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A higher intake of foods rich in flavonoids such as quercetin can reduce the risk of cardiovascular disease. Enzymatically modified isoquercitrin (EMIQ®) has a bioavailability 17-fold higher than quercetin aglycone and has shown potential cardiovascular disease moderating effects in animal studies. The present study aimed to determine if acute ingestion of EMIQ® improves endothelial function, blood pressure, and cognitive function in human volunteers at risk of cardiovascular disease. Twenty-five participants (12 males, 13 females) with at least one cardiovascular disease risk factor completed this randomized, controlled, crossover study. In a random order, participants were given EMIQ® (2 mg aglycone equivalent)/kg body weight or placebo alongside a standard breakfast meal. Endothelial function, assessed by flow mediated dilatation (FMD) of the brachial artery was measured before and 1.5 hrs after intervention. Blood pressure (BP), arterial stiffness, cognitive function, BP during cognitive stress and measures of quercetin metabolites, oxidative stress and markers of nitric oxide (NO) production were assessed post-intervention. After adjustment for pre-treatment measurements and treatment order, EMIQ® treatment resulted in a significantly higher FMD response compared to the placebo [0.60%, 95% CI: 0.03, 1.17 (p=0.04)]. Plasma concentrations of quercetin metabolites were significantly higher (p<0.001) after EMIQ® treatment compared to the placebo. No changes in blood pressure, arterial stiffness, cognitive function, or biochemical parameters were observed. In this human intervention study, the acute administration of EMIQ® significantly increased circulating quercetin metabolites and improved endothelial function. Further clinical trials are required to assess whether health benefits are associated with long-term EMIQ® consumption.
Pain and depression are common in the population and co-morbid with each other. Both are predictive of one another and are also associated with cognitive function; people who are in greater pain and more depressed respectively perform less well on tests of cognitive function. It has been argued that pain might cause deterioration in cognitive function, whereas better cognitive function earlier in life might be a protective factor against the emergence of disease. When looking at the dynamic relationship between these in chronic diseases, studying samples that already have advanced disease progression often confounds this relationship.
Using data from waves 1 to 3 of the English Longitudinal Study of Ageing (ELSA) (n = 516), we examined the interplay between pain, cognitive function and depression in a subsample of respondents reporting a diagnosis of arthritis at wave 2 of the ELSA using cross-lagged panel models.
The models showed that pain, cognitive function and depression at wave 1, prior to diagnosis, predict pain at wave 2, and that pain at wave 1 predicts depression at wave 2. Pain and depression at wave 2 predict cognitive function at wave 3.
The results indicate that better cognitive function might be protective against the emergence of pain prior to an arthritis diagnosis, but cognitive function is subsequently impaired by pain and depression. Furthermore, higher depression predicts lower cognitive function, but not vice versa. This is discussed in the context of the emerging importance of inflammation in depression.
Decreases in cognitive function related to increases in oxidative stress and inflammation occur with ageing. Acknowledging the free radical-quenching activity and anti-inflammatory action of the carotenoid lycopene, the aim of the present review was to assess if there is evidence for a protective relationship between lycopene and maintained cognitive function or between lycopene and development or progression of dementia. A systematic literature search identified five cross-sectional and five longitudinal studies examining these outcomes in relation to circulating or dietary lycopene. Among four studies evaluating relationships between lycopene and maintained cognition, three reported significant positive relationships. Neither of the two studies reporting on relationship between lycopene and development of dementia reported significant results. Of four studies investigating circulating lycopene and pre-existing dementia, only one reported significant associations between lower circulating lycopene and higher rates of Alzheimer's disease mortality. Acknowledging heterogeneity among studies, there is insufficient evidence and a paucity of data to draw firm conclusions or tease apart direct effects of lycopene. Nevertheless, as low circulating lycopene is a predictor of all-cause mortality, further investigation into its relationship with cognitive longevity and dementia-related mortality is warranted.
Frailty is associated with cognitive decline in older adults. However, the mechanisms explaining this relationship are poorly understood. We hypothesized that sleep quality may mediate the relationship between frailty and cognition.
154 participants aged between 50-90 years (mean = 69.1 years, SD = 9.2 years) from the McKnight Brain Registry were included.
