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INTRODUCTION: The contribution of neuropsychological assessments to risk assessment for incident dementia is underappreciated. METHODS: We analyzed neuropsychological testing results in dementia‐free participants in the Atherosclerosis Risk in Communities (ARIC) study. We examined associations of index domain–specific neuropsychological test performance with incident dementia using cumulative incidence curves and Cox proportional hazards models. RESULTS: Among 5296 initially dementia‐free participants (mean [standard deviation] age of 75.8 [5.1] years; 60.1% women, 22.2% Black) over a median follow‐up of 7.9 years, the covariate‐adjusted hazard ratio varied substantially depending on the pattern of domain‐specific performance and age, in an orderly manner from single domain language abnormalities (lowest risk) to single domain executive or memory abnormalities, to multidomain abnormalities including memory (highest risk). DISCUSSION: By identifying normatively defined cognitive abnormalities by domains based on neuropsychological test performance, there is a conceptually orderly and age‐sensitive spectrum of risk for incident dementia that provides valuable information about the likelihood of progression. Highlights: Domain‐specific cognitive profiles carry enhanced prognostic value compared to mild cognitive impairment.Single‐domain non‐amnestic cognitive abnormalities have the most favorable prognosis.Multidomain amnestic abnormalities have the greatest risk for incident dementia.Patterns of domain‐specific risks are similar by sex and race. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? How accurate are self-assessments of cognitive performance and do they vary across different cognitive assessment strategies and human immunodeficiency virus and mild cognitive impairment (MCI) status. • What is the main finding of this study? No effects of human immunodeficiency virus status were found for cognitive performance or self-assessment of performance. MCI status was associated with poorer performance on testing and overestimations in self-assessments. • What is the meaning of the finding? Both MCI+ and MCI- participants misestimated their performance. Thus, cognitive challenges can only be validly confirmed with performance-based assessments, although comparing performance to self-assessments may identify important individual-level challenges. Self-assessment of cognitive abilities can be an important predictor of clinical outcomes. This study examined impairments in self-assessments of cognitive performance, assessed with traditional neuropsychological assessments and novel virtual reality tests among older persons with and without human immunodeficiency virus (HIV) and mild cognitive impairment (MCI). One hundred twenty-two participants (82 persons with HIV; 79 MCI+) completed a traditional neuropsychological battery, DETECT virtual reality cognitive battery, and self-reported their general cognitive complaints, depressive symptoms, and perceptions of DETECT performance. Relationships between DETECT performance and self-assessments of performance were examined as were the correlations between general cognitive complaints and performance. These relations were evaluated across HIV and MCI status, considering the associations of depressive symptoms, performance, and self-assessment. We found no effect of HIV status on objective performance or self-assessment of DETECT performance. However, MCI+ participants performed worse on DETECT and traditional cognitive tests, while also showing a directional bias towards overestimation of their performance. MCI- participants showed a bias toward underestimation. Cognitive complaints were reduced compared to objective performance in MCI+ participants. Correlations between self-reported depressive symptoms and cognitive performance or self-assessment of performance were nonsignificant. MCI+ participants underperformed on neuropsychological testing, while overestimating performance. Interestingly, MCI- participants underestimated performance to approximately the same extent as MCI+ participants overestimated. Practical implications include providing support for persons with MCI regarding awareness of limitations and consideration that self-assessments of cognitive performance may be overestimated. Similarly, supporting older persons without MCI to realistically appraise their abilities may have clinical importance. [ABSTRACT FROM AUTHOR]

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To test whether targeted therapeutic mild hypercapnia (TTMH) would attenuate cerebral oxygen desaturation detected using near-infrared spectroscopy during cardiac surgery requiring cardiopulmonary bypass (CPB). Randomized controlled trials. Operating rooms and intensive care unit of tertiary hospital. The study comprised 30 patients undergoing cardiac surgery with CPB. Patients were randomly assigned to receive either standard carbon dioxide management (normocapnia) or TTMH (target arterial carbon dioxide partial pressure between 50 and 55 mmHg) throughout the intraoperative period and postoperatively until the onset of spontaneous ventilation. Relevant biochemical and hemodynamic variables were measured, and cerebral tissue oxygen saturation (SctO 2) was monitored with near-infrared spectroscopy. Patients were followed-up with neuropsychological testing. Patient demographics between groups were compared using the Fisher exact and Mann-Whitney tests, and SctO 2 between groups was compared using repeated measures analysis of variance. The median patient age was 67 years (interquartile range [IQR] 62-72 y), and the median EuroSCORE II was 1.1. The median CPB time was 106 minutes. The mean intraoperative arterial carbon dioxide partial pressure for each patient was significantly higher with TTMH (52.1 mmHg [IQR 49.9-53.9 mmHg] v 40.8 mmHg [IQR 38.7-41.7 mmHg]; p < 0.001) as was pulmonary artery pressure (23.9 mmHg [IQR 22.4-25.3 mmHg] v 18.5 mmHg [IQR 14.8-20.7 mmHg]; p = 0.004). There was no difference in mean percentage change in SctO 2 during CPB in the control group for both hemispheres (left: –6.7% v –2.3%; p = 0.110; right: –7.9% v –1.0%; p = 0.120). Compliance with neuropsychological test protocols was poor. However, the proportion of patients with drops in test score >20% was similar between groups in all tests. TTMH did not increase SctO 2 appreciably during CPB but increased pulmonary artery pressures before and after CPB. These findings do not support further investigation of TTMH as a means of improving SctO 2 during and after cardiac surgery requiring CPB. [ABSTRACT FROM AUTHOR]

Concussion is a challenging and controversial medical diagnosis that can test even the most seasoned practitioner. Knowledge on this topic is ever evolving. It was not so long ago that grading guidelines were based on loss of consciousness and amnesia. Medicine has seen a renaissance of discovery over the past 20 years in concussion evaluation and management. A PubMed search for "concussion" between 1990 and 2000 produced just over 1000 articles and that same search including the last 18 years expands to over 10,000 publications. The most recent knowledge and recommendations are discussed based on the published evidence. [ABSTRACT FROM AUTHOR]

