B – 66 Impact of Social Determinants of Health on Outcomes of Disorders of Consciousness Rehabilitation

Archives of Clinical Neuropsychology · 2025-09-26

Abstract Objective This study aims to evaluate the relationship between recovery in patients with a disorder of consciousness (DOC) in an acute inpatient rehabilitation (AIR) setting and social determinants of health (SDH) such as insurance payor source and length of rehabilitation stay (LOS). Method A retrospective analysis of a consecutive sample of 197 individuals seen in AIR between 2013 and 2024 was conducted. Variables of interest include age, sex, mechanism of injury, insurance payor source, mean income and poverty rate of patients’ home zip code, LOS in AIR, change in Coma Recovery Scale, Revised (CRS-R) score, and change in CRS-R diagnosis over the course of admission to AIR. CRS-R scores and diagnoses included in analyses were collected upon admission to and discharge from AIR. Results In this sample, mechanism of injury, sex, age, and neighborhood economic factors were not found to be significantly related to change in CRS-R score or change in CRS-R diagnosis. LOS was found to have a significant positive correlation of rs = 0.46 (p < .001) to change in overall CRS-R score, and also significantly increased the likelihood of positive change in CRS-R diagnosis (rs = 0.42, p < .001). There was a significant relationship between payor source and LOS X2 (3, N=197)=9.44, p=0.024, but further analyses were not significant when adjusted for multiple comparisons. Conclusion This retrospective study indicates that LOS in AIR is positively associated with improved cognitive outcome for individuals with a DoC. Payor source was found to have a significant relationship with length of stay.

Psychosocial Determinants Conferring Resilience after TBI: Current Understanding

Current Physical Medicine and Rehabilitation Reports · 2024-07-15 · 8 citations

Abstract Purpose of review Traumatic Brain Injury (TBI) is a complex condition, with outcomes ranging from profound disability to remarkable recovery. Considerable variability in outcomes is observed, even among those with similar injury mechanisms, severity and neuropathological pattern. This indicates a need to explore resilience factors influencing TBI recovery. Recent findings This narrative review synthesizes existing literature, focusing on individual, social, and community factors impacting resilience post-TBI. Recent research highlights how individual factors such as personality traits, coping strategies, and premorbid psychiatric history, as well as social and contextual factors, like social support and social determinants of health (SDoH) all impact TBI recovery. We also discuss clinical applications of resilience-focused interventions to promote health and wellbeing after TBI. Summary An improved understanding of resilience factors and pathways to recovery post-TBI is crucial for optimizing outcomes. Future research should focus on developing comprehensive interventions addressing individual, social, and community-level factors to foster resilience and enhance TBI recovery.

The study protocol of the winners project: a randomized and controlled trial using a videogame-based training program in pediatric cancer survivors

European Psychiatry · 2024-04-01

Introduction Childhood cancer survivors have neurocognitive sequelae that in most survivor follow-up programs are underdiagnosed and for which there is usually no treatment plan. Video games have demonstrated various psychological and neurocognitive benefits in different subpopulations, such as patients with organic neurological deficits or children with ADHD. However, few studies have been carried out using video games-based interventions in the paediatric oncology population. Objectives The aim of this work is to present the WINNERS study protocol, the objectives of which are to diagnose the neurological and cognitive sequelae in child cancer survivors, and to demonstrate the benefit in these areas of a training program based on video games. Methods A randomized controlled and unblinded trial is presented. Fifty-six patients aged 8 to 17 years stratified into two age groups (8-12 and 13-17) who had received any of the following treatments 1 to 6 years before the enrolment will be selected: high-dose chemotherapy with blood-brain barrier crossing, intrathecal or intraventricular chemotherapy, CNS radiotherapy or hematopoietic stem cell transplantation. A neuropsychological evaluation will be performed consisting of a battery of neuropsychological tests to assess parameters such as attention, memory, visuospatial ability or speed of response, as well as a neuroimaging evaluation by structural and functional magnetic resonance imaging. The evaluation will be repeated 3 months and 6 months after the enrolment. Patients will be randomized to a treatment group or to a recycled waiting group. Intervention will consist on a 12-week training at home using 3 video games: a brain training game, an exergaming game and a skill training game. Results According to the hypotheses of this study, it is expected that the proposed program of videogame-based interventions will improve neurocognitive and other wellbeing parameters in the intervention group. Conclusions This study aims to improve the quality of care for patients who have survived a cancer disease by detecting sequelae that have so far been poorly attended, and by proposing a gamification-based intervention program that is effective and attractive for this population. Disclosure of Interest None Declared

