[Prevalence and manifestations of aggression in adult patients with acquired brain injury: a review]. / Prevalentie en uitingsvormen van agressie bij volwassen patiënten met niet-aangeboren hersenletsel: een literatuuroverzicht.

BACKGROUND: Aggression after acquired brain injury has a major impact on daily functioning for the patient, their family, and caregivers.
AIM: To present the prevalence and manifestations of aggression in patients with different types of brain injury.
METHOD: Systematic search of the literature in PubMed, Psycinfo and Embase.
RESULTS: Fourty-one studies were included in which 15 different outcome measures for aggression were used. The prevalence of agitation ranged between 4.0%-93.9% (median 35.8%), of aggression between 3.7%-88.0% (median 35.3%) and of hostility between 4.0%-45.7% (median 9.1%). Prevalence rates were highest in patients with traumatic brain injury. Verbal aggression occurred more frequently (median 33.0%, 14.0%-70.0%) than physical aggression (median 11.5%, 1.5%-33.8%), but manifestations of aggression were only examined in ten studies.
CONCLUSION: Aggression is a common behavioral problem after brain injury. The prevalence varies and depends on the type of brain injury, the specific target behavior and the outcome measure. It is recommended to reach consensus on definitions and outcome measures.

Predictors of health-related quality of life and participation after brain injury rehabilitation: The role of neuropsychological factors.

The aims of this longitudinal study were: (1) to assess associations between neuropsychological factors and health-related quality of life (HRQoL) and participation three months after discharge from inpatient acquired brain injury (ABI) rehabilitation; and (2) to determine the best neuropsychological predictor of HRQoL and participation after controlling for demographic and injury-related factors. Patients with ABI (n = 100) were assessed within approximately two weeks of enrolment in inpatient rehabilitation. Predictor variables included demographic and injury-related characteristics and the following neuropsychological factors: active and passive coping, attention, executive functioning, verbal memory, learning potential, depressive symptoms, motivation, extraversion, neuroticism and self-awareness. Bivariate analyses revealed that passive coping, executive functioning, depressive symptoms, extraversion, and neuroticism were significantly associated with HRQoL and/or participation. Neuropsychological factors significantly explained additional variance in HRQoL (18.1-21.6%) and participation (6.9-20.3%) after controlling for demographic and injury-related factors. However, a higher tendency towards passive coping was the only significant neuropsychological predictor (ß = -0.305 to -0.464) of lower HRQoL and participation. This study shows that neuropsychological functioning, and in particular passive coping, plays a role in predicting HRQoL and participation after inpatient ABI rehabilitation and emphasises the importance of addressing patients' coping styles in an early phase of ABI rehabilitation.

Awareness of memory functioning in patients with stroke who have a good functional outcome.

PRIMARY OBJECTIVE: To determine whether patients with stroke who have a good functional outcome show awareness of memory functioning and whether over- and under-estimation of memory performance are differentially related to neuropsychological performance. RESEARCH DESIGN: Prospective cohort study. METHODS AND PROCEDURES: The Barrow Neurological Institute Screen for Higher Cerebral Functions and a brief neuropsychological assessment were used to evaluate language, orientation, attention, visuospatial problem-solving, perception, reasoning, executive functioning, memory, affect and awareness of memory functioning. As for the latter, the patient's estimate of memory functioning was compared with his or her actual memory performance. Patients were divided into three groups: good-estimators (estimated performance = actual performance), over-estimators (estimated performance > actual performance) and under-estimators (estimated performance < actual performance). MAIN OUTCOMES AND RESULTS: In total, 54 patients with stroke were included, of whom 27 patients were classified as good-estimators, 19 as over-estimators and eight as under-estimators. Compared to good-estimators, over-estimators had significantly lower scores for all cognitive domains. Under-estimators had significantly poorer affect compared to good-estimators. CONCLUSIONS: These preliminary results suggest that over- and under-estimation of memory functioning can be observed in patients with stroke who have a good functional outcome and that they may reflect distinct underlying neuropsychological processes.

Clinicians' views on learning in brain injury rehabilitation.

PRIMARY OBJECTIVE: To determine clinicians' views on learning ability in brain injury rehabilitation. RESEARCH DESIGN: Online survey. METHODS AND PROCEDURES: An online survey was sent to physicians, psychologists and therapists of three Dutch organizations for neuropsychology or rehabilitation. The survey enquired (1) whether clinicians take learning ability into account; (2) about factors influencing learning ability; and (3) about assessment tools used to assess learning ability. MAIN OUTCOMES AND RESULTS: Thirty-seven physicians, 83 psychologists and 43 therapists completed the online survey. In total, 93% of respondents reported that they take learning ability into account when making a prognosis. The most frequently mentioned factors influencing learning ability were cognition, awareness of deficits and motivation. Learning ability was mainly determined by means of cognitive and memory tests and observations during therapy. CONCLUSIONS: This study demonstrates that a patient's learning ability may be influenced by not only cognition but also by motivation and awareness of deficits. Structured and standardized assessment of these factors may be suggested for standard use in clinical practice. More research is needed about the influence these factors have on the learning process.

