The effect of moderate to heavy alcohol consumption on neuropsychological performance as measured by the repeatable battery for the assessment of neuropsychological status.

BACKGROUND: Excessive alcohol use is associated with damage to the structure and function of the brain and impairment of cognition and behavior. Traditional test batteries used to assess cognitive performance in alcoholics are extensive and costly, limiting their use across various clinical and research settings. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a relatively new instrument that attempts to overcome some of these limitations. As yet the individual effect of moderate to heavy alcohol consumption on RBANS performance has not been examined. The primary aim of this study was to explore and quantify differences in performance between controls and drinkers on the RBANS and to examine the influence of age, gender, and alcohol use patterns on test performance. METHODS: Data from a subset of "Using Our Brains" (UoB) donors (n = 28) still actively drinking and meeting criteria for moderate to heavy alcohol use (30 to 80 g of ethanol per day) (Harper, 1988) and 28 matched controls (age, education, and premorbid Intelligence Quotient) were compared. RESULTS: Participants in the alcohol group performed below the healthy control group on the visuospatial and immediate memory index, and also on the RBANS total score p < 0.001 and showed a greater decline in RBANS scores from estimated cross-sectional premorbid levels. There was a positive association between alcohol ingestion in the preceding 12 months and the language index p < 0.03 and the semantic fluency subtest (p < 0.03). Age was negatively associated with story memory (p < 0.02), coding (p < 0.001), list recognition (p < 0.01), story recall (p < 0.03), and figure recall (p < 0.02). CONCLUSION: Our results suggest that the RBANS is able to detect and characterize differences in verbal fluency, visuospatial skills, components of declarative memory, and psychomotor speed between healthy controls and moderate to heavy active alcohol users. Executive functions, commonly affected by alcoholism and not included in the RBANS, require assessment with additional measures.

Effects of diffuse axonal injury on speed of information processing following severe traumatic brain injury.

To test the hypothesis that slowed information processing in traumatic brain injury is related to diffuse axonal injury (DAI), the authors compared 10 patients with predominant DAI (diffuse group) and minimal DAI (mixed injury group) on the Symbol Digit Modalities Test, simple and choice reaction time, Trail Making Tests A and B, and the Stroop Neuropsychological Screening Test. The diffuse group was slower than the mixed injury and control groups on basic speed of processing tasks. This difference was not apparent on complex speeded tasks once basic speed of processing was controlled for. The diffuse group's slower speed of processing was not accounted for by differences in injury severity, age, or time postinjury. The diffuse group showed greater recovery over time.

Pharmacological management of Dysautonomia following traumatic brain injury.

PRIMARY OBJECTIVE: To document and critically evaluate the likely effectiveness of pharmacological treatments used in a sample of patients with Dysautonomia and to link these findings to previously published literature. RESEARCH DESIGN: Retrospective case control chart review. METHODS AND PROCEDURES: Data were collected on age, sex and GCS matched subjects with and without Dysautonomia (35 cases and 35 controls). Data included demographic and injury details, physiological parameters, medication usage, clinical progress and rehabilitation outcome. Descriptive analyses were undertaken to characterize the timing and frequency of CNS active medications. MAIN OUTCOMES AND RESULTS: Dysautonomic patients were significantly more likely to receive neurologically active medications. A wide variety of drugs were utilised with the most frequent being morphine/midazolam and chlorpromazine. Cessation of morphine/midazolam produced significant increases in heart rate and respiratory rate but not temperature. Chlorpromazine may have modified respiratory rate responses, but not temperature or heart rate. CONCLUSIONS: The features of Dysautonomia are similar to a number of conditions treated as medical emergencies. Despite this, no definitive treatment paradigm exists. The best available evidence is for morphine (especially intravenously), benzodiazepines, propanolol, bromocriptine and possibly intrathecal baclofen. Barriers to improving management include the lack of a standardized nomenclature, formal definition or accepted diagnostic test. Future research needs to be conducted to improve understanding of Dysautonomia with a view to minimizing disability.

Sex differences in injury severity and outcome measures after traumatic brain injury.

OBJECTIVE: To investigate the effect of a patient's sex on various measures of injury severity and outcome after rehabilitation in a matched sample of patients with traumatic brain injury (TBI). DESIGN: Retrospective data were retrieved from a database that contains information routinely collected on all patients admitted for inpatient rehabilitation. SETTING: Inpatient rehabilitation unit of major teaching hospital in Australia. PARTICIPANTS: Fifty-four women with TBI after a motor vehicle crash (MVC) were identified from the Brain Injury Rehabilitation Database. An equal number of men were then matched for age and years of education. All subjects met the study admission criteria of having being involved in a high-speed MVC. Exclusion criteria included history of a previous head injury, chronic amnesia, psychiatric disturbance, and significant alcohol and/or substance abuse. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Differences, by sex, in patient scores on measures of injury severity and outcome after TBI. RESULTS: Men had significantly greater levels of injury severity as indicated by the Glasgow Coma Scale scores (U=994.0, P=.002) and length of posttraumatic amnesia (U=880.0, P=.016) when compared with women. No significant sex differences existed in the outcome measures or in injuries not associated with the central nervous system. CONCLUSIONS: Few investigations exist on the effect of patient sex on measures of injury severity and outcome after a TBI. In the present study, men's levels of injury severity were greater than women's despite the same admission criteria (high-speed MVC) being applied to both sexes.

