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Gradwohl BD, Mangum RW, Tolle KA, Pangilinan PH, Bieliauskas LA, Spencer RJ. Validating the usefulness of the NSI validity-10 with the MMPI-2-RF. Int J Neurosci 2020; 130:926-932. [PMID: 31928283 DOI: 10.1080/00207454.2019.1709844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose/Aim of the Study: The Neurobehavioral Symptom Inventory (NSI) is a 22-item self-report measure created to quantify the somatosensory, cognitive, and affective symptoms of Post-concussive Syndrome. Developers of the NSI used a subset of 10 items, the Validty-10, to measure symptom overreporting. We compared the Validity-10 versus the remaining NSI items (i.e., the Remaining-12) for how accurately they detect symptom exaggeration on the Minnesota Multiphasic Personality Inventory Second Edition - Restructured Form (MMPI-2-RF).Materials and Methods: We used a sample of 45 veterans evaluated in a Polytrauma/TBI Clinic of a Midwest VA Healthcare System who completed the NSI and MMPI-2-RF.Results: The Vaidity-10, Remaining-12, and Total Score all strongly correlated with mean of the MMPI-2-RF validity scales (r = .65, .67, and .70, respectively), illustrating equivalency among the various NSI scores. Groups were created based on significant T score elevation on any MMPI-2-RF validity scale (i.e. F-r > 119, or Fp-r, F-s, FBS, or RBS > 99). ROC analyses demonstrated that areas under the curve were equivalent for NSI Total Score (.84), Validity-10 (.81), and Remaining-12 (.81) in detecting overreporting.Conclusions: These findings do not support the notion that the Validity-10 has unique utility as an embedded symptom validity scale and highlights the likelihood that NSI Total Score can also serve this function.
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Affiliation(s)
- Brian D Gradwohl
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical System, Ann Arbor, MI, USA
| | - Ryan W Mangum
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical System, Ann Arbor, MI, USA
| | - Kathryn A Tolle
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical System, Ann Arbor, MI, USA
| | - Percival H Pangilinan
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical System, Ann Arbor, MI, USA
| | - Linas A Bieliauskas
- Department of Psychiatry, University of Michigan Medical System, Ann Arbor, MI, USA
| | - Robert J Spencer
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical System, Ann Arbor, MI, USA
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Light SN, Bieliauskas LA, Taylor SF. Measuring change in anhedonia using the "Happy Faces" task pre- to post-repetitive transcranial magnetic stimulation (rTMS) treatment to left dorsolateral prefrontal cortex in Major Depressive Disorder (MDD): relation to empathic happiness. Transl Psychiatry 2019; 9:217. [PMID: 31481688 PMCID: PMC6722063 DOI: 10.1038/s41398-019-0549-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 06/30/2019] [Accepted: 07/17/2019] [Indexed: 01/10/2023] Open
Abstract
We investigated whether repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) would reduce anhedonia in a sample of 19 depressed adults (Mage = 45.21, SD = 11.21, 63% women) randomized to either active or sham rTMS. To track anhedonia, patients completed the Snaith-Hamilton Pleasure Scale (SHAPS)1 and a novel behavioral task called "Happy Faces," which required patients to interpret neutral versus various intensities of positively valenced human facial expressions. Patients had to indicate dichotomously whether any degree of positive emotion was expressed. We expected that more anhedonic patients would struggle most with low intensity happy faces; often incorrectly calling them neutral. Patients also completed a self-report measure of "empathic happiness"-i.e., vicarious joy. Measures were completed pre- to post-treatment. Results indicate rTMS to DLPFC related to improvement in interpretation of subtle forms of happiness in active rTMS patients relative to sham. Furthermore, empathic happiness and anhedonia score were significantly antagonistic across all patients.
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Affiliation(s)
- Sharee N. Light
- 0000 0004 1936 7400grid.256304.6Positive Affective Neuroscience Laboratory, Department of Psychology, Georgia State University, 140 Decatur Street, Atlanta, GA 30303 USA
| | - Linas A. Bieliauskas
- 0000000086837370grid.214458.eNeuropsychology Section, Department of Psychiatry, University of Michigan Medical School, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI 48105 USA
| | - Stephan F. Taylor
- 0000000086837370grid.214458.eDepartment of Psychiatry, University of Michigan Medical School, Rachel Upjohn Building, 4250 Plymouth Rd., Ann Arbor, MI 48109-2700 USA
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3
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Gabel NM, Waldron-Perrine B, Spencer RJ, Pangilinan PH, Hale AC, Bieliauskas LA. Suspiciously slow: timed digit span as an embedded performance validity measure in a sample of veterans with mTBI. Brain Inj 2018; 33:377-382. [DOI: 10.1080/02699052.2018.1553311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nicolette M. Gabel
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, USA
| | | | - Robert J. Spencer
- Mental Health Services, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Percival H. Pangilinan
- Department of Physical Medicine and Rehabilitation, Michigan Medicine/VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Andrew C. Hale
- Mental Health Services, VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Linas A. Bieliauskas
- Department of Neuropsychology, University of Michigan Health System, Ann Arbor, USA
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Tolle K, Spencer RJ, Montgomery V, Bieliauskas LA. Emerging evidence for speeded alphabet printing as a measure of processing speed and working memory. Applied Neuropsychology: Adult 2018; 26:573-580. [DOI: 10.1080/23279095.2018.1472094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Kathryn Tolle
- Mental Health Service VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Robert J. Spencer
- Mental Health Service VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Valencia Montgomery
- Mental Health Service VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Linas A. Bieliauskas
- Mental Health Service VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan, USA
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5
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Light SN, Bieliauskas LA, Zubieta JK. "Top-Down" Mu-Opioid System Function in Humans: Mu-Opioid Receptors in Ventrolateral Prefrontal Cortex Mediate the Relationship Between Hedonic Tone and Executive Function in Major Depressive Disorder. J Neuropsychiatry Clin Neurosci 2018; 29:357-364. [PMID: 28412878 DOI: 10.1176/appi.neuropsych.16090171] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cognitive dysfunction and anhedonia, the reduced ability to experience pleasure, are commonly comorbid symptoms that are persistent following successful resolution of negative affect in major depressive disorder (MDD). Little is known about whether they share common etiology. In the present study, the relationship between ventrolateral prefrontal cortex (VLPFC) activity, cognitive dysfunction (i.e., executive dysfunction), and positive emotionality was investigated in conjunction with mu-opioid neurotransmission in a sample of 39 MDD patients. Results suggest that increased endogenous mu-opioid tone in the VLPFC mediates the relationship between increased trait positive emotionality and more efficient executive functioning.
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Affiliation(s)
- Sharee N Light
- From the Department of Psychology, Georgia State University, Atlanta (SNL); the Department of Psychiatry, Neuropsychology Section, University of Michigan, Ann Arbor, Mich. (LAB); and the Department of Psychiatry University of Utah, Salt Lake City, Utah (J-K Z)
| | - Linas A Bieliauskas
- From the Department of Psychology, Georgia State University, Atlanta (SNL); the Department of Psychiatry, Neuropsychology Section, University of Michigan, Ann Arbor, Mich. (LAB); and the Department of Psychiatry University of Utah, Salt Lake City, Utah (J-K Z)
| | - Jon-Kar Zubieta
- From the Department of Psychology, Georgia State University, Atlanta (SNL); the Department of Psychiatry, Neuropsychology Section, University of Michigan, Ann Arbor, Mich. (LAB); and the Department of Psychiatry University of Utah, Salt Lake City, Utah (J-K Z)
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Hinrichs KH, Hayek A, Kalmbach D, Gabel N, Bieliauskas LA. Cognitive reserve and executive function: Effect on judgment of health and safety. ACTA ACUST UNITED AC 2018; 53:863-872. [PMID: 28273320 DOI: 10.1682/jrrd.2015.04.0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/31/2016] [Indexed: 11/05/2022]
Abstract
Individuals with the same neurological conditions do not necessarily manifest the same behavioral presentation, which suggests differences in resilience and vulnerability among individuals, a concept known as cognitive reserve. This study sought to explore the relationship among cognitive reserve, executive functioning, and health and safety judgment among a sample of older adult inpatients in an extended medical care unit at a Veterans Health Administration hospital. We hypothesized that cognitive reserve, as determined by an estimate of premorbid intellectual ability, would act as a protective factor against poor judgment in older adults with executive dysfunction. Participants included 200 Veterans who completed a comprehensive neuropsychological assessment, including measures of health and safety judgment, executive functioning, global cognitive functioning, and premorbid intellectual ability. After controlling for global cognitive functioning, executive functioning abilities did not have an effect on judgment abilities among those with high estimated intellectual ability. However, executive functioning had a significant effect on judgment abilities among those with low estimated intellectual ability. Our results suggest that intact executive functioning is critical for making appropriate health and safety decisions for patients with lower measured intellectual abilities and provide further support for the cognitive reserve model. Clinical implications are also discussed.
