OBJECTIVE:Despite a growing interest in the long-term effects of concussion and repetitive head impacts (RHIs) on brain health, understanding is limited regarding the clinical and cognitive changes that may accrue during collegiate athletics. METHODS:Collegiate student-athletes enrolled in the Concussion Assessment, Research, and Education Consortium from 2014 to 2021 (N=3,663) completed baseline (at initial enrollment) and exit (at the end of college) assessments. Proxies for RHIs were estimated with sport contact classification (high exposure, low exposure, and unexposed) and total years of primary sport participation. Multivariable linear regressions were used to examine the effects of these variables and the lifetime number of concussions on change scores across somatic, postural stability, and neurocognitive measures. RESULTS:Both low- and high-exposure sport student-athletes had lower (i.e., better) symptom change scores (symptom total: β=-0.62, 95% CI=-1.01, -0.24, p=0.002 [low exposure]; β=-0.80, 95% CI=-1.20, -0.40, p<0.001 [high exposure], and symptom severity: β=-1.58, 95% CI=-2.47, -0.70, p<0.001 [low exposure]; β=-2.17, 95% CI=-3.09, -1.24, p<0.001 [high exposure]), compared with student-athletes in unexposed sports. High-exposure student-athletes had faster reaction time change scores during neurocognitive testing (β=-0.02, 95% CI=-0.03, -0.01, p=0.001). Student-athletes with one or two previous concussions had improved cognitive change scores (β=0.35, 95% CI=0.14, 0.57, p=0.001), compared with those without concussion. A greater number of total years of primary sport participation was associated with lower symptom total change scores (β=-0.06, 95% CI=-0.10, -0.02, p=0.004). CONCLUSIONS:These findings suggest that RHIs or lifetime number of concussions have no clinical consequences during university athletics. Further longitudinal investigations are warranted to evaluate brain health later in life.
OBJECTIVE:The capacity to complete financial tasks accurately and efficiently is fundamental to financial independence; however, early declines in the progression of Alzheimer's disease may contribute to personal financial loss, risk for elder abuse, and increased caregiver burden. Slower performance on measures of financial capacity may reflect early disease-related changes, foreshadowing subsequent cognitive decline. The authors investigated the relationship between the time needed to complete financial tasks and white matter tract diffusion characteristics among older individuals with or without mild cognitive impairment (MCI). METHODS:Fifteen participants with MCI and 15 healthy control participants completed diffusion MRI scans, a neuropsychological assessment, and the Financial Capacity Instrument-Short Form (FCI-SF). In analyses of data adjusted for demographic characteristics, Geriatric Depression Scale scores, and FCI-SF total score, the authors used diffusion tensor imaging to investigate correlations between the time needed to complete financial tasks and diffusion characteristics of white matter tracts terminating in the angular and fusiform gyri. RESULTS:FCI-SF completion times were significantly prolonged among participants with MCI compared with healthy control participants. The two groups did not significantly differ in diffusion metrics across the selected white matter tracts. FCI-SF total completion time was significantly correlated with multiple diffusion metrics in the arcuate, vertical occipital, and inferior longitudinal fasciculi of individuals with MCI. CONCLUSIONS:Completion time measures of the FCI-SF may reflect early disease-related changes in white matter tracts implicated in reading and arithmetic performance.
Klüver-Bucy syndrome (KBS) is a neuropsychiatric condition characterized by hypersexuality, hyperorality, hyperphagia, visual agnosia, hypermetamorphosis, and emotional changes such as placidity and loss of fear. Distinct diagnostic criteria are used to define both complete and partial KBS, but clinicians often face challenges due to symptom variability and unvalidated criteria. In this systematic review, the authors searched the PubMed, Embase, PsycNet, Latin America and the Caribbean Literature on Health Sciences, and OpenGrey literature databases from their inception to January 24, 2025, focusing on KBS case reports and series. Inclusion criteria required patients to meet at least three of the six classic KBS features (partial KBS) or all six features (complete KBS). Studies involving orbitofrontal syndrome were excluded. Data were independently extracted and summarized. In total, 141 articles describing 157 cases that met the inclusion criteria were included. Hypersexuality (84%), hyperorality (84%), and hyperphagia (73%) were most common in KBS, whereas hypermetamorphosis (52%) and visual agnosia (47%) were less frequent. Cognitive changes, such as attentional and memory disturbances, were also common. Neuroimaging showed bilateral temporal lobe lesions in 73% of KBS cases. Major KBS causes included central nervous system infections (27%), traumatic brain injuries (14%), and autoimmune conditions (12%). Most reports lacked standardized symptom assessment, risking underreporting of features such as visual agnosia and hypermetamorphosis. This review highlights variability in KBS and its neuropsychiatric features. A new diagnostic framework with defined certainty levels is proposed. Future research should validate these criteria and explore targeted therapies to improve the understanding and management of this syndrome.
