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This study investigated how proactive and reactive cognitive control processing in the brain was associated with habitual sleep health. BOLD fMRI data was acquired from 81 healthy adults with normal sleep (41 females, age 20.96 - 39.58 years) during a test of cognitive control (Not-X CPT). Sleep health was assessed in the week before MRI scanning, using both objective (actigraphy) and self-report measures. Multiple measures indicating poorer sleep health - including later/more variable sleep timing, later chronotype preference, more insomnia symptoms and lower sleep efficiency - were associated with stronger and more widespread BOLD activations in fronto-parietal and subcortical brain regions during cognitive control processing (adjusted for age, sex, education, and fMRI task performance). Most associations were found forreactivecognitive control activation, indicating that poorer sleep health is linked to a ‘hyper-reactive’ brain state. Analysis of time-on-task effects showed that, with longer time on task, poorer sleep health was predominantly associated with increasedproactivecognitive control activation, indicating recruitment of additional neural resources over time. Finally, shorter objective sleep duration was associated with lower BOLD activation with time on task and poorer task performance. In conclusion, even in ‘normal sleepers’, relatively poorer sleep health is associated with altered cognitive control processing, possibly reflecting compensatory mechanisms and / or inefficient neural processing.

Objective To describe personal factors in patients with mild traumatic brain injury (MTBI) and 2 control groups and to explore how such factors were associated with postconcussion symptoms (PCSs). Design Prospective cohort study. Setting Level 1 trauma center and outpatient clinic. Participants Participants (N=541) included patients with MTBI (n=378), trauma controls (n=82), and community controls (n=81). Main Outcome Measures Data on preinjury health and work status, personality, resilience, attention deficit/hyperactivity, and substance use. Computed tomography (CT) findings and posttraumatic amnesia were recorded. Symptoms were assessed at 3 months with the British Columbia Postconcussion Symptom Inventory and labeled as PCS+ if ≥3 symptoms were reported or the total score was ≥13. Predictive models were fitted with penalized logistic regression using the least absolute shrinkage and selection operator (lasso) in the MTBI group, and model fit was assessed with optimism-corrected area under the curve (AUC) of the receiver operating characteristic curve. Results There were few differences in personal factors between the MTBI group and the 2 control groups without MTBI. Rates of PCS+ were 20.8% for the MTBI group, 8.0% for trauma controls, and 1.3% for community controls. In the MTBI group, there were differences between the PCS+ and PCS− group on most personal factors and injury-related variables in univariable comparisons. In the lasso models, the optimism-corrected AUC for the full model was 0.79, 0.73 for the model only including personal factors, and 0.63 for the model only including injury variables. Working less than full time before injury, having preinjury pain and poor sleep quality, and being female were among the selected predictors, but also resilience and some personality traits contributed in the model. Intracranial abnormalities on CT were also a risk factor for PCS. Conclusions Personal factors convey important prognostic information in patients with MTBI. A vulnerable work status and preinjury health problems might indicate a need for follow-up and targeted interventions.

The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a battery of computerized neuropsychological tests commonly used in Europe in neurology and psychiatry studies, including clinical trials. The purpose of this study was to investigate test-retest reliability and to develop reliable change indices and regression-based change formulas for using the CANTAB in research and practice involving repeated measurement. A sample of 75 healthy adults completed nine CANTAB tests, assessing three domains (i.e., visual learning and memory, executive function, and visual attention) twice over a 3-month period. Wilcoxon signed-rank tests showed significant practice effects for 6 of 14 outcome measures with effect sizes ranging from negligible to medium (Hedge’s g: .15–.40; Cliff’s delta: .09–.39). The Spatial Working Memory test, Attention Switching Task, and Rapid Visual Processing test were the only tests with scores of adequate test-retest reliability. For all outcome measures, Pearson’s and Spearman’s correlation coefficients ranged from .39 to .79. The measurement error surrounding difference scores was large, thus requiring large changes in performance (i.e., 1–2 SDs) in order to interpret a change score as reliable. In the regression equations, test scores from initial testing significantly predicted retest scores for all outcome measures. Age was a significant predictor in several of the equations, while education was a significant predictor in only two of the equations. The adjusted R2 values ranged between .19 and .67. The present study provides results enabling clinicians to make probabilistic statements about change in cognitive functions based on CANTAB test performances. 2020 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4. 0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way