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Affiliation(s)
| | | | | | - Nicolette Gabel
- Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
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7
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Flaherty JM, Spencer RJ, Drag LL, Pangilinan PH, Bieliauskas LA. Streamlining screening of emotional function in Veterans with traumatic brain injury. J Clin Psychol 2018; 74:1281-1292. [DOI: 10.1002/jclp.22595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 11/08/2017] [Accepted: 01/06/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Lauren L. Drag
- Department of Neurology and Neurological Sciences; Stanford University Medical Center
| | | | - Linas A. Bieliauskas
- Veterans Affairs Ann Arbor Healthcare System
- University of Michigan Health System
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Stelmokas J, Bieliauskas LA, Kitchen Andren KA, Hogikyan R, Alexander NB. Self-Reported Health and Safety Awareness Improves Prediction of Level of Care Needs in Veterans Discharged From a Postacute Unit. PM R 2017; 9:1122-1127. [PMID: 28400222 DOI: 10.1016/j.pmrj.2017.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/13/2017] [Accepted: 03/23/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the differential value of a self-reported health and safety awareness measure relative to other medical, psychosocial, and cognitive factors in predicting level of care (LOC) needs after hospital discharge. DESIGN Retrospective medical record review. SETTING Community living center postacute care (CLC-PAC) unit at a Veterans Affairs hospital. PARTICIPANTS A total of 175 veterans admitted to the Veterans Affairs hospital or directly to the CLC-PAC from home. METHODS Cognitive status was assessed with the Mini-Mental State Examination, Digit Span Backward subtest, Trail Making Test (Part B), and Hopkins Verbal Learning Test-Revised. Self-report of health and safety awareness was measured with the Independent Living Scales Health and Safety (ILS-HS) subscale. Additional demographic and admission-related variables were coded, along with medical comorbidity, with the Charlson Comorbidity Index and depression using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision Depression Checklist. MAIN OUTCOME MEASUREMENTS Increased level of care was collected from social work and occupational therapy notes and defined as increased assistance with activities of daily living or nursing home placement comparing prehospitalization with CLC-PAC discharge. RESULTS A total of 19% (n = 34) of residents required increased LOC on CLC-PAC discharge. The ILS-HS was a significant predictor of increased LOC above and beyond age and Mini Mental Status Examination score; for each standard deviation decrease in ILS-HS, there was an increased likelihood of greater LOC (odds ratio 0. 54, 95% confidence interval 0.35-0.83). Other neuropsychological tests (memory, executive functioning) did not significantly improve the model. CONCLUSIONS The inclusion of the ILS-HS to a standard cognitive screen (Mini Mental Status Examination) can improve prediction of increased LOC. Although select aspects of memory and executive functioning independently contribute to increased LOC prediction, the ILS-HS likely measures a unique aspect of cognitive functioning that may be specific to discharge planning needs in CLC-PAC residents. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Julija Stelmokas
- Veterans Affairs Ann Arbor Healthcare System Mental Health Service, 116B, 2215 Fuller Road, Ann Arbor, MI 48105; Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, Ann Arbor, MI; Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI(∗).
| | - Linas A Bieliauskas
- Veterans Affairs Ann Arbor Healthcare System Mental Health Service, Ann Arbor, MI; Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI(†)
| | - Katherine A Kitchen Andren
- Veterans Affairs Ann Arbor Healthcare System Mental Health Service, Ann Arbor, MI; Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI(‡)
| | - Robert Hogikyan
- Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, Ann Arbor, MI; Department of Internal Medicine and Division of Geriatric and Palliative Medicine, The University of Michigan, Ann Arbor, MI(§)
| | - Neil B Alexander
- Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, Ann Arbor, MI; Department of Internal Medicine and Division of Geriatric and Palliative Medicine, The University of Michigan, Ann Arbor, MI(¶)
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9
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Dawson EL, Caveney AF, Meyers KK, Weisenbach SL, Giordani B, Avery ET, Schallmo MP, Bahadori A, Bieliauskas LA, Mordhorst M, Marcus SM, Kerber K, Zubieta JK, Langenecker SA. Executive Functioning at Baseline Prospectively Predicts Depression Treatment Response. Prim Care Companion CNS Disord 2017; 19. [PMID: 28196313 DOI: 10.4088/pcc.16m01949] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022] Open
Abstract
Objective Existing cognitive and clinical predictors of treatment response to date are not of sufficient strength to meaningfully impact treatment decision making and are not readily employed in clinical settings. This study investigated whether clinical and cognitive markers used in a tertiary care clinic could predict response to usual treatment over a period of 4 to 6 months in a sample of 75 depressed adults. Methods Patients (N = 384) were sequentially tested in 2 half-day clinics as part of a quality improvement project at an outpatient tertiary care center between August 2003 and September 2007; additional subjects evaluated in the clinic between 2007 and 2009 were also included. Diagnosis was according to DSM-IV-TR criteria and completed by residents and attending faculty. Test scores obtained at intake visits on a computerized neuropsychological screening battery were the Parametric Go/No-Go task and Facial Emotion Perception Task. Treatment outcome was assessed using 9-item Patient Health Questionnaire (PHQ-9) self-ratings at follow-up (n = 75). Usual treatment included psychotropic medication and psychotherapy. Decline in PHQ-9 scores was predicted on the basis of baseline PHQ-9 score and education, with neuropsychological variables entered in the second step. Results PHQ-9 scores declined by 46% at follow-up (56% responders). Using 2-step multiple regression, baseline PHQ-9 score (P ≤ .05) and education (P ≤ .01) were significant step 1 predictors of percent change in PHQ-9 follow-up scores. In step 2 of the model, faster processing speed with interference resolution (go reaction time) independently explained a significant amount of variance over and above variables in step 1 (12% of variance, P < .01), while other cognitive and affective skills did not. This 2-step model accounted for 28% of the variance in treatment change in PHQ-9 scores. Processing speed with interference resolution also accounted for 12% variance in treatment and follow-up attrition. Conclusions Use of executive functioning assessments in clinics may help identify individuals with cognitive weaknesses at risk for not responding to standard treatments.
