Rob Pepper, CEO, NeuroTrax Corp.

Neurology is undergoing a significant shift. While demand for neurological care continues to rise, the supply of practicing neurologists is unable to keep pace, creating a widening gap with real consequences for patient access, wait times, and care quality. As neurological conditions grow more prevalent, and as diagnostics and therapeutics become more sophisticated, clinicians need tools that expand their reach, streamline evaluations, and improve decision-making. NeuroTrax helps fill exactly that need.

The U.S. is experiencing a sustained and worsening shortage of neurologists. Demand is surging due to an aging population, increased prevalence of Alzheimer’s disease, Parkinson’s disease, stroke, and other neurological disorders, and expanded insurance coverage that has brought more patients into the system. At the same time, therapeutic advancements are enabling longer-term disease management, which increases the number of patients requiring ongoing specialist oversight. Studies have projected a national neurologist shortfall approaching 19%, accompanied by some of the longest wait times in all of medicine.

This is where NeuroTrax can make an immediate impact. As a digital neuromarker capable of quantifying cognitive domains with clinical-grade precision, NeuroTrax allows providers, including overburdened neurologists, to triage more efficiently, monitor patients remotely, and identify cognitive changes earlier than traditional methods.

Another major trend is the accelerating shift toward neurology subspecialties, including stroke, epilepsy, movement disorders, sleep disorders, neuroimmunology, and more. While this expansion improves specialized care, it also contributes to a shrinking pool of general neurologists. Compounding this shift is the rise of neurohospitalists who are focused primarily on inpatient settings.

NeuroTrax supports both generalists and specialists by offering standardized, domain-specific cognitive insights relevant across the continuum of neurological care. Whether a clinician is assessing attention in ADHD, processing speed in MS, memory function in early Alzheimer’s disease, or executive function in post-stroke recovery, NeuroTrax provides a consistent, objective measurement framework.

The national neurologist shortage is amplified in rural and underserved regions, areas commonly referred to as “neurology deserts.” Patients in these communities face major barriers to timely evaluation and follow-up care. NeuroTrax helps reduce geographic disparities by providing a scalable, digital cognitive assessment platform that can be administered in primary care offices, community clinics, or remotely when appropriate. By functioning as a digital neuromarker, NeuroTrax provides non-specialists with objective cognitive data to guide next steps, allowing neurologists to focus their limited time on the most complex cases.

Neurology is not declining; it's evolving. The pressures facing the field underscore a growing need for digital tools that support early detection, triage, monitoring, and interdisciplinary care. NeuroTrax is uniquely positioned to meet these challenges, enabling clinicians to deliver higher-quality neurological and cognitive care, no matter the practice setting or subspecialty.

Want to see how NeuroTrax can strengthen your neurology practice?

Contact us today to learn more.

NeuroTrax Science Team and Glen M. Doniger, PhD

For many primary care physicians, evaluating cognitive decline poses a challenge: traditional screening tools are limited, while referrals to specialists can take months. NeuroTrax bridges that gap, bringing objective, comprehensive cognitive assessment directly into the primary care setting.

Built for everyday clinical workflows, NeuroTrax provides precise data across seven cognitive domains, including memory, attention, executive function, processing speed, and visual spatial ability, all within a single, 45-minute digital session. Staff can easily administer the test, and results are available instantly through clear, visual reports. With built-in reimbursement under CPT codes 96138, 96139, and 96146, NeuroTrax enhances both clinical care and practice efficiency.

Research supports the practicality and accuracy of computerized cognitive testing in primary care. In a multicenter study of nearly 100 memory clinic participants, NeuroTrax effectively distinguished individuals with mild cognitive impairment (MCI) from both cognitively healthy adults and those with mild Alzheimer’s disease [1]. Measures of memory, executive function, visual spatial skills, and verbal fluency showed strong discriminant validity comparable to, and in some cases outperforming, traditional paper-based neuropsychological tests. Other studies have shown that this discriminant validity is robust to comorbid depressive symptoms [2] and socioethnic factors [3]. Taken together, these findings highlight the platform’s precision, efficiency, and suitability for routine clinical use, especially where full neuropsychological testing is impractical.

Additionally, in a large usability study of over 2,800 elderly patients, 83% rated NeuroTrax “easy to use,” including those over age 75 and with significant cognitive impairment [4]. Supervisors reported minimal frustration, highlighting that digital testing with NeuroTrax is feasible, even for non-computer users. These findings confirm that cognitive assessment need not be confined to specialty clinics; it can be successfully implemented in everyday practice.

Further evidence demonstrates NeuroTrax’s ability to capture subtle deficits missed by conventional paper-based tools. In a study comparing visual spatial assessments, NeuroTrax’s computerized battery detected impairments with greater sensitivity and reliability than standard screens like the Clock Drawing Test or Mini-Mental State Examination [5]. Such precision allows earlier identification of mild cognitive impairment (MCI), enabling proactive management before decline progresses to dementia.

With new Alzheimer’s treatments now available for early-stage disease, timely and accurate cognitive assessment has never been more critical. NeuroTrax empowers primary care providers to detect, track, and manage cognitive changes in-house, bolstering patient trust and improving outcomes.

Ready to see how NeuroTrax fits into your primary care workflow? Contact us today to learn how you can deliver same-day cognitive clarity for your patients.