Participants underwent a full neuropsychological evaluation, frailty and subjective sleep quality assessments. Direct relationships between frailty and cognitive function were assessed using linear regression models. Statistical mediation of these relationships by sleep quality was assessed using nonparametric bootstrapping procedures.
Frailty severity predicted weaker executive function (B = −2.77, β = −0.30, 95% CI = −4.05 – −1.29) and processing speed (B = −1.57, β = −0.17, 95% CI = −3.10 – −0.16). Poor sleep quality predicted poorer executive function (B = −0.47, β = −0.21, 95% CI = −0.79 – −0.08), processing speed (B = −0.64, β = −0.28, 95% CI = −0.98 – −0.31), learning (B = −0.42, β = −0.19, 95% CI = −0.76 – −0.05) and delayed recall (B = −0.41, β = −0.16, 95% CI = −0.80 – −0.31). Poor sleep quality mediated the relationships between frailty severity and executive function (B = −0.66, β = −0.07, 95% CI = −1.48 – −0.39), learning (B = −0.85, β = −0.07, 95% CI = −1.85 – −0.12), delayed recall (B = −0.47, β = −0.08, 95% CI = −2.12 – −0.39) and processing speed (B = −0.90, β = −0.09, 95% CI = −1.85 – −0.20).
Relationships between frailty severity and several cognitive outcomes were significantly mediated by poor sleep quality. Interventions to improve sleep quality may be promising avenues to prevent cognitive decline in frail older adults.
Objectives: Research on developmental outcomes of preterm birth has traditionally focused on adverse effects. This study investigated the prevalence and correlates of resilience in 146 extremely preterm/extremely low birth weight (EPT/ELBW) children (gestational age <28 weeks and/or birth weight <1000 g) attending kindergarten and 111 term-born normal birth weight (NBW) controls. Methods: Adaptive competence (i.e., “resilience” in the EPT/ELBW group) was defined by scores within grade expectations on achievement tests and the absence of clinically elevated parent ratings of child behavior problems. The “adaptive” children who met these criteria were compared to the “maladaptive” children who did not on child and family characteristics. Additional analyses were conducted to assess the conjoint effects of group (ELBW vs. NBW) and family factors on adaptive competence. Results: A substantial minority of the EPT/ELBW group (45%) were competent compared to a majority of NBW controls (73%), odds ratio (95% confidence interval)=0.26 (0.15, 0.45), p<.001. Adaptive competence was associated with higher cognitive skills, more favorable ratings of behavior and learning not used to define adaptive competence, and more advantaged family environments in both groups, as well as with a lower rate of earlier neurodevelopmental impairment in the EPT/ELBW group. Higher socioeconomic status and more favorable proximal home environments were associated with competence independent of group, and group differences in competence persisted across the next two school years. Conclusions: The findings document resilience in kindergarten children with extreme prematurity and highlight the role of environmental factors as potential influences on outcome. (JINS, 2019, 25, 362–374)
To examine whether emotional intelligence (EI) is associated with cognitive function (CF) in a sample of community-dwelling, non-demented elderly out-patients.
Correlational cross-sectional study.
Two memory clinics in an urban community in central Israel.
Individuals age 60 and older without dementia, recruited from two memory clinics (N = 151).
Health history was obtained from medical charts. All participants underwent tests measuring CF, basic and instrumental function, general mental ability (GMA), EI, and depression.
Mean age of the participants was 79 years (SD = 7.00) with 96 females (63.6%). Mean score for Montreal Cognitive Assessment (MoCA) was 21.62 (SD = 3.09) and for EI was 14.08 (SD = 3.30). Linear multiple regression analysis was conducted to examine associations of CF with EI while controlling for gender, age, education, GMA, and Charlson Comorbidity Index (CCI). Age, education, GMA, and CCI were significant correlates of CF and accounted for 31.1% of the variance [F(7,143) = 10.8, p<0.01] in CF. EI was added in the second block and was the factor most strongly associated with CF, explaining an additional 9.1% (a total of 40.2%) of the variance in CF [F(8,142) = 13.2, p<0.01].
This study is the first to show the association between EI and CF in older adults. Future prospective studies are needed to explicate the possibility of EI as a protective factor against cognitive decline.
