Motor dysfunction profiles in traumatic brain injury and postconcussion syndrome.

Motor measures are sensitive to central lesions, but they are also affected by peripheral injury and motivation. The motor skills profiles of proven brain injury clients were compared with the profiles of healthy postconcussion patients. The chief result was a double dissociation: The traumatic brain injury (TBI) group produced a motor dysfunction gradient consistent with upper motor neuron disease, while the compensation-seeking postconcussion group produced a nonphysiologic pattern. Objective measures of behavioral pain and emotional distress did not correlate with the findings. Motor skill deficiencies in postconcussion syndrome (PCS) are probably functional in nature.

Comparison of multiple scoring methods for Rey's malingered amnesia measures.

The predictive accuracy of Andre Rey's malingered amnesia measures (Memory for Fifteen Items and Word Recognition List) was examined. Discriminant function and crosstabulation analytic strategies were applied to predict membership in either a traumatically brain injured group (n = 60) or in a litigated minor head injury group claiming permanent severe disability (n = 90). Satisfactory hit rates were achieved with Rey's original scoring methods, but improved hit rates were obtained with scoring modifications. Removal of dense amnesiacs from the sample resulted in even better hit rates. Rey's measures appear to be valid for the assessment of cognitive malingering in settings where litigated disability claims are out of proportion to injury characteristics. Rey's measures are not appropriate for globally and severely impaired patients in clinical settings.

Carbamazepine offers no psychotropic advantage over phenytoin in adult epileptic subjects.

We compared 19 men on carbamazepine (CBZ) monotherapy with 19 men on phenytoin (PHT) monotherapy, all of whom had standard therapeutic levels. The two groups were matched for age, sex, education, premorbid predicted IQ, seizure frequency, duration, number, type and aetiology, weekly ethanol consumption and psychiatric history. The two groups did not differ statistically on self- and reliable-informant rated personality inventories, word recognition, face recognition, confrontation naming, finger oscillation or trailmaking series completion times. These data fail to support a behavioural and cognitive advantage of CBZ over PHT in adult epileptics.

Waves earlier than P3 are more informative in putative subcortical dementias: a study with mapping and neuropsychological techniques.

Thirty subjects (normal controls, patients with putative subcortical dementia and non-demented patient controls) were studied using advanced neurophysiological (16 scalp-electrode positions, computer-assisted brain electrical activity mapping, auditory oddball paradigm) and neuropsychological techniques. Our study suggests that waves earlier than P3 (N1, P2 and N2) are all correlated with global measures of cognitive functions. They are, however, differentially correlated with specific measures of cognitive functions, N1 and P2 with mental speed and N2 with short-term memory. The abnormalities of these waves (earlier than P3) may be an electrophysiologic marker of dementia in patients with putative subcortical states.

Pathogenesis of reduplicative paramnesia.

The incidence of reduplicative paramnesia was sampled with a structured interview in 50 consecutive alcoholic inpatients. Four had reduplicative paramnesia (RP group) and 46 did not (non-RP group). Three of four patients in RP group had acute right hemispheric lesions and none had a left hemispheric lesion; 19 non-RP patients had left hemispheric lesions, 2 had right, and 25 had none. These data are in keeping with the previous suggestions that the neuroanatomical basis for reduplicative paramnesia is an acute right hemispheric lesion superimposed on chronic diffuse or bifrontal deficit.

Neuropsychological improvement following endarterectomy as a function of outcome measure and reconstructed vessel.

30 patient receiving right or left carotid reconstruction and 15 medically matched controls were compared pre- and post-surgically on measures of motor speed, sustained vigilance, verbal memory and verbal and nonverbal intellectual function. The group receiving right sided vessel reconstruction demonstrated the largest post-operative improvement in intellectual function in any of the groups. The findings suggest that increased blood perfusion following right sided endarterectomy facilitates the right hemisphere's exclusive control of bilateral attention/arousal responses. In addition, findings suggest that detection of post-endarterectomy improvement may be dependent on the specific task dimension sampled, e.g., speed vs. cognitive ability and verbal-graphic vs. nonverbal symbol manipulation.

Electrophysiologic validation of two categories of dementias--cortical and subcortical.

Recently, the dementias have been classified into 2 categories-Cortical (CD) and Subcortical (SD). Some studies have questioned this classification. We attempted to validate the classification on electrophysiologic grounds. Fourteen of 15 patients with SD had relatively normal EEGs as compared to only 3 of 15 patients with CD, matched for age, sex and severity of dementia (p greater than 0.01). SER test results were often abnormal in the SD group but always normal in CD patients. These preliminary data appear to validate the classification of dementias into SD and CD categories.