Neuropsychological deficit profiles for service members with mild traumatic brain injury.

BACKGROUND: Neuropsychological deficits are generally assessed in terms of absolute level of functioning, e.g. high average, average, low average, although there is increased interest in calculating indices of relative degree of decline, e.g. mild, moderate, severe. OBJECTIVE: To examine differences in demographic, psychiatric, and military-specific characteristics for relative degree of decline in neuropsychological profiles attributed to traumatic brain injuries (TBIs) among service members (SMs). METHODS: Data were drawn from an existing clinical database of 269 SMs who received neuropsychological evaluations for TBI (Wechsler Test of Adult Reading, Wechsler Adult Intelligence Scale, California Verbal Learning Test, Delis-Kaplan Executive Function System) at a military treatment facility between 2013 and 2018. Independent sample t-tests and one-way ANOVA tests with pairwise comparisons were performed. RESULTS: Memory and problem-solving abilities were the most and least affected domains, respectively. Greater relative decline was observed among male and White SMs and those with post-traumatic stress disorder (PTSD). By contrast, there were no differences in relative decline according to military rank or work status. CONCLUSION: Relative degree of decline after TBI among SMs is differentially impacted according to neuropsychological domain, with greater impairment among male and White SMs as well as those with PTSD.

Personality and Spirituality as Predictors of Mental Health and Salivary Alpha-Amylase Activity in Breast Cancer Survivors.

OBJECTIVES: To determine the relative predictive validity of personality and spirituality for mental health and salivary alpha-amylase (sAA) in breast cancer (BC) survivors. SAMPLE & SETTING: 23 BC survivors participated in a single-group, cross-sectional study. METHODS & VARIABLES: Predictor variables included personality and spiritual variables. Outcome variables included subjective physical and mental health outcomes and sAA, a neuroimmune biomarker. RESULTS: Hierarchical regressions indicated that (a) conscientiousness and forgiveness independently predict 38% and 11% of variance in mental health scores, respectively; and (b) conscientiousness and forgiveness independently predict 15% and 24% of the variance in sAA, respectively. Consistent with psychoneuroimmunology theory, personality and spiritual variables independently influence subjective mental health and neuroimmune activity in BC survivors. IMPLICATIONS FOR NURSING: Nurses should be aware of BC survivors' personality characteristics and spiritual dispositions so that distinct interventions can be offered to promote mental health and reduce stress-related neuroimmune inflammation.

Factor analysis of the Personality Assessment Inventory in service members with traumatic brain injury.

PRIMARY OBJECTIVE: To identify the factor structure of the Personality Assessment Inventory (PAI) clinical scales for military service members with traumatic brain injury (TBI). RESEARCH DESIGN: Retrospective analysis of existing data base. METHODS AND PROCEDURES: The sample included 210 service members with TBI who completed the PAI as part of a neuropsychological evaluation at a military TBI clinic. Statistical analysis included exploratory factor analysis of 214 items of the 11 PAI clinical scales. MAIN OUTCOMES AND RESULTS: Exploratory factor analysis indicated a four-factor solution accounting for 30.4% of the variance in scores. A review of the face validity of the items from each factor generated the following factor labels: Somatic/Psychiatric/Cognitive Distress, Social Distress, Substance Misuse, and Depression. CONCLUSIONS: The PAI appears to assess general distress (i.e., somatic/psychiatric/cognitive) and substance misuse constructs for both psychiatric and TBI populations, but it also appears to assess a "social distress" construct (i.e., difficulties socializing in both military and civilian populations) that is unique to military populations. Suggestions are offered to re-conceptualize PAI clinical scales specific to psychopathology (i.e., schizophrenia, paranoia, mania, borderline, antisocial) and personality disorders (i.e., borderline, antisocial) in terms of neurologic and military specific issues for service members with TBI.

Predicting military readiness using objective and subjective indices of neuropsychological impairment in service members with mild traumatic brain injury.

