Background: The concept of mild cognitive impairment (MCI) has evolved since its original concept... more Background: The concept of mild cognitive impairment (MCI) has evolved since its original conception. So, too, have MCI diagnostic methods, all of which have varying degrees of success in identifying individuals at risk of conversion to dementia. The neuropsychological actuarial method is a straightforward diagnostic approach that has shown promise in large datasets in identifying individuals with MCI who are likely to have progressive courses. This method has been increasingly applied in various iterations and samples, raising questions of how best to apply this method and when caution should be used. Objective: Our objective was to review the literature investigating use of the neuropsychological actuarial method to diagnose MCI to identify strengths and weaknesses of this approach, as well as highlight areas for further research. Methods: Databases PubMed and PsychInfo were systematically searched for studies that compared the neuropsychological actuarial method to some other dia...
Considering reproducibility as the most important factor for longitudinal studies, given low fals... more Considering reproducibility as the most important factor for longitudinal studies, given low false-positive rates and a better preserved, more cohesive temporal structure, currently aggressive ICA-AROMA is likely the most suitable noise regression technique for rs-fMRI studies of older adults.
OBJECTIVE A variety of factors affect list learning performance and relatively few studies have e... more OBJECTIVE A variety of factors affect list learning performance and relatively few studies have examined the impact of word selection on these tests. This study examines the effect of both language and memory processing of individual words on list learning. METHOD Item-response data from 1,219 participants, Mage = 74.41 (SD = 7.13), Medu = 13.30 (SD = 2.72), in the Harmonized Cognitive Assessment Protocol were used. A Bayesian generalized (non)linear multilevel modeling framework was used to specify the measurement and explanatory item-response theory models. Explanatory effects on items due to learning over trials, serial position of words, and six word properties obtained through the English Lexicon Project were modeled. RESULTS A two parameter logistic (2PL) model with trial-specific learning effects produced the best measurement fit. Evidence of the serial position effect on word learning was observed. Robust positive effects on word learning were observed for body-object integr...
Objective: The Jak/Bondi actuarial method has been found to be superior to consensus diagnosis in... more Objective: The Jak/Bondi actuarial method has been found to be superior to consensus diagnosis in identifying MCI in some but not all populations and may not perform as well in diverse samples. In this study, diagnostic agreement between actuarial and clinical consensus methods was examined by ethnic group in the heavily Hispanic/Latinx Texas Alzheimer’s Research and Care Consortium (TARCC) cohort. Method: TARCC participants with consensus diagnoses of NC and MCI at baseline (n = 1011; 66.47% female; 49.75% Hispanic; Mage = 67.28; Medu = 13.21) were reclassified via actuarial criteria of two failed tests (>1 SD below normative [MOANS in TARCC] mean) in one cognitive domain OR one failed test in 3+ cognitive domains. Chi square analyses investigated diagnostic agreement and test fail rates by ethnicity. Results: Diagnostic agreement significantly differed between ethnic groups (Cramer’s V = 0.42). 57% of the Hispanic consensus-NC group were relabeled as actuarial-MCI while just 12...
Objective: Estimating when full time care will be needed in Alzheimer’s Clinical Syndrome (ACS) i... more Objective: Estimating when full time care will be needed in Alzheimer’s Clinical Syndrome (ACS) is difficult. This is due to limited research identifying the factors associated with loss of independent living (LOI), which may differ across dementia stages. Thus, we examined which clinical and neuropsychological factors predict LOI in the early-to-middle and late stages of ACS. Method: Using the National Alzheimer’s Coordinating Center dataset, individuals with ACS aged ≥50 years with no prior stroke were studied. LOI was based on self/informant report of progressing from requiring some assistance with complex activities at ACS diagnosis to needing assistance with basic activities. Four survival analyses were conducted to predict LOI (M time to LOI = 3.6 visits), for the early-to-middle (MMSE at diagnosis ≥20; N = 3128) and late stages of ACS (MMSE≤19; N = 737). Fifteen clinical predictors at time of ACS diagnosis were examined, followed by neuropsychological test scores added to the...
