Shown here is a selection of independent research publications using ANAM.
Click on a heading to jump directly to that section
General Research: General Research includes peer-reviewed studies including ANAM on a wide range of topics, including chronic diseases and treatment guidelines.
Military Research: Military Research includes numerous examples of research done using ANAM as a key tool in assessing cognition of service members and veterans, as well as research evaluating the use of ANAM.
Sports-Related Research: Sports-Related Research is composed of several studies done using ANAM in a sports context. Much, though not all, of this research is devoted to ANAM in concussion management.
Test Validation Research: Test Validation Research is a compilation of research designed around testing the validity and reliability of ANAM.
Automated Neuropsychological Assessment Metrics (ANAM) Measures of Cognitive Effects of Alzheimer's Disease
Archives of Clinical Neuropsychology, 2005 May: Vol 20 (3), 403-8
Levinson D, Reeves D, Watson J, Harrison M
National Cognitive Recovery Foundation
Eight individuals with Alzheimer's disease, and eight age-matched controls, were administered the MMSE, the Yesavage GDS, and a customized subset of the Automated Neuropsychological Assessment Metrics (ANAM) Battery. Accuracy (percent correct) and efficiency (number of correct responses per minute) of performance on six ANAM tasks were assessed. The patients' GDS scores indicated no depression. Although their MMSE scores (mean were significantly lower than those of the controls), they nonetheless indicated that the patients were still functioning at a fairly high level. Analysis of ANAM accuracy scores indicated that the patients were significantly impaired on three tasks measuring working memory. A discriminant function analysis revealed 93.8% correct classification. Analysis of ANAM efficiency scores revealed that except for simple reaction time, the patients were significantly impaired on all tasks. A discriminant function analysis correctly classified 100% of the participants. Given the small size of the groups in the present study, this finding especially underscores the sensitivity of ANAM to the cognitive effects of Alzheimer's disease, as indicated by the large effect sizes. The findings further indicate that ANAM might be capable of detecting more subtle effects of the disease at an earlier stage in its progress.
Recovery of cerebral blood flow following sports-related concussion
Meier, T. B., Bellgowan, P. S. F., Singh, R., Kuplicki, R., Polanski, D. W., & Mayer, A. R. (2015).
Physiological and neurobehavioral effects of cholinesterase inhibition in healthy adults
Physiology & Behavior, 138(0), 165-172.
Morasch, K. C., Aaron, C. L., Moon, J. E., & Gordon, R. K. (2015).
Remote cognitive assessments for patients with multiple sclerosis: a feasibility study
Multiple Sclerosis Journal, 1-8.
Settle, J. R., Robinson, S. A., Kane, R., Maloni, H. W., & Wallin, M. T. (2015).
Remote cognitive assessments for patients with multiple sclerosis: a feasibility study
Multiple Sclerosis Journal 1-8.
Settle, J. R., Robinson, S. A., Kane, R., Maloni, H. W., & Wallin, M. T. (2015).
A longitudinal evaluation of diffusion kurtosis imaging in patients with mild traumatic brain injury
Brain Injury, 29(1), 47-57.
Stokum, J. A., Sours, C., Zhuo, J., Kane, R., Shanmuganathan, K., & Gullapalli, R. P. (2015).
The effects of chronic marijuana use on circadian entrainment
Chronobiology International 1-7.
Whitehurst, L. N., Fogler, K., Hall, K., Hartmann, M., & Dyche, J. (2015).
Impact of fatigue on cognitive functioning among premenopausal women with fibromyalgia syndrome and rheumatoid arthritis: The controlled study
Journal of Musculoskeletal Pain, 21(2) , 135-146.
Akdogan, S., Ayhan, F. F., Yildirim, S., & Borman, P. (2013).
Novel Strategies for Biodetection: Preliminary Application to Traumatic Brain Injury
MRS Online Proceedings Library, 1599.
Anderson, A. S., Vu, D. M., Sanchez, T., Iyer, S., & Mukundan, H. (2014).
Psychopharmacology of theobromine in healthy volunteers
Psychopharmacology, 228(1), 109-118.
Baggott, M. J., Childs, E., Hart, A. B., Bruin, E., Palmer, A. A., Wilkinson, J. E., & Wit, H. (2013).
Relationships of Post traumatic Stress Symptoms and Sleep Measures to Cognitive Performance in Young-Adult African Americans
J Trauma Stress, 27(2), 217-223.
Brownlow, J. A., Hall Brown, T. S., & Mellman, T. A. (2014).
Uncontrolled eating is associated with reduced executive functioning
Clinical Obesity, 4(3), 172-179.
Calvo, D., Galioto, R., Gunstad, J., & Spitznagel, M. B. (2014).
Screening for traumatic brain injury: Findings and public health implications
The Journal of Head Trauma Rehabilitation, 29(6), 479-489.
Dams-O’Connor, K., Cantor, J. B., Brown, M., Dijkers, M. P., Spielman, L. A., & Gordon, W. A. (2014).
The neurocognitive effects of simulated use-of-force scenarios
Forensic Science, Medicine, and Pathology, 10(1), 9-17.
Dawes, D. M., Ho, J. D., Vincent, A. S., Nystrom, P. C., Moore, J. C., Steinberg, L. W., . . . Miner, J. R. (2014).
Neurocognitive performance using the Windows spaceflight cognitive assessment tool (WinSCAT) in human spaceflight simulations
Aerospace Science and Technology, 35(0), 87-92.
De la Torre, G. G., Mestre Navas, J. M., & Guil Bozal, R. (2014).
Evaluation of sumatriptan-naproxen in the treatment of acute migraine: a placebo-controlled, double-blind, cross-over study assessing cognitive function
Headache, 53(4), 656-664.
Edwards, K. R., Rosenthal, B. L., Farmer, K. U., Cady, R. K., & Browning, R. (2013).
Self-reported physical activity is associated with cognitive function in lean, but not obese individuals
Clinical Obesity, 4(6), 309-315.
Galioto Wiedemann, R., Calvo, D., Meister, J., & Spitznagel, M. B. (2014).
Longitudinal and Prognostic Evaluation of Mild Traumatic Brain Injury: A 1H-Magnetic Resonance Spectroscopy Study
George, E. O., Roys, S., Sours, C., Rosenberg, J., Zhuo, J., Shanmuganathan, K., & Gullapalli, R. P. (2014).
Substance Use and Mental Health Characteristics Associated with Cognitive Functioning Among Adults Who Use Methamphetamine
Journal of Addictive Diseases, 32(1), 11-25.
Herbeck, D. M., & Brecht, M.-L. (2013).
COMT Val158Met modulates subjective responses to intravenous nicotine and cognitive performance in abstinent smokers
Pharmacogenomics J, 13(6), 490-497. doi: 10.1038/tpj.2013.1
Herman, A. I., Jatlow, P. I., Gelernter, J., Listman, J. B., & Sofuoglu, M. (2013).
Differential effects of amphetamine and haloperidol on temporal reproduction: Dopaminergic regulation of attention and clock speed
Neuropsychologia, 51(2), 284-292.
Lake, J. I., & Meck, W. H. (2013).
Perfusion deficits in patients with mild traumatic brain injury characterized by dynamic susceptibility contrast MRI
NMR in Biomedicine 26 651-663.
Liu, W., B. Wang, et al. (2013).
Complexity Analysis of Resting State Magnetoencephalography Activity in Traumatic Brain Injury Patients
Journal of Neurotrauma, 30(20), 1702-1709.
Luo, Q., D. Xu, et al. (2013).
Using compressed speech to measure simultaneous processing in persons with and without visual impairment
Psychology in the Schools, 50(10), 1084-1091.
Marks, W. J., Jones, W. P., & Loe, S. A. (2013).
Possible Medication-Resistant Deficits in Adult ADHD
Journal Attenton Disorders
Maruta, J., Spielman, L. A., Tseretopoulos, I. D., Hezghia, A., & Ghajar, J. (2014).
Virtual reality stroop task for assessment of supervisory attentional processing
Journal of clinical and experimental neuropsychology, 35(7), 1-15.
Parsons, T. D., Courtney, C. G., & Dawson, M. E. (2013).
Cognitive impairment and its relation to imaging measures in multiple sclerosis: a study using a computerized battery
Journal of Neuroimaging, 23(3), 445-452.
