Depression after traumatic brain injury as a function of Glasgow Outcome Score.

One hundred and five patients with traumatic brain injury (TBI) were assessed for depressive symptomatology at 6 months postinjury and 66 of those patients were examined again at 12 months postinjury. At 6 months, 42% of the patients with TBI and 20% of the Other Injury Control Group (OIC) were identified as depressed. Individuals with poor outcome (as measured by Glasgow Outcome Score [GOS]) had a higher frequency of depressive symptomatology than those with good GOS outcome. At 12 months, 36% of the patients with TBI and 28% of the OIC group were identified as depressed. At 12 months, there was no difference in terms of frequency of depressive symptomatology among patients with TBI with poor, moderate, or good outcome.

Depression, cognition, and functional correlates of recovery outcome after traumatic brain injury.

The present study investigated the prevalence and magnitude of depressive symptomatology in a sample of patients who had sustained traumatic brain injury (TBI) six months earlier. Depression was examined as a function of recovery outcome status, and its association with neuropsychological functioning, personal competency, and employability was also explored. Subjects were 100 patients who had previously sustained moderate-to-severe TBI who were enrolled as research subjects in the UCLA Brain Injury Research Center, and 30 matched control subjects who had sustained traumatic injuries other than to the head six months prior to evaluation. The results showed a significant association between depression and recovery status as measured by the Glasgow Outcome Scale (GOS). A significant majority of depressed subjects were found in the poorer GOS outcome groups (severe and moderate disability), compared to TBI subjects who had good GOS outcomes, and control subjects. This association was also reflected in the magnitude of the mean depression scores on two self-report measures of depression. However, no association was found between depression status and performance on the neuropsychological measures. Effects of depression were found only on an examiner-rated Patient Competency scale, and a metacognition measure based on self-report. These results are discussed in terms of brain injury severity, recovery status, and metacognition issues in TBI and other disorders.

Neuropsychological, psychosocial and vocational correlates of the Glasgow Outcome Scale at 6 months post-injury: a study of moderate to severe traumatic brain injury patients.

Traumatic brain injury (TBI) subjects at Glasgow Outcome Scale levels 3 (severe disability), 4 (moderate disability), 5 (good recovery), and an other-injury control group (OIC) were compared in terms of neuropsychological, psychosocial, and vocational functioning 6 months after injury. Subjects were a sample of 100 patients with a moderate to severe traumatic brain injury (TBI) and a matched sample of 30 other-injury control subjects (OIC) enrolled in the UCLA Brain Injury Research Center study of TBI outcome. Overall, the results showed a systematic decrease in mean neuropsychological test performance as a function of increasing GOS severity, as well as an increased prevalence of symptoms of depression and lower ratings on measures assessing employability and capacity for self care. TBI patients in the 'severe' and 'moderate disability' groups were distinctly inferior to the 'good recovery' and 'OIC' groups, who were quite similar to each other in terms of cognitive, psychosocial, and vocational outcomes. The results demonstrate overall support for the predictive and concurrent validity of the GOS 6 months post injury. Despite these results, which strengthen the utility and appeal of the GOS for multicentre studies, concerns still remain regarding GOS category 4 (moderate disability), which was shown to lack sufficient discriminability in this study.

Normative data stratified by age and education for the Neuropsychological Screening Battery for Hispanics (NeSBHIS): Initial report.

Neuropsychological assessment of monolingual Spanish-speaking people in the United States is both a common practice and an ethical dilemma. Lack of appropriate tests, the absence of norms, use of interpreters, and the multiplicity of in-house translations of commonly used measures add to the problem of accurate assessment. This paper helps address the lack of appropriate measures for the neuropsychological assessment of Latinos in the United States by providing a standardization of the Neuropsychological Screening Battery for Hispanics (NeSBHIS). Normative data on a sample of 300 Hispanic subjects stratified by gender, age, and education are provided. Current results reveal that not one measure of cognitive functioning is free from education effects. Both nonverbal measures and psychomotor speed measures were highly related to education. Age effects were noted on measures of psychomotor speed, visuospatial reasoning, and visuoconstructive skills. Gender effects were found on measures of psychomotor speed and language, with males achieving higher scores than females. The limitations of the current findings are considered. Further research for the validation of the NeSBHIS with clinical populations, as well as further normative data collection at the national and international levels, is needed.

Postpolio syndrome--response to deprenyl (selegiline).

Two patients with postpolio syndrome are presented. The first case developed mild Parkinson's syndrome, for which she was treated with a levodopa/carbidopa combination followed by the institution of deprenyl. An unexpected improvement in the symptoms of postpolio syndrome was noted. The second patient who was unaffected by Parkinson's syndrome was started on deprenyl alone and reported a similar improvement in symptomatology.

Cognitive and behavioral aspects of brain-injury rehabilitation.

The most exciting area in current neurologic rehabilitation concerns cognitive remediation following brain injury. The experimental substrate upon which such rehabilitation rests is not yet firm, but results to date are suggestive of a positive effect, if not in specific cognitive ability, at least in functional and behavioral outcome. As more controlled studies are performed and as improved neuropsychological, behavioral, and social measures are developed, it can be anticipated that improved patient selection and therapeutic intervention will emerge. Also, as we gain further understanding of the molecular and cellular consequences of brain injury, it is not unreasonable to expect improved pharmacologic therapy of the various sequelae of brain injury. It would be remiss, however, to not close by extolling the best means of injury treatment, that is, prevention.

Evoked potential testing in relatives of multiple sclerosis patients.

Evoked potential (EP) tests were obtained in 110 neurologically normal first-degree relatives of patients with multiple sclerosis. Visual EP tests were performed in all relatives; brainstem auditory and median nerve somatosensory EP tests were performed in 67 relatives. The relatives had a mean visual EP P100 latency that was significantly longer than that for normal subjects controlled for age and gender. Asymmetries were seen in results from individual MS relatives, including interocular visual EP P100 differences of up to 14 ms, and interarm somatosensory Erb-N18 differences of up to 3.0 ms. We identified 19 pairs of patients and relatives who were HLA identical and 18 other pairs who were HLA double nonmatched. EP asymmetries were seen more often in the HLA identical siblings than in the HLA double patients, especially if they share HLA types with the patients. Since less than 2% of siblings of MS patients would be expected to eventually develop clinical MS, these small subclinical electrophysiological changes are not expected to be a sign of the future appearance of clinical MS. Clinicians should be aware not to overinterpret small EP changes in relatives of MS patients.

Somatosensory evoked potential testing in multiple sclerosis.

Evoked potentials can be elicited by electrical stimulation of the median nerve or other locations. Recordings can be made of the electrical signals at the peripheral nerve, plexus, spinal cord, brainstem, and hemispheric levels. When the stimulation and recording techniques are kept constant, the evoked potentials can be used to measure pathophysiological abnormalities in MS and other conditions. Evoked potentials are abnormal in most persons with MS, which helps to establish the diagnosis. These techniques also hold promise of value in clinical trials of possible MS therapies and as an aid in the epidemiological and genetic studies of MS.

Visual evoked responses in patients with multiple sclerosis.

The visual evoked response (VER) was evaluated in a series of multiple sclerosis patients and normal subjects. The data showed significant delays in wave peak latencies among the patient evoked responses. The prolonged latencies correlated closely with visual impairment; however, even patients with a previous history of visual impairment, but with no deficits noticeable on examination at the time of study, showed a delay in wave peak latencies. The results further suggest that the VER is primarily altered when there are central field defects.