Neuroradiologic correlates of cognitive impairment in adult Moyamoya disease.

BACKGROUND AND PURPOSE: MMD has been shown to result in impairment of executive functioning in adults. The purpose of this study was to correlate presurgical neuropsychological assessments with the severity of primary MMD as measured by CBF and CVR and with secondary damage from MMD as estimated by cortical stroke and WMD. MATERIALS AND METHODS: A retrospective analysis of 31 adult patients with MMD was performed. Xe-CT was used to obtain CBF and CVR, and MRI was reviewed to grade cortical stroke and WMD. Two tests of executive functioning (FAS and TMT-B) were correlated with imaging findings. A multiple regression analysis was performed. RESULTS: There was a significant overall positive relationship between mean CBF and FAS (P = .038) and TMT-B scores (P = .014). A significant negative relationship was present between the WMD score and the FAS (P = .009) and TMT-B scores (P = .015). Per-region analysis demonstrated that FAS and TMT-B scores were significantly decreased by the presence of a posterior stroke (P < .0001 and P = .001) or WMD (P = .006 and P = .004). All patients with posterior parieto-occipital WMD or stroke also had secondary disease in the anterior regions. CONCLUSIONS: Impaired executive functioning in adults with MMD is most strongly associated secondary damage in the form of WMD or cortical stroke. The effect is most profound with parieto-occipital lobe involvement, likely a reflection of overall disease severity. Increasing global WMD burden may be a better indicator of cognitive decline than cortical infarction. Patients with higher baseline CBF seem to have better cognitive functioning.

Impact of musical experience on the Seashore Rhythm Test.

The Seashore Rhythm Test (SRT) is sensitive to musical talent. The possibility that this reduces its clinical sensitivity in cognitively impaired persons with musical experience was investigated. Subjects were 101 referrals to the neuropsychology service of a large medical center. The results indicate that patients with a substantial amount of musical experience tend to perform normally on the SRT, even when overall performance on a neuropsychological test battery suggests cognitive impairment. This finding suggests caution in interpreting normal SRT results in those with a musical background.

Validity of the serial seven procedure.

Serial subtraction by seven (Serial Seven Test, SST) is frequently used in mental status evaluation for dementia as a measure of concentration. Validation research on the SST has been limited. The literature to date raises significant concern about the nature of the procedure. The purpose of the present study was to evaluate the nature and validity of the SST. The participants were 80 consecutive outpatient referrals to the neuropsychology consultation service of two large general medical hospitals. All subjects were administered a comprehensive neuropsychological assessment battery, including the Mini Mental State Examination version of the SST. Multiple regression analysis indicated that calculation skill is at least as important as concentration, in predicting SST performance. Measures of overall level of cognitive dysfunction, education, and psychopathology were unrelated to SST performance. The results suggest that SST performance is heavily influenced by basic arithmetic skill and that the procedure should be used with caution as a measure of concentration or other nonacademic mental abilities.

Late-onset post-concussion symptoms after mild brain injury: the role of premorbid, injury-related, environmental, and personality factors.

The present study investigated the possible role of a number of pre- peri-, and post-traumatic factors in the experience of post-concussion syndrome (PCS). These factors included: (1) history of premorbid risk factors, (2) severity of injury, and (3) post-morbid functioning and environmental factors. Subjects were 55 persons with mild brain injury. PCS was defined in terms of the severity and impact of 'late-onset' symptoms. Pre- and peri-traumatic factors were not associated with level of PCS symptom impact. Among post-traumatic factors, only level of psychological distress was strongly associated with impact level. The results suggest the importance of psychological factors in prolonged PCS.

Family stressors in traumatic brain injury: a two-year follow-up.

A review of the literature suggests that psychosocial disability in traumatic brain-injured (TBI) individuals and distress in families continues long after the initial injury. In this study the relationship of family stress to a number of factors was studied longitudinally. Caregivers of 51 TBI inpatients were interviewed at rehabilitation admission and by phone at 6, 12, and 24 months postinjury. Caregivers' most common complaints about their relatives were a lack of involvement in leisure activities, fatigue, slowness, and forgetfulness. Increasingly severe temper outbursts, anxiety, and self-centeredness were reported over time. Aggressiveness was reported by caregivers as moderate or severe in 31% of cases by 2 years postinjury. Of all complaints, only reports of inappropriate social behavior decreased over time. Despite caregivers' increasing complaints about their relatives, there were no trends toward greater self-reported stress over time. At the 2-year assessment, stress was significantly higher for caregivers of those with an at risk psychosocial history, and for those without sufficient funds for services. Caregivers reporting financial strain increased 22% from rehabilitation admission. Forty-seven percent of caregivers had altered or given up their jobs at 1 year postinjury, and 33% at 2 years postinjury. Although self-perceived measurements of stress did not increase over time, caregivers reported notable increases in medication use and substance use, and decreases in employment and financial status over the 2-year time period. When spouse and parent caregiver responses were compared, spouses reported a consistently greater number of behavioral problems, which increased in severity over time. Those behaviors associated with mood disturbances predominated.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy study of THINKable in the attention and memory retraining of traumatically head-injured patients.