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Affiliation(s)
- Erica L Dawson
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Angela F Caveney
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Kortni K Meyers
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Sara L Weisenbach
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Bruno Giordani
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Erich T Avery
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Michael-Paul Schallmo
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Armita Bahadori
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Linas A Bieliauskas
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Matthew Mordhorst
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Sheila M Marcus
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Kevin Kerber
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Jon-Kar Zubieta
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Scott A Langenecker
- Department of Psychiatry, The University of Illinois at Chicago, 1601 W Taylor Ave, Chicago, 60612. .,Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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Stelmokas J, Gabel N, Flaherty JM, Rayson K, Tran K, Anderson JR, Bieliauskas LA. Delirium Detection and Impact of Comorbid Health Conditions in a Post-Acute Rehabilitation Hospital Setting. PLoS One 2016; 11:e0166754. [PMID: 27902744 PMCID: PMC5130207 DOI: 10.1371/journal.pone.0166754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 12/03/2022] Open
Abstract
Misdiagnosis and under-detection of delirium may occur in many medical settings. This is important to address as delirium clearly increases risk of morbidity and mortality in such settings. This study assessed whether Veterans who screened positive on a delirium severity measure (Memorial Delirium Assessment Scale; MDAS) differed from those with and without corresponding medical documentation of delirium in terms of cognitive functioning, psychiatric/medical history, and medication use. A medical record review of 266 inpatients at a VA post-acute rehabilitation unit found that 10.9% were identified as delirious according to the MDAS and/or medical records. Of the Veterans who screened positive on the MDAS (N = 19), 68.4% went undetected by medical screening. Undetected cases had a higher number of comorbid medical conditions as measured by the Age-Adjusted Charlson Index (AACI) scores (median = 9, SD = 3.15; U = 5.5, p = .003) than medically documented cases. For Veterans with a score of 7 or greater on the AACI, the general relative risk for delirium was 4.46. Delirium is frequently under-detected in a post-acute rehabilitation unit, particularly for Veterans with high comorbid illness. The relative risk of delirium is up to 4.46 for those with high medical burden, suggesting the need for more comprehensive delirium screening in these patients.
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Affiliation(s)
- Julija Stelmokas
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Nicolette Gabel
- University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Jennifer M. Flaherty
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, United States of America
| | - Katherine Rayson
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
| | - Kathileen Tran
- University of Michigan, Ann Arbor, Michigan, United States of America
| | | | - Linas A. Bieliauskas
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
- University of Michigan, Ann Arbor, Michigan, United States of America
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11
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Spencer RJ, Waldron-Perrine B, Drag LL, Pangilinan PH, Axelrod BN, Bieliauskas LA. Neuropsychological test validity in Veterans presenting with subjective complaints of 'very severe' cognitive symptoms following mild traumatic brain injury. Brain Inj 2016; 31:32-38. [PMID: 27819490 DOI: 10.1080/02699052.2016.1218546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study explored the utility of combining data from measures of performance validity and symptom validity among Veterans undergoing neuropsychological evaluation for mild traumatic brain injury (mTBI). BACKGROUND Persistent cognitive impairments following mTBI are often reported by returning combat veterans. However, objectively-measured cognitive deficits are not common among individuals with mTBI, raising the question of whether negative impression management influences self-ratings. METHODS Self-report ratings were obtained for memory, concentration, decision-making, and processing speed/organization using a 5-point scale ranging from 'none' to 'very severe'. Veterans also completed brief neuropsychological testing which included measures of performance validity. RESULTS Study 1 examined data from 122 participants and demonstrated that veterans reporting a 'very severe' cognitive deficit were over three times as likely to demonstrate poor effort on a validity test than those without a very severe rating. Study 2 replicated these findings in an independent sample of 127 veterans and also demonstrated that both severity of self-report ratings and performance on an embedded measure of effort were predictive of poor effort on a stand-alone performance validity test. CONCLUSION Veterans with suspected mTBI who report 'very severe' cognitive impairment have a greater likelihood of putting forth sub-optimal effort on objective testing.
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Affiliation(s)
- Robert J Spencer
- a Department of Mental Health Services , VA Ann Arbor Healthcare System , Ann Arbor , MI , USA
| | - Brigid Waldron-Perrine
- a Department of Mental Health Services , VA Ann Arbor Healthcare System , Ann Arbor , MI , USA
| | - Lauren L Drag
- b Stanford University Medical Center , Stanford , CA , USA
| | - Percival H Pangilinan
- c Department of Physical Medicine and Rehabilitation , University of Michigan Health System , Ann Arbor , MI , USA
| | - Bradley N Axelrod
- d Psychology Section, Mental Health Service , John D. Dingell Department of Veterans Affairs Medical Center , Detroit , MI , USA
| | - Linas A Bieliauskas
- a Department of Mental Health Services , VA Ann Arbor Healthcare System , Ann Arbor , MI , USA.,e Department of Psychiatry , University of Michigan Health System , Ann Arbor , MI , USA
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12
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Abstract
This study evaluated whether using the Peabody Picture Vocabulary Test-First Edition (PPVT-I) basal and ceiling criteria would result in similar estimates of receptive vocabulary while permitting administration of fewer test items when using the third and fourth editions of the PPVT. Data were retrospectively collected from 119 adult inpatients who completed a neuropsychological screen that included the PPVT-III or PPVT-IV, which were re-scored using PPVT-I criteria. PPVT-III/IV raw scores were not significantly different from PPVT-I raw scores. Although the difference between the PPVT-III/IV and PPVT-I standard scores was statistically significant, the difference was less than 8 points in 95% of cases. On average, 15 fewer items would be administered using the PPVT-I rules, leading to shorter administration time.
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Affiliation(s)
| | - Robert J Spencer
- b 2 Mental Health Service, VA Ann Arbor Healthcare System , Ann Arbor , MI , USA
| | - Linas A Bieliauskas
- b 2 Mental Health Service, VA Ann Arbor Healthcare System , Ann Arbor , MI , USA.,c 3 Neuropsychology Section , University of Michigan Health System , Ann Arbor , MI , USA
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13
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Waldron-Perrine B, Hennrick H, Spencer RJ, Pangilinan PH, Bieliauskas LA. Postconcussive symptom report in polytrauma: influence of mild traumatic brain injury and psychiatric distress. Mil Med 2016; 179:856-64. [PMID: 25102528 DOI: 10.7205/milmed-d-13-00282] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Many studies have evaluated the influence of mild traumatic brain injury (mTBI) on neuropsychological test performance and on report of postconcussive symptoms. However, most studies that examine postconcussion syndrome (PCS) do not address the issue of "polytrauma," which is common in military mTBI. This study investigated simultaneously demographic, injury-related, and psychiatric symptom predictors of PCS report in a veteran, polytrauma sample. In prediction of overall report of PCS symptoms with demographic, traumatic brain injury, psychiatric and sleep variables, 60% of the variance was explained. Semipartial correlations revealed that post-traumatic stress disorder uniquely explained 7% of the variance, depression 2%, and sleep dissatisfaction 3%; injury and demographic characteristics accounted for no unique variance. In all 5 hierarchical multiple regressions (prediction of total Neurobehavioral Symptom Inventory score and 4 individual factor scores), the total models were significant (p < 0.001). Accurate diagnosis and treatment necessitates an integrative analysis of PCS, psychiatric, behavioral, and health symptom report in addition to neuropsychological functioning in the polytrauma population. This study demonstrated that emotional distress was uniquely predictive of total report of PCS and that no injury-related characteristics were predictive. This is of particular relevance in a Veteran population given the high rates of both mTBI and psychiatric disturbance.
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Affiliation(s)
| | - Heather Hennrick
- VA Ann Arbor Healthcare System, 2215 Fuller Drive, Ann Arbor, MI 48105
| | - Robert J Spencer
- VA Ann Arbor Healthcare System, 2215 Fuller Drive, Ann Arbor, MI 48105
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14
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Boxley L, Flaherty JM, Spencer RJ, Drag LL, Pangilinan PH, Bieliauskas LA. Reliability and factor structure of the Hospital Anxiety and Depression Scale in a polytrauma clinic. J Rehabil Res Dev 2016; 53:873-880. [PMID: 28273327 DOI: 10.1682/jrrd.2015.05.0088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 12/16/2015] [Indexed: 11/05/2022]
Abstract
The Hospital Anxiety and Depression Scale (HADS) is a brief self-report measure of anxiety and depression symptoms. This study examined the internal consistency and factor structure of the HADS among Veterans in a polytrauma/traumatic brain injury clinic. The sample consisted of 312 Veterans. A confirmatory factor analysis of the depression and anxiety subscales showed, not surprisingly, that the two factors were highly correlated (r = 0.7). Goodness of fit statistics for the two-factor model were acceptable (root mean square error of approximation = 0.06, comparative fit index = 0.94). The HADS demonstrated very good reliability overall (alpha = 0.89) and for the individual subscales (alpha = 0.84). This study supports the use of the HADS as a screen for depression and anxiety in the assessment of mild traumatic brain injury in a Veteran population.
