Evidence regarding cognitive impairment following concussion/mild traumatic brain injury (mTBI) has been conflicting. Criticism has focused on what is being measured, how it is being measured, and who is being measured (Pertab et al, 2009; Iverson, 2010). However, literature suggests that clinicians and researchers should examine how individuals complete a task rather than what they achieve (Geary et al, 2011). Studies examining the drawing process used to complete the Rey-Osterrieth Complex Figure Task (RCF) have been inconclusive and methodologically weak. The current study addressed several criticisms and limitations by examining whether observing RCF drawing process, including a novel strategy construct, could support a diagnosis of persisting post-concussive symptoms.

Sixteen individuals with a history of concussion/mTBI and sixteen matched controls (age, sex, IQ) were included in multiple regression analyses to examine whether RCF drawing constructs predict post-concussive symptoms (mean age 43.59 years; 22 female). At least 3 months had passed since the concussive/mTBI event. Post-concussive symptoms were assessed with the Rivermead Post-Concussive Symptoms Questionnaire (RPCSQ) and the Mental Fatigue Scale (MFS). Separate regression analyses were conducted for each scale. Predictor variables were statistically selected from a catalogue of 4 RCF drawing process constructs - Wholeness, Order, Continuation and Strategy; 15 traditional measures of cognitive function; and 3 psychological state measures. 17 variables were included in the model for the RPCSQ, including Order and Strategy. 18 variables were included for the MFS, including Order, Continuation and Strategy.

Order scores were found to be one of the strongest predictors of RPCSQ scores (B = -2.06; ß= 0.20), and MFS scores (B = -1.54, ß = 0.26). Individuals drawing fewer core elements at the start of the drawing process were found to report more post-concussive symptoms. Participants who observed a stronger temporal-spatial strategy heuristic, as measured by the Strategy construct, reported more symptoms, particularly mental fatigue (RPCSQ: B = 0.49, ß = 0.09; MFS: B = 0.58, ß = 0.19). Continuation was also found to be predictive of MFS scores (B = -0.24, ß = -0.14), such that the fewer continuation points that were observed, the greater the MFS score.

Two constructs of RCF drawing process - Order and Strategy - were found to predict persisting post-concussive symptoms generally, and mental fatigue specifically. Continuation was also found to predict mental fatigue. Such findings provide a cognitive explanation for patient reports of mental fatigue following concussion - recognised as the most common and persistent symptom. Strict adherence to a temporal-spatial strategy may indicate cognitive inflexibility - a theory supported by the inclusion and influence of other cognitive tasks in the regression models that rely on cognitive flexibility. Individuals exert more effort to shift between perceptual planes and to override global bias, thereby expending cognitive resources more quickly and to a greater extent. These findings provide a credible explanation for the lack of evidence of cognitive impairments in previous research, where neuropsychological tasks focus on attainment rather than process. These findings highlight the clinical importance of assessing cognitive dysregulation, specific cognitive processes and cognitive deficits post-concussion/mTBI.

To investigate the informative value of nightmares on neurobehavioral functioning in individuals with mild traumatic brain injury (mTBI) beyond general sleep disturbance.

A sample of 146 adults with mTBI (mean age = 45.1±16.0), recruited from a specialized concussion treatment center, underwent an assessment of neurobehavioral functioning using the Behavioral Assessment Screening Tool (BAST), self-reported habitual sleep disturbance and quality (via the Pittsburgh Sleep Quality Index; PSQI), and reported nightmare frequency in the past two weeks.

Nightmare frequency was the strongest predictor of negative affect (ß = .362, p <.001), anxiety (ß = .332, p <.001), and impulsivity (ß = .270, p <.001) after controlling for sex and age. Sleep disturbance accounted for the greatest variance in depression (ß = .493, p <.001), burden from concussion (ß = .477, p <.001), and fatigue (ß = .449, p <.001) after controlling for sex and age.

Nightmares independently associate with neurobehavioral symptoms and likely have differential etiology from reported sleep disturbance. Nightmare frequency was more strongly related to positive neurobehavioral symptoms (i.e., added factors that impact functioning, e.g., anxiety), while general sleep disturbance was associated with negative neurobehavioral symptoms (i.e., factors taken away that impact functioning, e.g., lack of energy). Our findings suggest that neuropsychological evaluations of individuals with mTBI should assess for sleep disturbance and nightmare frequency as risk factors for neurobehavioral barriers to functioning.

An accurate accounting of prior sport-related concussion (SRC) is critical to optimizing the clinical care of athletes with SRC. Yet, obtaining such a history via medical records or lifetime monitoring is often not feasible necessitating the use of self-report histories. The primary objective of the current project is to determine the degree to which athletes consistently report their SRC history on serial assessments throughout their collegiate athletic career.

Data were obtained from the NCAA-DoD CARE Consortium and included 1621 athletes (914 male) from a single Division 1 university who participated in athletics during the 2014-2017 academic years. From this initial cohort, 752 athletes completed a second-year assessment and 332 completed a third-year assessment. Yearly assessments included a brief self-report survey that queried SRC history of the previous year. Consistency of self-reported SRC history was defined as reporting the same number of SRC on subsequent yearly evaluation as had been reported the previous year.

For every year of participation, the number of SRC reported on the baseline exam (Reported) and the number of SRC recorded by athletes and medical staff during the ensuing season (Recorded) were tabulated. In a subsequent year, the expected number of SRC (Expected) was computed as the sum of Reported and Recorded. For participation years in which Expected could be computed, the reporting deviation (RepDev) gives the difference between the number of SRCs which were expected to be reported at a baseline exam based on previous participation year data and the number of SRCs which was actually reported by the athlete or medical record during the baseline exam. The reporting deviation was computed only for those SRC that occurred while the participant was enrolled in the current study (RepDevSO). Oneway intraclass correlations (ICC) were computed between the expected and reported numbers of SRC.

341 athletes had a history of at least one SRC and 206 of those (60.4%) had a RepDev of 0. The overall ICC for RepDev was 0.761 (95% CI 0.73-0.79). The presence of depression (ICC 0.87, 95% CI 0.79-0.92) and loss of consciousness (ICC 0.80, 95% CI 0.720.86) were associated with higher ICCs compared to athletes without these variables. Female athletes demonstrated higher self-report consistency (ICC 0.82, 95% CI 0.79-0.85) compared to male athletes (ICC 0.72, 95% CI 0.68-0.76). Differences in the classification of RepDev according to sex and sport were found to be significant (x2=77.6, df=56, p=0.03). The sports with the highest consistency were Women’s Tennis, Men’s Diving, and Men’s Tennis with 100% consistency between academic years. Sports with the lowest consistency were Women’s Gymnastics (69%), Men’s Lacrosse (70%), and Football (72%). 96 athletes had at least one study-only SRC in the previous year and 69 of those (71.9%) had a RepDevSO of 0 (ICC 0.673, 95% CI 0.64-0.71).

