Was the COVID-19 Pandemic Associated with Gender Disparities in Authorship of Manuscripts Submitted to Clinical Neuropsychology Journals?

OBJECTIVE: The COVID-19 pandemic exacerbated gender disparities in some academic disciplines. This study examined the association of the pandemic with gender authorship disparities in clinical neuropsychology (CN) journals. METHOD: Author bylines of 1,018 initial manuscript submissions to four major CN journals from March 15 through September 15 of both 2019 and 2020 were coded for binary gender. Additionally, authorship of 40 articles published on pandemic-related topics (COVID-19, teleneuropsychology) across nine CN journals were coded for binary gender. RESULTS: Initial submissions to these four CN journals increased during the pandemic (+27.2%), with comparable increases in total number of authors coded as either women (+23.0%) or men (+25.4%). Neither the average percentage of women on manuscript bylines nor the proportion of women who were lead and/or corresponding authors differed significantly across time. Moreover, the representation of women as authors of pandemic-related articles did not differ from expected frequencies in the field. CONCLUSIONS: Findings suggest that representation of women as authors of peer-reviewed manuscript submissions to some CN journals did not change during the initial months of the COVID-19 pandemic. Future studies might examine how risk and protective factors may have influenced individual differences in scientific productivity during the pandemic.

Crash Risk Following Return to Driving After Moderate-to-Severe TBI: A TBI Model Systems Study.

OBJECTIVE: To examine motor vehicle crash frequency and risk factors following moderate-to-severe traumatic brain injury (TBI). SETTING: Eight TBI Model Systems sites. Participants: Adults ( N = 438) with TBI who required inpatient acute rehabilitation. DESIGN: Cross-sectional, observational design. MAIN MEASURES: Driving survey completed at phone follow-up 1 to 30 years after injury. RESULTS: TBI participants reported 1.5 to 2.5 times the frequency of crashes noted in the general population depending on the time frame queried, even when accounting for unreported crashes. Most reported having no crashes; for those who experienced a crash, half of them reported a single incident. Based on logistic regression, age at survey, years since injury, and perception of driving skills were significantly associated with crashes. CONCLUSION: Compared with national statistics, crash risk is higher following TBI based on self-report. Older age and less time since resuming driving were associated with lower crash risk. When driving was resumed was not associated with crash risk. These results do not justify restricting people from driving after TBI, given that the most who resumed driving did not report experiencing any crashes. However, there is a need to identify and address factors that increase crash risk after TBI.

Barriers to driving and psychosocial outcomes after traumatic brain injury.

OBJECTIVE: Examine considerations and perceived barriers to return to driving, and their association with psychosocial outcomes among adults with traumatic brain injury (TBI) who were not driving. METHODS: 174 adults with moderate-to-severe TBI enrolled in the TBI Model System participated in this cross-sectional study. All participants were drivers prior to their TBI. Outcome measures included the Barriers to Driving Questionnaire, Disability Rating Scale, Patient Health Questionnaire-9, General Anxiety Disorder-7, and Satisfaction With Life Scale. Descriptive analyses examined considerations and barriers to driving, including differences associated with demographic characteristics. Moderation analyses investigated the extent to which disability moderated the relationship between barriers and psychosocial outcomes. RESULTS: Social barriers were the most strongly endorsed domain, whereas physical barriers were endorsed least. The profile of endorsements differed for men and women, and for Black and White participants, on both theoretical considerations in returning to drive and experiences of barriers in doing so. Disability level moderated the relationship between barriers to driving and depression and life satisfaction, but not anxiety. CONCLUSION: The experience of barriers to driving is differentially associated with psychosocial outcomes among nondriving adults with TBI. Adults with low disability appear to be at risk for distress, even compared to other nondrivers.

Effects of a Sexual Health Interview among Arab American Women: An Experimental Disclosure Study.

