Our Research

The amygdala plays a role in emotion, learning, and memory and has been implicated in behavioral disorders. Better understanding of the amygdala circuitry is crucial to develop new therapies for these disorders. We used data from 200 healthy-subjects from the human connectome project. Using probabilistic tractography, we created population statistical maps of amygdala connectivity to brain regions involved in limbic, associative, memory, and reward circuits. Based on the amygdala connectivity with these regions, we applied k-means …

In this module, we'll begin by understanding traumatic brain injury. It's causes and consequences. From there, we'll discuss methods for screening TBI and its sequelae thereafter.

Introduction: This study intended to evaluate the safety and possible therapeutic effect of…

Interventions for chronic discogenic spine pain are currently insufficient in lowering individual patient suffering and global disease burden. A 2016 study of platelet rich plasma (PRP) for chronic discogenic pain previously demonstrated clinically significant response among active group patients compared with controls.

Understanding the structural connectivity of key brainstem nuclei with limbic cortical regions is essential to the development of therapeutic neuromodulation for depression, chronic pain, addiction, anxiety and movement disorders. Several brainstem nuclei have been identified as the primary central nervous system (CNS) source of important monoaminergic ascending fibers including the noradrenergic locus coeruleus, serotonergic dorsal raphe nucleus, and dopaminergic ventral tegmental area. However, due to practical challenges to their study, there is limited data regarding their in vivo anatomic connectivity in humans.

HIV-associated neurocognitive disorder (HAND) occurs in a significant percentage of HIV-infected (HIV+) adults. Increased intraindividual variability (IIV) in cognitive function may be an early marker of emerging neurocognitive disorder, which suggests that IIV may be a sensitive measure of neurologic compromise in HIV. In the current study, we hypothesize that increased IIV may predict impending morbidity, including future cognitive decline and death.

This chapter presents a broad overview of current knowledge regarding the complex nature of adherence to medication regimens and those factors most clearly associated with individuals' medication-taking behavior. In doing so, it begins with a critical review of medication adherence methodologies and measurement techniques, including clinician ratings, self-report measures, pill counts, pharmacy records, electronic monitoring, physiological measurements such as blood tests, and laboratory-based analog measures. An examination of medication adherence behaviors in select neurocognitive disorders then follows, with special attention paid to research conducted in the areas of normal aging, dementia, HIV/AIDS, and psychiatric illness. These disorders were chosen because they represent well the varied literature in the field and illustrate many of the common problems associated with medication nonadherence in those with impaired cognitive abilities. The chapter also includes a brief review of the major psychosocial models that have been used to explain adherence behavior, including theories related to autonomy and self-efficacy, treatment expectancies, the health beliefs model, the theory of reasoned action, and social action theory. It concludes with an evaluation of various medication management interventions, discussion of future directions in medication adherence research, and recommendations for clinicians. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Two service members were diagnosed with PTSD due to military trauma exposure. One presented with the classical manifestation; the other presented with the dissociative subtype. A statistical map revealed anterior localization of insula connectivity in the classical PTSD patient and posterior localization in the dissociative PTSD patient. These differences suggest that dissociative PTSD may be identified, understood, and treated as a disorder related to increased posterior insula connectivity. This double case study provides preliminary evidence for a concrete neuroanatomical discrepancy between insula function in classical and dissociative PTSD that may help explain the emergence of different coping strategies

An ever-growing population experiences a wide range of psychopathologies, and there is now more than ever a need for clear differential diagnoses between disorders. Furthering this need is the fact that many psychological, psychiatric, and neurological disorders have overlapping features. Functional neuroimaging has been shown to differentiate not only between the function of different brain structures but also between the roles of these structures in functional networks. The aim of this article is to aid in the goal of parsing out disorders on the basis of specific symptom domains by utilizing the most recent literature on functional networks. Current literature on the role of brain networks in relation to different psychopathological symptom domains is examined and corresponding circuit-based therapies that have been or may be used to treat them are discussed. Research on depression, obsession and compulsions, addiction, anxiety, and psychosis is reviewed. An understanding of networks and their specific dysfunctions opens the possibility of a new form of psychopathological treatment

Focused ultrasound is a novel brain stimulation modality that combines the noninvasiveness of repetitive transcranial magnetic stimulation and the precision of deep brain stimulation. In this review, the authors examine low-intensity focused ultrasound for brain mapping and neuromodulation. They also discuss high-intensity focused ultrasound, which is used for incisionless surgeries, such as capsulotomies for obsessive-compulsive disorder. Future potential applications of focused ultrasound are also presented.