The military is interested in identifying factors to improve the readiness of service members with traumatic brain injury (TBI). TBI outcome studies have primarily used objective neuropsychological data interpreted using the absolute level of functioning (i.e., high average, average, low average), though research suggests it is also important to consider other objective indices of the relative degree of decline (e.g., mild, moderate, severe) and subjective complaints. The current study determined the predictive ability of objective indices of neuropsychological functioning (i.e., absolute level and the relative degree of decline) and subjective complaints (i.e., Neurobehavioral Symptom Inventory) in terms of military work status (i.e., return to duty, medically disabled, retired) for 113 service members with mild TBI. ANOVAs and post-hoc tests indicated individuals who were able to return to duty had higher absolute indices and lower relative decline scores in working memory and overall intelligence, as well as lower subjective neuropsychological complaints when compared to those who were disabled or retired. Multinomial logistic regression models generally supported these findings, except relative decline scores were not predictive of military work status likely due to issues of collinearity (i.e., relative decline scores are calculated using absolute scores). In conclusion, indices of absolute functioning and subjective neuropsychological impairments appear to be predictors of the ability to return to duty post-TBI in military populations, emphasizing the need to focus on cognitive reserve and emotional resilience as potential interventions.

Comparing indices of objective and subjective neuropsychological impairments in service members with mild traumatic brain injury.

Neuropsychological impairments are evaluated using subjective measures and objective tests, although their relationship remains unclear. This is likely because objective data is interpreted in terms of absolute level of functioning (e.g., high average, average, low average) while subjective complaints are interpreted in terms of relative decline from premorbid levels (e.g., mild, moderate, severe). The current study calculated objective indices of estimated degree of relative decline (i.e., difference between current cognitive ability and estimated premorbid level) to compare objective and subjective indices of relative decline for military service members with mild traumatic brain injury (mTBI). Contrary to hypotheses, more indices of absolute level of functioning were significantly correlated with subjective neuropsychological (i.e., Neurobehavioral Symptom Inventory) and psychological complaints (e.g., Personality Assessment Inventory) than relative decline scores. The results suggest stronger cognitive abilities may be associated with greater cognitive reserve or emotional resilience and, thereby, less subjective complaints for individuals with TBI, regardless of the extent of neuropsychological decline experienced.

Examining Cultural, Ethnic, and Religious Differences with the Brief Multidimensional Measure of Religiousness and Spirituality in the U.S. and India.

The Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) is regularly used to measure spirituality and religiosity in U.S. Christian populations, although it has not been used for making comparisons with non-Western groups. This study compared BMMRS results for 109 individuals (60 in the U.S. and 49 in India) with traumatic brain injury (TBI) from different cultures (U.S., India), ethnic groups (African American, Caucasian, South Asian), and religions (Christian, Hindu, Muslim). In general, the results indicated that U.S. African Americans and Christians reported being the most spiritual, South Asians and Hindus the least. Groups differed significantly in self-reported spiritual experiences, but less in frequency of religious activities. Results suggest using caution when applying Western-based measures of religion and spirituality in non-Western, non-Christian populations.

The integration of sensations and mental experiences into a unified experience: A neuropsychological model for the "sense of self".

A continued weakness in the cognitive neurosciences is the lack of a model to explain the phenomenological experience of the "self." This article proposes a model that suggests that the right hemisphere association area integrates physical sensations and mental experiences into a unified experience (i.e., a "sense of self") that is best conceptualized and understood as the subjective experience of "mineness." This model presents a unifying framework for neurologic and psychiatric disorders of the self (i.e., dis-integrated sense of "mineness"), as well as a neuropsychological framework to explain several human characteristics and experiences. Research is reviewed that indicates the sense of self can be activated to serve as the neuropsychological foundation of "self-integrated" character traits such as empathy (i.e., experiencing other's thoughts/emotions as "mine"), and conversely, the inhibition of this integrative process which can serve as the foundation of "selfless" experiences such as transcendence and forgiveness. Future research and clinical applications are discussed.

