Biomedical subjects

C M Cullum

Publications and source records attributed to C M Cullum.

At least 55 records · Page 3Linked to original sources

PubMed1991

Short- and long-term psychological status following stroke. Short form MMPI results.

Indices of self-reported depression and psychological adjustment after stroke were evaluated using a short form of the MMPI. Patients with poststroke periods of 2 to 6 and 7 to 24 months were selected, and indices of general intellectual functioning and lesion size/location were obtained. Despite similar levels of intellectual functioning and lesion parameters, the longer duration group showed significantly higher depression scores and significant (T greater than 70) elevations on several other clinical scales of the MMPI. In contrast, the mean overall profile of the short-duration group was roughly within normal limits. These findings have implications for the clinical assessment and treatment of stroke patients and long-term psychological adjustment after stroke.

Adaptation, Psychological↗

PubMed1989

The use of the Halstead-Reitan test battery with older adults.

As with younger individuals, neuropsychological evaluation of the older patient with suspected cognitive decline should be reasonably comprehensive. Only through careful analysis of the overall pattern as well as level of performance across various measures can both the likelihood and nature of cerebral dysfunction be ascertained. A neuropsychological battery such as an expanded HRB appears to be well suited for the comprehensive evaluation of the older individual who may be mildly to moderately impaired, whereas briefer test batteries may be sufficient and more practical in some cases. The HRB is widely used in clinical and research settings, yet only a few published studies have provided reference data with respect to large groups of adults over the age of 60. Preliminary data suggest that the HRB has adequate reliability and validity in older as well as younger age groups. However, information regarding the level and pattern of performance of normal individuals over the age of 75 is lacking for the HRB as well as for virtually all other popular neuropsychological measures. Studies consistently have shown that many of the component HRB measures are quite sensitive to the effects of age (as well as education), and therefore, traditional normative cutoff scores produce an unacceptably high rate of false positive diagnostic predictions in older populations. Until more appropriate older age norms are available, great caution must be used in the interpretation of results.

Adolescent↗

PubMed1988

Short-form MMPI findings in patients with predominantly lateralized cerebral dysfunction. Neuropsychological and computerized axial tomography-derived parameters.

Short-form MMPI profiles of cerebrovascular accident and head injury patients with evidence of predominantly lateralized (N = 94) or diffuse (N = 59) cerebral damage were examined in conjunction with quantified computed axial tomographic and neuropsychological data. Results indicated that all groups tended to produce similar overall MMPI profiles, with primary elevations on Scales 8 (Sc) and 2 (D). Across the sample as a whole, patients with left hemisphere damage displayed somewhat more frequent Scale 2 elevations, although this finding was influenced by etiology effects. Left frontal lesion size among patients with left hemisphere damage was negatively associated with Scale 2 scores, and right posterior lesion size was positively associated with Scale 2 scores among patients with right hemisphere damage. Longer lesion durations generally were associated with increased MMPI scores. Results underscore the complex and multidimensional nature of the interrelationships between affective processes and localized cerebral damage.

Adolescent↗

PubMed1988

Poststroke depression and psychosis.

Stroke is capable of producing a varied spectrum of neurobehavioral syndromes that may come to the attention of the mental health professional evaluating psychiatric symptoms in elderly individuals. The neurobehavioral effects may include affective or psychotic symptoms and may occur immediately after the stroke or months to years later. The presence of underlying (or pre-existing) brain disease may have an adverse effect on the resolution of the neuropsychiatric symptoms. Although there are no treatment response studies in the area of psychosis following stroke, the response of poststroke depression to antidepressants makes attempted pharmacologic treatment of symptoms justified.

Brain↗

PubMed1988

Neuropsychology of late-life psychoses.

The number of published neuropsychological studies of older psychiatric patients have been few. Moreover, almost nothing is known about the neuropsychological status of older individuals who develop psychotic symptoms for the first time later in life. Because of the spectrum of possible diagnostic considerations, careful diagnostic evaluations are of critical importance. Such evaluations should include comprehensive history-taking (using several sources), in addition to medical, psychiatric, neurologic, neuroimaging, and neuropsychological assessments. As the number of older individuals in our population grows, we will be increasingly faced with neuropsychiatric disorders that may arise de novo in the elderly. Multimodal and longitudinal investigations of older patients who develop psychotic or depressive symptoms are needed.

