Emotional disturbances and their interaction with neuropsychological deficits

Predicting outcome following mild traumatic brain injury: protocol for the longitudinal, prospective, observational Concussion Recovery (CREST) cohort study

INTRODUCTION

Mild traumatic brain injury (mTBI) is a complex injury with heterogeneous physical, cognitive, emotional and functional outcomes. Many who sustain mTBI recover within 2 weeks of injury; however, approximately 10%-20% of individuals experience mTBI symptoms beyond this 'typical' recovery timeframe, known as persistent post-concussion symptoms (PPCS). Despite increasing interest in PPCS, uncertainty remains regarding its prevalence in community-based populations and the extent to which poor recovery may be identified using early predictive markers.

OBJECTIVE

(1) Establish a research dataset of people who have experienced mTBI and document their recovery trajectories; (2) Evaluate a broad range of novel and established prognostic factors for inclusion in a predictive model for PPCS.

METHODS AND ANALYSIS

The Concussion Recovery Study (CREST) is a prospective, longitudinal observational cohort study conducted in Perth, Western Australia. CREST is recruiting adults aged 18-65 from medical and community-based settings with acute diagnosis of mTBI. CREST will create a state-wide research dataset of mTBI cases, with data being collected in two phases. Phase I collates data on demographics, medical background, lifestyle habits, nature of injury and acute mTBI symptomatology. In Phase II, participants undergo neuropsychological evaluation, exercise tolerance and vestibular/ocular motor screening, MRI, quantitative electroencephalography and blood-based biomarker assessment. Follow-up is conducted via telephone interview at 1, 3, 6 and 12 months after injury. Primary outcome measures are presence of PPCS and quality of life, as measured by the Post-Concussion Symptom Scale and the Quality of Life after Brain Injury questionnaires, respectively. Multivariate modelling will examine the prognostic value of promising factors.

ETHICS AND DISSEMINATION

Human Research Ethics Committees of Royal Perth Hospital (#RGS0000003024), Curtin University (HRE2019-0209), Ramsay Health Care (#2009) and St John of God Health Care (#1628) have approved this study protocol. Findings will be published in peer-reviewed journals and presented at scientific conferences.

TRIAL REGISTRATION NUMBER

ACTRN12619001226190.

Depressive symptoms, memory complaints, and memory test performance

The impact of emotional factors on subjective cognitive complaints and memory test performance has been a topic of extensive research, produced conflicting results. Investigators typically used self-report inventories that lack measures of response bias. Studies have also neglected to use performance validity tests (PVTs) to screen participants for incomplete effort. In the present study, 27% of the original sample of non-litigating outpatient referrals (N = 416) failed to meet self-report and performance validity criteria. Remaining participants (N = 226) were classified into high and low depression groups using their median score (66 T) on Scale D (Depression) of the MMPI-2. "High depression" subjects scored over 65 T on the D scale (MN = 77 T). "Low depression" subjects scored below 66 T (MN = 56 T). Test performances were compared across WAIS-IV Digit Span, Wechsler Memory Scale IV Logical Memory and Visual Reproduction subtests, and the Miami Selective Learning Test. High and low depressive groups exhibited no significant mean score differences on any memory measures. Cognitive Complaints on the Cognitive Difficulties Scale (CDS) were associated with level of depressive symptoms (r(226) =.42, p <.001). Complaints were predictive of delayed (30 min) list recall (r(224) =.19, p =.006, but were not related to eight other memory measures. Results suggest that, in general, depression severity is predictive of cognitive complaints yet has little, if any, relation to memory test performance.

Minimal emotional dysfunctions (MED) in personality disorders

The concept of minimal emotional dysfunctions (MED) refers to traditional psychopathology in order to describe, classify, and understand personality disorders. Emotional dysfunctions encompass disorders of affect predominance, production, expression, experience, modulation, and regulation. MED can explain the dimensional nature of personality disorders, their multidimensionality and problems with categorical classifications. It can stimulate research on the etiology of personality disorders in reference to modern developmental brain research and trauma psychology. It can guide new developments in pharmacotherapy and psychotherapy. It is suggested to focus on MED in future developments of the description and classification of personality disorders.