Associations between religious and spiritual variables and neuroimmune activity in survivors of breast cancer: a feasibility study.

PURPOSE: Chronic stress is associated with neuroimmune inflammation and adverse outcomes in breast cancer survivors. Some breast cancer survivors rely on religious and spiritual (R/S) variables to manage stress after breast cancer treatment. A spiritually based psychoneuroimmunological (PNI) model of health suggests that R/S variables influence neuroimmune activity; however, these associations are not well-established. A pilot study was conducted to assess the feasibility of studying associations between R/S variables and neuroimmune biomarkers in breast cancer survivors. METHOD: Salivary alpha-amylase (sAA) and interleukin-6 (IL-6) were sampled among women previously treated for breast cancer. The primary aim was to assess feasibility and acceptability of the sampling protocol. A secondary aim explored associations between sAA, IL-6, R/S variables, and health outcomes. RESULT: Forty-one women completed the study. Biomarker sampling yielded 246 acceptable specimens used for analysis. SAA was detectable in 96% of specimens and IL-6 was detectable in 44% of specimens. The R/S variables with the strongest associations to sAA were spiritual self-rank (rs = .39; p < .05) and forgiveness (rs = .40; p < .05). The R/S variable with the strongest association to salivary IL-6 was positive congregational support (rs = .42; p < .05). CONCLUSION: Feasibility and acceptability of the sampling protocol were confirmed. Reference ranges for sAA and IL-6 for female breast cancer survivors are presented. Results suggest that spiritual beliefs and religious practices are associated with neuroimmune activity, adding credence to a spiritually based PNI model of health. Findings lay the foundations for future R/S-based interventions to promote health and well-being in breast cancer survivors.

A Retrospective Study of Demographic, Medical, and Psychological Predictors of Readiness in Service Members With Mild Traumatic Brain Injury.

INTRODUCTION: Given the significant number of service members who have incurred mild traumatic brain injury (TBI) over the past two decades, this study was completed to determine the relative contribution of demographic, TBI-related, and psychological factors that predict the readiness of service members with primarily mild TBI. METHODS AND MATERIALS: This retrospective study included 141 service members who were evaluated at an outpatient military TBI rehabilitation clinic. Information regarding demographics, TBI-related variables, and psychological factors was collected and entered into hierarchical multinomial logistic regressions to predict military work status. Demographic predictor variables included age, race, gender, rank, service branch; TBI-specific variables including time since injury and neuropsychological variables (i.e., Wechsler Adult Intelligence Scale-IV (WAIS-IV) Full Scale Intelligence Quotient (FSIQ) and Processing Speed Indices; California Verbal Learning Test-IV total recall t-score); and psychiatric variables including concomitant psychiatric diagnoses and Personality Assessment Inventory indices. The outcome variable was the service member's military work status (i.e., return to duty (RTD); Medical Evaluation Board-disabled (MEB); retired) at time of discharge from the TBI clinic. RESULTS: Statistical analyses indicated that the total model predicted 31% of the variance in work status, with demographics predicting 16% of the variance, concomitant psychiatric diagnoses and WAIS-IV FSIQ predicting an additional 12%, and subjective somatic/psychological distress (Personality Assessment Inventory indices) predicting an additional 3%. Regarding the primary groups of interest (i.e., RTD vs. MEB), stepwise regressions indicated that those who RTD have higher intelligence and report less physical/psychological distress than the disabled group. CONCLUSIONS: In general, those service members who were able to RTD versus those who were classified as disabled (MEB) were of higher IQ and reported less somatic/psychological distress. Of note, traditional indices of TBI severity did not predict the ability of the sample to RTD. The results suggest the importance of treating psychological conditions and identifying possible indicators of resilience (e.g., higher intelligence) to increase the readiness of service members with mild TBI.

Psychological predictors of functional outcomes in service members with traumatic brain injury.

