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Fedewa SA, Buckner TW, Parks SG, Tran DQ, Cafuir L, Antun AG, Mattis S, Kempton CL. Racial and Ethnic Differences in Distress, Depression, and Quality of Life in people with hemophilia. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01616-3. [PMID: 37133726 DOI: 10.1007/s40615-023-01616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/20/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
Hemophilia-related distress (HRD) has been shown to be higher among those with lower educational attainment, but potential racial/ethnic differences have not been previously described. Thus, we examined HRD according to race/ethnicity. This cross-sectional study was a planned secondary analysis of the hemophilia-related distress questionnaire (HRDq) validation study data. Adults aged ≥ 18 years with Hemophilia A or B were recruited from one of two hemophilia treatment centers between July 2017-December 2019. HRDq scores can range from 0-120, and higher scores indicate higher distress. Self-reported race/ethnicity was grouped as Hispanic, non-Hispanic White (NHW) and non-Hispanic Black (NHB). Unadjusted and multivariable linear regression models were used to examine mediators of race/ethnicity and HRDq scores. Among 149 participants enrolled, 143 completed the HRDq and were included in analyses. Approximately 17.5% of participants were NHB, 9.1% were Hispanic and 72.0% were NHW. HRDq scores ranged from 2 to 83, with a mean of 35.1 [standard deviation (SD) = 16.5]. Average HRDq scores were significantly higher among NHB participants (mean = 42.6,SD = 20.6; p-value = .038) and similar in Hispanic participants (mean = 33.8,SD = 16.7, p-value = .89) compared to NHW (mean = 33.2,SD = 14.9) participants. In multivariable models, differences between NHB vs NHW participants persisted when adjusting for inhibitor status, severity, and target joint. However, after household income was adjusted for, differences in HRDq scores were no longer statistically significant (β = 6.0 SD = 3.7; p-value = .10). NHB participants reported higher HRD than NHW participants. Household income mediated higher distress scores in NHB compared to NHW participants, highlighting the urgent need to understand social determinants of health and financial hardship in persons with hemophilia.
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Affiliation(s)
- Stacey A Fedewa
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA, USA.
| | - Tyler W Buckner
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Duc Q Tran
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - Lorraine Cafuir
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - Ana G Antun
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Shanna Mattis
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - Christine L Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA, USA
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Guasch S, Scott LC, Figueroa J, Buckner TW, Mattis S, Tran DQ, Kempton CL. Cross-sectional study evaluating the association of haemophilia-related distress and clinically relevant outcomes. Haemophilia 2023; 29:505-512. [PMID: 36639952 DOI: 10.1111/hae.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/14/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION In chronic diseases, disease-related distress can impact disease outcomes. Distress and haemophilia-related distress has been demonstrated in people with haemophilia (PwH). The association of haemophilia-related distress on disease outcomes among PwH is unknown. AIM To study the association of haemophilia-related distress with haemophilia specific outcomes, including adherence to prophylactic therapy, the presence of a target joint, healthcare utilization and work-impairment. METHODS In a cross-sectional study, adults with haemophilia A or B were enrolled in a study to validate the haemophilia-related distress questionnaire (HRDq). In this planned analysis, univariate and multivariate associations between the HRDq total score and disease outcomes were explored. RESULTS The 114 participants in this analysis were male, mostly with haemophilia A (92%) and severe disease (52%) with a median age of 31.9 years. On univariate analysis, HRDq total score (5-point change) was associated with the presence of a target joint (P = .002), high healthcare utilization (P = .011), poor adherence (P = .033) and work-impairment (P ≤ .001). After adjustment for age, race, severity and other potential confounders, adherence (aβ 0.33, 95% CI .17, .49) and work-impairment (aβ 4.69, 95% CI 3.27-6.1) remained statistically significantly associated with HRDq total score. CONCLUSION Haemophilia-related distress is associated with poor adherence to factor prophylaxis and work-impairment. The direction of the association (causation) is yet to be determined and requires future study.
