INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Shubert Complex (Posters 1-60) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #7 Rate of Subjective Cognitive Concerns in Former American Football Players: Associations with Informant Reports and Demographic, Genetic, and Neurobehavioral Status Jennifer Adler, VA San Diego Healthcare System, San Diego, United States Monica Ly, VA San Diego Healthcare System, San Diego, United States Euky Yhang, Department of Biostatistics, Boston University School of Public Health, Boston, United States Yorghos Tripodis, Department of Biostatistics, Boston University School of Public Health, Boston, United States Charles Adler, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, United States Laura Balcer, Department of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, United States Charles Bernick, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, United States Sarah Banks, Department of Psychiatry, University of California San Diego Health, San Diego, United States William Barr, Department of Neurology, NYU Grossman School of Medicine, New York, United States Jennifer Wethe, Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Scottsdale, United States Mark Bondi, VA San Diego Healthcare System, San Diego, United States Lisa Delano-Wood, Department of Psychiatry, University of California San Diego Health, La Jolla, United States Robert Cantu, Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, United States David Dodick, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, United States Michael McClean, Department of Environmental Health, Boston University School of Public Health, Boston, United States Jesse Mez, Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, United States Joseph Palmisano, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, United States Brett Martin, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, United States Jeffrey Cummings, Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, United States Martha Shenton, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, United States Eric Reiman, Banner Alzheimer’s Institute, Phoenix, United States Robert Stern, Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, United States Michael Alosco, Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, United States Category: Concussion/Mild TBI (Adult) Keyword 1: cognitive functioning Keyword 2: sports-related neuropsychology Keyword 3: self-report Objective: Subjective cognitive concerns (SCC) can be an early indicator of Alzheimer’s disease (AD) and other neurodegerative disorders. However, SCC can have biological and non-biological associations. Former elite football players frequently report cognitive and neurobehavioral symptoms that may relate to incipient chronic traumatic encephalopathy or related dementias. Given that rates of SCC and its associated correlates in this population are poorly understood, we characterized SCC in former elite football players, including frequency of reported concerns, risk factors, informant report concordance, and associations with objective neuropsychological test performance. Participants and Methods: 180 former American football players (mean age=57.2, 34% Black, 29% APOE-e4 carrier) completed neuropsychological testing and SCC measures, including the AD8 (cutoff: >2), 12 memory items of the Cognitive Change Index (CCI; cutoff: >20), and the BRIEF-A Metacognition Index (BRIEF-MI; cutoff: T>65). Informants completed versions of the AD8 and BRIEF-MI. Difference scores were calculated using continuous SCC measures (informant minus participant report). Logistic regressions tested whether demographic variables (age, race, education), APOE-e4 allele status, and neuropsychiatric symptoms (Beck Depression Inventory-II [BDI-II], Beck Anxiety Inventory [BAI], Post-traumatic Stress Disorder Checklist [PCL-5], pain (subjective 0-10 rating scale), Barratt Impulsiveness Scale-11 [BIS-11], Alcohol Use Disorders Identification Test [AUDIT], and Epworth Sleepiness Scale [ESS]) predicted SCC (yes/no based on cutoffs above). Linear regressions tested whether SCC (yes/no) predicted neuropsychological factor scores (verbal memory, visual memory, executive functioning/processing speed). Multiple comparisons were corrected using the false discovery rate method. Results: High SCC rates across the sample: 68% (n=123) reported AD8 scores consistent with global cognitive impairment, 77% (n=138) endorsed CCI scores consistent with memory impairment, and 43% (n=77) reported BRIEF-MI scores consistent with clinically meaningful executive dysfunction. Participant and informant scores were generally concordant such that 60% had AD8 scores within one point and 58% BRIEF-MI scores within 1 SD. However, on average, study partners endorsed higher AD8 (mean difference=0.36, p=.02) but lower BRIEF-MI scores (mean difference=-2.27, p=.03). Higher self-reported SCC relative to informant report correlated with BDI-II scores (AD8: r=-0.15, p=.04; BRIEF-MI: r=-0.22, p=.005). Younger age and fewer years of education were associated with higher AD8 and CCI scores (p’s<.05). Adjusting for demographic characteristics, higher BDI-II, BAI, PCL-5, BIS-11, ESS, and pain scores predicted all three measures of SCC (all q’s<.05). Higher AD8, CCI, and BRIEF-MI scores were associated with lower executive functioning; higher CCI and BRIEF-MI scores were associated with lower verbal memory; and higher AD8 scores were associated with lower visual memory (all q’s<.05). However, no neuropsychological associations were found for any SCC measure after adjusting for BDI-II scores. Conclusions: SCC is common in former American football players, generally aligns with informant reports, and corresponds to objective neuropsychological test performance. However, neuropsychiatric symptoms—especially symptoms of depression—are strong correlates of SCC and account for associations between SCC and objective cognitive performance. Findings underscore that retired athletes with SCC would benefit from treatment of psychiatric symptoms, pain, and sleep difficulties. Future research should explore how SCC in the context of repetitive head impact exposure may differ from other at-risk populations such as preclinical AD.