Background: As eye tracking-based assessment of cognition becomes more widely used in older adults, particularly those at risk for dementia, reliable and scalable methods to collect high-quality data are required. Eye tracking-based cognitive tests that utilize device-embedded cameras have the potential to reach large numbers of people as a screening tool for preclinical cognitive decline. However, to fully validate this approach, more empirical evidence about the comparability of eyetracking-based paradigms to existing cognitive batteries is needed.Objective: Using a population of clinically normal older adults, we examined the relationship between a 30-minute Visual Paired Comparison (VPC) recognition memory task and cognitive composite indices sensitive to a subtle decline in domains associated with Alzheimer disease. Additionally, the scoring accuracy between software used with a commercial grade eye tracking camera at 60 frames per second (FPS) and a manually scored procedure used with a laptop-embedded web camera (3 FPS) on the VPC task was compared, as well as the relationship between VPC task performance and domain-specific cognitive function.Methods: A group of 49 clinically normal older adults completed a 30-min VPC recognition memory task with simultaneous recording of eye movements by a commercial-grade eye-tracking camera and a laptop-embedded camera. Relationships between webcam VPC performance and the Preclinical Alzheimer Cognitive Composite (PACC) and National Institutes of Health Toolbox Cognitive Battery (NIHTB-CB) were examined. Inter-rater reliability for manually scored tests was analyzed using Krippendorff's kappa formula, and we used Spearman's Rho correlations to investigate the relationship between VPC performance scores with both cameras. We also examined the relationship between VPC performance with the device-embedded camera and domain-specific cognitive performance.Results: Modest relationships were seen between mean VPC novelty preference and the PACC (r=.39, P=.007) and NIHTB-CB (r=.35, P=.03) composite scores, and additional individual neurocognitive task scores including letter fluency (r=.33, P=.02), category fluency (r=.36, P=.01), and Trail Making Test A (-.40, P=.006). Robust relationships were observed between the 60 FPS eye tracker and 3 FPS webcam on both trial-level VPC novelty preference (r=.82, P<.001) and overall mean VPC novelty preference (r=.92 P<.001). Inter-rater agreement of manually scored web camera data was high (kappa=.84).Conclusions: In a sample of clinically normal older adults, performance on a 30-minute VPC task correlated modestly with computerized and paper-pencil based cognitive composites that serve as preclinical Alzheimer disease cognitive indices. The strength of these relationships did not differ between camera devices. We suggest that using a device-embedded camera is a reliable and valid way to assess performance on VPC tasks accurately and that these tasks correlate with existing cognitive composites. [ABSTRACT FROM AUTHOR]

Surgical management of epilepsy is an established safe and effective way in improving patients' seizure frequency and overall morbidity. A robust array of options is available to carry out an in-depth evaluation of a surgical candidate in epilepsy. However, underutilisation of the available options may seriously challange post-operative outcomes. In this paper, we discuss the different aspects of various non-invasive and invasive procedures available to evaluate a surgical candidate of epilepsy and discuss their relative advantages and position in the diagnostic algorithm. [ABSTRACT FROM AUTHOR]

Unlabelled: Using 8-hour human laboratory experiments, we evaluated the analgesic efficacy of vaporized cannabis in patients with neuropathic pain related to injury or disease of the spinal cord, most of whom were experiencing pain despite traditional treatment. After obtaining baseline data, 42 participants underwent a standardized procedure for inhaling 4 puffs of vaporized cannabis containing either placebo, 2.9%, or 6.7% delta 9-THC on 3 separate occasions. A second dosing occurred 3 hours later; participants chose to inhale 4 to 8 puffs. This flexible dosing was used to attempt to reduce the placebo effect. Using an 11-point numerical pain intensity rating scale as the primary outcome, a mixed effects linear regression model showed a significant analgesic response for vaporized cannabis. When subjective and psychoactive side effects (eg, good drug effect, feeling high, etc) were added as covariates to the model, the reduction in pain intensity remained significant above and beyond any effect of these measures (all P < .0004). Psychoactive and subjective effects were dose-dependent. Measurement of neuropsychological performance proved challenging because of various disabilities in the population studied. Because the 2 active doses did not significantly differ from each other in terms of analgesic potency, the lower dose appears to offer the best risk-benefit ratio in patients with neuropathic pain associated with injury or disease of the spinal cord.Perspective: A crossover, randomized, placebo-controlled human laboratory experiment involving administration of vaporized cannabis was performed in patients with neuropathic pain related to spinal cord injury and disease. This study supports consideration of future research that would include longer duration studies over weeks to months to evaluate the efficacy of medicinal cannabis in patients with central neuropathic pain. [ABSTRACT FROM AUTHOR]

Objectives Determine the relationship between cognitive function and health literacy in heart failure (HF) knowledge in patients with HF. Background HF requires extensive, complex treatment; thus, cognition and health literacy may contribute to understanding and self-management of HF. Methods Participants were 330 HF outpatients. Health literacy was assessed using the Medical Term Recognition Test and the Rapid Estimate of Adult Literacy in Medicine. Global cognitive function was screened with the Modified Mini-Mental Status Examination. HF knowledge was assessed with the Dutch Heart Failure Knowledge Scale (DHFKS). Results Health literacy ( β = .26, p < .001) and cognition ( β = .36, p < .001) were related to DHFKS. Both scores were independently associated with DHFKS (health literacy: β = .13, p = .044 and cognition: β = .30, p < .001). Conclusions Impairments in health literacy and cognition were independently associated with reduced HF knowledge. Interventions should address both factors to be maximally effective. [ABSTRACT FROM AUTHOR]

Background HIV-associated neurocognitive disorder incurs a significant burden on HIV patients in Asia-Pacific countries; however, the incidence is difficult to estimate due to a lack of local epidemiological data. The impact of neurocognitive impairment in HIV patients is often underestimated due to a lack of education and awareness, and there are consequently gaps in the provision of screening and diagnosis to enable earlier intervention to limit neurocognitive impairment. Method This review seeks to redress the imbalance by promoting awareness and education among physicians concerning the neurovirulence of HIV and thereby increase screening efforts to improve diagnosis rates and clinical outcomes for underserved patients in this region. The Asia, Australia, and Middle East (AAME) HAND Advisory Board convened expert regional representatives to review current practice and recommend appropriate measures related to the implementation of standardised screening programmes and treatment recommendations to curb the developing HAND epidemic in the region. In particular, we recommend basic neuropsychological testing protocols that could be efficiently introduced into clinical practice for routine screening. Result We also propose simple guidelines for the management of HAND. We believe that HAND is a significant and under-reported diagnosis in HIV patients that warrants both greater recognition and further clinical investigation of the underlying pathophysiology and the impact of HIV disease progression, with HAND being associated with worse medication adherence and therefore possibly increased risk of ARV treatment failure. Discussion Widespread screening will lead to greater recognition of HAND and earlier intervention, which may lead to improved management strategies in the future. [ABSTRACT FROM AUTHOR]