In the past, psychotherapy and neuropharmacological approaches have been the most common treatments for disordered thoughts, moods, and behaviors. One new path of brain therapeutics is in the deployment of noninvasive approaches designed to reprogram brain function at the cellular level. Treatment at the cellular level may be considered for a wide array of disorders, ranging from mood disorders to neurodegenerative disorders. Brain-targeted biological therapy may provide minimally invasive and accurate delivery of treatment. The present article discusses the hurdles and advances that characterize the pathway to this goal.

The original Human Connectome Project yielded a rich data set on structural and functional connectivity in a large sample of healthy young adults using improved methods of data acquisition, analysis, and sharing.

Anxiety Disorders are prevalent and often chronic, recurrent conditions that reduce quality of life. The first-line treatments, such as serotonin reuptake inhibitors and cognitive behavioral therapy, leave a significant proportion of patients symptomatic. As psychiatry moves toward targeted circuit-based treatments, there is a need for a theory that unites the phenomenology of anxiety with its underlying neural circuits. The Alarm, Belief, Coping (ABC) theory of anxiety describes how the neural circuits associated with anxiety interact with each other and domains of the anxiety symptoms, both temporally and spatially. The latest advancements in neuroimaging techniques offer the ability to assess these circuits in vivo. Using Neurosynth, a large open-access meta-analytic imaging database, the association between terms related to specific neural circuits was explored within the ABC theory framework. Alarm-related terms …

Background: This study sought to validate the clinical utility of multimodal magnetic resonance imaging (MRI) techniques in the assessment of neurodegenerative disorders. We intended to demonstrate that advanced neuroimaging techniques commonly used in research can effectively be employed in clinical practice to accurately differentiate heathy aging and dementia subtypes

Introduction: Studying neuro-structural markers of intellectual giftedness (IG) will inform scientific understanding of the processes helping children excel academically. Methods: Structural and diffusion-weighted MRI was used to compare regional brain shape and connectivity of 12 children with average to high average IQ and 18 IG children, defined as having IQ greater than 145.

Objective: Transcranial Focused Ultrasound (tFUS) is a promising new potential neuromodulation tool. However, the safety of tFUS neuromodulation has not yet been assessed adequately. Patients with refractory temporal lobe epilepsy electing to undergo an anterior temporal lobe resection present a unique opportunity to evaluate the safety and efficacy of tFUS neuromodulation. Histological changes in tissue after tFUS can be examined after surgical resection, while further potential safety concerns can be assessed using neuropsychological testing

Of recent interest in neuromodulation is the use of Low Intensity Focused Ultrasound [[1]] (FUS), itself a topic of significant interest and of several experiments conducted recently in humans with FUS [[2], [3]]. The FDA Guidance on acoustic output for diagnostic ultrasound limits the derated spatial-peak temporal-average ultrasound intensity (ISPTA.3) to 0.72 W/cm2. Much of the human neuromodulation work has been conducted at this limit [[2]]. However, as this threshold was established principally for diagnostic, as opposed to therapeutic ultrasound, some groups have conducted research at higher intensities

Objective: This study intended to evaluate a possible therapeutic effect among patients with treatment-refractory generalized anxiety disorder (trGAD) by using transcranial focused ultrasound (tfUS) tfUS to disrupt amygdalar activity. Methods: Eight participants with severe trGAD as outlined in the DSM-V were recruited from Los Angeles neurology and psychiatry clinics. All participants completed eight weekly 10-minute tfUS sessions targeting the right amygdala. Functional and structural neuroimaging were used to navigate individual targets. Outcome measures including the Hamilton Anxiety Inventory (HAM-A, primary outcome), Hamilton Depression Inventory (HAM-D), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI-II) were collected before and after every treatment session. Data was collected from May 2020 through December 2020.

An individual participating in a pilot study of low-intensity focused ultrasound (fUS) for treatment-resistant generalized anxiety disorder (trGAD) found total relief in anxiety symptoms as well as a higher efficacy in subsequent repeated transcranial magnetic stimulation (rTMS) trials for treatment resistant major depressive disorder (trMDD). This individual suffered from an inability to relax, fearfulness, autonomic dysfunction (e.g., difficulty breathing, cold sweats, shakiness, trembling), difficulty concentrating, poor memory, disrupted sleep, fatigue, and loss of libido. Previously, the individual had sufficient trials of 8+ medications (Sertraline, Escitalopram, Bupropion HCl, Duloxetine, Venlafaxine, Aripiprazole, Olanzapine, Ketamine infusions); psychotherapy; ECT two rounds, 24 sessions; diet, exercise, and sleep interventions; acupuncture, massage therapy; and meditation. In the study cohort, this individual was the only true non-responder and did not report any benefit initially upon completing the study protocol; however, his treatment history, comorbid major depression and treatment response following this study protocol constitute additional significant findings. The individual has historically suffered from both trGAD and trMDD; prior to his entrance into this study, he had previously completed two courses of navigated rTMS to resolve his depression, which ended up exacerbating his anxiety. After completing this study intervention, the individual underwent another course of navigated rTMS and responded with complete resolution of both depression and anxiety. During the individual’s two-month post-completion evaluation, he