Poster

02/15/2024
09:30 am - 10:40 am
Room: Shubert Complex (Posters 1-60)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #7

Rate of Subjective Cognitive Concerns in Former American Football Players: Associations with Informant Reports and Demographic, Genetic, and Neurobehavioral Status

Jennifer Adler, VA San Diego Healthcare System, San Diego, United States
Monica Ly, VA San Diego Healthcare System, San Diego, United States
Euky Yhang, Department of Biostatistics, Boston University School of Public Health, Boston, United States
Yorghos Tripodis, Department of Biostatistics, Boston University School of Public Health, Boston, United States
Charles Adler, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, United States
Laura Balcer, Department of Neurology, Population Health and Ophthalmology, NYU Grossman School of Medicine, New York, United States
Charles Bernick, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, United States
Sarah Banks, Department of Psychiatry, University of California San Diego Health, San Diego, United States
William Barr, Department of Neurology, NYU Grossman School of Medicine, New York, United States
Jennifer Wethe, Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Scottsdale, United States
Mark Bondi, VA San Diego Healthcare System, San Diego, United States
Lisa Delano-Wood, Department of Psychiatry, University of California San Diego Health, La Jolla, United States
Robert Cantu, Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, United States
David Dodick, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, United States
Michael McClean, Department of Environmental Health, Boston University School of Public Health, Boston, United States
Jesse Mez, Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, United States
Joseph Palmisano, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, United States
Brett Martin, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, United States
Jeffrey Cummings, Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, United States
Martha Shenton, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Boston, United States
Eric Reiman, Banner Alzheimer’s Institute, Phoenix, United States
Robert Stern, Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, United States
Michael Alosco, Boston University Alzheimer’s Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, United States

Category: Concussion/Mild TBI (Adult)

Keyword 1: cognitive functioning
Keyword 2: sports-related neuropsychology
Keyword 3: self-report

Objective:

Subjective cognitive concerns (SCC) can be an early indicator of Alzheimer’s disease (AD) and other neurodegerative disorders. However, SCC can have biological and non-biological associations. Former elite football players frequently report cognitive and neurobehavioral symptoms that may relate to incipient chronic traumatic encephalopathy or related dementias. Given that rates of SCC and its associated correlates in this population are poorly understood, we characterized SCC in former elite football players, including frequency of reported concerns, risk factors, informant report concordance, and associations with objective neuropsychological test performance.

Participants and Methods:

180 former American football players (mean age=57.2, 34% Black, 29% APOE-e4 carrier) completed neuropsychological testing and SCC measures, including the AD8 (cutoff: >2), 12 memory items of the Cognitive Change Index (CCI; cutoff: >20), and the BRIEF-A Metacognition Index (BRIEF-MI; cutoff: T>65). Informants completed versions of the AD8 and BRIEF-MI. Difference scores were calculated using continuous SCC measures (informant minus participant report). Logistic regressions tested whether demographic variables (age, race, education), APOE-e4 allele status, and neuropsychiatric symptoms (Beck Depression Inventory-II [BDI-II], Beck Anxiety Inventory [BAI], Post-traumatic Stress Disorder Checklist [PCL-5], pain (subjective 0-10 rating scale), Barratt Impulsiveness Scale-11 [BIS-11], Alcohol Use Disorders Identification Test [AUDIT], and Epworth Sleepiness Scale [ESS]) predicted SCC (yes/no based on cutoffs above). Linear regressions tested whether SCC (yes/no) predicted neuropsychological factor scores (verbal memory, visual memory, executive functioning/processing speed). Multiple comparisons were corrected using the false discovery rate method.

Results:

High SCC rates across the sample: 68% (n=123) reported AD8 scores consistent with global cognitive impairment, 77% (n=138) endorsed CCI scores consistent with memory impairment, and 43% (n=77) reported BRIEF-MI scores consistent with clinically meaningful executive dysfunction. Participant and informant scores were generally concordant such that 60% had AD8 scores within one point and 58% BRIEF-MI scores within 1 SD. However, on average, study partners endorsed higher AD8 (mean difference=0.36, p=.02) but lower BRIEF-MI scores (mean difference=-2.27, p=.03). Higher self-reported SCC relative to informant report correlated with BDI-II scores (AD8: r=-0.15, p=.04; BRIEF-MI: r=-0.22, p=.005). Younger age and fewer years of education were associated with higher AD8 and CCI scores (p’s<.05). Adjusting for demographic characteristics, higher BDI-II, BAI, PCL-5, BIS-11, ESS, and pain scores predicted all three measures of SCC (all q’s<.05). Higher AD8, CCI, and BRIEF-MI scores were associated with lower executive functioning; higher CCI and BRIEF-MI scores were associated with lower verbal memory; and higher AD8 scores were associated with lower visual memory (all q’s<.05). However, no neuropsychological associations were found for any SCC measure after adjusting for BDI-II scores.

Conclusions:

SCC is common in former American football players, generally aligns with informant reports, and corresponds to objective neuropsychological test performance. However, neuropsychiatric symptoms—especially symptoms of depression—are strong correlates of SCC and account for associations between SCC and objective cognitive performance. Findings underscore that retired athletes with SCC would benefit from treatment of psychiatric symptoms, pain, and sleep difficulties. Future research should explore how SCC in the context of repetitive head impact exposure may differ from other at-risk populations such as preclinical AD.