The efficacy of computer-assisted attention and memory retraining was evaluated with 15 severely head-injured patients. Training with selected exercises tailored to the individual's needs were provided from the THINKable program for up to 20 hours in both the attention and memory remediation modules. The experimental design evaluated outcome by juxtaposing multiple baseline procedures with a pre- and post-group comparison. Significant results were documented on the computerized tasks, psychometric measures and on patient and observer ratings of everyday behaviours of attention and memory.

Prediction of long-term cognitive outcome of brain injury with neuropsychological, severity of injury, and demographic data.

A comparison was made of the relative power of a brief post-injury neuropsychological assessment and a brain-injury severity measure (PTA) to predict long-term cognitive outcome after severe brain injury. Subjects were 78 patients with severe brain injury. Regression analysis revealed that neuropsychological variables were as predictive of outcome as PTA. A combination of neuropsychological, brain-injury severity, and demographic variables predicted a substantial proportion of variance in both general cognitive ability and memory functioning at outcome. Removal of PTA from the set of predictors had only modest impact on predictive power, suggesting that, in the absence of accurate injury severity data, meaningful prediction about long-term cognitive outcome can still be made.

The neuropsychological phenotype in Turner syndrome.

Numerous studies have demonstrated a significant depression in performance IQ (PIQ) in Turner Syndrome (TS) females, but the neuropsychological interpretation of this finding remains unclear. The present study addressed the following questions regarding the neuropsychological phenotype in TS: Are TS women neuropsychologically impaired? Is the impairment lateralized and How consistent is the neuropsychological phenotype across TS individuals? Unlike previous studies, the present study utilized both normal and brain damaged female controls. All subjects were given an extended Halstead-Reitan neuropsychological battery. The TS females were significantly worse than normals but not significantly different from brain damaged females in their overall level of neuropsychological functioning. However, their impairment was not lateralized. Their pattern of lateralizing findings was similar to that found in the Diffuse and Normal groups, but significantly different from either the right or left unilateral lesion groups. Fairly consistent deficits were found on tests of visuospatial skills and long term memory, but there was considerable variability in all the other test findings among TS individuals. The results are discussed in relation to the recent findings (Inglis and Lawson, 1981) that verbal-performance IQ discrepancies may be unreliable indicators of lateralized cerebral dysfunction in females. Hence the depressed PIQ in TS appears not to indicate predominantly right hemisphere dysfunction and may not even indicate a consistent underlying neuropsychological phenotype.

Utility of the Seashore Tonal Memory Test in neuropsychological assessment.

This study assessed the diagnostic utility of the Seashore Tonal Memory Test in detecting and localizing cerebral lesions. A group of 238 subjects with focal or diffuse cerebral lesions and a group of 112 normal comparison subjects were administered the Seashore Tonal Memory Test and the Halstead-Reitan Battery. All brain-damaged subgroups did significantly worse than the normal group on the Tonal Memory Test. Patients with right-hemisphere lesions were more impaired on this test than were those with left-hemisphere lesions. In contrast, Seashore Rhythm Test scores were not significantly different for groups with right- versus left-hemisphere lesions. Tonal Memory performance was not found to be related to more precise location of structural lesions within the right hemisphere. Step-wise discriminate function analyses indicated that the Tonal Memory Test adds to the Halstead-Reitan Battery in discriminating left-hemisphere from right-hemisphere lesions and that, for this purpose, it was a better discriminator than all but one of the individual tests currently in the battery.

Use of demographic variables to predict full scale IQ: a replication and extension.

The evaluation of current level of neuropsychological functioning is handicapped by the lack of validated actuarial methods for estimating premorbid intellectual functioning. The present study cross-validated and attempted to improve the one existing method of using demographic variables in a systematic way to predict WAIS Full Scale IQ (Wilson et al., 1978). A sample of 491 neurologically normal subjects was used. The results generally supported the IQ prediction equation, but did reveal systematic differences in accuracy of prediction and direction of prediction error for IQs in the high and low ranges. Also, a simpler IQ prediction formula that uses only years of education was developed and compared with the 5-variable Wilson et al. formula.

The relationship between level of adjustment and expectations for therapy.

Investigated Goldstein's (1962) hypothesis of a curvilinear relationship between client expectancy and psychotherapy outcome, based partly on a similar relationship between client expectancy and adjustment. One hundred and ten new clients at a university counseling center completed self-assessments and were rated on an adjustment scale by their therapists at the beginning and end of therapy. There was no curvilinear relationship between adjustment and expectancy, but a linear relationship between expectancy and self-assessed outcome was found. Because no relationship was obtained between expectancy and therapist-defined outcome, method variance may account for the association between expectancy and outcome from the client's perspective.

Nocturnal biofeedback for nocturnal bruxism.

Reports have appeared recently describing the successful reduction of nocturnal bruxism through nocturnal biofeedback. These claims of effective treatments rest mainly on the use of a single index of integrated masseter EMG levels as a measure of bruxism and are based only on short-term effects. The present study was conducted to provide a more rigorous evaluation of the effectiveness of nocturnal biofeedback for nocturnal bruxism through the use of all-night polysomnographic recordings. The results from multiple indices of bruxism are internally consistent and indicate that simple nocturnal biofeedback does not appear to be effective in reducing nocturnal bruxing. Recommendations are made for a more comprehensive approach to the treatment of nocturnal bruxism.