Rehabilitation of Persistent Post-Concussion Symptoms in Retired and Active NHL Players: Clinical Case Series

ObjectiveTo present the evaluation of 12 rehabilitation cases as a case series in sports-related concussion.BackgroundSport-related concussion is a common injury in the NHL. While most athletes recover within few weeks of sustaining a mild head injury, some still experience persistent symptoms for months or years after following recommended recovery and return to play guidelines.Design/MethodsTwelve male NHL athletes (6/6 active/retired; mean age/height/weight/symptom duration/#concussions [SD]: 33.4 years [7.9]: 185.8 cm [5.1]: 94.8 kg [14.6]; 121 wks: [156]; 4.3 [2.3]) with persistent but mild post-concussion symptoms were treated for 10 sessions at an outpatient neurorehabilitation center specializing in functional neurology. The athletes were evaluated before- and after treatment utilizing the C3 Logix platform. The interventions included joint manipulation, neuromuscular re-education, vestibular rehabilitation in a whole-body off-axis rotational device, orthoptic exercises, and cognitive training. Graded Symptoms Checklist (0–162), Digit-Symbol Coding, Simple- and Choice Reaction Time, and Trail Making Test A/B were analyzed in Graphpad PRISM. 9.1.0 by multiple paired t-tests with Holm-Šídák corrections. Results are reported as differences-of-means pre- to post-treatment (SE) with Cohen's d effect sizes [ES] (0.2, 0.5, 0.8 represents small, medium, and large effect sizes, respectively). p-values <0.05 were considered significant.ResultsGraded Symptom Checklist score (p < 0.001): −25.1 (4.0) [1.83]; Digit-Symbol Matching speed (#symbols) (p = 0.03): 6.2 (1.9) [0.92]; Simple reaction time (ms) (p = 0.03): −74.7 (22.9) [0.94]; Choice reaction time (ms) (p = 0.009): −106.1 (26.0) [1.18]; Trails A (s) (p = 0.04) [0.80]: −2.6 (0.9); and Trails B (s) (p = 0.04): −6.0 (2.2) [0.79].ConclusionsThe present case series shows that a functional neurology approach of multimodal short duration intensive therapies can produce clinically meaningful improvements with large and very large effect sizes, in both the concussion symptoms and neurocognitive performance, of 12 professional NHL players experiencing symptom stagnation.

Association Between Diet And Cognitive Performance In Adults Aged 60 And Over: NHANES, 2011–2014

There is limited evidence examining associations between diet and cognitive performance (CP) in older adults. We used the 2011-2014 National Health and Nutrition Examination Survey to determine if meeting dietary recommendations was associated with CP in adults 60+ years of age. Diet was based on the healthy eating index (HEI) 2015 and categorized into quintiles (higher quintiles indicating healthier diet). CP was based on word list learning, animal naming, and digit symbol substitution test, with scores above 25th percentile indicating adequate performance. Multivariate logistic regression modeling was conducted and adjusted for potential cofounders. A total of 3,068 participants completed the CP tests. A slightly higher percentage of participants were female (54.0%), predominantly White (80.5%) and the largest percentage (54.7%) was 60 to 69 years of age. The mean HEI-2015 score (0-100) was 54.89 (SE = 0.56). High CP scores increased with healthier dietary quintiles. However, results were only significant (p for trend &lt;0.05) for digit symbol substitution test when comparing those in the highest quintile (82.53%) to those in the lowest (70.23%). Compared with participants in the lowest quintile of HEI-2015, participants in the highest quintile had a two-fold increased odds of better digit symbol substitution test scores, after adjusting for confounders (Odds Ratio [OR]: 1.96, 95% Confidence Interval [CI]: 1.28-3.01). Results showed that meeting healthy diet recommendations is associated with improved digit symbol substitution test, a marker of attention, processing speed and executive function. Future research should consider the role of diet in older adults to improve cognitive performance.

Muscle Bioenergetics and Cognitive Executive Function: The SOMMA Study Baseline

Better executive function has been associated with faster walking speed, but the basis for this association is unclear. Systemic factors appear to contribute mitochondrial function across multiple tissues including muscle and brain. We hypothesized that muscle-based measures of bioenergetics capacity would be associated with cognitive function at SOMMA’s baseline. MRI-based ATPMAX and muscle fiber respirometry-based max OXPHOS were correlated with scores on the MoCA (mean: 24.0; SD: 3.2); Trails B (mean: 138 seconds; SD: 73) and the Digit Symbol Coding Tests (mean: 50.8; SD: 14.9). The spearman correlations between ATPmax and the three measures were: 0.10 (p=0.29); -0.20 (p=0.03) and 0.16 (p=0.09), respectively. The association between max OXPHOS were: 0.18 (p=0.02); -0.20 (p&lt;0.01) and 0.11 (p=0.13), respectively. Some associations appeared stronger in men than women. Gender interactions and whether energetics mediate some of the association between cognitive function and gait speed will be explored in the full baseline sample.