Objectives This cohort study was conducted to examine patterns of symptom reporting in concussed athletes in two different testing environments. Design A prospective cohort study was conducted with repeated measures. Methods Self-reported symptoms collected by team athletic trainers using the ImPACT Post-Concussion Scale (PCS) were compared to symptoms collected in a confidential setting using structured interviews for depression and anxiety. Ratings were scaled to match scoring of the PCS and categorized into symptom-domains. Scores collected 2 days post-concussion were compared across different rating scales. Confidential self-report scores approximately 9 days post-concussion in cleared athletes were compared to PCS scores collected during return-to-play decisions. Finally, confidential self-report scores collected 9 days post-concussion were compared between cleared and not cleared athletes. Results Athletes self-reported significantly fewer symptoms to team athletic trainers using the ImPACT test compared to self-reported symptoms collected in a confidential setting during the acute phase of concussion using standard psychiatric interviews. Athletes cleared to play continued to underreport symptoms 9 days post-concussion, particularly psychiatric symptoms. Finally, cleared athletes self-reported similar magnitude of symptoms than non-cleared athletes 9 days post-concussion in confidential research setting. Conclusions The systematic underreporting of post-concussion symptoms may represent motivated behavior or differences in self-reporting data acquisition. By underreporting symptoms, many cleared athletes are still symptomatic over 1-week post-concussion. This study highlights the need for objective measures for somatic and psychiatric symptoms. [ABSTRACT FROM AUTHOR]

Background: Patients with heart failure (HF) have high rates of cognitive impairment and depressive symptoms. Depressive symptoms have been associated with greater cognitive impairments in HF; however, it is not known whether particular clusters of depressive symptoms are more detrimental to cognition than others. Objective: The aim of this study was to identify whether somatic and/or nonsomatic depressive symptom clusters were associated with cognitive function in persons with HF. Methods: Participants were 326 HF patients (40.5% women, 26.7% non-white race-ethnicity, aged 68.6 ± 9.7 years). Depressive symptoms were measured using a depression questionnaire commonly used in medical populations: the Patient Health Questionnaire-9. Somatic and nonsomatic subscale scores were created using previous factor analytic results. A neuropsychological battery tested attention, executive function, and memory. Composites were created using averages of age-adjusted scaled scores. Regressions adjusting for demographic and clinical factors were conducted. Results: Regressions revealed that Patient Health Questionnaire-9 total was associated with attention (β = -.14, P = .008) and executive function (β = -.17, P = .001). When analyzed separately, the nonsomatic subscale, but not the somatic symptoms subscale (P values Q .092), was associated with attention scores (β = -.15, P = .004) and memory (β = -.11, P= .044). Both nonsomatic (β = -.18, PG .001) and somatic (β = -.11, P = .048) symptoms were related to executive function. When included together, only the nonsomatic symptom cluster was associated with attention (β = -.15, P = .020) and executive function (β = -.19, P = .003). Conclusions: Greater overall depressive symptom severity was associated with poorer performance on multiple cognitive domains, an effect driven primarily by the nonsomatic symptoms of depression. Clinical Implications: These findings suggest that screening explicitly for nonsomatic depressive symptoms may be warranted and that the mechanisms underlying the depression-cognitive function relationship in HF are not solely related to sleep or appetite disturbance. Thus, interventions that target patients' somatic symptoms only (eg, poor appetite or fatigue) may not yield maximum cognitive benefit compared with a comprehensive treatment that targets depressed mood, anhedonia, and other nonsomatic symptoms. [ABSTRACT FROM AUTHOR]

Summary Cognitive dysfunction is a common symptom in patients with chronic kidney disease (CKD). In this review, we highlight the clinical relevance of cognitive impairment in patients with CKD. After a summary of the different pathophysiological components of this frequently overlooked clinical condition, we summarize and evaluate the available neurocognitive tests and reflect on their utility in everyday clinical practice. Finally, we identify future areas of research and allude to the fact that inclusion of cognitive function testing in routine clinical care of patients with CKD could be cost effective by reducing nonadherence to medication and improving quality of life, and even survival. [ABSTRACT FROM AUTHOR]

Accurate assessment of cognitive impairment requires comparison of cognitive performance in individuals to performance in a comparable healthy normative population. Few prior studies have included a large number of black participants and few have excluded participants from the normative sample with subclinical/ latent neurological disease or dementia. This study provides age, race, and education-specific normative data for 8 cognitive tests derived from 320 black and 392 white participants aged 61 to 82 years (mean 71 y) in the Atherosclerosis Risk in Communities (ARIC) study without clinical or subclinical/latent neurological disease. Normative data are provided for the Delayed Word Recall Test, Logical Memory Parts I and II, theWord Fluency Test, Animal Naming, the Trail Making Test Parts A and B and the Digit Symbol Substitution Test. Age, race, and education-specific mean and –1.5 SD scores are given in tabular form and graphically, as well as regression-based equations to derive adjusted score cut-points. These robust normative data should enhance comparison across studies of cognitive aging, where these measures are widely used, and improve interpretation of performance on these tests for the diagnosis of cognitive impairment not only within the ARIC cohort, but also among older blacks and whites with similar demographics. [ABSTRACT FROM AUTHOR]

Neuropsychological evaluations of preoperative epilepsy surgical candidates have been a routine portion of the multidisciplinary evaluation at most epilepsy centers for decades. Neuropsychology assessments have been explored as a means to predict and identify postoperative cognitive deficits after resections (chiefly temporal lobe), and in numerically quantifying those changes that do occur. In this manuscript, we describe the typical tools used, including tests of general intelligence, tests of language, tests of visuospatial cognition, and tests of verbal memory. Evidence for or against the use of the neuropsychological evaluation as a means to localize seizure onset, or as an adjunct for ictal focus lateralization is also included. [ABSTRACT FROM AUTHOR]