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Affiliation(s)
- Laura Boxley
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jennifer M Flaherty
- Department of Psychiatry & Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA
| | - Robert J Spencer
- Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Lauren L Drag
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Percival H Pangilinan
- Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.,University of Michigan Health System, University of Michigan, Ann Arbor, MI
| | - Linas A Bieliauskas
- Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.,University of Michigan Health System, University of Michigan, Ann Arbor, MI
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Flaherty JM, Spencer RJ, Drag LL, Pangilinan PH, Bieliauskas LA. Limited usefulness of the Rey Fifteen-Item Test in detection of invalid performance in veterans suspected of mild traumatic brain injury. Brain Inj 2015; 29:1630-4. [DOI: 10.3109/02699052.2015.1075249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Briceño EM, Rapport LJ, Kassel MT, Bieliauskas LA, Zubieta JK, Weisenbach SL, Langenecker SA. Age and gender modulate the neural circuitry supporting facial emotion processing in adults with major depressive disorder. Am J Geriatr Psychiatry 2015; 23:304-13. [PMID: 25085721 PMCID: PMC4241383 DOI: 10.1016/j.jagp.2014.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 05/15/2014] [Accepted: 05/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Emotion processing, supported by frontolimbic circuitry known to be sensitive to the effects of aging, is a relatively understudied cognitive-emotional domain in geriatric depression. Some evidence suggests that the neurophysiological disruption observed in emotion processing among adults with major depressive disorder (MDD) may be modulated by both gender and age. Therefore, the present study investigated the effects of gender and age on the neural circuitry supporting emotion processing in MDD. DESIGN Cross-sectional comparison of fMRI signal during performance of an emotion processing task. SETTING Outpatient university setting. PARTICIPANTS One hundred adults recruited by MDD status, gender, and age. MEASUREMENTS Participants underwent fMRI while completing the Facial Emotion Perception Test. They viewed photographs of faces and categorized the emotion perceived. Contrast for fMRI was of face perception minus animal identification blocks. RESULTS Effects of depression were observed in precuneus and effects of age in a number of frontolimbic regions. Three-way interactions were present between MDD status, gender, and age in regions pertinent to emotion processing, including frontal, limbic, and basal ganglia. Young women with MDD and older men with MDD exhibited hyperactivation in these regions compared with their respective same-gender healthy comparison (HC) counterparts. In contrast, older women and younger men with MDD exhibited hypoactivation compared to their respective same-gender HC counterparts. CONCLUSIONS This the first study to report gender- and age-specific differences in emotion processing circuitry in MDD. Gender-differential mechanisms may underlie cognitive-emotional disruption in older adults with MDD. The present findings have implications for improved probes into the heterogeneity of the MDD syndrome.
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Affiliation(s)
- Emily M. Briceño
- University of Michigan Department of Psychiatry, Ann Arbor, MI,Wayne State University Department of Psychology, Detroit, MI
| | - Lisa J. Rapport
- Wayne State University Department of Psychology, Detroit, MI
| | - Michelle T. Kassel
- University of Michigan Department of Psychiatry, Ann Arbor, MI,University of Illinois at Chicago Department of Psychiatry, Chicago, IL
| | | | - Jon-Kar Zubieta
- University of Michigan Department of Psychiatry, Ann Arbor, MI
| | - Sara L. Weisenbach
- University of Michigan Department of Psychiatry, Ann Arbor, MI,University of Illinois at Chicago Department of Psychiatry, Chicago, IL,Jesse Brown VA Healthcare System, Chicago, IL
| | - Scott A. Langenecker
- University of Michigan Department of Psychiatry, Ann Arbor, MI,University of Illinois at Chicago Department of Psychiatry, Chicago, IL
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Kraal AZ, Waldron-Perrine B, Pangilinan PH, Bieliauskas LA. Affect and psychiatric symptoms in a veteran polytrauma clinic. Rehabil Psychol 2015; 60:36-42. [DOI: 10.1037/rep0000017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Waldron-Perrine B, Hennrick H, Spencer RJ, Pangilinan PH, Bieliauskas LA. Postconcussive symptom report in polytrauma: influence of mild traumatic brain injury and psychiatric distress. Mil Med 2014. [PMID: 25102528 DOI: 10.7205/milmed-d-13–00282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Many studies have evaluated the influence of mild traumatic brain injury (mTBI) on neuropsychological test performance and on report of postconcussive symptoms. However, most studies that examine postconcussion syndrome (PCS) do not address the issue of "polytrauma," which is common in military mTBI. This study investigated simultaneously demographic, injury-related, and psychiatric symptom predictors of PCS report in a veteran, polytrauma sample. In prediction of overall report of PCS symptoms with demographic, traumatic brain injury, psychiatric and sleep variables, 60% of the variance was explained. Semipartial correlations revealed that post-traumatic stress disorder uniquely explained 7% of the variance, depression 2%, and sleep dissatisfaction 3%; injury and demographic characteristics accounted for no unique variance. In all 5 hierarchical multiple regressions (prediction of total Neurobehavioral Symptom Inventory score and 4 individual factor scores), the total models were significant (p < 0.001). Accurate diagnosis and treatment necessitates an integrative analysis of PCS, psychiatric, behavioral, and health symptom report in addition to neuropsychological functioning in the polytrauma population. This study demonstrated that emotional distress was uniquely predictive of total report of PCS and that no injury-related characteristics were predictive. This is of particular relevance in a Veteran population given the high rates of both mTBI and psychiatric disturbance.
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Affiliation(s)
| | - Heather Hennrick
- VA Ann Arbor Healthcare System, 2215 Fuller Drive, Ann Arbor, MI 48105
| | - Robert J Spencer
- VA Ann Arbor Healthcare System, 2215 Fuller Drive, Ann Arbor, MI 48105
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Spencer RJ, Axelrod BN, Drag LL, Waldron-Perrine B, Pangilinan PH, Bieliauskas LA. WAIS-IV Reliable Digit Span is no More Accurate Than Age Corrected Scaled Score as an Indicator of Invalid Performance in a Veteran Sample Undergoing Evaluation for mTBI. Clin Neuropsychol 2013; 27:1362-72. [DOI: 10.1080/13854046.2013.845248] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Briceño EM, Weisenbach SL, Rapport LJ, Hazlett KE, Bieliauskas LA, Haase BD, Ransom MT, Brinkman ML, Pecina M, Schteingart DE, Starkman MN, Giordani B, Welsh RC, Noll DC, Zubieta JK, Langenecker SA. Shifted inferior frontal laterality in women with major depressive disorder is related to emotion-processing deficits. Psychol Med 2013; 43:1433-1445. [PMID: 23298715 PMCID: PMC4380502 DOI: 10.1017/s0033291712002176] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Facial emotion perception (FEP) is a critical human skill for successful social interaction, and a substantial body of literature suggests that explicit FEP is disrupted in major depressive disorder (MDD). Prior research suggests that weakness in FEP may be an important phenomenon underlying patterns of emotion-processing challenges in MDD and the disproportionate frequency of MDD in women. Method Women with (n = 24) and without (n = 22) MDD, equivalent in age and education, completed a FEP task during functional magnetic resonance imaging. RESULTS The MDD group exhibited greater extents of frontal, parietal and subcortical activation compared with the control group during FEP. Activation in the inferior frontal gyrus (IFG) appeared shifted from a left >right pattern observed in healthy women to a bilateral pattern in MDD women. The ratio of left to right suprathreshold IFG voxels in healthy controls was nearly 3:1, whereas in the MDD group, there was a greater percentage of suprathreshold IFG voxels bilaterally, with no leftward bias. In MDD, relatively greater activation in right IFG compared with left IFG (ratio score) was present and predicted FEP accuracy (r = 0.56, p < 0.004), with an inverse relationship observed between FEP and subgenual cingulate activation (r = - 0.46, p = 0.02). CONCLUSIONS This study links, for the first time, disrupted IFG activation laterality and increased subgenual cingulate activation with deficient FEP in women with MDD, providing an avenue for imaging-to-assessment translational applications in MDD.