The pursuit of an effective therapeutic intervention for dementia has inspired interest in the class of medications known as tyrosine kinase inhibitors such as bosutinib. Methods. Thirty-one patients with probable Alzheimer dementia or Parkinson spectrum disorder with dementia completed 12 months of bosutinib therapy and an additional 12 months of follow-up. The Clinical Dementia Rating scale (as estimated by the Quick Dementia Rating System [QDRS]) was the primary cognitive status outcome measure. Secondary outcome measures included the Repeatable Battery Assessment of Neuropsychological Status (RBANS) and the Montreal Cognitive Assessment. Cox regression methods were used to compare results with population-based estimates of cognitive decline.

Background: Existing therapies for myofascial and neuralgic forms of cervicobrachial pain may have unsatisfactory outcomes. Alternative therapies may be considered, particularly for individuals who have failed to respond. Contemporary conceptualizations of chronic pain mechanisms include the contribution of inflammatory factors; therefore, locally targeted antiinflammatory administrations may play a role in treatment of cervicobrachial pain.Alpha 2 macroglobulin (A2M) is a plasma protein that acts as a molecular trap for inflammatory factors such as tumor necrosis factor. After plasma is enriched for A2M, it may be considered as a possible injectable agent to counteract inflammation that may occur with a cervicobrachial pain syndrome.

A 29-year-old woman presented with head and neck dystonia, as well as functional seizures. The patient was an active military service member with a history of combat-related trauma. Resting blood oxygen level dependent (BOLD) functional MRI (fMRI) scans of the brain demonstrated an increased anterior cingulate component of the salience network and hyper-connectivity between the insula and cingulate. Following neurological and psychiatric evaluation, she was diagnosed with dissociative post-traumatic stress disorder, partially presenting as a functional movement disorder. Inhibitory repetitive transcranial magnetic stimulation (rTMS) was prescribed with the anterior cingulate as the primary target, and supplementary motor and premotor cortices as secondary targets. The treatment was intended to suppress tremors both directly and indirectly. Thirty-six sessions later, her symptoms were in remission, and she returned to active duty. This case demonstrates the potential efficacy of fMRI-guided rTMS in the treatment of dissociative PTSD.

Introduction: Repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC is used to treat major depressive disorder (MDD). Current approximation of DLPFC location is done using a standardized rTMS position 5.5cm anterior to the left primary motor cortex, and generally results in modest remission rates in the literature. However, this approach may fail to account for variability in individualized localization of function. This case report demonstrates the potential efficacy of using a stimulated fMRI scan to determine the precise position of TMS targets in an attempt to improve treatment outcomes.

Emerging data has demonstrated that depression involves inflammatory processes in the brain. Exosome treatments are thought to have potential anti-inflammatory benefits. This study intended to provide clinical relief for patients with depression by increasing localized perfusion to Brodmann area 25 (BA25) in combination with intravenous exosome delivery. Here, we detail two case studies in which neuro-navigated ultrasound was used to aid exosomal delivery to the subgenual cingulate (SGC, BA25). The patients were both diagnosed with severe treatment-resistant Major Depressive Disorder (MDD) and had previously undergone transcranial magnetic stimulation (TMS) and intensive regimens of antidepressant medication with no symptom relief. Functional and structural imaging were used to navigate ultrasound application targets for the SGC. Safety and efficacy of focused ultrasound and exosomes were evaluated for both patients.

HIV-related white matter (WM) differences reported across studies are inconsistent. This is due to clinical and demographic heterogeneity of HIV infected populations, and variations in diffusion MRI (dMRI) acquisition, processing, and analysis methods across studies. Therefore, reliable neuroanatomical consequences of infection and therapeutic targets are difficult to identify. Here, we pooled data from six existing HIV studies from around the world as part of the ENIGMA-HIV consortium to evaluate (1) the effects of harmonization of dMRI measures across sites using ComBat, and (2) whether an improved, higher-order tensor dMRI model, the tensor distribution function (TDF), and derived scalar index (FATDF) conferred higher sensitivity across heterogeneous sites to understand the effect of HIV on WM microstructure. This study suggests that improved dMRI indices and harmonization of these measures across cohorts, may be helpful for detecting consistent effects of disease on the brain in international multi-site studies, while preserving biological differences.