PRIMARY OBJECTIVE: Research is increasingly demonstrating the significant impact that non-medical factors can have on outcomes of service members (SMs) with mild traumatic brain injury (mTBI). Thus, the current study examined which demographic, TBI-related factors, and psychological variables are most predictive of functional outcomes. RESEARCH DESIGN: Retrospective database analysis from medical chart review. METHODS AND PROCEDURES: One hundred forty-one patients who received rehabilitation services at an outpatient TBI military treatment facility between 2013 and 2018. Data collected included demographic variables, time since injury, neuropsychological measures, psychological diagnoses, Personality Assessment Inventory (PAI) scores, and Walter Reed Functional Impairment Scale (FIS). Hierarchical linear regression models were used to predict functional outcomes (measured by FIS total, work, social functioning scales). MAIN OUTCOMES AND RESULTS: Results indicated that comorbid PTSD diagnosis and PAI Negative Impression Management (NIM) score were predictive of total functional, work, and social outcomes, over and above demographic and TBI-related factors. CONCLUSIONS: Current findings confirmed the importance of evaluating and treating psychological factors, as well as exploring one's responding style (NIM), when managing chronic mTBI in SMs. Given ongoing findings of psychological underpinnings to mTBI outcome, there is further need to focus on early interventions to optimize psychological and functional outcomes for SMs.

Two latent classes of diagnostic and treatment procedures among traumatic brain injury inpatients.

To characterize latent classes of diagnostic and/or treatment procedures among hospitalized U.S. adults, 18-64 years, with primary diagnosis of TBI from 2004-2014 Nationwide Inpatient Samples, latent class analysis (LCA) was applied to 10 procedure groups and differences between latent classes on injury, patient, hospital and healthcare utilization outcome characteristics were modeled using multivariable regression. Using 266,586 eligible records, LCA resulted in two classes of hospitalizations, namely, class I (n = 217,988) (mostly non-surgical) and class II (n = 48,598) (mostly surgical). Whereas orthopedic procedures were equally likely among latent classes, skin-related, physical medicine and rehabilitation procedures as well as behavioral health procedures were more likely among class I, and other types of procedures were more likely among class II. Class II patients were more likely to have moderate-to-severe TBI, to be admitted on weekends, to urban, medium-to-large hospitals in Midwestern, Southern or Western regions, and less likely to be > 30 years, female or non-White. Class II patients were also less likely to be discharged home and necessitated longer hospital stays and greater hospitalization charges. Surgery appears to distinguish two classes of hospitalized patients with TBI with divergent healthcare needs, informing the planning of healthcare services in this target population.

The behavioral presentation of an individual with a disordered sense of self.

There is increased recognition that the brain processes a "sense of self" (best understood as a sense of "mineness") in the right hemisphere association area and which can be distorted due to neurologic injury. Although there are numerous descriptions of types of disorders of the self (e.g., asomatognosia, anosognosia, mirror misidentification disorder, Capgras syndrome, schizophrenia), there are few descriptions of the subjective experiences of individuals with traumatic brain injury (TBI) who experience a reduced sense of self. This article presents a longitudinal case study of a woman in her early 40s with a primarily right hemisphere TBI and disorder of the self who had difficulties relating her experiences from the perspective of the self. Subjective interviews, neuropsychological test scores, and objective personality testing illustrate how she reported her experiences of a diminished sense of self, and how this sense of self improved over the normal course of recovery following the TBI. This case demonstrates clinically relevant information regarding how individuals with a reduced "sense of self" (i.e., "mineness") associated with a right hemisphere TBI may report their subjective experiences and perform on objective testing.

Factor Structure of the Brief Multidimensional Measure of Religiousness/Spirituality in US and Indian Samples with Traumatic Brain Injury.