Background Previous investigators have observed changes in cognitive and psychiatric domains after GPi-DBS for dystonia, such as declines in semantic verbal fluency and set shifting or increased suicidality. Others have reported stability or improvements in select areas, such as graphomotor speed and mood. Interpretation of these findings is limited by inclusion of select patient populations or limited neuropsychological testing. Objective To describe cognitive and neuropsychiatric outcomes in a cohort of patients with primary and secondary dystonia undergoing Globus Pallidus pars interna deep brain stimulation (GPi-DBS). Methods Patients with primary and secondary dystonia were evaluated at baseline and post-operatively with a comprehensive battery of neuropsychological tests and mood inventories including anxiety, depression and hopelessness scales. Statistical significance was calculated with one-tailed student t-test, defined as p value < 0.05. Results Twelve patients were included in the study. Nine were male (75%) and the mean age at baseline assessment was 42.3 years (range 13–68; SD 18.0). The majority had focal or segmental dystonia (8/12, 66%), 4 patients had generalized dystonia. Three patients had monogenic dystonias (DYT 1 and DYT 3), and two patients had acquired (tardive) dystonia. Mean time between surgery and follow-up was 13.1 months (SD 3.1). Subjects demonstrated stable performance on most tests, with statistically significant improvements noted in working memory (letter-number sequencing), executive function (trail-making B), anxiety and depression. Conclusions In an etiologically and clinically diverse patient population, administration of comprehensive battery of cognitive tests pre and post-operatively suggests that GPi-DBS is safe from cognitive and psychiatric perspectives. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cognitive impairment is a common permanent sequela of traumatic brain injury (TBI). Its objectivization is based on neuropsychological and neurophysiological assessment. Neuropsychological evaluation requires a test battery, whereas for neurophysiological assessment the most significant is application of P300 Event-elated Potentials (ERPs). The aim of the study was to determine whether it is possible to differentiate between degrees of severity of TBI on the basis of neuropsychological and neurophysiological parameters. PATIENTS AND METHODS: A total of 90 patients with closed TBI were evaluated at least one year after trauma. Subjects were classified into three groups according to severity of TBI: mild, moderate and severe. In all subjects the Intelligence Test, the Wisconsin Card Sorting Test (WCST) and P300 ERPs were performed. RESULTS: General intelligence measures did not prove sensitivity enough to differentiate levels of severity of TBI, whereas the number of achieved categories on the WCST significantly discerned patients with mild and moderate TBI from patients with severe TBI. Perseverative errors significantly separated patients with mild TBI from patients with moderate and severe TBI. Non-perseverative errors significantly differentiated only patients with mild TBI from patients with severe TBI. Finally, P300 latency (EPLAT) significantly differentiated patients with mild TBI from patients with moderate and severe TBI. The results show that the applied test battery can discriminate between different levels of severity of TBI and emphasize the importance of P300 ERP in the evaluation of patients with brain injury. CONCLUSIONS: Our findings indicate that the WCST and ERP P300 latency have a significant role in the assessment of cognitive deficit related to TBI. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cognitive dysfunction is common among bariatric surgery candidates and associated with poorer weight loss outcomes. Identification of a brief screening measure to detect cognitive impairment in this population is needed, because comprehensive neuropsychological evaluations may not be available in all clinical settings. Methods: The present study examined the utility of the Mini-Mental State Examination (MMSE) for detecting cognitive impairment in 30 bariatric surgery candidates by comparing impairment on the MMSE (at varying cutoffs) to impairment on a comprehensive neuropsychological test battery. Results: Results indicated that the MMSE showed low sensitivity and specificity in identifying impairment, even at the more stringent MMSE cutoffs of 27 and 28. Conclusion: These findings suggest that the MMSE is a poor screener for cognitive impairment in bariatric surgery candidates. Future research is needed to identify or develop cognitive screeners for use in this population. [Copyright &y& Elsevier]

HIV-Associated Neurocognitive Disorder (HAND) is a prevalent condition among persons with HIV resulting in cognitive impairments that may impact daily functioning. The relationship between neuropsychological (NP) test performance and functional status was investigated based on social services received (SSR) among 285 HIV-infected and 242 HIV-negative participants enrolled in the Hawai'i Aging with HIV Cohort. HIV-infected participants scored significantly lower than the HIV-negative group on all measures of NP testing and also reported receiving SSR at a higher rate. Among HIV-infected participants, more SSR correlated with poorer overall global NP performance (ρ = -0.25, P < .001), as well as poorer performance in NP domains assessing psychomotor speed (ρ = -0.25, P < .001), and learning and memory (ρ = -0.19, P = .02). NP test performance did not correlate with the number of SSR among HIV-negative participants. Supplemental Security Income (SSI) was the most commonly utilized social service among HIV-infected. Receiving SSI was associated on multivariate analysis with poorer NP performance independent of lack of full time work, or nadir CD4 count. Poorer NP performance among HIV-infected individuals is associated with increased risk for social services. Interventions to address causes of cognitive dysfunction in this population may decrease demand for social services. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to examine the current literature on the integration of pharmacological interventions within neurorehabilitation and neuropsychological testing settings in patients with Traumatic Brain Injury (TBI). This review was conducted using the following databases: Taylor & Francis, Science Direct, Google Scholar, and ProQuest Central. Inclusion criteria consisted of peer-reviewed articles published in English between the years of 2006-2020. Keywords for the search included pharmacotherapy, beta-blockers, adrenergic antagonists, neurorehabilitation, neuropsychological testing, and traumatic brain injury (TBI). Literature Review. Independent extraction by multiple observers. In cases of TBI or other insults to the cerebral cortex, patients may experience a wide array of cognitive & somatic anxiety symptomatology. The literature reviewed shows that adrenergic antagonist agents may help get patients up to a baseline performance level to obtain more accurate psychometric measurements. When not contraindicated, beta-blockers (e.g., propranolol) have the potential to be incorporated safely on an as-needed basis for patients undergoing neurorehabilitation and neuropsychological testing within an interdisciplinary, integrated healthcare environment. Studies show beta-blockers can lessen cognitive anxiety via a decrease in somatization, in turn yielding more accurate results of cognitive ability, deficits, or improvement. Contrary to anxiolytic sedative-hypnotic agents (e.g., benzodiazepines), which have risks of cognitive impairments, data shows that beta-blockers may be an appropriate choice in neurorehabilitative interventions and neuropsychological testing because their intake does not result in an artificially enhanced cognitive ability. N/A. [ABSTRACT FROM AUTHOR]

