The nature, diagnosis and treatment of post-concussion syndrome

INTRODUCTION: The relationship between brief loss of consciousness, subsequent cognitive and emotional complaints, and impact on daily functioning continues to be hotly debated. DEVELOPMENT: In this paper the strong variability about prevalence of the postconcussional syndrome found in several studies is outstanding and the main issues of this disagreement are suggested. Recent neuroimaging techniques are discussed and some neuropsychological measures are suggested. CONCLUSIONS: Currents models (organic/psychogenic) of postconcussional symptoms are reviewed, and a multifactorial model which integrates biological factors with the relevance of neuropsychological deficits--attention, memory, speed of information processing--and coping process is proposed. Finally, according with this model, we conclude with some suggestions to improve neuropsychological intervention and medical treatment of these patients.     

Neuropsychological symptom presentation after electrical injury

OBJECTIVE: This study explored the relationship of neuropsychological complaints to accident- and injury-related characteristics, affective state, and work status in a group of electrical injury (EI) patients. METHODS: Sixty-three EI patients and 22 electricians with no history of electrical shock completed the Neuropsychological Symptom Checklist and the Beck Depression Inventory as part of an extensive neuropsychological evaluation. RESULTS: The EI group endorsed significantly more physical, cognitive, and emotional symptoms than did the controls. Symptom complaints were not related to injury parameters or litigation status. Only the time interval between injury and assessment accounted for differences in symptom presentation, with patients in the postacute stages of recovery showing the most cognitive and emotional complaints. CONCLUSION: The neuropsychological syndrome of electrical injury survival includes physical, cognitive, and emotional complaints. Considering that most electrically injured patients are treated within the acute medical setting, greater attention needs to be directed early in the course of treatment toward addressing neuropsychologic and psychiatric issues.     

Relationship between depression, fatigue, subjective cognitive impairment, and objective neuropsychological functioning in patients with multiple sclerosis.

Objective: This study explored the influence of depression and fatigue on subjective cognitive complaints and objective neuropsychological impairment in patients with multiple sclerosis (MS). Methods: Data for this study were taken from a randomized controlled trial, comparing 16 weeks of telephone-administered cognitive-behavioral therapy and telephone-administered supportive emotion focused therapy for the treatment of depression. The sample includes 127 patients with MS. The following self-report measures were collected pre- and posttreatment: Perceived Deficits Questionnaire, Beck Depression Inventory-II, and Modified Fatigue Impact Scale. Measures of objective cognitive functioning and the Hamilton Rating Scale for Depression were administered over the telephone. Results: Our results showed that changes in depression and fatigue significantly predicted changes in subjective cognitive complaints from pre- to posttreatment, with patients perceiving fewer cognitive problems at posttreatment (β = .36, p     

A neuropsychological approach to cognitive remediation: Microcomputer applications.

Presents a case report to illustrate a neuropsychological approach to the principles and practice of cognitive remediation and the potential application of microcomputer-assisted procedures in remediating cognitive impairment. Initial neuropsychological evaluation of this right-handed female who sustained a severe head injury in a car accident indicated acquired impairment in cognitive functioning. An individually designed and systematically implemented program of microcomputer exercises focused remediation on particular deficits. A general improvement in performance on the microcomputer exercises was observed during the course of the retraining program. Follow-up neuropsychological evaluation further indicated significant gain in new learning and problem-solving skills, mental flexibility, and psychomotor functioning. (French abstract) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Working memory performance predicts subjective cognitive complaints in HIV infection.

The authors examined the contribution of working memory performance to subjective cognitive complaints in HIV infection beyond the influence of depressive symptoms. Thirty-six adults with HIV infection were administered neuropsychological (NP) tests of working memory, complex psychomotor efficiency, verbal learning, delayed recall, and questionnaires measuring depressive symptoms and cognitive complaints. Working memory performance, depression scores, and complex psychomotor efficiency were most strongly associated with self-reported cognitive complaints, whereas verbal learning scores and simple psychomotor efficiency showed more modest associations. Regression analyses revealed working memory performance to be the strongest NP predictor of self-reported cognitive complaints, comparable with depression scores in the amount of variance explained. These results suggest that working memory performance may be well suited to reflect how patients function in their everyday environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Triphenyltin acetate toxicity: a biochemical and ultrastructural study on mouse thymocytes

