Frank M. Webbe

Status of computerized cognitive testing in aging: A systematic review

Early detection of cognitive decline in the elderly has become of heightened importance in parallel with the recent advances in therapeutics. Computerized assessment might be uniquely suited to early detection of changes in cognition in the elderly. We present here a systematic review of the status of computer‐based cognitive testing, focusing on detection of cognitive decline in the aging population.

Short-term and long-term outcome of athletic closed head injuries

The continued development of the sport environment as a laboratory for clinical investigation of mild head injury has greatly advanced the use of neuropsychological assessment in evaluating brain-injured athletes, and tracking their symptoms and recovery in an objective manner. The use of neurocognitive baseline measures has become critical in determining whether a brain-injured athlete has recovered function sufficiently to return to play. The rapid growth of computerized and web-based neurocognitive assessment measures provides an efficient, valid technology to put such testing within the reach of most institutions and organizations that field sport teams. Moreover, the knowledge of the recovery curve following mild head injury in the sport environment can be generalized to the management of MTBI in general clinical environments where baseline measures are unlikely. What we know today is that sideline assessments of severity are not predictive of which athletes will show the most typical 5- to 10-day recovery period and which will report persistent PCS complaints and exhibit impaired neurocognitive performance for an extended time. The research on mechanisms of brain injury in MTBI suggests that unpredictable, diffuse white-matter damage may control much of the variability in functional impairments and recovery duration.

Recency and Frequency of Soccer Heading Interact to Decrease Neurocognitive Performance

This study investigated the role of heading recency interacting with heading frequency in determining neuropsychological deficits associated with heading the ball during soccer play. Sixty-four high-ability male soccer players ages 16 to 34 completed the California Verbal Learning Test (CVLT), the Trailmaking Test, the Paced Auditory Serial Addition Test (PASAT), the Facial Recognition Test, the Rey-Osterrieth Complex Figure, and the Shipley Scales. Heading recency interacted with heading frequency, such that players with the highest self-reported estimates of heading who also experienced heading within the previous 7 days scored significantly lower on CVLT, Shipley, Trailmaking, and PASAT than other combinations of heading and recency. Although strict ball-to-head contacts could not be isolated as sufficient to cause this interaction, these results increase the weight of evidence that heading behavior is problematic for causing at least transient cognitive impairment.

Normative Values of Major SCAT2 and SCAT3 Components for a College Athlete Population

The Sports Concussion Assessment Tool-2 (SCAT2) is a posttrauma evaluative screener for concussion. Although a revised version (SCAT3) recently was released, the SCAT2 continues in use. Moreover, there have been no reports of normative values with college athletes with the SCAT2 or SCAT3. Similar to the SCAT3, the SCAT2 includes a 22-item self-report symptom scale, the Standardized Assessment of Concussion (SAC), and a hard surface-only version of the Balance Error Scoring System (BESS). The SCAT3 does not employ a total score and adds an optional gait component. The purpose of this study was to develop normative values for collegiate athletes on the SCAT2 and its subparts with respect to sex, collision risk by sport, and concussion history. In preseason, 477 college athletes (332 male, 145 female) completed the SCAT2. The average total score was 91.08 (SD = 5.60). The average number of symptoms endorsed was 1.75. Average SAC and BESS scores were 27.17 (SD = 2.01) and 25.64 (SD = 4.07), respectively. Little or no difference was found in total and component scores due to sex, sport type, or concussion history. When baseline measurement is lacking, these data provide a good benchmark for interpreting SCAT2 and SCAT3 performance.

Sport and team differences on baseline measures of sport-related concussion

CONTEXT With the advent of the National Collegiate Athletic Associations (NCAAs) mandating the presence and practice of concussion-management plans in collegiate athletic programs, institutions will consider potential approaches for concussion management, including both baseline and normative comparison approaches. OBJECTIVE To examine sport and team differences in baseline performance on a computer-based neurocognitive measure and 2 standard sideline measures of cognition and balance and to determine the potential effect of premorbid factors sex and height on baseline performance. DESIGN Cross-sectional study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 437 NCAA Division II student-athletes (males = 273, females = 164; age = 19.61 ± 1.64 years, height = 69.89 ± 4.04 inches [177.52 ± 10.26 cm]) were recruited during mandatory preseason testing conducted in a concussion-management program. MAIN OUTCOME MEASURE(S) The computerized Concussion Resolution Index (CRI), the Standardized Assessment of Concussion (Form A; SAC), and the Balance Error Scoring System (BESS). RESULTS Players on the mens basketball team tended to perform worse on the baseline measures, whereas soccer players tended to perform better. We found a difference in total BESS scores between these sports (P = .002). We saw a difference between sports on the hard-surface portion of the BESS (F6,347 = 3.33, P = .003, ηp(2) = 0.05). No sport, team, or sex differences were found with SAC scores (P > .05). We noted differences between sports and teams in the CRI indices, with basketball, particularly the mens team, performing worse than soccer (P < .001) and softball/baseball (P = .03). When sex and height were considered as possible sources of variation in BESS and CRI team or sport differences, height was a covariate for the team (F1,385 = 5.109, P = .02, ηp(2) = 0.013) and sport (F1,326 = 11.212, P = .001, ηp(2) = 0.033) analyses, but the interaction of sex and sport on CRI indices was not significant in any test (P > .05). CONCLUSIONS Given that differences in neurocognitive functioning and performance among sports and teams exist, the comparison of posttraumatic and baseline assessment may lead to more accurate diagnoses of concussion and safer return-to-participation decision making than the use of normative comparisons.