References:

[1] Dwolatzky, T., Whitehead, V., Doniger, G.M., Simon, E.S., Schweiger, A., Jaffe, D., and Chertkow, H. (2003). Validity of a novel computerized cognitive battery for mild cognitive impairment. BMC Geriatrics, 3:4. PMID: 14594456

[2] Doniger, G.M., Dwolatzky, T., Zucker, D.M., Chertkow, H., Crystal, H., Schweiger, A., and Simon, E.S. (2006). Computerized cognitive testing battery identifies MCI and mild dementia even in the presence of depressive symptoms. American Journal of Alzheimer’s Disease and Other Dementias, 21, 28–36. PMID: 16526587

[3] Doniger, G.M., Jo, M-Y., Simon, E.S., and Crystal, H.A. (2009). Computerized cognitive assessment of mild cognitive impairment in urban African Americans. American Journal of Alzheimer’s Disease and Other Dementias, 24, 396–403. PMID: 19700670

[4] Fillit, H.M., Simon, E.S., Doniger, G.M., and Cummings, J.L. (2008). Practicality of a computerized system for cognitive assessment in the elderly. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 4, 14–21. PMID: 18631946

[5] Punchik, B., Shapovalov, A., Dwolatzky, T., and Press, Y. (2015). Visual-spatial perception: A comparison between instruments frequently used in the primary care setting and a computerized cognitive assessment battery. Clinical Interventions in Aging, 10, 1881–1887. PMID: 26648704

The future of cognitive medicine lies in predictive biomarkers, blood- and physiology-based indicators that can presage cognitive decline before symptoms emerge. NeuroTrax digital cognitive testing has been at the forefront of integrating these biomarkers into research and clinical assessment.

In studies of older adults with cardiovascular disease, NeuroTrax assessments revealed that plasma lipids and apolipoproteins predict accelerated cognitive decline nearly two decades later. Specifically, higher Apo-B and LDL-C levels were linked to greater declines in memory and visual spatial function, highlighting the potential of lipid biomarkers to indicate risk for later-life cognitive impairment [1].

Serum uric acid (UA), a natural antioxidant, has also been investigated using NeuroTrax assessments. Lower UA levels were associated with poorer global cognition, memory, and executive function a decade later, highlighting the connection between oxidative stress, vascular burden, and cognitive outcomes [2].

Additionally, cerebrovascular reactivity (CVR) measured by transcranial doppler as a physiological biomarker has been shown to correlate with executive function and global cognitive performance. Impaired CVR, especially in the presence of carotid large-vessel disease, predicted reduced cognitive scores across multiple domains, emphasizing the importance of microvascular health in maintaining brain function [3].

NeuroTrax’s platform allows researchers to combine digital cognitive assessments with biomarker data seamlessly, creating a comprehensive view of brain health. By capturing subtle changes in cognitive function alongside blood and vascular indicators, NeuroTrax facilitates early risk identification and supports precision interventions tailored to individual patients.

As biomarker research expands, the integration of these measures (e.g., p-tau217 for Alzheimer’s disease) with standardized digital cognitive testing promises more accurate prediction and monitoring of brain health. NeuroTrax enables this next-generation approach, bridging the gap between lab-based biomarkers and clinically actionable insights.

Ready to complement your biomarker metrics with objective digital cognitive outcomes? Contact NeuroTrax today.

References:

[1] Lutski, M., Weinstein, G., Goldbourt, U., and Tanne, D. (2019). Plasma lipids, apolipoproteins, and subsequent cognitive decline in men with coronary heart disease. Journal of Alzheimer’s Disease, 67, 827–837. PMID: 30664505

[2] Molshatzki, N., Weinstein, G., Streifler, J.Y., Goldbourt, U., and Tanne, D. (2015). Serum uric acid and subsequent cognitive performance in patients with pre-existing cardiovascular disease. PloS One, 10: e0120862. PMID: 25794156

Stroke is a leading cause of long-term disability, often leaving patients with persistent physical and cognitive impairments. Yet new evidence shows that hyperbaric oxygen therapy (HBOT) can help restore function even long after the initial injury. A recent case study demonstrates how HBOT enabled remarkable recovery in a 45-year-old post-stroke patient, including improvement in cognitive function documented by NeuroTrax digital testing.

The patient, 15 months post-hemorrhagic stroke, presented with right-sided weakness, impaired gait, and cognitive deficits. After completing 83 HBOT sessions (2.0 ATA, 90 minutes each), the outcomes were extraordinary:

Clinical improvements:

• Regained independent walking with a quadruped cane
• Noticeable gains in strength, balance and coordination
• Improved speech fluency and articulation

Cognitive improvements (on NeuroTrax):

• +31.2% in verbal memory
• +10.7% in information processing speed
• +8.6% in attention

Imaging confirmation:

• Diffusion tensor imaging (DTI) revealed increased white matter integrity
• SPECT scans showed enhanced perfusion (+15.9%) in motor and frontal regions, aligning with improved mobility and cognition

This case highlights HBOT’s ability to actuate neuroplasticity and metabolic recovery in viable brain tissue. Additionally, NeuroTrax testing provided objective, quantifiable evidence of cognitive restoration, in line with the functional and imaging changes.

In another case study of a 62-year-old fibromyalgia patient treated with 60 HBOT sessions, NeuroTrax testing captured a 10% improvement in global cognition and a 26.9% gain in attention, supported by imaging that showed enhanced white matter integrity and brain perfusion. In addition to illustrating the versatility and efficacy of HBOT, these cases demonstrate the utility of NeuroTrax in characterizing and quantifying HBOT-related cognitive recovery.

For clinicians, the integration of NeuroTrax with advanced therapies like HBOT offers a powerful, evidence-based framework for tracking and optimizing neurorehabilitation outcomes.

Contact us to learn how NeuroTrax can bring objective, data-driven insights to your clinical practice.

Full text (open access):

https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-025-05453-2

Citations:

Khairy, S., Mouzayan, G., Wang, Z., Qureshi, U., Zaitoun, R., and Efrati, S. (2025). Anatomical and metabolic brain imaging correlation of neurological improvements following hyperbaric oxygen therapy—post-stroke recovery: A case report. Journal of Medical Case Reports, 19:493. PMID: 41068989

Mouzayan, G., Khairy, S., Wang, Z., Qureshi, U., Zaitoun, R., and Efrati, S. (2025). Efficacy of hyperbaric oxygen therapy in treating fibromyalgia linked to childhood trauma after late-onset and over a decade of symptoms: A case report. Journal of Medical Case Reports, 19:386. PMID: 40765001

A central challenge in neuroscience is to understand how brain structure relates to cognitive function. Advances in imaging, including magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI), combined with digital cognitive testing (NeuroTrax) are helping to clarify these relationships in clinical contexts like multiple sclerosis (MS) and normal aging.