Approximately 40% of athletes do not consistently report their SRC history, potentially further complicating the clinical management of SRC. These findings encourage clinicians to be aware of factors which could influence the reliability of self-reported SRC history.

The purpose of this study was to explore overall recovery time and post-concussive symptoms (PCSS) of pediatric concussion patients who were referred to a specialty concussion clinic after enduring a protracted recovery (>28 days). This included patients who self-deferred care or received management from another provider until recovery became complicated. It was hypothesized that protracted recovery patients, who initiated care within a specialty concussion clinic, would have similar recovery outcomes as typical acute injury concussion patients (i.e., within 3 weeks).

Retrospective data were gathered from electronic medical records of concussion patients aged 6-19 years. Demographic data were examined based on age, gender, race, concussion history, and comorbid psychiatric diagnosis. Concussion injury data included days from injury to initial clinic visit, total visits, PCSS scores, days from injury to recovery, and days from initiating care with a specialty clinic to recovery. All participants were provided standard return-to-learn and return-to-play protocols, aerobic exercise recommendations, behavioral health recommendations, personalized vestibular/ocular motor rehabilitation exercises, and psychoeducation on the expected recovery trajectory of concussion.

52 patients were included in this exploratory analysis (Mean age 14.6, SD ±2.7; 57.7% female; 55.7% White, 21.2% Black or African American, 21.2% Hispanic). Two percent of our sample did not disclose their race or ethnicity. Prior concussion history was present in 36.5% of patients and 23.1% had a comorbid psychiatric diagnosis. The patient referral distribution included emergency departments (36%), local pediatricians (26%), neurologists (10%), other concussion clinics (4%), and self-referrals (24%).

Given the nature of our specialty concussion clinic sample, the data was not normally distributed and more likely to be skewed by outliers. As such, the median value and interquartile range were used to describe the results. Regarding recovery variables, the median days to clinic from initial injury was 50.0 (IQR=33.5-75.5) days, the median PCSS score at initial visit was 26.0 (IQR=10.0-53.0), and the median overall recovery time was 81.0 (IQR=57.0-143.3) days.

After initiating care within our specialty concussion clinic, the median recovery time was 21.0 (IQR=14.0-58.0) additional days, the median total visits were 2.0 (IQR=2.0-3.0), and the median PCSS score at follow-up visit was 7.0 (IQR=1-17.3).

Research has shown that early referral to specialty concussion clinics may reduce recovery time and the risk of protracted recovery. Our results extend these findings to suggest that patients with protracted recovery returned to baseline similarly to those with an acute concussion injury after initiating specialty clinic care. This may be due to the vast number of resources within specialty concussion clinics including tailored return-to-learn and return-to-play protocols, rehabilitation recommendations consistent with research, and home exercises that supplement recovery. Future studies should compare outcomes of protracted recovery patients receiving care from a specialty concussion clinic against those who sought other forms of treatment. Further, evaluating the influence of comorbid factors (e.g., psychiatric and/or concussion history) on pediatric concussion recovery trajectories may be useful for future research.

To determine the association between in-vivo spectroscopy metabolite data, the local connectome, and markers of initial injury severity (I.e., history of loss of consciousness; LoC) in traumatic brain injury (TBI), in a heterogenous sample of Veterans and non-Veterans with a history of remote mild-to-moderate TBI (I.e., >6 months).

Participants with complete PRESS magnetic resonance spectroscopy (MRS) and diffusion weighted imaging (DWI) data (N = 41) were sampled from a larger multisite study of chronic mild-to-moderate TBI (Nmiid = 38; Nmoderate = 3; 54% with LoC; 46% with multiple TBI). The sample was predominantly male (76%) with ages ranging from 23-59 (M = 36.9, SD = 10.1), with 98% holding at least a high school degree (M = 14.5 years of education, SD = 2.4). Fully tissue-and-relaxation-corrected metabolite concentration estimates in the dorsal anterior cingulate (30x30x30mm voxel) were modeled using Osprey 2.4.0. Total creatine (tCr), total choline (tCho), total N-acetylaspartate (tNAA), glutamate/glutamine (Glx), and myo-inositol (mI) were analyzed. Logistic regression was used to measure the association between metabolites and history of TBI with LoC. Correlational connectometry using the normalized spin distribution function was performed for metabolites associated with LoC, to characterize the local connectome associated with metabolites of interest, controlling for age and sex, and correcting for multiple comparisons (FDR < .050 with 4000 permutations). A profile approach was used to interpret diffusion metrics, contrasting quantitative anisotropy (QA) with fractional anisotropy (FA). Local connectome tracks were then clustered to identify the larger white matter tract.

Glx (p = .008) and tCr (p = .032) were significantly associated with history of TBI with LoC. Increased Glx was associated with increased QA in 11,001 tracks, accounting for 1.4% of the total white matter tracks in the brain. 90% of tracks were identified in bilateral cingulum (33%), bilateral thalamic (13%), bilateral corticospinal (13%), corpus callosum (12%), left arcuate fasciculus (9%), left frontoparietal aslant tracts (6%), and bilateral inferior fronto-occipital fasciculus (4%) tracts. In contrast, FA was not associated with Glx. The same pattern emerged for tCr, with 10,542 tracks identified predominantly in bilateral cingulum (29%), corpus callosum (21%), bilateral corticospinal (15%), bilateral corticostriatal (7%), bilateral medial lemniscus (7%), left cortico-pontine (3%), left thalamic (2%), and bilateral superior longitudinal fasciculus (2%) tracts. Post-hoc exploratory analyses of mean QA across regions of cingulum found that increased QA was associated with self-report measures of headache intensity, fatigue, and perceived change in executive functioning.

Results provided evidence that multimodal imaging can identify subtle markers of initial TBI severity years after injury. Neurometabolite concentrations were associated with diffuse changes in the local connectome; the pattern of discrepancy between FA and QA was suggestive of reduced potential for neuroplasticity. Exploratory analyses further indicated that variability in white matter density in the cingulum, an important connection for limbic regions, was associated with a range of problems commonly reported in clinical settings, which may be informative for diagnosis and treatment planning.

