INS NYC 2024 Program

Poster	Poster Session 05 Program Schedule 02/15/2024 02:30 pm - 03:45 pm Room: Shubert Complex (Posters 1-60) Poster Session 05: Neuropsychiatry \| Addiction/Dependence \| Stress/Coping \| Emotional/Social Processes Final Abstract #23 Patterns and Predictors of Cognitive Change over Time in Chronic Traumatic Brain Injury: Insights from a Longitudinal Telephone-Based Study Jill Del Pozzo, Icahn School of Medicine at Mount Sinai, New York, United States Belinda Yew, Icahn School of Medicine at Mount Sinai, New York, United States Lisa Spielman, Icahn School of Medicine at Mount Sinai, New York, United States Enna Selmanovic, Icahn School of Medicine at Mount Sinai, New York, United States Danielle Shpigel, San Diego VA/UCSD, San Diego, United States Kristen Dams-O'Connor, Icahn School of Medicine at Mount Sinai, New York, United States Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult) Keyword 1: traumatic brain injury Keyword 2: assessment Keyword 3: cognitive functioning Objective: Traumatic brain injury (TBI) often results in enduring cognitive deficits across multiple domains, affecting daily functioning and life quality. A subset of long-term survivors experience post-recovery cognitive decline. Early detection of cognitive decline is essential for treatment and care planning. Though neuropsychological testing is the gold standard, there is a need for broadly deployable assessment tools capable of measuring clinically meaningful fluctuations in post-TBI cognition over time. We investigated whether the Brief Test of Adult Cognition by Telephone (BTACT) can detect cognitive change in individuals living with chronic TBI, and explored factors associated with cognitive decline to identify modifiable treatment targets. Participants and Methods: Ninety individuals aged ≥40 years who sustained a complicated mild to severe TBI at least one year prior to study enrollment. Participation involved two telephone-based visits approximately one year apart. Demographic information was collected using the National Survey of Midlife Development in the United States (MIDUS-II) telephone questionnaire. TBI exposure and severity data were obtained through medical record review and the Brain Injury Screening Questionnaire (BISQ). The BTACT is a telephone-administered performance-based test of cognitive performance across six domains: episodic memory, working memory, verbal fluency, reasoning, executive functioning, and processing speed. Comorbid medical conditions, and physical and psychosocial functioning were assessed using the MIDUS-II Health Survey and self-administered questionnaire (SAQ), and National Alzheimer's Coordinating Center (NACC) Subject Health History. We calculated a Reliable Change Index (RCI) to quantify clinically meaningful change (i.e., improvement or decline) in BTACT performance. Results: At study enrollment, participants were 62(SD=11) years old, 81% White, 56% male, and 77% had at least a college education. Time since injury was 6.7(SD=7.2) years. Participants reported an average of 3.4(SD=3.2) lifetime blows to the head, and 2.2(SD=1.9) TBIs. Cognitive decline was observed in 10%-28% of participants across cognitive domains. Memory remained relatively stable, with >60% showing no change in episodic memory, immediate recall, and delayed recall. Processing speed varied considerably over time, with 28% declining and 22% improving. Factors associated with decline included number of lifetime blows to the head, male sex, dyspnea, increased depressive and anxiety symptoms, seizures, illegal drug use, and number of cardiovascular comorbidities. Notably, age was not a significant predictor of decline. Conclusions: The BTACT is a brief telephone-administered multi-domain cognitive screening tool that can be feasibly deployed for screening and surveillance. The BTACT is sensitive to detecting clinically meaningful change in domain-specific and global cognitive function over periods as brief as one year in a sample of individuals living with chronic TBI. Our finding that a subset of our sample improved while others declined is consistent with prior research indicating that cognitive function can change years after injury. We identified potentially modifiable targets for the prevention of post-TBI cognitive decline. The BTACT may be useful in surveillance and chronic disease management to facilitate early identification of decline. Telephone administration permits broad inclusion in research, including those unable to attend in-clinic study visits.

