Scientific Publications & Studies
Year:
Journal
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Stress Response to Winter Warfare Training: Potential Impact of Location
“Prior research has shown a relationship between hormone dysregulation, impaired cognitive and physical performance, and injury. This study by the Naval Health Research Center, Leidos Inc. and the University of Southern California investigated the hormonal changes experienced by warfighters training in extremely cold weather and harsh terrain, and the correlation of such changes with cognitive performance.
Findings from the study showed alterations in stress-related and growth-related hormones, as well as cognitive performance throughout winter warfare training (WWT), while metabolic hormones were unchanged. The increase in stress hormones (i.e., ACTH and cortisol) was associated with a decrease in cognitive performance. These findings 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.”
Ketone Monoester Attenuates Declines in Cognitive Performance and Oxygen Saturation During Acute Severe Hypoxic Exposure Under Resting Conditions
“Acute hypoxic exposure causes reduced blood oxygen saturation and impairs 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 act as a countermeasure to the decline in blood oxygen saturation and cognitive performance during acute sever hypoxic exposure under resting conditions.
DANA test results showed significant differences between subjects who received ketone supplements and those who received the placebo during hypoxia. Specifically, the decline in cognitive efficiency scores during hypoxia was significantly reduced in the ketone supplements subjects. The decline in blood oxygen saturation during hypoxia was also significantly reduced in the ketone supplements subjects. 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.
The findings validate the sensitivity of DANA to detect changes in cognitive performance at rest as a result of ketone supplements taken prior to hypoxic exposure.”
Digital Neuropsychological Measures by Defense Automated Neurocognitive Assessment: Reference Values and Clinical Correlates
“Boston University conducted this study with participants in the Framingham Heart Study and the Boston University Alzheimer’s Disease Research Center to establish reference values for, and investigate the association of clinical risk factors with, the digital neuropsychological measures derived from DANA.
Sex-specific reference values in 3 age groups were generated for the digital cognitive measures of each DANA test. 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.
The reference values for participants under age 60 revealed that women exhibited shorter reaction times, indicative for cognitive function, in the DANA test involving verbal memory and attention. However, men displayed quicker reaction times than women in the DANA tests assessing spatial processing and reaction time. In both males and females, reaction times slowed down with increasing age.
Findings showed that different digital cognitive measures were significantly associated with varying numbers of clinical risk factors (including cholesterol levels, myocardial infarction and stroke) across the 3 DANA tests, highlighting the need for comprehensive evaluations of clinical risk factors in understanding cognitive performance.”
Comparing Hypothermic and Thermal Neutral Conditions to Induce Metabolic Suppression
“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 by the University of Buffalo 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. The study utilized DANA to evaluate the effects of dexmedetomidine and metabolic suppression on cognition.
Test results showed that there was a significant difference in performance on DANA between baseline and start of recovery after sedation and metabolic suppression in both a neutral and cold environment. 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.”
Comparing Cognitive Tests and Smartphone-Based Assessment in 2 US Community-Based Cohorts
Boston University conducted this study with participants in the Framingham Heart Study and the Bogalusa Heart Study to test the validity and reliability of DANA as a measure of cognitive performance in comparison to traditional assessments.
Study results found that performance on the 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 assess aspects of cognitive function known to be associated with Alzheimer disease and Alzheimer disease-related dementia.
Orthostatic Challenge Causes Distinctive Symptomatic, Hemodynamic and Cognitive Responses in Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
“This study by the Bateman Home Center of Excellence, Columbia University and Harvard Medical School 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).
Results from the DANA tests assessed before and after the OI test revealed that, immediately after completion of the OI test, cognitive efficiency dropped for both Long COVID and ME/CFS patients, whereas it rose in the healthy control subjects. The slowed reaction time observed is consistent with the subjective reports by Long COVID and ME/CFS patients that orthostatic challenge leads to worsening in their cognitive function.
These findings illustrate the sensitivity of DANA and its ability to detect cognitive impairment associated with Long COVID and ME/CFS.”
A Metabolic Intervention for Improving Human Cognitive Performance During Hypoxia
“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 had been shown to attenuate cognitive decline caused by hypoxia in rodents. This study by the Florida Institute for Human and Machine Cognition and the Buck Institute for Research on Aging addressed whether ketosis could improve cognitive function in humans exposed to hypoxia.
Results found that the DANA test scores were significantly higher when oxygen levels were normal as compared to the hypoxia condition, indicating significant hypoxia effects on cognition. Furthermore, during hypoxia exposure, DANA test scores were higher for subjects who had received the ketone supplements than in the placebo group. These results demonstrated a protective effect of ketone supplements on cognitive function against the negative effects of acute, mild hypoxia.
The results of the study demonstrate the sensitivity of DANA to detect changes in cognitive performance a result of hypoxia and ketone supplements.