Depressive symptoms as a factor in neuropsychological test performance: MMPI-2 and selected tests of the Halstead-Reitan/Halstead-Russell Battery

The potential impact of depressive symptoms on neuropsychological test performance has been studied extensively yielding mixed results. Self-report depression inventories have been most often used, without a means to screen participants for response bias. Studies have also neglected to screen participants for incomplete effort in testing. In the present study, 48% of an initial sample of outpatient referrals (N = 247) failed to meet traditional validity criteria. The remaining participants were screened for cerebral pathology and then classified into high and low depressive symptom groups (ns = 46) using the median score on Scale D (Depression) of the MMPI-2. The "high depression" subjects scored over 70 T on the D scale (MN = 80 T). The "low depression" subjects scored below 65 T (MN = 58 T). Age, education, and estimated intelligence were equivalent across groups. Neuropsychological test performances were compared across eight tests: Revised Category Test, Trail Making Test, Part B, Tactual Performance Test (TPT), TPT Memory and Location, Reitan-Indiana Aphasia Screening Test, Seashore Rhythm Test, and the Speech Perception Test. A MANOVA revealed no main effect for group., F(8,69) = 1.05, n.s., and univariate analyses for each test also showed no intergroup differences. The results provide evidence that these neuropsychological tests are appropriately interpreted within a framework of brain-behavior relationships irrespective of an examinee's emotional status.

Towards the Development of an Integrative, Evidence-Based Suite of Indicators for the Prediction of Outcome Following Mild Traumatic Brain Injury: Results from a Pilot Study

Background: Persisting post-concussion symptoms (PPCS) is a complex, multifaceted condition in which individuals continue to experience the symptoms of mild traumatic brain injury (mTBI; concussion) beyond the timeframe that it typically takes to recover. Currently, there is no way of knowing which individuals may develop this condition. Method: Patients presenting to a hospital emergency department (ED) within 48 h of sustaining a mTBI underwent neuropsychological assessment and demographic, injury-related information and blood samples were collected. Concentrations of blood-based biomarkers neuron specific enolase, neurofilament protein-light, and glial fibrillary acidic protein were assessed, and a subset of patients also underwent diffusion tensor–magnetic resonance imaging; both relative to healthy controls. Individuals were classified as having PPCS if they reported a score of 25 or higher on the Rivermead Postconcussion Symptoms Questionnaire at ~28 days post-injury. Univariate exact logistic regression was performed to identify measures that may be predictive of PPCS. Neuroimaging data were examined for differences in fractional anisotropy (FA) and mean diffusivity in regions of interest. Results: Of n = 36 individuals, three (8.33%) were classified as having PPCS. Increased performance on the Repeatable Battery for the Assessment of Neuropsychological Status Update Total Score (OR = 0.81, 95% CI: 0.61–0.95, p = 0.004), Immediate Memory (OR = 0.79, 95% CI: 0.56–0.94, p = 0.001), and Attention (OR = 0.86, 95% CI: 0.71–0.97, p = 0.007) indices, as well as faster completion of the Trails Making Test B (OR = 1.06, 95% CI: 1.00–1.12, p = 0.032) at ED presentation were associated with a statistically significant decreased odds of an individual being classified as having PPCS. There was no significant association between blood-based biomarkers and PPCS in this small sample, although glial fibrillary acidic protein (GFAP) was significantly increased in individuals with mTBI relative to healthy controls. Furthermore, relative to healthy age and sex-matched controls (n = 8), individuals with mTBI (n = 14) had higher levels of FA within the left inferior frontal occipital fasciculus (t (18.06) = −3.01, p = 0.008). Conclusion: Performance on neuropsychological measures may be useful for predicting PPCS, but further investigation is required to elucidate the utility of this and other potential predictors.

Psychopathological influence of lumbar disc herniation in male adolescent

PURPOSE

There is no report about psychopathological effect causing by disc herniation. The disease could impose psychopathological influence on the social life, the treatment period, and response to the treatment. This study was to evaluate retrospectively the psychopathological influence of lumbar disc herniation (LDH) among Korean 19-year-old males.

MATERIALS AND METHODS

We compared the Korean military multiphasic personality inventory (KMPI) profiles of 74 LDH cases with the KMPI profiles of 150 controls. The LDH groups were categorized to 2 groups according to the presence of thecal sac compression by disc materials, and evaluated the relation between the KMPI and LDH.

