1
|
Split M, Pluim McDowell C, Lopez FV, Almklov E, Filoteo JV, Lessig S, Litvan I, Schiehser DM. The relationship between objective and subjective executive function in Parkinson's disease. J Clin Exp Neuropsychol 2024; 46:207-217. [PMID: 38721997 DOI: 10.1080/13803395.2024.2340812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 04/02/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Difficulties in executive functioning (EF) are common in PD; however, the relationship between subjective and objective EF is unclear. Understanding this relationship could help guide clinical EF assessment. This study examined the relationship between subjective self-reported EF (SEF) and objective EF (OEF) and predictors of SEF-OEF discrepancies in PD. METHOD One-hundred and sixteen non-demented PD participants completed measures of OEF (i.e. problem-solving, cognitive flexibility, inhibition, and working memory) and SEF (Frontal Systems Behavior Scale-Self Executive Dysfunction Subscale). Pearson bivariate correlations and linear regressions were performed to examine the relationship between SEF and OEF and the non-motor symptoms (e.g. mood, fatigue), demographic, and PD characteristic (e.g. MCI status) predictors of discrepancies between OEF and SEF (|OEF minus SEF scores|). Correlates of under-, over-, and accurate-reporting were also explored. RESULTS Greater SEF complaints and worse OEF were significantly associated (β =.200, p = .009) and 64% of participants accurately identified their level of OEF abilities. Fewer years of education and greater symptoms of depression, anxiety, and fatigue significantly correlated with greater discrepancies between OEF and SEF. Fatigue was the best predictor of EF discrepancy in the overall sample (β = .281, p = .022). Exploratory analyses revealed apathy and fatigue associated with greater under-reporting, while anxiety associated with greater over-reporting. CONCLUSIONS SEF and OEF are significantly related in PD. Approximately 64% of non-demented persons with PD accurately reported their EF skill level, while 28% under-reported and 8% over-reported. SEF-OEF discrepancies were predicted by fatigue in the overall sample. Preliminary evidence suggests reduced apathy and fatigue symptoms relate to more under-reporting, while anxiety relates to greater over-reporting. Given the prevalence of these non-motor symptoms in PD, it is important to carefully consider them when assessing EF in PD.
Collapse
Affiliation(s)
- Molly Split
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | | | - Francesca V Lopez
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Erin Almklov
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - J Vincent Filoteo
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Stephanie Lessig
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Dawn M Schiehser
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
2
|
Parrilla MM, Kautiainen RJ, King TZ. Sleep quality and executive function in a diverse sample of healthy young adults. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-9. [PMID: 38170836 DOI: 10.1080/23279095.2023.2297299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Few studies examine the relationship between sleep and executive function in diverse samples of young adults. Our research aims to fill this gap by analyzing how self-reported sleep quality is related to informant-rated executive function as a whole and its working memory component in a diverse sample of 29 healthy college students. Using the self-report measure, the Pittsburgh Sleep Quality Index (PSQI), we divided our sample into two groups based on cutoff criteria (score ≥5: poor sleep): good sleep quality (n = 11) and poor sleep quality (n = 18). Participants were on average 20.86 years old. Informants rated participants' executive functioning and working memory using the Frontal Systems Behavior Scale (FrSBe) and Behavior Rating Inventory of Executive Function (BRIEF). Individuals in the poor sleep quality group were reported as having significantly worse executive function and working memory scores. Young adult college students who report less than 7 hours of sleep per night have lower scores on informant measures of working memory and executive function. This study raises awareness about how self-reported sleep experiences are related to other's observation of cognitive abilities in everyday life in a diverse young adult sample.
Collapse
Affiliation(s)
- Maria M Parrilla
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| |
Collapse
|
3
|
Venkatesan UM, Rabinowitz AR, Bernier RA, Soto JA, Hillary FG. Effects of Perceived Discrimination on Behavioral Health Outcomes in People Aging With Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:191-200. [PMID: 36731038 DOI: 10.1097/htr.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate major and everyday experiences of discrimination (MED and EED, respectively) in relation to behavioral health outcomes in people with traumatic brain injury (PwTBI). SETTING Outpatient research laboratory. PARTICIPANTS Adults, 50 years or older, with a chronic (1+ year) history of moderate or severe TBI ( N = 118). DESIGN Cross-sectional observational study. MAIN MEASURES MED and EED (primary measures of interest) and behavioral health outcomes: global cognition, psychological symptoms, neurobehavioral symptoms, societal participation, and health-related quality of life (HRQoL). In participants with available geodata ( N = 28), neighborhood socioeconomic deprivation (ND) was examined as a potential contributor to MED, EED, and measured outcomes. RESULTS EED and MED were significantly associated with psychological symptoms, neurobehavioral symptoms, and HRQoL after correction for multiple comparisons. Counter to expectations, EED were related to higher societal participation. MED and EED were unrelated to cognition. When MED and EED were entered together in hierarchical regressions, only EED made significant contributions beyond demographic and injury-related covariates to each outcome. Sensitivity analyses revealed that most of these relationships were not solely accounted for by disability-related discrimination. ND showed negligible associations with discrimination but moderate effect sizes for cognition and participation. Race was not significantly related to discrimination and was not a significant predictor in regression models but was strongly associated with ND. CONCLUSION The current data provide preliminary support for perceived discrimination as an important factor in neurobehavioral and psychosocial health, but not cognitive performance, after TBI. These relationships appear to be driven by daily experiences of discriminatory treatment versus single major instances of injustice. Measured outcomes may also reflect socioeconomic challenges and structural discrimination faced by diverse PwTBI, although more work in this area is urgently needed. Multiple sources of marginalization and disenfranchisement and their functional effects should be considered in TBI rehabilitation and outcome monitoring.
Collapse
Affiliation(s)
- Umesh M Venkatesan
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Drs Venkatesan and Rabinowitz); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Drs Venkatesan and Rabinowitz); Department of Neurosciences, UC San Diego School of Medicine, La Jolla, California (Dr Bernier); Department of Psychology, Pennsylvania State University, University Park (Drs Soto and Hillary); and Department of Neurology, Penn State Hershey Medical Center, Hershey, Pennsylvania (Dr Hillary)
| | | | | | | | | |
Collapse
|
4
|
Annaheim C, Hug K, Stumm C, Messerli M, Simon Y, Hund-Georgiadis M. Neurofeedback in patients with frontal brain lesions: A randomized, controlled double-blind trial. Front Hum Neurosci 2022; 16:979723. [PMID: 36188178 PMCID: PMC9521487 DOI: 10.3389/fnhum.2022.979723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Frontal brain dysfunction is a major challenge in neurorehabilitation. Neurofeedback (NF), as an EEG-based brain training method, is currently applied in a wide spectrum of mental health conditions, including traumatic brain injury. Objective This study aimed to explore the capacity of Infra-Low Frequency Neurofeedback (ILF-NF) to promote the recovery of brain function in patients with frontal brain injury. Materials and methods Twenty patients hospitalized at a neurorehabilitation clinic in Switzerland with recently acquired, frontal and optionally other brain lesions were randomized to either receive NF or sham-NF. Cognitive improvement was assessed using the Frontal Assessment Battery (FAB) and the Test of Attentional Performance (TAP) tasks regarding intrinsic alertness, phasic alertness and impulse control. Results With respect to cognitive improvements, there was no significant difference between the two groups after 20 sessions of either NF or sham-NF. However, in a subgroup of patients with predominantly frontal brain lesions, the improvements measured by the FAB and intrinsic alertness were significantly higher in the NF-group. Conclusion This is the first double-blind controlled study using NF in recovery from brain injury, and thus also the first such study of ILF NF. Although the result of the subgroup has limited significance because of the small number of participants, it accentuates the trend seen in the whole group regarding the FAB and intrinsic alertness (p = 0.068, p = 0.079, respectively). We therefore conclude that NF could be a promising candidate promoting the recoveryfrom frontal brain lesions. Further studies with larger numbers of patients and less lesion heterogeneity are needed to verify the usefulness of NF in the neurorehabilitation of patients with frontal brain injury (NCT02957695 ClinicalTrials.gov).
Collapse
Affiliation(s)
- Christine Annaheim
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
5
|
Wakely H, Radakovic R, Bateman A, Simblett S, Fish J, Gracey F. Psychometric Properties of the Revised Dysexecutive Questionnaire in a Non-clinical Population. Front Hum Neurosci 2022; 16:767367. [PMID: 35308604 PMCID: PMC8924056 DOI: 10.3389/fnhum.2022.767367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Aims The aim of this study was to assess the psychometric properties of the revised self-rated version of the Dysexecutive Questionnaire (DEX-R) within a non-clinical sample. Methods The study was hosted online, with 140 participants completing the DEX-R, GAD-2 and PHQ-2. Sixty participants also completed the FrSBe, with 99 additionally completing the DEX-R again 3 weeks later. Correlations with demographic factors and symptoms of anxiety and depression were conducted. Rasch and factor analysis were also used to explore underlying subconstructs. Results The DEX-R correlated highly with the FrSBe, indicating sound concurrent validity. Internal consistency, split-half reliability and test-retest reliability were excellent. Age and symptoms of depression and anxiety correlated with DEX-R scores, with older age associated with less dysexecutive problems. The Rasch analysis confirmed the multidimensionality of the rating scale, and a three-factor structure was found relating to activation-self-regulatory, cognitive and social-emotional processes. Frequencies of responses on DEX-R items varied, many were not fully endorsed indicating specific relevance of most but not all items to patients. Conclusion Interpretations of DEX-R ratings of dysexecutive problems should consider mood and individual variation. Systematic comparison of DEX-R responses between healthy and clinical groups could help identify a suitable cut off for dysexecutive symptoms.