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Caffeine May Disrupt the Impact of Real-Time Drowsiness on Cognitive Performance: a Double-blind, Placebo-controlled Small-Sample Study
“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 weakens the positive associations between drowsiness and reduced cognitive function, and (2) whether such weakening effect fluctuates depending on the complexity of the cognitive task.
In comparing DANA test results between subjects who received caffeine and those who received the placebo, higher drowsiness did not result in a constant 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 task, while producing similar but weaker trends in the simpler cognitive tasks.
Findings show the sensitivity of DANA to detect changes in cognitive performance as a result of fatigue and caffeine.”
Performance on the DANA Brief Cognitive Test Correlates with MACE Cognitive Score and may be a New Tool to Diagnose Concussion
“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 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).
Results confirmed the validity of DANA to provide accurate assessments.
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 overcome the critical limitations of MACE.
No evidence of practice effects improving performance was observed with the DANA testing, despite investigators’ original hypothesis that repeated DANA testing would result in improvements in performance.”
Neurocognitive Performance Deficits Related to Immediate and Acute Blast Overpressure Exposure
“This study by the Walter Reed Army Institute of Research utilized DANA to measure the effects of explosive blast overpressure at the sub-concussive level on cognitive performance.
The findings indicated that increasing blast overpressure can lead to transient degradations in neurocognitive performance.
The study showed the sensitivity of DANA to detect changes in cognitive function as a result of both immediate and acute exposure to blast overpressure.”
Defense Automated Neurobehavioral Assessment Accurately Measures Cognition in Patients Undergoing Electroconvulsive Therapy for Major Depressive Disorder
“This study by Johns Hopkins University compared 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 undergoing electroconvulsive therapy (ECT) treatment.
Results validated DANA to the MMSE and found that DANA was a more sensitive overall measurement of cognition as compared with the MMSE.
The study found DANA to be an appropriate method of measuring changes in cognitive function over time. “
Stress-Related Mental Health Symptoms in Coast Guard: Incidence, Vulnerability, and Neurocognitive Performance
“Researchers from Rutgers University and Duke University School of Medicine used DANA to evaluate neurocognitive performance of US coastguard personnel, an understudied military population.
Results found that impaired neurocognitive performance was concentrated among those subjects whose self-reported surveys supported a diagnosis of PTSD and major depressive disorder (MDD). The deficit was most pronounced in simple reaction time and response inhibition tests.
This study demonstrates the sensitivity of DANA to detect deficits in cognition associated with PTSD and MDD.”
Home-Based Telemental Health for Rural Veterans
“Pilot 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.
Methods: 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.
Results: The DANA-based measures of PTSD, depression, and other neurocognitive measures, indicated a favorable response to receipt of the HBTH intervention.
Longitudinal Validity of DANA: This study highlights the validity and reliability of DANA to track subtle changes in cognition over time.”
Computerized Cognitive Testing Norms in Active-Duty Military Personnel: Potential for Contamination by Psychologically Unhealthy Individuals
“When clinicians interpret neuropsychological testing results, they compare a person’s scores to a set of “”normal”” values. But for these comparisons to be meaningful, the “”normal”” group must truly represent healthy individuals. To ensure this, people with conditions that might affect test results—such as mental health disorders—are often excluded when creating these reference points.
The focus of this Army-funded original research study was to evaluate how mental health conditions, like PTSD and depression, impact cognitive test performance in active-duty military personnel. This is important because past research on digital cognitive assessments for military members has not fully accounted for the effects of these conditions, even though they are quite common in this group.
Findings showed that those who self-reported higher levels of psychological distress tended to perform worse on certain cognitive tests. This suggests that mental health conditions that are relatively common in this population need to be taken into account when establishing normative datasets for cognitive assessment results in the military.”
Cognition, Mood, and Purpose in Life in Neuromyelitis Optica Spectrum Disorder
“Researchers from Johns Hopkins University 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.
The results of this study showed that DANA’s code substitution test is sensitive to detect cognitive impairment in NMOSD.
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.”
A Pilot to Investigate the Feasibility of Mobile Cognitive Assessment of Elderly Patients and Caregivers in the Home
“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.
Results from the study demonstrate the ability and sensitivity of DANA to detect cognitive deficits related to AD in both in-clinic and at-home settings. Study results found that the more complex DANA 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.”
Performance on the Defense Automated Neurobehavioral Assessment Across Controlled Environmental Conditions
“This study by the Naval Submarine Medical Research Laboratory, U.S. Army Aeromedical Research Laboratory, and Walter Reed National Military Medical Center confirmed the test-retest reliability of DANA between assessments performed by the same subjects in different environmental conditions.
Analyses showed that there were no significant differences in performance within each simulated environmental condition associated with repeated administrations (i.e., no practice effects).”
