental period (AYA; ages 12-25 years). The Adolescent Sleep Wake Scale (ASWS) is a 28-item measure of overall subjective sleep quality, including five sleep behavior domains (difficulty going to bed, falling asleep, maintaining sleep, reinitiating sleep, and returning to wakefulness), and has been validated to assess overall sleep quality and insomnia symptoms in adolescents (12-18 years). The current study aimed to examine whether the ASWS could be used to assess sleep across the AYA period by investigating the validity of the measure in a national sample of young adults (ages 19-25) using validated adult sleep measures. MATERIALS AND METHODS: A national sample recruited through Amazon's MTurk (N = 332; Mean age = 23.37 (SD = 1.55); 53.8% female; 51.4% Caucasian) completed an online survey including the ASWS, the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Bivariate correlational analyses were performed to explore convergent and discriminant validity. RESULTS: The ASWS total score was strongly correlated with both the PSQI total score (r = -0.68) and ISI (r = -0.71) total score. The subscales of the PSQI, including Sleep Latency, Sleep Disturbance, and Daytime Dysfunction were correlated with corresponding ASWS domains. There were weak correlations with other subscales. Internal consistency was good (α = 0.88). CONCLUSIONS: Our results suggest that the ASWS measures areas of sleep problems in a manner consistent with the most frequently utilized self-report assessment in adults and supports the use of the ASWS across AYA.

Sedation selection to reduce delirium risk: Why dexmedetomidine may be a better choice.

ABSTRACT: In 2018, the Society of Critical Care Medicine published the Pain Agitation Delirium Immobility and Sleep Disruption guidelines that recommend protocol assessment-based pain and sedation management. Since the publication of these guidelines, multiple studies and meta-analyses have been conducted comparing sedative options in the Intensive Care Unit (ICU) setting including dexmedetomidine and propofol. Sedatives are on a continuum when it comes to delirium risk. Propofol, like benzodiazepines, causes changes in sleep patterns by suppressing the rapid eye movement sleep stage not seen with dexmedetomidine, worsening the ICU patient's already poor sleep quality. This reduction in sleep quality increases the risk of delirium. As patient advocates, advanced practice nurses play a vital role in minimizing risk of patient harm. Sedative use and management are areas of opportunity for nurses to minimize this risk. When sedatives are needed, daily sedation vacations should be conducted to re-evaluate the minimum required dose. These practices can reduce sedation risks for delirium and allow for bedside screening and early detection.

Fronto-temporal dementia: a case study and strategies and support for caregivers.

Fronto-temporal dementia, also known as fronto-temporal lobular degeneration, is the second most common form of early-onset dementia with a prevalence equal to Alzheimer's dementia. Behavioural variant fronto-temporal dementia primarily involves the frontal and temporal lobes of the brain. Myelination of nerve fibres in these areas allow for highly synchronized action potential timing. Diagnosis is often significantly delayed because symptoms are insidious and appear as personality and behavioural changes such as lack of inhibition, apathy, depression, and being socially inappropriate rather than exhibiting marked memory reductions. In this article, a case study illustrates care strategies and family education. Management of severe behavioural symptoms requires careful evaluation and monitoring. Support is especially important and beneficial in the early to middle stages of dementia when nursing home placement may not be required based on the individual's condition.

Methods of identifying delirium: A research protocol.

Delirium is an acute disorder affecting up to 80% of intensive care unit (ICU) patients. It is associated with a 10-fold increase in cognitive impairment, triples the rate of in-hospital mortality, and costs $164 billion annually. Delirium acutely affects attention and global cognitive function with fluctuating symptoms caused by underlying organic etiologies. Early detection is crucial because the longer a patient experiences delirium the worse it becomes and the harder it is to treat. Currently, identification is through intermittent clinical assessment using standardized tools, like the Confusion Assessment Method for ICU. Such tools work well in clinical research but do not translate well into clinical practice because they are subjective, intermittent and have low sensitivity. As such, healthcare providers using these tools fail to recognize delirium symptoms as much as 80% of the time. Delirium-related biochemical derangement leads to electrical changes in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. However, continuous EEG monitoring is not feasible due to cost and need for skilled interpretation. Studies using limited-lead EEG show large differences between patients with and without delirium while discriminating delirium from other causes. The Ceribell is a limited-lead device that analyzes EEG. If it is capable of detecting delirium, it would provide an objective physiological monitor to identify delirium before symptom onset. This pilot study was designed to explore relationships between Ceribell and delirium status. Completion of this study will provide a foundation for further research regarding delirium status using the Ceribell data.