Although sexuality is an important aspect of peoples' health and well-being, many people-professionals and patients alike-find sexuality uncomfortable to discuss. In Arab culture, certain sexual thoughts and behaviors are taboo, particularly for women, and it is not known whether an interview in which Arab American women disclose their sexuality to a health professional would be well-received and beneficial or upsetting and harmful. This experimental study tested whether engaging in a disclosure-oriented sexual health interview affects Arab American women's sexual and psychological health. A sample of 134 Arab American women, ages 18-35 years (M = 20.6), completed self-report measures of sexual health and attitudes and psychological symptoms, and then were randomized to an interview or control (waitlist) condition. The 60-min disclosure interview inquired about sexual attitudes, experiences, and conflicts. Five weeks later, all participants completed follow-up measures. Post-interview reports suggest that participants responded favorably to the interview and generally benefited from participation. Analyses of covariance (controlling for baseline levels of the outcome measure) indicated that the interview led to significantly greater sexual satisfaction and less discomfort with sexual self-disclosure at 5-week follow-up, compared to controls; the two conditions did not differ on follow-up sexual self-schema, sexual self-esteem, or psychological symptoms. Moderation analyses revealed that participation in the interview differentially improved the sexual self-schema of women with no past sexual experience, compared to women with sexual experience. These experimental findings suggest the value, rather than the risk, of clinicians encouraging Arab American women to openly disclose and discuss their sexual experiences and attitudes in a confidential, empathic setting.

Return to Driving After Moderate-to-Severe Traumatic Brain Injury: A Traumatic Brain Injury Model System Study.

OBJECTIVE: Describe who is able to return to driving (RTD) after moderate-to-severe traumatic brain injury (TBI), when this occurs, who maintains that activity, and the association with outcome. DESIGN: Cross-sectional descriptive study. SETTING: Eight follow-up sites of the TBI Model Systems (TBIMS) program. PARTICIPANTS: 618 participants enrolled in the TBIMS and 88 caregivers (N=706). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A survey was completed from 1-30 years postinjury focusing on RTD. Descriptors included demographic information, injury severity, and current employment status. Outcome was assessed at the time of the interview, including depression, quality of life, functional status, and community participation. RESULTS: Of 706 respondents, 78% (N = 552) RTD, but 14% (N = 77) of these did not maintain that activity. Of those who RTD, 43% (N = 192) did so within 6 months of the injury and 92% did so within 24 months postinjury. The percentage of people driving after TBI did not differ significantly based on age at time of injury or follow-up. There were significant differences between drivers and nondrivers with respect to severity of injury, seizures, race, education, employment, rural vs urban setting, marital status, and family income. We performed a multivariate logistic regression to examine the association between driving status and demographic variables, adjusting for other variables in the model. The strongest associations were with current employment, family income, race, seizures, and severity of injury. Driving was associated with greater community participation, better functional outcomes, fewer symptoms of depression, and greater life satisfaction. CONCLUSIONS: Over a span of 30 years, three-quarters of people experiencing moderate-to-severe TBI return to driving a personal vehicle, although not everyone maintains this activity. Employment, race, family income, and seizures are strongly associated with RTD.

Pain anxiety and rehabilitation outcomes after acquired brain injury.

Purpose: The purpose of this study was to examine pain anxiety after acquired brain injury (ABI) and its relationship to rehabilitation outcomes.Materials and Method: Participants consisted of 89 adults with an ABI participating in outpatient rehabilitation therapy. They completed a battery of neuropsychological tests at baseline along with surveys of mood, health-related self-efficacy, and pain anxiety. Separately, occupational therapists assessed basic and instrumental activities of daily living (ADLs) as well as therapy engagement across treatment after the sixth session.Results: Individuals who reported high pain anxiety had fewer years of formal education, lower self-efficacy, and more emotional distress than those with low pain anxiety. Although Blacks were about half (56%) of the study sample, they comprised the majority (73.1%) of individuals in the high pain anxiety group. Pain anxiety was negatively related to therapy engagement. Moderation analysis using linear regression indicated that pain anxiety moderated the influence of self-efficacy on basic ADLs.Conclusions: Pain anxiety, particularly when high, is negatively associated with rehabilitation outcomes for individuals with ABI. Among those with high pain anxiety, health-related self-efficacy is an important resilience characteristic to improve functional outcomes. In rehabilitation therapy, pain anxiety provides a novel intervention target to enhance ABI recovery.

Driving patterns, confidence, and perception of abilities following moderate to severe traumatic brain injury: a TBI model system study.