Abstract: Background: Early detection of dementia is becoming more and more important owing to the advent of pharmacologic treatment. Objective: The goals of this study were to establish prevalence of mild cognitive impairment (MCI) subtypes in an outpatient memory clinic cohort using two different modes of MCI determination. Design: Consecutive patients complaining of cognitive problems who came to the memory outpatient clinic for assessment of a possible cognitive disorder were included in the study. Setting: Academic medical center. Participants: Six hundred eighty consecutive patients complaining about cognitive problems who came to the memory outpatient clinic for assessment of a possible cognitive disorder and fulfilled the inclusion criteria were included in the study. For 676 patients, sufficient data for MCI classification were available. Results: Categorizing MCI patients into MCI subtypes according to the minimum mode of MCI classification revealed the following results: 106 patients (15.7%) were categorized as cognitively healthy, whereas 570 patients (84.3%) met the criteria for MCI. MCI patients were subtyped as amnestic mild cognitive impairment (aMCI) single domain (31 patients; 4.6%), aMCI multiple domain (226 patients; 33.4%), non-aMCI single domain (125 patients; 18.5%), and non-aMCI multiple domain (188 patients; 27.8%). Categorizing MCI patients into MCI subtypes according to the mean mode of MCI classification revealed the following results: 409 patients (60.5%) were categorized as cognitively healthy, whereas 267 patients (39.5%) met the criteria for MCI. MCI patients were subtyped as aMCI single domain (47 patients; 6.9%), aMCI multiple domain (57 patients; 8.5%), non-aMCI single domain (97 patients; 14.3%), and non-aMCI multiple domain (66 patients; 9.8%). Conclusion: MCI diagnosis frequencies are substantially affected by the criteria used for estimation of MCI. The effect of modifying the presence of impairment on a single cognitive measure versus the presence of impairment on a mean composite score of a certain domain differed considerably, ranging from 39.5% to 84.3%, indicating the importance of the development of guidelines for operationalizing MCI. [Copyright &y& Elsevier]

Abstract: We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling medium-dose (3.53%), low-dose (1.29%), or placebo cannabis with the primary outcome being visual analog scale pain intensity. Psychoactive side effects and neuropsychological performance were also evaluated. Mixed-effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the 2 active dose groups'' results (P > .7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo versus low-dose, 2.9 for placebo versus medium-dose, and 25 for medium- versus low-dose. As these NNTs are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well tolerated, and neuropsychological effects were of limited duration and readily reversible within 1 to 2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. Perspective: The analgesia obtained from a low dose of delta-9-tetrahydrocannabinol (1.29%) in patients, most of whom were experiencing neuropathic pain despite conventional treatments, is a clinically significant outcome. In general, the effect sizes on cognitive testing were consistent with this minimal dose. As a result, one might not anticipate a significant impact on daily functioning. [Copyright &y& Elsevier]

The article presents a study that was conducted to determine the impact of cognition in Alzheimer disease and related disorders. The study included 280 patients who received 1,514 assessments using the functional assessment staging test procedure (FAST) and the Mild Cognitive Impairment (MCI) Screen. It informs that latent parameters were used to transform ordinal FAST measure into a continuous measure.

Abstract: Cognitive dysfunction affects 40–65% of multiple sclerosis (MS) patients. To date, conventional paper and pencil neuropsychological testing has been the method of choice for detecting deficits. However, the expense and lack of access to these tests make it difficult for many patients to obtain an assessment. With the introduction of computerized cognitive testing, certain barriers to assessment can be reduced. This paper critically reviews the currently available computerized batteries, including the Automated Neuropsychology Assessment Matrix (ANAM), the Mindstreams Computerized Cognitive Battery (MCCB), the Amsterdam Neuropsychological Tasks (ANT), the Cognitive Stability Index (CSI), and the Cognitive Drug Research (CDR) battery. Recent developments in this field show promise, although further research is required before this approach can be more widely implemented. [Copyright &y& Elsevier]

Abstract: Background: This study was designed to assess changes in brain volume and cognitive abilities in memantine-treated patients with Alzheimer’s disease (AD) by using an exploratory, single-arm, delayed-start design. Methods: Cholinesterase inhibitor-treated patients with AD (N = 47; Mini-Mental State Examination score range: 15–23) were enrolled in an observational lead-in period (weeks: 1–24), followed by an open-label period of add-on memantine treatment (weeks: 25–48). The patients underwent magnetic resonance imaging at weeks 0 (baseline), 24 (immediately before memantine initiation), and 48 (endpoint), and a battery of neuropsychological tests at weeks 0, 24, 28, 36, and 48. The primary outcome measure was the annualized rate of change (%) in total brain volume (TBV) between the two study periods. Data were analyzed using paired t-tests. Results: There were no statistically significant differences in the rates of change in TBV, ventricular volume, or left hippocampal volume between the study periods; however, the memantine treatment period was associated with a significantly slower right hippocampal atrophy (−5.5% ± 12.0% vs −10.8% ± 7.2%; P = .038). Memantine treatment was also associated with superior performances on the Boston Naming Test (P = .034) and the Trail Making Test, Part B (P = .001), but also with a higher number of errors (i.e., repetitions and intrusions) on the California Verbal Learning Test. Memantine was found to be safe and well tolerated. Conclusions: In this study, no difference in the rates of TBV change between the two periods was observed; however, memantine treatment was found to be associated with slowing of right hippocampal atrophy, and with improvement on one test of executive functioning as well as a test of confrontation naming ability. Trials using structural magnetic resonance imaging and a delayed-start design may be a feasible option for the assessment of treatments for AD. [Copyright &y& Elsevier]