Choosing the Right Delirium Assessment Tool.

Delirium is an increasing concern with current combined annual costs for the United States and Europe of approximately $350 billion. Although standardized definitions and diagnostic criteria exist, more than 80% of delirium in the acute care setting is overlooked or misdiagnosed. Delays in identification result in increases in severity and mortality and a reduction in quality of life. Selecting an assessment tool is the first step toward improving recognition.

Neurocognitive outcomes after aneurysmal subarachnoid hemorrhage: Identifying inflammatory biomarkers.

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe type of stroke which carries a high case-fatality rate. Those who survive the ictus of aneurysm rupture harbor substantial risks of neurological morbidity, functional disability, and cognitive dysfunction. Although the pervasiveness of cognitive impairment is widely acknowledged as a long-term sequela of aSAH, the mechanisms underlying its development are poorly understood. The onset of aSAH elicits activation of the inflammatory cascade, and ongoing neuroinflammation is suspected to contribute to secondary complications, such as vasospasm and delayed cerebral ischemia. In this review, we analyze the extant literature regarding the relationship between neuroinflammation and cognitive dysfunction after aSAH. Pro-inflammatory cytokines appear to play a role in maintaining normal cognitive function in adults unaffected by aSAH. However, in the setting of aSAH, elevated cytokine levels may correlate with worse neuropsychological outcomes. This seemingly dichotomous relationship between neuroinflammation and cognition suggests that the action of cytokines varies, depending on their physiologic environment. Experimental therapies which suppress the immune response to aSAH appear to have a beneficial effect on cognitive outcomes. However, further studies are necessary to determine the utility of inflammatory mediators as biomarkers of neurocognitive outcomes, as well as their role in the management of aSAH.

Continuous infusion of low-dose unfractionated heparin after aneurysmal subarachnoid hemorrhage: a preliminary study of cognitive outcomes.

OBJECTIVECognitive dysfunction occurs in up to 70% of aneurysmal subarachnoid hemorrhage (aSAH) survivors. Low-dose intravenous heparin (LDIVH) infusion using the Maryland protocol was recently shown to reduce clinical vasospasm and vasospasm-related infarction. In this study, the Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive changes in aSAH patients treated with the Maryland LDIVH protocol compared with controls.METHODSA retrospective analysis of all patients treated for aSAH between July 2009 and April 2014 was conducted. Beginning in 2012, aSAH patients were treated with LDIVH in the postprocedural period. The MoCA was administered to all aSAH survivors prospectively during routine follow-up visits, at least 3 months after aSAH, by trained staff blinded to treatment status. Mean MoCA scores were compared between groups, and regression analyses were performed for relevant factors.RESULTSNo significant differences in baseline characteristics were observed between groups. The mean MoCA score for the LDIVH group (n = 25) was 26.4 compared with 22.7 in controls (n = 22) (p = 0.013). Serious cognitive impairment (MoCA ≤ 20) was observed in 32% of controls compared with 0% in the LDIVH group (p = 0.008). Linear regression analysis demonstrated that only LDIVH was associated with a positive influence on MoCA scores (ß = 3.68, p =0.019), whereas anterior communicating artery aneurysms and fevers were negatively associated with MoCA scores. Multivariable linear regression analysis resulted in all 3 factors maintaining significance. There were no treatment complications.CONCLUSIONSThis preliminary study suggests that the Maryland LDIVH protocol may improve cognitive outcomes in aSAH patients. A randomized controlled trial is needed to determine the safety and potential benefit of unfractionated heparin in aSAH patients.

It's not what you expect: feedback negativity is independent of reward expectation and affective responsivity in a non-probabilistic task.

