Symptom Factors and Neuropsychological Performance in Collegiate Athletes with Chronic Concussion Symptoms

Objective The present study explored the relationship between specific types of postconcussion symptoms and cognitive outcomes in student–athletes with chronic concussion symptoms. Method Forty student–athletes with chronic concussion symptoms were given a battery of neuropsychological tests and rated themselves on a variety of postconcussion symptoms, which included the following factors derived from prior work: Physical, Sleep, Cognitive, Affective, and Headache. Cognitive outcomes included performance on composites for the memory and attention/executive functioning speed tests, respectively. The following covariates were also explored: Sex, depression symptoms, number of previous concussions, and time since injury. Results Headache was the only individual symptom factor that significantly (p < .05) predicted worse attention/executive functioning performance. None of the symptom factors were significantly related to memory performance over and above the variable of time since injury, such that longer time since injury was related to worse memory performance. Conclusion Comparable to work examining symptom predictors of cognitive outcomes in acutely concussed samples, headache predicted worse attention/executive functioning performance. Additionally, we found that the longer athletes had been symptomatic since injury, the “worse” their memory functioning. Understanding how headache and the length of time an individual is symptomatic are related to cognitive outcomes can help inform treatment and recommendations for athletes with prolonged symptom recovery.

Association between negative cognitive bias and depression: A symptom-level approach

Cognitive models of depression posit that negatively biased self-referent processing and attention have important roles in the disorder. However, depression is a heterogeneous collection of symptoms and it is unlikely that all symptoms are associated with these negative cognitive biases. The current study involved 218 community adults whose depression ranged from no symptoms to clinical levels of depression. Random forest machine learning was used to identifythe most important depression symptom predictors of each negative cognitive bias. Depression symptoms were measured with the Beck Depression Inventory – II. Performance of models was evaluated using predictive R-squared (𝑅2 𝑝𝑟𝑒𝑑), the expected variance explained in data not used to train the algorithm, estimated by 10 repetitions of 10-fold cross-validation. Using the Self- Referent Encoding Task (SRET), depression symptoms explained 34% to 45% of the variance in negative self-referent processing. The symptoms of sadness, self-dislike, pessimism, feelings of punishment, and indecision were most important. Notably, many depression symptoms made virtually no contribution to this prediction. In contrast, for attention bias for sad stimuli, measured with the dot-probe task using behavioral reaction time and eye gaze metrics, no reliable symptom predictors were identified. Findings indicate that a symptom-level approach may provide new insights into which symptoms, if any, are associated with negative cognitive biases in depression. General Scientific Summary: This study finds that many symptoms of depression are not strongly associated with thinking negatively about oneself or attending to negative information. This implies that negative cognitive biases may not be strongly associated with depression per se, but may instead contribute to the maintenance of specific depression symptoms, such as sadness, self-dislike, pessimism, feelings of punishment, and indecision.

Abstract 19118: Symptom Predictors of Delayed ST-Elevation Myocardial Infarction Presentation

Introduction: Through various systematic initiatives, cardiac centers routinely reach targeted door-to-balloon (DTB) treatment times of less than 90 minutes resulting in improved outcomes. However, in an effort to further optimize outcomes, by reducing total ischemic time, focus on symptom onset and their impact on presentation is needed. Hypothesis: This study aimed to identify whether the type and nature of specific symptoms are associated with delays in presentation in STEMI patients. Methods: 549 patients with complete data presenting with STEMI from April 2008 to December 2012 to a tertiary hospital were retrospectively studied. False activations were excluded. 449 patients were included in this analysis. Symptom-onset-to-hospital arrival time (symptom-onset time was identified by review of medical records, pre-hospital emergency services data and by interviewing patient’s and their family) was analyzed for the following factors: type of symptoms (chest pain, dyspnea, cardiac arrest) and nature of symptoms (constant or intermittent). Non-parametric univariate and multivariate analyses (PROC GLIMMIX) were carried out using Statistical Analysis Systems version 9.1 (SAS Institute, Cary, NC) statistical software package. Results: See table Conclusion: As expected, STEMI patients presenting with cardiac arrest who survived pre-hospital resuscitation presented the fastest, while patients with dyspnea had a significantly longer delay than patients with chest pain. Patients with intermittent symptoms presented significantly later than those with constant symptoms. Of particular interest, symptom-onset-to-door presentation remains long even with the classical symptom of constant chest pain (the most common STEMI symptom presentation). Thus, continued and enhanced population education and awareness is necessary to see further significant decreases in total ischemic time in STEMI patients.

Xiaoqinglong Granules as Add-On Therapy for Asthma: Latent Class Analysis of Symptom Predictors of Response

Xiaoqinglong granules (XQLG) has been shown to be an effective therapy in asthma animal models. We reviewed the literature and conducted this study to assess the impact of XQLG as an add-on therapy to treatment with fluticasone/salmeterol (seretide) in adult patients with mild-to-moderate, persistent asthma. A total of 178 patients were randomly assigned to receive XQLG and seretide or seretide plus placebo for 90 days. Asthma control was assessed by asthma control test (ACT), symptoms scores, FEV1, and PEF. Baseline patient-reported Chinese medicine (CM)-specific symptoms were analyzed to determine whether the symptoms may be possible indicators of treatment response by conducting latent class analysis (LCA). There was no statistically significant difference in ACT score between two groups. In the subset of 70 patients with symptoms defined by CM criteria, XQLG add-on therapy was found to significantly increase the levels of asthma control according to global initiative for asthma (GINA) guidelines (P=0.0329). There was no significant difference in another subset of 100 patients with relatively low levels of the above-mentioned symptoms (P=0.1291). Results of LCA suggest that patients with the six typical symptoms defined in CM may benefit from XQLG.