Documenting Compliance and Symptom Reactivity for Ambulatory Assessment Methodology Following Concussion in Adolescents and Young Adults: Feasibility of the Mobile Neurocognitive Health (MNCH) Project.

OBJECTIVE: Evaluate compliance, symptom reactivity, and acceptability/experience ratings for an ecological momentary assessment (EMA) protocol involving ultra-brief ambulatory cognitive assessments in adolescent and young adult patients with concussion. SETTING: Outpatient concussion clinic. PARTICIPANTS: 116 patients aged 13 to 25 years with concussion. DESIGN: Prospective research design was used to examine compliance, symptom reactivity, and acceptability/experience for the Mobile Neurocognitive Health Project (MNCH); an EMA study of environmental exposures, symptoms, objective cognitive functioning, and symptom reactivity involving 4, daily EMA surveys (7:30 am, 10:30 am, 3:00 pm, 8:00 pm) for a period of 7 days following concussion. Overall compliance rates, symptom reactivity scores, and participant acceptability/experience ratings were described. A series of non-parametric Friedman Tests with post-hoc Wilcoxon signed-rank tests were used to examine differences in compliance and reactivity related to time of day and over the course of the protocol (first 3 days [Early Week] vs last 4 days [Late Week]). MAIN MEASURES: Compliance rates, symptom reactivity scores, participant experience/acceptability. RESULTS: Overall median compliance was 71%, and there were significantly fewer 7:30 am surveys completed compared to the 10:30 am (Z = -4.88,P ≤ .001), 3:00 pm (Z = -4.13,P ≤ .001), and 8:00 pm (Z = -4.68, P ≤ .001) surveys. Compliance for Early Week surveys were significantly higher than Late Week (Z = -2.16,P = .009). The median symptom reactivity score was 34.39 out of 100 and was significantly higher for Early Week compared to Late Week (Z = -4.59,P ≤ .001). Ninety-nine percent (89/90) of the sample agreed that the app was easy to use, and 18% (16/90) indicated that the app interfered with their daily life. CONCLUSION: Adolescents and young adults with concussion were compliant with the MNCH EMA protocol. Symptom reactivity to the protocol was low and the majority of participants reported that the app and protocol were acceptable. These findings support further investigation into applications of EMA for use in concussion studies.

Design and methods of the mobile assessment of cognition, environment, and sleep (MACES) feasibility study in newly diagnosed breast cancer patients.

Endocrine therapy (ET) for breast cancer treatment is associated with cognitive complaints, but their etiology is poorly understood. To address this, we developed and implemented an ambulatory assessment protocol consisting of wearable activity monitors, brief surveys of affect, context, and perceived impairments, and ultra-brief performance-based measures of cognition. Newly diagnosed, ER/PR+, stage 0-III, female breast cancer patients, were recruited. Ambulatory assessments were conducted on smart phones and wearable activity monitors were used to monitor sleep and physical activity. Participants were asked to complete five 7-day measurement bursts (one before starting ET and one each month for 4 consecutive months while on ET). We observed a consent rate of 36%, 27 women completed the study. Of the women that withdrew, 91% dropped prior to the midpoint of follow up. There were no significant differences in demographics, clinical breast cancer characteristics, sleep or physical activity patterns, or measures of cognition between women who completed versus withdrew. Women who did not complete the study provided fewer valid days of baseline data. In conclusion, while some women may be overwhelmed with their cancer diagnosis, we did not identify any predictive characteristics of women whom did not complete the study. This novel method enables the prospective study of psychological changes associated with cancer treatment, capturing a wide array of information about behavior, experience, and cognition, thus providing a picture of the lived experiences of cancer patients before and during exposure to ET.

Detecting cognitive decline in high-functioning older adults: The relationship between subjective cognitive concerns, frequency of high neuropsychological test scores, and the frontoparietal control network.