Meta-analysis of psychosocial interventions for caregivers of people with dementia.

OBJECTIVES: To review published reports of interventions for caregivers (CGs) of persons with dementia, excluding respite care, and provide recommendations to clinicians. DESIGN: Meta-analytical review. Electronic databases and key articles were searched for controlled trials, preferably randomized, published in English from 1985 to 2001 inclusive. Thirty studies were located and scored according to set criteria, and the interventions' research quality and clinical significance were judged. SETTING: Home or noninstitutional environment. PARTICIPANTS: Informal CGs-persons providing unpaid care at home or in a noninstitutional setting. MEASUREMENTS: The primary measures were psychological morbidity and burden. Other varied outcome measures such as CG coping skills and social support were combined with measures of psychological distress and burden to form a main outcome measure. RESULTS: The quality of research increased over the 17 years. Results from 30 studies (34 interventions) indicated, at most-current follow-up, significant benefits in caregiver psychological distress (random effect size (ES) = 0.31; 95% confidence interval (CI) = 0.13-0.50), caregiver knowledge (ES = 0.51; CI = 0.05-0.98), any main caregiver outcome measure (ES = 0.32; CI = 0.15-0.48), and patient mood (ES = 0.68; CI = 0.30-1.06), but not caregiver burden (ES = 0.09; CI = -0.09-0.26). There was considerable variability in outcome, partly because of differences in methodology and intervention technique. Elements of successful interventions could be identified. Success was more likely if, in addition to CGs, patients were involved. Four of seven studies indicated delayed nursing home admission. CONCLUSION: Some CG interventions can reduce CG psychological morbidity and help people with dementia stay at home longer. Programs that involve the patients and their families and are more intensive and modified to CGs' needs may be more successful. Future research should try to improve clinicians' abilities to prescribe interventions.

Defining the role of the caregiver in Alzheimer's disease treatment.

The day-to-day responsibility of caring for a person with dementia often exacts a toll upon the caregiver, which may be manifested psychologically, physically, socially and financially. The last decade has witnessed the advent of drug availability for the treatment of Alzheimer's disease, specifically the cholinesterase inhibitors. Caregivers are integral to the initiation, administration and monitoring of treatment. In particular, they provide substitute informed consent when patients are no longer competent to do so. While there is evidence that cholinesterase inhibitors may reduce caregiver burden and time spent assisting patients, there are also burdens associated with being the person responsible for administering medication. Caregivers are key to research into the use of medications for Alzheimer's disease. They have roles in recruitment and consent and monitoring response and adverse effects. Increasingly, caregivers themselves are recognised as legitimate targets for evaluating the efficacy of new pharmacological agents for Alzheimer's disease (as benefits have been demonstrated for them). Caregivers have responsibilities regarding the drug treatment of patients with Alzheimer's disease, and require information about the medications so that they can have realistic expectations. Doctors need to work in partnership with caregivers and patients when prescribing drugs for Alzheimer's disease.

Who cares for the carer? The often forgotten patient.

BACKGROUND: Dementia not only affects the patient but also those nearest the patient most notably the carer. It is known that caring for a patient with dementia can adversely affect one's psychological, physical, social and financial health. OBJECTIVE: To highlight the needs of the carer of a patient with dementia and suggest means by which general practitioners may provide the necessary support for these carers. DISCUSSION: The GP has a key role in providing support to the carer of the patient with dementia. General practitioners and carers can work as partners in the long term management of dementia thereby reducing the adverse health effects on the carer.

Is 'gamma' (40 Hz) synchronous activity disturbed in patients with traumatic brain injury?

OBJECTIVES: The objective of this work is to determine whether Gamma (40 Hz) synchronous activity has disturbed patients with severe traumatic brain injury (TBI). METHODS: Using a conventional auditory oddball paradigm, the extent of Gamma synchrony across multiple scalp sites in specific frequency bands as a function of time was examined in 15 patients with severe TBI and 15 age- and sex-matched controls. Averaged Gamma synchrony was analyzed using within and between group multiple analyses of variance with region (left versus right hemisphere, anterior versus posterior region) as the within factor. RESULTS: Compared to controls, subjects with TBI displayed significantly delayed early Gamma latency (from -150 to 150 ms) (F((1,28))=10.28, P<0.003) across all sites in addition to other specific regional disturbances. For late Gamma synchrony, subjects with TBI displayed delayed Gamma latency at the left hemisphere (from 200 to 450 ms) (F((1,28))=8.71, P<0.006) and posterior region (F((1,28))=9.18, P<0.006) in comparison to controls. CONCLUSIONS: Impaired integration of spatially distributed brain activity ('40 Hz' electroencephalogram rhythms) may be an important marker of deficits of cortical network binding postulated to be abnormal in people who have survived TBI.

Perceptual learning in the rat: stimulus differentiation or latent inhibition of common elements?

Preexposure to an unreinforced stimulus facilitates learning (perceptual learning) under some conditions, but it can have the opposite effect (latent inhibition) under other conditions. Researchers have suggested that perceptual learning depends on a change of context, whereas latent inhibition is usually context specific. The associative theory explains both phenomena within a single framework. The authors report 4 experiments that show that perceptual learning does not depend on a context change. The experiments suggest that latent inhibition, unlike perceptual learning, depends on passive exposure. Thus the results do not support the associative theory. They are more consistent with Gibson's stimulus-differentiation theory.