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Fatigue is one of the most common symptoms followingtraumatic brain injury (TBI). Despite its prevalence, fatigueremains a challenging concept to define and measure. The aim of the present study was to explore potential relationships between self-rated fatigue in patients with TBI and performance on several widely used neuropsychological tests. In across-sectional design, patients with TBI (n = 68) and healthy controls (n = 27) underwent a comprehensive battery of commonly used neuropsychological tests and completed two self-assessment fatigue scales, the Fatigue Severity Scale and the Mental Fatigue Scale. Patients with TBI performed worse on neuropsychological tests of short-term memory, processing speed and executive functioning (inhibition) compared to healthy controls. Within the TBI group, only the Paced Auditory Serial Addition Test (PASAT) and the Stroop—Inhibition task showed significant correlations with measures of fatigue. However, after adjusting for relevant demographic variables, including age, gender, education and TBI severity, only PASAT remained significantly associated with the Mental Fatigue Scale (r = .45, p = .005). Within the healthy control group, no such associations were found. These results highlight an interesting relationship between PASAT performance and self-assessed fatigue. With further research, PASAT, modifications of it or similar measures could potentially help clinicians in evaluating fatigue in patients with TBI.

Objective: Neuropsychological testing has traditionally been performed on site using standardized paper-pencil tests. Online platforms now offer the potential of conducting such testing at home but requires validation before widespread use. In this pilot study with healthy adults, we examine the convergent validity of the newly developed test battery Mindmore Remote.

Method: Fifty-two healthy participants were tested using both Mindmore Remote at home and traditional neuropsychological testing on site. The order of presentation was randomized. Associations between test performance on the two batteries were compared using Pearson and Spearman correlations.

Results: Results revealed significant correlations between all Mindmore Remote tests and traditional tests. Verbal tests showed stronger correlations (r = .71–.83) than non-verbal tests (r = .48–.71). Further, correlations were stronger for users who made responses using a computer mouse than for touch pad users.

Conclusions: Mindmore Remote tests that rely on verbal in-and output were comparable to traditional face-to-face neuropsychological tests. However, although promising, further validation is needed for tests that require visuo-motor interaction. In comparison with similar studies, the results indicate that test modification, rather than remote administration, is accountable for weaker correlations.

Background: Neuropsychological assessment traditionally requires physical meetings where patients meet psychologists on site at a clinic. This procedure may pose logistical challenges, for instance when patients are less mobile, or in sparsely populated areas where the distance to healthcare facilities may be considerable. Digital tests for remotely assessing cognitive functions may provide invaluable tools in these situations but need to be validated.

Objective: We aim to investigate to what degree the tests in a remote digital neuropsychological test-battery (Mindmore Remote) correspond to traditional neuropsychological tests.

Method: Fifty-two healthy participants between ages 19 and 89 years underwent both traditional neuropsychological testing procedures on site and remote testing on a computer at home. To avoid sequence effects, the order of testing (traditional / digital) was randomized. The tests examined (1) processing speed, (2) visual-scanning and attention, (3) visual short-term and working memory, (4) verbal learning, (5) episodic memory, (6) verbal production, (7) inhibition, and (8) cognitive flexibility. Associations between traditional and digital versions were assessed by correlations.

Results: Significant positive correlations were found for all tests. The strength of the relationship between the remote and traditional tests ranged from r = .36 to r = .83 in the following order: visual working memory (r = .36), visual short-term memory (r = .40), visual scanning (r = .45), visuomotor speed (r = .59), inhibition (r = .62), visual attention and processing speed (r = .65), cognitive flexibility (r = .71), verbal learning (r = .71), verbal production (r = .78) and episodic memory (r = .81-.83).

Conclusion: Several of the remote digital tests have the potential to be used in neuropsychological assessment. However, relatively weak relationships between tests that requires motor responses warrants further investigations before clinical implementation.

