[A neurofunctional model of consciousness: its neurophysiological and cognitive bases]. / Modelo neurofuncional de la conciencia: bases neurofisiologicas y cognitivas.

Interest in the causal relation between consciousness and the underlying neuronal activity has grown in recent decades. Numerous experimental studies have been carried out on the brain structures and networks underlying consciousness in animal models, in patients with brain damage and with very precise functional neuroimaging. In spite of the great multitude of findings, there is no theoretical proposal that integrates this knowledge under a coherent theoretical framework based on the evidence obtained. Existing theories offer a dismembered view of consciousness, since they pose causal explanations that do not include a global functional perspective of the interaction of the different brain networks involved in consciousness. This work offers a theoretical framework that integrates the empirical knowledge, generated in recent decades, into a neurofunctional model of consciousness. This model represents consciousness as an epiphenomenon resulting from the sequential activation of different neural loops that are formed by specific brain structures and networks which receive feedback from their own operations in order to reconfigure their own functional states and the entire system. The ascending reticular activating system, the thalamocortical networks and the cortico-cortical networks sustain cognitive processes that are differentiated, although highly dependent and fundamental for the final experience of consciousness. All these systems form a single physiological space where the individual can deploy different cognitive skills that allow the emergence of complex behaviours such as language, thought and social cognition.

TITLE: Modelo neurofuncional de la conciencia: bases neurofisiologicas y cognitivas.El interes por la relacion causal existente entre la conciencia y la actividad neuronal subyacente ha aumentado en las ultimas decadas. Se han llevado a cabo numerosos estudios experimentales en modelos animales, en pacientes con daño cerebral y con neuroimagen funcional con una excelente precision sobre las estructuras y redes cerebrales que subyacen a la conciencia. A pesar de la gran multitud de hallazgos, no existe una propuesta teorica que integre este conocimiento bajo un marco teorico coherente basado en las evidencias obtenidas. Las teorias existentes ofrecen una vision desmembrada de la conciencia, ya que plantean explicaciones causales que no incluyen una perspectiva funcional global sobre la interaccion del conjunto de redes cerebrales involucradas en la conciencia. Este trabajo ofrece un marco teorico que integra el conocimiento empirico, generado en las ultimas decadas, en un modelo neurofuncional de la conciencia. Este modelo representa la conciencia como un epifenomeno resultante de la activacion secuencial de diferentes bucles neuronales que estan formados por estructuras y redes cerebrales especificas retroalimentadas por sus propias operaciones para poder reconfigurar sus propios estados funcionales y todo el sistema. El sistema reticular activador ascendente, las redes talamocorticales y las redes corticocorticales sostienen procesos cognitivos diferenciados, aunque altamente dependientes y basicos para la experiencia final de conciencia. Todos estos sistemas forman un unico espacio fisiologico en donde el individuo puede desplegar diferentes habilidades cognitivas que permiten la emergencia de conductas complejas como el lenguaje, el pensamiento y la cognicion social.

Acute predictors for mortality after severe TBI in Spain: Gender differences and clinical data.

OBJECTIVE: The main objective of this study is to determine whether gender affects global mortality and functional outcome after severe traumatic brain injury (TBI). METHODS: This retrospective cohort study included 629 patients with severe TBI (14.9% female) admitted to the ICU of a university hospital. Patients were split into gender groups to study potential differences in global mortality and functional outcome at ICU discharge and 6 months post-trauma using the GOS. The following variables were analysed: age, intracranial injury, injury mechanism, injury severity, factors contributing to secondary brain injury, monitoring level, treatment, complications, length of stay in the ICU and cause of death. RESULTS: No differences were found between gender groups in neuromonitoring level or surgical procedures. Women had higher APACHE II scores, a higher incidence of pre-hospital hypotension, anaemia and transfusion and higher mortality rates in the ICU (OR = 1.74; 95% CI = 1.09-2.77) and 6 months post-trauma (OR = 1.65; 95% CI = 1.02-2.67). There were no significant differences in functional outcome at ICU discharge or 6 months post-injury. The multivariate analysis did not show gender as an independent predictive factor in mortality after severe TBI. CONCLUSION: In this study, gender was not found to be an independent predictor for poorer outcome after severe TBI.

[Predictors of the recovery of cognitive functions in patients with traumatic brain injury]. / Predictores de la recuperación funcional cognitiva en pacientes con traumatismo craneoencefálico.

