Peter Bayley, PhD

All Publications

• Actual concordance between veterans' with Gulf War Illness and their providers' illness perceptions is not related to patient satisfaction nor treatment adherence. Patient education and counseling Boska, R. L., Phillips, L. A., Lesnewich, L. M., Bloeser, K. J., Lin, Y., Bayley, P. J., Helmer, D. A., McAndrew, L. M. 2025; 141: 109329

  Abstract

  OBJECTIVE: Patients with persistent physical symptom (PPS) conditions, such as Gulf War Illness (GWI), report disagreement or "non-concordance" with their providers about PPS conditions and dissatisfaction with healthcare. When patients perceive concordance with their providers about their PPS condition, they have increased satisfaction and adherence. While literature supports perceived concordance, there is a lack of research on actual concordance (i.e., the congruence of patients' and providers' perceptions of the patients' illness).METHODS: Among dyads of Veterans with GWI and their provider, we tested the hypotheses that greater actual concordance would be associated with greater Veterans' satisfaction and adherence. We also explored the relationship of actual concordance with Veterans' and providers' perceived concordance.RESULTS: Correlations suggest there is little agreement between Veterans and providers regarding GWI illness perceptions or perceptions of concordance. Polynomial regression analyses showed that actual concordance was not significantly related to Veterans' satisfaction, adherence, or perceptions of concordance, nor to providers' perceptions of concordance.CONCLUSION: Although literature finds Veterans' perceived concordance with their provider about PPS influences patients' experiences of care, our results suggest that actual concordance may have limited influence on experiences of care and either Veterans' or providers' perceived concordance. That is, the results suggest there does not need to be objective agreement between patients and providers about PPS, rather patients' perception of agreement influences their satisfaction and adherence.PRACTICE IMPLICATIONS: Our results suggest that patients with PPS and their providers may have difficulties in estimating if there is shared agreement in the relationship and demonstrate the importance of explicitly assessing patients' perceptions of concordance.

  View details for DOI 10.1016/j.pec.2025.109329

  View details for PubMedID 40972072

• Yoga versus transdiagnostic cognitive behavioural therapy for emotional disorders in community-dwelling adults: Study protocol for a non-inferiority randomised controlled trial ADVANCES IN INTEGRATIVE MEDICINE Mathersul, D. C., Byrne, J. M., Lau, J. Y., Schutze, R. M., Learmonth, Y. C., Fujiyama, H., Naragon-Gainey, K., McEvoy, P. M., Bayley, P. J. 2025; 12 (3)

  View details for DOI 10.1016/j.aimed.2025.100484

  View details for Web of Science ID 001522874900002

• VetDash: a clinical dashboard for enhancing measurement-based care in veteran health JAMIA OPEN Allende, S., Sullivan, H. S., Bayley, P. J. 2025; 8 (4): ooaf075

  Abstract

  Measurement-based care (MBC) improves clinical decision-making but remains underutilized in the Veterans Health Administration due to barriers such as provider awareness, time constraints, and user-experience limitations. This study describes the development of the War Related Illness and Injury Study Center Veteran Dashboard (VetDash), a patient-level clinical dashboard designed to integrate the VA's Collect, Share, Act model into the provider workflow.VetDash was developed using R Shiny, utilizing data from the WRIISC Clinical Intake Packet Database. It integrates patient-reported health data and military history into a dashboard hosted on a Linux-based Shiny Server within the VA's intranet.VetDash includes four modules: Patient Characteristics, Patient Health Symptoms, Patient Exposures, and Patient Self-Report Measures. Providers can visualize patient-reported symptoms, military exposures, and self-report measures, and compare patients to provider-defined cohorts.VetDash facilitates MBC integration into the clinical workflow, potentially improving personalized patient care. Future research should evaluate its impact on clinical decisions, outcomes, and explore further enhancements.

  View details for DOI 10.1093/jamiaopen/ooaf075

  View details for Web of Science ID 001540764400001

  View details for PubMedID 40747456

  View details for PubMedCentralID PMC12313089

• DTI-Derived Evaluation of Glymphatic System Function in Veterans with Chronic Multisymptom Illness. AJNR. American journal of neuroradiology Zhang, Y., Moore, M. S., Rahimpour, Y., Clark, J. D., Bayley, P. J., Ashford, J. W., Furst, A. J. 2025

  Abstract

  Chronic Multisymptom Illness includes symptoms of fatigue, pain, sleep difficulties, as well as neurological, respiratory, and gastrointestinal problems and is particularly common in veterans from the 1990-91 Gulf War and the Afghanistan and Iraq Wars. Glymphatic system function may play an important role in the etiopathology of Chronic Multisymptom Illness but has not been addressed. DTI-derived analysis along the perivascular space provides a promising proxy for glymphatic system function by evaluating the status of perivascular space fluid flow. The objective of this study was to compare this DTI-derived glymphatic index in veterans with CMI and healthy controls, and to reveal possible correlations between this index and the severity of CMI symptoms.DTI-derived indices were extracted from imaging data of 203 veterans who met clinical diagnostic criteria for Chronic Multisymptom Illness, and 224 age-matched healthy control subjects from multiple public research databases. Severity of Chronic Multisymptom Illness, sleep difficulty, pain intensity, and the degree of chronic fatigue were based on self-report measures. MRI scanner and site variations were harmonized. Statistical analyses were performed adjusting for demographic confounding factors.Both healthy controls and veterans showed significantly reduced glymphatic indices associated with increased age. Compared to controls, veterans showed bilaterally lower indices (Cohen's d = -.47; p < .001) after adjusting for age, sex, and education. Across the entire sample of veterans, negative correlations were observed between glymphatic indices and pain intensities (r = -.17; p = .01), sleep disturbances (r = -.17; p = .02), degree of fatigue (r = -.20; p = .006), severity of Chronic Multisymptom Illness (r = -.17; p = .02), and the indices were positively correlated with medullar volumes (r = -.19; p = .007). Note, these results showing significant outcomes for a group of patients do not guarantee the same outcome for individual patients.This study suggests that impaired glymphatic functions are strongly associated with Chronic Multisymptom Illness. These findings improve our understanding of the pathological mechanism underlying Chronic Multisymptom Illness and point to DTI-based metrics as a potential biomarker for disease severity in this condition.CMI＝ Chronic multisymptom illness; GWI＝ Gulf War Illness; PVS＝ perivascular space; DTI-ALPS＝ DTI-analysis along the perivascular space; HC＝ healthy control; TBI＝ traumatic brain injury; PTSD＝ post-traumatic stress disorder; PSQI＝ Pittsburgh sleep quality index; BPI＝ brief pain inventory; CFS＝ chronic fatigue syndrome.

  View details for DOI 10.3174/ajnr.A8901

  View details for PubMedID 40579044

• Randomized Feasibility Trial of Teleyoga versus In-Person Yoga for Treating Chronic Musculoskeletal Pain in Veterans. Research square Mahoney, L., Pahade, S., Mahoney, H., Fitz, K., Keaney, A., Parker-Bridges, K., Francisco, J. M., Lau, A., Hitching, R., Walker, B., Gupta, A., Jo, B., Lohnberg, J. A., Clark, J. D., Bayley, P. J. 2025

  Abstract

  Chronic pain impacts approximately 20% of the United States adult population and 50-75% of Veterans. It is treatment-resistant, and medications include the risk of addiction or overdose. The VA is promoting complementary and integrative health (CIH) for use along with existing treatments. Yoga can provide effective treatment for many health problems, including pain. Some of the challenges of providing yoga in healthcare include barriers such as space, time, and transportation. We studied the feasibility of conducting a randomized controlled trial (RCT) treating Veterans with chronic musculoskeletal pain with yoga delivered online versus in-person.We developed a yoga protocol for treating chronic musculoskeletal pain online using online cohorts (n = 9, 15) with chronic musculoskeletal pain. Optimal treatment parameters were established. The resulting yoga protocol consisted of 12 weekly 75-minute classes with home-practice on 5 non-class days/week. The second phase of the study established the feasibility of conducting an RCT comparing in-person and online yoga. Thirty-four participants (30 male) were randomized to in-person (n = 16) or online yoga (n = 18). Measures were collected at baseline and end-of-treatment.We successfully met our Veterans participant recruitment goals for the study. Furthermore, the retention rates were 83% for teleyoga and 68% for in-person yoga, which exceeded our a priori feasibility target of 65%. Protocol adherence was 8.62 classes (71.8%, range = 2-12) in the teleyoga group and 9.25 classes (77.1%, range = 4-12) for in-person yoga, again exceeding our feasibility rate of 65%. Treatment satisfaction was measured using a 33-item questionnaire where each item was rated on a 0-4-point scale. Average treatment satisfaction was 3.2 in the teleyoga group and 3.6 in the in-person group, exceeding the feasibility target of ≥ 2. There were no serious adverse events. Yoga fidelity was assessed by scoring 20% of the classes and was 91% overall. Analysis of secondary outcome measures showed that only the teleyoga group experienced a statistically significant reduction in pain.It is feasible to conduct an RCT comparing teleyoga to in-person yoga to treat chronic musculoskeletal pain in Veterans. Treatment may provide a reduction in pain severity and pain interference.clinicaltrials.gov NCT04074109, August 29, 2019.

  View details for DOI 10.21203/rs.3.rs-6265068/v1

  View details for PubMedID 40678237

  View details for PubMedCentralID PMC12270236

• US military veterans' perceived concordance with their providers regarding persistent physical symptoms prospectively predicts satisfaction with care and adherence to care plans ANNALS OF BEHAVIORAL MEDICINE Phillips, L., Lesnewich, L. M., Bloeser, K., Lin, Y., Boska, R. L., Hyde, J. K., Bayley, P. J., Chandler, H. K., Reinhard, M. J., Santos, S. L., Stewart, R., Helmer, D. A., McAndrew, L. M. 2025; 59 (1)

  Abstract

  Medically unexplained, persistent physical symptoms and syndromes are commonly seen in primary care. These are debilitating for patients and difficult to treat, causing frustration for patients and providers.This study investigates how well US military veterans with multiple persistent physical symptoms (PPS), called Gulf War illness (GWI), agree with their healthcare providers about their illness. This agreement, called perceived concordance, is hypothesized to influence veterans' satisfaction with care, adherence to care plans, and disability levels.Participants were 230 veterans with GWI deployed to the 1990-1991 Gulf War who were recruited from Veteran Affairs primary care and War Related Illness and Injury Study Centers (WRIISCs). Veterans' GWI perceptions and perceived concordance with their providers regarding GWI were assessed at a medical visit. Veterans' self-reported satisfaction with care, adherence to care plans, and disability levels were measured at 1 week, 1 month, and 6 months post-baseline.Bivariate correlations indicated that veterans' GWI-related illness perceptions were related to veterans' satisfaction with care and reports of functional disability. Beyond these effects, veterans' perceived concordance with the provider regarding GWI was positively associated with satisfaction over time (e.g., fixed-effect estimate = 0.36, P < .001 for 1-week follow-up) and adherence to care plans (fixed-effect estimate averaged across all timepoints = 0.03, P = .03) but was unrelated to reported disability.Veterans' perceived concordance with their providers about GWI seems to be important for patient satisfaction and adherence to care plans. More research with longer-term follow-up is needed to understand how perceived concordance might influence disability levels and the outcome of care plans.