Objective To investigate whether cognitive reserve moderates differences in cognitive functioning between patients with mild traumatic brain injury (MTBI) and controls without MTBI and to examine whether patients with postconcussion syndrome have lower cognitive functioning than patients without postconcussion syndrome at 2 weeks and 3 months after injury. Design Trondheim MTBI follow-up study is a longitudinal controlled cohort study with cognitive assessments 2 weeks and 3 months after injury. Setting Recruitment at a level 1 trauma center and at a general practitioner-run, outpatient clinic. Participants Patients with MTBI (n=160) according to the World Health Organization criteria, trauma controls (n=71), and community controls (n=79) (N=310). Main Outcome Measures A cognitive composite score was used as outcome measure. The Vocabulary subtest was used as a proxy of cognitive reserve. Postconcussion syndrome diagnosis was assessed at 3 months with the British Columbia Postconcussion Symptom Inventory. Results Linear mixed models demonstrated that the effect of vocabulary scores on the cognitive composite scores was larger in patients with MTBI than in community controls at 2 weeks and at 3 months after injury (P=.001). Thus, group differences in the cognitive composite score varied as a function of vocabulary scores, with the biggest differences seen among participants with lower vocabulary scores. There were no significant differences in the cognitive composite score between patients with (n=29) and without (n=131) postconcussion syndrome at 2 weeks or 3 months after injury. Conclusion Cognitive reserve, but not postconcussion syndrome, was associated with cognitive outcome after MTBI. This supports the cognitive reserve hypothesis in the MTBI context and suggests that persons with low cognitive reserve are more vulnerable to reduced cognitive functioning if they sustain an MTBI. This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.

OBJECTIVE To test the hypothesis that poor sleep quality has a stronger negative effect on cognitive control function and psychological health after mild traumatic brain injury (mTBI) than after orthopedic injury. METHOD Patients with mTBI (n = 197) and trauma controls with orthopedic injuries (n = 82) were included in this prospective longitudinal study. The participants (age 16-60) completed three computerized neurocognitive tests assessing response speed and accuracy at 2 weeks and 3 months after injury, as well as questionnaires and interviews assessing sleep quality and psychological distress at 2 weeks, 3 months, and 12 months after injury. Separate Linear Mixed Models (LMMs) for each of the outcome measures (response speed, response accuracy, psychological distress) were performed. RESULTS We observed a significant interaction effect between poor sleep quality and group (mTBI vs. trauma controls) in the response speed (p = .028) and psychological distress (p = .001) models, driven by a greater negative impact of poor sleep quality on response speed and psychological distress in the mTBI group. We found no such interaction effect for response accuracy (p = .825), and poor sleep quality was associated with worse accuracy to a similar extent for both groups. CONCLUSIONS Our findings show that poor sleep quality has a more negative impact on cognitive control function and psychological outcome in patients with mTBI, compared to trauma controls. This indicates an increased vulnerability to poor sleep quality in patients who have suffered an mTBI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

IntroductionInsomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.Methods and analysisA parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.Ethics and disseminationThe study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.Trial registration numberClinicalTrials.gov Registry (NCT04621643); Pre-results.

Objective To examine the trajectories of persistent postconcussion symptoms (PPCS) after mild traumatic brain injury (MTBI) and to investigate which injury-related and personal factors are associated with symptom reporting. Design Prospective longitudinal cohort study. Follow-up at 3 and 12 months postinjury. Setting A level 1 trauma center and an emergency outpatient clinic. Participants Patients with MTBI (n=358), trauma controls (n=75), and community controls (n=78). Main outcome measures Symptoms were assessed with the British Columbia Postconcussion Symptom Inventory. Participants were categorized as having moderate to severe PPCS (msPPCS) when reporting ≥3 moderate/severe symptoms or a BC-PSI total score of ≥13. BC-PSI total scores were compared between the groups and were further used to create cut-offs for reliable change by identifying uncommon and very uncommon change in symptoms in the community control group. Associations between symptom reporting and 25 injury-related and personal factors were examined. Results The MTBI group had a similar prevalence of msPPCS at 3 and 12 months (21%), and reported more symptoms than the control groups. Analyses of individual trajectories, however, revealed considerable change in both msPPCS and BC-PSI total scores in the MTBI group, where both worsening and improvement was common. Intracranial lesions on CT were associated with a greater likelihood of improving from 3 to 12 months. Those with msPPCS at both assessments were more likely to be women and to have these personal preinjury factors: reduced employment, pain, poor sleep, low resilience, high neuroticism and pessimism, and a psychiatric history. Conclusions Group analyses suggest a stable prevalence of msPPCS the first year postinjury. However, there was considerable intra-individual change. Several personal factors were associated with maintaining symptoms throughout the first year.

In this prospective, longitudinal study, we aimed to determine the prevalence and stability of sleep-wake disturbance (SWD) and fatigue in a large representative sample of patients (Trondheim mild traumatic brain injury [mTBI] follow-up study). We included 378 patients with mTBI (age 16–60), 82 matched trauma controls with orthopedic injuries, and 83 matched community controls. Increased sleep need, poor sleep quality, excessive daytime sleepiness, and fatigue were assessed at 2 weeks, 3 months, and 12 months after injury. Mixed logistic regression models were used to evaluate clinically relevant group differences longitudinally. Prevalence of increased sleep need, poor sleep quality, and fatigue was significantly higher in patients with mTBI than in both trauma controls and community controls at all time points. More patients with mTBI reported problems with excessive daytime sleepiness compared to trauma controls, but not community controls, at all time points. Patients with complicated mTBI (intracranial findings on computed tomography or magnetic resonance imaging) had more fatigue problems compared to those with uncomplicated mTBI, at all three time points. In patients with mTBI who experienced SWDs and fatigue 2 weeks after injury, around half still had problems at 3 months and approximately one third at 12 months. Interestingly, we observed limited overlap between the different symptom measures; a large number of patients reported one specific problem with SWD or fatigue rather than several problems. In conclusion, our results provide strong evidence that mTBI contributes significantly to the development and maintenance of SWDs and fatigue.

