COVID-19 has been considered a possible cause of post-traumatic stress disorder (PTSD) or similar conditions. However, what specific disease symptoms may contribute most to prolonged PTSD-like symptoms in COVID-19 survivors is unclear. The study aimed to present the factor structure of COVID-19 symptoms and identify which symptoms of COVID-19 best explain the subsequent presence of PTSD-like symptoms in mild COVID-19 survivors. COVID-positive adults (n = 341) completed online self-report scales at the baseline assessment (T1) and after approximately 4 months (T2), including The Patient Health Questionnaire Anxiety-Depression Scale; The Scale of Psychosocial Experience Related to COVID-19, The Primary Care PTSD Screen for DSM-5; and self-designed questionnaires evaluating the severity of COVID-related medical and neurocognitive symptoms and pre-pandemic variables. Exploratory factor analysis revealed five factors of COVID-19 symptoms: flu-like, respiratory, cold, neurological, and neurocognitive. Hierarchical logistic regression showed that besides selected control variables (anxiety and depression, presence of PTSD-like symptoms, COVID-related stigma in T1), neurocognitive symptoms of COVID-19 in T1 but not other symptoms of the disease were a significant predictor of the presence of PTSD-like symptom in T2. Findings suggest a need for a comprehensive neurocognitive assessment of people diagnosed with COVID-19 and prompt interventions targeting the prevention of potential risks for long-term PTSD-like states at the community level.

OBJECTIVE:This study aimed to estimate the occurrence of depressive symptoms in a global population of young, middle-aged and older adults amid the COVID-19 pandemic. Study data also assessed the impact of the social restrictions caused by the pandemic on depressive symptomatology. METHODS:A self-administered internet-based survey was completed by 111,225 individuals residing in 176 countries (March-April 2020). We retained: demographic data, depressive symptoms (PHQ8), anxieties specific to the COVID-19, personality traits (Big-Five Personality Questionnaire), comorbidity frequency, health quality, behavioral variables (i,e., staying at home, avoiding social gatherings, social distancing in the past week). Occurrence of depressive symptoms was estimated using standard cut-offs (total PHQ8 score ≥ 10). Hierarchical regression modeling examined correlates of depressive symptoms (PHQ8 score) in three groups stratified by age, i.e., 18-34, 35-54 and 55+ years. RESULTS:Moderate to severe depressive symptoms were present in 27% of young, 15% middle-aged and 9% older adults. Younger age, female gender, not partnered, higher anxiety, and poorer health were associated with elevated depressive symptoms. Staying at home/not attending social gatherings were minor contributors to depressive symptoms in young and middle-aged adults. These were not significant in older adults. Social distancing was a marginal contributor in middle-aged and near significant in older adults, but not significant in young adults. CONCLUSIONS:The occurrence of depressive symptoms is decreasing with advancing age. Increased risk of depressive symptoms was associated with being a younger adult, females, single/divorced, poorer health and higher anxiety. In all age groups, the presence of depressive symptoms was greater than global estimates preceding the COVID-19 pandemic. Social restrictions amid the COVID-19 pandemic were marginal risks for depressive symptoms.

ABSTRACT Objectives There is a growing demand for remote assessment options for measuring cognition after mild traumatic brain injury (mTBI). The current study evaluated the criterion validity of the Brief Test of Adult Cognition by Telephone (BTACT) in distinguishing between adults with mTBI and trauma controls (TC) who sustained injuries not involving the head or neck. Methods The BTACT was administered to the mTBI (n = 46) and TC (n = 35) groups at 1–2 weeks post-injury. Participants also completed the Rivermead Post Concussion Symptoms Questionnaire. Results The BTACT global composite score did not significantly differ between the groups (t(79) = −1.04, p = 0.30); the effect size was small (d = 0.23). In receiver operating characteristic curve analyses, the BTACT demonstrated poor accuracy in differentiating between the groups (AUC = 0.567, SE = 0.065, 95% CI [0.44, 0.69]). The BTACT’s ability to discriminate between mTBI and TCs did not improve after excluding mTBI participants (n = 15) who denied ongoing cognitive symptoms (AUC = 0.567, SE = 0.072, 95% CI [0.43, 0.71]). Conclusions The BTACT may lack sensitivity to subacute cognitive impairment attributable to mTBI (i.e., not explained by bodily pain, post-traumatic stress, and other nonspecific effects of injury).

