Differential clinical sensitivity of specific parameters of the Rey Auditory-Verbal Learning Test.
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Adolescent↗
Biomedical subjects
D Mungas
Publications and source records attributed to D Mungas.
An empirical analysis of specific syndromes of violent behavior.
One hundred thirty-eight neuropsychiatric outpatients were rated according to relevant behavioral parameters of violence. A cluster analysis based on these ratings yielded five homogenous subgroups. Two groups, which differed only in severity of violence, were defined by a behavioral pattern closely resembling the episodic dyscontrol syndrome. One group was defined by infrequent but very severe violence, one by relatively infrequent violence of lesser severity, and one by no history of violence. These groups were clearly differentiated by a number of variables including neurological and psychiatric diagnoses, verbal aggression parameters, and neurological and psychiatric history variables. A specific etiology for violence, even within relatively homogenous subgroups, was not supported, with results suggestive of multiple determination by biological and psychosocial factors. On the other hand, different patterns of potential etiological factors were identified for different groups, which holds implications for theoretical understanding of violence and for differential diagnosis, treatment, and prevention.
Adolescent↗
Interictal behavior abnormality in temporal lobe epilepsy. A specific syndrome or nonspecific psychopathology?
Two studies examine the degree to which the traits measured by the Bear and Fedio personality inventory are specific to temporal lobe epilepsy. In the first study, none of the 18 traits discriminated among a group of temporal lobe epileptics with behavioral-psychiatric disorders, a group of patients with concomitant neurological and behavioral-psychiatric disorders, and a group of patients with psychiatric but not neurological illness. The second study demonstrated that a very large percentage of variance in the traits can be accounted for by presence or absence of psychiatric illness. The results of these two studies suggest that previously reported differences between temporal lobe epileptics and normals on these trait variables reflect underlying differences in degree of nonspecific psychopathology and do not necessarily indicate the presence of a specific behavioral syndrome in temporal lobe epilepsy.
Dominance, Cerebral↗
Application of item response theory for development of a global functioning measure of dementia with linear measurement properties.
An ideal measure of global functioning for patients with dementia would discriminate at very high and very low levels of functioning and would have linear measurement properties such that a given change in score corresponds to the same amount of change in underlying ability at any part of the ability continuum. Using item response theory methods, linearity of test measurement can be directly assessed and items can be selected to construct a test with desired measurement characteristics. The purpose of this study was to apply item response theory methods to evaluating and developing global functioning scales. Subjects were 1207 patients who had received comprehensive dementia evaluations. Items were selected from two measures of cognitive functioning (Mini Mental State Examination, MMS; Blessed Information Memory Concentration Test, BIMCT) and one measure of independent functioning (Blessed-Roth Dementia Rating Scale, BRDRS). The MMS and BIMCT showed significant non-linearity of measurement, especially at low and high ability levels. A brief composite measure was created by selecting from the three instruments 25 items that fit a uniform distribution of item difficulty across the entire range of ability measured by the three instruments. This composite measure and the BRDRS showed better linearity of measurement than the other two instruments. Results have implications for development of a psychometrically sophisticated, brief measure of global functioning for clinical and research use in dementia.
Activities of Daily Living↗
Is the distinction between situational and nonsituational primary depression valid?
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Adjustment Disorders↗
EEG alpha activity and personality traits.
Comparisons between EEG spectral power in the fast alpha (9-12 Hz) range and scores obtained on the Millon Clinical Personality Inventory (MCMI) were made in two populations of subjects. The first was a group of 60 individuals who reported no personal or family history of alcoholism. The second was a subgroup of 13 sons of alcoholics and 13 matched control subjects. In the first population, 30% of the subjects were classified as "high" alpha based on the criteria that their EEG in the 9-12 Hz range was over 75 microV2/octave in amplitude. Using this same criteria, 69% of the sons of alcoholics and 31% of their matched controls were also classified as "high" alpha. In both populations, subjects with high amplitude fast frequency EEG alpha activity in lead P4-O2 scored significantly higher on the Histrionic-Gregarious scale of the MCMI than subjects with low amplitude activity in this lead. These results are consistent with some previous studies showing a positive relationship between EEG alpha activity and extroverted personality traits. These results suggest that fast frequency alpha activity may be associated with some definable personality traits.