OBJECTIVE: Describe driving patterns following moderate-to-severe traumatic brain injury (TBI). Participants: Adults (N = 438) with TBI that required inpatient acute rehabilitation who had resumed driving. DESIGN: Cross-sectional, observational design. SETTING: Eight TBI Model System sites. MAIN MEASURES: A driving survey was completed at phone follow-up. RESULTS: Most respondents reported driving daily, although 41% reported driving less than before their injury. Driving patterns were primarily associated with employment, family income, sex, residence, and time since injury, but not injury severity. Confidence in driving was high for most participants and was associated with a perception that the TBI had not diminished driving ability. Lower confidence and perceived loss of ability were associated with altered driving patterns. CONCLUSION: Most people with moderate-to-severe TBI resume driving but perhaps not at pre-injury or normal levels compared to healthy drivers. Some driving situations are restricted. The relationship between low confidence/perceived loss of ability and driving patterns/restrictions suggests people with TBI are exhibiting some degree of caution consistent with those perceptions. Careful assessment of driving skills and monitoring during early stages of RTD is warranted, particularly for younger, male, and/or single drivers who express higher levels of confidence.

Age and gender modulate the neural circuitry supporting facial emotion processing in adults with major depressive disorder.

OBJECTIVES: Emotion processing, supported by frontolimbic circuitry known to be sensitive to the effects of aging, is a relatively understudied cognitive-emotional domain in geriatric depression. Some evidence suggests that the neurophysiological disruption observed in emotion processing among adults with major depressive disorder (MDD) may be modulated by both gender and age. Therefore, the present study investigated the effects of gender and age on the neural circuitry supporting emotion processing in MDD. DESIGN: Cross-sectional comparison of fMRI signal during performance of an emotion processing task. SETTING: Outpatient university setting. PARTICIPANTS: One hundred adults recruited by MDD status, gender, and age. MEASUREMENTS: Participants underwent fMRI while completing the Facial Emotion Perception Test. They viewed photographs of faces and categorized the emotion perceived. Contrast for fMRI was of face perception minus animal identification blocks. RESULTS: Effects of depression were observed in precuneus and effects of age in a number of frontolimbic regions. Three-way interactions were present between MDD status, gender, and age in regions pertinent to emotion processing, including frontal, limbic, and basal ganglia. Young women with MDD and older men with MDD exhibited hyperactivation in these regions compared with their respective same-gender healthy comparison (HC) counterparts. In contrast, older women and younger men with MDD exhibited hypoactivation compared to their respective same-gender HC counterparts. CONCLUSIONS: This the first study to report gender- and age-specific differences in emotion processing circuitry in MDD. Gender-differential mechanisms may underlie cognitive-emotional disruption in older adults with MDD. The present findings have implications for improved probes into the heterogeneity of the MDD syndrome.

Rasch analysis of the coping inventory for stressful situations in individuals with moderate to severe traumatic brain injury.

OBJECTIVE: To evaluate psychometric properties of the Coping Inventory for Stressful Situations (CISS) in individuals with traumatic brain injury (TBI). DESIGN: Archival study using Rasch analysis. SETTING: Postacute rehabilitation hospital. PARTICIPANTS: Adults (N=331) 1 to 15 years after moderate to severe TBI, recruited consecutively. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: CISS. RESULTS: Indices of unidimensionality and model fit supported the scale's proposed multidimensional structure consisting of Task, Emotion, and Avoidant coping style; 3 unidimensional scales showed better fit than a single combined scale. The 3 scales met Rasch expectations of reliability and separation for persons and items, as well as adequate response category functioning. The scales were generally well targeted but showed some evidence of ceiling effect for Task, and floor effects for Emotion and Avoidant coping; item difficulties did not fully capture extreme ranges demonstrated by some participants, suggesting that measurement of coping after TBI on the CISS would be improved with additional items at low and high ranges of difficulty. Results were generally equivalent for cross-sectional groups representing short-term (1y), intermediate (2y), and long-term (5-15y). CONCLUSIONS: The CISS showed good psychometric properties as a measure of coping style among persons with moderate to severe TBI in acute and chronic phases of recovery, and showed evidence of multidimensionality as predicted by theory, consistent with 3 unidimensional scales. Added items tapping broader (or more accessible, less cognitively complex) ranges of coping responses would likely benefit the scale overall and improve correspondence with the response needs of people with TBI.