Collapse
Affiliation(s)
- Hannah Wakely
- Faculty of Medicine and Health Sciences, Cambridgeshire and Peterborough NHS Foundation Trust, University of East Anglia, Norwich, United Kingdom
| | - Ratko Radakovic
- Faculty of Medicine and Health Sciences, Cambridgeshire and Peterborough NHS Foundation Trust, University of East Anglia, Norwich, United Kingdom
- The Euan MacDonald Centre for Motor Neurone Disease, University of Edinburgh, Edinburgh, United Kingdom
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Aging and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Bateman
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - Sara Simblett
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
| | - Jessica Fish
- Department of Clinical Neuropsychology and Clinical Health Psychology, St George’s Hospitals NHS Foundation Trust, London, United Kingdom
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Fergus Gracey
- Faculty of Medicine and Health Sciences, Cambridgeshire and Peterborough NHS Foundation Trust, University of East Anglia, Norwich, United Kingdom
| |
Collapse
|
6
|
Zirbes C, Jones A, Manzel K, Denburg N, Barrash J. Assessing the Effects of Healthy and Neuropathological Aging on Personality with the Iowa Scales of Personality Change. Dev Neuropsychol 2021; 46:393-408. [PMID: 34283684 DOI: 10.1080/87565641.2021.1956500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Personality changes in older adults with brain disease may be confounded by effects of normal aging. In this cross-sectional study, ratings with the Iowa Scales of Personality Change for 62 healthy older adults (OA-H, aged 60+) were compared to matched older adults with brain diseases (OA-BD). OA-H did not show any significant personality changes from middle age to older adulthood. However, between 10% and 20% of OA-H developed a disturbance in Lack of Stamina, Inflexibility, Lability, and Lack of Insight. Otherwise, the pattern of findings suggesting normal aging effects on personality disturbances in clinical groups are generally minimal.
Collapse
Affiliation(s)
- Christian Zirbes
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, United States
| | - Andrew Jones
- Department of Computer Science, Princeton University, Princeton, United States
| | - Kenneth Manzel
- Department of Neurology, University of Iowa, Iowa City, United States
| | - Natalie Denburg
- Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, United States
| | - Joseph Barrash
- Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, United States
| |
Collapse
|
7
|
The Neurological Predictor Scale Predicts Adaptive Functioning via Executive Dysfunction in Young Adult Survivors of Childhood Brain Tumor. J Int Neuropsychol Soc 2021; 27:1-11. [PMID: 32641194 DOI: 10.1017/s1355617720000624] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Survivors of childhood brain tumors experience neurological sequelae that disrupt everyday adaptive functioning (AF) skills. The Neurological Predictor Scale (NPS), a cumulative measure of tumor treatments and sequelae, predicts cognitive outcomes, but findings on its relation to informant-reported executive dysfunction (ED) and AF are mixed. Given known effects of frontal-subcortical system disruptions on AF, this study assessed the NPS' relationship with AF as mediated by frontal systems dysfunction, measured by the Frontal Systems Behavior Scale (FrSBe). METHODS 75 participants (Mage = 23.5, SDage = 4.5) were young adult survivors of childhood brain tumors at least 5 years past diagnosis. FrSBe and Scales of Independent Behavior-Revised (SIB-R), a measure of AF, were administered to informants. Parallel multiple mediator models included Apathy and ED as mediators, and age at diagnosis and time between diagnosis and assessment as covariates. RESULTS More complex treatment and sequelae were correlated with poorer functioning. Mediation models were significant for all subscales: Motor Skills (MS), p = .0001; Social Communication (SC), p = .002; Personal Living (PL), p = .004; Community Living (CL), p = .007. The indirect effect of ED on SC and CL was significant; the indirect effect of Apathy was not significant for any subscales. CONCLUSIONS More complex tumor treatment and sequelae were associated with poorer long-term AF via increased ED. Cognitive rehabilitation programs may focus on the role of executive function and initiation that contribute to AF, particularly SC and CL skills, to help survivors achieve comparable levels of independence in everyday function as their peers.
Collapse
|
8
|
Association of HIV serostatus and metabolic syndrome with neurobehavioral disturbances. J Neurovirol 2020; 26:888-898. [PMID: 32734380 DOI: 10.1007/s13365-020-00878-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/09/2020] [Accepted: 07/03/2020] [Indexed: 12/15/2022]
Abstract
Metabolic syndrome (MetS), a constellation of related metabolic risk factors, is a common comorbidity associated with cognitive difficulty in people living with HIV (PLWH). Neurobehavioral disturbances (e.g., behavioral manifestations of frontal-subcortical dysfunction) are also prevalent in HIV, yet the role MetS might play in HIV-associated neurobehavioral disturbances is unknown. Thus, we examined the link between MetS and neurobehavioral disturbances in PLWH. Participants included 215 adults (117 PLWH, 98 HIV-uninfected), aged 36 to 65 years, from a cohort study at the University of California San Diego. Using the Frontal Systems Behavior Scale, we captured neurobehavioral disturbances (apathy, disinhibition, and executive dysfunction). MetS was defined by the National Cholesterol Education Program's Adult Treatment Panel-III criteria. Covariates examined included demographic, neurocognitive impairment, and psychiatric characteristics. When controlling for relevant covariates, both HIV serostatus and MetS were independently associated with greater apathy and executive dysfunction. HIV, but not MetS, was associated with greater disinhibition. The present findings suggest an additive effect of HIV and MetS on specific neurobehavioral disturbances (apathy and executive dysfunction), underscoring the importance of identifying and treating both HIV and MetS to lessen central nervous system burden among PLWH.
Collapse
|
9
|
Gefen T, Teylan MA, Besser L, Pollner E, Moshkovich A, Weintraub S. Measurement and characterization of distinctive clinical phenotypes using the Frontotemporal Lobar Degeneration Module (FTLD-MOD). Alzheimers Dement 2020; 16:918-925. [PMID: 32400973 PMCID: PMC7580870 DOI: 10.1002/alz.12098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/31/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The Frontotemporal Lobar Degeneration Module (FTLD-MOD) was designed as a research neuropsychological battery to evaluate clinical symptoms associated with FTLD. This study investigated whether the FTLD-MOD could differentiate between primary progressive aphasia (PPA) and behavioral variant frontotemporal dementia (bvFTD), two distinct FTLD-related syndromes. METHODS Retrospective analysis was conducted on data collected from the initial visit of 165 subjects with PPA, 268 with bvFTD, and 251 cognitively normal controls from the National Alzheimer's Coordinating Center. Generalized linear models were used to compare group performance patterns on FTLD-MOD tasks of language, behavior, and memory. RESULTS PPA participants showed significantly poorer performances on all language tasks whereas bvFTD participants demonstrated poorer performances on most behavioral measures. There were no differences in memory performances. Descriptive data on participant groups are provided for reference. DISCUSSION Findings from this multi-center sample suggest that the FTLD-MOD can differentiate between distinctive clinical phenotypes commonly associated with FTLD.
Collapse
Affiliation(s)
- Tamar Gefen
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Merilee A. Teylan
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Lilah Besser
- Institute for Human Health and Disease Intervention (I-HEALTH), School of Urban and Regional Planning, Florida Atlantic University, Boca Raton, Florida, USA
| | - Emma Pollner
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anna Moshkovich
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
10
|
Immunological and Neurometabolite Changes Associated With Switch From Efavirenz to an Integrase Inhibitor. J Acquir Immune Defic Syndr 2020; 81:585-593. [PMID: 31045650 DOI: 10.1097/qai.0000000000002079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The biological mechanisms by which efavirenz (EFV) causes central nervous system (CNS) effects are unclear. The objective of this pilot study was to elucidate the mechanisms underlying these CNS effects by correlating well-described neuropsychological (NP) changes with neurometabolites and immunologic markers following switch off EFV. SETTING Two single-arm parallel switch studies among HIV-infected adults in Boston, USA, from 2015 to 2017. METHODS Twenty asymptomatic HIV-infected adults on EFV-containing regimens were switched to an integrase strand transfer inhibitor-based regimen for 8 weeks. NP assessments were conducted before and after switch and correlated with neurometabolite changes measured using magnetic resonance spectroscopy and immunological markers. All pre-EFV and post-EFV measures were evaluated using matched-paired analyses. RESULTS NP testing demonstrated improvement in the domains of mood, cognition, and sleep off EFV. Magnetic resonance spectroscopy revealed decreases in the neurometabolite glutathione level (P = 0.03), a marker of oxidative stress after switch. Inhibitory neuronal activity as reflected by gamma-amino butyric acid levels increased (P = 0.03), whereas excitatory neurotransmitters glutamine + glutamate (Glx) and aspartate decreased (P = 0.04, 0.001). Switching off EFV was also associated with changes in inflammatory markers; plasma markers sCD14 (P = 0.008) decreased, whereas I-FABP and TNFRI levels increased (P = 0.05, 0.03). Cellular markers CD4 and CD8 HLA-DR-/CD38 subsets both increased (P = 0.05, 0.02). CONCLUSIONS Even asymptomatic participants showed improvements in NP parameters when switched off EFV. These improvements were associated with decreased CNS oxidative stress and excitatory neuronal activity. Changes in immune activation biomarkers suggested overall decreased inflammation. EFV may exert CNS effects through oxidative and inflammatory pathways, providing insight into possible mechanisms of EFV neurotoxicity.
