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Background: The Learning Ratio (LR) is a novel learning score that has shown improved utility over other learning metrics in detecting Alzheimer's disease (AD) across multiple memory tasks. However, its utility on the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Test (CERAD WLMT), a widely used list learning measure sensitive to decline in neurodegenerative disease, is unknown. The goal of the current study was to determine the utility of LR on the CERAD WLMT in differentiating between diagnostic (MiNCD vs MaNCD) and etiologic groups (VaD vs AD) in a veteran sample. Methods: Raw learning slope (RLS) and LR scores were examined in 168 veterans diagnosed with major neurocognitive disorder (MaNCD), mild neurocognitive disorder (MiNCD), or normal aging following neuropsychological evaluation. Patients with MaNCD were further classified by suspected etiology (i.e. microvascular disease vs AD). Results: Whereas RLS scores were not significantly different between MiNCD and MaNCD, LR scores were significantly different between all diagnostic groups ( p ' s < .05). Those with AD had lower LR scores and RLS scores compared to those with VaD ( p ' s < .05). LR classification accuracy was acceptable for MiNCD (AUC = .76), excellent for MaNCD (AUC = .86) and VaD (AUC = .81), and outstanding for AD (AUC = .91). Optimal cutoff scores for WLMT LR were derived from Youden's index. Conclusion: Results support the use of LR scores over RLS when interpreting the CERAD WLMT and highlight the clinical utility of LR in differentiating between diagnostic groups and identifying suspected etiology.

Objectives: The study compared the accuracy of the Mini-Mental State Examination (MMSE) with its modified version (3MS) in distinguishing healthy older adults from adults with cognitive impairment due to suspected Alzheimer’s disease (AD) or vascular disease (VaD). Method: Participants were 98 veterans who underwent comprehensive neuropsychological evaluation due to concern for cognitive decline. Participants were selected via retrospective chart review on the basis of diagnosis. They had diagnoses of mild or major neurocognitive disorder due to suspected AD (N=20), mild or major neurocognitive disorder due to suspected VaD (N=44), or no neurocognitive diagnosis (i.e., healthy adult comparisons; HC, N=34). Results: The 3MS demonstrated superior detection of cognitive impairment. The extent of this enhanced detection was influenced by the suspected etiology of cognitive impairment. The 3MS and MMSE had comparable discrimination of AD and HC. With respect to VaD, the 3MS showed superior discriminability compared to the MMSE. Conclusions: Overall, results support the adoption of the 3MS over that of the MMSE. The 3MS is a superior (and free) tool for detecting cognitive impairment in geriatric populations. Its use is recommended for first-line screening of cognitive symptoms in older adult populations, especially those with concern for VaD.

Objective: Discuss anticipated patterns of cognitive and emotional dysfunction, prognostic indicators, and treatment considerations based on review of (a) neuroinvasive properties of prior human coronaviruses and (b) extensively researched disorders which share similar neurological mechanisms., Method: A web-based comprehensive search of peer-reviewed journals was conducted based on a variety of key terms (and variants of) including coronavirus, neuroinvasion, cognitive dysfunction, viral pandemics, respiratory illness, critical illness, and metabolic disease. Articles were chosen based on relevance to the current topic and ability to provide unique thematic information. Historical articles were included if these added scientific merit to recent literature. Review of information in widely disseminated news articles was followed-up with direct review of cited scientific literature. Databases searched included Google Scholar, PubMed, and Ovid Medline., Results: Based on neuroinvasive properties of prior coronaviruses and existing research on similar neurophysiological conditions with detrimental cognitive effects, COVID-19-especially those with severe symptoms-are at risk for cognitive decline and significant psychiatric/behavioral sequela., Conclusions: There are few studies examining cognitive outcomes in COVID-19. This review argues that neuropsychological sequelae are to be expected in patients with COVID-19. Considerations for clinicians working with this unique population are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Research among a wide range of cohorts (e.g. civilian, military) has increasingly highlighted traumatic brain injury (TBI) as a risk factor for suicidal thoughts and behaviors, including death by suicide. With this recognition, subsequent changes in clinical practice, such as TBI screenings among individuals seeking mental health services, as well as suicide risk assessment among individuals seeking rehabilitation services are essential. Information provided below is aimed at highlighting key and emerging findings regarding suicide and TBI, with the goal of encouraging providers and researchers to explore changing and expanding evidence-based clinical practices to match the needs of those living with a history of TBI., (Copyright © 2017. Published by Elsevier Ltd.)

