Insufficient Sleep Following Pediatric Mild Traumatic Brain Injury Correlates With Neurocognitive Dysfunction

ObjectiveAnalyze the impact of sleep disturbance on neurocognitive function in children recovering from mild traumatic brain injury (mTBI).BackgroundSleep disturbance of any nature is reported in more than half of all mTBI patients. The pathophysiology of sleep disturbance following mTBI is associated with structural and functional disruptions of sleep circuitry and circadian rhythm. Specifically in the pediatric population, untreated sleep disturbance has been shown to delay mTBI recovery and compound other morbidities including neurocognitive dysfunction.Design/MethodsA retrospective chart review of 118 pediatric patients (mean age = 14.56 ± 2.03 years) recovering from mTBI was performed. Epworth Sleepiness Scale (SF-8) results were analyzed in relation to CNS Vital Signs (CNSVS) neurocognitive test outcomes. SF-8 is a subjective estimation of a patient's daytime sleepiness. CNSVS uses a multitude of domains to objectively evaluate the overall neurocognitive status of a patient. Pearson correlations were calculated using a type I error of p < 0.05 between variables.ResultsEpworth Sleepiness Scale (SF-8) results showed 28.82% of participants experienced excessive daytime sleepiness sufficient enough to recommend medical attention. Upon further analysis, there was a significant negative correlation between SF-8 and CNSVS neurocognitive test outcomes including complex attention (r = −0.37; p = 0.0004), cognitive flexibility (r = −0.24; p = 0.0151), executive function (r = −0.21; p = 0.0350), and simple attention (r = −0.36; p = 0.0003) scores. This means as SF-8 scores increased (participants defined as excessively sleepy), neurocognitive function scores in these domains decreased. There was not enough evidence to conclude a significant correlation between other CNSVS domains and SF-8 (all p > 0.05).ConclusionsOur findings support the concern of neurocognitive dysfunction among pediatric mTBI patients with sleep disturbance. Further analysis is needed to determine if mTBI is the primary source or an exacerbating factor of sleep disturbance within this population. Nonetheless, these findings suggest a need for thorough evaluation when treating sleep concerns, irrespective of a history of childhood mTBI.

Brain MRI and neuropsychological findings at long-term follow-up after COVID-19 hospitalisation: an observational cohort study

ObjectivesTo report findings on brain MRI and neurocognitive function, as well as persisting fatigue at long-term follow-up after COVID-19 hospitalisation in patients identified as high risk for affection of the central nervous system.DesignAmbidirectional observational cohort study.SettingAll 734 patients from a regional population in Sweden with a laboratory-confirmed COVID-19 diagnosis admitted to hospital during the period 1 March to 31 May 2020.ParticipantsA subgroup (n=185) with persisting symptoms still interfering with daily life at a telephone follow-up 4 months after discharge were invited for a medical and neuropsychological evaluation. Thirty-five of those who were assessed with a neurocognitive test battery at the clinical visit, and presented a clinical picture concerning for COVID-19-related brain pathology, were further investigated by brain MRI.Main outcome measuresFindings on brain MRI, neurocognitive test results and reported fatigue.ResultsTwenty-five patients (71%) had abnormalities on MRI; multiple white matter lesions were the most common finding. Sixteen patients (46%) demonstrated impaired neurocognitive function, of which 10 (29%) had severe impairment. Twenty-six patients (74%) reported clinically significant fatigue. Patients with abnormalities on MRI had a lower Visuospatial Index (p=0.031) compared with the group with normal MRI findings.ConclusionsIn this group of patients selected to undergo MRI after a clinical evaluation, a majority of patients had abnormal MRI and/or neurocognitive test results. Abnormal findings were not restricted to patients with severe disease.

Regression-Based Norms and Validation of the Cambridge Neuropsychological Test Automated Battery among Community-Living Older Adults in Singapore