Objective: To examine differences in concussion symptom reporting between female and male adults ... more Objective: To examine differences in concussion symptom reporting between female and male adults considering current psychological symptoms such as anxiety and depression and pre-injury factors in order to identify sex differences which may guide treatment efforts. Method: This prospective study is part of the North Texas Concussion Registry (ConTex). Subjects (N ¼ 132) age 19 to 78 years had sustained a concussion within 30 days of clinic visit. The independent variable was sex and covariates included age, ethnicity, current anxiety and depression ratings, history of attention deficit disorder, history of headache/migraine, and time to clinic. The dependent variables were 22 post-concussion symptoms as measured by the Sport Concussion Assessment Tool-5 Post-Concussion Symptom Scale. Results: Analysis of covariance and ordinal logistic regression results both revealed that females had a greater likelihood of reporting increased symptom severity for 15/22 concussion symptoms. The largest risk ratios (effect size) in symptom reporting between sexes (higher symptoms in females) included: feeling more emotional 4.05 (0.72), fatigue or low energy 4.05 (0.72), sensitivity to light 3.74 (0.69), headache 3.65 (0.57), balance problems 3.31 (0.53), pressure in head 3.06 (0.51), and neck pain 2.97 (0.60). Conclusions: Adult females in our sample reported higher levels of many concussion symptoms than males and showed an increased risk of developing these same symptoms following concussion. Examination of the magnitude of sex difference in concussion symptom reporting will better inform medical staff to anticipate and address symptoms that may present greater challenges for adult females.
Background: Life expectancy (LE) following Alzheimer’s disease (AD) is highly variable. The liter... more Background: Life expectancy (LE) following Alzheimer’s disease (AD) is highly variable. The literature to date is limited by smaller sample sizes and clinical diagnoses. Objective: No study to date has evaluated predictors of AD LE in a retrospective large autopsy-confirmed sample, which was the primary objective of this study. Methods: Participants (≥50 years old) clinically and neuropathologically diagnosed with AD were evaluated using National Alzheimer’s Coordinating Center (N = 1,401) data. Analyses focused on 21 demographic, medical, neuropsychiatric, neurological, functional, and global cognitive predictors of LE at AD dementia diagnosis. These 21 predictors were evaluated in univariate analyses. Variables found to be significant were then entered into a forward multiple regression. LE was defined as months between AD diagnosis and death. Results: Fourteen predictors were significant in univariate analyses and entered into the regression. Seven predictors explained 27% of LE ...
In healthy adults, neural oscillatory activity within a predominantly left‐lateralized network of... more In healthy adults, neural oscillatory activity within a predominantly left‐lateralized network of brain regions underlies verbal working memory (VWM) performance, but how mild cognitive impairment (MCI) impacts these oscillatory dynamics is not well characterized. The present study utilized the spatiotemporal precision of magnetoencephalographic (MEG) brain imaging to investigate the effects of MCI on the neural oscillations serving specific phases (i.e., encoding, maintenance) of VWM. In congruence with the compensation‐related utilization of neural circuits hypothesis (CRUNCH), we hypothesized that MCI patients would recruit greater neural resources during VWM.
Previous magnetoencephalography (MEG) studies have shown that individuals with mild cognitive imp... more Previous magnetoencephalography (MEG) studies have shown that individuals with mild cognitive impairment and Alzheimer’s disease (AD) demonstrate increases in δ and θ, decreases in α and β, and lower ratios of relative power between high and low frequency bands compared to controls. This analysis investigates the association between global cortical atrophy, a measure of neurodegeneration, and MEG resting‐state oscillations in cortical regions that show early AD neuropathology.
The purpose of this review is to critically examine studies that have examined investigated the M... more The purpose of this review is to critically examine studies that have examined investigated the Montreal Cognitive Assessment (MoCA) and functional or medical outcomes and other health variables in patients with non-neurologic medical conditions. Databases OVID Medline and Embase were systematically searched through April 2020, yielding 281 articles that were separately screened for inclusion. Study characteristics extracted from retained articles are presented in Table S1 (online supplemental materials). Thirty-six articles were retained. Cognitive impairment as assessed by the MoCA was associated with adverse health variables including increased morbidity/mortality, poorer functional abilities, increased length of hospital stay, and increased hospital readmissions in 34 of 36 articles. Cognitive impairment as detected by the MoCA was shown in 34 of 36 studies to be associated with worse functional or medical status compared to those with better cognitive functioning across a variety of medical populations. Further research is needed to better understand how to best use the MoCA to potentially inform treatment planning in medical populations, including referral for more detailed neuropsychological evaluation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Neuropsychiatric symptoms (NPS) are common in neurodegenerative disease, but longitudinal studies... more Neuropsychiatric symptoms (NPS) are common in neurodegenerative disease, but longitudinal studies using large autopsy-confirmed samples are lacking. Our primary aim was to investigate progression of NPS over time in autopsy-confirmed Alzheimer’s disease (ad), Lewy body disease (LBD), and mixed (ad+LBD) cohorts. Data on individuals (age > =50) with autopsy-confirmed ad (N = 1568), ad+LBD (N = 349), and LBD (N = 142) was obtained from the National Alzheimer’s Coordinating Center (Mean visits = 2.61). Neuropsychiatric Inventory Questionnaire (NPI-Q) and 15-item Geriatric Depression Scale (GDS) scores were used to measure NPS. Multilevel zero-inflated binomial regression models were used to assess if NPI-Q and GDS scores differed among ad, ad+LBD, and LBD groups over time. Covariates included: years from baseline to final visit, cognitive status at baseline (i.e., normal, MCI, or dementia), demographic characteristics, MMSE, Functional Activities Questionnaire, and psychotropic treat...
