Clinical detection of intellectual deterioration associated with brain damage.

Leli and Filskov (1979) reported cross-validated classification accuracy that equalled 83% for a discriminant function derived on two measures of intellectual deterioration. This investigation made a preliminary assessment of the clinical utility of this function through a clinical-actuarial classification paradigm. Wechsler-Bellevue Intelligence Scale Form I protocols from 12 nonpsychotic nonimpaired and 12 cerebrally impaired individuals were used by experienced clinicians and predoctoral interns to identify the presence of intellectual deterioration associated with brain damage through their own clinical experience (Clinical Judgment condition) and, then, in conjunction with the discriminant function (Clinical-Actuarial condition). The classification accuracy from the discriminant function weights (Actuarial condition) and those from clinicians in the Clinical-Actuarial condition were statistically comparable and significantly above chance levels. These results indicate that the clinician who is assessing for the presence of intellectual deterioration associated with brain damage should rely heavily upon a valid actuarial index.

Actuarial assessment of Wechsler Verbal-Performance Scale differences as signs of lateralized cerebral impairment.

Long-standing clinical lore holds that a discrepancy between Wechsler-Bellevue (W-B) Verbal/Performance Scale weighted scores is a more sensitive sign of lateralized brain damage than a discrepancy between Verbal/Performance Scale IQ. To assess this question, two step-wise discriminant functions using W-B Verbal and Performance Scale weighted scores (Function 1) and IQs (Function 2) as independent variables were derived and cross-validated on right- and left-hemisphere-lesioned subjects. Cross-validation hit rates were statistically comparable through disappointingly low (Function 1-67%, Function 2-64%). These results do not support the clinical lore which favors a weighted discrepancy score over an IQ-discrepancy as a sign of lateralized cerebral impairment.

Actuarial detection and description of brain impairment with the W-B form I.

In conjunction with other psychological tests, actuarial prediction studies have used the adult Wechsler scales to detect and describe the nature of brain impairment. However, the classification base rates from the independent use of the adult Wechsler scales have not been determined empirically. This investigation addressed this problem by assessing the ability of these scales to identify the presence, chronicity, extent, and lateralization of brain impairment through four cross-validated discriminant functions (N = 150). Hit rates from the function that differentiated nonpsychotic nonimpaired from brain-impaired Ss equalled 79%, while hit rates that equalled 75% were obtained from a function that compared right- from left-hemisphere lesioned Ss. Hit rates equalled 50% for the two functions that made acute vs. chronic and lateralized vs. diffusely impaired comparisons, respectively. In addition to cross-validating them on larger samples, it was recommended that the clinical utility of the functions be determined though a clinical-actuarial prediction paradigm.

Clinical-actuarial detection and description of brain impairment with the W-B form I.

Assessed the clinical utility of four cross-validated discriminant functions derived on Wechsler-Bellevue (W-B) variables (Leli & Filskov, 1981) through a clinical-actuarial prediction paradigm. These functions were constructed to be actuarial indices of the presence, chronicity, extent, and lateralization of brain impairment. From W-B and demographic data gathered on brain-impaired and nonimpaired individuals, 6 students and 6 clinicians were asked to identify the presence and describe the nature of brain impairment with (Clinical-Actuarial condition) and without (Clinical Judgment condition) the four functions. Relative to the Clinical Judgment condition, Clinical-actuarial prediction was significantly better in identifying and determining the extent of brain impairment. Actuarial classification was significantly more superior in lateralizing deficits than were the other conditions. In both judgment conditions, students and clinicians did not differ significantly in classification accuracy. These results indicate that with actuarial indices, the adult Wechsler scales can be used accurately to identify and lateralize brain impairment.

Cognitive function in patients with multiple sclerosis.

The performance of patients with multiple sclerosis on selected psychological tests was examined to ascertain the usefulness of such examinations to diagnosis. Cognitive impairment was studied in relationship to disease-related factors, physician's identification of cerebral involvement, and psychological adjustment. The results indicate that half the subjects exhibited cognitive impairment. Levels of neurologic involvement, physical impairment, and depression were not predictive of cognitive impairment. Of the subjects who were judged on neurological examination to have intact mentation, half were actually impaired. Impaired cognitive functioning, which is often not detected through routine examination, may occur early in the disease. These deficits may represent manifestations of otherwise undetectable plaques in the subcortical white matter.

Neuropsychological effects of electroconvulsive therapy.

Although ECT as the treatment of choice for psychotic depression has been in use for many years, little is known about the neocortical residual of such treatments inferred from behavioral measures. The major portion of the literature has been concerned with inferred or observed changes in affective state. The present study compared pre- and posttreatment performances on the Halstead-Reitan neuropsychological battery of 20 patients who were receiving ECT from two different machines. Most Ss gave indicators of cerebral impairment prior to treatment when performance of one side of the body was contrasted with performance of the other side. After treatment, there was an increased number of Ss who evidenced signs consistent with damage to the right cerebral hemisphere. Some concern was raised that a large number of patients who eventually are subject ot ECT because of depression behave in this way because of an undiagnosed neocortical dysfunction. There is some suggestion that the effect of the procedure is to either create or intensify a right hemisphere focus as inferred from behavioral measures.