Objective The Cambridge Neuropsychological Test Automated Battery (CANTAB) is widely used in research and clinical settings. However, little is known about the use of the CANTAB in the local aging context. This study aimed to develop normative data for various CANTAB measures in community-living older adults in Singapore. Normative data were built using the regression-based approach. A secondary aim was to examine the concurrent validity of CANTAB measures with their traditional neurocognitive test counterparts. Method A total of 210 older adults (Mage = 67.27 years, SD = 5.45) from an existing cohort study completed standard neurocognitive tests and a CANTAB battery. A total of 160 were normal aging, 46 diagnosed with Mild Cognitive Impairment (MCI), and one diagnosed with Dementia. Older adults with MCI and Dementia were not included in the calculation of norms but were included in other analyses. For the CANTAB battery, regression-based norms were generated for each CANTAB measure, with age, sex, and education included as covariates. Concurrent validity was examined by correlating the CANTAB measures with their traditional neurocognitive counterparts. Results As expected, performance across most CANTAB measures declined significantly with increasing age and decreasing education levels. There were no significant effects of sex on most CANTAB measures. Our study also showed that some CANTAB measures demonstrated good concurrent validity as they significantly correlated with their traditional neurocognitive test counterparts. Conclusions We have developed age, sex, and education-specific CANTAB norms for use in the local aging context. The advantages and challenges of using the CANTAB in the local aging context are discussed.

OS05.4.A Do neurocognitive deficits explain the differences between brain tumour patients and their proxies assessing the patient’s I-ADL?

BACKGROUND Neurocognitive deficits are common among brain tumour patients, and may impact on patient awareness of deficits in instrumental activities in daily life (IADL). This study aimed to examine differences between patient-reported and proxy-reported assessments of the patient’s performance of IADL, and whether the level of (dis)agreement is associated with neurocognitive deficits. MATERIAL AND METHODS A phase III EORTC questionnaire measuring IADL in brain tumour patients (EORTC IADL-BN32) and six neurocognitive test measures were administered as part of a larger multicentre international study designed to develop a brain tumour specific IADL questionnaire. Bland-Altman plots and Mann-Whitney U tests were used to evaluated patient- and proxy-reported IADL on a group level. Subsequently, Mann-Whitney U tests were performed to compare patient-proxy difference scores (patient IADL score - their proxy IADL score) between patients who were considered clearly neurocognitively impaired (≥2 neurocognitive test measures; ≤2.0 SD below healthy controls) and patients who were not. Furthermore, multinomial logistic regression analyses were performed to examined which sociodemgraphic, clinical, and particularly neurocognitive variables were independently associated with patients and proxies differing in their evaluation of patient’s IADL. RESULTS Patients (N=81) and proxies (N=81), on group level, did not significantly differ on either the IADL individual item or scale scores. However, significant differences were found on patient-proxy difference scores between patients who were (N=37) and were not (N=44) considered clearly neurocognitively impaired for 10/32 individual items and one of the scales (i.e. Scale 4: Administrative tasks), all showing that the proxies of clearly neurocognitively impaired patients reported more problems relative to the patients themselves, compared to proxies of patients not clearly neurocognitively impaired. Furthermore, for each scale, a neurocognitive variable, either impaired information processing speed, cognitive flexibility, verbal fluency or the number of neurocognitive test measures impaired, was found to be independently associated with proxies reporting more problems. For 4/5 scales, a clinical variable was additionally independently associated with proxies reporting more problems. Only one variable was independently associated with patient reporting more problems, namely being in active treatment was found to be associated with patients reporting more problems on Scale 4: Administrative tasks. CONCLUSION Results imply a consistent trend of clearly neurocognitively impaired patients underreporting problems with IADL compared to their proxies. It would therefore be advised to administer both the patient- and proxy-version of the EORTC IADL-BN32, particularly if neurocognitive deficits are presumed.

A-73 Neurocognitive Profiles in Patients Following Covid-19 Infection

Objective Little is known about neurocognitive function in patients with persisting cognitive complaints following Covid-19 infection. Initial studies, utilizing cognitive screening measures or case reports, suggest presence of deficits in attention and executive function. This study investigated cognitive functioning among individuals with Covid-19 infection. Methods The sample included 20 individuals referred to an outpatient Covid-19 recovery clinic at the Cleveland Clinic. At the time of Covid-19 diagnosis, 45% required hospitalization, 15% were in an intensive care unit, 10% needed mechanical ventilation, and 10% had delirium. Patients underwent neuropsychological evaluation on average 157 days after a Covid-19 positive PCR test. Results This sample (n = 20) was predominately female (85%), White non-Hispanic (70%), with a mean education of 15 years. For the majority of patients, neurocognitive test results were interpreted as within expectation compared to normative samples. Cognitive deficits, when present, were largely seen on isolated tests involving attention or executive function. Seventy percent of patients were treated for a mood disorder prior to Covid-19. At the time of testing, 45% of the sample endorsed moderate to severe symptoms of depression and/or anxiety and 92% noted significant fatigue as measured by the Fatigue Severity Scale. Conclusions Cognitive deficits, when observed, are consistent with prior research. These findings suggest that in patients with similar presentations, psychological implications of Covid-19 and other persisting symptoms (e.g., fatigue) may play a significant role in subjective cognitive complaints. These patients would likely benefit from resources to manage persisting or new mood symptoms and compensatory strategies for cognitive inefficiencies they experience.