One study investigated whether MRI-derived brain volumes were associated with cognitive performance in people with MS [1]. Using NeuroTrax’s cognitive testing platform, researchers assessed nine domains, including memory, executive function, and processing speed. Significant correlations were observed between global cognitive scores and whole brain, white matter, gray matter, thalamic, hippocampal, and lesion volumes. Thalamic and lateral ventricular volumes were the strongest predictors of performance across domains, highlighting the thalamus as a key hub for cognitive integrity in MS.

Research in healthy aging populations has provided further insights into how brain microstructure supports cognition [2]. Results showed a domain-specific pattern: executive function was linked to frontal white matter and the superior longitudinal fasciculus (SLF); processing speed correlated with the cingulum, corona radiata, inferior longitudinal fasciculus (ILF), parietal white matter, and thalamus; and memory was associated with temporal and frontal regions, including the cingulate cortex and parahippocampus.

A follow-up study extended these findings with tractography of temporal lobe projections [3]. Executive function performance was tied to DTI parameters in the SLF and uncinate fasciculus (UF), while processing speed was related to integrity in the cingulum, fornix, ILF, and SLF. Memory performance showed strong associations with the fornix, cingulum, ILF, SLF, and UF. Taken together, these results illustrate how distinct white matter pathways underpin different aspects of cognition.

By combining NeuroTrax with MRI and DTI, researchers are able to link specific cognitive domains to measurable brain structures and tracts. This linkage underscores the value of digital cognitive testing for detecting subtle changes, validating neuroimaging findings, and potentially guiding targeted interventions in both clinical and aging populations.

Contact us today to learn how NeuroTrax supports clinical and research applications in brain health.

References:

[1] Golan, D., Doniger, G.M., Srinivasan, J., Sima, D.M., Zarif, M., Bumstead, B., Buhse, M., Van Hecke, W., Wilken, J., and Gudesblatt, M. (2020). The association between MRI brain volumes and computerized cognitive scores of people with multiple sclerosis. Brain and Cognition, 145: 105614. PMID: 32927305

[2] Sasson, E., Doniger, G.M., Pasternak, O., Tarrasch, R., and Assaf, Y. (2012). Structural correlates of cognitive domains in normal aging with diffusion tensor imaging. Brain Structure and Function, 217, 503–515. PMID: 21909706

[3] Sasson, E., Doniger, G.M., Pasternak, O., Tarrasch, R., and Assaf, Y. (2013). White matter correlates of cognitive domains in normal aging with diffusion tensor imaging. Frontiers in Neuroscience, 7:32. PMID: 23493587

Traumatic brain injury (TBI) can cause subtle cognitive deficits that are often challenging to detect with imaging alone. While MRI reveals structural damage, it may not capture a comprehensive view of impairments. Combining advanced neuropsychological testing like NeuroTrax with MRI offers a comprehensive approach to assessment.

NeuroTrax is a clinically focused web-based testing platform for evaluating multiple domains (e.g., memory, attention, executive function, processing speed). Its standardized scores can reveal mild deficits, making it valuable in clinical and legal contexts. For example, a patient with mild TBI may show no obvious abnormalities on structural imaging, however NeuroTrax testing can reveal measurable declines in processing speed or executive function. These insights can validate patient symptoms, guide treatment planning, and provide objective evidence in litigation or compensation cases.

Additionally, embedded in the NeuroTrax platform is an algorithm to assess effort and detect negative response bias (NRB), which can distort testing results. Validated in TBI populations, this algorithm demonstrates high sensitivity (87.5%) and specificity (98%), correctly classifying 94% of cases as genuine effort or malingered effort. This ensures the reliability of cognitive data, particularly in a litigation context.

MRI provides insight into brain structure and activity, but NeuroTrax can provide additional findings of deficits. Combining NeuroTrax’s quantitative assessment with MRI enhances diagnostic accuracy, especially in cases where structural imaging is inconclusive. NeuroTrax includes effort-validation tools that enhance the trustworthiness of cognitive results. This integrated approach guides targeted rehabilitation and provides robust evidence in medical-legal evaluations.

Ultimately, leveraging NeuroTrax's domain-specific tests alongside MRI offers a powerful, comprehensive method for assessing the complex effects of TBI, supporting clinical decision making enabling precise diagnosis and tailored intervention strategies.

Interested in how NeuroTrax can complement MRI to improve post-TBI assessment and rehabilitation? Contact us to learn more about integrating these tools into your practice.

References:

• Bar-Hen, M., Doniger, G.M., Golzad, M., Geva, N., and Schweiger, A. (2015). Journal of Clinical and Experimental Neuropsychology, 37, 1086–1097. PMID: 26327146
• Doniger, G.M., Simon, E.S., and Schweiger, A. (2008). Applied Neuropsychology, 15, 250–263. PMID: 19023742
• Silverberg, N.D., Iverson, G.L., and ACRM Brain Injury Special Interest Group Mild TBI Task Force members. (2023). Archives of Physical Medicine and Rehabilitation, 104, 1343–1355. PMID: 37211140

Fibromyalgia often involves central sensitization, cognitive fog, pain, and limited mobility, particularly challenging when symptoms are rooted in early-life trauma. However, a new case gives reason for optimism: a 62-year-old patient, with fibromyalgia persisting for over ten years and linked to childhood trauma, showed dramatic improvements following hyperbaric oxygen therapy (HBOT).

