Investigation on Gender Differences in Leadership of Stroke-Related Clinical Trials.

BACKGROUND: Gender disparities among principal investigators of clinical trials (CT) can have implications regarding the areas of investigation, methods, conduct, trial enrollment, and interpretation of results. An estimation of the gender gap in the leadership of stroke-related CTs from North America has to date not been undertaken. METHODS: We extracted information about stroke-related CTs between 2011 and 2020 from www. CLINICALTRIALS: gov and PubMed. We examined the gender distribution according to the academic credentials and the trial type. The gender of PIs and authors was determined using gender package in R, which identifies gender using historical data from the United States. Additionally, we obtained information from Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education data resource books on the gender composition of full-time neurology faculty, neurology residents and vascular neurology fellows. RESULTS: In these analyses of 821 CTs registered on Clinicaltrials.gov and 110 trials published on PubMed, we found that gender disparity among the PIs, first and last authors have persisted over the last decade without any significant trend toward parity (P>0.05). On examining the gender distribution according to academic credentials and trial type, we found that men were over-represented in the sub-group of PIs with an MD degree (78.11% versus 21.87%; P<0.01) and those leading acute stroke trials (86.04% versus 13.89%; P<0.01). We also found that a lower proportion of women neurology residents pursued a vascular neurology fellowship during this period (33.5% versus 42.5%; P<0.05). CONCLUSIONS: Our results show that the favorable trend toward gender parity seen in Neurology faculty over the last decade has not translated to the same in the leadership of CTs. Our findings merit further investigation and a re-examination of efforts toward inclusion of women as leaders of stroke-related CTs.

Light aerobic exercise modulates executive function and cortical excitability.

Single bouts of aerobic exercise can modulate cortical excitability and executive cognitive function, but less is known about the effect of light-intensity exercise, an intensity of exercise more achievable for certain clinical populations. Fourteen healthy adults (aged 22 to 30) completed the following study procedures twice (≥7 days apart) before and after 30 min of either light aerobic exercise (cycling) or seated rest: neurocognitive battery (multitasking performance, inhibitory control and spatial working memory), paired-pulse TMS measures of cortical excitability. Significant improvements in response times during multitasking performance and increases in intracortical facilitation (ICF) were seen following light aerobic exercise. Light aerobic exercise can modulate cortical excitability and some executive function tasks. Populations with deficits in multitasking ability may benefit from this intervention.

Axonal injury, sleep disturbances, and memory following traumatic brain injury.

OBJECTIVES: Traumatic brain injury (TBI) is associated with sleep deficits, but it is not clear why some report sleep disturbances and others do not. The objective of this study was to assess the associations between axonal injury, sleep, and memory in chronic and acute TBI. METHODS: Data were acquired from two independent datasets which included 156 older adult veterans (69.8 years) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with prior moderate-to-severe TBIs and 90 (69.2 years) controls and 374 (39.6 years) from Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) with a recent mild TBI (mTBI) and 87 controls (39.6 years), all who completed an MRI, memory assessment, and sleep questionnaire. RESULTS: Older adults with a prior TBI had a significant association between axonal injury and sleep disturbances [ß = 9.52, 95% CI (4.1, 14.9), p = 0.01]. Axonal injury predicted changes in memory over 1-year in TBI [ß = -8.72, 95% CI (-18, -2.7), p = 0.03]. We externally validated those findings in TRACK-TBI where axonal injury within 2 weeks after mTBI was significantly associated with higher sleep disturbances in the TBI group at 2 weeks[ß = -7.2, 95% CI (-14, -0.50), p = 0.04], 6 months [ß = -16, 95% CI (-24, -7.6), p ≤ 0.01], and 12 months post-injury [ß = -11, 95% CI (-19, -0.85), p = 0.03]. These associations were not significant in controls. INTERPRETATIONS: Axonal injury, specifically to the left anterior internal capsule is robustly associated with sleep disturbances in multiple TBI populations. Early assessment of axonal injury following mTBI could identify those at risk for persistent sleep disturbances following injury.

Slowing of Parameterized Resting-State Electroencephalography After Mild Traumatic Brain Injury.

Reported changes in electroencephalography (EEG)-derived spectral power after mild traumatic brain injury (mTBI) remains inconsistent across existing literature. However, this may be a result of previous analyses depending solely on observing spectral power within traditional canonical frequency bands rather than accounting for the aperiodic activity within the collected neural signal. Therefore, the aim of this study was to test for differences in rhythmic and arrhythmic time series across the brain, and in the cognitively relevant frontoparietal (FP) network, and observe whether those differences were associated with cognitive recovery post-mTBI. Resting-state electroencephalography (rs-EEG) was collected from 88 participants (56 mTBI and 32 age- and sex-matched healthy controls) within 14 days of injury for the mTBI participants. A battery of executive function (EF) tests was collected at the first session with follow-up metrics collected approximately 2 and 4 months after the initial visit. After spectral parameterization, a significant between-group difference in aperiodic-adjusted alpha center peak frequency within the FP network was observed, where a slowing of alpha peak frequency was found in the mTBI group in comparison to the healthy controls. This slowing of week 2 (collected within 2 weeks of injury) aperiodic-adjusted alpha center peak frequency within the FP network was associated with increased EF over time (evaluated using executive composite scores) post-mTBI. These findings suggest alpha center peak frequency within the FP network as a candidate prognostic marker of EF recovery and may inform clinical rehabilitative methods post-mTBI.