Eighty-five subjects at various stages of human immunodeficiency virus (HIV-1) infection and 39 seronegative controls underwent neurological and neuropsychological evaluation to assess the relationship between cognitive test results and subjective complaints (cognitive, affective, motor, and other). The effect of psychiatric disorders on the association between cognitive performance and complaints of the patients was also examined. Patients with symptomatic infection had higher frequency of complaints than subjects at asymptomatic stage. Detailed neuropsychological examination confirmed a strong association between poor verbal memory and cognitive complaints. Poor performance on cognitive speed and flexibility was associated with motor complaints and motor abnormalities. These associations were not explained by psychiatric disorders or elevated depression questionnaire scores. Our observations indicate that, especially in symptomatic HIV-1 infection cognitive changes reported by patients often reflect "objective" cognitive decline, and may be the earliest signs of HIV-1 associated cognitive disorder. No direct relationship was observed between "subjective" complaints and neuropsychological performance of asymptomatic subjects. Understanding the significance of reported cognitive changes have important therapeutic implications.     

Depressed mood does not explain neuropsychological deficits in HIV-infected persons.

The relationship of depressed mood to cognitive disturbance in HIV infection was examined in a sample of 139 homosexual men. Ss were grouped according to the classification of the Centers for Disease Control: 39 were in Group IV, 62 were in Group II or Group III, and 38 were HIV-negative. Ss completed the Profile of Mood States and 10 neuropsychological tests. Analysis employing a classification approach indicated that, although symptoms of depression and neuropsychological impairment were more common in Ss who were HIV-positive, particularly those classified as Group IV, there were no systematic relationships between depression and neuropsychological impairment. Depressed mood and cognitive disturbance each seem to have unique associations to HIV illness status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Relationship Between Neuropsychological Functioning and Driving Ability in Dementia: A Meta-Analysis.

A meta-analysis of 27 primary studies was conducted to examine the relationship between neuropsychological functioning and driving ability for adults with dementia. When studies using a control group were included, the relationship between cognitive measures and on-road or non-road driving measures was significant for all reported domains; mean correlations ranged from .35 to .65. Caregiver reports of driving ability and cognitive variables were correlated significantly only on measures of mental status and visuospatial skills. When studies using a control group were excluded, moderate mean correlations were observed for visuospatial skills and on-road or non-road measures, and for mental status with non-road tests. Other effects were small or nonsignificant. Implications for basing driving recommendations on neuropsychological testing are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention deficit disorder and neuropsychological functioning in children with Tourette's syndrome.

Neuropsychological deficits in Tourette's syndrome (TS) may result from comorbid psychiatric disorders. This study compared the neuropsychological performance of TS children with and without attention deficit disorder (ADD). Participants were 82 children between 6 and 18 yrs of age with TS, 36 of whom had ADD. ADD children did not differ from non-ADD children in age or in onset or duration of TS but did display more severe complex tics and obsessive-compulsive symptoms. After statistical control for these characteristics, ADD children demonstrated significant deficits in various elements of attention, including encoding, sustaining, and focusing/ executing, and in academic achievement. They did not differ in IQ, non-attentional cognitive skills, or sensorimotor functions. The comorbid psychiatric disorders associated with TS yield distinct patterns of neuropsychological functioning that may reflect overlapping neuroanatomic substrates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of symptoms, lung function, mood, and social support on level of functioning of patients with COPD

To explain how symptoms, lung function, mood, and social support affect level of functioning, patients (N = 143) with chronic obstructive pulmonary disease (COPD) completed measures assessing their symptoms (Bronchitis-Emphysema Symptom Checklist), mood (Profile of Mood States), social support (Personal Resource Questionnaire), and functioning (Sickness Impact Profile). Those who were receiving oxygen therapy (n = 52) had significantly lower FEV1 scores and experienced significantly poorer functioning than those who were not receiving oxygen therapy (n = 91). Results of path analyses indicated that symptoms and mood directly, and social support indirectly, influenced the functioning of those who were not receiving oxygen. For those who were receiving oxygen, only symptoms directly, and FEV1 indirectly, influenced their functioning. These models need to be confirmed using other samples of patients with COPD.     

Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.