The association between falls and autonomy in older adults is mediated by self-efficacy

Objective Falling has various physical and psychological consequences in older adults. We aimed at replicating previous findings that reported autonomy is associated with a history of falls and that this association is moderated by self-efficacy. We further assumed that cognitive function would moderate this relationship. Method We analyzed data from the German Ageing Survey (“Deutscher Alterssurvey,” DEAS, year 2017, n = 6626), a longitudinal cohort-based survey of individuals living in private households aged 40 and over in Germany. Results Linear regression confirmed that perceived autonomy was negatively associated with a history of falls. With higher self-efficacy, the association between falls and autonomy was less substantial. Further, we extend previous findings in that self-efficacy also mediated the effect of falls on perceived autonomy. Against our assumptions, cognition as measured with the digit-symbol substitution test predicted perceived autonomy but did not moderator this association. Discussion We conclude that interventions facilitating self-efficacy might ameliorate negative effects of falling on autonomy of older adults.

Celebrity worship and cognitive skills revisited: applying Cattell’s two-factor theory of intelligence in a cross-sectional study

Background Almost two decades of research produced mixed findings on the relationship between celebrity worship and cognitive skills. Several studies demonstrated that cognitive performance slightly decreases with higher levels of celebrity worship, while other studies found no association between these constructs. This study has two aims: (1) to extend previous research on the association between celebrity worship and cognitive skills by applying the two-factor theory of intelligence by Cattell on a relatively large sample of Hungarian adults, and (2) to investigate the explanatory power of celebrity worship and other relevant variables in cognitive performance. Methods A cross-sectional study design was used. Applying an online survey, a total of 1763 Hungarian adults (66.42% male, Mage = 37.22 years, SD = 11.38) completed two intelligence subtests designed to measure ability in vocabulary (Vocabulary Test) and digit symbol (Short Digit Symbol Test). Participants also completed the Celebrity Attitude Scale and the Rosenberg Self-esteem Scale. Subjective material wealth, current family income and general sociodemographics were also reported by participants. Results Linear regression models indicated that celebrity worship was associated with lower performance on the cognitive tests even after controlling for demographic variables, material wealth and self-esteem, although the explanatory power was limited. Conclusions These findings suggest that there is a direct association between celebrity worship and poorer performance on the cognitive tests that cannot be accounted for by demographic and socioeconomic factors.

The Association Between Lentiform Nucleus Function and Cognitive Impairments in Schizophrenia

Introduction: Cognitive decline is the core schizophrenia symptom, which is now well accepted. Holding a role in various aspects of cognition, lentiform nucleus (putamen and globus pallidus) dysfunction contributes to the psychopathology of this disease. However, the effects of lentiform nucleus function on cognitive impairments in schizophrenia are yet to be investigated.Objectives: We aim to detect the fractional amplitude of low-frequency fluctuation (fALFF) alterations in patients with schizophrenia, and examine how their behavior correlates in relation to the cognitive impairments of the patients.Methods: All participants underwent magnetic resonance imaging (MRI) and cognitive assessment (digit span and digit symbol coding tests). Screening of brain regions with significant changes in fALFF values was based on analysis of the whole brain. The data were analyzed between Jun 2020 and Mar 2021. There were no interventions beyond the routine therapy determined by their clinicians on the basis of standard clinical practice.Results: There were 136 patients (75 men and 61 women, 24.1 ± 7.4 years old) and 146 healthy controls (82 men and 64 women, 24.2 ± 5.2 years old) involved in the experiments seriatim. Patients with schizophrenia exhibited decreased raw scores in cognitive tests (p &lt; 0.001) and increased fALFF in the bilateral lentiform nuclei (left: 67 voxels; x = −24, y = −6, z = 3; peak t-value = 6.90; right: 16 voxels; x = 18, y = 0, z = 3; peak t-value = 6.36). The fALFF values in the bilateral lentiform nuclei were positively correlated with digit span-backward test scores (left: r = 0.193, p = 0.027; right: r = 0.190, p = 0.030), and the right lentiform nucleus was positively correlated with digit symbol coding scores (r = 0.209, p = 0.016).Conclusion: This study demonstrates that cognitive impairments in schizophrenia are associated with lentiform nucleus function as revealed by MRI, involving working memory and processing speed.

