Publications by authors named "Kelly Coulehan"

13 Publications

  • Page 1 of 1

Anatomical brain MRI study of pediatric cancer survivors treated with chemotherapy: Correlation with behavioral measures.

Magn Reson Imaging 2020 10 8;72:8-13. Epub 2020 Jun 8.

Departments of Radiology, Stony Brook University, Stony Brook, NY, United States of America; Neurology, Stony Brook University, Stony Brook, NY, United States of America. Electronic address:

The negative impacts of chemotherapy on pediatric patients treated with chemotherapy during the formative years of brain development are understudied compared to adult chemotherapy cancer patients. This work investigated the morphometry, cortical thickness, and subcortical volumes using MRI and their correlations with behavioral measures in pediatric oncology survivors treated with chemotherapy. Chemotherapy-treated childhood cancer survivors (N = 15, 15.12 ± 5.98 years old) diagnosed with a non-central nervous system malignancy and healthy age-matched controls (N = 15, 15.13 ± 4.21 years old) were studied. MRI was acquired at 3 Tesla. Behavioral Rating Inventory of Executive Functioning (BRIEF) Parental Rating, Purdue Pegboard manual dexterity and n-back working memory measures were administered. Structural MRI scans at 3 Tesla were acquired. Voxel-based morphometry, cortical thickness and subcortical volumes were analyzed and correlated with behavioral scores. Parametric statistics with a p < .05 and adjusted for multiple comparison corrections were performed. Patients exhibited significantly smaller gray-matter volumes in the left globus pallidum, bilateral thalami, left caudate and left nucleus accumbens (p < .05) and thinner cortex in the right parahippocampal gyrus (p < .05) compared to controls. BRIEF scores were similar to normative values. Purdue Pegboard revealed manual dexterity deficits compared to normative values, and the n-back task showed working-memory deficits in patients compared to controls. Left thalamus volume positively correlated with dexterity performance (p = .029). The number of correct answers positively correlated and the number of incorrect answers negatively correlated with total-brain and white-matter volume (p < .05), but not gray-matter volume (p > .05). Our results support the hypothesis that the neurotoxicity of systemic chemotherapy has widespread negative effects on brain development in pediatric oncology patients with relatively mild cognitive deficits. MRI identified neuroanatomical changes have the potential to provide neural correlates of the sequelae associated with pediatric chemotherapy.
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http://dx.doi.org/10.1016/j.mri.2020.05.007DOI Listing
October 2020

Neural correlates of working memory function in pediatric cancer survivors treated with chemotherapy: an fMRI study.

NMR Biomed 2020 06 25;33(6):e4296. Epub 2020 Mar 25.

Department of Radiology, Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, New York.

The goal of this study is to investigate the neural correlates of working memory function associated with chemotherapy in pediatric cancer survivors using event-related functional MRI (fMRI) analysis. Fifteen pediatric cancer survivors treated with chemotherapy and 15 healthy controls were studied. Blood oxygenation level dependent (BOLD) fMRI was acquired. A visual n-back task was used to test working memory function during the fMRI scan. Responses were recorded via an MRI compatible button box for analysis. fMRI scans were analyzed using statistical parametric mapping software. All statistics were corrected for multiple comparisons by false discovery rate, with p < 0.05 as significance. Patients however gave more incorrect responses (p < 0.05), more no responses (p < 0.05), and longer response times (p < 0.05) compared with healthy controls. Correct responses generated significantly lower BOLD responses in the posterior cingulate for pediatric cancer survivors compared with controls (p < 0.05). Incorrect responses generated significantly greater BOLD responses in the angular gyrus in survivors (p < 0.05), and no response trials generated greater BOLD responses within the superior parietal lobule (p < 0.05) compared with controls. Working memory impairment appears to be due to an inability to manipulate information and to retrieve information from memory. The ability to delineate the affected neural circuits associated with chemotherapy-induced cognitive impairment could inform treatment strategies, identify patients at high risk of developing cognitive deficits, and pre-emptively tailor behavioral enrichment to overcome specific cognitive deficits.
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http://dx.doi.org/10.1002/nbm.4296DOI Listing
June 2020

Neurocognitive intra-individual variability within HIV+ adults with and without current substance use.

Neuropsychology 2020 Mar 30;34(3):321-330. Epub 2019 Dec 30.

Department of Psychology.