Role of character strengths in outcome after mild complicated to severe traumatic brain injury: a positive psychology study.

OBJECTIVE: To examine the effects of character strengths on psychosocial outcomes after mild complicated to severe traumatic brain injury (TBI). DESIGN: Prospective study with consecutive enrollment. SETTING: A Midwestern rehabilitation hospital. PARTICIPANTS: Persons with mild complicated to severe TBI (N=65). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Community Integration Measure, Disability Rating Scale, Modified Cumulative Illness Rating Scale, Positive and Negative Affect Schedule, Satisfaction with Life Scale, Values in Action Inventory of Strengths, and Wechsler Test of Adult Reading. RESULTS: Character virtues and strengths were moderately associated with subjective outcomes, such that there were fewer and less strong associations between character virtues/strengths and objective outcomes than subjective outcomes. Specifically, positive attributes were associated with greater life satisfaction and perceived community integration. Fewer and less strong associations were observed for objective well-being; however, character strengths and virtues showed unique value in predicting physical health and disability. Positive affectivity was not meaningfully related to objective outcomes, but it was significantly related to subjective outcomes. In contrast, negative affectivity was related to objective but not subjective outcomes. CONCLUSIONS: Given the strength of the associations between positive aspects of character or ways of perceiving the world and positive feelings about one's current life situation, treatments focused on facilitating these virtues and strengths in persons who have experienced TBI may result in better perceived outcomes and potentially subsequently lower comorbidities.

Rasch analysis of the community integration measure in persons with traumatic brain injury.

OBJECTIVE: To examine the measurement properties of the Community Integration Measure (CIM) in persons with traumatic brain injury (TBI). DESIGN: Rasch analysis was used to retrospectively evaluate the CIM. SETTING: Rehabilitation hospital. PARTICIPANTS: Persons (N=279) 1 to 15 years after a TBI. INTERVENTIONS: None. MAIN OUTCOME MEASURE: CIM RESULTS: The CIM met Rasch expectations of unidimensionality and reliability (person separation ratio=2.01, item separation ratio=4.52). However, item endorsibility was poorly targeted to the participants' level of community integration. A ceiling effect was found with this sample. CONCLUSIONS: The CIM is a relatively reliable and unidimensional scale. Future iterations might benefit from the addition of items that are more difficult to endorse (ie, improved targeting).

Brief narrative exposure therapy for posttraumatic stress in Iraqi refugees: a preliminary randomized clinical trial.

Many Iraqi refugees suffer from posttraumatic stress. Efficient, culturally sensitive interventions are needed, and so we adapted narrative exposure therapy into a brief version (brief NET) and tested its effects in a sample of traumatized Iraqi refugees. Iraqi refugees in the United States reporting elevated posttraumatic stress (N = 63) were randomized to brief NET or waitlist control conditions in a 2:1 ratio; brief NET was 3 sessions, conducted individually, in Arabic. Positive indicators (posttraumatic growth and well-being) and symptoms (posttraumatic stress, depressive, and somatic) were assessed at baseline and 2- and 4-month follow-up. Treatment participation (95.1% completion) and study retention (98.4% provided follow-up data) were very high. Significant condition by time interactions showed that those receiving brief NET had greater posttraumatic growth (d = 0.83) and well-being (d = 0.54) through 4 months than controls. Brief NET reduced symptoms of posttraumatic stress (d = -0.48) and depression (d = -0.46) more, but only at 2 months; symptoms of controls also decreased from 2 to 4 months, eliminating condition differences at 4 months. Three sessions of brief NET increased growth and well-being and led to symptom reduction in highly traumatized Iraqi refugees. This preliminary study suggests that brief NET is both acceptable and potentially efficacious in traumatized Iraqi refugees.

Detecting feigned cognitive impairment using pupillometry on the Warrington Recognition Memory Test for Words.

