Predicting Cognitive Functioning, Activities of Daily Living, and Participation 6 Months after Mild to Moderate Stroke.

OBJECTIVE: Predicting neurocognitive and functional outcomes in stroke is an important clinical task, especially in rehabilitation settings. We assessed acute predictors of cognitive and functional outcomes 6 months after mild to moderate stroke. METHODS: We conducted a retrospective analysis of acute clinical data and 6-month follow-up telephone interviews for 498 mild to moderate stroke patients. Predictors were sociodemographic variables, the National Institute of Health Stroke Scale (NIHSS), basic physical measures, the Mesulam Cancellation Test, the Short Blessed Test (SBT), Trails A/B, and the Boston Naming Test. The outcome variables were the Communication, Memory and Thinking, ADL/IADLs, and Participation subscales from the Stroke Impact Scale. We conducted four hierarchical multiple regression analyses with demographic variables and the NIHSS score entered into the first step, followed by physical variables in the second step, and neuropsychological variables in the final step. RESULTS: Physical variables explained more variance in ADL/IADLs and Participation outcomes than in Communication and Memory and Thinking outcomes, while cognitive predictors exhibited the opposite trend. The SBT was the only significant independent predictor of Communication and Memory and Thinking (p's < .001), while the NIHSS was the only measure that significantly predicted ADL/IADLs (p < .001) and Participation (p = .002). Poorer performance on screening measures predicted worse cognitive and functional outcomes 6 months post-stroke. CONCLUSIONS: These results support the clinical utility of administering brief screening instruments during acute recovery from mild to moderate stroke. Neuropsychologists should prioritize performance on screening measures assessing acute neurologic status and cognitive dysfunction when making recommendations for post-stroke rehabilitation.

Left caudal middle frontal gray matter volume mediates the effect of age on self-initiated elaborative encoding strategies.

Aging is associated with decreased self-initiated use of effective elaborative encoding strategies. Little is currently known regarding what factors drive age differences in self-initiated encoding strategies. The present research investigated whether age differences in prefrontal gray matter integrity contribute to age differences in self-initiated elaborative encoding strategies. The relationships between age, prefrontal regional gray matter volumes, and overall use of self-initiated elaborative encoding strategies were examined in healthy younger and older adults. Gray matter volume was calculated from structural MRI scans using Freesurfer. Encoding strategy use was assessed by retrospective item-by-item strategy self-reports given after a verbal intentional encoding task. Left caudal middle frontal gray matter volume mediated the effect of age on overall self-initiated use of elaborative encoding strategies. This suggests that age-associated declines in prefrontal gray matter integrity significantly contribute to age-associated declines in effective encoding strategies.

Parents Perceive Improvements in Socio-emotional Functioning in Adolescents with ASD Following Social Skills Treatment.

The current study examined the effectiveness of a social skills treatment (PEERS) for improving socio-emotional competencies in a sample of high-functioning adolescents with ASD. Neuropsychological and self- and parent-report measures assessing social, emotional, and behavioral functioning were administered before and after treatment. Following social skills treatment, adolescents with ASD exhibited decreased aggression, anxiety, and withdrawal, as well as improvements in emotional responsiveness, adaptability, leadership, and participation in activities of daily living, though no change was found in affect recognition abilities. These findings suggest that PEERS social skills treatment improves particular aspects of emotional, behavioral, and social functioning that may be necessary for developing and maintaining quality peer relationships and remediating social isolation in adolescents with ASD.

The effect of premorbid attention-deficit/hyperactivity disorder on neuropsychological functioning in individuals with acute mild traumatic brain injuries.

INTRODUCTION: Mild traumatic brain injury (mTBI) is a frequent, yet undertreated condition that typically manifests with transient neurological and cognitive symptoms that resolve over the course of several weeks. In contrast, attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that presents initially in childhood but often persists into adulthood. mTBI and ADHD include overlapping symptomatology, making it difficult for clinicians to disentangle the sequelae of each condition when they co-occur in the same individual. We hypothesized that neuropsychological tests would be sensitive to preexisting ADHD in inpatients with acute mTBIs. METHOD: We retrospectively examined the medical charts of 100 inpatients, aged 18-40 years (96% Caucasian; 77% male) with mTBIs in an acute care setting, half of whom had self-reported the presence of premorbid ADHD, and half of whom were matched controls. We analyzed group differences across neuropsychological tests of attention, processing speed, and executive functions, examined the profile ratings of independent, blinded, board-certified neuropsychologists, and correlated cognitive performance with time from traumatic injury to testing. RESULTS: Individuals with premorbid ADHD (a) performed significantly worse than their matched counterparts on several tests of attention, processing speed, and working memory, and (b) were significantly more likely to produce profiles later rated as impaired by independent, board-certified clinical neuropsychologists. In addition, time from traumatic injury to testing was found to be negatively correlated with neurocognitive performance. CONCLUSIONS: These findings (a) argue for the utility of a brief assessment of premorbid ADHD in the acute care of individuals with mTBIs and (b) provide clinicians with a barometer for gauging the relative contributions of premorbid ADHD to neuropsychological impairments in the neurocognitive profiles of individuals with mTBIs. Reported effect sizes will assist clinicians in accurately weighing the impact of premorbid ADHD when interpreting such profiles.