OBJECTIVE: Neuropsychologists have difficulty detecting cognitive decline in high-functioning older adults because greater neurological change must occur before cognitive performances are low enough to indicate decline or impairment. For high-functioning older adults, early neurological changes may correspond with subjective cognitive concerns and an absence of high scores. This study compared high-functioning older adults with and without subjective cognitive concerns, hypothesizing those with cognitive concerns would have fewer high scores on neuropsychological testing and lower frontoparietal network volume, thickness, and connectivity. METHOD: Participants had high estimated premorbid functioning (e.g., estimated intelligence ≥75th percentile or college-educated) and were divided based on subjective cognitive concerns. Participants with cognitive concerns (n = 35; 74.0 ± 9.6 years old, 62.9% female, 94.3% White) and without cognitive concerns (n = 33; 71.2 ± 7.1 years old, 75.8% female, 100% White) completed a neuropsychological battery of memory and executive function tests and underwent structural and resting-state magnetic resonance imaging, calculating frontoparietal network volume, thickness, and connectivity. RESULTS: Participants with and without cognitive concerns had comparable numbers of low test scores (≤16th percentile), p = .103, d = .40. Participants with cognitive concerns had fewer high scores (≥75th percentile), p = .004, d = .71, and lower mean frontoparietal network volumes (left: p = .004, d = .74; right: p = .011, d = .66) and cortical thickness (left: p = .010, d = .66; right: p = .033, d = .54), but did not differ in network connectivity. CONCLUSIONS: Among high-functioning older adults, subjective cognitive decline may correspond with an absence of high scores on neuropsychological testing and underlying changes in the frontoparietal network that would not be detected by a traditional focus on low cognitive test scores.

Ambulatory Assessment in Concussion Clinical Care and Rehabilitation.

Concussion is a mild traumatic brain injury that is characterized by a wide range of physical, emotional, and cognitive symptoms as well as neurocognitive, vestibular, and ocular impairments that can negatively affect daily functioning and quality of life. Clinical consensus statements recommend a targeted, clinical profile-based approach for management and treatment. This approach requires that clinicians utilize information obtained via a clinical interview and a multi-domain assessment battery to identify clinical profile(s) (e.g., vestibular, mood/anxiety, ocular, migraine, cognitive fatigue) and prescribe a corresponding treatment/rehabilitation program. Despite this comprehensive approach, the clinical picture can be limited by the accuracy and specificity of patient reports (which often conflate timing and severity of symptomology), as well as frequency and duration of exposure to symptom exacerbating environments (e.g., busy hallways, sitting in the back seat of a car). Given that modern rehabilitation programs leverage the natural environment as a tool to promote recovery (e.g., expose-recover approach), accurate characterization of the patient clinical profile is essential to improving recovery outcomes. Ambulatory assessment methodology could greatly benefit concussion clinical care by providing a window into the symptoms and impairments experienced by patients over the course of their daily lives. Moreover, by evaluating the timing, onset, and severity of symptoms and impairments in response to changes in a patient's natural environment, ambulatory assessments can provide clinicians with a tool to confirm clinical profiles and gauge effectiveness of the rehabilitation program. In this perspective report, we review the motivations for utilizing ambulatory assessment methodology in concussion clinical care and report on data from a pilot project utilizing smart phone-based, ambulatory assessments to capture patient reports of symptom severity, environmental exposures, and performance-based assessments of cognition for 7 days following their initial evaluation.

Introducing the female Cambridge face memory test - long form (F-CFMT+).

The Cambridge Face Memory Test (CFMT) is one of the most used assessments of face recognition abilities in the science of face processing. The original task, using White male faces, has been empirically evaluated for psychometric properties (Duchaine & Nakayama, 2006), while the longer and more difficult version (CFMT+; Russell et al., 2009) has not. Critically, no version exists using female faces. Here, we present the Female Cambridge Face Memory Test - Long Form (F-CFMT+) and evaluate the psychometric properties of this task in comparison to the Male Cambridge Face Memory Test - Long Form (M-CFMT+). We tested typically developing emerging adults (18 to 25 years old) in both Cambridge face recognition tasks, an old-new face recognition task, and a car recognition task. Results indicate that the F-CFMT+ is a valid, internally consistent measure of unfamiliar face recognition that can be used alone or in tandem with the M-CFMT+ to assess recognition abilities for young adult White faces. When used together, performance on the F-CFMT+ and M-CFMT+ can be directly compared, adding to the ability to understand face recognition abilities for different kinds of faces. The two tasks have high convergent validity and relatively good divergent validity with car recognition in the same task paradigm. The F-CFMT+ will be useful to researchers interested in evaluating a broad range of questions about face recognition abilities in both typically developing individuals and those with atypical social information processing abilities.