This study investigates subacute cognitive effects of mild traumatic brain injury (MTBI) in the Trondheim Mild TBI Study, as measured, in part, by the neuropsychological test battery of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) program, including computerized tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and traditional paper-and-pencil tests. We investigated whether cognitive function was associated with injury severity: intracranial traumatic lesions on neuroimaging, witnessed loss of consciousness (LOC), or post-traumatic amnesia (PTA)1 h. Further, we explored which of the tests in the CENTER-TBI battery might be associated with the largest subacute effects of MTBI (i.e., at 2 weeks post-injury). We recruited 177 patients with MTBI (16-59 years of age) from a regional trauma center and an outpatient clinic,79 trauma control participants, and 81 community control participants. The MTBI group differed from community controls only on one traditional test of processing speed (coding

The effects of mild–moderate partial sleep deprivation on affective and cognitive functioning were evaluated in a naturalistic home environment, mimicking short sleep typically caused by demands from work or society. A total of 52 healthy individuals aged 18–35 was included in an 11-day study protocol. Participants slept at home, and sleep patterns were observed using actigraphs and sleep diaries. After maintaining habitual sleep for 7 days, the participants were asked to sleep 2 hours less than their average sleep duration for the last three nights of the study protocol. A not-X continuous performance test was administered at 9 am (± 90 minutes) on days 1, 4, 8 (habitual sleep), 9 and 11 (sleep deprivation). Performance-based measures included response accuracy and speed. Participant-reported measures included how well the participants felt they performed and how exhausted they were from taking the test, as well as positive and negative affect. There was a significant change in reaction time, number of commission errors, subjective performance, subjective exertion, and positive affect across the visits. Specifically, there was a linear decrease in reaction time, performance, and positive affect throughout the study, and a significant quadratic trend for commissions and exertion (first decreasing, then increasing after sleep deprivation). The univariate tests for omissions and negative affect were not significant. We conclude that sleeping 1.5–2 hours less than usual leads to faster response speed, but more commission errors and decreased positive affect. This indicates that individuals become more impulsive and experience less positive affect after a period of short sleep. This is an open access article distributed under the terms of the Creative Commons CC BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The aim was to investigate how neuroticism moderates the affective consequences of personalized mild-moderate partial sleep deprivation. A total of 52 healthy subjects aged 18–35 years completed the NEO PI-3 at baseline, before they completed an 11-day study protocol. After maintaining habitual sleep for seven days, the participants were asked to sleep 2 h less than their average sleep duration, the last three nights of the study protocol. Sleep patterns were observed using actigraphs and sleep diaries. The participants completed the PANAS questionnaire measuring positive and negative affect at 9 am (±90 min) at day 1, 4, 8 (habitual sleep), 9 and 11 (partial sleep deprived). We found that participants with higher scores on neuroticism experienced a decrease in negative affect following sleep deprivation. Participants with lower scores on neuroticism experienced an increase in negative affect after sleep deprivation. Positive affect was reduced following sleep deprivation, regardless of scores on neuroticism.

Objective This study examined cognitive functioning at approximately two weeks following mild traumatic brain injury (MTBI) and explored whether tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) revealed greater differences between patients with MTBI and controls than traditional neuropsychological tests. Method Patients with MTBIs (n = 177) according to the World Health Organization criteria, trauma controls with orthopedic injuries (n = 79), and community controls (n = 81) were assessed with 18 neuropsychological tests an average of 17 days post injury (SD = 3 days). The tests consisted of both traditional, well-established, paper and pencil tests (9 tests, 11 outcome measures) and tests from the CANTAB battery (9 tests, 14 outcome measures). Results Of the 25 outcome measures, the groups only differed significantly on the Coding subtest from the WAIS-IV battery (uncorrected Kruskal-Wallis test: p = 0.025), with lower performance in the MTBI group compared to the community control group (Cliff’s delta = -0.20). Effect sizes of the differences between patients with MTBI and community controls ranged from -0.16 to 0.01 on the CANTAB tests and -0.20 to 0.00 on the traditional tests. Effect sizes of the differences between patients with MTBI and trauma controls ranged from -0.13 to 0.06 on the CANTAB tests and -0.15 to 0.02 on the traditional tests. Conclusions Patients with MTBI did not have significantly lower cognitive test performance than trauma controls or community controls on a large number of tests two weeks after injury. Further, differences between patients with MTBI and controls were similar for the CANTAB battery and traditional tests.