Performance on the DANA Brief Cognitive Test Correlates With MACE Cognitive Score and May Be a New Tool to Diagnose Concussion.

Nearly 380,000 U.S. service members between 2000 and 2017 were, and at least 300,000 athletes annually are, diagnosed with concussion. It is imperative to establish a gold-standard diagnostic test to quickly and accurately diagnose concussion. In this non-randomized, prospective study, we examined the reliability and validity of a novel neurocognitive assessment tool, the Defense Automated Neurobehavioral Assessment (DANA), designed to be a more sensitive, yet efficient, measure of concussion symptomatology. In this study, the DANA Brief version was compared to an established measure of concussion screening, the Military Acute Concussion Evaluation (MACE), in a group of non-concussed service members. DANA Brief subtests demonstrated low to moderate reliability, as measured by intra-class correlation coefficient (ICC; values range: 0.28-0.58), which is comparable to other computerized neurocognitive tests that are widely-implemented to diagnose concussion. Statistically significant associations were found between learning and memory components of the DANA Brief and the diagnostic MACE cognitive test score (DANA Brief subtests: CDD: R 2 = 0.05, p = 0.023; CDS: R 2 = 0.10, p = 0.010). However, a more robust relationship was found between DANA Brief components involving attention and working memory, including immediate memory, and the MACE cognitive test score (DANA Brief subtests: GNG: R 2 = 0.08, p = 0.003; PRO: R 2 = 0.08, p = 0.002). These results provide evidence that the DANA Rapid version, a 5-min assessment self-administered on a hand-held portable device, based on the DANA Brief version, may serve as a clinically useful and improved neurocognitive concussion screen to minimize the time between injury and diagnosis in settings where professional medical evaluation may be unavailable or delayed. The DANA's portability, durability, shorter test time and lack of need for a medical professional to diagnose concussion overcome these critical limitations of the MACE.

Long-term Stability and Reliability of Baseline Cognitive Assessments in High School Athletes Using ImPACT at 1-, 2-, and 3-year Test-Retest Intervals.

OBJECTIVE: The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) neurocognitive testing battery is a widely used tool used for the assessment and management of sports-related concussion. Research on the stability of ImPACT in high school athletes at a 1- and 2-year intervals have been inconsistent, requiring further investigation. We documented 1-, 2-, and 3-year test-retest reliability of repeated ImPACT baseline assessments in a sample of high school athletes, using multiple statistical methods for examining stability. METHODS: A total of 1,510 high school athletes completed baseline cognitive testing using online ImPACT test battery at three time periods of approximately 1- (N = 250), 2- (N = 1146), and 3-year (N = 114) intervals. No participant sustained a concussion between assessments. RESULTS: Intraclass correlation coefficients (ICCs) ranged in composite scores from 0.36 to 0.90 and showed little change as intervals between assessments increased. Reliable change indices and regression-based measures (RBMs) examining the test-retest stability demonstrated a lack of significant change in composite scores across the various time intervals, with very few cases (0%-6%) falling outside of 95% confidence intervals. CONCLUSION: The results suggest ImPACT composites scores remain considerably stability across 1-, 2-, and 3-year test-retest intervals in high school athletes, when considering both ICCs and RBM. Annually ascertaining baseline scores continues to be optimal for ensuring accurate and individualized management of injury for concussed athletes. For instances in which more recent baselines are not available (1-2 years), clinicians should seek to utilize more conservative range estimates in determining the presence of clinically meaningful change in cognitive performance.

Staying on the job: The relationship between work performance and cognition in individuals diagnosed with multiple sclerosis.