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Affiliation(s)
- Sara Guasch
- Department of Medicine, Virginia Tech Carillion School of Medicine and Research Institute, Roanoke, Virginia, USA
| | - Lia C Scott
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Janet Figueroa
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tyler W Buckner
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shanna Mattis
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Duc Q Tran
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christine L Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, Georgia, USA
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Barry V, Buckner TW, Lynch ME, Figueroa J, Mattis S, Stout ME, Kempton CL. An evaluation of PROMIS health domains in adults with haemophilia: A cross-sectional study. Haemophilia 2021; 27:375-382. [PMID: 33866654 DOI: 10.1111/hae.14321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/24/2020] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The Patient-Reported Outcomes Measurement Information System (PROMIS) provides measures of health status that assess physical, mental and social well-being from the patient perspective. PROMIS measures are used in clinical practice and research across various patient populations but are not yet validated among patients with haemophilia. AIM Evaluate the sensitivity of PROMIS to indicators of haemophilia clinical severity and compare PROMIS measures to those from other PRO instruments. METHODS Male adults with haemophilia (n = 115) completed the PROMIS-29 short form which includes 4 questions for each of 7 domains: depression, anxiety, ability to participate in social roles and activities, physical function, pain interference, fatigue and sleep disturbance. Participant responses for each domain were scored on a T-score metric with a mean of 50 and a standard deviation of 10 based on the original PROMIS reference sample of US adults. Participants also completed other generic and haemophilia-specific health-related quality of life questionnaires. RESULTS Participants who experienced higher pain and depression levels reported significantly worse health in every PROMIS domain compared with their peers. Those who had recently needed to use crutches, visit an emergency department or were currently unemployed or disabled also reported poor PROMIS scores on most domains. Construct validity was supported by correlations between PROMIS domain scores and domain scores reported using the EQ-5D-5L and Haem-A-QoL. CONCLUSION The PROMIS instrument provides a potentially valuable tool to evaluate the impact of haemophilia and suggests usefulness in research and clinical practice.
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Affiliation(s)
- Vaughn Barry
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Shanna Mattis
- Emory University School of Medicine, Atlanta, GA, USA
| | - Mary E Stout
- Emory University School of Medicine, Atlanta, GA, USA
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Kempton CL, Michaels Stout M, Barry V, Figueroa J, Buckner TW, Gillespie S, Ellen Lynch M, Mattis S, Whitten S, McCracken C. Validation of a new instrument to measure disease-related distress among patients with haemophilia. Haemophilia 2020; 27:60-68. [PMID: 33141984 DOI: 10.1111/hae.14187] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In patients with haemophilia, general psychological distress as measured by the National Comprehensive Cancer Network (NCCN) distress thermometer has been associated with pain, disability and increased healthcare utilization. AIMS To develop and validate a measure of haemophilia-related distress. METHODS After qualitative interviews, the Hemophilia-Related Distress Questionnaire (HRDq) was developed. To validate the HRDq, adults (≥18 years) with haemophilia were enrolled, reported demographic and clinical information, and completed the HRDq and other questionnaires that measured similar constructs. Analysis included factor analysis and assessment of internal consistency using Cronbach's α, convergent validity using Pearson's correlation coefficient, and discriminant validity by comparing subgroups of patients. Test-retest reliability was assessed using an intraclass correlation coefficient (ICC). RESULTS Among 130 enrolled participants, 126 (median age=32.7 years) completed the 24 item HRDq in a median time of 5.4 minutes with overall HRDq scores ranging from 2 to 83 (median score=31.5; higher scores indicating higher distress). Assessment of convergent validity demonstrated a strong correlation (ρ>.60) of the HRDq total score with the NCCN Distress Thermometer, Haem-A-QoL total Score, and PROMIS-29 Profile social role domain and a mild to moderate correlation with all other questionnaire domains (.3-.59, p < .05). Distress was higher among those who had less education, were not employed, and were disabled and was not significantly different among those with severe compared with non-severe disease. Assessment of test-retest reliability demonstrated an ICC value of .84 (95% CI .71-.91) for the total score. CONCLUSIONS The HRDq demonstrates good internal consistency, construct and discriminant validity, and retest reliability with a low responder burden.
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Affiliation(s)
- Christine L Kempton
- Department of Hematology and Medical Oncology and Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Mary Michaels Stout
- Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Vaughn Barry
- Department of Hematology and Medical Oncology and Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Janet Figueroa
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Scott Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Mary Ellen Lynch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Shanna Mattis
- Department of Hematology and Medical Oncology and Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Stephanie Whitten
- Department of Hematology and Medical Oncology and Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Courtney McCracken
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Emory University, Atlanta, GA, USA
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Mattis S, Barry V, Taylor N, Lynch ME, Tatum K, Whitten S, Kempton CL. Disease-related distress among adults with haemophilia: A qualitative study. Haemophilia 2019; 25:988-995. [PMID: 31577383 DOI: 10.1111/hae.13850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/23/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Distress related to disease burden has been defined and described among people with chronic diseases including diabetes and cancer. In these populations, disease-specific distress is associated with health outcomes. Haemophilia-related distress is less understood. AIM To identify qualitative features of haemophilia-related distress among affected adults to ultimately inform the creation of a measurement tool. METHODS Adults with haemophilia A or B associated with a large haemophilia treatment centre in the south-eastern U.S. were recruited to participate in this qualitative study. Fifteen participants completed semi-structured telephone interviews. Interviews lasted 1-2 hours and explored experiences of distress related to various aspects of haemophilia. Interviews were audio taped, transcribed and coded using NVIVO, software for organizing, managing and analysing qualitative data. Coding was deductive and inductive, and the analysis was thematic. RESULTS Haemophilia-related distress was broadly related to feelings of isolation and vulnerability which incorporated health system factors, physical functioning, caretaker roles and psychological considerations. Specific features associated with haemophilia-related distress included lack of trust in the knowledge of haemophilia and care provided by staff in community healthcare settings, concerns about the future such as health insurance access and ageing/disability, long-standing feelings of being different from others and feeling like an outsider, treatment burdens and fear of acute bleeds. Protective factors included supportive relationships with family, friends and haemophilia care teams through which participants received practical and emotional support. CONCLUSION Features of haemophilia-related distress were identified. Results will facilitate distress measurement and intervention efforts to reduce distress in adults with haemophilia.