To determine the effects of the non-classic psychedelic, ibogaine, on cognitive functioning. Ibogaine is an indole alkaloid derived from the Tabernanthe Iboga plant family, indigenous to Africa, and traditionally used in spiritual and healing ceremonies. Ibogaine has primarily been studied with respect to its clinical efficacy in reducing substance addiction. There are, however, indications that it also may enhance recovery from traumatic experiences. Ibogaine is a Schedule 1 substance in the USA.

Participants were U.S. Special Operations Veterans who had independently and voluntarily referred themselves for an ibogaine retreat at a specialized clinic outside the USA prior to learning about this observational study. After meeting rigorous screening requirements, 30 participants were enrolled, all endorsing histories of combat and repeated blast exposure, as well as traumatic brain injury. Participants were seen in person pre-treatment, post-treatment, and one-month post-treatment for neuropsychological testing, neuroimaging, and collection of clinical outcome measures. All 30 participants were seen pre- and post-treatment, of whom 27 were also able to return one-month post-treatment.

The neuropsychological battery included the the Hopkins Verbal Learning Test (HVLT), the Brief Visuospatial Memory Test - Revised (BVMT-R), the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Working Memory Index (Digit Span and Arithmetic) and Processing Speed Index (Symbol Search and Coding), and the Delis-Kaplan Executive Function System (D-KEFS) tests of Verbal Fluency (VF), Trail Making (TMT), Color Word (CW), and Tower Test (TT). For repeated measures, alternate forms were used whenever possible.

Repeated-measures ANOVA revealed significant effects of time, with post-treatment improvements across multiple measures including processing speed (WAIS-IV PSI; F(2,25) = 26.957, p < .001), executive functions (CW Conditions 3 and 4: F(1.445,25) = 11.383, p < .001 and F(1.381,25) = 7.687, p = .004, respectively), verbal fluency (VF Condition 3 correct and accuracy: F(2,25) = 6.419, p = .003 and F(2,25) = 153.076, p < .001, respectively), and verbal learning (HVLT Total Recall (alternate forms used at each time point): F(1.563,23) = 6.958, p = .004). Score progression graphs are presented. Performance on all other cognitive measures did not significantly change following treatment.

To our knowledge, this is the first prospective study examining neuropsychological test performance following ibogaine use at post-treatment and one-month post-treatment time points. Our results indicated that several cognitive domains improved either post-treatment or one-month post-ibogaine treatment, suggesting ibogaine’s therapeutic potential for cognition in the context of traumatic brain injury and mood disorders. Potential explanations include neuroplastic changes, reduction of PTSD and mood-related effects on cognitive functioning, and practice effects. While we found no evidence of negative cognitive consequences for up to one-month post-single-ibogaine treatment, further study of this substance is necessary to clarify its clinical utility and safety parameters.

Pediatric brain tumor survivors treated with proton radiation therapy (PRT) prior to 4 years of age are at high risk for poor cognitive and developmental outcomes. This cross-sectional study examined developmental outcomes and educational service utilization at follow-up in a cohort of pediatric survivors treated with PRT before the age of 4 years.

A total of 46 patients (58.7% female, 93.5% White) were assessed using age-appropriate measures for executive, behavioral, and adaptive functioning. Mean age at PRT was 2.4 years (SD=0.9, range 1.0-3.9 years); mean age at follow-up was 7.0 years (SD=4.8, range 2.0-18.6 years). Mean follow-up interval was 4.57 years (SD=4.52, range 0.9-16.2 years). Diagnoses included ependymoma (n=26, 54.2%), medulloblastoma (n=7, 14.6%), craniopharyngioma (n=4, 8.3%), and a few other tumor types. Infratentorial tumors were most common (69.6%). Treatment included prior surgical resection (93.5%) and chemotherapy (60.9%). Posterior fossa syndrome was present in 10.9% (n=5). PRT field consisted of focal (n=41, 89.1%) or craniospinal irradiation (CSI) (n=5, 10.9%). The impact of demographic, diagnostic, and treatment-related factors was examined, including age at PRT, gender, time interval since PRT, radiation field, and tumor location, on intelligence quotient (IQ), adaptive skills, and executive functioning. Rates of impairment (T-scores >65) were calculated. The utilization of educational services was determined.

Mean IQ (SS = 97.6, SD=16.3), as well as mean global executive functioning (Mean T=53.4, SD=11.1) and adaptive skills (Mean SS = 92.5, SD=21.4), as assessed by parent rating scales (BRIEF; SIB), were in the average range. Despite mean scores being within the average range, a large proportion of patients demonstrated difficulties with social withdrawal (28.3%) and activities of daily living (28.3%) (BASC), and global executive dysfunction (17.4%) (BRIEF). Younger age at PRT was associated with lower global adaptive skills at follow-up (r=.39, p=.005), better activities of daily living (r=.53, p<.001), lower social skills (r=.43, p=.002), and more hyperactivity (r=-.37, p=.008), but not aggression, anxiety, depression, somatization, atypical behaviors, withdrawal, or attention problems. Longer follow-up interval was correlated with better activities of daily living (r=.46, p<.001), but more anxiety (r=.39, p=.006). Gender, SES, radiation field, history of hydrocephalus, and location of tumor were not significantly related to primary outcome variables. Posterior fossa syndrome was associated with lower adaptive skills (t=2.90, p=.003) and IQ (t=2.02, p=.026). Of those enrolled in school, 59% received special education services and/or accommodations (IEP n=18, Early Intervention n=6; 504 Plan n=3).

Overall, PRT before age 4 years was associated with difficulties with withdrawal, adaptive skills, and executive functioning. Younger age at PRT was associated with lower adaptive functioning, lower social skills, and higher hyperactivity, but not with IQ, attention, mood, or anxiety. While a longer time interval since treatment was associated with improvement in activities of daily living, anxiety was increased, suggesting some late emotional effects. Furthermore, posterior fossa syndrome after surgery was related to lower adaptive skills and IQ. Attention problems were not indicated. Approximately half received school services/accommodations. Young children treated with PRT require proactive support and services to foster their developmental outcomes.