Poster

02/15/2024
02:30 pm - 03:45 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 05: Neuropsychiatry | Addiction/Dependence | Stress/Coping | Emotional/Social Processes

Final Abstract #23

Patterns and Predictors of Cognitive Change over Time in Chronic Traumatic Brain Injury: Insights from a Longitudinal Telephone-Based Study

Jill Del Pozzo, Icahn School of Medicine at Mount Sinai, New York, United States
Belinda Yew, Icahn School of Medicine at Mount Sinai, New York, United States
Lisa Spielman, Icahn School of Medicine at Mount Sinai, New York, United States
Enna Selmanovic, Icahn School of Medicine at Mount Sinai, New York, United States
Danielle Shpigel, San Diego VA/UCSD, San Diego, United States
Kristen Dams-O'Connor, Icahn School of Medicine at Mount Sinai, New York, United States

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult)

Keyword 1: traumatic brain injury
Keyword 2: assessment
Keyword 3: cognitive functioning

Objective:

Traumatic brain injury (TBI) often results in enduring cognitive deficits across multiple domains, affecting daily functioning and life quality. A subset of long-term survivors experience post-recovery cognitive decline. Early detection of cognitive decline is essential for treatment and care planning. Though neuropsychological testing is the gold standard, there is a need for broadly deployable assessment tools capable of measuring clinically meaningful fluctuations in post-TBI cognition over time. We investigated whether the Brief Test of Adult Cognition by Telephone (BTACT) can detect cognitive change in individuals living with chronic TBI, and explored factors associated with cognitive decline to identify modifiable treatment targets.

Participants and Methods:

Ninety individuals aged ≥40 years who sustained a complicated mild to severe TBI at least one year prior to study enrollment. Participation involved two telephone-based visits approximately one year apart. Demographic information was collected using the National Survey of Midlife Development in the United States (MIDUS-II) telephone questionnaire. TBI exposure and severity data were obtained through medical record review and the Brain Injury Screening Questionnaire (BISQ). The BTACT is a telephone-administered performance-based test of cognitive performance across six domains: episodic memory, working memory, verbal fluency, reasoning, executive functioning, and processing speed. Comorbid medical conditions, and physical and psychosocial functioning were assessed using the MIDUS-II Health Survey and self-administered questionnaire (SAQ), and National Alzheimer's Coordinating Center (NACC) Subject Health History. We calculated a Reliable Change Index (RCI) to quantify clinically meaningful change (i.e., improvement or decline) in BTACT performance.

Results:

At study enrollment, participants were 62(SD=11) years old, 81% White, 56% male, and 77% had at least a college education. Time since injury was 6.7(SD=7.2) years. Participants reported an average of 3.4(SD=3.2) lifetime blows to the head, and 2.2(SD=1.9) TBIs. Cognitive decline was observed in 10%-28% of participants across cognitive domains. Memory remained relatively stable, with >60% showing no change in episodic memory, immediate recall, and delayed recall. Processing speed varied considerably over time, with 28% declining and 22% improving. Factors associated with decline included number of lifetime blows to the head, male sex, dyspnea, increased depressive and anxiety symptoms, seizures, illegal drug use, and number of cardiovascular comorbidities. Notably, age was not a significant predictor of decline.

Conclusions:

The BTACT is a brief telephone-administered multi-domain cognitive screening tool that can be feasibly deployed for screening and surveillance. The BTACT is sensitive to detecting clinically meaningful change in domain-specific and global cognitive function over periods as brief as one year in a sample of individuals living with chronic TBI. Our finding that a subset of our sample improved while others declined is consistent with prior research indicating that cognitive function can change years after injury. We identified potentially modifiable targets for the prevention of post-TBI cognitive decline. The BTACT may be useful in surveillance and chronic disease management to facilitate early identification of decline. Telephone administration permits broad inclusion in research, including those unable to attend in-clinic study visits.