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Affiliation(s)
- Shanna Mattis
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Vaughn Barry
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Natalie Taylor
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mary Ellen Lynch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Katharine Tatum
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie Whitten
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christine L Kempton
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Barry V, Stout ME, Lynch ME, Mattis S, Tran DQ, Antun A, Ribeiro MJ, Stein SF, Kempton CL. The effect of psychological distress on health outcomes: A systematic review and meta-analysis of prospective studies. J Health Psychol 2019; 25:227-239. [PMID: 30973027 DOI: 10.1177/1359105319842931] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 12/15/2022] Open
Abstract
Distress effects are widely examined in cross-sectional studies with less known about effects on future health. This review summarizes distress impacts on health among adults in prospective studies and describes available distress measurement tools. Four inter-disciplinary databases were searched. Effects of distress on mortality and other outcomes were reviewed and estimated in a meta-analysis. A total of 19 studies were assessed which incorporated 10 distress tools. Distress had a detrimental effect on health regardless of the population studied, distress tool used, and health outcome examined. There was an increased mortality risk among those reporting high versus low distress (pooled hazard ratio (95% confidence interval) = 1.29 (1.15-1.46)).
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Affiliation(s)
| | | | | | | | | | | | - Maria Ja Ribeiro
- Emory University, USA.,Atlanta Veterans Affairs Medical Center, USA
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Barry V, Steffens C, Mattis S, Sidonio RF, Tran DQ, Kempton CL. A cross-sectional study of non-attendance among patients at a US hemophilia treatment center 2010-2014. Haemophilia 2018; 24:902-910. [DOI: 10.1111/hae.13553] [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] [Accepted: 05/31/2018] [Indexed: 12/30/2022]
Affiliation(s)
- V. Barry
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - C. Steffens
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - S. Mattis
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - R. F. Sidonio
- Division of Hematology/Oncology; Department of Pediatrics; Aflac Blood and Cancer Disorders; Emory University School of Medicine; Atlanta GA USA
| | - D. Q. Tran
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
| | - C. L. Kempton
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta GA USA
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Barry V, Lynch ME, Tran DQ, Antun A, DeBalsi A, Hicks D, Lasseter F, Mattis S, Ribeiro MJA, Stein SF, Kempton CL. Exploring changes in distress among individuals with bleeding disorders: What is linked to improvements in distress? J Health Psychol 2017; 24:1724-1733. [DOI: 10.1177/1359105317695877] [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] [Indexed: 11/15/2022] Open
Abstract
Adults with chronic bleeding disorders report high distress, but it is unclear how distress varies over time. Patients rated their distress on a 10-point scale at two clinic visits. Of 83 patients, roughly one-quarter reported consistent no/low distress (29%), one-quarter reported consistent distress (22%), and half (49%) reported a change in distress of at least two points. Overall activity levels, depressive symptoms, and non-White race were significantly associated with worsening and consistent distress in adjusted analyses while improvements in activity levels and depressive symptoms during the study period were associated with distress improvement. Our results suggest that distress is modifiable.