  View details for DOI 10.1093/abm/kaaf028

  View details for Web of Science ID 001471479800003

  View details for PubMedID 40257120

  View details for PubMedCentralID PMC12010244

• Reconsidering thought suppression and ironic processing: implications for clinical treatment of traumatic memories. Frontiers in psychology Mamat, Z., Levy, D. A., Bayley, P. J. 2024; 15: 1496134

  View details for DOI 10.3389/fpsyg.2024.1496134

  View details for PubMedID 39723401

  View details for PubMedCentralID PMC11669253

• Estimating survival in data-driven phenotypes of mental health symptoms and peripheral biomarkers: A prospective study BRAIN BEHAVIOR & IMMUNITY-HEALTH Allende, S., Bayley, P. J. 2024; 39: 100815

  Abstract

  Chronic psychological stress has widespread implications, including heightened mortality risk, mental and physical health conditions, and socioeconomic consequences. Stratified precision psychiatry shows promise in mitigating these effects by leveraging clinical heterogeneity to personalize interventions. However, little attention has been given to patient self-report.We addressed this by combining stress-related self-report measures with peripheral biomarkers in a latent profile analysis and survival model. The latent profile models were estimated in a representative U.S. cohort (n = 1255; mean age = 57 years; 57% female) and cross-validated in Tokyo, Japan (n = 377; mean age = 55 years; 56% female).We identified three distinct groups: "Good Mental Health", "Poor Mental Health", and "High Inflammation". Compared to the "Good Mental Health" group, the "High Inflammation" and "Poor Mental Health" groups had an increased risk of mortality, but did not differ in mortality risk from each other.This study emphasizes the role of patient self-report in stratified psychiatry.

  View details for DOI 10.1016/j.bbih.2024.100815

  View details for Web of Science ID 001333543900001

  View details for PubMedID 39045519

  View details for PubMedCentralID PMC11263790

• Editorial: Online data collection for human neuroscience: challenges and opportunities. Frontiers in human neuroscience Mills-Finnerty, C., Bayley, P. J., Clifford, J. O., Ashford, J. W. 2024; 18: 1440711

  View details for DOI 10.3389/fnhum.2024.1440711

  View details for PubMedID 38983755

  View details for PubMedCentralID PMC11231419

• Episodic memory assessment: effects of sex and age on performance and response time during a continuous recognition task FRONTIERS IN HUMAN NEUROSCIENCE Clifford Jr, J. O., Anand, S., Tarpin-Bernard, F., Bergeron, M. F., Ashford, C. B., Bayley, P. J., Ashford, J. 2024; 18: 1304221

  Abstract

  Continuous recognition tasks (CRTs) assess episodic memory (EM), the central functional disturbance in Alzheimer's disease and several related disorders. The online MemTrax computerized CRT provides a platform for screening and assessment that is engaging and can be repeated frequently. MemTrax presents complex visual stimuli, which require complex involvement of the lateral and medial temporal lobes and can be completed in less than 2 min. Results include number of correct recognitions (HITs), recognition failures (MISSes = 1-HITs), correct rejections (CRs), false alarms (FAs = 1-CRs), total correct (TC = HITs + CRs), and response times (RTs) for each HIT and FA. Prior analyses of MemTrax CRT data show no effects of sex but an effect of age on performance. The number of HITs corresponds to faster RT-HITs more closely than TC, and CRs do not relate to RT-HITs. RT-HITs show a typical skewed distribution, and cumulative RT-HITs fit a negative survival curve (RevEx). Thus, this study aimed to define precisely the effects of sex and age on HITS, CRs, RT-HITs, and the dynamics of RTs in an engaged population.MemTrax CRT online data on 18,255 individuals was analyzed for sex, age, and distributions of HITs, CRs, MISSes, FAs, TC, and relationships to both RT-HITs and RT-FAs.HITs corresponded more closely to RT-HITs than did TC because CRs did not relate to RT-HITs. RT-FAs had a broader distribution than RT-HITs and were faster than RT-HITs in about half of the sample, slower in the other half. Performance metrics for men and women were the same. HITs declined with age as RT-HITs increased. CRs also decreased with age and RT-FAs increased, but with no correlation. The group over aged 50 years had RT-HITs distributions slower than under 50 years. For both age ranges, the RevEx model explained more than 99% of the variance in RT-HITs.The dichotomy of HITs and CRs suggests opposing cognitive strategies: (1) less certainty about recognitions, in association with slower RT-HITs and lower HIT percentages suggests recognition difficulty, leading to more MISSes, and (2) decreased CRs (more FAs) but faster RTs to HITs and FAs, suggesting overly quick decisions leading to errors. MemTrax CRT performance provides an indication of EM (HITs and RT-HITs may relate to function of the temporal lobe), executive function (FAs may relate to function of the frontal lobe), processing speed (RTs), cognitive ability, and age-related changes. This CRT provides potential clinical screening utility for early Alzheimer's disease and other conditions affecting EM, other cognitive functions, and more accurate impairment assessment to track changes over time.

  View details for DOI 10.3389/fnhum.2024.1304221

  View details for Web of Science ID 001204668400001

  View details for PubMedID 38638807

  View details for PubMedCentralID PMC11024362

• Teleyoga for Patients With Alzheimer's Disease and Chronic Musculoskeletal Pain and Their Caregivers: A Feasibility Study. Global advances in integrative medicine and health Allende, S., Mahoney, L., Francisco, J. M., Fitz, K., Keaney, A., Parker-Bridges, K., Mahoney, H., Jo, B., Greenberg, J., Bayley, P. J. 2024; 13: 27536130241240405

  Abstract

  Chronic musculoskeletal pain is common in patients with Alzheimer's disease (AD), and there is growing awareness that chronic pain has an impact on the progression of dementia. Yoga has shown promise in treating chronic pain. However, attending in-person yoga can be difficult for AD patients.To assess the feasibility, acceptability and preliminary efficacy of an online yoga (teleyoga) protocol suitable for AD patients with chronic pain, and their caregivers.Patients with comorbid mild AD and chronic musculoskeletal pain (n = 15, 57-95 y/o; 73% Female) and their caregivers (n = 15, 50-75 y/o; 67% Female) received 12-week of teleyoga individually (n = 5 dyads) or in groups (n = 10 dyads). Study measures included standard feasibility metrics, and secondary outcomes included the Brief Pain Inventory-Short Form (BPI-SF), Beck Depression Inventory-II (BDI-II), and cognitive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Caregivers also completed measures of caregiver burden, and quality of life (Short Form Health Survey-36, SF-36).Feasibility measures showed adequate treatment adherence (85.1% in patients and 86.3% in caregivers), acceptability (mean acceptability rating = 3.0 for patients and 3.3 for caregivers, indicating positive approval), recruitment rate (n = 16 dyads within 1-year), retention rate (87%), missing data rate (.03%), and fidelity of treatment delivery (87%). Preliminary efficacy findings in the AD group showed significant reductions in pain severity (BPI-SF mean Δ = -.93, P = .045) and depression (BDI-II; mean Δ = -9.85, P = .005). %). Preliminary efficacy findings in the caregiver group showed significant reductions in depression (BDI-II mean Δ = -6.88, P = .036) and fatigue (SF-36 mean Δ = 9.81, P = .021).Results show that teleyoga is a feasible treatment for patients with comorbid mild AD and chronic musculoskeletal pain. Results also provide preliminary evidence of health benefits of teleyoga for both AD patients and their caregivers.

  View details for DOI 10.1177/27536130241240405

  View details for PubMedID 38545336

  View details for PubMedCentralID PMC10966998

• The Therapeutic Potential of Yoga for Alzheimer's Disease: A Critical Review. Journal of Alzheimer's disease : JAD Brown, A., Bayley, P. J. 2024; 101 (s1): S521-S535

  Abstract

  Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, memory impairment, and behavioral changes, significantly impacting the quality of life of affected individuals and their caregivers. While pharmacological treatments offer limited relief, nonpharmacological interventions, like yoga, have gained attention for their potential therapeutic benefits. This critical review synthesizes findings from various studies on the feasibility, adherence, physical function, cognitive improvements, inflammatory markers, neuroprotection, and mood and behavioral changes associated with yoga interventions for older adults with AD. Despite these promising results, further research with randomized controlled trials, larger sample sizes, control groups, longitudinal follow-ups, standardized protocols, and diverse populations is necessary to confirm these benefits and understand the long-term effects of yoga on AD progression. This critical review highlights yoga's potential as a valuable nonpharmacological intervention in the holistic management of AD.

  View details for DOI 10.3233/JAD-240719

  View details for PubMedID 39422963

• New tablet-based screening tool for assessment of cognitive decline in Nigeria JOURNAL OF ALZHEIMERS DISEASE Anand, S., Bayley, P. J., Clifford Jr, J. O., Ashford, J. 2024; 102 (1): 33-34

  Abstract

  We comment on the importance of the novel tablet-based screening tool for cognitive decline recently studied in Nigeria by Ogbuagu et al. TabCAT-BHA was administered on an iPad in urban and rural settings and was found to be a sensitive and culturally appropriate tool for assessing cognitive function and impairment. With accuracy, portability, speed, and ease of use, this study shows that such tests, computerized or online, have the potential to improve the screening of cognitive decline in diverse countries such as Nigeria, to facilitate early treatment and improved care and quality of life.

  View details for DOI 10.1177/13872877241283676

  View details for Web of Science ID 001410732500006

  View details for PubMedID 39497297

• Distance-Based Lifestyle Medicine for Veterans with Chronic Multi-symptom Illness (CMI): Health Coaching as Behavioral Health Intervention for Clinical Adherence Summers, A. C., McCullers, R., Jachimowicz, W., Breneman, C. B., Samuel, I., Bayley, P. J., Proctor, L., Eizadi, L., Chester, J., Barrett, J., Reinhard, M. J., Costanzo, M. E. edited by Schmorrow, D. D., Fidopiastis, C. M. SPRINGER INTERNATIONAL PUBLISHING AG. 2024: 236-249

  View details for DOI 10.1007/978-3-031-61572-6_16

  View details for Web of Science ID 001281297200016

• Emotion regulation and heart rate variability may identify the optimal posttraumatic stress disorder treatment: analyses from a randomized controlled trial. Frontiers in psychiatry Mathersul, D. C., Zeitzer, J. M., Schulz-Heik, R. J., Avery, T. J., Bayley, P. J. 2024; 15: 1331569

  Abstract

  Introduction: High variability in response and retention rates for posttraumatic stress disorder (PTSD) treatment highlights the need to identify "personalized" or "precision" medicine factors that can inform optimal intervention selection before an individual commences treatment. In secondary analyses from a non-inferiority randomized controlled trial, behavioral and physiological emotion regulation were examined as non-specific predictors (that identify which individuals are more likely to respond to treatment, regardless of treatment type) and treatment moderators (that identify which treatment works best for whom) of PTSD outcome.Methods: There were 85 US Veterans with clinically significant PTSD symptoms randomized to 6 weeks of either cognitive processing therapy (CPT; n = 44) or a breathing-based yoga practice (Sudarshan kriya yoga; SKY; n = 41). Baseline self-reported emotion regulation (Difficulties in Emotion Regulation Scale) and heart rate variability (HRV) were assessed prior to treatment, and self-reported PTSD symptoms were assessed at baseline, end-of-treatment, 1-month follow-up, and 1-year follow-up.Results: Greater baseline deficit in self-reported emotional awareness (similar to alexithymia) predicted better overall PTSD improvement in both the short- and long-term, following either CPT or SKY. High self-reported levels of emotional response non-acceptance were associated with better PTSD treatment response with CPT than with SKY. However, all significant HRV indices were stronger moderators than all self-reported emotion regulation scales, both in the short- and long-term. Veterans with lower baseline HRV had better PTSD treatment response with SKY, whereas Veterans with higher or average-to-high baseline HRV had better PTSD treatment response with CPT.Conclusions: To our knowledge, this is the first study to examine both self-reported emotion regulation and HRV, within the same study, as both non-specific predictors and moderators of PTSD treatment outcome. Veterans with poorer autonomic regulation prior to treatment had better PTSD outcome with a yoga-based intervention, whereas those with better autonomic regulation did better with a trauma-focused psychological therapy. Findings show potential for the use of HRV in clinical practice to personalize PTSD treatment.Clinical trial registration: ClinicalTrials.gov identifier, NCT02366403.