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Affiliation(s)
- Emily M. Briceño
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
- Department of Psychology, Wayne State University, 5057 Woodward Avenue, 7 floor, Detroit, MI, USA
| | - Sara L. Weisenbach
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
- Ann Arbor VA Medical Center, 2215 Fuller Road, Ann Arbor, MI, USA
| | - Lisa J. Rapport
- Department of Psychology, Wayne State University, 5057 Woodward Avenue, 7 floor, Detroit, MI, USA
| | - Kathleen E. Hazlett
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
| | - Linas A. Bieliauskas
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
- Ann Arbor VA Medical Center, 2215 Fuller Road, Ann Arbor, MI, USA
| | - Brennan D. Haase
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
| | - Michael T. Ransom
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
| | - Michael L. Brinkman
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
| | - Marta Pecina
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
| | - David E. Schteingart
- Department of Internal Medicine, 1500 E. Medical Center Drive, University of Michigan Medical Center, Ann Arbor MI, USA
| | - Monica N. Starkman
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
| | - Bruno Giordani
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
| | - Robert C. Welsh
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
| | - Douglas C. Noll
- Department of Radiology, 1500 E. Medical Center Drive, University of Michigan Medical Center, Ann Arbor MI, USA
- Department of Biomedical Engineering, 1107 Carl A. Gerstacker Building, 2200 Bonisteel, Blvd, University of Michigan, Ann Arbor MI, USA
| | - Jon-Kar Zubieta
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
- Department of Radiology, 1500 E. Medical Center Drive, University of Michigan Medical Center, Ann Arbor MI, USA
| | - Scott A. Langenecker
- Department of Psychiatry, University of Michigan Medical Center, 4250 Plymouth Rd, Ann Arbor MI, USA
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Nelson WM, Bieliauskas LA. Vytautas J. Bieliauskas (1920–2013). American Psychologist 2013; 68:885. [DOI: 10.1037/a0033933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Spencer RJ, McGuire AP, Tree HA, Waldron-Perrine B, Pangilinan PH, Bieliauskas LA. Report of traumatic brain injury information sources among OIF/OEF Veterans undergoing polytrauma evaluations. ACTA ACUST UNITED AC 2013; 50:1-6. [DOI: 10.1682/jrrd.2012.01.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Weisenbach SL, Rapport LJ, Briceno EM, Haase BD, Vederman AC, Bieliauskas LA, Welsh RC, Starkman MN, McInnis MG, Zubieta JK, Langenecker SA. Reduced emotion processing efficiency in healthy males relative to females. Soc Cogn Affect Neurosci 2012. [PMID: 23196633 DOI: 10.1093/scan/nss137] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined sex differences in categorization of facial emotions and activation of brain regions supportive of those classifications. In Experiment 1, performance on the Facial Emotion Perception Test (FEPT) was examined among 75 healthy females and 63 healthy males. Females were more accurate in the categorization of fearful expressions relative to males. In Experiment 2, 3T functional magnetic resonance imaging data were acquired for a separate sample of 21 healthy females and 17 healthy males while performing the FEPT. Activation to neutral facial expressions was subtracted from activation to sad, angry, fearful and happy facial expressions. Although females and males demonstrated activation in some overlapping regions for all emotions, many regions were exclusive to females or males. For anger, sad and happy, males displayed a larger extent of activation than did females, and greater height of activation was detected in diffuse cortical and subcortical regions. For fear, males displayed greater activation than females only in right postcentral gyri. With one exception in females, performance was not associated with activation. Results suggest that females and males process emotions using different neural pathways, and these differences cannot be explained by performance variations.
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Affiliation(s)
- Sara L Weisenbach
- Department of Psychiatry, University of Michigan Medical School, 2101 Commonwealth Boulevard, Suite C, Ann Arbor, MI, USA.
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Waldron-Perrine B, McGuire AP, Spencer RJ, Drag LL, Pangilinan PH, Bieliauskas LA. The Influence of Sleep and Mood on Cognitive Functioning Among Veterans Being Evaluated for Mild Traumatic Brain Injury. Mil Med 2012. [DOI: 10.7205/milmed-d-12-00169] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
In a population of inpatients, individuals were observed to continually score in the impaired range on the Frontal Assessment Battery (FAB) without exhibiting other signs of frontal-lobe damage. Investigations were undertaken to determine if the subtest structure, demographic factors, or general cognitive functioning may be responsible for patients' poor performance on the FAB overall. Participants were inpatients at the Ann Arbor Veterans Hospital who were administered a standard neuropsychological screening battery. This battery included the FAB, among other tests, as part of regular clinical care. Included in these study analyses were 292 patients with a mean age of 67.27 years (SD = 12.41). Descriptive analyses revealed that 63.7% of patients scored in the impaired range on the FAB based on the criteria set forth by Dubois, Slachevsky, and Litvan ( 2000 ). Analyses of individual subtest performance failed to find any single test that would characterize participants' poor performance overall. Nonetheless, the total FAB score was related to age, general cognitive functioning, and premorbid estimates of intellectual functioning. The internal reliability also was found to be lower than that reported previously. While the FAB may measure frontal-lobe functions, it appears to be influenced by a multitude of other demographic and neuropsychological factors.
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Affiliation(s)
- Christopher J Graver
- Department of Psychology, Neuropsychology Clinic, Madigan Army Medical Center, Tacoma, Washington, USA.
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Considine CM, Weisenbach SL, Walker SJ, McFadden EM, Franti LM, Bieliauskas LA, Maixner DF, Giordani B, Berent S, Langenecker SA. Auditory memory decrements, without dissimulation, among patients with major depressive disorder. Arch Clin Neuropsychol 2011; 26:445-53. [PMID: 21593060 DOI: 10.1093/arclin/acr041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Questions have been raised about whether poor performance on memory tasks by individuals with major depressive disorder (MDD) might be the result of poor or variable effort or disease-related disruption of neural circuits supporting memory functions. The present study examined performance on a measure of task engagement and on an auditory memory task among 45 patients with MDD (M age = 47.82, SD = 19.55) relative to 32 healthy controls (HC; M age = 51.03, SD = 22.09). One-hundred percent of HC and MDD volunteers performed above the threshold for adequate effort on a formal measure of task engagement. The MDD subjects performed significantly more poorly than the HC subjects on an auditory learning and memory test. The present results suggest that auditory memory difficulties do occur among those with MDD and that decrements in performance in this group may be related to factors other than lack of effort.
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Affiliation(s)
- Ciaran M Considine
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48105, USA
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Kronfol Z, Litman HJ, Back-Madruga C, Bieliauskas LA, Lindsay KL, Lok AS, Fontana RJ. No increase in depression with low-dose maintenance peginterferon in prior non-responders with chronic hepatitis C. J Affect Disord 2011; 129:205-12. [PMID: 20889211 PMCID: PMC3025085 DOI: 10.1016/j.jad.2010.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 09/15/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Peginterferon and ribavirin treatment of chronic hepatitis C (CHC) is frequently associated with dose-limiting neuropsychiatric toxicity. The purpose of this study is to determine whether prolonged administration of low-dose peginterferon-α2a is associated with an increase in the rate and severity of depression compared to untreated controls. METHODS 129 non-responders to full-dose peginterferon and ribavirin treatment were randomized to low-dose maintenance treatment with peginterferon-α2a 90 μg/week or no treatment for 3.5 years. Depression was assessed using the Beck Depression Inventory (BDI-II) and the Composite International Diagnostic Interview (CIDI) at baseline and at 12, 24, 36, and 48 months. "Clinical depression" was defined as BDI-II ≥11 and/or meeting DSM-IV criteria for major depression on the CIDI. Serial cortisol and serotonin plasma concentrations were obtained in a subgroup of patients. RESULTS Rates of clinical depression did not significantly differ over time or between treatment groups. Baseline clinical depression was the only significant predictor of clinical depression over time (p<0.001). Rates of clinical depression were also significantly higher in patients experiencing liver disease progression (p=0.016). Antidepressant use did not significantly differ between groups. Adjusted whole blood serotonin levels dropped significantly over time (p=0.04), but there was no group by time effect. LIMITATIONS Lack of significant group differences in antidepressant use does not completely preclude significant mood changes masked by antidepressants. Results may differ in treatment naïve CHC patients or in those receiving full-dose peginterferon. CONCLUSIONS Prolonged low-dose peginterferon-α2a treatment is not associated with an increase in the frequency or severity of clinical depression in prior non-responder patients with chronic hepatitis C.