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Affiliation(s)
- Vaughn Barry
- Emory University, USA
- Children’s Healthcare of Atlanta, USA
| | | | | | | | | | - Denise Hicks
- Emory University, USA
- Children’s Healthcare of Atlanta, USA
| | | | - Shanna Mattis
- Emory University, USA
- Children’s Healthcare of Atlanta, USA
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Barry V, Lynch ME, Tran DQ, Antun A, Cohen HG, DeBalsi A, Hicks D, Mattis S, Ribeiro MJA, Stein SF, Truss CL, Tyson K, Kempton CL. Distress in patients with bleeding disorders: a single institutional cross-sectional study. Haemophilia 2015; 21:e456-64. [DOI: 10.1111/hae.12748] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/26/2022]
Affiliation(s)
- V. Barry
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - M. E. Lynch
- Department of Psychiatry and Behavioral Services; Emory University School of Medicine; Atlanta Georgia USA
| | - D. Q. Tran
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta Georgia USA
| | - A. Antun
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta Georgia USA
| | - H. G. Cohen
- Winship Cancer Institute of Emory University; Atlanta Georgia USA
| | - A. DeBalsi
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - D. Hicks
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - S. Mattis
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - M. J. A. Ribeiro
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta Georgia USA
| | - S. F. Stein
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta Georgia USA
| | - C. L. Truss
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - K. Tyson
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
| | - C. L. Kempton
- Division of Hematology/Oncology; Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia USA
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia USA
- Department of Hematology and Medical Oncology; Emory University School of Medicine; Atlanta Georgia USA
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Williams-Russo P, Sharrock NE, Mattis S, Liguori GA, Mancuso C, Peterson MG, Hollenberg J, Ranawat C, Salvati E, Sculco T. Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology 1999; 91:926-35. [PMID: 10519494 DOI: 10.1097/00000542-199910000-00011] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [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: 11/26/2022]
Abstract
BACKGROUND Data are sparse on the incidence of postoperative cognitive, cardiac, and renal complications after deliberate hypotensive anesthesia in elderly patients. METHODS This randomized, controlled clinical trial included 235 older adults with comorbid medical illnesses undergoing elective primary total hip replacement with epidural anesthesia. The patients were randomly assigned to one of two levels of intraoperative mean arterial blood pressure management: either to a markedly hypotensive mean arterial blood pressure range of 45-55 mmHg or to a less hypotensive range of 55-70 mmHg. Cognitive outcome was assessed by within-patient change on 10 neuropsychologic tests assessing memory, psychomotor, and language skills from before surgery to 1 week and 4 months after surgery. Prospective standardized surveillance was performed for cardiovascular and renal outcomes, delirium, thromboembolism, and blood loss and replacement. RESULTS The two groups were similar at baseline in terms of age (mean, 72 yr), sex (50% women), comorbid conditions, and cognitive function. After operation, no significant differences in the incidence of early or long-term cognitive dysfunction were observed between the two blood pressure management groups. There were no significant differences in the rates of other adverse consequences, including cardiac, renal, and thromboembolic complications. In addition, no differences occurred in the duration of surgery, intraoperative estimated blood loss, or transfusion rates. CONCLUSIONS Elderly patients can safely receive controlled hypotensive epidural anesthesia with this protocol. There was no evidence of greater risks, or early benefits, with the use of the more markedly hypotensive range.
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Affiliation(s)
- P Williams-Russo
- Department of Medicine, Cornell Medical College, New York, New York, USA.
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Abstract
This case highlights the complexities of evaluating and treating psychiatric symptoms that are concurrent with a seizure disorder. Interictal and postictal psychoses, affective disorders, personality changes, and cognitive deficits are common problems that require modified psychiatric treatments.
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Affiliation(s)
- H P Blumberg
- Department of Psychiatry, Cornell University Medical College, New York 10021, USA
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12
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Williams-Russo P, Sharrock NE, Mattis S, Szatrowski TP, Charlson ME. Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. JAMA 1995; 274:44-50. [PMID: 7791257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To compare the effect of epidural vs general anesthesia on the incidence of long-term cognitive dysfunction after total knee replacement surgery in older adults. DESIGN Randomized controlled clinical trial. SETTING Orthopedic specialty academic hospital. PATIENTS A total of 262 patients undergoing elective primary total knee replacement with a median age of 69 years; 70% women. INTERVENTION Random assignment to either epidural or general anesthesia. MAIN OUTCOME MEASURES A thorough neuropsychological assessment was performed preoperatively and repeated at 1 week and 6 months postoperatively. Cognitive outcome was assessed by within-patient change on 10 tests of memory, psychomotor, and language skills. Prospective standardized surveillance for cardiovascular complications was performed to allow simultaneous assessment of anesthetic effects on cognitive and cardiovascular outcomes. RESULTS The two groups were similar at baseline in terms of age, sex, comorbidity, and cognitive function. There were no significant differences between the epidural and general anesthesia groups in within-subject change from baseline on any of the 10 cognitive test results at either 1 week or 6 months. Overall, 5% of patients showed a long-term clinically significant deterioration in cognitive function. There was no difference between the anesthesia groups in the incidence of major cardiovascular complications (3% overall). CONCLUSIONS The type of anesthesia, general or epidural, does not affect the magnitude or pattern of postoperative cognitive dysfunction or the incidence of major cardiovascular complications in older adults undergoing elective total knee replacement. This is the largest trial of the effects of general vs regional anesthesia on cerebral function reported to date, with more than 99% power to detect a clinically significant difference on any of the neuropsychological tests.