RESULTS

The decrease of the faking-good response scale and increase of the faking-bad response scale were observed more in the LDH group than in the normal volunteer group (p<0.05). The neurosis set such as anxiety, depression and somatization was markedly increased in the LDH group compared to the normal volunteers group (p<0.05). The scale of personality disorder was also increased more in the LDH group (p=0.002). The differences of KMPI scales were not correlated with the severe pathology of LDH.

CONCLUSION

Young male with LDH may tend to have more abnormal results of multiphasic personality inventory test compared to the normal volunteers, suggesting that LDH may be related to the psychopathology in young males in Korea. Therefore, clinicians are recommended to evaluate and treat the psychopathological aspects in patients with LDH.

The psychopathological influence of adolescent idiopathic scoliosis in korean male : an analysis of multiphasic personal inventory test results

OBJECTIVE

There are few published studies which have documented psychopathological abnormalities in patients with of adolescent idiopathic scoliosis (AIS) The aim of this study was to evaluate the psychopathological influence of AIS in Korean 19-year-old males.

METHODS

The authors compared the Korean military multiphasic personal inventory (KMPI) military profiles of 105 AIS cases (more than 10 degrees of Cobb's angle without surgical treatment) with the KMPI profiles of 108 normal controls. The AIS group was split depending on Cobb's angle to further evaluate this relation by the severity of AIS.

RESULTS

A significantly decreased result on the faking-good response scale and an significantly increased result on the faking-bad response were observed in the AIS group compared to the control (p<0.012). The neurosis scale results, including anxiety, depression and somatization symptoms, were significantly increased in the AIS group compared to the control (p<0.010). The severity level of personality disorder and schizophrenia were also significantly increased in the AIS group (p<0.010). Differences in KMPI scale scores were not related to the severity of AIS.

CONCLUSION

Young males with AIS tend to have abnormal results on the multiphasic personal inventory test compared to normal volunteers, suggesting that AIS may be related to psychopathology in the young male group in Korea. Although these psychopathology in AIS were differently observed compared to normal controls, but not interfered with military life. Clinicians are recommended to pay attention the psychopathological traits of patients with AIS.

The psychopathological influence of congenital heart disease in Korean male adolescents: an analysis of multiphasic personal inventory test results

PURPOSE

The aim of this study was to evaluate the psychopathological influence of congenital heart disease (CHD) in Korean 19-year-old males.

MATERIALS AND METHODS

The authors compared the Korean military multiphasic personal inventory (KMPI) military profiles of 211 CHD cases (atrial septal defect, ventricular septal defect, patent ductus arteriosus, or combined CHD) with the KMPI profiles of 300 normal controls. The CHD group was also divided according to whether or not the subjects had undergone open cardiac surgery in order to evaluate the psychopathological effects of an operation among the subjects.

RESULTS

A decreased result on the faking-good response scale and an increased result on the faking-bad response were observed in the CHD group compared to the control (p<0.01). The neurosis scale results, including anxiety, depression and somatization symptoms, were markedly increased in the CHD group compared to the control (p<0.01). The severity level of personality disorder was also increased in the CHD group (p<0.001). Differences in KMPI scale scores were not related to open cardiac surgery history.

CONCLUSION

In this study, young males with CHD tended to report more abnormal results on the multiphasic personal inventory test in comparison to normal subjects, suggesting that CHD may be related to psychopathology in young males in Korea. Therefore, clinicians are recommended to evaluate the psychopathological traits of patients with CHD.

The impact of primary spontaneous pneumothorax on multiphasic personal inventory test results in young South Korean males

PURPOSE

Few reports have documented psychopathological abnormalities in patients with primary spontaneous pneumothorax (PSP). We analyzed the results of a multiphasic personal inventory test to investigate the psychopathologic impact of PSP in young Korean males.

MATERIALS AND METHODS

The authors reviewed the results of a Korean military multiphasic personal inventory (KMPI) administered to military conscripts in South Korea. A total of 234 young males participated in this study. The normal volunteer group (n=175) comprised individuals who did not have any lung disease. The PSP group (n=59) included individuals with PSP. None of the examinees had any psychological problems. The KMPI results of both groups were compared.