The influence of item familiarization on neural discriminability during associative memory encoding and retrieval.

Associative memory requires one to encode and form memory representations not just for individual items, but for the association or link between those items. Past work has suggested that associative memory is facilitated when individual items are familiar rather than simultaneously learning the items and their associative link. The current study employed multivoxel pattern analyses (MVPA) to investigate whether item familiarization prior to associative encoding affects the distinctiveness of neural patterns, and whether that distinctiveness is also present during associative retrieval. Our results suggest that prior exposure to item stimuli impacts the representations of their shared association compared to stimuli that are novel at the time of associative encoding throughout most of the associative memory network. While this distinction was also present at retrieval, the overall extent of the difference was diminished. Overall the results suggest that stimulus familiarity influences the representation of associative pairings during memory encoding and retrieval, and the pair-specific representation is maintained across memory phases irrespective of this distinction.

Intelligence and creativity share a common cognitive and neural basis.

Are intelligence and creativity distinct abilities, or do they rely on the same cognitive and neural systems? We sought to quantify the extent to which intelligence and creative cognition overlap in brain and behavior by combining machine learning of fMRI data and latent variable modeling of cognitive ability data in a sample of young adults (N = 186) who completed a battery of intelligence and creative thinking tasks. The study had 3 analytic goals: (a) to assess contributions of specific facets of intelligence (e.g., fluid and crystallized intelligence) and general intelligence to creative ability (i.e., divergent thinking originality), (b) to model whole-brain functional connectivity networks that predict intelligence facets and creative ability, and (c) to quantify the degree to which these predictive networks overlap in the brain. Using structural equation modeling, we found moderate to large correlations between intelligence facets and creative ability, as well as a large correlation between general intelligence and creative ability (r = .63). Using connectome-based predictive modeling, we found that functional brain networks that predict intelligence facets overlap to varying degrees with a network that predicts creative ability, particularly within the prefrontal cortex of the executive control network. Notably, a network that predicted general intelligence shared 46% of its functional connections with a network that predicted creative ability-including connections linking executive control and salience/ventral attention networks-suggesting that intelligence and creative thinking rely on similar neural and cognitive systems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evaluating the organizational structure and specificity of network topology within the face processing system.

There is increasing appreciation that network-level interactions among regions produce components of face processing previously ascribed to individual regions. Our goals were to use an exhaustive data-driven approach to derive and quantify the topology of directed functional connections within a priori defined nodes of the face processing network and evaluate whether the topology is category-specific. Young adults were scanned with fMRI as they viewed movies of faces, objects, and scenes. We employed GIMME to model effective connectivity among core and extended face processing regions, which allowed us to evaluate all possible directional connections, under each viewing condition (face, object, place). During face processing, we observed directional connections from the right posterior superior temporal sulcus to both the right occipital face area and right fusiform face area (FFA), which does not reflect the topology reported in prior studies. We observed connectivity between core and extended regions during face processing, but this limited to a feed-forward connection from the FFA to the amygdala. Finally, the topology of connections was unique to face processing. These findings suggest that the pattern of directed functional connections within the face processing network, particularly in the right core regions, may not be as hierarchical and feed-forward as described previously. Our findings support the notion that topologies of network connections are specialized, emergent, and dynamically responsive to task demands.

Improving sensitivity to eye gaze cues in autism using serious game technology: study protocol for a phase I randomised controlled trial.

INTRODUCTION: Autism spectrum disorder (ASD) is characterised by impairments in social communication. Core symptoms are deficits in social looking behaviours, including limited visual attention to faces and sensitivity to eye gaze cues. We designed an intervention game using serious game mechanics for adolescents with ASD. It is designed to train individuals with ASD to discover that the eyes, and shifts in gaze specifically, provide information about the external world. We predict that the game will increase understanding of gaze cues and attention to faces. METHODS AND ANALYSIS: The Social Games for Adolescents with Autism (SAGA) trial is a preliminary, randomised controlled trial comparing the intervention game with a waitlist control condition. 34 adolescents (10-18 years) with ASD with a Full-Scale IQ between 70 and 130 and a minimum second grade reading level, and their parents, will be randomly assigned (equally to intervention or the control condition) following baseline assessments. Intervention participants will be instructed to play the computer game at home on a computer for ~30 min, three times a week. All families are tested in the lab at baseline and approximately 2 months following randomisation in all measures. Primary outcomes are assessed with eye tracking to measure sensitivity to eye gaze cues and social visual attention to faces; secondary outcomes are assessed with questionnaires to measure social skills and autism-like behaviours. The analyses will focus on evaluating the feasibility, safety and preliminary effectiveness of the intervention. ETHICS AND DISSEMINATION: SAGA is approved by the Institutional Review Board at Pennsylvania State University (00005097). Findings will be disseminated via scientific conferences and peer-reviewed journals and to participants via newsletter. The intervention game will be available to families in the control condition after the full data are collected and if analyses indicate that it is effective. TRIAL REGISTRATION NUMBER: NCT02968225.