Collapse
|
11
|
Adams AG, Schweitzer D, Molenberghs P, Henry JD. A meta-analytic review of social cognitive function following stroke. Neurosci Biobehav Rev 2019; 102:400-416. [DOI: 10.1016/j.neubiorev.2019.03.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/14/2019] [Accepted: 03/14/2019] [Indexed: 01/20/2023]
|
12
|
Johnen A, Bertoux M. Psychological and Cognitive Markers of Behavioral Variant Frontotemporal Dementia-A Clinical Neuropsychologist's View on Diagnostic Criteria and Beyond. Front Neurol 2019; 10:594. [PMID: 31231305 PMCID: PMC6568027 DOI: 10.3389/fneur.2019.00594] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
Behavioral variant frontotemporal dementia (bvFTD) is the second leading cognitive disorder caused by neurodegeneration in patients under 65 years of age. Characterized by frontal, insular, and/or temporal brain atrophy, patients present with heterogeneous constellations of behavioral and psychological symptoms among which progressive changes in social conduct, lack of empathy, apathy, disinhibited behaviors, and cognitive impairments are frequently observed. Since the histopathology of the disease is heterogeneous and identified genetic mutations only account for ~30% of cases, there are no reliable biomarkers for the diagnosis of bvFTD available in clinical routine as yet. Early detection of bvFTD thus relies on correct application of clinical diagnostic criteria. Their evaluation however, requires expertise and in-depth assessments of cognitive functions, history taking, clinical observations as well as caregiver reports on behavioral and psychological symptoms and their respective changes. With this review, we aim for a critical appraisal of common methods to access the behavioral and psychological symptoms as well as the cognitive alterations presented in the diagnostic criteria for bvFTD. We highlight both, practical difficulties as well as current controversies regarding an overlap of symptoms and particularly cognitive impairments with other neurodegenerative and primary psychiatric diseases. We then review more recent developments and evidence on cognitive, behavioral and psychological symptoms of bvFTD beyond the diagnostic criteria which may prospectively enhance the early detection and differential diagnosis in clinical routine. In particular, evidence on specific impairments in social and emotional processing, praxis abilities as well as interoceptive processing in bvFTD is summarized and potential links with behavior and classic cognitive domains are discussed. We finally outline both, future opportunities and major challenges with regard to the role of clinical neuropsychology in detecting bvFTD and related neurocognitive disorders.
Collapse
Affiliation(s)
- Andreas Johnen
- Section for Neuropsychology, Department of Neurology, University Hospital Münster, Münster, Germany
| | - Maxime Bertoux
- Univ Lille, Inserm UMR 1171 Degenerative and Vascular Cognitive Disorders, CHU Lille, Lille, France
| |
Collapse
|
13
|
Lewis C, Walterfang M, Velakoulis D, Vogel AP. A Review: Mealtime Difficulties following Frontotemporal Lobar Degeneration. Dement Geriatr Cogn Disord 2019; 46:285-297. [PMID: 30423586 DOI: 10.1159/000494210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/01/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) can result in a decline in behavior, language, and motor function. Mealtime disturbances are a common and significant outcome of FTLD. Disturbances during mealtimes can arise from dysphagia or may occur secondary to behavioral changes such as rapid eating, mealtime rigidity, and altered diet preferences. SUMMARY Few studies have comprehensively evaluated eating behavior or dysphagia in individuals presenting with FTLD pathology despite the potential impact on medical safety and individual quality of life. Dysphagia is reported in the late stages of frontotemporal dementia and early in the motor subtypes of FTLD. The identification of dysphagia can alert individuals and medical teams to disease progression and provide insight into the nature and spread of the underlying neuropathology. Improved understanding of eating behaviors can improve individual care and may enhance diagnostic accuracy. Key Message: Aberrant eating behavior and swallowing difficulties are reported in the conditions associated with FTLD neuropathology. The consequences of mealtime disturbances include health risks associated with an increased BMI and aspiration, reduction of an individual's independence, and an increase in caregiver stress and burden. Here we review and summarize the literature on eating behavior and swallow impairments (dysphagia) in each of the syndromes caused by FTLD.
Collapse
Affiliation(s)
- Courtney Lewis
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Victoria, Australia, .,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany, .,Redenlab, Melbourne, Victoria, Australia,
| |
Collapse
|
14
|
Identification of Sexual Disinhibition in Dementia by Family Caregivers. Alzheimer Dis Assoc Disord 2019; 33:154-159. [DOI: 10.1097/wad.0000000000000302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Ledochowski J, Andrade BF, Toplak ME. A novel unstructured performance-based task of executive function in children with attention-deficit/hyperactivity disorder. J Clin Exp Neuropsychol 2019; 41:445-459. [PMID: 30712495 DOI: 10.1080/13803395.2019.1567694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Executive functions (EFs) have been assessed with performance-based measures and rating scales. Research has shown a lack of association between these two methods. One factor that might contribute to this difference is the structure provided on performance-based measures that is not provided on rating scales. This study examined the role of structure on self-directed task completion, an aspect of EF, using a novel unstructured performance-based task (UPT). METHOD Children aged 8-12 years (38 attention-deficit/hyperactivity disorder, ADHD; 42 typically developing) and their caregivers participated. We compared performance on the UPT, performance-based measures of EF (Stroop test and Trail-Making Test), and a rating scale to assess EF (Barkley Deficits in Executive Functioning Scale-Children and Adolescents, BDEFS-CA). RESULTS Group differences were found across all measures. Significant associations emerged between the UPT and Stroop test, Trail-Making Test, and BDEFS-CA, but no significant associations were found between the Stroop test or Trail-Making Test and the BDEFS-CA. In regression analyses, performance-based tasks and the rating scale both uniquely predicted UPT performance. The UPT was a significant predictor of group status when entered with performance-based tasks, but the UPT did not enter as a significant predictor when entered with the rating scale. CONCLUSION The UPT is a promising measure to assess self-directed task completion in children with ADHD.
Collapse
Affiliation(s)
| | - Brendan F Andrade
- b Child Youth and Emerging Adult Program , Margaret and Wallace McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health , Toronto , ON , Canada.,c Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Maggie E Toplak
- a Psychology , York University , Toronto , ON , Canada.,d LaMarsh Centre for Child and Youth Research , Toronto , ON , Canada
| |
Collapse
|
16
|
Stewart CC, Boyle PA, James BD, Yu L, Han SD, Bennett DA. Associations of APOE ε4 With Health and Financial Literacy Among Community-Based Older Adults Without Dementia. J Gerontol B Psychol Sci Soc Sci 2018; 73:778-786. [PMID: 27174891 PMCID: PMC6283314 DOI: 10.1093/geronb/gbw054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/21/2016] [Indexed: 01/10/2023] Open
Abstract
Objectives Older adults often exhibit low health and financial literacy, but the reasons why remain unclear. One possibility is that those older adults at high risk for developing dementia demonstrate low literacy even in the absence of marked cognitive impairment. We therefore examined associations of health and financial literacy with the APOE ε4 allele, the chief genetic risk factor for Alzheimer's disease, among older adults without dementia. Method Participants were 487 older adults without dementia enrolled in the Rush Memory and Aging Project (mean age = 83, mean years of education = 15, 77% female, 91% non-Hispanic White). Participants underwent APOE genotyping and assessments of cognition, health literacy, and financial literacy. Health and financial literacy scores were also averaged into a total literacy score. Results ε4 was associated with lower total and health literacy, with a trend toward an association with lower financial literacy, after adjustment for age, sex, and education. Associations of ε4 with lower total and health literacy persisted after further adjustment for global cognitive function and 5 specific cognitive domains. Discussion ε4 affects literacy even in the absence of clinical dementia and does so relatively independent of performance on traditional cognitive tests.
Collapse
Affiliation(s)
- Christopher C Stewart
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Patricia A Boyle
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Bryan D James
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Lei Yu
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - S Duke Han
- Departments of Family Medicine, Neurology, and Psychology, University of Southern California, Los Angeles
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
17
|
Ducharme S, Price BH, Dickerson BC. Apathy: a neurocircuitry model based on frontotemporal dementia. J Neurol Neurosurg Psychiatry 2018; 89:389-396. [PMID: 29066518 PMCID: PMC6561783 DOI: 10.1136/jnnp-2017-316277] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/02/2017] [Accepted: 09/14/2017] [Indexed: 01/14/2023]
Abstract
Apathy is a symptom shared among many neurological and psychiatric disorders. However, the underlying neurocircuitry remains incompletely understood. Apathy is one of the core features of behavioural variant frontotemporal dementia (bvFTD), a neurodegenerative disease presenting with heterogeneous combinations of socioaffective symptoms and executive dysfunction. We reviewed all neuroimaging studies of apathy in frontotemporal dementia (FTD) attempting to refine a neurocircuitry model and inform clinical definitions. Levels of apathy have been consistently shown to correlate with the severity of executive dysfunctions across a wide range of diseases, including FTD. Some authors view 'energisation'-the loss of which is central in apathy-as a core executive function. Apathy in FTD is most robustly associated with atrophy, hypometabolism and/or hypoperfusion in the dorsolateral prefrontal cortex, the anterior and middle cingulate cortex, the orbitofrontal cortex and the medial and ventromedial superior frontal gyri. Data also suggest that abnormalities in connecting white matter pathways and functionally connected more posterior cortical areas could contribute to apathy. There is a lack of consistency across studies due to small samples, lenient statistical thresholds, variable measurement scales and the focus on apathy as a unitary concept. Integrating findings across studies, we revise a neurocircuitry model of apathy divided along three subcomponents (cognition/planning, initiation, emotional-affective/motivation) with specific neuroanatomical and cognitive substrates. To increase consistency in clinical practice, a recommendation is made to modify the bvFTD diagnostic criteria of apathy/inertia. More generally, we argue that bvFTD constitutes a disease model to study the neurocircuitry of complex behaviours as a 'lesion-based' approach to neuropsychiatric symptoms observed across diagnostic categories.
