Concussion Subtyping in Patients With Persistent Post-Concussive Symptoms Using a New Concussion Clinical Profile Screen Tool (CP Screen)

ObjectiveTo identify the prevalence of subtypes in Persistent Post Concussion Symptoms (PPCS) and investigate their potential relationships.BackgroundThe CP-Screen is designed to evaluate 5 clinical profiles and 2 modifiers that are predominant within concussion patients. The CP screen includes 29 items that are expressed as weighted outcome scores for each of the 7 concussion subtypes.Design/MethodsThis was a retrospective-chart review of 1,136 visits for 362 patients with PPCS at a concussion center. Age range was 12–81 and average age was 32, 65.7% were female and 34.3% male. 360 visits were in the 12–21 pediatric age range. Each patient completed an electronic CP-Screen prior to each visit, which was uploaded to the EHR. All patients were seen between October 2020 and April 2021.ResultsOverall, the most common subtypes were cognitive (34.0%), neck (17.8%), and mood (16.8%). The highest overall observed subtype average CP symptom score was mood (32.8/89) and the lowest was visual (23.6/89). For pediatric the most common phenotypes were cognitive (36.7%), mood (17.9%), and visual (15.4%). The highest observed pediatric average CP symptom score was mood (30.8/89) and the lowest was sleep (20.1/89). For those with cognitive primary profile, neck and ocular were the most common secondary and tertiary profiles in both groups. Females presented with cognitive, mood, neck as their most common profiles compared to cognitive, neck, ocular in males in both groups. Neck, mood, and visual primary profiles all presented with cognitive fatigue as their secondary profile.ConclusionsCP screen was overall a useful tool in helping identify clinical profiles in PPCS. Cognitive fatigue was a predominant profile in PPCS across all ages and sexes. Those with predominant mood profiles presented with the highest symptom scores. Mood profile was more predominant in females. Cognitive primary profile was found to be most linked to cervical, mood, and visual profiles.

Fatigue in children and adolescents perinatally infected with human immunodeficiency virus: an observational study

Background Fatigue is common among adults living with human immunodeficiency virus (HIV) as well as children with a chronic disease (CCD). Fatigue can have disastrous effects on health status, including health related quality of life (HRQOL). Even so, fatigue is underexplored in children and adolescents perinatally infected with HIV (PHIV+) in the Netherlands. The objective of this observational study is to explore fatigue in PHIV+ and its association with their HRQOL. Methods We measured HRQOL and fatigue using the Pediatric Quality of Life Inventory™ (PedsQL 4.0) and the PedsQL Multidimensional Fatigue Scale (MFS). The PedsQL MFS encompasses three subscales: general fatigue, sleep/rest fatigue and cognitive fatigue, and a total fatigue score. We compared outcomes of PHIV+ children and adolescents in the Amsterdam University Medical Centre with three groups: 1) HIV-uninfected controls (HIV-) matched for age, sex, region of birth, socioeconomic status and adoption status, 2) CCD, and 3) the general Dutch population. Within the PHIV+ group we explored associations between fatigue and HRQOL. Results We enrolled 14 PHIV+ (median age 10.2 years [IQR 9.2–11.4]) and 14 HIV-. Compared to CCD, PHIV+ significantly reported less general fatigue (mean difference 13.0, 95% CI 1.3 to 24.8). PHIV+ did not score significantly different on any of the other PedsQL MFS scales compared to HIV-, CCD or the general Dutch population. PHIV children scored relatively low on the cognitive fatigue scale in comparison to HIV-uninfected matched controls, CCD and the general population, although these differences did not reach significance. Among PHIV+, a lower score on total fatigue, general fatigue and cognitive fatigue was associated with a lower HRQOL score. Conclusions The results of this study suggest that PHIV children and adolescents do not experience more symptoms of fatigue than their healthy peers. However, PHIV children and adolescents may be more likely to experience cognitive fatigue. Fatigue in PHIV also appears to be associated with children’s HRQOL. Further research should confirm these exploratory findings.

The Impact of Cognitive and Physical Effort Exertion on Physical Effort Decisions: A Pilot Experiment

Research suggests that cognitive fatigue has a negative impact on physical activity participation. However, the mechanisms underlying this effect are yet unclear. Using an effort-based decision-making paradigm, we examined whether individuals weigh physical effort-costs more strongly when they are cognitively or physically fatigued. Twenty university students visited the lab on three occasions. On each visit, participants underwent a manipulation that was designed to either induce cognitive fatigue (i.e., 2-back task), physical fatigue (i.e., handgrip exercise), or served as a control condition (i.e., documentary watching). After the manipulations, participants performed an effort-based decision-making task in which they decided for 125 offers whether they accepted the offer to exert the required level of physical effort to obtain rewards that varied in value. The probability to accept offers declined with increasing effort requirements whereas the general probability to accept offers was not reduced by any of the experimental conditions. As expected, the decline in accepted offers with increasing effort requirements was stronger after prolonged exertion of physical effort compared to the control condition. Unexpectedly, this effect was not found after exerting cognitive effort, and exploratory analyses revealed that the impact of physical effort exertion on physical effort-based decisions was stronger than that of cognitive effort exertion. These findings suggest that people weight future physical effort-costs more strongly after exerting physical effort, whereas we could not find any evidence for this after exerting cognitive effort. We discuss multiple explanations for this discrepancy, and outline possibilities for future research.

Quantifying the Distorting Effect of Rapid Guessing on Estimates of Coefficient Αlpha

An underlying threat to the validity of reliability measures is the introduction of systematic variance in examinee scores from unintended constructs that differ from those assessed. One construct-irrelevant behavior that has gained increased attention in the literature is rapid guessing (RG), which occurs when examinees answer quickly with intentional disregard for item content. To examine the degree of distortion in coefficient alpha due to RG, this study compared alpha estimates between conditions in which simulees engaged in full solution (i.e., do not engage in RG) versus partial RG behavior. This was done by conducting a simulation study in which the percentage and ability characteristics of rapid responders as well as the percentage and pattern of RG were manipulated. After controlling for test length and difficulty, the average degree of distortion in estimates of coefficient alpha due to RG ranged from -.04 to .02 across 144 conditions. Although slight differences were noted between conditions differing in RG pattern and RG responder ability, the findings from this study suggest that estimates of coefficient alpha are largely robust to the presence of RG due to cognitive fatigue and a low perceived probability of success.

Quantifying the Distorting Effect of Rapid Guessing on Estimates of Coefficient Αlpha

An underlying threat to the validity of reliability measures is the introduction of systematic variance in examinee scores from unintended constructs that differ from those assessed. One construct-irrelevant behavior that has gained increased attention in the literature is rapid guessing (RG), which occurs when examinees answer quickly with intentional disregard for item content. To examine the degree of distortion in coefficient alpha due to RG, this study compared alpha estimates between conditions in which simulees engaged in full solution (i.e., do not engage in RG) versus partial RG behavior. This was done by conducting a simulation study in which the percentage and ability characteristics of rapid responders as well as the percentage and pattern of RG were manipulated. After controlling for test length and difficulty, the average degree of distortion in estimates of coefficient alpha due to RG ranged from −.04 to .02 across 144 conditions. Although slight differences were noted between conditions differing in RG pattern and RG responder ability, the findings from this study suggest that estimates of coefficient alpha are largely robust to the presence of RG due to cognitive fatigue and a low perceived probability of success.