Joseph A. Boscarino

The lateralizing value of neuropsychological data remains an important topic. However, no research has examined the utility of Wechsler Memory Scale - Fourth Edition (WMS-IV) recognition memory composites and difference scores between these to assess their accuracy in differentiating patients with right temporal lobe epilepsy (RTLE) from left temporal lobe epilepsy (LTLE). This observational study analyzed archival data among 41 presurgical patients with TLE to examine the predictive utility of memory recognition indices and the difference score between these composites derived from the WMS-IV in differentiating seizure laterality. Independent t-tests, chi-square, logistic regression, and receiver operating characteristic (ROC) curve analyses were conducted. 23 LTLE patients (mean age = 36.48 years, SD = 10.15) and 18 RTLE patients (mean age = 42.78 years, SD = 13.22) were selected after being diagnosed based on concordant semiology, long-term video EEG monitoring, and neuroimaging. WMS-IV recognition index difference scores (RIDS) were significantly higher in RTLE than LTLE (p = .006, d = -.909). The WMS-IV RIDS was a significant predictor of seizure laterality after controlling for sex and yielded adequate accuracy in differentiating right and left TLE cases (AUC = .742). The current findings support the utility and adequate accuracy of the WMS-IV RIDS in improving neuropsychological lateralization in patients with TLE.

Background: The Montreal Cognitive Assessment (MoCA) is widely used for cognitive screening. Despite numerous studies showing that MoCA scores are affected by demographic variables including age, education, and race, the instrument is typically evaluated using a raw score or simple one-point education correction in clinical practice. Objective: In this study, we comprehensively evaluate the diagnostic accuracy of the MoCA in a large cohort of individuals being evaluated for mild cognitive impairment or dementia. Methods: We used data from the National Alzheimer's Coordinating Center (NACC) database to examine diagnostic accuracy of the MoCA, using both raw scores and Z-scores subject to non-linear demographic correction. We present comprehensive accuracy statistics, concordance with APOE ε4 status, and predictive validity of a mild cognitive impairment classification for the subsequent development of dementia. Results: We find that non-linear demographic correction modestly enhances diagnostic performance for individuals with mild cognitive impairment and dementia and results in classifying a higher proportion of APOE ε4 homozygous participants as individuals with dementia as compared to MoCA raw scores. Conclusions: Non-linear demographic correction may improve the diagnostic accuracy of the MoCA and increase concordance with a major known risk factor for Alzheimer's disease (i.e., APOE ε4 status).

Objective: Postoperative neuropsychological deficits pose a significant challenge for temporal lobe epilepsy (TLE) surgery, particularly in the language‐dominant hemisphere. Two surgical approaches have been suggested to mitigate such adverse outcomes: stereotactic laser amygdalohippocampectomy (SLAH) and hippocampus‐sparing anterior temporal lobectomy (HSATL). This retrospective cohort study compares the seizure control and neuropsychological outcomes of HSATL and SLAH in language‐dominant TLE. Methods: A retrospective cohort study compared 27 patients (nine male, mean age = 35.8 years) with drug‐resistant TLE and normal imaging localized to the language‐dominant left temporal lobe, undergoing either HSATL ( n = 22) or SLAH ( n = 5) between 2014 and 2021. Comprehensive pre‐ and ≥1‐year postoperative neuropsychological testing and imaging were performed, with seizure outcomes tracked for at least 1 year postoperatively. However, to assess the impact of mesial temporal sclerosis (MTS) on SLAH outcomes, we included seven additional patients with MTS who underwent SLAH in a secondary analysis. Results: HSATL led to significant declines in logical memory ( p = .04) despite sparing the hippocampus, which were not seen following SLAH in patients regardless of MTS status. SLAH trended toward improved semantic fluency, immediate verbal memory, and executive function despite hippocampal ablation. Including both MTS(+) and MTS(−) patients, there was a significant decline in letter fluency following SLAH (.04), with subgroup analyses demonstrating significantly greater declines in MTS(+) patients undergoing SLAH (.02). Additionally, 100% of patients undergoing SLAH achieved seizure freedom versus 72.7% following HSATL ( p = .046, including MTS[+] patients) at last follow‐up. Significance: In language‐dominant TLE, SLAH demonstrated comparable seizure outcomes and superior verbal memory retention compared to HSATL, albeit with greater letter fluency impairment. Preliminary findings challenge prioritizing hippocampal preservation for verbal memory function, suggesting potential cognitive advantages with SLAH specifically targeting mesial structures while maximally preserving cortical structures and white matter tracts critical for language networks. However, this intervention may negatively impact letter fluency, suggesting careful preoperative screening and discussion.

This study aimed to adapt the Compassion Fatigue-Short Scale to Portugal and examine the reliability and validity of the Portuguese version of the scale (Pt-CF-Short Scale) among Portuguese firefighters. The factor structure of the Pt-CF-Short Scale was compared to the one-factor model fit and a two-factor model and second-order factor model in a sample of 512 firefighters. Confirmatory factor analysis procedures confirmed the good fit of a second-order factor model with two first-order factors (secondary trauma and job burnout). The Pt-CF-Short Scale showed good internal consistency evidence. The Kessler Psychological Distress Scale (K-10), the Brief Symptom Inventory (BSI) and WHOQOOL-Bref were used as convergent measures to assess psychological distress, anxiety, depression, and interpersonal sensitivity and quality of life, respectively. The measure presented a strong correlation with psychological distress and weak and negative association with quality of life. The Pt-CF-Short Scale contributes to understanding compassion fatigue and its correlates within the context of emergency workers. Results indicate that this scale is a valid and reliable assessment tool in evaluating compassion fatigue.