The HBOT protocol involved 60 sessions over 12 weeks (90 minutes per session at 2 ATA). Post-treatment outcomes were impressive:

• Pain and symptom metrics: FIQR dropped from 60.5 to 44; fibromyalgia criteria score decreased from 16 to 12.
• Medication reduction: Discontinuation of pregabalin and halving of duloxetine dosage.
• Mobility gains: Walking speed increased from 3.2 to 4.5 km/h, with better balance and coordination.
• Neurocognitive improvements: NeuroTrax computerized testing recorded a 10% improvement in global cognitive function and a 26.9% gain in attention, providing objective evidence of cognitive recovery in fibromyalgia.
• Brain imaging: SPECT and diffusion tensor imaging confirmed enhanced brain perfusion and white matter integrity, corroborating the clinical and cognitive outcomes.

This case not only highlights HBOT’s potential to promote neuroplasticity and functional recovery but also demonstrates the unique clinical value of NeuroTrax – its precision facilitated detection and quantification of cognitive changes that traditional assessments might miss. For clinicians managing complex, trauma-associated fibromyalgia, the combination of HBOT and NeuroTrax offers both a promising therapeutic avenue and a rigorous way to track recovery.

Larger studies are needed, but this case, with its rich multi-domain evaluations and NeuroTrax metrics, offers critical, clinician-friendly insights into effective treatment of fibromyalgia.

Contact us to find out more about how NeuroTrax can bring objective cognitive insights to your practice. 

Full text (open access):

https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-025-05453-2

Citation:

Mouzayan, G., Khairy, S., Wang, Z., Qureshi, U., Zaitoun, R., and Efrati, S. (2025). Efficacy of hyperbaric oxygen therapy in treating fibromyalgia linked to childhood trauma after late-onset and over a decade of symptoms: A case report. Journal of Medical Case Reports, 19:386. PMID: 40765001

A. Elahi, MD, Neurospa Brain Rejuvenation Centers, Corona Del Mar, CA

Early-onset Alzheimer’s Disease (AD) is a rare form of AD defined by signs and symptoms before age 65. Several studies have shown high frequency repetitive transcranial magnetic stimulation (rTMS) to be an effective treatment for individuals with mild cognitive impairment (MCI) or AD when applied to the left and/or right dorsolateral prefrontal cortex (DLPFC), with clear improvements on standardized assessments of cognitive function.

We recently published a case report of a 44-year-old patient with clinical and laboratory characteristics of definite early-onset AD in which rTMS led to marked cognitive improvements in multiple cognitive domains on the NeuroTrax assessment. Overall change from baseline was 18.1%, with improvement in verbal function, executive function, memory, working memory, and attention. Interestingly, there was no change on NeuroTrax’s problem solving test, which has been used as a measure of premorbid IQ. We hope these findings spark clinical interest in exploring rTMS for the treatment of dementia.

Full text (open access):

https://www.sciencedirect.com/science/article/pii/S2467981X23000197

Citation:

Elahi, A., and Frechette, T. (2023). Repetitive transcranial magnetic stimulation for early-onset Alzheimer’s disease – a case report. Clinical Neurophysiology Practice, 8, 161–163. PMID: 37588010

Older adults with greater variability in gait characteristics related to step length and walking speed are more likely to fall, especially after stroke. Recent evidence has suggested that C-C chemokine receptor 5 (CCR5), an established factor involved in immune processes and neuromodulation, may be a promising target for post-stroke recovery. In rodents, CCR5 knockdown was shown to promote motor recovery and increase axonal sprouting after stroke. In humans, post-stroke patients with the CCR5-Δ32 mutation have improved cognitive and motor recovery.

A newly published study by Molad and colleagues investigated the relationship between gait variability and CCR5-Δ32 carrier status. The findings are based on a large prospective cohort of post-stroke patients (Tel Aviv Brain Acute Stroke Cohort; TABASCO) with gait and NeuroTrax computerized cognitive assessment at admission, 6, 12, and 24 months. Analysis was for 335 patients with both gait and CCR5-Δ32 data. The researchers found lower variability and higher speed at 6 and 12 months for carriers vs. non-carriers, even after adjustment for age, gender, education, ethnicity, and stroke severity. This was also true when patients performed a dual (concurrent) task. Notably, lower stride time variability during the dual task was associated with better cognitive function, with a stronger correlation for CCR5-Δ32 carriers than non-carriers, who had higher variability and lower cognitive scores.

This study is the first to report that carriers of a naturally occurring loss-of-function mutation (CCR5-Δ32) show better gait at 6 and 12 months post-stroke that is similar to healthy older individuals. Greater gait variability among non-carriers may be a predictive marker for falls and cognitive decline. Indeed reciprocity between gait variability and cognitive scores suggests the presence of cognitive-motor interactions. The work builds on previous results from the same cohort showing a relationship of CCR5-Δ32 carrier status with cognitive deterioration and depression in humans, as well findings of a correlation with motor function in mice. The investigators posit that CCR5-Δ32 may be a promising molecular target for intervention by reducing inflammatory response. Recently, they initiated a phase 2 clinical trial to examine the safety and efficacy of Maraviroc, a CCR5 antagonist, in post-stroke cognitive impairment; NeuroTrax is an outcome.

Full text (open access):

https://onlinelibrary.wiley.com/doi/10.1111/ene.15637

Citation:

Molad, J., Hallevi, H., Seyman, E., Rotschild, O., Bornstein, N.M., Tene, O., Giladi, N., Hausdorff, J.M., Mirelman, A., and Ben Assayag, E. (2022). CCR5-Δ32 polymorphism – a possible protective factor from gait impairment among post-stroke patients. European Journal of Neurology. PMID: 36380716

Although the global COVID-19 pandemic has subsided and lockdowns seem a thing of the past, cognitive symptoms persist even after a mild COVID infection. Indeed brain fog appears to be experienced by approximately 88% of ‘long COVID’ patients. 

This brain fog is characterized by difficulties affecting planning, decision-making, processing speed and memory. But are there effective treatments for COVID-related brain fog? Based on the results of a study recently published in Scientific Reports, the answer is a resounding yes.