Pellicano, C., Kane, R. L., Gallo, A., Xiaobai, L., Stern, S. K., Ikonomidou, V. N., . . . Bagnato, F. (2013).
Neuropsychological Correlates of Anger, Hostility, and Relationship-Relevant Distortions in Thinking among Partner Violent Men
Journal of Family Violence, 29(6), 625-641. doi: 10.1007/s10896-014-9614-5
Persampiere, J., Poole, G., & Murphy, C. (2014).
Effects of filtering visual short wavelengths during nocturnal shift work on sleep and performance
Chronobiology International, 30(8), 951-962.
Rahman, S., Shapiro, C., Wang, F., Ainlay, H., Kazmi, S., Brown, T., & Casper, R. (2013).
PER3 and ADORA2A polymorphisms impact neurobehavioral performance during sleep restriction
Journal of Sleep Research, 22(2), 160-165.
Rupp, T. L., Wesensten, N. J., Newman, R., & Balkin, T. J. (2013).
S-100β does not predict outcome after mild traumatic brain injury
Brain Injury, 28(11), 1430-1435.
Ryb, G. E., Dischinger, P. C., Auman, K. M., Kufera, J. A., Cooper, C. C., Mackenzie, C. F., & Kane, R. L. (2014).
Default mode network interference in mild traumatic brain injury – A pilot resting state study
Brain Research, 1537, 201-215.
Sours, C., J. Zhuo, et al. (2013).
Associations between interhemispheric functional connectivity and the Automated Neuropsychological Assessment Metrics (ANAM) in civilian mild TBI
Brain Imaging and Behavior, 1-14.
Sours, C., Rosenberg, J., Kane, R., Roys, S., Zhuo, J., Shanmuganathan, K., & Gullapalli, R. (2014).
Monitoring seafarers’ cognitive performance under stressor factors during a voyage by Automated Neuropsychological Assessment Metrics
Universitatii Maritime Constanta.Analele, 14(20), 291-310.
Tac, U., Tavacioglu, L., Bolat, P., Kora, O. K., & Bolat, F. (2013).
Inattention, impulsive action, and subjective response to d-amphetamine
Drug and Alcohol Dependence, 133(1), 127-133.
Weafer, J., & de Wit, H. (2013).
Changes in fatigue and cognition in patients with relapsing forms of multiple sclerosis treated with natalizumab
International Journal of MS Care, 15(3), 120-128.
Wilken, J., Kane, R. L., Sullivan, C. L., Gudesblatt, M., Lucas, S., Fallis, R., . . . Foulds, P. (2013).
Efficacy of the ANAM General Neuropsychological Screening Battery (ANAM GNS) for detecting neurocognitive impairment in a mixed clinical sample
Clin Neuropsychol, 27(3), 376-385.
Woodhouse, J., Heyanka, D. J., Scott, J., Vincent, A. S., Roebuck-Spencer, T. M., Domboski-Davidson, K., . . . Adams, R. (2013).
Cognitive Dysfunction in Multiple Sclerosis: Assessment, Imaging, and Risk Factors
Journal of Rehabilitation Research & Development (JRRD). 43(1), 63-72; 2006
Mitchell T. Wallin, MD, MPH; Jeffrey A. Wilken, PhD; Robert Kane, PhD. Washington, DC, Department of Veterans Affairs (VA) Medical Center, Washington, DC; Department of Neurology, Georgetown University, Washington, DC; VA Maryland Health Care System, Multiple Sclerosis Center of Excellence East, Baltimore, MD; Department of Psychology, University of Maryland, College Park, MD
Conclusion: Studies in recent years have clarified the pattern of cognitive dysfunction in MS.
Dissociation often exists between cognitive dysfunction in MS and traditional neurological deficits. Preliminary research with the ANAM indicates that it correctly categorizes MS patients as cognitively intact or impaired. Specifically, a logistic regression indicated that the ANAM accurately predicted the performance of 48 patients as intact or impaired 96 percent of the time . With increasing numbers of imaging and clinical assessment tools, researchers have started to identify risk factors and biological markers of cognitive dysfunction in MS. Correlations between cognitive dysfunction and neuroimaging parameters, however, remain moderate at best. Newer imaging techniques such as diffusion tensor MRI, functional MRI, and MRI spectroscopy will hopefully better clarify structural-functional relationships. Additionally, because cognitive dysfunction assessment in MS has traditionally been time consuming, efforts should be made toward integrating shorter assessment batteries such as the ANAM into routine clinical examinations. The VA MSCoE East (Multiple Sclerosis Center of Excellence) has initiated projects to make these assessments practical and efficient for patients and healthcare providers. Finding and confirming risk factors for cognitive dysfunction will be challenging because MS is a complex, dynamic disease that evolves slowly. Longitudinal MS studies that assess biological markers and temporal trends in cognitive dysfunction are particularly needed. With the recent advances in molecular neuroscience that have contributed to advances in other dementia disorders , we remain optimistic about the future. The goal of research efforts is early identification of MS patients who will develop cognitive dysfunction. Ultimately, these patients would receive therapy that would modify the disease course in the pre-symptomatic period.
The Utility of Computerized Neuropsychological Assessment of Cognitive Dysfunction in Patients with Relapsing-remitting Multiple Sclerosis
Multiple Sclerosis.2003; May 9(2): 119-127
Traditional paper-and-pencil neuropsychological batteries used to document cognitive deficits in multiple sclerosis (MS) patients lack timing precision. This makes it difficult to accurately measure psychomotor slowing, a central cognitive symptom of MS. Additionally, traditional batteries lack multiple alternate forms necessary to control for practice effects when assessing cognition over time. Finally, such batteries are lengthy and expensive. Computerized neuropsychological batteries address many of these shortcomings. They measure response time more precisely, require less administration time, include alternate forms, and are ideal for rapid screening/triage. Although there are normative data on the reliability and validity of computerized measures, there have been no controlled validation studies with MS patients. The current study was designed to validate a computerized neuropsychological battery (ANAM) for use with relapsing-remitting (RR) MS patients. Prior to initiation of interferon-b-1a (Avonex) treatment, subjects participated in a neuropsychological evaluation consisting of traditional and computerized measures. Moderate-to -high correlations were found between computerized and traditional measures. Computerized tests accurately predicted performance on key traditional tests. The battery was also concordant with traditional measures in identifying RR MS patients with and without neurocognitive impairment. Findings are discussed with respect to increased accuracy and accessibility of neuropsychological evaluations for MS patients.
Automated Neuropsychiatric Measurements of Information Processing in Fibromyalgia
Rheumatology International; 2008 Apr; 28(6): 561-566
Brian Walitt, Tresa Roebuck-Spencer, Joseph Bleiberg, Gregory Foster and Arthur Weinstein
Washington Hospital Center (Washington D.C.); National Rehabilitation Hospital (Washington D.C.); MedStar Research Institute (Hyattsville, MD)
Aberrant central neurological functioning is believed to contribute to the abnormal sensations of fibromyalgia (FM). Most patients with FM complain of diminished cognitive function. This study sought to compare objective cognitive function between FM and healthy controls at baseline and to determine if symptomatic improvement was related to objective cognitive improvement. Automated Neuropsychological Assessment Metrics (ANAM) was used to quantify neurocognitive function. Performance on ANAM was compared between subjects with FM, musculoskeletal pain, and pain-free controls. Ten separate FM subjects completed an 8-week comprehensive treatment program. Serial testing with ANAM and the Fibromyalgia Impact Questionnaire was conducted. Statistical analysis was performed using repeated Wilcoxon signed rank tests. No differences were noted on ANAM between controls and subjects with pain disorders. A clinical improvement (FIQ median change 33.9, P = 0.002) was noted with treatment without concomitant change in ANAM scores. No cognitive impairment in FM was demonstrated using ANAM.
Magnitudes of Decline on Automated Neuropsychological Assessment Metrics Subtest Scores Relative to Predeployment Baseline Performance Among Service Members Evaluated for Traumatic Brain Injury in Iraq
Journal of Head Trauma Rehabilitation (January/February 2012), 27:1, 45-54
Craig Bryan, PsyD, ABPP; Ann Marie Hernandez, PhD
Section Editor(s): Bruce Caplan, PhD, ABPP; Jennifer Bogner, PhD, ABPP
Objective: Identify the proportion of service members demonstrating declines in Automated Neuropsychological Assessment Metrics (ANAM) scores as part of a traumatic brain injury (TBI) evaluation conducted while deployed to Iraq.