Objective: HIV infection and current substance use (SU) are linked to cognitive and functional deficits, yet findings on their combined effects are mixed. Neurocognitive intraindividual variability, measured as dispersion of scores across a neuropsychological battery, is associated with worse cognitive outcomes and functional deficits among HIV+ adults but has not been studied in the context of HIV+ adults with current SU. We hypothesized that, among HIV+ adults, current SU would be associated with greater dispersion, that greater dispersion would be associated with worse medication adherence, and that this relationship would be worse among substance users.

Method: Forty HIV+ adults completed neuropsychological, psychiatric, SU, and medical evaluations and an electronic medication adherence measure. General linear models evaluated the main effect of SU status on neurocognitive dispersion, and models stratified by SU status evaluated the effect of dispersion on medication adherence, adjusting for relevant covariates.

Results: The SU+ group showed greater dispersion than did the SU- group, t(38) = 2.74, p = .049, d = 0.81, but this association did not survive multiple comparisons. Stratified analyses indicated a negative relationship between dispersion and medication adherence among the SU+ group but not in the SU- group; however, this effect was reduced after accounting for depressive symptoms.

Conclusions: We found preliminary evidence that current SU is associated with greater neurocognitive dispersion among HIV+ adults. SU and neurocognitive dispersion may have a synergistic effect on medication adherence; however, this effect is largely accounted for by depressive symptoms. Future research should examine progression of dispersion in HIV and consequent neurocognitive and functional deficits in those with current SU. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/neu0000612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042077PMC
March 2020

Language mapping using electrocorticography versus stereoelectroencephalography: A case series.

Epilepsy Behav 2018 07 26;84:148-151. Epub 2018 May 26.

Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.

Direct electrical stimulation (DES) is sometimes used in epilepsy surgery to identify areas that may result in language deficits if resected. Extraoperative language mapping is usually performed using electrocorticography (ECOG) - grids and strip electrodes; however, given the better safety profile of stereoelectroencephalogaphy (SEEG), it would be desirable to determine if mapping using SEEG is also effective. We report a case series of fifteen patients that underwent language mapping with either ECOG (5), SEEG (9), or both (1). Six patients in the SEEG group underwent resection or ablation with only mapping via SEEG. No patients in the SEEG group that underwent resective or ablative surgery experienced persistent language deficits. These results suggest that language mapping with SEEG may be considered as a clinically useful alternative to language mapping with ECOG.
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http://dx.doi.org/10.1016/j.yebeh.2018.04.032DOI Listing
July 2018

Neuropsychological function is improved among opioid dependent adults who adhere to opiate agonist treatment with buprenorphine-naloxone: a preliminary study.

Subst Abuse Treat Prev Policy 2017 Nov 15;12(1):48. Epub 2017 Nov 15.

Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, 10467, USA.

Background: Among persons with opioid use disorder (OUD), neuropsychological dysfunction is associated with depression, and better neuropsychological function is associated with opioid abstinence. However, it is unknown whether depressive symptomatology or adherence to opiate agonist treatment are associated with neuropsychological change over time.

Methods: We recruited 20 buprenorphine/naloxone-treated adults with OUD (M Age = 45.2 years [SD = 8.1]; 25% female) to complete baseline and 6 month visits containing a neuropsychological test battery and self-reported measures of depressive symptomatology and medication adherence.

Results: Depressive symptomatology was not significantly related to neuropsychological change (p's > .05). Greater adherence to buprenorphine/naloxone was associated with improvements in learning, memory, and global functioning (r's = .52-60; p's < .05).

Conclusions: Among OUD patients, greater adherence to buprenorphine/naloxone is associated with improved neuropsychological functioning over time. In contrast, depressive symptomatology is not associated with neuropsychological functioning over time. Supporting adherence to buprenorphine/naloxone may improve and/or preserve learning and memory functioning in individuals treated for OUD.

Trial Registration: NCT01108679 . Registered 21 April 2010.
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http://dx.doi.org/10.1186/s13011-017-0133-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688712PMC
November 2017

The Combined Roles of Nonsomatic Depressive Symptomatology, Neurocognitive Function, and Current Substance Use in Medication Adherence in Adults Living With HIV Infection.

J Assoc Nurses AIDS Care 2018 Mar - Apr;29(2):178-189. Epub 2017 Aug 23.