OBJECTIVE:The authors evaluated changes associated with a 3-week interdisciplinary intensive outpatient program that delivers integrated neuropsychiatric rehabilitation for veterans and first responders with persistent postconcussive and co-occurring symptoms after remote traumatic brain injury. METHODS:In this retrospective cohort study, 128 patients completed patient-reported measures, including the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist for DSM-5 (PCL-5), and Life Satisfaction Questionnaire-11 (LiSat-11), and objective assessments, comprising Addenbrooke's Cognitive Examination-III (ACE-III), gait speed, computerized dynamic posturography (for conducting the Sensory Organization Test [SOT]), and Modified Clinical Test of Sensory Interaction in Balance (mCTSIB). Paired t tests were used to compare intake with discharge measures, and a linear mixed-effects model was used to examine NSI scores over time with covariate adjustment. RESULTS:The NSI total score decreased by 15.6 points (41%, Cohen's d=1.11); ACE-III scores improved by 6.8 points (Cohen's d=1.41); and forward and backward gait speeds, SOT composite scores, and mCTSIB condition 4 scores showed significant improvements (Cohen's d=0.68-0.87). The proportion of patients screening at or above a common PTSD threshold on the PCL-5 declined from 51% at intake to 20% at discharge, and higher baseline PCL-5 scores were associated with higher NSI scores across time points (p<0.001). CONCLUSIONS:These findings are consistent with multidomain benefits of intensive, interdisciplinary neuropsychiatric rehabilitation in this population. These results support the potential of integrated care models to reduce symptom burden and improve cognitive, mobility, vestibular, and life satisfaction outcomes over 3 weeks, while underscoring the close linkage between posttraumatic stress severity and neurobehavioral symptom burden.
OBJECTIVE:The relationship between hydrocephalus and comorbid psychiatric conditions among adults remains unclear. The authors characterized the prevalence of psychiatric conditions among adult patients with hydrocephalus and compared the rates of these conditions among hydrocephalus subtypes. METHODS:A retrospective study of patients ages ≥18 years from a tertiary hydrocephalus specialty center was conducted by reviewing electronic health record data. Participants (N=2,668) were required to have an ICD-10 diagnosis of hydrocephalus (G91) or congenital hydrocephalus (Q03) in their active problem list. Hierarchical logistic regression analysis was performed to compare psychiatric outcomes among hydrocephalus subtypes after analyses had been adjusted for age at the last visit, gender, and number of hydrocephalus center encounters. RESULTS:Overall, 31% of the study participants had at least one comorbid psychiatric condition, most commonly depression (15%), anxiety disorder (10%), dementia (7%), or a substance use disorder (5%). Female gender was significantly associated with depression and anxiety disorder. Older age was linked to increased odds of dementia and a history of psychiatric encounters, and younger age was associated with anxiety disorders, substance use disorders, intellectual disability, developmental disorders, and childhood-onset behavioral and emotional disorders. Congenital hydrocephalus was associated with higher odds of intellectual disability, and no significant difference in psychiatric outcomes was detected between communicating and obstructive hydrocephalus. CONCLUSIONS:Comorbid psychiatric conditions affect a substantial proportion of adult patients with hydrocephalus. Age and gender differences in psychiatric diagnoses resemble trends in the general population. These findings highlight a need to improve psychiatric screening among adult patients with hydrocephalus.