Background: Although TBI has been associated with poorer performance on cognitive tests in the general population and military combatants, little is known about the proportion of service members demonstrating declines in ANAM scores after TBI.
Methods: Military personnel (n=116) referred to a combat support hospital for TBI evaluation in Iraq underwent a standardized intake evaluation including computerized neurocognitive testing, psychological and physical health questionnaires, a clinical interview, and a physical examination by a physician. Predeployment and postinjury cognitive performance among service members with and without a TBI diagnosis was compared.
Results: A significantly larger proportion of patients with TBI demonstrated greater declines in speed across all ANAM subtests compared with patients with no TBI. Differences in accuracy scores among patients with TBI relative to patients without TBI were nonsignificant. Patients with TBI also demonstrated greater than minimal declines on throughput Simple Reaction Time, Procedural Reaction Time, Code Substitution-Learning, and Spatial Memory scores, with no significant differences on Code Substitution-Delayed or Mathematical Processing (MATH). A similar pattern was seen among individuals examined within 72 hours of index injury.
Conclusion: Assessment of cognitive impairment following TBI in a combat zone may assist providers in making treatment recommendations for service members with mild TBI.
Validity of the Virtual Reality Stroop Task (VRST) in active duty military
Journal of Clinical & Experimental Neuropsychology, 35(2), 112-123.
Armstrong, C. M., Reger, G. M., Edwards, J., Rizzo, A. A., Courtney, C. G., & Parsons, T. D. (2013).
Ubiquitin Carboxy-Terminal Hydrolase L1 as a serum neurotrauma biomarker for exposure to occupational low-level blast
Frontiers in Neurology, 6.
Carr, W., Yarnell, A. M., Ong, R., Walilko, T., Kamimori, G. H., da Silva, U., . . . LoPresti, M. L. (2015).
Using base rates of low scores to interpret the ANAM4 TBI-MIL battery following mild traumatic brain injury
Arch Clin Neuropsychol, 30(1), 26-38.
Ivins, B. J., Lange, R. T., Cole, W. R., Kane, R., Schwab, K. A., & Iverson, G. L. (2015).
Eight-Day Temporal Stability of the Automated Neuropsychological Assessment Metric (ANAM) in a Deployment Environment
Applied Neuropsychology: Adult, 1-7.
Dretsch, M., Parish, R., Kelly, M., Coldren, R., & Russell, M. (2015).
Multiple Past Concussions are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers
Journal of Neurotrauma.
Dretsch, M., Silverberg, N., & Iverson, G. L. (2015).
Acute post-traumatic stress symptoms and age predict outcome in military blast concussion
Mac Donald, C. L., Adam, O. R., Johnson, A. M., Nelson, E. C., Werner, N. J., Rivet, D. J., & Brody, D. L. (2015).
No effect of deployment environment in establishing baseline neurocognitive scores in U.S. Army soldiers
Applied Neuropsychology: Adult, 20(4), 272-276.
Dretsch, M. N., Coldren, R. L., Kelly, M. P., Parish, R. V., & Russell, M. L. (2013)
No significant acute and subacute differences between blast and blunt concussions across multiple neurocognitive measures and symptoms in deployed soldiers
Dretsch, M., Kelly, M., Coldren, R., Parish, R., & Russell, M. (2014).
Analysis of Post-Deployment Cognitive Performance and Symptom Recovery in U.S. Marines
PLoS ONE, 8(11), e79595.
Haran, F. J., Alphonso, A. L., Creason, A., Campbell, J. S., Johnson, D. R., Young, E., & Tsao, J. W. (2013).
Effects of Hyperbaric Oxygen on Symptoms and Quality of Life Among Service Members With Persistent Postconcussion Symptoms: A Randomized Clinical Trial
JAMA internal medicine.
Miller, R. S., Weaver, L. K., Bahraini, N., Churchill, S., Price, R. C., Skiba, V., . . . Liu, J. (2014).
Effect of clinical characteristics on cognitive performance in service members and veterans with histories of blast-related mild traumatic brain injury
Brain Injury, 28(13-14), 1667-1674.
Neipert, L., Pastorek, N. J., Troyanskaya, M., Scheibel, R. S., Petersen, N. J., & Levin, H. S. (2014).
Blast-related mild traumatic brain injury in the acute phase: Acute stress reactions partially mediate the relationship between loss of consciousness and symptoms
Brain Injury, 28 (8), 1052-1062.
Norris, J. N., Sams, R., Lundblad, P., Frantz, E., & Harris, E. (2014).
ANAM4 TBI Reaction Time-Based Tests Have Prognostic Utility for Acute Concussion
Military Medicine, 178 (7), 767-774.
Norris, J. N., W. Carr, et al. (2013).
Serum brain biomarker level, neurocognitive performance and self-reported symptom changes in soldiers repeatedly exposed to low-level blast: A breacher pilot study
Journal of Neurotrauma, 30 (19), 1620-1630.
Tate, C. M., K. K. W. Wang, et al. (2013).
Acute white matter differences in the fornix following mild traumatic brain injury using diffusion tensor imaging
Journal of Neuroimaging, 23(2), 224-227.
Yallampalli, R., Wilde, E. A., Bigler, E. D., McCauley, S. R., Hanten, G., Troyanskaya, M., . . . Levin, H. S. (2013).
Postconcussional disorder and PTSD symptoms of military-related traumatic brain injury associated with compromised neurocircuitry
Hum Brain Mapp, 35(6), 2652-2673.
Yeh, P. H., Wang, B., Oakes, T. R., French, L. M., Pan, H., Graner, J., . . . Riedy, G. (2014).
Assessment of Acute Concussion in the Combat Environment
Archives of Clinical Neuropsychology (2012), First published online: April 3, 2012.
Mark P. Kelly, Rodney L. Coldren, Robert V. Parish, Michael N. Dretsch, and Michael L. Russell
Despite the prevalence of concussion in soldiers deployed to Iraq and Afghanistan, neuropsychological tests used to assist in concussion management have not been validated on the battlefield. This study evaluated the validity of the Automated Neuropsychological Assessment Metrics (ANAM) in the combat environment. Cases meeting criteria for concussion, healthy controls, and injured controls were assessed. Soldiers were administered the ANAM, traditional neuropsychological tests, and a background questionnaire. Cases were enrolled within 72 h of concussion. Cases exhibited poorer performance than controls on all ANAM subtests, with significant differences on simple reaction time (SRT), procedural reaction time (PRT), code substitution, and matching to sample (p < .001). Discriminant ability of scores on SRT and PRT subtests was 71%, which improved to 76% when pre-deployment baseline scores were available. An exploratory clinical decision tool incorporating ANAM scores and symptoms improved discriminant ability to 81%. Results provide initial validation of the ANAM for detecting acute effects of battlefield concussion.
Comparison of Concussive Symptoms, Cognitive Performance, and Psychological Symptoms Between Acute Blast- Versus Nonblast-Induced Mild Traumatic Brain Injury
Journal of the International Neuropsychological Society (2011), 17, 36-45
Cynthia A. Luethcke, Craig J. Bryan, Chad E. Morrow, and William C. Isler, Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
Maxwell Air Force Base, Montgomery, Alabama, Air Force Medical Operations Agency, San Antonio, Texas
Blast-related head injuries are one of the most prevalent injuries among military personnel deployed in service of Operation Iraqi Freedom. Although several studies have evaluated symptoms after blast injury in military personnel, few studies compared them to nonblast injuries or measured symptoms within the acute stage after traumatic brain injury (TBI). Knowledge of acute symptoms will help deployed clinicians make important decisions regarding recommendations for treatment and return to duty. Furthermore, differences more apparent during the acute stage might suggest important predictors of the long-term trajectory of recovery. This study evaluated concussive, psychological, and cognitive symptoms in military personnel and civilian contractors (N582) diagnosed with mild TBI (mTBI) at a combat support hospital in Iraq. Participants completed a clinical interview, the Automated Neuropsychological Assessment Metric (ANAM), PTSD Checklist-Military Version (PCL-M), Behavioral Health Measure (BHM), and Insomnia Severity Index (ISI) within 72 hr of injury. Results suggest that there are few differences in concussive symptoms, psychological symptoms and neurocognitive performance between blast and nonblast mTBIs, although clinically significant impairment in cognitive reaction time for both blast and nonblast groups is observed. Reductions in ANAM accuracy were related to duration of loss of consciousness, not injury mechanism.