Collapse
Affiliation(s)
- Simon Ducharme
- Department of Psychiatry, Montreal Neurological Institute and McGill University Health Centre, Montreal, Québec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Québec, Canada
| | - Bruce H Price
- Department of Neurology, Harvard University, McLean Hospital, Boston, Massachusetts, USA
| | - Bradford C Dickerson
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Schei J, Nøvik TS, Thomsen PH, Lydersen S, Indredavik MS, Jozefiak T. What Predicts a Good Adolescent to Adult Transition in ADHD? The Role of Self-Reported Resilience. J Atten Disord 2018; 22:547-560. [PMID: 26399710 DOI: 10.1177/1087054715604362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE ADHD is a disorder associated with impairment and comorbid psychiatric problems in young adulthood; therefore, factors that may imply a more favorable outcome among adolescents with ADHD are of interest. METHOD This study used a longitudinal design to assess whether adolescent personal resilience characteristics during adolescence protected against psychosocial impairment, depression, and anxiety 3 years later. Self-reported protective factors were used as baseline measures in the assessment of 190 clinically referred adolescents with ADHD. A semi-structured diagnostic interview was performed at the follow-up. RESULTS In a group of youth with ADHD, personal resilience characteristics were associated with better psychosocial functioning in young adulthood, and less depression and anxiety. CONCLUSION Although further research is needed, these results indicate that personal resilience characteristics may be protective factors in the transitional period from adolescence to early adulthood.
Collapse
Affiliation(s)
- Jorun Schei
- 1 St. Olavs University Hospital, Trondheim, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Stene Nøvik
- 1 St. Olavs University Hospital, Trondheim, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway
| | - Per Hove Thomsen
- 1 St. Olavs University Hospital, Trondheim, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway.,3 Aarhus University Hospital, Denmark
| | - Stian Lydersen
- 2 Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit S Indredavik
- 1 St. Olavs University Hospital, Trondheim, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Jozefiak
- 1 St. Olavs University Hospital, Trondheim, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
19
|
Rönngren Y, Björk A, Haage D, Audulv Å, Kristiansen L. Perspectives of a tailored lifestyle program for people with severe mental illness receiving housing support. Perspect Psychiatr Care 2018; 54:309-316. [PMID: 28901554 DOI: 10.1111/ppc.12239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/06/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of the present study was to describe the acceptability of the lifestyle program PHYS/CAT and to get information about the tools used for assessment of functional exercise capacity, cognitive performance, and self-health-related quality of life. DESIGN AND METHODS The findings are based on focus groups and the researchers' experiences of conducting the program as well as using the assessment tools. FINDINGS The acceptability of the program and the assessment tools was mainly satisfactory. PRACTICE IMPLICATIONS The program with relational, educational, and supportive dimensions may be a promising tool to be integrated into daily nursing care.
Collapse
Affiliation(s)
- Ylva Rönngren
- Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Annette Björk
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - David Haage
- Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Åsa Audulv
- Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden
| | | |
Collapse
|
20
|
Dollman AK, Figaji AA, Schrieff-Elson LE. Academic and Behavioral Outcomes in School-Age South African Children Following Severe Traumatic Brain Injury. Front Neuroanat 2017; 11:121. [PMID: 29326559 PMCID: PMC5733492 DOI: 10.3389/fnana.2017.00121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/28/2017] [Indexed: 12/19/2022] Open
Abstract
Background: Children who have sustained severe traumatic brain injuries (TBIs) demonstrate a range of post-injury neurocognitive and behavioral sequelae, which may have adverse effects on their academic and behavioral outcomes and interfere with school re-entry, educational progress, and quality of life. These post-TBI sequelae are exacerbated within the context of a resource-poor country like South Africa (SA) where the education system is in a somewhat precarious state especially for those from disadvantaged backgrounds. Objectives: To describe behavioral and academic outcomes of a group of school-aged SA children following severe TBI. Methods: The sample included 27 school-age children who were admitted to the Red Cross War Memorial Children's Hospital (RXH), SA, between 2006 and 2011 for closed severe TBI and who received intracranial monitoring. We collected behavioral data using the Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF) and academic information sourced from the BRIEF, CBCL, medical folders, and caregivers. Analyses include descriptive statistics and bivariate correlation matrices. Results: The descriptive results show that (1) more than half of the participants experienced clinically-significant behavioral problems across the CBCL scales, (2) the working memory BRIEF subscale appeared to be the most problematic subdomain, (3) two thirds of the sample were receiving some form of, or were in the process of being placed in, special needs education, (4) there was a three-fold increase in the use of special education services from pre- to post-injury, and (5) more than half (n = 16) of the sample repeated at least one grade after returning to school post-injury. Correlation analyses results suggest that children with increased externalizing behavioral problems and executive dysfunction are more likely to repeat a grade post-injury; and that children with executive dysfunction post-TBI are more likely to require some form of special educational services. Conclusion: While there is a vast amount of literature on pediatric TBI (pTBI) academic and behavioral outcomes, little literature exists on the pTBI population from the developing world and SA specifically. This is important to address given unique challenges that face the country and its educational system, and its implications for the management and care of children post-TBI.
Collapse
Affiliation(s)
- Aimee K Dollman
- Applied Cognitive Science and Experimental Neuropsychology Team, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Anthony A Figaji
- Division of Neurosurgery, Department of Surgery, School of Child and Adolescent Health, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Leigh E Schrieff-Elson
- Applied Cognitive Science and Experimental Neuropsychology Team, Department of Psychology, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
21
|
Apathy and Cognitive Deficits in Patients with Transient Global Ischemia After Cardiac Arrest. Cogn Behav Neurol 2017; 30:172-175. [DOI: 10.1097/wnn.0000000000000139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Philpott AL, Andrews SC, Staios M, Churchyard A, Fisher F. Emotion Evaluation and Social Inference Impairments in Huntington's Disease. J Huntingtons Dis 2017; 5:175-83. [PMID: 27163947 DOI: 10.3233/jhd-160190] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Huntington's disease (HD) is an inherited neurodegenerative disorder characterised by motor, cognitive and neuropsychiatric symptoms. Recent research has established that individuals with HD display reduced discrimination of emotional facial expressions and impaired higher-order social cognitive skills, including 'theory of mind'. OBJECTIVE This study aimed to further characterise the emotion evaluation and theory of mind deficits in HD in an ecologically-valid context, and determine their impact on socially-relevant functional abilities. METHODS A sample of 17 HD participants and 24 healthy controls were assessed using The Awareness of Social Inference Test (TASIT), together with additional self- and informant rated measures of cognition, social communication, empathy and neuropsychiatric symptoms. RESULTS Participants with HD showed significant difficulties in evaluating negative emotions, and understanding sincere, sarcastic and 'paradoxical sarcastic' statements, compared with controls. The ability to evaluate positive emotions was negatively correlated with behavioural problems, but no other clinical, behavioural or communication measures correlated significantly with TASIT subscales. CONCLUSIONS These findings suggest that social cognitive difficulties in symptomatic HD may be underpinned by more generalised impairments, related to deciphering social exchanges, as opposed to a selective theory of mind deficit. Such difficulties have the potential to place significant strain on interpersonal relationships, and thus warrant thorough clinical assessment, using ecologically-valid tools, to promote early detection and development of person-centred interventions.
Collapse
Affiliation(s)
| | - Sophie C Andrews
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
| | - Mathew Staios
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
| | | | - Fiona Fisher
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
| |
Collapse
|
23
|
Hart T, Rabinowitz AR, Whyte J, Kim J. Pre-injury assessment of everyday executive function in moderate to severe traumatic brain injury. Neuropsychol Rehabil 2017; 29:1085-1094. [PMID: 28832248 DOI: 10.1080/09602011.2017.1364271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Executive dysfunction is frequently observed in moderate to severe traumatic brain injury (TBI) and is commonly assessed with objective measures or subjective rating scales. Given the variability in executive function in the normal population, a reliable measure of pre-injury executive function would be of considerable value. In this study we examined pre-injury self and collateral (relative or friend) ratings on the Frontal Systems Behavior Rating Scale (FrSBe). Fifty-one persons with moderate to severe TBI and their collaterals provided before- and after-TBI ratings at 3 months post injury. A subset of 36 dyads were retested at 6 and 12 months; 26 neurologically intact controls and their collaterals also provided FrSBe ratings. At 3 months post injury, the difference between patient and collateral ratings of current status was larger than the difference relating to premorbid status, suggesting that patients were able to rate themselves from a pre-injury perspective. However, pre-injury ratings from collaterals were more reliable over time compared with patients' self-ratings. For all sets of ratings - before injury, after injury, and status of healthy controls - collateral ratings indicated more abnormality, overall, than comparable self-ratings. Evaluating one's own executive behaviour may be a difficult task even without TBI, with the difficulty exacerbated by the effects of injury.