Objective: The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. Method: To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. Results: Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37–.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. Conclusions: The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective four-year follow-up study of children at risk for ADHD: psychiatric, neuropsychological, and psychosocial outcome

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a familial disorder that places the siblings of ADHD children at high risk for ADHD, conduct, mood, and anxiety disorders. Although the pattern of psychiatric risk has been well documented by prior family studies, neither the short- nor long-term outcome of these high-risk siblings has been prospectively examined. OBJECTIVE: To document the 4-year psychiatric, psychosocial, and neuropsychological outcome of the siblings of children with ADHD. METHOD: DSM-III-R structured diagnostic interviews and blind raters were used to conduct a 4-year follow-up of siblings from ADHD and control families. The siblings were also evaluated for cognitive, achievement, social, school, and family functioning. RESULTS: At follow-up, significant elevations of behavioral, mood, and anxiety disorders were found among the siblings of ADHD children. The high-risk siblings had high rates of school failure and showed evidence of neuropsychological and psychosocial dysfunction. These impairments aggregated among the siblings who had ADHD. CONCLUSIONS: The siblings of ADHD children are at high risk for clinically meaningful levels of psychopathology and functional impairment. In addition to supporting hypotheses about the familial transmission of ADHD, the results suggest that the high-risk siblings might be appropriate targets for primary preventive interventions.     

Response variability is associated with self-reported cognitive fatigue in multiple sclerosis.

Cognitive fatigue is a common, often debilitating symptom of multiple sclerosis (MS). Although MS patients frequently report that fatigue negatively affects cognitive functioning, most studies have found little evidence for a direct relationship between self-reported cognitive fatigue and traditional measures of neuropsychological functioning. The purpose of the present study was to examine the association between self-reported cognitive fatigue and a measure of response time variability (RTV). MS patients demonstrated significantly higher RTV than controls, and RTV was highly correlated with self-reported cognitive fatigue among relapsing-remitting and secondary progressive MS patients. Results highlight the need to implement newer methods to further elucidate the relationship between cognitive fatigue and neuropsychological functioning in MS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occult ectopic ACTH secretion due to recurrent lung carcinoid: long-term control of hypercortisolism by continuous subcutaneous infusion of octreotide

OBJECTIVES: Patients with chronic fatigue syndrome complain of physical and mental fatigue that is worsened by exertion. It was predicted that the cognitive and motor responses to vigorous exercise in patients with chronic fatigue syndrome would differ from those in depressed and healthy controls. METHODS: Ten patients with chronic fatigue syndrome, 10 with depressive illness, and 10 healthy controls completed cognitive and muscle strength testing before and after a treadmill exercise test. Measures of cardiovascular functioning and perceived effort, fatigue, and mood were taken during each stage of testing. RESULTS: Depressed patients performed worst on cognitive tests at baseline. During the treadmill test, patients with chronic fatigue syndrome had higher ratings of perceived effort and fatigue than both control groups, whereas patients with depression reported lower mood. After exertion, patients with chronic fatigue syndrome showed a greater decrease than healthy controls on everyday tests of focused (p=0.02) and sustained (p=0.001) attention, as well as greater deterioration than depressed patients on the focused attention task (p=0.03). No between group differences were found in cardiovascular or symptom measures taken during the cognitive testing. CONCLUSIONS: Patients with chronic fatigue syndrome show a specific sensitivity to the effects of exertion on effortful cognitive functioning. This occurs despite subjective and objective evidence of effort allocation in chronic fatigue syndrome, suggesting that patients have reduced working memory capacity, or a greater demand to monitor cognitive processes, or both. Further insight into the pathophysiology of the core complaints in chronic fatigue syndrome is likely to be realised by studying the effects of exercise on other aspects of everyday functioning.     

Addressing executive functioning and cognitive rehabilitation in the treatment of schizophrenia.

ABSTRACT. Schizophrenia spectrum disorders are currently viewed as having a neuropsychological basis included in the etiology. Cognitive deficits that occur in schizophrenia are primarily observed in the areas of attention–concentration, memory, and planning. These abilities are commonly viewed under the broader spectrum of executive functioning. Research has shown that these executive functioning skills can be improved through the use of cognitive rehabilitation interventions. This article includes a case study documenting the use of cognitive rehabilitation strategies with a patient diagnosed with schizophrenia who possessed documented deficits in executive functioning. The discussion illustrates the possible progress that may be made in the treatment of schizophrenia when this additional tier of intervention is used. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ability of counselors to detect cognitive impairment among substance-abusing patients: An examination of diagnostic efficiency.