Examining risk factors for the development of dementia, a devastating condition, is of increasing importance in clinical research. Adverse childhood experiences (ACEs) represent one set of potentially modifiable dementia risk factors with known impacts on neurodevelopment and health. Refining approaches used in previous reviews, the authors of this review and meta-analysis sought to answer the question, What is the strength of the association between ACEs and dementia in later life? The authors searched PubMed, EMBASE, and Web of Science, including peer-reviewed studies involving adults exposed to ACEs and a comparison group of unexposed adults. The outcome of interest was dementia of any etiology, and study quality was assessed. Separate meta-analyses were performed with odds ratios and hazard ratios (HRs). The literature search yielded 2,032 articles, of which 13 were included for analysis. ACE exposure (OR=1.54, 95% CI=1.38-1.71, p<0.001; HR=1.51, 95% CI=1.24-1.84, p<0.001) and exposure to parental death in childhood (OR=1.42, 95% CI=1.16-1.74, p<0.001) were associated with increased odds of or risk for developing dementia, respectively. This meta-analytic review is the most extensive examination of the ACE-dementia relationship to date, and its findings suggest that several ACEs are associated with increased dementia odds and risk. Although the number of studies reviewed was small and the studies were mostly of fair quality, necessitating caution in interpretation, nearly all of their results supported the association between ACE and dementia. High-quality prospective cohort studies incorporating biomarkers to measure ACE outcomes will be essential.
OBJECTIVE:The authors conducted a systematic review and meta-analysis of clinical trials testing rehabilitation therapies for treating functional neurological disorder (FND). METHODS:The authors searched databases for clinical trials of patients with FND who received rehabilitation therapies. Some trials included a mental health intervention, but psychotherapy-only trials were excluded. Study quality was assessed by using a modified version of the NIH quality assessment tool for a before-after (pre-post) study with no control group. RESULTS:In total, 8,162 studies were screened for eligibility. Among these, 30 articles (N=1,581 participants) were included. Results of a meta-analysis of proportions revealed that 74% of the participants in FND rehabilitation trials had clinical improvement, but effect sizes varied significantly across studies. Twenty-three studies provided sufficient data to calculate pre-post rehabilitation effect sizes, which were uniformly positive for FND symptoms and physical function. Meta-analysis of seven available randomized controlled trials (RCTs) indicated a significant treatment effect on FND symptoms and that effects on physical function, fatigue, and mental health were not statistically significant. The generalizability of these findings was limited by heterogeneity across studies, attributed to differences in populations, treatment protocols, study designs, and outcome measures. CONCLUSIONS:Rehabilitation therapies are a promising approach for improving FND symptoms, and calculated estimates indicate that >70% of patients experience clinical improvement after rehabilitative treatment. However, additional high-quality RCTs are needed to clarify the overall efficacy of rehabilitation for FND and to identify which aspects of clinical improvement are most responsive to rehabilitation interventions.
OBJECTIVE:Neurological symptoms are commonly reported among individuals with postacute sequelae of COVID-19 (PASC), with cognitive impairment being the most common feature, but cognitive trajectories in PASC have not been clearly defined. The authors determined long-term cognitive changes in a cohort of individuals hospitalized with COVID-19, characterized their distinct cognitive trajectories, and identified factors associated with each trajectory at 36 months posthospitalization. METHODS:The sample comprised 630 patients who were hospitalized with severe COVID-19 symptoms; 214 patients returned for at least one follow-up assessment over a 36-month period. Cognitive function, including attention, cognitive flexibility, processing speed, and memory, was evaluated by using BrainCheck, a validated digital platform, at 3-6, 12, 24, and 36 months posthospitalization. Longitudinal changes in cognitive performance and their associations with demographic factors, medical history, and neuropsychiatric symptoms were analyzed with linear mixed-effects models. RESULTS:Four distinct cognitive trajectories over 36 months were identified and characterized. Group 1 (N=103, 48%) exhibited consistent normal cognitive function, group 2 (N=14, 7%) transitioned from unimpaired to impaired, group 3 (N=29, 14%) changed from impaired to unimpaired, and group 4 (N=68, 32%) showed persistent impairment across all domains. Poorer cognitive outcomes were associated with Hispanic ethnicity, although effects varied across domains. CONCLUSIONS:As with many viral encephalitides, some patients showed stable normal or abnormal cognition or improved cognition over time. Surprisingly, however, a fourth subset exhibited delayed cognitive decline. This observation suggests that PASC-associated mechanisms, perhaps including chronic cerebral inflammation, may cause progressive cognitive impairment well after the initial infection clears.