INTRODUCTION: After a traumatic brain injury (TBI), cognitive functionality may be severely altered. Some studies have aimed at identifying the best predictive variables for cognitive recovery, however, results still remain unclear. AIMS: To assess the recovery of cognitive functionality in TBI patients after a rehabilitation programme, and to identify the variables that best predict the cognitive recovery. PATIENTS AND METHODS: We conducted a retrospective pre-post study with 58 adult TBI patients that underwent an intensive rehabilitation programme. All of them were assessed using the cognitive functions sub-scale from the FIM+FAM scale, at admission and discharge. Both scores were compared using non-parametric test Wilcoxon. Cognitive functionality gain percentage was calculated and correlated with all the collected data. A multiple linear regression analysis was carried out to identify the best predictors of cognitive functionality gain percentage by introducing all clinical, demographic and cognitive information. RESULTS: The group's cognitive functionality increased significantly from 33,6% to 85% (p < 0,01). Patients with higher cognitive functionality gain percentage were those with younger age, shorter time post-TBI, and higher scores on cognitive functions sub-scale, conditional attention and Luria's memory word tests. The best predictors for cognitive functionality gain percentage were time post-TBI and cognitive functions at admission (adjusted R(2) = 55,8%). CONCLUSIONS: Patients who started rehabilitation sooner and had a higher cognitive functionality at admission, showed the greatest increase in cognitive functionality gain percentage. Other variables like age, or scores on cognitive tests must also be considered in future studies.

TITLE: Predictores de la recuperacion funcional cognitiva en pacientes con traumatismo craneoencefalico.Introduccion. Tras un traumatismo craneoencefalico (TCE), el funcionamiento cognitivo de los pacientes puede resultar gravemente alterado. Diversos estudios han tratado de identificar las variables que mejor predicen su recuperacion. Objetivos. Evaluar la recuperacion funcional cognitiva de pacientes con TCE tras un programa de neurorrehabilitacion e identificar las variables predictoras de dicha recuperacion. Pacientes y metodos. Estudio pre-post retrospectivo de 58 pacientes adultos con TCE que realizaron un programa de rehabilitacion intensivo. Todos fueron evaluados mediante la subescala de funcionalidad cognitiva de la medida de la independencia funcional + medida de la evaluacion de la funcionalidad (FIM+FAM), al inicio y al final de la rehabilitacion. Ambas puntuaciones fueron comparadas mediante la prueba no parametrica de Wilcoxon. Se calculo el porcentaje de ganancia funcional cognitiva y se correlaciono con todas las variables recogidas. A partir de toda la informacion clinica, demografica y cognitiva recogida, realizamos un analisis de regresion lineal multiple para identificar los mejores predictores de dicha ganancia. Resultados. La funcionalidad cognitiva aumento significativamente del 33,6% al 85% (p < 0,01). Los pacientes con mayor porcentaje de ganancia funcional cognitiva fueron aquellos con menor edad y periodo post-TCE, y mayores puntuaciones en la subescala cognitiva de la FIM+FAM y en las pruebas de atencion condicional y curva de aprendizaje de Luria. Los mejores predictores de la recuperacion funcional fueron el periodo post-TCE y la funcionalidad cognitiva al inicio (R2 ajustado = 55,8%). Conclusiones. El comienzo temprano de la rehabilitacion y la mayor funcionalidad cognitiva al inicio resultaron ser los mejores predictores de la recuperacion funcional cognitiva. Otras variables, como la edad o puntuaciones en pruebas cognitivas, tambien deben considerarse en futuros estudios.

Accuracy of the S100ß protein as a marker of brain damage in traumatic brain injury.

INTRODUCTION: This study tested the hypothesis that S100ß is a useful screening tool for detecting intracranial lesion (IL) in patients with a normal level of consciousness after traumatic brain injury (TBI). METHODS: One hundred and forty-three post-TBI patients without a decrease in consciousness (GCS = 15) and with at least one neurological symptom (e.g. transitory loss of consciousness, amnesia, headache, dizziness or vomiting) were prospectively included. A blood sample was drawn at 6-hours post-TBI. A routine CT scan was obtained within 24 hours post-injury. Diagnostic properties of S100ß for IL prediction in CT scan findings were tested using ROC-analysis. RESULTS: A total of 15 patients (10.5%) had IL. Serum levels were significantly higher in these patients. Significant differences were found between S100ß levels and CT scan findings (p = 0.007). ROC-analysis showed that S100ß is a useful tool for detecting the presence of IL in CT scans (p = 0.007). In this series, the best cut-off for S100ß is 0.130 µg L(-1), with 100% sensitivity and 32.81% specificity. CONCLUSION: Within the first 6 hours post-TBI, serum S100ß seems to be an effective biochemical indicator of IL in patients without a decrease in consciousness. These results indicate that higher S100ß cut-off values substantially improve the clinical relevance of this protein.

