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Objective Culturally and linguistically appropriate neuropsychological assessments for the large number of primary Spanish speakers in the United States remain imperative to serve the needs of this underserved population. As part of a larger co-norming project, we generated demographically adjusted norms for the Brief Visuospatial Memory Test-revised (BVMT-R) and the Hopkins Verbal Learning Test-revised (HVLT-R) for use with native Spanish speakers from the U.S.-Mexico border regions. Participants and Method Participants were 202 healthy native Spanish speakers recruited in San Diego, CA and Tucson, AZ, ages 19 to 60, with education ranging from 0-20 years, and 59% women. Test stimuli for the HVLT-R and instructions for both tests were adapted into Spanish by a team of native Spanish speakers from multiple countries using standard procedures (Cherner et al. 2007). Raw scores for the various learning and delayed recall outcomes were converted to T-scores using fractional polynomial equations accounting for effects of education, age, and sex. We then computed the rates of impairment that would be obtained when applying the original published norms for these two tests, and compared these results to the expected rate of impairment of -1SD (around 16%) derived from the normal distribution of T-scores in our new, demographically corrected norms. Results Results showed significant overestimation of impairment when applying the original norms for non-Hispanic English speakers to our Spanish-speaking sample, ranging from 35-38% for HVLT-R and 25-26% for BVMTR. As expected, these overestimations of impairment were greater for individuals with lower education, but our demographically corrected norms reduced the rate of impairment for all levels of education. Conclusions These findings highlight the urgent need to account for demographic effects on neuropsychological performance in order to improve the diagnostic accuracy of our measures when applied to US-dwelling Spanish speakers. References Cherner, M. Suarez, P. Lazzaretto, D. Fortuny, L. A. I. Mindt, M. R. Dawes, S.... & HNRC group. (2007). Demographically corrected norms for the Brief Visuospatial Memory Test-revised and Hopkins Verbal Learning Test-revised in monolingual Spanish speakers from the US–Mexico border region.  Archives of Clinical Neuropsychology ,  22 (3), 343-353. [ABSTRACT FROM AUTHOR]

Objective Soroxchi/Acute Mountain Sickness (AMS) is a condition that can result in cerebral and pulmonary hypoxia. Neuropsychological research on AMS is minimal and the long-term effects on cognition and behavior are unclear. AMS is associated with cognitive impairments in processing speed, attention, and executive functions as well as neurobehavioral symptoms. This case study delineates the neuropsychological and neurobehavioral changes secondary to bilateral globus pallidus (GP) lesions associated with AMS. Case Description Patient is a 51-year old, primarily Spanish-speaking, male of Mexican descent with 9 years of education, and who had traveled to La Paz, Bolivia (4,070 MASL) for work. Upon arrival, fatigue and dizziness led to hospitalization to treat acute pulmonary edema and hypoxia. Brain MRI revealed hyperintense bilateral GP lesions. Medical history was notable for hyperlipidemia. Psychiatric history was unremarkable. Neuropsychological assessment 4 months post-AMS revealed impairments in visuo-conceptual and speeded complex visuospatial abilities, executive functions, and confrontation naming. Cognitive improvements were noted in delayed recall of non-contextual verbal information and confrontation naming ten months post-AMS. Significant mood and personality changes were reported; patient endorsed anhedonia, fatigue, alexithymia, avolition, and sleep difficulties. Family described patient as depressed, apathetic, and socially withdrawn. Pharmacological and psychotherapy treatments were recommended and initiated. Diagnostic Impressions and Outcomes Findings were consistent with a diagnosis of Mild Neurocognitive Disorder. His family denied neurobehavioral improvements post interventions. Discussion This case study is the first to characterize the long-term neuropsychological and neurobehavioral changes following bilateral GP lesions secondary to AMS. Declines in visual-conceptual abilities reveal a new finding for this type of cerebral incident. [ABSTRACT FROM AUTHOR]