Depression, global neurocognitive (GNC) function, and substance use disorders (SUDs) are each associated with medication adherence in persons living with HIV (PLWH). Because somatic symptoms can inflate depression scores in PLWH, the role of nonsomatic depressive symptomatology (NSDS) should be considered in adherence. However, the combined roles of NSDS, GNC function, and current SUDs in predicting combined antiretroviral therapy (cART) adherence remain poorly understood. Forty PLWH (70% Latina/o; 30% non-Hispanic White) completed psychiatric/SUD, neurocognitive, and self-report cART adherence evaluations. Higher NSDS was associated with suboptimal adherence (p < .01), but optimal and suboptimal adherers did not differ in GNC function or current SUDs. Only NSDS was associated with suboptimal adherence, after accounting for GNC function and SUDs (p = .01). NSDS uniquely predicted self-reported adherence, beyond GNC function and current SUDs among ethnically diverse PLWH. Methodological issues between present and prior studies should also be considered.
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http://dx.doi.org/10.1016/j.jana.2017.08.002DOI Listing
June 2019

Neurocognitive, psychiatric, and substance use characteristics in opioid dependent adults.

Addict Behav 2016 09 31;60:137-43. Epub 2016 Mar 31.

Psychology Department, Fordham University, United States; Mount Sinai School of Medicine, Departments of Neurology and Psychiatry, United States.

Aims: To describe neurocognitive function among opioid-dependent adults seeking buprenorphine treatment and to explore the impact of lifetime psychiatric conditions on neurocognitive function. To explore the additive interaction of patient-based characteristics that may help to inform treatment.

Design: Cross-sectional assessment of neurocognitive function, substance use, and psychiatric characteristics of adults seeking buprenorphine treatment within substance use treatment centers in New York City.

Participants: Thirty-eight opioid-dependent adults seeking buprenorphine treatment.

Measurements: A comprehensive battery, which included measures of executive functioning, learning, memory, verbal fluency, attention, processing speed, and motor functioning were administered. The Wide Range Achievement Test-Third Edition, the Composite International Diagnostic Interview, and an audio computer assisted structured interview were also completed. Correlations and independent sample t-tests were used to ascertain group differences.

Findings: Thirty-nine percent of participants were impaired in global neurocognitive function (n=15). Over one third were impaired in either: learning (n=28), memory (n=26), executive functioning (n=17), motor functioning (n=17), attention/working memory (n=14) or verbal fluency (n=12). Lifetime history of alcohol dependence was associated with impairment in global neurocognitive, executive functioning, and motor functioning. Lifetime history of cocaine dependence was associated with impairment in executive functioning and motor functioning (all p's<0.05). Major depressive disorder history was not associated with neurocognitive impairment.

Conclusions: Among this sample of opioid-dependent adults, there were high rates of global and domain-specific neurocognitive impairment, with severe impairment in learning and memory. Lifetime alcohol and cocaine dependence were associated with greater neurocognitive impairment, particularly in executive functioning. Because executive functioning is critical for decision-making and learning/memory dysfunction may interfere with information encoding, these findings suggest that opioid-dependent adults may require enhanced support for medical decision-making.
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http://dx.doi.org/10.1016/j.addbeh.2016.03.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508857PMC
September 2016

[Formula: see text]The Relative Utility of Three English Language Dominance Measures in Predicting the Neuropsychological Performance of HIV+ Bilingual Latino/a Adults.

Clin Neuropsychol 2016 02 3;30(2):185-200. Epub 2016 Mar 3.

a Department of Psychology , Fordham University , New York , NY , USA.

Objective: Given the disproportionate impact of neurologic disorders such as HIV on racial/ethnic minorities, neuropsychologists are increasingly evaluating individuals of diverse linguistic backgrounds. This study compares the utility of two brief and one comprehensive language measure to account for variation in English neuropsychological performance within a bilingual population.

Method: Sixty-two HIV+ English/Spanish bilingual Latino adults completed three language measures in English and Spanish: Self-Reported Language Ability; Verbal Fluency (FAS/PMR); and the Woodcock Munoz Language Survey-Revised (WMLS-R). All participants also completed an English language neuropsychological (NP) battery.