Leukotriene receptor antagonist use and cognitive decline in normal cognition, mild cognitive impairment, and Alzheimer’s dementia

Background Leukotriene receptor antagonists (LTRAs) alleviate Alzheimer’s disease (AD) pathology and improve cognition in animal models; however, clinical evidence is limited. This study aimed to explore the associations between the use of LTRAs (montelukast or zafirlukast) and cognitive performance in people with normal cognition, mild cognitive impairment (MCI), or AD dementia. We hypothesized that LTRA use would be associated with better cognitive performance over time. Methods This longitudinal observational study used data from the National Alzheimer’s Coordinating Center. Within groups of participants with normal cognition, MCI, or AD dementia, LTRA users were matched 1:3 to non-users using propensity score matching. Cognitive domains including immediate and delayed memory (Wechsler Memory Scale Revised-Logical Memory IA and IIA), psychomotor processing speed (Digit Symbol Substitution Test), and language (animal naming, vegetable naming, and Boston Naming Test) were compared between users and non-users in mixed-effects linear or Poisson regression models. Results In AD dementia, LTRA use was associated with a slower decline in psychomotor processing speed, as measured by the Digit Symbol Substitution Test (Β = 1.466 [0.253, 2.678] symbols/year, n = 442), and language, as measured by animal naming (Β = 0.541 [0.215, 0.866] animals/year, n = 566), vegetable naming (B = 0.309 [0.056, 0.561] vegetables/year, n = 565), and the Boston Naming Test (B = 0.529 [0.005, 1.053] items/year, n = 561). Effect sizes were small but persisted after controlling for a 10% false discovery rate. LTRA use was not associated with changes in memory performance in AD, nor was it associated with changes in cognitive performance in people with normal cognition or MCI. In a post hoc analysis, LTRA use was associated with a slower decline in clinical progression in MCI (B = −0.200 [−0.380, −0.019] points/year, n = 800) and AD dementia (B = −0.321 [−0.597, −0.046] points/year, n = 604) as measured by CDR Sum of Boxes. Conclusions The use of LTRAs was associated with preserved function in non-amnestic cognitive domains in AD dementia. The role of leukotrienes and their receptors in cognitive decline warrants further investigation and the leukotriene pathway may represent a target for AD treatment.

How do we measure attention? Using factor analysis to establish construct validity of neuropsychological tests

We investigated whether standardized neuropsychological tests and experimental cognitive paradigms measure the same cognitive faculties. Specifically, do neuropsychological tests commonly used to assess attention measure the same construct as attention paradigms used in cognitive psychology and neuroscience? We built on the “general attention factor”, comprising several widely used experimental paradigms (Huang et al., 2012). Participants (n = 636) completed an on-line battery (TestMyBrain.org) of six experimental tests [Multiple Object Tracking, Flanker Interference, Visual Working Memory, Approximate Number Sense, Spatial Configuration Visual Search, and Gradual Onset Continuous Performance Task (Grad CPT)] and eight neuropsychological tests [Trail Making Test versions A & B (TMT-A, TMT-B), Digit Symbol Coding, Forward and Backward Digit Span, Letter Cancellation, Spatial Span, and Arithmetic]. Exploratory factor analysis in a subset of 357 participants identified a five-factor structure: (1) attentional capacity (Multiple Object Tracking, Visual Working Memory, Digit Symbol Coding, Spatial Span), (2) search (Visual Search, TMT-A, TMT-B, Letter Cancellation); (3) Digit Span; (4) Arithmetic; and (5) Sustained Attention (GradCPT). Confirmatory analysis in 279 held-out participants showed that this model fit better than competing models. A hierarchical model where a general cognitive factor was imposed above the five specific factors fit as well as the model without the general factor. We conclude that Digit Span and Arithmetic tests should not be classified as attention tests. Digit Symbol Coding and Spatial Span tap attentional capacity, while TMT-A, TMT-B, and Letter Cancellation tap search (or attention-shifting) ability. These five tests can be classified as attention tests.

Discriminant Validity of the WAIS-R Digit Symbol Substitution Test in Subjective Cognitive Decline, Mild Cognitive Impairment (Amnestic Subtype) and Alzheimer’s Disease Dementia (ADD) in Greece

Objective: The aim of the current study was to estimate the discriminant potential and validity of the Digit Symbol Substitution Test (DSST) of the WAIS-R in the Greek elderly population meeting criteria for subjective cognitive decline (SCD), mild cognitive impairment (aMCI; amnestic subtype), or Alzheimer’s disease dementia (ADD). Method: Four hundred eighty-eight community-dwelling older adults, visitors of the Day Center of Alzheimer Hellas, participated in the study. Two hundred forty-three of them met the criteria for ADD, one hundred eighty-two for aMCI and sixty-three for SCD. Results: Path analysis indicated that the DSST score is affected by age group, educational level, and diagnostic category, but is not affected by gender. The ROC curve analysis showed that the DSST sum score could perfectly differentiate SCD from ADD patients, whereas test’s discriminant potential between aMCI and dementia ADD’s subtype was satisfactory. However, DSST was unable to separate the SCD from the aMCI group. Conclusion: It appears that the DSST is unable to separate the SCD from aMCI population. Therefore, the test in question may be insensitive to incipient cognitive decline. On the contrary, the discriminant potential of the DSST as regards SCD and ADD is excellent, while discrimination between aMCI and ADD is good.