Clinical Neuropsychologist最新文献

Objective: Oppositional defiant disorder (ODD) frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and may impact sex differences in clinical and executive function (EF) phenotypes of ADHD. This study examines whether clinical symptoms and "hot" and "cold" EF task performance differs among children with ADHD with and without ODD relative to typically developing (TD) children. Method: Participants included 372 8-12-year-old children: 158 with ADHD without ODD (28% girls), 74 with ADHD + ODD (28% girls), and 140 TD (34% girls). Parent- and self-report questionnaires assessing ADHD symptoms, externalizing and internalizing problems, emotional lability, and irritability were obtained. Children completed delay discounting, go/no-go (GNG), and spatial span tasks to assess hot and cold EF. Results: Relative to same-sex children with ADHD, girls with ADHD + ODD showed higher inattention symptoms, whereas boys with ADHD + ODD showed higher hyperactive/impulsive symptoms. Emotional lability and irritability were higher in children with ADHD + ODD than ADHD, regardless of sex. For EF tasks, greater delay discounting was observed in girls with ADHD + ODD compared to TD girls, whereas boys with ADHD only showed poorer visual-spatial working memory compared to boys with ADHD + ODD. Boys and girls with ADHD (regardless of ODD) showed higher GNG reaction time variability than TD children, whereas only boys with ADHD (regardless of ODD) made more inhibition errors than TD boys. Conclusions: While symptom measures consistently differentiated ADHD from ADHD + ODD groups regardless of sex, hot and cool EF differences varied across measures and by sex, demonstrating their value in understanding sex differences in youth with ADHD with and without co-occurring ODD.

Objective: To examine the interaction between early cognition and motor functioning when predicting functional independence, community participation, homeboundness, and return-to-work 1 year after traumatic brain injury (TBI). Method: Data from 101 adults (M age = 39.6 years) across two TBI Model Systems sites. Cognitive performance (Brief Test of Adult Cognition by Telephone) and motor functioning (FIM-Motor score/Continuity Assessment Record and Evaluation) were collected at inpatient rehabilitation discharge. Functional independence (Glasgow Outcome Scale-Extended, GOS-E), community participation (Participation Assessment with Recombined Tools-Objective-17, PART-O-17), homeboundness, and return-to-work were collected at 12-month follow-up. Motor functioning was hypothesized to moderate the relationship between cognition and 1-year outcomes. Results: Using multiple regression, early cognitive performance significantly predicted community participation, whereas motor functioning significantly predicted functional independence. Surprisingly, neither cognition nor motor functioning significantly predicted later employment or homeboundness. Rehabilitation length of stay and higher income were the only relevant predictors of return to work. The interaction between cognition and motor functioning did not meaningfully contribute to predicting outcomes at 1 year post-injury. Conclusions: Cognition and motor functioning offer distinct and independent contributions to rehabilitation outcomes among people with TBI. These findings underscore the importance of interventions that address post-TBI cognitive impairments as an avenue to improve participation after TBI. Critically, this study demonstrates that such interventions may be equally important for people with TBI across varying levels of motor functioning. Future studies should examine the impact of outpatient rehabilitation interventions on the predictive relationship between early cognition and post-TBI functional outcomes.

Objectives: The association between head injury history and subjective cognitive symptoms among contact sport athletes has been frequently reported, but links between head injury history and performance-based measures have been more variable. Dispersion-based intraindividual variability (IIV) may better align with subjective cognitive concerns and be a more sensitive measure of subtle head injury-related changes. This study investigated the associations among IIV, subjective cognitive symptoms, and head injury history. Methods: Former collegiate football players (N = 57 included in analyses; age = 38 ± 1.5 years) completed evaluations consisting of neuropsychological assessment, subjective rating of cognition (Neuro-QoL Cognitive Functioning-Short Form and Behavior Rating Inventory of Executive Function-Adult; BRIEF-A), and structured interviews of head impact history (i.e. HIEE). Three IIV indices were calculated reflecting degree of dispersion across cognitive domains: Memory-IIV, reaction time/processing speed-IIV (RT/PS-IIV), and attention/executive function-IIV. General linear models were fit to test associations among IIV, subjective measures, concussion history, and Head Impact Exposure Estimate (HIEE). Results: Greater history of concussion and RHI exposure were not significantly associated with levels of cognitive dispersion (IIV indices, p's >.05). Worse general subjective cognition was associated with greater RT/PS-IIV, and worse BRIEF-A metacognition was associated with greater memory-IIV, even when controlling for psychological distress and sleep quality. Conclusions: Results support the assessment of dispersion in cognitive performance as a useful objective measure that complements subjective cognitive symptoms. While IIV is clinically relevant for detecting subtle cognitive difficulties not captured by central tendency methods, it may only indirectly, if at all, relate to changes associated specifically with head injury history.

