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Some children and adolescents have persistent concussion symptoms that extend beyond the typical 3-4 week recovery window. Our understanding about what to expect when recovery is atypical, particularly in elementary-age children, is incomplete because there are very few targeted studies of this age group in the published literature. Aims were to identify lingering symptoms that present at three months post-concussion and to determine what factors are associated with prolonged recovery in an elementary-age group. Participants were 123 children aged 5-10 years who were seen at specialized concussion clinics, divided into expected and late recovery groups. Parents rated concussion symptoms on a scale from the Sideline Concussion Assessment Tool-5 (SCAT-5). The most frequent symptoms were headache, irritability, feeling more emotional, and sensitivity to noise. Stepwise logistic regression determined that female sex and total symptom burden at initial visit, but not any specific symptom, predicted prolonged recovery. Clinicians are advised to carefully monitor children who report numerous symptoms after concussion, particularly when the concussed children are girls.

Introduction: The risk reduction for Alzheimer's disease (rrAD) trial was a multisite clinical trial to assess exercise and intensive vascular pharmacological treatment on cognitive function in community-dwelling older adults at increased risk for Alzheimer's disease., Methods: Eligibility, consent, and randomization rates across different referral sources were compared. Informal interviews conducted with each site's project team were conducted upon study completion., Results: Initially, 3290 individuals were screened, of whom 28% were eligible to consent, 805 consented to participate (87.2% of those eligible), and 513 (36.3% of those consented) were randomized. Emails sent from study site listservs/databases yielded the highest amount (20.9%) of screened individuals. Professional referrals from physicians yielded the greatest percentage of consented individuals (57.1%). Referrals from non-professional contacts (ie, friends, family; 75%) and mail/phone contact from a site (73.8%) had the highest yield of randomization., Discussion: Professional referrals or email from listservs/registries were most effective for enrolling participants. The greatest yield of eligible/randomized participants came from non-professional and mail/phone contacts. Future trials should consider special efforts targeting these recruitment approaches., Highlights: Clinical trial recruitment is commonly cited as a significant barrier to advancing our understanding of cognitive health interventions.The most cited referral source was email, followed by interviews/editorials on the radio, television, local newspapers, newsletters, or magazine articles.The referral method that brought in the largest number of contacts was email but did not result in the greatest yield of consents or eligible participants.The sources that yielded the greatest likelihood of consent were professional referrals (ie, physician), social media, and mail/phone contact from study site.The greatest yield of eligible/randomized participants came from non-professional contacts and mail/phone contact from a site.Findings suggest that sites may need to focus on more selective referral sources, such as using contact mailing and phone lists, rather than more widely viewed recruitment sources, such as social media or TV/radio advertisements., Competing Interests: The authors report no conflicts of interest. Author disclosures are available in the supporting information., (© 2023 The Authors. Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Oceanographic changes adjacent to Antarctica have global climatic and ecological impacts. However, this is the most challenging place in the world to obtain marine data due to its remoteness and inhospitable nature, especially in winter. Here, we present more than 2000 Conductivity-Temperature-Depth (CTD) profiles and associated water sample data collected with (almost uniquely) full year-round coverage from the British Antarctic Survey Rothera Research Station at the west Antarctic Peninsula. Sampling is conducted from a small boat or a sled, depending on the sea ice conditions. When conditions allow, sampling is twice weekly in summer and weekly in winter, with profiling to nominally 500 m and with discrete water samples taken at 15 m water depth. Daily observations are made of the sea ice conditions in the area. This paper presents the first 20 years of data collection, 1997-2017. This time series represents a unique and valuable resource for investigations of the high-latitude ocean's role in climate change, ocean/ice interactions, and marine biogeochemistry and carbon drawdown., (© 2023. The Author(s).)