Designing for Older Adult Users of Handheld Technology

There are few interface design guidelines for handheld devices used by adults sixty years and older. Yet, this growing user group would benefit from the portability offered by such technology in promoting health management and social interaction. In this paper, we describe a usability framework for conducting studies on the use of a PocketPC by older adult caregivers. The usability framework provides a basis for conducting studies taking into account the user profile of an older adult, environment factors, usability quality factors, and technology objectives

Enhancing Cognitive Screening in Geriatric Care: Use of an Internet-Based System

Cognitive screening measures for age-related cognitive impairment have been found to have only fair validity, and the risks of harm even may outweigh the benefits at this time (U.S. Preventative Service Task Force, 2003). A large-scale project designed to assess elder care in Primary Care Physician offices noted that dementia evaluation and treatment was one of the most overlooked aspects of care. Taken together, these studies cited the lack of time and technical expertise in test administration as the most prominent barriers to the accurate detection of dementia in Primary Care Physician offices. It was for these reasons that the Cognitive Screening Test (CST) was created. The CST requires no physician time or training to administer or interpret it. The current study investigated the clinical utility of this cognitive screening system by comparing the results of 102 patients to those of expert geriatricians, using consensus conference methods for diagnosis. Overall clinical utility demonstrated scores at .80 or above for sensitivity, specificity, and positive and negative predictive power. In contrast, the MMSE had only a .38 sensitivity. A Receiver Operating Curve (ROC) analysis indicated a .863 accuracy rating for the predetermined cut score on the CST.

Attention-Deficit Hyperactivity Disorder Status and Baseline Neurocognitive Performance in High School Athletes

Approximately 136,000 concussions occur annually in American high school sports. Neuropsychological data indicate that children with preexisting cognitive difficulties, such as attention-deficit hyperactivity disorder (ADHD), may have protracted recovery from concussion. ADHD, with an estimated prevalence of 11% in youth, may increase an athletes vulnerability to sustaining sports-related traumatic brain injury (TBI). The preponderance of evidence focusing on TBI and ADHD has derived from motor vehicle accidents rather than sports-related incidents. Thus, it is paramount to explore how ADHD may relate to injury in the sports concussion context, as well as to assess how ADHD may affect baseline neurocognitive testing. Adolescent athletes with ADHD (n = 256) demonstrated significantly reduced Verbal Memory, Visual Motor, and Impulse Control index scores compared with their peers without ADHD (n = 256). Athletes with ADHD were nearly twice as likely to have sustained a prior concussion (ADHD, 14.1%; non-ADHD, 7.8%). Knowledge regarding the unique neurocognitive profile of athletes with ADHD may enhance clinical management decisions.

The role of executive functioning in quality of life in pediatric intractable epilepsy

OBJECTIVE Children with epilepsy are vulnerable to executive dysfunction, but the relationship between executive functioning (EF) and quality of life (QOL) in children with epilepsy is not fully delineated. This exploratory study elucidated the relationship between ecological EF and QOL in pediatric intractable epilepsy. METHOD Fifty-four consecutively referred pediatric epilepsy surgery candidates and their parents were administered IQ measures, the Behavior Rating Inventory of Executive Function (BRIEF), and the Quality of Life in Childhood Epilepsy (QOLCE) as part of a comprehensive neuropsychological evaluation. RESULTS A significant difference was found in QOL between those with and without clinical impairments on the BRIEF [t(52)=3.93; p<.001]. That is, children with executive dysfunction had lower overall QOL. All seizure variables and BRIEF scales were associated with overall QOL [F(12, 40)=6.508; p=.001; R2=.661]. Working memory from the BRIEF was the most frequently elevated scale in our sample (57%). Those with executive dysfunction had 9.7 times the risk of having poor QOL. CONCLUSIONS Poor EF control according to behavior ratings is significantly related to QOL in intractable pediatric epilepsy. Identification of executive dysfunction in home environments is an essential component of presurgical evaluations and target for intervention, which may improve QOL.

History of neuropsychological study of sport-related concussion

Abstract Although the medical literature has a long history of description and comment on concussion, the occurrence of concussion within the context of sports other than boxing was not judged to be problematic until the 1980s. Neuropsychological assessment played a critical and integral role in identifying the cognitive sequelae of concussion and mapping out the short- and long-term vagaries in recovery. This paper captures that history and expands upon current applications of neuropsychological assessment in the diagnosis and management of sport-related concussion.