The randomized, sham-controlled, double blind trial examined the effect of hyperbaric oxygen therapy (HBOT) on post-COVID patients with ongoing symptoms for at least 3 months after confirmed infection. In the study, conducted by Dr. Shai Efrati and his team at the Shamir (Assaf Harofeh) Medical Center, seventy-three patients were randomized to receive 40 sessions of HBOT or sham. NeuroTrax computerized cognitive testing (primary outcome) and secondary outcomes were administered at baseline and 1-3 weeks after the last treatment session. Significantly greater improvement over time in the HBOT vs. sham group was found for attention, executive function, and global cognitive function (which also correlated with increased perfusion in the left supramarginal gyrus). Taken together, results indicated that HBOT can induce neuroplasticity and improve cognitive, psychiatric, fatigue, sleep and pain symptoms.

The new study is the first prospective, randomized sham-controlled trial demonstrating significant improvement beyond the expected clinical recovery course in post-COVID patients. The results are the latest addition to a body of work from Dr. Efrati’s group showing beneficial cognitive effects of HBOT in such conditions as stroke and traumatic brain injury. In all of these studies, scores from NeuroTrax tests were the primary cognitive outcomes.

For cognitive assessment of patients who have recovered from COVID-19, NeuroTrax offers a 30-minute battery that consists of 6 tests covering memory, executive function, attention, and information processing speed domains. For more information, ask your NeuroTrax representative about the Post COVID Testing Suite.

Full text (open access):

https://www.nature.com/articles/s41598-022-15565-0

Citation:

Zilberman-Itskovich, S., Catalogna, M., Sasson, E., Elman-Shina, K., Hadanny, A., Lang, E., Finci, S., Polak, N., Fishlev, G., Korin, C., Shorer, R., Parag, Y., Sova, M., and Efrati, S. (2022). Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: Randomized controlled trial. Scientific Reports, 12:11252. PMID: 35821512

Keeping busy is widely regarded as important for maintaining cognitive fidelity and overall brain health. However, stay-at-home orders and rising unemployment during the current pandemic have made this particularly challenging. 

Underscoring the importance of mental activity to brain health, researchers at Tel Aviv Medical Center led by Prof. Einor Ben Assayag recently found a link between occupational status and cognitive function after a stroke. Specifically, patients who were employed prior to the stroke had better cognitive performance compared to those who were unemployed. Further, employed patients who resumed working had better cognitive function than those who never returned to work.

The findings are based on a large clinical cohort of stroke patients (Tel Aviv Brain Acute Stroke Cohort; TABASCO) tested with NeuroTrax computerized cognitive assessment at admission, as well as 6, 12, and 24 months later. Data were analyzed from 273 first-ever stroke survivors of working age, of which 174 were employed prior to the stroke. Pre-stroke unemployment was associated with diabetes, hypertension, dyslipidemia, depression, poorer cognitive scores and brain atrophy. Further, post-stroke cognitive decline was more prevalent among previously unemployed patients. Of patients who had been employed, those who returned to work had higher cognitive scores and fewer depressive symptoms. Engaging in mentally stimulating jobs reduced risk of cognitive decline, and participation in social activities conferred partial protection against cognitive decline even in unemployed patients.

These results confirm that keeping busy is indeed protective against cognitive decline. Specifically, people who are employed experience less cognitive decline associated with a stroke, and those who return to work after a stroke have less chance of cognitive decline. Notably, the study design highlights the value of longitudinal follow-up with validated tools to track changes in cognitive performance. Based on their results, the authors advise clinicians to emphasize the importance of work resumption and social engagement after a stroke. More generally, brain health should be safeguarded amid the current pandemic by exploiting remote employment and social networking opportunities.

Citation:

Hallevi, H., Molad, J., Kliper, E., Seyman, E., Niry, D., Bornstein, N.M., and Ben Assayag, E. (2020). Working status is related to post stroke/TIA cognitive decline: Data from the TABASCO study. Journal of Stroke and Cerebrovascular Diseases, 29:105019. PMID: 32807434

A newly published report from researchers at McGill University and a multinational team, including investigators from the University of Bristol and Harvard Medical School, evaluated the relationship between childhood growth trajectory and cognitive ability in a large, population-based cohort. 

In the study, 12,368 children born at term were followed up with cognitive assessment at ages 6.5 and 16 years. According to the article, NeuroTrax computerized cognitive testing was selected to measure cognition at 16 years in view of its strong test-retest reliability and correlation with traditional neuropsychological tests.

Highly controlled analyses revealed that overall size, timing of the childhood growth spurt, size at birth and post-infancy growth velocity were associated with cognitive ability at early school age and adolescence. Among the many control variables were type of delivery, delivery or postnatal complications, gender of the child, gestational age at birth, 5-minute Apgar score, and parental occupation. Different approaches were used to model continuous growth trajectory over time and to differentiate infant from post-infancy growth.

This International Journal of Epidemiology report is the first to document persistence of associations between early growth and later cognitive ability over time. The findings highlight the importance of considering children’s growth as a continuum from birth through childhood rather than in infancy alone when determining associations with later health outcomes like cognition. Notably, the study highlights the suitability of NeuroTrax testing for widespread implementation and its ability to meaningfully track cognitive function as it relates to clinical indicators.

The finding that child growth after infancy, but not during infancy, was associated with later cognition suggests that genetic and post-infancy environmental factors (e.g., nutrition) may play important roles in cognitive development. The authors point out that although rapid gain of weight and height in children has been linked to negative health outcomes, the current results suggest that faster child growth is associated with better cognitive abilities. Additional studies are needed to investigate whether the obtained associations persist into adulthood and evaluate important cognition-related life outcomes like academic success, educational attainment and employment.