Adults with recurrent depression have been shown to have cognitive deficits also while in remission. Thus, it has been suggested that with a chronic course of depression, poorer executive control can be a vulnerability factor for depressive relapse. This has led to research on how cognitive remediation training can protect against recurrent depressive episodes. Findings indicate that such training has short term effects on cognitive functioning, and small effect on depression symptoms. Less focus has been on how “standard” psychotherapy can have positive effects on executive and attentional control. Mindfulness-based cognitive therapy (MBCT) has been shown to be as effective as antidepressant medication in preventing relapses of depressive episodes. Mindfulness training in healthy samples seems to improve executive and attentional control. However, the few studies of MBCT in recurrent depression show mixed effects on executive and attentional control. As far as we know, no prior study has investigated the effect of MBCT in recurrent depression with the revised version of the attention network test (ANT-R). In a randomized controlled trial, we expected that the MBCT group would show enhanced executive control and lower levels of attentional fluctuations than the wait-list controls (WLC) from pre (T0) to post (T1) treatment. We further investigated if positive effects of MBCT on executive and attentional control were associated with reduction in depression symptoms.

Adults with recurrent depression in partial or full remission (N = 64) were randomized to MBCT or WLC. In the MBCT and WLC groups, 25 and 29, respectively, performed the ANT-R at T0 and T1. The attention network reaction time scores of executive control, alerting, and orienting were calculated in addition to attention fluctuations scores of intra-individual reaction time variability (IIVRT) and exgaussian-mean of longer reaction times (TAU). Self-reported depression symptoms were measured with BDI-II. The two groups were compared at baseline on full-scale IQ (WASI), executive control (D-KEFS Stroop), and processing speed (D-KEFS TMT).

The MBCT and WCL groups did not differ significantly in age or gender distribution, education, full-scale IQ or in baseline executive and attentional control as measured with the ANT-R, Stroop and TMT. The MBCT group showed a higher efficiency in conflict detection as measured with the executive control score from T0 to T1 compared to the WLC. This positive effect of MBCT on executive control was independent from the greater reductions in depression symptoms in the MBCT group compared to in the WLCs. However, reduction in depression symptoms at T1 was associated with enhanced efficiency in responding to alerting cues in conflict detection. No effects of MBCT compared to WLC were found at T1 on the attention fluctuation measures (IIVRT and TAU).

The findings from the current study indicates that MBCT enhances executive control in adults with recurrent depression. As such, MBCT may target an important cognitive vulnerability factor in the chronic course of recurrent depression that may contribute to its efficacy in preventing depressive relapses. It was also observed that reductions in depression symptoms led to higher alertness in conflict detection.

An understanding of factors that contribute to informant ratings of patients’ functional abilities is crucial, not only because these ratings are used to diagnose individuals with mild cognitive impairment (MCI) versus dementia, but also because these ratings are commonly used as outcome measures in clinical trials. While these ratings are assumed to be largely accurate, research shows they are subject to biases. Caregiver distress, higher caregiver educational attainment, and higher patient age are associated with a higher discrepancy between informant and patient reports of functional abilities. Studies on informant ratings of functional abilities that simultaneously control for patient objective cognitive abilities remain sparse. The current study aims to evaluate caregiver characteristics as predictors of informant-rated functional status while controlling for patient objective cognitive abilities in MCI.

Individuals with a clinical diagnosis of MCI (Albert, 2011 criteria) were referred to the Cognitive Empowerment Program (CEP), a comprehensive lifestyle program addressing modifiable risk factors associated with progression. This study included cross-sectional data from 118 newly enrolled individuals and their caregivers who served as informants. Patient cognitive functioning was assessed with the Montreal Cognitive Assessment (MoCA). Predictors of interest included caregiver-rated functional abilities (Functional Activities Questionnaire; FAQ), caregiver burden (Zarit Burden Interview; ZBD), caregiver depressive symptoms (Center for Epidemiological Studies Depression scale; CES-D), caregiver stress (Perceived Stress Scale; PSS), and caregivers’ self-rated communicative effectiveness (Communicative Effectiveness Index; CETI). Hierarchical linear regression models were run to predict FAQ while controlling for patient MoCA scores. Separate models were run for the caregiver variables of interest including caregiver age, ZBD, CES-D, PSS, and CETI.

Caregivers were 75.6% spouses, 17.1% adult children, 3.3% unmarried partners/cohabitating partners, and 4.1% friends. The mean age of individuals with MCI was 74.7 years (SD: 6.96, mean education = 16.2±2.60 years; 47% female) and the mean age of caregivers was 66.4 (SD: 12.88, mean education = 16.3±2.34; 66% female). Worse ratings of functional abilities on the informant-rated FAQ were found for patients with lower MoCA scores (ß = .242, p = .008). Importantly, while controlling for MoCA scores, worse ratings of functional abilities on the FAQ were found for informants with lower age (ß = -0.269, p = .003), higher perceived stress (ß = 0.267, p = .003), higher caregiver burden (ß = 0.289, p < 0.001), and lower self-rated communication effectiveness (ß = -0.324, p < .001). Caregiver depression (ß = 0.089, p = .084) and education (ß = -0.137, p = .147) were not significant predictors of functional ability ratings while controlling for MoCA scores.

Results of the current study highlight the potential for biases in informant ratings regarding functional abilities in MCI. Informant ratings were found to be significantly influenced by caregiver age, stress, burden, and communicative effectiveness. A key finding is that younger caregivers, such as adult children, may report greater functional impairment in individuals with MCI. The current findings have implications for the use of perceived functional ratings, both for diagnostic purposes and as outcome measures in clinical trials.

Goal-Oriented Attentional Self-Regulation (GOALS) is a cognitive rehabilitation training that targets difficulties with executive control functions. Prior research has found that GOALS training improves executive function, functional outcomes, and PTSD symptoms in Veterans with comorbid PTSD and TBI. The objective of this study is to assess the effects of GOALS training versus an active time-matched Behavioral Health Education (BHE) intervention in military Veterans with history of mTBI and executive function difficulties.

Thirty-four veterans with a history of mild TBI (>6 months post-injury) and cognitive difficulties were randomized to GOALS or BHE group intervention. GOALS is a cognitive rehabilitation intervention that incorporates mindfulness-based attention regulation training, and goal management strategies applied to participant-defined goals. It consists of ten 2-hour sessions administered in small group format, and three individual 1-hour sessions. The BHE group is a matched control condition that mirrors GOALS in terms of duration and level of involvement. Participants completed a comprehensive evaluation consisting of neuropsychological and ecologically valid functional performance measures of complex attention and executive function, before and after GOALS or BHE intervention. Overall neuropsychological attention/executive functioning included measures of working memory (Letter Number Sequencing, Auditory Consonant Trigrams), mental flexibility (Design & Verbal Fluency Switching, Trails B, Stroop Inhibition/Switching), inhibition (Stroop Inhibition), and sustained attention (Digit Vigilance). The Goal Processing Scale (GPS) was used to measure ecologically valid complex functional performance.