OBJECTIVE To elucidate specific symptoms that may differ between adolescent female and male athle... more OBJECTIVE To elucidate specific symptoms that may differ between adolescent female and male athletes after a sports-related concussion (SRC) and identify symptoms that may require greater clinical attention by medical and athletic staff. DESIGN Prospective. SETTING This study is part of a larger research project conducted at clinics in the North Texas Concussion Network (ConTex) Registry. PARTICIPANTS Subjects (N = 491) aged 12 to 18 years who sustained a diagnosed SRC within 30 days of clinic visit. INDEPENDENT VARIABLES Sex (female vs male). Covariates included age, race, current mood (anxiety and depression), learning disability/ADHD, and time to clinic. MAIN OUTCOME MEASURES Twenty-two individual postconcussion symptoms as measured by the Post-Concussion Symptom Scale from the Sport Concussion Assessment Tool-5 (SCAT-5). RESULTS Girls endorsed higher levels of anxiety and depression symptoms at initial clinic visit. analysis of covariance results revealed that girls had significantly greater symptom severity of headache, dizziness, sensitivity to light, sensitivity to noise, pressure in the head, feeling slowed down, fatigue, and drowsiness than boys. Ordinal logistic regression results also revealed that girls had significantly greater predicted odds of higher symptom severity on these 8 symptoms and in trouble concentrating than boys. CONCLUSIONS Closer examination of specific symptoms with attention to patients' current levels of anxiety and depression symptoms may better inform medical and athletic staff to anticipate and address symptoms that may present greater challenges for adolescent girls than boys.
Objective Various methods are used to derive normative data for neuropsychological assessment mea... more Objective Various methods are used to derive normative data for neuropsychological assessment measures. The National Alzheimer’s Coordinating Center (NACC) regression norms (2011) are frequently used within Alzheimer’s Disease Research Centers, yet little research exists comparing these norms to similar regression/non-regression-based norms. Normative data for the widely-used Trail Making Test (TMTA&B) was compared between two regression-based normative data methods (Mitrushina and NACC) and traditional normative methods (i.e., Mayo’s Older Americans Normative Studies [MOANS]). Method TMTA&B data were obtained from 14,873 cognitively normal NACC participants (ages: 50–89; education: M = 15.81, SD = 2.90). T-scores for TMTA&B scores based on Mitrushina, NACC, and MOANS norms were computed. T-scores for regression norms were bounded from 20 to 80. Cohen’s d effect sizes were used to compare differences in scores. Results MOANS and Mitrushina norms produced similar normative scores in ...
Objective Research in pediatric concussion has investigated mechanism of injury and symptom repor... more Objective Research in pediatric concussion has investigated mechanism of injury and symptom reporting separately, but there is no study that examines differences in symptom reporting across multiple mechanisms of injury in elementary school-aged children. The purpose of the study was to examine symptom presentation and determine if symptoms of concussed children in middle childhood differ based upon mechanism of injury. Methods Participants included 104 children between the ages of 6 and 10 years enrolled from area concussion clinics within 30 days of injury. All participants completed an initial clinic visit that collected demographic and injury characteristics as well as measures of post-concussion symptoms, anxiety, and depression based on parent report. We grouped the participants based on mechanism of injury (sports related, fall, hit by object, and motor vehicle accident). Results There was a significant group difference for age (p = 0.02) and history of previous concussion. Headache, fatigue, and trouble concentrating were the most commonly reported symptoms (> 50% of sample). We found no significant group differences in reported symptoms, although sleep disturbance approached significance. We also found no significant differences for total post-concussion symptom counts or total scores on a screener for anxiety or depression. Conclusions Overall, there were no symptom differences by mechanism of injury in this young age group; however, research with larger samples is needed to enhance knowledge of the physical and emotional sequelae of concussion in younger children and inform best practices for timely interventions.
Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetiti... more Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency of TES in a cohort of retired professional contact sport athletes, compare the frequency of TES to clinical consensus diagnoses, and identify predictors that increase the likelihood of TES diagnosis. Participants were 85 retired professional contact sport athletes from a prospective cohort at the University of Texas Southwestern Medical Center and the University of Texas at Dallas. Participants ranged in age from 23 to 79 (M = 55.95, SD = 13.82) and obtained 7 to 19 years of education (M = 16.08, SD = 1.03). Retirees were either non-Hispanic white (n = 62) or African-American (n = 23). Retired athletes underwent a standard clinical evaluation, which included a clinical interview, neurological exam, neuroimaging, neuropsychological testing, and conse...
Objective: Although individual components of metabolic syndrome (MetS) are linked to faster disea... more Objective: Although individual components of metabolic syndrome (MetS) are linked to faster disease progression, previous research evaluating these relationships in MetS and Alzheimer's disease (AD) has yielded mixed results. We evaluated autopsy-confirmed cases of AD to determine if the presence of MetS was related to the age of disease onset and life expectancy. Method: 1055 subjects with autopsy-confirmed AD (Braak neurofibrillary tangle stages ≥3 combined with at least moderate neuritic amyloid plaques) were obtained from the National Alzheimer's Coordinating Center database. Subjects with co-occurring neuropathological diagnoses were excluded. MetS was defined using International Diabetes Federation parameters. Subjects were classified as having MetS (n = 116) if they had obesity and ≥2 additional conditions (diagnosis/ treatment of: diabetes, hypertension, or lipid abnormality). Obese subjects with one other MetS condition were classified as "at risk" (n = 136). Analyses of covariance (ANCOVA) were used to assess if clinician-estimated age of onset and time from onset to death differed between those with and without MetS, controlling for education, race, gender, and apolipoprotein ε4 status. Results: Average age of onset differed between groups by a maximum of 1 year, which was not statistically significant (F(2,1048) = 0.238, p = .79). Similarly, average life expectancy differed by < 1 year between groups and did not differ statistically (F(2,946) = 0.341, p = .71). Conclusions: MetS status was not significantly related to disease onset or life expectancy in this autopsy-confirmed AD sample. It is possible that treatment for MetS component conditions may moderate the relationship between MetS and AD in patients without co-occurring neuropathological diagnoses, and future studies should examine this relationship.
Objective: Dementia risk can vary among ethnicities and has been associated with a history of tra... more Objective: Dementia risk can vary among ethnicities and has been associated with a history of traumatic brain injury (TBI) in some individuals. However, previous studies on the long-term effects of remote TBI on developing dementia have been limited to predominantly non-diverse samples. We evaluated age of Alzheimer's disease (AD) onset in those with and without a history of TBI in three racial/ethnic cohorts. Method: Data were obtained from the National Alzheimer's Coordinating Center. Clinician-estimated age of AD onset was compared among non-Hispanic Caucasian (n = 721), non-Hispanic African American (n = 74), and Hispanic (n = 57) groups. Cohorts were dichotomized based on history of remote TBI with loss of consciousness (LOC; >1 year prior to first visit with no chronic deficits). Controlling for education, ANCOVAs were used to evaluate mean differences in age of AD onset in males and females with and without history of TBI. Results: TBI history was associated with an approximately 3-year earlier onset in non-Hispanic Caucasians (p < .001) and non-Hispanic African Americans (p = .003), with no interaction by sex (p's > .05). In the Hispanic group, an interaction was observed between sex and TBI (p = .018). TBI was not related to earlier onset in Hispanic males (p = .610), but was related to a 5-year earlier onset in Hispanic females (p = .007). Conclusions: Remote TBI with LOC was a risk factor for earlier AD onset across racial/ethnic groups, but sex may play a role within Hispanic populations. Future studies should examine if cultural, genetic, or other factors contribute to the potentially earlier disease expression in female Hispanics with a history of TBI.