Abstract The immense burden of depressive disorders is on the rise, with global prevalence estimates in 2017 ranging from 4% to 13%. The novel coronavirus SARS-CoV-2 is likely to impact the established risk factors for depressive disorders. Thus, a rapid increase in depression prevalence can be expected amid the COVID-19 pandemic. Using epidemiologic data (N=111,225) derived from an extant online survey “Measuring Worldwide COVID-19 Attitudes and Beliefs” (launched by Fetzer and colleagues, March-April 2020) in 178 countries, we examined age-dependent global prevalence of depression and assessed the impact of social factors caused by the COVID-19 pandemic on depressive symptomatology. Point prevalence of depression was measured using the PHQ8 standard cut-off score (i.e., ≥10). Correlates of depressive symptoms were analyzed with hierarchical regression modeling separately in three age groups, i.e., 18-34, 35-54 and 55+ years. We found that nearly 20% of individuals globally revealed significant symptoms of depression, including 27% of young, 15% middle-aged, 9% adults aged 55+. These data suggest that the prevalence of depression is 2-5 times higher than global estimates preceding the COVID-19 pandemic. Regression modeling explained approx. 50% variability in depressive symptoms across the three age groups. Increased risk of depression was found in females, single or divorced individuals, and those who presented poorer health and higher anxiety. Social restrictions amid the COVID-19 pandemic were marginal risks for depression. Together, this study highlights the impact of the COVID-19 pandemic on the mental health of people of different ages and urges the development of increased access to psychological interventions.

Purpose: Numerous studies suggest that infection with coronavirus SARS-CoV-2, which causes acute respiratory distress syndrome and COVID-19 illness, can lead to changes in the central nervous system (CNS). Consequently, some individuals with SARS-CoV-2 infection may also present the symptoms of neuropsychological disorders. The goals of this literature review is the synthesis of various perspectives and up-to-date scientific knowledge as well as the formulation of initial recommendations for clinical practice. Views: According to current state of knowledge, numerous SARS-CoV-2 infection-specific and nonspecific risk factors exist for brain damage, which might lead to neuropsychological impairments in individuals who have recovered from COVID-19. The emerging evidence suggests significant behavioral and cognitive deficits in COVID-19 survivors, which are present in the early phase after recovery and persist for several months. Neuropsychological disturbances can potentially include a wide spectrum of disorders, yet deficits of attention, memory, executive functions, language and visuospatial orientation are among most commonly identified. The relationship between cognitive impairment, emotional disturbances and severity of COVID-19 symptoms needs to be submitted to further research. Conclusions: The scientific knowledge resulting from neuropsychological empirical studies during the COVID-19 pandemic allows for a postulate of an urgent evidence-based systematic neuropsychological research to be conducted among COVID-19 survivors. More than anything, the recovered individuals must be provided with adequate neuropsychological help in the form of neuropsychological diagnosis, monitoring and rehabilitation.

OBJECTIVE:To propose a set of internationally harmonized procedures and methods for assessing neurocognitive functions, smell, taste, mental, and psychosocial health, and other factors in adults formally diagnosed with COVID-19 (confirmed as SARS-CoV-2 + WHO definition).METHODS:We formed an international and cross-disciplinary NeuroCOVID Neuropsychology Taskforce in April 2020. Seven criteria were used to guide the selection of the recommendations' methods and procedures: (i) Relevance to all COVID-19 illness stages and longitudinal study design; (ii) Standard, cross-culturally valid or widely available instruments; (iii) Coverage of both direct and indirect causes of COVID-19-associated neurological and psychiatric symptoms; (iv) Control of factors specifically pertinent to COVID-19 that may affect neuropsychological performance; (v) Flexibility of administration (telehealth, computerized, remote/online, face to face); (vi) Harmonization for facilitating international research; (vii) Ease of translation to clinical practice.RESULTS:The three proposed levels of harmonization include a screening strategy with telehealth option, a medium-size computerized assessment with an online/remote option, and a comprehensive evaluation with flexible administration. The context in which each harmonization level might be used is described. Issues of assessment timelines, guidance for home/remote assessment to support data fidelity and telehealth considerations, cross-cultural adequacy, norms, and impairment definitions are also described.CONCLUSIONS:The proposed recommendations provide rationale and methodological guidance for neuropsychological research studies and clinical assessment in adults with COVID-19. We expect that the use of the recommendations will facilitate data harmonization and global research. Research implementing the recommendations will be crucial to determine their acceptability, usability, and validity.

