Daniel R. Seichepine

Profile of self-reported problems with executive functioning in college and professional football players.

Repetitive mild traumatic brain injury (mTBI), such as that experienced by contact-sport athletes, has been associated with the development of chronic traumatic encephalopathy (CTE). Executive dysfunction is believed to be among the earliest symptoms of CTE, with these symptoms presenting in the fourth or fifth decade of life. The present study used a well-validated self-report measure to study executive functioning in football players, compared to healthy adults. Sixty-four college and professional football players were administered the Behavior Rating Inventory of Executive Function, adult version (BRIEF-A) to evaluate nine areas of executive functioning. Scores on the BRIEF-A were compared to published age-corrected normative scores for healthy adults Relative to healthy adults, the football players indicated significantly more problems overall and on seven of the nine clinical scales, including Inhibit, Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, and Task Monitor. These symptoms were greater in athletes 40 and older, relative to younger players. In sum, football players reported more-frequent problems with executive functioning and these symptoms may develop or worsen in the fifth decade of life. The findings are in accord with a growing body of evidence that participation in football is associated with the development of cognitive changes and dementia as observed in CTE.

Relation of Parkinson's Disease Subtypes to Visual Activities of Daily Living

Visual perceptual problems are common in Parkinsons disease (PD) and often affect activities of daily living (ADLs). PD patients with non-tremor symptoms at disease onset (i.e., rigidity, bradykinesia, gait disturbance or postural instability) have more diffuse neurobiological abnormalities and report worse non-motor symptoms and functional changes than patients whose initial symptom is tremor, but the relation of motor symptom subtype to perceptual deficits remains unstudied. We assessed visual ADLs with the Visual Activities Questionnaire in 25 non-demented patients with PD, 13 with tremor as the initial symptom and 12 with an initial symptom other than tremor, as well as in 23 healthy control participants (NC). As expected, the non-tremor patients, but not the tremor patients, reported more impairment in visual ADLs than the NC group, including in light/dark adaptation, acuity/spatial vision, depth perception, peripheral vision and visual processing speed. Non-tremor patients were significantly worse than tremor patients overall and on light/dark adaptation and depth perception. Environmental enhancements especially targeted to patients with the non-tremor PD subtype may help to ameliorate their functional disability.

White matter hyperintensity and cognitive functioning in the racial and ethnic minority cohort of the Framingham Heart Study.

Background: Previous studies have demonstrated an association between white matter hyperintensities (WMH) and cognitive performance primarily in Caucasian samples, limiting generalizability to other ethnic and racial groups. This study investigated the association of WMH and cognition in an ethnic and racial minority cohort (Omni) of the Framingham Heart Study and compared these results to the Caucasian (Offspring) cohort. Methods: Quantitative brain MRI and neuropsychological evaluations were performed on stroke- and dementia-free participants. Cognitive assessment included verbal memory, visuospatial memory and organization, language, and executive functioning. Linear regression models were conducted to assess the association between WMH and cognitive function. Results: The Omni group presented with demographic factors that significantly differed from those of the Offspring group: they were younger, but had more stroke risk factors such as hypertension. In the Offspring group, WMH volume was significantly associated with poorer performance on tests of executive function and visual organization. No significant associations between WMH and cognitive measures were found in the Omni group, but no differences (significant interaction terms) were seen between the regression coefficients. Conclusions: The Omni cohort had greater variability in factors that may mediate the association of WMH and cognition. More research is needed to investigate how stroke risk factors impact on the occurrence of WMH and its association with cognition in more diverse cohorts.

Side and Type of Initial Motor Symptom Influences Visuospatial Functioning in Parkinson's Disease

BACKGROUND/OBJECTIVES Visuospatial problems are common in Parkinsons disease (PD) and likely stem from dysfunction in dopaminergic pathways and consequent disruption of cortical functioning. Characterizing the motor symptoms at disease onset provides a method of observing how dysfunction in these pathways influences visuospatial cognition. We examined two types of motor characteristics: Body side (left or right) and type of initial symptom (tremor or symptom other than tremor). METHODS 31 non-demented patients with PD, 16 with left-side onset (LPD) and 15 with right-side onset (RPD), as well as 17 healthy control participants (HC). The PD group was also divided by type of initial motor symptom, 15 having tremor as the initial symptom and 16 having an initial symptom other than tremor. Visuospatial function was assessed with the Clock Drawing Test. RESULTS Of the four Clock Drawing scoring methods used, the Rouleau method showed sensitivity to subgroup differences. As predicted, the LPD and non-tremor subgroups, but not the other subgroups, performed more poorly than the HC group. CONCLUSION The findings provide further evidence for differences in cognition between these subtypes of PD and highlight the importance of considering disease subtypes when examining cognition.

Lifetime Multiple Mild Traumatic Brain Injuries Are Associated with Cognitive and Mood Symptoms in Young Healthy College Students