Objective: Chronic Traumatic Encephalopathy (CTE) has received significant media coverage as a major health concern for collision sport athletes and combat veterans. This survey study investigated neuropsychologists' perspectives of CTE.Methods: Neuropsychologists (N = 325) were contacted via electronic advertisement posted to popular neuropsychology professional listservs and completed a survey regarding their perspectives of: the proposed sequelae of repeated concussions, the strength of the CTE research base, and its media coverage.Results: Most respondents (91%) were at least somewhat familiar with the concept of CTE. Moderate uncertainty was reported (i.e. up to 30%) regarding the effects of repeated concussions. Most felt the research in support of CTE was unreliable (80%) and weak regarding claims that repeated concussions cause CTE (91%), independently cause behavioral/emotional/cognitive dysfunction (86%), or increase the risk for neurodegeneration (79%). Respondents agreed patients are concerned about CTE (92%), concerns are influenced by the media (96%) that presents a biased/alarmist view of CTE (96%), and patient recovery is influenced by their CTE beliefs (82%).Conclusions: There was strong agreement that the media presents an alarmist/biased view of CTE that influences patients concerns and outcomes following concussion. This presentation is incongruent with the perceptions of surveyed neuropsychologists who find the research in support of CTE to be weak and unreliable. More research is needed to determine the potential effects of repeated (sub)concussive events. As public knowledge will continue to be influenced by the media and health care professionals, future research should explore CTE perceptions across other health care disciplines.

Objective: The long-term health of former athletes with a history of multiple concussions and/or repetitive head impact (RHI) exposure has been of growing interest among the public. The true proportion of dementia cases attributable to neurotrauma and the neurobehavioral profile/sequelae of multiple concussion and RHI exposure among athletes has been difficult to determine. Methods: Across three exposure paradigms (i.e. group comparisons of athletes vs. controls, number of prior concussions, and level of RHI exposure), this review characterizes the prevalence of neurodegenerative/neurological disease, changes in cognitive and psychiatric function, and alterations on neuroimaging. We highlight sources of variability across studies and provide suggested directions for future investigations. Results: The most robust finding reported in the literature suggests a higher level of symptom endorsement (general, psychiatric, and cognitive) among those with a greater history of sport-related concussion from adolescence to older adulthood. Pathological processes (e.g. atrophy, tau deposition, and hypometabolism) may be more likely to occur within select regions (frontal and temporal cortices) and structures (thalamus and hippocampus). However, studies examining concussion(s) and RHI exposure with imaging outcomes have yet to identify consistent associations or evidence of a dose-response relationship or a threshold at which associations are observed. Discussion: Studies have not observed a simple dose-response relationship between multiple concussions and/or RHI exposure with cognitive, psychiatric, or in vivo neurobiological outcomes, particularly at lower levels of play. The relationship between prior concussion and RHI exposure with long-term outcomes in former athletes is complex and likely influenced by -several non-injury-related factors.

Objective: The purpose of this review is to summarize the long-term cognitive, psychological, fluid biomarker, and neuroimaging outcomes following repetitive concussive and subconcussive blast exposures sustained through a military career. Method/Results: A review of the literature was conducted, with 450 manuscripts originally identified and 44 manuscripts ultimately included in the review. The most robust studies investigating how repetitive concussive and subconcussive exposures related to cognitive performance suggest there is no meaningful impact. Although there are minimal studies that suggest some small impacts on neuroimaging and fluid biomarkers, most findings have been in very small samples and fail to replicate. Both repetitive blast mTBI and subconcussive blasts appeared to be associated with increased self-reported symptoms. Many of the studies suffered from small sample size, failure to correct for multiple comparisons, and inappropriate control groups. Conclusions: Overall, there is little evidence to support that repetitive blast mTBIs or subconcussive blast exposures have a lasting impact on cognition, neuroimaging, or fluid biomarkers. In contrast, there does appear to be a relationship between these exposures and self-reported psychological functioning, though it is unclear what mechanism drives this relationship. Small sample size, lack of correction for multiple comparisons, limited control groups, lack of consideration of important covariates, limited diversity of samples, and lack of reliable and valid measures for assessment of blast exposure are major limitations restricting this research. Patients should be encouraged that while research is ongoing, there is little to currently suggest long-term cognitive or neurological damage following repetitive blast exposure.

Objective: The long-recognized association of brain injury with increased risk of dementia has undergone significant refinement and more detailed study in recent decades. Chronic traumatic encephalopathy (CTE) is a specific neurodegenerative tauopathy related to prior exposure to repetitive head impacts (RHI). We aim to contextualize CTE within a historical perspective and among emerging data which highlights the scientific and conceptual evolution of CTE-related research in parallel with the broader field of neurodegenerative disease and dementia.