OBJECTIVE: Pupillometry provides information about physiological and psychological processes related to cognitive load, familiarity, and deception, and it is outside of conscious control. This study examined pupillary dilation patterns during a performance validity test (PVT) among adults with true and feigned impairment of traumatic brain injury (TBI). PARTICIPANTS AND METHODS: Participants were 214 adults in three groups: adults with bona fide moderate to severe TBI (TBI; n = 51), healthy comparisons instructed to perform their best (HC; n = 72), and healthy adults instructed and incentivized to simulate cognitive impairment due to TBI (SIM; n = 91). The Recognition Memory Test (RMT) was administered in the context of a comprehensive neuropsychological battery. Three pupillary indices were evaluated. Two pure pupil dilation (PD) indices assessed a simple measure of baseline arousal (PD-Baseline) and a nuanced measure of dynamic engagement (PD-Range). A pupillary-behavioral index was also evaluated. Dilation-response inconsistency (DRI) captured the frequency with which examinees displayed a pupillary familiarity response to the correct answer but selected the unfamiliar stimulus (incorrect answer). RESULTS: All three indices differed significantly among the groups, with medium-to-large effect sizes. PD-Baseline appeared sensitive to oculomotor dysfunction due to TBI; adults with TBI displayed significantly lower chronic arousal as compared to the two groups of healthy adults (SIM, HC). Dynamic engagement (PD-Range) yielded a hierarchical structure such that SIM were more dynamically engaged than TBI followed by HC. As predicted, simulators engaged in DRI significantly more frequently than other groups. Moreover, subgroup analyses indicated that DRI differed significantly for simulators who scored in the invalid range on the RMT (n = 45) versus adults with genuine TBI who scored invalidly (n = 15). CONCLUSIONS: The findings support continued research on the application of pupillometry to performance validity assessment: Overall, the findings highlight the promise of biometric indices in multimethod assessments of performance validity.

Emotion-Focused Psychodynamic Interview for People with Chronic Musculoskeletal Pain and Childhood Adversity: A Randomized Controlled Trial.

Childhood adversity and emotional conflicts are associated with the presence and severity of chronic musculoskeletal pain (CMP), yet common treatments for CMP do not address such risk factors. We developed a single session, emotion-focused psychodynamic interview, based on Emotional Awareness and Expression Therapy and Intensive Short-term Psychodynamic Therapy, and we tested the interview's effects on pain-related outcomes and potential psychological mediators in a randomized, controlled trial. Adults (N = 91; ages 21-70, M = 44.64; 87.9% women) reporting CMP and at least 3 adverse childhood experiences completed measures at baseline and 6-week follow-up. Participants were randomized to immediate interview or waitlist control conditions. The 90-minute interview was conducted via videoconference, and the interviewer elicited disclosure of adversities and conflicts, linked these with pain, and encouraged the experience and expression of adaptive emotions. Analyses indicated that conditions did not differ significantly on change in pain severity; however, compared to control, the interview led to a significantly greater reduction in pain interference (P = .016, ηp2 = .05) and a similar trend for anxiety (P = .058, ηp2 = .04). The interview also significantly changed several potential mediators: pain-related anxiety (P = .008, ηp2 = .06), pain controllability (P = .016, ηp2 = .06), and psychological (P < .001, ηp2 = .15) and brain attributions (P = .022, ηp2 = .05) for pain. Participants viewed the interview as very valuable. We conclude that addressing childhood adversities and conflicts in a psychodynamic interview is beneficial for people with CMP. PERSPECTIVE: This study found that, compared to waitlist control, a 90-minute, remotely-administered, emotion-focused, psychodynamic interview improved pain interference, and anxiety among adults with chronic musculoskeletal pain and childhood adversity. Intensive emotional work can be done in a single session to the benefit of patients with chronic musculoskeletal pain.

Personality differences among patients with chronic aphasia predict improvement in speech-language therapy.

BACKGROUND: Negative affectivity and neurocognitive deficits including executive dysfunction have been shown to be detrimental to rehabilitation therapies. However, research on the relationship between neuropsychological deficits and improvement in speech-language therapy (SLT) for aphasia is sparse. OBJECTIVE: To examine the relationships among neurocognitive and psychological functioning and improvement in SLT following aphasia due to stroke. METHODS: Fifty patients who were ≥ 9 months post stroke and enrolled in outpatient SLT to treat aphasia participated. Using standard language assessment measures, the authors evaluated language functioning at initiation of the study and after participants completed various SLT protocols. Executive functioning, visuospatial skills, attention, and memory also were assessed to provide indices of convergent and discriminant validity. Participants' mood and affectivity were evaluated by self-report, and their functional abilities and recovery of function since stroke were assessed via caregiver report. RESULTS: A multiple regression model testing the combined powers of neurocognitive and psychological variables was significant (P = .004, R2 = 0.33), with psychological and neurocognitive functioning accounting for 15% of the variance in relative language change beyond that accounted for by stroke severity and gross cognitive functioning. Negative affectivity expressed on the Positive and Negative Affectivity Scale made unique contributions to the model. CONCLUSIONS: Improvement in SLT is substantially related to neurocognitive and psychological functioning, particularly affectivity. Assessment of these characteristics may assist in identifying patients who are likely to improve and in tailoring treatment programs to yield optimal outcomes.