Skull fracture, with or without clinical signs, in mTBI is an independent risk marker for neurosurgically relevant intracranial lesion: a cohort study.

PRIMARY OBJECTIVE: To explore the possibility of identifying skull fracture, with or without clinical signs, as a predictor of positive CT scans in mild traumatic brain injury (mTBI). RESEARCH DESIGN: Prospective cohort study, matched 1:1 for five potential confounding variables (age, sex, symptoms, mechanism of injury and extracranial trauma severity). METHODS AND PROCEDURES: The study was performed on patients with mTBI (Glasgow Coma Scale 15-14), with or without radiologically demonstrated skull fracture. The cohort with skull fracture included 155 patients selected from a sample of 5097 mTBI patients treated during 1998 at the Critical Care and Emergency Department of the Trauma Centre. The cohort without skull fracture was prospectively recruited from patients with mTBI treated in the same department from 2002-2005. MAIN OUTCOMES AND RESULTS: The percentage of patients with intracranial lesion (IL) was significantly higher in mTBI patients with skull fracture than in those without. The risk of requiring neurosurgery was 5-fold higher when skull fracture was present. Of mTBI patients with skull fracture and IL, 63.2% showed no clinical signs of bone injury. CONCLUSIONS: Skull fracture, with or without clinical signs, in mTBI patients is associated with an increased risk of neurosurgically-relevant intracranial lesion.

Brain function in the minimally conscious state: a quantitative neurophysiological study.

OBJECTIVE: To explore possible EEG power spectrum and coherence differences between patients in minimally conscious state (MCS) and patients with severe neurocognitive disorders (SND), who show signs of awareness. We also try to find EEG cortical sources that differentiate between both conditions using LORETA source analysis. METHODS: We studied 16 patients with traumatic brain injury (7 MCS, 9 SND; aged 18-49) and compared EEG power spectra, coherence, and LORETA sources at rest for both groups. RESULTS: EEG power spectra revealed significant differences in the delta range of both conditions. Patients in MCS showed a notably increased power in this band, compared to SND patients. LORETA analysis showed that posterior sources of delta and theta frequencies had higher amplitude in MCS patients than in SND patients. Regarding fast frequencies, lower source magnitudes in temporal and frontal lobes were found for MCS patients. CONCLUSIONS: Our results stress the importance of fronto-temporal-parietal associative cortices within the "awareness-regions" model. Our results also suggest a relation between excess of slow wave activity and diminished level of awareness in brain injury population. SIGNIFICANCE: Neurophysiological correlates in brain damaged patients who are severely impaired could be used to assess the integrity of brain areas responsible for awareness.

Cognitive deterioration due to GH deficiency in patients with traumatic brain injury: a preliminary report.

PRIMARY OBJECTIVE: To determine whether cognitive and behavioural disorders observed in TBI patients are due to hormonal deficits or to the brain injury itself. RESEARCH DESIGN: Transversal, between-group design. METHODS AND PROCEDURES: Studied 22 severe TBI patients (GCS < 8): 11 had isolated GH deficiency and 11 did not. Prepared detailed clinical reports on patients and performed physical examinations, standard biochemical and full blood count analysis. Patients underwent neuropsychological assessment and hormonal evaluation 6 months after TBI diagnosis. RESULTS: TBI patients with GH deficiency show greater deficits in attention, executive functioning, memory and emotion than those without GH deficiency. CONCLUSIONS: Results show GH-related cognitive impairment in patients who develop GH deficiency after TBI and suggest that treatment of GH deficiency would improve cognition. The clinical importance of these findings should be established to better understand the nature, magnitude and meaning of GH-related cognitive impairment in patients who develop GH deficiency after TBI.

