Effects of Cumulative Years of Contact/Collision Sports on Neuropsychological Outcomes

ObjectiveTo determine the relationship between prolonged exposure to repetitive head impacts (RHI) through contact sports, as assessed by cumulative years contact sport participation, and quality of life outcomes in current/former contact sport athletes.BackgroundCumulative lifetime RHI exposure may be a more meaningful measure than age of first exposure to contact sports to assess effects of RHI on neurologic function, however effects on young adults remain mixed.Design/MethodsTwenty-one physically active current/former contact sport athletes (35.0 ± 12.2 years, 66.7% male) completed an online questionnaire. To assess quality of life and psychological status, participants completed the Apathy Evaluation Scale-Self Rated (AES-S), Short Form 12 (SF-12), Satisfaction with Life Survey (SWLS), and Sport Concussion Assessment Tool 5 (SCAT5) Symptoms. Participants self-reported years of organized contact sport history (16.9 ± 10.5 years, range: 1–45) along with covariates (sex, LD/ADHD, age, concussion history). Generalized linear models were used to examine the association between cumulative years contact sport and psychological outcomes, while controlling for covariates.ResultsCumulative years contact sports was a significant positive predictor of better apathy ratings (p = 0.038) and SWLS (p = 0.001). For every year increase, there was an associated 1.1% reduction in AES-S and 1.6% improvement in SWLS. Cumulative years was not a significant predictor of SF-12 Mental Component Summary (p = 0.113), SF-12 Physical Component Summary (p = 0.289), or symptoms (p = 0.237).ConclusionsCumulative years of contact sport history was associated with better patient reported outcomes in current/former contact/collision sport athletes. This provides insight into later life effects of prolonged RHI exposure on neuropsychological outcomes in a more diverse subject pool outside of retired football players. Long-term neurologic effects remain to be elucidated, however, in early adulthood collision sports have positive mental health outcomes.

A state-space approach for longitudinal outcomes: An application to neuropsychological outcomes

Longitudinal assessments are crucial in evaluating the disease state and trajectory in patients with neurodegenerative diseases. Neuropsychological outcomes measured over time often have a non-linear trajectory with autocorrelated residuals and a skewed distribution. We propose the adjusted local linear trend model, an extended state-space model in lieu of the commonly used linear mixed-effects model in modeling longitudinal neuropsychological outcomes. Our contributed model has the capability to utilize information from the stochasticity of the data while accounting for subject-specific trajectories with the inclusion of covariates and unequally spaced time intervals. The first step of model fitting involves a likelihood maximization step to estimate the unknown variances in the model before parsing these values into the Kalman filter and Kalman smoother recursive algorithms. Results from simulation studies showed that the adjusted local linear trend model is able to attain lower bias, lower standard errors, and high power, particularly in short longitudinal studies with equally spaced time intervals, as compared to the linear mixed-effects model. The adjusted local linear trend model also outperforms the linear mixed-effects model when data is missing completely at random, missing at random, and, in certain cases, even in data with missing not at random.

Long-Term Neuropsychological Outcomes Following Temporal Lobe Epilepsy Surgery: An Update of the Literature

We present an update of the literature concerning long-term neuropsychological outcomes following surgery for refractory temporal lobe epilepsy (TLE). A thorough search was conducted through the PubMed and Medline electronic databases for studies investigating neuropsychological function in adult patients undergoing resective TLE surgery and followed for a mean/median > five years period. Two independent reviewers screened citations for eligibility and assessed relevant studies for the risk of bias. We found eleven studies fulfilling the above requirements. Cognitive function remained stable through long-term follow up despite immediate post-surgery decline; a negative relation between seizure control and memory impairment has emerged and a possible role of more selective surgery procedures is highlighted.

Delirium and neuropsychological outcomes in critically Ill patients with COVID-19: a cohort study

ObjectiveTo characterise the clinical course of delirium for patients with COVID-19 in the intensive care unit, including postdischarge neuropsychological outcomes.DesignRetrospective chart review and prospective survey study.SettingIntensive care units, large academic tertiary-care centre (USA).ParticipantsPatients (n=148) with COVID-19 admitted to an intensive care unit at Michigan Medicine between 1 March 2020 and 31 May 2020 were eligible for inclusion.Primary and secondary outcome measuresDelirium was the primary outcome, assessed via validated chart review method. Secondary outcomes included measures related to delirium, such as delirium duration, antipsychotic use, length of hospital and intensive care unit stay, inflammatory markers and final disposition. Neuroimaging data were also collected. Finally, a telephone survey was conducted between 1 and 2 months after discharge to determine neuropsychological function via the following tests: Family Confusion Assessment Method, Short Blessed Test, Patient-Reported Outcomes Measurement Information System Cognitive Abilities 4a and Patient-Health Questionnaire-9.ResultsDelirium was identified in 108/148 (73%) patients, with median (IQR) duration lasting 10 (4–17) days. In the delirium cohort, 50% (54/108) of patients were African American and delirious patients were more likely to be female (76/108, 70%) (absolute standardised differences >0.30). Sedation regimens, inflammation, delirium prevention protocol deviations and hypoxic-ischaemic injury were likely contributing factors, and the most common disposition for delirious patients was a skilled care facility (41/108, 38%). Among patients who were delirious during hospitalisation, 4/17 (24%) later screened positive for delirium at home based on caretaker assessment, 5/22 (23%) demonstrated signs of questionable cognitive impairment or cognitive impairment consistent with dementia and 3/25 (12%) screened positive for depression within 2 months after discharge.ConclusionPatients with COVID-19 commonly experience a prolonged course of delirium in the intensive care unit, likely with multiple contributing factors. Furthermore, neuropsychological impairment may persist after discharge.