Objective In right hemisphere cerebrovascular accident (CVA), expected deficits might include inattention syndromes, visuospatial impairment, or neglect. This case study adds to the literature by presenting neuropsychological data from a patient with a complex medical history who experienced two right hemisphere CVAs. The aim is to demonstrate that neuropsychological deficits following CVA may not be as expected in patients with comorbidities, and to highlight the importance of neuropsychological assessment in such cases. Method The patient is a 69-year-old, right-handed, African American man who presented with reading and memory difficulties, problems recognizing faces, and vision impairment following right occipital and temporoparietal ischemic CVAs. Comprehensive neuropsychological evaluation was conducted. Formal measures were utilized, but the examiners were also required to devise appropriate bedside measures. Results The patient had difficulty recognizing his caregiver's face. He could not identify facial expressions made by examiners, but commented on individual facial features. Design copies were distorted/fragmented, and he evidenced difficulty integrating visual components into a whole. He also demonstrated spelling and verbal memory impairment (BDAE Oral Spelling raw = 0; HVLT-R recall and recognition < 1st percentile). Full results are included in a supplemental data table. Conclusions Results were strongly suggestive of simultanagnosia, though this disorder typically results from bilateral parietal-occipital lesions. Additionally, the neuropsychological impairments noted extended beyond those typical of right hemisphere CVA, likely related to the patient's history of multiple comorbidities (e.g. infectious disease, polysubstance abuse). This case highlights the importance of neuropsychological assessment in the care of medically complex patients, and the unique ability of neuropsychologists to conduct such evaluations. [ABSTRACT FROM AUTHOR]

Objective With over 37 million Spanish-speakers, the US is the second country in the world with the largest number of Spanish-speakers. Identification of neurological dysfunction via neuropsychological testing for this language group requires knowledgeable application of available tests and normative data. Accordingly, we investigated whether rates of neurocognitive impairment (NCI) varied based on the Spanish language normative method used. Method Participants included 254 healthy native Spanish-speakers (Age: M = 37.3, SD = 10.4; Education: M = 10.7, SD = 4.3; 59% Female; 78.7% of known Mexican origin/descent) living in the US-Mexico border region. Participants completed the Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test (TMT) A&B, and Animal Naming in Spanish. Raw test scores were converted to demographically-adjusted T-scores based on normative adjustments developed for this population (Neuropsychological Norms for the US-Mexico Border Region in Spanish [NP-NUMBRS]) and norms developed based on samples in Mexico (Latin American Norms from Mexico [LAN-M] and NEUROPSI). Rates of NCI (T < 40) based on the different normative methods were compared via McNemar's tests. Results Rates of NCI for NP-NUMBRS and NEUROPSI fell between the expected 15-17%. Compared to NP-NUMBRS, significantly lower rates were found when applying LAN-M for HVLT-R Total (4%) and Delayed Recall (8%), TMT-A (1%), and Animal Naming (10%; all ps <.0002). No significant differences were found for TMT-B (p >.05). Conclusions Present findings revealed that while the NP-NUMBRS and NEUROPSI norms yielded similar NCI rates, and LAN-M norms underestimated NCI on three tests. This highlights the importance of carefully considering available normative adjustments for Spanish-speakers when applying them to specific populations. [ABSTRACT FROM AUTHOR]

Objective Mayo's Older Adult Normative Studies (MOANS) have served as an important resource for clinicians for three decades. Data collection was completed prior to the development and widespread use of Mild Cognitive Impairment (MCI) as a construct. Therefore, a portion of individuals included in the MOANS normative studies likely had undetected cognitive impairment. Method The Mayo Clinic Study of Aging (MCSA) is a population-based study of cognitive aging among Olmsted County, Minnesota, residents that began in October 2004. We applied age-adjusted MOANS norms (Ivnik et al. 1992) for the Auditory Verbal Learning Test (AVLT) long delay recall to cognitively unimpaired participants age 56 or older in the MCSA (N = 3,603). We used 1-sample tests of proportions comparing observed impairment rates to impairment rates expected based on a normal distribution of performance. Results Results showed that a significantly lower than expected number of participants demonstrated impaired delayed recall based on MOANS norms (all p's <.001). Using a lenient cut-off (< -1 SD), only 7.3% of participants demonstrated impaired performance (vs. 15.9% expected), and this was more pronounced for females (3.5% impaired) relative to males (11.1% impaired). Further, only 0.6% of participants demonstrated impaired performance at a cut-off of < -2 SD, and no participants aged 80-91 reached this cut-off (2.3% expected). Conclusions Results suggest that the sensitivity of the original MOANS norms is lowered by likely inclusion of individuals with MCI, particularly in females. Updated normative data for the AVLT that exclude individuals with MCI and adjust for sex are needed. [ABSTRACT FROM AUTHOR]