Objective: To determine whether early adult cognitive ability is a risk factor for depressive symptoms in midlife and how genetic and environmental influences explain the association and to examine cross-sectional relationships between depressive symptoms and specific cognitive abilities at midlife. Design: A 35-year longitudinal and cross-sectional twin study of cognitive aging. Setting: Large multicenter study in the United States. Participants: One thousand two hundred thirty-seven male twins aged 51 to 60years. Measurements: At the age of 20years and midlife, participants completed the same version of a general cognitive ability test (Armed Forces Qualification Test [AFQT]). Midlife testing included an extensive neurocognitiveprotocol assessing processing speed, verbal memory, visual-spatial memory, working memory, executive function, and visual-spatial ability. Participants completed the Center for Epidemiologic Studies Depression Scale before cognitive testing and provided health and life style information during a medical history interview. Results: Lower age 20 AFQT scores predicted higher levels of depressive symptoms at age 55 years (r = -0.16,p <0.001). In bivariate twin modeling, 77% of the correlation between early cognitive ability and midlife depressive symptoms was due to shared genetic influences. Controlling for current age, age 20 AFQT, and nonindependence of observations, depressive symptoms were associated with worse midlife AFQT scores and poorer performance in all cognitive domains except verbal memory. Conclusion: Results suggest that low cognitive ability is a risk factor for depressive symptoms; this association is partly due to shared genetic influences. Crosssectional analyses indicate that the association between depressive symptoms and performance is not linked to specific cognitive domains. [ABSTRACT FROM AUTHOR]

Abstract: Amnestic mild cognitive impairment (MCI) might be more likely to progress to Alzheimer’s disease than single non-memory MCI and multiple domain MCI. After excluding those who did not conform to the inclusion criteria of amnestic MCI or healthy controls, a neuropsychologic battery that included the Mini-Mental State Examination, Clinical Dementia Rating, Chinese version of the Montreal Cognitive Assessment, Instrumental Activities of Daily Living scale and Auditory Verbal Learning Test was performed on 150 amnestic MCI and 150 normal control patients. The Chinese version of the Montreal Cognitive Assessment was measured for its test–retest reliability, sensitivity and specificity. Blood was collected for apolipoprotein E (APOE) genotyping. Compared with the control group, the amnestic MCI group performed significantly worse on all neuropsychological tests, and non-APOE-ε4 carriers in the amnestic MCI group performed better than APOE-ε4 carriers in the amnestic MCI group. The set of neuropsychological tests in our study could distinguish amnestic MCI participants from normal elderly participants accurately. APOE did have a role in amnestic MCI patients, but the magnitude and mechanism of its influence are not fully understood. [Copyright &y& Elsevier]

The article focuses on the subacute symptoms of sports-related brain concussion. Concussion is defined as a complex pathophysiologic process induced by traumatic biomechanical forces that affect that brain. Concerns over return to play among athletes who suffered concussion are considered. The evaluation of athletes with persistent postconcussive symptoms is explained. The article also discusses the management of concussive symptoms.

Abstract: Background: Subjective cognitive impairment (SCI) in older persons without manifest symptomatology is a common condition with a largely unclear prognosis. We hypothesized that (1) examining outcome for a sufficient period by using conversion to mild cognitive impairment (MCI) or dementia would clarify SCI prognosis, and (2) with the aforementioned procedures, the prognosis of SCI subjects would differ significantly from that of demographically matched healthy subjects, free of SCI, termed no cognitive impairment (NCI) subjects. Methods: A consecutive series of healthy subjects, aged ≥40 years, presenting with NCI or SCI to a brain aging and dementia research center during a 14-year interval, were studied and followed up during an 18-year observation window. The study population (60 NCI, 200 SCI, 60% female) had a mean age of 67.2 ± 9.1 years, was well-educated (mean, 15.5 ± 2.7 years), and cognitively normal (Mini-Mental State Examination, 29.1 ± 1.2). Results: A total of 213 subjects (81.9% of the study population) were followed up. Follow-up occurred during a mean period of 6.8 ± 3.4 years, and subjects had a mean of 2.9 ± 1.6 follow-up visits. Seven NCI (14.9%) and 90 SCI (54.2%) subjects declined (P < .0001). Of NCI decliners, five declined to MCI and two to probable Alzheimer''s disease. Of SCI decliners, 71 declined to MCI and 19 to dementia diagnoses. Controlling for baseline demographic variables and follow-up time, Weibull proportional hazards model revealed increased decline in SCI subjects (hazard ratio, 4.5; 95% confidence interval, 1.9–10.3), whereas the accelerated failure time model analysis with an underlying Weibull survival function showed that SCI subjects declined more rapidly, at 60% of the rate of NCI subjects (95% confidence interval, 0.45–0.80). Furthermore, mean time to decline was 3.5 years longer for NCI than for SCI subjects (P = .0003). Conclusions: These results indicate that SCI in subjects with normal cognition is a harbinger of further decline in most subjects during a 7-year mean follow-up interval. Relevance for community populations should be investigated, and prevention studies in this at-risk population should be explored. [Copyright &y& Elsevier]