People with multiple sclerosis (MS) are apt to become unemployed as the disease progresses, and most research implies that this is due to diminishing mobility. Some studies have shown that presence of cognitive impairment also predicts employment status. Yet, no studies have examined how neuropsychological factors predict vocational performance among individuals with MS who remain employed. We assessed employer- and self-rated work performance, mobility status, and neuropsychological function in a sample of 44 individuals diagnosed with MS. Results suggest that cognitive impairment is common in these employed individuals, despite largely intact mobility status. Moreover, a significant interaction emerged, such that cognitively impaired individuals' work performance was rated more poorly by supervisors. In contrast, self-ratings of work performance were higher in cognitively impaired than in unimpaired participants. These novel findings suggest that cognitive impairment may influence work performance, even in patients whose physical disability status is relatively intact.

Obesity and deep brain stimulation: an overview.

Deep brain stimulation (DBS) has been employed to treat a variety of disorders such as Parkinson disease, dystonia, and essential tremor. Newer indications such as epilepsy and obsessive-compulsive disorder have been added to the armamentarium. In this review, we present an initial summary of current methods in the management of obesity and then explore efforts in neuromodulation and DBS as a novel modality in the treatment of obesity disorders.

Validation of the repeatable battery for the assessment of neuropsychological status--effort index in a veteran sample.

The RBANS Effort Index (RBANS-EI; Silverberg, Wertheimer, & Fichtenberg, 2007) is an embedded measure of effort within a frequently employed neuropsychological screening battery. While it has been criticized for inadequate specificity in older non-litigating samples (Hook, Marquine, & Hoelzle, 2009; Warren et al., 2010), the RBANS-EI has yet to be investigated in a non-geriatric veteran sample. Archival data were collected from 85 veterans who completed the RBANS and WMT within either a routine neuropsychological evaluation (n = 66) or compensation evaluation (n = 19). At a cutoff of >3 RBANS-EI exhibited strong specificity (.94) yet limited sensitivity (.31) in the prediction of WMT performance. Examination of RBANS-EI component subtests found that List Recognition <17 had strong specificity (.90) and moderate sensitivity (.52) in discriminating WMT performance groups. In contrast, Digit Span performance was comparable between those passing and failing the WMT. Present findings indicate that both the RBANS-EI and List Recognition subtest may be useful in detecting suboptimal effort yet raise questions regarding the Digit Span component of the RBANS-EI.

Detection of suboptimal effort with symbol span: development of a new embedded index.

Developing embedded indicators of suboptimal effort on objective neurocognitive testing is essential for detecting increasingly sophisticated forms of symptom feigning. The current study explored whether Symbol Span, a novel Wechsler Memory Scale-fourth edition measure of supraspan visual attention, could be used to discriminate adequate effort from suboptimal effort. Archival data were collected from 136 veterans classified into Poor Effort (n = 42) and Good Effort (n = 94) groups based on symptom validity test (SVT) performance. The Poor Effort group had significantly lower raw scores (p < .001) and age-corrected scaled scores (p < .001) than the Good Effort group on the Symbol Span test. A raw score cutoff of <14 produced 83% specificity and 50% sensitivity for detection of Poor Effort. Similarly, sensitivity was 52% and specificity was 84% when employing a cutoff of <7 for Age-Corrected Scale Score. Collectively, present results suggest that Symbol Span can effectively differentiate veterans with multiple failures on established free-standing and embedded SVTs.

Expansion and re-examination of Digit Span effort indices on the WAIS-IV.

The Digit Span subtest was significantly revised for the WAIS-IV as an ordinal sequencing trial was added to increase working memory demands. The present investigation sought to validate an expanded version of Reliable Digit Span (RDS-R) as well as age-corrected scaled score (ACSS) from the recently revised Digit Span. Archival data were collected from 259 veterans completing the WAIS-IV Digit Span subtest and Word Memory Test (WMT). Veterans failing the WMT performed significantly worse (p < .001) on the ACSS, RDS-R, and traditional RDS. Operational characteristics of the ACSS, RDS-R, and RDS were essentially equivalent; however, sensitivity was quite modest when selecting cutoffs with strong specificity. While current results suggest that Digit Span effort indices can contribute to the detection of suboptimal effort, additional symptom validity indicators should be employed to compensate for limited sensitivity.