Migraine and post-traumatic stress disorder (PTSD) are both twice as common in women as men. Cross-sectional studies have shown associations between migraine and several psychiatric conditions, including PTSD. PTSD is disproportionally common among patients in headache clinics, and individuals with migraine and PTSD report greater disability from migraines and more frequent medication use. To further clarify the nature of the relationship between PTSD and migraine, we conducted bidirectional analyses of the association between (1) migraine and incident PTSD and (2) PTSD and incident migraine.

We used longitudinal data from 1989–2020 among the 33,327 Nurses’ Health Study II respondents to the 2018 stress questionnaire. We used log-binomial models to estimate the relative risk of developing PTSD among women with migraine and the relative risk of developing migraine among individuals with PTSD, trauma-exposed individuals without PTSD, and individuals unexposed to trauma, adjusting for race, education, marital status, high blood pressure, high cholesterol, alcohol intake, smoking, and body mass index.

Overall, 48% of respondents reported ever experiencing migraine, 82% reported experiencing trauma and 9% met the Diagnostic and Statistical Manual of Mental Disorders-5 criteria for PTSD. Of those reporting migraine and trauma, 67% reported trauma before migraine onset, 2% reported trauma and migraine onset in the same year and 31% reported trauma after migraine onset. We found that migraine was associated with incident PTSD (adjusted relative risk [RR]: 1.26, 95% confidence interval [CI]: 1.14–1.39). PTSD, but not trauma without PTSD, was associated with incident migraine (adjusted RR: 1.20, 95% CI: 1.14–1.27). Findings were consistently stronger in both directions among those experiencing migraine with aura.

Our study provides further evidence that migraine and PTSD are strongly comorbid and found associations of similar magnitude between migraine and incident PTSD and PTSD and incident migraine.

Computerized clinical decision support (CDS) assists healthcare professionals in making decisions to improve patient care. In the realms of antimicrobial stewardship (ASP) and infection prevention (IP) programs, CDS interventions can play a crucial role in optimizing antibiotic prescribing practices, reducing healthcare-associated infections, and promoting diagnostic stewardship when optimally designed. This primer article aims to provide ASP and IP professionals with a practical framework for the development, design, and evaluation of CDS interventions.

Large academic medical center design: Established frameworks of CDS evaluation, “Five Rights” of CDS and the “Ten Commandments of Effective Clinical Decision Support”, were applied to two real-world examples of CDS tools, a Vancomycin Best Practice Advisory and a Clostridioides Difficile order panel, to demonstrate a structured approach to developing and enhancing the functionality of ASP/IP CDS interventions to promote efficacy and reduce unintended consequences of CDS.

By outlining a structured approach for the development and evaluation of CDS interventions, with focus on end user engagement, efficiency and feasibility, ASP and IP professionals can leverage CDS to enhance IP/ASP quality improvement initiatives aimed to improve antibiotic utilization, diagnostic stewardship, and adherence to IP protocols.

The brain can be represented as a network, with nodes as brain regions and edges as region-to-region connections. Nodes with the most connections (hubs) are central to efficient brain function. Current findings on structural differences in Major Depressive Disorder (MDD) identified using network approaches remain inconsistent, potentially due to small sample sizes. It is still uncertain at what level of the connectome hierarchy differences may exist, and whether they are concentrated in hubs, disrupting fundamental brain connectivity.

We utilized two large cohorts, UK Biobank (UKB, N = 5104) and Generation Scotland (GS, N = 725), to investigate MDD case–control differences in brain network properties. Network analysis was done across four hierarchical levels: (1) global, (2) tier (nodes grouped into four tiers based on degree) and rich club (between-hub connections), (3) nodal, and (4) connection.

In UKB, reductions in network efficiency were observed in MDD cases globally (d = −0.076, pFDR = 0.033), across all tiers (d = −0.069 to −0.079, pFDR = 0.020), and in hubs (d = −0.080 to −0.113, pFDR = 0.013–0.035). No differences in rich club organization and region-to-region connections were identified. The effect sizes and direction for these associations were generally consistent in GS, albeit not significant in our lower-N replication sample.

Our results suggest that the brain's fundamental rich club structure is similar in MDD cases and controls, but subtle topological differences exist across the brain. Consistent with recent large-scale neuroimaging findings, our findings offer a connectomic perspective on a similar scale and support the idea that minimal differences exist between MDD cases and controls.