  View details for DOI 10.3389/fpsyt.2024.1331569

  View details for PubMedID 38389985

• Yoga is effective for treating chronic pain in veterans with Gulf War Illness at long-term follow-up. BMC complementary medicine and therapies Allende, S., Mathersul, D. C., Schulz-Heik, J. R., Avery, T. J., Mahoney, L., Bayley, P. J. 2023; 23 (1): 319

  Abstract

  BACKGROUND: Clinical Practice Guidelines for Gulf War Illness (GWI) recommend integrative health approaches such as yoga for relief from symptoms, yet little is known about the long-term efficacy of yoga in reducing symptoms of GWI. Here, we evaluated the long-term efficacy of yoga and cognitive-behavioral therapy (CBT) chronic pain treatment in a randomized controlled trial (RCT) of 75 Veterans (57 men, 42-71±7.1 years of age) with Gulf War Illness (GWI).METHODS: Participants received either 10 weeks of yoga or 10 weeks of CBT for chronic pain. The primary outcome measures were pain severity, and pain interference (Brief Pain Inventory-Short Form). The secondary outcome measures were fatigue, as indicated by a measure of functional exercise capacity (6-Minute Walk Test), depression, autonomic symptom severity, and quality of life. Piecewise linear mixed models were used to examine study hypotheses.RESULTS: Compared to the CBT group, yoga was associated with greater reductions in pain severity during the 6-month follow-up period (group * time interaction: b=0.036, se=0.014, p=.011). Although we did not find between-group differences in the other primary or secondary outcome measures during follow-up (p's>0.05), exploratory analyses revealed within-group improvements in pain interference, total pain (an experimental outcome variable which combines pain severity and interference), and fatigue in the yoga group (p's<0.05) but not in the CBT group.CONCLUSIONS: This is the first study to report long-term follow-up results of yoga as a treatment for GWI. Our results suggest that yoga may offer long-term efficacy in reducing pain, which is a core symptom of GWI.TRIAL REGISTRATION: Secondary analyses of ClinicalTrials.gov NCT02378025.

  View details for DOI 10.1186/s12906-023-04145-y

  View details for PubMedID 37704984

• US Veterans Show Improvements in Subjective but Not Objective Sleep following Treatment for Posttraumatic Stress Disorder: Secondary Analyses from a Randomised Controlled Trial DEPRESSION AND ANXIETY Mathersul, D. C., Schulz-Heik, R., Avery, T. J., Allende, S., Zeitzer, J. M., Bayley, P. J. 2023; 2023

  View details for DOI 10.1155/2023/7001667

  View details for Web of Science ID 001054964900001

• ′She thought the same way I that I thought:′ a qualitative study of patient-provider concordance among Gulf War Veterans with Gulf War Illness PSYCHOLOGY & HEALTH Lesnewich, L. M., Hyde, J. K., McFarlin, M. L., Bolton, R. E., Bayley, P. J., Chandler, H. K., Helmer, D. A., Phillips, L., Reinhard, M. J., Santos, S. L., Stewart, R. S., McAndrew, L. M. 2025; 40 (4): 616-634

  Abstract

  Objective: Medically unexplained symptoms (MUS), such as chronic fatigue syndrome, irritable bowel syndrome, and Gulf War Illness (GWI), are difficult to treat. Concordance-shared understanding between patient and provider about illness causes, course, and treatment-is an essential component of high-quality care for people with MUS. This qualitative paper focuses on the experiences of United States military Veterans living with GWI who have endured unique healthcare challenges. Methods & Measures: Qualitative interviews were conducted with 31 Veterans with GWI to explore factors that contribute to and detract from concordance with their Veteran Affairs (VA) healthcare providers. In addition to being seen by VA primary care, over half of participants also sought care at a War Related Illness and Injury Study Center, which specializes in post-deployment health. Deductive and inductive codes were used to organize the data, and themes were identified through iterative review of coded data. Results: Major themes associated with patient-provider concordance included validation of illness experiences, perceived provider expertise in GWI/MUS, and trust in providers. Invalidation, low provider expertise, and distrust detracted from concordance. Conclusion: These findings suggest providers can foster concordance with MUS patients by legitimizing patients' experiences, communicating knowledge about MUS, and establishing trust.

  View details for DOI 10.1080/08870446.2023.2248481

  View details for Web of Science ID 001056242700001

  View details for PubMedID 37654203

• US Veterans Show Improvements in Subjective but Not Objective Sleep following Treatment for Posttraumatic Stress Disorder: Secondary Analyses from a Randomised Controlled Trial. Depression and anxiety Mathersul, D. C., Schulz-Heik, R. J., Avery, T. J., Allende, S., Zeitzer, J. M., Bayley, P. J. 2023; 2023: 7001667

  Abstract

  Sleep disturbances are a prominent feature of posttraumatic stress disorder (PTSD), and poorer sleep quality is associated with higher PTSD severity. This highlights the importance of monitoring sleep outcomes alongside PTSD symptoms in treatments targeting PTSD. Yet few studies monitor both sleep and PTSD outcomes, unless sleep is the primary treatment target. Furthermore, inconsistencies remain about the effects of first-line, evidence-based PTSD treatments on sleep.Here, we explored changes in sleep in secondary analyses from a randomised controlled trial that originally assessed the noninferiority of a breathing-based yoga practice (Sudarshan kriya yoga; SKY) to a first-line PTSD treatment (cognitive processing therapy (CPT)) for clinically significant PTSD symptoms among US veterans (intent-to-treat N = 85; per protocol N = 59). Sleep was assessed via subjective (self-reported sleep diary), PTSD symptom severity items (self-reported and clinician-administered insomnia/nightmare sleep items), and objective (wrist actigraphy) measures.Following treatment, subjective sleep diary measures of quality, latency, and wake duration showed small effect size (d = .24 - .39) improvements, with no significant differences between treatment groups. Significant improvements were also observed in PTSD sleep symptoms, though CPT (d = .34) more reliably reduced nightmares while SKY (d = .44-.45) more reliably reduced insomnia. In contrast, there were no significant treatment-related effects for any of the actigraphy-measured sleep indices.To our knowledge, this is the first study to investigate sleep as an outcome of CPT or SKY for PTSD, across a combination of subjective diary, PTSD symptom severity, and objective actigraphic measures. Findings lend support to a growing body of evidence that trauma-focused psychotherapy for PTSD improves sleep and suggest that yoga-based interventions may also be beneficial for sleep among individuals with emotional or mental health disorders like PTSD. This trial is registered with NCT02366403.

  View details for DOI 10.1155/2023/7001667

  View details for PubMedID 40224604

  View details for PubMedCentralID PMC11922038

• The role of the brainstem in sleep disturbances and chronic pain of Gulf War and Iraq/Afghanistan veterans. Frontiers in molecular neuroscience Zhang, Y., Moore, M., Jennings, J. S., Clark, J. D., Bayley, P. J., Ashford, J. W., Furst, A. J. 2023; 16: 1266408

  Abstract

  Introduction: Gulf War Illness is a type of chronic multisymptom illness, that affects about 30% of veterans deployed to the 1990-91 Persian Gulf War. Veterans deployed to Iraq/Afghanistan after 2000 are reported to have a similar prevalence of chronic multisymptom illness. More than 30 years after the Persian Gulf War, Gulf War Illness still has an unexplained symptom complex, unknown etiology and lacks definitive diagnostic criteria and effective treatments. Our recent studies have found that substantially smaller brainstem volumes and lower fiber integrity are associated with increased sleep difficulty and pain intensity in 1990-91 Persian Gulf War veterans. This study was conducted to investigate whether veterans deployed to Iraq/Afghanistan present similar brainstem damage, and whether such brainstem structural differences are associated with major symptoms as in Gulf War Illness.Methods: Here, we used structural magnetic resonance imaging and diffusion tensor imaging to measure the volumes of subcortices, brainstem subregions and white matter integrity of brainstem fiber tracts in 188 veterans including 98 Persian Gulf War veterans and 90 Iraq/Afghanistan veterans.Results: We found that compared to healthy controls, veterans of both campaigns presented with substantially smaller volumes in brainstem subregions, accompanied by greater periaqueductal gray matter volumes. We also found that all veterans had reduced integrity in the brainstem-spinal cord tracts and the brainstem-subcortical tracts. In veterans deployed during the 1990-91 Persian Gulf War, we found that brainstem structural deficits significantly correlated with increased sleep difficulties and pain intensities, but in veterans deployed to Iraq/Afghanistan, no such effect was observed.Discussion: These structural differences in the brainstem neurons and tracts may reflect autonomic dysregulation corresponding to the symptom constellation, which is characteristic of Gulf War Illness. Understanding these neuroimaging and neuropathological relationships in Gulf War and Iraq/Afghanistan veterans may improve clinical management and treatment strategies for modern war related chronic multisymptom illness.

  View details for DOI 10.3389/fnmol.2023.1266408

  View details for PubMedID 38260809

• Correctness and response time distributions in the MemTrax continuous recognition task: Analysis of strategies and a reverse-exponential model. Frontiers in aging neuroscience Ashford, J. W., Clifford, J. O., Anand, S., Bergeron, M. F., Ashford, C. B., Bayley, P. J. 2022; 14: 1005298

  Abstract

  A critical issue in addressing medical conditions is measurement. Memory measurement is difficult, especially episodic memory, which is disrupted by many conditions. On-line computer testing can precisely measure and assess several memory functions. This study analyzed memory performances from a large group of anonymous, on-line participants using a continuous recognition task (CRT) implemented at https://memtrax.com. These analyses estimated ranges of acceptable performance and average response time (RT). For 344,165 presumed unique individuals completing the CRT a total of 602,272 times, data were stored on a server, including each correct response (HIT), Correct Rejection, and RT to the thousandth of a second. Responses were analyzed, distributions and relationships of these parameters were ascertained, and mean RTs were determined for each participant across the population. From 322,996 valid first tests, analysis of correctness showed that 63% of these tests achieved at least 45 correct (90%), 92% scored at or above 40 correct (80%), and 3% scored 35 correct (70%) or less. The distribution of RTs was skewed with 1% faster than 0.62 s, a median at 0.890 s, and 1% slower than 1.57 s. The RT distribution was best explained by a novel model, the reverse-exponential (RevEx) function. Increased RT speed was most closely associated with increased HIT accuracy. The MemTrax on-line memory test readily provides valid and reliable metrics for assessing individual episodic memory function that could have practical clinical utility for precise assessment of memory dysfunction in many conditions, including improvement or deterioration over time.