Results: It was hypothesized that the comprehensive English/Spanish WMLS-R language dominance index (LDI) would be significantly correlated with NP performance, as well as the best predictor of NP performance over and above the two brief language measures. Contrary to our hypothesis, the WMLS-R LDI was not significantly correlated to NP performance, whereas the easily administered Verbal Fluency and Self-Report LDIs were each correlated with global NP performance and multiple NP domains. After accounting for Verbal Fluency and Self-Report LDI in a multivariate regression predicting NP performance, the WMLS-R LDI did not provide a unique contribution to the model.

Conclusions: These findings suggest that the more comprehensive WMLS-R does not improve understanding of the effects of language on NP performance in an HIV+ bilingual Latino population.
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http://dx.doi.org/10.1080/13854046.2016.1139185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5189637PMC
February 2016

Socioeconomic Status and Neuropsychological Functioning: Associations in an Ethnically Diverse HIV+ Cohort.

Clin Neuropsychol 2015 14;29(2):232-54. Epub 2015 Apr 14.

a Department of Psychology , Fordham University , Bronx , NY , USA.

Objective: There is limited research examining the relationship between socioeconomic status (SES) and neuropsychological functioning, particularly in racial/ethnic minority and HIV+ populations. However, there are complex associations between poverty, education, HIV disease, race/ethnicity, and health outcomes in the US.

Method: We explored these relationships among an ethnically diverse sample of 134 HIV+ adults using a standardized SES measure (i.e., the Hollingshead scale), a comprehensive NP test battery, and a functional evaluation (i.e., Patient's Assessment of Own Functioning Inventory and Modified Instrumental Activities of Daily Living Scale).

Results: Bivariate analyses showed that adult SES was significantly, positively correlated with neuropsychological performance on specific tests within the domains of verbal fluency, attention/concentration, learning, memory, processing speed, and executive functioning, and childhood SES was significantly linked to measures of verbal fluency, processing speed, and executive functioning. In a series of linear regressions, controlling for SES significantly attenuated group differences in NP test scores between racial/ethnic minority individuals and non-Hispanic White individuals. Finally, SES scores significantly differed across HIV-Associated Neurocognitive Disorder (HAND) diagnoses. In a binary logistic regression, SES was the only independent predictor of HAND diagnosis.

Conclusions: HIV+ individuals with lower SES may be more vulnerable to HIV-associated neuropsychological sequelae due to prominent health disparities, although the degree to which this is influenced by factors such as test bias remains unclear. Overall, our results suggest that SES is significantly linked to neuropsychological test performance in HIV+ individuals, and is an important factor to consider in clinical practice.
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http://dx.doi.org/10.1080/13854046.2015.1029974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443910PMC
August 2015

Cognitive estimations as a measure of executive dysfunction in childhood epilepsy.

Child Neuropsychol 2016 11;22(1):65-80. Epub 2014 Nov 11.

e Departments of Neurology and Psychiatry , Mt Sinai School of Medicine , New York , NY , USA.

Children and adolescents with epilepsy are known to demonstrate executive function deficits. Despite prior work that has shown that cognitive estimation tasks are sensitive to executive dysfunction in children, such tasks have not been studied in children with epilepsy. This is particularly important given the fact that executive tasks have heretofore shown poor ecological validity, and it has been speculated that estimation tasks may show stronger ecological validity than other executive tests. One hundred and thirteen clinically referred children and adolescents with epilepsy were included. The Biber Cognitive Estimations Test was sensitive to cognitive dysfunction, with about half showing impairments on this task in comparison to age-matched normative data; the most frequently impaired subscales were quantity estimation and time estimation. Moreover, the Biber Cognitive Estimation Test showed moderate correlations with not only overall intellectual functions and academic achievement but also other commonly administered tests of executive functions, including digit span, Trailmaking, and the Tower of London but not with the contingency naming test. Cognitive estimations were also modestly correlated with age of epilepsy onset but not other epilepsy-severity variables such as number of antiepilepsy drugs (AEDs) or seizure frequency. Unfortunately, the hypothesis that the Biber Cognitive Estimation Test would show strong ecological validity was not supported, as it showed weak relations with parent-reported executive function deficits. The significance and limitations of this investigation are discussed.
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http://dx.doi.org/10.1080/09297049.2014.967670DOI Listing
February 2016

The role of decision-making ability in HIV/AIDS: impact on prospective memory.

J Clin Exp Neuropsychol 2014 4;36(7):730-41. Epub 2014 Aug 4.

a Department of Psychology , Fordham University , Bronx , NY , USA.