RESULTS

There were more abnormal responses in the PSP group (17.0%) than the normal volunteer group (9.1%, p=0.002). The anxiety scale and depression scale scores of the neurosis category were greater for the PSP group than the normal group (p=0.039 and 0.014, respectively). The personality disorder and paranoia scale scores of the psychopathy category were greater for the PSP group than the normal group (p=0.007 and 0.018, respectively).

CONCLUSION

Young males with PSP may have greater tendencies to suffer from anxiety, depression, personality disorders, and paranoia compared to normal individuals. Clinicians should be advised to evaluate the psychopathological aspects of patients with PSP.

Affective state and cognitive functioning in patients with intracranial tumors: validity of the neuropsychological baseline assessment

OBJECTIVES

The aim of this paper is to investigate the relationship between the affective and cognitive states of neurooncological patients prior to the neurosurgical treatment to assess associations between distress levels and neuropsychological test performance in this sample and setting.

METHODS

The prospective study population consists of 172 patients. Patients were studied preoperatively with a comprehensive test battery consisting of a variety of affective and cognitive measures. Psychological instruments included the Hospital Anxiety and Depression Scale, the Amsterdam Preoperative Anxiety and Information Scale, and the Acute Stress Disorder Scale.

RESULTS

Factor analysis revealed two factors representing subjective affective functioning: whereas one reflects the patients' more general emotional state (Hospital Anxiety and Depression Scale, Acute Stress Disorder Scale), the second reflects anxiety specifically related to the neurosurgical procedure (Amsterdam Preoperative Anxiety and Information Scale). After age and education have been accounted for via linear regression analyses, affect did not contribute to cognitive performance in any of the cognitive domains in the whole patient sample. However, in patients with extreme levels of psychiatric morbidity, there was evidence for distinct cognitive morbidity consistent with previous research.

CONCLUSIONS

Our results suggest that, for a large variety of widely used neuropsychological measures and for most neurooncological patients, the preoperative neuropsychological baseline assessment can be considered valid and dependable. In patients with extreme levels of distress, however, distinct cognitive domains might be differentially affected.

Self-Reported Generalised Anxiety and Psychomotor Test Performance in Healthy South Africans

Tests like the Grooved Pegboard may have specific value in South Africa in the context of screening for HIV-associated neurocognitive disorders. However, there are inconsistent findings on the relationship between self-reported anxiety and neuropsychological performance in healthy adults, and in particular on tests of psychomotor functions such as the Form Board and Grooved Pegboard. Given the potential value, it is important to clarify the relationship between self-reported anxiety and performance on psychomotor tests among South African samples. Two studies are presented here. One sample of 170 young adults (19–30 years) completed the Form Board and Grooved Pegboard, after completing an anxiety scale. A second sample of 1,056 healthy adults (19–49 years) completed the Grooved Pegboard only after completing an anxiety scale. Age, gender, and education have previously been found to confound performance on these tests, and they were thus entered into a Multiple Regression Analysis, together with anxiety. In the first study, anxiety did not contribute significantly to performance variance. In the second study, both gender and anxiety did contribute significantly, and separate gender group regressions were thus done. Anxiety did not have a negative influence on performance in the female group, but it did contribute significantly to reducing performance in the male group. In review of these findings, this study cautions that anxiety may confound psychomotor test performance, and that clinicians need to be aware of its potential influence.

Neuropsychological assessment of chronic non-malignant pain patients treated in a multidisciplinary pain centre

The aim of the study was to investigate the influence of pain, sedation, pain medications and socio-demographics on cognitive functioning in chronic non-malignant pain patients. Chronic non-malignant pain patients (N=91) treated in a multidisciplinary pain centre were compared with age and sex matched healthy volunteers (N=64). Furthermore four subgroups of patients were examined: Group 1 (N=21) received no pain medications, group 2 (N=19) were in long-term oral opioid treatment, group 3 (N=18) were treated with antidepressants and/or anticonvulsants and group 4 (N=33) were treated with a combination of long-term oral opioids and antidepressants and/or anticonvulsants. Assessments comprised pain (PVAS) and sedation (SVAS), Continuous Reaction Time (CRT) testing for sustained attention, Finger Tapping Test (FTT) testing for psychomotor speed, Paced Auditory Serial Addition Task (PASAT) testing for information processing and working memory and Mini Mental State Examination (MMSE). CRT and FTT were impaired in the total patient sample. Treatment with opioids was associated with poorer performance of PASAT. High scores of PVAS and SVAS were associated with poor performance of PASAT and CRT, respectively. MMSE seems to be too insensitive for detecting the milder forms of cognitive impairment found in chronic non-malignant patients.