  View details for DOI 10.3389/fnagi.2022.1005298

  View details for PubMedID 36437986

  View details for PubMedCentralID PMC9682919

• Randomised clinical non-inferiority trial of breathing-based meditation and cognitive processing therapy for symptoms of post-traumatic stress disorder in military veterans. BMJ open Bayley, P. J., Schulz-Heik, R. J., Tang, J. S., Mathersul, D. C., Avery, T., Wong, M., Zeitzer, J. M., Rosen, C. S., Burn, A. S., Hernandez, B., Lazzeroni, L. C., Seppala, E. M. 2022; 12 (8): e056609

  Abstract

  OBJECTIVE: Test whether Sudarshan Kriya Yoga (SKY) was non-inferior to cognitive processing therapy (CPT) for treating symptoms of post-traumatic stress disorder (PTSD) among veterans via a parallel randomised controlled non-inferiority trial.SETTING: Outpatient Veterans Affairs healthcare centre.PARTICIPANTS: 85 veterans (75 men, 61% white, mean age 56.9) with symptoms of PTSD participated between October 2015 and March 2020: 59 participants completed the study.INTERVENTIONS: SKY emphasises breathing routines and was delivered in group format in a 15-hour workshop followed by two 1-hour sessions per week for 5 weeks. CPT is an individual psychotherapy which emphasises shifting cognitive appraisals and was delivered in two 1-hour sessions per week for 6 weeks.MEASURES: The primary outcome measure was the PTSD Checklist-Civilian Version (PCL-C). The secondary measures were the Beck Depression Inventory-II (BDI-II) and Positive and Negative Affect Scale (PANAS).RESULTS: Mean PCL-C at baseline was 56.5 (±12.6). Intent-to-treat analyses showed that PCL-C scores were reduced at 6weeks (end of treatment) relative to baseline (SKY, -5.6, d=0.41, n=41: CPT, -6.8, d=0.58, n=44). The between-treatment difference in change scores was within the non-inferiority margin of 10 points (-1.2, 95%CI -5.7 to 3.3), suggesting SKY was not inferior to CPT. SKY was also non-inferior at 1-month (CPT-SKY: -2.1, 95%CI -6.9 to 2.8) and 1-year (CPT-SKY: -1.8, 95%CI -6.6 to 2.9) assessments. SKY was also non-inferior to CPT on the BDI-II and PANAS at end of treatment and 1month, but SKY was inferior to CPT on both BDI-II and PANAS at 1year. Dropout rates were similar (SKY, 27%, CPT, 34%: OR=1.36, 95%CI 0.51 to 3.62, p=0.54).CONCLUSIONS: SKY may be non-inferior to CPT for treating symptoms of PTSD and merits further consideration as a treatment for PTSD.TRIAL REGISTRATION NUMBER: NCT02366403.

  View details for DOI 10.1136/bmjopen-2021-056609

  View details for PubMedID 36008059

• Valued living among veterans in breath-based meditation treatment or cognitive processing therapy for posttraumatic stress disorder: Exploratory outcome of a randomized controlled trial. Global advances in health and medicine Schulz-Heik, R. J., Lazzeroni, L. C., Hernandez, B., Avery, T. J., Mathersul, D. C., Tang, J. S., Hugo, E., Bayley, P. J. 2022; 11: 2164957X221108376

  Abstract

  Valued living is the extent to which an individual's behavior is consistent with what they believe is important or good. It is unknown whether many complementary and integrative treatments and psychotherapies for posttraumatic stress disorder enhance valued living, and for whom.Measure within- and between-group changes in valued living in Veterans who completed cognitive processing therapy (CPT) and sudarshan kriya yoga (SKY) for posttraumatic stress disorder (PTSD); evaluate moderators of improvement.Participants with clinically significant symptoms of PTSD were assigned to CPT, a first line, evidence-based psychotherapy for PTSD or SKY, an emerging breath-based meditation with strong preliminary empirical support in a parallel-groups randomized controlled trial at a single Veterans Affairs healthcare center. The Valuing Questionnaire subscales for progress in valued living (VQ-P) and obstruction in valued living (VQ-O) were exploratory outcome measures. Assessors were blind to treatment assignment.59 participants completed treatment (29 CPT, 30 SKY). Participants in the CPT group improved from baseline to end of treatment in both VQ-Progress (d=0.55, p=0.02) and VQ-Obstruction (d=-0.51, p=0.03), while the SKY group did not improve on either subscale (d=0.08, p=0.69; d=0.00, p=1.00). However, differences between treatments were not statistically significant (p=0.16, 0.11, respectively). Participants reporting less valued living and more depression symptoms at baseline reported greater improvements in valued living following treatment.CPT may have a positive effect on valued living. Individuals lower in valued living and with more depression may derive relatively more benefit.

  View details for DOI 10.1177/2164957X221108376

  View details for PubMedID 35770246

  View details for PubMedCentralID PMC9234823

• Now is the Time to Improve Cognitive Screening and Assessment for Clinical and Research Advancement. Journal of Alzheimer's disease : JAD Ashford, J. W., Schmitt, F. A., Bergeron, M. F., Bayley, P. J., Clifford, J. O., Xu, Q., Liu, X., Zhou, X., Kumar, V., Buschke, H., Dean, M., Finkel, S. I., Hyer, L., Perry, G. 2022; 87 (1): 305-315

  Abstract

  Wang et al. analyze Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment accuracy as screening tests for detecting dementia associated with Alzheimer's disease (AD). Such tests are at the center of controversy regarding recognition and treatment of AD. The continued widespread use of tools such as MMSE (1975) underscores the failure of advancing cognitive screening and assessment, which has hampered the development and evaluation of AD treatments. It is time to employ readily available, efficient computerized measures for population/mass screening, clinical assessment of dementia progression, and accurate determination of approaches for prevention and treatment of AD and related conditions.

  View details for DOI 10.3233/JAD-220211

  View details for PubMedID 35431257

• Emotion dysregulation and heart rate variability improve in US veterans undergoing treatment for posttraumatic stress disorder: Secondary exploratory analyses from a randomised controlled trial. BMC psychiatry Mathersul, D. C., Dixit, K., Schulz-Heik, R. J., Avery, T. J., Zeitzer, J. M., Bayley, P. J. 2022; 22 (1): 268

  Abstract

  BACKGROUND: Emotion regulation (ER) is a key process underlying posttraumatic stress disorder (PTSD), yet, little is known about how ER changes with PTSD treatment. Understanding these effects may shed light on treatment processes.METHODS: We recently completed a non-inferiority design randomised controlled trial demonstrating that a breathing-based yoga practice (Sudarshan kriya yoga; SKY) was not clinically inferior to cognitive processing therapy (CPT) across symptoms of PTSD, depression, or negative affect. Here, in secondary exploratory analyses (intent-to-treat N=85; per protocol N=59), we examined whether self-reported ER (Difficulties in Emotion Regulation Scale; DERS) and physiological ER (heart rate variability; HRV) improved with treatment for clinically significant PTSD symptoms among US Veterans.RESULTS: DERS-Total and all six subscales improved with small-to-moderate effect sizes (d=.24-.66) following CPT or SKY, with no differences between treatment groups. Following SKY (but not CPT), HR max-min (average difference between maximum and minimum beats per minute), LF/HF (low-to-high frequency) ratio, and normalised HF-HRV (high frequency power) improved (moved towards a healthier profile; d=.42-.55).CONCLUSIONS: To our knowledge, this is the first study to demonstrate that a breathing-based yoga (SKY) improved both voluntary/intentional and automatic/physiological ER. In contrast, trauma-focused therapy (CPT) only reliably improved self-reported ER. Findings have implications for PTSD treatment and interventions for emotional disorders more broadly.TRIAL REGISTRATION: Secondary analyses of ClinicalTrials.gov NCT02366403 .

  View details for DOI 10.1186/s12888-022-03886-3

  View details for PubMedID 35428258

• Posttraumatic Stress Disorder Does Not Compromise Behavioral Pain Treatment: Secondary Analysis of a Randomized Clinical Trial Among Veterans. Global advances in health and medicine Schulz-Heik, R. J., Avery, T. J., Jo, B., Mahoney, L., Bayley, P. J. 2022; 11: 21649561221075578

  Abstract

  Background: Individuals with posttraumatic stress disorder (PTSD) and chronic pain evince different presentations, coping strategies, and treatment utilization patterns than individuals with chronic pain alone. Theorists have suggested that comorbid PTSD may complicate chronic pain treatment, and that integrated pain and PTSD treatment may be preferable to pain treatment alone.Objective: Assess whether comorbid PTSD moderates Veterans' response to yoga and/or cognitive behavioral therapy (CBT) for pain.Methods: Veterans with Gulf War illness (n = 75) were assessed using the Brief Pain Inventory at baseline and posttreatment as part of a randomized clinical trial. PTSD status was abstracted from participants' medical records.Results: PTSD+ participants (n = 41) reported more pain at baseline than PTSD- participants (n = 34; d = .66, p < .01). PTSD+ participants experienced more improvement in pain from baseline to posttreatment than PTSD- participants by a small to moderate, marginally statistically significant amount (d = .39, p = .07). The relationship between PTSD and treatment outcome was not moderated by treatment type (yoga vs CBT; p = .99). Observation of treatment responses across PTSD status (+ vs -) and treatment (yoga vs CBT) revealed that PTSD+ participants responded well to yoga.Conclusion: PTSD is not associated with reduced effectiveness of behavioral chronic pain treatment among Veterans with Gulf War illness. Therefore behavioral pain treatment should be made readily available to Veterans with pain and PTSD. Yoga deserves further consideration as a treatment for pain among individuals with PTSD.