Incremental validity of brief and abbreviated neuropsychological tests toward predicting functional outcomes in multiple sclerosis.

OBJECTIVE: This study examined the relationships among functional outcomes and performance on standard-length and abbreviated cognitive screening measures for multiple sclerosis (MS). METHOD: 72 adults with MS underwent neurological examination and cognitive screening. They completed standard-length and abbreviated versions of tests from the Minimal Assessment of Cognitive Function in MS (MACFIMS), the abbreviated aMACFIMS, and the Brief International Cognitive Assessment for MS (BICAMS). Functional outcomes included neurological disability, physical and psychological dysfunction, and employment status. RESULTS: Concordance of impairment classifications was examined between standard-length and abbreviated tests using logistic regression and ROC curve analyses. Overall, the abbreviated test versions showed a broad range of concordance with impairment classifications made using the full-length tests. Processing speed was the strongest correlate of neurological disability and employment status; immediate recall was the strongest predictor of subjective physical dysfunction. Test performance provided unique value toward predicting neurological disability and employment status, but not physical and psychological dysfunction. CONCLUSIONS: The findings replicate some support for abbreviated tests in MS assessment, although caveats regarding loss of validity associated with abbreviation remain. The findings extend prior research showing that abbreviated tests of processing speed and immediate recall can provide unique predictive information regarding objective functional outcomes.

Experiential training of mental health graduate students in emotional processing skills: A randomized, controlled trial.

Emotional processing interventions for trauma and psychological conflicts are underutilized. Lack of adequate training in emotional processing techniques and therapists' lack of confidence in utilizing such interventions are barriers to implementation. We developed and tested an experiential training to improve trainees' performance in a set of transtheoretical emotional processing skills: eliciting patient disclosure of difficult experiences, responding to defenses against disclosure, and eliciting adaptive emotions. Mental health trainees (N = 102) were randomized to experiential or standard training, both of which presented a 1-hr individual session administered remotely. Before and after training and at 5-week follow-up, trainees were videorecorded as they responded to videos of challenging therapy situations, and responses were coded for demonstrated skill. Trainees also completed measures of therapeutic self-efficacy, anxiety, and depression at baseline and follow-up. Repeated-measures analysis of variance indicated all three skills increased from pre- to posttraining for both conditions, which were maintained at follow-up. Importantly, experiential training led to greater improvements than standard training in the skills of eliciting disclosure (η² = .05, p = .03), responding to defenses (η² = .04, p = .05), and encouraging adaptive emotions (η² = .23, p < .001) at posttraining, and the training benefits for eliciting disclosure were maintained at follow-up. Both conditions led to improved self-efficacy. Trainees' anxiety decreased in the standard training, but not in the experiential. One session of experiential training improved trainees' emotional processing therapy skills more than didactic training, although more training and practice likely are needed to yield longer lasting skills. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cognitive enrichment and education quality moderate cognitive dysfunction in black and white adults with multiple sclerosis.