Neurocognitive parameters should be incorporated in the Minnesota Multiphasic Personality Inventory-2 assessment of patients with alcohol use disorders

INTRODUCTION AND AIMS

Treatment planning for alcohol use disorder (AUD) patients is often preceded by the assessment of psychopathology and personality with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). However, during periods of abstinence, cognitive impairments (e.g. attention, memory and executive dysfunctions) related to neurological and somatic pathology may affect level and pattern of MMPI-2 scale scores, resulting in clinical misinterpretation.

DESIGN AND METHODS

A re-analysis of the data of the Egger et al. study is conducted in order to examine the clinical significance of the MMPI-2 profiles of 222 AUD patients (mean age 42.2 ± 9.6 years; 76.6% men) by using neurologically relevant item correction procedures. Hierarchical cluster analyses of neurologically relevant item-corrected solutions were compared to the original MMPI-2 profile.

RESULTS

Impulsiveness and psychopathic deviation were identified as a common denominator.

DISCUSSION AND CONCLUSIONS

Uncorrected MMPI-2 assessment in AUD tends to overstress psychopathology and to overlook disinhibitory traits in early abstinence, caused by chronic alcoholism.

Influence of history of brain disease or brain trauma on psychopathological abnormality in young male in Korea : analysis of multiphasic personal inventory test

OBJECTIVE

The purpose of this study is to confirm whether brain disease or brain trauma actually affect psychopathology in young male group in Korea.

METHODS

The authors manually reviewed the result of Korean military multiphasic personal inventory (KMPI) in the examination of conscription in Korea from January 2008 to May 2010. There were total 237 young males in this review. Normal volunteers group (n=150) was composed of those who do not have history of brain disease or brain trauma. Brain disease group (n=33) was consisted of those with history of brain disease. Brain trauma group (n=54) was consisted of those with history of brain trauma. The results of KMPI in each group were compared.

RESULTS

Abnormal results of KMPI were found in both brain disease and trauma groups. In the brain disease group, higher tendencies of faking bad response, anxiety, depression, somatization, personality disorder, schizophrenic and paranoid psychopathy was observed and compared to the normal volunteers group. In the brain trauma group, higher tendencies of faking-good, depression, somatization and personality disorder was observed and compared to the normal volunteers group.

CONCLUSION

Young male with history of brain disease or brain trauma may have higher tendencies to have abnormal results of multiphasic personal inventory test compared to young male without history of brain disease or brain trauma, suggesting that damaged brain may cause psychopathology in young male group in Korea.

Gender effects on amygdala morphometry in adolescent marijuana users

Adolescent developments in limbic structures and the endogenous cannabinoid system suggest that teenagers may be more vulnerable to the negative consequences of marijuana use. This study examined the relationships between amygdala volume and internalizing symptoms in teenaged chronic marijuana users. Participants were 35 marijuana users and 47 controls ages 16-19 years. Exclusions included psychiatric (e.g., mood and anxiety) or neurologic disorders. Substance use, internalizing (anxiety/depression) symptoms and brain scans were collected after 28 days of monitored abstinence. Reliable raters manually traced amygdala and intracranial volumes on high-resolution magnetic resonance images. Female marijuana users had larger right amygdala volumes and more internalizing symptoms than female controls, after covarying head size, alcohol, nicotine and other substance use (p<0.05), while male users had similar volumes as male controls. For female controls and males, worse mood/anxiety was linked to smaller right amygdala volume (p<0.05), whereas more internalizing problems was associated with bigger right amygdala in female marijuana users. Gender interactions may reflect marijuana-related interruptions to sex-specific neuromaturational processes and staging. Subtle amygdala development abnormalities may underlie particular vulnerabilities to sub-diagnostic depression and anxiety in teenage female marijuana users.

