1// DANA peer-reviewed research & validation studies. 2// Add new studies by appending an object to this array â research.html renders it automatically. 3const RESEARCH_STUDIES = [ 4 { 5 "id": 0, 6 "topic": "Predicting Post-COVID-19 Cognitive Decline and Alzheimer's Disease Risk with DANA (NCT05143333, Study in Progress)", 7 "year": "2022-2024", 8 "journal": "Current Study", 9 "citation": "Kristen R. Hollinger, Steven R. Woods, Alexis Adams-Clark, So Yung Choi, Caroline L. Frank, Ryoko Susukida, Carol Thompson, Irving M. Reti, and Adam I. Kaplin, Johns Hopkins University, Departments of Neurology, Psychiatry and Behavioral Sciences, and Biostatistics\n\nNCT05143333 (Study in Progress)", 10 "summary": "Researchers are currently in the second part of an independent, NIH-funded pilot study conducted by Johns Hopkins University. In the first part of the study, JHU\u2019s multidisciplinary group successfully piloted DANA to evaluate cognitive trajectories in patients after COVID-19. The results from that study, and from studies conducted by other teams, suggest that older adults with a history of COVID-19 may represent an at-risk group for Alzheimer\u2019s Disease (AD). Accordingly, there is a pressing need to develop novel, accessible, sensitive methods of predicting post-COVID-19 cognitive decline and AD risk in order to allow for early detection and intervention. In this second phase of the study, the JHU team will apply machine learning to DANA to leverage the DANA platform\u2019s rich, high-frequency, high-sensitivity data in order to (i) accurately measure cognitive decline over short periods of time and (ii) predict risk for post-COVID-19 cognitive decline (and thus risk of AD).", 11 "url": null, 12 "tags": [ 13 "covid" 14 ] 15 }, 16 { 17 "id": 1, 18 "topic": "Adherence Timescale Impacts Completion Rates of High-Frequency Mobile Cognitive Assessments Among Older Adults", 19 "year": "2025", 20 "journal": "Exploration of Medicine", 21 "citation": "Adherence Timescale Impacts Completion Rates of High-Frequency Mobile Cognitive Assessments Among Older Adults\n\nKieffer Christianson, Department of Psychology, University of Nevada, Reno, and Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine; Meha Prabhu, Zachary T. Popp, Md Salman Rahman, Rhoda Au, and Phillip H. Hwang, Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine; James Drane, Marissa Lee, and Corinna Lathan, AnthroTronix; Honghuang Lin, Department of Medicine, UMass Chan Medical School; Rhoda Au and Phillip H. Hwang, The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, and Department of Epidemiology, Boston University School of Public Health; Rhoda Au, Department of Neurology and Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, and Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine; and Preeti Sunderaraman, Department of Psychiatry and Human Behavior, Brown University\n\nExploration of Medicine. 2025.\n\nDOI: 10.37349/emed.2025.1001356", 22 "summary": "This academic-industry research collaboration examined whether older adults could repeatedly complete brief DANA assessments remotely on their own mobile devices over an entire year. 33 participants, including 9 with cognitive impairment, were asked to complete 17 approximately five-minute DANA assessments at frequencies ranging from several times in one week to once per month.\n\nMost participants completed the required number of assessments, although they did not always complete them within the exact assigned time windows. Across the full year, 90.9% completed the total expected number of assessments, 78.8% completed them within the broader study segments, and 60.6% followed every specific deadline. Strict on-time completion decreased as the study progressed, but completion remained relatively high when participants were given a broader period in which to finish the assessments.\n\nDANA made it possible to conduct brief, repeated cognitive assessments remotely on participants\u2019 own devices, including among older adults with cognitive impairment. The study supports DANA\u2019s feasibility for longitudinal monitoring, decentralized research, and remote-care programs. It also shows that flexible scheduling, reminders, technical support, and the way \u201cadherence\u201d is defined can substantially affect reported completion rates.\n\nAcademic-industry feasibility study evaluating whether older adults, including those with cognitive impairment, could independently complete repeated DANA assessments on their own mobile devices over a full year.\nObjectives: Determine whether DANA could feasibly support frequent, remote, self-administered cognitive assessment among older adults with and without cognitive impairment over one year. The study al
22so examined whether reported completion rates changed depending on whether adherence was judged against exact deadlines, broader scheduling periods, or the total number of assessments completed.\nMethods: The study included 33 adults recruited through the Boston University Alzheimer\u2019s Disease Research Center. Participants had an average age of 73.5 years; 9 were cognitively impaired. Participants with dementia were excluded, and all cognitively impaired participants completed the study without the assistance of a study partner. During a remote onboarding visit, participants downloaded DANA onto their own device and completed a supervised practice session. Participants were then asked to complete 17 unsupervised 5-minute DANA assessments over one year, beginning with three assessments in one week, followed by weekly and then monthly assessments. The researchers evaluated three increasingly flexible definitions of adherence: (1) completing each assessment within its precise assigned window, (2) completing the required number within a broader segment, and (3) completing all required assessments at any point during the year. Participants could receive up to three reminders for each assessment.\nResults: Participants generally demonstrated that they could use DANA remotely over a sustained period. Under the strictest definition, on-time completion declined from 93.9% during the first segment to 72.7% during the final segment. There was a significant overall difference in strict adherence across the four segments, although the direct comparison between the first and final segment was borderline. Under the broader segment definition, completion remained between 87.9% and 97.0%, with no significant decline across segments. Across the entire year: 60.6% completed every assessment within its exact assigned time window; 78.8% completed the required number within each broader study segment; and 90.9% completed the total required number of assessments, regardless of the exact timing. These results indicate that many participants completed the expected DANA assessments but needed
22some flexibility regarding the precise deadlines. The study also demonstrated that older adults with cognitive impairment could independently participate in this remote DANA protocol.\nClinical/Operational Implications: (1) Feasibility of Long-Term Remote DANA Monitoring. Older adults used DANA on their own devices over a full year, supporting its use for longitudinal cognitive monitoring outside a clinic. (2) Usability Among Adults With Cognitive Impairment. Participants with cognitive impairment completed the study without a study partner, showing that cognitive impairment does not automatically prevent independent use of a brief mobile assessment. (3) Flexible Scheduling May Improve Participation. Most participants completed the required number of assessments even when they missed exact deadlines. (4) Reminders and Technical Support Matter. High completion rates occurred in a program that included onboarding, a practice session, reminders, technical assistance, and incentives. These supports should be considered when designing real-world DANA programs.", 23 "url": "https://doi.org/10.37349/emed.2025.1001356", 24 "tags": [ 25 "aging-and-cognition", 26 "remote-patient-care", 27 "validity-and-reliability" 28 ] 29 }, 30 { 31 "id": 2, 32 "topic": "Exploring the Effect of Repetitive Head Impacts on the Stability of Digital Cognitive Measures in Cognitively Intact Older Adults: A Pilot Study", 33 "year": "2025", 34 "journal": "Alzheimer\u2019s & Dementia", 35 "citation": "Exploring the Effect of Repetitive Head Impacts on the Stability of Digital Cognitive Measures in Cognitively Intact Older Adults: A Pilot Study\n\nHuitong Ding, Xavier Serrano, Edward Searls, Kristi Ho, Alexa Burk, Margaret Low, Chenglin Lyu, Katherine A. Gifford, Vijaya B. Kolachalama, Christopher J. Nowinski, Joseph N. Palmisano, Yorghos Tripodis, Katherine W. Turk, Andrew E. Budson, Ann C. McKee, Jesse Mez, Rhoda Au, Michael L. Alosco, and Zexu Li, Boston University Chobanian & Avedisian School of Medicine; and Honghuang Lin, University of Massachusetts Medical School\n\nAlzheimer\u2019s & Dementia. 2025.\n\nDOI: 10.1002/alz70856_103876", 36 "summary": "This independent pilot study asked whether DANA results remain consistent across repeated testing days and whether a history of repetitive head impacts (RHI) affects that consistency or the normal improvement that can occur with practice.\n\nAmong 58 cognitively intact older adults, day-to-day DANA performance was generally stable. However, the 10 participants with an RHI history showed greater variability on several measures involving Go/No-Go, Code Substitution, and Simple Reaction Time. Participants generally became faster on Procedural Response Time with additional testing days, but the RHI group appeared to receive less of that practice-related benefit.\n\nDANA provided information beyond whether a single score was \u201cnormal\u201d or \u201cabnormal.\u201d Repeated testing captured how consistently each person performed and whether performance improved as expected with familiarity. That makes DANA valuable for identifying subtle changes in cognitive stability or learning patterns before a person meets criteria for cognitive impairment.\n\nIndependent pilot study evaluating the day-to-day stability of DANA performance and whether older adults with an RHI history show different patterns of variability or practice-related improvement.\nObjectives: Determine whether digital cognitive measures remain stable across repeated DANA administrations in cognitively intact older adults and whether RHI exposure is associated with greater variability or a different response to repeated practice.\nMethods: The study included 58 cognitively intact adults enrolled through the Boston University Alzheimer\u2019s Disease Research Center who had completed DANA on at least 3 days. The DANA tests included: Simple Reaction Time (SRT), Procedural Reaction Time (PRT), Go/No-Go (GNG), Code Substitution (CS), Match-to-Sample (MTS) and Spatial Processing (SP). Participants\u2019 average age was 75.4 years; 67.2% were women. 10 participants had an RHI history, primarily related to soccer, football, rugby, and other sports. The researchers measured each participant\u2019s day-to-day variability. They compared the RHI and non-RHI groups and examined the effects of age, sex, number of testing days, RHI status, and the interaction between RHI status and repeated testing.\nResults: DANA performance was generally consistent across repeated testing days. However, participants with a history of RHI showed more day-to-day fluctuation on some measures involving GNG, CS, and SRT. Their cognitive performance was less stable and predictable across testing days than the performance of participants without an RHI history. On the PRT task, participants without RHI improved with repeated testing, while the RHI group showed a
36significantly different pattern and did not demonstrate the same practice-related improvement. Overall, DANA measures were generally stable, but older adults with RHI showed more variable performance and did not demonstrate the same practice-related improvement seen in participants without RHI. The findings suggest that RHI history may affect both how consistently a person performs from day to day and how their scores change as they become familiar with a task.\nClinical/Operational Implications: (1) DANA may support earlier identification of concerning trajectories. Repeated assessments could help distinguish expected day-to-day variation from a pattern of increasing inconsistency, stalled improvement, or decline. (2) Within-person variability may itself be informative. An unstable pattern may reveal something that an average score alone does not capture. (3) RHI history should inform interpretation. A clinician or researcher should not assume that all individuals will show the same learning curve across repeated tests.", 37 "url": "https://doi.org/10.1002/alz70856_103876", 38 "tags": [ 39 "aging-and-cognition", 40 "concussion-tbi", 41 "longitudinal-data" 42 ] 43 }, 44 { 45 "id": 3, 46 "topic": "Digital Neuropsychological Measures in Older Adults Exposed to Repetitive Head Impacts", 47 "year": "2025", 48 "journal": "Alzheimer\u2019s & Dementia", 49 "citation": "Digital Neuropsychological Measures in Older Adults Exposed to Repetitive Head Impacts\n\nHuitong Ding, Xavier Serrano, Edward Searls, Kristi Ho, Zexu Li, Alexa Burk, Margaret Low, Chenglin Lyu, Katherine A. Gifford, Vijaya B. Kolachalama, Christopher Nowinski, Joseph N. Palmisano, Yorghos Tripodis, Katherine W. Turk, Andrew E. Budson, Ann C. McKee, Jesse Mez, Rhoda Au, and Michael L. Alosco, Boston University Chobanian & Avedisian School of Medicine; and Honghuang Lin, University of Massachusetts Medical School\n\nAlzheimer\u2019s & Dementia. 2025.\n\nDOI: 10.1002/alz70856_103835", 50 "summary": "This independent study asked whether DANA could identify subtle cognitive differences in older adults who were considered cognitively normal but had a history of repeated head impacts.\n\nAmong 97 participants, those with a history of repetitive head impacts (RHI) responded significantly more slowly on Code Substitution and Procedural Response Time than those without RHI, even after the researchers adjusted for age and sex. No significant differences were found on Simple Reaction Time or Match-to-Sample. The clearest differences therefore appeared on more complex tasks involving processing speed, attention, decision-making, learning, and executive function\u2014not on the most basic reaction-time task.\n\nDANA identified performance differences within a population that standard clinical classification still considered cognitively intact. This supports DANA\u2019s value for detecting subtle cognitive changes that may not yet be obvious through symptoms or broad cognitive classifications, particularly in people with long-term exposure to contact sports, military activities, or other sources of repetitive head impacts.\n\nIndependent study evaluating whether DANA could detect subtle differences in cognitive performance among cognitively intact older adults with and without a history of repetitive head impacts.\nObjectives: Compare DANA performance between cognitively intact older adults with and without repetitive head impacts (RHI) exposure and determine whether particular digital cognitive measures were associated with an RHI history.\nMethods: The study included 97 cognitively intact participants from the Boston University Alzheimer\u2019s Disease Research Center. Their average age was 74.4 years; 63.9% were women. 22 participants were classified as having an RHI history, primarily from football, soccer, rugby, and other sports. RHI classification was based on the 2021 National Institute of Neurological Disorders and Stroke Traumatic Encephalopathy Syndrome research criteria. Participants completed 6 DANA tasks: Simple Reaction Time (SRT), Procedural Reaction Time (PRT), Go/No-Go (GNG), Code Substitution (CS), Match-to-Sample (MTS) and Spatial Processing (SP). The researchers statistically adjusted the results for age and sex and then compared the RHI and non-RHI groups.\nResults: Participants with an RHI history had significantly slower average response times on CS and PRT. No significant group differences were found in SRT or MS. The authors concluded that RHI was associated with specific response-speed differences in cognitively intact older adults and interpreted the findings as possible evidence of subtle changes in functions involving frontal brain systems.\
50nClinical/Operational Implications: (1) DANA may detect subtle differences before broad impairment is evident. All participants were considered cognitively intact, yet DANA identified differences associated with RHI history. (2) More complex DANA tasks may be particularly informative. Code Substitution and Procedural Response Time separated the groups, while basic Simple Response Time did not. (3) DANA may add value for people with long-term exposure histories. Repeated or periodic testing could provide an objective cognitive measure for former contact-sport athletes, veterans, service members, and others with cumulative head-impact exposure.", 51 "url": "https://doi.org/10.1002/alz70856_103835", 52 "tags": [ 53 "aging-and-cognition", 54 "concussion-tbi", 55 "validity-and-reliability" 56 ] 57 }, 58 { 59 "id": 4, 60 "topic": "AI-Driven Multi-Omics Modeling of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome", 61 "year": "2025", 62 "journal": "Nature Medicine", 63 "citation": "AI-Driven Multi-Omics Modeling of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome\n\nRuoyun Xiong and Julia Oh, Duke University; Ruoyun Xiong and Courtney Gunter, The University of Connecticut Health Center; Ruoyun Xiong, Elizabeth Aiken, Ryan Caldwell, Lina Kozhaya, Courtney Gunter, Derya Unutmaz, and Julia Oh, The Jackson Laboratory; and Suzanne D. Vernon and Lucinda Bateman, Bateman Horne Center.\n\nNature Medicine. 2025.\n\nDOI: 10.1038/s41591-025-03788-3.", 64 "summary": "This independent study used artificial intelligence to examine how myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) symptoms relate to changes in the immune system, gut microbiome, blood metabolites, and routine laboratory results. The researchers followed 249 participants for up to four years and used DANA as the study\u2019s objective measure of cognitive efficiency.\n\nThe AI model, called BioMapAI, learned different biological patterns for different symptoms and distinguished participants with ME/CFS from healthy controls with strong performance in the study cohort. Immune data were most informative for several symptoms, while gut-microbiome data were particularly useful for digestive, emotional, and sleep problems. Routine blood-test data generally had limited ability to predict symptoms, but cognitive efficiency measured by DANA was a notable exception.\n\nDANA gave the researchers a standardized, objective cognitive outcome that could be analyzed alongside thousands of biological measurements and patient-reported symptoms. This supports DANA\u2019s potential value as a functional endpoint in precision-medicine research\u2014helping determine whether biological differences or future treatments are associated with meaningful changes in cognitive performance.\n\nIndependent study that incorporated DANA into a four-year, AI-driven analysis of the biological and clinical complexity of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).\nObjectives: Develop and evaluate an explainable AI model that could connect biological changes in ME/CFS with the condition\u2019s varied symptoms and functional effects. DANA was included to provide an objective measure of cognitive efficiency, allowing the researchers to examine how patterns in the immune system, gut microbiome, blood metabolites, and routine laboratory results related to measurable cognitive performance as well as patient-reported symptoms.\nMethods: The four-year study followed 153 patients with ME/CFS and 96 healthy controls. Researchers collected extensive symptom data and several types of biological information, including immune profiles, gut-microbiome data, blood metabolites, and routine laboratory results. Participants also completed DANA testing. The DANA score was included as one of 12 clinical outcomes that the BioMapAI model attempted to predict from the biological data.\nResults: BioMapAI identified different biological patterns associated with different ME/CFS symptoms and distinguished patients from healthy controls with strong performance in the study cohort, although its accuracy was lower when tested on outside datasets. Different types of biological data were useful for different symptoms. Immune information was particularly informative for fatigue, pain, and orthostatic intolerance, while microbiome data were more closely connected with digestive, sleep, and emotional symptoms. Routine blood-test data were generally less useful, but cognitive efficiency measured through DANA was a notable exception. DANA therefore gave the researchers an objective cognitive outcome that could be connected with biological findings rather than relying only on patients\u2019 descriptions of \u201cbrain fog.\u201d\nClinical/Operational Implications: (1) Objective Cognition Within Multisystem Research. DANA supplied an objective cognitive-performance measure that could be analyzed alongside symptoms, immune activity, routine laboratory results, metabolism, and the gut microbiome. This supports using DANA as a functional endpoint when studying complex illnesses that affect several body systems. (2) Connecting Biology With Real-World Function. A biological change is not necessarily clinically meaningful unless it is accompanied by a change in how the person feels or functions. DANA can help determine whether biological findings or treatment effects are associated with measurable cognitive improvement or decline. (3) Precision-Medicine and AI Applications. The study demonstrates that DANA data can be incorporated into large AI and multi-omics models rather than treated as a separate standalone test. This creates opportunities to study which biological patterns are associated with cognitive impairment in individual patients. (4) Potential Relevance to Long COVID and Other Complex Illnesses. Because ME/CFS and long COVID share fatigue, post-exertional worsening, orthostatic intolerance, and cognitive problems, the same model of combining DANA with biological and symptom data may be valuable in other post-viral and chronic multisystem conditions.", 65 "url": "https://doi.org/10.1038/s41591-025-03788-3", 66 "tags": [ 67 "ai",
68 "autoimmune-disorders", 69 "longitudinal-data" 70 ] 71 }, 72 { 73 "id": 5, 74 "topic": "Practice Effects on Digital Cognitive Assessment Tools: Insights From the Defense Automated Neurobehavioral Assessment Battery", 75 "year": "2025", 76 "journal": "Alzheimer\u2019s & Dementia", 77 "citation": "Practice Effects on Digital Cognitive Assessment Tools: Insights From the Defense Automated Neurobehavioral Assessment Battery\n\nMatteo Bellitti and Meagan V. Lauber, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine; Meagan V. Lauber, Division of Graduate Medical Sciences, Boston University; Edward Searls, Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine; Honghuang Lin, Department of Medicine, University of Massachusetts Chan Medical School; Rhoda Au, Boston University Chobanian & Avedisian School of Medicine, Boston University Alzheimer\u2019s Disease Research Center, Framingham Heart Study, Boston University School of Public Health, and Department of Neurology; and Vijaya B. Kolachalama, Boston University Chobanian & Avedisian School of Medicine, Boston University Alzheimer\u2019s Disease Research Center, and Boston University Faculty of Computing & Data Sciences\n\nAlzheimer\u2019s & Dementia. 2025.\n\nDOI: 10.1002/alz.70644", 78 "summary": "Researchers for this independent study by Boston University were concerned that repeated use of digital cognitive assessments like DANA could introduce practice effects (performance improvements resulting from repeated exposure to the same task), and that such practice effects could make it harder to detect real cognitive impairment or change over time.\n\nThe study found that DANA was sensitive to differences in cognition but remained relatively insensitive to the influence of repeated testing, demonstrating its validity and utility as a longitudinal monitoring tool of cognitive performance.\n\nIndependent academic study that evaluated whether repeated DANA testing produced practice effects that could obscure true cognitive change in older adults, while also examining DANA\u2019s ability to distinguish cognitively impaired from cognitively intact participants.\nObjectives: Determine whether participants became faster on DANA because of prior exposure to the tests, whether practice effects differed between cognitively intact and impaired participants, and whether DANA response times could help classify participants by cognitive status.\nMethods: The study included 116 adults who were enrolled through the Boston University Alzheimer\u2019s Disease Research Center. The median age was 70; 84 participants were classified as cognitively intact and 32 as cognitively impaired. Participants completed a six-task DANA battery remotely and then repeated the assessments after 90 days. The researchers analyzed response times for correct answers while accounting for age, sex, education, the number of days between sessions, cognitive status, and where each response occurred within the task. They also tested logistic-regression and random-forest models to determine whether DANA response times and basic demographic information could classify participants as cognitively intact or impaired.\nResults: Participants showed modest between-session practice effects on three tasks. These findings suggest that prior exposure to DANA produced relatively small changes. Further, the Code Substitution and Procedural Reaction Time tasks were capable of distinguishing between participants who were cognitively impaired and those who were cognitively intact. The researchers concluded that, as a repeated measure of longitudinal assessment, DANA is sensitive to changes in cognition while remaining robust to the influence of practice effects.\nClinical/Operational Implications: (1) DANA is reliable for longitudinal monitoring. The relatively small between-session practice effects suggest that meaningful cognitive decline is less likely to be hidden simply because a person has previously completed the battery. (2) Code Substitution may be especially useful. It showed the clearest separation between cognitively intact and impaired participants, likely because it draws on several cognitive abilities at once, including processing speed, attention, learning, visual scanning, and memory. (3) Remote testing is feasible. Participants completed DANA at home on their own smartphones, supporting its use for decentralized studies, aging programs, and repeated monitoring outside a clinic.", 79 "url": "https://doi.org/10.1002/alz.70644", 80 "tags": [ 81 "aging-and-cognition", 82 "longitudinal-data", 83 "remote-patient-care", 84 "validity-and-reliability" 85 ] 86 }, 87 { 88 "id": 6, 89 "topic": "Digital Version of Defense Automated Neurobehavioral Assessment in South Asian Setting: Preliminary Evidence From the P-CARRS Study", 90 "year": "2025", 91 "journal": "Alzheimer\u2019s & Dementia", 92 "citation": "Digital Version of Defense Automated Neurobehavioral Assessment in South Asian Setting: Preliminary Evidence From the P-CARRS Study\n\nRam Jagannathan, Rima Pai, Mohammed K. Ali, and K.M. Venkat Narayan, Hubert Department of Global Health, Rollins School of Public Health, Emory University; Rani Komal, Sailesh Mohan, and Dorairaj Prabhakaran, Centre for Chronic Disease Control, New Delhi, India; Deepa Mohan, Poongothai Subramani, and V. Mohan, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India; V. Mohan, Dr. Mohan\u2019s Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India; Suvarna Alladi, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India; Nikhil Tandon, All India Institute of Medical Sciences, New Delhi, India; Allan I. Levey and Felicia Goldstein, Emory University School of Medicine\n\nAlzheimer\u2019s & Dementia. 2024;20(Suppl. 2):e087168. Poster Presentation, Biomarkers\u2014Non-Neuroimaging.\n\nDOI: 10.1002/alz.087168", 93 "summary": "This independent pilot study examined whether smartphone-based DANA testing could be used for c