Modern times have seen an increase in the use of focused ultrasound (FUS) for neuromodulation [1]. However, the field has yet to agree upon a way in which FUS should be targeted at deep brain structures. The most common is the anatomical method, which involves aiming the line orthogonal to the plane of the transducer to point at the desired subcortical target [2]. Then, by tracing the focal depth of the transducer along this line, one can identify the region of the brain currently in the focus of the transducer. Indeed, this gives the origin of the term “MR-guided focused ultrasound.” This method is not entirely desirable. One, the focus of the transducer is determined in degassed water, which needless to say, is not like brain tissue. This not only does not account for a loss of energy as the ultrasound travels through the skull, but also does not account for how the focus might change position when the ultrasound waves refract against the human skull. This is due to the different velocity of ultrasound waves in water versus through brain tissue. Individual variation in skull anatomy may exacerbate this difference further [3]. CT scans are needed a priori in order to plan out accurate targeting [4]. This drawback also applies to the use of previously acquired MR images with optical tracking devices [5].

Introduction: Preclinical studies support investigation of focused ultrasound for breakdown of cerebral pathologies in neurodegenerative conditions including Alzheimer's disease (AD) and Parkinson's disease (PD).

Introduction: Nonmotor symptoms, including depression, anxiety, apathy, and cognitive dysfunction, are common in Parkinson's disease (PD). Although a link between mood symptoms and cognitive impairment in PD has been theorized vis-à-vis striatal dopamine depletion, studies have been inconsistent regarding the relationship between mood symptoms and cognitive function. Inconsistencies may reflect the cross-sectional nature of previous studies. The current study examined the bidirectional longitudinal relationship between mood and cognition.

Objectives: Despite treatment-related improvements in morbidity and mortality, HIV-1-infected (HIV+) individuals continue to face a wide range of HIV-associated medical and HIV-associated neurocognitive disorders. Little is known about the impact of cognitive impairment on patients' health-related quality of life (HRQoL). To address this, the current studyv

The original Human Connectome Project yielded a rich data set on structural and functional connectivity in a large sample of healthy young adults using improved methods of data acquisition, analysis, and sharing. More recent efforts are extending this approach to include infants, children, older adults, and brain disorders. This paper introduces and describes the Human Connectome Project in Aging (HCP-A), which is currently recruiting 1200 + healthy adults aged 36 to 100+, with a subset of 600 + participants returning for longitudinal assessment. Four acquisition sites using matched Siemens Prisma 3T MRI scanners with centralized quality control and data analysis are enrolling participants. Data are acquired across multimodal imaging and behavioral domains with a focus on factors known to be altered in advanced aging. MRI acquisitions include structural (whole brain and high resolution hippocampal) plus multiband resting state functional (rfMRI), task fMRI (tfMRI), diffusion MRI (dMRI), and arterial spin labeling (ASL). Behavioral characterization includes cognitive (such as processing speed and episodic memory), psychiatric, metabolic, and socioeconomic measures as well as assessment of systemic health (with a focus on menopause via hormonal assays). This dataset will provide a unique resource for examining how brain organization and connectivity changes across typical aging, and how these differences relate to key characteristics of aging including alterations in hormonal status and declining memory and general cognition. A primary goal of the HCP-A is to make these data freely available to the scientific community, supported by the Connectome Coordination Facility (CCF) platform for data quality assurance, preprocessing and basic analysis, and shared via the NIMH Data Archive (NDA). Here we provide the rationale for our study design and sufficient details of the resource for scientists to plan future analyses of these data. A companion paper describes the related Human Connectome Project in Development (HCP-D, Somerville et al., 2018), and the image acquisition protocol common to both studies (Harms et al., 2018).

Objective: Repetitive transcranial magnetic stimulation (rTMS) is an FDA-approved therapy for major depressive disorder (MDD). The current study investigates the role of functional magnetic resonance imaging (fMRI) in navigating rTMS targets to improve treatment outcomes.

Objective. To elucidate additional TMS targets for patients with Generalized Anxiety Disorder (GAD), the present study attempts to integrate the neurological substrates of traditional psychological interventions and fMRI data.

Objective: HIV-associated neurocognitive disorder (HAND) occurs in a significant percentage of HIV-infected (HIV+) adults. Increased intraindividual variability (IIV) in cognitive function may be an early marker of emerging neurocognitive disorder, which suggests that IIV may be a sensitive measure of neurologic compromise in HIV. In the current study, we hypothesize that increased IIV may predict impending morbidity, including future cognitive decline and death.