OBJECTIVE: To examine the extent to which three sociobehavioral proxies of cognitive reserve-years of education, education quality, and cognitive enrichment-differ in their prediction of cognitive performance among Black and White people with MS (PwMS). METHODS: 82 PwMS (Black n = 41, White n = 41) underwent a neurological examination and a neuropsychological evaluation that included tests of word recognition (Wechsler Test of Adult Reading) as well as measures of verbal memory, visuospatial memory, and processing speed (the Brief International Cognitive Assessment for MS; BICAMS). Participants rated their lifetime engagement in various cognitively-enriching activities (Cognitive Reserve Scale). RESULTS: For the full sample, education quality and cognitive enrichment were more strongly associated with cognitive performance than were years of education. Cognitive enrichment was not associated with cognitive performance among participants with high education quality. In contrast, among participants with low education quality, cognitive enrichment was strongly associated with cognitive performance, suggesting that high engagement in cognitively-enriching activities provided similar protection to high education quality. Furthermore, among Black participants, cognitive enrichment and educational quality moderated the relationship between disability level and cognitive performance. In contrast, among White participants, cognitive enrichment did not provide additional protection beyond the buffering effect of education quality. CONCLUSIONS: PwMS can successfully build reserve through multiple routes, including formal education or informal cognitive enrichment. Treatment for MS should incorporate cognitively-enriching activities to build resilience against cognitive decline, particularly for members of marginalized racial/ethnic groups, who are at greatest risk for poor health outcomes, and for whom years of education may not best reflect education quality.

Randomized controlled trial of peer mentoring for individuals with traumatic brain injury and their significant others.

OBJECTIVES: To examine the efficacy of a peer-mentoring program for persons with traumatic brain injury (TBI) and their significant others, and to determine the relationship of this mentoring program to 3 main outcomes: (1) emotional well-being; (2) post-TBI quality of life; and (3) community integration. DESIGN: Randomized controlled trial. SETTING: Midwestern rehabilitation hospital. PARTICIPANTS: Persons with TBI (n=96) and significant others/caregivers (n=62). INTERVENTIONS: Persons with TBI and friends/caregivers who knew the person prior to their injury were randomly assigned to a treatment (mentored) or no-treatment (no mentoring) control group immediately prior to discharge from the rehabilitation unit and were mentored for up to 2 years. MAIN OUTCOME MEASURES: Peer Mentoring Questionnaire; Brief Symptom Inventory-18; Family Assessment Device; Coping Inventory for Stressful Situations; Short Michigan Alcohol Screening Test; Medical Outcomes Study 12-Item Short-Form Health Survey; and Community Integration Measure. RESULTS: Eighty-eight percent of individuals who were involved in the mentoring program reported positive experiences. t tests revealed that among persons with TBI, individuals who received mentoring had significantly better behavioral control and less chaos in the living environment (P=.04), lower alcohol use (P=.01), less emotion-focused (P=.04) and avoidance coping (P=.03), and good physical quality of life (P=.04) compared with those who did not receive mentoring. Among significant others, mentored individuals demonstrated greater community integration (P=.03) than the nonmentored control group. CONCLUSIONS: Mentoring can be an effective way to benefit mood and healthy coping after TBI, and it can help to prevent maladaptive behaviors, such as substance abuse and behavioral dyscontrol, in the living situation.

Utility of WAIS-IV Digit Span indices as measures of performance validity in moderate to severe traumatic brain injury.

Objective: The addition of Sequencing to WAIS-IV Digit Span (DS) brought about new Reliable Digit Span (RDS) indices and an Age-Corrected Scaled Score that includes Sequencing trials. Reports have indicated that these new performance validity tests (PVTs) are superior to the traditional RDS; however, comparisons in the context of known neurocognitive impairment are sparse. This study compared DS-derived PVT classification accuracies in a design that included adults with verified TBI. Methods: Participants included 64 adults with moderate-to-severe TBI (TBI), 51 healthy adults coached to simulate TBI (SIM), and 78 healthy comparisons (HC). Participants completed the WAIS-IV DS subtest in the context of a larger test battery. Results: Kruskal-Wallis tests indicated that all DS indices differed significantly across groups. Post hoc contrasts revealed that only RDS Forward and the traditional RDS differed significantly between SIM and TBI. ROC analyses indicated that RDS variables were comparable predictors of SIM vs. HC; however, the traditional RDS showed the highest sensitivity when approximating 90% specificity for SIM vs. TBI. A greater percentage of TBI scored RDS Sequencing < 1 compared to SIM and HC. Conclusion: In the context of moderate-to-severe TBI, the DS-derived PVTs showed comparable discriminability. However, the Greiffenstein et al. traditional RDS demonstrated the best classification accuracy with respect to specificity/sensitivity balance. This relative superiority may reflect that individuals with verified TBI are more likely to perseverate on prior instructions during DS Sequencing. Findings highlight the importance of including individuals with verified TBI when evaluating and developing PVTs.