Test anxiety in relation to measures of cognitive and intellectual functioning

The potential impact of test anxiety on cognitive testing was examined in a sample of 300 predominantly male veteran referrals who were administered a comprehensive neuropsychological test battery. Exclusionary criteria included failure on effort testing (n= 14). Level of test anxiety was significantly related to performance on the WAIS-III Working Memory Index (r = -.343, p < .001) but not to scores on the Processing Speed, Perceptual Organization, or Verbal Comprehension indexes. Test anxiety was not related to a global index of neuropsychological performance on the HRNES-R (Average Impairment Scale). Level of education had a collinear relationship with test anxiety in predicting cognitive test performance. Regression analyses revealed a more prominent role for education, indicating the possibility that test anxiety may be a reaction to, more than a cause of, deficient working memory performance. These results suggest that clinicians who use these particular tests should be reluctant to attribute poor test performance to anxiety that occurs during the testing process.

Newly diagnosed epilepsy: cognitive outcome at 5 years

Many people with epilepsy experience cognitive problems as a consequence of their epilepsy and its treatment. However, relatively few longitudinal studies have been conducted to investigate how these problems progress during the course of the disorder, particularly in those who are newly diagnosed. Fifty patients with newly diagnosed epilepsy were assessed using a comprehensive neuropsychological test battery before they started antiepileptic treatment and after a mean of 5 years. At the 5-year follow-up, the majority of cognitive measures remained stable, although significant (but subtle) declines were noted for memory and psychomotor speed domains in 38% of people with epilepsy.

Do UK university football club players suffer neuropsychological impairment as a consequence of their football (soccer) play?

Male players from football and rugby clubs and sportsmen from a variety of noncontact sports clubs at a UK university were compared on biographical and neuropsychological test measures. A data analysis paradigm was developed and employed to control the inflation of Type 1 error rate due to multiple hypotheses testing. Rugby players sustained most head injuries in their chosen sport, but neuropsychological tests of attention, memory, and executive function provided no evidence of performance impairment attributable to the number of head injuries sustained or the football, rugby, or noncontact sport groups. Footballers' heading frequency was related to the number of football head injuries sustained, but no relationship was detected between footballers' heading frequency and their neuropsychological test performance. Following discussion of pertinent methodological limitations it is concluded that there was no evidence in this dataset of neuropsychological impairment consistent with either mild head injury incidence or football heading frequency. However, a need for further research examining the long-term neuropsychological consequences of such head injuries was identified.

The contribution of pre-existing depression to the acute cognitive sequelae of mild traumatic brain injury

PRIMARY OBJECTIVE

To determine the effect of pre-existing depression on the cognitive sequelae of mild traumatic brain injury (mTBI) within 24 hours of injury.

RESEARCH DESIGN

A 2 x 2 between-subjects design was used to examine the effect of depression and injury type on neuropsychological test performance. The independent variables were the injury type (mTBI or control) and the presence of depression (depressed or not depressed).

METHODS AND PROCEDURES

Participants who had sustained mTBI (30 with depression, 30 without depression) within the previous 24 hours and control participants (19 with depression, 30 without depression) were assessed on the Digit Symbol Substitution Test (DSS), Hopkins Verbal Learning Test (HVLT) and the Speed of Comprehension Test.

RESULTS

Participants with mTBI performed worse than controls on the tests, particularly HVLT delayed recall and DSS total correct. Participants with depression did not perform worse than participants without depression. However, there was a significant univariate interaction for HVLT recognition, participants who had sustained mTBI and were classified in the depressed group exhibited worse recognition compared to mTBI participants without depression.

CONCLUSIONS

The results indicate that depression may interact with mTBI to impair word recognition during the acute phase after a head injury.