Citation:

Ahmed, A., Kramer, M.S., Bernard, J.Y., Perez Trejo, M.E., Martin, R.M., Oken, E., and Yang, S. (2020). Early-childhood-growth trajectory and later cognitive ability: Evidence from a large prospective birth cohort of healthy term-born children. International Journal of Epidemiology. PMID: 32743654

Is it possible to reverse the cognitive decline that inevitably accompanies healthy aging? Though not quite the proverbial fountain of youth, hyperbaric oxygen therapy (HBOT) may do the trick. 

According to a new paper published in the journal Aging, three months of oxygen therapy may lead to sizeable improvement in cognitive function and associated increases in cerebral blood flow (CBF). The NeuroTrax global cognitive score was the primary endpoint and evidenced a large benefit for HBOT as compared to a control condition. Substantial effects were also found in attention and information processing domains. Notably, improvement was more robust for computerized measures than for traditional pen-and-paper tests. HBOT led to increased CBF in brain regions related to age-related functional decline: superior and middle frontal gyri, supplementary motor area, and superior parietal lobule.

In the study, conducted by Dr. Shai Efrati and his team at the Shamir (Assaf Harofeh) Medical Center, sixty-three healthy adults ages 64 and older were randomized to receive HBOT or no intervention. Participants in the HBOT group completed sixty 90-minute sessions, 5 sessions per week, over a three-month period. In previous studies, Dr. Efrati’s group showed beneficial cognitive effects of HBOT in such conditions as stroke and traumatic brain injury, but this study is the first to demonstrate cognitive enhancement in healthy older adults. In all these studies, scores from NeuroTrax tests were the primary cognitive outcomes.

The new Aging paper suggests that oxygen treatment, combined with precision cognitive metrics for tracking change over time (as provided by NeuroTrax), offers promise in mitigating the gradual cognitive decline that accompanies normal aging. Given these encouraging findings, future studies might explore whether HBOT’s restorative properties can actually delay onset or slow progression of neurodegenerative disease.

Citation:

Hadanny, A., Daniel-Kotovsky, M., Suzin, G., Boussi-Gross, R., Catalogna, M., Dagan, K., Hachmo, Y., Abu Hamed, R., Sasson, E., Fishlev, G., Lang, E., Polak, N., Doenyas, K., Friedman, M., Tal, S., Zemel, Y., Bechor, Y., and Efrati, S. (2020). Cognitive enhancement of healthy older adults using hyperbaric oxygen: A randomized controlled trial. Aging, 12, 13740–13761. PMID: 32589613

See this Psychology Today article on the study.

The Mediterranean diet incorporates the traditional cuisine of countries bordering the Mediterranean Sea. It is typically high in vegetables, fruits, whole grains, beans, nuts and seeds, and olive oil. In the 1960s it was observed that coronary heart disease caused fewer deaths in Mediterranean countries like Greece and Italy than in the U.S. and northern Europe. Later on, the Mediterranean diet was found to be associated with reduced factors for cardiovascular disease. It is one of the healthy eating plans recommended by the Dietary Guidelines for Americans to promote health and prevent chronic disease. The diet is recognized by the World Health Organization as a healthy and sustainable dietary pattern and as an intangible cultural asset by the United Nations Educational, Scientific and Cultural Organization.

In the latest in a series of reports on the Bezafibrate Infarction Prevention (BIP) cohort, a recent paper in the journal Nutritional Neuroscience found that adherence to the Mediterranean diet predicts cognitive decline two decades later in men with cardiovascular disease. Participants were 200 men (mean age at baseline 57.3 ± 6.3 years) with stable coronary artery disease in a multicenter placebo-controlled randomized clinical trial who completed computerized cognitive assessment [NeuroTrax] 15 and 20 years after baseline. Based on 4-day food diaries, participants with poor adherence to the Mediterranean diet had poorer cognitive function and greater decline in overall cognitive function and visual spatial processing two decades later. Excluding those with interim stroke and dementia, poor adherence was associated with greater decline in overall cognitive function and executive function. Analyses adjusted for a host of variables: education, birth place, energy intake (kcal/day), height, smoking, body mass index, physical activity, New York Heart Association classification, history of hypertension, past myocardial infarction, C-reactive protein (CRP), insulin resistance, and diastolic blood pressure.

The new findings suggest that the Mediterranean diet may decrease existing vascular burden or prevent additional vascular injury, which may lead to improved cognitive performance and reduced decline. Alternatively, the results may be explained by other mechanisms including prevention of amyloid beta accumulation, tau hyperphosphorylation, oxidative stress, and inflammation. Referring to NeuroTrax, the authors note that “the use of a validated computerized assessment tool to quantify cognitive function globally and in specific domains” is a distinct strength of the study. Critically, the study may lay the groundwork for future intervention studies to reduce of cognitive decline in men with a high vascular burden.

Citation:

Lutski, M., Weinstein, G., Ben-Zvi, S., Goldbourt, U., and Tanne, D. (2020). Adherence to Mediterranean diet and subsequent cognitive decline in men with cardiovascular disease. Nutritional Neuroscience. PMID: 31965911

Newly published research in the journal Cell reported that neuronal knockdown of the CCR5 gene, implicated in learning/memory and uniquely expressed in cortical neurons after stroke, leads to early recovery of motor control. The groundbreaking study also demonstrated that administration of CCR5 antagonist devised for HIV produces similar effects on motor recovery post stroke and cognitive recovery post TBI. Critically, in a large clinical cohort of stroke patients (Tel Aviv Brain Acute Stroke Cohort; TABASCO), carriers of a naturally occurring loss-of-function mutation in CCR5 (CCR5-D32) showed better recovery of neurological impairments and cognitive function months after the stroke. The UCLA and Tel Aviv Medical Center researchers conclude that CCR5 is a translational target for neural repair in stroke and TBI as well as the first ever gene associated with enhanced recovery in human stroke.

