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Objective: Former National Football League (NFL) players’ working knowledge of concussion has not yet been evaluated, despite this population being a major clinical research target due to the association between repetitive head impacts (RHI) and long-term clinical impairments. This study examined former NFL players’ understanding of the current concussion definition, and the association between number of concussions with clinical function. Methods: 95 former NFL players (mean age = 55.29; mean NFL year = 8.10) self-reported number of concussions before being provided with a concussion definition and after being read a modern definition of concussion. Subjects reported number of concussions with loss of consciousness (LOC). Principal Component Analysis of a battery of tests generated behaviour/mood, psychomotor speed/executive function, and verbal and visual memory factor scores. Results: Post-definition number of concussions (median = 50) was five times the pre-definition (median = 10;p< 0.001). Greater pre- (p= 0.019) and post-definition concussions (p= 0.036) correlated with worse behaviour/mood scores, after controlling for years of football played, with specific effects for depressive symptoms and impulsivity. LOC did not account for variance beyond number of concussions. Conclusions: Practitioners and clinical researchers should provide a definition of concussion in the assessment of concussion history in former football players to facilitate accuracy and standardization. [ABSTRACT FROM PUBLISHER]

Obesity-associated cognitive impairments may be partially reversible through bariatric surgery. Depression, a prevalent comorbidity in bariatric surgery candidates, is linked with cognitive impairment and poorer surgical outcomes in other populations. No study has examined the effects of pre-operative depression on cognitive changes in bariatric surgery patients. Sixty-seven bariatric surgery patients completed a computerized cognitive test battery prior to surgery and 12 months post-operatively. The structured clinical interview for the DSM-IV Axis I disorders assessed major depressive disorder (MDD). Pre-surgery history of MDD was found in 47.8% of patients, but was not associated with greater baseline cognitive impairments. Repeated measures revealed improved cognitive abilities 12 months after surgery. Pre-surgery history of MDD did not influence post-operative cognitive function. Pre-operative history of MDD did not limit post-operative cognitive improvements. Larger studies with extended follow-ups are needed to clarify our findings and identify factors (e.g. older age) that may modify cognitive changes following surgery. [ABSTRACT FROM AUTHOR]

Purpose/Aim: Heart failure patients often require assistance with activities of daily living, including driving. Recent work shows heart failure patients commit more errors on a simulated driving task relative to controls and cognitive dysfunction contributed to these errors. We sought to extend these findings by examining whether structural magnetic resonance imaging indices correlate with driving independence and performance in heart failure. Materials and Methods: Forty-nine heart failure patients underwent brain magnetic resonance imaging and performed a battery assessing attention/executive function and memory. A self-report instrument was used to assess independence in transportation. A subset of heart failure participants ( N = 8) completed a validated driving simulator scenario. Results: Among the larger sample ( N = 49), reduced gray matter correlated with greater dependence in transportation and worse attention/executive function; in turn, worse attention/executive function predicted greater assistance with transportation ( p < 0.05). Among the subset that completed the driving simulator ( N = 8), reduced gray matter correlated with more stop signs missed and increased white matter hyperintensities correlated with greater collisions, centerline crossings and time out of lane ( p < 0.05). Poorer attention/executive function was also associated with more time over the speed limit on the driving simulation ( p < 0.05). Follow-up analyses showed the above effects were largely independent of age. Conclusions: Reduced structural brain integrity is associated with poorer reported and simulated driving in persons with heart failure. Larger prospective studies that employ on-road testing are needed to clarify brain changes and risk for unsafe driving in heart failure. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is associated with cognitive impairment, and bariatric surgery has been shown to improve cognitive functioning. Rapid improvements in glycemic control are common after bariatric surgery and likely contribute to these cognitive gains. We examined whether improvements in glucose regulation are associated with better cognitive function following bariatric surgery. Method: A total of 85 adult bariatric surgery patients underwent computerized cognitive testing and fasting blood draw for glucose, insulin, and glycated hemoglobin (HbA1c) at baseline and 12 months postoperatively. Results: Significant improvements in both cognitive function and glycemic control were observed among patients. After controlling for baseline factors, 12-month homeostatic model assessment of insulin resistance HOMA-IR predicted 12-month digits backward (β = –.253, p <.05), switching of attention–A (β =.156, p <.05), and switching of attention–B (β = –.181, p <.05). Specifically, as HOMA-IR decreased over time, working memory, psychomotor speed, and cognitive flexibility improved. Decreases in HbA1c were not associated with postoperative cognitive improvements. After controlling for baseline cognitive test performance, changes in body mass index (BMI) were also not associated with 12-month cognitive function. Conclusions: Small effects of improved glycemic control on improved aspects of attention and executive function were observed following bariatric surgery among severely obese individuals. Future research is needed to identify the underlying mechanisms for the neurocognitive benefits of these procedures. [ABSTRACT FROM AUTHOR]