Cognitive Change Associated with Self-Reported Mild Traumatic Brain Injury Sustained During the OEF/OIF Conflicts
The Clinical Neuropsychologist, doi: 10.1080/13854046.2011.650214, Available online: 24 Apr 2012
Tresa M. Roebuck-Spencer, Andrea S. Vincent, David A. Twillie, Bret W. Logan, Col Mary Lopez, Col Karl E. Friedl, Stephen J. Grate, Robert E. Schlegel and Kirby Gilliland
Traumatic brain injury (TBI) has received much attention due to high rates of this injury in Service Members returning from the Iraq/Afghanistan conflicts. This study examined cognitive performance in Service Members tested with ANAM prior to and following deployment. The sample was divided into a control group (n = 400) reporting no TBI injury prior to or during most recent deployment, and a group who self-reported a TBI injury (n = 502) during most recent deployment. This latter group was divided further based on self-report of post-concussion symptoms at post-deployment testing. All three groups performed similarly at pre-deployment. The group reporting TBI with active symptoms performed worst at post-deployment and included the highest percentage of individuals showing significant decline in cognitive performance over time (30.5%). A small sample of symptomatic individuals with a non-TBI reported injury did not demonstrate similar declines in performance, suggesting that active symptoms alone cannot account for these findings. Of those reporting a TBI injury during deployment, 70% demonstrated no significant change in cognitive performance compared with baseline. Although the exact etiology of observed declines is uncertain, findings indicate that individuals who self-report TBI during deployment with active symptomatology at post-deployment are at greatest risk for declines in cognitive performance. These individuals can be identified using self-report and brief computer-based testing. Importantly, the majority of active-duty individuals reporting TBI during deployment do not present with lasting significant cognitive impairment, a finding consistent with the civilian literature on mild TBI.
Mending the Mind: Multidisciplinary Efforts Converge to Help Service Members and Veterans Facing Brain Injuries
Army AL&T, January-March 2012, pp 89-92
Col Karl E. Friedl
Key points regarding cognitive assessment:
Studies have shown that cognitive tests detect concussion effects in individuals even after they report themselves to be symptom-free.
Performance on the Automated Neuropsychological Assessment Metrics in a Nonclinical Sample of Soldiers Screened for Mild TBI after Returning from Iraq and Afghanistan: a Descriptive Analysis.
J. Head Trauma Rehab. 2009 Jan-Feb; 24(1): 24-31.
Brian J. Ivins, MPS; Robert Kane, PhD; Karen A. Schwab, PhD
Defense and Veterans Brain Injury Center, Washington, DC
Purpose: To characterize cognitive test performance in a sample of US Army soldiers who had served in Iraq and Afghanistan and were tested after returning to their home base. To determine whether if a self-reported history of deployment-related traumatic brain injury (TBI), lifetime history of TBI, and the current postconcussive symptom status affected cognitive test performance.
Methods: A convenience sample of 956 soldiers was administered the Automated Neuropsychological Assessment Metrics (ANAM) test battery as well as questionnaires asking about deployment-related TBI, lifetime TBI history, and current TBI-related symptoms.
Results: Consistent with past mild TBI (MTBI) research, having a history of deployment-related MTBI up to 2 years prior to cognitive testing was not associated with poor ANAM performance after deployment. There also were no associations between poor ANAM performance and the number of lifetime TBIs, and injury severity and the number of problematic postconcussive symptoms.
Conclusions: A history of self-reported MTBI or current postconcussive symptoms does not increase the risk of cognitive impairment in service members returning from Iraq and Afghanistan.
Permission received from Lippincott: http://lww.com
Reference Data from the Automated Neuropsychological Assessment Metrics For Use in Traumatic Brain Injury in an Active Duty Military Sample
Mil Med. 2008 Sep; 173(9): 836-52.
Vincent AS. Bleiberg J, Yan S, Ivins B, Reeves DL, Schwab K, Gilliland K, Schlegel R, Gordon D
Center for the Study of Human Operator Performance, University of Oklahoma, Norman, OK 73072, USA
The current study examined the performance of active duty soldiers on the Automated Neuropsychological Assessment Metrics (ANAM) Traumatic Brain Injury (TBI) test battery, to expand the reference data for use in military settings. The effects of age and gender on cognitive performance also were explored. The ANAM TBI battery, consisting of six performance tests and two subjective scales, was administered to a sample of healthy active duty soldiers (N = 5,247) as part of a concussion surveillance program. Performance means and SDs, stratified according to age and gender, are reported as reference data. In addition, the impact of age and gender on performance measures was analyzed. Because ANAM is rapidly being adopted for use in many military medical and research applications, the establishment of these reference values is invaluable, particularly for assisting with rapid accurate evaluation and treatment in clinical settings.
Army Research Needs for Automated Neuropsychological Tests: Monitoring Soldier Health and Performance Status
Archives of Clinical Neuropsychology 22S (2007), S7-S14
Karl E. Friedl, Stephen J. Grate, Susan P. Proctor, James W. Ness, Brian J. Lukey, Robert L. Kane
U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760-5007, United States
Military Operational Medicine Research Program, Fort Detrick, MD 21702-5012, United States
Boston University School of Public Health, Boston, MA 02215, United States
VA Boston Healthcare System, Boston, MA 02130, United States
Department of Behavioral Biology, U.S. Military Academy, West Point, NY 10996, United States
VA Maryland Health Care System, Baltimore, MD 21201, United States
Abstract: Information on the mental status of soldiers operating at the limits of human tolerance will be vital to their management in future deployments; it may also allow earlier intervention for conditions such as undiagnosed Gulf War illnesses and Parkinson's Disease. The Army needs a parsimonious set of neuropsychological tests that reliably identify subtle changes for: (1) early detection of individual health and military performance impairments and (2) management of occupational and deployment health risks. Testing must characterize cognitive lapses in healthy individuals faced with relevant operational stressors (i.e., anxiety, information overload, thermal strain, hypoxia, fatigue, head impact, chemical or radiation exposures, and metabolic challenges). This effort must also explore the neuropsychological methods in militarily relevant conditions to extend our understanding of relevant functional domains and how well they correspond to modes of testing. The ultimate objective is unobtrusive real-time mental status monitoring.
Excerpt: More recently, ANAM has been used to assess effects of injury and disease states (e.g., head injury, multiple sclerosis, and Parkinson's disease). While different ANAM measures have been employed, there has been sufficient consistency to potentially shed light on anatomical and functional changes that can contribute to our understanding of less dramatic but important changes in healthy humans under stress. The thread that ties these issues together is the need of the military for a sensitive and consistent approach for measuring crucial changes in human performance.
Military and VA Telemedicine Systems for Patients with Traumatic Brain Injury
Journal of Rehabilitation Research & Development 2007:44(7); 1017-26
Philip Girard, MS
Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center, Washington, DC; Manchester Department of Veterans Affairs Medical Center, Manchester, NH
Abstract: Telemedicine plays a critical role within the Department of Veterans Affairs (VA) Veterans Health Administration by allowing the surveillance and care of patients who are isolated by geography, poverty, and disability. In military settings, telemedicine is being widely used to identify injury and illness and aid in the treatment, rehabilitation, and recovery of combat-wounded soldiers in theater. Rapid advances in both domains are transforming the way clinicians provide care, education, and support to patients with traumatic brain injury (TBI) and their families. This article discusses the military and VA telemedicine capabilities that are supporting the care of service members and veterans with TBI. These capabilities include new technologies that enhance the identification of TBI, management of symptoms in theater, and application of proven technologies (interactive video, Internet, and World Wide Web) to improve overall care coordination throughout military and VA systems. The impact of distance learning, teleconsultation, telerehabilitation, and home telehealth programs is also described within this context.