Objective: A variety of factors affect list learning performance and relatively few studies have examined the impact of word selection on these tests. This study examines the effect of both language and memory processing of individual words on list learning., Method: Item-response data from 1,219 participants, M age = 74.41 ( SD = 7.13), M edu = 13.30 ( SD = 2.72), in the Harmonized Cognitive Assessment Protocol were used. A Bayesian generalized (non)linear multilevel modeling framework was used to specify the measurement and explanatory item-response theory models. Explanatory effects on items due to learning over trials, serial position of words, and six word properties obtained through the English Lexicon Project were modeled., Results: A two parameter logistic (2PL) model with trial-specific learning effects produced the best measurement fit. Evidence of the serial position effect on word learning was observed. Robust positive effects on word learning were observed for body-object integration while robust negative effects were observed for word frequency, concreteness, and semantic diversity. A weak negative effect of average age of acquisition and a weak positive effect for the number of phonemes in the word were also observed., Conclusions: Results demonstrate that list learning performance depends on factors beyond the repetition of words. Identification of item factors that predict learning could extend to a range of test development problems including translation, form equating, item revision, and item bias. In data harmonization efforts, these methods can also be used to help link tests via shared item features and testing of whether these features are equally explanatory across samples. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Determine if head-injury exposure relates to later-in-life cognitive decline in older National Football League (NFL) retirees., Method: NFL retirees (aged 50+) with or without cognitive impairment underwent baseline (n = 53) and follow-up (n = 29; 13-59 months later) neuropsychological evaluations. Cognitively normal (CN) retirees (n = 26) were age- and education-matched to healthy controls (n = 26). Cognitively impaired (CI) retirees with mild cognitive impairment or dementia (n = 27) were matched to a clinical sample (CS) by age, sex, education, and diagnosis (n = 83). ANOVAs compared neuropsychological composites at baseline and over time between retirees and their matched groups. Regression models evaluated whether concussions, concussions with loss of consciousness (LOC), or games played predicted neuropsychological functioning., Results: At baseline, CN retirees had slightly worse memory than controls (M CN retirees  = 50.69, SE CN retirees  = 1.320; M Healthy controls  = 57.08, SE Healthy controls  = 1.345; p = 0.005). No other group diferences were observed, and head-injury exposure did not predict neurocognitive performance at baseline or over time., Conclusions: Head-injury exposure was not associated with later-in-life cognition, regardless of cognitive diagnosis. Some retirees may exhibit lower memory scores compared to age-matched peers, though this is of unclear clinical significance.

Subject motion is a well-known confound in resting-state functional MRI (rs-fMRI) and the analysis of functional connectivity. Consequently, several clean-up strategies have been established to minimize the impact of subject motion. Physiological signals in response to cardiac activity and respiration are also known to alter the apparent rs-fMRI connectivity. Comprehensive comparisons of common noise regression techniques showed that the "Independent Component Analysis based strategy for Automatic Removal of Motion Artifacts" (ICA-AROMA) was a preferred pre-processing technique for teenagers and adults. However, motion and physiological noise characteristics may differ substantially for older adults. Here, we present a comprehensive comparison of noise-regression techniques for older adults from a large multi-site clinical trial of exercise and intensive pharmacological vascular risk factor reduction. The Risk Reduction for Alzheimer's Disease (rrAD) trial included hypertensive older adults (60-84 years old) at elevated risk of developing Alzheimer's Disease (AD). We compared the performance of censoring, censoring combined with global signal regression, non-aggressive and aggressive ICA-AROMA, as well as the Spatially Organized Component Klassifikator (SOCK) on the rs-fMRI baseline scans from 434 rrAD subjects. All techniques were rated based on network reproducibility, network identifiability, edge activity, spatial smoothness, and loss of temporal degrees of freedom (tDOF). We found that non-aggressive ICA-AROMA did not perform as well as the other four techniques, which performed table with marginal differences, demonstrating the validity of these techniques. Considering reproducibility as the most important factor for longitudinal studies, given low false-positive rates and a better preserved, more cohesive temporal structure, currently aggressive ICA-AROMA is likely the most suitable noise regression technique for rs-fMRI studies of older adults., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Scheel, Keller, Binder, Vidoni, Burns, Thomas, Stowe, Hynan, Kerwin, Vongpatanasin, Rossetti, Cullum, Zhang and Zhu.)