Background: Cognitive deficits are present in several neuropsychiatric disorders, including Alzheimer disease, schizophrenia, and depression. Assessments used to measure cognition in these disorders are time-consuming, burdensome, and have low ecological validity. To address these limitations, we developed a novel virtual reality shopping task-VStore.Objective: This study aims to establish the construct validity of VStore in relation to the established computerized cognitive battery, Cogstate, and explore its sensitivity to age-related cognitive decline.Methods: A total of 142 healthy volunteers aged 20-79 years participated in the study. The main VStore outcomes included verbal recall of 12 grocery items, time to collect items, time to select items on a self-checkout machine, time to make the payment, time to order coffee, and total completion time. Construct validity was examined through a series of backward elimination regression models to establish which Cogstate tasks, measuring attention, processing speed, verbal and visual learning, working memory, executive function, and paired associate learning, in addition to age and technological familiarity, best predicted VStore performance. In addition, 2 ridge regression and 2 logistic regression models supplemented with receiver operating characteristic curves were built, with VStore outcomes in the first model and Cogstate outcomes in the second model entered as predictors of age and age cohorts, respectively.Results: Overall VStore performance, as indexed by the total time spent completing the task, was best explained by Cogstate tasks measuring attention, working memory, paired associate learning, and age and technological familiarity, accounting for 47% of the variance. In addition, with λ=5.16, the ridge regression model selected 5 parameters for VStore when predicting age (mean squared error 185.80, SE 19.34), and with λ=9.49 for Cogstate, the model selected all 8 tasks (mean squared error 226.80, SE 23.48). Finally, VStore was found to be highly sensitive (87%) and specific (91.7%) to age cohorts, with 94.6% of the area under the receiver operating characteristic curve.Conclusions: Our findings suggest that VStore is a promising assessment that engages standard cognitive domains and is sensitive to age-related cognitive decline. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To evaluate the metabolic changes both in grey and white matter in Lafora disease using proton magnetic resonance spectroscopy and to determine the possible correlation with the pattern of cognitive impairment. Methods: Five patients with Lafora disease and six healthy controls were included in the study. Patients underwent at the same time-point neuropsychological testing and 1[H]MRS, using PRESS sequences (TE=136 and 25ms) positioned in the frontal and posterior cingulate gyrus cortexes and in the adjacent frontal and parietal white matter. Results: Neuropsychological testing showed in all patients a prevalent involvement of performance abilities—with partial sparing of verbal competences—and of executive functions, suggesting a major involvement of frontal areas. Analysis of 1[H]MRS showed a statistically significant reduction in NAA/mI and NAA/Cr in grey matter of patients compared to controls, more significant in frontal regions. In white matter, a significant reduction of NAA/mI ratio was observed both in the frontal and parietal regions, associated with a reduction of the NAA/Cr only in the frontal white matter. NAA/mI was found to be the most statistically significant altered parameter in all regions studied and the only significantly altered ratio in strong correlation with all sets of neuropsychological parameters. Conclusions: Our study confirmed the predominant metabolic damage in the frontal cortex, also demonstrating NAA/mI ratio to be the most sensitive parameter to detect metabolic brain changes in Lafora disease; moreover, it evidenced frontal white matter spectroscopic changes. Both spectroscopy values and clinical features of cognitive impairment showed a prevalent frontal impairment. [Copyright &y& Elsevier]

Abstract: The Food and Drug Administration (FDA), Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institute for Drug Abuse (NIDA) report that no sound scientific studies support the medicinal use of cannabis. Despite this lack of scientific validation, many patients routinely use ”medical marijuana,” and in many cases this use is for pain related to nerve injury. We conducted a double-blinded, placebo-controlled, crossover study evaluating the analgesic efficacy of smoking cannabis for neuropathic pain. Thirty-eight patients with central and peripheral neuropathic pain underwent a standardized procedure for smoking either high-dose (7%), low-dose (3.5%), or placebo cannabis. In addition to the primary outcome of pain intensity, secondary outcome measures included evoked pain using heat-pain threshold, sensitivity to light touch, psychoactive side effects, and neuropsychological performance. A mixed linear model demonstrated an analgesic response to smoking cannabis. No effect on evoked pain was seen. Psychoactive effects were minimal and well-tolerated, with some acute cognitive effects, particularly with memory, at higher doses. Perspective: This study adds to a growing body of evidence that cannabis may be effective at ameliorating neuropathic pain, and may be an alternative for patients who do not respond to, or cannot tolerate, other drugs. However, the use of marijuana as medicine may be limited by its method of administration (smoking) and modest acute cognitive effects, particularly at higher doses. [Copyright &y& Elsevier]

Abstract: Background: Early detection and diagnosis are critical to dementia care. However, many early cases remain undiagnosed as a result of the impracticality of neuropsychological testing, particularly in primary care. Mindstreams is an office-based computerized system for measuring cognitive function in multiple domains, with demonstrated validity, test-retest reliability, and sensitivity to treatment effects. This study evaluated its feasibility for assessment of the elderly. Methods: Usability data were collected after each of 2,888 consecutive initial-visit testing sessions at the first 11 clinical centers to use Mindstreams. The χ2 goodness-of-fit test was employed to determine whether patients and supervisors more often rated tests easy versus hard to use. Separate analyses were run for non–computer users, patients older than 75 years, and poor performers (≤1 standard deviation on overall battery performance). Results: For all patients (n = 2,888; age, 64.7 ± 18.2 years), 83% rated the tests easy to use (P < .001). Seventy-three percent of non–computer users, 70% of patients older than 75, and 69% of poor performers rated them easy to use (Ps < .001). Supervisor ratings and ease of understandability ratings were similar. For all patients, 76% of supervisor ratings indicated no patient frustration (P < .001). Seventy-eight percent of ratings for non–computer users, 76% for patients older than 75, and 74% for poor performers indicated no frustration (Ps < .001). Conclusions: Mindstreams was easily employed, including in patients with considerable cognitive impairment, supporting its practicality for in-office cognitive assessment of the elderly. The availability of such valid and practical assessment suggests the feasibility of integrating the technology within a clinical algorithm for improved detection of cognitive decline. [Copyright &y& Elsevier]

Abstract: This evidence-based review examines the utility of brief cognitive tests and neuropsychological testing (NPT) in the detection and diagnosis of mild cognitive impairment (MCI) and dementia. All patients presenting with cognitive complaints are recommended to have a brief screening test administered to document the presence and severity of memory/cognitive deficits. There is fair evidence to support the use of a range of new screening tests that can detect MCI and mild dementia with higher sensitivity (≥80%) than the Mini-Mental State Exam (MMSE). NPT should be part of a clinically integrative approach to the diagnosis and differential diagnosis of dementia. It should be applied selectively to address specific clinical and diagnostic issues including: 1) The distinction between normal cognitive functioning in the aged, MCI and early dementia: there is fair evidence that NPT can document the presence of specific diagnostic criteria and provide additional useful information on the pattern of memory/cognitive impairment. 2) The evaluation of risk for Alzheimer disease (AD) or other types of dementia in persons with MCI: there is fair evidence that NPT measures or profiles can predict progression to dementia (predictive accuracy ranges from ∼80 to 100%, sensitivities from 53 to 80%, and specificities from 67 to 99%). 3) Differential diagnosis: There is fair evidence that NPT can complement clinical history and neuroimaging in determining the dementia etiology. Different dementia types have distinguishable NPT profiles though these may be stage-dependent, and increased sensitivity may be at the expense of specificity. 4) When NPT is part of a comprehensive assessment, which also entails clinical interviews and consideration of other clinical data, there is good evidence that it can contribute to management decisions in MCI and dementia, including the determination of retained and impaired cognitive abilities, their functional and vocational impact, and opportunities for cognitive rehabilitation. [Copyright &y& Elsevier]