Abstract Advance Care Planning (ACP) makes up an integral part of the care continuum, especially for those living with chronic conditions such as HIV. Little research exists to understand how intersections of race, gender, sexuality and gender identity combine to influence the choices made by older adults living with HIV regarding ACP. The Research on Older Adults with HIV (ROAH) 2 study collected data from across the US and investigated the incidence and range of ACP amongst those 50+ living with HIV. Correlational analysis indicated that being White was significantly related to having at least one directive (R=0.070, p=0.035) where being African American correlated negatively with several forms of ACP. Additionally, there were also significant relationships between being Transgender, being gay, and being a woman as to the engagement with ACP options. Further analysis explored the impact of finance, self-rated health and social support networks.

Purpose Numerous studies suggest that infection with coronavirus SARS-CoV-2, which causes acute respiratory distress syndrome and COVID-19 illness, can lead to changes in the central nervous system (CNS). Consequently, some individuals with SARS-CoV-2 infection may also present the symptoms of neuropsychological disorders. The goals of this literature review is the synthesis of various perspectives and up-to-date scientific knowledge as well as the formulation of initial recommendations for clinical practice. Views According to current state of knowledge, numerous SARS-CoV-2 infection-specific and nonspecific risk factors exist for brain damage, which might lead to neuropsychological impairments in individuals who have recovered from COVID-19. The emerging evidence suggests significant behavioral and cognitive deficits in COVID-19 survivors, which are present in the early phase after recovery and persist for several months. Neuropsychological disturbances can potentially include a wide spectrum of disorders, yet deficits of attention, memory, executive functions, language and visuospatial orientation are among most commonly identified. The relationship between cognitive impairment, emotional disturbances and severity of COVID-19 symptoms needs to be submitted to further research. Conclusions The scientific knowledge resulting from neuropsychological empirical studies during the COVID-19 pandemic allows for a postulate of an urgent evidence-based systematic neuropsychological research to be conducted among COVID-19 survivors. More than anything, the recovered individuals must be provided with adequate neuropsychological help in the form of neuropsychological diagnosis, monitoring and rehabilitation.

Stroke survivors undergo a thorough cognitive diagnosis that often involves administration of multiple standardized tests. However, patient’s narrative discourse can provide clinicians with additional knowledge on patient’s subjective experience of illness, attitude toward current situation, and motivation for treatment. We evaluated the methods of analyzing thematic content and story types in relationship to cognitive impairment in stroke survivors with no aphasia (including 9 left hemisphere damage – LHD patients, and 16 right hemisphere damage – RHD patients). Cognitive impairment was evaluated in comparison to a group of 25 patients with orthopaedic injury not involving the brain. Our findings primarily show that higher elaboration on own cognitive problems, physical ailments or coping strategies in LHD patients and cognitive problems, emotional issues and circumstances of illness onset in RHD patients is related to deficits in executive functions and retrieval of information from memory. Furthermore, RHD patients who use more chaos story type show lower executive functioning. However, these results did not survive the significance threshold of p < 0.05 after Bonferroni adjustment for multiple comparisons. In conclusion, this study provides preliminary evidence that stroke survivor’s narrative can constitute an additional source of clinically-relevant information regarding patient’s experience of illness and attitude toward recovery. This knowledge can aid clinicians and nurses in everyday interactions with the patients and support individualized strategy to treatment. Still, the current results need be confirmed with future studies in a larger cohort of stroke patients.