Objective: To examine differences in concussion symptom reporting between female and male adults considering current psychological symptoms such as anxiety and depression and pre-injury factors in order to identify sex differences which may guide treatment efforts. Method: This prospective study is part of the North Texas Concussion Registry (ConTex). Subjects (N = 132) age 19 to 78 years had sustained a concussion within 30 days of clinic visit. The independent variable was sex and covariates included age, ethnicity, current anxiety and depression ratings, history of attention deficit disorder, history of headache/migraine, and time to clinic. The dependent variables were 22 post-concussion symptoms as measured by the Sport Concussion Assessment Tool-5 Post-Concussion Symptom Scale. Results : Analysis of covariance and ordinal logistic regression results both revealed that females had a greater likelihood of reporting increased symptom severity for 15/22 concussion symptoms. The largest risk ratios (effect size) in symptom reporting between sexes (higher symptoms in females) included: feeling more emotional 4.05 (0.72), fatigue or low energy 4.05 (0.72), sensitivity to light 3.74 (0.69), headache 3.65 (0.57), balance problems 3.31 (0.53), pressure in head 3.06 (0.51), and neck pain 2.97 (0.60). Conclusions: Adult females in our sample reported higher levels of many concussion symptoms than males and showed an increased risk of developing these same symptoms following concussion. Examination of the magnitude of sex difference in concussion symptom reporting will better inform medical staff to anticipate and address symptoms that may present greater challenges for adult females.

Background: Life expectancy (LE) following Alzheimer's disease (AD) is highly variable. The literature to date is limited by smaller sample sizes and clinical diagnoses., Objective: No study to date has evaluated predictors of AD LE in a retrospective large autopsy-confirmed sample, which was the primary objective of this study., Methods: Participants (≥50 years old) clinically and neuropathologically diagnosed with AD were evaluated using National Alzheimer's Coordinating Center (N = 1,401) data. Analyses focused on 21 demographic, medical, neuropsychiatric, neurological, functional, and global cognitive predictors of LE at AD dementia diagnosis. These 21 predictors were evaluated in univariate analyses. Variables found to be significant were then entered into a forward multiple regression. LE was defined as months between AD diagnosis and death., Results: Fourteen predictors were significant in univariate analyses and entered into the regression. Seven predictors explained 27% of LE variance in 764 total participants. Mini-Mental State Examination (MMSE) score was the strongest predictor of LE, followed by sex, age, race/ethnicity, neuropsychiatric symptoms, abnormal neurological exam results, and functional impairment ratings. Post-hoc analyses revealed correlations of LE were strongest with MMSE ≤12., Conclusion: Global cognitive functioning was the strongest predictor of LE following diagnosis, and AD patients with severe impairment had the shortest LE. AD patients who are older, male, white, and have more motor symptoms, functional impairment, and neuropsychiatric symptoms were also more likely have shorter LE. While this model cannot provide individual prognoses, additional studies may focus on these variables to enhance predictions of LE in patients with AD.