Objective To validate a fully automated scoring algorithm for the Rey-Osterrieth Complex Figure Test (ROCFT) by comparing the scoring results of the algorithm to the results of human raters. Method The algorithm consisted of a cascade of deep neural networks which were trained on human rater scores to extract the 18 segments of the figure, and to quantify the patient's performance. Algorithm results were compared to six expert raters for 303 drawings. We tested whether the average correlation between algorithm scores and scores by all human raters was equivalent to the average inter-rater correlation (with equality bound Δr <.05). The immediate and delayed recall trial were used; the copy trial showed a strong ceiling effect. Results The mean Pearson correlation between raters was.94 (SD = 0.01). The correlation between to algorithm and the raters was.88 (SD = 0.02). A two-one-sided t-tests (TOST) equivalence test showed that these correlations were not strictly equivalent, t(5) = 4.02, p =.995, 95% CI [0.35, 0.52]. Conclusions Although not strictly equivalent to human ratings, the algorithm's performance is high, approaching a level of reliability found among human raters. We expect that improved individual segment detection will bring the algorithm scoring accuracy on par with that of human raters. Algorithmic scoring of the ROCFT will likely save valuable time and lead to higher levels of standardization in clinical practice. [ABSTRACT FROM AUTHOR]

Objective Fergenbaum et al. 2009 found that obesity was linked to increased cognitive issues in otherwise healthy individuals, while another study found obesity to be neuroprotective in a sample of dementia patients (Fitzpatrick et al. 2009). The present study explores whether obesity is associated with worse cognitive dysfunction in those with Multiple Sclerosis (MS). Method This study examined archival neuropsychological test data of 40 patients diagnosed with MS. Participants were separated into two groups based on their BMI: healthy/overweight individuals and obese/morbidly obese. ANOVA was performed to compare performances between groups on tasks measuring learning and memory, processing speed, and executive functioning; areas commonly affected in MS. Results Significant differences between groups were noted on only portions of two different tests; unstructured verbal learning (p =.003) and mental sequencing (p =.048), but no differences were found in other tasks. Particularly, performance was statistically equal between groups on measures of response inhibition (p =.887), visual processing speed (p =.182), visuospatial learning (p =.118), visuospatial free recall (p =.205), simple auditory attention (p =.630), working memory (p =.223), psychomotor speed (p =.969), and complex divided attention (p =.202). Conclusion Obese patients with MS scored significantly better on the majority of tasks that we reviewed. These results seem to contradict a study that examined healthy subjects but seems to replicate findings in at least one clinical population; those with dementia. It is possible that increased BMI in clinical populations may indicate better overall health leading to better cognition, though if it is actually neuroprotective and only limited to MS and dementia is uncertain. Future research endeavors are discussed. [ABSTRACT FROM AUTHOR]