Collapse
Affiliation(s)
- Tessa Hart
- a Moss Rehabilitation Research Institute , Elkins Park , USA
| | | | - John Whyte
- a Moss Rehabilitation Research Institute , Elkins Park , USA
| | - Junghoon Kim
- a Moss Rehabilitation Research Institute , Elkins Park , USA.,b CUNY School of Medicine , The City College of New York , New York , USA
| |
Collapse
|
24
|
Esbensen AJ, Hooper SR, Fidler D, Hartley S, Edgin J, d’Ardhuy XL, Capone G, Conners F, Mervis CB, Abbeduto L, Rafii M, Krinsky-McHale SJ, Urv T. Outcome Measures for Clinical Trials in Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 122:247-281. [PMID: 28452584 PMCID: PMC5424621 DOI: 10.1352/1944-7558-122.3.247] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the National Institutes of Health (NIH) assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This article focuses on measures in the areas of cognition and behavior.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Leonard Abbeduto
- MIND Institute, University of California, Davis School of Medicine
| | | | | | - Tiina Urv
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | | |
Collapse
|
25
|
Bentvelzen A, Aerts L, Seeher K, Wesson J, Brodaty H. A Comprehensive Review of the Quality and Feasibility of Dementia Assessment Measures: The Dementia Outcomes Measurement Suite. J Am Med Dir Assoc 2017; 18:826-837. [PMID: 28283381 DOI: 10.1016/j.jamda.2017.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 12/19/2022]
Abstract
The diagnosis of dementia and the management of its associated symptoms are aided by high-quality assessment tools. However, there is disagreement on the optimal tools among abundant alternatives and lack of consistent quality standards across the different domains of dementia-related change (ie, cognition, severity, function, behavioral and psychological symptoms, delirium, quality of life). Standardization is difficult because the relevance of a measurement tool for health professionals may depend on the clinical setting and on the dementia type and severity. To address this need, we conducted a comprehensive and clinically relevant evidence-based review of dementia-related tools and present a set of recommended tools, the Dementia Outcomes Measurement Suite. The review revealed that considerable development has occurred in terms of assessment of persons with mild cognitive impairment, executive dysfunction, cognitively mediated functional change, and apathy. More research is needed to develop and validate tools to assess health-related quality of life and specific symptoms of dementia including anxiety, wandering, and repetitive vocalizations. This extensive overview of the quality of different measures may serve as a guide for health professionals clinically and for researchers developing new or improved dementia assessment tools.
Collapse
Affiliation(s)
- Adam Bentvelzen
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Liesbeth Aerts
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Katrin Seeher
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Jacqueline Wesson
- Aging Work and Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia; Center for Healthy Brain Aging (CHeBA), University of New South Wales Australia, Sydney, Australia.
| |
Collapse
|
26
|
Mack J, Marsh L. Parkinson's Disease: Cognitive Impairment. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:42-54. [PMID: 31975839 DOI: 10.1176/appi.focus.20160043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cognitive deficits are important and emerging clinical targets for psychiatrists caring for patients with Parkinson's disease (PD), a neurodegenerative disorder commonly accompanied by mood and psychotic disturbances and identified by its progressive motor abnormalities. Over the course of the disease and across all its stages, virtually every individual with PD experiences some degree of cognitive deficit, ranging from mild cognitive impairment to dementia. Across this spectrum, cognitive impairments affect functioning and quality of life, often more than motor aspects of the disease. Advances in treatments for motor deficits in PD now render the clinical significance of cognitive dysfunction more obvious, including its impact on psychiatric presentations and their treatment. Since cognitive dysfunction is underdetected and undertreated in clinical practice, holistic psychiatric care of PD patients warrants appreciation of the clinical presentation, biopsychosocial features, and treatment of cognitive impairment. Future directions for research and clinical care also discussed.
Collapse
Affiliation(s)
- Joel Mack
- Dr. Mack is with the Department of Psychiatry, Veterans Affairs Portland Health Care System and the Department of Psychiatry, Oregon Health & Science University, Portland, Oregon. Dr. Marsh is with the Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, and the Departments of Psychiatry and Neurology, Baylor College of Medicine, Houston, Texas. Send correspondence to Dr. Marsh (e-mail: )
| | - Laura Marsh
- Dr. Mack is with the Department of Psychiatry, Veterans Affairs Portland Health Care System and the Department of Psychiatry, Oregon Health & Science University, Portland, Oregon. Dr. Marsh is with the Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, and the Departments of Psychiatry and Neurology, Baylor College of Medicine, Houston, Texas. Send correspondence to Dr. Marsh (e-mail: )
| |
Collapse
|
27
|
Juengst SB, Switzer G, Oh BM, Arenth PM, Wagner AK. Conceptual model and cluster analysis of behavioral symptoms in two cohorts of adults with traumatic brain injuries. J Clin Exp Neuropsychol 2016; 39:513-524. [PMID: 27750469 DOI: 10.1080/13803395.2016.1240758] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Behavioral changes often occur after moderate-to-severe traumatic brain injury (TBI) and can lead to poor health, psychosocial functioning, and quality of life. Challenges in evaluating these behaviors often result from the complexity and variability in the way they are conceptualized and defined. We propose and test a conceptual model that is specific to behavioral symptoms after TBI, to serve as a basis for better assessment and treatment. We hypothesized that clusters of individuals, with unique emotional, cognitive, and behavioral characteristics, would emerge that would illustrate this conceptual model. METHODS We conducted model-based cluster analyses in two cohorts, 6-months post-injury (n = 79) and >6 months post-injury (n = 62), of adults with moderate-to-severe TBI to explore the face validity of our conceptual model by evaluating how participants clustered with regard to emotional (Patient Health Questionnaire 9, Positive and Negative Affect Schedule), cognitive (neuropsychological test battery), and frontal behavioral (Frontal Systems Behavior Scale) symptoms. RESULTS In each cohort, unique clusters of participants emerged that differed significantly with regard to emotional state, cognition, and behavior (ps<.05). Those 6-months post-injury clustered along a general continuum of symptom severity in emotional and behavioral symptom domains, from no impairment to severe impairment. Clusters in the chronic cohort (>6 months) demonstrated a more complex pattern of symptoms; the most severe behavioral symptoms occurred in the context of severe emotional symptoms, even in the absence of cognitive impairment. However, problematic behavioral symptoms were also present in the context of severe cognitive impairment, even in the absence of emotional symptoms. CONCLUSIONS Emotional, cognitive, and behavioral characteristics were represented as expected, based on the proposed conceptual model of behavior. This conceptual model provides the basis for evaluating behavioral changes after moderate-to-severe TBI and identifying modifiable targets and relevant subpopulations for behavioral intervention, with the goal of improved evidence-based personalized medicine for this population.
Collapse
Affiliation(s)
- Shannon B Juengst
- a Department of Physical Medicine and Rehabilitation , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Galen Switzer
- b Department of Medicine , University of Pittsburgh , Pittsburgh , PA , USA.,c Department of Psychiatry , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Byung Mo Oh
- d Department of Rehabilitation , Seoul National University Hospital , Seoul , South Korea
| | - Patricia M Arenth
- a Department of Physical Medicine and Rehabilitation , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Amy K Wagner
- a Department of Physical Medicine and Rehabilitation , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.,e Center for Neuroscience , University of Pittsburgh , Pittsburgh , PA , USA.,f Safar Center for Resuscitation Research , University of Pittsburgh , Pittsburgh , PA , USA
| |
Collapse
|
28
|
Lantrip C, Towns S, Roth RM, Giancola PR. Psychopathy traits are associated with self-report rating of executive functions in the everyday life of healthy adults. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.05.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
29
|
Singer EJ, Thames AD. Neurobehavioral Manifestations of Human Immunodeficiency Virus/AIDS: Diagnosis and Treatment. Neurol Clin 2016; 34:33-53. [PMID: 26613994 DOI: 10.1016/j.ncl.2015.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Behavioral disorders are common in persons infected with human immunodeficiency virus (HIV). The differential includes preexisting psychiatric diseases, substance abuse, direct effects of HIV infection, opportunistic infection, and the adverse effects of medical therapies. Many patients have more than one contributing or comorbid problem to explain these behavioral changes. The differential should always include consideration of psychosocial, genetic, and medical causes of disease. Treatment strategies must take into account the coadministration of antiretroviral therapy and the specific neurologic problems common in patients infected with HIV.
Collapse
Affiliation(s)
- Elyse J Singer
- NeuroInfectious Diseases Program, UCLA National Neurological AIDS Bank, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Room A129, Los Angeles, CA 90095, USA.
| | - April D Thames
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 740 Westwood Plaza, C8-746, Los Angeles, CA 90095, USA
| |
Collapse
|
30
|
Behavior Rating Inventory of Executive Function Adult Version in Patients with Neurological and Neuropsychiatric Conditions: Symptom Levels and Relationship to Emotional Distress. J Int Neuropsychol Soc 2016; 22:682-94. [PMID: 27126218 DOI: 10.1017/s135561771600031x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The present study explored the level of self-and informant reported executive functioning in daily living using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) in a large sample comprising healthy adults and patient cohorts with neurological and neuropsychiatric disorders. The relationship to neuropsychological test performance and self-reported emotional distress was explored, as well as the applicability of U.S. normative data. METHODS Scores on the self- and informant reported BRIEF-A are presented, along with scores on standardized cognitive tests, and on rating scales of self-reported emotional distress in a Norwegian healthy comparison group (n=115), patients with severe traumatic brain injury (n=125), focal frontal lobe damage (n=29), focal cerebellar lesion (n=24), Parkinson's disease (n=42), attention deficit hyperactivity disorder (n=34), type II bipolar disorder (n=21), and borderline personality disorder (n=18). RESULTS Strong associations were observed between the BRIEF-A and emotional distress in both the healthy group and in neurological groups, while no or weak relationships with IQ and performance-based tests of executive function were seen. The relationship between BRIEF-A and emotional distress was weaker in the neuropsychiatric patient groups, despite high symptom load in both domains. Healthy participants tended to have BRIEF-A scores 1/2-3/4 SD below the U.S. normative mean of T score=50. CONCLUSIONS The study demonstrates the need to interpret BRIEF-A results within a broad differential diagnostic context, where measures of psychological distress are included in addition to neuropsychological tests. Uncertainty about the appropriateness of U.S. normative data in non-U.S. countries adds to the need for interpretive caution. (JINS, 2016, 22, 682-694).