Consensus guidelines on screening for hypopituitarism following traumatic brain injury.

PRIMARY OBJECTIVE: The goal of this consensus statement is to increase awareness among endocrinologists and physicians treating patients with traumatic brain injury (TBI) of the incidence and risks of hypopituitarism among patients with TBI. RATIONALE: TBI poses significant risk to the pituitary gland, leading to elevated risks of diabetes, hypopituitarism and other endocrinopathies. Signs and symptoms associated with hypopituitarism often mimic the sequellae of TBI, although the severity of symptoms is not necessarily related to the severity of the injury. Patients with TBI-induced hypopituitarism may benefit both physically and psychologically from appropriate hormone replacement therapy (HRT). Participants at this unique consensus meeting attempted to define and spearhead an approach to increase awareness of the risks of TBI-induced endocrinopathies, in particular growth hormone deficiency (GHD), and to outline necessary and practical objectives for managing this condition. RECOMMENDATIONS: Systematic screening of pituitary function is recommended for all patients with moderate-to-severe TBI at risk of developing pituitary deficits. Patients with hypopituitarism benefit from appropriate hormonal replacement and prospects for rehabilitation of patients with TBI-induced hypopituitarism may be enhanced by appropriate HRT. Further exploration of this possibility requires: (1) active collaboration between divisions of endocrinology and rehabilitation at the local level to perform a screening of pituitary function in patients after TBI, (2) creation of a consultancy service by endocrine societies for use by rehabilitation centres, (3) development of continuing medical education (CME) programmes that can be offered as crossover training to the physicians who manage the care of patients with TBIs, (4) targeting of patient organizations with educational information for dissemination to patients and their families, (5) continued efforts to more clearly define the population at greatest risk of TBI-induced hypopituitarism and (6) monitor results of efficacy studies as they become available to evaluate whether and how much replacement therapy can improve the symptoms of individuals with TBI-induced hypopituitarism.

The locked-in syndrome: a challenge for therapy.

The locked-in syndrome (LIS) is a severe condition originated by a ventral pons lesion causing quadriplegia and anarthria but with a preserved consciousness. LIS seems to be a well defined clinical picture, although different problems still persist, such as the diagnosis as it is usually mistaken for akinetic mutism and a vegetative state; the unclear prognosis, because of the patient's psychological state and the lack of information and data concerning the different types of available treatment and the need for results. Rehabilitation is a challenge for physicians, new methods and techniques of specialized treatments for these patients are opening a new future that will allow us to abandon the initial pessimism. A more efficient rehabilitation of these patients depends on the intensity of the rehabilitation, the multidisciplinary approach, and duration of the treatment.

Driving with cognitive deficits: neurorehabilitation and legal measures are needed for driving again after severe traumatic brain injury.

PRIMARY OBJECTIVE: This article presents a retrospective study on a group of survivors of severe traumatic brain injury with the purpose of discerning whether post-traumatic cognitive deficits prevent them from safely resuming driving and to see if holistic neurorehabilitation improves the rate of patients fit for returning to driving. METHODS AND PROCEDURES: We studied 17 patients who had suffered severe traumatic brain injury (TBI) as measured by Glasgow Coma Scale scores. All subjects underwent a holistic, intensive and multidisciplinary neurorehabilitation program during a mean period of 10.53 months in the Centro de Rehabilitación de Daño Cerebral (CRECER)--Center for Brain Injury Rehabilitation--in Seville, Spain. Patients were divided into two different groups: drivers (patients who drove despite strong and repeated recommendations from the Center to desist from doing so when they began the rehabilitation program) and non-drivers (patients not driving at the time they began the rehabilitation program although they had a pre-injury driver's license). The FIM+FAM-Revised Scale [1] was administered both before commencing treatment and upon termination. RESULTS AND CONCLUSION: (1) Patients showing physical functionality above 80% returned to driving, regardless of their cognitive and/or emotional deficits, and against doctor recommendations. (2) Severe TBI survivors that have not been certified as fit to drive are at increased risk for driving incidents other than collisions and traffic accidents. This is illustrated by significant incidents involving some of the subjects in our study that were due to disorientation, confusion and confrontations with people or situations. (3) We found that neurorehabilitation is worthwhile; after integral and multidisciplinary neurorehabilitation more than 70% of survivors of severe TBI can return to driving with regular safety. (4) We also suggest that laws be introduced to keep not-clinically-apt patients from driving.