Background: The concept of mild cognitive impairment (MCI) has evolved since its original concept... more Background: The concept of mild cognitive impairment (MCI) has evolved since its original conception. So, too, have MCI diagnostic methods, all of which have varying degrees of success in identifying individuals at risk of conversion to dementia. The neuropsychological actuarial method is a straightforward diagnostic approach that has shown promise in large datasets in identifying individuals with MCI who are likely to have progressive courses. This method has been increasingly applied in various iterations and samples, raising questions of how best to apply this method and when caution should be used. Objective: Our objective was to review the literature investigating use of the neuropsychological actuarial method to diagnose MCI to identify strengths and weaknesses of this approach, as well as highlight areas for further research. Methods: Databases PubMed and PsychInfo were systematically searched for studies that compared the neuropsychological actuarial method to some other dia...
Considering reproducibility as the most important factor for longitudinal studies, given low fals... more Considering reproducibility as the most important factor for longitudinal studies, given low false-positive rates and a better preserved, more cohesive temporal structure, currently aggressive ICA-AROMA is likely the most suitable noise regression technique for rs-fMRI studies of older adults.
OBJECTIVE A variety of factors affect list learning performance and relatively few studies have e... more OBJECTIVE A variety of factors affect list learning performance and relatively few studies have examined the impact of word selection on these tests. This study examines the effect of both language and memory processing of individual words on list learning. METHOD Item-response data from 1,219 participants, Mage = 74.41 (SD = 7.13), Medu = 13.30 (SD = 2.72), in the Harmonized Cognitive Assessment Protocol were used. A Bayesian generalized (non)linear multilevel modeling framework was used to specify the measurement and explanatory item-response theory models. Explanatory effects on items due to learning over trials, serial position of words, and six word properties obtained through the English Lexicon Project were modeled. RESULTS A two parameter logistic (2PL) model with trial-specific learning effects produced the best measurement fit. Evidence of the serial position effect on word learning was observed. Robust positive effects on word learning were observed for body-object integr...
Objective: The Jak/Bondi actuarial method has been found to be superior to consensus diagnosis in... more Objective: The Jak/Bondi actuarial method has been found to be superior to consensus diagnosis in identifying MCI in some but not all populations and may not perform as well in diverse samples. In this study, diagnostic agreement between actuarial and clinical consensus methods was examined by ethnic group in the heavily Hispanic/Latinx Texas Alzheimer’s Research and Care Consortium (TARCC) cohort. Method: TARCC participants with consensus diagnoses of NC and MCI at baseline (n = 1011; 66.47% female; 49.75% Hispanic; Mage = 67.28; Medu = 13.21) were reclassified via actuarial criteria of two failed tests (>1 SD below normative [MOANS in TARCC] mean) in one cognitive domain OR one failed test in 3+ cognitive domains. Chi square analyses investigated diagnostic agreement and test fail rates by ethnicity. Results: Diagnostic agreement significantly differed between ethnic groups (Cramer’s V = 0.42). 57% of the Hispanic consensus-NC group were relabeled as actuarial-MCI while just 12...
Objective: Estimating when full time care will be needed in Alzheimer’s Clinical Syndrome (ACS) i... more Objective: Estimating when full time care will be needed in Alzheimer’s Clinical Syndrome (ACS) is difficult. This is due to limited research identifying the factors associated with loss of independent living (LOI), which may differ across dementia stages. Thus, we examined which clinical and neuropsychological factors predict LOI in the early-to-middle and late stages of ACS. Method: Using the National Alzheimer’s Coordinating Center dataset, individuals with ACS aged ≥50 years with no prior stroke were studied. LOI was based on self/informant report of progressing from requiring some assistance with complex activities at ACS diagnosis to needing assistance with basic activities. Four survival analyses were conducted to predict LOI (M time to LOI = 3.6 visits), for the early-to-middle (MMSE at diagnosis ≥20; N = 3128) and late stages of ACS (MMSE≤19; N = 737). Fifteen clinical predictors at time of ACS diagnosis were examined, followed by neuropsychological test scores added to the...