Neuropsychological Impairment as a Consequence of Football (Soccer) Play and Football Heading: Preliminary Analyses and Report on University Footballers

Previous research has claimed neuropsychological impairment occurs as a result of professional and amateur football play, and, specifically, football heading. However, much of this research exhibits substantial methodological problems. By investigating less committed amateur level footballers, the current study sought to gain some insight into the developmental history of any neuropsychological consequences of football play. University football, rugby and noncontact sports players were compared on a range of biographical and neuropsychological test variables. While playing their chosen sports, rugby players sustained many more head injuries than footballers and noncontact sportsmen, but footballers did not sustain significantly more head injuries than noncontact sportsmen. The number of head injuries sustained predicted Trails B and TAP Divided Attention latencies in a positive fashion. After controlling for the number of head injuries sustained, sport group effects were detected with TAP Divided Attention accuracy scores, with footballers exhibiting poorest performance. After controlling for the number of head injuries sustained, the total amount of heading done by footballers predicted the number of Wisconsin Card Sorting category shifts in a negative fashion. Nevertheless, over interpretation of all of these results should be resisted because of the exploratory nature of the analyses and the possibility that the sport groups may differ in ways other than just the nature of their sports activities.

Impaired Awareness of Deficits and Treatment Adherence Among People With Traumatic Brain Injury or Spinal Cord Injury

OBJECTIVE

To examine the relation between impaired awareness of deficits (IAD) and treatment adherence and to verify previous findings regarding the types of disabilities that people with traumatic brain injury (TBI) tend to underestimate.

DESIGN

Cross-sectional study.

PARTICIPANTS

Twenty-four persons with moderate to severe TBI and 16 persons with traumatic spinal cord injury (SCI) admitted to an inpatient neurorehabilitation program.

MAIN OUTCOME MEASURES

IAD assessed using the short version of the Problem Checklist of the Head Injury Family Interview and treatment adherence using the Medical Regimen Adherence Scale.

RESULTS

Presence of IAD is linked with poor adherence. Patients with TBI significantly underestimate their emotional/behavioural and cognitive disabilities, but accurately assess their physical disabilities, whereas patients with SCI accurately assess all spheres. Patients with TBI are significantly less aware of their disabilities compared with the patients with SCI as expected.

CONCLUSIONS

These results confirm IAD's link to treatment adherence, and support the observation that IAD is a common clinical feature of brain injury that should be carefully considered when making prognoses and developing and applying interventions with this population.

Predictive Testing for Huntington's Disease: How Does it Impact on Cognitive Performance?

The discovery of a polymorphic DNA marker for Huntington's Disease (HD) in 1983, and the specific gene responsible in 1993, led to predictive testing programmes out of which came research into whether or not cognitive impairment was present presymptomatically in those at risk for HD. The results of these studies have been conflicting and inconclusive. Methodoiogical limitations have probably contributed to the differing findings. The present study attempted to expand upon previous studies by analysing the data in a more comprehensive manner, and with additional control conditions. In this study, 26 individuals, at risk but presymptomatic, for HD were recruited from the Johannesburg Predictive Testing Programme and administered a battery of psychological tests prior to molecular analysis. Of this HD group, 11 were subsequently positive for the gene (the HD+ group) and 15 were negative (HD- group). A carefully chosen control group, (matched for age, sex, and education - Control Group 1) and a group of individuals experiencing a life threatening medical illness (without CNS involvement - Control Group 2) were administered the same battery of psychological tests. Four-way Analysis of Variance between the HD+, HD-, and Control groups was conducted to detect specific differences between the groups. The results indicated that the HD+ group showed mild impairment for declarative memory function. However, it would appear that undergoing the psychological evaluation itself impacted upon the test performance of both the HD+ and HD- groups.

The neuropsychological assessment of dementia

It has become standard practice to base the diagnosis of dementia on the combination of neuropsychological and non-behavioral findings. The present article provides a short, clinically oriented synopsis of the targets, investigational procedures, and difficulties of the modern neuropsychological approach to the diagnosis of dementia. Over the years, neuropsychology has developed assessment tools to evaluate the cognitive and behavioral abnormalities of many dementias. Validated tests of memory, language, executive, and other cognitive functions are used to screen for dementia and identifying certain dementia profiles. Behavioral assessment procedures are available for non-cognitive neurodegenerative alterations. At present, problems arise mainly with the behavioral heterogeneity of certain dementia syndromes. Especially problematic are discrimination of age-associated or mild cognitive impairments from incipient dementia and the impact of psychiatric symptoms on cognitive functions. It is concluded that neuropsychology offers a valuable contribution to the diagnosis and differential diagnosis of dementia.