Objective Explore neuropsychological and quality of life outcomes of epilepsy surgery in an underserved, primarily immigrant, Spanish-speaking cohort of people with epilepsy (PWE). Methods Pre- and postsurgical Neuropsychological Screening Battery for Hispanics (NeSBHIS) and Quality of Life in Epilepsy-31 (QOLIE-31; Spanish Version) results were compared for 22 adult Latinos (females = 50%), from Mexico (81.8%), El Salvador (9.1%) and Guatemala (9.1%). All participants were part of a comprehensive epilepsy center in Los Angeles. Mean surgical age was 33.5 years (SD = 8.5), while mean education was 8.7 years (SD = 3.1). Seizures were exclusively lateralized to right (59.1%) and left hemispheres (40.9%). Results One-tailed, paired t-tests demonstrated statistically significant differences between pre- and postsurgical raw scores for Digit Span, t(21) = -2.52, p = 0.02 (presurgical M = 8.05, SD = 1.70; postsurgical M = 7.32, SD = 1.43), and the Auditory Verbal Learning Test (AVLT) Delayed Recall, t(21) = -2.99, p < 0.01 (presurgical M=10.00, SD=2.51; postsurgical M = 8.55 SD = 2.61). Respective effect sizes were moderate (d =.54; d =.64). QOLIE-31 scores improved on all subscales, as expected. Significant changes |p < 0.05| were found on most QOLIE-31 subscales, i.e. Seizure Worry, Emotional Well-Being, Social Function and Overall Quality of Life. Remaining subscales did not significantly improve, i.e. Energy/Fatigue, Cognitive and Medication Effects. Conclusions Attention and verbal memory declines after epilepsy surgery were associated with limited improvements on QOLIE-31 subscales of Cognitive, Energy/Fatigue and Medication Effects in Latino PWE. Previous studies have not simultaneously examined neuropsychological and QOLIE-31 outcomes after epilepsy surgery in this unique, underserved, Spanish-speaking population. Further investigation is warranted. [ABSTRACT FROM AUTHOR]

Objective Despite potential for dependence and adverse neurological effects, long-term benzodiazepine (BDZ) use is common among persons living with HIV (PLWH). As PLWH are at risk for CNS dysfunction, we retrospectively examined the association between BDZ use and HIV-associated neurocognitive disorders (HAND). Methods 306 PLWH (mean age = 45.1 years) underwent comprehensive neurobehavioral evaluations. Current BDZ use (BDZ+) was determined via self-report. Using propensity scores, 153 BDZ- individuals were matched to 153 BDZ+ participants on demographics, HIV disease characteristics, and comorbidities. Multiple regression models examined HAND and demographically-adjusted neurocognitive T-scores as a function of BDZ group, adjusting for estimated premorbid ability, current affective symptoms, and nadir CD4 count. Secondary analyses explored neurocognitive correlates of positive BDZ urine toxicology screens (TOX+). Results Median BDZ use was 24 months. Compared to BDZ-, BDZ+ had higher likelihood of HAND (OR = 2.14; p =.003) and poorer global (d = -0.33, p =.005), processing speed (d = -0.29, p =.013), and motor T-scores (d = -0.35, p = 0.003). Compared to BDZ+/TOX-, BDZ+/TOX+ users exhibited additional decrements in global (p =.033), executive function (p =.019), and delayed recall T-scores (p =.006). Conclusions BDZ use may elevate risk for HAND, potentially through diffuse neurocognitive slowing and acute compromise of recall and higher-order capacities. These effects are robust to psychosocial and HIV-specific factors and occur in comparison to a tightly-matched BDZ- group. Indications for BDZs (e.g. insomnia) may also impact neurocognition and/or manifest from latent neuropathology. Longitudinal studies should evaluate potential causal associations between HAND and BDZs. Given the extent of BDZ use and possibility of neurocognitive recovery post-abstinence, interventional studies should explore treatment alternatives to BDZs in PLWH. [ABSTRACT FROM AUTHOR]