Objective: To characterize supervision levels across residential settings at 1 year post-TBI and explore predictors of supervision in a Veteran and Service-member population., Setting: Five VA Polytrauma Rehabilitation Centers., Participants: A total of 302 individuals enrolled in the VA TBI Model Systems (TBIMS) research program., Design: Prospective, longitudinal, multisite., Main Measures: Primary residence and supervision levels measured via scores on the Supervision Rating Scale. For predictive modeling, scores were dichotomized into 2 groups: those that were fully independent/living alone or required only some supervision during the day (independent group, n = 195) and those that required overnight supervision, full-time indirect supervision, and full-time direct supervision (dependent group, n = 107)., Results: Thirty-five percent were receiving supervision at 1 year post-TBI across residential settings and 28% were living in alternative settings. Multivariate modeling indicated that older age and longer posttraumatic amnesia (PTA) were predictive of having a need for supervision at 1 year postinjury., Conclusions: Supervision needs are long-term features of moderate and severe TBI. Results of this study lend support to the shift toward conceptualizing TBI as a chronic disease.

Objective: With an increasing rate of childhood obesity, it is critical to find fun and effective ways of providing children with opportunities to be physically active while at school to mediate this outcome. Using games as a mode of exercise (Exergaming) could be one such way. We aimed to compare the physiologic response and enjoyment of elementary school children when playing Xbox ® Kinect ® versus participating in regular activities during recess., Materials and Methods: Twenty-four children participated individually once in Kinect and once in regular activity sessions on separate days during recess for the allotted time. Sessions were at least 1 week apart, and the order of the sessions was randomized. During the Kinect session, participants played the Reflex Ridge game. During the regular session, participants engaged in self-selected activities. Energy expenditure, metabolic equivalents of task (METS), time in moderate to vigorous activity, percentage of activity in sedentary, light, moderate, vigorous and very vigorous levels, heart rate, rate of perceived exertion (RPE), and Physical Activity Enjoyment Scale were measured for each session and compared using a paired samples t-test., Results: Significantly greater RPE (P = 0.024), percentage of activity at sedentary (P = 0.019), very vigorous (P < 0.001) levels, and lesser percentage of activity at moderate level (P = 0.008) were noted during the Kinect session., Conclusion: Playing Kinect was comparable to playing outside with classmates. When necessary, such as in inclement weather, whole-body interactive videogames can be a viable alternative physical activity. However, this has to be validated with a larger sample study.

(1) Background: Acute bouts of exercise have been associated with affective changes. Exercise supplemented with distraction may divert attention from unpleasant feelings commonly associated with exercise to more pleasant feelings. The purpose of this study was to compare affective responses to exercise with and without distraction. (2) Methods: 25 individuals volunteered for this investigation and completed all three conditions. This study included three 30 min cycle ergometry exercise conditions, a control condition with no stimuli and two test conditions; one supplemented with a self-selected video and the other self-selected music. The Feeling Scale (FS) was administered prior to, every 10 min during, immediately following, and 10 min post exercise. (3) Results: These data demonstrate a significant condition effect for FS during exercise. The condition effect was due to FS being greater in the video and distraction conditions. There was no time by condition interaction seen during exercise. (4) Conclusion: These data indicate that distraction may be effective in supporting a more pleasant exercise experience and could potentially increase exercise adherence.

Many athletes avoid using mouthguards because they believe that they impair their ability to breath and negatively affect performance. Recently, some manufacturers have developed "vented" mouthguards (VentMGs) to address this concern. The purposes of this investigation were to describe the impact of a commercially available "vented" boil-and-bite mouthguard on the physiological responses to graded exercise and to determine whether the use of the same mouthguard influences performance during traditional physical agility tests. Recreationally trained males (n = 15) (age = 24 ± 1 year; (Equation is included in full-text article.)= 43.5 ± 1.9 ml·kg·min; body mass index = 25.2 ± 0.9) completed 3 randomly assigned trials where they wore no mouthguard (control), a traditional mouthguard (TradMG), or a VentMG. During each trial, subjects completed a modified maximal exercise test on a cycle ergometer and a series of physical agility tests (40-m dash, vertical leap, broad jump, 3-cone drill, and shuttle run). No differences were seen between control and the TradMG in any cardiorespiratory measures at any time during the maximal exercise test. Ventilation and blood lactate were lower (p ≤ 0.05) during VentMG at 200 W and at MAX; however, no differences in (Equation is included in full-text article.)were observed. Although TradMG had no impact on physical agility, VentMG produced a higher (1.9 cm; p = 0.03) vertical leap than control. Both mouthguard conditions negatively affected perceptions of breathability, comfort, and ability to communicate, but no differences existed between the 2 conditions. These findings confirm that TradMG has no negative impact on physiological function during exercise and physical agility; however, VentMG may have a positive impact at higher workload and on vertical leap.