Background: Prospective memory (ProM), a form of episodic memory related to execution of future intentions, is important for everyday functioning. Among persons living with HIV (PLWH), executive dysfunction is implicated in ProM impairments. However, specific subcomponents of executive functioning involved in ProM deficits remain poorly understood. Unlike more "traditional" neurocognitive (NC) measures of executive functioning associated with dorsolateral prefrontal cortex (i.e., conceptual reasoning, abstraction), those associated with medial orbitofrontal/ventromedial prefrontal (mOF/vmP) cortex (i.e., decision making, inhibitory control, goal-oriented behavior) have yet to be examined in ProM.

Method: This study characterized ProM ability in a sample of 89 HIV-seropositive adults and examined the unique role of decision-making ability in ProM. Participants completed a standard NC battery, the Iowa Gambling Task (IGT; a decision-making measure), and the Memory for Intentions Screening Test (MIST; a ProM measure).

Results: Correlational analyses revealed that both traditional executive functioning measures and the IGT were associated with ProM. Regression analyses revealed that the IGT significantly predicted ProM, even after accounting for NC measures. Among all NC measures, only executive functioning significantly contributed to ProM.

Discussion: Further examination of mOF/vmP-sensitive executive dysfunction within this population is needed as PLWH may require more tailored treatment recommendations due to specific decision-making difficulties that can impact medication management.
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http://dx.doi.org/10.1080/13803395.2014.935705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584640PMC
July 2015

Multidimensional effects of acculturation on English-language neuropsychological test performance among HIV+ Caribbean Latinas/os.

J Clin Exp Neuropsychol 2012 25;34(8):814-25. Epub 2012 May 25.

Department of Psychology, Fordham University, New York, NY, USA.

Acculturation has been linked to neuropsychological performance in several ethnic groups. However, research among Latina/o samples has examined primarily Mexicans/Mexican Americans and has not examined Latina/o clinical populations of Caribbean descent. This study examined associations between a multidimensional acculturation measure and neuropsychological performance among 82 HIV+ Caribbean Latina/o adults. Multivariate results showed that US acculturation significantly predicted 11-14% of the variance in global neuropsychological functioning, verbal fluency, and processing speed, whereas Latina/o acculturation predicted 6-8% of the variance in motor and executive function (trend level associations). Both linguistic and nonlinguistic cultural factors had distinct effects on neuropsychological performance.
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http://dx.doi.org/10.1080/13803395.2012.683856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434263PMC
February 2013

Visuospatial and verbal fluency relative deficits in 'complicated' late-preterm preschool children.

Early Hum Dev 2009 Dec 30;85(12):751-4. Epub 2009 Oct 30.

Department of Pediatrics, Inova Fairfax Hospital for Children, 3300 Gallows Road, Falls Church, Virginia 22042, USA.

Background: Late-preterm children constitute a majority of all preterm deliveries (75%). Their immature brain development at birth has been associated with an increased risk for morbidities. Data have been sparse regarding neuropsychological outcomes in the preschool years.

Aim: To examine general cognition, attention/working memory, language, manual coordination/motor dexterity, visuomotor, visuospatial, and executive functions in preschoolers born late-preterm (LPT; 34-36 gestational weeks) who required NICU admission compared to term-born participants.

Design: Single-center retrospective cohort study of 95 three-year-old children; 60 born LPT in 2004-2005 and admitted to the NICU compared to 35 healthy term-born participants born > or =37 gestational weeks and > or =2500 g.

Results: LPT birth was associated with visuospatial (p=.005), visuomotor (p=.012), and executive function (noun [p=.018] and action-verb [p=.026] fluency) relative deficits, but not attention/working memory, receptive or expressive language, nonverbal reasoning, or manual coordination/dexterity deficit.

Conclusions: Late-preterm birth is likely to be associated with negative neuropsychological sequelae, although subtle and selective compared to effects reported for children born at an earlier gestational age. Visuospatial function appears to be especially vulnerable to disruption even at preschool age, and verbal fluency may be useful as an early predictor of executive dysfunction in childhood. Routine preschool neuropsychological evaluation is recommended to identify delay or deficit in LPT children preparing for school entry, and may highlight underlying vulnerable neural networks in LPT children.
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http://dx.doi.org/10.1016/j.earlhumdev.2009.10.002DOI Listing
December 2009