Excerpt: The goal of the DVBIC research is to test the technical feasibility of remote cognitive assessment systems that could (1) allow medics to identify TBI and postconcussion syndrome (PCS) in the field and (2) give VA and community healthcare providers the ability to identify TBI remotely. The TBI assessment system is a Web-based program that contains evaluation questionnaires and brief cognitive screening tests, including:
- The PCS Checklist and Scale, which assess the most common symptoms experienced after TBI.
- The State-Trait Anxiety Inventory and the Automated Neuropsychological Assessment Metrics (ANAM) Mood and Sleep Scales, which provide focused assessment of mood and anxiety disturbance.
- The DVBIC clinical tracking form, which documents injury characteristics such as severity and cause.
- The ANAM Simple Reaction Time and Continuous Performance subtests, which objectively measure cognitive functioning.
- Together these tests help clinicians identify the areas of the brain that may have been affected by the injury. Step-by-step instructions are provided as the patient works through the test. Areas of concern can be flagged for easy reference by physician's assistants (PAs) onsite, and full reports can be gathered by a neuropsychologist at different intervals or reviewed by specialists and returned with recommendations. Various technical, security, and logistical issues are involved in the delivery of such testing; however, limited deployment with a laptop computer with high-speed Internet access has been successful.
Case Report: Treatment of Mild Traumatic Brain Injury with Hyperbaric Oxygen
Hyperbaric Medicine 2009: 36(6); 391-9.
Wright JK, Zant E, Groom K, Schlegel RE, Gilliland K.
720th Special Tactics Group, Hurlburt Field, Florida, USA
Two United States Air Force Airmen were injured in a roadside improvised explosive device (IED) blast in Iraq in January 2008. Both airmen suffered concussive injuries and developed irritability, sleep disturbances, headaches, memory difficulties and cognitive difficulties as symptoms of mild traumatic brain injury (mTBI). Six months after injury, repeat Automated Neuropsychological Assessment Metrics (ANAM) testing showed deterioration, when compared to pre-injury baseline ANAM assessment, in all measured areas (simple reaction time, procedural reaction time, code substitution learning, code substitution delayed, mathematical processing, and matching to sample). The airmen were treated with hyperbaric oxygen in treatments of 100% oxygen for one hour at 1.5 atmospheres absolute, resulting in rapid improvement of headaches and sleep disturbances, improvement in all symptoms and resolution of most symptoms. Repeat ANAM testing after completion of the hyperbaric treatments - nine months after initial injury - showed improvement in all areas, with most measures improving to pre-injury baseline levels. The airmen received no other treatment besides medical monitoring. Repeat neuropsychologic testing confirmed the improvement. We conclude that the improvement in symptoms and ANAM performance is most likely attributable to HBO treatment.
Association of Time Since Deployment, Combat Intensity, and Posttraumatic Stress Symptoms with Neuropsychological Outcomes Following Iraq War Deployment
Archives of General Psychiatry 2009; 66(9): 996-1004.
Copyright (2009) American Medical Association. All rights reserved.
Marx, Brian P. PhD; Brailey, Kevin PhD; Proctor, Susan P., DSc; MacDonald, Helen Z. PhD; Graefe, Anna C. BA; Amoroso, Paul MD, MPH; Heeren, Timothy PhD; Vasterling, Jennifer J. PhD
Behavioral Sciences Division, Veterans Affairs National Center for PTSD (Drs Marx, Brailey, MacDonald, and Vasterling and Ms Graefe); Psychology Service (Drs Marx, Brailey, MacDonald, and Vasterling) and Research Service (Dr Proctor), Veterans Affairs Boston Healthcare System; Department of Psychiatry, Boston University School of Medicine (Drs Marx, Brailey, MacDonald, and Vasterling); and Departments of Environmental Health (Dr Proctor) and Biostatistics (Dr Heeren), Boston University School of Public Health, Boston; US Army Research Institute of Environmental Medicine, Natick, Massachusetts (Dr Proctor); and Madigan Army Medical Center, Fort Lewis, Washington (Dr Amoroso).
Conclusions: In this study of army soldiers deployed to the Iraq war, only PTSD symptoms (among soldiers back from deployment for 1 year) were associated with a neuropsychological deficit (reduced attention). Greater combat intensity was associated with enhanced reaction time, irrespective of time since return.
Excerpt: To avoid multiplicity of outcomes and protect against type I error, analyses included only outcome measures of theoretical interest (i.e., those found to differentiate deployers from non-deployers in the previous report 6) (Table 1). These included residualized T3 values of the Neurobehavioral Evaluation System, third edition,32 Continuous Performance Task omissions (a sustained attention task requiring detection of targets from distracter stimuli); Automated Neuropsychological Assessment Metric 33 scores (simple reaction-time throughput, a calculated measure of reaction-time efficiency, taking into account accuracy and response time); Wechsler Memory Scale, third edition,34 verbal paired associates I summary scores (requiring learning of unrelated word pairs); and Wechsler Memory Scale 35 visual reproductions percent retention (requiring reproduction of geometric designs from memory).
Outpatient Mental Healthcare of Military Personnel at a Remote U.S. Air Base in Northern Iraq
Government Report Publication No AFRL-SA-BR-TR-2009-0017 : Accession Number: ADA511279 (2009) JuneTeg W. McBride, Major, USAF
Air Force Materiel
Command, Brooks AFB, TX
This article is a descriptive utilization study of a United States Air Force (USAF) outpatient mental health clinic at a remote Air Base in northern Iraq over an 8-month period (Nov 07 - Jun 08). This study provides a description of the clinic and psychological services (i.e., intake and triage, hospitalization, aero-medical evacuations and follow-up care), and utilization data of military personnel seeking care. The study follows the outline of a previously published study (Chappelle & Lumley, 2006) for those interested in comparing services and utilization data between northern and southern regions of Iraq over similar lengths of time. The study also provides recommendations to USAF military mental health providers preparing to serve the mental health needs of military personnel during their deployment.Excerpt: The screening included administration of the Military Acute Concussion Evaluation (MACE) and the Automated Neuropsychological Assessment Metrics (ANAM). The ANAM has been used extensively with Army soldiers following deployment (Vasterling et al., 2006). The level of acute impairment, the patient's unique duty requirements, and the likelihood of re-exposure were considered when making return-to-duty recommendations.
Influence of Demographics on Computerized Cognitive Testing in a Military Sample
Military Psychology, Volume 20, Issue 3 July 2008 , pages 187 - 203
T. M. Roebuck-Spencer, D. L. Reeves, J. Bleiberg, A. N. Cernich, K. Schwab, B. Ivins, A. Salazar, S. Harvey, F. Brown, D. Warden
Center for Cognitive Neuroscience, National Rehabilitation Hospital, Washington, DC
Abstract: Computerized cognitive testing with software programs such as the Automated Neuropsychological Assessment Metrics (ANAM) has long been used to assess cognition in military samples. This study describes demographic influences on computerized testing performance in a large active duty military sample (n = 2366). Performance differences between men and women were minimal on most ANAM subtests, but there was a clear speed/accuracy trade-off, with men favoring speed and women favoring accuracy on the Continuous Performance Test (CPT) subtest. As expected, reaction time increased with age on most subtests, with the exception of Mathematical Processing Test (MTH). Higher education resulted in significant but minimal performance increases on Code Substitution (CDS), Matching to Sample (MSP), and Memory Search (STN) subtests. In contrast, substantial performance differences were seen between education groups on the MTH subtest. These data reveal that it is important to consider demographic factors, particularly age, when using ANAM to draw conclusions about military samples. These results also point to the importance of exploring demographic influences for all reaction time-based computerized assessment batteries.
Beyond Diagnosis: Understanding the Healthcare Challenges of Injured Veterans Through the Application of the International Classification of Functioning, Disability and Health (ICF)
The Clinical Neuropsychologist, 2009;23:8, 1416-1432.