Objectives: This report examined theta-band neurodynamics for potential biomarkers of brain health in athletes with concussion. Methods: Participants included college-age contact/collision athletes with (N=24) and without a history of concussion (N=16) in Study 1. Study 2 (N=10) examined changes over time in contact/collision athletes. There were two primary dependent variables: (1) theta-band phase-synchronization (e.g., functional connectivity) between medial and right-lateral electrodes; and (2) the within-subject correlation between synchronization strength on error trials and post-error reaction time (i.e., operationalization of cognitive control). Results: Head injury history was inversely related with medial-lateral connectivity. Head injury was also related to declines in a neurobehavioral measure of cognitive control (i.e., the single-trial relationship between connectivity and post-error slowing). Conclusions: Results align with a theory of connectivity-mediated cognitive control. Mild injuries undetectable by behavioral measures may still be apparent on direct measures of neural functioning. This report demonstrates that connectivity and cognitive control measures may be useful for tracking recovery from concussion. Theoretically relevant neuroscientific findings in healthy adults may have applications in patient populations, especially with regard to monitoring brain health. (JINS 2019, 25, 314–323)
Korsakoff’s syndrome (KS) is a chronic neuropsychiatric disorder characterised by severe anterograde amnesia and executive deficits. Theory of Mind (ToM) is the capacity to represent others’ mental states such as their knowledge, thoughts, feelings, beliefs, and intentions in order to explain and predict their behaviour. Surprisingly this topic has received hardly any attention in research on KS, although the severity of behavioural problems in KS suggest possible ToM difficulties. The aim of the present study was therefore to assess whether cognitive and affective ToM are impaired in patients with KS.
We examined 21 KS patients and 21 age- and gender-matched healthy controls on three standardised tests that assess cognitive and affective ToM, including the subtests of the mini-Social Cognition and Emotional Assessment battery and a specialised version of the Sally–Anne Test.
KS patients showed largely impaired cognitive and affective ToM compared to healthy controls, as reflected in large effect sizes on both cognitive and affective ToM tests. Executive deficits explained problems in emotion recognition, but not other ToM aspects.
KS patients have large impairments in both cognitive and affective aspects of social cognition. Their ability to recognise emotions, take the perspective of others, and understand socially awkward situations is vastly compromised. The impairments in ToM functioning are to a large degree functionally discrepant from executive disorders that are commonly present in KS. This study therefore highlights the importance to properly index ToM functioning in neuropsychological assessments for individuals with a possible KS diagnosis.
To assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children.
Prospective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children.
Children discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children.
SAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73).
Despite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.
This study aimed to determine the diagnostic utility of a Chinese test battery for evaluating cognitive loss in elderly Chinese Americans.
Data from a pilot study at the Mount Sinai Alzheimer’s Disease Research Center was examined. All participants were > 65 years old, primarily Chinese speaking, with adequate sensorimotor capacity to complete cognitive tests. A research diagnosis of normal mild cognitive impairment (MCI) or Alzheimer’s disease (AD) was assigned to each participant in consensus conference. Composite scores were created to summarize test performance on overall cognition, memory, attention executive function, and language. Multivariable logistic regression models were used to assess the sensitivity of each cognitive domain for discriminating three diagnostic categories. Adjustment was made for demographic variables (i. e., age, gender, education, primary language, and years living in the USA).
The sample included 67 normal, 37 MCI, and 12 AD participants. Performance in overall cognition, memory, and attention executive function was significantly worse in AD than in MCI, and performance in MCI was worse than in normal controls. Language performance followed a similar pattern, but differences did not achieve statistical significance among the three diagnostic groups.
This study highlights the need for cognitive assessment in elderly Chinese immigrants.
Our recent single-photon emission computed tomography (SPECT) study of patients with late-onset Alzheimer’s disease (AD) revealed that regional cerebral blood flow (rCBF) was reduced in the frontal, temporal, and limbic lobes, and to a lesser degree in the parietal and occipital lobes. Moreover, these patients’ scores on the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) were significantly correlated with rCBF in some gyri of the frontal, parietal, and limbic lobes. Our present study aimed to understand how vascular factors and metabolic disease influenced the relationship between rCBF and ADAS-cog scores.
We divided late-onset AD patients into two groups according to their Hachinski Ischemic Score (HIS), low vascular risk patients had values of ≤4 (n=25) and high vascular risk patients had scores ≥5 (n=15). We examined rCBF using brain perfusion SPECT data.