93ognitive screening in a socioeconomically and linguistically diverse population of adults over age 50 in Delhi and Chennai, India. The study compared DANA performance with the Mini-Cog, a traditional brief paper-and-pencil cognitive screening test.\n\nDANA was administered in approximately 20 minutes to 358 participants. Participants who screened as cognitively impaired on the Mini-Cog showed significantly lower cognitive efficiency on certain DANA tasks. These findings show that selected DANA measures captured objective cognitive-performance differences corresponding with results from an established clinical screening tool.\n\nThe study shows DANA\u2019s validity and utility as a scalable mobile assessment tool to aid in assessing cognitive function in older adults in diverse and resource-constrained settings.\n\nIndependent pilot study evaluating the feasibility and clinical relevance of smartphone-based DANA cognitive screening among a diverse population of older adults in India.\nObjectives: Evaluate the use of an Android-based version of DANA for cognitive screening in a South Asian population and determine whether DANA performance differed according to Mini-Cog screening status, age, sex, and education.\nMethods: The study included 358 adults over age 50 who were participating in the ongoing population-based Precision-CARRS study in Delhi and Chennai, India. The participants had a median age of 61 years, ranged in age from 50 to 89 years, and were 56% female. Approximately 8% had no more than primary schooling, 66% had a high-school or secondary education, and 26% were college graduates or above. Participants completed a DANA battery and the traditional paper-and-pencil Mini-Cog. The DANA battery included Code Substitution (CS), Go/No-Go (GNG), Memory Search (MS), Spatial Processing (SP), and Simple Reaction Time (SRT). The Mini-Cog included three-item recall and clock drawing.\nResults: 58 participants, representing 16% of the cohort, screened as cognitively impaired on the Mini-Cog. Older age was associated with lower DANA cognitive-efficiency scores, slower response times, and fewer correct responses. No significant sex differences were found. Performance differed by education level on only two of the five DANA tasks\u2014CS and MS. After adjustment for age and education, participants in the Mini-Cog-impaired group showed several significant DANA differences: (1) on GNG, they had lower cognitive efficiency and slower response times; (2) on MS, they had lower cognitive efficiency and substantially fewer correct responses; (3) on SP, they had fewer correct responses; and (4) CS and SRT did not significantly distinguish the two groups. The strongest overall group differences therefore appeared in tasks involving response inhibition and working memory rather than basic reaction speed alone.\nClinical/Operational Implications: (1) Scalable Smartphone-Based Screening. DANA was administered in approximately 20 minutes to 358 adults in a diverse, resource-constrained setting, supporting the feasibility of mobile cognitive screening where specialist services may be difficult to access. (2) Objective Multi-Domain Cognitive Measurement. DANA provided separate measures of response speed, accuracy, cognitive efficiency, response inhibition, working memory, and visuospatial function rather than reducing performance to a single screening score. GNG and MS were particularly useful in distinguishing participants who screened as impaired on the Mini-Cog. (3) Potential Triage and Referral Tool. DANA may help identify individuals who warrant closer monitoring or a more complete clinical or neuropsychological evaluation, particularly when large populations must be screened efficiently. (4) Potential for Broader Global-Health Deployment. The use of an Android-based platform supports future applications in community health programs, underserved areas, rural settings, and other environments where conventional neuropsychological testing may be difficult to scale.", 94 "url": "https://doi.org/10.1002/alz.087168", 95 "tags": [ 96 "aging-and-cognition", 97 "remote-patient-care", 98 "validity-and-reliability" 99 ] 100 }, 101 { 102 "id": 7,
103 "topic": "Relationships Between Fatigue, Cognitive Function, and Upright Activity in a Randomized Trial of Oxaloacetate for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome", 104 "year": "2025", 105 "journal": "Frontiers in Neurology", 106 "citation": "Relationships Between Fatigue, Cognitive Function, and Upright Activity in a Randomized Trial of Oxaloacetate for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome\n\nSuzanne D. Vernon, Candace Rond, Jennifer Bell, Bella Rond, Brayden Yellman, and Lucinda Bateman, Bateman Horne Center; Yifei Sun and Shad Roundy, Department of Mechanical Engineering, University of Utah; David L. Kaufman, Center for Complex Diseases; and Alan B. Cash, Terra Biological LLC\n\nFrontiers in Neurology. 2025.\n\nDOI: 10.3389/fneur.2025.1691147", 107 "summary": "Oxaloacetate (OAA) is a substance naturally found in the body that helps cells produce energy and has shown promise in reducing fatigue symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Researchers in this study examined whether OAA supplementation was associated with changes in fatigue, cognitive function, and the amount of time participants could remain upright.\n\nDANA provided an objective way to measure the cognitive difficulties, or \u201cbrain fog,\u201d associated with ME/CFS and tracked cognitive changes during treatment. It showed that cognitive performance could improve even when changes in fatigue and upright activity were smaller or did not follow the same pattern.\n\nIn this secondary article from a randomized, double-blind clinical trial, researchers examined the interrelationships between fatigue, cognitive performance and physical activity and their responsiveness to treatment in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).\nObjectives: To examine whether self-reported fatigue was related to objective cognitive performance and time spent upright, and whether those relationships differed between participants receiving OAA supplements and those receiving control capsules.\nMethods: The analysis used data from 82 adults with ME/CFS who participated in the 90-day RESTORE ME randomized, double-blind clinical trial. Participants received either 2,000 mg per day of oxaloacetate or rice-flour control capsules. Oxaloacetate is a naturally occurring substance involved in cellular energy production. Participants were evaluated at baseline and after 30, 60, and 90 days. At each visit, they completed a fatigue questionnaire and DANA testing. The DANA test battery included Simple Reaction Time (SRT), Procedural Reaction Time (PRT), and Go/No-Go (GNG). They also wore an ankle sensor for seven days after each visit to measure the average amount of time they spent upright with their feet on the floor.\nResults: The OAA group showed greater cognitive improvement over time, with a significant between-group difference at 60 days, and similar trends at the other visits. In the OAA group, participants reporting greater fatigue showed less cognitive improvement. This relationship was not found in the control group, suggesting that fatigue and cognitive response were more closely connected among participants receiving OAA. The OAA participants also showed a modest increase in time spent upright after 30 days. However, the difference was no longer statistically significant at Days 60 or 90. Fatigue levels did not strongly predict upright activity in either treatment group.\nClinical/Operational Implications: (1) Objective Measurement of Brain Fog. DANA provided an objective measure of cognitive performance in a condition where symptoms such as fatigue and brain fog are commonly measured through patient reports. (2) Cognitive and Physical Recovery May Differ. Participants could improve cognitively without showing a matching or sustained increase in upright activity. This supports evaluating cognitive, symptom, and physical outcomes separately. (3) DANA Can Help Track Treatment Response. Repeated DANA testing identified cognitive changes over the course of treatment and helped distinguish cognitive responders from participants whose improvement was limited to fatigue. (4) Multidimensional Assessment Is Important. Fatigue alone did not fully explain either cognitive performance or upright activity. Combining DANA, symptom measures, and wearable information provided a more complete picture of treatment response.", 108 "url": "https://doi.org/10.3389/fneur.2025.1691147", 109 "tags": [ 110 "covid", 111 "fatigue", 112 "medications-and-supplements", 113 "therapeutic-interventions" 114 ] 115 }, 116 { 117 "id": 8, 118 "topic": "REGAIN: A Randomized Controlled Clinical Trial of Oxaloacetate for Improving the Symptoms of Long COVID", 119 "year": "2025", 120 "journal": "Frontiers in Neuroscience", 121 "citation": "REGAIN: A Randomized Controlled Clinical Trial of Oxaloacetate for Improving the Symptoms of Long COVID\n\nSuzanne D. Vernon, Candace Rond, Jennifer Bell, Brindisi Butler, Sara Isolampi, Annaleah Otteson, Pearl Phalw
121ane and Lucinda Bateman, Bateman Horne Center; Samantha Mower and Shad Roundy, Department of Mechanical Engineering, University of Utah; David L. Kaufman, Center for Complex Diseases; and Alan B. Cash, Terra Biological LLC\n\nFrontiers in Neuroscience. 2025.\n\nDOI: 10.3389/fnins.2025.1627462", 122 "summary": "This randomized, double-blind clinical trial studied 69 adults with long COVID who had moderate-to-severe fatigue. Participants received either 2,000 mg per day of oxaloacetate or matching control capsules for 42 days. Oxaloacetate is a substance naturally found in the body that helps cells produce energy; the researchers tested whether supplementing it could improve fatigue, cognitive problems, and other long-COVID symptoms.\n\nDANA provided an objective way to measure the \u201cbrain fog\u201d associated with long COVID and to track whether cognition changed during treatment. It showed that cognitive performance in participants receiving oxaloacetate improved more than the control group. DANA also helped demonstrate that participants whose symptoms improved tended to show corresponding improvements in cognitive performance.\n\nThis randomized, double-blind clinical trial used DANA as an objective measure of cognitive change during oxaloacetate treatment for long COVID.\nObjectives: To evaluate the efficacy of oral oxaloacetate (OAA) in improving fatigue and cognitive function in adults with long COVID.\nMethods: 69 adults with long COVID and moderate-to-severe fatigue were randomized to receive either 2,000 mg per day of OAA, as a supplement intended to support energy metabolism, or matched control capsules. 35 participants were assigned to OAA and 34 to control; 33 and 29, respectively, completed treatment. Participants were assessed at baseline, Day 21, and Day 42. The study\u2019s main measure was whether participants\u2019 fatigue improved, based on the Chalder Fatigue Questionnaire. The researchers also measured changes in overall symptoms, quality of life, the amount of time participants spent upright, and cognitive performance using DANA. The DANA test battery included Simple Reaction Time (SRT), Procedural Reaction Time (PRT), and Go/No-Go (GNG).\nResults: The OAA group did not improve more than the control group on the study\u2019s main fatigue questionnaire. On a different questionnaire that measured fatigue and overall long-COVID symptoms, the OAA group improved more quickly. Their fatigue scores were significantly better than the control group\u2019s at Day 21, but the difference was no longer statistically significant by Day 42 because both groups had improved. More participants receiving OAA met the study\u2019s definition of meaningful symptom improvement, although that difference was not statistically conclusive. DANA showed significantly greater improvement in the OAA group for PRT at Days 21 and 42, GNG at Day 42, and total cognitive efficiency at both timepoints. Total cognitive efficiency improved by 8.7% versus 0.2% at Day 21 and by 10.7% versus approximately no change at Day 42. SRT improved over time but did not significantly differ between groups.\nClinical/Operational Implications: (1) Objective Measurement of Brain Fog. DANA detected treatment-related cognitive differences that were not captured by the trial\u2019s primary fatigue questionnaire, demonstrating the value of directly measuring cognitive performance rather than relying exclusively on symptom reports. (2) Symptom and Cognitive Response Converged. Participants receiving OAA who experienced meaningful symptom improvement also tended to show greater objective cognitive improvement, suggesting that DANA may help identify and validate treatment responders.", 123 "url": "https://doi.org/10.3389/fnins.2025.1627462", 124 "tags": [ 125 "covid", 126 "fatigue", 127 "medications-and-supplements", 128 "therapeutic-interventions" 129 ] 130 }, 131 { 132 "id": 9, 133 "topic": "The Potential Efficacy of Continuous Plantar Foot Cooling During Relatively Mild Simulated Occupational Heat Stress", 134 "year": "2025", 135 "journal": "European Journal of Applied Physiology", 136 "citation": "The Potential Efficacy of Continuous Plantar Foot Cooling During Relatively Mild Simulated Occupational Heat Stress\u2014A Pilot Study\n\nJason M. Keeler, Department of Health and Human Performance, Congdon School of Health Sciences, High Point University, and Department of Kinesiology, Indiana University School of Public Health; Charlie Walker and Molly Heikkinen, Department of Kinesiology, Indiana University School of Public Health; Amanda Regester, Blair D. Johnson, and Zachary J. Schlader, Department of Kinesiology and Nutrition and Exercise Research Center, Indiana University School of Public Health; Y. Sungtaek Ju, Department of Mechanical and Aerospace Engineering and Department of Bioengineering, University of California, Los Angeles; and Lihua Jin, Department of Mechanical and Aerospace Engineering, University of California, Los Angeles\n\nEuropean Journal of Applied Physiology. 2025.\n\nDOI: 10.1007/s00421-025-06053-0", 137 "summary": "Foot cooling reduced participants\u2019 thermal discomfort and limited the increase in heart rate during a later physical work capacity test, suggesting that it may reduce some cardiovascular and perceptual strain. However, it did not significantly reduce core temperature, increase physical work output, or improve c
137ognitive performance measured by DANA. Importantly, the relatively mild heat exposure did not impair most DANA scores in either condition, limiting the researchers\u2019 ability to determine whether foot cooling could protect cognition under more severe heat stress.\n\nThe study demonstrates the feasibility of using DANA as a portable, multi-domain cognitive outcome measure in occupational and environmental research. DANA can help researchers distinguish between subjective discomfort, physiological strain, and actual changes in cognitive performance.\n\nIndependent pilot study investigating whether continuously cooling the soles of the feet could reduce increases in core body temperature, preserve cognitive performance, and improve physical work capacity during simulated occupational heat stress.\nObjectives: Heat exposure can increase core body temperature, cardiovascular strain, fatigue, and thermal discomfort and, under sufficiently severe conditions, may impair cognitive and physical performance. The purpose of this study was to establish preliminary effect sizes for the influence of plantar foot cooling on core temperature as the primary outcome, cognitive performance as the secondary outcome, and physical work capacity as the tertiary outcome. The researchers hypothesized that foot cooling would reduce the rise in core temperature, alleviate heat-related cognitive deficits, and preserve work capacity.\nMethods: 12 healthy adults (5 women), completed a randomized, counterbalanced crossover study in which every participant underwent both a foot-cooling trial and a control trial on separate days. Participants exercised in an environmental chamber maintained at approximately 38.7\u00b0C and 46% relative humidity. Each trial included 60 minutes of steady-state upper-body exercise, cognitive testing, a rest interval, and a 60-minute self-paced physical work capacity test. DANA cognitive testing was completed before and after the steady-state exercise period while participants stood with their bare feet on either cooled or noncooled plates. The DANA battery included Go/No-Go, Code Substitution, Spatial Processing, Memory Search, and Match to Sample.\nResults: The participants\u2019 core temperatures increased during both the steady-state exercise period and the physical work capacity test, but foot cooling did not significantly reduce the increase in core temperature. Foot cooling also did not significantly improve average physical power output. There were no statistically significant differences between the foot-cooling and control conditions for cognitive efficiency on any of the five DANA tasks.\nClinical/Operational Implications: (1) Objective Cognitive Monitoring During Environmental Stress. DANA provided a portable and repeatable means of measuring multiple cognitive domains during a controlled occupational heat simulation. It can be used alongside temperature, heart-rate, wearable, and subjective-perception data to determine whether physiological strain is accompanied by a meaningful decline in cognitive readiness. (2) Distinguishing Comfort From Performance. Participants felt cooler and experienced less cardiovascular strain during foot cooling, but their cognitive and physical performance did not significantly change. DANA helped demonstrate that improvements in comfort or physiological measures should not automatically be interpreted as improvements in operational performance. (3) Establishing Stress Thresholds. The absence of cognitive deterioration under these relatively mild conditions helps define the level of heat exposure that may be insufficient to produce measurable cognitive impairment in young, healthy adults.", 138 "url": "https://doi.org/10.1007/s00421-025-06053-0", 139 "tags": [ 140 "operational-performance", 141 "therapeutic-interventions" 142 ] 143 }, 144 { 145 "id": 10, 146 "topic": "Detection of Cognitive Performance Deterioration Due to Cold-Air Exposure in Females Using Wearable Electrodermal Activity and Electrocardiogram", 147 "year": "2025", 148 "journal": "Biosensors", 149 "citation": "Detection of Cognitive Performance Deterioration Due to Cold-Air Exposure in Females Using Wearable Electrodermal Activity and Electrocardiogram\n\nYoungsun
149Kong, Riley McNaboe, Hugo F. Posada-Quintero and Ki H. Chon, College of Engineering, University of Connecticut, Md Billal Hossain, Analog Devices, Krystina Diaz, Leidos, and Jeffrey Bolkhovsky, Naval Submarine Medical Research Laboratory\n\nBiosensors. 2025.\n\nDOI: 10.3390/bios15020078", 150 "summary": "This independent pilot study examined whether cold exposure could slow cognitive performance in women and whether wearable signals could help detect that decline.\n\nDANA provided the repeated, objective cognitive measurements needed to identify when performance began to decline and which abilities were most affected. When paired with wearable data, DANA can help establish an individual baseline and distinguish meaningful cognitive slowing from normal variation, supporting real-time monitoring of performance under cold, fatigue, illness, medication, heat, or other operational stressors.\n\nProlonged exposure to cold can impair reaction time and cognitive function. Prior studies show that females are evidenced to be more sensitive to cold exposure. This independent pilot study investigated the relationship between physiological metrics and cognitive performance deterioration of females under cold stress and whether models could be developed to predict cognitive performance by tracking physiological metrics.\nMethods: Wearable electrodermal activity (EDA) and electrocardiogram (ECG) were continuously collected from 19 females in a room-temperature environment on one day, and in a cold environment (10 \u25e6C) on a second day. During each of the two 140-minute sessions, the subjects underwent five sessions of a DANA test battery every 30 minutes. The test battery included simple reaction time (SRT), procedural reaction time (PRT), go/no-go (GNG), code substitution (CS) and spatial discrimination (SPD). Researchers then compared performance across sessions and performed machine learning techniques on EDA- and heart rate variability (HRV)-derived features to detect cognitive performance deterioration due to cold exposure.\nResults: Cold exposure resulted in slower reaction time while accuracy remained fairly consistent. DANA's CS task was the most sensitive to cognitive performance deterioration in the cold condition. During the cold sessions, heart rate was the strongest indicator of deterioration of cognitive performance. When reaction time was slower, heart rate tended to be higher, and a beat-to-beat calmness measure (HRV/RMSSD) tended to dip (especially on the spatial task). Result suggests that cognitive performance deterioration due to cold exposure, especially in a task utilizing short-term memory, can be effectively detected using commonly available wearable devices such as those that collect ECG and EDA. The models developed in the study can be used for application to female military personnel deployed in cold environments, enabling preemptive action to reduce risk during operations and facilitating the development of individualized, situation-dependent scheduling and shift rotation strategies.\nClinical/Operational Implications: (1) A practical \u201csignal-check\u201d for cognitive slowing under many kinds of stress. DANA gives a quick, repeatable way to flag slowed processing in tasks that load memory, attention, and executive control\u2014capacities impacted by cold, heat, illness, fatigue, meds, or high workload. (2) DANA + wearables. DANA paired with wearables can be used to create personalized baselines and detect true performance changes.", 151 "url": "https://doi.org/10.3390/bios15020078", 152 "tags": [ 153 "ai", 154 "military", 155 "operational-performance", 156 "womens-health" 157 ] 158 }, 159 { 160 "id": 11, 161 "topic": "Digital Neuropsychological Measures by Defense Automated Neurocognitive Assessment: Reference Values and Clinical Correlates", 162 "year": "2024", 163 "journal": "Frontiers in Neurology", 164 "citation": "Digital Neuropsychological Measures by Defense Automated Neurocognitive Assessment: Reference Values and Clinical Correlates\n\nHuitong Ding, Minzae Kim, Edward Searls, Spencer Low, Zachary Popp, Zexu Li, Kriti Goyal, Lindsay Hathaway, Jose Monteverde, Salman Rahman, Akwaugo Igwe and Rhoda Au, Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine; Preeti Sunderaraman, The Framingham Heart Study and Department of Neurology, Boston University Chobanian & Avedisian School of Medicine; Ileana De Anda-Duran, School of Public Health and Tropical Medicine, Tulane University; Phillip H. Hwang, Department of Epidemiology, Boston University School of Public Health; Vijaya B. Kolachalama, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, and Department of Computer Science, Faculty of Computing & Data Sciences, Boston University; and Honghuang Lin, Department of Medicine, University of Massachusetts Chan Medical School\n\nFrontiers in Neurology. 2024.\n\nDOI 10.3389/fneur.2024.1340710", 165 "summary": "Boston University conducted this study with participants in the Framingham Heart Study to establish normal reference values for cognitive test scores on DANA. The study al
165so analyzed how DANA scores were associated with health factors like diabetes and cholesterol levels, providing insight into how common medical conditions affect brain performance.\n\nThe study successfully generated sex-specific reference values for each of the DANA tests in 3 age groups (under 60, 60-69, and 70+), providing a validated framework for identifying normal vs. abnormal cognitive performance in older adults. Further, the study\u2019s findings linked scores for each of the DANA tests to a number of health conditions. In the Code Substitution test (matching symbols and numbers), slower response times were linked to higher levels of diabetes and cholesterol. In the Go-No-Go test (a focus and self-control task), slower responses were tied to higher blood sugar, while faster responses were linked to lower blood pressure and better cognitive scores (as measured by MMSE, a common mental status test). In the Simple Reaction Time test (basic speed test), slower responses were associated with higher blood pressure and a history of heart attack or stroke, but faster responses were connected to a lower chance of having congestive heart failure.\n\nThe findings from this study show that DANA doesn\u2019t just measure mental performance\u2014it also reflects underlying health risks in an aging population. This makes DANA a practical, non-invasive tool to support early detection, risk stratification, and longitudinal monitoring of both brain and body health in clinical care settings.\n\nIndependent study conducted with participants in the Framingham Heart Study (FHS) and the Boston University Alzheimer\u2019s Disease Research Center (BU ADRC) to establish reference values for, and investigate the association of clinical risk factors with, the digital neuropsychological measures derived from DANA.\nMethods: 932 FHS participants (average age of 63 years, 57.3% women) formed the reference cohort, and 57 BU ADRC participants (average age of 74, 64.9% women) were included as the validation cohort, with all participants characterized as cognitively intact. All participants completed 3 DANA tests: simple reaction time (SRT), go/no-go (GNG), and code substitution (CS).\nResults: Sex-specific reference values in 3 age groups (under 60, 60-69, and 70 and older) of the reference cohort were generated for the digital cognitive measures of each DANA test, and the validation cohort results mostly aligned with those values. Associations between the digital cognitive measures and 19 clinical risk factors were also examined and unique clinical correlations were seen for the different DANA tests.\nReference Values Findings: Women under 60 performed better than men on the CS task, suggesting higher cognitive processing speed in that domain. However, men performed better than women in the GNG and SRT tasks, indicating task-specific performance differences that may reflect varying strengths in cognitive domains such as response inhibition or sensorimotor speed. In both males and females, reaction times slowed down with increasing age.\nClinical Risk Factors Findings: The CS test was sensitive to metabolic health indicators like diabetes and cholesterol. The GNG test correlates with glucose regulation, blood pressure, and cognitive function. SRT reflects cardiovascular risks like stroke, MI and CHF.\nClinical/Operational Implications: (1) Establishes Age- and Sex-Based Norms for Digital Cognitive Testing. The study successfully generated sex-specific reference values, providing a validated framework for identifying normal vs. abnormal cognitive performance in older adults. (2) Enhances Use of DANA in Routine Clinical Practice. With these reference values, clinicians can now compare a patient\u2019s DANA score to what\u2019s typical for their demographic, identify early cognitive decline or changes related to aging, chronic disease, or medication effects, and use DANA as a screening tool in preventive care, geriatrics, cardiology, and primary care. (3) Demonstrates DANA\u2019s Sensitivity to Medical Risk Factors. DANA has utility in detecting subtle changes in cognitive health that may relate to broader medical issues\u2014even in people without diagnosed cognitive issues. This opens the door for DANA to be used in risk stratification, identifying patients whose medical conditions may be quietly affecting their brain function. (4) Supports Broader Use in Research and Remote Monitoring. DANA\u2019s mobile format, paired with this new normative data, makes it well-suited for large-scale population health studies, remote or telehealth-based cognitive monitoring, and digital health platforms and wellness programs.", 166 "url": "https://doi.org/10.3389/fneur.2024.1340710", 167 "tags": [ 168 "aging-and-cognition", 169 "clinical-risk-factors", 170 "reference-values" 171 ] 172 }, 173 { 174 "id": 12, 175 "topic": "Comparing Cognitive Tests and Smartphone-Based Assessment in 2 US Community-Based Cohorts", 176 "year": "2024", 177 "journal": "Journal of the American Heart Association", 178 "citation": "Comparing Cognitive Tests and Smartphone-Based Assessment in 2 US Community-Based Cohorts\n\nIleana De Anda-Duran, Shirine Moukaled, Xuanyi Jin and Lydia Bazzano, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine; Preeti Sunderaraman, Edward Searls, Zachary Popp, Cody Karjadi, Huitong Ding, Sherral Devine, Ludy C. Shih, Spencer Low, Vijaya B. Kolachalama, and Rhoda Au, Chobanian & Avedisian School of Medicine, Boston University; Phillip H. Hwang, Department of Epidemiology, School of Public Health, Boston University; Honghuang Lin, Chan Medical School, University of Massachusetts; David J. Libon, Department of Psychology and New Jersey Institute of Successful Aging, School of Osteopathic Medicine, Rowan University\n\nJournal of the American Heart Association. 2024.\n\nDOI: 10.1161/JAHA.123.032733", 179 "summary": "Boston University conducted this study with participants in the Framingham Heart Study and the Bogalusa Heart Study (two of the most respected, long-running epidemiological studies in the U.S.) to test the validity and reliability of DANA to measure cognitive performance compared to traditional assessments.\n\nStudy results confirm that DANA\u2019s cognitive assessments are clinically valid and correlate well with traditional neuropsychological test results. By using two distinct and diverse cohorts, the study proves that DANA works across various populations, not just in a narrow, ideal sample. Results also show that DANA can be used remotely, helping more people get screened and monitored more often\u2014easily, affordably, and at scale.\n\nIndependent study conducted with participants in the Framingham Heart Study (FHS) and the Bogalusa Heart Study (BHS) to test the validity and reliability of DANA as a measure of cognitive performance in comparison to traditional assessments.\nObjectives: Determine the extent to which smartphone-based DANA measures of cognitive performance correlate with traditional, validated paper and pencil neuropsychological test measurements in two diverse cohorts.\nMethods: 406 FHS participants (average age of 57 years old) and 59 BHS participants (average age of 49 years old), all characterized as cognitively normal, completed DANA cognitive testing in a remote, self-administered and unsupervised manner. The test battery included 3 DANA tests: simple reaction time (SRT), go/no-go (GNG), and code substitution (CS). DANA test results were then compared to results from the participants\u2019 most recent neuropsychological test administered by trained personnel as part of ongoing testing of FHS and BHS participants.\nResults: Performance on the smartphone-based DANA cognitive tasks was congruent with cognitive performance measured by using traditional, validated paper and pencil neuropsychological protocols in these two geographically distinct and diverse cohorts. The findings suggest that the DANA cognitive tests can asse