Collapse
|
31
|
Cabrera S, Edelstein K, Mason WP, Tartaglia MC. Assessing behavioral syndromes in patients with brain tumors using the frontal systems behavior scale (FrSBe). Neurooncol Pract 2016; 3:113-119. [PMID: 31386079 PMCID: PMC6668266 DOI: 10.1093/nop/npv055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Personality changes following brain tumors may be due to disruption of frontal-subcortical networks. The relation between personality changes and tumor parameters such as volumes of the surgical cavity, residual tumor, or nonspecific white matter abnormalities is unknown. In this study we examined the relation between these tumor parameters and abnormal behaviors typically associated with frontal lobe dysfunction. METHODS Thirty-one patients with intracranial tumors who completed the Frontal Systems Behavior Scale (FrSBe) during clinical neuropsychological assessment and had a solitary, well-delimited brain lesion on MRI within 3 months of that assessment were included. Tumor parameters were manually segmented using OsiriX. Nonparametric statistics were used to determine the relationship between tumor parameters and frontal behavioral dysfunction as measured by FrSBe scores. RESULTS Patients reported significantly more behavior problems after tumor diagnosis. Tumor cavity volume was correlated with self-reported Executive Dysfunction (rho = 0.450, P = .047), and there was a trend in the relationship with self-reported Apathy (rho = 0.438, P = .053). Nonspecific white matter abnormality volume was also correlated with self-reported Apathy (rho = 0.810, P = .01). There were no correlations between FrSBe scores and residual tumor volume or summed volumes of tumor-related parameters. CONCLUSION Our results suggest that tumor parameters have differential effects on behaviors associated with frontal-subcortical networks and corroborate the high frequency of behavioral dysfunction in brain tumor patients. Examination of these relationships in a prospective trial is warranted to establish incidence, prevalence, risk factors, and consequences of behavioral disturbances in brain tumor patients.
Collapse
Affiliation(s)
- Sergio Cabrera
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
| | - Kim Edelstein
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
| | - Warren P. Mason
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
| | - Maria Carmela Tartaglia
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
| |
Collapse
|
32
|
Myrga JM, Juengst SB, Failla MD, Conley YP, Arenth PM, Grace AA, Wagner AK. COMT and ANKK1 Genetics Interact With Depression to Influence Behavior Following Severe TBI: An Initial Assessment. Neurorehabil Neural Repair 2016; 30:920-930. [PMID: 27154305 DOI: 10.1177/1545968316648409] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Genetic variations in the dopamine (DA) system are associated with cortical-striatal behavior in multiple populations. This study assessed associations of functional polymorphisms in the ankyrin repeat and kinase domain (ANKK1; Taq1a) and catechol-O-methyltransferase (COMT; Val158Met) genes with behavioral dysfunction following traumatic brain injury (TBI). PARTICIPANTS This was a prospective study of 90 survivors of severe TBI recruited from a level 1 trauma center. MAIN MEASURES The Frontal Systems Behavior Scale, a self- or family report questionnaire evaluating behavior associated with frontal lobe dysfunction, was completed 6 and 12 months postinjury. Depression was measured concurrently with the Patient Health Questionnaire-9. Study participants were genotyped for Val158Met and Taq1a polymorphisms. RESULTS No statistically significant behavioral differences were observed by Taq1a or Val158Met genotype alone. At 12 months, among those with depression, Met homozygotes (Val158Met) self-reported worse behavior than Val carriers (P = .015), and A2 homozygotes (Taq1a) self-reported worse behavior than A1 carriers (P = .028) in bivariable analysis. Multivariable models suggest an interaction between depression and genetic variation with behavior at 12 months post-TBI, and descriptive analysis suggests that carriage of both risk alleles may contribute to worse behavioral performance than carriage of either risk allele alone. CONCLUSION In the context of depression, Val158Met and Taq1a polymorphisms are individually associated with behavioral dysfunction 12 months following severe TBI, with preliminary evidence suggesting cumulative, or perhaps epistatic, effects of COMT and ANKK1 on behavioral dysfunction.
Collapse
Affiliation(s)
- John M Myrga
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | | | - Yvette P Conley
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Patricia M Arenth
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Anthony A Grace
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA Department of Neuroscience, University of Pittsburgh, Pittsburgh PA Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
33
|
Wolters Gregório G, Ponds RW, Smeets SM, Jonker F, Pouwels CG, van Heugten CM. How Stable Is Coping in Patients with Neuropsychiatric Symptoms after Acquired Brain Injury? Changes in Coping Styles and Their Predictors in the Chronic Phase. J Neurotrauma 2016; 33:696-704. [DOI: 10.1089/neu.2015.3900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gisela Wolters Gregório
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Department Acquired Brain Injury Huize Padua, GGZ Oost Brabant, Boekel, the Netherlands
| | - Rudolf W.H.M. Ponds
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Adelante, Rehabilitation Centre, Hoensbroek, the Netherlands
| | - Sanne M.J. Smeets
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Frank Jonker
- Department Vesalius, Altrecht GGZ, Den Dolder, the Netherlands
| | - Climmy G.J.G. Pouwels
- Department Acquired Brain Injury Huize Padua, GGZ Oost Brabant, Boekel, the Netherlands
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
34
|
Carvalho JO, Buelow MT, Ready RE, Grace J. Associations Between Original and a Reduced Frontal Systems Behavior Scale (FrSBe), Cognition, and Activities of Daily Living in a Large Neurologic Sample. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:125-32. [DOI: 10.1080/23279095.2015.1012759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Janessa O. Carvalho
- Department of Psychology, Bridgewater State University, Bridgewater, Massachusetts
| | - Melissa T. Buelow
- Department of Psychology, The Ohio State University Newark, Newark, Ohio
| | - Rebecca E. Ready
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Janet Grace
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence
- Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| |
Collapse
|
35
|
Life after Adolescent and Adult Moderate and Severe Traumatic Brain Injury: Self-Reported Executive, Emotional, and Behavioural Function 2-5 Years after Injury. Behav Neurol 2015; 2015:329241. [PMID: 26549936 PMCID: PMC4621342 DOI: 10.1155/2015/329241] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/01/2015] [Indexed: 12/16/2022] Open
Abstract
Survivors of moderate-severe Traumatic Brain Injury (TBI) are at risk for long-term cognitive, emotional, and behavioural problems. This prospective cohort study investigated self-reported executive, emotional, and behavioural problems in the late chronic phase of moderate and severe TBI, if demographic characteristics (i.e., age, years of education), injury characteristics (Glasgow Coma Scale score, MRI findings such as traumatic axonal injury (TAI), or duration of posttraumatic amnesia), symptoms of depression, or neuropsychological variables in the first year after injury predicted long-term self-reported function. Self-reported executive, emotional, and behavioural functioning were assessed among individuals with moderate and severe TBI (N = 67, age range 15–65 years at time of injury) 2–5 years after TBI, compared to a healthy matched control group (N = 72). Results revealed significantly more attentional, emotional regulation, and psychological difficulties in the TBI group than controls. Demographic and early clinical variables were associated with poorer cognitive and emotional outcome. Fewer years of education and depressive symptoms predicted greater executive dysfunction. Younger age at injury predicted more aggressive and rule-breaking behaviour. TAI and depressive symptoms predicted Internalizing problems and greater executive dysfunction. In conclusion, age, education, TAI, and depression appear to elevate risk for poor long-term outcome, emphasising the need for long-term follow-up of patients presenting with risk factors.
Collapse
|
36
|
Zweifel-Zehnder AE, Stienen MN, Chicherio C, Studerus-Germann A, Bläsi S, Rossi S, Gutbrod K, Schmid N, Beaud V, Mondadori C, Brugger P, Sacco L, Müri R, Hildebrandt G, Fournier JY, Keller E, Regli L, Fandino J, Mariani L, Raabe A, Daniel RT, Reinert M, Robert T, Schatlo B, Bijlenga P, Schaller K, Monsch AU. Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations. Acta Neurochir (Wien) 2015; 157:1449-58. [PMID: 26179382 DOI: 10.1007/s00701-015-2480-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND In a high proportion of patients with favorable outcome after aneurysmal subarachnoid hemorrhage (aSAH), neuropsychological deficits, depression, anxiety, and fatigue are responsible for the inability to return to their regular premorbid life and pursue their professional careers. These problems often remain unrecognized, as no recommendations concerning a standardized comprehensive assessment have yet found entry into clinical routines. METHODS To establish a nationwide standard concerning a comprehensive assessment after aSAH, representatives of all neuropsychological and neurosurgical departments of those eight Swiss centers treating acute aSAH have agreed on a common protocol. In addition, a battery of questionnaires and neuropsychological tests was selected, optimally suited to the deficits found most prevalent in aSAH patients that was available in different languages and standardized. RESULTS We propose a baseline inpatient neuropsychological screening using the Montreal Cognitive Assessment (MoCA) between days 14 and 28 after aSAH. In an outpatient setting at 3 and 12 months after bleeding, we recommend a neuropsychological examination, testing all relevant domains including attention, speed of information processing, executive functions, verbal and visual learning/memory, language, visuo-perceptual abilities, and premorbid intelligence. In addition, a detailed assessment capturing anxiety, depression, fatigue, symptoms of frontal lobe affection, and quality of life should be performed. CONCLUSIONS This standardized neuropsychological assessment will lead to a more comprehensive assessment of the patient, facilitate the detection and subsequent treatment of previously unrecognized but relevant impairments, and help to determine the incidence, characteristics, modifiable risk factors, and the clinical course of these impairments after aSAH.