HIV infection and aging are both associated with neurodegeneration. However, whether the aging process alone or other factors associated with advanced age account for the progression of neurodegeneration in the aging HIV‐positive (HIV+) population remains unclear. Methods: HIV+ (n = 70) and HIV‐negative (HIV−, n = 34) participants underwent diffusion tensor imaging (DTI) and metrics of microstructural properties were extracted from regions of interest (ROIs). A support vector regression model was trained on two independent datasets of healthy adults across the adult life‐span (n = 765, Cam‐CAN = 588; UiO = 177) to predict participant age from DTI metrics, and applied to the HIV dataset. Predicted brain age gap (BAG) was computed as the difference between predicted age and chronological age, and statistically compared between HIV groups. Regressions assessed the relationship between BAG and HIV severity/medical comorbidities. Finally, correlation analyses tested for associations between BAG and cognitive performance. Results: BAG was significantly higher in the HIV+ group than the HIV− group F (1, 103) = 12.408, p = .001). HIV RNA viral load was significantly associated with BAG, particularly in older HIV+ individuals (R 2 = 0.29, F(7, 70) = 2.66, p = .021). Further, BAG was negatively correlated with domain‐level cognitive function (learning: r = −0.26, p = .008; memory: r = −0.21, p = .034). Conclusions: HIV infection is associated with augmented white matter aging, and greater brain aging is associated with worse cognitive performance in multiple domains.

Introduction: Past studies have shown that a large portion of individuals with Parkinson's disease (PD) and mild cognitive impairment (MCI) will revert to a cognitively intact (CI) status in the future. Aging studies have shown that individuals who revert from MCI to CI are at increased risk for reconverting to MCI or dementia in the future. The current study examined if individuals who revert from PD-mild cognitive impairment (PD-MCI) to CI will be at increased risk for future PD-MCI and Parkinson's disease dementia (PDD).

Purpose: A previous study showed that assessment of language laterality could be improved by adding grammar tests to the recovery phase of the intracarotid amobarbital procedure (IAP) (Połczyńska et al. 2014). The aim of this study was to further investigate the extent to which grammar tests lateralize language function during the recovery phase of the IAP in a larger patient sample.

Introduction Brain surgery in the language dominant hemisphere remains challenging due to unintended post-surgical language deficits, despite using pre-surgical functional magnetic resonance (fMRI) and intraoperative cortical stimulation. Moreover, patients are often recommended not to undergo surgery if the accompanying risk to language appears to be too high. While standard fMRI language mapping protocols may have relatively good predictive value at the group level, they remain sub-optimal on an individual level. The standard tests used typically assess lexico-semantic aspects of language, and they do not accurately reflect the complexity of language either in comprehension or production at the sentence level. Among patients who had left hemisphere language dominance we assessed which tests are best at activating language areas in the brain. Method We compared grammar tests (items testing word order in actives and passives, wh-subject and object questions, relativized subject and object clauses and past tense marking) with standard tests (object naming, auditory and visual responsive naming), using pre-operative fMRI. Twenty-five surgical candidates (13 females) participated in this study. Sixteen patients presented

Despite recent advances in treatment, hepatitis C remains a significant public health problem. The hepatitis C virus (HCV) is known to infiltrate the brain, yet findings from studies on associated neurocognitive and neuropathological changes are mixed. Furthermore, it remains unclear if HCV eradication improves HCV-associated neurological compromise. This study examined the longitudinal relationship between neurocognitive and neurophysiologic markers among healthy HCV- controls and HCV+ adults following successful HCV eradication. We hypothesized that neurocognitive outcomes following treatment would be related to both improved cognition and white matter integrity. Participants included 57 HCV+ participants who successfully cleared the virus at the end of treatment (sustained virologic responders [SVRs]) and 22 HCV- controls. Participants underwent neuropsychological testing and, for a nested subset of participants, neuroimaging (diffusion tensor imaging) at baseline and 12 weeks following completion of HCV therapy. Contrary to expectation, group-level longitudinal analyses did not reveal significant improvement in neurocognitive performance in the SVRs compared to the control group. However, a subgroup of SVRs demonstrated a significant improvement in cognition relative to controls, which was related to improved white matter integrity. Indeed, neuroimaging data revealed beneficial effects associated with clearing the virus, particularly in the posterior corona radiata and the superior longitudinal fasciculus. Findings suggest that a subgroup of HCV+ patients experienced improvements in cognitive functioning following eradication of HCV, which appears related to positive changes in white matter integrity. Future research should examine whether any additional improvements in neurocognition and white matter inte