Adult↗
Verbal learning differences in epileptic patients with left and right temporal lobe foci.
A verbal learning test patterned after and using the same format as the Rey Auditory-Verbal Learning Test was administered to the following three groups: (1) patients with left temporal lobe epilepsy (L-TLE) as defined by EEG criteria (n = 11); (2) patients with right temporal lobe epilepsy (n = 10); and (3) normal controls (n = 11). Performance was highly similar for all three groups during the five immediate recall learning trials. The performance of the L-TLE group, averaged across three delayed recall trials (free recall, phonemic cued recall, semantic cued recall), was significantly poorer than that of the other two groups. The L-TLE group showed the worst performance on the phonemic cued recall trial, poor performance on the delayed free recall trial, and relatively intact performance on the semantic cued recall trial. Immediate and delayed free recall and phonemic and semantic cued recall for the distractor list did not discriminate groups. Word frequency, word presentation order, and concrete versus abstract words did not have different effects across groups.
Adolescent↗
Risk factor and behavioral differences between vascular and Alzheimer's dementias: the pathway to end-stage disease.
Differences between vascular dementia and Alzheimer's dementia may be present in both risk factors and in behavioral manifestations. Behavioral distinctions may be apparent only at particular stages of the disease process, but comparisons at different stages require a large number of subjects. The California Alzheimer Disease Diagnostic and Treatment Center Program has collected data on a large number of subjects with dementia. We examined differences in risk factors and in behaviors in 502 subjects with vascular dementia and 810 subjects with probable Alzheimer's dementia. With respect to risk factors, vascular dementia subjects were more likely to have a history of general anesthesia. We found no difference in history of closed head trauma, family history of dementia, or cigarette smoking, suggesting that these factors are less likely to have a disease-specific etiologic role. With respect to behaviors, subjects with vascular dementia were more likely to have depression in all stages of dementia. Subjects with Alzheimer's dementia were more likely to exhibit wandering in the middle or late stages. Subjects were similar in five other behavioral factors in the three stages studied. We conclude that general anesthesia is a risk factor for vascular dementia and that depression is more prevalent in vascular dementia, while wandering is more characteristic of Alzheimer's dementia.
Aged↗
Propranolol for the control of disruptive behavior in senile dementia.
Six patients with senile dementia, exhibiting severe, disruptive behavior were effectively treated with propranolol in doses ranging from 80 mg per day to 560 mg per day. All six patients were given a trial of propranolol after conventional therapy had failed, and in all patients, the agitated behavior significantly improved. There were no adverse side effects requiring the discontinuation of the propranolol, and in all cases, the agitated behavior was controlled without inducing general sedation. Both the nursing home staff and the families were pleased with the therapeutic effects. Propranolol represents a possible alternative way of addressing the severe problem of agitated behavior in senile dementia patients.
Aged↗
Assessment of disruptive behavior associated with dementia: the Disruptive Behavior Rating Scales.
Disruptive behavior associated with dementia is a major clinical problem, but there has been limited methodology for assessing it. This study describes the development of a set of rating scales used to measure four dimensions of disruptive behavior that present frequent problems in patients with dementia: physical aggression, verbal aggression, agitation, and wandering. In addition, a total disruptive behavior scale is derived by averaging scores from these four scales. A sample of 16 patients in a skilled nursing facility was used to test interrater reliability and validity of this instrument. Interrater reliability was quite favorable for all scales. There was clear evidence for convergent validity of all scales except the verbal aggression scale, where a substantial correlation was found with one relevant external measure but not the other. There was also favorable evidence of discriminant validity for all scales except the verbal aggression scale. Psychometric properties of this instrument appear to be promising and indicate that it has potential utility for further research on causes and treatments for disruptive behavior in demented patients.
Activities of Daily Living↗