ERP studies commonly utilize gambling-based reinforcement tasks to elicit feedback negativity (FN) responses. This study used a pattern learning task in order to limit gambling-related fallacious reasoning and possible affective responses to gambling, while investigating relationships between the FN components between high and low reward expectation conditions. Eighteen undergraduates completed measures of reinforcement sensitivity, trait and state affect, and psychophysiological recording. The pattern learning task elicited a FN component for both high and low win expectancy conditions, which was found to be independent of reward expectation and showed little relationship with task and personality variables. We also observed a P3 component, which showed sensitivity to outcome expectancy variation and relationships to measures of anxiety, appetitive motivation, and cortical asymmetry, although these varied by electrode location and expectancy condition. Findings suggest that the FN reflected a binary reward-related signal, with little relationship to reward expectation found in previous studies, in the absence of positive affective responses.

Right Temporal Lobe Atrophy: A Case That Initially Presented as Excessive Piety.

OBJECTIVE: Variants of frontotemporal lobar degeneration (FTLD) are associated with distinct clinical, pathological, and neuroanatomical profiles. Lines of emerging research indicate a rare variant with focal atrophy of the right temporal lobe (RTLA). The objective was to present case data and discussion of an individual with RTLA in order to assist with conceptualization of this variant. METHOD: A 60-year-old, right-handed, college-educated Protestant minister with RTLA was evaluated. This patient presented with several hallmark behavioral and psychiatric features with personality changes, including hyper-religiosity, depression, and social disinhibition. Given the profession of the patient, the observed personality alterations (e.g., religiosity and pietism) were initially excused, which delayed diagnosis. RESULTS: In addition to cognitive deficits, an examination of affect processing within visual and auditory channels revealed severe impairment in emotion recognition with features of prosopagnosia. These impairments were in general more severe than the cognitive impairment observed on traditional neuropsychological measures. CONCLUSIONS: This case provides support for an FTLD right temporal lobe variant. This case also illustrates the importance of neuropsychological evaluation of affect processing in the differential diagnosis and treatment planning for FTLD and its subtypes.

Empirical validation of a short version of the Adolescent Sleep-Wake Scale using a sample of ethnically diverse adolescents from an economically disadvantage community.

OBJECTIVE: There is a need for brief, psychometrically sound instruments to assess adolescent sleep, particularly for ethnic minority and economically disadvantaged adolescents. A 10-item short version of the Adolescent Sleep-Wake Scale was recently proposed based upon exploratory factor analysis with primarily Caucasian healthy adolescents from middle- to high-income families. The aim of this study was to expand the utility of the short version of the Adolescent Sleep-Wake Scale by investigating the empirical and construct validity of the measure on an ethnically diverse sample of adolescents from an economically disadvantaged community. MATERIALS AND METHODS: Participants included 467 adolescents (40% African American, 35.5% Caucasian, 16.5% Latino, and 7.9% multiethnic), aged 12-18 years (mean = 15.27 years, SD = 1.96 years), who completed the Adolescent Sleep-Wake Scale. A confirmatory factor analysis (CFA) was conducted with Mplus 7 based on the three-factor solution proposed by Essner et al. (2014). RESULTS: CFA indicated that the three-factor structure was a good fit for the data (χ(2) (29) = 52.053, p = 0.005, root mean square error of approximation (RMSEA) = 0.04, CFI = 0.98, TLI = 0.96, standardized root mean residuals (SRMR) = 0.03), and factor loadings for each item were >0.40. Cronbach's alphas by ethnicity indicated that the scale has acceptable reliability (0.70 ≤ α ≤ 0.90) for African American, Caucasian, and multiethnic adolescents, but not for Latino adolescents. CONCLUSION: Our results support the use of the Adolescent Sleep-Wake Scale short form for the majority of ethnic minority and economically disadvantaged adolescents.

Posterior cortical atrophy: a case study of Benson's syndrome that initially presented as anxiety disorder.