Aged↗

PubMed1988

Clinical presentation of late-onset schizophrenia.

DSM-III-R defines late-onset schizophrenia as schizophrenia that begins after age 45. The authors describe five patients who met DSM-III-R criteria for this disorder. The characteristic features of the disorder include bizarre delusions (usually of a persecutory nature), auditory hallucinations, a history of normal functioning at least until age 45, and a deterioration in personal-social functioning after the onset of illness. Physical examination, routine laboratory tests, neuropsychological evaluation, and magnetic resonance imaging (MRI) scans did not suggest the presence of any diagnosable organic mental disorder. In each of the five cases, mood disorders, delusional (paranoid) disorder, and schizophrenia with onset before age 45 were also considered in the differential diagnosis and ruled out. The authors' case vignettes support the premise that late-onset schizophrenia is a clinically diagnosable entity. Cautions in the diagnosis and treatment of such patients are discussed.

Age Factors↗

PubMed1987

Handedness and dementia.

Some researchers have speculated that left-hand dominance is more prevalent among patients suffering from dementia of the Alzheimer's type which began prior to age 65 yr. and that, in those patients, the disease runs a more rapid course. In the present study, seven left-handed dementia patients were matched with seven right-handed dementia patients on the basis of age and years of education and were compared with regard to neuropsychological compromise. While the left-handed group was somewhat more impaired than the right-handed subjects, the difference between the two groups was not statistically significant.

Aged↗

PubMed1987

Relationship between cognitive and morphological asymmetry in dementia of the Alzheimer type: a CT scan study.

In this study we investigated the association between morphological asymmetry and patterns of cognitive ability in dementia of Alzheimer's type (DAT). Digitized CT scans were used to estimate volumetric parameters of the brain. The volume of the cranium, brain parenchyma, the subarachnoid space, and lateral ventricles was computed. The volume of the subarachnoid space was used as an index of cortical atrophy, while the ventricular volume served as an estimate of subcortical atrophy. Asymmetry indices were computed for all structures as the difference between left and right volume divided by their average and multiplied by 100. Cognitive asymmetry index was computed by dividing the difference between VIQ and PIQ of the Wechsler Adult Intelligence Scale (WAIS) by their average and multiplying by 100. After statistically controlling for cranial asymmetry, hemispheric asymmetry was found to correlate positively with cognitive asymmetry. The correlation was somewhat greater for male than for female patients. Asymmetry of both cortical and subcortical atrophy correlated negatively with cognitive asymmetry.

Aged↗

PubMed1986

Ventricle size, cortical atrophy and the relationship with neuropsychological status in closed head injury: a quantitative analysis.

Forty-eight patients with a history of moderate to severe closed-head injury (CHI) were examined with neuropsychological measures and computerized tomography (CT). CT scans were assessed with computerized techniques to determine estimated ventricular volumes (VV) and the degree of cortical atrophy (ATVOL) in each patient. VV's then were used to determine volumetric ventricle-brain ratios (VBR) to correct for head size. The WAIS, Wechsler Memory Scale (WMS) and Halstead-Reitan Neuropsychological Test Battery (HRNTB) were administered to all patients. Correlational analyses were undertaken between VBR and ATVOL measures. PIQ but not VIQ was negatively correlated with VBR and ATVOL, particularly in terms of right-hemisphere measures. WMS Memory Quotient (MQ) also was negatively correlated with VBR and ATVOL with no lateralization. Several HRNTB measures similarly were correlated with ventricular and atrophy estimates. Correlational results also were analyzed in terms of the influence of higher and lower VBR and ATVOL, and the prior presence of hematoma. Results are discussed in terms of the latent effects of cerebral damage secondary to CHI on neuropsychological functioning.

Adult↗

PubMed1986

The relationship between cortical atrophy and ventricular volume.