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Affiliation(s)
- Ziad Kronfol
- Depression Center, University of Michigan, Ann Arbor, MI
| | | | - Carla Back-Madruga
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Linas A. Bieliauskas
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI
- Psychology Service, Veterans Affairs Health System, Ann Arbor, MI
| | - Karen L. Lindsay
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anna S. Lok
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Robert J. Fontana
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Drag LL, Bieliauskas LA, Langenecker SA, Greenfield LJ. Cognitive functioning, retirement status, and age: results from the Cognitive Changes and Retirement among Senior Surgeons study. J Am Coll Surg 2010; 211:303-7. [PMID: 20800185 DOI: 10.1016/j.jamcollsurg.2010.05.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 05/20/2010] [Accepted: 05/20/2010] [Indexed: 01/26/2023]
Abstract
BACKGROUND Accurate assessment of cognitive functioning is an important step in understanding how to better evaluate both clinical and cognitive competence in practicing surgeons. As part of the Cognitive Changes and Retirement among Senior Surgeons study, we examined the objective cognitive functioning of senior surgeons in relation to retirement status and age. STUDY DESIGN Computerized cognitive tasks measuring visual sustained attention, reaction time, and visual learning and memory were administered to both practicing and retired surgeons at annual meetings of the American College of Surgeons. Data from 168 senior surgeons aged 60 and older were compared with data from 126 younger surgeons aged 45 to 59, with performance below 1.5 standard deviations or more indicating a significant difference between the groups. RESULTS Sixty-one percent of practicing senior surgeons performed within the range of the younger surgeons on all cognitive tasks. Seventy-eight percent of practicing senior surgeons aged 60 to 64 performed within the range of the younger surgeons on all tasks compared with 38% of practicing senior surgeons aged 70 and older. Forty-five percent of retired senior surgeons performed within the range of the younger surgeons on all tasks. No senior surgeon performed below the younger surgeons on all 3 tasks. CONCLUSIONS The majority of practicing senior surgeons performed at or near the level of their younger peers on all cognitive tasks, as did almost half of the retired senior surgeons. This suggests that older age does not inevitably preclude cognitive proficiency. The variability in cognitive performance across age groups and retirement status suggests the need for formal measures of objective cognitive functioning to help surgeons detect changes in cognitive performance and aid in their decisions to retire.
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Affiliation(s)
- Lauren L Drag
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
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Bieliauskas LA, Depp C, Kauszler ML, Steinberg BA, Lacy M. IQ and Scores on the Mini-Mental State Examination (MMSE). Aging, Neuropsychology, and Cognition 2010. [DOI: 10.1076/anec.7.4.227.799] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
This article addresses key topics in cognitive aging, intending to provide the reader with a brief overview of the current state of research in this growing, multidisciplinary field. A summary of the physiological changes in the aging brain is provided as well as a review of variables that influence cognitive abilities in older age. Normal aging differentially affects various aspects of cognition, and specific changes within various domains such as attention, executive functioning, and memory are discussed. Various theories have been proposed to account for the cognitive changes that accompany normal aging, and a brief examination of these theories is presented in the context of these domain-specific changes.
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Affiliation(s)
- Lauren L Drag
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
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Spencer RJ, Drag LL, Walker SJ, Bieliauskas LA. Self-reported cognitive symptoms following mild traumatic brain injury are poorly associated with neuropsychological performance in OIF/OEF veterans. ACTA ACUST UNITED AC 2010; 47:521-30. [DOI: 10.1682/jrrd.2009.11.0181] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lee HJ, Drag LL, Bieliauskas LA, Langenecker SA, Graver C, O'Neill J, Greenfield L. Results from the cognitive changes and retirement among senior surgeons self-report survey. J Am Coll Surg 2009; 209:668-671.e2. [PMID: 19854410 DOI: 10.1016/j.jamcollsurg.2009.08.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 08/07/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Cognitive Changes and Retirement among Senior Surgeons (CCRASS) study suggested that although subjective cognitive awareness may play a role in surgeons' retirement decisions, self-perceived cognitive decline did not predict objective cognitive performance. This article summarizes results from all participants who completed the survey portion of the CCRASS study. STUDY DESIGN A survey examining subjective cognitive changes, changes in caseload, involvement in new technology, and retirement decisions, was administered to 995 surgeons at annual meetings of the Clinical Congress of the American College of Surgeons between 2001 and 2006. RESULTS Forty-five percent reported increased caseload volume and 48% reported increased caseload complexity during the previous 5 years. In addition, 75% and 73% denied any recent changes in memory recall or name recognition, respectively. Increasing age was associated with decreases in clinical caseload and complexity. The majority of respondents across all age groups reported active participation in either learning (64%) or contributing (13%) to new technology in the field. Among surgeons with no imminent plans for retirement, 58% reported that a retirement decision will be based on skill level. CONCLUSIONS Increasing age was associated with decreases in caseload and case complexity. But a steady proportion of surgeons, even in the oldest age group, are active in new surgical innovations and challenging cases. Most reported no changes in perceived cognitive abilities. The majority of surgeons who had made no decision to retire reported that their decision will be based on skill level rather than age.
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Affiliation(s)
- H Jin Lee
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
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Abstract
PRIMARY OBJECTIVE To review of studies that focus on the assessment of driving competence among the elderly who are at increased risk of being involved in automobile crashes. The current status of neuropsychological testing as a predictor of driving safety in this population is critically evaluated. MAIN OUTCOMES AND RESULTS Several domains of neuropsychological assessment have been shown to be related to safe driving in older age groups, including vision-based testing, attention-based testing, and testing of executive functions. Use of a driving simulator to investigate crash risk has been particularly effective. CONCLUSIONS The argument is made that a combination of test approaches be used to develop an algorithm for efficient screening of elderly drivers on a regular basis and that use of a driving simulator to measure driving performance under challenge should be incorporated as part of this evaluation.
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Affiliation(s)
- Linas A Bieliauskas
- VA Medical Center/University of Michigan Health System, Ann Arbor, Michigan 48105, USA.
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Fontana RJ, Kronfol Z, Lindsay KL, Bieliauskas LA, Padmanabhan L, Back-Madruga C, Lok AS, Stoddard AM. Changes in mood states and biomarkers during peginterferon and ribavirin treatment of chronic hepatitis C. Am J Gastroenterol 2008; 103:2766-75. [PMID: 18721241 PMCID: PMC3712502 DOI: 10.1111/j.1572-0241.2008.02106.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Depression is a frequent side effect of interferon therapy in patients with chronic hepatitis C (CHC). The aim of this study was to identify baseline and on-treatment predictors of depression in CHC patients receiving peginterferon and ribavirin. METHODS In total, 201 prior nonresponders with advanced fibrosis were treated with peginterferon alfa-2a and ribavirin for 24 wk in the Hepatitis C Antiviral Long-term Treatment against Cirrhosis trial. Of these, 74 continued on antiviral therapy through week 48. Mood states were assessed with the Beck Depression Inventory II and the Composite International Diagnostic Interview. Plasma cortisol and whole blood serotonin levels were measured in 101 subjects at weeks 0, 4, 24, 48, and 72. RESULTS The incidence of interferon-induced depression was 23% and 42% at weeks 24 and 48, respectively. Although 22% of patients had baseline depression, the absence of a week 20 virological response was the only independent predictor of interferon-induced depression at week 24 (P = 0.0009). Plasma cortisol levels did not change during treatment nor correlate with depression. In contrast, whole blood serotonin/platelet levels significantly decreased during treatment, but did not correlate with interferon-induced depression through week 24 (P = 0.35), nor through week 48 (P = 0.51). CONCLUSION Depression during peginterferon and ribavirin therapy was associated with a lower antiviral response. The significant reduction in whole blood serotonin levels over time suggest that further studies of the serotonergic pathway are warranted to identify the mediators of interferon-induced depression.