Collapse
Affiliation(s)
- Antoinette E Zweifel-Zehnder
- Division of Neuropaediatrics, Development, and Rehabilitation, Department of Paediatrics, Inselspital Bern, Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Manning KJ, Alexopoulos GS, Banerjee S, Morimoto SS, Seirup JK, Klimstra SA, Yuen G, Kanellopoulos T, Gunning-Dixon F. Executive functioning complaints and escitalopram treatment response in late-life depression. Am J Geriatr Psychiatry 2015; 23:440-5. [PMID: 24388222 PMCID: PMC4043930 DOI: 10.1016/j.jagp.2013.11.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 11/18/2013] [Accepted: 11/19/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Executive dysfunction may play a key role in the pathophysiology of late-life depression. Executive dysfunction can be assessed with cognitive tests and subjective report of difficulties with executive skills. The present study investigated the association between subjective report of executive functioning complaints and time to escitalopram treatment response in older adults with major depressive disorder (MDD). METHODS 100 older adults with MDD (58 with executive functioning complaints and 42 without executive functioning complaints) completed a 12-week trial of escitalopram. Treatment response over 12 weeks, as measured by repeated Hamilton Depression Rating Scale scores, was compared for adults with and without executive complaints using mixed-effects modeling. RESULTS Mixed effects analysis revealed a significant group × time interaction, F(1, 523.34) = 6.00, p = 0.01. Depressed older adults who reported executive functioning complaints at baseline demonstrated a slower response to escitalopram treatment than those without executive functioning complaints. CONCLUSION Self-report of executive functioning difficulties may be a useful prognostic indicator for subsequent speed of response to antidepressant medication.
Collapse
Affiliation(s)
- Kevin J Manning
- Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
| | | | - Samprit Banerjee
- Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | | | - Joanna K Seirup
- Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Sibel A Klimstra
- Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | - Genevieve Yuen
- Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY
| | | | | |
Collapse
|
38
|
Cristofori I, Viola V, Chau A, Zhong W, Krueger F, Zamboni G, Grafman J. The neural bases for devaluing radical political statements revealed by penetrating traumatic brain injury. Soc Cogn Affect Neurosci 2015; 10:1038-44. [PMID: 25656509 DOI: 10.1093/scan/nsu155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/24/2014] [Indexed: 11/14/2022] Open
Abstract
Given the determinant role of ventromedial prefrontal cortex (vmPFC) in valuation, we examined whether vmPFC lesions also modulate how people scale political beliefs. Patients with penetrating traumatic brain injury (pTBI; N = 102) and healthy controls (HCs; N = 31) were tested on the political belief task, where they rated 75 statements expressing political opinions concerned with welfare, economy, political involvement, civil rights, war and security. Each statement was rated for level of agreement and scaled along three dimensions: radicalism, individualism and conservatism. Voxel-based lesion-symptom mapping (VLSM) analysis showed that diminished scores for the radicalism dimension (i.e. statements were rated as less radical than the norms) were associated with lesions in bilateral vmPFC. After dividing the pTBI patients into three groups, according to lesion location (i.e. vmPFC, dorsolateral prefrontal cortex [dlPFC] and parietal cortex), we found that the vmPFC, but not the dlPFC, group had reduced radicalism scores compared with parietal and HC groups. These findings highlight the crucial role of the vmPFC in appropriately valuing political behaviors and may explain certain inappropriate social judgments observed in patients with vmPFC lesions.
Collapse
Affiliation(s)
- Irene Cristofori
- Cognitive Neuroscience Laboratory, Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, IL, 60611, USA, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA,
| | - Vanda Viola
- Department of Psychology, University of Rome "La Sapienza", Rome, 00185, Italy, IRCCS Fondazione Santa Lucia, Rome, 00179, Italy
| | - Aileen Chau
- Cognitive Neuroscience Laboratory, Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, IL, 60611, USA
| | - Wanting Zhong
- Cognitive Neuroscience Laboratory, Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, IL, 60611, USA, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA
| | - Frank Krueger
- Molecular Neuroscience Department, George Mason University, Fairfax, VA, 22030, USA, Department of Psychology, George Mason University, Fairfax, VA, 22030, USA, and
| | - Giovanna Zamboni
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, OX3 9DU, UK
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Rehabilitation Institute of Chicago, Chicago, IL, 60611, USA, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA
| |
Collapse
|
39
|
Wolters Gregório G, Ponds RWHM, Smeets SMJ, Jonker F, Pouwels CGJG, Verhey FR, van Heugten CM. Associations between executive functioning, coping, and psychosocial functioning after acquired brain injury. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2015; 54:291-306. [DOI: 10.1111/bjc.12074] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Gisela Wolters Gregório
- Faculty of Health, Medicine and Life Sciences; Department of Psychiatry and Neuropsychology; School for Mental Health and Neuroscience; Maastricht University; The Netherlands
- Department ABI Huize Padua; GGZ Oost Brabant; Boekel The Netherlands
| | - Rudolf W. H. M. Ponds
- Faculty of Health, Medicine and Life Sciences; Department of Psychiatry and Neuropsychology; School for Mental Health and Neuroscience; Maastricht University; The Netherlands
- Adelante, Rehabilitation Centre; Hoensbroek The Netherlands
| | - Sanne M. J. Smeets
- Faculty of Health, Medicine and Life Sciences; Department of Psychiatry and Neuropsychology; School for Mental Health and Neuroscience; Maastricht University; The Netherlands
| | - Frank Jonker
- Department Vesalius; Altrecht GGZ; Den Dolder The Netherlands
| | | | - Frans R. Verhey
- Faculty of Health, Medicine and Life Sciences; Department of Psychiatry and Neuropsychology; School for Mental Health and Neuroscience; Maastricht University; The Netherlands
| | - Caroline M. van Heugten
- Faculty of Health, Medicine and Life Sciences; Department of Psychiatry and Neuropsychology; School for Mental Health and Neuroscience; Maastricht University; The Netherlands
- Faculty of Psychology and Neuroscience; Department of Neuropsychology and Psychopharmacology; Maastricht University; The Netherlands
| |
Collapse
|
40
|
Gerritsen CJ, Toplak ME, Sciaraffa J, Eastwood J. I can't get no satisfaction: potential causes of boredom. Conscious Cogn 2014; 27:27-41. [PMID: 24794051 DOI: 10.1016/j.concog.2013.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 10/01/2013] [Accepted: 10/07/2013] [Indexed: 11/17/2022]
Abstract
A variety of causes of boredom have been proposed including environmental, motivational, emotional, and cognitive factors. Here, we explore four potential cognitive causes of boredom: inattention, hyperactivity, impulsivity, and executive dysfunction. Specifically, we examine the unique and common associations between these factors and boredom propensity. Recent research has established that the two most commonly used measures of boredom propensity (BPS and BSS) are not measuring the same underlying construct. Thus, a second goal of the present project is to determine the unique and common roles of inattention, hyperactivity, impulsivity and poor executive system functioning in predicting the BPS and BSS specifically. The findings reveal that inattention, hyperactivity and executive dysfunction predict boredom propensity, with shared variance accounting for the greater part of this effect. Further, executive dysfunction and hyperactivity uniquely predict boredom propensity as measured by the BPS and BSS, respectively.
Collapse
|
41
|
Joshi A, Barsuglia J, Mather M, Jimenez E, Shapira J, Mendez MF. Evaluation of emotional blunting in behavioral variant frontotemporal dementia compared to Alzheimer's disease. Dement Geriatr Cogn Disord 2014; 38:79-88. [PMID: 24603498 PMCID: PMC4104135 DOI: 10.1159/000357838] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Emotional blunting is a major clinical feature of behavioral variant frontotemporal dementia (bvFTD). Assessing the change in emotional blunting may facilitate the differential diagnosis of this disorder and can quantify a major source of distress for the patients' caregivers and families. METHODS We evaluated investigator ratings on the Scale for Emotional Blunting (SEB) for 13 patients with bvFTD versus 18 patients with early-onset Alzheimer's disease (AD). The caregivers also performed SEB ratings for both the patients' premorbid behavior (before dementia onset) and the patients' behavior on clinical presentation (after dementia onset). RESULTS Before the onset of dementia, the caregivers reported normal SEB scores for both dementia groups. After the onset of dementia, both caregivers and investigators reported greater SEB scores for the bvFTD patients compared to the AD patients. The patients were rated to be much more emotionally blunted by the bvFTD caregivers than by the investigators. A change of ≥15 in the caregiver SEB ratings suggests bvFTD. The change in caregiver SEB ratings was positively correlated with bifrontal hypometabolism on FDG-PET scans. CONCLUSIONS Changes in the caregiver assessment of emotional blunting with dementia onset can distinguish patients with bvFTD from those with AD, and they may better reflect the impact of emotional blunting than similar assessments made by clinicians/investigators.