Utilizing volumetric measures of brain morphology, the relationship between cortical atrophy and ventricular dilation was examined in a sample of 59 Alzheimer's Disease patients and 48 closed head injury patients. Correlation matrices were constructed and factor analyses performed in order to elucidate the various relationships. In the Alzheimer Disease sample there appeared to be a moderately strong relationship between cortical atrophy and ventricular volume. However, analyses also lent support to the position that cortical atrophy and ventricular dilation reflect processes which are related yet somewhat independent. Results obtained from the closed head injury sample indicated that focal damage effects were more evident in cortical atrophy measures, while generalized effects were relatively more important in ventricular dilation. Finally, the relationships between neuropsychological performance and various combinations of high and low cortical atrophy and ventricular volume measures were modest.

Adolescent↗

PubMed1986

Neuropsychological characteristics and atrophic brain changes in senile and presenile dementia.

Groups of presenile (n = 41) and senile (n = 97) dementia patients were compared on neuropsychological measures and volumetric estimates of atrophy and ventricular enlargement as depicted on computerized axial tomography. Despite their significantly greater age, the senile patients were not markedly significant different on neuropsychological measures when the effect of education was covaried. Likewise, there were no significant differences between the two groups in terms of cortical atrophy despite that variable's known relationship with age. Ventricular size was not significantly different between groups when age effects were statistically controlled. It is concluded that the pathologic effects of presenile dementia are roughly equivalent to the total of the effects of both the disease and aging processes in senile dementia. Therefore, the disease appears to be more dramatic when it occurs in younger patients. It may be that younger patients are less healthy than older patients presenting with the disease and, consequently, are less able to withstand its effects. The present sample is compared with those of other studies reporting a markedly more pathologic presentation associated with presenile relative to senile dementia.

Journal Article↗

PubMed1985

Intellectual and memory impairment in dementia. Computerized axial tomography volume correlations.

Ventricular volume estimates and an index of cerebral atrophy were obtained from computerized axial tomography scans of patients with presenile or senile dementia of probable Alzheimer's type. These measures were used to examine the correlation between morphological brain change and performance on the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Memory Scale (WMS). Despite ventricular volumes in excess of 60% larger than normal, no significant correlations were found between ventricular size and WAIS or WMS performance. The index of pericerebral atrophy did correlate negatively with various WAIS measures, particularly Performance IQ, and some aspects of WMS performance. Results suggest that in Alzheimer's disease, pericerebral atrophy measures, but not ventricular dilation, correlate with intellectual decline and certain aspects of memory impairment.

Aged↗

PubMed1985

Neuropsychological and computerized axial tomography volume characteristics of empirically derived dementia subgroups.

Neuropsychological assessment data from 138 Alzheimer's disease patients were cluster-analyzed to yield five separate subgroups. These clusters are best described as follows. Cluster I is a low-functioning subgroup characterized by severe generalized deficits (N = 25), cluster II is a subgroup characterized by a higher level of visual-spatial skills relative to the other groups (N = 39), cluster III (N = 21) and cluster IV (N = 42) are virtually indistinguishable in terms of verbal ability and memory, but do differ with regard to visual-spatial skills, and cluster V is a subgroup which presented with relatively better preserved verbal abilities (N = 11). Despite their different neuropsychological profiles, the subgroups did not differ significantly with regard to those complaints that were noted early in the course of the disease process. However, they were found to differ significantly with regard to the patients' educational backgrounds, the distribution of males and females, and the age of the patients at the time of onset of the disease. Analysis of the degree and lateralization of cortical atrophy using volumetric techniques suggested little relationship with neuropsychological examination results. Ventricular volume differences among the five subgroups were not found to be statistically significant after the effect of age had been partialled out. Results are discussed in relation to the multiple factors relating to brain structure and cognition in Alzheimer's disease.

Adult↗

PubMed1985

Late effects of hematoma on brain morphology and memory in closed head injury.