Patients in the TABASCO cohort are followed up post-stroke to evaluate long-term recovery. NeuroTrax computerized cognitive testing is administered at baseline, 6, 12, and 24 months. For the Cell study, 446 patients with NeuroTrax scores available were screened for the CCR5-D32 mutation; 68 were found to be carriers. There were no differences in baseline cognitive performance between carriers and non-carriers. However, at 1 year, CCR5-D32 carriers showed improvement in memory, verbal function, attention, and overall cognitive performance relative to non-carriers, even after adjustment for age, gender and education. There was converging evidence of CCR5-D32 carrier improvement on the MoCA, as well as improvement on functional and neurological scales.

Stroke and TBI cause loss of connections in adjacent and interacting brain regions. A mechanism of action for CCR5 knockdown in recovery from brain injury may be in preventing the loss of synaptic connections in adjacent cortex or promoting the formation of new connections after brain injury. Specifically, CCR5 knockdown induces recovery through two intracellular cascades, CREB and dual leucine zipper kinase (DLK), both of which mediate injury signals, dendritic spine morphogenesis, and axonal regeneration in other systems. Led by Prof. S. Thomas Carmichael of UCLA and Dr. Einor Ben Assayag of Tel Aviv Medical Center, the authors state that their data point to the CCR5 receptor system as a valid target for future clinical trials of a stroke and TBI recovery approach.

Citation:

Joy, M.T., Ben Assayag, E., Shabashov-Stone, D., Liraz-Zaltsman, S., Mazzitelli, J., Arenas, M., Abduljawad, N., Kliper, E., Korczyn, A.D., Thareja, N.S., Kesner, E.L., Zhou, M., Huang, S., Silva, T.K., Katz, N., Bornstein, N.M., Silva, A.J., Shohami, E., and Carmichael, S.T. (2019). CCR5 is a therapeutic target for recovery after stroke and traumatic brain injury. Cell, 176, 1143–1157. PMID: 30794775

Chronic stress is a contributing factor to cognitive aging, and genetic factors may amplify its role in cognitive dysfunction. Acute ischemic stroke, a well-known risk factor for dementia and cognitive decline is associated with elevated levels of cortisol, the primary stress hormone. In a newly published prospective study, Tel Aviv Medical Center researchers led by Dr. Einor Ben Assayag evaluated whether higher cortisol levels at bedtime and post-awakening are associated with long-term brain alterations and changes in cognitive performance [NeuroTrax], and whether APOE genotype modifies these associations in stroke patients.

Participants were 182 cognitively intact ischemic stroke and transient ischemic attack (TIA) survivors from the Tel Aviv Brain Acute Stroke Cohort (TABASCO) study. Salivary cortisol levels (bedtime and post-awakening) were measured and computerized cognitive assessment [NeuroTrax] completed on admission and after 6, 12, and 24 months. During hospitalization, participants received 3T MRI scans and APOE genotyping. Higher bedtime cortisol levels immediately post-stroke were associated with larger neurological deficits as well as poorer white matter integrity and cognitive function (executive function, attention, and overall) up to 24 months post-stroke. These findings remained significant after adjustment for age, gender, education, smoking, stroke severity, apolipoprotein E4 (ApoE4) status, and body mass index. The deleterious effect of high bedtime cortisol on memory was more pronounced for carriers of the ApoE4 genotype. Participants with high admission bedtime cortisol levels continued to have relatively elevated bedtime levels across all examined timepoints, and this group had poorer memory and executive function scores compared with the lower cortisol group at 24 months post-stroke. Post-awakening cortisol levels were not associated with neuroimaging findings or cognitive performance.

In summary, high bedtime salivary cortisol level may predict worse cognitive outcome in stroke survivors up to 2 years after the event, and this association may be modified by ApoE4 genotype. To mitigate these effects, the authors recommend stress management interventions in these patients. Of note, the authors cite “use of an extensive and validated computerized cognitive tool battery of multi-domain cognitive tests” [NeuroTrax] as a study strength.

Citation:

Tene, O., Hallevi, H., Korczyn, A.D., Shopin, L., Molad, J., Kirschbaum, C., Bornstein, N.M., Shenhar-Tsarfaty, S., Kliper, E., Auriel, E., Usher, S., Stalder, T., and Ben Assayag, E. (2018). The price of stress: High bedtime salivary cortisol levels are associated with brain atrophy and cognitive decline in stroke survivors. Results from the TABASCO prospective cohort study. Journal of Alzheimer‘s Disease, 65, 1365–1375. PMID: 30149451

Modifiable lifestyle behaviors and control or avoidance of cardiovascular risk factors are among the most promising strategies for prevention of cognitive decline and dementia, but is this true even for individuals with a high vascular risk profile? According to a new study published in the American Journal of Cardiology, the answer is yes. In the study, Sheba Medical Center researchers led by Prof. David Tanne found that cardiovascular health predicts cognitive decline 2 decades later among patients with pre-existing coronary artery disease.

Participants were 200 men (mean age at baseline 57.3 ± 6.3 years) with stable coronary artery disease in a large multicenter trial who completed computerized cognitive assessment [NeuroTrax] 15 and 20 years after baseline. Better cardiovascular health at baseline was associated with slower decline in overall cognitive performance, as well as executive function and visual spatial processing. Linear mixed-effect models were adjusted for age, education, employment, place of birth, and height at baseline. Results were similar after additional adjustment for depressive symptoms and cerebrovascular reactivity, as well as exclusion of participants with stroke and dementia. Cardiovascular health was measured by 3 health factors (fasting plasma glucose, low-density lipoprotein cholesterol, blood pressure) and 4 health behaviors (smoking, obesity, physical activity and adherence to Mediterranean diet).

In this unprecedented study on the relationship between cardiovascular health and cognitive decline in patients with preexisting coronary artery disease, the authors demonstrate that lifestyle factors are important predictors of late-life decline in cognitive function even among high-risk patients. Notably, the authors identify “use of a validated computerized assessment tool to quantify cognitive function globally and in specific domains” [NeuroTrax] as a strength of the study.