The degrees and patterns of reduced rCBF were largely similar between late-onset AD patients in both groups, regardless of HIS values. Cognitive function was significantly associated with rCBF among late-onset AD patients with low vascular risk (HIS≤4), but not among those with high vascular risk (HIS≥5). Furthermore, metabolic diseases, such as hypertension and diabetes mellitus, disrupted the relationships between hypoperfusion and cognitive impairments in late-onset AD patients.
Factors other than hypoperfusion, such as hypertension and diabetes mellitus, could be involved in the cognitive dysfunction of late-onset AD patients with high vascular risk.
Previous reports investigating adiposity and cognitive function in the population allude to a negative association, although the relationship in older adults is unclear. The aim of this study was to investigate the association of adiposity (BMI and waist:hip ratio (WHR)) with cognitive function in community-dwelling older adults (≥60 years). Participants included 5186 adults from the Trinity Ulster Department of Agriculture ageing cohort study. Neuropsychological assessment measures included the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Multi-variable linear regression models were used to assess the association between adiposity and cognitive function adjusting for insulin resistance, inflammation and cerebrovascular disease. The mean ages were 80·3 (sd 6·7), 71·0 (sd 7·3) and 70·2 (sd 6·3) years on the cognitive, bone and hypertensive cohorts, respectively. In the cognitive cohort, BMI was positively associated with immediate and delay memory, visuospatial/constructional ability, language and MMSE, and negatively with FAB (log-transformed), whereas WHR was negatively associated with attention. In the bone cohort, BMI was not associated with any cognitive domain, whereas WHR was negatively associated with visuospatial/constructional ability, attention and MMSE. In the hypertensive cohort, BMI was not associated with any cognitive domain, whereas WHR was negatively associated with immediate and delayed memory, visuospatial/constructional ability, language and MMSE and positively with FAB (log-transformed). In the cognitive and bone cohorts, the association of WHR and attention disappeared by further controlling for C-reactive protein and HbA1C. In this study of older adults, central adiposity was a stronger predictor of poor cognitive performance than BMI. Older adults could benefit from targeted public health strategies aimed at reducing obesity and obeseogenic risk factors to avoid/prevent/slow cognitive dysfunction.
Objectives: A substantial body of research has documented age-related declines in cognitive abilities among adults over 60, yet there is much less known about changes in cognitive abilities during midlife. The goal was to examine longitudinal changes in multiple cognitive domains from early midlife through old age in a large national sample, the Midlife in the United States (MIDUS) study. Methods: The Brief Test of Adult Cognition by Telephone (BTACT) was administered on two occasions (MIDUS 2, MIDUS 3), an average of 9 years apart. At MIDUS 3, those with the cognitive assessment (N=2518) ranged in age from 42 to 92 years (M=64.30; SD=11.20) and had a mean education of 14.68 years (SD=2.63). The BTACT includes assessment of key aging-sensitive cognitive domains: immediate and delayed free recall, number series, category fluency, backward digit span, processing speed, and reaction time for attention switching and inhibitory control, which comprise two factors: episodic memory and executive functioning. Results: As predicted, all cognitive subtests and factors showed very small but significant declines over 9 years, with differences in the timing and extent of change. Processing speed showed the earliest and steepest decrements. Those with higher educational attainment scored better on all tests except reaction time. Men had better executive functioning and women performed better on episodic memory. Conclusions: Examining cognitive changes in midlife provides opportunities for early detection of cognitive impairments and possibilities for preventative interventions. (JINS, 2018, 24, 805–820)
Objectives: The purpose of this study was to determine if intraindividual variability would be more sensitive than speed or accuracy in detecting subtle cancer-related cognitive disturbance. Methods: Data were from a previous study in which 60 breast cancer (BC) patients underwent neuropsychological assessment before commencement of chemotherapy and again following each chemotherapy cycle. Sixty healthy controls were tested at equivalent intervals. Hierarchical linear modeling was used to compare the BC and control groups in terms of accuracy, mean reaction time, and intraindividual variability in reaction time on a computerized continuous performance test with three conditions: a simple reaction time task, a “1-back” task, and a “2-back” task. Results: An increase in accuracy and response speed over sessions was noted on some tasks in the sample as a whole but there were no differences in these parameters between the BC patients and the controls on any condition. There was a significant group difference in change in intraindividual variability across sessions (i.e., a “group × session interaction”), albeit only on the most complex “2-back” task. Intraindividual variability declined in the control group (i.e., consistency improved with practice) but this practice effect was significantly attenuated in the BC patients. There was no main effect of group on the “2-back” task. Conclusions: Results support our hypothesis that intraindividual variability is a more sensitive indicator of subtle cognitive disturbance than conventional speed or accuracy measures and may have potential in the assessment of mild cognitive impairment in patients with non-central nervous system cancers. (JINS, 2018, 24, 1–11)
With a rise in the aging population and a consequential rise in persons diagnosed with dementia comes an increase in the number of informal caregivers who are caring for a loved one. The objective of the proposed study was to assess the neurocognitive and psychological effects of caring for a person with dementia or a related neurodegenerative disease in a sample of Canadian informal caregivers.