Individuals in the early stages of dementia may demonstrate language difficulties. The aim of the study was an evaluation of the differences in narrative discourse abilities across two types of dementia, i.e., Vascular Dementia (VaD) and Alzheimer’s Disease (AD) in comparison to the young and old elderly. The AD and VaD groups displayed a lower performance than the age-matched YE on tasks involving reasoning. The VaD partici- pants outperformed patients with AD in verbal memory and narrative discourse. Discourse macrostructure analyses showed that the VaD reproduced more propositions than did the AD participants, but that these were comparable to YE and OE. There were more conjunctions in narratives reproduced by the VaD participants as compared to other groups, although this tendency was only present in the story but not in fairy tale reproductions themselves. Individ- uals in the AD group had more difficulties than YE and OE individuals in figuring out the moral of fairy tales. Clinical and control groups reproduced the microstructure and superstructure of texts comparatively well. Discourse recall correlated with performance on verbal memory, attention/working memory, and reasoning. Differences in narrative discourse abilities were found. Alzheimer’s Disease (AD) patients scored lower in verbal memory than did Vascular Dementia (VaD) patients. Both groups however obtained lower results than the young and old elderly.

Abstract The impact of stigmatizing attitudes and discriminatory behaviors on health disparities and inequities in non-heterosexual individuals, people of color (PoC), older adults, and persons living with HIV becomes increasingly recognized. This quartette of stigmatized characteristics elevates the risk of barriers to medical services, burden of disease and unfavorable health outcomes in LGBTQ-PoC aging with HIV. Using data from ROAH 2.0 study (N=723), we explored facets of stigma, barriers to medical services and health status in racial/ethnic minorities of older adults with HIV (OAH) living in California, New York, and Illinois. Stigma was evident in >50% of OAH who expressed reservation to self-disclose HIV status. Importantly, 20%-24% of Asian, Black/African-American, Hispanic/Latinx and Multiracial vs. 7% White OAH withheld this information from at least one health care provider. Over 10% of OAH experienced prejudice/discrimination while accessing service. Non-disclosure and prejudice/discrimination were linked to lower self-rated health status, thus, evidencing stigma-related health burden.

Resting state functional Magnetic Resonance Imaging (RS-fMRI) provides the means to measure neuronal activity. One of the most commonly used methods to explore the RS-fMRI signal is the Probabilistic Independent Component Analysis (PICA). PICA allows to depict brain functional connectivity (FC) networks. Yet most of the IC maps obtained with this method do not represent any particular FC network. Consequently, those IC maps are classified as artifacts or noise of an unknown source. We hypothesized that the unexplained RS-fMRI signal patterns that are picked up by the PICA can be related to the differences in oxygen metabolism and blood flow in cortical layers. This study aimed at (1) providing preliminary evidence to the effects of laminar organization of neocortex on the RS-fMRI signal, and (2) evaluating the application of laminar maps to aid the classification of IC maps. We created laminar maps 1-4 that depict relative cortical thickness of layers IV and VI. Our data show that the RS-fMRI signal is significantly related to the relative thickness of the cortical layer VI but not layer IV. Importantly, the laminar maps 1-4 overlap with four separate IC maps. Thus, the laminar maps 1-4 improve classification and interpretation of the IC maps. Moreover, the laminar maps 1-4 may be considered as FC networks that are the bridging piece between particular cognitive functions. Together, these data provide preliminary evidence to the fundamental questions about the role of cortical layering in the RS-fMRI signal and brain FC networks.

