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72 Somatization and Headaches in people with insomnia during the COVID-19 Pandemic: the benefit of exercise.
- Kymberly Henderson-Arredondo, Samantha Jankowski, Emmett Suckow, Shivani Desai, Melissa Reich-Fuehrer, Lindsey Hildebrand, William D.S. Killgore
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 581-582
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Objective:
Stress is well known to increase the severity of somatization and insomnia. A recent major stressor that could have influenced the severity of these presentations was world-wide COVID-19 Pandemic. Somatization is the physical expression of stress and emotional distress that can manifest itself throughout various corporal domains and can be a comorbidity to insomnia. Headaches represent some of the most common complaints associated with brain injuries and neurological disorders but are common in somaticized disorders as well. In large survey study we examined whether exercise was associated with severity of somatization and headaches. We hypothesized that both healthy individuals and those with insomnia who exercised during the pandemic would report less severe somatic symptoms and headaches than those who did not.
Participants and Methods:A large survey was sent out to 4,073 individuals to measure their experience in numerous domains during the COVID-19 pandemic. This survey included a short symptom questionnaire used to measure somatization and the Insomnia Scale Index to measure insomnia. These questionnaires were administered along with a “yes or no” question on whether the participants exercised regularly in that period. A univariate ANOVA was performed to analyze the data to determine if exercise during the pandemic was beneficial in the reduction of somatic symptoms and headache severity. Furthermore, these tests were run to determine if the effect was greater on those with insomnia.
Results:The effect of insomnia and exercise on total somatic symptoms were significant at F(1, 3445)=650.5, p<0.001 and F(1, 3445)=26.1, p<0.001, respectively. For reported headache severity, there was a significant effect of exercise F(1, 4073)=14.5, p<0.001 and insomnia F(1, 4073)=160.5, p<0.001; therefore, those who exercised reported less severe headaches and those who suffered from insomnia reported more severe somatic symptoms. This meant that those who exercised reported less severe somatization and headaches than those who didn’t and those with insomnia reported more severe somatization and headaches than healthy individuals. However, the interaction between exercise and insomnia on overall somatization severity was not significant at F(1, 3445)=3.4, p=0.066 nor for reported headache severity F(1, 4073)=0.81, p=0.370. Despite there not being a significant interaction, the benefit of exercise was slightly greater on healthy individuals than those with insomnia.
Conclusions:Those with insomnia reported more severe headaches and overall somatic symptoms than non-insomniacs regardless of whether they exercised or not. Exercise did make a difference on the reported severity of headaches and somatization in both groups; however, the benefit of exercise on headaches and somatization was greater in individuals who do not suffer from insomnia. Thus, exercise was noted to be beneficial to those in the general population and those suffering from insomnia as it can potentially reduce the severity of somatization and headaches. Of course, this research was cross sectional and correlational, so the directionality of the effects cannot be inferred. For future research, it would be instrumental to use experimental methods to help determine the duration and type of exercise that may optimize its potential benefits on headaches and somatic symptoms.
70 Daily Routine and Psychological Resilience.
- Emmett J Suckow, Kymberly Henderson-Arredondo, Lindsey Hildebrand, Samantha R Jankowski, William D.S Killgore
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 579-580
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Objective:
Resiliency has been shown to attenuate and even protect against cognitive impairment from mental and physical stressors. Recently, it has been demonstrated that individuals who score high in psychological resilience tend to have less impairment following a mTBI.The COVID-19 pandemic proved to be an uncertain time for many. Periods of isolation, unemployment, and of course, sickness, meant more time at home. The partial or complete breakdown of an individual’s day-to-day routine paired with the stress of the pandemic has reinforced the need for psychological resilience. This analysis investigates the relationship between self-reported routine adherence and an individual’s corresponding psychological resilience. We hypothesize that individuals who maintained a structured daily routine during the pandemic will have higher levels of psychological resilience, enabling them to better handle periods of extreme stress.