Sandberg, Mark A., Bush, Shane S., and Martin Thomas
Abstract: Psychiatric and neurological disorders brought about by exposure to combat can create serious obstacles to community reintegration. Effective therapeutic and rehabilitative methods designed to address disorders that arise from combat are available. Yet there continues to be a need to develop both a deeper understanding of veterans' needs and best-practice methods to alleviate distress and facilitate community participation. Awareness of these needs served as the catalyst for the International Conference on Behavioral Health and Traumatic Brain Injury and is the basis for developing numerous new programs and service refinements across government and non-government organizations. Despite advances, community reintegration remains a complicated endeavor for many veterans returning home who are experiencing traumatic brain- and stress-related disorders. Accurately conceptualizing and codifying symptoms and barriers to community participation, beyond impairment analysis and diagnostic inclusion, is necessary to guide treatment planning and inform programmatic refinements. The International Classification of Function, Disability and Health (ICF) offer a useful taxonomic tool that can assist in refining an understanding of the challenges confronting our returning veterans. In turn, resources can be appropriately allocated and neuropsychological therapies and other rehabilitation interventions, which assist veterans to resume productive and satisfying lives, will more likely be developed and implemented.
Excerpt: Pre and post deployment would be critical times during which IFC health updated could be collected. Specific methods of health assessment would need to be identified, including those focusing on neurocognitive functions. The Automated Neuropsychological Assessment Metric (ANAM) is one such measure that has recently been implemented by the armed forces as a pre-deployment screening.
Evaluation of the Zurich Guidelines and exercise testing for return to play in adolescents following concussion
Clinical Journal Sports Medicine, 24(2), 128-133.
Darling, S. R., Leddy, J. J., Baker, J. G., Williams, A. J., Surace, A., Miecznikowski, J. C., & Willer, B. (2014).
Examining Neurocognitive Function in Previously Concussed Interscholastic Female Soccer Players
Appl Neuropsychol Child, 1-11.
Forbes, C. R., Glutting, J. J., & Kaminski, T. W. (2014).
The Effect of Visual and Sensory Performance on Head Impact Biomechanics in College Football Players
Ann Biomed Eng, 42(1), 1-10.
Harpham, J. A., Mihalik, J. P., Littleton, A. C., Frank, B. S., & Guskiewicz, K. M. (2014).
fMRI and brain activation after sport concussion: a tale of two cases
Frontiers in neurology, 5.
Hutchison, M. G., Schweizer, T. A., Tam, F., Graham, S. J., & Comper, P. (2014).
Factors Influencing Ball-Player Impact Probability in Youth Baseball
Sports Health: A Multidisciplinary Approach.
Matta, P. A., J. B. Myers, et al. (2013).
Reliable change, sensitivity, and specificity of a multidimensional concussion assessment battery: Implications for caution in clinical practice
Journal of Head Trauma Rehabilitation, 28(4), 274-283.
Register-Mihalik, J. K., Guskiewicz, K. M., Mihalik, J. P., Schmidt, J. D., Kerr, Z. Y., & McCrea, M. A. (2013).
Masters athletes exhibit larger regional brain volume and better cognitive performance than sedentary older adults
Journal Magnetic Resonance Imaging, 38(5), 1169-1176.
Tseng, B. Y., Uh, J., Rossetti, H. C., Cullum, C. M., Diaz-Arrastia, R. F., Levine, B. D., . . . Zhang, R. (2013).
Dehydration and performance on clinical concussion measures in collegiate wrestlers
Journal of Athletic Training, 48(2), 153-160.
Weber, A. F., J. P. Mihalik, et al. (2013).
Retest Reliability in Adolescents of a Computerized Neuropsychological Battery Used to Assess Recovery from Concussion
NeuroRehabilitation 2007; 22(3): 243-51
Segalowitz SJ, Mahaney P, Santesso DL, MacGregor L, Dywan J, Willer B
Psychology Department, Brock University, St. Catherine's, Ontario, Canada.
Exerpt: We examined in a group of 15-year-old adolescents the retest reliability over one week of 7 subscales of the Automated Neuropsychological Assessment Metrics (ANAM), a computerized battery based on standard neuropsychological test measures that is one of several such batteries available to assess concussion effects. Since the principle behind these computerized batteries is to assess athletes before injury and after injury to determine the level of deficit and whether the individual is safe to return to play, it is critical that such batteries have excellent retest reliability. Retest reliability of the ANAM was good, especially for the aggregate of throughput scores, reaching 0.87, but lower for individual subtests, especially for those measuring only speed of processing. Thus, the ANAM aggregated score appears to have robust reliability for cognitive measures involving memory and attention in 15-year-olds. Limitations related to assessing return-to-baseline after concussion in adolescents are discussed.
Reprinted from above cited publication, copyright 2007, with permission from IOS Press (www.iospress.nl)
Repeated Measures of Cognitive Processing Efficiency in Adolescent Athletes: Implications for Monitoring Recovery from Concussion.
Neuropsychiatry & Neuropsychol Behav Neurol. 1999 Jul; 12(3): 167-169.
Daniel JC, Olesniewicz MH, Reeves DL, Tam D, Bleiberg J, Thatcher R, Salazar A.
Objective: The objective of this study was to determine whether an adolescent athlete, in the absence of concussion, would be expected to show an improvement in cognitive function during the course of a high school football season.
Background: At least 60,000 American high school football players suffer cerebral concussion every year, and symptoms may persist for 4 or more years in as many as 24%.
Method: 34 members of a cohort of healthy athletes, aged 13-18, were administered a computerized neuropsychologic test battery from the Automated Neuropsychological Assessment Metrics (ANAM) before and after the 1997 high school football season, with a mean interval of 16.1 (range 12.3-20.4) weeks between tests. Preseason and postseason scores on eight tests were compared, with significance determined by paired t-test. For those tests in which an improvement was noted, one-way analysis of variance and Wilcoxon tests were used with both preseason and postseason data to determine if there was a measurable difference in cognitive processing efficiency between older and younger subjects.
Results: Improvements in processing efficiency (p < 0.001) were noted on tests designed to measure visual scanning and sustained attention (CDS), immediate recall (CDI), and short-term memory (CDD). Older subjects generally performed better on each of these tests, though the difference was significant in only one case (postseason CDI, 17-18 year olds vs. 13-14 year olds, Wilcoxon, p = 0.043).
Conclusions: Our findings suggest that ANAM is sensitive to differences and improvements in cognitive function during a 4 month interval in adolescence. They also suggest that using "return to baseline" cognitive function as the criterion for evidence of recovery from concussion may be insufficient, especially when the baseline measurement was obtained 4 or more months prior to the date of "full recovery."
Permission received from Lippincott http://lww.com
Prolonged Recovery of Memory Function After Mild Traumatic Brain Injury in Adolescent Athletes
J Neurosurg 108(3): 511-516, 2008
Anita Sim, PhD., Lori Terryberry-Spohr, PhD., and Kathryn R. Wilson, MA
Madonna Rehabilitation Hospital, Lincoln; University of Nebraska-Lincoln, Nebraska;
And Department of Psychiatry and Neurobehavioral Sciences, University of Virginia
Neuropsychological Performance, Postural Stability, and Symptoms After Dehydration.
Journal of Athletic Training, Vol 42(1), Jan-Mar, 2007. pp. 66-75.
Patel, Akshay V., Mihalik, Jason P., Notebaert, Andrew J., Guskiewicz, Kevin M., Prentice, William E.
Context: Dehydration and concussion are common in athletic performance. Some experts have speculated that dehydration may negatively influence performance on tests commonly used for concussion assessment.
Objective: To determine how the signs and symptoms, neuropsychological performance, and postural stability are affected by dehydration. Main Outcome Measure(s): We used the Standardized Assessment of Concussion to test mental status, the Automated Neuropsychological Assessment Metrics (ANAM) to evaluate neuropsychological performance, the NeuroCom Sensory Organization Test and Balance Error Scoring System to test postural stability, the Graded Symptom Checklist to assess symptom presence and severity in our participants, and urine specific gravity and body mass to determine hydration status.
Results: No differences were noted for the Standardized Assessment of Concussion, total Balance Error Scoring System errors, composite Sensory Organization Test, and composite ANAM scores between conditions. Subjects in the dehydrated condition had significant deterioration in visual memory (t23 = 2.130, P < .001) and fatigue measures (t23 = -7.880, P < .001) as assessed by ANAM. The dehydrated condition resulted in subjects reporting a significantly higher number(t23 = -8.585, P 23 = -7.673, P < .001) of symptoms than the euhydrated subjects on the Graded Symptom Checklist.