Objective: To examine differences in concussion symptom reporting between female and male adults ... more Objective: To examine differences in concussion symptom reporting between female and male adults considering current psychological symptoms such as anxiety and depression and pre-injury factors in order to identify sex differences which may guide treatment efforts. Method: This prospective study is part of the North Texas Concussion Registry (ConTex). Subjects (N ¼ 132) age 19 to 78 years had sustained a concussion within 30 days of clinic visit. The independent variable was sex and covariates included age, ethnicity, current anxiety and depression ratings, history of attention deficit disorder, history of headache/migraine, and time to clinic. The dependent variables were 22 post-concussion symptoms as measured by the Sport Concussion Assessment Tool-5 Post-Concussion Symptom Scale. Results: Analysis of covariance and ordinal logistic regression results both revealed that females had a greater likelihood of reporting increased symptom severity for 15/22 concussion symptoms. The largest risk ratios (effect size) in symptom reporting between sexes (higher symptoms in females) included: feeling more emotional 4.05 (0.72), fatigue or low energy 4.05 (0.72), sensitivity to light 3.74 (0.69), headache 3.65 (0.57), balance problems 3.31 (0.53), pressure in head 3.06 (0.51), and neck pain 2.97 (0.60). Conclusions: Adult females in our sample reported higher levels of many concussion symptoms than males and showed an increased risk of developing these same symptoms following concussion. Examination of the magnitude of sex difference in concussion symptom reporting will better inform medical staff to anticipate and address symptoms that may present greater challenges for adult females.
Background: Life expectancy (LE) following Alzheimer’s disease (AD) is highly variable. The liter... more Background: Life expectancy (LE) following Alzheimer’s disease (AD) is highly variable. The literature to date is limited by smaller sample sizes and clinical diagnoses. Objective: No study to date has evaluated predictors of AD LE in a retrospective large autopsy-confirmed sample, which was the primary objective of this study. Methods: Participants (≥50 years old) clinically and neuropathologically diagnosed with AD were evaluated using National Alzheimer’s Coordinating Center (N = 1,401) data. Analyses focused on 21 demographic, medical, neuropsychiatric, neurological, functional, and global cognitive predictors of LE at AD dementia diagnosis. These 21 predictors were evaluated in univariate analyses. Variables found to be significant were then entered into a forward multiple regression. LE was defined as months between AD diagnosis and death. Results: Fourteen predictors were significant in univariate analyses and entered into the regression. Seven predictors explained 27% of LE ...
In healthy adults, neural oscillatory activity within a predominantly left‐lateralized network of... more In healthy adults, neural oscillatory activity within a predominantly left‐lateralized network of brain regions underlies verbal working memory (VWM) performance, but how mild cognitive impairment (MCI) impacts these oscillatory dynamics is not well characterized. The present study utilized the spatiotemporal precision of magnetoencephalographic (MEG) brain imaging to investigate the effects of MCI on the neural oscillations serving specific phases (i.e., encoding, maintenance) of VWM. In congruence with the compensation‐related utilization of neural circuits hypothesis (CRUNCH), we hypothesized that MCI patients would recruit greater neural resources during VWM.
Previous magnetoencephalography (MEG) studies have shown that individuals with mild cognitive imp... more Previous magnetoencephalography (MEG) studies have shown that individuals with mild cognitive impairment and Alzheimer’s disease (AD) demonstrate increases in δ and θ, decreases in α and β, and lower ratios of relative power between high and low frequency bands compared to controls. This analysis investigates the association between global cortical atrophy, a measure of neurodegeneration, and MEG resting‐state oscillations in cortical regions that show early AD neuropathology.
The purpose of this review is to critically examine studies that have examined investigated the M... more The purpose of this review is to critically examine studies that have examined investigated the Montreal Cognitive Assessment (MoCA) and functional or medical outcomes and other health variables in patients with non-neurologic medical conditions. Databases OVID Medline and Embase were systematically searched through April 2020, yielding 281 articles that were separately screened for inclusion. Study characteristics extracted from retained articles are presented in Table S1 (online supplemental materials). Thirty-six articles were retained. Cognitive impairment as assessed by the MoCA was associated with adverse health variables including increased morbidity/mortality, poorer functional abilities, increased length of hospital stay, and increased hospital readmissions in 34 of 36 articles. Cognitive impairment as detected by the MoCA was shown in 34 of 36 studies to be associated with worse functional or medical status compared to those with better cognitive functioning across a variety of medical populations. Further research is needed to better understand how to best use the MoCA to potentially inform treatment planning in medical populations, including referral for more detailed neuropsychological evaluation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Neuropsychiatric symptoms (NPS) are common in neurodegenerative disease, but longitudinal studies... more Neuropsychiatric symptoms (NPS) are common in neurodegenerative disease, but longitudinal studies using large autopsy-confirmed samples are lacking. Our primary aim was to investigate progression of NPS over time in autopsy-confirmed Alzheimer’s disease (ad), Lewy body disease (LBD), and mixed (ad+LBD) cohorts. Data on individuals (age > =50) with autopsy-confirmed ad (N = 1568), ad+LBD (N = 349), and LBD (N = 142) was obtained from the National Alzheimer’s Coordinating Center (Mean visits = 2.61). Neuropsychiatric Inventory Questionnaire (NPI-Q) and 15-item Geriatric Depression Scale (GDS) scores were used to measure NPS. Multilevel zero-inflated binomial regression models were used to assess if NPI-Q and GDS scores differed among ad, ad+LBD, and LBD groups over time. Covariates included: years from baseline to final visit, cognitive status at baseline (i.e., normal, MCI, or dementia), demographic characteristics, MMSE, Functional Activities Questionnaire, and psychotropic treat...