The winners project: neuropsycological changes after a video game-based training program in pediatric cancer survivors. a case report

European Psychiatry · 2024-04-01

Introduction Children who have undergone an oncological process and have received treatment with chemotherapy or radiotherapy on the central nervous system may have significant neurocognitive sequelae. Some video games have shown neurocognitive benefits in people with impairments in different areas, such as attention or memory. Objectives This work aims to demonstrate the benefit of a video game-based training program to improve the neurocognitive profile in a child survivor of cancer. Methods The patient is a 9-year-old female who was diagnosed with acute lymphoblastic leukemia at the age of 4 years. She received routine treatment of this disease by chemotherapy, including high-dose chemotherapy (with blood-brain barrier crossing) and intrathecal chemotherapy. She is currently 3 years after the end of treatment. The Continuous Performance Test 3 (CPT-3) (sustained attention/vigilance) was administered before and after a multifaceted training program consisting of playing 3 video games for 12 weeks, as follows: a brain-training game (4 days per week, 7-12 minutes per day), a skill-training game (2 days per week, 10 minutes per day) and an exergaming game (2 days per week, 10 minutes per day). Results Prior to intervention, the patient had 3 atypical z-scores on the CPT-3 (z scores: mean = 0, S.D. = 1), with a pattern compatible with ADHD (omissions z = 1.2; hit reaction time z = 3.4; hit reaction time block change z = 1.2). After intervention, she had only an atypical z-score (hit reaction time z = 3.6), with a pattern compatible with slowing, without ADHD. Conclusions The neuropsychological evaluation of this patient showed an improvement in his attentional pattern on the CPT-3 after the video game-based training. Disclosure of Interest None Declared

77 Symptoms of RBD and Cognitive Performance in Healthy Young Adults

Journal of the International Neuropsychological Society · 2023-11-01

Objective: REM sleep behavior disorder (RBD) is a parasomnia characterized by vivid dreams and motor behavior such that people appear to “act out their dreams.” These are sudden and often violent bodily movements such as punching or kicking, or vocalizations such as laughing or shouting. RBD is mostly associated with the older adult male population. However, recent studies show that RBD and REM sleep without atonia (RSWA) also occur in other populations, including women, children, and adolescents. Given the prodromal period before an individual can develop the classic symptoms of RBD and that RBD is not just limited to older adult males, it is important to study subclinical features of RBD. RBD is a parasomnia and poor sleep is well known to affect cognitive domains. Additionally, RBD is separately shown to negatively affect cognition in older adults. Given these connections, the association between RBD symptoms and cognition among young adults warrants further study. The purpose of this study was to evaluate the association between RBD symptoms and cognitive domains, specifically attention, processing speed, executive function, and working memory. Participants and Methods: University students from the Bronx, NY (N=50, mean age = 19.8, female = 78.4%) completed the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ). Estimated intellectual ability was assessed using the Wechsler Test of Adult Reading (WTAR). Cognitive assessment included the Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Test (attention and executive function) and the Cogstate battery (Groton Maze Learning Test (executive function), Chase Test (processing speed), Identification Test (attention), One Back Test (attention), and Two Back Test (working memory)). Psychosocial assessment included the Perceived Stress Scale (PSS), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI). Results: A series of general linear models were used to determine the relationship between RBD symptoms and cognition. Race/ethnicity, depressive symptoms, and estimated intellectual ability were included as covariates. Using a cutoff score of five (range: 0-13) on the RBDSQ, the ANCOVAs determined that there was no association between RBD symptoms and the cognitive domains of attention, processing speed, executive function, and working memory. However, there was a trend for attention as measured by the Identification task (F(1,41) = 3.85, p = 0.057). Interestingly, Pearson’s chi-square test revealed that the relationship between depressive symptoms and RBD symptoms was significant (x2 = 6.87, p = 0.009). Those who had high RBD symptoms were more likely to have high depressive symptoms. Conclusions: Our analyses indicated that in healthy young adults, RBD symptoms are not associated with the cognitive domains of attention, processing speed, executive function, or working memory. However, there may be a trend for attention, which warrants further research with a larger sample size. Of interest, young adults with RBD symptoms were more likely to have clinically significant depressive symptoms. Given that RBD in older adults is associated with incident dementia with Lewy body and Parkinson’s disease, which are associated with cognitive decline and depression, further work is necessary to explore the mechanisms of this connection as well as the development of clinical disorders.