179ss aspects of cognitive function known to be associated with Alzheimer disease and Alzheimer disease-related dementia.\nClinical/Operational Implications: (1) Validated for Clinical Cognitive Screening. DANA\u2019s digital tests accurately reflect real cognitive performance, and DANA can be used as a trusted, remote screening tool for cognitive health\u2014especially helpful when in-person testing is not feasible. (2) Supports Use in Diverse Populations. DANA works effectively in diverse populations, making it a tool for reaching underrepresented groups in clinical care and research, where access to neuropsychological testing is limited. (3) Scalability & Remote Monitoring. DANA can be used remotely, allowing for frequent monitoring of cognition over time. This enables early detection of cognitive decline and ongoing assessment without needing repeat clinic visits.", 180 "url": "https://doi.org/10.1161/JAHA.123.032733", 181 "tags": [ 182 "aging-and-cognition", 183 "remote-patient-care", 184 "validity-and-reliability" 185 ] 186 }, 187 { 188 "id": 13, 189 "topic": "Stress Response to Winter Warfare Training: Potential Impact of Location", 190 "year": "2024", 191 "journal": "Military Medicine", 192 "citation": "Stress Response to Winter Warfare Training: Potential Impact of Location\n\nLauren M. Visconti, Warfighter Performance Department, Naval Health Research Center, Warfighter Performance, Leidos Inc., and Human and Evolutionary Biology, University of Southern California; Laura J. Palombo and Andrea C. Givens, Warfighter Performance Department, Naval Health Research Center and Warfighter Performance, Leidos Inc.; Lorraine P. Turcotte, Human and Evolutionary Biology, University of Southern California; and Karen R. Kelly, Warfighter Performance, Leidos Inc., and Human and Evolutionary Biology, University of Southern California\n\nMilitary Medicine. 2024.\n\nDOI: 10.1093/milmed/usae075", 193 "summary": "Prior research has shown a relationship between hormone dysregulation, impaired cognitive and physical performance, and injury. This pilot study by the Naval Health Research Center, Leidos Inc. and the University of Southern California, investigated how training in very cold and harsh environments affects hormones and brain function.\n\nResults showed that there was an increase in stress-related and growth-related hormones and a decrease in cognitive performance throughout the study's training exercises. Accordingly, DANA was able to detect changes in cognitive function (like slower reaction times and lower attention) that correlated with hormonal stress responses. This pilot study also hints at how tracking cognitive performance alongside biological measures (like hormones or glucose) could support care for people with chronic illness, PTSD, or hormonal disorders\u2014where stress and cognition are often linked.\n\nIndependent pilot study that investigated the hormonal changes experienced by warfighters training in extremely cold weather and harsh terrain, and the correlation of such changes with cognitive performance.\nObjectives: Prior research has shown a relationship between hormone dysregulation, impaired cognitive and physical performance, and injury. The goal of this study was to quantify the hormonal responses and adaptations that occur in elite military personnel during winter warfare training (WWT).\nMethods: 14 Army Special Forces operators (13 males; 1 female; mean age of 31 years) engaged in 2 separate WWT weeks in Montana (MT) and Alaska (AK), separated by 1 month. The participants underwent cognitive testing (via DANA), which consisted of the following tests: simple reaction time (SRT), procedural reaction time (PRT), and go/no-go (GNG), at their home base in Colorado prior to engagement (baseline), and again on the first and last day of WWT in both MT and AK. Sleep quality was assessed (via the Pittsburg Sleep Quality Index (PSQI)) and blood samples were taken at baseline and again on the first and last day of WWT in both MT and AK. Plasma samples were then analyzed for (i) stress-related biomarkers (cortisol and adrenocorticotropic hormone (ACTH)), (ii) metabolic hormones (thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and leptin), and (iii) growth-related hormones (total testosterone (TT), free testosterone (fT), dehydroepiandrosterone sulfate (DHEA-S), thyroid-stimulating hormone (TSH), insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3), and sex hormone-binding globulin (SHBG)).\nResults: Findings from the study showed alterations in stress-related and growth-related hormones, as well as cognitive performance throughout WWT, while metabolic hormones were unchanged. The variation in hormones between training locations may be reflective of travel time and distance from home station. The increase in stress hormones (i.e., ACTH and cortisol) and associated decrease in cognitive performance observed in AK suggest heightened physiological strain in AK compared to MT, despite similarities in training routine, protocol, and sleep quality. These data suggest that training in cold environments, similar to the WWT locations, may exacerbate the physiological strain experienced by operators, which may negatively impact warfighter health and performance. Therefore, an acclimatization period and additional recovery time may be warranted for cold-weather trainings.\nClinical/Operational Implications: (1) Objective Cognitive Monitoring Under Stress. DANA was able to detect changes in cognitive function that correlated with hormonal stress responses. This shows DANA can be a reliable, mobile tool for tracking brain performance in high-stress environments\u2014whether in the military, athletic settings, or occupations involving extreme conditions (e.g., firefighters, emergency responders, etc.). (2) Early Detection of Performance Risk. The decline in cognitive scores alongside stress hormone spikes suggests DANA can help identify individuals who are at risk of mental fatigue, poor decision-making, or decreased performance\u2014before mistakes or injuries happen. (3) Supports Recovery Planning. By using DANA regularly, clinicians or commanders could better monitor recovery needs and determine when someone has returned to baseline after physically or mentally taxing events. This can guide protocols for acclimatization, rest, or rotation out of extreme environments to protect long-term health and readiness. (4) Broader Health Applications. This pilot study al
193so hints at how tracking cognitive performance alongside biological measures (like hormones or glucose) could support care for people with chronic illness, PTSD, or hormonal disorders\u2014where stress and cognition are often linked.", 194 "url": "https://doi.org/10.1093/milmed/usae075", 195 "tags": [ 196 "hormones", 197 "military", 198 "operational-performance" 199 ] 200 }, 201 { 202 "id": 14, 203 "topic": "Comparing Hypothermic and Thermal Neutral Conditions to Induce Metabolic Suppression", 204 "year": "2024", 205 "journal": "Therapeutic Hypothermia and Temperature Management", 206 "citation": "Comparing Hypothermic and Thermal Neutral Conditions to Induce Metabolic Suppression\n\nJon C. Rittenberger, Guthrie Robert Packer Hospital Emergency Medicine Residency and Department of Emergency Medicine, University of Buffalo; Brian M. Clemency, Brian Monaco and David Hostler, Department of Emergency Medicine and Center for Research and Education in Special Environments, University of Buffalo; Jacqueline Schwob and Joshua T. Murphey, Center for Research and Education in Special Environments, University of Buffalo\n\nTherapeutic Hypothermia and Temperature Management. 2024.\n\nDOI: 10.1089/ther.2023.0085", 207 "summary": "In space, astronauts need to keep carbon dioxide (CO\u2082) levels low, and slowing their metabolism reduces CO\u2082 production. This could help CO\u2082 filters on spacecraft last longer. This study was conducted by the University of Buffalo to test how a sedative combined with cold exposure\u2014used to slow down the body\u2019s metabolism\u2014affects cognition.\n\nIn the study, DANA was used before, during, and after sedation to track performance on cognitive tasks. Results showed clear declines in cognitive performance following sedation and cold exposure, with delayed recovery in colder conditions. These changes were measurable across multiple time points, highlighting DANA\u2019s sensitivity to real-time, medication-induced cognitive impairment.\n\nIndependent study that utilized DANA to evaluate the effects of metabolic suppression and sedation on cognition.\nObjectives: A decrease of carbon dioxide production by astronauts during spaceflight could significantly prolong the active life of CO2 scrubbers, which are used to remove excess carbon dioxide from the air in spacecraft to maintain a safe and healthy environment. Metabolic suppression decreases carbon dioxide production. Sedation and cold environments are required for metabolic suppression. This study was conducted to test a new oral formulation of dexmedetomidine (a sympatholytic anesthesia) as a potential sedative to induce metabolic suppression and reduce CO2 production during spaceflight.\nMethods: 6 subjects (4 males; average age of 30 years old) participated in this crossover trial where they were exposed to a cold environment and a thermal neutral environment and sedated with dexmedetomidine for 3 hours in each condition. The subjects completed a DANA test battery prior to and immediately after exposure to each environmental condition. Subjects also completed the same DANA text battery every 30 minutes during the 150-minute recovery time following each environmental condition exposure. The DANA test battery included simple reaction time (assesses basic reaction time), procedural reaction time (tests attention and processing speed), and go/no-go (tests speed, accuracy, response commissions and omissions).\nResults: There was a significant difference in performance on DANA between baseline and start of recovery, regardless of thermal exposure. However, the cold condition resulted in performance decrements for a longer interval. These results suggest that after metabolic suppression, a period of cognitive recovery may be required before completing mission critical tasks.\nClinical/Operational Implications: (1) Monitoring Medication Effects on Cognition. The study supports the use of DANA as a digital tool to detect and monitor how medications impact cognitive function in real time. Potential use cases include post-operative monitoring, tracking side effects, titrating doses, and assessing cognitive baselines. (2) Remote Cognitive Health Tracking. Because DANA is a smartphone-based tool, it can be used to track cognitive recovery remotely\u2014especially useful in places like space, the battlefield, or isolated environments where traditional neuropsychological assessments are impractical. (3) Application in High-Risk or Operational Settings. DANA could be embedded into safety protocols for astronauts, military personnel, or critical-care patients to ensure readiness before resuming high-stakes activities after sedation, cold exposure, or metabolic
207suppression.", 208 "url": "https://doi.org/10.1089/ther.2023.0085", 209 "tags": [ 210 "medications-and-supplements", 211 "operational-performance" 212 ] 213 }, 214 { 215 "id": 15, 216 "topic": "Ketone Monoester Attenuates Declines in Cognitive Performance and Oxygen Saturation During Acute Severe Hypoxic Exposure Under Resting Conditions", 217 "year": "2024", 218 "journal": "Experimental Physiology", 219 "citation": "Ketone Monoester Attenuates Declines in Cognitive Performance and Oxygen Saturation During Acute Severe Hypoxic Exposure Under Resting Conditions\n\nTyler S. McClure and Brendan Egan, School of Health and Human Performance, Dublin City University; Jeffrey Phillips, Kody Coleman, Ed Chappe, Gary R. Cutter, Todd Norell, Marcas M. Bamman, Healthspan, Resilience and Performance Research, Florida Institute for Human and Machine Cognition; Andrew P. Koutnik, Healthspan, Resilience and Performance Research, Florida Institute for Human and Machine Cognition and Sansum Diabetes Research Institute, Santa Barbara; Brianna J. Stubbs, Buck Institute for Research on Aging; and Dawn Kernagis, Healthspan, Resilience and Performance Research, Florida Institute for Human and Machine Cognition and Department of Neurosurgery, University of North Carolina.\n\nExperimental Physiology. 2024.\n\nDOI: 10.1113/EP091794", 220 "summary": "Low-oxygen conditions reduce oxygen levels in the blood and impair cognitive function. This study by the Florida Institute for Human and Machine Cognition, the Buck Institute for Research on Aging, and the University of North Carolina, investigated whether ketone supplements could counteract the cognitive decline experienced in low-oxygen conditions.\n\nDANA test results showed a clear drop in cognitive performance during low-oxygen exposure. However, the decline in performance was significantly reduced in study participants who took the ketone supplements vs those that received the placebo.\n\nThis study demonstrates DANA\u2019s sensitivity to detect real-time changes in cognitive performance due to factors like low oxygen conditions (e.g., hypoxia, COPD, sleep apnea) and dietary supplements, and its utility to evaluate the effectiveness of interventions (like new treatments, supplements, medications or lifestyle changes) on brain health.\n\nIndependent study examining the effects of ketone supplements on cognitive function during hypoxic exposure under resting conditions.\nObjectives: Acute hypoxic exposure causes reduced blood oxygen saturation and impairs cognitive function. This study investigated whether ketone supplements could act as a countermeasure to the decline in blood oxygen saturation and cognitive performance during acute sever hypoxic exposure at rest.\nMethods: 23 male military aviation students (mean age of 25 years) participated in this single-blind, placebo-controlled, randomized crossover study, which consisted of 2 identical experimental trials, separated by 48 hours between trials. During both experimental trials, each participant performed cognitive assessments via DANA and RightEye (an eye-tracking cognitive assessment) at rest in 3 different environments, with a 30-minute break between each testing round. The 3 environments included room air (baseline), normoxia (standard oxygen levels at sea level), and hypoxia (severely reduced oxygen levels found at high altitudes). The normoxia and mild hypoxia environments were achieved with a reduced oxygen breathing device. At each trial, participants were randomly assigned to receive 2 separate doses of either the ketone supplements or a placebo, consumed 30 minutes before both the normoxia environment and the hypoxia environment. The DANA tests used were the code substitution simultaneous (CSS) and code substitution delayed (CSD) tests. Blood samples were taken throughout both trials.\nResults: The RightEye cognitive test did not detect any changes. However, significant differences between the ketone supplements treatment and the placebo were found in the DANA test scores during hypoxia. Specifically, the decline in cognitive efficiency scores for CSD during hypoxia was significantly attenuated with the ketone supplements treatment. The decline in blood oxygen saturation during hypoxia was also significantly reduced with the ketone supplements treatment. Accordingly, this study showed that ketone supplements taken prior to the severe hypoxic exposure reduces the hypoxia-induced declines in blood oxygen saturation and cognitive performance.\nClinical/Operational Implications: (1) DANA can detect subtle cognitive changes under physiological stress. DANA is sensitive enough to pick up real-time changes in cognitive performance due to factors like low oxygen or dietary supplements. Accordingly, DANA can be used to monitor patients with respiratory conditions (e.g., COPD, sleep apnea) where oxygen levels fluctuate. (2) Clinical Trials and Interventions. Since DANA was able to detect cognitive improvement from ketones, it can be used to evaluate the effectiveness of interventions (like new treatments, supplements, or lifestyle changes) on brain health.", 221 "url": "https://doi.org/10.1113/EP091794", 222 "tags": [ 223 "medications-and-supplements", 224 "operational-performance", 225 "oxygen-levels-and-cognition" 226 ] 227 }, 228 { 229 "id": 16, 230 "topic": "Ketone Monoester Attenuates Oxygen Desaturation During Weighted Ruck Exercise Under Acute Hypoxic Exposure but Does Not Impact Cognitive Performance", 231 "year": "2024", 232 "journal": "Experimental Physiology", 233 "citation": "Ketone Monoester Attenuates Oxygen Desaturation During Weighted Ruck Exercise Under Acute Hypoxic Exposure but Does Not Impact Cognitive Performance\n\nTyler S. McClure and Brendan Egan, School of Health and Human Performance, Dublin City University; Jeffrey Phillips, Kody Coleman, Ed Chappe, Gary R. Cutter, Todd Norell, Marc
233as M. Bamman, Healthspan, Resilience and Performance Research, Florida Institute for Human and Machine Cognition; Andrew P. Koutnik, Healthspan, Resilience and Performance Research, Florida Institute for Human and Machine Cognition and Sansum Diabetes Research Institute, Santa Barbara; Brianna J. Stubbs, Buck Institute for Research on Aging; and Dawn Kernagis, Healthspan, Resilience and Performance Research, Florida Institute for Human and Machine Cognition and Department of Neurosurgery, University of North Carolina.\n\nExperimental Physiology. 2024.\n\nDOI: 10.1113/EP091789", 234 "summary": "This second study by the Florida Institute for Human and Machine Cognition, the Buck Institute for Research on Aging, and the University of North Carolina, examined whether ketone supplements could counteract the cognitive decline experienced in low-oxygen conditions with an additional factor\u2014exercise.\n\nThe study found that ketone supplements helped maintain better oxygen levels in the blood under low-oxygen conditions. But\u2014unlike in the researchers\u2019 earlier study (done while participants were resting)\u2014DANA confirmed that the ketones did not improve cognitive performance during exercise. The researchers believed the results were different in this study because exercise itself improves brain function, and that boost was strong enough to cancel out the negative effects of low oxygen, making it hard to see a difference from the ketone supplements.\n\nResults from both
234studies together show how DANA can be used to understand how interventions affect brain function across different physical states\u2014resting, active, and stressed.\n\nIndependent study examining the effects of ketone supplements on cognitive function during hypoxic exposure while performing moderate-intensity exercise.\nObjectives: Acute hypoxic exposure causes reduced blood oxygen saturation and impairs cognitive function. This study investigated whether ketone supplements could mitigate the decline in blood oxygen saturation and cognitive performance during acute sever hypoxic exposure while performing moderate-intensity exercise.\nMethods: 16 males (mean age of 24 years) participated in this single-blind, placebo-controlled, randomized crossover study, which consisted of 2 identical experimental trials, separated by 48 hours between trials. The experimental trials consisted of an exercise protocol of two 20-minute sessions of walking on a treadmill at 3.2 km/h on a 10% incline while wearing a weighted vest, performed in a normobaric altitude chamber (to simulate acute severe hypoxia). Each participant performed a cognitive assessment via DANA (among other tests) prior to entering the chamber (baseline), then again before starting the first session, in between the first and second sessions, and after the second session. The DANA tests used were the simultaneous code substitution (CSS) and delayed code substitution (CSD) tests. At the first trial, participants were randomly assigned to receive a treatment of either the ketone supplements or the placebo, which was consumed after the baseline testing. At the second trial, participants received the opposite treatment (either the ketone supplements or the placebo) that they received in the first trial. Blood samples were taken throughout both trials.\nResults: The decline in blood oxygen saturation during hypoxia was significantly reduced with the ketone supplements treatment. However, this blood oxygen saturation \u2018advantage\u2019 compared with the placebo did not translate into differences in cognitive performance (like it did in the researchers\u2019 prior study where the participants were tested in a non-exercising, resting state). In this study, DANA confirmed that no cognitive advantage existed with the ketone supplements. The researchers sited prior studies that had shown that acute exercise can temporarily enhance cognitive performance. Accordingly, the researchers attributed the findings in this study to the potent effect of acute exercise improving cognitive performance being greater than the declines expected under hypoxia.\nClinical/Operational Implications: (1) DANA can detect subtle changes in brain function during physical and environmental stress. Although ketones did not improve cognition in this case, DANA was still used successfully to track cognitive performance during exercise and hypoxia. This supports DANA\u2019s utility as a portable tool for measuring brain function in dynamic, high-stress environments, like military operations, altitude training, or extreme sports. (2) Therapeutic Interventions. The study showed better blood oxygen levels with ketones\u2014but no parallel brain performance improvement. DANA helped confirm this. DANA can be utilized in evaluating supplements or interventions for their impact on real-time cognitive functioning and aid in confirming whether physiological improvements translate to cognitive improvements.", 235 "url": "https://doi.org/10.1113/EP091789", 236 "tags": [ 237 "medications-and-supplements", 238 "operational-performance", 239 "oxygen-levels-and-cognition" 240 ] 241 }, 242 { 243 "id": 17, 244 "topic": "Sex Differences in Autonomic Functions and Cognitive Performance During Cold-Air Exposure and Cold-Water Partial Immersion", 245 "year": "2024", 246 "journal": "Frontiers in Physiology", 247 "citation": "Sex Differences in Autonomic Functions and Cognitive Performance During Cold-Air Exposure and Cold-Water Partial Immersion\n\nYoungsun Kong, Riley McNaboe, Hugo F. Posada-Quintero and Ki H. Chon, Biomedical Engineering, University of Connecticut, Md Billal Hossain, Analog Devices, Jeffrey Bolkhovsky, Naval Submarine Medical Research Laboratory, and Matthew Daley and Krystina Diaz, Naval Submarine Medical Research Laboratory and Leidos.\n\nFrontiers in Physiology. 2024.\n\nDOI: 10.3389/fphys.2024.1463784", 248 "summary": "This independent study examined whether men and women respond differently to cold exposure, both physically and cognitively.\n\nDANA provided a quick, repeatable way to detect these subtle changes, including slower performance even when accuracy remained stable. The study supports using DANA alongside wearable physiological data and individualized baselines to better understand who may be at risk for cognitive decline in cold environments and to guide safer operational planning, training, and work-rest schedules.\n\nThis independent study investigated the differences between males and females in autonomic functions and cognitive performance during cold exposure.\nMethods: 22 men, 19 women (mean age of 24) participated in this study, wherein the subjects were exposed to 3 different environments (room-temperature air, cold air, and cold water) across 3 separate days (1 environment per day). In each environment, the subjects completed a DANA test battery every 30 minutes, consisting of simple reaction time (SRT), procedural reaction time (PRT), go/no-go (GNG), code substitution (CS) and spatial discrimination (SPD). Subjects performed 5 DANA test batteries in the normal and cold air environments (2.5 hours) and 3 test batteries in the cold water environment (1.5 hours). During each experimental condition, physiological data were collected to assess autonomic function, including electrodermal activity (EDA) data and heart rate variability (HRV) derived from electrocardiogram signals.\nResults: In cold air, women slowed on spatial manipulation tasks, immediate memory, and attention; men were the same or faster. The slowdown in women was most obvious early in exposure and eased with time/practice. In cold water, men showed slower immediate memory versus normal/cold air; women did not. Both males and females exhibited smaller EDA amplitudes during cold-air and cold-water conditions compared to room temperature air. For HRV, only male subjects exhibited significantly greater values in low-frequency and very-low-frequency components during cold air exposure compared to the normal condition.\nClinical/Operational Implications: (1) DANA is sensitive to cognitive changes in women. DANA picks up changes in cognition in women even when \u201caccuracy\u201d looks fine. (2) Baseline smartly\u2014and capture women\u2019s biological context. Unmeasured factors (e.g., hormonal status/menstrual cycle) can modulate cold responses\u2014collecting these will sharpen DANA interpretation in women.", 249 "url": "https://doi.org/10.3389/fphys.2024.1463784", 250 "tags": [ 251 "military", 252 "operational-performance", 253 "womens-health" 254 ] 255 }, 256 { 257 "id": 18, 258 "topic": "Cognitive Impairment in Post-Acute Sequelae of COVID-19 and Short Duration Myalgic Encephalomyelitis Patients is Mediated by Orthostatic Hemodynamic Changes", 259 "year": "2023", 260 "journal": "Frontiers in Neuroscience", 261 "citation": "Cognitive Impairment in Post-Acute Sequelae of COVID-19 and Short Duration Myalgic Encephalomyelitis Patients is Mediated by Orthostatic Hemodynamic Changes\n\nHeather Day, University of Utah School of Medicine; Brayden Yellman, Sarah Hammer, Candace Rond, Jennifer Bell, Saeed Abbaszadeh, Lucinda Bateman and
