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PubMed1995

Estimating premorbid intelligence in African-American and white elderly veterans using the American version of the National Adult Reading Test.

Knowledge of earlier intellectual functioning can be very helpful in the diagnosis of neurocognitive disorders. The National Adult Reading Test (Nelson, 1982), based on the observation that reading irregularly spelled words remains intact in mild dementia, may be useful for this purpose. A version for speakers of American English (AMNART) was recently published (Grober & Sliwinski, 1991). The present study evaluated the validity of the AMNART with demented and nondemented African-American and White elderly veterans. The average differences between African-American and White participants on the AMNART and WAIS-R were similar. The differences between demented and nondemented patients were greater on the WAIS-R than on the AMNART, as expected. Paradoxically, the AMNART appears to over-estimate IQ among nondemented individuals with lower WAIS-R scores, but underestimate IQ among more impaired demented patients. Using Grober and Sliwinski's (1991) 10-point discrepancy rule between AMNART and WAIS-R VIQ scores, 70% of demented and nondemented veterans were successfully classified. No discontinuation rule for the AMNART could be established because word difficulty order varies across samples.

Black or African American↗
PubMedDate not supplied

Memory for a geometrical configuration in the cognitively impaired elderly.

The objective of this study was to analyze the mnemonic reconstruction of a complex spatial configuration in a group of 10 men and women, 70-88 years, with a diagnosis of organic brain syndrome and 10 controls matched for age, sex and educational background. A Piagetian model of a geometrical configuration with contingent and non-contingent properties was used to establish a heirarchical order of memorial organization for spatial structures. Subjects were evaluated one hour and one week after learning in reconstruction tasks. Although individuals with dementia performed more poorly than the age-matched controls, the hierarchy of chosen characteristics reflected a schematic progression in the organization of spatial memory in both groups.

Aged↗
PubMed2006

Relationship of antiretroviral treatment to postmortem brain tissue viral load in human immunodeficiency virus-infected patients.

Human immunodeficiency virus (HIV)-1 invades the central nervous system (CNS) soon after infection and is partially protected there from host immunity and antiretroviral drugs (ARVs). Sanctuary from highly active antiretroviral therapy (HAART) in the CNS could result in ongoing viral replication, promoting the development of drug resistance and neurological disease. Despite the importance of these risks, no previous study has directly assessed HAART's effects on brain tissue viral load (VL). The authors evaluated 61 HIV-infected individuals for whom both histories of HAART treatment and postmortem brain tissue VL measurements were available. Two groups were defined based on HAART use in the 3 months prior to death: HAART(+) subjects had received HAART, and HAART(-) subjects had not received HAART. HIV RNA was quantified in postmortem brain tissue (log10 copies/10 microg total tissue RNA) and antemortem plasma (log10 copies/ml) by reverse transcriptase-polymerase chain reaction (RT-PCR). Brain tissue VLs were significantly lower among HAART(+) subjects compared to HAART(-) subjects (median 2.6 versus 4.1; P= .0007). These findings suggest that despite the limited CNS penetration of many antiretroviral medications, HAART is at least partially effective in suppressing CNS viral replication. Because some HAART regimens may be better than others in this regard, regimen selection strategies could be used to impede CNS viral activity, limit neuronal dysfunction, and prevent or treat clinical neurocognitive disorders in HIV-infected patients. Furthermore, such strategies might help to prevent the development of ARV resistance.

Adult↗
PubMed2006

Action (verb) fluency predicts dependence in instrumental activities of daily living in persons infected with HIV-1.

Inspired by the hypothesized neural dissociation between the retrieval of nouns and verbs, several studies now support the construct validity of Action (verb) Fluency as a measure of frontostriatal systems function. Relative to traditional noun- and letter-cued verbal fluency tests, Action Fluency is more sensitive to HIV-1-associated neuropsychological impairment, which may reflect inefficiencies engaging motor representations during action retrieval in this population. Accordingly, impaired Action Fluency might adversely impact instrumental activities of daily living (IADL) by disrupting the production and organization of script-based action schemas upon which successful IADL performance depends. The present study thus sought to evaluate the ecological validity of Action Fluency as a predictor of IADL among persons with HIV-1 infection. Action, Letter (FAS), and Noun (animal) fluency were compared in 21 HIV-1-infected participants with self-reported IADL dependence relative to 76 demographically comparable HIV-1-infected participants who reported no IADL declines. Results revealed significant between-group differences in Action and Letter Fluency, but not Noun Fluency. Action Fluency achieved an overall hit rate of 76% and was more sensitive than Letter Fluency in classifying IADL dependent participants. Individuals with impaired Action Fluency performance had a fivefold risk of concurrent IADL dependence as compared to those who performed within normal limits. Findings suggest that Action Fluency may possess incremental ecological validity in the identification of HIV-1-associated neurocognitive disorders.