Investigating the Influence of Biological Sex on the Behavioral and Neural Basis of Face Recognition.

There is interest in understanding the influence of biological factors, like sex, on the organization of brain function. We investigated the influence of biological sex on the behavioral and neural basis of face recognition in healthy, young adults. In behavior, there were no sex differences on the male Cambridge Face Memory Test (CFMT)+ or the female CFMT+ (that we created) and no own-gender bias (OGB) in either group. We evaluated the functional topography of ventral stream organization by measuring the magnitude and functional neural size of 16 individually defined face-, two object-, and two place-related regions bilaterally. There were no sex differences in any of these measures of neural function in any of the regions of interest (ROIs) or in group level comparisons. These findings reveal that men and women have similar category-selective topographic organization in the ventral visual pathway. Next, in a separate task, we measured activation within the 16 face-processing ROIs specifically during recognition of target male and female faces. There were no sex differences in the magnitude of the neural responses in any face-processing region. Furthermore, there was no OGB in the neural responses of either the male or female participants. Our findings suggest that face recognition behavior, including the OGB, is not inherently sexually dimorphic. Face recognition is an essential skill for navigating human social interactions, which is reflected equally in the behavior and neural architecture of men and women.

Beyond the FFA: Brain-behavior correspondences in face recognition abilities.

Despite the thousands of papers investigating the neural basis of face perception in both humans and non-human primates, very little is known about how activation within this neural architecture relates to face processing behavior. Here, we investigated individual differences in brain-behavior correspondences within both core and extended regions of the face-processing system in healthy typically developing adults. To do so, we employed a set of behavioral and neural measures to capture a multifaceted perspective on assessing these brain-behavior relations. This included quantifying face and object recognition behavior, the magnitude and size of functional activation within each region, as well as a measure of global activation across regions. We report that face, but not object, recognition behavior was associated with 1) the magnitude of face-selective activation in the left FFA1, 2) larger face-related regions in multiple bilateral face-patches in the fusiform gyri as well as the bilateral anterior temporal lobe and amygdala, and 3) more distributed global face-network activation. In contrast, face recognition behavior was not associated with any measure of object- or place-selective activation. These findings suggest that superior behavior is served by engaging sufficiently large, distributed patches of neural real estate, which might reflect the integration of independent populations of neurons that enables the formation of richer representations.

Individual differences in symptom severity and behavior predict neural activation during face processing in adolescents with autism.

Despite the impressive literature describing atypical neural activation in visuoperceptual face processing regions in autism, almost nothing is known about whether these perturbations extend to more affective regions in the circuitry and whether they bear any relationship to symptom severity or atypical behavior. Using fMRI, we compared face-, object-, and house-related activation in adolescent males with high-functioning autism (HFA) and typically developing (TD) matched controls. HFA adolescents exhibited hypo-activation throughout the core visuoperceptual regions, particularly in the right hemisphere, as well as in some of the affective/motivational face-processing regions, including the posterior cingulate cortex and right anterior temporal lobe. Conclusions about the relative hyper- or hypo-activation of the amygdala depended on the nature of the contrast that was used to define the activation. Individual differences in symptom severity predicted the magnitude of face activation, particularly in the right fusiform gyrus. Also, among the HFA adolescents, face recognition performance predicted the magnitude of face activation in the right anterior temporal lobe, a region that supports face individuation in TD adults. Our findings reveal a systematic relation between the magnitude of neural dysfunction, severity of autism symptoms, and variation in face recognition behavior in adolescents with autism. In so doing, we uncover brain-behavior relations that underlie one of the most prominent social deficits in autism and help resolve discrepancies in the literature.