Interactions between the endocannabinoid system (ECS) and neurotransmitter systems might mediate the risk of developing a schizophrenia spectrum disorder (SSD). Consequently, we investigated in patients with SSD and healthy controls (HC) the relations between (1) plasma concentrations of two prototypical endocannabinoids (N-arachidonoylethanolamine [anandamide] and 2-arachidonoylglycerol [2-AG]) and (2) striatal dopamine synthesis capacity (DSC), and glutamate and y-aminobutyric acid (GABA) levels in the anterior cingulate cortex (ACC). As anandamide and 2-AG might reduce the activity of these neurotransmitters, we hypothesized negative correlations between their plasma levels and the abovementioned neurotransmitters in both groups.

Blood samples were obtained from 18 patients and 16 HC to measure anandamide and 2-AG plasma concentrations. For all subjects, we acquired proton magnetic resonance spectroscopy scans to assess Glx (i.e. glutamate plus glutamine) and GABA + (i.e. GABA plus macromolecules) concentrations in the ACC. Ten patients and 14 HC also underwent [18F]F-DOPA positron emission tomography for assessment of striatal DSC. Multiple linear regression analyses were used to investigate the relations between the outcome measures.

A negative association between 2-AG plasma concentration and ACC Glx concentration was found in patients (p = 0.008). We found no evidence of other significant relationships between 2-AG or anandamide plasma concentrations and dopaminergic, glutamatergic, or GABAergic measures in either group.

Our preliminary results suggest an association between peripheral 2-AG and ACC Glx levels in patients.

Former professional American football players have a high relative risk for neurodegenerative diseases like chronic traumatic encephalopathy (CTE). Interpreting low cognitive test scores in this population occasionally is complicated by performance on validity testing. Neuroimaging biomarkers may help inform whether a neurodegenerative disease is present in these situations. We report three cases of retired professional American football players who completed comprehensive neuropsychological testing, but “failed” performance validity tests, and underwent multimodal neuroimaging (structural MRI, Aß-PET, and tau-PET).

Three cases were identified from the Focused Neuroimaging for the Neurodegenerative Disease Chronic Traumatic Encephalopathy (FIND-CTE) study, an ongoing multimodal imaging study of retired National Football League players with complaints of progressive cognitive decline conducted at Boston University and the UCSF Memory and Aging Center. Participants were relatively young (age range 55-65), had 16 or more years of education, and two identified as Black/African American. Raw neuropsychological test scores were converted to demographically-adjusted z-scores. Testing included standalone (Test of Memory Malingering; TOMM) and embedded (reliable digit span, RDS) performance validity measures. Validity cutoffs were TOMM Trial 2 < 45 and RDS < 7. Structural MRIs were interpreted by trained neurologists. Aß-PET with Florbetapir was used to quantify cortical Aß deposition as global Centiloids (0 = mean cortical signal for a young, cognitively normal, Aß negative individual in their 20s, 100 = mean cortical signal for a patient with mild-to-moderate Alzheimer’s disease dementia). Tau-PET was performed with MK-6240 and first quantified as standardized uptake value ratio (SUVR) map. The SUVR map was then converted to a w-score map representing signal intensity relative to a sample of demographically-matched healthy controls.

All performed in the average range on a word reading-based estimate of premorbid intellect. Contribution of Alzheimer’s disease pathology was ruled out in each case based on Centiloids quantifications < 0. All cases scored below cutoff on TOMM Trial 2 (Case #1=43, Case #2=42, Case #3=19) and Case #3 also scored well below RDS cutoff (2). Each case had multiple cognitive scores below expectations (z < -2.0) most consistently in memory, executive function, processing speed domains. For Case #1, MRI revealed mild atrophy in dorsal fronto-parietal and medial temporal lobe (MTL) regions and mild periventricular white matter disease. Tau-PET showed MTL tau burden modestly elevated relative to controls (regional w-score=0.59, 72nd%ile). For Case #2, MRI revealed cortical atrophy, mild hippocampal atrophy, and a microhemorrhage, with no evidence of meaningful tau-PET signal. For Case #3, MRI showed cortical atrophy and severe white matter disease, and tau-PET revealed significantly elevated MTL tau burden relative to controls (w-score=1.90, 97th%ile) as well as focal high signal in the dorsal frontal lobe (overall frontal region w-score=0.64, 74th%ile).