Dysfunction in executive functions is common among patients with chronic pain. However, the relationships between executive functioning and pain management have not been extensively studied. In this study, 189 outpatients (160 women, 29 men; mean age 33.15) with chronic pain underwent an extensive neuropsychological assessment, including several tests of executive functions. In addition, all participants completed self-assessment questionnaires regarding pain and interference of pain in everyday life. After adjusting for effects of age, education, and depression, several aspects of executive functioning were significantly associated with self-assessed everyday interference of pain (rs = 0.13–0.22, all ps < 0.05). This indicates that lower performance on tests of executive functioning was significantly associated with a higher degree of pain interference and a lower degree of life control. Pain characteristics such as pain intensity, pain duration, and pain spreading were not associated with executive functioning. These results suggest that preserved executive functions are related to better coping with pain, but not directly to the pain itself, in patients with chronic pain. Depression was also associated with self-management of pain, indicating that patients with lower executive functioning in combination with depression may need special attention during rehabilitation.

Objectives: Fatigue is common in patients with chronic pain. Still, there is a lack of studies examining objectively measurable cognitive aspects of fatigue: cognitive fatigability (CF). We aimed to investigate the presence of CF in patients with chronic pain and its relation to self-rated fatigue, attention, pain characteristics, sleep disturbance, depression, and anxiety.

Methods: Two hundred patients with chronic pain and a reference group of 36 healthy subjects underwent a comprehensive neuropsychological test battery, including measurement of CF with the Wechsler Adult Intelligence Scale-III Coding subtest, and self-assessment of trait and state fatigue.

Results: The patients with chronic pain did not show more CF as compared to the reference group. There was an association between CF and processing speed on a test of sustained and selective attention in the chronic pain group, while self-rated fatigue measures and pain characteristics were not associated with CF. Self-rated fatigue measures were highly correlated with self-rated pain intensity, spreading of pain, depression, anxiety, and sleep disturbance.

Conclusions: The findings highlight the distinction between objective and subjective aspects of fatigue in chronic pain, and that the underlying causes of these different aspects of fatigue need to be studied further.

Introduction: There are great potential benefits of being able to conduct neuropsychological assessments remotely, especially for hard-to-reach or less mobile patient groups. Such tools need to be equivalent to standard tests done in the clinic and also easy to use in a variety of clinical populations.

Methods and analysis: This study protocol describes a cross-sectional study aimed at validating the newly developed digitalized neuropsychological test battery Mindmore Remote in patients with neurological disorders and injuries. Diagnoses comprise traumatic brain injury, stroke, Parkinson’s disease, multiple sclerosis, brain tumour and epilepsy. 50 patients in each patient group will be included. In addition, 50 healthy controls will be recruited. All participants will undergo both testing with Mindmore Remote at home and traditional neuropsychological assessment face-to-face in a randomised order. The primary outcome is the association between tests from the Mindmore Remote battery and their equivalent traditional neuropsychological tests. Further, bias between methods and differences between groups will also be investigated.

Ethics and dissemination: The study protocol has been approved by the Swedish Ethical Review Authority (2022-06230-01) and adheres to the declaration of Helsinki. All participants will be given oral and written information about the study and sign informed consent forms before entering the study. All participants are informed that they can terminate their participation in the study at any given time, without giving any explanation, and participating in the study or not will not affect their care at the clinic. Neither authors nor personnel involved in the research project are affiliated with Mindmore AB. The results from the study will be published in peer-reviewed scientific journals and presented at national and international conferences on the topic.

Trial registration number: NCT05819008.

INTRODUCTION: Chronic pain (CP) is one of the most frequently presenting conditions in health care and many patients with CP report mental fatigue and a decline in cognitive functioning. However, the underlying mechanisms are still unknown.

METHODS AND ANALYSIS: This study protocol describes a cross-sectional study aimed at investigating the presence of self-rated mental fatigue, objectively measured cognitive fatigability and executive functions and their relation to other cognitive functions, inflammatory biomarkers and brain connectivity in patients with CP. We will control for pain-related factors such as pain intensity and secondary factors such as sleep disturbances and psychological well-being. Two hundred patients 18-50 years with CP will be recruited for a neuropsychological investigation at two outpatient study centres in Sweden. The patients are compared with 36 healthy controls. Of these, 36 patients and 36 controls will undergo blood sampling for inflammatory markers, and of these, 24 female patients and 22 female controls, between 18 and 45 years, will undergo an functional MRI investigation. Primary outcomes are cognitive fatigability, executive inhibition, imaging and inflammatory markers. Secondary outcomes include self-rated fatigue, verbal fluency and working memory. The study provides an approach to study fatigue and cognitive functions in CP with objective measurements and may demonstrate new models of fatigue and cognition in CP.