Subjective Cognitive Complaints in Concussion.

Studies of symptoms after concussion have been focused heavily on athletic and military populations; generalizability to "civilians" has not recently been demonstrated. We selected cognitive symptoms as an important target to assess because of impact on school and employment. We evaluated cognitive complaints in a highly symptomatic (Rivermead Post-Concussion Symptoms Questionnaire [PCSQ], mean [M] = 29.5) civilian sample (n = 100; age: M = 41.4; 36 male/64 female; days post-injury: range 14-154, M = 51.4) of consecutive referrals to a concussion specialty clinic. The Behavior Rating of Executive Functions-Adult version (BRIEF-A) was used to assess subjective cognitive symptoms. Independent variables were prior neurologic and psychiatric history, current neurological symptoms, objective neuropsychological tests and several measures of depression (Beck Depression Inventory, Second Edition [BDI2]), anxiety (Beck Anxiety Inventory), and stress (Post-Traumatic Stress Checklist-Civilian form). No demographic characteristic, injury measure, or past or current neurological history had any association with cognitive symptoms. Prior psychiatric history (57% of patients) was associated with abnormal BRIEF-A. Cognitive tests were overall in the average range, with only mild and sporadic associations with BRIEF-A elevations. All psychological measures showed significant associations with BRIEF-A elevations. Regression analyses for the BRIEF-A revealed depression was the significant contributor (BDI2, ß = 0.73) with prior psychiatric history (ß = 0.16) and age (ß = 0.14) accounting to a lesser extent. In this civilian cohort, subjective cognitive symptoms appear to be due to psychological distress (in particular, depression) and prior psychiatric history more than actual cognitive impairment or other presenting symptoms. These findings illuminate the importance of early diagnosis and treatment of mood/emotional symptoms after injury.

Exposure to American Football and Neuropsychiatric Health in Former National Football League Players: Findings From the Football Players Health Study.

BACKGROUND: Former American football players have a higher prevalence of cognitive impairment than that of the US general population. It remains unknown what aspects of playing football are associated with neuropsychiatric outcomes. HYPOTHESIS: It was hypothesized that seasons of professional football, playing position, and experience of concussions were associated with cognition-related quality of life (QOL) and indicators of depression and anxiety. STUDY DESIGN: Descriptive epidemiology study. METHODS: The authors examined whether seasons of professional football, playing position, and experience of concussions, as measured by self-report of 10 symptoms, were associated with cognition-related QOL and indicators of depression and anxiety in a cross-sectional survey conducted 2015 to 2017. Cognition-related QOL was measured by the short form of the Quality of Life in Neurological Disorders: Applied Cognition-General Concerns. The Patient Health Questionnaire-4 measured depression and anxiety symptoms. Of 13,720 eligible men with apparently valid contact information, 3506 players returned a questionnaire at the time of this analysis (response rate = 25.6%). RESULTS: Seasons of professional play (risk ratio [RR] per 5 seasons = 1.19, 95% CI = 1.06-1.34) and playing position were associated with cognition-related QOL. Each 5 seasons of play was associated with 9% increased risk of indicators of depression at borderline statistical significance (P = .05). When compared with former kickers, punters, and quarterbacks, men who played any other position had a higher risk of poor cognition-related QOL, depression, and anxiety. Concussion symptoms were strongly associated with poor cognition-related QOL (highest concussion quartile, RR = 22.3, P < .001), depression (highest quartile, RR = 6.0, P < .0001), and anxiety (highest quartile, RR = 6.4, P < .0001), even 20 years after last professional play. CONCLUSION: The data suggest that seasons of play and playing position in the NFL are associated with lasting neuropsychiatric health deficits. Additionally, poor cognition-related QOL, depression, and anxiety appear to be associated with concussion in the long term.

Self-reported sleep duration affects tandem gait, but not steady-state gait outcomes among healthy collegiate athletes.

