Objective: To examine the association between sleep during the acute stage of concussion and long-term outcomes. Literature Survey: Literature searches were performed 1 July 2018 to 1 August 2018 in Ovid MEDLINE, CINAHL, and Web of Science, along with hand searching for gray literature and cited references. Of the 610 search results, 359 unique references were reviewed after duplicates were removed. Methodology: Two reviewers independently reviewed and came to consensus on which titles/abstracts met inclusion/exclusion criteria (n = 23). The 23 full-text articles were assessed independently by the same two reviewers for eligibility. Consensus was achieved, leaving four articles for quality assessment and data extraction. One person extracted relevant data from each study using a standard data-extraction table. The data extraction table was reviewed by two reviewers and consensus was achieved for completeness and accuracy. Quality appraisal was conducted to assess the risk for potential bias and quality of included articles. Synthesis: Two of the articles included children younger than 16 years old and two included a wide age range. In general, poorer sleep was associated with poorer outcomes following concussion at reassessments across any age population. In addition, poorer sleep in the acute stage of concussion was associated with poorer long-term outcomes and recovery. Conclusions: The variability in sleep assessments used, symptoms assessed, length of time to reassessments, and comparator group included made data synthesis challenging. The use of standard valid and reliable sleep assessments is recommended. Future studies may consider if addressing sleep disturbances early following concussion will improve longer-term outcomes.

Background The growing societal and economic impact of Alzheimer’s disease (AD) is further compounded by the present lack of disease-modifying interventions. Non-pharmacological intervention approaches, such as exercise, have the potential to be powerful approaches to improve or mitigate the symptoms of AD without added side effects or financial burden associated with drug therapies. Various forms and regiments of exercise (i.e., strength, aerobic, multicomponent) have been reported in the literature; however, conflicting evidence obscures clear interpretation of the value and impact of exercise as an intervention for older adults with AD. The primary objective of this review will be to evaluate the effects of exercise interventions for older adults with AD. In addition, this review will evaluate the evidence quality and synthesize the exercise training prescriptions for proper clinical practice guidelines and recommendations. Methods This systematic review and meta-analysis will be carried out by an interdisciplinary collective representing clinical and research stakeholders with diverse expertise related to neurodegenerative diseases and rehabilitation medicine. Literature sources will include the following: Embase, PsychINFO, OVID Medline, and Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily. Inclusion criteria are participants with late onset AD and structured exercise interventions with prescribed duration, frequency, and intensity. The primary outcome of this study will center on improved or sustained cognitive functioning. Secondary outcomes will include institutionalization-related outcomes, ability in activities of daily living, mood and emotional well-being, quality of life, morbidity, and mortality. Analysis procedures to include measurement of bias, data synthesis, sensitivity analysis, and assessment of heterogeneity are described in this protocol. Discussion This review is anticipated to yield clinically meaningful insight on the specific value of exercise for older adults with AD. Improved understanding of diverse exercise intervention approaches and their specific impact on various health- and function-related outcomes is expected to guide clinicians to more frequently and accurately prescribe meaningful interventions for those affected by AD. Systematic review registration PROSPERO CRD42020175016.

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Objective: To examine the association between sleep quality during the chronic stage of concussion and post-concussion outcomes. Literature Survey: Literature searches were performed during July 1st to August 1st, 2019 in selected databases along with searching grey literature. Out of the 733 results, 702 references were reviewed after duplicate removal. Methodology: Three reviewers independently reviewed and consented on abstracts meeting eligibility criteria (n=35). The full-text articles were assessed independently by two reviewers. Consensus was achieved, leaving four articles. Relevant data from each study was extracted using a standard data-extraction table. Quality appraisal was conducted to assess potential bias and the quality of articles. Synthesis: One study included children (18-60 months) and three studies included adolescents and/or adults (ranging 12 years to 35). The association between sleep and cognition (two studies), physical activity (one study), and emotion symptoms (one study) was examined. Sleep quality was associated with decreased cognition and emotional symptoms, but not with meeting physical activity guidelines 6 months post-concussion injury. Conclusions: The heterogeneity in age of participants and outcomes across studies and limited number of included studies made interpretations difficult. Future studies may consider if addressing sleep quality following concussion will improve outcomes.

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