261Suzanne D. Vernon, Bateman Horne Center; Derya Unutmaz, Jackson Laboratory for Genomic Medicine, University of Connecticut\n\nFrontiers in Neuroscience. 2023.\n\nDOI: 10.3389/fnins.2023.1203514", 262 "summary": "This study by the Bateman Horne Center and the University of Connecticut was one of the first large scale, clinical research, time series analyses to compare ME/CFS (chronic fatigue syndrome) patients with Long COVID patients. Both patient populations report orthostatic intolerance (OI)\u2014a problem where just being upright can cause dizziness, brain fog, and fatigue. In this study, researchers examined the relationship between the hemodynamic (blood flow) changes and the cognitive decline associated with OI\u2014and used DANA to measure the cognitive changes.\n\nAs in the Bateman Horne Center's 2022 study, DANA test results showed that both Long COVID and ME/CFS patients had worse cognitive performance than healthy controls immediately after the OI test. This study's findings also showed that narrow pulse pressure and increased heart rate were objectively linked to worse DANA scores\u2014especially in Long COVID and early ME/CFS patients. In long-term ME/CFS patients, DANA detected persistent cognitive impairment that was not tied to circulatory changes, suggesting lasting neural or structural changes. In older patients (ages 40\u201365), the cognitive effects of the OI test were more pronounced.\n\nThis study reinforces that DANA is a clinically useful, sensitive tool to detect cognitive impairment triggered by changes in blood flow and heart rate, especially in early-stage Long COVID and ME/CFS. It also shows that cognitive testing with DANA can help clinicians distinguish between reversible, physiologically driven brain fog and long-term cognitive decline\u2014supporting more targeted, stage-specific care.\n\nSecond independent Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) study using DANA to measure the effect of orthostatic intolerance (OI) on cognitive function in these patient populations.\nObjectives: There is a consistent finding of a link between OI and cerebral hypoperfusion causing corresponding cognitive deficits. This study is one of the first large scale, clinical research, time series analyses to compare short illness duration ME/CFS patients with Long COVID patients. Since OI is one of the common symptoms experienced by post-infection ME/CFS and Long COVID patients, this study was conducted to determine whether cerebral hypoperfusion that occurs from orthostatic challenge causes decreased cognitive efficiency and slower reaction times.\nMethods: 34 Long COVID patients, 71 <4 yr duration ME/CFS patients, 69 >10 yr ME/CFS patients, and 82 healthy control subjects completed DANA testing immediately before and after completing the 10-Minute NASA Lean Test (a passive stand test), and then completed subsequent DANA testing at 2 days and 7 days after said orthostatic challenge. The DANA test battery included simple reaction time (SRT), procedural reaction time (PRT), and go/no-go (GNG).\nResults: Cognitive efficiency was significantly lower in all disease groups compared to healthy controls immediately after the lean test. Cognitive efficiency remained low for the >10 yr ME/CFS patients at both 2 and 7 days after the lean test. For the Long COVID patients, there was (i) a significant direct effect of Long COVID on cognitive efficiency on the PRT and GNG tests, (ii) a significant indirect effect of pulse pressure (systolic blood pressure minus diastolic blood pressure) on cognitive efficiency on the GNG test, and (iii) there was a significant indirect effect of increased heart rate on cognitive efficiency on the PRT test. Accordingly, this was one of the first studies to demonstrate the impact of orthostatic hemodynamic change on cognition in Long COVID. For the <4 yr duration ME/CFS patients, there was a significant indirect effect of increased heart rate on cognitive efficiency on the PRT test. However, hemodynamic changes did not correlate with cognitive impairment for >10 year ME/CFS patients, even though cognitive impairment remained. These findings underscore the need for early diagnosis to mitigate direct hemodynamic and other physiological effects on symptoms of cognitive impairment.\nClinical/Operational Implications: (1) DANA is a Sensitive Tool to Detect Real-Time Cognitive Decline. The study further validates DANA\u2019s sensitivity in detecting acute, real-world drops in cognitive function, particularly during or after physical stressors. (2) Helps Identify Physiological Drivers of Cognitive Impairment. Narrow pulse pressure and increased heart rate were objectively linked to worse DANA scores\u2014especially in Long COVID and early ME/CFS patients. These markers are easily measurable, and when paired with DANA, they create a powerful diagnostic combo to uncover the root cause of brain fog. (3) Highlights Disease Duration and Age Effects. In long-term ME/CFS patients, DANA detected persistent cognitive impairment that was not tied to circulatory changes, suggesting lasting neural or structural changes. In older patients (ages 40\u201365), the cognitive effects of standing were more pronounced, reinfor
262cing the value of age-aware assessment tools like DANA. (4) Supports Early Intervention and Disease Monitoring. Since DANA detects both short-term and lasting cognitive problems\u2014and correlates with underlying physiological instability\u2014it can help identify patients early in disease course, track response to treatment and adjust activity recommendations to prevent cognitive crashes. (5) Enables Easy Office-Based or Remote Testing. DANA can be used before and after orthostatic challenges, both in clinics and at home, making it an ideal tool for monitoring symptom flares and remote assessments in different patient populations.", 263 "url": "https://doi.org/10.3389/fnins.2023.1203514", 264 "tags": [ 265 "covid", 266 "fatigue" 267 ] 268 }, 269 { 270 "id": 19, 271 "topic": "Orthostatic Challenge Causes Distinctive Symptomatic, Hemodynamic and Cognitive Responses in Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome", 272 "year": "2022", 273 "journal": "Frontiers in Medicine", 274 "citation": "Orthostatic Challenge Causes Distinctive Symptomatic, Hemodynamic and Cognitive Responses in Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome\n\nSuzanne D. Vernon, Lucinda Bateman, Sarah Hammer, Jennifer Bell, and Saeed Abbaszadeh, The Bateman Home Center of Excellence; Sherlyn Funk and Gregory J. Stoddard, Department of Family & Preventive Medicine, University of Utah School of Medicine; W. Ian Lipkin, Center for Solutions for ME/CFS, Center for Infection and Immunity, Mailman School of Public Health, Columbia University; Anthony L. Komaroff, Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School\n\nFrontiers in Medicine. 2022.\n\nDOI: 10.3389/fmed.2022.917019", 275 "summary": "In this study, researchers from the Bateman Home Center of Excellence, Columbia University, and Harvard Medical School, examined whether a quick, in-office test that simulates standing up for 10 minutes (called the NASA Lean Test) would trigger cognitive impairment in people with Long COVID and ME/CFS (chronic fatigue syndrome)\u2014and whether those changes could be objectively measured using DANA.\n\nDANA test results confirmed that the Long COVID and ME/CFS patients had worsened cognitive performance after the test\u2014just from standing upright for 10 minutes, matching their reports of \u201cbrain fog.\u201d In contrast, the healthy control subjects actually performed better on the DANA cognitive tests after standing.\n\nThe study shows that DANA is sensitive enough to pick up subtle brain fog after a simple physical challenge, which is crucial for illnesses like Long COVID and ME/CFS, where symptoms like fatigue and brain fog are often invisible and hard to quantify. The findings highlight DANA\u2019s ability to capture objective data on cognitive decline and DANA's utility in clinical trials testing treatments for brain fog, fatigue, or post-viral syndromes.\n\nIndependent study that utilized DANA to detect and measure cognitive impairment associated with orthostatic intolerance (OI) in patients with Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).\nObjectives: Determine whether a simple, standardized, office-based test of OI would aggravate symptoms associated with Long COVID and ME/CFS and produce objective hemodynamic and cognitive abnormalities, the latter being evaluated by DANA.\nMethods: 42 Long COVID patients, 26 ME/CFS patients, and 20 healthy control subjects participated in this study. Immediately before and after completing the 10-Minute NASA Lean Test (a simple, standardized test of OI), participants completed DANA cognitive testing and a symptom assessment. The DANA test battery included simple reaction time (SRT), procedural reaction time (PRT), and go/no-go (GNG). Participants\u2019 blood pressure and heart rate were measured immediately before and after, and each minute during, the OI test. Participants completed subsequent DANA testing 2 days and 7 days after the OI test.\nResults: There was a significant worsening of symptoms during and immediately after the OI test only in the two patient groups, and not in the healthy control subjects. Both patient groups experienced increased diastolic blood pressure which caused a reduced pulse pressure and an abnormally narrowed blood pressure ratio. Finally, the DANA tests assessed before and after the OI test revealed that, immediately after completion of the OI test, cognitive efficiency in all three tests dropped in both patient groups, whereas it rose in the healthy control subjects. The difference between each of the two patient groups and the healthy control group was statistically significant for the PRT and SRT tests. The slowed reaction time observed is consistent with the subjective reports by people with Long COVID and with ME/CFS that orthostatic challenge leads to worsening in their cognitive function. Slowed reaction time is one of the most sensitive measures of impaired cognitive functioning and has been the most consistently measured objective finding in ME/CFS neurocognitive research.\nClinical/Operational Implications: (1) DANA can objectively detect cognitive impairment triggered by physical stress and in post-viral illnesses. The study showed that DANA was sensitive enough to pick up subtle brain fog after a simple physical challenge (just standing). This is crucial for illnesses like Long COVID and ME/CFS, where symptoms like fatigue and brain fog are often invisible and hard to quantify. (2) Disability Assessments and Clinical Trials. Because DANA captures objective data on cognitive decline, it can be used as part of functional assessments for disability claims and clinical trials testing treatments for brain fog, fatigue, or post-viral syndromes.", 276 "url": "https://doi.org/10.3389/fmed.2022.917019", 277 "tags": [ 278 "covid", 279 "fatigue" 280 ] 281 }, 282 { 283 "id": 20, 284 "topic": "Defining Biological Phenotypes of Mild Traumatic Brain Injury Using Saliva MicroRNA Profiles", 285 "year": "2022", 286 "journal": "Journal of Neurotrauma", 287 "citation": "Defining Biological Phenotypes of Mild Traumatic Brain Injury Using Saliva MicroRNA Profiles\n\nSteven D. Hicks, Brooke P. Lichak, Andrea C. Loeffert, Cayce Onks, Robert P. Olympia and Jayson Loeffert, Departments of Pediatrics, Family Medicine, Emergency Medicine and Orthopedics and Rehabilitation, College of Medicine, Penn State University, John Leddy and Mohammad Nadir Haider, Department of Sports Medicine, SUNY Buffalo School of Medicine and Biomedical Sciences and Department of Orthopedics, State University of New York at Buffalo, Michael Dretsch, US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Priscilla Tennant, Quadrant Biosciences, Inc., Scott L. Zuckerman, Department of Neurosurgery, Vanderbilt University Medical Center, Chuck Monteith, Department of Sports Medicine, Colgate University, and Christina L. Master, Department of Pediatrics, Children\u2019s Hospital of Philadelphia\n\nJournal of Neurotrauma. 2022.\n\nDOI: 10.1089/neu.2022.0018", 288 "summary": "This independent, multicenter study examined whether saliva biomarkers could identify biologically distinct types of concussion. The biological groups differed in factors such as age, time since injury, prior concussions, and reported symptoms, but they did not show clear overall differences on standard balance or cognitive testing. Some subgroups nevertheless showed distinct patterns\u2014for example, poor cognition and balance, cognitive problems without balance deficits, balance problems with relatively normal cognition, or high symptoms without major objective impairment. This suggests that concussion biology, symptoms, cognition, and balance may reflect different parts of the injury and should be considered together rather than treated as interchangeable.\n\nDANA provided an objective measure of how participants were functioning cognitively at the time of testing. It helped show that biologically similar patients may perform differently, and that patients with similar symptoms may have different patterns of cognitive impairment. Used alongside biomarkers, symptom reports, and balance testing, DANA can contribute to a more complete and potentially more personalized assessment of concussion.\n\nConcussion is biologically heterogeneous, yet clinical care typically relies on
288symptoms and functional tests. This independent study explored whether saliva microRNA (miRNA) profiles could objectively sort concussed patients into biologically distinct subgroups (\u201cphenotypes\u201d) that might lead to more personalized concussion care.\nObjectives: Determine whether saliva miRNA profiles could differentiate concussed individuals into biologically distinct clusters and whether such clusters correspond to clinically meaningful data (medical/demographic traits, symptoms, and functional measures of balance and cognition).\nMethods: This study included a multicenter cohort of 251 participants with an average age of 18 (\u00b1 7) years; 57% male), all with a clinical diagnosis of mild traumatic brain injury (mTBI). Participants presented at one of the clinical sites within 14 days post-injury. At enrollment, all participants reported symptoms via the Post-Concussion Symptom Scale and provided saliva samples. A portion of the participants (177) also underwent a balance test using the ClearEdge system and completed a DANA test battery. The DANA test battery included simple reaction time tested at the beginning of the battery (SRT1) and again at the end of the battery (SRT2), procedural reaction time (PRT), and go/no-go (GNG). The 251 participants were optimally grouped into 10 distinct miRNA clusters based on a targeted panel of 22 miRNAs previously linked to concussion biology. The researchers then compared demographic/medical history, symptom scores and functional testing across the groups. Finally, the miRNAs defining each cluster were mapped to infer physiological pathways that may characterize each biological subgroup and potentially relate to symptomology and pharmacologic targets.\nResults: There were differences among clusters in age, days post-injury, history of prior concussions, and subjective symptoms. In contrast, there were no significant differences among the clusters in standard clinical performance measures of balance or neurocognition. The authors suggest that this may be because balance and cognition are \u201cstate\u201d functions influenced by many factors (fatigue, hunger, mood, musculoskeletal factors), and may not map cleanly onto a single biological pathway reflected by a miRNA cluster. However, the study did find certain cognitive and balance performance patters by clusters. Cluster No. 2, described as having \u201crobust\u201d miRNA patterns seen in prior concussion work, performed the most poorly on functional assessments of neurocognition and balance. Cluster No. 4 reported symptoms primarily cognitive in nature, confirmed by low DANA scores, but no balance deficits. Cluster No. 5 had functional balance problems but relatively typical neurocognitive performance on DANA. Cluster No. 7 did not have any substantial objective deficits in cognition or balance, but had high subjective symptoms.\nClinical/Operational Implications: Even when concussed patients were clustered into biologically distinct saliva miRNA profiles, objective neurocognitive and balance performance were not significantly different between clusters\u2014supporting the idea that biomarker phenotypes and functional impairment are complementary dimensions of concussion assessment.", 289 "url": "https://doi.org/10.1089/neu.2022.0018", 290 "tags": [ 291 "concussion-tbi" 292 ] 293 }, 294 { 295 "id": 21, 296 "topic": "Caffeine May Disrupt the Impact of Real-Time Drowsiness on Cognitive Performance: a Double-blind, Placebo-controlled Small-Sample Study", 297 "year": "2021", 298 "journal": "Scientific Reports", 299 "citation": "Caffeine May Disrupt the Impact of Real-Time Drowsiness on Cognitive Performance: a Double-blind, Placebo-controlled Small-Sample Study\n\nE. Aidman, M. Balin, K. Johnson, E. Mitchelson and J. Fidock, Defense Science and Technology Group, Australian Government Department of Defense; Gemma Paech, Siobhan Banks and C. Yates, Behavior\u2011Brain\u2011Body Research Group, Justice and Society, University of South Australia; M. Pajcin, Clinical and Health Sciences, University of South Australia; Gary Kamimori, Behavioral Biology Branch, Walter Reed Army Institute of Research; S. Jackson, School of Psychology, University of Sydney\n\nScientific Reports. 2021.\n\nDOI: 10.1038/s41598-021-83504-6", 300 "summary": "Researchers from the Australian Government Department of Defense, University of South Australia, Walter Reed Army Institute of Research and University of Sydney, examined (1) whether caffeine could break the usual link between drowsiness and reduced cognitive function, and (2) whether such disrupting effect would fluctuate depending on the complexity of the cognitive task.\n\n
300In the study, caffeine did not stop any of the participants from getting drowsy. However, in comparing DANA test results between participants who received caffeine and those who received the placebo, caffeine did reduce the negative effect that drowsiness had on cognitive performance, especially for more complex tasks.\n\nThe findings underscore DANA\u2019s ability to measure the effectiveness of cognitive performance enhancers and therapeutic interventions. The study also highlights DANA\u2019s ability to separate how someone feels from how well their brain is actually working, which is critical in assessing interventions where subjective awareness may not match objective performance (e.g., in sedation, ADHD, or early cognitive decline).\n\nIndependent pilot study examining the connection between real-time drowsiness and cognitive task performance of varying complexity, and demonstrating the sensitivity of DANA to increased fatigue.\nObjectives: Determine whether caffeine weakens the positive associations between drowsiness and reduced cognitive function and whether such weakening effect fluctuates depending on the complexity of the cognitive task.\nMethods: 24 participants (12 males; 12 females; aged 18-31 years) were randomly allocated to either a placebo or caffeine group. Both groups received a 10-hour sleep opportunity and were then subject to 50 hours of total sleep deprivation (TSD). The caffeine group consumed 4 doses of caffeine every 2 hours on the first and second nights of TSD. Every 3 hours, all participants drove for 40 continuous minutes in a driving simulator. During the driving task, a randomly selected subgroup of 11 participants (5 from the caffeine group and 6 from placebo group) wore an infra-red oculography monitor that quantified drowsiness levels in the form of the Johns Drowsiness Scale (JDS) scores. After each driving task, all participants completed the following DANA tests: simple reaction time (SRT), procedural reaction time (PRT), and go/no-go (GNG).\nResults: Higher drowsiness (shown in increasing JDS scores) did not result in a linear decline in cognitive performance in the caffeine group. Further, the magnitude of this dissociation appeared to depend on task complexity, with caffeine significantly reducing the impact of drowsiness on executive performance in the GNG task, while producing similar but weaker trends in the PRT and SRT tasks. This is consistent with previous findings showing performance on simple tasks to be highly sensitive to sleep loss, while more complex tasks, such as response inhibition and decision making, tend to be less affected.\nClinical/Operational Implications: (1) DANA Is Sensitive to Real-Time Cognitive Changes. DANA is capable of detecting performance changes in real-time, even in high-fatigue, high-stress conditions like total sleep deprivation. It accurately measured slower reaction times, increased mental lapses and errors in decision-making and attention tasks. (2) DANA Can Evaluate the Impact of Interventions. DANA can objectively measure the effectiveness of cognitive performance-enhancing interventions, like caffeine. It can be used to monitor cognitive function during treatment, validate or fine-tune dosing strategies, and evaluate readiness. (3) Portable, Repeatable, Objective Monitoring Tool. Because DANA is mobile and designed for field use, it allows for scalable, repeatable testing without the need for full lab setups. This positions DANA as a practical solution for tracking mental sharpness in operational or clinical environments.", 301 "url": "https://doi.org/10.1038/s41598-021-83504-6", 302 "tags": [ 303 "fatigue", 304 "medications-and-supplements", 305 "military", 306 "operational-performance" 307 ] 308 }, 309 { 310 "id": 22, 311 "topic": "A Metabolic Intervention for Improving Human Cognitive Performance During Hypoxia", 312 "year": "2021", 313 "journal": "Aerospace Medicine and Human Performance", 314 "citation": "A Metabolic Intervention for Improving Human Cognitive Performance During Hypoxia\n\nKody Coleman, Jeff Phillips, Michelle Sciarini, Brianna Stubbs, Olivia Jackson and Dawn Kernagis, Florida Institute for Human and Machine Cognition and the Buck Institute for Research on Aging.\n\nAerospace Medicine and Human Performance. 2021.\n\nDOI: 10.3357/AMHP.5767.2021", 315 "summary": "Low-oxygen conditions cause a reduction in the body\u2019s blood oxygen levels, which negatively impacts cognitive function. Ketosis had been shown to offset cognitive decline caused by low-oxygen conditions in rodents. This study by the Florida Institute for Human and Machine Cognition and the Buck Institute for Research on Aging was the first to address whether ketosis could improve c
315ognitive function in humans.\n\nDANA\u2019s code substitution test (matching symbols and numbers) scores dropped during low-oxygen conditions, showing that oxygen deprivation negatively affected higher-level thinking. With ketone supplements, code substitution test performance improved under low-oxygen conditions, suggesting ketones helped protect the brain from oxygen-related decline. The simpler DANA tasks did not show much change, reinforcing that more complex thinking tasks are more sensitive to low-oxygen conditions\u2014and to the benefits of ketones.\n\nThe study demonstrates that DANA can detect cognitive impairments caused by physiological stress and is sensitive enough to differentiate those impairments between specific cognitive domains. The study also suggests DANA is a valuable tool for testing whether a treatment or supplement actually improves brain function, making it useful in clinical trials or therapeutic evaluations.\n\nIndependent pilot study that investigated whether ketosis could improve cognitive function in humans exposed to hypoxia.\nObjectives: Hypoxia causes a reduction in blood oxygen saturation and cerebral metabolic rate (the rate at which the brain consumes oxygen). Reduced cerebral metabolic rate negatively impacts cognitive function. Ketosis has been shown to attenuate cognitive decline caused by hypoxia in rodents. However, no research prior to this study had addressed whether ketosis could improve cognitive function in humans exposed to hypoxia.\nMethods: 11 male military aviation students (mean age of 24 years) participated in this pilot study, which consisted of 2 identical experimental trials, separated by 48 hours between trials. During both experimental trials, each participant performed cognitive assessments via DANA and RightEye (an eye-tracking cognitive assessment) at rest in 3 different environments, with a 30-minute break between each testing round. The 3 environments included room air (baseline), normoxia (standard oxygen levels at sea level), and mild hypoxia (reduced oxygen levels found at high altitudes). The normoxia and mild hypoxia environments were achieved with a reduced oxygen breathing device. At the first trial, participants were randomly assigned to receive 2 doses of either the ketone supplements or a placebo, consumed 30 minutes before both the normoxia environment and the hypoxia environment. At the second trial, participants received the opposite treatment (either the ketone supplements or the placebo) that they received in the first trial. The DANA test battery included simple reaction time (SRT), procedural reaction time (PRT) and the simultaneous code substitution (CSS) tests. Blood samples were taken throughout both trials.\nResults: DANA\u2019s CSS scores were significantly higher in the normoxia condition as compared to the hypoxia condition, indicating significant effects of hypoxia on cognitive function. Furthermore, during hypoxia exposure, CSS scores were higher with the ketone supplements treatment than in the placebo. These results demonstrated a protective effect of ketone supplements on cognitive function against the negative effects of acute, mild hypoxia. SRT and PRT did not show a significant decline during hypoxia. Based on prior research and the results of this study, the researchers speculated that that the physiological stress of hypoxia has greater effects on more complex cognitive processing, such as CCS, and thus these complex variables are more sensitive to interventions such as ketosis.\nClinical/Operational Implications: (1) DANA Detects Cognitive Effects of Physiological Stress. DANA can detect cognitive impairments caused by physiological stress, like low-oxygen conditions. This supports DANA\u2019s use in settings where cognitive performance may be affected by oxygen availability\u2014such as high-altitude training, critical care, respiratory illness (e.g., COPD), and sleep apnea or post-COVID fatigue. (2) DANA Helps Evaluate Therapeutic Interventions. DANA can detect the impacts of supplements on cognitive function and can be a valuable tool for testing whether a treatment or supplement actually improves brain function, making it useful in clinical trials or therapeutic evaluations. (3) Sensitive to Higher-Order Cognitive Functions. DANA is sensitive enough to differentiate cognitive impairments between specific cognitive domains\u2014not just general reaction speed. This is clinically useful when assessing patients with brain fog (e.g., Long COVID, chronic fatigue syndrome), early cognitive decline, and occupational fatigue or environmental stress (e.g., pilots, divers, soldiers). (4) Mobile, Real-Time Cognitive Monitoring in Operational Environments. DANA can be used in the field or at point-of-care to monitor how real-world stressors or supplements impact cognition. This translates to real-time readiness asse
315ssments or screening cognitive resilience in occupational, military, or sports medicine contexts.", 316 "url": "https://doi.org/10.3357/AMHP.5767.2021", 317 "tags": [ 318 "medications-and-supplements", 319 "military", 320 "operational-performance", 321 "oxygen-levels-and-cognition", 322 "therapeutic-interventions" 323 ] 324 }, 325 { 326 "id": 23, 327 "topic": "Saliva RNA Biomarkers Predict Concussion Duration and Detect Symptom Recovery: a Comparison with Balance and Cognitive Testing", 328 "year": "2021", 329 "journal": "Journal of Neurology", 330 "citation": "Saliva RNA Biomarkers Predict Concussion Duration and Detect Symptom Recovery: a Comparison with Balance and Cognitive Testing\n\nSteven Hicks, Andrea C. Loeffert, Cayce Onks, Jayson Loeffert and Robert P. Olympia, Departments of Pediatrics, Family Medicine, and Emergency Medicine, Penn State College of Medicine, Gregory Fedorchak, Aakanksha Rangnekar, Samantha DeVita, Jessica Rieger and Thomas Uhlig, Quadrant Biosciences, Inc., John Leddy and Mohammad N. Haider, SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Scott L. Zuckerman and Timothy Lee, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Chuck Monteith, Colgate University, Rebekah Mannix, Division of Emergency Medicine, Boston Children\u2019s Hospital, Harvard Medical School, Frank Middleton, Department of Neuroscience and Physiology, SUNY Upstate Medical University, Aaron Roberts, Department of Adena Regional Medical Center, Adena Bone and Joint Center, and Keith Owen Yeates, Department of Psychology, Alberta Children\u2019s Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary\n\nJournal of Neurology. 2021.\n\nDOI: 10.1007/s00415-021-10566-x", 331 "summary": "This independent multicenter study followed 112 young people with concussion to determine whether saliva biomarkers, cognitive testing, and balance testing could identify who would experience prolonged symptoms and who was recovering normally.\n\nDANA was most useful for tracking recovery over time rather than predicting the outcome from a single early test. Repeated DANA testing helped show whether cognitive performance was improving as expected or remaining stalled, particularly in reaction time and information processing. This supports its use alongside symptoms, balance, and biomarkers to guide follow-up care and safer return-to-school, sports, work, or other activities.\n\nThe goals of this independent study were to assess the ability of salivary non-coding RNA (ncRNA) levels to predict prolonged post concussion symptoms, and to examine the ability of ncRNAs to identify recovery compared to a cognition test (via DANA) and balance test.\nObjectives: In an adolescent population: (1) determine whether salivary ncRNAs measured within 14 days of injury can predict persistent post\u2011concussion symptoms (PPCS) at or after 21 days post\u2011injury; (2) determine whether salivary ncRNAs measured on or after 21 days can help identify symptom recovery; and (3) compare that capability against balance and cognitive testing.\nMethods: This study included a multicenter cohort of 112 participants, ages 8\u201324 (avg. age of 16 (\u00b1 4) years; 66% male), with a clinical diagnosis of mild traumatic brain injury (mTBI). All participants presented at one of the clinical sites within 14 days post-injury. At the initial assessment, all participants (1) reported symptoms via the Post-Concussion Symptom Scale, (2) underwent a balance test using the ClearEdge system, (3) completed a DANA test battery, and (4) provided saliva samples. The DANA test battery included simple reaction time tested at the beginning of the battery (SRT1) and again at the end of the battery (SRT2), procedural reaction time (PRT), and go/no-go (GNG). All participants completed the same testing protocol a second time on or after 21 days post-injury. The cohort was then divided into 2 groups, those with persistent post-concussion symptoms (PPCS) (32 participants) and those without (80 participants), based upon their self-reported symptom scores. Saliva samples taken from all participants were divided into a training set, evaluation set and a testing set. The training set (58% of both the PPCS group and the non-PPCS group) was used for ncRNA feature selection and predictive algorithm creation. The evaluation set