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Affiliation(s)
- P Williams-Russo
- Department of Medicine, Hospital for Special Surgery, Cornell University Medical College, New York, NY 10021, USA
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Abstract
OBJECTIVE The goals of this longitudinal investigation were 1) to study the rate of development of irreversible dementia in elderly depressed patients with a dementia syndrome that subsided after improvement of depression and 2) to compare it with that of depressed, never-demented patients. METHOD The subjects were 57 elderly patients consecutively hospitalized for major depression. At entry into the study, 23 subjects also met criteria for "reversible dementia," while 34 were without dementia. After a systematic clinical evaluation, the subjects were followed up at approximately yearly intervals for an average of 33.8 months. RESULTS Irreversible dementia developed significantly more frequently in the depressed group with reversible dementia (43%) than in the group with depression alone (12%). Survival analysis showed that the group with reversible dementia had a 4.69-times higher chance of having developed dementia at follow-up than the patients with depression alone. No clinical characteristics at entry into the study were found to discriminate the subjects who developed irreversible dementia during the follow-up period from those who remained nondemented. CONCLUSIONS These findings suggest that geriatric depression with reversible dementia is a clinical entity that includes a group of patients with early-stage dementing disorders. Therefore, identification of a reversible dementia syndrome is an indication for a thorough diagnostic workup and frequent follow-ups in order to identify treatable neurological disorders.
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Affiliation(s)
- G S Alexopoulos
- Department of Psychiatry, Cornell University Medical College, White Plains, NY
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14
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Abstract
Gender differences in cognition were investigated in schizophrenic inpatients and outpatients using the Dementia Rating Scale. Females displayed greater impairment on Attention and Conceptualization than males. Gender interacted with patient group for construction: females performed worse than males among inpatients and better among outpatients. Results may be related to the atypically early age of onset of females relative to males; attention to sampling and selection biases is needed in evaluating gender differences in cognition in schizophrenia.
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Affiliation(s)
- D Perlick
- Department of Psychiatry, New York Hospital-Cornell Medical Center, Westchester Division, White Plains 10605
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15
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Russ MJ, Roth SD, Lerman A, Kakuma T, Harrison K, Shindledecker RD, Hull J, Mattis S. Pain perception in self-injurious patients with borderline personality disorder. Biol Psychiatry 1992; 32:501-11. [PMID: 1445967 DOI: 10.1016/0006-3223(92)90218-o] [Citation(s) in RCA: 118] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pain ratings during the cold pressor test were significantly lower in female inpatients with borderline personality disorder who report that they do not experience pain during self-injury (BPD-NP group, n = 11), compared with similar patients who report that they do experience pain during self-injury (BPD-P group, n = 11), and normal female subjects (n = 6). Pain ratings were not significantly different in the BPD-P and normal control groups. Self-report ratings of depression, anger, anxiety, and confusion were significantly lower, and ratings of vigor significantly higher following the cold pressor test in the BPD-NP group, but not in the BPD-P group. Only anxiety was significantly lower in the normal control group following the cold pressor test. The implications and limitations of these preliminary findings are discussed.
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Affiliation(s)
- M J Russ
- New York Hospital-Cornell Medical Center/Westchester Division, White Plains 10605
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16
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Abstract
A multivariate approach incorporating both biological and psychosocial factors was used in a cross-sectional study of schizophrenic inpatients and outpatients selected to represent opposite ends of the outcome spectrum. Twenty-six RDC-diagnosed chronic schizophrenic patients hospitalized continuously for 18 months or longer, and 26 patients with a history of at least three years of community tenure without rehospitalization were matched for sex, age, ethnicity, SES and chronicity, and assessed on a structured family interview (Social Behavior Assessment Schedule), neuropsychological test battery, Brief Psychiatric Rating Scale and Premorbid Asociality Scale. Stepwise discriminant function analysis was performed; family ratings of patients' problem behaviors was the most powerful discriminator between the two groups and a composite measure of neuropsychological functioning ranked second. Other significant discriminators were BPRS scores, availability of social support to the family and age of onset. Family ratings of patient behavior were related to ratings of family burden and to BPRS scores. Further research is needed to understand the complex interactions between the diverse sets of social, clinical and neurobiological factors that determine long-term outcome in schizophrenia.