Background/objectives Repetitive mild traumatic brain injury (mTBI, also known as concussion) has been associated with a range of long-term mood and cognitive deficits, including executive dysfunction. Previous research in athletes suggests that cognitive and mood problems are associated with a history of repetitive mTBI. However, to date, no studies have examined the impact of a lifetime accumulation of repetitive mTBIs on cognition, particularly executive functioning, and mood in a sample of young adults who were not athletes. Therefore, the present study looked at potential effects of repetitive mTBIs on self-reported cognitive complaints, executive functioning, and mood in young adults. Methods Eighty-four total students responded, and 26 of those were excluded from analyses due to reporting only 1 mTBI. The final sample consisted of 58 healthy young adults (mean age = 22.84, STD = 4.88) who completed the Cognitive Complaint Index (CCI), the Behavior Rating Inventory of Executive Function, adult version (BRIEF-A), and the Beck Depression Inventory, second edition (BDI-II). Twenty-nine participants denied having an mTBI history, and 29 reported 2 or more lifetime mTBIs (range 2–7). Results Young otherwise healthy adults with a lifetime history of repetitive mTBI compared to those that reported no history of mTBI reported more change in cognitive functioning over the past 5 years, worse executive functioning, and more symptoms of depression. As the number of lifetime mTBIs increased, scores on the CCI, BRIEF-A, and BDI-II also increased, indicating worse functioning. Conclusion These findings suggest that a lifetime accumulation of two or more mTBIs as compared to a history of no reported mTBIs may result in worse cognitive functioning and symptoms of depression in young adults.

Luminance affects age-related deficits in object detection: Implications for computerized psychological assessments.

As psychological instruments are converted for administration on computers, differences in luminance and contrast of these displays may affect performance. Specifically, high-luminance assessments may mask age-group differences that are apparent under lower luminance conditions. We examined the effects of luminance and contrast on object detection using computerized and naturalistic assessments. Younger and older adults displayed more differences in performance across differing contrast levels in conditions that were matched for luminance, despite the conditions appearing perceptually different. These findings indicate that computerized assessments should be created with luminance levels that are similar to those of the tasks they purport to simulate in order to enhance their validity.

Office-Based Assessment of At-Risk Driving in Older Adults With and Without Cognitive Impairment.

Background: A multitest approach is optimal for the identification of at-risk driving among older adults. This study examined the predictive validity of a combination of office-based screening tests for on-road driving performance in older adults with and without mild cognitive impairment (MCI)/dementia. Methods: Forty-four normal control, 20 participants with MCI, and 20 participants with dementia completed a battery of office-based assessments. On-road driving evaluation classified participants as not at-risk (n = 65) or at-risk drivers (n = 19). Results: Logistic regression revealed age and 2 tests of visual attention abilities (Useful Field of View [UFOV] Divided Attention and Neuropsychological Assessment Battery [NAB] Driving Scenes) best predicted at-risk drivers (C statistic = 0.90); no cutoff score had both sensitivity and specificity >80%. Conclusions: Future research on larger and more clinically representative neurological samples will improve understanding of the utility of the UFOV Divided Attention and NAB Driving Scenes in detecting at-risk older adult drivers in the clinic.

Multiple Mild Traumatic Brain Injuries Are Associated with Increased Rates of Health Symptoms and Gulf War Illness in a Cohort of 1990–1991 Gulf War Veterans

Recent research demonstrated a relation between traumatic brain injury (TBI), health symptoms and diagnosis of Gulf War Illness (GWI) in Gulf War Veterans, but no study has examined the impact of multiple mild TBIs (mTBIs). A total of 229 male Gulf War Veterans from the Ft Devens Cohort were categorized by a number of mTBIs reported. One-way ANOVA and chi-square test of independence were used to test for differences in total reported health symptoms and diagnosis of chronic multisymptom illness (CMI) or Kansas GWI criteria, two of the most common case definitions of GWI. A total of 72 veterans reported no mTBIs (31.4%), 26 reported one mTBI (11.4%), 25 reported two mTBIs (10.9%), and 106 veterans reported sustaining three or more mTBIs (46.3%). Veterans reporting two or more mTBIs (p < 0.01) or three or more mTBIs (p < 0.001) endorsed significantly higher rates of health symptoms than Veterans reporting no mTBIs. Significantly higher rates of CMI (p = 0.035) and Kansas GWI criteria (p < 0.001) were seen in the three or more mTBI group. Results suggest two mTBIs increase risk of health symptoms, but three mTBIs may be the threshold needed to sustain chronic symptom reporting needed for a formal diagnosis. These findings highlight the importance of implementing policies and procedures monitoring head injuries in military personnel.

Office-based assessment of driving safety in older drivers with and without dementia

low clinical utility. Yet, as early detection becomes more reliable, this justification will not hold and the challenges of early detection will have to be confronted directly. One feature of this landscape is the variation in circumstances that could substantially alter the impact of disclosure. It is essential that policy be devised to address vulnerabilities created by circumstances that could also lead to various forms of disparate impact. Methods: This work explores the nature of vulnerability that arises from variation in circumstance, identifying overlap with genetic testing vulnerability and other relevant disease indicator-status disclosures. Employing legal and policy analysis of relevant protective law and regulation, this work develops a point plan for policy development for disclosure of pre-clinical Alzheimer’s. Results: Development of policy and law regarding just integration of disclosure of pre-clinical Alzheimer’s should not rely entirely on existing legislative and regulatory approaches. Rather the nature of vulnerabilities exposed by pre-clinical AD diagnosis is such that it requires consideration of aspects not addressed sufficiently or in the same way as may be found in other types of disease indicator-status protection legislation (e.g. GINA).While there is substantial overlap in rights, less overlap may be found as regards duties and obligations, and hence the attendant rights.Conclusions: The implications of realization of reliable detection of pre-clinical Alzheimer’s disease should not be underestimated. Introduction of early detection technology into clinical practice requires consideration of implications for a diverse society. This work addresses the aspect of differential impact and vulnerability due to variation in circumstances, and offers suggestions for policy and legal approaches to accommodate variation in circumstances in disclosure of preclinical Alzheimer’s disease.

P1-431: Altered semantic processing in healthy older adults at risk for Alzheimer’s disease

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