91 Athletic Status Predicts Neurocognitive Dispersion in College Students

Journal of the International Neuropsychological Society · 2023-11-01

Objective: Studies have reported that athletic conditioning or training may have neuropsychological benefits for adult athletes, including enhanced processing speed, executive function, and working memory and attention. However, others have reported that these benefits may be attenuated by an athlete’s level of exposure to repetitive, subconcussive head impacts, such as heading the ball in soccer. Neurocognitive dispersion, or intraindividual variability (IIV), has become an increasingly popular tool to assess neuropsychological performance in various clinical populations. Less dispersion is typically associated with more consistent and better overall performance (i.e., fewer lapses of reaction time and accuracy). However, few studies have utilized these measures in healthy young adults. The objective of this study was to determine if athletes and non-athletes exhibited different levels of neurocognitive dispersion on a battery of neuropsychological tasks. It was hypothesized that athletes would exhibit less neurocognitive dispersion compared to non-athletes, despite their exposure to repetitive subconcussive head impacts. Participants and Methods: Division 1 varsity and club team university athletes (n = 74, Mage = 19.93, female = 55%), and non-athlete undergraduate students (N = 154, Mage = 20.12, female = 69%) completed a neuropsychological battery consisting of 13 cognitive tests. Outcomes for each test were converted to standard scores and combined for overall neuropsychological performance. Two measures of IIV, intraindividual standard deviation (ISD) and maximum discrepancy (MD), were calculated across all 13 cognitive tests for each participant. Intraindividual standard deviation was calculated by taking the standard deviation of the mean performance across each task for each participant. Maximum discrepancy was calculated by subtracted the lowest standard score from the highest standard score per participant across all 13 cognitive tests. Results: Controlling for the impact of premorbid functioning, depressive symptoms, and gender, an analysis of covariance (ANCOVA) found significantly less ISD in athletes (M = 11.28, SD = 2.76) compared to non-athletes (M = 12.56, SD = 3.61) across all 13 neuropsychological tasks (η2 = 0.04, p = .004). Similarly, significantly lower MD scores were found in athletes (M = 40.25, SD = 11.14) compared to non-athletes (M = 44.69, SD = 14.07) across all 13 neuropsychological tasks (η2 = 0.03, p = .008). Post-hoc analyses revealed no significant differences when athletes were divided into contact and non-contact athletes. Conclusions: Similar to prior findings that aerobic exercise may enhance cognitive performance, both contact and non-contact college athletes exhibited less neurocognitive dispersion (as measured by ISD and MD) compared to non-athlete college students. However, no significant differences were found between non-contact athletes and contact athletes (soccer players) who were exposed to repetitive subconcussive heading events. These findings suggest that athletic performance in college-aged athletes may lead to more consistent and therefore overall better neuropsychological performance despite exposure to repetitive subconcussive head impacts.

Psychology Internship Training Amidst COVID-19: Balancing Training Opportunities, Patient Care, and Risk of Exposure

Journal of Clinical Psychology in Medical Settings · 2022-06-18 · 4 citations

Variable objective sleep quality is related to worse spatial learning and memory in young adults

Sleep Medicine · 2021 · 10 citations

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Cognitive Functioning of Glucocerebrosidase (GBA) Non-manifesting Carriers

Frontiers in Neurology · 2021 · 21 citations

• Psychology
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related PD.

Cultural Disparities in Deep Brain Stimulation (DBS) Decision Making in Patients with Parkinson Disease (PD) (1713)

Neurology · 2020-04-14 · 5 citations

To identify socio-cultural factors that affect when DBS is initially discussed with patients in a tertiary Movement Disorders center, and how these factors impact a patient’s decision to proceed with the surgical work-up and surgery.