Objective: To evaluate the literature examining the efficacy of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for migraine prophylaxis., Data Sources: MEDLINE (1966-October 2009) and International Pharmaceutical Abstracts were searched using the terms migraine, headache, renin-angiotensin system, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, aldosterone antagonist, and the individual agents in these classes., Study Selection and Data Extraction: English-language human clinical trials, case reports, and systematic reviews were evaluated for efficacy and safety data. The references of reviewed articles were examined to identify additional sources., Data Synthesis: Preventative trials evaluating ACE inhibitors consist of a case series, 2 open-label trials, and a placebo-controlled trial. Lisinopril reduced headache hours 20%, headache days 17%, and migraine days 21% versus placebo in the controlled trial (p < 0.05). Clinically significant (>50%) reductions in migraine measures were more common (52-66%) in open-label ACE inhibitor trials than in the controlled (32-36%) trial. Preventive trials evaluating ARBs consist of a meta-analysis, an open-label trial, and 2 placebo-controlled trials. Candesartan reduced headache hours 31%, headache days 26%, and migraine days 28% versus placebo in the first controlled trial (p < or = 0.001). Telmisartan did not reduce any prespecified primary or secondary outcome measures in the second controlled trial. Clinically significant reductions (>50%) in migraine measures were more common (54-88%) in open-label ARB trials than in the controlled (26-38%) trials. A prescription database review found that ACE inhibitor or ARB therapy halved the use of abortive migraine agents compared to diuretic therapy., Conclusions: ACE inhibitors and ARBs have migraine prophylaxis activity similar to that of some currently utilized agents. Low-dose lisinopril or candesartan may be reasonable second- or third-line agents, particularly in patients with other indications for ACE inhibitor or ARB therapy. Further controlled clinical trials are needed to delineate the role of these agents in migraine prevention.

Unlabelled: Individuals with chronic obstructive pulmonary disease (COPD) have been shown to benefit from participation in pulmonary rehabilitation (PR) programs that include exercise training and education., Purpose: To examine the relationship between improvements in 6 minute walk distance and perceived quality of life in individuals with COPD following completion of a PR program., Methods: The records of 139 individuals completing a PR program (3 times a week for 8 weeks) were retrospectively examined. Prior to entry and upon completion of the program each individual completed a 6 minute walk test (6MWT), the SF-36 Health survey, and the UCSD Shortness of Breath Questionnaire (SOB). SF-36 results were analyzed according to 8 subscales [Physical Functioning (PF), Role Physical (RF), Bodily Pain (BP), General Health (GH), Vitality (V), Social Functioning (SF), Role Emotional (RE), and Mental Health (MH)]., Results: PR resulted in significant improvements in 6MWTdistance (Pre = 845 +/- 37 ft, Post = 1127 +/- 32 ft, p < 0.001), PF (p < 0.001), RF (p = 0.001), Vitality (p = 0.002), SF (p < 0.001), RE (p = 0.037), MH (p < 0.001) and SOB (Pre = 53 +/- 2, Post = 47 +/- 2, p < 0.001). The change in 6MWT distance was not related to changes in PF (r = 0.17), RF (r = 0.03), GH (r = 0.03), Vitality (r = -0.001), SF (r = 0.01), RE (r = 0.06), MH (r = -0.04) or SOB (r = 0.12). The magnitude of improvement in 6MWT distance (68%) was much greater than that observed in PF (15%), RF (16%), GH (6%), VT (18%), SF (20%), RE (14%), MH (14%), or SOB (8%)., Conclusions: PR has a positive impact on 6 minute walk distance and perceived quality of life in individuals with COPD; however, changes in 6 minute walk distance appear to have no relationship to changes in perceived quality of life.