An Evaluation of the Consistency and Reliability of the Defense Automated Neurocognitive Assessment Tool
“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.
Study results found that DANA was a more sensitive measure of changes in cognitive performance than both ANAM and ImPACT. “
Performance on the Defense Automated Neurobehavioral Assessment Battery (DANA) and Simulated Driving Performance Over 50h of Continuous Wakefulness: Correlation between Neurocognitive and Operational Performance
“This study by the Walter Reed Army Institute of Research, University of South Australia, and the Defense and Science and Technology Organization, Australia, examined the relationship between neurocognitive and driving performance during sleep deprivation in subjects receiving caffeine or placebo.
Results from the study demonstrate the aptitude of DANA as an operational performance predictor. “
An Evaluation of the Consistency and Reliability of the Defense Automated Neurocognitive Assessment Tool
“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.
Study results found that DANA was a more sensitive measure of changes in cognitive performance than both ANAM and ImPACT. “
Development of an Objective, Functional Biomarker of Invisible Wounds of War for Use by Providers
“This joint study with the Department of Veterans Affairs and the Department of Defense analyzed the ability of DANA to operate as an objective neurocognitive biomarker of cognitive impairment associated with PTSD, depression, insomnia, anger and post-concussive symptoms.
The study results showed that DANA provides a reliable and sensitive measure of cognitive function that can be utilized by clinicians for initial diagnosis, treatment disposition, and assessing improvement and return to work determinations. “
AltitudeOmics: Decreased Reaction Time After High Altitude Cognitive Testing is a Sensitive Metric of Hypoxic Impairment
“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 the effects of hypoxia on cognitive function.
Results showed that DANA is a sensitive measure of change in cognitive performance due to hypoxia-induced cognitive impairment and that it has longitudinal validity to track changes over time. “
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
“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.
The study 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. 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.
Findings demonstrate the validity and utility of DANA as sensitive to cognitive impairment independently for concussion, PTSD, insomnia and depression.”
Defense Automated Neurobehavioral Assessment (DANA) – Psychometric Properties of a New Field-Deployable Neurocognitive Assessment Tool
“This is the original feasibility and reliability study testing the Defense Automated Neurobehavioral Assessment (DANA), which includes a description of its psychometric properties.
DANA was found to be a reliable instrument and compared favorably to other computer-based neurocognitive assessments.”
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Poster Representation
Spira, J.L., King, L.A., Lathan, C., Tsao, J. (2014, August). Development of an Objective, Functional Biomarker of Invisible Wounds of War for Use by Providers. Poster session presented at the Military Health System Research Symposium, Fort Lauderdale, FL.
Spira, J.L., King, L.A., Lathan, C., Tsao, J. (2014, August). Development of an Objective, Functional Biomarker of Invisible Wounds of War for Use by Providers. Poster session presented at the Military Health System Research Symposium, Fort Lauderdale, FL.
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Eonta, S.E., Paech, G.M., Banks, S., Johnson, K., Vedova, C.D., Kamimori, G.H. (August, 2014). Impact of Caffeine on Neurocognitive Performance During Sleep Deprivations Using the Defense Automated Neurobehavioral Assessment (DANA). Poster session presented at the Military Health Systems Research Symposium, Ft. Lauderdale, FL
Eonta, S.E., Paech, G.M., Banks, S., Johnson, K., Vedova, C.D., Kamimori, G.H. (August, 2014). Impact of Caffeine on Neurocognitive Performance During Sleep Deprivations Using the Defense Automated Neurobehavioral Assessment (DANA). Poster session presented at the Military Health Systems Research Symposium, Ft. Lauderdale, FL
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Kamimori, G.H., LaValle, C., Paech, G., Johnson, K., Banks S., Dark, H., & Eonta, S. (August, 2015). Performance on the Defense Automated Neurobehavioral Assessment Battery (DANA) and simulated driving performance over 50h of continuous wakefulness: Correlation between Neurocognitive and Operational Performance (#2003), Poster session presented at the Military Health Systems Research Symposium, Ft. Lauderdale, FL
Kamimori, G.H., LaValle, C., Paech, G., Johnson, K., Banks S., Dark, H., & Eonta, S. (August, 2015). Performance on the Defense Automated Neurobehavioral Assessment Battery (DANA) and simulated driving performance over 50h of continuous wakefulness: Correlation between Neurocognitive and Operational Performance (#2003), Poster session presented at the Military Health Systems Research Symposium, Ft. Lauderdale, FL
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Lathan, C., Resnick, H. (2017, April).Home-based Telemental Health for Rural Veterans. Poster presented at the American Telemedicine Association Conference, Orlando, FL.
Lathan, C., Resnick, H. (2017, April).Home-based Telemental Health for Rural Veterans. Poster presented at the American Telemedicine Association Conference, Orlando, FL.
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