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Affiliation(s)
- D Perlick
- Department of Psychiatry, New York Hospital-Cornell Medical Center, White Plains 10605
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17
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Perlick D, Mattis S, Stastny P, Silverstein B. Negative symptoms are related to both frontal and nonfrontal neuropsychological measures in chronic schizophrenia. Arch Gen Psychiatry 1992; 49:245-6. [PMID: 1567278 DOI: 10.1001/archpsyc.1992.01820030077010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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18
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Perlick D, Mattis S, Stastny P, Teresi J. Neuropsychological discriminators of long-term inpatient or outpatient status in chronic schizophrenia. J Neuropsychiatry Clin Neurosci 1992; 4:428-34. [PMID: 1422170 DOI: 10.1176/jnp.4.4.428] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study investigates specific neuropsychological functions discriminating schizophrenic patients with hospitalization beyond 18 months from patients residing in the community without rehospitalization beyond 3 years. Twenty-six Research Diagnostic Criteria-diagnosed chronic schizophrenic outpatients and 26 inpatients matched for sex, ethnicity, socioeconomic status, and chronicity completed a comprehensive neuropsychological battery and responded to an inventory of psychopathology. Discriminant function analyses showed that measures of motor coordination, preservation, memory, and attention discriminated between patient groups. Bilateral simultaneous fine motor coordination was the most potent discriminator between patient groups, independent of psychopathology. Implications for treatment and research on course and outcome in schizophrenia are discussed.
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Affiliation(s)
- D Perlick
- Department of Psychiatry, New York Hospital-Cornell Medical Center, White Plains 10605
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19
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Alexopoulos GS, Mattis S. Diagnosing cognitive dysfunction in the elderly: primary screening tests. Geriatrics (Basel) 1991; 46:33-8, 43-4. [PMID: 1743529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The recognition of cognitive disturbances in geriatric patients has important clinical implications for the primary care physician. Commonly seen cognitive dysfunctions include dementia, pseudodementia, delirium, and frontal lobe syndrome; these may be confounded by overlapping depression. The cognitive examination covers such intellectual and behavioral functions as attention, memory, and language. As many psychiatric disorders result from neurologic brain disease, a psychiatric examination is essential. Mental status questionnaires are useful for screening of high-risk populations for dementia and to quantify the degree of cognitive dysfunction for purposes of management planning and surveillance.
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20
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Abstract
Persistent executive deficit, usually seen following prefrontal damage, is reported in a patient recovering from head trauma. Repeated neuroradidological examinations failed to reveal a lesion within the frontal lobes, but a circumscribed lesion in the ventral mesencephalic tegmentum was found. It is proposed that the observed syndrome was caused by damage to mesencephalic reticular nuclei and their projections into prefrontal cortex. The concept of a "reticulo-frontal disconnection syndrome" is introduced and its possible role in head trauma and schizophrenia discussed.
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Affiliation(s)
- E Goldberg
- Medical College of Pennsylvania/Eastern Pennsylvania Psychiatric Institute, Philadelphia
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21
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Abstract
To determine the prevalence of unrecognized brain dysfunction accompanying chronic severe cardiac disease, we examined 20 clinically stable consecutive admissions to a cardiac rehabilitation service who were free of known stroke or dementia. Age range was 47 to 85 years (mean +/- SEM, 72.5 +/- 2.1 years), the male: female ratio was 10:10. Multiple cognitive deficits including significant memory impairment and disorientation were present in eight patients (40%), and seven of these eight patients were unable to administer their own medications reliably. An additional six patients (30%) showed milder impairments. One patient was found to be normal after neurological examination, four showed evidence of a single brain lesion, and 15 of 20 (75%) had multiple neurological abnormalities suggesting multifocal brain disease. The mechanism of cognitive deficits in cardiac patients is unclear, and it may be related to multiple infarcts, or acute or chronic hypoxic damage secondary to arrhythmias, cardiac failure, or small vessel disease of the brain. The term "circulatory dementia" is proposed to describe patients with vascular disease and non-Alzheimer type dementia. Patients with cardiac disease should undergo cognitive screening, as early identification of patients at risk of progressive intellectual loss may allow early use of preventive therapy.
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Affiliation(s)
- L L Barclay
- Burke Rehabilitation Center, Department of Dementia Research, White Plains, NY 10605
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22
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Levin HS, Mattis S, Ruff RM, Eisenberg HM, Marshall LF, Tabaddor K, High WM, Frankowski RF. Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 1987; 66:234-43. [PMID: 3806205 DOI: 10.3171/jns.1987.66.2.0234] [Citation(s) in RCA: 574] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The majority of hospital admissions for head trauma are due to minor injuries; that is, no or only transient loss of consciousness without major complications and not requiring intracranial surgery. Despite the low mortality rate following minor head injury, there is controversy surrounding the extent of morbidity and the long-term sequelae. The authors postulated that consecutively admitted patients who fulfilled research diagnostic criteria for minor head injury and who were carefully screened for antecedent neuropsychiatric disorder and prior head injury would exhibit subacute cognitive and memory deficits that would resolve over a period of 1 to 3 months postinjury. To evaluate this hypothesis, the neurobehavioral functioning of 57 patients was compared within 1 week after minor head injury (baseline) and at 1 month postinjury with that of 56 selected control subjects at three medical centers. Quantified tests of memory, attention, and information-processing speed revealed that neurobehavioral impairment demonstrated at baseline by all means of measurement generally resolved during the first 3 months after minor head injury. Although nearly all patients initially reported cognitive problems, somatic complaints, and emotional malaise, these postconcussion symptoms had substantially resolved by the 3-month follow-up examination. The data suggest that a single uncomplicated minor head injury produces no permanent disabling neurobehavioral impairment in the great majority of patients who are free of preexisting neuropsychiatric disorder and substance abuse.