Participants and Methods:8963 English-speaking adults (18-92 years old; 59.5% female) from across the U.S. completed an online, monthly cross-sectional (∼1000 participants per month), battery of questions that included the Connor-Davidson Resilience Scale (CD-RISC), and a self-reported sleep and routine rating(s) between June 2020 and April 2021. We measured the level of an individual’s routine by adding the self-reported survey scores of waking at the same time and maintaining a routine throughout the day. Both questions were scored 0-4 (Likert-style) for a score range of 0 to 8; higher scores indicated a higher adherence to a daily structure. Weeknight sleep (Sun-Thurs) was a self-reported average of the hours of sleep obtained over the past 4 weeks. A two-way ANCOVA was used to analyze the effects that routine had on subsequent psychological resilience scores while controlling for average sleep duration.
Results:A significant main effect routine on psychological resilience was found F(8,8953) =227, p=<.00001 after controlling for average reported weeknight sleep. An independent t-test was performed to determine the differences between those who fall above and below the average score (M= 5.1) for routine adherence. Individuals who were above average in adherence (M=71.1, SD=15.5) had significantly higher CD-RISC scores than individuals who did not (M=59.2, SD=16.7); t(9166)=35.1, p <0.001.
Conclusions:Individuals who maintained a more structured day throughout the pandemic were more likely to score higher on psychological resilience assessments than those who did not. Chronic stress is known to contribute to the development and exacerbation of many common psychiatric conditions like anxiety and depression. These results suggest that having a regular routine may have positive effects on an individual’s ability to bounce back from stressful cognitive and psychological events. This relationship should be further investigated in clinical populations as a potential intervention or adjunctive treatment for common neuropsychiatric conditions.
79 Continuous Theta Burst Stimulation (cTBS) over the Inferior Parietal Cortex Decreases Default Mode Connectivity and Improves Overnight Sleep in People with Insomnia
- William D. S. Killgore, Samantha Jankowski, Kymberly Henderson-Arredondo, Christopher Trapani, Heidi Elledge, Daniel Lucas, Andrew Le, Emmett Suckow, Lindsey Hildebrand, Michelle Persich, Brianna Zahorecz, Cohelly Salazar, Tyler Watson, Camryn Wellman, Deva Reign, Yu-Chin Chen, Ying-Hui Chou, Natalie S. Dailey
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 587-588
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Objective:
Chronic insomnia is a highly prevalent disorder affecting approximately one-in-three Americans. Insomnia is associated with increased cognitive and brain arousal. Compared to healthy individuals, those with insomnia tend to show greater activation/connectivity within the default mode network (DMN) of the brain, consistent with the hyperarousal theory. We investigated whether it would be possible to suppress activation of the DMN to improve sleep using a type of repetitive transcranial magnetic stimulation (rTMS) known as continuous theta burst stimulation (cTBS).
Participants and Methods:Participants (n=9, 6 female; age=25.4, SD=5.9 years) meeting criteria for insomnia/sleep disorder on standardized scales completed a counterbalanced sham-controlled crossover design in which they served as their own controls on two separate nights of laboratory monitored sleep on separate weeks. Each session included two resting state functional magnetic resonance imaging (fMRI) sessions separated by a brief rTMS session. Stimulation involved a 40 second cTBS stimulation train applied over an easily accessible cortical surface node of the DMN located at the left inferior parietal lobe. After scanning/stimulation, the participant was escorted to an isolated sleep laboratory bedroom, fitted with polysomnography (PSG) electrodes, and allowed an 8-hour sleep opportunity from 2300 to 0700. PSG was monitored continuously and scored for standard outcomes, including total sleep time (TST), percentage of time various sleep stages, and number of arousals.
Results:Consistent with our hypothesis, a single session of active cTBS produced a significant reduction of functional connectivity (p < .05, FDR corrected) within the DMN. In contrast, the sham condition produced no changes in functional connectivity from pre- to post-treatment. Furthermore, after controlling for age, we also found that the active treatment was associated with meaningful trends toward greater overnight improvements in sleep compared to the sham condition. First, the active cTBS condition was associated with significantly greater TST compared to sham (F(1,7)=14.19, p=.007, partial eta-squared=.67). Overall, individuals obtained 26.5 minutes more sleep on the nights that they received the active cTBS compared to the sham condition. Moreover, the active cTBS condition was associated with a significant increase in the percentage of time in rapid eye movement (REM%) sleep compared to the sham condition (F(1,7)=7.05, p=.033, partial eta-squared=.50), which was significant after controlling for age. Overall, active treatment was associated with an increase of 6.76% more of total sleep time in REM compared to sham treatment. Finally, active cTBS was associated with fewer arousals from sleep (t(8) = -1.84, p = .051, d = .61), with an average of 15.1 fewer arousals throughout the night than sham.