Objective: The purpose of this review is to critically examine studies that have examined investigated the Montreal Cognitive Assessment (MoCA) and functional or medical outcomes and other health variables in patients with non-neurologic medical conditions., Method: Databases OVID Medline and Embase were systematically searched through April 2020, yielding 281 articles that were separately screened for inclusion. Study characteristics extracted from retained articles are presented in Table S1 (online supplemental materials)., Results: Thirty-six articles were retained. Cognitive impairment as assessed by the MoCA was associated with adverse health variables including increased morbidity/mortality, poorer functional abilities, increased length of hospital stay, and increased hospital readmissions in 34 of 36 articles., Conclusions: Cognitive impairment as detected by the MoCA was shown in 34 of 36 studies to be associated with worse functional or medical status compared to those with better cognitive functioning across a variety of medical populations. Further research is needed to better understand how to best use the MoCA to potentially inform treatment planning in medical populations, including referral for more detailed neuropsychological evaluation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: To elucidate specific symptoms that may differ between adolescent female and male athletes after a sports-related concussion (SRC) and identify symptoms that may require greater clinical attention by medical and athletic staff., Design: Prospective., Setting: This study is part of a larger research project conducted at clinics in the North Texas Concussion Network (ConTex) Registry., Participants: Subjects (N = 491) aged 12 to 18 years who sustained a diagnosed SRC within 30 days of clinic visit., Independent Variables: Sex (female vs male). Covariates included age, race, current mood (anxiety and depression), learning disability/ADHD, and time to clinic., Main Outcome Measures: Twenty-two individual postconcussion symptoms as measured by the Post-Concussion Symptom Scale from the Sport Concussion Assessment Tool-5 (SCAT-5)., Results: Girls endorsed higher levels of anxiety and depression symptoms at initial clinic visit. analysis of covariance results revealed that girls had significantly greater symptom severity of headache, dizziness, sensitivity to light, sensitivity to noise, pressure in the head, feeling slowed down, fatigue, and drowsiness than boys. Ordinal logistic regression results also revealed that girls had significantly greater predicted odds of higher symptom severity on these 8 symptoms and in trouble concentrating than boys., Conclusions: Closer examination of specific symptoms with attention to patients' current levels of anxiety and depression symptoms may better inform medical and athletic staff to anticipate and address symptoms that may present greater challenges for adolescent girls than boys., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency of TES in a cohort of retired professional contact sport athletes, compare the frequency of TES to clinical consensus diagnoses, and identify predictors that increase the likelihood of TES diagnosis. Participants were 85 retired professional contact sport athletes from a prospective cohort at the University of Texas Southwestern Medical Center and the University of Texas at Dallas. Participants ranged in age from 23 to 79 (M = 55.95, SD = 13.82) and obtained 7 to 19 years of education (M = 16.08, SD = 1.03). Retirees were either non-Hispanic white ( n = 62) or African-American ( n = 23). Retired athletes underwent a standard clinical evaluation, which included a clinical interview, neurological exam, neuroimaging, neuropsychological testing, and consensus diagnosis of normal, mild cognitive impairment, or dementia. TES criteria were applied to all 85 athletes, and frequencies of diagnoses were compared. Fourteen predictors of TES diagnosis were evaluated using binary logistic regressions, and included demographic, neuropsychological, depression symptoms, and head-injury exposure variables. A high frequency (56%) of TES was observed among this cohort of retired athletes, but 54% of those meeting criteria for TES were diagnosed as cognitively normal via consensus diagnosis. Games played in the National Football League (OR = 0.993, p = 0.087), number of concussions (OR = 1.020, p = 0.532), number of concussions with loss of consciousness (OR = 1.141 p = 0.188), and years playing professionally (OR = 0.976, p = 0.627) were not associated with TES diagnosis. Degree of depressive symptomatology, as measured by the total score on the Beck Depression Inventory-II, was the only predictor of TES diagnosis (OR = 1.297, p < 0.001). Our results add to previous findings underscoring the risk for false positive diagnosis, highlight the limitations of the TES criteria in clinical and research settings, and question the relationship between TES and head-injury exposure. Future research is needed to examine depression in retired professional athletes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Schaffert, Didehbani, LoBue, Hart, Rossetti, Lacritz and Cullum.)

Objective: This study examined whether a history of traumatic brain injury (TBI) is associated with age at onset of Alzheimer's disease (AD) in three racial-ethnic groups., Methods: Data from 7,577 non-Hispanic Caucasian, 792 African American, and 870 Hispanic participants with clinically diagnosed AD were obtained from the National Alzheimer's Coordinating Center. Participants were categorized by the presence or absence of self-reported remote history of TBI (>1 year before diagnosis of AD) with loss of consciousness (LOC) (TBI+) or no history of TBI with LOC (TBI-). Any group differences in education; sex; APOE ε4 alleles; family history of dementia; or history of depression, stroke, hypertension, hypercholesterolemia, and diabetes were included in analyses of covariance comparing clinician-estimated age at AD symptom onset for the TBI+ and TBI- groups., Results: AD onset occurred 2.3 years earlier for non-Hispanic Caucasians (F=30.49, df=1, 7,572, p<0.001) and 3.4 years earlier for African Americans (F=5.17, df=1, 772, p=0.023) in the TBI+ group. In the Hispanic cohort, females in the TBI+ group had AD onset 5.6 years earlier, compared with females in the TBI- group (F=6.96, df=1, 865, p=0.008); little difference in age at AD onset was observed for Hispanic males with and without a TBI history., Conclusions: A history of TBI with LOC was associated with AD onset 2-3 years earlier in non-Hispanic Caucasians and African Americans and an onset nearly 6 years earlier in Hispanic females; no association was observed in Hispanic males. Further work in underserved populations is needed to understand possible underlying mechanisms for these differences.