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23
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Abstract
Recent memory correlated inversely with serum anticholinergic levels for verbal recall but not for recognition memory in 17 chronic schizophrenic inpatients taking neuroleptic medications. The results indicate that anticholinergic activity does not impair primary memory functioning in chronic schizophrenia.
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24
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Abstract
A previously reported technique for promoting robust free recall in amnesic subjects (Ridiculously Imaged Stories) was further studied in two amnesic patients to determine if there is a limit to the amount of information that can be acquired, and if the novelty of the storyline is essential for its efficacy. Two different lists of words were taught to each subject embedded in either a ridiculous or a logical story. The subjects learned combined totals of 160 (S1) and 120 (S2) words with perfect free recall at intervals up to 7 weeks between last list exposure and recall. No differences were observed in rates of learning between the two types of stories. These results challenge the view that amnesic subjects are unable to freely recall large amounts of new information within a newly acquired context. A theoretical integration of the data is explored.
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25
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Abstract
The quality of survival after severe and moderate head injury is highly dependent on the adequacy of cognitive recovery. The intellectual sequelae of head injury impede social and occupational reintegration more than physical disabilities do. The present study examines the course of cognitive recovery from the time of admission to 1 year after trauma. Included in the study were 68 patients with severe or moderate head injury who were 15 to 55 years old. The severity of injury was determined by the Glasgow coma scale. For this analysis, the data from tests of general intellect, language, verbal and nonverbal memory, and fine motor coordination were utilized. Standard scores (Z scores) were calculated for each test using the available normative data. Evaluation at discharge or 3 months after injury revealed I.Q. scores about 1.5 standard deviations (SD) below the mean, whereas language functioning was 4 SD, verbal memory was 5 SD, nonverbal memory was 5 SD, and fine motor coordination was 3 to 5 SD below the mean. All cognitive functions showed improvement over a 1-year period. Most of the recovery in linguistic functioning occurred during the first 6 months after trauma. This study suggests that all patients sustain significant mental sequelae after severe or moderate head injury. In spite of significant improvement during the 1st year, patients continue to have marked impairment in cognitive functions.
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Davidoff DA, Butters N, Gerstman LJ, Zurif E, Paul IH, Mattis S. Affective/motivational factors in the recall of prose passages by alcoholic Korsakoff patients. Alcohol 1984; 1:63-9. [PMID: 6537213 DOI: 10.1016/0741-8329(84)90039-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study assessed the role of motivational/affective factors in the recall of short stories by alcoholic Korsakoff patients. On both immediate and delayed recall, the Korsakoff patients remembered proportionately more of stories with a sexual theme than of passages which were neutral or aggressive in content. In contrast to the Korsakoff patients, the emotional theme of the story had no effect upon the recall performance of alcoholic (non-Korsakoff) and normal control subjects. While the two control groups evidenced no forgetting of textual material between immediate and delayed recall, the alcoholic Korsakoff patients showed a rapid and equivalent rate of forgetting of all three story types. These findings suggest that while motivational/affective factors may influence the alcoholic Korsakoff patients' selective attention and immediate recall, they have little or no influence upon the patients' inability to retain verbal information. The importance of this conclusion for encoding theories of amnesia is discussed.
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27
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Abstract
A learning technique was developed for chronically amnesic subjects which linked word-list items in a novel manner utilizing ridiculously-imaged-stories (RIS). By the 8th week of once-weekly 45 minute training sessions with RIS the five amnesic subjects were able to freely recall an average of 14 items from a 20-item list after a 1-week interval, but showed minimal recall after the same interval of another 20-word list that had been concurrently learned in a cued, modified free-recall condition. The effective RIS technique producing this robust recall combines stimuli embedded in a novel-arousing context with high-imagery, storyline, cuing, and spaced repetition. The net effect of this technique is interpreted as providing artificial "chunks" that can be encoded and transferred relatively normally into long-term memory.