Although fact-finding exercises are becoming increasingly common as a way to assess competency in neuropsychology (i.e., part of the board certification process), few formal resources are available to assist with developing skill and experience with these exercises. As the prevalence of clinical neuropsychologists attempting to achieve board certification through the American Board of Professional Psychology (ABPP) increases, resources for successful completion of this process are of ever increasing importance. While some previously published texts provide adequate preparation for the written exam, including Board Certification in Clinical Neuropsychology: A Guide to Becoming ABPP/ABCN Certified Without Sacrificing Your Sanity (Armstrong, Beebe, & Hilsabeck, 2008) and Guide to Board Certification in Clinical Neuropsychology (Alberts, Ebbe, & Kazar, 2013), these books do not provide in-depth overviews of the oral examination. Designed as a manual for both supervisors and trainees, The Neuropsychology Fact-Finding Casebook: A Training Resource fills this void. While framed in part as a manual for those preparing to complete the ABPP oral exam, this text is designed as a broader training resource for all levels of advanced trainees. Throug

Historically marginalized groups are likely to be exposed to social adversity, which predicts important mental health outcomes (e.g., depression). Despite the well-established relationship between adversity and poor health, few studies have examined how adversity differentially predicts mental health among people living with multiple, co-occurring marginalized identities or statuses. The current study fills this gap by examining whether relationships between social adversity and depressive symptoms differed between those living with or without a stigmatized disease (i.e., HIV) and/or marginalized racial/ethnic identity (i.e., African American).

Background: The current study examined the independent and interactive effects of HIV and marijuana (MJ) use on brain structure and cognitive function among a sample of HIV-positive (HIV+) and HIV-negative (HIV-) individuals.

The purpose of the current study was to examine the independent and interactive effects of social adversity (SA) and HIV infection on subcortical shape alterations and cognitive functions. Participants included HIV+ (n = 70) and HIV- (n = 23) individuals who underwent MRI, neurocognitive and clinical assessment, in addition to completing questionnaires from which responses were used to create an SA score. Bilateral amygdalae and hippocampi were extracted from T1-weighted images. Parametric statistical analyses were used to compare the radial distance of the structure surface to a median curve to determine the presence of localized shape differences as a function of HIV, SA and their interaction. Next, multiple regression was used to examine the interactive association between HIV and SA with cognitive performance data. An HIV*SA interactive effect was found on the shape of the right amygdala and left hippocampus. Specifically, HIV-infected participants (but not HIV-uninfected controls) who evidenced higher levels of SA displayed an inward deformation of the surface consistent with reduced volume of these structures. We found interactive effects of HIV and SA on learning/memory performance. These results suggest that HIV+ individuals may be more vulnerable to neurological and cognitive changes in the hippocampus and amygdala as a function of SA than HIV- individuals, and that SA indicators of childhood SES and perceived racial discrimination are important components of adversity that are associated with cognitive performance.

Objectives: Recent studies suggest that intraindividual variability (IIV) of neuropsychological performance may be sensitive to HIV-associated neurologic compromise. IIV may be particularly dependent upon the integrity of frontal-subcortical systems, and therefore may be a meaningful phenotype in HIV. We examined the relationship between change in IIV and white matter integrity among HIV seropositive (HIV+) and HIV seronegative (HIV-) individuals.

We examined how two critical constructs, health beliefs and sensation seeking, influence combination antiretroviral therapy adherence in HIV+ African Americans, and whether these factors mediate the association between age and adherence. Two-hundred-and-eighty-six HIV+ African Americans participated in this observational study. Path analyses revealed that higher levels of a specific health belief, perceived utility of treatment, and lower levels of a sensation-seeking component, Thrill and Adventure Seeking, directly predicted optimal adherence. The influence of age on adherence was partially mediated by lower Thrill and Adventure Seeking levels. Depression predicted adherence via perceived utility of treatment and Thrill and Adventure Seeking, whereas current substance abuse and dependence did via Thrill and Adventure Seeking. Poorer neurocognitive function had a direct, adverse effect on adherence. Our findings suggest that supporting the development of more positive perceptions about HIV treatment utility may help increase medication adherence among African Americans. This may be particularly relevant for those with higher levels of depression symptoms, which was directly associated with negative perceptions about treatment. Additionally, clinicians can assess sensation-seeking tendencies to help identify HIV+ African Americans at risk for suboptimal adherence. Compensatory strategies for medication management may help improve adherence among HIV+ individuals with poorer neurocognitive function.