Dissociating arabic numeral reading and basic calculation: a case study.

This study is about JS, a patient who suffered from anomia, phonological dyslexia and severe writing problems following a left hemispheric stroke. He showed good arabic numeral comprehension as evidenced in number-comparison tasks, but impairment in transcoding arabic numerals into verbal numbers and verbal numbers into arabic numerals. Although JS had several operand reading errors, the four arithmetic operations were not affected. In calculations with arabic numerals, he produced the correct results both in oral and written responses. For instance, when presented with the multiplication "7 x 3", JS read the operation as "four times five", but provided the correct response orally "twenty one" and written "21". This behavior goes against those hypotheses which posit that multiplication facts are verbally-based, and those which establish the same route for verbal number production in calculation and arabic numeral reading.

[Outcome after an intensive, holistic and multidisciplinary rehabilitation program after traumatic brain injury. Medico legal values]. / Eficacia de un programa de tratamiento intensivo, integral y multidisciplinar de pacientes con traumatismo craneoencefálico. Valores médico legales.

INTRODUCTION: This paper was designed to evaluate the integral rehabilitation treatments for patients with traumatic brain injury; data about efficiency of the C.RE.CER. intensive, holistic and multidisciplinary rehabilitation program is given. PATIENTS AND METHODS: The study was done keeping in mind not only the clinical aspects of rehabilitation, but also setting it within the judicial realm in which a great number of brain injury cases are found, mainly when caused by traffic accidents. A sample of 10 severe traumatic brain injury patients was studied, aged between 19 and 39. All the patients were assessed at the beginning and the end of the treatment, using a neuropsychological test battery, meanwhile were treated with the C.RE.CER. intensive, holistic and multidisciplinary rehabilitation program. RESULTS AND CONCLUSIONS: The results show a high efficiency of treatments in the majority of the patients, with reductions of more than 70% in emotional deficits and more than 60% in the global recovery of the patients that carried out the programs. This paper also shows some limitations of the criteria for compensation in Spanish legislation.

Neurobehavioural and cognitive profile of traumatic brain injury patients at risk for depression and suicide.

The possibility that patients who have suffered a traumatic brain injury will commit suicide is high, and in many cases clinicians tend to underestimate this possibility. In this study, 39 consecutive patients are studied through a Rorschach technique more than 1.5 years after their hospital discharge. The data show that 48.6% of the patients fulfil the criteria that classifies them as depressive, and, of these, 65% are at clinical risk to commit suicide (33.3% of the total of TBI patients); 25.6% have not met the criteria of depression or suicidal tendencies, and another 25.6% show very low suicide tendency scores. Only 15.6% of the total patients presented only depression without risk of suicide. The neurobehavioural and cognitive profile of the TBI suicide-prone patient shows an emotional person with cognitive difficulties in how they interpret reality, the person tries to understand what is happening around them, but is unable to cope. They show concrete thoughts, although they have difficulties solving problems and have few intellectual resources to cope with their surroundings. They do not know how to distance themselves from the emotional aspects of situations.

[Pre-postoperative neuropsychological evaluation in the surgical treatment of epilepsy]. / Evaluación neuropsicológica pre-postoperatoria en el tratamiento quirúrgico de la epilepsia.

INTRODUCTION: Epilepsy is one of the most common neurological disorders, affecting about one percent of the world population. Pharmacological treatment fails in one-third of these patients. Surgical intervention has become an accepted treatment option for those patients with seizure disorders that are refractory to conventional therapies. Cortical resection and callosotomy are the most widely accepted methods of surgical intervention. A prerequisite for success in this type of surgical intervention is the preoperative clinical assessment of the epilepsy surgery candidate. DEVELOPMENT: This paper examines the current uses of neuropsychological assessment in an epilepsy surgery program. Several areas are addressed for discussion with respect to the contributions of neuropsychological assessment: the preoperative evaluation of the epilepsy surgery candidates, including the clinical examination of language and memory functions during the Wada test; the neuropsychological changes that result from surgery and the predictive role of neuropsychology in these areas, and prediction for seizure control following surgery. CONCLUSION: Assessment of cognitive functions is an important component of the preoperative evaluation of the epilepsy surgery candidate, and is needed in order to obtain complete diagnostic information.

Executive functioning as outcome in patients after traumatic brain injury.

