Predictors of adherence to triptans: factors of sustained vs lapsed users.

OBJECTIVE: The present study was conducted to identify factors that predict adherence to triptans by migraine patients. BACKGROUND: Triptans have demonstrated efficacy for acute migraine yet many migraine sufferers discontinue their use. DESIGN AND METHODS: A survey study was conducted using 785 subjects (390 health maintenance organizations [HMO] and 395 non-HMO). Of those, 586 were sustained users of triptans (defined by at least 1 refill within the past year), and 199 were classified as lapsed users (ie, individuals who had 0 refills in the past year). Groups were compared on a variety of measures including a comprehensive Migraine Survey that included items related to efficacy and adverse events associated with the patient's current medication, as well as the Headache Impact Test (HIT)-6 and Migraine Disability Assessment Score (MIDAS) questionnaires. Data were analyzed with multivariate analysis of variance and stepwise multiple regression. RESULTS: Sustained users of triptans were significantly more satisfied with their medication, confident in the medication's ability to control headache, and reported control of migraine with fewer doses of medication. Sustained users also switched triptans products significantly less often than lapsed users, and reported greater benefit from triptan intervention in restoring normal daily functions, including improved cognitive ability, compared with lapsed users' ratings of their nontriptan medication. More lapsed users than sustained users reported adverse events associated with past triptan use. Results from multiple and logistic regression analyses correctly classified 95% of sustained users and identified the most significant predictors for sustained use as: satisfaction and belief in medication, reliability of response, effectiveness in rapidly restoring normal levels of productivity, and fewer doses of medication for resolving an attack. The HIT-6 and MIDAS distinguished between sustained and lapsed triptan users on days unable to do household work and missed family and social events. CONCLUSIONS: Predictors of adherence to triptans included satisfaction and confidence in triptans' ability to stop the migraine and associated symptoms and to return the individual to normal functioning. The findings suggest that lapsed users may not be receiving optimal treatment, and that if their past response to triptans was a consequence of inadequate education, they may benefit from additional education on proper use of triptans.

Reference data from the automated Neuropsychological Assessment Metrics for use in traumatic brain injury in an active duty military sample.

The current study examined the performance of active duty soldiers on the Automated Neuropsychological Assessment Metrics (ANAM) traumatic brain injury test battery, to expand the reference data for use in military settings. The effects of age and gender on cognitive performance also were explored. The ANAM traumatic brain injury battery, consisting of six performance tests and two subjective scales, was administered to a sample of healthy active duty soldiers (N = 5,247) as part of a concussion surveillance program. Performance means and SDs, stratified according to age and gender, are reported as reference data. In addition, the impact of age and gender on performance measures was analyzed. Because ANAM is rapidly being adopted for use in many military medical and research applications, the establishment of these reference values is invaluable, particularly for assisting with rapid accurate evaluation and treatment in clinical settings.

ANAM genogram: historical perspectives, description, and current endeavors.

This paper presents a historical overview and current perspective of the Automated Neuropsychological Assessment Metrics (ANAM) test system. We discuss the history of its development along with a synopsis of the evolution of computerized testing that has occurred and led to ANAM over the past 30 years within the Department of Defense (DoD). We include a description of our current system and test library. Finally, we present an overview of advanced development projects that are presently underway. We have intentionally avoided addressing issues of reliability, stability, clinical sensitivity, and construct validity in this paper. These issues are presented in other reports in this special issue.

The ARES test system for palm OS handheld computers.

The ARES (ANAM Readiness Evaluation System) is a cognitive testing system designed for operation on palm OS handheld computers i.e., Personal Digital Assistants (PDA). It provides an inexpensive and portable testing platform for field and clinical applications. ARES test batteries can be configured from a library of tests derived from the ANAM test system. ARES features include support of multiple users on a single PDA, a Microsoft Windows test battery authoring program, and a program for downloading, viewing, graphing, and archiving data. In validity tests, the same subjects were tested on identical ARES and conventional ANAM NeuroCog test batteries. Scores from the two platforms correlated highly, but absolute scores differed slightly. In reliability testing with the ARES Warrior battery, ARES scores were highly correlated in daily tests.

Reference values for performance on the Automated Neuropsychological Assessment Metrics V3.0 in an active duty military sample.

The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized measure of processing speed, cognitive efficiency, and memory. This study describes performance and psychometric properties of ANAM in an active duty, healthy military sample (N = 2,371) composed primarily of young (18-46 years) adult males. Rarely have neuropsychological reference values for use with individuals in the military been derived from a large, active duty military population, and this is the first computerized neuropsychological test battery with military-specific reference values. Although these results do not provide demographically corrected, formal normative data, they provide reference points for neuropsychologists and other health care providers who are using ANAM data in research or clinical settings, with patients of comparable demographics to the present sample.

Effect of repeated exposures to cold on cognitive performance in humans.

The effects of repeated exposure to cold temperature on cognitive performance were examined in 10 male subjects who were exposed to control (25 degrees C) and cold (10 degrees C) conditions on 10 successive days. A cognitive test battery (ANAM-ICE) was administered each day to assess complex and simple cognitive functioning accuracy, efficiency and response time. Rectal (T(rect)) and skin temperatures, thermal sensations, metabolic rate (M) and cardiovascular reactivity were also recorded. With the used cold exposure, inducing cold sensations and discomfort, superficial skin cooling (6-7 degrees C) and a slightly lowered T(rect) (0.4 degrees C) we observed three distinct patterns of cognitive performance: 1) negative, reflected in increased response times and decreased accuracy and efficiency; 2) positive, reflected in decreased response time and increased efficiency; and 3) mixed, reflected in a pattern of increases in both accuracy and response time and decreases in efficiency, and a pattern of decreases in both accuracy and response time. T(rect), thermal sensations, diastolic blood pressure (DBP) and heart rate (HR) were independent predictors of decreased accuracy, but also decreased response time. Cognitive performance efficiency was significantly improved and response times shorter over the 10-d period both under control and cold exposures suggesting a learning effect. However, the changes in cognitive performance over the 10-d period did not differ markedly between control and cold, indicating that the changes in the thermal responses did not improve performance. The results suggest that cold affects cognitive performance negatively through the mechanisms of distraction and both positively and negatively through the mechanism of arousal.

Longitudinal neurocognitive assessments of Ukrainians exposed to ionizing radiation after the Chernobyl nuclear accident.

A 4-year longitudinal study of the cognitive effects of the Chernobyl nuclear accident was conducted from 1995 to 1998. The controls were healthy Ukrainians residing several hundred kilometers away from Chernobyl. The exposed groups included Eliminators, Forestry workers and Agricultural workers living within 150 km of Chernobyl. Accuracy and efficiency of cognitive performance were assessed using ANAMUKR, a specialized subset of the Automated Neuropsychological Assessment Metrics (ANAM) battery of tests. Analyses of variance, followed by appropriate pairwise comparisons, indicated that the 4-year averaged levels of performance of the exposure groups (especially the Eliminators) were significantly lower than those of the controls on most measures; further, analyses of performance across time revealed significant declines in accuracy and efficiency, as well as psychomotor slowing, for all exposed groups over the 4-year period. These findings strongly indicate impairment of brain function resulting from both acute and chronic exposure to ionizing radiation.