EXAMINER executive function battery and neurologic morbidity in pediatric sickle cell disease.

Sickle cell disease (SCD) is blood disorder with a high risk for cerebral vascular morbidities that impact neurocognitive functioning. Specific cognitive abilities are known to be more sensitive to neurologic effects of SCD than IQ scores, yet there is little consensus about which measures to use to assess neurocognitive functioning. We evaluated the ability of the Executive Abilities: Methods and Instruments for Neurobehavioral Evaluation and Research (EXAMINER) Battery to detect neurologic effects in SCD. Thirty-two youth with SCD and sixty demographically-matched comparison youth completed the EXAMINER Battery and selected tests from the Woodcock-Johnson Tests of Cognitive Ability, 3rd edition (WJ-III). Neurologic severity was examined via clinical history for morbidities and midsagittal corpus callosum (CC) area. Results indicated cognitive performance decreased with increasing neurologic morbidity across all cognitive measures; two of four EXAMINER factors were related to CC area. The association with clinical history and midsagittal CC area appeared at least as large for the Examiner Battery scores as for the WJ-III measures. The Examiner Battery showed sensitivity to neurologic history and white matter effects in SCD; this new measure compares favorably to established measures of disease-related neurocognitive effects, but would benefit from further development.

Neural correlates of race-related social evaluations for African Americans and white Americans.

OBJECTIVE: To examine differences in patterns of brain activation associated with a race-related social evaluative task for a sample of African American and White American adults. METHOD: Participants were exposed to images of White American and African American targets embedded in various contexts across three emotional valences: angry/hostile, happy/joyful, and neutral/ambiguous. Functional magnetic resonance imaging was used to measure brain activity. RESULTS: Between-group comparisons revealed that African Americans, as compared to White Americans, exhibited activation in the inferior frontal gyrus and parahippocampal gyrus to images of happy (vs. neutral) same-race targets. White Americans, compared, to African Americans displayed activation in the inferior frontal gyrus and anterior cingulate cortex to images of happy (vs. neutral) same-race targets. Activation in limbic areas was observed for African Americans to neutral (vs. happy) images of White American targets, while no significant pattern of activation was found for White Americans to images of neutral/ambiguous African American targets. A significant correlation was found between scores for previous exposure to race-related incidents and amygdala activation for African Americans to White American targets. CONCLUSION: White Americans generally exhibited more activation in regions associated with conflict resolution and cognitive control, while African Americans exhibited activation mostly in areas associated with emotion and memory. Our findings further imply that previous exposure to race-related incidents for African Americans may alter neural responses to White American targets in imaging studies. Implications of the findings are discussed.

Language processing deficits in sickle cell disease in young school-age children.

Verbal IQ deficits are frequently reported for school-age children with sickle cell disease (SCD), yet the profile of language abilities in SCD is unclear. We examined semantic, syntactic, and phonological processing in five-to-seven-year-olds at high neurologic risk based on SCD subtype (N = 33), at low neurologic risk with SCD (N = 21), and without SCD (N = 54). Low-risk SCD did not show language processing deficits. High-risk SCD showed deficits in all three language domains. Language processing deficits in SCD at the start of middle childhood are related to neurologic risks and include language skills beyond vocabulary.

Use of handheld wireless technology for a home-based sickle cell pain management protocol.

PURPOSE: To evaluate use of a handheld electronic wireless device to implement a pain management protocol for participants with sickle cell disease (SCD). METHODS: Participants were 19 patients with SCD aged 9-20 who experienced vaso-occlusive pain. A single-session training on the use of cognitive-behavioral coping skills was followed by instruction on how to practice these skills and monitor daily pain experience using the device. Daily pain experience and practice of coping skills were collected for the 8-week intervention period using wireless technology. RESULTS: High rates of participation, daily diary completion and consumer satisfaction support the use of handheld wireless devices to implement this protocol. A comparison of the rates of self and device-recorded skills practice provides important information about the use of electronic monitoring for behavioral interventions. CONCLUSION: Wireless data transfer technology has significant potential to become a practical method to improve symptom monitoring and communication between patients and providers.