Effectiveness of a low intensity outpatient cognitive rehabilitation programme for patients in the chronic phase after acquired brain injury.

The aim of this prospective cohort study was to examine the effectiveness of a low intensity outpatient cognitive rehabilitation programme for patients with acquired brain injury in the chronic phase. Twenty-seven patients with acquired brain injury (i.e., stroke, traumatic brain injury, subarachnoid haemorrhage; 52% male) with a mean age of 49.5 (SD 9.2) years and 25 relatives with a mean age of 48.8 (SD 8.8) years were recruited to the study. Mean time since injury in the patient group was 1.9 years (SD 2.0). The group programme consisted of 15 weekly sessions of 2.5 hours and included cognitive strategy training, social skills training, and psycho-education. Patients also received homework. Relatives were invited to attend twice. Repeated measurements were taken: prior to treatment (baseline, T0); directly after treatment (T1, 21 weeks); and at follow-up (T2, 45 weeks). Primary outcome measures were individualised goals (GAS), cognitive failures (CFQ), and quality of life (SA-SIP). Patients did improve significantly on individual goals (p < .05) between T0 and T1 and the level of attainment remained stable between T1 and T2. Goals were mostly set in the cognitive and behavioural domains. There were no significant differences between the measurements (T0-T1-T2) on the CFQ and the SA-SIP. The programme had a positive effect on the individual goals set by the patients. However, this did not result in a higher participation level or a better quality of life. This may be due to the low intensity and short duration of the programme.

Checklist for cognitive and emotional consequences following stroke (CLCE-24): development, usability and quality of the self-report version.

OBJECTIVE: In this paper a new checklist (CLCE-24) for identification of cognitive and emotional problems after stroke is presented. The CLCE-24 is intended to support a clinical interview by health care professionals other than the trained (neuro)psychologist. METHODS: Patients were interviewed with the CLCE-24, 6 months post stroke. Usability was determined by interviews. Quality of the self-report version was determined using reference instruments (MMSE, CAMCOG). RESULTS: Sixty-nine patients participated in the study (37 men; mean age 66 years). Both patients and assessors were positive about the use of the CLCE-24. Eighty percent of the patients had cognitive and/or emotional problems (73% cognitive; 51% emotional problems). Patients with complaints on the CLCE-24 also showed problems on the MMSE and the CAMCOG (p<0.05). The CLCE-24 was a predictor of the MMSE and CAMCOG (Adj. R(2)=0.13 and 0.16, respectively) at 12 months post stroke. Internal consistency of the CLCE-24 was good (alpha of 0.81). CONCLUSIONS: The CLCE-24 is a usable and valid instrument for cognitive screening by health care professionals in the stroke service in the chronic phase after stroke.

Vascular cognitive disorders: memory, mental speed and cognitive flexibility after stroke.

This study investigated the occurrence of cognitive disorders 1 and 6 months after stroke in a cohort of patients with a first-ever stroke. In addition, it was investigated whether age, sex and level of education are risk factors for vascular cognitive disorders. Memory, simple speed, cognitive flexibility and overall cognitive functioning were examined in 139 patients at 1 and 6 months post-stroke. Inclusion criteria on admission were first cerebral stroke, age>/=40, no other neurological or psychiatric disorders and ability to communicate. Mean age was 69.3 years (S.D.=12.3). Patients were compared with a healthy control group matched for age, sex and level of education. A large group of patients who, at 1 month after stroke, scored below the cutoff on cognitive domains, scored above the cutoff on most of these cognitive domains at 6 months. For overall cognitive functioning, 16 out of 39, for memory, 13 out of 26 and for cognitive flexibility, 15 out of 49 patients, who at 1 month scored below the cutoff, scored above the cutoff at 6 months. Simple speed did not change; 12 patients scored above the cutoff and 7 patients scored below the cutoff at 6 months after stroke. Speaking in terms of improvement or deterioration, most people remained stable on the four cognitive domains (ranging from 37.6% to 83.5%), and a substantial group improved (ranging from 12.9% to 52.1%). Older and female patients had more cognitive disturbances. Overall, the conclusion is that the prognosis of cognitive functioning after stroke is general favourable, especially in younger patients.