Introduction: Treatment nonadherence is common in heart failure (HF) and is associated with poor health outcomes in this population. Recent cross-sectional work in heart failure and past work in other medical populations suggest that cognitive function is a key determinant of a patient’s ability to adhere to treatment recommendations. However, it is also possible that treatment adherence is an important modifier and predictor of cognitive function, though no study has examined this possibility, and we sought to do so in a sample of heart failure patients.Method: A total of 115 patients with heart failure self-reported adherence to treatment recommendations. The Modified Mini Mental State Examination (3MS), Trail Making Test Parts A and B, and the California Verbal Learning Test–II (CVLT–II) assessed cognitive function. These procedures were performed at baseline and a 12-month follow-up.Results:Global cognition and memory abilities improved over the 12-month period. Regression analyses controlling for baseline and medical and demographic factors showed that better baseline treatment adherence predicted improved 12-month performances on the 3MS and CVLT–II. Adherence to medication and diet regimens and smoking abstinence emerged as the most important contributors.Conclusions:Better treatment adherence predicted improved cognition one year later in HF. Prospective studies that utilize objective assessments of treatment adherence are needed to confirm our findings and examine whether improved treatment adherence preserves cognitive function in heart failure. [ABSTRACT FROM PUBLISHER]

Objective Heart failure (HF) is a known risk factor for cognitive impairment. Cardiac rehabilitation (CR) may attenuate poor neurocognitive outcomes in HF via improved physical fitness--a significant promoter of cognitive function. However, no study has examined the possible acute and lasting benefits of CR on cognitive function in persons with HF. Methods and resu lts Fifty-two patients with HF completed a 12-week Phase II CR program. All participants were administered neuropsy-chological testing and completed a brief physical fitness assessment at baseline, completion of CR (i.e. 12 weeks), and 12-month follow-up. Repeated measures analyses showed a significant time effect for both attention/executive function and memory (P< 0.05). Attention/executive function performance increased from baseline to 12 weeks and these gains remained up to 12 months; memory was unchanged from baseline to 12 weeks, but then improved between the 12-week and 12-month time points. Physical fitness improved from baseline to 12 weeks and these benefits were maintained 12 months later. Changes in physical fitness and cognitive function over time did not reach a statistically significant association, though poorer physical fitness was associated with decreased cognitive performance at the baseline and 12-month time points. Conclusions CR is associated with both acute and lasting cognitive benefits in patients with HF. Prospective studies with extended follow-ups are needed to clarify the mechanisms that underpin cognitive improvements following CR (e.g., improved cerebral perfusion) and whether CR can ultimately reduce risk for cognitive decline and conditions like Alzheimer's disease in HF. [ABSTRACT FROM AUTHOR]

Cognitive impairment is prevalent in heart failure (HF), though substantial variability in the pattern of cognitive impairment is found across studies. To clarify the nature of cognitive impairment in HF, we examined longitudinal trajectories across multiple domains of cognition in HF patients using latent growth class modeling. 115 HF patients completed a neuropsychological battery at baseline, 3-months and 12-months. Participants also completed the Beck Depression Inventory-II (BDI-II). Latent class growth analyses revealed a three-class model for attention/executive function, four-class model for memory, and a three-class model for language. The slope for attention/executive function and language remained stable, while improvements were noted in memory performance. Education and BDI-II significantly predicted the intercept for attention/executive function and language abilities. The BDI-II also predicted baseline memory. The current findings suggest that multiple performance-based classes of neuropsychological test performance exist within cognitive domains, though case-controlled prospective studies with extended follow-ups are needed to fully elucidate changes and predictors of cognitive function in HF. [ABSTRACT FROM PUBLISHER]