In order to examine the late effects of prior hematoma on brain morphology and memory in closed head injury (CHI), 16 patients with a history of hematoma and craniotomy following injury were matched with CHI patients without prior hematoma. Volumetric estimates of cortical atrophy and ventricle size computed from CT scans were obtained in addition to Wechsler Memory scale (WMS) scores. Patients with a history of hematoma demonstrated significantly greater cortical atrophy than nonhematoma CHI patients irrespective of hematoma location. The hematoma group also was found to have greater ventricular dilation, although this difference only approached significance. In terms of memory abilities, the hematoma group was more impaired on WMS Memory Quotient (MQ) and the Associate Learning subtest in particular. Results suggest that hematoma following head injury may promote additional detrimental effects on brain morphology and memory status.

Adolescent↗

PubMed1984

Quantifying cortical atrophy.

Most of the methods of quantifying cortical atrophy that have been proposed involve the estimation of the volume of enlarged sulci in the cerebral cortex. The authors propose that the surface area of the sulci is a more valid measure of cortical atrophy, and describe a system for measuring the surface area of the cortex, and present data in support of the method's reliability and validity.

Adult↗

PubMedDate not supplied

Cognitive functioning in chronic fatigue syndrome and depression: a preliminary comparison.

This study used a brief battery of neuropsychological measures to examine the performance of patients with chronic fatigue syndrome (CFS) (N = 16) and patients in a major depressive episode (N = 23). The overall neuropsychological performance of the CFS group was not significantly different from depressed patients, and both groups scored within normal limits on most measures. Variability of neuropsychologic performance was in general unrelated to level of depressive symptoms. The results are discussed in terms of the validity of the cognitive criterion for the CFS diagnosis. Subjective complaints of cognitive dysfunction by CFS patients in light of the lack of objective evidence for the same are considered in terms of a somatic vigilance hypothesis.

Adult↗

PubMedDate not supplied

Category fluency in mild cognitive impairment: reduced effect of practice in test-retest conditions.

Verbal fluency tests are commonly used in neurocognitive and mental status examinations in patients with suspected dementia. Inflation of test scores as a result of practice effects may yield false-negative results in test-retest and multidisciplinary settings, particularly among patients with mild cognitive deficits. To address this issue, animal naming was administered twice within a 1-week period to a group of individuals referred for suspected dementia who were ultimately diagnosed with mild cognitive impairment (MCI; amnestic form), probable Alzheimer disease (AD), or no dementia. A 2 x 3 repeated-measures analysis of variance revealed a statistically significant interaction between administration time and group. Post hoc analyses indicated that nondemented controls were the only group to demonstrate a significant practice effect, producing an average of approximately three more animal names at time two. Like patients with a diagnosis of AD, subjects with amnestic MCI failed to benefit from repeated exposure to the animal naming test, and only controls showed an average improvement upon retest. This underscores the cognitive similarity between individuals diagnosed with amnestic MCI and AD and suggests that improvement upon retest may be a diagnostically useful finding.

Aged↗

PubMedDate not supplied

Schizophrenia and nicotinic receptors.

Patients with schizophrenia often cannot respond to important features of their environment and filter out irrelevant stimuli. This dysfunction could be related to an underlying defect in inhibition--i.e., the brain's ability to alter its sensitivity to repeated stimuli. One of the neuronal mechanisms responsible for such inhibitory gating involves the activation of cholinergic nicotinic receptors in the hippocampus. These receptors are diminished in many specimens of hippocampal brain tissue obtained postmortem from schizophrenic patients. In living schizophrenic patients, stimulation of cholinergic receptors by nicotine transiently restores inhibitory gating of evoked responses to sensory stimuli. Many people with schizophrenia are heavy smokers, but the properties of the nicotinic receptor favor only short-term activation, which may explain why cigarette smoking is only a transient symptomatic remedy. This paper reviews the clinical phenomenology of inhibitory gating deficits in people with schizophrenia, the neurobiology of such gating mechanisms, and the evidence that some individuals with the disorder may have a heritable deficit in the nicotinic cholinergic receptors involved in this neurobiological function. Inhibitory gating deficits are only partly normalized by neuroleptic drugs and are thus a target for new therapeutic strategies for schizophrenia.

Antipsychotic Agents↗