The postmortem pathology of posterior cortical atrophy (PCA) and Alzheimer's disease (AD) are often identical. In contrast to AD, PCA is clinically different in that visuoperceptual skills are severely impaired, yet memory is relatively intact. In addition, patients with PCA often report depression with preserved insight. The present case study is a 56-year-old female who initially presented with anxiety and panic-like symptoms. The neuropsychological evaluation and imaging studies were consistent with PCA. This case study is relatively unique in that symptom onset presented as an anxiety disorder, yet formal evaluation revealed severe visuospatial impairment with minimal insight into the severity of cognitive impairment. Anxiety was alleviated following cessation of employment. This case highlights the importance of differential diagnostic consideration of affective and mood disorders and early forms of dementia.

Risk dishabituation: in repeated gambling, risk is reduced following low-probability "surprising" events (wins or losses).

In path-dependent risk taking, like playing a slot machine, the wager on one trial may be affected by the outcome of the preceding trial. Previous studies have shown that a person's risk-taking preferences may change as a result of the preceding trial (win or loss). For example, the "house money effect" suggests that risk taking may increase after a win, whereas the "break even effect" posits that risk taking increases after a loss. Independent of those findings, a person's emotional state has been found to influence risk taking. For example, the "mood maintenance hypothesis" supports the notion that positive affect decreases risk taking, and related research finds that increased negative affect increases risk taking. Because winning and losing may influence one's emotional state, we sought to investigate how both previous outcomes, as well as a person's emotional responses to those outcomes, independently influence subsequent risk taking. To do this, data were collected using three simplified slot machines where the chance of winning each trial was set to 13%, 50%, and 87%, respectively. Evidence for the break even and house money effects were found on the 13% and 87% games, respectively. Likewise, emotional valence was found to predict risk taking on these two tasks, with emotional valence fully explaining the break even effect observed on the 13% game. In addition to these results, the present research revealed that risk taking is reduced following low-probability ("surprising") events (i.e., a win in the 13% condition or loss in the 87% condition). Dubbed "risk dishabituation," this phenomenon is discussed, along with its likely corresponding emotional experience--surprise.

Brain function with complex decision making using electroencephalography.

A computer-administered assessment for decision making relevant to daily-living decisions, using the technique of complex decision making (CDM), has been previously developed and tested in our laboratory. The present study sought to identify unique patterns of brain activity in the alpha band associated with CDM. We recorded electroencephalogram (EEG) from 30 scalp sites, during a series of baseline, eyes open fixation tasks, and CDM tasks, in different contexts, in a group of 9 male and 7 female young healthy adults, aged 18 to 34. The decision making contexts, designed to simulate real-world, daily-living decisions, were about taking a bus, choosing a friend, job, medication, and participating in research. Electroencephalograms (EEGs) were divided into the frequency bands, alpha, beta, delta, theta, and gamma, though the primary focus of this paper is the alpha band. Analysis of mean EEG power spectra across the alpha bands - alpha1 (8-10 Hz), alpha2 (10-12 Hz), and alpha 3 (12-14 Hz) - showed significant decreases from baseline to the CDM task. In addition, we observed significant increases in delta, theta, beta, and gamma. There were also significant bivariate correlations between EEG spectra, mostly in low and mid alpha bands, behavioral performance on the CDM task, and scores on standardized measures of executive functioning, including the Trail-making Test and the Wisconsin Card Sorting Task. These results demonstrate how brain activity in complex decision making is distributed across alpha frequency bands and electrode regions and this activity relates to executive functioning.

5HTTLPR predicts left fusiform gyrus activation to positive emotional stimuli.

This study was designed to replicate and extend past research examining the impact of the serotonin transporter gene-linked polymorphic region (5HTTLPR) on neural activation during emotional processing. Six women with at least one short allele were compared to six age-matched women with long/long alleles of the 5HTTLPR. Participants were shown 36 positive and 36 negative slides from the International Affective Picture Set, while functional images were acquired using a 4-T magnetic resonance imaging scanner. Although we were unable to replicate past research demonstrating relatively increased amygdala activation among individuals with an "s" allele to negative stimuli, women with an s allele evidenced decreased left fusiform gyrus activation to positive emotional stimuli (as expected). We suggest that women with a short allele may be either less attentive or less "expert" with regard to positive emotional stimuli, and ideas for future research are presented.