Objective Examine whether performance on spoken language assessment measures may be associated with performance at different phases of verbal learning and recall tasks. Method The assessment records of 222 American Veterans with diverse neuropsychiatric conditions were analyzed using Exploratory Factor Analyses. There were no exclusion criteria. All participants completed the Visual Naming (VisNam), Sentence Repetition (SenRep), Controlled Word Association (COWA), and Token Tests of the Multilingual Aphasia Examination (MAE), and Benton Serial Digit Learning Test – 8 Digits (SDL8). Individual assessment instruments were factored using Principal Component Analyses (PCA). A three-factor solution of the SDL-8 was co-factored with the spoken language components of the MAE to identify common sources of variance. Results A three-factor solution of the SDL8 separated trials into three overlapping factors consisting of early (SDL8_Early), middle (SDL8_Middle), and late (SDL8_Late) trials. Co-factoring the three new scales with the verbal components of the MAE produced a five-factor model explaining 84.563% of the shared variance: 1) SDL8_Early loaded with SenRep, 2) SDL8_Middle loaded with SenRep, 3) SDL8_Late loaded with Token, 4) SDL8_Late loaded with COWA, and 5) VisNam alone formed the fifth factor. Conclusions The results suggest that rote repetition is largely associated with early trials and slightly associated with middle trials, while late trials are largely associated with auditory comprehension and slightly associated with verbal fluency. This may be indicative of a shift in use of spoken language abilities to accommodate increasing levels of complexity in presented verbal short-term memory tasks and thus reflective of a change on learning strategy to optimize performance. [ABSTRACT FROM AUTHOR]

Objective Lesions to the retrosplenial cortex secondary to acute stroke or tumor have been shown to disrupt Papez's circuit due to disconnection between the anterior thalamus and hippocampus, via the posterior cingulate, producing an amnestic syndrome. This case demonstrates how small but strategic lacunes in this region may produce memory deficits. Method The patient is a 52-year-old, right-handed, African-American woman with 18 years of education who reported memory changes over the last 8 years (e.g. misplacing items, forgetting details of conversations). Her medical history was notable for BMI of 31 and borderline diabetes. She completed structural magnetic resonance imaging 6 years prior to, and concordant with, her neuropsychological evaluation. Both scans showed two small (2-3 mm) right-sided retrosplenial lacunes, without evidence of hippocampal or global volume loss over the 6-year span. Results Her neurocognitive profile was characterized by impairments in both verbal (stories, word-list) and figural memory, with relative strengths in attention, processing speed, and executive functioning. Across memory measures, she performed in the low average-to-mildly impaired range on immediate recall, mildly-to-severely impaired range on delayed recall, and did not benefit from yes-no recognition format. She demonstrated additional features of an amnestic profile, including flat learning slope, recency effect, elevated cued recall intrusion errors, and very elevated false positive errors on recognition. Conclusions Findings expand upon the existing literature to show that chronic, small retrosplenial lacunes can disrupt the connection between the anterior thalamus and hippocampus, resulting in a clinical presentation of circumscribed memory impairment that persists years beyond acute vascular changes. [ABSTRACT FROM AUTHOR]

Objective Atypical language laterality, secondary to refractory epilepsy, presents complications to surgical planning/cognitive outcomes. Extant research shows the non-dominant hemisphere reallocates neural resources for language compensation in response to left-sided lesions (resulting in decreased visuoperceptual/visual memory). The present study examined relationships between 1) lesion location and atypical language organization and 2) lesion location/language laterality on performance on memory (California Verbal Memory Test 2nd-edition (CVLT; Delayed Recall), and visuoperceptual (Rey-Osterrieth Complex Figure Test, ROCFT; Copy) tests in relation to lesion location in a sample of patients with intractable epilepsy. Method Retrospective data was compiled on patients with refractory epilepsy undergoing interdisciplinary pre-surgical workup (N = 101), mean age of 37.2 (SD = 11.9) and mean education of 12.3 (SD = 3.7). The sample was then stratified by non-lesional (n = 48), left (n = 26), right (n = 21) or bilateral (n = 6) mesial temporal sclerosis (MTL); and, language laterality was confirmed by neuroradiologists via functional Magnetic Resonance Imaging (fMRI) scans. Results Analyses showed patients with left MTS were more likely to have atypical language organization, X2 (1, N = 47) = 6.6, p =.01. Moreover, significant differences on T-scores for CVLT, F (3,15) = 3.81, p =.04, 95% Cl [-1.73, -.08] and ROCFT, F(4,28) = 2.85, p =.046 95% Cl [31.62, 46.17] were found between groups stratified by lesion location/language laterality, respectively. Conclusions Organization of language in epileptic populations presents atypically in conjunction with left-sided lesions. Additionally, cognitive processes such as verbal memory and visuoperceptual abilities suffer based on lesion presence/location and language laterality in this fMRI confirmed sample. [ABSTRACT FROM AUTHOR]