ETHICS AND DISSEMINATION: The study has been approved by the Swedish Ethics Review Board (Dnr 2018/424-31; 2018/1235-32; 2018/2395-32; 2019-66148; 2022-02838-02). All patients gave written informed consent to participate in the study. The study findings will be disseminated through publications in journals within the fields of pain, neuropsychology and rehabilitation. Results will be spread at relevant national and international conferences, meetings and expert forums. The results will be shared with user organisations and their members as well as relevant policymakers.

TRIAL REGISTRATION NUMBER: NCT05452915.

Hjärnavbildningsmetoder är samlingsnamnet på ett stort antal tekniker som gör det möjligt att visualisera en levande persons hjärna. Teknikerna erbjuder alltså ett "fönster in i hjärnan" - en möjlighet som är hisnande men idag vardag både i forskning och i klinisk verksamhet. Under de senaste decennierna har olika tekniska landvinningar möjliggjort alltmer förfinade undersökningar, och denna utveckling fortsätter alltjämt. Verksamheter med inriktning på olika former av hjärnavbildning återfinns på sjukhus, universitet och forskningscentra. De ofta högteknologiska metoderna kräver att team av specialister, såsom inom neuroradiologi och fysiologi, samarbetar. På många platser är också neuropsykologer centrala medarbetare i dessa team, och det här kapitlet är riktat just mot (blivande) neuropsykologer med intresse för att nyttja hjärnavbildningsmetoder.

Background: Sedentary behavior has previously been associated with the risk of depression. In addition, older adults have been proven to be more sedentary and more depressed than other age groups. However, studies using objective measures of sedentary behavior and taking physical activity into account are lacking. Thus, the purpose of this population-based study was to examine how total sedentary time and length of sedentary bouts were associated with the risk of depression among 70-year-olds.

Methods: The present study used data from the Healthy Ageing Initiative (n = 3,633), an ongoing cross-sectional research project in Umeå, Sweden. Sedentary behavior was measured objectively with the ActiGraph GT3X+ accelerometer, and depression was measured with the Geriatric Depression Scale. Several covariates, including physical activity, were included in logistic regression analyses.

Results: Results from two hierarchical logistic regression models showed that a greater percentage of the day spent sedentary [odds ratio (OR) = 1.031, p = 0.010] and longer average length of sedentary bouts (OR = 1.116, p = 0.045) increased the risk of depression.

Limitations: Limitations include of possible underrepresentation of severely depressed participants, and possible observer effects.

Conclusions: The present study verified the relationship between sedentary behavior and depression and provides new information about the risks associated with increased length of sedentary bouts.  These findings may be important to consider in the development of future recommendations for the prevention of depression among older adults.

Objective: To examine the prevalence of white matter hyperintensities (WMHs) in patients with traumatic brain injury (TBI) as compared to healthy controls, and to investigate whether there is an association between WMH lesion burden and performance on neuropsychological tests in patients with TBI.

Methods: A total of 59 patients with TBI and 27 age- and gender-matched healthy controls underwent thorough neuropsychological testing and magnetic resonance imaging. The quantification of WMH lesions was performed using the fully automated Lesion Segmentation Tool.

Results: WMH lesions were more common in patients with TBI than in healthy controls (p = .032), and increased with higher TBI severity (p = .025). Linear regressions showed that WMH lesions in patients with TBI were not related to performance on any neuropsychological tests (p > .05 for all). However, a negative relationship between number of WMH lesions in patients with TBI and self-assessed fatigue was found (r = - 0.33, p = .026).

Conclusion: WMH lesions are more common in patients with TBI than in healthy controls, and WMH lesions burden increases with TBI severity. These lesions could not explain decreased cognitive functioning in patients with TBI but did relate to decreased self-assessment of fatigue after TBI.