The current study examined the independent and combined effects of HIV and marijuana (MJ) use (no use, light use, and moderate-to-heavy use) on neurocognitive functioning among a convenience sample of HIV-positive (HIV+) and HIV-negative (HIV-) individuals recruited from HIV community care clinics and advertisements in the Greater Los Angeles area. MJ users consisted of individuals who reported regular use of MJ for at least 12 months, with last reported use within the past month. Participants included 89 HIV+ (n = 55) and HIV- (n = 34) individuals who were grouped into non-users, light users, and moderate-to-heavy users based on self-reported MJ use. Participants were administered a brief cognitive test battery and underwent laboratory testing for CD4 count and viral load. HIV+ individuals demonstrated lower performance on neurocognitive testing than controls, and moderate-to-heavy MJ users performed more poorly on neurocognitive testing than light users or non-users. Moderate-to-heavy HIV+ users performed significantly lower on learning/memory than HIV- moderate-to-heavy users (MD = -8.34; 95% CI: -16.11 to -0.56) as well as all other comparison groups. In the domain of verbal fluency, HIV+ light users outperformed HIV- light users (MD = 7.28; 95% CI: 1.62-12.39), but no HIV group differences were observed at other MJ use levels. HIV+ MJ users demonstrated lower viral load (MD = -0.58; 95% CI: -1.30 to 0.14) and higher CD4 count than non-users (MD = 137.67; 95% CI: 9.48-265.85). The current study findings extend the literature by demonstrating the complex relationship between HIV status and MJ use on neurocognitive and clinical outcomes.

Standard volumetric neuroimaging studies have demonstrated preferential atrophy of subcortical structures among individuals with HIV. However, to our knowledge, no study has investigated subcortical shape alterations secondary to HIV and whether advancing age impacts that relationship. This study employed 3D morphometry to examine the independent and interactive effects of HIV and age on shape differences in nucleus accumbens, amygdala, caudate, hippocampus, pallidum, putamen, and thalamus in 81 participants ranging in age from 24 to 76 including 59 HIV+ individuals and 22 HIV-seronegative controls. T1-weighted MRI underwent a preprocessing pipeline followed by automated subcortical segmentation. Parametric statistical analyses were used to determine independent effects of HIV infection and age on volume and shape in each region of interest (ROI) and the interaction between age and HIV serostatus in predicting volume/shape in each ROI. Significant main effects for HIV were found in the shape of right caudate and nucleus accumbens, left pallidum, and hippocampus. Age was associated with differences in shape in left pallidum, right nucleus accumbens and putamen, and bilateral caudate, hippocampus, and thalamus. Of greatest interest, an age × HIV interaction effect was found in the shape of bilateral nucleus accumbens, amygdala, caudate, and thalamus as well as right pallidum and putamen such that increasing age in HIV participants was associated with greater shape alterations. Traditional volumemetric analyses revealed main effects for both HIV and age but no age × HIV interaction. These findings may suggest that age and HIV infection conferred additional deleterious effects on subcortical shape abnormalities beyond the independent effects of these factors. Hum Brain Mapp 38:1025-1037, 2017. © 2016 Wiley Periodicals, Inc.

This study examined the reliability of high angular resolution diffusion tensor imaging (HARDI) data collected on a single individual across several sessions using the same scanner. HARDI data was acquired for one healthy adult male at the same time of day on ten separate days across a one-month period. Environmental factors (e.g. temperature) were controlled across scanning sessions. Tract Based Spatial Statistics (TBSS) was used to assess session-to-session variability in measures of diffusion, fractional anisotropy (FA) and mean diffusivity (MD).

Degenerative brain changes in Alzheimer's disease may occur in reverse order of normal brain development based on the retrogenesis model. This study tested whether evidence of reverse myelination was observed in mild cognitive impairment (MCI) using a data-driven analytic approach based on life span developmental data. Whole-brain high-resolution diffusion tensor imaging scans were obtained for 31 patients with MCI and 79 demographically matched healthy older adults. Comparisons across corpus callosum (CC) regions of interest (ROIs) showed decreased fractional anisotropy (FA) in the body but not in the genu or splenium; early-, middle-, and late-myelinating ROIs restricted to the CC revealed decreased FA in late- but not early- or middle-myelinating ROIs. Voxelwise group differences revealed areas of lower FA in MCI, but whole-brain differences were equally distributed across early-, middle-, and late-myelinating regions. Overall, results within the CC support the retrogenesis model, although caution is needed when generalizing these results beyond the CC.

In its most pure form, the human amnesic syndrome involves a disabling impairment in new learning accompanied by some degree of impairment in aspects of remote memory in the context of relatively normal intellectual ability, language, and attention span. Neuropsychological research has clearly shown that lesions within the brain’s extended memory system (medial temporal lobe, diencephalon, and basal forebrain) produce anterograde amnesia while leaving other aspects of memory (retrieval of general knowledge, vocabulary, names) relatively intact. The episodic–semantic distinction has been useful in explaining key characteristics of the human amnesic syndrome. This chapter provides a framework for characterizing the distinction between “episodic” and “semantic” memory, and discusses the clinical features and assessment of disordered function in each of these two domains.