  View details for DOI 10.1177/21649561221075578

  View details for PubMedID 35186445

• Self-Reported Autonomic Dysregulation in Gulf War Illness. Military medicine Avery, T. J., Mathersul, D. C., Schulz-Heik, R. J., Mahoney, L., Bayley, P. J. 1800

  Abstract

  INTRODUCTION: Autonomic nervous system dysregulation is commonly observed in Gulf War illness (GWI). Using a new sample, we sought to replicate and extend findings from a previous study that found autonomic symptoms predicted physical functioning in Veterans with GWI.MATERIALS AND METHODS: A linear regression model was used to predict physical functioning (36-item Short Form Health Survey (SF-36); n=73, 75% male). First, we examined the predictive value of independent variables individually in the model including: the 31-item Composite Autonomic Symptom Score (COMPASS-31) total score, body mass index (BMI), mental health burden (i.e., post-traumatic stress disorder [PTSD] and/or depression), and COMPASS-31 subscales: orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor. Next, we estimated linear regression models containing the three variables (autonomic symptoms, BMI, and mental health burden) identified as predictors of physical functioning from the prior study.RESULTS: These linear regression models significantly predicted physical functioning and accounted for 15% of the variance with COMPASS-31, 36.6% of variance with COMPASS-31 and BMI, and 38.2% of variance with COMPASS-31, BMI, and mental health burden. Then, forward step-wise linear regressions were applied to explore new models including COMPASS-31 subscales. Two new models accounted for more of the variance in physical functioning: 39.3% with added gastrointestinal symptoms (beta=-2.206, P=.001) and 43.4% of variance with both gastrointestinal (beta=-1.592, P=.008) and secretomotor subscales (beta=-1.533, P=.049). Unlike the previous study we intended to replicate, mental health burden was not a significant predictor in any of our models.CONCLUSIONS: Treatments that address autonomic dysregulation should be prioritized for research and clinical recommendations for Veterans with GWI who experience chronic pain.

  View details for DOI 10.1093/milmed/usab546

  View details for PubMedID 34966941

• Rapid neural reorganization during retrieval practice predicts subsequent long-term retention and false memory. Nature human behaviour Zhuang, L., Wang, J., Xiong, B., Bian, C., Hao, L., Bayley, P. J., Qin, S. 2021

  Abstract

  Active retrieval can alter the strength and content of a memory, yielding either enhanced or distorted subsequent recall. However, how consolidation influences these retrieval-induced seemingly contradictory outcomes remains unknown. Here we show that rapid neural reorganization over an eight-run retrieval practice predicted subsequent recall. Retrieval practice boosted memory retention following a 24-hour (long-term) but not 30-minute delay, and increased false memory at both delays. Long-term retention gains were predicted by multi-voxel representation distinctiveness in the posterior parietal cortex (PPC) that increased progressively over retrieval practice. False memory was predicted by unstable representation distinctiveness in the medial temporal lobe (MTL). Retrieval practice enhanced the efficiency of memory-related brain networks, through building up PPC and MTL connections with the ventrolateral and dorsolateral prefrontal cortex that predicted long-term retention gains and false memory, respectively. Our findings indicate that retrieval-induced rapid neural reorganization together with consecutive consolidation fosters long-term retention and false memories via distinct pathways.

  View details for DOI 10.1038/s41562-021-01188-4

  View details for PubMedID 34621051

• Clinical Yoga Program Utilization in a Large Health Care System PSYCHOLOGICAL SERVICES Avery, T. J., Schulz-Heik, R., Friedman, M., Mahoney, L., Ahmed, N., Bayley, P. J. 2021; 18 (3): 389-397

  Abstract

  The U.S. Department of Veterans Affairs (VA) offers yoga for multiple conditions. Little information is available regarding how frequently yoga is utilized, by whom, or for which medical conditions. Here we describe referral patterns and patient adoption rates in a clinical yoga program, including telehealth yoga, at VA Palo Alto Health Care System (VAPAHCS). Referral and demographic data were extracted from the electronic medical records of 953 veterans (692 male, 261 female) referred to the outpatient clinical yoga program between 2010 and 2016. Attendance data were extracted from the same time plus 1 year. Referee demographics were compared to the overall VAPAHCS population. Twenty-two of the 187 referring providers accounted for half (50.4%) of referrals, predominantly from primary care and mental health clinics. Compared to the overall VAPAHCS patient population, referees were similar age and more likely to be female. Attendance was associated with age (older veterans were more likely to attend) but not gender. Those referred for mental health reasons were more likely to attend yoga compared to those referred for physical symptoms or for wellness (e.g., strength, health, mindfulness). Telehealth yoga follow through was lower but attendance rate similar to in-person yoga. These data provide an overview of referral and uptake in a large VA setting. Overall, referral was performed by a few providers in mental health and primary care clinics. The typical demographic of attendee was a White male from the Vietnam War era, reflective of the VA population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

  View details for DOI 10.1037/ser0000420

  View details for Web of Science ID 000683772100011

  View details for PubMedID 32134306

• Brainstem damage is associated with poorer sleep quality and increased pain in gulf war illness veterans. Life sciences Zhang, Y., Vakhtin, A. A., Dietch, J., Jennings, J. S., Yesavage, J. A., Clark, J. D., Bayley, P. J., Ashford, J. W., Furst, A. J. 2021: 119724

  Abstract

  AIMS: Gulf War Illness (GWI) is manifested as multiple chronic symptoms, including chronic pain, chronic fatigue, sleep problems, neuropsychiatric disorders, respiratory, gastrointestinal, and skin problems. No single target tissue or unifying pathogenic process has been identified that accounts for this variety of symptoms. The brainstem has been suspected to contribute to this multiple symptomatology. The aim of this study was to assess the role of the brainstem in chronic sleep problems and pain in GWI veterans.MATERIALS AND METHODS: We enrolled 90 veterans (Age = 50 ± 5, 87% Male) who were deployed to the 1990-91 Gulf War and presented with GWI symptoms. Sleep quality was evaluated using the global Pittsburgh Sleep Quality Index. Pain intensities were obtained with the Brief Pain Inventory sum score. Volumes in cortical, subcortical, brainstem, and brainstem subregions and diffusion tensor metrics in 10 bilateral brainstem tracts were tested for correlations with symptom measures.KEY FINDINGS: Poorer sleep quality was significantly correlated with atrophy of the whole brainstem and brainstem subregions (including midbrain, pons, medulla). Poorer sleep quality also significantly correlated with lower fractional anisotropy in the nigrostriatal tract, medial forebrain tract, and the dorsal longitudinal fasciculus. There was a significant correlation between increased pain intensity and decreased fractional anisotropy in the dorsal longitudinal fasciculus. These correlations were not altered after controlling for age, sex, total intracranial volumes, or additional factors, e.g., depression and neurological conditions.SIGNIFICANCE: These findings suggest that the brainstem plays an important role in the aberrant neuromodulation of sleep and pain symptoms in GWI.

  View details for DOI 10.1016/j.lfs.2021.119724

  View details for PubMedID 34144059

• Heart rate and heart rate variability as outcomes and longitudinal moderators of treatment for pain across follow-up in Veterans with Gulf War illness. Life sciences Mathersul, D. C., Dixit, K., Avery, T. J., Schulz-Heik, R. J., Zeitzer, J. M., Mahoney, L. A., Cho, R. H., Bayley, P. J. 2021: 119604

  Abstract

  AIMS: Accumulating evidence suggests Gulf War illness (GWI) is characterised by autonomic nervous system dysfunction (higher heart rate [HR], lower heart rate variability [HRV]). Yoga - an ancient mind-body practice combining mindfulness, breathwork, and physical postures - is proposed to improve autonomic dysfunction yet this remains untested in GWI. We aimed to determine (i) whether HR and HRV improve among Veterans with GWI receiving either yoga or cognitive behavioural therapy (CBT) for pain; and (ii) whether baseline autonomic functioning predicts treatment-related pain outcomes across follow-up.MAIN METHODS: We present secondary analyses of 24-hour ambulatory cardiac data (mean HR, square root of the mean squared differences between successive R-R intervals [RMSSD], high frequency power [HF-HFV], and low-to-high frequency ratio [LF/HF] extracted from a 5-min window during the first hour of sleep) from our randomised controlled trial of yoga versus CBT for pain among Veterans with GWI (ClinicalTrials.govNCT02378025; N = 75).KEY FINDINGS: Veterans who received CBT tended towards higher mean HR at end-of-treatment. Better autonomic function (lower mean HR, higher RMSSD/HF-HRV) at baseline predicted greater reductions in pain across follow-up, regardless of treatment group. Better baseline autonomic function (mid-range-to-high RMSSD/HF-HRV) also predicted greater pain reductions with yoga, while worse baseline autonomic function (higher mean HR, lower RMSSD/HF-HRV) predicted greater pain reductions with CBT.SIGNIFICANCE: To our knowledge, this is the first study to suggest that among Veterans with GWI, HR may increase with CBT yet remain stable with yoga. Furthermore, HR and HRV moderated pain outcome across follow-up for yoga and CBT.

  View details for DOI 10.1016/j.lfs.2021.119604

  View details for PubMedID 33984356

• Yoga is effective in treating symptoms of Gulf War illness: A randomized clinical trial. Journal of psychiatric research Bayley, P. J., Schulz-Heik, R. J., Cho, R., Mathersul, D., Collery, L., Shankar, K., Ashford, J. W., Jennings, J. S., Tang, J., Wong, M. S., Avery, T. J., Stanton, M. V., Meyer, H., Friedman, M., Kim, S., Jo, B., Younger, J., Mathews, B., Majmundar, M., Mahoney, L. 2020

  Abstract

  Many Veterans of the 1990-1991 Gulf War report symptoms of Gulf War Illness, a condition involving numerous chronic symptoms including pain, fatigue, and mood/cognition symptoms. Little is known about this condition's etiology and treatment. This study reports outcomes from a randomized controlled single-blind trial comparing yoga to cognitive behavioral therapy for chronic pain and other symptoms of Gulf War Illness. Participants were Veterans with symptoms of GWI: chronic pain, fatigue and cognition-mood symptoms. Seventy-five Veterans were randomized to treatment via selection of envelopes from a bag (39 yoga, 36 cognitive behavioral therapy), which consisted of ten weekly group sessions. The primary outcomes of pain severity and interference (Brief Pain Inventory- Short Form) improved in the yoga condition (Cohen's d=.35, p=0.002 and d=0.69, p<0.001, respectively) but not in the CBT condition (d=0.10, p=0.59 and d=0.25 p=0.23). However, the differences between groups were not statistically significant (d=0.25, p=0.25; d=0.43, p=0.076), though the difference in an a-priori-defined experimental outcome variable which combines these two variables into a total pain variable (d=0.47, p=0.047) was significant. Fatigue, as indicated by a measure of functional exercise capacity (6-min walk test) was reduced significantly more in the yoga group than in the CBT group (between-group d=.27, p=0.044). Other secondary outcomes of depression, wellbeing, and self-reported autonomic nervous system symptoms did not differ between groups. No adverse events due to treatment were reported. Yoga may be an effective treatment for core Gulf War Illness symptoms of pain and fatigue, making it one of few treatments with empirical support for GWI. Results support further evaluation of yoga for treating veterans with Gulf War Illness. CLINICAL TRIAL REGISTRY: clinicaltrials.gov Registration Number NCT02378025.