The impact of “moral injury” (MI) among deployed veterans, defined as actions in combat that violate a veteran's moral beliefs and result in psychological distress, has increasingly become a significant clinical concern separate from other trauma- and stressor-related disorders. MI involves severe distress over violations of core beliefs often followed by feelings of guilt and conflict and is common among veterans with PTSD. While the psychological impact of PTSD is well-documented among veterans, this has been done less so with respect to MI. We studied MI among 1,032 deployed veterans who were outpatients in a large non-profit multi-hospital system in central Pennsylvania. The study included active duty and Guard/Reserve members, as well as veterans who were not Department of Veterans Affairs (VA) service users. Our hypothesis was that, controlling for other risk factors, veterans with high MI would have current mental disorders. Our secondary hypothesis was that MI would be associated with other psychopathologies, including chronic pain, sleep disorders, fear of death, anomie, and use of alcohol/drugs to cope post deployment. Most veterans studied were deployed to Vietnam (64.1%), while others were deployed to post-Vietnam conflicts in Iraq and Afghanistan and elsewhere. Altogether, 95.1% of the veterans were male and their mean age was 61.6 years (SD = 11.8). Among the veterans, 24.4% had high combat exposure, 10.9% had PTSD, 19.8% had major depressive disorder, and 11.7% had a history of suicidal thoughts. Based on the Moral Injury Events Scale (MIES), 25.8% had high MI post deployment, defined as a score above the 75th percentile. Results show that high MI among veterans was associated with current global mental health severity and recent mental health service use, but not suicidal thoughts. In addition, as hypothesized, MI was also associated with pain, sleep disorders, fear of death, anomie, use of alcohol/drugs to cope post-deployment, and poor unit support/morale during deployment. Deployed veterans with MI are more likely to have current mental health disorders and other psychological problems years after deployment. Further research is advised related to the screening, assessment, treatment, and prevention of MI among veterans and others after trauma exposures.

Introduction: Since veteran suicide is a concern and our knowledge of predictive factors is still limited, our objective was to assess risk factors for suicide, including genetic factors, among deployed veterans. Methods: For this study, we surveyed 1730 veterans who were outpatients in a multi-hospital system in Pennsylvania. Altogether, 1041 veterans (60%) provided a DNA sample. The genetic risk variants investigated were within loci previously associated with PTSD and substance misuse, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variations, which were used to calculate a polygenic risk score (range=0– 8, mean=3.6, SD=1.4). Results: Most veterans (56.2%) were deployed to Vietnam while significant numbers were deployed to Iraq, Afghanistan, and other post-Vietnam conflicts. Overall, 95.1% of the veterans were male, their mean age was 56.2 (SD=12), and 95.6% were Caucasian. Among the veterans, 24% had high combat exposure. The prevalence of lifetime suicidal thoughts was 11.3%. Additionally, 5.7% ever developed a suicide plan or attempted suicide in their lifetimes. Among those with a history of a lifetime suicide attempt or suicide plan, the PTSD genetic risk score was significantly higher (OR=3.96 vs 3.55, p=0.033), but for suicidal thoughts, this association was not significant (p=0.717). In multivariable analysis (MVA) logistic regression, significant predictors of attempting suicide or having a suicide plan were history of depression (OR=5.04, p< 0.001), PTSD genetic risk score (OR=1.25, p=0.036), history of childhood abuse/neglect (OR=2.24, p=0.009), and lifetime marijuana use (OR= 1.56, p=0.020). Conversely, rural residence was protective for suicide risk (OR=0.49; p=0.031). For suicidal thoughts, in the MVA genetic risk score was not significant (p=0.697), but history of child abuse/neglect (p< 0.001), history of depression (p> 0.001), low psychological resilience (p=0.004), and lifetime marijuana use (p=0.022) were significant. Discussion: In this study, we identified genetic risk variants and other predictors for suicide among veterans that may have implications for future screening and clinical care. Further research is advised.

We investigated factors associated with rates of recommended monitoring of chronic hepatitis B (HBV) patients for viral DNA and alanine aminotransferase (ALT), and initiation of antiviral treatment among eligible patients, in a US cohort of patients under routine care. Patients were categorised by treatment indication: definite, equivocal or ineligible. Baseline covariates included demographics, clinical characteristics and specialist care status. ‘Recommended monitoring’ was defined ≥1 ALT or HBV DNA test per year. Logit models, univariate then multivariable, were used to evaluate factors associated with monitoring and treatment. Among 3,830 patients, treatment was received by 67.5% (788/1168 patients) in the ‘definite’ category, and 34.1% (208/610 patients) in the ‘equivocal’ category, of whom 109 moved up to ‘definite’ status at some point during follow‐up. Sex, age and specialist care were independently associated with receipt of treatment in ‘definite’ patients. Routine monitoring rates were high prior to treatment in ‘definite/ treated’ patients (ALT: 77%; DNA: 85%) but declined afterwards (ALT 63%; DNA 36%). Rates of monitoring were lower in ‘definite/ untreated’ patients (ALT: 48%; DNA: 32%). Among ‘equivocal/ treated’ patients, lower age and comorbidity scores were associated with receipt of treatment; ALT monitoring rates were similar before and after treatment initiation (41% and 46%, respectively), while rates of DNA monitoring declined (55% and 29%). Monitoring among ‘treatment ineligible’ patients was similar to those in the ‘equivocal’ and untreated ‘definite’ groups. A large proportion of US HBV patients under routine care did not receive recommended annual laboratory monitoring, especially after initiation of antiviral treatment, and nearly one‐third of patients with ‘definite’ indications for antiviral therapy remained untreated.

Maladaptive drinking is an increasing concern among military policy makers and healthcare providers. The goal of this study was to assess how social and psychological factors relate to alcohol prob...