Activities of Daily Living↗
PubMed2007

Motor based assessment of neurocognitive functioning in resource-limited international settings.

This study compared variance accounted for by neuropsychological tests in both a brief motor battery and in a comprehensive neuropsychological battery. 327 HIV+ subjects received a comprehensive cognitive battery and a shorter battery (Timed Gait, Grooved Pegboard, and Fingertapping). A significant correlation existed between the motor component tests and the more comprehensive battery (52% of variance). Adding Digit symbol and Trailmaking increased the amount of variance accounted for (73%). Motor battery sensitivity to impairment diagnosis was 0.79 and specificity was 0.76. A motor battery may have broader utility to diagnose and monitor HIV related neurocognitive disorders in international settings.

Adolescent↗
PubMed2005

Psychiatric diagnostic dilemmas in the medical setting.

OBJECTIVE: To review the problems posed for doctors by the failure of existing taxonomies to provide a satisfactory method for deriving diagnoses in cases of physical/psychiatric comorbidity, and of relating diagnoses on multiple axes. METHOD: Review of existing taxonomies and key criticisms. The author was guided in selection by his experience as a member of the working parties involved in the creation of the American Psychiatric Association's DSM-IV. RESULTS: The attempts of the two major taxonomies, the ICD-10 and the American Psychiatric Association's DSM-IV, to address the problem by use of glossaries and multiple axes are described, and found wanting. Novel approaches, including McHugh and Slavey's perspectives of disease, dimensions, behaviour and life story, are described and evaluated. The problem of developing valid and reliable measures of physical/psychiatric comorbidity is addressed, including a discussion of genetic factors, neurobiological variables, target markers and other pathophysiological indicators. Finally, the concept of depression as a systemic illness involving brain, mind and body is raised and the implications of this discussed. CONCLUSIONS: Taxonomies require major revision in order to provide a useful basis for communication and research about one of the most frequent presentations in the community, physical/psychiatric comorbidity.

Comorbidity↗
PubMed1978

Psychosocial factors in elderly patients admitted to a psychiatric hospital.

Over a three-year period, 204 consecutive patients admitted to a psychiatric unit for the elderly were studied and their progress was followed for a further two years. For three-quarters, it was their first ever admission to such a unit. More than half were suffering from a functional psychiatric disorder. In 35.8% a life stress was of aetiological importance. 27.9% were discharged to their own homes, 31.9% into care and 35.3% died. 17.6% were admitted on at least one further occasion. Male sex, age over 75 and the presence of organic psychiatric disorders were associated with an unfavourable outcome. Age under 75, married civil status and functional psychiatric disorder were associated with a favourable outcome. Re-admission was common amongst females who were admitted with a diagnosis of psychotic depression, and discharged to their own homes. A life stress including a loss of physical health in the year preceding admission did not adversely affect outcome. At a time of life when many losses are experienced and physical powers are reduced, the elderly seem remarkably resilient and able to work through the crisis which has brought about their admission.

Adaptation, Psychological↗
PubMed1976

A clinical comparison of tests of organicity in elderly patients.

The quantification and standardization of observations of clinically significant organicity in the elderly is possible through the administration of specific cognitive tests. In this study, four organicity tests were evaluated on a geriatric medical/surgical patient group, with the SPMSQ yielding the best correlation with a clinical diagnosis of organicity. The SPMSQ is also recommended for its ease of administration, brevity, quantitative output, and straight-forward interpretation. The FHT produces an increment of improvement in the identification of organic groups, thus serving as a useful second test. The MSQ, while longer and slightly more complex, is roughly equivalent to the SPMSQ. The MFD test, the most lengthy and complex of the four instruments used, did not add sufficient additional information for this sample to warrant its inclusion in a testing regimen. Accurate diagnosis is critical for the geriatric patient if excessive morbidity and mortality are to be avoided, and unnecessarily long hospital stays are to be reduced. The availability of a short, easily administered test like the SPMSQ can effectively improve the assessment of the elderly patient at little additional cost to the clinician.

Aged↗
PubMed1993

Virologic markers of human immunodeficiency virus type 1 in cerebrospinal fluid. The HIV Neurobehavioral Research Center Group.

As part of a longitudinal study, 265 cerebrospinal fluid (CSF) specimens from 204 human immunodeficiency virus type 1 (HIV-1)-seropositive subjects and 43 seronegative controls were evaluated. Of the 204 seropositive persons, 78 (38%) had > or = 1 CSF culture positive for HIV-1; the probability of being culture positive increased as the number of CSF samples obtained increased (P = .0018). Significantly correlated with culture positivity were elevations in CSF protein level (P = .014) and CSF white blood cell count (P = .001). Virus was more readily cultured from clarified CSF (89%, 42/47) than from the cellular fraction (30%, 14/47; P < .00001). Amplification of HIV-1 DNA by polymerase chain reaction (PCR) from 25 seropositive persons was positive in 9 (82%) of 11 culture-positive and in 4 (29%) of 14 culture-negative specimens, while amplification of viral RNA detected all 11 culture-positive and 9 (64%) of the 14 culture-negative CSF specimens. These data support the hypothesis that the development of HIV-1-associated neurocognitive disorders are not dependent solely on the presence of HIV-1 within the central nervous system.