Fifty-seven informal caregivers of a person with dementia or a related neurodegenerative disease (mean age = 66.26, SD = 7.55) and 97 non-caregivers (mean age = 69.16, SD = 4.84) were recruited. Neuropsychological measures of attention, cognitive flexibility, verbal learning, delayed recall, and verbal fluency were examined, and questionnaires related to perceived stress, quality of life, mood, and self-esteem were administered.
Caregivers made more errors on a measure of cognitive flexibility (p = 0.02), generated fewer words on measures of phonemic fluency (p < 0.01) and semantic fluency (p < 0.001), and learned significantly fewer words on a list-learning task (p < 0.01). Caregivers also reported experiencing significantly more perceived stress (p < 0.001), lower quality of life (p < 0.001), and were more likely to meet the cut-off for clinically significant depressive symptoms on a self-report scale (p < 0.001).
These data contribute to a growing body of literature that consistently points to the need for immediate action to improve the welfare of caregivers.
Objectives: Military deployment is associated with increased risk of adverse emotional and cognitive outcomes. Longitudinal associations involving posttraumatic stress disorder (PTSD), relatively mild traumatic brain injury (TBI), and neurocognitive compromise are poorly understood, especially with regard to long-term outcomes, and rigorous research is necessary to better understand the corresponding relationships. The objective of this study was to examine short-term and long-term (>5 years) longitudinal associations among PTSD, neurocognitive performance, and TBI following military deployment. Methods: In this prospective study, N=315 U.S. Army soldiers were assessed at military installations before (2003–2005) and after (2004–2006) an index deployment to the Iraq War, and again an average of 7.6 years later (2010–2014) as a nationally dispersed cohort of active duty soldiers, reservists, and veterans. Thus, the study design allowed for two measurement intervals over which to examine changes. All assessments included the PTSD Checklist, civilian version, and individually-administered performance-based neurocognitive tests. TBI history was derived from clinical interview. Results: Autoregressive analyses indicated that visual reproduction scores were inversely related to subsequent PTSD symptom severity at subsequent assessments. Conversely, increases in PTSD symptom severity over each measurement interval were associated with poorer verbal and/or visual recall at the end of each interval, and less efficient reaction time at post-deployment. TBI, primarily mild in this sample, was associated with adverse PTSD symptom outcomes at both post-deployment and long-term follow-up. Conclusions: These results suggest longitudinal relationships among PTSD symptoms, TBI, and neurocognitive decrements may contribute to sustained emotional and neurocognitive symptoms over time. (JINS, 2018, 24, 311–323)
Objectives: Preterm children demonstrate deficits in executive functions including inhibition, working memory, and cognitive flexibility; however, their goal setting abilities (planning, organization, strategic reasoning) remain unclear. This study compared goal setting abilities between very preterm (VP: <30 weeks/<1250 grams) and term born controls during late childhood. Additionally, early risk factors (neonatal brain abnormalities, medical complications, and sex) were examined in relationship to goal setting outcomes within the VP group. Methods: Participants included 177 VP and 61 full-term born control children aged 13 years. Goal setting was assessed using several measures of planning, organization, and strategic reasoning. Parents also completed the Behavior Rating Inventory of Executive Function. Regression models were performed to compare groups, with secondary analyses adjusting for potential confounders (sex and social risk), and excluding children with major neurosensory impairment and/or IQ<70. Within the VP group, regression models were performed to examine the relationship between brain abnormalities, medical complications, and sex, on goal setting scores. Results: The VP group demonstrated a clear pattern of impairment and inefficiency across goal setting measures, consistent with parental report, compared with their full-term born peers. Within the VP group, moderate/severe brain abnormalities on neonatal MRI predicted adverse goal setting outcomes at 13. Conclusions: Goal setting difficulties are a significant area of concern in VP children during late childhood. These difficulties are associated with neonatal brain abnormalities, and are likely to have functional consequences academically, socially and vocationally. (JINS, 2018, 24, 372–381)
Anxiety and depression are both important correlates of cognitive function. However, longitudinal studies investigating how they covary with cognition within the same individual are scarce. We aimed to simultaneously estimate associations of between-person differences and within-person variability in anxiety and depression with cognitive performance in a sample of non-demented older people.