331(23% of total) was used to minimize bias, and the testing set (19% of total) was used to validate the accuracy of the resulting predictive algorithms.\nResults: At the initial assessment (\u226414 days), none of the balance or neurocognitive scores differed between those who later did vs did not meet PPCS criteria. In contrast, by \u226521 days, differences appeared in 2 of the balance tests and in all 4 DANA tests. Most PPCS participants did not display improvement between the 2 time points, whereas most non-PPCS participants significantly improved. The between-group difference was most evident in 3 DANA tests, PRT, SRT1 and SRT2. The ncRNA between-groups differences between testing points mirrored changes in balance and cognition. As for the predictive modeling, the model combining balance and DANA scores accurately differentiated symptomatic individuals from recovered individuals \u226521 days post-recovery. The model using ncRNAs and age identified recovered participants with slightly higher performance. Finally, the model that combined balance, DANA scores and ncRNAs yielded the best results.\nClinical/Operational Implications: (1) Adolescent/youth utility and validity. This study supports DANA-relevant measures in an 8\u201324-year-old concussion population; (2) DANA detects subtle, ongoing cognitive effects during recovery. DANA is valuable for follow-up monitoring and return-to-activity decisions when patients feel \u201csomewhat better\u201d yet may still show measurable cognitive inefficiency\u2014helping reduce premature return to play/work/school; (3) DANA for Recovery Tracking (Longitudinal Change). A key clinical leverage of DANA is in tracking within-person changes over repeated administrations, rather than trying to make a high-stakes call from a single snapshot. DANA\u2019s \u201csuperpower\u201d is helping clinicians identify whether a patient is showing the expected recovery trajectory (objective improvement) versus a stalled trajectory (little or no improvement), which can prompt closer monitoring, adjusted activity progression, and more individualized return-to-activity planning.", 332 "url": "https://doi.org/10.1007/s00415-021-10566-x", 333 "tags": [ 334 "concussion-tbi" 335 ] 336 }, 337 { 338 "id": 24, 339 "topic": "Overpressure Exposure From .50-Caliber Rifle Training Is Associated With Increased Amyloid Beta Peptides in Serum", 340 "year": "2020", 341 "journal": "Frontiers in Neurology", 342 "citation": "Overpressure Exposure From .50-Caliber Rifle Training Is Associated With Increased Amyloid Beta Peptides in Serum\n\nBharani Thangavelu, Christina R. LaValle, Michael J. Egnoto, Jeffrey Nemes, Angela M. Boutt\u00e9 and Gary H. Kamimori, Brain Trauma Neuroprotection Branch, and Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research\n\nFrontiers in Neurology. 2020.\n\nDOI: 10.3389/fneur.2020.00620", 343 "summary": "The purpose of this study by the Walter Reed Army Institute of Research was to evaluate how repeated exposure to blast waves from firing .50-caliber rifles affects the brain, even if the exposure is too mild to cause a concussion. To do this, researchers looked for TBI-associated biomarkers via blood samples and neurocognitive metrics via DANA.\n\nAnalysis results indicated that amyloid beta peptides, a TBI-related biomarker, may have utility as a biomarker of low level overpressure caused by .50-caliber rifle fire. Although no serious cognitive impairments were found using DANA in this study, combining it with blood biomarkers may provide a fuller picture of brain stress or injury that traditional symptom checks or imaging might miss.\n\nIndependent pilot study that evaluated TBI-associated biomarkers, neurocognitive metrics (via DANA), and reported symptomology among participants exposed to repeated, low level blast overpressure from .50-caliber rifle fire.\nObjectives: This study assessed acute changes in TBI-associated biomarkers as a consequence of repeated overpressure exposure from .50-caliber rifle use.\nMethods: 15 active duty law enforcement personnel (all male; age range 33-52 years) participated in a 3-day, .50-caliber training course. Participants were equipped with pressure sensors and DANA neurocognitive testing. The DANA test battery included
343simple reaction time (assesses basic reaction time), procedural reaction time (tests attention and processing speed), and go/no-go (tests speed, accuracy, response commissions and omissions). Blood sampling and symptomology assessments were conducted before and after each daily training session.\nResults: Amyloid beta peptides, a TBI-related biomarker, may have utility as a biomarker of low level overpressure caused by .50-caliber rifle fire. The levels of the other TBI-related biomarkers assessed were generally unaffected. Biomarker changes (i) were not associated with the cumulative effect of exposures, (ii) were not significantly correlated with number of shots fired per day, and (iii) were not significantly correlated with the DANA test results or to participants\u2019 reported symptoms.\nClinical/Operational Implications: (1) Operational Monitoring Tool. DANA can be used in military or occupational settings to track neurocognitive performance in real time, particularly in personnel exposed to potentially harmful environments like blast waves. (2) Early Intervention Potential. Even when individuals feel fine and don\u2019t show symptoms, subtle biological changes (like elevated amyloid beta levels) may signal the need for rest or further evaluation. DANA could play a key role in identifying early warning signs of cognitive stress. (3) Baseline Comparison Utility. By testing before and after exposure, DANA allows for personal baseline comparisons, which is crucial in detecting small but significant changes in cognition that could accumulate over time.", 344 "url": "https://doi.org/10.3389/fneur.2020.00620", 345 "tags": [ 346 "blast-overpressure-exposure", 347 "military", 348 "concussion-tbi" 349 ] 350 }, 351 { 352 "id": 25, 353 "topic": "Performance on the DANA Brief Cognitive Test Correlates with MACE Cognitive Score and may be a New Tool to Diagnose Concussion", 354 "year": "2020", 355 "journal": "Frontiers in Neurology", 356 "citation": "Performance on the DANA Brief Cognitive Test Correlates with MACE Cognitive Score and may be a New Tool to Diagnose Concussion\n\nJennifer R. Pryweller, Ellen C. O'Conor, and Abhi Pandhi, Department of Neurology, College of Medicine, University of Tennessee Health Science Center; Brandon C. Baughman, Department of Neurology, College of Medicine, University of Tennessee Health Science Center, and Semmes Murphey Clinic; Samuel D. Frasier, Department of Otolaryngology - Head and Neck Surgery, Naval Medical Center Portsmouth; Jiajing Wang, Division of Biostatistics, Department of Preventative Medicine, University of Tennessee Health Science Center; Aimee A. Morrison, Hospital of the University of Pennsylvania; Jack W. Tsao, University of Tennessee Health Science Center, Memphis Veterans Affairs Medical Center, and Children's Foundation Research Institute, Le Bonheur Children's Hospital\n\nFrontiers in Neurology. 2020.\n\nDOI: 10.3389/fneur.2020.00839", 357 "summary": "The objective of this independent study by the University of Tennessee Health Science Center, Naval Medical Center Portsmouth, and Hospital of the University of Pennsylvania, was to test DANA's ability to diagnose concussion in a remote, deployed environment, as compared to an established measure of concussion screening, the Military Acute Concussion Evaluation (MACE).\n\nResults from the study confirmed the validity of DANA to provide accurate assessments. DANA also showed no significant learning effect, meaning test results did not change much just because someone took the test multiple times. The study noted that the portability and durability of DANA, its shorter test time, and its lack of need for a medical professional to diagnose concussion overcame the critical limitations of MACE.\n\nNo evidence of practice effects improving performance was observed with the DANA testing, despite investigators\u2019 original hypothesis that repeated DANA testing would result in improvements in performance.\n\nIndependent study conducted to test the validity of DANA as a tool to diagnose concussion in a remote, deployed environment, as compared to an established measure of concussion screening, the Military Acute Concussion Evaluation (MACE).\nSelection of DANA for Study: The investigators selected DANA be
357cause it is \u201ca durable and portable neurocognitive assessment tool that can be self-administered on a handheld device, making it well-suited for military operations and/or extreme environments as well as the sideline of a sports field.\u201d\nMethods: MACE and DANA were administered to 40 male U.S. Marines deployed in Afghanistan who had not sustained a concussion within past 3 months. MACE and DANA were administered again at 24 hours and 48 hours after baseline assessment. The DANA test battery included seven subtests: simple reaction time (SRT) assessing basic reaction time (administered twice, once at the beginning of the test battery and once at the end, giving two subtests, SRT1 and SRT2), procedural reaction time (PRT) measuring attention and processing speed, go/no-go (GNG) which assesses speed, accuracy, and response omissions and commissions, code substitution simultaneous (CSS) assessing visual scanning, processing speed, attention, learning and immediate memory, spatial discrimination (SPD) which measures spatial manipulation, and code substitution delayed (CSD) which assesses visual recognition memory. The DANA battery also included a Patient Health Questionnaire (PHQ), a Primary Care PTSD screen (PC-PTSD), and an Insomnia Screening Index (ISI).\nResults: Validity of DANA to provide accurate assessments was confirmed. Scores on the PRT and GNG subtests were significantly associated with the MACE scores, and the PRT, GNG, SRT1 and SRT2 subtests were the most sensitive to post-concussion impairment. Additionally, there was no evidence of practice effects improving performance despite investigators\u2019 original hypothesis that repeated DANA testing would result in improvements in performance. The researchers concluded that the portability and durability of DANA, its shorter test time, and its lack of need for a medical professional to diagnose concussion overcome the critical limitations of MACE.\nClinical/Operational Implications: (1) DANA is a Field-Ready Concussion Screening Tool. DANA can detect cognitive changes related to concussion and can serve as a viable alternative or supplement to MACE, particularly in environments where medical personnel are not readily available (e.g., military, sports sidelines, remote clinics). Its digital, self-administered format means it can be deployed widely and quickly in high-risk settings. (2) Useful for Serial Monitoring and Recovery Tracking. Since DANA showed minimal practice effects, it can be used repeatedly to track cognitive changes over time, such as monitoring recovery after injury. This is important for return-to-duty or return-to-play decisions. (3) Potential to Improve Early Diagnosis. Early, accurate detection of concussion is critical to prevent further brain injury. DANA can help bridge the gap between injury and diagnosis, especially in environments where delays in medical evaluation are common. (4) Paves the Way for Broader Use Beyond the Military. Although tested with Marines, these results support the use of DANA in other populations\u2014athletes, first responders, and civilians\u2014where fast, portable, objective concussion screening is needed.", 358 "url": "https://doi.org/10.3389/fneur.2020.00839", 359 "tags": [ 360 "comparative-study", 361 "concussion-tbi", 362 "military", 363 "validity-and-reliability" 364 ] 365 }, 366 { 367 "id": 26, 368 "topic": "Diagnosing Mild Traumatic Brain Injury Using Saliva RNA Compared to Cognitive and Balance Testing", 369 "year": "2020", 370 "journal": "Clinical and Translational Medicine", 371 "citation": "Diagnosing Mild Traumatic Brain Injury Using Saliva RNA Compared to Cognitive and Balance Testing\n\nSteven D. Hicks, Kevin J. Zhen, Andrea C. Loeffert, Cayce Onks, Jayson Loeffert, Raymond Y. Kim and Robert P. Olympia, Departments of Pediatrics, Family Medicine, Orthopedics and Rehabilitation and Emergency Medicine, Penn State College of Medicine, Gregory Fedorchak, Samantha DeVita and Aakanksha Rangnekar, Quadrant Biosciences, Inc., John Leddy and Mohammad N. Haider, UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York, Zofia Gagnon, Callan D. McLoughlin, Matthew Badia, Jason Randall and Miguel Madeira, Departments of Biomedical Science, Environmental Science and Biology, Marist College, AaronM. Yengo-Kahn and JustinWenzel, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Matthew Heller and Hallie Zwibel, Department of Family Medicine, New York Institute of Technology College of Osteopathic Medicine, Aaron Roberts and Samantha Johnson, Adena Bone and Joint Center, Adena Regional Medical Center, Chuck Monteith, Athletic Training Department, Colgate University, Michael N. Dretsch, US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Thomas R. Campbell, Athletic Training Department, Old Dominion University, Rebekah Mannix, Division of Emergency Medicine, Boston Children\u2019s Hospital, Harvard Medical School, and Christopher Neville and Frank Middleton, Departments of PT Education and Neuroscience and Physiology, SUNY Upstate Medical University\n\nClinical and Translational Medicine. 2020.\n\nDOI: 10.1002/ctm2.197", 372 "summary": "This independent multicenter study examined whether saliva-based biomarkers could help diagnose mild traumatic brain injury and how they compared with symptoms, balance testing, and DANA. Participants with mTBI performed worse on all four DANA tests and reported substantially more symptoms than controls, while balance results were less consistent. Salivary non-coding RNA patterns also helped distinguish mTBI from controls. The strongest diagnostic performance came from combining multiple types of information\u2014symptoms, DANA, balance, and saliva biomarkers\u2014rather than relying on any single measure.\n\nDANA provided an objective measure of the cognitive slowing and reduced efficie
372ncy associated with mTBI and added meaningful diagnostic value when combined with symptom reports. The study supports using DANA as part of a broader, multimodal concussion assessment, with saliva biomarkers serving as a potentially useful noninvasive complement rather than a replacement for functional cognitive testing.\n\nThis independent study was conducted to asses the ability of salivary non\u2011coding RNAs (ncRNAs) to serve as a diagnostic adjunct to current clinical tools (like DANA) in diagnosing mild traumatic brain injury (mTBI).\nObjectives: Determine whether salivary ncRNAs can objectively help diagnose mTBI, and how that approach compares to (and complements) symptom scales, balance testing, and computerized neurocognitive testing (DANA).\nMethods: This study involved 538 individuals (avg. age of 18 (\u00b16) years; 61% male). 251 of those participants had been diagnosed with mTBI and had presented at one of 11 clinical sites within 14 days post-injury. The control group included 287 individuals with absence of mTBI in the previous 12 weeks, but who had enrolled at outpatient clinics and sports clinics for orthopedic injuries. Saliva samples taken from all participants were analyzed using RNA sequencing to quantify multiple classes of ncRNAs, and the data were split into a training set and a testing set. The training set (80% of both the mTBI group and the control group) was used to create predictive algorithms and the testing set (remaining 20% of each group) was used to validate the accuracy of the predictive algorithms. A subset of 321 participants (mTBI = 176 and control group = 145) completed a self-reported symptom questionnaire, a balance test (via the ClearEdge System) and neurocognitive testing (via DANA). The DANA test battery included simple reaction time tested at the beginning of the battery (SRT1) and again at the end of the battery (SRT2), procedural reaction time (PRT), and go/no-go (GNG).\nResults: In the subset assessed for symptoms, balance and cognition via DANA, mTBI participants showed significantly lower scores on all four DANA cognitive tests and reported markedly higher symptom burden/severity than controls. Balance testing results were mixed. As for the diagnostic predictive models, the model based on ncRNAs combined with basic clinical covariates (age and chronic headache status) distinguished mTBI from controls with solid discriminative performance. In the subset of participants who also completed standardized symptom scales and objective cognitive and balance testing, symptom reports plus each of the objective tests achieved slightly lower but comparable diagnostic accuracy ranges. Combining symptom reports with selected salivary ncRNA features produced higher AUC values than symptoms alone (and in their dataset, was at least competitive with the common \u201csymptoms + DANA\u201d combination). They also reported a \u201cmaximal\u201d combined model (symptoms + DANA + balance + saliva ncRNAs) with cross-validated AUC around 0.925 in that subset.\nClinical/Operational Implications: (1) DANA differentiates mTBI; (2) DANA scores combined with symptom data has strong diagnostic performance; (3) Salivary ncRNAs may be a noninvasive objective adjunct that can achieve diagnostic performance similar to DANA and balance testing, and may provide additive value when combined with symptom scales.", 373 "url": "https://doi.org/10.1002/ctm2.197", 374 "tags": [ 375 "concussion-tbi" 376 ] 377 }, 378 { 379 "id": 27, 380 "topic": "Neurocognitive Performance Deficits Related to Immediate and Acute Blast Overpressure Exposure", 381 "year": "2019", 382 "journal": "Frontiers in Neurology", 383 "citation": "Neurocognitive Performance Deficits Related to Immediate and Acute Blast Overpressure Exposure\n\nChristina R. LaValle, Walter S. Carr, Michael J. Egnoto, Anthony C. Misistia, Jonathan E. Salib, Alejandro N. Ramos and Gary H. Kamimori, Center for Military Psychiatry and Neuroscience Research, Walter Reed Army Institute of Research\n\nFrontiers in Neurology. 2019.\n\nDOI: 10.3389/fneur.2019.00949", 384 "summary": "This study by the Walter Reed Army Institute of Research investigated how exposure to explosions, even when the blast is not strong enough to cause a diagnosed concussion, might still temporarily affect how well a person can think and react. These types of exposures are called sub-concussive blasts\u2014they do not lead to a medical diagnosis but may still impact performance or how a person feels. DANA was utilized in the study to measure the effects of the sub-concussive blasts on cognitive performance.\n\nThe study showed that DANA, especially its Procedural Reaction Time task, can detect small but real declines in cognitive function after sub-concussive blast exposure. This makes it a powerful tool for monitoring cognitive health in high-risk professions and for catching early signs of brain stress before they become diagnosable conditions.\n\nThe study al
384so highlights DANA's utility as an objective, field-ready tool to track subtle cognitive shifts over repeated exposures\u2014potentially helping prevent more serious long-term effects like chronic traumatic encephalopathy (CTE). Further, since DANA can identify temporary performance declines, it can be used to help determine when someone should rest or be pulled from training, when someone is cognitively ready to return to duty, and if cognitive recovery is occurring as expected over time.\n\nIndependent study that utilized DANA to measure the effects of explosive blast overpressure at the sub-concussive level on cognitive performance.\nMethods: 202 male, active duty military personnel (avg. age of 30 years old and fit for duty) were administered DANA during a military breacher training course immediately following breaching charges (to measure immediate effects) and at the end of the training day (to measure acute effects). The DANA test battery included simple reaction time (SRT), procedural reaction time (PRT), and go/no-go (GNG).\nResults: Increasing blast overpressure (being peak overpressure experienced in a training day) can lead to transient degradations in neurocognitive performance. The PRT task in DANA, which measures attention, processing speed, and working memory, was the most sensitive to detecting small, temporary declines in thinking performance following blast exposure. Higher peak blast pressure was associated with slower performance on the PRT task\u2014even when the person felt fine and had no clinical diagnosis.\nClinical/Operational Implications: (1) DANA Can Detect Subtle, Subclinical Cognitive Impairment. DANA can pick up on performance changes that are too mild to be detected by standard medical evaluations (i.e., in undiagnosed individuals). This is especially valuable for early intervention, long-term monitoring, and risk assessment in high-exposure occupations. (2) Supports Monitoring Cognitive Health in At-Risk Populations. DANA provides an objective, field-ready tool to track subtle cognitive shifts over repeated exposures\u2014potentially helping prevent more serious long-term effects like chronic traumatic encephalopathy (CTE). (3) Enables Targeted Recovery and Readiness Assessments. Since DANA can identify temporary performance declines, it can be used to help determine when someone should rest or be pulled from training, when someone is cognitively ready to return to duty, and if cognitive recovery is occurring as expected over time.", 385 "url": "https://doi.org/10.3389/fneur.2019.00949", 386 "tags": [ 387 "blast-overpressure-exposure", 388 "military", 389 "concussion-tbi" 390 ] 391 }, 392 { 393 "id": 28, 394 "topic": "Occupational Blast Wave Exposure During Multiday 0.50 Caliber Rifle Course", 395 "year": "2019", 396 "journal": "Frontiers in Neurology", 397 "citation": "Occupational Blast Wave Exposure During Multiday 0.50 Caliber Rifle Course\n\nMaciej Skotak and Namas Chandra, Department of Biomedical Engineering, New Jersey Institute of Technology; Christina LaValle, Blast-Induced Neurotrauma Department, Walter Reed Army Institute of Research and the Geneva Foundation; Anthony Misistia, Blast-Induced Neurotrauma Department, Walter Reed Army Institute of Research and Cherokee Nation Businesses; Michael J. Egnoto and Gary Kamimori, Blast-Induced Neurotrauma Department, Walter Reed Army Institute of Research\n\nFrontiers in Neurology. 2019.\n\nDOI: 10.3389/fneur.2019.00797", 398 "summary": "Researchers from New Jersey Institute of Technology and Walter Reed Army Institute of Research utilized DANA in this study to measure the effects of low level blast overpressure from .50-caliber rifles on cognitive performance.\n\nThis study shows that DANA can detect small, task-specific changes in cognitive function during repeated exposure to .50 caliber weapon blasts\u2014particularly in more complex mental tasks like decision-making and impulse control. The study also highlights DANA\u2019s value in tracking individual variability. DANA can support personalized risk profiles by identifying who is most vulnerable to blast-related or fatigue-induced cognitive decline. Finally, the study supports using DANA for long-term tracking of cognitive function, especially for individuals exposed to regular blast activity.\n\nIndependent study that utilized DANA to measure the effects of low level blast overpressure from .50-caliber weapon systems on cognitive performance.\nMethods: 20 military and law enforcement professional marksmen (all male; age range between late 20s and early 50s) participated in a 3-day .50-caliber training course. Subjects were equipped with blast pressure sensors to measure how much blast exposure they received, and were administered DANA each day prior to training, during the training, and at the end of the training day. The DANA test battery included
398simple reaction time, procedural reaction time, and go/no-go.\nResults: The DANA test results showed a pattern of decreased test performance over the 3-day training period. However, these changes were not directly tied to the amount of blast exposure, indicating other factors\u2014like fatigue or individual sensitivity\u2014might have played a role. There was also an increasing spread in scores, showing that participants responded differently over time. The study noted certain limitations, including that there was high variability in the number of rounds fired between subjects and that there were statistically significant differences in pressure sensor data between rifle lengths. Accordingly, the authors suggested that further study utilizing a more sophisticated experimental design is needed.\nClinical/Operational Implications: (1) DANA Detects Subtle Cognitive Changes from Operational Stress. DANA can detect small, subclinical shifts in mental performance in real-world environments\u2014specifically reaction speed and cognitive control. This makes DANA valuable for ongoing performance monitoring in military, law enforcement, or high-risk occupations. DANA can help determine when someone needs a break, rest, or recovery time after repeated high-stress exposure. (2) Longitudinal Monitoring. The study supports using DANA for long-term tracking of cognitive function, especially for individuals exposed to regular blast activity. DANA can be utilized to determine recovery time needed after training or exposure, early signs of persistent cognitive decline, and risk thresholds for cumulative exposure. (3) Valuable for Tracking Individual Variability. The variation in performance responses between subjects shows that not everyone reacts the same way to blast exposure or fatigue. DANA can support personalized risk profiles by identifying who is most vulnerable to blast-related or fatigue-induced cognitive decline.", 399 "url": "https://doi.org/10.3389/fneur.2019.00797", 400 "tags": [ 401 "blast-overpressure-exposure", 402 "military", 403 "concussion-tbi" 404 ] 405 }, 406 { 407 "id": 29, 408 "topic": "The Oral Microbiome of Early Stage Parkinson\u2019s Disease and Its Relationship with Functional Measures of Motor and Non-Motor Function", 409 "year": "2019", 410 "journal": "PLoS One", 411 "citation": "The Oral Microbiome of Early Stage Parkinson\u2019s Disease and Its Relationship with Functional Measures of Motor and Non-Motor Function\n\nDragos Mihaila, Jordan Donegan, Daria LaRocca, Danny Zheng, Michael Vidal, Christopher Neville and Frank A. Middleton, Departments of Neurology, Neuroscience and Physiology, Physical Therapy Education, Psychiatry and Behavioral Sciences, Biochemistry and Molecular Biology, and Pediatrics, SUNY Upstate Medical University, Sarah Barns and Qian Du, SUNY Upstate Medical University and Quadrant Biosciences, Inc., and Richard Uhlig, Quadrant Biosciences, Inc.\n\nPLoS ONE. 2019.\n\nDOI: 10.1371/journal.pone.0218252", 412 "summary": "This independent study examined whether people with early-stage Parkinson\u2019s disease (PD) had measurable changes in their oral microbiome and whether those biological differences occurred alongside changes in cognition, balance, movement, smell, and taste. The study included 48 participants with early PD and 36 matched healthy controls. DANA was used as part of a broad functional assessment to provide objective measures of cognitive function.\n\nParticipants with early PD performed worse on DANA\u2019s Procedural Reaction Time and Go/No-Go tasks, while Simple Reaction Time was also slower but was described by the authors as a trend. The findings are notable because the participants\u2019 overall disease severity was generally mild. The authors acknowledged that Parkinson\u2019s-related movement slowing could affect reaction-time scores, but concluded that poorer performance on tasks with greater cognitive demands\u2014particularly Go/No-Go\u2014suggested impairment beyond motor speed alone.\n\nThe saliva analysis identified specific microbial and human RNA differences associated with early PD, even though the groups did not differ in their overall level of microbial diversity. DANA helped show that these biological differences occurred in a population already demonstrating subtle, objective functional changes.\n\nThe study supports DANA\u2019s value as one component of a broader, multimodal assessment.\n\nIndependent study that used DANA as part of a broad functional assessment to characterize subtle cognitive and reaction-time differences accompanying oral microbiome changes in early-stage Parkinson\u2019s disease (PD).\nObjectives: Determine whether people with early-stage PD had a distinct pattern of microorganisms and human RNA in their saliva and whether those biological patterns were associated with measurable differences in motor, cognitive, balance, autonomic, smell, and taste function. DANA was included to provide objective measures of cognitive performance that c