The present study was designed to determine how traumatic brain injury affect executive functioning, to know whether different treatments in the acute phase improve this functioning, and to check whether the severity of the neurocognitive impairment is detected by the Glasgow Outcome Scale (GOS). Ability for problem solving and executive functioning within 2 years after Traumatic Brain Injury (TBI) was examined in 35 conscious survivors. Two groups were formed. One group consisted of 13 patients who needed neurosurgery. The other group was made up of 22 patients without neurosurgical treatment. All were treated in the Neurosurgical Intensive Care Unit and in the Rehabilitation Service. The following variables were registered: Secondary Lesions, Glasgow Coma Scale (GCS), CT, subacute CT, and Glasgow Outcome Scale. Neuropsychological tests administered were Wisconsin Card Sorting Test (WCST) and the Tower of Hanoi/Sevilla. Comparing both groups' test performance (man Whitney U) we found that a severe traumatic brain injury, whatever the treatment applied in the acute phase, impairs the executive functioning of the patients; this impairment is related to acute pathophysiological events. The neurosurgical intervention does not improve the executive functioning. The Glasgow Outcome Scale does not detect more than 25% of the patients with severe impairment. It is suggested that the Tower of Hanoi/Sevilla could be a good tool to evaluate the executive functioning routinely in TBI patients as outcome. It also suggested that mild TBI patients must be referred for a complete neuropsychological examination.

The attentional system in brain injury survivors.

The present study was designed to check the model of attention proposed by Posner and Petersen (1990), in patients with traumatic brain injury. We analyzed a series of neuropsychological tests administered to these patients after they were discharged from the hospital. Scores obtained from this group were subjected to factor analysis. The results of this analysis could be characterized by four factors which accounted for 85.4% of the variance. According to our data, factor 1 (perceptual and motor speed) and factor 2 (vigilance and alertness) represent Posner's posterior attention system. Factor 3 (encoding) and factor 4 (shifting) represent Posner's anterior attention system (AAS), but we have to consider that the AAS is not only attention but is shared by other cognitive processes. The results also suggest that the attention system could be stable and could be defined independently from the type of patient and type of illness.

[Visual constructive deficits and coma depth]. / Déficits visoconstructivos y profundidad del coma.

The present study has the purpose of relating the capacities of visual retention with the Benton Visual Retention Test and the level of coma depth, which is measured with the GCS (Glasgow Coma Scale). 31 subject suffering cranioencephalic damage admitted to the intensive care unit (ICU) have been studied. GCS scores were obtained during their stay in the intensive care unit and the Benton Visual Retention Test was administered after hospital discharge. The procedure followed consists in comparing the performance of subjects with higher GCS scores to subjects with lower values when executing administration. A of form C of BVRT. We could conclude as follows: firstly that BVRT is a useful tool to detect the existence of brain damage; secondly, indexes of brain damage presence with BVRT are: a low figure in correct design, more errors, less errors in distortion and rotation; more errors in the left visual hemifield. Thirdly, the depth of coma is a good prognosis index on BVRT execution and in consequence of visuo-constructive abilities.

The computerized Tower of Hanoi: a new form of administration and suggestions for interpretation.

A computerized version of the Tower of Hanoi with a new form of administration was administered to two different groups, 15 men and 22 women, who were university students reporting normal psychological histories, and 24 traumatically brain-injured patients (20 men and 4 women). Scores on this test for both groups can be interpreted as an index of ability to solve problems and of learning strategies. Men and women scored differently on the task, i.e., women used different strategies than men to solve problems.

Cannabis and cerebral hemispheres: a chrononeuropsychological study.

This work is a study of the possibility that chronic consumption of derivatives of cannabis can affect the cognitive styles and the brain, altering the relations between both cerebral hemispheres. The results indicate that the Basic Rest-Activity Cycle (BRAC) between two different cognitive styles is not altered in the subjects of the control group; however, there is an alteration in the BRAC of the cerebral hemispheres in the chronic users of hashish.

Mental performance in long-term heavy cannabis use: a preliminary report.

Mental performance of 23 male chronic cannabis users was measured on the 1958 Wechsler Adult Intelligence Scale and compared with scores of a control group. Analysis showed significant differences on nine of the 14 scores especially those indicating capacity for compromise, the elaboration of adequate judgments, and the capacity of verbalization and communication.