Participants in the Lothian Birth Cohort 1921 study, a population-based narrow-age sample (mean age at wave 1 = 79 years, n = 535), were examined on five occasions across 13 years. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS) and cognitive performance was assessed with tests of reasoning, logical memory, and letter fluency. Data were analyzed using two-level linear mixed-effects models with within-person centering.
Divergent patterns were observed for anxiety and depression. For anxiety, between-person differences were more influential; people who scored higher on HADS anxiety relative to other same-aged individuals demonstrated poorer cognitive performance on average. For depression, on the other hand, time-varying within-person differences were more important; scoring higher than usual on HADS depression was associated with poorer cognitive performance relative to the average level for that participant. Adjusting for gender, childhood mental ability, emotional stability, and disease burden attenuated these associations.
The results from this study highlight the importance of addressing both between- and within-person effects of negative mood and suggest that anxiety and depression affect cognitive function in different ways. The current findings have implications for assessment and treatment of older age cognitive deficits.
Severe head injury or brain injury presents clinical neuroscientists with a unique challenge. Based on an objective assessment of cognitive and neurological function, it is sometimes hard to recognize our patients as members of our moral community (actually or potentially) but we treat them as if that were is the case, and, therefore, as if they need rescuing. Thus their existences as enigmata—beings who may or may not reveal themselves to us through social and personal function realized in conversations and relationships—are in doubt. However, the objective mode of assessing individuals and their mental functions needs to be bracketed here, as we reconnect with them and offer them our help in the restorative journey that they need to take. The journey has many tortuous paths comprising it, not the least of which is the existential question of whether the damaged human being with whom we are engaged actually can be restored to a meaningful life. A negative answer to that question can bring the whole process to an abrupt end. Neuroscience cannot answer some of these questions, as they are ethical. Is this a life worth living and are our commitments going to go the distance that must be traversed here. Therefore, this is an area where ethics take priority over neuroscience, and it is on our ethical response that everything else hinges. Understanding the light this throws on the nature of a human being takes us to the heart of the value of every human being and the nexus of mutuality that is the moral community.
Objectives: The Automated Neuropsychological Assessment Metrics 4 TBI-MIL (ANAM4) is a computerized cognitive test often used in post-concussion assessments with U.S. service members (SMs). Existing evidence, however, remains mixed regarding ANAM4’s ability to identify cognitive issues following mild traumatic brain injury (mTBI). Studies typically examine ANAM4 by comparing mean scores to baseline or normative scores. A more fine-grained approach involves examining inconsistency within an individual’s performance. Methods: Data from a sample of 231 were healthy control SMs and 100 SMs within 7 days of mTBI who took the ANAM4 were included in analyses. We examine each individual’s performance on a simple reaction time (SRT) subtest that is administered at the beginning (SRT1) and end (SRT2) of the ANAM4 battery, and calculate the standard deviation of difference scores by trial across administrations. Results: Multivariate analysis of variance and univariate analyses revealed group differences across all comparisons (p<.001) with pairwise comparisons revealing higher intra-individual variability and slower raw reaction time for the mTBI group compared with controls. Effect sizes were small though exceeded the recommended minimum practical effect size (ES>0.41). Conclusions: While inconsistencies in performance are often viewed as noise or test error, the results suggest intra-individual cognitive variability may be more sensitive than central tendency measures (i.e., comparison of means) in detecting changes in cognitive function in mTBI. Additionally, the findings highlight the utility of ANAM4’s repeating a subtest at two points in a battery to explore within-subject differences in performance. (JINS, 2017, 23, 1–6)