Personality profile and neuropsychological test performance in chronic cocaine-abusers

Little is known about the association between personality disorders and neuropsychological test performance in chronic cocaine users. The aims of the present study were to (1) pinpoint the specific neuropsychological characteristics of chronic cocaine abusers, (2) analyze their personality profile, and (3) explore the association between personality traits and neuropsychological test performance. A sample of 42 drug-abusers (mean age = 34.15; SD = 6.73; mean educational level = 11.44; SD = 2.01) was selected from a state rehabilitation facility and was compared to a control group (mean age = 34.53; SD = 9.01; mean educational level = 12.29; SD = 1.31). The following information was collected for each subject: (1) A clinical history adapted from Horton (1996). (2) The Personality Assessment Inventory (PAI) (Morey, 1991). (3) A neuropsychological test battery including: Arithmetic and Digits subtests from the WAIS-R, California Verbal Learning Test, Trial Making Test, Verbal Fluency tests, Rey-Osterrieth Complex Figure, Wisconsin Card Sorting Test, Benton Visual Retention Test, Stroop Neurological Screening Test and Hooper Visual Organization. Thirty-seven of the drug-dependent subjects obtained an abnormal score in at least one PAI scale. The personality profile of the drug-dependent subjects found via the PAI pointed to a Borderline/Antisocial personality, frequently associated with mania features. In six of the drug-abusers, a normal personality profile was observed. Neuropsychological test performance scores were within the low average or borderline range. The most abnormal scores were observed in attention, memory, and executive functioning tests. The results did not show any robust association between personality profile and neuropsychological test performance.

Assessment of malingering in chronic pain patients using neuropsychological tests

Validity checks into neuropsychological tests have been successful at detecting malingering in litigant patients with mild brain injury in recent years. This study expanded on these findings and examined whether 6 neuropsychological tests could be used to detect malingering in litigant (n = 55) and nonlitigant (n = 53) patients claiming cognitive deficits due to chronic pain. Encouraging findings were found. When patients were matched on age, gender, racial or ethnic background, years of education, and time postinjury, almost one third (29%) of patients in the litigant group failed 2 or more validity checks in these 6 neuropsychological tests versus none (0%) of the patients in the nonlitigant group. This result challenges the validity of some litigant patients who complain of cognitive deficits due to chronic pain. Furthermore, the findings suggest that neuropsychological assessments can be used as part of the assessment of chronic pain complainants. Further investigation of the validity markers in these 6 neuropsychological tests is recommended.

The postconcussion syndrome after mild head trauma: is brain damage overdiagnosed? Part 1

Many investigators attribute the postconcussion syndrome following mild closed head injury to permanent brain damage. The evidence supporting this conclusion is reviewed, including the force necessary to cause permanent brain damage; the basis for determining whether the patient was exposed to sufficient force in the accident to permanently damage the brain; the basis for determining whether the patient actually has permanent brain damage (not just brain dysfunction) traceable to the accident; and whether the location and severity of brain damage is sufficient to account for the postconcussion syndrome.

CONCLUSION

the evidence for permanent traumatic brain damage as the cause of the postconcussion syndrome following mild closed head injury is weak.

Malingering and mild brain injury: how low is too low

The purpose of this study was to investigate potential validity markers for 4 commonly used neuropsychological tests. Participants were divided into 5 groups: moderate/severe brain injury (n = 27), mild brain injury--nonlitigating (n = 35), normal controls (n = 30), mild brain injury--litigating (n = 49), and malingering "actors" (n = 20). Participants completed a flexible neuropsychological battery that included the 4 tests of interest (Judgment of Line Orientation, Token Test, Dichotic Listening, and 20-item forced choice). Results demonstrated cutoff levels on all 4 tests below which people with mild brain injury would not be expected to fall. The fact that some litigants, but no nonlitigants, fell below these cutoff levels suggests these tests and their cutoff levels may be used appropriately as internal validity markers. There was 100% specificity and 95% sensitivity found when all 4 tests were used together (1-test criteria) to separate litigants, nonlitigants, and actors. It is suggested that further examination of these tests and other neuropsychological tests, be completed so that, eventually, all neuropsychological tests will have internal validity markers.