Objective Poorer sleep quality is related to worse cognitive functioning in the general population and people living with HIV; however, many studies use self-report sleep questionnaires that rely on retrospective recall. This study aimed to examine the relationship between objective (wrist actigraphy) and subjective sleep quality with neurocognitive functioning. Method Eighty-five adults aged 50-74 years with and without HIV (HIV+ n = 53, HIV- n = 32) were recruited from the community and ongoing studies at UC San Diego. Participants completed comprehensive neuropsychological testing assessing global and domain-specific cognition. Participants wore actigraphy watches for 14 nights after neuropsychological testing to objectively assess sleep quality (i.e. total sleep time (TST), efficiency, wake after sleep onset, and sleep fragmentation). The Pittsburgh Sleep Quality Index assessed subjective sleep quality. Results After adjusting for demographic variables and use of sleep medications, there were no differences in any sleep quality measures by HIV status (p's>0.05). In separate adjusted linear regression models, lower sleep efficiency (p = 0.02; 95% CI: -9.5, -1.1) and greater sleep fragmentation (p = 0.02; 95% CI: -0.82, -0.09) were associated with worse learning. Less TST was associated with worse working memory (p = 0.02; 95% CI: -9.2, -0.8). In contrast, worse subjective sleep quality was associated with worse executive function (p < 0.01; 95% CI: -1.18, -0.23) and working memory (p = 0.03; 95% CI: -1.22, -0.07). Conclusion Both objective and subjective sleep quality were associated with cognition in both persons with and without HIV; however, subjective and objective sleep quality were associated with different cognitive domains. Therefore, both objective and subjective sleep quality are important health behaviors to assess. [ABSTRACT FROM AUTHOR]

There is a high rate of medical and psychiatric comorbidities in the HIV population (Kilbourne et al, 2001), many of which complicate the clinical picture, especially with respect to cognitive functioning (Milanini & Valcour, 2017). It is important to be aware of the impact multiple disorders can have on formulating impressions and treatment planning. We reviewed the records of 35 consecutive patients with HIV seen in our neuropsychology clinic in a county hospital. The 30 men and 5 women had a mean age of 49 (SD = 13.7), with mean education of 13.5 years (SD = 2.0). Average age of HIV diagnosis was 33 (SD = 9.3). Patients had an average of eight major comorbid medical and psychiatric diagnoses, including ADHD (45%), mood disorders (62%), developmental disorders (11%), substance abuse or dependence (45%), sleep apnea (11%), TBI (31%), stroke (14%), cardiovascular disease (51%), and hepatitis (20%). Neuropsychological data were available for 33 patients. Performance on CVLT Trial 5 and Delayed Recall, Rey-Ostereith Copy, WAIS-IV Information and Digit Span, as well as Trail Making A and B were used to measure memory and executive functioning. 21% of the sample obtained one score that was >2 SD below the normative means, and 45% obtained 2 or more scores >2 SD below the mean.In this clinical sample referred for evaluation of cognitive functioning, there was a high rate of comorbid diagnoses. This review highlights the point that comorbid diagnoses are a common presentation and must be considered when discussing etiology of cognitive impairment and treatment planning. [ABSTRACT FROM AUTHOR]