This article will critically examine the relevance of neuropsychological testing in forensic settings, particularly whether neuropsychologists can make accurate predictions as to whether an individual who has sustained a closed head injury can return to work, attend school, maintain competitive employment, or live independently solely based on their neuropsychological test data. It will also discuss some of the problems that neuropsychologists face when evaluating individuals who had sustained damage to the prefrontal cortex of the brain, and the importance of the ecological validity of the neuropsychological tests that are routinely administered by neuropsychologists. [ABSTRACT FROM AUTHOR]

The article presents a case study of globular glial tauopathy (GGT) in an 80-year-old man with Alzheimer-type dementia. The patient underwent gallyas silver staining, which highlighted glial inclusions in the section of frontal cortex. It discusses the clinical and neuropathologic outcomes in a patient with a tauopathy described by the presence of globular oligodendroglial inclusions in the white matter, in which manifestaions were most compatible with Alzheimer's disease (AD).

Abstract: With increased public awareness of Alzheimer''s disease (AD), the licensing of four anti-dementia drugs, and the recent National Institute for Clinical Excellence (2001) guidelines for the use of these drugs, there is renewed debate among primary and secondary care practitioners on the usefulness of memory clinics. Many clinics were criticized in the past as simply being recruiting grounds for drug trials. However, in recent years the emphasis has shifted more to early diagnosis and treatment. Proponents cite long-term benefits for patients and carers and high levels of satisfaction from GPs. Detractors point to high unit cost and poor follow-up. Using published evidence this contribution reviews the processes of referral, assessment, investigation and management in current clinics. The outcomes for patients are discussed, as well as the place of memory clinics in health services of the 21st century. [Copyright &y& Elsevier]

Objective: To determine the change in neurocognitive test performance in children with primary hypertension after initiation of antihypertensive therapy.Study Design: Subjects with hypertension and normotensive control subjects had neurocognitive testing at baseline and again after 1 year, during which time the subjects with hypertension received antihypertensive therapy. Subjects completed tests of general intelligence, attention, memory, executive function, and processing speed, and parents completed rating scales of executive function.Results: Fifty-five subjects with hypertension and 66 normotensive control subjects underwent both baseline and 1-year assessments. Overall, the blood pressure (BP) of subjects with hypertension improved (24-hour systolic BP load: mean baseline vs 1 year, 58% vs 38%, P < .001). Primary multivariable analyses showed that the hypertension group improved in scores of subtests of the Rey Auditory Verbal Learning Test, Grooved Pegboard, and Delis-Kaplan Executive Function System Tower Test (P < .05). However, the control group also improved in the same measures with similar effects sizes. Secondary analyses by effectiveness of antihypertensive therapy showed that subjects with persistent ambulatory hypertension at 1 year (n = 17) did not improve in subtests of Rey Auditory Verbal Learning Test and had limited improvement in Grooved Pegboard.Conclusions: Overall, children with hypertension did not improve in neurocognitive test performance after 1 year of antihypertensive therapy, beyond that also seen in normotensive controls, suggesting improvements with age or practice effects because of repeated neurocognitive testing. However, the degree to which antihypertensive therapy improves BP may affect its impact upon neurocognitive function. [ABSTRACT FROM AUTHOR]

Objective: To compare neurocognitive test performance of children with primary hypertension with that of normotensive controls.Study Design: Seventy-five children (10-18 years of age) with newly diagnosed, untreated hypertension and 75 frequency-matched normotensive controls had baseline neurocognitive testing as part of a prospective multicenter study of cognition in primary hypertension. Subjects completed tests of general intelligence, attention, memory, executive function, and processing speed. Parents completed rating scales of executive function and the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ-SRBD).Results: Hypertension and control groups did not differ significantly in age, sex, maternal education, income, race, ethnicity, obesity, anxiety, depression, cholesterol, glucose, insulin, and C-reactive protein. Subjects with hypertension had greater PSQ-SRBD scores (P = .04) and triglycerides (P = .037). Multivariate analyses showed that hypertension was independently associated with worse performance on the Rey Auditory Verbal Learning Test (List A Trial 1, P = .034; List A Total, P = .009; Short delay recall, P = .013), CogState Groton Maze Learning Test delayed recall (P = .002), Grooved Pegboard dominant hand (P = .045), and Wechsler Abbreviated Scales of Intelligence Vocabulary (P = .016). Results indicated a significant interaction between disordered sleep (PSQ-SRBD score) and hypertension on ratings of executive function (P = .04), such that hypertension heightened the association between increased disordered sleep and worse executive function.Conclusions: Youth with primary hypertension demonstrated significantly lower performance on neurocognitive testing compared with normotensive controls, in particular, on measures of memory, attention, and executive functions. [ABSTRACT FROM AUTHOR]

Objective: We investigated effects of 3 weekly courses of fetal betamethasone (βM) on motivation and cognition in juvenile baboon offspring utilizing the Cambridge Neuropsychological Test Automated Battery. Study Design: Pregnant baboons (Papio species) received 2 injections of saline control or 175 μg/kg βM 24 hours apart at 0.6, 0.65, and 0.7 gestation. Offspring (saline control female, n = 7 and saline control male, n = 6; βM female [FβM], n = 7 and βM male [MβM], n = 5) were studied at 2.6-3.2 years with a progressive ratio test for motivation, simple discriminations and reversals for associative learning and rule change plasticity, and an intra/extradimensional set-shifting test for attention allocation. Results: βM exposure decreased motivation in both sexes. In intra/extradimensional testing, FβM made more errors in the simple discrimination reversal (mean difference of errors [FβM – MβM] = 20.2 ± 9.9; P ≤ .05), compound discrimination (mean difference of errors = 36.3 ± 17.4; P ≤ .05), and compound reversal (mean difference of errors = 58 ± 23.6; P < .05) stages as compared to the MβM offspring. Conclusion: This central nervous system developmental programming adds growing concerns of long-term effects of repeated fetal synthetic glucocorticoid exposure. In summary, behavioral effects observed show sex-specific differences in resilience to multiple fetal βM exposures. [Copyright &y& Elsevier]