The aim of this paper was to determine the factor structure of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) based on a sample of individuals from diverse cultures (i.e., USA, India), ethnicities (i.e., Caucasian, African-American, South Asian), and religions (i.e., Christian, Muslim, Hindu). A total of 109 individuals with traumatic brain injury (TBI) were included. Participants completed the BMMRS as part of a broader study on spirituality, religion, prosocial behaviors, and neuropsychological function. A principal components factor analysis with varimax rotation and Kaiser normalization identified a six-factor solution accounting for 72% of the variance in scores. Five of the factors were deemed to be interpretable and were labeled based on face validity as: (1) Positive Spirituality/Religious Practices; (2) Positive Congregational Support; (3) Negative Spirituality/Negative Congregational Support; (4) Organizational Religion; and (5) Forgiveness. The results were generally consistent with previous studies, suggesting the existence of universal religious, spiritual, and congregational support factors across different cultures and faith traditions. For health outcomes research, it is suggested that the BMMRS factors may be best conceptualized as measuring the following general domains: (a) emotional connectedness with a higher power (i.e., spirituality, positive/negative); (b) culturally based behavioral practices (i.e., religion); and (c) social support (i.e., positive/negative). The results indicate that factor relationships may differ among spiritual, religious, and congregational support variables according to culture and/or religious tradition.

Effect of Physical and Academic Stress on Illness and Injury in Division 1 College Football Players.

Stress-injury models of health suggest that athletes experience more physical injuries during times of high stress. The purpose of this study was to evaluate the effect of increased physical and academic stress on injury restrictions for athletes (n = 101) on a division I college football team. Weeks of the season were categorized into 3 levels: high physical stress (HPS) (i.e., preseason), high academic stress (HAS) (i.e., weeks with regularly scheduled examinations such as midterms, finals, and week before Thanksgiving break), and low academic stress (LAS) (i.e., regular season without regularly scheduled academic examinations). During each week, we recorded whether a player had an injury restriction, thereby creating a longitudinal binary outcome. The data were analyzed using a hierarchical logistic regression model to properly account for the dependency induced by the repeated observations over time within each subject. Significance for regression models was accepted at p ≤ 0.05. We found that the odds of an injury restriction during training camp (HPS) were the greatest compared with weeks of HAS (odds ratio [OR] = 2.05, p = 0.0003) and LAS (OR = 3.65, p < 0.001). However, the odds of an injury restriction during weeks of HAS were nearly twice as high as during weeks of LAS (OR = 1.78, p = 0.0088). Moreover, the difference in injury rates reported in all athletes during weeks of HPS and weeks of HAS disappeared when considering only athletes that regularly played in games (OR = 1.13, p = 0.75) suggesting that HAS may affect athletes that play to an even greater extent than HPS. Coaches should be aware of both types of stressors and consider carefully the types of training methods imposed during times of HAS when injuries are most likely.

Functional and structural indices of empathy: Evidence for self-orientation as a neuropsychological foundation of empathy.

OBJECTIVE: To evaluate a model that hypothesizes that empathy is associated with decreased right parietal lobe (RPL)-related self-orientation (i.e., increased selflessness), which allows individuals to more easily empathize with others. PARTICIPANTS: Thirty one individuals with documented neuroradiological abnormalities due to traumatic brain injury (TBI) referred for clinical evaluations. MEASURES: Cerebral integrity was measured with both functional (i.e., neuropsychological tests) and structural indices (i.e., MRI). Participants were administered comprehensive neuropsychological tests associated with general bilateral frontal, temporal, and parietal lobe functioning, a self-report measure of empathy (i.e., Penner's Prosocial Personality Battery), and an objective measure of empathy (i.e., Prisoner's Dilemma). Twenty participants also completed structural MRI analysis of the bilateral frontal, temporal, parietal, and insular cortices measured in terms of volume. RESULTS: Pearson correlations indicated that empathy was related to increased neuropsychological indices of RPL and frontal lobe (primarily left frontal) functioning. The only MRI indices associated with empathy were the bilateral insula. Neither functional nor structural cerebral indices were significantly related to objective measures of empathy. CONCLUSIONS: Contrary to hypotheses, empathy appears to be associated with increased RPL functioning. It is suggested that to incorporate the experiences of others into the experience of the self (i.e., to be empathetic), one must have an intact sense of the self.