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28
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Goldberg E, Gerstman LJ, Mattis S, Hughes JE, Sirio CA, Bilder RM. Selective effects of cholinergic treatment on verbal memory in posttraumatic amnesia. J Clin Neuropsychol 1982; 4:219-34. [PMID: 7142421 DOI: 10.1080/01688638208401131] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The combined effects or orally administered physostigmine and lecithin were assessed in a double-blind study of a single patient with posttraumatic amnesia. Treatment improved verbal recall but not verbal recognition, visual memory, or conceptual reasoning. Both storage and retrieval of words in verbal memory were facilitated. Greater improvement in learning of longer or semantically homogeneous word lists than shorter or semantically mixed lists may indicate that treatment reduced the effects of interstimulus interference. Greater divergence of recognition response biases for semantically homogeneous vs. mixed lists was observed under treatment, reflecting some enhancement of semantic appreciation. Absence of a treatment effect on visual nonverbal memory may be due in part to lateralization of the mesencephalic lesion to the left in this patient. Lack of improvement of encoding capacity, d', or conceptual reasoning may reflect a greater dependence of basal forebrain structures on catecholaminergic than cholinergic mechanisms.
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30
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Goldberg E, Gerstman LJ, Mattis S, Hughes JE, Bilder RM, Sirio CA. Effects of cholinergic treatment on posttraumatic anterograde amnesia. Arch Neurol 1982; 39:581. [PMID: 7115149 DOI: 10.1001/archneur.1982.00510210051012] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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31
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Abstract
A test designed to assess the adequacy of knowledge about specific words, presumed to be well established in long-term storage, was administered to 5 alcoholic Korsakoff patients, 3 post-trauma amnesics, and 5 normal controls. The 400 question true/false test tapped knowledge of basic and obscure attributes and functions of 25 noun-concepts. The data indicate that traumatic amnesics made more total errors than Korsakoff amnesics, who in turn made more errors than normals. However, Korsakoffs made a greater proportion of errors on basic-knowledge items than the other groups. It is concluded that semantic organization is impaired in both amnesic groups, although differently. The post-trauma error pattern suggests a uni-factor deficit while the Korsakoff pattern suggests a multifactor deficit.
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32
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Goldberg E, Antin SP, Bilder RM, Gerstman LJ, Hughes JE, Mattis S. Retrograde amnesia: possible role of mesencephalic reticular activation in long-term memory. Science 1981; 213:1392-4. [PMID: 7268442 DOI: 10.1126/science.7268442] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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33
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Kovner R, Mattis S, Goldmeier E, Davis L. Korsakoff amnesic syndrome: the result of simultaneous deficits in several independent processes? Brain Lang 1981; 12:23-32. [PMID: 7225789 DOI: 10.1016/0093-934x(81)90003-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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35
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Erenberg G, Mattis S, French JH. A multidisciplinary study of 400 children referred to a developmental clinic in an urban ghetto area. Cleve Clin Q 1979; 46:57-65. [PMID: 455714 DOI: 10.3949/ccjm.46.2.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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36
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Rapin I, Mattis S, Rowan AJ, Golden GG. Verbal auditory agnosia in children. Dev Med Child Neurol 1977; 19:197-207. [PMID: 870358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Four (possibly five) boys are described with a profound comprehension deficit for acoustic language, leading to severe or complete abolition of expressive speech. One boy had presumed megalencephaly from birth but was of superior intelligence. He had a severe articulation deficit from early childhood, with delayed acquisition of speech. Another boy is thought to have a small angiomatous anomaly in the depth of the left parietal lobe. No brain lesions are known in the other three. Evidence for bilateral brain dysfunction consists of minor motor abnormalities in three boys, oromotor deficits in two boys, and bilaterally synchronous diffuse or independent focal paroxysmal discharges in the EEG of three, possibly four, of the boys. Seizures have occurred in only three boys, and have been easily controlled with anticonvulsants. One boy with a grossly abnormal EEG has had no clinical seizures to date and has not benefited frome one year of anticonvulsant therapy. Two of the boys are brothers, including the boy in whome the diagnosis is questionable since speech was never normal and since he has had neither seizures for an abnormal EEG. The severity of EEG abnormalities did not correlate closely with the course of the language deficit. The relationship of this syndrome to acquired aphasia in children, to Wernicke's aphasia and pure word deafness in adults, and to developmental lagnuage disability with predominantly receptive deficits, is discussed. One child illustrated the close association between writing and phonologic encoding and decoding operations, and two children the preservation of linguistic skills provided the acoustic channel was by-passed and language presented visually. This latter point has been emphasized because of its implications for the remedial education of children with this syndrome.
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Coblentz JM, Mattis S, Zingesser LH, Kasoff SS, Wiśniewski HM, Katzman R. Presenile dementia. Clinical aspects and evaluation of cerebrospinal fluid dynamics. Arch Neurol 1973; 29:299-308. [PMID: 4542729 DOI: 10.1001/archneur.1973.00490290039003] [Citation(s) in RCA: 233] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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