Preclinical research has demonstrated a window of vulnerability in the immediate aftermath of concussion wherein continued activity and stimulation can impair or prolong neurobehavioral recovery. However, this concept has not been quantified in a human population.Context:

Timely removal from activity after concussion symptoms remains problematic despite heightened awareness. Previous studies indicated potential adverse effects of continuing to participate in physical activity immediately after sustaining a concussion.

Chronic traumatic encephalopathy (CTE) is a neuropathologically defined disease reportedly linked to a history of repetitive brain trauma. As such, retired collision sport athletes are likely at heightened risk for developing CTE. Researchers have described distinct pathological features of CTE as well a wide range of clinical symptom presentations, recently termed traumatic encephalopathy syndrome (TES). These clinical symptoms are highly variable, non-specific to individuals described as having CTE pathology in case reports, and are often associated with many other factors. This review describes the cognitive, emotional, and behavioral changes associated with 1) developmental and demographic factors, 2) neurodevelopmental disorders, 3) normal aging, 4) adjusting to retirement, 5) drug and alcohol abuse, 6) surgeries and anesthesia, and 7) sleep difficulties, as well as the relationship between these …

Non-concussed individuals may report a variety of concussion-like symptoms even in the absence of a diagnosed brain injury. Previous studies described concussion-like symptom reporting in adolescent athletes. This study provides complementary data on concussion-like symptoms in collegiate athletes.

Recent clinical practice parameters encourage systematic use of concussion surveillance/management tools that evaluate participating athletes at baseline and after concussion. Office-based tools (Sports Concussion Assessment Tool; SCAT2) require accurate baseline assessment to maximize utility but no normative data exist for children on the SCAT2, limiting identification of “normal” or “impaired” score ranges. The purpose of this study was to develop child and adolescent baseline norms for the SCAT2 to provide reference values for different age groups. A community-based approach was implemented to compile baseline performance data on the SCAT2 in 761 children aged 9 to 18 to create age- and sex-graded norms. Findings indicate a significant age effect on SCAT2 performance such that older adolescents and teenagers produced higher (better) total scores than younger children (ages 9 to 11) driven by …

Concussions, or mild traumatic brain injuries, are prevalent among youth and young adults. These injuries may disrupt a person's daily activities (occupations) including school, physical activity, work, and socialization. Rehabilitation professionals, such as occupational therapists (OTs), are experts in providing individualized intervention to address these temporary life changes during recovery.

Computerized neurocognitive assessments are commonly used to manage sport-related concussion. Variations in baseline performance may influence neurocognitive performance after injury as well as the amount of time needed for an athlete to be cleared for return to sport participation.

Over the past 2 decades, concussion care is increasingly in demand as research and media attention shed light on the importance of proper diagnosis and medical management to prevent complex, potentially disabling sequelae. The purpose of this review is to discuss the future of clinical concussion care across selected topics under the broad themes of diagnosis/assessment, intervention/treatment, and patient characteristics/presentations with the intent to direct clinicians’ attention to important anticipated developments in the field. The current status of biomarkers, clinical settings, models of clinical concussion, return-to-activity, clinical subpopulations, treatment approaches, patient perceptions of injury, and social media are reviewed along with predictions for future developments.

Although concussion continues to be a major source of acute and chronic injury in automotive, athletic and military arenas, concussion injury mechanisms and risk functions are ill-defined. To overcome this knowledge gap, we have developed, tested and deployed a head impact monitoring mouthguard (IMM) system. The IMM system was first calibrated in 731 laboratory tests against Hybrid III and NOCSAE headforms with Reference kinematic sensors. Next, during on-field play involving n= 54 amateur American athletes in football and boxing, there were tens of thousands of kinematic signatures collected by the IMM. A total of 890 true positive head impacts were confirmed using a combination of signal processing and NINDS/NIH Common Data Elements methods [1].

To examine the effectiveness of a six-session multidisciplinary intervention of coordinated cognitive behavioral therapy (CBT) and programmed aerobic exercise for patients suffering from persistent post-concussion symptoms (PPCS) as measured via a battery of validated patient-reported assessments.

To evaluate cardiorespiratory functions in youth with persistent post-concussion symptoms compared to controls and to examine the predictive value of relevant demographic and medical variables.

To evaluate cardiorespiratory response to a cognitive/emotional stressor in youth with persistent post-concussion symptoms (PPCS).

The objective of this study is to compare the impacted domains documented in an initial physician note and reviewed by an OT retrospectively, with the reported impacted domains when an OT and neurologist complete a joint evaluation.

Within a sample of patients with prolonged post-concussion symptoms, the current study evaluated the etiology of patients reported cognitive symptoms.

This study’s goal is to delineate the potential added value of OT services to a multidisciplinary pediatric concussion team that optimizes functional recovery.

To examine the occurrence and predictors of exertional effects following cognitive effort in post-acute concussion patients.