Relationships among spirituality, religious practices, personality factors, and health for five different faith traditions.

To determine: (1) differences in spirituality, religiosity, personality, and health for different faith traditions; and (2) the relative degree to which demographic, spiritual, religious, and personality variables simultaneously predict health outcomes for different faith traditions. Cross-sectional analysis of 160 individuals from five different faith traditions including Buddhists (40), Catholics (41), Jews (22), Muslims (26), and Protestants (31). Brief multidimensional measure of religiousness/spirituality (BMMRS; Fetzer in Multidimensional measurement of religiousness/spirituality for use in health research, Fetzer Institute, Kalamazoo, 1999); NEO-five factor inventory (NEO-FFI; in Revised NEO personality inventory (NEO PI-R) and the NEO-five factor inventory (NEO-FFI) professional manual, Psychological Assessment Resources, Odessa, Costa and McCrae 1992); Medical outcomes scale-short form (SF-36; in SF-36 physical and mental health summary scores: A user's manual, The Health Institute, New England Medical Center, Boston, Ware et al. 1994). (1) ANOVAs indicated that there were no significant group differences in health status, but that there were group differences in spirituality and religiosity. (2) Pearson's correlations for the entire sample indicated that better mental health is significantly related to increased spirituality, increased positive personality traits (i.e., extraversion) and decreased personality traits (i.e., neuroticism and conscientiousness). In addition, spirituality is positively correlated with positive personality traits (i.e., extraversion) and negatively with negative personality traits (i.e., neuroticism). (3) Hierarchical regressions indicated that personality predicted a greater proportion of unique variance in health outcomes than spiritual variables. Different faith traditions have similar health status, but differ in terms of spiritual, religious, and personality factors. For all faith traditions, the presence of positive and absence of negative personality traits are primary predictors of positive health (and primarily mental health). Spiritual variables, other than forgiveness, add little to the prediction of unique variance in physical or mental health after considering personality. Spirituality can be conceptualized as a characterological aspect of personality or a distinct construct, but spiritual interventions should continue to be used in clinical practice and investigated in health research.

Randomized prospective study of a work place ergonomic intervention for individuals with rheumatoid arthritis and osteoarthritis.

OBJECTIVE: To conduct a longitudinal randomized controlled trial comparing a work place ergonomic intervention versus a control (i.e., provision of written educational materials) for persons with rheumatoid arthritis (RA) or osteoarthritis (OA) regarding employment, physical, and symptom outcomes. METHODS: Eighty-nine participants (mean age 50.54 years, 87% women, 38% with RA, 62% with OA) were randomized into the intervention or control group. Seventy-five participants completed baseline, 12-month, and 24-month evaluations. Outcome measures included Arthritis Impact Measurement Scales 2 (AIMS2) physical, symptom (i.e., pain), and role scores (i.e., impact of arthritis on employment); Job Satisfaction Survey (JSS); and Brief Symptom Inventory Global Severity Index. The study design was a 2-factor (treatment and time) with repeated measures on 1 factor (time) design used with baseline as a covariate for 12- and 24-month data. RESULTS: Between-group analyses indicated differences at 24 months for the AIMS2 role score (P < 0.03), with the intervention group reporting less arthritis-related impact on their work. Within-group analyses indicated significant improvements for the intervention group in AIMS2 change scores for physical functioning and symptom variables at 12 months (P < 0.04 and P < 0.01, respectively) and 24 months (P < 0.01 and P < 0.01, respectively). Job satisfaction (JSS) decreased at 12 months for both the intervention (P < 0.01) and control groups (P < 0.01), and at 24 months for the control group (P < 0.01). CONCLUSION: An ergonomic work place intervention (versus a control) is associated with decreased arthritis-related work difficulties over 2 years for individuals with OA and RA, as well as improvements in physical functioning and pain.