Insular Connectivity Is Associated With Self-Appraisal of Cognitive Function After a Concussion

Concussion is associated with acute cognitive impairments, with declines in processing speed and reaction time being common. In the clinical setting, these issues are identified via symptom assessments and neurocognitive test (NCT) batteries. Practice guidelines recommend integrating both symptoms and NCTs into clinical decision-making, but correlations between these measures are often poor. This suggests that many patients experience difficulties in the self-appraisal of cognitive issues. It is presently unclear what neural mechanisms give rise to appraisal mismatch after a concussion. One promising target is the insula, which regulates aspects of cognition, particularly interoception and self-monitoring. The present study tested the hypothesis that appraisal mismatch is due to altered functional connectivity of the insula to frontal and midline structures, with hypo-connectivity leading to under-reporting of cognitive issues and hyper-connectivity leading to over-reporting. Data were collected from 59 acutely concussed individuals and 136 normative controls, including symptom assessments, NCTs and magnetic resonance imaging (MRI) data. Analysis of resting-state functional MRI supported the hypothesis, identifying insular networks that were associated with appraisal mismatch in concussed athletes that included frontal, sensorimotor, and cingulate connections. Subsequent analysis of diffusion tensor imaging also determined that symptom over-reporting was associated with reduced fractional anisotropy and increased mean diffusivity of posterior white matter. These findings provide new insights into the mechanisms of cognitive appraisal mismatch after a concussion. They are of particular interest given the central role of symptom assessments in the diagnosis and clinical management of concussion.

Much of the Neurocognitive Impairment in Schizophrenia is Due to Factors Other Than Schizophrenia Itself: Implications for Research and Treatment

Patients with schizophrenia perform worse on neuropsychological tasks than controls. While most experts ascribe poor performance to neurocognitive impairment, an emerging literature is identifying important nonspecific mediators of neurocognitive test performance, some of which can be accounted for in trials (eg, motivation, effort, defeatist performance beliefs, stress, anxiety, physical inactivity). Other factors are harder, if not impossible, to control when patients are compared to non-clinical participants (eg, hospitalization, medication effects, distraction due to positive symptoms). Effect sizes of neurocognitive performance differences are usually not adjusted for these confounders, and the level of neurocognitive impairment due to schizophrenia is thus likely exaggerated. We suggest some ways for researchers to account for the effects of these mediators. Secondary influences that negatively affect neurocognitive performance should not be treated as mere noise. They give important insight into causal mechanisms and may inform more effective treatments that go beyond cognitive remediation.

Validation of the Hungarian Version of Addenbrooke's Cognitive Examination for Detecting Major and Mild Neurocognitive Disorders

Aim: The screening of cognitive decline is a mandatory step in the early diagnosis and appropriate treatment of dementia to begin. In order to achieve this, an easy-to-take, validated neurocognitive test with good specificity and sensitivity are essential in the assessment. The aim of this study was to evaluate the Hungarian version of Addenbrooke’s Cognitive Examination (version I., ACE)- by comparing it with the conventional Mini-Mental State Examination (MMSE)- as a new form of assessment in order to screen for early dementia among the elderly. Study Design: Descriptive cross-sectional. Place and Duration of Study: This study is a part of a larger research, conducted among voluntary elderly from the city of Pécs (Hungary) between January 2016 and December 2018. Methodology: The study refers to 66 patients with mild neurocognitive disorder (NCD), 51 patients with major NCD, and 133 healthy participants. The Diagnostic and Statistical Manual of Mental Disorders (version 5.) criteria were used for the diagnosis of dementia. Statistical analysis was performed using the receiver operator characteristics method. Results: The optimal cut-off score for the ACE-I for detecting mild NCD was 82, with a sensitivity of 89% and a specificity of 96%. The optimal cut-off for the ACE for identifying major NCD was 76 with sensitivity of 98% and a specificity of 98%. Conclusion: We concluded that the Hungarian version of the ACE is an accurate test for the detection of NCD, and could be adopted in various clinical practices.