Low scores on performance validity tests complicate the interpretation of the severity of cognitive deficits, but do not negate the presence of true cognitive impairment or an underlying neurodegenerative disease. In the rapidly developing era of biomarkers, neuroimaging tools can supplement neuropsychological testing to help inform whether cognitive or behavioral changes are related to a neurodegenerative disease.

A commonly used confrontation naming task used in the United States is The Boston Naming Test (BNT). Performance differences has been found in Caucasian and ethnic minorities on the BNT. The Cordoba Naming Test (CNT) is a 30-item confrontation naming task developed in Argentina. Past research has shown acculturation levels can influence cognitive performance. Furthermore, one study evaluated geriatric gender differences on CNT performance in Spanish. Researchers reported that older male participants outperformed female participants on the CNT. To our knowledge, researchers have not evaluated ethnic differences on the CNT using a geriatric sample. The purpose of the present study was to examined CNT performance and acculturation in a Latinx and Caucasian geriatric sample. It was predicted the Caucasian group would outperform the Latinx group on the CNT. Moreover, the Caucasian group would report higher acculturation levels on the Abbreviated Multidimensional Acculturation Scale (AMAS) compared to the Latinx group.

The sample consisted of 9 Latinx and 11 Caucasian participants with a mean age of 66.80 (SD =6.10), with an average of 14.30 (SD = 2.00) years of education. All participants were neurologically and psychologically healthy and completed the CNT and the AMAS in English. Acculturation was measured via the AMAS English subscales (i.e., English Language, United States. Identity, United States, Competency). A series of ANCOVAs, controlling for years of education completed and gender, was used to evaluate CNT performance and acculturation.

The ethnic groups were not well demographically matched (i.e., years of education and gender).We found that the Caucasian group outperformed the Latinx group on CNT performance p = .012, ηp 2 = .34. Furthermore, the Caucasian group reported higher acculturation levels (i.e., English Language, United States, Identity, United States, Competency) compared to the Latinx group p’s < .05, ηps2 = .42-.64.

To our knowledge, this is the first study to evaluate CNT performance between ethnic groups with a geriatric sample. As expected the Caucasian group outperformed the Latinx group on the CNT. Also, as expected the Caucasian group reported higher English acculturation levels compared to the Latinx group. Our findings are consistent with past studies showing ethnic differences on confrontational naming performance (i.e., The Boston Naming Test), favoring Caucasians. A possible explanation for group differences could have been linguistic factors (e.g., speaking multiple languages) in our Latinx group. Therefore, since our Latinx group reported lower levels of English Language, United States identity, and United States competency the Latinx group assimilation towards United States culture might of influence their CNT performance. Future studies with different ethnic groups (e.g., African-Americans) and a larger sample size should examine if ethnic differences continue to cross-validate in a geriatric sample.

A 30-item confrontation naming test was developed in Argentina for Spanish speakers, The Cordoba Naming Test (CNT). The Boston Naming Test is an established confrontation naming task in the United States. Researchers have used the Boston Naming Test to identify individuals with different clinical pathologies (e.g., Alzheimer’s disease). The current literature on how Spanish speakers across various countries perform on confrontational naming tasks is limited. To our knowledge, one study investigated CNT performance across three Spanish-speaking countries (i.e., Argentina, Mexico, and Guatemala). Investigators found that the Guatemalan group underperformed on the CNT compared to the Argentine and Mexican groups. The purpose of this study was to extend the current literature and investigate CNT performance across five Spanish-speaking countries (i.e., Argentina, Mexico, Guatemala, Colombia, United States). We predicted that the Argentine group would outperform the other Spanish-speaking countries.

The present study sample consisted of 502 neurologically and psychologically healthy participants with a mean age of 29.06 (SD = 13.41) with 14.75 years of education completed (SD = 3.01). Participants were divided into five different groups based on their country of birth and current country residency (i.e., United States, Mexico, Guatemala, Argentina, & Colombia). All participants consented to voluntary participation and completed the CNT and a comprehensive background questionnaire in Spanish. The CNT consisted of 30 black and white line drawings, ranging from easy to hard in difficulty. An ANCOVA, controlling for gender, education, and age, was used to evaluate CNT performance between the five Spanish-speaking country groups. Meanwhile, a Bonferroni post-hoc test was utilized to evaluate the significant differences between Spanish-speaking groups. We used a threshold of p < .05 for statistical significance.