Post GOALS training, but not post BHE, participants significantly improved on measures of attention /executive function including overall performance (p=.02), working memory (p=.04), sustained attention (p=.03)., and inhibition (p=.01). On measures of complex functional task performance, post GOALS participants significantly improved in the domain of planning (p=.02).

GOALS training improved performance on neuropsychological and ecologically valid functional measures of complex attention and executive function in Veterans with mild TBI and cognitive difficulties. The current study highlights how mindfulness-based attention regulation and goalmanagement strategies applied to personal goals has positive effects across various outcomes. A percentage of individuals with mTBI continue to report persistent problems with cognition and daily functioning. Cognitive rehabilitation training such as GOALS may be beneficial for those with persistent difficulties following mTBI, even in chronic phase.

Agricultural workers are immersed in environments associated with increased risk for adverse psychiatric and neurological outcomes. Agricultural work-related risks to brain health include exposure to pesticides, heavy metals, and organic dust. Despite this, there is a gap in our understanding of the underlying brain systems impacted by these risks. This study explores clinical and cognitive domains, and functional brain activity in agricultural workers. We hypothesized that a history of agricultural work-related risks would be associated with poorer clinical and cognitive outcomes as well as changes in functional brain activity within cortico-striatal regions.

The sample comprised 17 agricultural workers and a comparison group of 45 non-agricultural workers recruited in the Northern Colorado area. All participants identified as White and non-Hispanic. The mean age of participants was 51.7 years (SD = 21.4, range 18-77), 60% identified as female, and 37% identified as male. Participants completed the National Institute of Health Toolbox (NIH Toolbox) and Montreal Cognitive Assessment (MoCA) on their first visit. During the second visit, they completed NIH Patient-Reported Outcomes Measurement Information System (PROMIS) measures and underwent functional magnetic resonance imaging (fMRI; N = 15 agriculture and N = 35 non-agriculture) while completing a working memory task (Sternberg). Blood oxygen-level dependent (BOLD) response was compared between participants. Given the small sample size, the whole brain voxel-wise group comparison threshold was set at alpha = .05, but not otherwise corrected for multiple comparisons. Cohen’s d effect sizes were estimated for all voxels.

Analyses of cognitive scores showed significant deficits in episodic memory for the agricultural work group. Additionally, the agricultural work group scored higher on measures of self-reported anger, cognitive concerns, and social participation. Analyses of fMRI data showed increased BOLD activity around the orbitofrontal cortex (medium to large effects) and bilaterally in the entorhinal cortex (large effects) for the agricultural work group. The agricultural work group also showed decreased BOLD activity in the cerebellum and basal ganglia (medium to large effects).

To our knowledge, this study provides the first-ever evidence showing differences in brain activity associated with a history of working in agriculture. These findings of poorer memory, concerns about cognitive functioning, and increased anger suggest clinical relevance. Social participation associated with agricultural work should be explored as a potential protective factor for cognition and brain health. Brain imaging data analyses showed increased activation in areas associated with motor functioning, cognitive control, and emotion. These findings are limited by small sample size, lack of diversity in our sample, and coarsely defined risk. Despite these limitations, the results are consistent with an overall concern that risks associated with agricultural work can lead to cognitive and psychiatric harm via changes in brain health. Replications and future studies with larger sample sizes, more diverse participants, and more accurately defined risks (e.g., pesticide exposure) are needed.

Children born very preterm (VPT; <32 weeks gestation) are at increased risk for long-term neurocognitive sequelae such as behavioral problems. These problems may be caused by disrupted brain development, particularly white matter abnormalities that affect network efficiency, as shown via diffusion magnetic resonance imaging (dMRI). There is evidence that short-term interventions for pediatric clinical populations can lead to behavioral improvements as well as associated neuroplasticity. Adapted from a previous parenting intervention for families of young children with traumatic brain injury, the novel Building Better Brains and Behavior (B4) program teaches responsive parenting skills for families of children born preterm. It is hypothesized that parent-reported externalizing symptoms will improve from pre- to postintervention and that these improvements will be mirrored by an increase in neural efficiency.

VPT children between the ages of 3-8 with documented behavioral problems were recruited to participate in a single-arm pilot clinical trial. Families began with a baseline visit in which the Child Behavior Checklist (CBCL) was administered as a measure of behavior problems, and the child underwent dMRI. Parents then participated in the 7-session intervention integrating self-guided, online learning modules with live virtual coaching sessions with a therapist. Twenty three participants enrolled, 15 of which completed the intervention and baseline MRI scan; 4 children were excluded from analysis due to not meeting eligibility criteria, leaving 11 participants for analysis of intervention effects (8 males, Mage=5.42). At program completion, families returned for a follow-up that entailed another CBCL questionnaire and dMRI scan. Eight children completed the post-intervention scan and five were retained for analysis (4 males, Mage=5.83). Imaging data was analyzed using the Brain Connectivity Toolbox, which generated graph theoretical metrics to characterize the topological organization of anatomical networks.

A paired samples t-test showed significant reduction of externalizing behavior problems pre-intervention (M=61.12, SD=10.02) to post-intervention (M=55.00, SD=11.62; f(10)=3.09, p=0.01). At baseline, externalizing behavior problems were positively correlated with normalized clustering coefficient, r(10)=0.59, p=0.04, and small-worldness, r(10)=0.64, p=0.03. Change in externalizing symptoms pre- to post-intervention was positively correlated with baseline global efficiency, r(4)=0.94, p=0.02, and negatively correlated with mean local efficiency, r(4)=-0.89, p=0.03, and normalized characteristic path length, r(4)=-0.89, p=0.03.

Preliminary results indicate that VPT children who exhibit higher levels of externalizing symptoms show higher normalized clustering coefficient (which is expected of networks with less integration), and higher small-worldness (which is unexpected). Greater behavioral improvements were associated with higher baseline characteristic path length as expected, but lower baseline global efficiency; this may indicate that children who had lower global efficiency to begin with benefitted from the intervention the most. Due to the small sample size and lack of corrections for multiple comparisons, these results are not definitive and further research is needed to elucidate associations between structural connectivity and behavioral intervention in children born very preterm.