Sheba Medical Center is recognized as one of the top 10 hospitals worldwide by Newsweek.

Visit Sheba online: https://www.shebaonline.org/ 

Citation:

Lutski, M, Weinstein, G., Goldbourt, U., and Tanne, D. (2018). Cardiovascular health and cognitive decline 2 decades later in men with preexisting coronary artery disease. American Journal of Cardiology, 121, 410–415. PMID: 29273206

NeuroTrax and DriveABLE join forces to redefine cognitive assessments

Medina, NY – NeuroTrax Corporation (“NeuroTrax”) is pleased to announce its partnership with DriveABLE Assessment Centres Inc. (“DriveABLE”) to bring a comprehensive suite of cognitive assessment tools to the healthcare community.

With an aging baby boomer population and multiple medical conditions impacting cognitive ability, the need for general, as well as specialized cognitive assessment tools, is growing. NeuroTrax and DriveABLE, with over 30 years of combined experience in cognitive assessment, identified this growing need and have worked together to provide a continuum of service for multi-domain general cognitive testing (NeuroTrax) and specialized driver-risk assessment (DriveABLE).

Physicians can begin by evaluating cognitive function and then choose to follow up with a driving-specific assessment. All assessments are reimbursable through existing CPT Procedure codes, which provide a significantly increased financial benefit and overall value proposition to the physician and his/her practice.

Dr. Robert Bashuk, a neurologist and managing partner of NorthWest Neurology PC in Marietta, Georgia, has been using the suite of tools offered by NeuroTrax and DriveABLE as a use case and has seen significant value, both in what he can offer his patients and the financial reward to the practice.

“I take care of hundreds of patients with cognitive impairment: TBI, stroke, Alzheimer's, Parkinson's, sleep apnea, chronic pain, MS etc. If they are driving or want to return to driving, then we do NeuroTrax and a DriveABLE assessment. If they do not drive, then we only do the NeuroTrax. All 5 of our doctors within our practice follow this protocol. In 2015 we did approximately 1200 NeuroTrax and 500 DriveABLE assessments. I get reimbursed for use of both products. It is a significant financial benefit, and I would recommend this combination to any physician to use.”

NeuroTrax’s CEO, Jeff Atkinson, believes that the partnership with DriveABLE will meet a critical need in healthcare. “We are constantly looking for opportunities to expand the suite of tools available to our customers to provide the best comprehensive care for their patients. Through customers like Dr. Bashuk, the NeuroTrax and DriveABLE combination has proven to be a strong suite of cognitive assessment tools that will enhance any practice. NeuroTrax is pleased to be offering DriveABLE along with our NeuroTrax products.”

About NeuroTrax

NeuroTrax was founded in 2000 by a multi-disciplinary team including a US board-certified neurologist. The company develops innovative computerized cognitive tests used by medical professionals for clinical decision support.

Our reimbursable SaaS cloud solutions objectively measure memory and thinking in patients with various neurological disorders. The software serves as a trusted clinical decision support solution aiding in the assessment and benchmarking of cognitive impairment. Scientific credibility has been established with 130 peer-reviewed articles. With over 220,000 testing sessions administered, NeuroTrax's customer base includes over 400 clients with a 95% year-over-year renewal rate.

The company is working to promote brain wellness through better access to scientific testing, objective and clear reporting, and evidence-based recommendations.

NeuroTrax strives to empower patients and their families, clinicians, and researchers with innovative science for brain health.

About DriveABLE

At DriveABLE, we combine cutting-edge technology with proven research to deliver cognitive driver assessment tools for the medical community, governments, insurers, and commercial fleets. Our solutions help identify if medications or medical conditions have affected a person’s ability to drive.

DriveABLE has been providing driver risk assessments for over 15 years, and our products are licensed and distributed across North America, New Zealand and South Korea. It is our goal to protect competent drivers, accurately identify cognitively unsafe drivers, and to help improve safety on our roads.

For information on NeuroTrax, visit us online at www.neurotrax.com

Jeffrey A. Atkinson, DM, PhD, PMP

Chief Executive Officer

Phone: +1 855-638-7687, Option 1, Ext. 6020

sales@neurotrax.com

For information on DriveABLE, visit us online at www.driveable.com

John Brown, Vice President Business Development

Phone: (780) 628-364, ext 2

sales@driveable.com

Overweight and obesity in adolescents have increased substantially in recent decades, and today affect a third of the adolescent population in some developed countries. While the dangers posed by high adult BMI on cognitive function in later life have been documented, the association of adolescent BMI with cognitive function in midlife has not yet been reported. (BMI, or Body Mass Index, is a calculation of a person’s weight in kilograms divided by the square of their height in meters.)

To shed light on this issue, scientists at The Hebrew University-Hadassah Braun School of Public Health and Community Medicine set out to determine the association between cumulative life course burden of high-ranked body mass index (BMI), and cognitive function in midlife. The research was led by Professor Jeremy Kark from the Braun School, in The Hebrew University of Jerusalem’s Faculty of Medicine, working with colleagues in Israel and the United States.

The researchers used weight and height data from 507 individuals tracked for over 33 years starting at age 17. The participants completed a computerized cognitive assessment [NeuroTrax] at ages 48–52, and their socioeconomic position was assessed by multiple methods. Using mixed models the researchers calculated the life-course burden of BMI from age 17 to midlife, and used multiple regression to assess associations of BMI and height with global cognition and its five component domains.

“In this population-based study of a Jerusalem cohort, followed longitudinally from adolescence for over 33 years, we found that higher BMI in late adolescence and the long-term cumulative burden of BMI predicted poorer cognitive function later in life. Importantly, this study shows that an impact of obesity on cognitive function in midlife may already begin in adolescence, independently of changes in BMI over the adult life course,” said the paper’s senior author, Professor Kark.

For more information, see: https://news.afhu.org/news/higher-bmi-in-adolescence-may-affect-cognitive-function-in-midlife