Objective An investigation into memory and intellectual functioning of 18 individuals with neurofibromatosis type 1 (NF-1) was undertaken. Method Ten children [mean age=8.9 (SD = 3.4; range = 5-16), 54.5% male, 81.9% Caucasian, 9.1% African American, 9.1% mixed race] and 9 adults [mean age = 55.7 (SD = 23.9; range = 19-88), 63.6% male, 90.9% Caucasian, 9.1% African American] completed neuropsychological assessments. One individual completed initial assessment as a child and underwent re-evaluation as an adult, and 1 child and 2 adults completed re-evaluations. Results For adults, the Wechsler Adult Intelligence Scale (WAIS-4/3) was administered. For children, Wechsler Intelligence Scale for Children (WISC-5/4), Wechsler Preschool and Primary Scale of Intelligence (WPPSI-3), Stanford-Binet Intelligence Scales (SB-5), and WAIS-3 were utilized. Mean Full Scale IQ (FSIQ) in adults was 83.4 (SD = 12.8; range 69-98) and in children was 83.8 (SD = 11.6; range 65-102). Visual and verbal memory was assessed with a variety of instruments, and performance ranged from impaired to high normal across immediate recall (percentile range < 1-98), delayed recall (percentile range < 1-91), and delayed recognition (percentile range < 1-91). Conclusions Mean intelligence among persons in this NF-1 clinical sample was found to be in low average range. Many persons with NF-1 showed mean immediate and delayed verbal recall in normal range, though a subset of individuals demonstrated impaired range verbal memory. Overall, children with NF-1 tend to show memory performance at levels above their own IQ level. Adults with NF-1 frequently perform at levels equivalent to or above their IQ level, albeit with exceptions evidenced among a subset of adults. [ABSTRACT FROM AUTHOR]

Purpose Early versions of the Sports Concussion Assessment Tool utilized a summary score, but it was removed in the third edition due to lack of empirical support (Guskiewicz et al. 2013). Echemendia et al. (2017) note that the SCAT-5's changes, such as an expansion from a 5-word to 10-word list, improved utility over previous additions. Therefore, empirical support for a summary score on the SCAT-5 should be reassessed. Methods Collegiate athletes (N=532, 64% male) completed the SCAT-5 and ImPACT during their baseline evaluation. Various SCAT-5 summary score formulas were created to determine a concurrently valid summary score that remained comprehensive of all three SCAT-5 domains (cognitive, symptom, vestibular). The summary score was calculated by: [Immediate Memory Total + Delayed Recall + Orientation + Concentration + (30 – BESS Total Errors) - Total Symptom Score]. Results Pearson correlations determined that the summary score was significantly correlated with ImPACT Verbal Memory (r=.27, p<.001), Visual Memory (r=.24, p<.001), Visual-Motor Speed (r=.30, p<.001), Reaction Time (r=-.25, p<.001) and Total Symptoms (r=-.18, p<.001). Conclusion Our results support the validity of a SCAT-5 summary score. Clinically, the summary score is intended to measure changes in global functioning across baseline, post-trauma and follow-up concussion evaluation. Additionally, it should serve as a measure of global progression during the acute post-trauma window of sideline to post-trauma evaluation. Future research should examine the SCAT-5 summary score with outcome measures such as recovery time. [ABSTRACT FROM AUTHOR]

Purpose The dual-task (DT) paradigm consists of concurrent administration of motor and cognitive tasks which may demonstrate improved measurement properties of the included tasks as compared to independent administration. Our study examined the test-retest reliability of a clinically-relevant DT assessment. Methods Our prospective cohort study included 60 (53.3% female) healthy, recreationally active college students (Age=20.5–1.34 years; Height=171.7–9.33 cm). Participants completed the Standardized Assessment of Concussion (SAC) and timed tandem gait (TTG) test concurrently for the DT assessment at two time points separated by a two-week test-retest interval. The SAC composite score (45 points) was calculated by summing the domain scores of immediate memory (30 points) which consisted of a 10-word list, concentration (5 points), and delayed recall (10 points). The TTG composite score was calculated by summing the mean time to complete the TTG during each SAC task (3 trials for immediate memory, up to 5 trials for the digits-backwards task, and one trial for the months in reverse order and delayed recall tasks). Mixed-model intraclass correlation coefficients (ICC[3,1]) with 95% confidence intervals were calculated to evaluate test-retest reliability between time points for the SAC and TTG composite scores. Results Mean SAC (39.4–3.80 vs. 39.6–3.49 points) and TTG (52.1–9.44 vs. 48.2–8.33 sec) composite scores were observed at time points 1 and 2, respectively. Moderate (ICC[3,1]=0.56 [0.26, 0.74]) and good (ICC[3,1]=0.88 [0.80, 0.93]) test-retest reliability were observed for the SAC and TTG composite scores, respectively. Conclusion Test-retest reliability for our DT assessment aligns with previously established values for independent administration of the SAC and TTG. [ABSTRACT FROM AUTHOR]