Conclusions:Overall, these findings suggest that this simple and brief cTBS approach can alter DMN brain functioning in the expected direction and was associated with trends toward improved objectively measured sleep, including increased TST and REM% and fewer arousals during the night following stimulation. These findings emerged after only a single 40-second treatment, and it remains to be seen whether multiple treatments over several days or weeks can sustain or even improve upon these outcomes.
58 Preliminary Development of a Virtual Reality Neuropsychological Assessment System
- William D. Killgore, Kymberly Henderson-Arredondo, Natalie S. Dailey, Jason Zhang, Samantha Jankowski, Ao Li, Huayu Li, Deva Reign, Emmett Suckow, Lindsey Hildebrand, Camryn Wellman, Jerzy Rozenblit, Janet Roveda
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 735-736
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Objective:
While there exist numerous validated neuropsychological tests and batteries to measure cognitive and behavioral capacities, the vast majority of these are time intensive and difficult to administer and score outside of the clinic. Moreover, many existing assessments may have limited ecological validity in some contexts (e.g., military operations). Therefore, we have been developing a novel approach to administering neuropsychological assessment using a virtual reality (VR) “game” that will collect simultaneously acquired multidimensional data that is synthesized by machine learning algorithms to identify neurocognitive strengths and weaknesses in a fraction of the time of typical assessment approaches. For our initial pilot project, we developed a preliminary VR task that involved a brief game-like military “shoot/no-shoot” task that collected data on hits, false alarms, discriminability, and response times under a context-dependent rule set. This prototype task will eventually be expanded to include a significantly more complex set of tasks with greater cognitive demands, sensor feeds, and response variables that could be modified to fit many other contexts. The objective of this project was to construct a rudimentary pilot version and demonstrate whether it could predict outcomes on standard neuropsychological assessments.
Participants and Methods:To demonstrate proof-of-concept, we collected data from 20 healthy participants from the general population (11 male; age=24.8, SD=7.8) with high average intelligence (IQ = 112, SD=10.7). All participants completed the Wechsler Abbreviated Scale of Intelligence-II (WASI-II), and several neuropsychological tests including the ImPACT, the Attention and Executive Function modules of the Neuropsychological Assessment Battery (NAB), and the VR task. Initially, we used a prior dataset from 359 participants (n=191 mild traumatic brain injury; n=120healthy control; n=48 sleep deprived) to serve as a training sample for machine learning models. Based on these outcomes, we applied machine learning, as well as standard multiple regression approaches to predict neuropsychological outcomes in the 20 test participants.
Results:In this limited study, the machine learning approach did not converge on a meaningful prediction due to the instability of the small sample. However, standard multiple linear regression using stepwise entry/deletion of the VR task variables significantly predicted neuropsychological performance. The VR task predicted WASI-II vocabulary (R=.457, p=.043), NAB Attention Index (R=.787, p=.001), and NAB Executive Function Index (R=.715, p=.002). Interestingly, these performances were generally as good or better than the predictions resulting from the ImPACT, a commercially available neuropsychological test battery, which correlated with WASI-II vocabulary (R=.557, p=.011), NAB Attention Index (R=.574, p=.008), and NAB Executive Function Index (R=.619, p=.004).
Conclusions:Our pilot VR task was able to predict performances on standard neuropsychological assessment measures at a level comparable to that of a commercially available computerized assessment battery, providing preliminary evidence of concurrent validity. Ongoing work is expanding this rudimentary task into one involving greater complexity and nuance. As multivariate data integration models are incorporated into the tasks and extraction features, future work will collect data on much larger samples of individuals to develop and refine the machine learning models. With additional work this approach may provide an important advance in neuropsychological assessment methods.