OBJECTIVE To elucidate specific symptoms that may differ between adolescent female and male athle... more OBJECTIVE To elucidate specific symptoms that may differ between adolescent female and male athletes after a sports-related concussion (SRC) and identify symptoms that may require greater clinical attention by medical and athletic staff. DESIGN Prospective. SETTING This study is part of a larger research project conducted at clinics in the North Texas Concussion Network (ConTex) Registry. PARTICIPANTS Subjects (N = 491) aged 12 to 18 years who sustained a diagnosed SRC within 30 days of clinic visit. INDEPENDENT VARIABLES Sex (female vs male). Covariates included age, race, current mood (anxiety and depression), learning disability/ADHD, and time to clinic. MAIN OUTCOME MEASURES Twenty-two individual postconcussion symptoms as measured by the Post-Concussion Symptom Scale from the Sport Concussion Assessment Tool-5 (SCAT-5). RESULTS Girls endorsed higher levels of anxiety and depression symptoms at initial clinic visit. analysis of covariance results revealed that girls had significantly greater symptom severity of headache, dizziness, sensitivity to light, sensitivity to noise, pressure in the head, feeling slowed down, fatigue, and drowsiness than boys. Ordinal logistic regression results also revealed that girls had significantly greater predicted odds of higher symptom severity on these 8 symptoms and in trouble concentrating than boys. CONCLUSIONS Closer examination of specific symptoms with attention to patients' current levels of anxiety and depression symptoms may better inform medical and athletic staff to anticipate and address symptoms that may present greater challenges for adolescent girls than boys.
Objective Various methods are used to derive normative data for neuropsychological assessment mea... more Objective Various methods are used to derive normative data for neuropsychological assessment measures. The National Alzheimer’s Coordinating Center (NACC) regression norms (2011) are frequently used within Alzheimer’s Disease Research Centers, yet little research exists comparing these norms to similar regression/non-regression-based norms. Normative data for the widely-used Trail Making Test (TMTA&B) was compared between two regression-based normative data methods (Mitrushina and NACC) and traditional normative methods (i.e., Mayo’s Older Americans Normative Studies [MOANS]). Method TMTA&B data were obtained from 14,873 cognitively normal NACC participants (ages: 50–89; education: M = 15.81, SD = 2.90). T-scores for TMTA&B scores based on Mitrushina, NACC, and MOANS norms were computed. T-scores for regression norms were bounded from 20 to 80. Cohen’s d effect sizes were used to compare differences in scores. Results MOANS and Mitrushina norms produced similar normative scores in ...
Objective Research in pediatric concussion has investigated mechanism of injury and symptom repor... more Objective Research in pediatric concussion has investigated mechanism of injury and symptom reporting separately, but there is no study that examines differences in symptom reporting across multiple mechanisms of injury in elementary school-aged children. The purpose of the study was to examine symptom presentation and determine if symptoms of concussed children in middle childhood differ based upon mechanism of injury. Methods Participants included 104 children between the ages of 6 and 10 years enrolled from area concussion clinics within 30 days of injury. All participants completed an initial clinic visit that collected demographic and injury characteristics as well as measures of post-concussion symptoms, anxiety, and depression based on parent report. We grouped the participants based on mechanism of injury (sports related, fall, hit by object, and motor vehicle accident). Results There was a significant group difference for age (p = 0.02) and history of previous concussion. Headache, fatigue, and trouble concentrating were the most commonly reported symptoms (> 50% of sample). We found no significant group differences in reported symptoms, although sleep disturbance approached significance. We also found no significant differences for total post-concussion symptom counts or total scores on a screener for anxiety or depression. Conclusions Overall, there were no symptom differences by mechanism of injury in this young age group; however, research with larger samples is needed to enhance knowledge of the physical and emotional sequelae of concussion in younger children and inform best practices for timely interventions.
Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetiti... more Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency of TES in a cohort of retired professional contact sport athletes, compare the frequency of TES to clinical consensus diagnoses, and identify predictors that increase the likelihood of TES diagnosis. Participants were 85 retired professional contact sport athletes from a prospective cohort at the University of Texas Southwestern Medical Center and the University of Texas at Dallas. Participants ranged in age from 23 to 79 (M = 55.95, SD = 13.82) and obtained 7 to 19 years of education (M = 16.08, SD = 1.03). Retirees were either non-Hispanic white (n = 62) or African-American (n = 23). Retired athletes underwent a standard clinical evaluation, which included a clinical interview, neurological exam, neuroimaging, neuropsychological testing, and conse...
Objective: Although individual components of metabolic syndrome (MetS) are linked to faster disea... more Objective: Although individual components of metabolic syndrome (MetS) are linked to faster disease progression, previous research evaluating these relationships in MetS and Alzheimer's disease (AD) has yielded mixed results. We evaluated autopsy-confirmed cases of AD to determine if the presence of MetS was related to the age of disease onset and life expectancy. Method: 1055 subjects with autopsy-confirmed AD (Braak neurofibrillary tangle stages ≥3 combined with at least moderate neuritic amyloid plaques) were obtained from the National Alzheimer's Coordinating Center database. Subjects with co-occurring neuropathological diagnoses were excluded. MetS was defined using International Diabetes Federation parameters. Subjects were classified as having MetS (n = 116) if they had obesity and ≥2 additional conditions (diagnosis/ treatment of: diabetes, hypertension, or lipid abnormality). Obese subjects with one other MetS condition were classified as "at risk" (n = 136). Analyses of covariance (ANCOVA) were used to assess if clinician-estimated age of onset and time from onset to death differed between those with and without MetS, controlling for education, race, gender, and apolipoprotein ε4 status. Results: Average age of onset differed between groups by a maximum of 1 year, which was not statistically significant (F(2,1048) = 0.238, p = .79). Similarly, average life expectancy differed by < 1 year between groups and did not differ statistically (F(2,946) = 0.341, p = .71). Conclusions: MetS status was not significantly related to disease onset or life expectancy in this autopsy-confirmed AD sample. It is possible that treatment for MetS component conditions may moderate the relationship between MetS and AD in patients without co-occurring neuropathological diagnoses, and future studies should examine this relationship.
Objective: Dementia risk can vary among ethnicities and has been associated with a history of tra... more Objective: Dementia risk can vary among ethnicities and has been associated with a history of traumatic brain injury (TBI) in some individuals. However, previous studies on the long-term effects of remote TBI on developing dementia have been limited to predominantly non-diverse samples. We evaluated age of Alzheimer's disease (AD) onset in those with and without a history of TBI in three racial/ethnic cohorts. Method: Data were obtained from the National Alzheimer's Coordinating Center. Clinician-estimated age of AD onset was compared among non-Hispanic Caucasian (n = 721), non-Hispanic African American (n = 74), and Hispanic (n = 57) groups. Cohorts were dichotomized based on history of remote TBI with loss of consciousness (LOC; >1 year prior to first visit with no chronic deficits). Controlling for education, ANCOVAs were used to evaluate mean differences in age of AD onset in males and females with and without history of TBI. Results: TBI history was associated with an approximately 3-year earlier onset in non-Hispanic Caucasians (p < .001) and non-Hispanic African Americans (p = .003), with no interaction by sex (p's > .05). In the Hispanic group, an interaction was observed between sex and TBI (p = .018). TBI was not related to earlier onset in Hispanic males (p = .610), but was related to a 5-year earlier onset in Hispanic females (p = .007). Conclusions: Remote TBI with LOC was a risk factor for earlier AD onset across racial/ethnic groups, but sex may play a role within Hispanic populations. Future studies should examine if cultural, genetic, or other factors contribute to the potentially earlier disease expression in female Hispanics with a history of TBI.
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Papers by Heidi Rossetti