Background The role of cervical muscle (neck) strength in traumatic brain and spine injury and chronic neck pain disorders is an area of active research. Characterization of the normal ranges of neck strength in healthy young adults is essential to designing future investigations of how strength may act as a modifier for risk and progression in head and neck disorders. Objective To develop a normative reference database of neck strength in a healthy young adult population; and to evaluate the relationship of neck strength to anthropometric measurements. Design Cross-sectional. Setting An academic medical center research institution. Participants 157 healthy young adults (ages 18–35) had their neck strength measured with fixed frame dynamometry (FFD) during one visit to establish a normative neck strength database. Interventions Not applicable. Main Outcome Measurements Peak and average strength of the neck muscles was measured in extension, forward flexion, and right and left lateral flexion using FFD. The ranges of peak and average neck strength were characterized and correlated with anthropometric characteristics. Results 157 subjects (84 male, 73 female; average age 27 years) were included in the normative sample. Neck strength ranged from 38–383 Newtons in men and from 15–223 Newtons in women. Normative data are provided for each sex in all four directions. Weight, BMI, neck circumference, and estimated neck muscle volume were modestly correlated with neck strength in multiple directions (correlation coefficients <0.43). In a multivariate regression model, weight in women and neck volume in men were significant predictors of neck strength. Conclusions Neck strength in healthy young adults exhibits a broad range, is significantly different in men than in women and correlates only modestly with anthropometric characteristics.

Objective Anticholinergic/sedative drug use, measured by the Drug Burden Index (DBI), is linked to cognitive impairment in older adults. Yet, studies on the DBI's association with neuropsychological functioning are lacking, especially in underserved groups at increased risk of cognitive impairment. We examined cross‐sectional relationships between total DBI (DBIT) and an age‐adjusted analogue (Adj DBIT) with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in diverse adults with type 2 diabetes mellitus (T2DM). Based on results of a prior study, we anticipated higher DBIs would be associated with worse memory at older ages. Methods One hundred five adults with T2DM (age = 57 ± 9 years, 65% female, 62% Black, 27% Hispanic/Latino, HbA1c = 7.8 ± 1.8) participated. Although memory outcomes were normally distributed, DBIT values were positively skewed. Spearman correlations assessed their bivariate relationships with RBANS. Adjusting for comorbidities, polypharmacy, HbA1c, and education, we tested the moderating effect of age on DBI‐RBANS associations at mean ±1 standard deviations of age. Results One third of the participants endorsed current sedative/anticholinergic use. Mean DBIT was 0.385, and mean Adj DBIT was 0.393 (ranges = 0.00‐4.22). Drug burden negatively correlated with RBANS Immediate Memory (DBIT rs = −0.237, P = .013; Adj DBIT rs = −0.239, P = .014) but no other indices. There was a significant DBI*Age interaction; the negative effect of drug burden on Immediate Memory was significant for ages greater than or equal to 55 years old. Conclusions Sedative/anticholinergic drug exposure was prevalent in these diverse T2DM patients. Adjusting for covariates, greater drug burden was associated with worse memory acquisition among older adults only. Prospective studies should examine these relationships over time and assess whether dementia biomarkers affect the interaction.

Aim: Polypharmacy, depression, and disease-specific distress are prevalent in type 2 diabetes (T2D). Polypharmacy may add to the emotional burden of treatment. Our group previously showed that insulin use is linked with increased distress; however, few studies have examined polypharmacy in relation to mental health in T2D. The present study examined cross-sectional relationships between the number of medications and emotional distress in a T2D sample. Method: Adults with T2D (N=120, age=56(9.7), 64% female, 25% Hispanic/Latino) self-reported medication regimens and diabetes distress; depression was assessed by clinical interview. Due to severely skewed and kurtotic outcome variables, we used logistic regression with emotional distress dichotomized at clinical cutoffs. Independent relationships were assessed between the total number of medications (oral + insulin) and emotional distress, adjusting for age, sex, presence of diabetes complications, and insulin (yes/no). The moderating effect of insulin was examined. Results: Number of prescribed medications (M=6.5(3.8)) was not associated with depression (OR=1.09 [95% CI: 0.97-1.21]), diabetes (OR=0.97 [95% CI: 0.88-1.07]) or regimen (OR=0.97 [95% CI: 0.88-1.08]) distress. In multivariate models, age was negatively associated with higher odds of depression (OR=0.95 [95% CI: 0.91-0.99]), diabetes (OR= 0.95 [95% CI: 0.91-0.99]) and regimen (OR=0.94 [95% CI: 0.90-0.99]) distress. Diabetes complications were associated with 3.08-fold increased odds (95% CI: 1.28-7.40) of depression. Insulin use did not moderate the relationship between number of medications and emotional distress. Conclusion: The number of prescribed medications was not associated with depression or diabetes distress, suggesting that polypharmacy alone does not account for psychological aspects of perceived disease burden. As age was a notable predictor, younger individuals may be at more risk for the negative psychological impact of T2D and its treatment. Disclosure C.A. Solon: None. M.Z. Sears: None. C.J. Hoogendoorn: None. E.K. Seng: Consultant; Self; Eli Lilly and Company, GlaxoSmithKline plc. Other Relationship; Self; Haymarket Media. S.A. Margolis: None. J.S. Gonzalez: None.