BACKGROUND: Sleep deficits are associated with motor and cognitive function deficits, even in the absence of a recent concussion. RESEARCH QUESTION: Does the amount of self-reported sleep prior to pre-season concussion testing affect single-task and dual-task instrumented steady-state gait and timed tandem gait test performance? METHODS: One hundred and fourteen healthy collegiate athletes (mean age 18.8 ±â€¯0.7 years; 60% female) reported the amount of sleep they received during the prior night and completed a timed tandem gait test and an instrumented assessment of steady-state gait in both single-task and dual-task conditions. Outcome variables included spatio-temporal gait parameters during steady-state gait, best and mean tandem gait times, and cognitive test accuracy. RESULTS: Participants who reported sleeping <7 h of sleep during the night prior to testing (n = 62) had significantly longer tandem gait times in single-task and dual-task conditions (11.1 ±â€¯2.2 vs. 10.1 ±â€¯2.0 s and 14.5 ±â€¯4.3 vs. 12.3 ±â€¯2.6 s, respectively; p = .009) compared to those who reported sleeping ≥7 h (n = 52). No significant differences between groups were observed for spatio-temporal steady-state gait variables or for cognitive test accuracy. SIGNIFICANCE: Self-reported sleep duration may be associated with baseline testing tandem gait performance. Thus, as sleep can play a role in motor abilities, clinicians may consider interpreting tandem gait performance in light of sleep duration during the night prior to testing.

The utility of instrumented dual-task gait and tablet-based neurocognitive measurements after concussion.

OBJECTIVES: Quantitative and non-invasive measurements acquired by neurocognitive or gait evaluations are useful concussion management components. Emerging technology has allowed for the development of portable and objective tests which may be potentially useful across many settings where evaluations take place. Our aim was to examine the association between instrumented dual-task gait and tablet-based neurocognitive outcome variables with an acute concussion. DESIGN: A total of 59 collegiate athletes were identified and tested within 5days of concussion (n=18, 50% female, 20±1years of age) or as a part of a baseline examination (n=41, 29% female, 19±1years of age). METHODS: Participants completed an instrumented dual-task gait evaluation and a tablet-based neurocognitive evaluation. Outcome variables were compared with t-tests, and a multivariable logistic regression model was constructed to identify the association between the presence of a concussion and test performance. RESULTS: Compared with controls, participants with concussion reported significantly more severe symptoms (PCSS=19.1±15.2 vs. 4.1±6.3; p<0.001), walked significantly slower during dual-task conditions (87.7±10.4cm/s vs. 98.1±15.4cm/s; p=0.01), and responded with significantly slower simple reaction times (305.2±32.4ms vs. 275.4±22.1ms; p<0.001). After adjusting for the effect of potential confounding variables, these three variables (more severe symptoms, slower walking speed, and slower reaction time) remained independently associated with concussion (adjusted odds ratios=1.181, 0.916, and 1.043, respectively). CONCLUSIONS: Relatively simple quantitative measurements of dual-task gait and reaction time may be useful and portable clinical tests in the multifaceted assessment of concussion.

Concussion: Evaluation and management.

Concussion is a common problem often managed by nonneurologists. It is often accompanied by headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues. Here, we outline how to evaluate and manage concussion, including treatment of the most common symptoms.

Pathogenesis of Pain.

The pathogenesis of pain sensation includes mechanisms that result in acute or chronic pain. Pain itself is described as an unpleasant sensory and emotional experience beginning with a peripheral stimulus that undergoes a physiological process ultimately resulting in the sensation of pain. Biologists recognize pain to be a common sign of potential tissue damage. Hence, pain sensation is protective in function. However, pathologic states of pain exist secondary to disruption of the nociceptive process both peripherally and centrally or secondary to psychological conditions. It is essential to identify these aberrant states of pain and distinguish them from situations of potential tissue damage. Chronic pain is defined as pain that exceeds 3 or 6 months duration. This article is an overview of the essential neuroanatomy and neurophysiology of normal pain nociception, its clinical implications, and the development of persistent and pathological pain conditions following improperly or poorly treated pain.

Early and persistent 'extreme delta brush' in a patient with anti-NMDA receptor encephalitis.

Since its original description in 2007, anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis associated with an ovarian teratoma is an increasingly recognized etiology of previously unexplained encephalopathy and encephalitis. Extreme delta brush (EDB) is a novel electroencephalogram (EEG) finding seen in many patients with anti-NMDAR encephalitis. The presence of this pattern is associated with a more prolonged illness, although the specificity of this pattern is unclear. Additionally, the frequency and sensitivity of EDB in anti-NMDAR encephalitis and its implications for outcome have yet to be determined. We report a patient with early evidence of extreme delta brush and persistence of this pattern 17.5 weeks later with little clinical improvement.

Specificity of social support for back pain patients: do patients care who provides what?

This study examined low back pain patients' (N=50) perceptions of what they considered to be helpful and unhelpful social support from various sources over the previous six months. Among types of social support, tangible support was most likely to be rated as helpful, whereas emotional support was the type of support most likely to be rated as unhelpful. Patients reported only rare instances of dissatisfaction with tangible support across various providers. Among support sources, instances of tangible support from physicians, and emotional support from friends, family, and spouses were recalled as most helpful. Physical therapists were named as providing the greatest amount of all three types of social support and were rated as rarely providing unhelpful social support. These findings suggest that the desirability of different types of social support varies as a function of the source of support and indicate that physical therapists are perceived by back pain patients as particularly helpful in their provision of social support.