  View details for DOI 10.1016/j.jpsychires.2020.11.024

  View details for PubMedID 33218747

• Evaluation of adding the CANTAB computerized neuropsychological assessment battery to a traditional battery in a tertiary care center for veterans APPLIED NEUROPSYCHOLOGY-ADULT Schulz-Heik, R., Fahimi, A., Durazzo, T. C., Friedman, M., Bayley, P. J. 2020; 27 (3): 256–66

  View details for DOI 10.1080/23279095.2018.1534735

  View details for Web of Science ID 000523570900005

• Brainstem Atrophy in Gulf War Illness. Neurotoxicology Zhang, Y., Avery, T., Vakhtin, A. A., Mathersul, D. C., Tranvinh, E., Wintermark, M., Massaband, P., Ashford, J. W., Bayley, P. J., Furst, A. J. 2020

  Abstract

  BACKGROUND: Gulf War illness (GWI) is a condition that affects about 30% of veterans who served in the 1990-91 Persian Gulf War. Given its broad symptomatic manifestation, including chronic pain, fatigue, neurological, gastrointestinal, respiratory, and skin problems, it is of interest to examine whether GWI is associated with changes in the brain. Existing neuroimaging studies, however, have been limited by small sample sizes, inconsistent GWI diagnosis criteria, and potential comorbidity confounds.OBJECTIVES: Using a large cohort of US veterans with GWI, we assessed regional brain volumes for their associations with GWI, and quantified the relationships between any regional volumetric changes and GWI symptoms.METHODS: Structural magnetic resonance imaging (MRI) scans from 111 veterans with GWI (Age=49±6, 88% Male) and 59 healthy controls (age=51±9, 78% male) were collected at the California War Related Illness and Injury Study Center (WRIISC-CA) and from a multicenter study of the Parkinson's Progression Marker Initiative (PPMI), respectively. Individual MRI volumes were segmented and parcellated using FreeSurfer. Regional volumes of 19 subcortical, 68 cortical, and 3 brainstem structures were evaluated in the GWI cohort relative to healthy controls. The relationships between regional volumes and GWI symptoms were also assessed.RESULTS: We found significant subcortical atrophy, but no cortical differences, in the GWI group relative to controls, with the largest effect detected in the brainstem, followed by the ventral diencephalon and the thalamus. In a subsample of 58 veterans with GWI who completed the Chronic Fatigue Scale (CFS) inventory of Centers for Disease Control and Prevention (CDC), smaller brainstem volumes were significantly correlated with increased severities of fatigue and depressive symptoms.CONCLUSION: The findings suggest that brainstem volume may be selectively affected by GWI, and that the resulting atrophy could in turn mediate or moderate GWI-related symptoms such as fatigue and depression. Consequently, the brain stem should be carefully considered in future research focusing on GWI pathology.

  View details for DOI 10.1016/j.neuro.2020.02.006

  View details for PubMedID 32081703

• Brain and Physiological Markers of Autonomic Function Are Associated With Treatment-Related Improvements in Self-Reported Autonomic Dysfunction in Veterans With Gulf War Illness: An Exploratory Pilot Study. Global advances in health and medicine Mathersul, D. C., Eising, C. M., DeSouza, D. D., Spiegel, D., Bayley, P. J. 2020; 9: 2164956120922812

  Abstract

  Background: Gulf War Illness (GWI) is a poorly understood condition characterized by a constellation of mood, cognitive, and physical symptoms. A growing body of evidence demonstrates autonomic nervous system (ANS) dysfunction. Few published treatment studies exist for GWI.Method: We recently completed a randomized controlled trial comparing a 10-week group yoga intervention to 10-week group cognitive behavioral therapy (CBT) for veterans with GWI. Here, we present exploratory data on ANS biomarkers of treatment response from a small pilot exploratory neurophysiological add-on study (n=13) within that larger study.Results: Findings suggest that veterans with GWI receiving either yoga or CBT for pain improved following treatment and that changes in biological ANS-especially for the yoga group-moved in the direction of healthy profiles: lower heart rate, higher square root of the mean squared differences between successive R-R intervals (RMSSD), greater parasympathetic activation/dominance (increased high-frequency heart rate variability [HF-HRV], decreased low-frequency/high-frequency [LF/HF] ratio), reduced right amygdala volume, and stronger amygdala-default mode/amygdala-salience network connectivity, both immediately posttreatment and at 6-month follow-up. Biological mechanisms of CBT appeared to underlie improvements in more psychologically loaded symptoms such as self-reported fatigue and energy. Higher tonic arousal and/or more sympathetic dominance (higher skin conductance, lower RMSSD, lower HF-HRV, higher LF/HF ratio) pretreatment predicted greater treatment-related improvements in self-reported ANS for both the yoga and CBT group.Conclusion: These exploratory pilot data provide preliminary support for the suggestion that treatment (yoga, CBT) is associated with improvements in both biological and self-reported ANS dysfunctions in GWI. The major limitation for these findings is the small sample size. Larger and more controlled studies are needed to replicate these findings and directly compare biomarkers of yoga versus CBT.

  View details for DOI 10.1177/2164956120922812

  View details for PubMedID 32426178

• Study protocol for a non-inferiority randomised controlled trial of SKY breathing meditation versus cognitive processing therapy for PTSD among veterans BMJ OPEN Mathersul, D. C., Tang, J. S., Schulz-Heik, R., Avery, T. J., Seppala, E. M., Bayley, P. J. 2019; 9 (4)

  View details for DOI 10.1136/bmjopen-2018-027150

  View details for Web of Science ID 000471157200229

• Evaluation of adding the CANTAB computerized neuropsychological assessment battery to a traditional battery in a tertiary care center for veterans. Applied neuropsychology. Adult Schulz-Heik, R. J., Fahimi, A., Durazzo, T. C., Friedman, M., Bayley, P. J. 2019: 1–11

  Abstract

  Numerous advantages of and concerns about computerized neuropsychological assessment systems have been noted. Here we report a program evaluation of incorporating a computerized system, the Cambridge Neuropsychological Test Automated Battery (CANTAB), in our tertiary assessment center for Veterans. Patients were 23 consecutive referrals to the Western War Related Illness and Injury Study Center, an interdisciplinary assessment center within the Veterans Affairs Healthcare System for Veterans with complex medical presentations. Patients were administered both the CANTAB and a brief traditional neuropsychological battery. The correlation between global composite scores from each method was .71 (p<.05), indicating "good" concordance. Concordance was "fair" to "good" for scores on specific cognitive domains. However, concordance was lower when classifying patients' cognition as "impaired" or "not-impaired" based on a cutoff score. Despite the CANTAB's primarily visuospatial interface, discrepancy between the two methods' scores was not associated with patients' visuospatial abilities. The two methods were similarly sensitive to deficits associated with posttraumatic stress disorder, which is prevalent among the Center's patients. The CANTAB was judged to be a valid and useful complement to, but not an acceptable alternative to a traditional neuropsychologist-administered cognitive assessment battery for the Center's specific patients and needs.

  View details for PubMedID 30633552

• Study protocol for a non-inferiority randomised controlled trial of SKY breathing meditation versus cognitive processing therapy for PTSD among veterans. BMJ open Mathersul, D. C., Tang, J. S., Schulz-Heik, R. J., Avery, T. J., Seppälä, E. M., Bayley, P. J. 2019; 9 (4): e027150

  Abstract

  Post-traumatic stress disorder (PTSD) is a debilitating, highly prevalent condition. Current clinical practice guidelines recommend trauma-focused psychotherapy (eg, cognitive processing therapy; CPT) as the first-line treatment for PTSD. However, while these treatments show clinically meaningful symptom improvement, the majority of those who begin treatment retain a diagnosis of PTSD post-treatment. Perhaps for this reason, many individuals with PTSD have sought more holistic, mind-body, complementary and integrative health (CIH) interventions. However, there remains a paucity of high-quality, active controlled efficacy studies of CIH interventions for PTSD, which precludes their formal recommendation.We present the protocol for an ongoing non-inferiority parallel group randomised controlled trial (RCT) comparing the efficacy of a breathing meditation intervention (Sudarshan Kriya Yoga [SKY]) to a recommended evidence-based psychotherapy (CPT) for PTSD among veterans. Assessors are blinded to treatment group. The primary outcome measure is the PTSD Checklist-Civilian Version and a combination of clinical, self-report, experimental and physiological outcome measures assess treatment-related changes across each of the four PTSD symptom clusters (re-experiencing, avoidance, negative cognitions or mood and hyperarousal/reactivity). Once the RCT is completed, analyses will use both an intent-to-treat (using the 'last observation carried forward' for missing data) and a per-protocol or 'treatment completers' procedure, which is the most rigorous approach to non-inferiority designs.To the best of our knowledge, this is this first non-inferiority RCT of SKY versus CPT for PTSD among veterans. The protocol is approved by the Stanford University Institutional Review Board. All participants provided written informed consent prior to participation. Results from this RCT will inform future studies including larger multi-site efficacy RCTs of SKY for PTSD and other mental health conditions, as well as exploration of cost-effectiveness and evaluation of implementation issues. Results will also inform evidence-based formal recommendations regarding CIH interventions for PTSD.NCT02366403; Pre-results.

  View details for PubMedID 30948610

• Genetic Risk of Alzheimer's Disease: Three Wishes Now That the Genie is Out of the Bottle. Journal of Alzheimer's disease : JAD Frank, L., Wesson Ashford, J., Bayley, P. J., Borson, S., Buschke, H., Cohen, D., Cummings, J. L., Davies, P., Dean, M., Finkel, S. I., Hyer, L., Perry, G., Powers, R. E., Schmitt, F. 2018

  Abstract

  The availability and increasing popularity of direct-to-consumer genetic testing for the presence of an APOE4 allelle led the Alzheimer's Foundation of America Medical, Scientific and Memory Screening Advisory Board to identify three critical areas for attention: 1) ensure consumer understanding of test results; 2) address and limit potential negative consequences of acquiring this information; and 3) support linking results with positive health behaviors, including potential clinical trial participation. Improving access to appropriate sources of genetic counseling as part of the testing process is critical and requires action from clinicians and the genetic testing industry. Standardizing information and resources across the industry should start now, with the input of consumers and experts in genetic risk and health information disclosure. Direct-to-consumer testing companies and clinicians should assist consumers by facilitating consultation with genetic counselors and facilitating pursuit of accurate information about testing.

  View details for PubMedID 30282369

• Genetic Risk of Alzheimer's Disease: Three Wishes Now That the Genie is Out of the Bottle JOURNAL OF ALZHEIMERS DISEASE Frank, L., Ashford, J., Bayley, P. J., Borson, S., Buschke, H., Cohen, D., Cummings, J. L., Davies, P., Dean, M., Finkel, S. I., Hyer, L., Perry, G., Powers, R. E., Schmitt, F. 2018; 66 (2): 421-423

  View details for DOI 10.3233/JAD-180629

  View details for Web of Science ID 000451224700001

• Tele-yoga for Chronic Pain: Current Status and Future Directions. Global advances in health and medicine Mathersul, D. C., Mahoney, L. A., Bayley, P. J. 2018; 7: 2164956118766011

  Abstract

  Pain is a pervasive, debilitating disorder that is resistant to long-term pharmacological interventions. Although psychological therapies such as cognitive behavior therapy demonstrate moderate efficacy, many individuals continue to have ongoing difficulties following treatment. There is a current trend to establish complementary and integrative health interventions for chronic pain, for which yoga has been found to have exciting potential. Nevertheless, an important consideration within the field is accessibility to adequate care. Telehealth can be used to provide real-time interactive video conferencing leading to increased access to health care for individuals located remotely or who otherwise have difficulty accessing services, perhaps through issues of mobility or proximity of adequate services. This article assesses the current status and feasibility of implementing tele-yoga for chronic pain. Methodological limitations and recommendations for future research are discussed.