Research on healthcare disparities has found that racial and ethnic minority population were less likely to receive intensive and effective rehabilitation following an acquired brain injury compared to their White counterparts. Immigrant status and language barriers further perpetuate the disparities in access to rehabilitation care. In addition to institutional barriers such as absence of culturally and linguistically appropriate health materials as well as lack of cultural competency training for staff, patient factors such as dissonance in cultural value orientation to health care has been identified as a common culturally-mediated barrier accounting for lower healthcare utilization rate among immigrants. Cultural factors including health beliefs and values impact patient’s self-appraisal of illness and have been studied as significant predictors for treatment adherence. The present case study seeks to demonstrate the role of socio-cultural factors in shaping the course of a Chinese immigrant patient’s neuropsychological evaluation and cognitive rehabilitation following an aneurysm rupture and subarachnoid hemorrhage.

The patient is a 64-year-old, monolingual Mandarin-speaking female who was born and raised in mainland China, referred for neuropsychological evaluation for treatment planning following an anterior communicating artery aneurysm rupture and subarachnoid hemorrhage. Cognitive complaints included selective retrograde amnesia and difficulty with short-term episodic memory. Patient completed neuropsychological assessment, then underwent a course of time-limited cognitive remediation.

Neuropsychological assessment was administered in Mandarin Chinese, and the majority of the tests utilized available norms from Mandarin-speaking Chinese population. While the patient continued to demonstrate at or above average functioning in aspects of executive function, she exhibited a pattern of “rapid forgetting” on modality-nonspecific learning and memory in addition to reductions in attention, working memory, psychomotor speed and visuo-perceptual integration. In the absence of mood symptoms, the patient demonstrated emotional resilience and strong family support system. Given reportedly minimal benefits from prior SLP intervention, barriers to treatment were examined and considered: linguistic factor, difficulty in holding on to information due to anterograde amnesia, and the lack of family involvement in the treatment process. In the context of Chinese family system and immigration history, family-centered care is imperative for the patient’s rehabilitation process. Main treatment goals included improving awareness of cognitive deficits as well as reinforcing consistent use of external strategies to compensate for impaired orientation and memory. Flexibility in the use of evidenced-based interventions were emphasized. The patient’s family were counselled in a culturally competent manner to further understand the aspects that matter the most for the patient and incorporate multi-sensory learning to facilitate intervention.

In this case study, we utilized culturally and linguistically appropriate norms and critically examined barriers to treatment from a contextual lens. This case highlights the role of culturally competent neuropsychological evaluation and incorporating a strength-based and multi-method approach in informing treatment planning for cognitive rehabilitation with immigrant population. Given the dearth in the existing cross-cultural literature, there is a clear need to conduct high-quality research in under-studied and under-represented immigrant populations to reduce the gap in service delivery and enhance treatment effectiveness.

Migraine is one of the leading causes of disability worldwide and a recognized contributor to health disparities with public health implications. Although migraine is a highly prevalent neurological condition, research on the cognitive manifestations of migraines is inconsistent. Studies have confirmed neurocognitive compromise during the presence of a migraine attack, with it’s onset and frequency being associated with greater cognitive decline. Research on the cognitive implications of migraines in underserved communities is scarce. The American Migraine Prevalence and Prevention Study (2015) found that the prevalence of chronic migraines was the highest amongst Hispanic females compared to White females. Latina/os are 50% less likely to receive a migraine diagnosis and adequate headache medication when compared to non-Hispanic White patients. Latina women were more likely to report somatic symptoms than White and African American participants (F=8.96; p>0.001) (Liefland et al., 2014). Somatoform disorders are often diagnosed amongst Latina/os to account for medical unexplained symptoms, and if misdiagnosed can be stigmatizing and detrimental to treatment. We illustrate the critical role that neuropsychologists play by utilizing Socially Responsible Neuropsychology (SRN), a theoretical framework that promotes equitable and precise neuropsychological care to reduce misdiagnosis, elucidate cognitive implications, and address the complex medical needs of Latina/o/ patients. Given the limited literature on migraines and neurocognitive functioning, our objective is to present two case studies to illustrate the neuropsychological implications among bilingual Latina/o with chronic migraines.

Two highly educated Latina/o women, ages 39 and 41 years old, with chronic migraines, cognitive decline, diagnoses and a history of somatization symptoms. The onset of symptoms was gradual, worsening in intensity and frequency, along with notable motor symptoms (e.g., paralysis, weakness, numbness, bilateral tremors), photophobia, and phonophobia. Their cognitive complaints were conceptualized as part of a somatoform presentation by their providers.

The SRN model guided clinical decision-making to establish reliable normative anchors to identify relative impairment compared to premorbid estimates. Testing was completed in English after establishing language dominance via English and Spanish measures of verbal fluency. Cognitive profiles identified declines in attention, processing speed, language, perceptual reasoning, visual memory, executive functioning, motor functioning, and notable decline in their functioning over several years. The neuropsychological profile discounted the presence of a somatoform disorder. One case was diagnosed with an Unspecified Mild Neurocognitive Disorder, while the other case met criteria for a Major Neurocognitive Disorder due to Multiple Etiologies (i.e., vascular contribution, migraines, history of other contributions- choking episode).

Given the decline in each profile, it was hypothesized that the patients’ utilization of compensatory strategies and higher education may have masked the onset of symptoms. These complex cases highlight the need for comprehensive neuropsychological evaluations that are culturally and linguistically responsive to boost the sensitivity of accurate diagnosis. The ability to objectively capture neurocognitive decline offers a unique opportunity to enhance treatment, which would have otherwise remained undetected and untreated. The SRN model enhanced diagnostic considerations, treatment planning, and allowed for advocacy strategies to improve the quality of life, and access to culturally/linguistically appropriate resources.

Dysnomia may be one of the earlier neuropsychological signs of Alzheimer’ disease (Cullum & Liff, 2014), making it an essential part of dementia evaluations. The Verbal Naming (VNT) is a verbal naming-to-definition task designed to assess possible dysnomia in older adults (Yochim et al., 2015) and has been used as an alternative to tasks that predominately rely on picture-naming paradigms. These researchers investigated the influences of age, educational level, cognitive diagnosis, educational quality, and race to examine if race would be a remaining significant factor in the performance of the VNT.

Black (n=57) and White (n=127) participant data were collected during clinical neuropsychological evaluations, which included the VNT alongside other cognitive measures. A multiple regression was utilized controlling for age, educational level, cognitive diagnosis, educational quality via reading level, and race to investigate if race would remain a significant predictor of test performance.