412ould help define the participants\u2019 functional status alongside the saliva biomarkers.\nMethods: The cross-sectional study included 84 participants: 48 with early-stage PD and 36 age- and sex-matched healthy controls. Each participant provided a saliva sample for sequencing of microbial RNA and human mRNA and completed a broad assessment of movement, cognition, balance, smell, taste, autonomic symptoms, depression, and quality of life. The DANA battery included Simple Reaction Time (SRT), Procedural Reaction Time (PRT), and Go/No-Go (GNG). The researchers compared functional performance and microbial abundance between groups. They also tested whether a selected combination of oral microbial features could distinguish PD participants from controls and explored associations among microbes, human salivary RNA, disease history, and functional performance.\nResults: Participants with early PD showed poorer performance across several motor, balance, sensory, and cognitive measures despite having generally mild disease. On DANA, the clearest differences were lower PRT and GNG scores. SRT performance was also lower; however, the authors described the SRT finding in the text as a trend rather than a clear significant difference. The authors explained that motor slowing associated with Parkinson\u2019s disease could contribute to slower responses on DANA. However, GNG requires participants to respond on some trials and withhold a response on others. Because GNG performance was also reduced, the researchers concluded that the results likely reflected some difficulty with decision-making and response control in addition to motor slowing alone.\nClinical/Operational Implications: (1) DANA Detected Functional Differences in Mild, Early-Stage Disease. Participants with early PD showed poorer performance on PRT and GNG even though their overall disease severity was generally mild, supporting DANA\u2019s sensitivity to subtle functional changes. (2) More Than Basic Motor Speed. Although motor slowing related to PD may influence reaction-time testing, poorer GNG performance suggests that DANA may also capture changes in attention, decision-making, and response control. (3) Objective Functional Context for Biomarkers. DANA helped show whether emerging saliva biomarkers were present alongside measurable changes in how participants actually performed, rather than relying only on molecular differences or symptom reports. (4) Role in Multimodal Assessment. DANA can be combined with movement testing, balance, sensory assessment, symptoms, and future biomarkers to create a broader picture of early Parkinson\u2019s disease.", 413 "url": "https://doi.org/10.1371/journal.pone.0218252", 414 "tags": [ 415 "validity-and-reliability" 416 ] 417 }, 418 { 419 "id": 30, 420 "topic": "Brain-Related Proteins as Serum Biomarkers of Acute, Subconcussive Blast Overpressure Exposure: A Cohort Study of Military Personnel", 421 "year": "2019", 422 "journal": "PLoS One", 423 "citation": "Brain-Related Proteins as Serum Biomarkers of Acute, Subconcussive Blast Overpressure Exposure: A Cohort Study of Military Personnel\n\nAngela M. Boutte, Bharani Thangavelu, Janice Gilsdorf and Deborah A. Shear, Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Christina R. LaValle, Jeffrey Nemes and Gary H. Kamimori, Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research\n\nPLoS ONE. 2019.\n\nDOI: 10.1371/journal.pone.0221036", 424 "summary": "This independent military study examined whether brief exposure to blast overpressure during breacher training produced measurable changes in symptoms, cognitive performance, and blood-based markers associated with brain injury. Twenty-nine active-duty Army personnel completed DANA testing, symptom assessments, and blood draws before and shortly after two controlled blast exposures.\n\nDANA provided an objective way to detect subtle, short-term performance changes even when participants did not have a diagnosed concussion. The study supports comparing service members with their own pre-exposure baselines and using DANA alongside symptoms, blast measurements, and biomarkers to better understand the immediate functional effects of subconcussive blast exposure and identify individuals who may need closer monitoring or recovery time.\n\nThis independent study addressed whether serum biomarkers commonly used in TBI research can augment field neurocognitive testing (like DANA) and symptom reporting soon after exposure to blast overpressure.\nObjectives: Subconcussive blast overpressure exposure (typical of breaching training) can cause concussion-like symptoms and performance decrements without meeting criteria for diagnosed concussion/mTBI. This study was conducted to determine whether acute changes occurred in neurocognitive performance (via DANA), self-reported symptoms, and serum concentrations of multiple brain/TBI-associated proteins (GFAP, UCH-L1, Nf-L, tau, A\u03b2-40 and A\u03b2-42) when comparing pre-exposure vs. post-exposure measurements in military personnel undergoing a controlled breacher training blast exposure.\nMethods: 29 active duty US Army personnel (all male; age range 21-43 years) who were participating in a two-week breacher training course partook in this study, which occurred on a single training day. Each participant experienced two, back-to-back blast overpressure events (heavy wall breaches) in one session. Overpressure exposure during the session was measured via a B3-H pressure sensor mounted on the left shoulder to approximate incident pressure and record peak pressure and impulse. Neurocognitive testing (via DANA), blood sampling, and symptomology assessments were conducted 8 hours before and within 1 hour after the session. The DANA subtasks included
424simple reaction time (SRT), procedural reaction time (PRT) and go/no-go (GNG).\nResults: Participants experienced symptomology similar to concussion, with headaches (52%), taking longer to think (41%), and dizziness (31%) being the most frequently reported. Pre and post DANA findings showed significantly slower SRT after exposure, but no significant changes in PRT and GNG scores. Pre and post biomarker measurements evidenced a median elevation of Nf-L, tau, A\u00df-40 or -42, but a suppression of GFAP. Cognitive decrements and biomarker shifts co-occurred, but were not strongly coupled person-by-person across the whole cohort. However, in analyzing just the group whose reported symptoms increased, SRT, PRT and GNG were significantly worse in those reporting dizziness, and dizziness was also significantly associated with biomarker dysregulation.\nClinical/Operational Implications: (1) DANA can detect subtle operational decrements even without diagnosed concussion. The significant SRT slowing after two blast exposures indicates DANA\u2019s SRT can be sensitive to acute subconcussive overpressure effects in breachers. (2) DANA can provide symptom-linked performance context. DANA is a useful tool for triaging functional impact tied to how the service member feels after exposure. (3) \u201cPaired-baseline\u201d interpretation (within-person change). The study\u2019s design mirrors how DANA is often intended to be used operationally: compare a person to themselves (pre vs post), not only to population norms.", 425 "url": "https://doi.org/10.1371/journal.pone.0221036", 426 "tags": [ 427 "blast-overpressure-exposure", 428 "military", 429 "concussion-tbi" 430 ] 431 }, 432 { 433 "id": 31, 434 "topic": "Neurocognitive and Fine Motor Deficits in Asymptomatic Adolescents during the Subacute Period after Concussion", 435 "year": "2018", 436 "journal": "Journal of Neurotrauma", 437 "citation": "Neurocognitive and Fine Motor Deficits in Asymptomatic Adolescents during the Subacute Period after Concussion\n\nRichard J. Servatius, Just D. Handy, Kevin C. H. Pang and Catherine A. Mazzola, Rutgers Biomedical Health Sciences, Rutgers University; Kevin M. Spiegler, Graduate School of Biomedical Sciences, Rutgers University; Jack W. Tsao, University of Tennessee Health Science Center, and Children's Foundation Research Institute, Le Bonheur Children's Hospital\n\nJournal of Neurotrauma. 2018.\n\nDOI: 10.1089/neu.2017.5314", 438 "summary": "Researchers from Rutgers University, University of Tennessee Health Science Center, and Le Bonheur Children's Hospital compared DANA to ImPACT to determine their sensitivity to concussion in teenagers recovering from a concussion.\n\nThe study found that DANA detected significant cognitive deficits in teens recovering from concussions that were not picked up by the ImPACT test.\n\nThis study shows that DANA can detect lingering cognitive issues in teenagers recovering from concussion\u2014even when other tools say they are fine. Clinically, this supports DANA\u2019s use as a sensitive, portable tool to guide recovery, reduce risk of re-injury, and ensure safer return-to-play or return-to-learn decisions.\n\nIndependent pilot study comparing DANA to ImPACT to determine their sensitivity to concussion in post concussed adolescents.\nMethods: ImPACT and DANA were administered to 15 adolescents with a concussion diagnosis, and to 14 non-injured adolescents serving as the control group. The DANA test battery included simple reaction time, procedural reaction time, and go/no-go.\nResults: No significant between-groups differences were observed in ImPACT performance; however, performance deficits were apparent for the DANA assessment. DANA showed significantly lower throughput scores for simple reaction time and choice reaction time tasks, measuring speed, accuracy and response inhibition, in the concussed group compared to the control group.\nClinical/Operational Implications: (1) DANA Detects Subtle, Ongoing Cognitive Impairments in Concussed Youth. DANA can detect lingering cognitive issues in teenagers recovering from concussion\u2014especially in the subacute phase (days to weeks after injury), which can help reduce risk of re-injury, and ensure safer return-to-play or return-to-learn decisions. (2) Portable, Objective Assessment Tool. DANA is handheld and digital, making it easier to administer in clinics, schools, sports settings, or at home. This allows for frequent, repeatable cognitive testing without needing a full desktop setup or clinical staff to administer a paper-based test.", 439 "url": "https://doi.org/10.1089/neu.2017.5314", 440 "tags": [ 441 "comparative-study", 442 "concussion-tbi" 443 ] 444 }, 445 { 446 "id": 32, 447 "topic": "Defense Automated Neurobehavioral Assessment Accurately Measures Cognition in Patients Undergoing Electroconvulsive Therapy for Major Depressive Disorder", 448 "year": "2018", 449 "journal": "Journal of ECT", 450 "citation": "Defense Automated Neurobehavioral Assessment Accurately Measures Cognition in Patients Undergoing Electroconvulsive Therapy for Major Depressive Disorder\n\nKristen R. Hollinger, Steven R. Woods, Alexis Adams-Clark, So Yung Choi, Caroline L. Franke, Ryoko Susukida, Carol Thompson, Irving M. Reti, and Adam I. Kaplin, Johns Hopkins University, Departments of Neurology, Psychiatry and Behavioral Sciences, and Biostatistics\n\nJournal of ECT. 2018.\n\nDOI: 10.1097/YCT.0000000000000448", 451 "summary": "This study by Johns Hopkins University looked at patients undergoing electroconvulsive therapy (ECT) for major depressive disorder (MDD)\u2014a treatment typically used when other antidepressants don\u2019t work. The researchers compared DANA to the standard Mini-Mental State Examination (MMSE) in tracking how patients\u2019 cognitive function changed over time during their treatment.\n\nThe DANA test results aligned with MMSE scores, showing that DANA is a valid way to measure cognitive function. DANA was also shown to detect changes in cognition over time more sensitively than MMSE\u2014especially when MMSE scores hit the maximum value (\"ceiling effect\") and could not detect further improvement or decline.\n\nThis study illustrates how DANA\u2019s sensitivity and design for high-frequency use enables real-time monitoring of cognitive effects from therapeutic interventions. It also points to DANA\u2019s utility in the collection of longitudinal cognitive data. DANA's portability and ease of use enable frequent testing over time\u2014ideal for building longitudinal cognitive profiles during therapeutic interventions. These longitudinal data can help map individual recovery trajectories, assess treatment efficacy over time, and inform future predictive models.\n\nIndependent study comparing the validity and sensitivity of DANA and the standard Mini-Mental State Examination (MMSE) in measuring cognition over time in subjects with major depressive disorder (MDD) undergoing electroconvulsive therapy (ECT) treatment.\nObjectives: The MMSE is the most commonly used method of tracking cognitive function in ECT studies, but it is not a t
451imed test, and it has a maximum score of 30, creating a ceiling effect. DANA provides results that are timed to the millisecond and it measures cognition using accuracy (number correct), reaction time, and a combined accuracy and reaction time throughput (i.e., no maximum score). The purpose of this study was to measure the relationship between DANA and MMSE scores and measure cognitive changes over time using DANA and the MMSE.\nMethods: 17 patients diagnosed with MDD (who failed to respond to standard pharmacological intervention and psychotherapy and were therefore receiving ECT treatment at the Johns Hopkins Hospital Department of Psychiatry) were administered paired DANA and MMSE tests at baseline and throughout their 8 month inpatient stay. The DANA test battery included simple reaction time (SRT), procedural reaction time (PRT), code substitution (CS), spatial processing (SP), and memory search (MS) tests. 2 separate analyses were then performed: one to validate DANA against MMSE data, and one to measure how the MMSE ceiling effect affected such validation. All cognitive data collected in the study were included in the first analyses to validate DANA when measured against MMSE. MMSE scores of 30 (along with their corresponding DANA scores) were excluded in the second set of analyses to determine if the relationship between DANA and MMSE scores was strengthened when the MMSE ceiling effect was removed.\nResults: Statistically significant relationships were measured between DANA and MMSE scores pooled from all patients in both analyses. Further, examination of the within-patient DANA and MMSE data over time revealed the following: (1) nearly half of all patients had similar trends in DANA and MMSE scores over time, further validating DANA to the MMSE; (2) some patients experienced declines in both MMSE and DANA scores over time, but at different rates (e.g., MMSE scores did not decline until the very end of the testing period, whereas DANA tests demonstrated a steady, linear performance decline over the entire testing period). The observation that DANA allows for discrete, measurable changes whereas MMSE cannot detect impairment suggests an enhanced sensitivity of the DANA test as compared with MMSE; and (3) a clear MMSE upper limit was detected in the 5 patients who had the maximum MMSE score initially and experienced no change in MMSE scores over time, whereas the DANA scores for such patients went up or down, highlighting the ceiling effect limitation of the MMSE.\nClinical/Operational Implications: (1) Treatment Efficacy and Monitoring. DANA\u2019s sensitivity and design for high-frequency use enables real-time monitoring of cognitive effects from therapeutic interventions, not just at the beginning and end of care, but throughout the course\u2014something most standard tools (e.g., MMSE) can't practically provide. By monitoring cognition frequently and sensitively, DANA allows clinicians to catch negative cognitive trends early and respond (e.g., adjust treatment intensity or frequency), identify patients improving cognitively, possibly allowing for more aggressive or sustained therapeutic intervention, or avoid overtreatment in patients showing rapid response with cognitive side effects. (2) Longitudinal Data. DANA's portability and ease of use enable frequent testing over time\u2014ideal for building longitudinal cognitive profiles during therapeutic interventions. This can help map individual recovery trajectories, assess treatment efficacy over time, and inform future predictive models.", 452 "url": "https://doi.org/10.1097/YCT.0000000000000448", 453 "tags": [ 454 "comparative-study", 455 "depression", 456 "longitudinal-data", 457 "therapeutic-interventions" 458 ] 459 }, 460 { 461 "id": 33, 462 "topic": "Healthy Active Duty Military with Lifetime Experience of Mild Traumatic Brain Injury Exhibits Subtle Deficits in Sensory Reactivity and Sensory Integration During Static Balance", 463 "year": "2018", 464 "journal": "Military Medicine", 465 "citation": "Healthy Active Duty Military with Lifetime Experience of Mild Traumatic Brain Injury Exhibits Subtle Deficits in Sensory Reactivity and Sensory Integration During Static Balance\n\nW. Geoffrey Wright, Neuromotor Sciences Program, College of Public Health, Temple University and Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, Justin D. Handy and Alejandro Ortiz, Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, Pelin Avcu, Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers University, F. Jay Haran, Uniformed Services
465University of the Health Sciences, Michael Doria, U.S. Coast Guard Headquarters, and Richard J. Servatius, Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, and Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers University\n\nMilitary Medicine. 2018.\n\nDOI: 10.1093/milmed/usX182", 466 "summary": "This independent military study examined whether healthy, symptom-free active-duty Coast Guard personnel with a remote lifetime history of mild traumatic brain injury (mTBI) exhibited subtle residual deficits in cognition, balance, or sensory reactivity. Participants completed DANA testing, plus a portable virtual-reality balance assessment, and an acoustic startle test.\n\nDANA performance did not differ based on either the presence or number of prior mTBIs. However, participants reporting more than one prior mTBI demonstrated greater postural sway during the most demanding balance condition. Participants with a lifetime history of mTBI also showed a weaker involuntary eye-blink response to sudden loud sounds, suggesting a subtle difference in sensory or nervous-system reactivity.\n\nDANA served as an objective cognitive comparator and demonstrated that the observed balance and sensory-reactivity differences were not accompanied by broad measurable cognitive deficits. The study supports combining cognitive, balance, vestibular, sensory, and symptom assessments rather than relying on any single measure to determine complete recovery.\n\nIndependent military study that used DANA to collect neurocognitive data as part of a multimodal assessment of subtle, long-term effects associated with a lifetime history of mTBI in active-duty coast guard personnel.\nObjective: To determine whether active-duty military personnel with a remote lifetime history of mTBI, but no current post-concussion symptoms, exhibited subtle deficits in neurocognitive performance, static balance, sensory integration, or acoustic startle reactivity.\nMethods: 36 active-duty Coast Guard personnel (7 women), were recruited from boat stations in Florida. 14 participants reported a prior mTBI: 9 reported one incident and 5 reported more than one. No participant had sustained a head injury during the preceding year, and all were symptom-free. Participants completed DANA testing to collect neurocognitive data. Balance was evaluated using the portable Virtual Environment TBI Screen. Acoustic startle reactivity was measured from the eye-blink response to sounds at 3 intensity levels. PTSD- and depression-symptom scores were included as covariates.\nResults: DANA showed no significant difference in overall neurocognitive performance between participants with and without a lifetime mTBI history. Results were also nonsignificant when participants were grouped according to no mTBI, one mTBI, or more than one mTBI. General balance performance did not differ simply according to the presence or absence of a prior mTBI. However, when participants were grouped by the number of prior incidents, a significant difference emerged. Participants reporting more than one mTBI exhibited the greatest center-of-pressure sway, suggesting a subtle deficit in visuovestibular or multisensory integration. Acoustic startle sensitivity (the likelihood of producing a response)did not significantly differ based on mTBI history. However, participants with a lifetime mTBI history produced smaller startle responses when they did respond. The magnitude finding was associated with the presence of a history of mTBI but did not show a clear dose-response relationship based on the number of reported injuries.\nClinical/Operational Implications: DANA\u2019s Role in Multimodal Assessment. DANA did not identify cognitive differences related to remote mTBI history in this sample. It nevertheless provided an objective cognitive comparator showing that the detected abnormalities were concentrated in sensory integration and reflex reactivity rather than broad neurocognitive performance.", 467 "url": "https://doi.org/10.1093/milmed/usX182", 468 "tags": [ 469 "military", 470 "concussion-tbi" 471 ] 472 }, 473 { 474 "id": 34, 475 "topic": "Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools Part 2: Utility for Assessment of Mild Traumatic Brain Injury in Emergency Department Patients", 476 "year": "2017", 477 "journal": "Journal of the International Neuropsychological Society", 478 "citation": "Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools Part 2: Utility for Assessment of Mild Traumatic Brain Injury in Emergency Department Patients\n\nLindsay D. Nelson, Robyn E. Furger, Peter Gikas, E. Brooke Lerner, Thomas A. Hammeke and Michael A. McCrea, Medical College of Wisconsin; William B. Barr, New York University School of Medicine; Christopher Randolph, Loyola University Medical School; Kevin Guskiewicz, University of North Carolina at Chapel Hill\n\nJournal of the International Neuropsychological Society. 2017.\n\nDOI: 10.1017/S1355617717000157", 479 "summary": "Researchers from the Medical College of Wisconsin, New York University School of Medicine, Loyola University Medical School, and University of North Carolina at Chapel Hill compared DANA, ANAM and ImPACT in assessing concussions in emergency room patients.\n\nThe three digital cognitive assessments did not yield significant differences between patients with concussion symptoms versus other injuries. Nonspecific injury factors, and other characteristics common in emergency room settings, likely affect performance of digital cognitive assessments across trauma patients as a whole, and thereby diminish the validity of such tools for assessing concussions in the emergency room patient population.\n\n
479Independent study comparing DANA, ANAM and ImPACT in assessing concussions in emergency room patients.\nObjectives: Evaluate the reliability and validity of three computerized neurocognitive assessment tools (CNTs; i.e., ANAM, DANA, and ImPACT) for assessing mild traumatic brain injury (mTBI) in patients recruited through a level I trauma center emergency department (ED).\nMethods: 94 patients presenting at the ED with a mTBI and 80 control subjects, all recruited from a level I trauma center emergency department, completed symptom and neurocognitive assessments within 72 hours of injury and at 15 and 45 days post-injury. Concussion symptoms were also assessed via phone at 8 days post-injury.\nResults: The CNTs evaluated, developed and widely used to assess sport-related concussion, did not yield significant differences between patients with mTBI versus other injuries. Symptom scores better differentiated groups than CNTs, with effect sizes weaker than those reported in sport-related concussion studies. Nonspecific injury factors, and other characteristics common in ED settings, likely affect CNT performance across trauma patients as a whole and thereby diminish the validity of CNTs for assessing mTBI in this patient population.\nClinical/Operational Implications: DANA May Be Less Effective in Emergency Room Trauma Populations. The study suggests that DANA (and similar tools) may not be reliable for diagnosing concussion in complex, real-world ER environments, where patients present with a wide variety of injuries and stressors. Environmental factors in emergency departments\u2014such as noise, stress, pain, and varied educational backgrounds\u2014may reduce the accuracy and consistency of computerized neurocognitive testing. Accordingly, DANA and similar tools might need adjusted protocols or combined use with symptom checklists to be clinically valuable in ER settings.", 480 "url": "https://doi.org/10.1017/S1355617717000157", 481 "tags": [ 482 "comparative-study", 483 "concussion-tbi" 484 ] 485 }, 486 { 487 "id": 35, 488 "topic": "Stress-Related Mental Health Symptoms in Coast Guard: Incidence, Vulnerability, and Neurocognitive Performance", 489 "year": "2017", 490 "journal": "Frontiers in Psychology", 491 "citation": "Stress-Related Mental Health Symptoms in Coast Guard: Incidence, Vulnerability, and Neurocognitive Performance\n\nRichard J. Servatius, Department of Veteran Affairs, Syracuse Veterans Affairs Medical Center; Justin D. Handy, Nora Ko, and Pelin Avcu, Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers University; Michael J. Doria, United States\nCoast Guard; Catherine E. Myers, Department of Veterans Affairs, VA New Jersey Health Care System; Christine E. Marx, Veterans Affairs Mid-Atlantic Mental Illness, Research Education and Clinical Center, Durham Veterans Affairs Medical Center, and Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Robert Lipsky, Department of Neurosciences, INOVA Health System; W. Geoffrey Wright, Neuromotor Sciences Program, Temple University; and Jack W. Tsao, Department of Neurology, University of Tennessee Health Science Center, and Department of Neurology, Memphis Veteran Affairs Administration Medical Center\n\nFrontiers in Psychology. 2017.\n\nDOI: 10.3389/fpsyg.2017.01513", 492 "summary": "Researchers from Rutgers University and Duke University School of Medicine examined mental health and cognitive performance in active-duty U.S. Coast Guard personnel, an understudied military population.\n\nResults found that participants with symptoms of PTSD and major depressive disorder (MDD) performed worse on the DANA cognitive tests\u2014especially those with both conditions. DANA helped identify that these mental health challenges are linked to slower thinking and poorer cognitive performance\u2014even in healthy, active service members.\n\nUnlike self-reported symptoms, DANA provides quantifiable data on how mental health conditions like PTSD and depression impact cognitive speed and accuracy, which can affect mission-critical decisions and performance. Although this study focused on the Coast Guard, the findings support using DANA in other high-stress professions (e.g., law enforcement, emergency responders) to assess how stress affects brain performance over time.\n\nIndependent study that used DANA to evaluate neurocognitive performance of US coastguard personnel, an understudied military population.\nObjectives: Determine prevalence of PTSD and major depressive disorder (MDD) in this military population, examine whether symptoms of PTSD and MDD impact cognitive function, and assess the ability of two personality factors previously identified as vulnerabilities\u2014distressed (Type D) personality and behaviorally inhibited (