Alzheimer's Disease (AD) is an age-related disease with modifiable risk factors such as hypertension, hypercholesterolemia, obesity, and physical inactivity influencing the onset and progression. There is however, no direct evidence that reducing these risk factors prevents or slows AD. The Risk Reduction for Alzheimer's Disease (rrAD) trial is designed to study the independent and combined effects of intensive pharmacological control of blood pressure and cholesterol and exercise training on neurocognitive function. Six hundred and forty cognitively normal older adults age 60 to 85 years with hypertension and increased risk for dementia will be enrolled. Participants are randomized into one of four intervention group for two years: usual care, Intensive Reduction of Vascular Risk factors (IRVR) with blood pressure and cholesterol reduction, exercise training (EX), and IRVR+EX. Neurocognitive function is measured at baseline, 6, 12, 18, and 24 months; brain MRIs are obtained at baseline and 24 months. We hypothesize that both IRVR and EX will improve global cognitive function, while IRVR+EX will provide a greater benefit than either IRVR or EX alone. We also hypothesize that IRVR and EX will slow brain atrophy, improve brain structural and functional connectivity, and improve brain perfusion. Finally, we will explore the mechanisms by which study interventions impact neurocognition and brain. If rrAD interventions are shown to be safe, practical, and successful, our study will have a significant impact on reducing the risks of AD in older adults. NCT Registration: NCT02913664., (Copyright © 2019. Published by Elsevier Inc.)

Background: The current evidence is inconclusive to support the benefits of aerobic exercise training (AET) for preventing neurocognitive decline in patients with amnestic mild cognitive impairment (aMCI)., Objective: To examine the effect of a progressive, moderate-to-high intensity AET program on memory and executive function, brain volume, and cortical amyloid-β (Aβ) plaque deposition in aMCI patients., Methods: This is a proof-of-concept trial that randomized 70 aMCI patients to 12 months of AET or stretching and toning (SAT, active control) interventions. Primary neuropsychological outcomes were assessed by using the California Verbal Learning Test-second edition (CVLT-II) and the Delis-Kaplan Executive Function System (D-KEFS). Secondary outcomes were the global and hippocampal brain volumes and the mean cortical and precuneus Aβ deposition., Results: Baseline cognitive scores were similar between the groups. Memory and executive function performance improved over time but did not differ between the AET and SAT groups. Brain volume decreased and precuneus Aβ plaque deposition increased over time but did not differ between the groups. Cardiorespiratory fitness was significantly improved in the AET compared with SAT group. In amyloid positive patients, AET was associated with reduced hippocampal atrophy when compared with the SAT group., Conclusion: The AET and SAT groups both showed evidence of slightly improved neuropsychological scores in previously sedentary aMCI patients. However, these interventions did not prevent brain atrophy or increases in cortical Aβ deposition over 12 months. In amyloid positive patients, AET reduced hippocampal atrophy when compared with the SAT group.