Results suggested that race was still a significant predictor (p = .003) of VNT scores despite efforts to control other sources of variance. Additionally, other cognitive measures such as WAIS-IV Block Design (p = .004) and D-KEFS Tower Test (p = .004) also showed statistically significant relationships with race in the same model, whereas verbal memory (CVLT) and verbal fluency (D-KEFS) did not. The NAB Naming analysis violated the assumption of homoscedasticity; therefore, results with the NAB Naming test were not further interpreted.

These results suggest that race is a significant predictor of performance on some cognitive measures, including the VNT. However, it did not predict performance on verbal memory or verbal fluency. Future investigations of racial differences on neuropsychological test performance would benefit from consideration of variables that may account for discrepancies between White and Black examinees. Several proxy variables could include educational quality, acculturation, and economic status.

Aggregation of phosphorylated tau (pTau) is a hallmark feature of Alzheimer’s disease (AD). Novel assays now allow pTau to be measured in plasma. Elevated plasma pTau predicts subsequent development of AD, cortical atrophy and AD-related pathologies in the brain. We aimed to determine whether elevated pTau is associated with cognitive functioning in older adults prior to the development of dementia.

Independently living older adults (N = 48, mean age = 70.0 years; SD = 7.7; age range 55-88 years; 35.4% male) free of dementia or clinical stroke were recruited from the community and underwent blood draw and neuropsychological assessment. Plasma was assayed using the Quanterix Simoa® pTau-181 V2 Advantage Kit to quantify pTau-181 levels and APOE genotyping was conducted on the blood cell pellet fraction obtained from plasma separation. Global cognition was assessed using the Dementia Rating Scale-2 (DRS-2) and executive function was assessed using the Stroop, D-KEFS-2 Fluency, and Trails Making Test. Diagnosis of mild cognitive impairment (MCI) was determined based on overall neuropsychological performance. Participants were diagnosed as MCI if they scored >1 SD below norm-referenced values on 2 or more tests within a domain (language, executive, memory) or on 3 tests across domains.

Multiple linear regression analysis revealed a significant negative association between plasma pTau-181 levels and DRS-2 (B = -2.57, 95% CI (-3.68, -1.47), p <.001), Stroop Color-Word score (B = -2.64, 95% CI (-4.56, - 0.71), p = .009) and Fruits and Vegetables Fluency (B = -1.67, 95% CI (-2.84, -0.49), p = .007), adjusting for age, sex, education and APOE4 status. MCI diagnosis was determined for 43 participants, of which 8 (18.6%) met criteria. Logistic regression analysis revealed that pTau-181 levels are associated with increased odds of MCI diagnosis (OR = 2.18, 95% CI (1.01, 4.68), p = .046), after accounting for age, sex, education and APOE4 status.

Elevated plasma pTau-181 is associated with worse cognition, particularly executive function, and predicts MCI diagnosis in older adults. Higher plasma pTau-181 was associated with increased odds of MCI diagnosis. Detection of pTau-181 in plasma allows a novel, non-invasive method to detect burden of one form of AD pathology. These findings lend support to the use of plasma pTau-181 as a valuable marker in detecting even early cognitive changes prior to the development of AD. Additional longitudinal studies are warranted to explore the prognostic value of plasma pTau-181 over time.

Sleep contributes to memory retention and recall. Alzheimer’s disease (AD) patients experience decreased slow wave activity (SWA) during sleep. This decrease in SWA is associated with impaired memory consolidation (Lee et al., 2020). Long-term forgetting (LTF) over days or weeks has been linked to memory consolidation deficits and has been suggested as an early marker of AD that could be useful for identifying at-risk individuals for preclinical AD trials (Weston et al., 2018). Here, we examined associations between LTF and SWA in a sample of Presenilin-1 (PSEN1) E280A mutation carriers with autosomal dominant Alzheimer’s disease and non-carrier family members. Carriers of this mutation usually develop dementia in their forties (Fuller et al., 2019).

Fourteen cognitively unimpaired PSEN1-E280A mutation carriers and sixteen age-matched non-carriers (mean age: 34.2 years) from the Colombia-Boston (COLBOS) biomarker study were included. Participants completed an overnight polysomnogram (PSG) and memory testing (NEUROPSI Word List) at 3-time points: 1) the night before PSG: immediate recall (Day1-ImmRecall) and a 20-minute delayed recall (Day1-DelayedRecall), 2) recall the following day (Day2-recall), and 3) recall one week later (Day7-recall). SWA was measured as the ratio 0. 6-1Hz/0.6-4Hz in frontopolar and frontotemporal regions and was calculated for sleep stages N2+N3 (slow wave sleep) based on an automated staging algorithm. Each participant’s LTF was calculated as the percent retention between Day 1 immediate recall and Day 7 recall (Butler, 2009). Mann-Whitney U tests were used to compare differences in recall, SWA, and LTF between groups. Spearman’s correlation was used to examine the associations between memory recall at different time points and SWA, as well as between LTF and SWA.

On Day 1, carriers had lower performance in immediate recall (p=0.02), compared to non-carriers, but there were no group differences in the 20-minute delayed recall. Carriers also recalled fewer words on Day 2 (p=0.03) and Day 7 (p=0.009) and had greater LTF (p=0.03). There were no group differences in SWA. In our overall sample, worse performance on word list delayed recall on Day 1, Day 2, and Day 7 was associated with less SWA across both frontotemporal (Day1: p=0.04, Day2: p=0.02, Day7: p=0.02) and frontopolar (all Ps<0.01) regions. In carriers, only worse performance on Day 1 delayed recall was associated with lower SWA in the frontopolar region (r= 0.535; p=0.049). Memory recall on other days was not associated with SWA in any brain regions. Additionally, greater LTF was associated with less SWA across both frontopolar (r= 0.507; p=0.005) and frontotemporal regions (r= 0.463 p= 0.01).

Preliminary findings suggest that long-term forgetting is associated with less slow- wave activity in preclinical autosomal dominant Alzheimer’s disease. These results also suggest that SWA may be related to pre-sleep learning and subsequent overnight memory consolidation processes. LTF testing may be useful in selecting individuals for preclinical AD trials. Future research on the impact of slow wave activity on LTF may be useful in identifying ways to enhance short- and long-term memory consolidation in individuals at greater risk for dementia.