Objective: This systematic review aimed to synthesize early data on typology and topography of brain abnormalities in adults with COVID-19 in acute/subacute phase. Methods: We performed systematic literature search via PubMed, Google Scholar and ScienceDirect on articles published between January 1 and July 05, 2020, using the following strategy and key words: ((covid[Title/Abstract]) OR (sars-cov-2[Title/Abstract]) OR (coronavirus[Title/Abstract])) AND (brain[Title/Abstract]). A total of 286 non-duplicate matches were screened for original contributions reporting brain imaging data related to SARS-Cov-2 presentation in adults. Results: The selection criteria were met by 26 articles (including 21 case reports, and 5 cohort studies). The data analysis in a total of 361 patients revealed that brain abnormalities were noted in 124/361 (34%) reviewed cases. Neurologic symptoms were the primary reason for referral for neuroimaging across the studies. Modalities included CT (-angiogram, -perfusion, -venogram), EEG, MRI (-angiogram, functional), and PET. The most frequently reported brain abnormalities were brain white matter (WM) hyperintensities on MRI 66/124 (53% affected cases) and hypodensities on CT (additional 23% affected cases), followed by microhemorrhages, hemorrhages and infarcts, while other types were found in < 5% affected cases. WM abnormalities were most frequently noted in bilateral anterior and posterior cerebral WM (50% affected cases). Conclusion: About a third of acute/subacute COVID-19 patients referred for neuroimaging show brain abnormalities suggestive of COVID-19-related etiology. The predominant neuroimaging features were diffuse cerebral WM hypodensities / hyperintensities attributable to leukoencephalopathy, leukoaraiosis or rarefield WM.

ABSTRACT Introduction Cortical thinning is associated with aging; however, lifestyle factors can moderate this relationship. Two distinct lifestyle behaviors associated with brain health are regular moderate-to-vigorous physical activity (MVPA) and limited sedentary behavior (SB). However, it is unclear whether MVPA and SB levels contribute to cortical thickness independent of each other. We therefore investigated the independent relationships of MVPA and SB with cortical thickness using baseline data from a randomized controlled trial. Methods At baseline, we measured MVPA and SB for 7 d using the SenseWear Mini. A subset of the randomized controlled trial participants ( n = 30) underwent a 3T magnetic resonance imaging scan, wherein region-specific cortical surface morphometric analyses were performed using T1-weighted structural magnetic resonance imaging. We conducted regression analyses using a surface-based cluster size exclusion method for multiple comparisons within FreeSurfer neuroimaging software to determine if MVPA and SB are independently correlated with region-specific cortical thickness. Results This subset of participants had a mean age of 61 yr (SD = 9 yr), and 80% were female. Higher MVPA was associated with greater cortical thickness in the temporal pole (cluster size, 855 mm 2 ; cortical thickness range, 2.59–3.72 mm 2 ; P < 0.05) and superior frontal gyrus (cluster size, 1204 mm 2 ; cortical thickness range, 2.41–3.15 mm 2 ; P < 0.05) of the left hemisphere, independent of SB. Sedentary behavior was not associated with greater cortical thickness in any region, independent of MVPA. Conclusions Our results indicate that adults with greater MVPA—independent of SB—are associated with greater cortical thickness in regions, which are susceptible to age-associated atrophy.

The aim of this study was to further elucidate the relationship between the olfactory system and psychosocial functioning. Previous studies have shown that olfactory sensitivity is related to traits such as extraversion, agreeableness, and emotionality. In this study, the model of agency and communion as well as additional measures of social activity were used. The possible influence of HIV infection, believed to affect both chemosensory functions and social behaviors, was examined. 103 male participants were analyzed, of whom 45 were infected with HIV. Olfactory sensitivity was significantly related to the level of communion (p = .01), trait defined as interpersonal warmth, devotion to others, and morality. The effect was independent of the presence of HIV. Eagerness to engage in social activities, a construct indicating how actively one takes part in social life, was positively associated with olfactory sensitivity only in HIV+ individuals (p = .003). This result may imply that active participation in social life can buffer olfactory impairments in HIV patients.