492BI) temperament\u2014to predict stress-related mental health problems.\nMethods: 241 active duty coastguard personnel serving at 8 different boat stations were administered DANA cognitive tests, plus standardized surveys for PTSD, MDD, concussion history, Type D personality, BI temperament, combat exposure, and sleep quality. The DANA cognitive tests included simple reaction time, procedural reaction time, code substitution, spatial discrimination, go/no-go, Sternberg memory search, and match to sample.\nResults: 15% of participants showed signs of PTSD and 8% showed signs of MDD. These conditions were often related more to non-military trauma than military experiences. People with symptoms of PTSD and MDD performed worse on the DANA cognitive tests\u2014especially those with both conditions. The deficit was most pronounced in simple reaction time and response inhibition (Go-No-Go). Individual vulnerabilities were predictive of stress-related mental health symptoms. BI temperament was strongly associated with PTSD and Type D personality strongly predicted MDD.\nClinical/Operational Implications: (1) Objective Performance Measurement. DANA can identify subtle cognitive impairments associated with PTSD and depression and provide quantifiable data on how mental health conditions impact cognitive speed and accuracy, which can affect mission-critical decisions and performance. (2) Support for Routine Monitoring. DANA can be integrated into routine screenings in military or high-stress professions (e.g., law enforcement, emergency responders) to monitor cognitive health and detect issues early\u2014before they impair operational performance.", 493 "url": "https://doi.org/10.3389/fpsyg.2017.01513", 494 "tags": [ 495 "depression", 496 "military", 497 "ptsd" 498 ] 499 }, 500 { 501 "id": 36, 502 "topic": "Computerized Cognitive Testing Norms in Active-Duty Military Personnel: Potential for Contamination by Psychologically Unhealthy Individuals", 503 "year": "2017", 504 "journal": "Applied Neuropsychology", 505 "citation": "Computerized Cognitive Testing Norms in Active-Duty Military Personnel: Potential for Contamination by Psychologically Unhealthy Individuals\n\nIan Coffman, Helaine E. Resnick, James Drane and Corinna E. Lathan, AnthroTronix, Inc.\n\nApplied Neuropsychology: Adult. 2017.\n\nDOI: 10.1080/23279095.2017.1330749", 506 "summary": "The focus of this Army-funded original research study was to evaluate how mental health conditions, like PTSD, depression and sleep-related issues, impact cognitive performance in active-duty military personnel. The goal was to determine if these conditions could distort what\u2019s considered \"normal\" brain function in military populations.\n\nFindings showed that those who reported higher levels of psychological distress tended to perform worse on DANA tests. These results show that psychological symptoms, even in \u201cactive-duty\u201d personnel, can significantly affect cognitive performance.\n\nThis study validated that DANA reliably detects decreased cognitive performance associated with common psychological conditions such as PTSD, depression and sleep-related issues. It also highlight\u2019s DANA\u2019s usefulness in long-term monitoring and readiness assessment.\n\nThe study warns that using unfiltered military samples (without accounting for mental health) can skew the definition of \u201cnormal\u201d brain function. DANA can help create stratified norms\u2014that is, baseline standards adjusted for PTSD, depression, or sleep issues\u2014leading to more accurate diagnoses and treatment planning.\n\nArmy-funded original research study that utilized DANA to identify a negative correlation between cognitive function and PTSD, depression and sleep-related issues in active-duty military personnel.\nObjectives: Examine the effects of PTSD, depression and sleep health on cognitive performance and understand the impact of these measures on normative data in active duty military personnel.\nMethods: DANA was administered to 808 active duty service members aged 18 \u2013 64 (71% male, 59% had been previously deployed). The DANA test battery included
506standardized surveys for PTSD, depression and sleep disturbance, and the following cognitive tests: simple reaction time tested at the beginning of the battery (SRT1) and again at the end of the battery (SRT2), procedural reaction time (PRT), go/no-go (GNG), code substitution simultaneous (CSS), code substitution delayed (CSD), spatial processing (SP), and match to sample (MTS).\nResults: Those who reported higher levels of psychological distress performed worse on the DANA tests. In particular, higher PTSD severity scores were significantly associated with poorer performance on five DANA subtests: SRT1, PRT, GNG, CSS, and SRT2, indicating an inverse relation between PTSD severity and cognition. These results show that psychological symptoms, even in \u201cactive-duty\u201d personnel, can significantly affect cognitive performance.\nClinical/Operational Implications: (1) DANA Can Identify Cognitive Impairment Linked to PTSD, depression, and sleep issues. DANA reliably detects decreased cognitive performance associated with common psychological conditions like PTSD, depression and sleep-related issues. (2) Better Norms for Cognitive Health. DANA can help create stratified norms\u2014that is, baseline standards adjusted for PTSD, depression, or sleep issues\u2014leading to more accurate diagnoses and treatment planning. (3) Applicable for Long-Term Monitoring and Readiness Assessment. Because of its ease of use and digital format, DANA can be used periodically to monitor changes in cognitive performance, especially in high-risk professions like the military, first responders, or athletes. It can also be useful in tracking the effects of deployment, trauma exposure, or recovery from treatment.", 507 "url": "https://doi.org/10.1080/23279095.2017.1330749", 508 "tags": [ 509 "depression", 510 "military", 511 "ptsd", 512 "reference-values", 513 "sleep-health" 514 ] 515 }, 516 { 517 "id": 37, 518 "topic": "Home-Based Telemental Health for Rural Veterans", 519 "year": "2017", 520 "journal": "Poster presented at the American Telemedicine Association Conference", 521 "citation": "Home-Based Telemental Health for Rural Veterans\n\nCorinna Lathan, AnthroTronix, Inc.; Helaine Resnick, Resnick, Chodorow & Associates\n\nPresented at the American Telemedicine Association Conference. 2017.", 522 "summary": "This pilot study, conducted with the support of the U.S. Department of Veteran Affairs and the Department of Defense, utilized DANA to examine whether mental health therapy delivered at home through video calls (telemental health) could help rural Veterans with PTSD, many of whom have difficulty accessing traditional in-person care.\n\nDANA tracked changes in cognition and self-reported symptoms of PTSD, depression, and sleep problems, over time. Because DANA is tablet/smartphone-based, it allowed Veterans to complete these assessments remotely from home, removing the need for in-person clinic visits. Findings showed cognitive improvement and symptom relief, suggesting that therapy had a positive effect\u2014not only on mood, but also on brain function.\n\nThis study confirms that DANA can be effectively used in telemental health settings, allowing clinicians to track therapy progress and symptom changes without needing in-person visits. This aids in creating scalable, cost-effective behavioral health models, particularly for rural, underserved, or mobility-limited populations.\n\nThe study demonstrates DANA\u2019s utility in assessing the effect of therapeutic interventions on cognition and capture neurocognitive improvement trends over the course of therapy. DANA's real-time and longitudinal data collection is valuable for both clinical decision-making and research into the long-term effects of mental health treatments.\n\nPilot study (with the support of the U.S. Department of Veteran Affairs and the Department of Defense) that utilized DANA to assess the feasibility and effectiveness of a home-based telemental health (HBTMH) intervention among rural veterans with established PTSD.\nMethods: 29 veterans with PTSD completed the protocol, which consisted of 12 twice-weekly psychotherapy sessions via HBTMH. DANA was administered at baseline, mid-treatment and post-treatment. The DANA test battery included neurological assessments and standardized surveys for PTSD, depression and sleep quality.\nResults: The DANA-based measures of PTSD, depression, and other neurocognitive measures, indicated a favorable response to receipt of the HBTH intervention.\nClinical/Operational Implications: (1) DANA + Telemental Health. DANA can be effectively used in telemental health settings, allowing clinicians to track therapy progress and symptom changes without needing in-person visits. This aids in creating scalable, cost-effective behavioral health models, particularly for rural, underserved, or mobility-limited populations. (2) Assess and Track Therapeutic Interventions. DANA can asse
522ss the effect of therapeutic interventions on cognition and capture neurocognitive improvement trends over the course of therapy. (3) Longitudinal Data. DANA makes it feasible to collect structured, repeatable cognitive and emotional health data across time, outside of the clinic. This is valuable for both clinical decision-making and research into the long-term effects of mental health treatments.", 523 "url": null, 524 "tags": [ 525 "longitudinal-data", 526 "military", 527 "ptsd", 528 "remote-patient-care", 529 "therapeutic-interventions" 530 ] 531 }, 532 { 533 "id": 38, 534 "topic": "A Pilot to Investigate the Feasibility of Mobile Cognitive Assessment of Elderly Patients and Caregivers in the Home", 535 "year": "2016", 536 "journal": "Journal of Geriatrics Palliative Care", 537 "citation": "A Pilot to Investigate the Feasibility of Mobile Cognitive Assessment of Elderly Patients and Caregivers in the Home\n\nCorinna Lathan, Ian Coffman, Rita Shewbridge, Marissa Lee and Helaine E. Resnick, AnthroTronix, Inc.; Rosanna Cirio and Pasquale Fonzetti, Burke Rehabilitation Hospital; P. Murali Doraiswamy, Duke Institute for Brain Sciences\n\nJournal of Geriatrics Palliative Care. 2016.\n\nJ Geriatrics Palliative Care 2016;4(1): 6;\n\nDOI: 10.13188/2373-1133.1000017", 538 "summary": "This joint pilot study with Burke Rehabilitation Hospital and Duke Institute for Brain Sciences assessed (1) the feasibility of DANA for use by patients with Alzheimer's disease (AD) and their caregivers, (2) the sensitivity of DANA for detecting mild cognitive impairment and dementia, and (3) the reliability of DANA when administered remotely after being administered in a clinical setting.\n\nThe study found that everyone could complete the simple tests, both in the clinic and at home, the more complex tests were too difficult for the AD patients, DANA could detect cognitive impairment, and results from the at-home tests were similar to the in-clinic results, meaning the tool worked reliably in both settings.\n\nThis study shows that DANA\u2019s simpler tasks are feasible, sensitive, and reliable tools for tracking cognitive performance in early Alzheimer\u2019s patients\u2014at home or in the clinic. It paves the way for remote cognitive health monitoring in aging populations, supporting earlier detection, intervention, and continuity of care.\n\nJoint pilot study to assess the feasibility of DANA for use by patients with Alzheimer's disease (AD) and their caregivers, and the reliability of DANA when administered remotely after being administered in a clinical setting.\nObjectives: (1) assess the in-clinic feasibility of administering a battery of tests via a mobile cognitive performance instrument (i.e., DANA) among AD patient-caregiver dyads;
538 (2) assess the sensitivity of this instrument for detecting mild cognitive impairment (MCI) and dementia; and (3) test the feasibility and reliability of this instrument for assessing in-home cognitive performance.\nMethods: Participants included 7 dyads of patients diagnosed with mild AD and their informal caregivers. Participants were administered an initial DANA test battery in the clinic, which consisted of 3 simpler cognitive tests (simple reaction time (SRT), procedural reaction time (PRT), and Go/No-Go (GNG)), and 4 more complex cognitive tests (code substitution-learning (CSL), code substitution-recall (CSR), spatial processing (SP) and matching to sample (MTS)). SRT was tested at the beginning of the battery (SRT1) and again at the end of the battery (SRT2). Thereafter, the participants completed at least one DANA test battery per week at home, for a period of 90 days. The at-home test battery only included SRT1, PRT, and GNG.\nResults: AD patients and multiple caregivers were unable to complete the more complex cognitive tests (CSL, CSR, SP and MTS) in the in-clinic test battery; however, the simpler cognitive tests (SRT1, PRT, GNG and SRT2) were reliability completed by all participants. There were significant differences between the AD patients group and the caregivers group for the in-clinic SRT1 and SRT2 tests. The at-home test results for both AD patients and caregivers were similar to the in-clinic test results for all of the same subtests (SRT1, PRT and GNG). The more complex tests were not appropriate for this population; however, the simpler tests appear to be appropriate and feasible for AD patients and their caregivers in both in-clinic and at-home settings. Results show a reliable transfer of the sensitivity of DANA to cognitive deficits related to AD from in-clinic to at-home settings.\nClinical/Operational Implications: (1) DANA Can Detect Cognitive Differences in Alzheimer\u2019s Patients. DANA is sensitive enough to show performance differences in people with Alzheimer\u2019s, which supports the use of DANA as a quick screening tool to identify early cognitive decline. (2) DANA Is Feasible for Use in Early Alzheimer\u2019s Monitoring. DANA\u2019s simpler tests are accessible to patients with mild cognitive impairment, including those with early-stage Alzheimer\u2019s. This makes it a practical option for routine cognitive screening or ongoing monitoring at home. (3) Supports Remote, Longitudinal Cognitive Testing. DANA produced reliable results at home that matched in-clinic results, enabling remote cognitive monitoring. This is especially important for older adults who may have mobility issues, transportation barriers, or live in rural areas. (4) Guides Tailoring Assessments for Different Cognitive Disorders. The study shows that not all cognitive tests are appropriate for individuals with cognitive impairment\u2014highlighting the need to tailor digital tools to patient ability levels. DANA test batteries can be customized to include only the most relevant and feasible subtests for Alzheimer's or dementia populations. (5) Enables Caregiver-Patient Paired Monitoring. Since both patients and caregivers used DANA, it demonstrates potential for parallel tracking, where clinicians can assess how caregiving impacts cognitive health in both groups.", 539 "url": null, 540 "tags": [ 541 "aging-and-cognition", 542 "remote-patient-care" 543 ] 544 }, 545 { 546 "id": 39, 547 "topic": "Cognition, Mood, and Purpose in Life in Neuromyelitis Optica Spectrum Disorder", 548 "year": "2016", 549 "journal": "Journal of the Neurological Sciences", 550 "citation": "Cognition, Mood, and Purpose in Life in Neuromyelitis Optica Spectrum Disorder\n\nKristen R. Hollinger, Caroline Franke, Ana Arenivas, Steven R. Woods, Maureen A. Mealy, Michael Levy, and Adam I. Kaplin, Departments of Psychiatry and Behavioral Sciences, and Neurology, Johns Hopkins University\n\nJournal of the Neurological Sciences. 2016.\n\nDOI: 10.1016/j.jns.2016.01.010", 551 "summary": "Researchers from Johns Hopkins University utilized DANA to detect and measure impairments in cognitive function in persons with
551neuromyelitis optica spectrum disorder (NMOSD) which, like MS, is an autoimmune disorder that damages the nervous system.\n\nThe study found that people with NMOSD had lower cognitive performance on DANA\u2019s code substitution test, compared to the control group. They also scored higher on depression, though that wasn't tied to their mobility level. Poor sleep was strongly linked to worse cognitive scores in NMOSD patients, but not in the control group\u2014suggesting NMOSD patients are more vulnerable to the effects of sleep loss on thinking.\n\nThis study demonstrates that DANA is a sensitive and practical tool for detecting cognitive impairment in people with NMOSD\u2014especially in ways that older tests like the MMSE cannot. It highlights DANA\u2019s potential to support early detection, remote monitoring, and personalized care strategies in chronic neurological diseases where cognition, sleep, and mood interact in complex ways.\n\nIndependent pilot study that utilized DANA to detect and measure impairments in cognitive function in persons with neuromyelitis optica spectrum disorder (NMOSD) which, like MS, is an autoimmune disorder that damages the nervous system.\nObjectives: This was the first study to evaluate and compare cognition, mood and life purpose in NMOSD and control subjects.\nMethods: 20 control subjects and 23 individuals with NMOSD completed a DANA test battery that included a PHQ-9 depression survey and the following cognitive tests: simple reaction time (SRT), procedural reaction time (PRT), spatial processing (SP) and code substitution (CS). Participants also completed a Purpose in Life (PIL) survey. Disease duration, mobility and sleep were examined to determine if any of these factors were related to cognition in NMOSD.\nResults: The results of this study showed that DANA's CS test is sensitive to detect cognitive impairment in NMOSD. Further, the average PHQ-9 score of the NMOSD group fell in the mildly depressed category, as opposed to the control group's average score, which placed them in the non-depressed category. However, PHQ-9 scores were unrelated to mobility status in the NMOSD subjects. The results also found a relationship between cognitive test performance and sleep in NMOSD patients, with NMOSD patients who reported significantly less sleep the previous night performing worse on cognitive tests. This relationship between hours of sleep and cognition did not exist in the control subjects, suggesting that NMOSD patients may be more vulnerable to the cognitively impairing effects of little sleep.\nDANA vs MMSE: The authors cited a prior study that used a computerized mini-mental state examination (MMSE) to measure cognitive function in both NMOSD and MS patients. Unlike the results of the DANA test in this study, the computerized MMSE in the prior study did not detect any differences in cognitive performance between the NMOSD patients and the control group. However, as the authors for this study noted, the MMSE has a maximum score, creating a ceiling effect that can be easily reached. In contrast, DANA measures reaction time down to the millisecond, allowing for extremely sensitive results that span a wider range than the MMSE.\nClinical/Operational Implications: (1) DANA Detects Cognitive Impairment in NMOSD Patients. This study shows that DANA can identify cognitive impairment associated with NMOSD. These impairments may go undetected by general-purpose tools like the MMSE, which lack sensitivity. (2) Enables Personalized Monitoring of Sleep and Cognitive Health. DANA uncovered a unique link between sleep quality and cognitive function in NMOSD patients, which wasn't seen in healthy individuals. This suggests DANA could help track and manage cognitive vulnerabilities related to sleep loss, supporting personalized care plans (e.g., emphasizing sleep hygiene in NMOSD treatment). (3) Valuable for Mood and Cognitive Symptom Integration. With built-in assessments like the PHQ-9, DANA offers a one-stop platform to monitor both mood and cognitive function, which is critical in managing chronic neurological diseases where depression is common. (4) Feasible for Broader Research and Clinical Use. Because DANA is mobile, self-administered, and quick, it is
551well-suited for both in-clinic and remote cognitive testing. This makes it ideal for longitudinal studies and routine monitoring in patients with NMOSD, MS, or similar disorders.", 552 "url": "https://doi.org/10.1016/j.jns.2016.01.010", 553 "tags": [ 554 "autoimmune-disorders" 555 ] 556 }, 557 { 558 "id": 40, 559 "topic": "Performance on the Defense Automated Neurobehavioral Assessment Across Controlled Environmental Conditions", 560 "year": "2016", 561 "journal": "Applied Neuropsychology: Adult", 562 "citation": "Performance on the Defense Automated Neurobehavioral Assessment Across Controlled Environmental Conditions\n\nF. Jay Haran, Naval Submarine Medical Research Laboratory; Michael N. Dretch, Warfighter Health Division, U.S. Army Aeromedical Research Laboratory; Joseph Bleiberg, Walter Reed National Military Medical Center\n\nApplied Neuropsychology: Adult. 2016.\n\nDOI: 10.1080/23279095.2016.1166111", 563 "summary": "This study by the Naval Submarine Medical Research Laboratory, the U.S. Army Aeromedical Research Laboratory, and the Walter Reed National Military Medical Center tested the reliability of DANA across different operationally-relevant environmental conditions.\n\nThis study shows that DANA is a stable and reliable tool for assessing cognitive function\u2014even in hot or cold environments common to military and field operations. Its consistency and resistance to test-retest bias make it ideal for real-time brain health monitoring, particularly after suspected concussion or when evaluating cognitive readiness in challenging conditions.\n\nIndependent study that confirmed the test-retest reliability of DANA between assessments performed by the same subjects in different environmental conditions.\nMethods: 16 male active-duty U.S. Navy Experimental Diving Unit personnel were administered DANA 4 times: once in a baseline, thermoneutral environment, and then 3 additional times in simulated, operationally-relevant environments for exposure to cold, heat and humidity. The DANA test battery included simple reaction time (SRT), code substitution simultaneous (CSS), procedural reaction time (PRT), spatial processing (SP), go/no-go (GNG), and code substitution delayed (CSD).\nResults: DANA had high test-retest reliability between assessments performed by the same subjects in different environmental conditions. There were no significant differences in performance within each simulated environmental condition associated with repeated administrations (i.e., practice effects).\nClinical/Operational Implications: (1) DANA Is Reliable in Real-World Operational Conditions. DANA maintains its accuracy and reliability even in extreme environments, making it a trusted tool for military, field, or emergency settings. (2) Return-to-Duty or Concussion Screening. Because DANA performance remains stable under stress, it can be used to screen for mild traumatic brain injury (mTBI) or track recovery even in the field, where quick and objective assessments are critical. This supports safer, evidence-based return-to-duty decisions after head injuries. (3) No Practice Effects. The absence of practice effects means that clinicians can safely use DANA for repeated testing (e.g., daily during recovery) without concern that patients will improve just by getting used to the test. This makes DANA well-suited for longitudinal monitoring, where accurate trends over time matter more than a single snapshot. (4) Broader Validation for Field-Based Cognitive Tools. The study reinforces DANA as a robust, mobile neurocognitive testing platform suited for operational and extreme environments\u2014not just clinic settings. It opens the door for wider military, athletic, and disaster-response use, where portable and reliable cognitive testing is needed in unpredictable conditions.", 564 "url": "https://doi.org/10.1080/23279095.2016.1166111", 565 "tags": [ 566 "military", 567 "validity-and-reliability" 568 ] 569 }, 570 { 571 "id": 41, 572 "topic": "An Evaluation of the Consistency and Reliability of the Defense Automated Neurocognitive Assessment Tool", 573 "year": "2015", 574 "journal": "Applied Psychological Measurement", 575 "citation": "An Evaluation of the Consistency and Reliability of the Defense Automated Neurocognitive Assessment Tool\n\nC. R. Ru
575sso and Corinna Lathan, AnthroTronix, Inc.\n\nApplied Psychological Measurement. 2015.\n\nDOI: 10.1177/0146621615577361", 576 "summary": "This original research study compared the test-retest reliability and sensitivity of DANA with that of ANAM and ImPACT in a group of 162 U.S. Air Force Academy football team players.\n\nThe study results found that DANA showed high test\u2013retest reliability, meaning the results were consistent when the same people took the test at different times. Results also indicated that DANA was a more reliable than both ANAM and ImPACT, and was a more sensitive measure of changes in cognitive performance than both ANAM and ImPACT.\n\nThis study shows that DANA is a reliable and highly sensitive tool for monitoring brain performance over time. It outperforms other computerized neurocognitive tests in consistency and sensitivity, making it ideal for clinical, sports, and operational settings where accurate and repeatable cognitive tracking is essential.\n\nOriginal research study that compared the test-retest reliability and sensitivity of DANA with that of ANAM and ImPACT.\nMethods: DANA was administered to 162 U.S. Air Force Academy football team players at the beginning, middle and end of the season. The DANA test battery included simple reaction time, procedural reaction time, and go/no-go. Reliability and sensitivity of DANA were then compared to those of ANAM and ImPACT, as reported in a 2013 study article for comparable neurocognitive subtests.\nResults: The results showed that DANA has greater test-retest reliability than ANAM and ImPACT. The study also found that DANA had a reliability coefficient, or \u201cminimum difference\u201d (MD)\u2014the smallest score change that counts as real and not just noise\u2014 with tighter upper and lower bounds than both ANAM and ImPACT.\nClinical/Operational Implications: (1) DANA Is a Highly Reliable Cognitive Testing Tool. DANA showed superior test\u2013retest reliability compared to the other digital cognitive tools used for concussion assessment, ANAM and ImPACT. This makes it well-suited for tracking cognitive changes over time, like during concussion recovery or monitoring brain health in high-risk occupations. (2) DANA Can Detect Real Cognitive Changes. DANA's smaller MD values means DANA is better at detecting meaningful changes in performance. This is critical for early detection of mild impairments or recovery from brain injury, where subtle changes matter. (3) Enables More Precise, Data-Driven Decisions. The findings suggest that DANA can support return-to-play or return-to-duty decisions with greater confidence because it reliably reflects real changes\u2014not just variability in testing. (4) Supports Use in Sports, Military, and Clinical Settings. Because this study involved healthy athletes in a high-performance, physically demanding setting, it demonstrates that DANA is ideal for field-based applications. The consistency of results across different time points means DANA can be used to monitor cognitive function throughout a season, deployment, or treatment plan.", 577 "url": "https://doi.org/10.1177/0146621615577361", 578 "tags": [ 579 "comparative-study", 580 "concussion-tbi" 581 ] 582 }, 583 { 584 "id": 42, 585 "topic": "Performance on the Defense Automated Neurobehavioral Assessment Battery (DANA) and Simulated Driving Performance Over 50h of Continuous Wakefulness: Correlation between Neurocognitive and Operational Performance", 586 "year": "2015", 587 "journal": "Poster presented at the Military Health Systems Research Symposium", 588 "citation": "Performance on the Defense Automated Neurobehavioral Assessment Battery (DANA) and Simulated Driving Performance Over 50h of Continuous Wakefulness: Correlation between Neurocognitive and Operational Performance\n\nGary H Kamimori, Christina LaValle, Heather Dark and Stephanie Eonta, Behavior Biology Branch, Walter Reed Army Institute of Research; Gemma Paech and Siobhan Banks, Center for Sleep Research, University of South Australia; Kayla Johnson, Defense and Science and Technology Organization, Australia\n\nPresented at the Military Health Systems Research Symposium. 2015.", 589 "summary": "This study by the Walter Reed Army Institute of Research, University of South Australia, and the Defense and Science and Technology Organization, Australia, examined how sleep deprivation affects cognitive performance and driving ability, and whether DANA could be used to predict driving safety\u2014especially under extreme fatigue. It also examined whether caffeine could delay or reduce performance decline.\n\nResults from the study confirm the aptitude of DANA as an operational performance predictor. DANA is a powerful, mobile cognitive tool for detecting and predicting fatigue-related impairments, especially in driving and other operational tasks. Its strong correlation with real-world performance\u2014and sensitivity to sleep loss and caffeine\u2014positions it as a valuable tool for fatigue risk management, readiness asse