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Affiliation(s)
| | - Ziad Kronfol
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Karen L. Lindsay
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Linas A. Bieliauskas
- Department of Psychiatry, University of Michigan, Ann Arbor, MI,Psychology Service, Veterans Affairs Health System, Ann Arbor, MI
| | | | - Carla Back-Madruga
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anna S.F. Lok
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI
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Boom-Saad Z, Langenecker SA, Bieliauskas LA, Graver CJ, O’Neill JR, Caveney AF, Greenfield LJ, Minter RM. Surgeons outperform normative controls on neuropsychologic tests, but age-related decay of skills persists. Am J Surg 2008; 195:205-9. [DOI: 10.1016/j.amjsurg.2007.11.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 11/07/2007] [Accepted: 11/07/2007] [Indexed: 11/24/2022]
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Chatel DM, Lamberty GJ, Bieliauskas LA. Prescription privileges for psychologists: A professional affairs committee survey of division 40 members. Clin Neuropsychol 2007; 7:190-196. [DOI: 10.1080/13854049308401521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Daniel M. Chatel
- a University of Michigan and VA Medical Center , Ann Arbor , Michigan
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42
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Whitney KA, Maoz O, Hook JN, Steiner AR, Bieliauskas LA. IQ and Scores on the Mini-Mental State Examination (MMSE): Controlling for Effort and Education Among Geriatric Inpatients. Aging, Neuropsychology, and Cognition 2007; 14:545-52. [PMID: 17828629 DOI: 10.1080/13825580600850934] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Mini-Mental State Examination (MMSE) and the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) were administered to 76 Extended Care Center inpatients of a Veterans Affairs Medical Center, 56 of whom did not carry a diagnosis associated with brain impairment, and 20 of whom had a diagnosis associated with degenerative or cerebrovascular conditions. MMSE and PPVT-III scores, the latter of which estimates verbal IQ, were significantly correlated in both groups, even when controlling for the effects of education. This correlation was attenuated, but remained significant, in the face of varying levels of patient effort. The findings of this study support earlier findings, which also suggest that interpretation of "impaired" performance on the MMSE for those with IQ scores below 90 should be interpreted with caution. Average MMSE scores for Wechsler IQ classifications are provided.
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Affiliation(s)
- Kriscinda A Whitney
- Psychiatry Ambulatory Care, Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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43
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Langenecker SA, Caveney AF, Giordani B, Young EA, Nielson KA, Rapport LJ, Bieliauskas LA, Mordhorst MJ, Marcus S, Yodkovik N, Kerber K, Berent S, Zubieta JK. The sensitivity and psychometric properties of a brief computer-based cognitive screening battery in a depression clinic. Psychiatry Res 2007; 152:143-54. [PMID: 17445911 DOI: 10.1016/j.psychres.2006.03.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2005] [Revised: 01/10/2006] [Accepted: 03/01/2006] [Indexed: 11/17/2022]
Abstract
At present, there is poor accuracy in assessing cognitive and vegetative symptoms in depression using clinician or self-rated measures, suggesting the need for development of standardized tasks to assess these functions. The current study assessed the psychometric properties and diagnostic specificity of a brief neuropsychological screening battery designed to assess core signs of depression; psychomotor retardation, attention and executive functioning difficulties, and impaired emotion perception within an outpatient psychiatry setting. Three hundred eighty-four patients with mood disorders and 77 healthy volunteers participated. A large percentage of patients met diagnostic criteria for Major Depressive Disorder alone (49%) or with another comorbid psychiatric disorder (24%). A brief, 25-min battery of computer-based tests was administered to control participants and patients measuring the constructs of inhibitory control, attention, visual perception, and both executive and visual processing speed. The patient groups performed significantly worse than the control group regardless of diagnosis on visual perception and attention accuracy and processing speed factors. Surprisingly, the anxiety disorder group performed better than several other psychiatric disorder groups in inhibitory control accuracy. Developing valid and reliable measures of cognitive signs in mood disorders creates excellent opportunities for tracking cognitive status prior to initiation of treatment, and allows for reliable retest following treatment.
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Affiliation(s)
- Scott A Langenecker
- Department of Psychiatry, University of Michigan Medical Center, C480 Med Inn Building, 1500 East Medical Center, Ann Arbor, MI 48109, USA.
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44
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Bieliauskas LA, Back-Madruga C, Lindsay KL, Wright EC, Kronfol Z, Lok ASF, Fontana RJ. Cognitive reserve and neuropsychological functioning in patients infected with hepatitis C. J Int Neuropsychol Soc 2007; 13:687-92. [PMID: 17521478 DOI: 10.1017/s1355617707070877] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 01/02/2007] [Accepted: 01/02/2007] [Indexed: 11/07/2022]
Abstract
This study evaluated the influence of cognitive reserve on neuropsychological test performance in 198 patients infected with the hepatitis C virus. IQ scores, educational level, and occupational rating were combined to calculate a Cognitive Reserve Score (CRS) for each patient. Similar to studies of infection with the human immunodeficiency virus, there was a significantly increased risk of impairment in neuropsychological test performance in individuals with lower CRSs. It is important to account for CRS when assessing cognitive findings in large-scale clinical trials.
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Affiliation(s)
- Linas A Bieliauskas
- Neuropsychology Section, Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, Michigan 48105, USA.
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Fontana RJ, Bieliauskas LA, Lindsay KL, Back-Madruga C, Wright EC, Snow KK, Lok ASF, Kronfol Z, Padmanabhan L. Cognitive function does not worsen during pegylated interferon and ribavirin retreatment of chronic hepatitis C. Hepatology 2007; 45:1154-63. [PMID: 17465000 DOI: 10.1002/hep.21633] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED Treatment of chronic hepatitis C with pegylated interferon (peginterferon) and ribavirin can cause or exacerbate depression but its effects on cognitive function are largely unknown. The aim of this study was to determine whether treatment with peginterferon and ribavirin adversely impacts cognitive function in patients with chronic hepatitis C. Prior nonresponders to interferon were retreated with peginterferon alfa-2a and ribavirin for 24 (n=177) or 48 weeks (n=57) in the Hepatitis C Antiviral Long-term Treatment Against Cirrhosis trial. Cognitive function was prospectively assessed using a battery of 10 standardized neuropsychological tests at weeks 0, 24, 48, and 72. Cognitive impairment was defined based upon a global deficit score. The Beck Depression Inventory and Brief Symptom Inventory were used to assess mood status. The 57 subjects who completed 48 weeks of antiviral therapy reported significant increases in difficulty concentrating, emotional distress, and symptoms of depression, all of which improved after cessation of therapy [P<0.0001, analysis of variance (ANOVA)]. Nonetheless, the frequency of cognitive impairment did not increase during the first 24 weeks of treatment in 177 patients (34% versus 32%, P=0.64) nor in the 57 patients completing 48 weeks of treatment (P=0.48, ANOVA). CONCLUSION Retreatment of prior non-responders with peginterferon and ribavirin was not associated with objective evidence of cognitive impairment as measured by a comprehensive battery of neuropsychological tests. The lack of cognitive impairment is reassuring and suggests that self-reported symptoms of cognitive dysfunction are more likely related to the systemic and psychiatric side effects of antiviral treatment rather than measurable changes in cognition.
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Affiliation(s)
- Robert J Fontana
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0362, USA.
