The effect of blood alcohol level and preinjury chronic alcohol use on outcome from severe traumatic brain injury in Hispanics, anglo-Caucasians, and African-americans.

OBJECTIVE: To examine (a) ethnic differences in blood alcohol level (BAL) and preinjury chronic alcohol use (PI-ETOH) within a severe closed head injury (CHI) sample and (b) the main and interaction effects of BAL, PI-ETOH, and ethnicity on functional outcome following severe CHI. PARTICIPANTS: A total of 434 Hispanic, Anglo-Caucasian, and African-American individuals with severe CHI. DESIGN: Retrospective cohort study. SETTING: Consecutive admissions to a level 1 trauma center. MAIN MEASURES: After admission to the trauma center, BAL was collected for each patient. Additional information regarding PI-ETOH was collected in a subset of patients (N = 116). Functional outcome was measured using the Disability Rating Scale (DRS) at 6 months after injury. RESULTS: A one-way analysis of variance revealed ethnic differences in mean BAL. Hierarchical multiple regression indicated that BAL did not predict DRS outcomes after controlling for pertinent covariates. An interaction effect between PI-ETOH and ethnicity was observed, such that presence of chronic alcohol use predicted worse functional outcome for Anglo-Caucasians and African-Americans, but more favorable outcome for Hispanics. CONCLUSIONS: Ethnic differences in BALs within our severe traumatic brain injury sample mirrored ethnic drinking patterns observed in the general population, with Hispanics having the highest BALs. A paradoxical relationship between PI-ETOH and functional outcome was observed for Hispanics.

Functional magnetic resonance imaging of working memory reveals frontal hypoactivation in middle-aged adults with cognitive complaints.

Older adults with cardiovascular disease (CVD) often complain about cognitive difficulties including reduced processing speed and attention. On cross-sectional examination, such reports relate more closely to mood than to cognitive performance; yet, in longitudinal studies, these complaints have foreshadowed cognitive decline over time. To test the hypothesis that self-reported cognitive difficulties reflect early changes in brain function, we examined cognitive complaints and depression in relation to blood oxygen level dependent (BOLD) response to a cognitive task in middle-aged adults at risk for CVD. Forty-nine adults (ages 40 to 60 years) completed a measure of perceived cognitive dysfunction (Cognitive Difficulties Scale), medical history questionnaire, neuropsychological assessment and functional magnetic resonance imaging (fMRI) during a working memory task. Increased report of cognitive difficulties was significantly associated with weaker task-related activation in the right superior frontal/ middle frontal gyrus (F(4,44) = 3.26; p = .020, CDS ß = -0.39; p = .009) and the right inferior frontal gyrus (F(4,44) = 3.14; p = .024, CDS ß = -0.45; p = .003), independent of age, education, and self-reported depressive symptoms. Lower activation intensity in the right superior frontal gyrus was related to trends toward poorer task performance. Thus, self-reported cognitive difficulties among cognitively normal middle-aged adults may provide important clinical information about early brain vulnerability that should be carefully monitored.

Current serum lipoprotein levels and FMRI response to working memory in midlife.

AIMS: Given that high cholesterol levels at midlife are a risk factor for future cognitive decline, the goal of the current study was to determine if cholesterol-related alterations in the cerebrovascular response to cognition could be detected at midlife. METHODS: Forty adults, aged 40-60 years, performed a 2-Back working memory task during fMRI. The associations between serum total cholesterol, HDL-cholesterol, and total cholesterol/HDL-cholesterol concentrations to task-related activation intensity were modeled using multivariate multiple regression (two-tailed p < 0.02). RESULTS: Higher levels of total cholesterol/HDL-cholesterol related to reduced working memory-related activation intensity in the left inferior parietal lobe, right superior frontal gyrus, and right middle frontal gyrus. CONCLUSION: These data provide preliminary support for a deleterious effect of elevated total cholesterol/HDL-cholesterol ratio on cerebrovascular support for cognition in midlife.

Psychopathic and nonpsychopathic inmates differ from normal controls in tolerance levels of electrical stimulation.

With a Tursky electrode applied to the ventral surface of the forearm two samples of inmates (28 psychopaths and 28 nonpsychopaths) were compared to 29 normal controls. No differences were found among the three groups in lower detection thresholds. While there was no difference between the inmate groups in terms of pain tolerance, both inmate groups had a higher tolerance for pain than did the controls. Results do not support previous findings or theories/hypotheses about pain thresholds in psychopathic and nonpsychopathic inmates. Differential learning and experience of pain among inmates, as well as the association among testosterone, dominance, extraversion, and criminality, are suggested to account for the results.

Sadism and other paraphilias in normal controls and aggressive and nonaggressive sex offenders.

Penile circumference responses (PCRs) to a visual age/gender erotic preference battery were analyzed from 60 normal controls and 227 sexual offenders. Sixty offenders were classified as sexual aggressives on the basis of their behavior and damage to their victims. The mean PCR to sadism slides (visual portrayals of nonsexual violence against fully clothed females) was significantly larger for the sexually aggressive group compared to the sexual nonaggressive offender and normal control groups. There were no significant differences in mean victim damage scores between the sexual aggressives who responded significantly to the sadism slides and those who did not. Thus, PCRs were not useful in identifying more from less dangerous sexual aggressives. The incidence of a clinically significant PCR to any of the four paraphilic categories included in the assessment battery was 28, 60, and 65% in the normal controls, sexual nonaggressives, and sexual aggressives, respectively. For sadism, it was 5, 8, and 45% respectively, for these groups. Pedophilia had a low incidence of co-occurrence with other paraphilias whereas sadism, transvestism/fetishism, and the courtship disorder paraphilias had a high incidence of co-occurrence.

Stimuli eliciting sexual arousal in genital exhibitionists: a possible clinical application.

The sexually arousing effects of erotic and nonerotic slides were monitored with a penile mercury strain gauge in 14 exhibitionists, 21 normal controls, and 34 nonexhibitionist sex offenders. Responses to 60 slides, constituting 12 distinct categories, were analyzed. The exhibitionists responded sexually to scenes of fully clothed erotically neutral females, whereas the two control groups did not respond to this slide material. No other significant differences were observed between the three groups on the remaining 11 categories. The results support previous reports of sexual arousal in exhibitionists to nonerotic signals from females and are consistent with a hypothesis of exhibitionists displaying culturally unapproved sexual display signals as a consequence of cortical disinhibition.