589ssment, and safety-critical decision support in both clinical and occupational settings.\n\nIndependent study demonstrating the sensitivity of DANA to fatigue and its ability to predict operational performance.\nObjectives: Examine the correlation between neurocognitive and operational performance.\nMethods: After receiving baseline sleep, 24 participants were randomly assigned to either a caffeine or placebo group. All participants were subject to 50 hours of sleep deprivation and completed DANA cognitive testing (simple reaction time, procedural reaction time, and go/no go) and operational testing on a driving simulator every 4 hours.\nResults: Performance declined the longer participants stayed awake. Those who took caffeine performed better for longer than those on placebo. DANA\u2019s results\u2014particularly reaction time and lapses\u2014were strongly related to driving performance. The consistency, magnitude, and statistical significance of between- and within-subject correlations demonstrates the aptitude of DANA to predict driving performance (average and individual) during sleep deprivation.\nClinical/Operational Implications: (1) DANA Can Be Used to Predict Operational Impairment. The study clearly shows that DANA is a valid proxy for evaluating real-world safety risks, such as driving performance and fatigue-related impairment in jobs requiring alertness (e.g., healthcare, military, aviation, trucking). (2) Supports Use of DANA for Fatigue Monitoring. Since performance on DANA strongly correlates with real-world failure points like crashes, it could be used in fatigue management programs like before shift work, during high-risk operations, and post-call or extended duty cycles. (3) Enables Intervention and Recovery Strategy Evaluation. DANA can be used to objectively test whether interventions like caffeine, naps, or supplements help restore cognitive performance under fatigue. (4) Applicable in Fatigue-Sensitive Industries. The strong predictive power of DANA on driving outcomes supports its potential in transportation (DOT, trucking, rail), aviation and flight readiness, and shift-based professions (nurses, surgeons, factory workers).", 590 "url": null, 591 "tags": [ 592 "fatigue", 593 "medications-and-supplements", 594 "military", 595 "operational-performance" 596 ] 597 }, 598 { 599 "id": 43, 600 "topic": "Ubiquitin Carboxy-Terminal Hydrolase-L1 as a Serum Neurotrauma Biomarker for Exposure to Occupational Low-Level Blast", 601 "year": "2015", 602 "journal": "Frontiers in Neurology", 603 "citation": "Ubiquitin Carboxy-Terminal Hydrolase-L1 as a Serum Neurotrauma Biomarker for Exposure to Occupational Low-Level Blast\n\nWalter Carr, Angela M. Yarnell, Gary H. Kamimori and Matthew L. LoPresti, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Ricardo Ong, U.S. Army Special Forces Command, Timothy Walilko, Applied Research Associates, Inc., Uade da Silva and Richard M. McCarron, NeuroTrauma Department, Naval Medical Research Center\n\nFrontiers in Neurology. 2015.\n\nDOI: 10.3389/fneur.2015.00049", 604 "summary": "This multi-site military study examined whether serum UCH-L1 could serve as an objective biomarker of neurological effects from repeated low-level blast exposure during explosive-breaching training. Participants wore helmet-mounted blast sensors, provided daily blood samples, and completed symptom, balance, and neurocognitive assessments that included ANAM and DANA.\n\nUCH-L1 increased during the two-week training period and declined after blast exposure ended, but its relationship with measured blast magnitude was weak and inconsistent. UCH-L1 changes did not correlate with DANA performance, self-reported symptoms, or most other behavioral measures. The study therefore did not support UCH-L1 as a reliable standalone indicator of the neurological effects of low-level blast. Instead, it supports combining blast exposure data, biomarkers, cognitive testing, symptoms, and balance measures.\n\nThis independent, observational study examined whether serum UCH-L1 could serve as an objective neurotrauma biomarker for repeated occupational low-level blast exposure and whether biomarker changes corresponded with DANA performance, symptoms, postural stability, or measured blast magnitude.\nObjectives: To determine whether the blood protein UCH-L1 increased following repeated occupational low-level blast exposure and whether those increases corresponded with blast magnitude, cognitive performance, symptoms, or postural stability.\nMethods: The study followed 108 male active-duty military breachers and instructors at 3 sites during 2 weeks of advanced explosive-breaching training. Participants wore helmet-mounted blast sensors and provided daily blood samples. Supporting assessments included
604symptoms, balance testing, and computer-based neurocognitive testing with ANAM and DANA. The paper does not identify how many participants used each cognitive battery.\nResults: UCH-L1 increased during training and was elevated after the final blast-exposure session, then declined during a subsequent non-blast session. Higher blast pressure was statistically associated with greater UCH-L1 elevation in the primary analysis, but the relationship was weak and explained only approximately 5% of the variation. The session involving the largest blast showed no relationship between blast magnitude and UCH-L1. Further, there were no statistically reliable associations between UCH-L1 elevations and available DANA performance, self-reported symptoms, prior head injury, or prior blast exposure. Some balance measures worsened, but those changes did not correlate with UCH-L1.", 605 "url": "https://doi.org/10.3389/fneur.2015.00049", 606 "tags": [ 607 "blast-overpressure-exposure", 608 "military", 609 "concussion-tbi" 610 ] 611 }, 612 { 613 "id": 44, 614 "topic": "The Impact of Multiple Concussions on Emotional Distress, Post-Concussive Symptoms, and Neurocognitive Functioning in Active Duty United States Marines Independent of Combat Exposure or Emotional Distress", 615 "year": "2014", 616 "journal": "Journal of Neurotrauma", 617 "citation": "The Impact of Multiple Concussions on Emotional Distress, Post-Concussive Symptoms, and Neurocognitive Functioning in Active Duty United States Marines Independent of Combat Exposure or Emotional Distress\n\nJames Spira, National Center for PTSD, Department of Veterans Affairs; Corinna Lathan, AnthroTronix, Inc.; Joseph Bleiberg, National Intrepid Center of Excellence in Psychological Health and Traumatic Brain Injury, Walter Reed National Military Medical Center; Jack W. Tsao, U.S. Navy Bureau of Medicine and Surgery\n\nJournal of Neurotrauma. 2014.\n\nDOI: 10.1089/neu.2014.3363", 618 "summary": "The goal of this joint study with the Walter Reed National Military Medical Center and U.S. Navy Bureau of Medicine and Surgery was to determine whether concussions uniquely impact emotional and cognitive functioning, independent of depression, PTSD, deployment history, or combat exposure, all of which can also negatively affect cognitive function.\n\nThe study results revealed that multiple and recent concussions have distinct and lasting impacts on emotional, post-concussive, and cognitive functioning. Such results counter the argument that lingering symptoms are solely due to emotional trauma or deployment stress. Results further demonstrated that the DANA tests on attention and simple discrimination were more sensitive to the effects of concussions than the more complex spatial processing or memory tests.\n\nThis study shows that DANA is a valuable tool for disentangling the complex relationship between concussion, mental health, and brain function. It helped reveal that while a single concussion may not have long-lasting effects, multiple concussions are linked to emotional distress, cognitive decline, and persistent symptoms, even in individuals who appear physically ready for duty.\n\nJoint study showing the cross-sectional validity and utility of DANA as sensitive to cognitive impairment independently for concussion, PTSD, insomnia and depression.\nObjectives: Determine whether concussions uniquely impact emotional and cognitive functioning, independent of depression, PTSD, deployment history, or combat exposure, all of which can also negatively affect cognitive function.\nMethods: 646 active duty 2nd Marine Expeditionary Force members (avg. age of 22 years old) were administered a DANA test battery consisting of 8 neurocognitive tests and 5 self-reported psychological tests. Concussion history and deployment history were also collected. Neurocognitive test scores were analyzed with the inclusion of the surveys for combat exposure, depression, PTSD and deployment history as covariates to determine the relative factors influencing neurocognitive functioning.\nResults: The results revealed that the presence of three or more lifetime concussions was associated with a decrease in cognitive efficiency, independent of PTSD and depressive symptoms or likely diagnosis. Further, the presence of previous concussion, independent of previous deployment or combat exposure, was associated with worse levels of PTSD, depression, and insomnia. Validity and utility of DANA was shown to be sensitive to changes in cognitive function from a variety of factors, including concussion, PTSD, insomnia and depression. The DANA tests on attention and simple discrimination were more sensitive to the effects of concussions than the more complex spatial processing or memory tests.\nClinical/Operational Implications: (1) DANA Helps Separate Brain Injury Effects from Psychological Symptoms. Because DANA includes both objective neurocognitive tasks and subjective symptom surveys, it can help clinicians and researchers tease apart whether symptoms are due to concussion or mental health. This is especially useful in complex populations like military personnel, where PTSD and concussion often overlap. (2) Confirms That Multiple Concussions Do Impact Brain Function. DANA detected real deficits in Marines with multiple concussions\u2014specifically in tasks requiring attention and quick thinking. This supports long-term cognitive monitoring in individuals with a history of repeated brain trauma. (3) DANA Is a Practical Tool for Use in Return-to-Duty Evaluations. Since all participants were \u201cfit for duty,\u201d yet those with multiple concussions still showed performance deficits, DANA can help identify hidden cognitive vulnerabilities not visible through routine screening. This could inform safer return-to-duty decisions or identify those who may need extra support or further evaluation. (4) Enables Scalable Monitoring Across Large, Mobile Populations. DANA was used with hundreds of Marines, showing its ability to be deployed at scale across military or field-based settings. This makes it valuable not just for research, but for operational health monitoring and triage.", 619 "url": "https://doi.org/10.1089/neu.2014.3363", 620 "tags": [ 621 "concussion-tbi", 622 "depression", 623 "military", 624 "ptsd", 625 "sleep-health" 626 ] 627 }, 628 { 629 "id": 45, 630 "topic": "AltitudeOmics: Decreased Reaction Time After High Altitude Cognitive Testing is a Sensitive Metric of Hypoxic Impairment", 631 "year": "2014", 632 "journal": "NeuroReport", 633 "citation": "AltitudeOmics: Decreased Reaction Time After High Altitude Cognitive Testing is a Sensitive Metric of Hypoxic Impairment\n\nEmma B. Roach, Corinna Lathan and Lawrence Wolpert, AnthroTronix, Inc.; Joseph Bleiberg, National Intrepid Center of Excellence, Walter Reed National Military Medical Center; Jack W. Tsao, U.S. Navy Bureau of Medicine and Surgery; Robert C. Roach, Department of Emergency Medicine, Altitude Research Center, University of Colorado\n\nNeuroReport. 2014.\n\nDOI: 10.1097/WNR.0000000000000169", 634 "summary": "This joint study with the Walter Reed National Military Medical Center, U.S. Navy Bureau of Medicine and University of Colorado utilized DANA to assess how high altitudes\u2014where there\u2019s less oxygen\u2014affect brain performance, specifically reaction time. The researchers wanted to understand how the brain reacts right after reaching high altitude and whether the brain adjusts (acclimates) over time.\n\nThis study shows that DANA is a highly sensitive and valid tool for detecting and tracking brain function under conditions of reduced oxygen (hypoxia). Its ability to measure subtle cognitive changes in extreme environments\u2014and to show recovery over time\u2014makes it ideal for monitoring mental performance in field, clinical, and occupational health settings.\n\nJoint study utilizing DANA to assess the effects of hypoxia on cognitive function.\nMethods: 21 health, physically fit participants, ages 19-23 years old, were administered a DANA test battery (1) at sea level, (2) immediately after ascending to an elevation over 5,000 meters, and (3) following 16 days of acclimation to such high altitude. The DANA test battery began with a simple reaction time test (SRT1) , followed by a 20-minute series of more complex cognitive tests, and then ended with a second simple reaction time test (SRT2). Two methods were used to quantify the altitude-induced impairment in reaction time: (1) comparing SRT1 scores taken at sea level to SRT1 scores taken immediately after ascending to high elevation (a baseline comparison), and (2) comparing SRT1 scores to SRT2 scores for each DANA testing time point (SRT1 to SRT 2 comparison).\nResults: No scoring difference was detected between the SRT1 and SRT2 taken at sea level, confirming that DANA testing does not induce sufficient cognitive loading to alter psychomotor performance in healthy participants under normal oxygen levels and barometric pressure. However, there was a significant reduction in scoring between the SRT1 and SRT2 taken immediately after ascension. Further, the SRT1 to SRT 2 comparison from immediately after ascension produced a much larger effect size than the baseline comparison, indicating that such comparison is a robust metric by which cognitive impairment may be quantitatively assessed. Finally, the SRT1 to SRT2 comparison after acclimation to the high altitude resembled that of the sea level SRT1 to SRT2 comparison.\nClinical/Operational Implications: (1) DANA Is Sensitive to Environmental Stress on the Brain. The study confirms that DANA can detect subtle cognitive impairments caused by low oxygen\u2014before more serious symptoms appear. This positions DANA as a field-ready tool for monitoring brain function in extreme environments (e.g., mountains, military ops, aviation, or spaceflight). (2) DANA Can Track Recovery and Adaptation Over Time. DANA captured the reversal of impairment after 16 days at altitude, showing its value for longitudinal monitoring\u2014watching how the brain adapts over time. This is useful in rehabilitation, recovery tracking, or monitoring conditions like concussion, sleep deprivation, or medication effects. (3) Provides a Reliable Way to Measure Cognitive Load and Fatigue. The SRT1 vs. SRT2 comparison offers a fast and reliable metric for measuring cognitive fatigue or decline during a task. The study's findings also support using the SRT1 vs. SRT2 comparison as a surrogate measure of cognitive change when a traditional baseline test is unavailable.", 635 "url": "https://doi.org/10.1097/WNR.0000000000000169", 636 "tags": [ 637 "longitudinal-data", 638 "operational-performance", 639 "oxygen-levels-and-cognition" 640 ] 641 }, 642 { 643 "id": 46, 644 "topic": "AltitudeOmics: The Integrative Physiology of Human Acclimatization to Hypobaric Hypoxia and Its Retention upon Reascent", 645 "year": "2014", 646 "journal": "PLoS One", 647 "citation": "AltitudeOmics: The Integrative Physiology of Human Acclimatization to Hypobaric Hypoxia and Its Retention upon Reascent\n\nAndrew W. Subudhi, Christopher Davis, Morgan Eutermoster, Oghenero Evero, Sonja Jameson-Van Houten, Colleen G. Julian, Jonathan Kark, Sherri
647Kark, Ryan Paterson and Robert C. Roach, Altitude Research Center, Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Nicolas Bourdillon and Bengt Kayser, Institute of Sports Sciences and Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Switzerland, Jenna Bucher, Jonathan E. Elliott, Julia P. Kern, See Eun Kim, Steven S. Laurie and Andrew T. Lovering, Department of Human Physiology, University of Oregon, Jui-Lin Fan, Lemanic Doctoral School of Neuroscience, University of Lausanne, Switzerland, Corinna Lathan, AnthroTronix, Inc., David M. Polaner, Departments of Anesthesiology and Pediatrics, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Benjamin J. Ryan, Department of Integrative Physiology, University of Colorado Boulder, James L. Spira, United States Department of Veterans Affairs, National Center for PTSD, Pacific Islands Health Care System, and Department of Psychiatry, University of Hawaii John A. Burns School of Medicine, Jack W. Tsao, United States Navy Bureau of Medicine and Surgery, and Nadine B. Wachsmuth, Department of Sports Medicine/Sports Physiology, University of Bayreuth, Germany\n\nPLoS ONE. 2014.\n\nDOI: 10.1371/journal.pone.0092191", 648 "summary": "This multidisciplinary field study examined whether DANA could detect the cognitive effects of very high altitude, whether cognitive performance recovered as people acclimatized, and how long that improvement remained after they returned to lower altitude. 21 healthy young adults completed repeated physiological, symptom, exercise, and DANA assessments at sea level, during initial exposure to 5,260 meters, after 16 days of acclimatization, and again after returning to the same altitude following either 7 or 21 days at lower altitude.\n\nImmediately after ascent, performance declined significantly on 5 of the 9 DANA tests, including measures of basic and choice reaction time, attention and learning, visuospatial memory, and information processing. After 16 days at altitude, performance on all 5 recovered to sea-level levels. When participants returned to altitude after 7 days away, the improvements in Code Substitution\u2014Simultaneous and Match to Sample were retained, but the reaction-time improvements were largely lost. After 21 days away, none of the DANA measures showed retained acclimatization.\n\nDANA objectively demonstrated that cognitive recovery is an important part of successful altitude acclimatization, and that this cognitive protection may fade faster than protection from mountain sickness or loss of exercise performance. It also showed that different cognitive abilities do not retain acclimatization equally. These findings support DANA\u2019s value for assessing readiness in military, aviation, rescue, mining, mountaineering, and other high-altitude operations where normal oxygen measurements or the absence of symptoms may not guarantee that reaction time and cognitive performance are fully protected.\n\nMultidisciplinary field study that used DANA to demonstrate how cognitive performance declines during acute exposure to very high altitude, recovers with acclimatization, and is only partly retained after time at lower altitude.\nObjectives: Characterize the physical and functional features of successful acclimatization to 5,260 meters and determine how much of that acclimatization remained after seven or 21 days at lower altitude. DANA was used to provide an objective measure of cognitive function alongside arterial oxygenation, hemoglobin, acute mountain sickness, and exercise performance.\nMethods: The study included 21 healthy, physically active adults (12 men and nine women) with an average age of 20.8 years. Participants were evaluated at sea level, during their first or second day at 5,260 meters, after approximately 16 days of acclimatization at that altitude, and again after returning to 5,260 meters following either 7 days at lower altitude for 14 participants or 21 days for seven participants. The DANA battery included Simple Reaction Time at the beginning of testing (SRT1), Simple Reaction Time repeated at the end of testing (SRT2), Procedural Reaction Time (PRT), Go/No-Go (GNG), Code Substitution-Simultaneous (CSS), Code Substitution-Delayed (CSD), Spatial Discrimination (SPD), Match to Sample (MTS), and Ster
648nberg\u2019s Memory Search (MS). Participants completed DANA twice at sea level and once at each altitude assessment.\nResults: During acute exposure to 5,260 meters, performance declined significantly on SRT1, SRT2, PRT, CSS, and MTS. No significant acute change was found on CSD, SPD, GNG, or MS. After 16 days of acclimatization, all 5 affected measures improved back to sea-level performance. The two sea-level DANA administrations did not differ significantly, supporting the conclusion that these changes reflected altitude exposure and acclimatization rather than simple familiarity with the tests. The retention of cognitive acclimatization depended on both the amount of time spent away from altitude and the type of cognitive ability measured. After 7 days at lower altitude, CSS and MTS remained near acclimatized levels, suggesting continued protection of abilities involving attention, learning, and short-term visuospatial memory. In contrast, SRT1, SRT2, and PRT showed little or no retained improvement, meaning reaction-time performance had moved back toward the poorer levels observed during initial altitude exposure. After 21 days at lower altitude, none of the DANA tests showed retained acclimatization. The cognitive results did not directly track the measured physiological results. Although oxygenation, symptoms, exercise, and cognition generally improved over the same acclimatization period, the amount of cognitive improvement in an individual was not significantly correlated with measured arterial oxygenation or hemoglobin. DANA therefore provided functional information that could not be reliably inferred from blood-oxygen measurements alone.\nClinical/Operational Implications: (1) DANA Detects Acute Cognitive Effects of Hypoxia. 5 DANA measures declined soon after ascent to 5,260 meters, demonstrating sensitivity to cognitive changes caused by acute high-altitude exposure. (2) Cognitive Recovery Is Part of Acclimatization. All 5 affected measures returned to sea-level performance after 16 days, providing objective evidence that successful acclimatization includes restoration of cognitive function, not merely improved oxygenation, fewer symptoms, or better exercise tolerance. (3) Different Cognitive Abilities Retain Acclimatization Differently. Attention, learning, and short-term visuospatial memory showed some protection after seven days away, while reaction-time improvements were largely lost. A person may therefore appear acclimatized in one cognitive area but remain vulnerable in another. (4) Recent Altitude Exposure Does Not Guarantee Full Cognitive Readiness. Protection from mountain sickness and exercise decline was better retained than cognitive reaction-time performance. Operational planners should not assume that someone is fully cognitively protected simply because the person feels well or previously acclimatized. (5) DANA Adds Information Beyond Oxygen Measurements. Individual cognitive changes were not reliably explained by arterial oxygenation or hemoglobin, supporting direct cognitive assessment rather than using physiological measures alone as a substitute for readiness. (6) Potential Use in Re-Ascent and Deployment Decisions. Brief DANA testing could help determine whether personnel returning to altitude after leave, rotation, evacuation, or staging at lower elevations have retained sufficient cognitive performance for safety-sensitive work. (7) Need for Individual Baselines and Repeated Testing. The study\u2019s design\u2014comparing each participant with their own sea-level and acclimatized performance\u2014supports using longitudinal DANA trends to assess the functional effects of altitude and recovery.", 649 "url": "https://doi.org/10.1371/journal.pone.0092191", 650 "tags": [ 651 "operational-performance", 652 "oxygen-levels-and-cognition", 653 "validity-and-reliability" 654 ] 655 }, 656 { 657 "id": 47, 658 "topic": "Defense Automated Neurobehavioral Assessment (DANA) - Psychometric Properties of a New Field-Deployable Neurocognitive Assessment Tool", 659 "year": "2013", 660 "journal": "Military Medicine", 661 "citation": "Defense Automated Neurobehavioral Assessment (DANA) - Psychometric Properties of a New Field-Deployable Neurocognitive Assessment Tool\n\nCorinna Lathan and Jack Vice, AnthroTronix, Inc.; James Spira, National Center for PTSD, Department of Veterans Affairs; Joseph Bleiberg, National Intrepid Center of Excellence in Psychological Health and Traumatic Brain Injury, Walter Reed National Military Medical Center; Jack W. Tsao, U.S. Navy Bureau of Medicine and Surgery\n\nMilitary Medicine. 2013.\n\nPMID: 38442224", 662 "summary": "This is the original feasibility and reliability study testing the Defense Automated Neurobehavioral Assessment (DANA), a mobile app designed to measure reaction time, attention, and mental performance in real time. Researchers wanted to see how well DANA works in real-world military environments, how accurate and reliable it is, and whether it c
662ould be used as a practical tool for detecting issues like concussion, exhaustion, or stress in military personnel.\n\nThis foundational study confirms that DANA is a reliable, accurate, and portable cognitive assessment tool built for both clinical and operational use. Its combination of high precision, resistance to learning effects, and integrated psychological assessments make it uniquely capable for use in military, sports, behavioral health, and remote monitoring environments.\n\nOriginal feasibility and reliability study testing the Defense Automated Neurobehavioral Assessment (DANA), which includes a description of its psychometric properties.\nPlatform and Latency: DANA utilizes a native application on a smart phone or tablet to measure reaction time, which registers a response much faster than a web application. The overall response time of the DANA platform in this initial study was 6.8 milliseconds. By comparison, the input variability with a personal computer can range anywhere from 4-25 milliseconds. Accordingly, the response latency of DANA is more accurate and sensitive.\nTest Batteries: All of the cognitive tests and psychological assessments included in the test batteries of DANA meet the requirements of the American Psychological Association\u2019s standard for tests and measurements and all tests are in the public domain. Tests were selected based upon their potential to address specific deployment-related concerns, such as concussion and combat distress or exhaustion. All tests have extensive literature regarding their reliability and validity. Cognitive tests cannot be learned or memorized, as test stimuli are generated at random and each test has practice trials before the actual test trials.\nReliability and Validity Test Methods: DANA was administered to 224 active duty service members (officers and enlisted) from the Air Force, Navy, and Marine Corps, across 5 extreme operational environments (arctic, jungle, altitude, desert, shipboard). Collected data was analyzed for descriptive statistics, split-half reliability, test-retest reliability and cross-test correlations, and such data was compared to previously reported data from other computer-based neurocognitive assessments.\nResults: DANA was found to be a reliable instrument and compared favorably to other computer-based neurocognitive assessments. Benefits of DANA include that it (a) includes relevant psychological tests as well as standard cognitive tests; (b) is built on a portable OS with more precise timing than previous NCATs; and (c) is a portable handheld device, which is more versatile than a laptop computer.\nClinical/Operational Implications: (1) Portable, Field-Ready Cognitive Assessment. DANA is more practical than older systems (like ImPACT or ANAM) because it runs on a smartphone or tablet. Its small size, low latency, and fast results make it ideal for field screening in military, sports, or remote care settings. (2) High Precision, Low Learning Bias. Unlike many cognitive tests, DANA\u2019s randomized test format ensures that results reflect actual cognitive state\u2014not familiarity with the test. This enhances its use in longitudinal tracking and serial evaluations (e.g., recovery from TBI, concussion, or fatigue). (3) Simultaneous Cognitive and Psychological Monitoring. Because DANA also includes validated depression, PTSD, and sleep-related assessments, it gives a more complete picture of brain health than purely cognitive tools. This makes it well-suited for integrated behavioral health care, both in clinical practice and in military/combat mental health. (4) Validated Across Stressful Environments. The study validated DANA under extreme environmental stressors, confirming it maintains integrity in non-controlled, high-stakes settings. This gives confidence in using DANA in military and disaster zones and expeditionary medicine", 663 "url": "https://pubmed.ncbi.nlm.nih.gov/38442224/", 664 "tags": [ 665 "military", 666 "validity-and-reliability" 667 ] 668 } 669];
Line numbers count LF bytes from the start of the resource, as the search results do. Vendor segments are library code the classifier recognised; they are stored but not indexed. Bytes are shown as Latin1 characters, one per byte.