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46
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Bieliauskas LA, Back-Madruga C, Lindsay KL, Snow KK, Kronfol Z, Lok AS, Padmanabhan L, Fontana RJ. Clinical Relevance of Cognitive Scores in Hepatitis C Patients with Advanced Fibrosis. J Clin Exp Neuropsychol 2007; 28:1346-61. [PMID: 17050262 DOI: 10.1080/13803390500473720] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mild neuropsychological impairment has previously been reported in chronic hepatitis C (CHC) patients. The aim of this study was to assess the presence and severity of cognitive impairment among a cohort of CHC patients with advanced fibrosis using clinician ratings compared to classification based upon statistical methods. In addition, we set out to determine the relationship between cognitive scores and functional status. Two experienced neuropsychologists provided "clinician ratings" on a battery of 10 neuropsychological tests performed in 100 randomly selected patients participating in the HALT-C clinical trial. The overall kappa between the 2 graders on level of impairment was 0.59. Clinician ratings (the gold standard) were similarly sensitive to identifying cognitive impairment as was classification based on standard scores (44% vs. 40%). Global Deficit Scores (GDS), derived from pooling standard scores, also identified 44% of patients as having mild impairment and were highly correlated with clinician ratings (r = .81 p = < 0.0001). Neither clinician ratings nor deficit scores correlated with SF-36 subscale or summary scores but did correlate with depression scores (p < .0007). In summary, clinician ratings and deficit scores identified a similar prevalence of cognitive impairment amongst CHC patients with advanced fibrosis. There was a significant correlation between cognitive impairment and self-reported depression.
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Steinberg BA, Bieliauskas LA, Smith GE, Ivnik RJ. Mayo's Older Americans Normative Studies: Age- and IQ-Adjusted Norms for the Wechsler Memory Scale--Revised. Clin Neuropsychol 2005; 19:378-463. [PMID: 16120536 DOI: 10.1080/13854040590945201] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Normative data sets for standardized neuropsychometric instruments often include adjustments for subject variables. There are reasons to believe, however, that improvements in interpretive accuracy that result from such adjustments are less than optimal. In particular, "years of formal education" may be less closely related to test performances than is general intellectual functioning. In this third of four reanalyses of results from the Mayo Clinic's Older Americans Normative Studies (MOANS) databases, age-adjusted index and scaled scores for the Wechsler Memory Scale-Revised were found to be more strongly associated with Mayo age-adjusted WAIS-R Full Scale IQ scores (rs=.271 to .631) than with education (rs=.089 to .310) for healthy older examinees between 56 and 99 years of age. These associations were strongest for Attention/Concentration and General Memory Index scores and, in general, for individuals with average intelligence (cf. Dodrill, 19971999). Tables of age- and IQ-adjusted percentile equivalents of Mayo age-adjusted WMS-R index scores and MOANS age-adjusted WMS-R subtest scaled scores are presented for eleven age ranges and seven IQ ranges.
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Affiliation(s)
- Brett A Steinberg
- Comprehensive Neuropsychological Services, P.C., Cheshire, CT 06410, USA.
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Steinberg BA, Bieliauskas LA, Smith GE, Ivnik RJ. Mayo's Older Americans Normative Studies: Age- and IQ-Adjusted Norms for the Trail-Making Test, the Stroop Test, and MAE Controlled Oral Word Association Test. Clin Neuropsychol 2005; 19:329-77. [PMID: 16120535 DOI: 10.1080/13854040590945210] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although normative data sets for standardized neuropsychometric instruments often include adjustments for subject variables, there are reasons to believe that improvements in interpretive accuracy that result from such adjustments are less than optimal. In particular, years of formal education may be less closely related to test performances than is general intellectual functioning. In this second of four reanalyses of results from the Mayo Clinic's Older Americans Normative Studies (MOANS) databases, age-adjusted scores for the Trail-Making Test, the Stroop Color-Word Test, and the MAE Controlled Oral Word Associations Test were found to be more strongly associated with Mayo age-adjusted WAIS-R Full Scale IQ scores (rs=.368 to .495) than with education (rs=.174 to .367) for healthy older examinees between 56 and 99 years of age. For the TMT and the COWAT, but not the Stroop, these associations became stronger as IQ increased (cf. Dodrill, 1997, 1999). Tables of age- and IQ-adjusted percentile equivalents of MOANS age-adjusted TMT, Stroop, and COWAT scores are presented for eleven age ranges and seven IQ ranges.
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Affiliation(s)
- Brett A Steinberg
- Comprehensive Neuropsychological Services, P.C., Cheshire, CT 06410, USA.
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Steinberg BA, Bieliauskas LA, Smith GE, Ivnik RJ, Malec JF. Mayo's Older Americans Normative Studies: Age- and IQ-Adjusted Norms for the Auditory Verbal Learning Test and the Visual Spatial Learning Test. Clin Neuropsychol 2005; 19:464-523. [PMID: 16120537 DOI: 10.1080/13854040590945193] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although normative data sets for standardized neuropsychometric instruments frequently feature adjustments for subject variables, there are reasons to believe that improvements in interpretive accuracy that result from such adjustments are less than optimal. In particular, years of education may be less closely associated with test performances than is overall intellectual functioning. In this last of four reanalyses of results from the Mayo Clinic's Older Americans Normative Studies (MOANS) databases, age-adjusted scores for the Rey Auditory Verbal Learning Test and the Visual Spatial Learning Test were found to be more strongly related to Mayo age-adjusted WAIS-R Full Scale IQ scores (rs=.150 to .395) than to education (rs=.060 to .236) for healthy older examinees between 56 and 99 years of age. Although AVLT-FSIQ correlations were greatest at moderate levels of intelligence, VSLT-FSIQ correlations consistently increased in strength as intelligence increased (cf. Dodrill, 19971999). Based on these results, we present tables of age- and IQ-adjusted percentile equivalents of Mayo age-adjusted AVLT index scores and MOANS age-adjusted AVLT and VSLT scaled scores for ten age ranges and either seven (AVLT) or five (VSLT) IQ ranges.
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Affiliation(s)
- Brett A Steinberg
- Comprehensive Neuropsychological Services, P.C., Cheshire, CT 06410, USA.
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Steinberg BA, Bieliauskas LA, Smith GE, Langellotti C, Ivnik RJ. Mayo's Older Americans Normative Studies: Age- and IQ-Adjusted Norms for the Boston Naming Test, the MAE Token Test, and the Judgment of Line Orientation Test. Clin Neuropsychol 2005; 19:280-328. [PMID: 16120534 DOI: 10.1080/13854040590945229] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although many extant normative data sets for standardized neuropsychometric instruments feature adjustments for subject variables, there are reasons to believe that improvements in interpretive accuracy that result from such adjustments are less than optimal. In particular, several theoretical considerations suggest that years of formal education may be less closely related to test performances than is general intellectual functioning. In this first of four reanalyses of results from the Mayo Clinic's Older Americans Normative Studies (MOANS) databases, age-adjusted scores on the Boston Naming Test, the MAE Token Test, and the Judgment of Line Orientation Test were indeed found to be more strongly associated with Mayo Age-adjusted WAIS-R Full Scale IQ scores (rs=.608, .473, and .502, respectively) than with education (rs=.310, .306, and .236, respectively) for healthy older examinees (56-99 years). Consistent with the remarks of Dodrill (19971999), these correlations generally decreased at higher levels of intelligence. The magnitude and pattern of such declines varied across the three tests, however, suggesting that IQ-test score associations must be empirically determined rather than assumed to be linear. Tables of Age- and IQ-Adjusted percentile equivalents of MOANS Age-adjusted BNT, Token Test, and JLO scaled scores are presented for eleven age ranges and seven IQ ranges. The article concludes with a discussion of factors that may underlie observed relations among age, intelligence, and neuropsychometric test performances.
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Affiliation(s)
- Brett A Steinberg
- Comprehensive Neuropsychological Services, P.C., Cheshire, CT 06410, USA.
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