Objective: To evaluate whether a history of traumatic brain injury (TBI) with reported loss of consciousness (LOC) is a risk factor for earlier onset of Alzheimer's disease (AD) in an autopsy-confirmed sample., Method: Data from 2,133 participants with autopsy-confirmed AD (i.e., at least Braak neurofibrillary tangle stages III to VI and CERAD neuritic plaque score moderate to frequent) were obtained from the National Alzheimer's Coordinating Center (NACC). Participants were categorized by presence/absence of self-reported remote (i.e., >1 year prior to their first Alzheimer's Disease Center visit) history of TBI with LOC (TBI+ vs. TBI-). Analyses of Covariance (ANCOVA) controlling for sex, education, and race compared groups on clinician-estimated age of symptom onset and age of diagnosis., Results: Average age of onset was 2.34 years earlier (p = .01) for the TBI+ group (n = 194) versus the TBI- group (n = 1900). Dementia was diagnosed on average 2.83 years earlier (p = .002) in the TBI+ group (n = 197) versus the TBI- group (n = 1936). Using more stringent neuropathological criteria (i.e., Braak stages V-VI and CERAD frequent), both age of AD onset and diagnosis were 3.6 years earlier in the TBI+ group (both p's < .001)., Conclusions: History of TBI with reported LOC appears to be a risk factor for earlier AD onset. This is the first study to use autopsy-confirmed cases, supporting previous investigations that used clinical criteria for the diagnosis of AD. Further investigation as to possible underlying mechanisms of association is needed. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

This study explored the utility of the Montreal Cognitive Assessment (MoCA) in the detection of cognitive change over time in a community sample (age ranging from 58 to 77 years). The MoCA was administered twice approximately 3.5 years apart ( n = 139). Participants were classified as mild cognitive impairment (MCI) or cognitively intact at follow-up based on multidisciplinary consensus. We excluded 33 participants who endorsed cognitive complaints at baseline. The MCI group ( n = 53) showed a significant decrease in MoCA scores ( M = -1.83, p < .001, d = 0.64). When accounting for age and education, the MCI group showed a decline of 1.7 points, while cognitively intact participants remained stable. Using Reliable Change Indices established by cognitively intact group, 42% of MCI participants demonstrated a decline in MoCA scores. Results suggest that the MoCA can detect cognitive change in MCI over a 3.5-year period and preliminarily supports the utility of the MoCA as a repeatable brief cognitive screening measure.

Background: The purpose of this study is to determine if the three-step Luria test is useful for differentiating between cognitive disorders., Methods: A retrospective record review of performance on the three-step Luria test was conducted on 383 participants from a university-based dementia clinic. The participants ranged in their diagnosis from frontotemporal dementia (FTD; n = 43), Alzheimer disease (AD; n = 153), mild cognitive impairment (MCI; n = 56), and normal controls (NC; n = 131). Performance of the Luria test was graded as normal or abnormal., Results: An abnormal test occurred in 2.3% of NC, 21.4% of MCI, 69.8% of FTD, and 54.9% of AD subjects. The frequency of abnormal tests in all diagnostic groups increased with functional impairment as assessed by the Clinical Dementia Rating scale (CDR). When CDR = 3 (severe), 100% of the FTD and 72.2% of the AD subjects had abnormal Luria tests., Conclusions: The three-step Luria test distinguished NC and persons with MCI from FTD and AD, but did not distinguish FTD from AD subjects.

Objectives: To test the hypothesis that cardiovascular risk factors (CRFs) influence predisposition to and the clinical course of Alzheimer disease (AD), the authors compared Choctaw Indians, a group with known high CRF with white persons with AD. In addition to CRF history, the authors investigated the frequency of apolipoprotein E4 (apoE4) genotype andplasma homocysteine (HC) levels., Method: The authors compared 39 Choctaw Indians with AD and 39 Choctaw Indians without AD to 39 white persons with AD with all groups similar in age. CRF history included diabetes, hypertension, high cholesterol or hypolipidemic agent use, or myocardial infarction. The authors also compared plasma HC concentration and apoE4 allele frequency., Results: Choctaw persons with AD differed significantly from white persons with AD in history of hypertension, diabetes, and in HC values but not from Indians without AD. There was a significantly lower apoE4 allele frequency in Choctaw Indian AD than white persons with AD, and both AD groups had an affected first degree relative significantly more often than Indian controls. There was no relationship between the number of CRF and age at onset among Indians or whites, whereas HC concentration was associated with significantly earlier age of onset for Choctaw Indians but not for whites., Conclusions: This small study suggests that in Choctaw Indians modifiable risk factors may play more of a role in disease pathogenesis than in whites and that nonmodifiable risk factors such as apoE4 may play less of a role.