Convergent/Divergent validity of the brief multidimensional measure of religiousness/spirituality: empirical support for emotional connectedness as a "spiritual" construct.

The objective of this article is to determine the convergent/divergent validity of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS; Fetzer Institute & National Institute on Aging Working Group 1999) subscales by correlating it with the Temperament and Character Inventory (TCI) Self-Transcendence subscales (i.e., Mysticism, Transpersonal Identification, Self-Forgetfulness; Cloninger et al. 1994). The cross-sectional analysis of 97 undergraduate/graduate students from a Midwestern university was made. The results are (1) all five BMMRS spirituality subscales were significantly correlated with the TCI Mysticism scale; (2) two BMMRS scales (i.e., Daily Spiritual Experiences, Values/Beliefs) were significantly correlated with the TCI Transpersonal Identification scales; (3) no BMMRS spiritual subscales were significantly correlated with the TCI Self-Forgetfulness scale; and (4) of the BMMRS religion scales, only the Organizational Religiousness subscale was correlated with any TCI subscale (i.e., Mysticism). The BMMRS appears to have adequate convergent/divergent validity, although the need exists to determine specific dimensions of spirituality. Inspection of the specific items of the BMMRS and TCI spiritual subscales that were most consistently correlated (i.e., BMMRS Daily Spiritual Experiences, Values/Beliefs; TCI Mysticism, Transpersonal Identification) suggests the existence of a distinct spiritual construct that is best conceptualized as the experience of emotional connectedness to the divine, nature, and/or others.

Effects of current exercise and diet on late-life cognitive health of former college football players.

OBJECTIVE: To determine the relative influence of current exercise and diet on the late-life cognitive health of former Division I collision-sport collegiate athletes (ie, football players) compared with noncollision-sport athletes and non-athletes. METHODS: Graduates (n = 400) of a Midwestern university (average age, 64.09 years; standard deviation, 13.32) completed a self-report survey to assess current demographics/physical characteristics, exercise, diet, cognitive difficulties, and physical and mental health. RESULTS: Former football players reported more cognitive difficulties, as well as worse physical and mental health than controls. Among former football players, greater intake of total and saturated fat and cholesterol and lower overall diet quality were significantly correlated with cognitive difficulties; current dietary intake was not associated with cognitive health for the noncollision-sport athletes or nonathletes. Hierarchical regressions predicting cognitive difficulties indicated that income was positively associated with fewer cognitive difficulties and predicted 8% of the variance; status as a former football player predicted an additional 2% of the variance; and the interaction between being a football player and total dietary fat intake significantly predicted an additional 6% of the total variance (total model predicted 16% of variance). Greater intake of dietary fat was associated with increased cognitive difficulties, but only in the former football players, and not in the controls. Prior participation in football was associated with worse physical and mental health, while more frequent vigorous exercise was associated with higher physical and mental health ratings. CONCLUSION: Former football players reported more late-life cognitive difficulties and worse physical and mental health than former noncollision-sport athletes and nonathletes. A novel finding of the present study is that current dietary fat was associated with more cognitive difficulties, but only in the former football players. These results suggest the need for educational interventions to encourage healthy dietary habits to promote the long-term cognitive health of collision-sport athletes.

Neuropsychological decline/improvement in opsoclonus myoclonus ataxia.

Opsoclonus myoclonus ataxia (OMA) is a rare neurological disorder (incidence = approximately 1/5 million) primarily associated with involuntary conjugate saccadic eye movements, involuntary muscle jerks, cerebellar ataxia, and neuropsychological impairments. Unfortunately, there is limited published data regarding the nature and course of neuropsychological impairments following OMA diagnosis and treatment. This study presents neuropsychological data obtained at 1, 4, and 18 months post-diagnosis of a 52-year-old male with OMA. The patient initially demonstrated significant global neurocognitive, psychomotor, and psychological difficulties with substantial improvement over time. Treatment included medication management, physical rehabilitation, and psychological intervention.