  View details for PubMedID 29637012

  View details for PubMedCentralID PMC5888810

• Psychological Flexibility and Set-Shifting Among Veterans Participating in a Yoga Program: A Pilot Study. Military medicine Avery, T. n., Blasey, C. n., Rosen, C. n., Bayley, P. n. 2018

  Abstract

  Trauma-focused psychotherapies do not meet the needs of all veterans. Yoga shows some potential in reducing stress and perhaps even PTSD in veterans, although little is understood about the mechanisms of action. This study identifies preliminary correlates of change in PTSD and perceived stress for veterans participating in yoga.Nine veterans (seven males and two females) were recruited from an existing clinical yoga program and observed over 16 wk. Severity of PTSD symptoms (PCL-5) and perceived stress (PSS-10) were collected at baseline and weeks 4, 6, 8, and 16. Psychological flexibility (AAQ-II) and set-shifting (ratio of trail making test A to B) were collected at baseline and at week 6. Subjects attended yoga sessions freely, ranging from 1 to 23 classes over the 16 weeks. The Stanford University Institutional Review Board approved this research protocol.Self-reported PTSD symptoms significantly reduced while perceived stress did not. Lower baseline set-shifting predicted greater improvements in PTSD between baseline and 4 weeks; early improvements in set-shifting predicted overall reduction in PTSD. Greater psychological flexibility was associated with lower PTSD and perceived stress; more yoga practice, before and during the study, was associated with greater psychological flexibility. Other predictors were not supported.In a small uncontrolled sample, psychological flexibility and set-shifting predicted changes in PTSD symptoms in veterans participating in a clinical yoga program, which supports findings from prior research. Future research should include an active comparison group and record frequency of yoga practiced outside formal sessions.

  View details for PubMedID 29590487

• OBESITY IS ASSOCIATED WITH AGE-RELATED HIPPOCAMPAL VOLUME REDUCTION Stanton, M. V., Soman, S., Fairchild, J., Furst, A., Adamson, M., Bayley, P. LIPPINCOTT WILLIAMS & WILKINS. 2017: A130-A131

  View details for Web of Science ID 000401250500347

• Results from a clinical yoga program for veterans: yoga via telehealth provides comparable satisfaction and health improvements to in-person yoga BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE Schulz-Heik, R. J., Meyer, H., Mahoney, L., Stanton, M. V., Cho, R. H., Moore-Downing, D. P., Avery, T. J., Lazzeroni, L. C., Varni, J. M., Collery, L. M., Bayley, P. J. 2017; 17

  Abstract

  Yoga is increasingly popular, though little data regarding its implementation in healthcare settings is available. Similarly, telehealth is being utilized more frequently to increase access to healthcare; however we know of no research on the acceptability or effectiveness of yoga delivered through telehealth. Therefore, we evaluated the feasibility, acceptability, and patient-reported effectiveness of a clinical yoga program at a Veterans Affairs Medical Center and assessed whether these outcomes differed between those participating in-person and those participating via telehealth.Veterans who attended a yoga class at the VA Palo Alto Health Care System were invited to complete an anonymous program evaluation survey.64 Veterans completed the survey. Participants reported high satisfaction with the classes and the instructors. More than 80% of participants who endorsed a problem with pain, energy level, depression, or anxiety reported improvement in these symptoms. Those who participated via telehealth did not differ from those who participated in-person in any measure of satisfaction, overall improvement (p = .40), or improvement in any of 16 specific health problems.Delivering yoga to a wide range of patients within a healthcare setting appears to be feasible and acceptable, both when delivered in-person and via telehealth. Patients in this clinical yoga program reported high levels of satisfaction and improvement in multiple problem areas. This preliminary evidence for the effectiveness of a clinical yoga program complements prior evidence for the efficacy of yoga and supports the use of yoga in healthcare settings.

  View details for DOI 10.1186/s12906-017-1705-4

  View details for Web of Science ID 000398770400012

  View details for PubMedID 28376861

  View details for PubMedCentralID PMC5381127

• Memory consolidation reconfigures neural pathways involved in the suppression of emotional memories NATURE COMMUNICATIONS Liu, Y., Lin, W., Liu, C., Luo, Y., Wu, J., Bayley, P. J., Qin, S. 2016; 7

  Abstract

  The ability to suppress unwanted emotional memories is crucial for human mental health. Through consolidation over time, emotional memories often become resistant to change. However, how consolidation impacts the effectiveness of emotional memory suppression is still unknown. Using event-related fMRI while concurrently recording skin conductance, we investigated the neurobiological processes underlying the suppression of aversive memories before and after overnight consolidation. Here we report that consolidated aversive memories retain their emotional reactivity and become more resistant to suppression. Suppression of consolidated memories involves higher prefrontal engagement, and less concomitant hippocampal and amygdala disengagement. In parallel, we show a shift away from hippocampal-dependent representational patterns to distributed neocortical representational patterns in the suppression of aversive memories after consolidation. These findings demonstrate rapid changes in emotional memory organization with overnight consolidation, and suggest possible neurobiological bases underlying the resistance to suppression of emotional memories in affective disorders.

  View details for DOI 10.1038/ncomms13375

  View details for PubMedID 27898050

• Memory consolidation reconfigures neural pathways involved in the suppression of emotional memories NATURE COMMUNICATIONS Liu, Y., Lin, W., Liu, C., Luo, Y., Wu, J., Bayley, P. J., Qin, S. 2016; 7: 13375

  Abstract

  The ability to suppress unwanted emotional memories is crucial for human mental health. Through consolidation over time, emotional memories often become resistant to change. However, how consolidation impacts the effectiveness of emotional memory suppression is still unknown. Using event-related fMRI while concurrently recording skin conductance, we investigated the neurobiological processes underlying the suppression of aversive memories before and after overnight consolidation. Here we report that consolidated aversive memories retain their emotional reactivity and become more resistant to suppression. Suppression of consolidated memories involves higher prefrontal engagement, and less concomitant hippocampal and amygdala disengagement. In parallel, we show a shift away from hippocampal-dependent representational patterns to distributed neocortical representational patterns in the suppression of aversive memories after consolidation. These findings demonstrate rapid changes in emotional memory organization with overnight consolidation, and suggest possible neurobiological bases underlying the resistance to suppression of emotional memories in affective disorders.

  View details for DOI 10.1038/ncomms13375

  View details for Web of Science ID 000388990400001

  View details for PubMedID 27898050

  View details for PubMedCentralID PMC5141344

• Mindfulness as a Weight Loss treatment for veterans FRONTIERS IN NUTRITION Stanton, M. V., Matsuura, J., Fairchild, J., Lohnberg, J. A., Bayley, P. J. 2016; 3: 30

  Abstract

  Despite substantial evidence for their effectiveness in treating disordered eating and obesity, mindfulness-based treatments have not been broadly implemented among Veterans. A number of reviews have reported mindfulness to be beneficial in promoting healthy eating behaviors and weight loss among non-Veteran samples. We discuss this approach in the context of the Veterans Affairs system, the largest integrated healthcare provider in the U.S. and in the context of Veterans, among whom obesity is at epidemic proportions. In this article, we discuss what is known about treating obesity using a mindfulness approach, mindfulness interventions for Veterans, a new pilot mindfulness-based weight loss program designed for Veterans, and future directions for this type of obesity treatment in Veterans. We conclude that this population may be uniquely poised to benefit from mindfulness-based treatments.

  View details for DOI 10.3389/fnut.2016.00030

  View details for Web of Science ID 000408960200001

  View details for PubMedID 27574603

  View details for PubMedCentralID PMC4983552

• The impact of depression on Veterans with PTSD and traumatic brain injury: A diffusion tensor imaging study. Biological psychology Isaac, L., Main, K. L., Soman, S., Gotlib, I. H., Furst, A. J., Kinoshita, L. M., Fairchild, J. K., Yesavage, J. A., Ashford, J. W., Bayley, P. J., Adamson, M. M. 2015; 105: 20-28

  Abstract

  A significant proportion of military personnel deployed in support of Operation Enduring Freedom and Operation Iraqi Freedom were exposed to war-zone events associated with traumatic brain injury (TBI), depression (DEP) and posttraumatic stress disorder (PTSD). The co-occurrence of TBI, PTSD and DEP in returning Veterans has recently increased research and clinical interest. This study tested the hypothesis that white matter abnormalities are further impacted by depression. Of particular relevance is the uncinate fasciculus (UF), which is a key fronto-temporal tract involved in mood regulation, and the cingulum; a tract that connects to the hippocampus involved in memory integration. Diffusion tensor imaging (DTI) was performed on 25 patients with a combination of PTSD, TBI and DEP and 20 patients with PTSD and TBI (no DEP). Microstructural changes of white matter were found in the cingulum and UF. Fractional anisotropy (FA) was lower in Veterans with DEP compared to those without DEP.

  View details for DOI 10.1016/j.biopsycho.2014.12.011

  View details for PubMedID 25559772

• Findings from the National Memory Screening Day Program JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Bayley, P. J., Kong, J. Y., Mendiondo, M., Lazzeroni, L. C., Borson, S., Buschke, H., Dean, M., Fillit, H., Frank, L., Schmitt, F. A., Peschin, S., Finkel, S., Austen, M., Steinberg, C., Ashford, J. W. 2015; 63 (2): 309-314

  Abstract

  To report experience with a large, nation-wide public memory screening program.Descriptive study of community-dwelling elderly adults.Local community sites (48 sites agreed to provide data) throughout the United States participating in National Memory Screening Day in November 2010.Of 4,369 reported participants, 3,064 had complete data records and are included in this report.Participants completed a questionnaire that included basic demographic information and a question about subjective memory concerns. Each site selected one of seven validated cognitive screening tests: Mini-Cog, General Practitioner assessment of Cognition, Memory Impairment Screen, Kokmen Short Test of Mental Status, Mini-Mental State Examination, Montreal Cognitive Assessment, Saint Louis University Mental Status Examination.Overall, 11.7% failed one of the seven screening tests. As expected, failure rates were higher in older and less-educated participants (P's < .05). Subjective memory concerns were associated with a 40% greater failure rate for persons of similar age and education but no memory concerns (odds ratio = 1.4, 95% confidence interval = 1.07-1.78), although only 11.9% of those who reported memory concerns (75% of all participants) had detectible memory problems.Screening for cognitive impairment in community settings yielded results consistent with expected effects of age and education. The event attracted a large proportion of individuals with memory concerns; 88.1% were told that they did not have memory problems detectible with the tests used. Further studies are needed to assess how participants respond to and use screening information, whether this information ultimately influences decision-making or outcomes, and whether memory screening programs outside healthcare settings have public health value.