BackgroundThe primary goal was to examine HIV-related changes in brain activation during a semantic memory task. The secondary goal was to assess whether the functional connectivity of the brain regions showing altered activity during the semantic memory task is related to HIV serostatus.Participants and procedureThe total group of 17 male subjects, aged on average 44 years, included 8 HIV+/cART+ and 9 demographically matched healthy comparators. Participants completed Famous Names Recognition task-functional magnetic resonance imaging (fMRI) and resting state fMRI.ResultsWe found an effect of HIV status on brain activation during the semantic memory task, despite comparable accuracy and reaction time across groups. Compared to healthy individuals, in HIV+ participants recognition of famous names elicited less activity in the fronto-striatal network, particularly in the left caudate nucleus (p = .049), left inferior frontal gyrus (p = .047), left thalamus (p = .031) and right thalamus (p = .047), as well as in the left middle occipital gyrus (p = .028). Although an effect of HIV status on functional connectivity of the brain regions showing altered activity during semantic memory task was not observed, resting-state activation of those regions was significantly correlated with performance on cognitive domains of attention, executive functioning, psychomotor speed and semantic skills.ConclusionsOur findings suggest the presence of functional brain network reorganization in HIV+/cART+ patients, particu-larly in subcortical regions of the fronto-striatal network, in the absence of neurocognitive decline.

Abstract Older adults with mild cognitive impairment (MCI) are at an elevated risk of falls. We conducted a pilot longitudinal observational study to examine the natural course of brain intrinsic functional connectivity (FC) and cognitive function changes in association to falling history in older adults with MCI. 15 MCI participants (mean age 75.9, range 67-86) included 10 non-fallers and 5 fallers (minimum two falls in the previous 12 months with one in the last 6 months) from Metro Vancouver, BC, Canada. At study entry and 1-year follow-up, participants completed brain scanning session of structural MRI and resting state (RS) functional MRI, the Montreal Cognitive Assessment (MoCA), and the Mini Mental State Examination (MMSE). Results indicated an interaction between time (baseline vs. follow-up) and falls history on RS-FC in individuals with MCI (p<0.001). At 1-year follow-up, MCI non-fallers showed increased FC between frontal, parietal and occipital cortex (from baseline R=0.141 to follow-up R=0.321) and lack of decline on cognitive measures. Meanwhile, MCI fallers showed weakening of FC between those brain regions (from baseline R=0.314 to follow-up R=0.201) with simultaneous cognitive deterioration. Significant relationships between FC strength and cognitive status existed only at follow-up (R=0.525, p<0.05), suggesting that the triggered functional compensatory brain mechanisms in MCI non-fallers are not successfully executed in MCI fallers. Together, our pilot data suggest that older adults with MCI who fall show more advanced brain functional degradation with adjacent cognitive decline as compared to MCI individuals who do not fall.

PURPOSE: Preliminary evidence suggests osteoarthritis (OA) is a risk factor for dementia. One potential reason is 87% of adults with OA are inactive, and low moderate-to-vigorous physical activity (MVPA) and high sedentary behaviour (SB) are each risk factors for brain atrophy. While regular MVPA and low SB are thus critical for brain health, it is unclear 1) what aspects of brain structure are associated with these behaviours among adults with OA; and 2) whether the relationships of MVPA and SB with brain structure are independent of each other. Hence, we investigated the independent relationships of MVPA and SB with brain structure in adults with knee OA. METHODS: This was a secondary cross-sectional analysis of a six month, proof-of-concept randomized controlled trial (RCT) to promote MVPA and reduce SB among adults with knee OA. At study entry, we objectively measured MVPA and SB for 7 days using the SenseWear Mini. Following this observation period, participants (N= 30) underwent a 3T magnetic resonance image (MRI) scan, wherein T1-weighted structural MRIs were performed to measure cortical thickness. We performed regression analyses using a surface-based cluster size exclusion method for multiple comparisons within the FreeSurfer neuroimaging software to determine if 1) MVPA was associated with greater cortical thickness independent of SB; and 2) SB was associated with less cortical thickness independent of MVPA. RESULTS: Participants had a mean age of 61 years (SD= 9 years), and 80% were female. Higher MVPA was associated with greater cortical thickness in the temporal pole (cluster size= 855 mm2; p< 0.05) and superior frontal area (cluster size= 1204 mm2; p< 0.05) of the left hemisphere independent of SB. SB was not associated with greater cortical thickness in any region independent of MVPA. CONCLUSIONS: Higher MVPA is associated with greater cortical thickness in adults with OA, however SB does not appear to be strongly associated with brain structure. Promoting MVPA among adults with OA may thus be an important strategy for maintaining cognitive health among this population.