Purpose Traditional "paper and pencil" neuropsychological tests and computerized test batteries have been employed in the assessment of sports-related concussion (SRC). Each type of test has inherent strengths and weaknesses. The NHL has constructed a "hybrid" battery of tests that uses both traditional and computerized measures in the evaluation of its players suspected of SRC. The purpose of this paper is to use factor analytic techniques to examine the relationships among the measures that comprise this battery. Methods Post-injury neuropsychological test data using the hybrid battery were obtained from 343 NHL players following their first concussion while playing in the league. ImPACT was used as the computer test battery. The traditional battery included: Hopkins Verbal Learning Test, Brief Visuospatial Memory Test, Color Trails, PSU Cancellation, Symbol Digits Modalities Test (including incidental memory), and Verbal Fluency. Results Five factors were extracted explaining 64.55% of the variance. The factor labels and the measures principally loading on each factor were as follows: Factor 1, Verbal Learning and Memory (HVLT Total and Delayed Recall); Factor 2, Processing Speed (Color Trails A/B, PSU Cancellation, and SDMT-Total); Factor 3, Visual Memory (BVMT- Total and Delayed); Factor 4, Cued Memory (ImPACT-Visual and Verbal Memory Composites); and Factor 5, Reaction Time (ImPACT Reaction Time and Visual Motor Speed composites). Conclusion These data underscore the unique contributions of traditional and ImPACT neuropsychological measures to the evaluation SRC in a sample of professional hockey players. It appears that both approaches measure different aspects of cognitive functioning. The next logical step is to use these data in evaluating the diagnostic utility of these measures as part of a combined battery. [ABSTRACT FROM AUTHOR]

Purpose The assessment of concussed athletes uses standardized tools like the Sport Concussion Assessment Tool (SCAT). The purpose of this study was to evaluate whether concussed athletes accurately recalled baseline functioning. Methods A retrospective cohort analysis of University football student-athletes from 2014-16 seasons was conducted. Forty-six student-athletes (M=19.7, SD=1.8) who suffered a concussion during the competitive season underwent a post-concussion assessment with a sports medicine physician within 24 hours of injury. Assessments included use of the symptom report from The SCAT3. Athletes were asked to recall their pre-injury baseline functioning. Results Of the 46 athletes who underwent assessments, 22 reported having at least 1 symptom (M=1.4, SD=2.0) at baseline evaluations. Yet at the initial medical evaluation, only 10 of these athletes correctly recalled having symptoms prior to injury, and none of them accurately reported their total symptom report. Paired t-tests revealed significant differences between an athletes predicted recall of the number of symptoms (M=0.7, SD=1.2) and total symptom scores (M=2.1, SD=3.4) conditions; t(45)=-3.28, p=.002, d=0.48. Conclusion Having accurate information for diagnosing concussions is important during concussion medical evaluations. Many clinicians depend on an athlete's subjective reporting of symptom change. Our results indicate that an athlete's accuracy of pre-injury functioning is poor, consistent with what has been termed "the good old days bias." The findings suggest having baseline assessments can be helpful and clinicians may need to carefully understand an athletes pre-morbid functioning. [ABSTRACT FROM AUTHOR]