  View details for DOI 10.1111/jgs.13234

  View details for PubMedID 25643739

• Predicting cognitive function in veterans with TBI and multiple health complaints Kong, J., Sheng, T., Main, K., Kinoshita, L., Fairchild, J., Ashford, J., Bayley, P., Isaac, L., Adamson, M. INFORMA HEALTHCARE. 2014: 692-693

  View details for Web of Science ID 000335017000429

• Age-related atrophy of white matter tracts in veterans Adamson, M., Main, K., Kong, J., Noda, A., Hernandez, B., Taylor, J., Lazzeroni, L., Ashford, J., Bayley, P. INFORMA HEALTHCARE. 2014: 612–13

  View details for Web of Science ID 000335017000238

• Challenges to be overcome using population-based sampling methods to recruit veterans for a study of post-traumatic stress disorder and traumatic brain injury BMC MEDICAL RESEARCH METHODOLOGY Bayley, P. J., Kong, J. Y., Helmer, D. A., Schneiderman, A., Roselli, L. A., Rosse, S. M., Jackson, J. A., Baldwin, J., Isaac, L., Nolasco, M., Blackman, M. R., Reinhard, M. J., Ashford, J. W., Chapman, J. C. 2014; 14

  Abstract

  Many investigators are interested in recruiting veterans from recent conflicts in Afghanistan and Iraq with Traumatic Brain Injury (TBI) and/or Post Traumatic Stress Disorder (PTSD). Researchers pursuing such studies may experience problems in recruiting sufficient numbers unless effective strategies are used. Currently, there is very little information on recruitment strategies for individuals with TBI and/or PTSD. It is known that groups of patients with medical conditions may be less likely to volunteer for clinical research. This study investigated the feasibility of recruiting veterans returning from recent military conflicts--Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF)--using a population-based sampling method.Individuals were sampled from a previous epidemiological study. Three study sites focused on recruiting survey respondents (n = 445) who lived within a 60 mile radius of one of the sites.Overall, the successful recruitment of veterans using a population-based sampling method was dependent on the ability to contact potential participants following mass mailing. Study enrollment of participants with probable TBI and/or PTSD had a recruitment yield (enrolled/total identified) of 5.4%. We were able to contact 146 individuals, representing a contact rate of 33%. Sixty-six of the individuals contacted were screened. The major reasons for not screening included a stated lack of interest in the study (n = 37), a failure to answer screening calls after initial contact (n = 30), and an unwillingness or inability to travel to a study site (n = 10). Based on the phone screening, 36 veterans were eligible for the study. Twenty-four veterans were enrolled, (recruitment yield = 5.4%) and twelve were not enrolled for a variety of reasons.Our experience with a population-based sampling method for recruitment of recent combat veterans illustrates the challenges encountered, particularly contacting and screening potential participants. The screening and enrollment data will help guide recruitment for future studies using population-based methods.

  View details for DOI 10.1186/1471-2288-14-48

  View details for Web of Science ID 000334440800001

  View details for PubMedID 24713131

• Improving dementia care: The role of screening and detection of cognitive impairment ALZHEIMERS & DEMENTIA Borson, S., Frank, L., Bayley, P. J., Boustani, M., Dean, M., Lin, P., McCarten, J. R., Morris, J. C., Salmon, D. P., Schmitt, F. A., Stefanacci, R. G., Mendiondo, M. S., Peschin, S., Hall, E. J., Fillit, H., Ashford, J. W. 2013; 9 (2): 151-159

  Abstract

  The value of screening for cognitive impairment, including dementia and Alzheimer's disease, has been debated for decades. Recent research on causes of and treatments for cognitive impairment has converged to challenge previous thinking about screening for cognitive impairment. Consequently, changes have occurred in health care policies and priorities, including the establishment of the annual wellness visit, which requires detection of any cognitive impairment for Medicare enrollees. In response to these changes, the Alzheimer's Foundation of America and the Alzheimer's Drug Discovery Foundation convened a workgroup to review evidence for screening implementation and to evaluate the implications of routine dementia detection for health care redesign. The primary domains reviewed were consideration of the benefits, harms, and impact of cognitive screening on health care quality. In conference, the workgroup developed 10 recommendations for realizing the national policy goals of early detection as the first step in improving clinical care and ensuring proactive, patient-centered management of dementia.

  View details for DOI 10.1016/j.jalz.2012.08.008

  View details for Web of Science ID 000317092700007

  View details for PubMedID 23375564

• Retrogenesis: A Model of Dementia Progression in Alzheimer's Disease Related to Neuroplasticity JOURNAL OF ALZHEIMERS DISEASE Ashford, J., Bayley, P. J. 2013; 33 (4): 1191-1193

  View details for DOI 10.3233/JAD-2012-121124

  View details for Web of Science ID 000313964200026

  View details for PubMedID 23090006

• EEG Coherence between prefrontal and posterior cortical regions is related to negative personality traits FRONTIERS IN HUMAN NEUROSCIENCE Isaac, L., Bayley, P. J. 2012; 6

  View details for DOI 10.3389/fnhum.2012.00269

  View details for Web of Science ID 000309580900001

  View details for PubMedID 23060773

  View details for PubMedCentralID PMC3463831

• Pilot Expertise and Hippocampal Size: Associations with Longitudinal Flight Simulator Performance AVIATION SPACE AND ENVIRONMENTAL MEDICINE Adamson, M. M., Bayley, P. J., Scanlon, B. K., Farrell, M. E., Hernandez, B., Weiner, M. W., Yesavage, J. A., Taylor, J. L. 2012; 83 (9): 850-857

  Abstract

  Previous research suggests that the size of the hippocampus can vary in response to intensive training (e.g., during the acquisition of expert knowledge). However, the role of the hippocampus in maintenance of skilled performance is not well understood. The Stanford/Veterans Affairs Aviation MRI Study offers a unique opportunity to observe the interaction of brain structure and multiple levels of expertise on longitudinal flight simulator performance.The current study examined the relationship between hippocampal volume and three levels of aviation expertise, defined by pilot proficiency ratings issued by the U.S. Federal Aviation Administration (11). At 3 annual time points, 60 pilots who varied in their level of aviation expertise (ages ranging from 45 to 69 yr) were tested.At baseline, higher expertise was associated with better flight simulator performance, but not with hippocampal volume. Longitudinally, there was an Expertise x Hippocampal volume interaction, in the direction that a larger hippocampus was associated with better performance at higher levels of expertise.These results are consistent with the notion that expertise in a cognitively demanding domain involves the interplay of acquired knowledge ('mental schemas') and basic hippocampal-dependent processes.

  View details for DOI 10.3357/ASEM.3215.2012

  View details for Web of Science ID 000307919100002

  View details for PubMedID 22946348

• Imaging the Alzheimer Brain: The Pathology and Pathophysiological Bases of Alzheimer's Disease: Implications for Advancing Diagnostic Imaging Introduction HANDBOOK OF IMAGING THE ALZHEIMER BRAIN Ashford, J., Salehi, A., Furst, A., Bayley, P. edited by Ashford, J. W., Rosen, A., Adamson, M., Bayley, P., Sabri, O., Furst, A., Black, S. E., Weiner, M. 2011; 2: 3-10

  View details for DOI 10.3233/978-1-60750-793-2-3

  View details for Web of Science ID 000351445400002

• P300 Energy Loss in Aging and Alzheimer's Disease HANDBOOK OF IMAGING THE ALZHEIMER BRAIN Ashford, J., Coburn, K. L., Rose, T. L., Bayley, P. J. edited by Ashford, J. W., Rosen, A., Adamson, M., Bayley, P., Sabri, O., Furst, A., Black, S. E., Weiner, M. 2011; 2: 435-444

  View details for DOI 10.3233/978-1-60750-793-2-435

  View details for Web of Science ID 000351445400037

• Structural Imaging Introduction HANDBOOK OF IMAGING THE ALZHEIMER BRAIN Bayley, P. J., Frisoni, G. B., Jack, C. R. edited by Ashford, J. W., Rosen, A., Adamson, M., Bayley, P., Sabri, O., Furst, A., Black, S. E., Weiner, M. 2011; 2: 45-46

  View details for DOI 10.3233/978-1-60750-793-2-45

  View details for Web of Science ID 000351445400005

• Measuring Memory in Large Group Settings Using a Continuous Recognition Test JOURNAL OF ALZHEIMERS DISEASE Ashford, J., Gere, E., Bayley, P. J. 2011; 27 (4): 885-895

  Abstract

  Memory function generally deteriorates with age, and memory impairments are a common symptom of serious illness such as dementia. Although screening tests are widely used throughout Medicine, they are not yet commonly used to detect memory impairments. The objective of this study was to characterize an audience-based memory test suitable for administration to a large number of individuals simultaneously. A continuous recognition test was developed to assess memory function in audiences using a slide-show in which 50 images were presented, of which 25 were repeated. Audience members responded by recording if an image was a repetition. The test was administered to a total of 1018 participants at 25 sites with an average audience size of 41 individuals (range = 9-142). A total of 868 individuals aged 40-97 y completed the test appropriately and provided their age, education level, and gender. Recognition memory as measured by discriminability (d') showed a significant decline with age (40-49 y old, d' = 3.51; 90-99 y old, d' = 1.95, p < 0.001) together with a greater than three-fold increase in variability. Individuals with less than 13 y of education had lower scores than those with more education (d' = 2.13 vs. 2.88, respectively, p < 0.001). These results are consistent with the known effects of age and education on memory. There were no significant effects of gender on test performance. Such memory tests represent a practical and novel approach to screen for the signs of early dementia.

  View details for DOI 10.3233/JAD-2011-110950

  View details for Web of Science ID 000298368100019

  View details for PubMedID 21908910

• P300 Energy Loss in Aging and Alzheimer's Disease JOURNAL OF ALZHEIMERS DISEASE Ashford, J., Coburn, K. L., Rose, T. L., Bayley, P. J. 2011; 26: 229-238

  Abstract

  The amplitude of the event-related potential P300 component is sensitive to aging and Alzheimer's disease (AD). Using a standard 20-electrode configuration, the P300 was measured during an "oddball" task in 14 young normal individuals (YN: 21-41 years), 11 elderly normal individuals (EN: 61-80 years), and 23 probable AD patients (AD: 63-93 years; NINCDS-ADRDA criteria). P300 latencies and amplitudes were measured at PZ. Additionally, algorithmic calculations were made from spline plots across the 11 central electrodes for P300 peak voltage latency and total field energy. The measured versus calculated latencies were in general agreement. Furthermore, the measured P300 voltage amplitude was closely related to the calculated total field energy. P300 voltage latency was significantly prolonged in the elderly, but not more so in AD patients (average latency [ms ± SD]; YN, 315 ± 21; EN, 364 ± 48 and AD, 361 ± 56). P300 amplitude showed the expected pattern of change from young to elderly to AD (average voltage [uV ± SD]; YN, 13 ± 5.1; EN, 8.3 ± 2.8; and AD, 4.9 ± 3.3). Summing the squares of each wave (an indication of power: P = V2 R) showed the expected change with age more strongly than the P300 amplitude (average ± SD; YN, 44,397 ± 32,386; EN, 9,996 ± 7,018; and AD, 3,347 ± 2,971). Mini-Mental State Exam scores showed no relationship to P300 latency and minimal relationship to amplitude. Results suggest that the P300 is not obliterated in early AD, but is barely discernable in late AD. The approaches to calculating the P300 described here are potentially useful for measuring specific neural systems affected by aging and AD.

  View details for DOI 10.3233/JAD-2011-0061

  View details for Web of Science ID 000297842800016

  View details for PubMedID 21971463