Identification of pre-clinical Alzheimer’s disease (AD) is necessary for the development of future disease-modifying treatments, which would ideally target pre-clinical stages to mitigate functional loss. Despite advanced in biomarker development, clinical trials are still without a non-invasive and cost-effective means of identifying pre-symptomatic subjects who are at high risk for eventual conversion to AD. In previous work, we developed a machine learning algorithm using neuropsychological test scores and health history to identify subjects at high risk for eventual conversion. Here, we examine the performance of a similar algorithm in predicting the timing of that conversion in years.

Data were obtained from the National Alzheimer’s Coordination Center (NACC) Uniform Data Set (UDS) version 3.0. Subjects with normal cognition at baseline were used to train a multi-class Random Forest classifier to predict conversion to AD. Each subject could be classified as a short-, mid-, or long-term converter (0-3 years, 4 to 6 years, and 7 to 9 years, respectively) or as a non-converter, if no dementia diagnosis was given within ten years of baseline. Predictors included baseline demographics, basic medical history, and neuropsychological test results. Algorithms were evaluated using standard, cross-validated performance metrics.

Multi-class Matthews correlation coefficient between predicted time to diagnosis and the ground truth averaged 0.26 +/- 0.06 across 100 cross validation splits. Prediction accuracy exceeded 0.67 in all cases, when computed for each class individually, and was greatest for the short-term (0.75) and nonconverter (0.78) classes.

Machine-learning algorithms applied to neuropsychological, demographic, and medical history information were able to predict the eventual timing of conversion to dementia in cognitively healthy adults significantly better than chance. Results were most accurate when predicting shorter time to conversion. Results illustrate the potential of this data analytic approach for targeted recruitment in clinical trials.

Population studies have shown that Black individuals are at higher risk for MCI and dementia than White individuals but are more likely to be underdiagnosed or misdiagnosed. Although multiple contributory factors have been identified in relation to neurocognitive diagnostic disparities among persons of color, few studies have investigated race-associated differences in MCI and dementia classification across diagnostic methods. The current study examined the agreement of cognitive classification made via semi-structured interview and neuropsychological assessment.

Only participants assigned normal cognitive status or cognitive impairment with presumed Alzheimer’s etiology were included in the study. Baseline visit data in the National Alzheimer’s Coordinating Center (NACC) dataset was collected to compare correspondence of cognitive classification (normal cognition, MCI, dementia) via semi-structured interview (Clinical Dementia Rating; CDR) with formal NACC diagnostic determination. NACC diagnostic determination was further separated by single clinician and consensus diagnostic methods. Inter-rater agreement was evaluated using chi-squared tests, and respective analyses were stratified for race (Black vs White), ethnicity (Hispanic vs Non-Hispanic), and education (<12 years vs. >12 years).

The sample size included 4,739 Black and 26,393 White participants across 43 Alzheimer’s Disease Research Centers (ADRCs). Inter-rater analyses between CDR (semi-structured interview) versus single-clinician and formal consensus NACC diagnostic methods showed strong (all (pc>.70) consistency in cognitive diagnoses overall, irrespective of race, ethnicity, and education. The percentage of agreement between diagnostic methods was nearly 100% for those categorized as cognitively normal or with dementia. However, the agreement for MCI was considerably lower (ranging from 28-74%) and revealed a disparity in diagnostic method between Black and White individuals. White individuals diagnosed with MCI via CDR (CDR total =0.5) were more likely to be labeled as having dementia regardless of NACC diagnostic method. However, Black individuals diagnosed with MCI via CDR were equally likely to be diagnosed as cognitively normal or with dementia via the formal consensus method.

Irrespective of race and other demographic variables, diagnostic methods had high agreement for groups labeled with normal cognition and dementia. Agreement was consistently lower for the group labeled with MCI, with Black individuals having greater variability in diagnostic differentials when diagnosed via formal consensus method. The results of the study suggest that neuropsychological assessment continues to be an integral component of diagnosing individuals with MCI, reducing possible sources of bias.

Responsive neurostimulation (RNS) is a surgical intervention to reduce the frequency of seizures as an adjunctive therapy for patients with drug-resistant epilepsy (DRE). Presurgical neuropsychological evaluations capture symptoms of anxiety and depression, which occur in higher rates within the epilepsy population than in the general population; however, the effects of mood are commonly overlooked or underappreciated in the conceptualization of cognitive functioning and overall quality of life. Previous studies have shown the effects of attentional control and executive functioning on engagement in meditative states. The present study examines pre and post-meditation self-reported anxiety symptoms and the electrophysiological changes captured intracranially during meditation sessions in patients implanted with an RNS device. This study seeks to utilize presurgical neuropsychological evaluations to explore relationships between cognitive profiles and meditative state changes, and reductions in anxiety.

This study presents a series of 10 patients who underwent RNS device implantation for the treatment of DRE at Mount Sinai Hospital. All patients had at least one contact in the basolateral amygdala. Prior to surgical implantation of the RNS device, all patients completed a comprehensive neuropsychological evaluation based on the NIH Common Data Elements Battery for Epilepsy Patients. Patients in this study completed a 17-and 22-minute meditation protocol based on loving-kindness and Focal Awareness (FA) meditation. Control points and mind-wandering phases were utilized to distinguish the meditative portion of the study during intracranial recordings. All patients completed a pre- and post-meditation questionnaire adapted from the PROMIS Anxiety Short Form as well as self-ratings on meditation depth and satisfaction.

Presurgical neuropsychological evaluation of patients showed elevated levels of anxiety on the BAI (M = 18.14, SD = 12.03) and depression on the BDI-II (M = 15.57, SD = 6.92). Neuropsychological findings localized to frontal or frontotemporal deficits in 80% of the patients were captured in this study. Regarding lateralization, 50% of patients presented with bilateral weakness on neuropsychological evaluation, with the rest showing unilateral profiles. A negative correlation was observed between patient responses on pre-meditation anxiety measures and self-reported depth of engagement in meditation, r = -0.65, p = .043. When all meditation sessions were evaluated, patients displayed a reduction in anxiety levels pre- and post- meditation, t = 2.3, p = .03.

Present findings suggest a reduction in anxiety symptoms following completion of a meditation paradigm. Additionally, a relationship between anxiety and depth of engagement in meditation was identified. During each meditation session, electrocorticography data was collected and analyzed. Given the high comorbidities of anxiety and depression as well as cognitive symptoms common for individuals with epilepsy, a systems-based approach may enhance conceptualization of neuropsychological and neuropsychiatric evaluations, which may have a significant clinical impact. Evaluation of neuropsychological profiles, meditation effects, and anxiety in this population may support cross-discipline understanding of cognitive and psychiatric profiles to better inform treatment recommendations.