Obesity is associated with cognitive dysfunction in children and adolescents, although the mechanisms underlying these deficits remain unclear. This study examined the associations between body mass index (BMI) and regional gray matter volume and white matter integrity in 120 healthy children and adolescents (6-18 years of age) who underwent magnetic resonance and diffusion tensor imaging. Bonferroni-corrected partial correlation analyses controlling for demographic and clinical characteristics revealed significant inverse associations between demographically standardized BMI values and gray matter volume of frontal ( r = −0.31) and limbic ( r = −0.35) brain regions. No such pattern emerged for fractional anisotropy of white matter tracts. Subsequent hierarchical regression analyses indicated that the relationship between standardized BMI and structural gray and white matter brain indices did not vary with age. These findings suggest that obesity in children and adolescents is associated with decreased volume of frontal and limbic cerebral gray matter regions. Further research is much needed to better elucidate possible brain-based mechanisms for cognitive dysfunction associated with obesity. [ABSTRACT FROM AUTHOR]

Obesity is an established risk factor for cognitive impairment. Theories of cognitive reserve suggest that premorbid factors, such as intellectual ability, may attenuate the expression of cognitive impairment due to age or disease. The current study examined whether cognitive reserve, defined as estimated premorbid intellectual ability, moderates the relationship between obesity and cognitive function in obese adults. Participants without major medical or psychological conditions completed a computerized battery of neuropsychological tests. Hierarchical regression models found a significant interaction between BMI and cognitive reserve for attention/executive function and memory, suggesting that cognitive reserve attenuates the expression of obesity-related cognitive impairment. [ABSTRACT FROM AUTHOR]

Left atrial (LA) diameter is easily attainable from echocardiograph and sensitive to underlying cardiovascular disease severity, although its association with neurocognitive outcomes is not well understood. Fifty older adults (64.50 ± 9.41 years), recruited from outpatient cardiology clinics and local papers who underwent magnetic resonance imaging, were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and completed psychosocial self-report measures. LA diameter was quantified using echocardiogram. Hierarchical regression analyses revealed that greater LA size was independently associated with reduced performance on the following RBANS composites: language, delayed memory, and total index ( p < 0.05 for all). Hierarchical regression analysis demonstrated no significant association between LA diameter and whole brain volume ( p > 0.05). The current study suggests that greater LA size is associated with cognitive dysfunction in older adults and prospective studies are needed to validate these findings and elucidate underlying mechanisms. [ABSTRACT FROM AUTHOR]

Cognitive impairment is common in heart failure patients. Poor dietary habits are associated with reduced neurocognitive function in other medical populations, including diabetes and Alzheimer's disease. This study examined whether dietary habits help moderate the relationship between heart failure severity and cognitive function. A total of 152 persons with heart failure completed neuropsychological testing and a fitness assessment. Dietary habits were assessed using the Starting the Conversation-Diet questionnaire, a nutrition measure suggested for use in primary care settings. Moderation analyses showed that better dietary habits attenuated the adverse impact of heart failure severity on frontal functioning (b = 1.28, p < 0.05). Follow-up analyses revealed consumption of foods high in sodium was associated with reduced cognitive function (p < 0.05). This study suggests dietary habits can moderate the association between heart failure and performance on tests of attention and executive function. Longitudinal studies are needed to confirm and clarify the mechanisms for our findings. [ABSTRACT FROM PUBLISHER]

Objective: Sports-related concussions are associated with both acute and long-term consequences. Past work has identified novel risk factors and modifiers for concussions, including mood and neuropsychiatric disorders. Attention Deficit Hyperactivity Disorder (ADHD) is a common neuropsychiatric disorder that may also contribute to concussion risk, although no study has examined this possibility. Methods: One hundred and thirty-nine NCAA Division-I athletes at Kent State University (KSU) self-reported a history of prior concussion and diagnostic history of ADHD as part of a larger concussion management programme at KSU. Results: ADHD was prevalent (10.1%) and 18.0% of the sample reported a prior history of at least one concussion injury. 50.4% of athletes with ADHD reported a history of at least one prior concussion vs 14.4% of athletes without ADHD, which represented a significant difference ( p < 0.01). Analyses showed that athletes with ADHD were more likely to report a past history of concussions than those without ADHD ( F (1,133) = 4.31, p = 0.04). Conclusion: ADHD is prevalent in NCAA Division-I athletes and associated with history of past concussions. If replicated, these findings could have important implications in the prevention and management of concussions in athletes with ADHD. [ABSTRACT FROM AUTHOR]