Counselors (N?=?12) in 1 of 2 substance abuse treatment facilities were asked to identify which of their patients (N ?=?97) had general neurocognitive impairment. Counselors were required to base their judgements on information collected from patients during psychosocial history gathering, clinical interviews, physical examinations, brief cognitive screening tests, and substance abuse severity evaluations, but not on neuropsychological test results. All patients were subsequently administered a neuropsychological test battery. Diagnostic agreement between counselors' impressions of patients' cognitive status and patients' actual neuropsychological test performance was poor. Subsequent analyses revealed counselors' impressions about patients' neuropsychological functioning were based on information that did not reliably discriminate between cognitively impaired and intact patients (e.g., years of education and self-reported symptoms of cognitive dysfunction). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of clinical variables on neuropsychological performance in multiple sclerosis

The effects of age, educational level, duration and course of the disease, physical disability and mood status on several cognitive functions (short- and long-term memory, frontal functions, attention, language and visuospatial skills) have been evaluated in 42 multiple sclerosis (MS) patients. The Hamilton Depression Rating Scale (HDRS) scores and a secondary progressive disease course significantly influenced neuropsychological performance. Factorial analysis revealed that indexes of (1) frontal function impairment, (2) long-term verbal memory and language function impairment, and (3) visuospatial short- and long-term memory and visuoperceptive function impairment accounted for 85% of the variance in neuropsychological performance. Only the first factor was significantly related to the presence of depressive symptomatology, as assessed by the HDRS. These results indicate that both the course of the disease and the presence of affective disorders must be taken into account when evaluating the natural history of cognitive impairment in MS and suggest that depressive symptomatology and cognitive dysfunction in MS are related to the involvement of at least partially overlapping anatomofunctional circuits.     

Early cognitive deficits in Swedish gene carriers of Huntington's disease.

The primary focus of this study was to examine whether there is early neuropsychological impairment in presymptomatic Huntington's disease (HD). A broad neuropsychological assessment battery was administered to 24 asymptomatic gene carriers (HD+) and 31 noncarriers (HD-). The gene carriers revealed inferior cognitive functioning as compared with the noncarriers in memory and executive functions. When the gene carriers were assigned to 2 groups based on predicted years to onset (with 15 and over being HD+ late and under 15 being HD+ near), the HD+ near group performed significantly worse than the HD+ late group in all domains but ability to shift conceptually and visuospatial memory. Results suggest that early cognitive deficits are detectable prior to motor symptoms, first in memory functions and then in executive functions and perceptual motor speed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are the subjective complaints of traumatically brain injured patients reliable?

The present study was designed to compare the subjective complaints of 50 traumatically brain injured (TBI) patients with the observations of their significant others. The complaints of the TBI patients and their significant others were contrasted according to the severity of the TBI and the type of complaint (physical, cognitive/behavioural and emotional). While no differences were found in physical complaints, the cognitive/behavioural and emotional complaints of TBI patients, regardless of the severity of the initial TBI, were significantly under-reported in comparison to the observations of their significant others. The data suggests that while this finding was most likely due to the TBI patients' poor awareness, it was unlikely to be the result of psychological denial since all of these individuals were evaluated in the context of being a plaintiff in personal injury litigation or a claimant in a Workers' Compensation claim. The data suggests that the cerebral trauma these patients sustained played a major role in their ability to recognize their cognitive, behavioural and emotional symptoms. Finally, the data suggests that clinicians should obtain information about the TBI patients' cognitive/behavioural and emotional functioning from their significant others, rather than rely entirely on the TBI patients' subjective assessment of these problems.     

Chicken microchromosomes are hyperacetylated, early replicating, and gene rich

Persons with chronic pain often report a range of physical symptoms beyond their primary pain complaint itself. We predicted that non-specific physical symptom complaints would correlate more strongly with pain-related distress than with general measures of distress, and that they would contribute directly to disability. Results from 210 adults with chronic pain showed that collateral physical complaints are common in persons with chronic pain. Correlational analyses showed that greater reporting of physical complaints was associated with reports of higher pain severity, higher levels of depression, more cognitive, escape/avoidance, fearful appraisal, and physiological symptoms of pain-related anxiety and more physical and psychosocial disability. Regression analyses showed that, with pain-related anxiety variables entered either before or after depression, physiological symptoms of pain-related anxiety significantly predicted physical complaints. In comparison with cognitive and somatic depression symptoms physiological symptoms of pain-related anxiety were the stronger predictor.