Conclusions: Our results suggest that moderate dehydration (-2.5 ± 0.63%) significantly influenced the self-report of symptoms commonly associated with concussion. Dehydration resulted in a deterioration of visual memory and increases in the self-report of fatigue. Despite these findings, dehydration did not affect other neuropsychological and postural stability objective testing measures for concussion.
Automated Neuropsychological Assessment Metrics Sports Medicine Battery.
Arch Clin Neuropsychol. (2007) 22(1): S101-S114
Cernich A, Reeves D, Sun W, Bleiberg J.
Baltimore Veteran's Affairs Medical Center; BT/116/MH: 10 N Greene Street, Baltimore, MD 21201, United States.
This paper describes the development and ongoing validation of the ANAM-sports medicine battery (ASMB) for use in concussion surveillance and management. A review of previous research utilizing the ASMB highlights current issues in concussion surveillance including: tracking cognitive recovery, effect of previous concussion history on acute concussion presentation, and clinical decision making using computerized measures. ASMB interpretation using reliable change indices or impairment indices is highlighted. Future development of the ASMB is discussed as it relates to interpretation of ASMB, development of appropriate norms, and defining adequate baseline assessment. This includes the definition of practice effects, the effects of maturation on test performance and definition of adequate baseline assessment that clearly defines a subject's normal cognitive performance level. ASMB is ready for cautious introduction into clinical practice for use by neuropsychologists with experience in both sports concussion and computerized testing.
Measurement of Head Impacts in Collegiate Football Players: Clinical Measures of Concussion After High- and Low-Magnitude Impacts
Neurosurgery 61(6): 1236-1243, 2007
McCaffrey, Meghan A.; Mihalik, Jason P. M.S.; Crowell, Dean H. M.A.; Shields, Edgar W. PhD; Guskiewicz, Kevin M. Ph.D.
Department of Exercise and Sport Science, Curriculum in Human Movement Science, The University of North Carolina, Chapel Hill, North Carolina
Conclusion: Our findings suggest that sustaining an impact greater than 90 g does not result in acute observable balance and neurocognitive deficits within 24 hours of sustaining the impact. Although previous studies have suggested a theoretical injury threshold, none have been founded on empirical data collected on the playing field in real-time. Future studies should consider the cumulative effects of impacts of varying magnitudes.
Excerpt: Participants were tested using the Automated Neuropsychological Assessment Metrics (ANAM) battery to assess neurocognitive function&The sports medicine battery has been used at our institution for more than 5 years and has been designed to maximize the benefits of computerized testing while minimizing the time needed to complete preseason baseline and post-injury follow-up testing.
Athlete Characteristics and Outcome Scores for Computerized Neuropsychological Assessment: A Preliminary Analysis
J Athl Train 2007 Oct-Dec; 42(4): 515-523.
Cathleen N Brown, PhD, ATC,* Kevin M Guskiewicz, PhD, ATC, FACSM, and Joseph Bleiberg, PhD
Conclusions: Performance on computerized neuropsychological tests may be affected by a number of factors, including sex, SAT scores, alertness at the time of testing, and the athlete's sport. To avoid making clinical misinterpretations, clinicians should acknowledge that individual baselines vary over time and should account for this variation.
Excerpt: One of the many computerized NP test batteries is the Automated Neuropsychological Assessment Metrics (ANAM; Army Medical Research and Materiel Command, Ft Detrick, MD), which is not yet commercially available. It consists of a battery of subtests that assess standard NP constructs, such as processing speed, short-term memory, working memory, and resistance to interference. Bleiberg et al. used ANAM to detect concussions in a military population. While ANAM data are available on large military samples, limited civilian collegiate data are available. As mentioned, access to individual baseline data is not always feasible; therefore, access to normative data may help the clinician.
Test Validation Research
The effects of display size on performance
Ergonomics, 58(3), 337-354.
Hancock, P. A., Sawyer, B. D., & Stafford, S. (2015).
An initial validation of the Virtual Reality Paced Auditory Serial Addition Test in a college sample
Journal of Neuroscience Methods, 222(0), 15-23.
Parsons, T. D., & Courtney, C. G. (2014).
Initial Clinical Validation of an Embedded Performance Validity Measure within the Automated Neuropsychological Metrics (ANAM)
Archives of clinical neuropsychology, 28(7), 700-710.
Roebuck-Spencer, T. M., Vincent, A. S., Gilliland, K., Johnson, D. R., & Cooper, D. B. (2013).
Evidence for Added Value of Baseline Testing in Computer-Based Cognitive Assessment
Journal of Athletic Training, 48(4), 499-511.
Roebuck-Spencer, T. M., Vincent, A. S., Schlegel, R. E., & Gilliland, K. (2013).
Assessing Change with the Automated Neuropsychological Assessment Metrics (ANAM): Issues and Challenges.
Archives of Clinical Neuropsychology 2007 Feb; 22 Suppl 1: S79-87.
Roebuck-Spencer T, Sun W, Cernich AN, Farmer K, Bleiberg J
National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010, United States.
Accurately documenting cognitive change is important, as neuropsychologists are routinely asked to determine cognitive change following disease progression or medical intervention. Computerized testing batteries, such as the Automated Neuropsychological Assessment Metrics (ANAM), are good tools for assessing change, because they allow for randomization of stimuli, creating near limitless alternate forms and reducing practice effects. The question remains, however, as to how best to determine reliable change in performance using ANAM. The current study compared the use of Reliable Change Index (RCI) and regression based methods (REG) calculated from 28 individuals with migraine. These methods then were applied to an independent sample of 25 individuals with migraine assessed with ANAM at baseline, headache, and following pharmacologic treatment. Traditional repeated measures analyses revealed declines in cognitive efficiency following migraine onset on two of four ANAM tasks and significant improvement on all ANAM tasks following treatment. Rates of deterioration and improvement did not significantly differ between RCI and REG methods, although were slightly different across the ANAM tasks used in this study. A combined ANAM score categorized the most individuals as demonstrating cognitive change, revealing that 60% of subjects declined in performance following headache and 84% improved following migraine treatment.
Identifying and Monitoring Cognitive Deficits in Clinical Populations Using Automated Neuropsychological Assessment Metrics (ANAM) Tests.
Arch Clin Neuropsychol. 2007 Feb; 22 Suppl 1: S115-26. Epub 2006 Nov 13.
ReviewKane RL, Roebuck-Spencer T, Short P, Kabat M, Wilken J.
VA Maryland Healthcare System, United States
In this article we review studies in which Automated Neuropsychological Assessment Metrics (ANAM) measures were used to screen for impairment in various clinical populations. These clinical groups include patients with multiple sclerosis, systemic lupus erythematosus, Parkinson's disease, Alzheimer's dementia, acquired brain injury, and migraine headache. Data are also presented from a group of outpatient referrals unselected with respect to clinical condition. Findings support the use of ANAM as a screening procedure for identifying the impaired patient.
Factor Analysis of Computerized and Traditional Tests used in Mild Brain Injury Research
Clin Neuropsychol. 2000 Aug; 14(3): 287-94.
Bleiberg J, Kane RL, Reeves DL, Garmoe WS, Halpern E.
National Rehabilitation Hospital, Washington DC 20010 USA
The present study examines the relation between a set of computerized neuropsychological measures, Automated Neuropsychological Assessment Metrics (ANAM), and a set of traditional clinical neuropsychological tests. Both sets of tests have been employed in recent studies of mild brain injury. Factor analysis and stepwise regression indicate that both sets of tests measure s=imilar underlying constructs of cognitive processing speed, resistance to interference, and working memory. The present findings indicate strong concordance between computerized and traditional neuropsychological measures and support the construct validity of ANAM and similar procedures.
Consistency of Within-day and Across-day Performance After Mild Brain Injury
Neuropsychiatry Neuropsychol & Behav Neurol. 1997 Oct; 10(4): 247-53.
Bleiberg J, Garmoe WS, Halpern EL, Reeves DL, Nadler JD.
National Rehabilitation Hospital, Medlantic Research Institute, Washington, DC, USA.