Adult↗
PubMed1992

Psychiatric diagnoses: a continuing controversy.

Psychiatric Medicine has been accused justly of making its diagnoses on the patient's report of symptoms and the physician's subjective observations of the patient. The main problem has been the lack of reliable data compounded by the stigma of a mental diagnosis. More recently, third-party pressures have become an added threat to objectivity. New knowledge of brain function, especially neurotransmitters, and more specific and effective medication have made the need for accurate diagnoses more acute. Psychiatry has responded by frequent and often controversial changes in its diagnostic criteria. Much of the controversy stems from a lack of accurate measurements to validate the diagnoses, thereby allowing for differences of opinion of a highly subjective nature. The problem is complicated by the chronic, but irrational, belief that there is a separation between mental and somatic illness.

Diagnosis, Differential↗
PubMed1982

Differential diagnosis and mental illness.

In considering the argument that Thomas Szasz advances on behalf of his claim that there is no mental illness, it becomes evident that despite his stated assumptions, moral valuations are necessarily tied up with assessment of disease. By following his remarks about differential diagnosis, it becomes evident that behavior is the occasion for differential diagnosis, that behavior determines which anatomical deviations are counted as diseases, and that Szasz's insistence on autonomy introduces his own moral assumptions into the concept of disease. Consequently, although none of these considerations disproves Szasz's conclusions about the existence of mental illness, neither can his argument support the weight of that conclusion.

Acting Out↗
PubMed1985

The two-syndrome concept: origins and current status.

The two-syndrome concept postulates two "dimensions of pathology" underlying schizophrenia--a reversible (and potentially neuroleptic-responsive) component and a sometimes progressive and relatively irreversible component associated with the deficit state and poor long-term outcome. Negative symptoms (narrowly defined) appear to be more closely associated with the latter component (the type II syndrome), as also are cognitive impairments, abnormal involuntary movements, and behavioral deterioration. This syndrome is assumed to be more closely related than the type I syndrome of positive symptoms to the structural brain changes inferred from pneumoencephalograms, computed tomography scans, and recent post-mortem studies. However, since both syndromes often occur in the same patient--sometimes at the same point in time--they presumably have the same etiology.

Antipsychotic Agents↗
PubMed1981

Infantile autism reviewed: a decade of research.

Progress in the study of infantile autism over the past 10 years was reviewed in terms of classification and diagnosis, relation to other disorders, demographics, parental characteristics, genetics, intelligence, language, perceptual processes, behavioral characteristics, neurobiological, biochemical and pharmacological aspects, behavioral/educational treatment methodologies, prognosis, and theoretical considerations. This decade's research led to the now generally accepted position that infantile autism is a type of developmental disorder accompanied by severe and, to a large extent, permanent intellectual/behavioral deficits. However, its relationship to other forms of developmental disorders and to mental retardation remains to be delineated. Perceptual/cognitive/language defects appear central to the autistic syndrome, but the specific underlying mechanisms are unknown. Most studies indicate that autistic children have more signs of brain dysfunction than do normal children and about the same number as mentally retarded children. The overwhelming evidence suggests that te treatment of choice for maximal benefit to autistic children is a systematic, intrusive behavioral/educational approach. Yet, in spite of significant gains in almost all children treated, the typical prognostic picture is poor in terms of achieving self-supportive adulthood. The parents of autistic children have been found to be essentially similar to parents of children with organic brain disorders, and manifest no psychopathology which conceivably could induce the disorder. The vast majority of theoretical articles appearing in the 1970s proposed some from of neurobiological defect as the causative factor in autism. One of the major goals for future research is to undertake more extensive comparative studies on nonautistic brain dysfunctional children and autistic children that could yield cleared differential behavioral profiles and testable neurobiological hypotheses.

Autistic Disorder↗
PubMed1982

Clinical research in child psychiatry--methods and strategies.

Research methods in child psychiatry are derived from many disciplines--epidemiology, genetics, neurochemistry, pharmacology, electrophysiology, psychology, linguistics, and analytical chemistry--as well as several branches of medicine, particularly pediatrics, neurology, and psychiatry. The application of methods must be informed by the knowledge and concerns which emerge from the clinician's authentic clinical engagement with children and families. Research strategies require the definition of specific questions which can be addressed by discrete studies as well as the progressive integration of findings and perspectives. Systematic clinical investigations require institutional supports--opportunities and enticements for young investigators, long-term stability of research groups, and ease of collaboration and among specialists.

Child↗