Results revealed significant group differences between the five Spanish speaking groups on the CNT, p = .000, np2 = .48. Bonferroni post-hoc test revealed that the United States group significantly underperformed on the CNT compared to all the Spanish-speaking groups. Next, we found the Guatemalan group underperformed on the CNT compared to the Argentinian, Mexican, and Colombian groups. Additionally, we found the Argentinian group outperformed the Mexican, Guatemalan, and United States groups on the CNT. No significant differences were found between the Argentinian group and Colombian group or the Mexican group and Colombian group on the CNT.

As predicted, the Argentinian group outperformed all the Spanish-speaking groups on the CNT except the Colombian group. Additionally, we found that the United States group underperformed on the CNT compared to all the Spanish-speaking groups. A possible explanation is that Spanish is not the official language in the United States compared to the rest of the Spanish-speaking groups. Meanwhile, a possible reason why the Argentinian and Colombian groups demonstrated better CNT performances might have been that it was less culturally sensitive than the United States, Mexican, and Guatemalan groups. Further analysis is needed with bigger sample sizes across other Spanish-speaking countries (e.g., Costa Rica, Chile) to evaluate what variables, if any, are influencing CNT performance.

Nonpathological aging has been linked to decline in both verbal and visuospatial memory abilities in older adults. Disruptions in resting-state functional connectivity within well-characterized, higherorder cognitive brain networks have also been coupled with poorer memory functioning in healthy older adults and in older adults with dementia. However, there is a paucity of research on the association between higherorder functional connectivity and verbal and visuospatial memory performance in the older adult population. The current study examines the association between resting-state functional connectivity within the cingulo-opercular network (CON), frontoparietal control network (FPCN), and default mode network (DMN) and verbal and visuospatial learning and memory in a large sample of healthy older adults. We hypothesized that greater within-network CON and FPCN functional connectivity would be associated with better immediate verbal and visuospatial memory recall. Additionally, we predicted that within-network DMN functional connectivity would be associated with improvements in delayed verbal and visuospatial memory recall. This study helps to glean insight into whether within-network CON, FPCN, or DMN functional connectivity is associated with verbal and visuospatial memory abilities in later life.

330 healthy older adults between 65 and 89 years old (mean age = 71.6 ± 5.2) were recruited at the University of Florida (n = 222) and the University of Arizona (n = 108). Participants underwent resting-state fMRI and completed verbal memory (Hopkins Verbal Learning Test - Revised [HVLT-R]) and visuospatial memory (Brief Visuospatial Memory Test - Revised [BVMT-R]) measures. Immediate (total) and delayed recall scores on the HVLT-R and BVMT-R were calculated using each test manual’s scoring criteria. Learning ratios on the HVLT-R and BVMT-R were quantified by dividing the number of stimuli (verbal or visuospatial) learned between the first and third trials by the number of stimuli not recalled after the first learning trial. CONN Toolbox was used to extract average within-network connectivity values for CON, FPCN, and DMN. Hierarchical regressions were conducted, controlling for sex, race, ethnicity, years of education, number of invalid scans, and scanner site.

Greater CON connectivity was significantly associated with better HVLT-R immediate (total) recall (ß = 0.16, p = 0.01), HVLT-R learning ratio (ß = 0.16, p = 0.01), BVMT-R immediate (total) recall (ß = 0.14, p = 0.02), and BVMT-R delayed recall performance (ß = 0.15, p = 0.01). Greater FPCN connectivity was associated with better BVMT-R learning ratio (ß = 0.13, p = 0.04). HVLT-R delayed recall performance was not associated with connectivity in any network, and DMN connectivity was not significantly related to any measure.

Connectivity within CON demonstrated a robust relationship with different components of memory function as well across verbal and visuospatial domains. In contrast, FPCN only evidenced a relationship with visuospatial learning, and DMN was not significantly associated with memory measures. These data suggest that CON may be a valuable target in longitudinal studies of age-related memory changes, but also a possible target in future non-invasive interventions to attenuate memory decline in older adults.