Methods: We provide a narrative state-of-the-science update on CTE neuropathology, clinical manifestations, biomarkers, different types and patterns of head impact exposure relevant for CTE, and the complicated influence of neurodegenerative co-pathology on symptoms.

Conclusions: Now almost 20 years since the initial case report of CTE in a former American football player, the field of CTE continues evolving with increasing clarity but also several ongoing controversies. Our understanding of CTE neuropathology outpaces that of disease-specific clinical correlates or the development of in-vivo biomarkers. Diagnostic criteria for symptoms attributable to CTE are still being validated, but leveraging increasingly available biomarkers for other conditions like Alzheimer's disease may be helpful for informing the CTE differential diagnosis. As diagnostic refinement efforts advance, clinicians should provide care and/or referrals to providers best suited to treat an individual patient's clinical symptoms, many of which have evidence-based behavioral treatment options that are etiologically agnostic. Several ongoing research initiatives and the gradual accrual of gold standard clinico-pathological data will pay dividends for advancing the many existing gaps in the field of CTE.

Objective: The present study aimed to examine the impact of lifetime blast exposure (LBE) on neuropsychological functioning in service members and veterans (SMVs). Method: Participants were 282 SMVs, with and without history of traumatic brain injury (TBI), who were prospectively enrolled in a Defense and Veterans Brain Injury Center (DVBIC)-Traumatic Brain Injury Center of Excellence (TBICoE) Longitudinal TBI Study. A cross-sectional analysis of baseline data was conducted. LBE was based on two factors: Military Occupational Speciality (MOS) and SMV self-report. Participants were divided into three groups based on LBE: Blast Naive (n = 61), Blast + Low Risk MOS (n = 96), Blast + High Risk MOS (n = 125). Multivariate analysis of variance (MANOVA) was used to examine group differences on neurocognitive domains and the Minnesota Multiphasic Personality Inventory-2 Restructured Form. Results: There were no statistically significant differences in attention/working memory, processing speed, executive functioning, and memory (Fs < 1.75, ps > .1, η_p²s < .032) or in General Cognition (Fs < 0.95, ps > .3, η_p²s < .008). Prior to correction for covariates, lifetime blast exposure was related to Restructured Clinical (F(18,542) = 1.77, p = .026, η_p² = .055), Somatic/Cognitive (F(10,550) = 1.99, p = .033, η_p² = .035), and Externalizing Scales (F(8,552) = 2.17, p = .028, η_p² = .030); however, these relationships did not remain significant after correction for covariates (Fs < 1.53, ps > .145, η_p²s < .032). Conclusions: We did not find evidence of a relationship between LBE and neurocognitive performance or psychiatric symptoms. This stands in contrast to prior studies demonstrating an association between lifetime blast exposure and highly sensitive blood biomarkers and/or neuroimaging. Overall, findings suggest the neuropsychological impact of lifetime blast exposure is minimal in individuals remaining in or recently retired from military service.

Objective: This study explored the relationship between concussion history and cognition/mood in former collegiate athletes in middle-to-later adulthood. Method: 407 former collegiate athletes aged 50+ (M = 61.4; 62.7% male) participated in the College Level Aging AThlete Study (CLEAATS) and completed the Cognitive Function Instrument (CFI), 40-item Telephone Interview for Cognitive Status (TICS-40), PHQ-8, GAD-7, and self-report questionnaires, including concussion history. Kruskal-Wallis tests assessed for differences among groups based on concussion history (0, 1-2, 3-4, 5+ concussions). Hierarchical multiple regressions including demographic factors as covariates examined relationships between concussion history, emotional symptoms, and subjective/objective cognition. Results: Participants with 5+ concussions reported significantly greater subjective cognitive concerns and depressive symptoms than other concussion groups, but no differences were found in objective cognition. Hierarchical regression revealed concussion history and emotional symptoms explained 29% and 15% of the variance in subjective and objective cognition, respectively. The number of concussions accounted for unique variance in subjective cognition but was not significantly associated when mood symptoms were added to the model. Neither diagnosed concussions nor emotional symptoms were associated with objective cognition. Conclusions: When accounting for concussion history, those with 5+ concussions reported greater subjective cognitive symptoms than those with 0-2 concussions, and greater depressive symptoms than those with 0 concussions. Concussion history was not significantly related to subjective cognition when compared to mood, and concussion history and mood symptoms were not associated with objective cognition. Results highlight the importance of considering mood symptoms when evaluating the relationship between concussion history and cognition in former athletes.