The objective of this study was to determine whether inconsistent and erratic within-day and across-day performance is a symptom of mild to moderate traumatic brain injury (TBI), and to determine whether impaired consistency of performance can coexist, in the same patient, with intact or "normal" performance on single administrations of neuropsychological and other cognitive tests. The design was a matched-pair study in which a computerized cognitive test battery was administered 30 times over 4 days to all subjects. Performance patterns between TBI and control subjects were compared. Subjects also received traditional neuropsychological testing. The setting was a rehabilitation hospital outpatient department. The subjects were 12 adult volunteers, six with documented TBI and six with no history of TBI, neurologic illness, or injury. Control subjects showed consistent improvement of performance over days 1 to 4, whereas subjects with TBI showed erratic and inconsistent performance across days. In addition to inconsistent performance, some subjects with TBI showed worsening performance across days. The main outcome measures were performance on the Automated Neuropsychological Assessment Metrics (ANAM) battery and performance on traditional neuropsychological tests. Some patients with TBI in the study who have normal initial performance on traditional clinical neuropsychological tests and newly developed computerized cognitive tests show abnormalities of sustained performance. Such abnormalities are most apparent when performance is observed over multiple days, and are characterized by erratic and inconsistent across-day performance. Inconsistent performance was observed even in those subjects with TBI whose initial performance was equal to or better than that of the control subjects. Deficits in dynamic performance may explain why some patients with TBI who have excellent neuropsychological test performance nonetheless complain of functional decrement from pre-morbid ability.
Permission received from Lippincott http://lww.com
Monitoring Recovery From Traumatic Brain Injury Using Automated Neuropsychological Assessment Metrics (ANAM V1.0)
Arch Clin Neuropsychol. 1997; 12(2): 155-66.
Levinson DM, Reeves DL.
Office of Research, National Cognitive Recovery Foundation, Santa Ana, CA 92705, USA
Twenty-two students in the Coastline Community College Traumatic Head Injury Program completed two sessions of neuropsychological testing spaced 2-3 months apart, using ANAM V1.0. Eight (GP1) were marginally injured, seven (GP2) mildly, and seven (GP3) moderately. Comparisons of first-session accuracy scores with normative data revealed that GP1 was impaired on one test, while GPs 2 and 3 were impaired on 3 and 4 tests, respectively. Second-session accuracy scores were normal for GPs 1 and 2 on all tests, and impaired on one for GP3. Comparisons of first-session efficiency scores with normative data indicated that GP1 was significantly impaired on 2 tests, while GPs 2 and 3 were impaired on all 6. Second-session efficiency scores were normal for GP1 on 5 tests; GPs 2 and 3 also improved but remained impaired on all 6 tests. Based on efficiency, 91 % of the individuals were correctly classified.
ANAM® Genogram: Historical Perspectives, Description, and Current Endeavors
Archives of Clinical Neuropsychology 2007 Feb; 22(1): 15-37
Dennis L. Reeves, Kathryn P. Winter, Joseph Bleiberg and Robert L. Kane
Clinvest, Springfield, MO, United States Spawar Systems Center, NAS, Pensacola, FL, United States National Rehabilitation Hospital, Washington, DC, United States VA Maryland Healthcare System, University of Maryland School of Medicine, United States
This paper presents a historical overview and current perspective of the Automated Neuropsychological Assessment Metrics (ANAM®) test system. We discuss the history of its development along with a synopsis of the evolution of computerized testing that has occurred and led to ANAM® over the past 30 years within the Department of Defense (DOD). We include a description of our current system and test library. Finally, we present an overview of advanced development projects that are presently underway.
We have intentionally avoided addressing issues of reliability, stability, clinical sensitivity, and construct validity in this paper. These issues are presented in other reports in this special issue. DOI:10.1016/j.acn.2006.10.013
Construct Validity of Selected Automated Neuropsychological Assessment Metrics (ANAM) Battery Measures
The Clinical Neuropsychologist, Volume 15, Issue 4 December 2001 , pages 498 - 507
Michael H. Kabat; Robert L. Kane; Angela L. Jefferson; Raymond K. DiPino
Abstract: The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized library of tests designed to assess neurocognitive functioning across administrations (Kane & Reeves, 1997). This study was designed to examine neuropsychological constructs measured by selected ANAM measures and to compare them with traditional measures putatively assessing similar domains. The sample consisted of 191 outpatients with suspected neurocognitive dysfunction. Correlations and regressions indicated significant relationships between traditional and computerized tests measuring similar constructs. PCA results yielded a three-factor solution: Factor I (Processing Speed/Efficiency), Factor II (Retention/Memory), and Factor III (Working Memory). DOI: 10.1076/clin.15.4.498.1882
Examining the Usability of a Computerized Cognitive Training Program in People with Traumatic Brain Injury: A Pilot Study
Archives of Physical Medicine and Rehabilitation, 90(10), e18-e19
Matthew Lebowitz, Joshua Cantor, Wayne Gordon, Lisa Spielman, Teresa Ashman, Theodore Tsaousides and Laila Spina
Mount Sinai Medical Center, New York, NY
Objective: To evaluate the feasibility and utility of a program of computerized cognitive exercises as an intervention for people with traumatic brain injury (TBI).
Design: Pilot pre-post study.
Setting: Participants' homes in an urban community.
Participants: 8 individuals with mild to severe TBI who were 8 months to 22 years post- injury (M=125.75 months, SD=36.6).
Main Outcome Measures: Automated Neuropsychological Assessment Metrics (ANAM 4), a validated computerized neuropsychological battery that tests processing speed, working memory, attention, encoding, spatial processing, and accuracy. Cognitive Failures Questionnaire (CFQ), Frontal Systems Behavior Scale (FRSBE), User Experience Survey (UES).
Conclusions: Computerized speed and attention training may be a viable intervention for outpatients with TBI. The intervention can be delivered in patients' homes with support provided remotely. Further study in randomized trials is warranted.
Feasibility of a Computerized Cognitive Skill-building Program in an Inpatient Traumatic Brain Injury Rehabilitation Setting
Archives of Physical Medicine and Rehabilitation, 90(10), e19-e20
Kristen Dams-O'Connor, Matthew Lebowitz, Joshua Cantor, Wayne Gordon and Laila Spina
Mount Sinai Medical Center, New York, NY
Objective: To explore the feasibility of a computerized cognitive skill-building program for individuals with acute traumatic brain injury (TBI).
Design: Case study.
Setting: Inpatient TBI rehabilitation unit at an urban medical facility.
Patient: 20-year-old woman with severe TBI, 65 days post-injury. Patient was out of PTA during study.
Main Outcome Measures: (1) Automated Neuropsychological Assessment Metrics (ANAM-4), a validated computerized neuropsychological battery that tests processing speed, working memory, attention, encoding, spatial processing, and accuracy. (2) User Experience Survey and brief interview assessing overall experience and impressions of training program.
Conclusions: Computerized cognitive skill-building program is usable by a subset of individuals with TBI during acute inpatient rehabilitation. Recommendations for increasing the feasibility of this intervention on an inpatient unit are discussed.
Reliability and Construct Validity of the Automated Neuropsychological Assessment Metrics (ANAM) Mood Scale
Archives of Clinical Neuropsychology 2008;23(1): 73-85
Johnson Dan R.; Vincent Andrea S.; Johnson Ashley E.; Gilliland Kirby; Schlegel Robert
Center for the Study of Human Operator Performance, University of Oklahoma, Norman, OK
Abstract: The reliability and construct validity of the Automated Neuropsychological Assessment Metrics (ANAM) mood scale (AMS) were examined using concurrent, well-validated measures of mood and confirmatory factor analysis (CFA) with a sample of 210 volunteer college students. The AMS was given in computerized format with multiple adjectives using a visual analog Likert scale yielding seven dimensions of mood including vigor, restlessness, depression, anger, fatigue, anxiety, and happiness. All seven mood dimensions of the AMS demonstrated excellent test-retest reliability and internal consistency. Also, the AMS anxiety dimension correlated strongly with the Spielberger's State Anxiety Inventory (r= 0.67) and the AMS depression dimension correlated strongly with the Beck Depression Inventory-II (r= 0.71). CFA revealed that the AMS 7-factor mood model fit the data well and significantly better than an alternative, theoretically plausible model. When concurrent measures of mood were incorporated in the CFA model, the AMS demonstrated both convergent and discriminant validity. The AMS 7-factor model explained 55.12% of the total variance in the items. It was concluded that the AMS provides a brief yet reasonably complete and valid assessment of mood.