Collapse
Affiliation(s)
- Aditi Joshi
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| | - Joseph Barsuglia
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michelle Mather
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elvira Jimenez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jill Shapira
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| | - Mario F. Mendez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
- V.A. Greater Los Angeles Healthcare System, Los Angeles, California
| |
Collapse
|
42
|
Abstract
Executive functions refer to a constellation of higher-level cognitive abilities that enable goal-oriented behavior. The NIH EXAMINER battery was designed to assess executive functions comprehensively and efficiently. Performance can be summarized by a single score, the "Executive Composite," which combines measures of inhibition, set-shifting, fluency, and working memory. We evaluated the ecological validity of the Executive Composite in a sample of 225 mixed neurological patients and controls using the Frontal Systems Behavior Scale (FrSBe), an informant-based measure of real-world executive behavior. In addition, we investigated the neuroanatomical correlates of the Executive Composite using voxel-based morphometry in a sample of 37 participants diagnosed with dementia, mild cognitive impairment, or as neurologically healthy. The Executive Composite accounted for 28% of the variance in Frontal Systems Behavior Scale scores beyond age. Even after including two widely used executive function tests (Trails B and Stroop) as covariates, the Executive Composite remained a significant predictor of real-world behavior. Anatomically, poorer scores on the Executive Composite were associated with smaller right and left dorsolateral prefrontal volumes, brain regions critical for good executive control. Taken together, these results suggest that the Executive Composite measures important aspects of executive function not captured by standard measures and reflects the integrity of frontal systems.
Collapse
|
43
|
|
44
|
Abstract
Executive functioning is widely targeted when human cognition is assessed, but there is little consensus on how it should be operationalized and measured. Recognizing the difficulties associated with establishing standard operational definitions of executive functioning, the National Institute of Neurological Disorders and Stroke entered into a contract with the University of California-San Francisco to develop psychometrically robust executive measurement tools that would be accepted by the neurology clinical trials and clinical research communities. This effort, entitled Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (EXAMINER), resulted in a series of tasks targeting working memory, inhibition, set shifting, fluency, insight, planning, social cognition and behavior. We describe battery conceptualization and development, data collection, scale construction based on item response theory, and lay the foundation for studying the battery's utility and validity for specific assessment and research goals.
Collapse
|
45
|
The APOE ε4 allele is associated with increased frontally mediated neurobehavioral symptoms in amnestic MCI. Alzheimer Dis Assoc Disord 2013; 27:109-15. [PMID: 22874659 DOI: 10.1097/wad.0b013e318266c6c3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The apolipoprotein E ε4 allele is a risk factor for late-onset Alzheimer disease (AD), and the frontal lobes may be among the regions that manifest effects of ε4 even early in the disease. We predicted that among patients with amnestic mild cognitive impairment (aMCI) and AD, ε4 would be associated with increased neurobehavioral symptoms when assessed using a measure sensitive to frontal lobe integrity. We obtained cognitive data and caregiver ratings on the Frontal Systems Behavior Scale (FrSBe) for aMCI patients (N=29 ε4 carriers; N=29 noncarriers) and AD patients (N=47 carriers; N=42 noncarriers). In both diagnostic groups, ε4 carriers had lower scores on tests of memory but did not differ on cognitive screening measures or tests of executive functioning. There were no differences in retrospective caregiver ratings of preillness status on the FrSBe by ε4 status in either diagnostic group. However, in the aMCI group, ε4 carriers had elevated current FrSBe Executive Dysfunction scores in comparison with noncarriers. In the AD group, there were no differences in current FrSBe scores by genotype group. Results indicate that ε4-related behavior change occurs in the aMCI stage but may not be apparent by the AD stage.
Collapse
|
46
|
Martin S, Wolters P, Billings N, Toledo-Tamula MA, Hammoud DA, Welch P, Darnell D, Holland SM, Freeman AF. Neurobehavioral profiles in individuals with hyperimmunoglobulin E Syndrome (HIES) and brain white matter hyperintensities. J Clin Immunol 2013; 33:1175-84. [PMID: 23963745 PMCID: PMC5467306 DOI: 10.1007/s10875-013-9932-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/08/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE Individuals with hyperimmunoglobulin E Syndrome (HIES) have central nervous system abnormalities, including focal white matter hyperintensities (WMH), or unidentified bright objects. This cross-sectional study aimed to describe the cognitive and emotional functioning and quality of life of people with HIES. We also sought to explore the relationship between cognitive functioning and WMHs in this population. METHODS Twenty-nine individuals (13 males) with autosomal-dominant HIES (mean age = 35.1 years, range 16-55) were administered a comprehensive psychological assessment as part of a natural history protocol. The assessment included measures of global cognitive functioning (Wechsler Adult Intelligence Scale-III), memory (California Verbal Learning Test-II, Wechsler Memory Scale-III), executive skills (Delis Kaplan Executive Function System), and attention (Test of Everyday Attention). Emotional symptoms and quality of life also were assessed. RESULTS All mean cognitive scores were within normal limits. Mean scores on memory and executive functioning measures were significantly lower than Full Scale IQ scores (ps < .05). Substantial percentages of patients self-reported executive skills to be in the clinical range. Patients with fewer (1-20) versus more (21+) WMHs scored significantly better on measures of global cognitive skills, visual-perceptual skills, and working memory. Mean scores on emotional symptom and quality of life measures were in the average range and unrelated to WMHs. CONCLUSIONS Global cognitive functioning was average to high average in our sample of individuals with HIES. However, focal brain lesions were associated with lower scores in specific domains. Emotional functioning and quality of life are within normal limits in this sample.
Collapse
Affiliation(s)
- Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA,
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
McLean AM, Jarus T, Hubley AM, Jongbloed L. Associations between social participation and subjective quality of life for adults with moderate to severe traumatic brain injury. Disabil Rehabil 2013; 36:1409-18. [DOI: 10.3109/09638288.2013.834986] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
48
|
Konstantinopoulou E, Aretouli E, Ioannidis P, Karacostas D, Kosmidis MH. Behavioral disturbances differentiate frontotemporal lobar degeneration subtypes and Alzheimer's disease: evidence from the Frontal Behavioral Inventory. Int J Geriatr Psychiatry 2013; 28:939-46. [PMID: 23135894 DOI: 10.1002/gps.3907] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 10/04/2012] [Accepted: 10/16/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Behavioral assessment is useful for the diagnosis of frontotemporal lobar degeneration (FTLD). We explored the ability of the Frontal Behavioral Inventory (FBI) to discriminate between patients with distinct subtypes of FTLD and patients with Alzheimer's disease (AD), as well as the influence of demographic variables on FBI scores. METHODS The FBI was administered to the caregivers of 87 patients diagnosed with FTLD [64 behavioral variant FTLD, 19 aphasic variant FTLD (primary progressive aphasia), and 4 motor/extrapyramidal variant (corticobasal syndrome)] and 30 patients with AD. Patients with AD were older than patients with FTLD. The two groups did not differ with respect to duration of illness, level of education, or sex ratio. RESULTS Age significantly predicted disinhibited positive behaviors, such as perseverations and irritability, whereas education did not contribute to FBI ratings. Classification accuracy for the discrimination of AD and mixed FTLD groups was 81%. Moreover, 88.3% and 83.7% accuracy was achieved for the discrimination of AD and behavioral variant FTLD, and AD and primary progressive aphasia groups, respectively. The Total Negative subscale of the FBI, which summarizes the presence of deficit (negative) behaviors, was the best discriminator. A cut-off score of 17 provided 83% sensitivity and 98% specificity in distinguishing between FTLD and AD patients. CONCLUSIONS The FBI is a sensitive and specific tool for the differential diagnosis of FTLD from AD. The optimal cut-off point for the detection of FTLD patients was lower than that initially proposed.
Collapse
Affiliation(s)
- Eleni Konstantinopoulou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | |
Collapse
|
49
|
A Multidimensional Approach to Apathy after Traumatic Brain Injury. Neuropsychol Rev 2013; 23:210-33. [DOI: 10.1007/s11065-013-9236-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/26/2013] [Indexed: 12/14/2022]
|
50
|
Frontal systems related symptoms in cocaine dependent patients with comorbid personality disorders. Psychopharmacology (Berl) 2013; 228:367-73. [PMID: 23483199 DOI: 10.1007/s00213-013-3040-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 02/18/2013] [Indexed: 10/27/2022]
Abstract
RATIONALE The co-occurrence of cocaine dependence and personality disorders may contribute to frontal systems-related behavioral symptoms in cocaine users. OBJECTIVE This study aims to characterize apathy, disinhibition, and dysexecutive symptoms in cocaine users with comorbid personality disorders. METHODS Thirty-nine participants meeting criteria for cocaine dependence and personality disorders, 35 participants meeting criteria for cocaine dependence without comorbidities, and 29 controls matched for age, education, and IQ completed the Frontal Systems Behavior Scale (FrSBe), which provides present and retrospective assessments (of the period preceding cocaine use) about apathy, disinhibition, and dysexecutive symptoms. Additionally, relatives of cocaine patients (34 relatives from comorbid patients and 31 relatives from noncomorbid patients) completed the informant version of the FrSBe. We used one-way ANOVAs to investigate present-moment differences between the groups and related samples t tests to quantify changes between pre-disorder and present-moment symptoms. RESULTS Cocaine users with personality disorders self-reported higher present-moment apathy and disinhibition symptoms than noncomorbid users and controls. Informant ratings showed that comorbid users exhibited pre-disorder elevations in apathy, disinhibition and dysexecutive symptoms, and that these symptoms did not significantly change between the pre-disorder and the present-moment assessments. In contrast, noncomorbid users exhibited increased apathy, disinhibition, and dysexecutive symptoms at present-moment compared with pre-disorder measures. CONCLUSIONS The co-occurrence of cocaine dependence and personality disorders is associated with elevated frontal systems-related behavioral symptoms. Comorbid and noncomorbid users differ in frontal symptoms' trajectories, with the former showing pre-disorder stable elevations and the latter showing lower baseline symptoms but greater addiction-related elevations.
Collapse
|